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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Dec 12, 2022

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

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

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


Key Takeaways

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


More about Dr Stephanie Weyrauch

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

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

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

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


More about Dr Krystyna Holland

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

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

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


More about Dr Jennifer Hyer

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

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

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

Suggested Keywords

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

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


                        Dr. Stephanie Weyrauch.


LinkedIn:         Krystyna Holland PT, DPT.

                        Stephanie Weyrauch DPT.

Twitter:            @TheSteph21.

Instagram:       @thesteph21.



Subscribe to Healthy, Wealthy & Smart:


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Dec 5, 2022

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

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

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


Key Takeaways

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


More about Corey Hiben

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

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

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

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


Suggested Keywords

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



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


To learn more, follow Corey at:


LinkedIn:         Corey Hiben.

Instagram:       @coreyhiben.

Facebook:       Corey Hiben.

Podcast:          The Health Hustle.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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

Nov 29, 2022

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

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

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


Key Takeaways

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


More about Jamey Schrier

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


Suggested Keywords

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



FREE GIFT: PT Practice Quiz.


To learn more, follow Jamey at:


LinkedIn:         Jamey Schrier.

Instagram:       @jameyschrierpfu.

Facebook:       Jamey Schrier.


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Read the Full Transcript here: 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Unknown Speaker  16:56  
Right, right. Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Unknown Speaker  38:38  
it complicated.

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

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

Unknown Speaker  39:47  
Keep it simple.

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

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

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

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

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

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

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

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

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

Nov 22, 2022

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

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

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


Key Takeaways

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


More about Julie Bee

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

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


Suggested Keywords

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



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

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

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To learn more, follow Julie at:


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

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LinkedIn:         Julie Bee.

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Twitter:            @thejuliebee.


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Nov 14, 2022

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

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

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


Key Takeaways

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


More about Maia Monell

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

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

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


Suggested Keywords

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


Download the App on iOS and Android.


To learn more, follow Maia at:


LinkedIn:         Maia Monell.

Instagram:       @letsnavit.



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Oct 31, 2022

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

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

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


Key Takeaways

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


More about Scott Colby

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

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


Suggested Keywords

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


Recommended Reading:

The 5 Languages of Appreciation in the Workplace.


FREE Gift: Gratitude Toolkit.


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Facebook:       Scott Colby.

Instagram:       @scottcolby.



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Read the Full Transcript Here: 


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



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



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



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



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



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



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



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



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



So your habit, habit stacking.



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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

Oct 24, 2022

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

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

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


Key Takeaways

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


More about Matty Lansdown

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

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

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

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


Suggested Keywords

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


Recommended Reading:

Atomic Habits, by James Clear.

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


To learn more, follow Matty at:


Facebook:       Busy Mothers FB Group.

                        Matty Lansdown.

Mailing List:     Join the Mailing List.

Podcast:          How to Not Get Sick and Die.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript here: 


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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



when really long meal,



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



Absolutely. And



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

Oct 17, 2022

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

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

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


Key Takeaways

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


More about Dr. Meg Mill

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

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


Suggested Keywords

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


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



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

Live Group Program Head Strong.


To learn more, follow Meg at:


Podcast:          A Little Bit Healthier.

Instagram:       @drmegmill.

Facebook:       Headache Healing Club.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



Oh, that's a good one.



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



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



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



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



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


Oct 10, 2022

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

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

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


Key Takeaways

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


More about Brenden Kumarasamy

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

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

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


Suggested Keywords

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


Recommended Reading:

Thirst, by Scott Harrison.


To learn more, follow Brenden at:


YouTube:        MasterTalks.

LinkedIn:         Brenden Kumarasamy.


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Apple Podcasts:




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Read the Full Transcript Here: 


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



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



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



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



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



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



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



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



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



I like that. I like that a lot.



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



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



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



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



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



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



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



That makes a lot of sense. I was just



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



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



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



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



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



You're muted, by the way



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



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



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



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



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



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






when we're,



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



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



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



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



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



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

Sep 26, 2022

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

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

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


Key Takeaways

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


More about Evangelos Pappas

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

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

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


Suggested Keywords

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


To learn more, follow Evangelos at:


Twitter:            @evpappas.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



So when is the past Oh, well. Invitation.



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



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



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

Sep 19, 2022

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

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

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


Key Takeaways

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


More about Sidni Kast

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

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

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

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


Suggested Keywords

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


To learn more, follow Sidni at:


Instagram:       @sidnikast


Facebook:       @missnorthdakota2022


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


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



Hello, thank you so much for having me.



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



sweet. Go ahead stuff.



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



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



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



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



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



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



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



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



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

Aug 29, 2022

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

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

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


Key Takeaways

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


More about Dr. Mercedes Aguirre Valenzuela

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

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

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

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

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


Suggested Keywords

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



Our Experiences Matter When it Comes To Advocacy

APTA Patient Action Center


To learn more, follow Dr. Valenzuela at:

LinkedIn:         Mercedes Aguirre Valenzuela

Instagram:       @theptadvocate


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here:


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



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



So I graduated in 2020.



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



Especially I,



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



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



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



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



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



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



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



Yes, perfect. So



in turn



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



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



Well, I will say contact me because I love



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



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



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



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



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



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



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

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

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

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

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


Key Takeaways

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


More about Dr. Katie O’Bright

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

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

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

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


Suggested Keywords

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



Chicago PC Course (Aug 27-28).

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

Use “HWSPodcast2022” for $50 Discount.


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


Cell:                 312-772-2322


Facebook:       Redefine Health Ed

Instagram:       @redefinehealthed

Twitter:            @RedefineConEd

TikTok:            @redefinehealthed

LinkedIn:         Redefine Health Education


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Read the Full Transcript Here: 


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



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



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



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



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



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



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



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



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



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



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



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



So I'm just trying to figure out



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



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



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



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



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



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



But what I teach is



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



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



and do you have any



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



So you had said, you briefly



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



Hopefully, business number.



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



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



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



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



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



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



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



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



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



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


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

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

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

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


Key Takeaways

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


More about Relinde Moors

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

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

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

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


Suggested Keywords

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



5 Myths About Limiting Beliefs that Keep Entrepreneurs Stuck.

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


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Facebook:       Relinde Moors

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Instagram:       @relindemoors


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Read the Full Transcript Here: 


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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



Awesome. And we'll have all the links at podcast at healthy, wealthy So that you can go on and click and take a take this limiting shift any limiting belief course. So we will have all of the and links to all of your social media and everything else as well. Now, before we go the last question, which is when I asked everyone, and that's knowing where you are now in your life, and in your career, what advice would you give to your younger self?



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



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



Thank you, Karen. Really lovely to be here.



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


Jul 25, 2022

In this episode, Co-Founders of Trailhead Learning Collective, Jenn Bell, PT, ScD, COMT, and Audrey Elias, PT, PhD, OCS, talk about their work doing Continuing Education different.

Today, they talk about the current state of Continuing Education, integration of information, and addressing Continuing Education courses. How is Trailhead Learning Collective different?

Hear about active learning techniques, some upcoming retreats, and get Audrey and Jenn’s advice to their younger selves, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Our patients are human, but we, as clinicians, are human, and it’s important to respect that.”
  • “There is a time and place for everything.”
  • “There is an alternative way to get your continuing education done that also takes care of yourself.”
  • “Remain flexible and keep watching for those opportunities.”
  • “All of it is worth it. All those experiences are things that you can draw on.”
  • “It’s alright to go do different things that aren’t exactly on your path.”


More about Audrey Elias and Jenn Bell

Jenn Bell, PT, ScD, COMT, and Audrey Elias, PT, PhD, OCS, are co-founders of Trailhead Learning Collective.

Audrey is clinical faculty in the University of Montana School of Physical Therapy and
Rehabilitation Sciences.

She completed her DPT in 2009, did her residency with Therapeutic Associates in Washington state, and then completed her PhD in clinical  biomechanics at the University of Montana in 2015. She then did a post-doc at the University of Guelph before returning to UMPT as clinical faculty, training entry-level students and residents in the DPT program and in the UMPT clinic. Her primary area of research involves how psychological factors play into movement, particularly following knee injury. Most importantly, she loves being outside, whether skiing, running, hiking, paddle-boarding, or lounging around a campfire with her son and husband.

Jenn is the Program Director and Director of Clinical Education at UMPT.

She completed PT school in 2006, then completed her COMT in 2012 and her ScD from Texas Tech in 2013, all while treating patients in a variety of settings in rural Alaska. She has treated patients and taught in PT programs in virtually every setting all over  the world, including Kenya, Ethiopia, and Malawi, and is an internationally-recognized expert in inter-professional education and global health. She is also the co-Primary Investigator and Team Advisor for Montana Inter-Professional Student Hotspotting, improving outcomes in underserved populations in rural Montana. Above all, she is always, always, having a good time outside with family, friends, food, and an adventure, setting an example for her two young daughters.

Together, and through the values of adventure, growth, authenticity, collaboration, and respect, Jenn and Audrey are working to build a collective of compassionate, confident, critical thinkers who utilize best-practices in their field.


Suggested Keywords

Healthy, Wealthy, Smart, ConEd, Education, Learning, Research, Networking, Integration, Innovation, Collaboration,



Prevention & Wellness for the Running Athlete.


Get 10% off your first retreat: Mention Healthy, Wealthy, & Smart at Registration.


To learn more, follow Audrey and Jenn at:


Facebook:       Trailhead Learning Collective

Instagram:       @audreyroseelias




Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


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



Hey everybody, welcome back to the podcast. I am your host, Karen Litzy. I want to thank you all for joining us today. And again, if you haven't then definitely subscribe to the podcast on any platform in which podcasts are streamed. So today's episode, we are talking about doing continuing education different and my guest today are Dr. Jenn Bell and Dr. Art Audrey Elias. They are cofounders of Trailhead learning collective. Audrey is a clinical faculty in the University of Montana School of Physical Therapy and rehabilitative sciences. She completed her DPT in 2009 Did her residency with therapeutic associates in Washington state and then completed her PhD in Clinical biomechanics at the University of Montana in 2015. She then did a postdoc at the University of Guelph before returning to you and PT as clinical faculty training entry level students and residents in the DPT program and in the UN PT clinic. Her primary area of research involves how psychological factors play into movement, particularly following knee injury. Most importantly, she loves being outside weather, skiing, running, hiking, paddleboarding, or lounging around a campfire with her son and her husband. Jen is the program director and clinical and Director of Clinical Education at UMP T. She completed PT school in 2006 then completed her Colm T in 2012, and her side Dee from Texas Tech in 2013, all while treating patients in a variety of settings in rural Alaska. She has treated patients and taught and PT programs in virtually every setting all over the world including Kenya, Ethiopia and Malawi, and is an internationally recognized expert in interprofessional education and Global Health. She is also the CO primary investigator and team advisor for Montana interprofessional student hotspotting improving outcomes in underserved populations in rural Montana. Above all, she is always having a good time outside with family friends food and an adventurer setting example for her two young daughters together and through the values of adventure growth and authenticity, collaboration and respect. Jen and Audrey are working to build a collective of compassionate, confident critical thinkers who utilize best practices in their field. Now, like I said, they are the founders of Trailhead learning collective. And Jen and Audrey have a special offer for healthy, wealthy and smart listeners. If you go to their website, which is on the podcast dot healthy, wealthy dot smart page, and you want to check out their next learning opportunity. Then you get 10% off because you're listening to this podcast. So if you go to Trailhead Or go to the podcast website, and when you apply to be part of their next learning opportunity, and mentioned this podcast will get 10% off. So a big thank you to Jen and Audrey for that. And in the meantime, everyone enjoyed today's episode. Hello, Jen and Audrey. Thank you so much for coming on to the podcast today to talk about the innovative way you guys are doing continuing education courses. So doing Con Ed differently, and I love it. But before we get into that, Jen, why don't we start with you say a little bit about yourself. So the viewers know or the viewers, the listeners know who's who.



Yeah, it sounds great. So I'm Tim Doyle and I'm the Program Director and the Director of Clinical Education at the University of Montana's physical therapy program. I've been at UN for nine years. I'm just going in to start my 10th year there, which is wild to think I've been doing this for almost a decade. And prior to moving to Montana, I was in Rural Clinical Practice in Alaska. And so I lived in a town of 2500 people at the end of the road for bed hospital. So got to kind of treat whatever walked in the door. It was a really great opportunity. And during that time, I was working on my doctorate of science who Texas Tech University Health Sciences Center. So yeah, it's all about



  1. Excellent, Audrey. Go ahead a little bit more about yourself.



Thanks, Karen. And I'm Audrey Elias. I am also at the University of Montana and clinical faculty there. I treat patients in the clinic, but most of my time is actually treating patients with students. So I'm a preceptor in our integrated clinical education program. And then I also teach in the DPT program, as well. I did my PhD at the University of Montana, I did my DPT at the University of Montana. So I pretty much have been in Montana for a very long time. But I also practiced in Washington, in the far west, on the Olympic Peninsula, in rural areas where we saw lots of different folk. Yeah, and then Jen and I are also cofounders of Trailhead learning collective. So we're heavy, heavy University of Montana. But we're also doing this other thing.



And we are going to talk about that today. But before we get into that, let's talk about the why behind it. So what has your clinical education or continuing clinical education been like in the past where you thought you know, this, I'm not connecting with this and I need to do something different. So talk a little bit about your journeys.



And you go ahead



yeah, um, so you know, carrying that's a great question kind of what informed us to get to this place or we decided to found Trailhead learning collective. You know, I've done I've been in clinical practice and a PT for 15 years, and I've done everything from going to CSM was 17,000 of my closest friends to Education Leadership Conference with the APTA Academy of Education, to, you know, the weekend course that someone brings into their clinic. And what I find oftentimes is that I'm in these courses. And, you know, I'm, I'm finding myself kind of not super engaged with the learning, there's a lot of lecture. And, you know, sitting around going from being in a really active profession where I'm doing everything from crawling around on the ground with my patients to helping them stand up and walk to sitting oftentimes at a plant in a clinic all weekend long, being lectured to. And so I was really looking for something different from that. Actually, what's your experience been? Well,



I did my orthopedic residency right out of school, and in private practice with therapeutic associates in Port Angeles, Washington, and I averaged one three day weekend of Con Ed a month for almost a year and a half. And I hosted those courses, I got the bagels, I got the coffee, I made sure the bathrooms were clean, I did all of that. So I've done a lot of that. And I've been I did my PhD and went to CSM was 17,000 of my closest friends over and over and over again. I've done like every kind of Con, as you can imagine, I've done you know, 45 minute online things through Harkness school for dance injury. I've done level one pelvic floor. And, you know, they got real intimate with 15 brand new people. And to be so to be my authentic self here, I will fall asleep if I am sitting down for more than 20 minutes. And I will not remember a single thing. Anyone tells me if I'm being lectured at, if I'm not actively engaged in I fell asleep in my first class in undergrad. I it's just how I work. So I have to have really engaging Con Ed, you know, if I'm going to learn anything, otherwise, I do it all on my own afterward, right? So I'll go to 18 hours on a weekend where I don't get to go on my run. I don't get to spend time with my family. I have a 10 year old now I don't get to do these other things that I wanted to do. And then I would have to go home and I'd have to review it all on the treadmill. Because now I'm moving I'm doing stuff and then I can actually learn or I'd have to like go for a run with Jen and tell her all about what we just did in order for me to actually process and I just thought to myself You know, I want something different. I want, I want to use this, I want to use this information immediately. And I also think, doing my PhD, we did, I did a randomized clinical trial, post ACL reconstruction stuff, and just trying to get help people understand how to use that. I can't just tell them, it does not work. It doesn't work. We have to do it, we have to not just show we have to do and work together on it. So yeah, I think it's just a long time of realizing that there's a place and a time for everything. And but there's but there needs to be this thing as well, that can serve people like me.



And, you know, you kind of described what a lot of continuing education courses are in the PT world where you go, you sit at a plan, you're taking notes, maybe you get a stretch break, you have like some sort of pastry, and coffee. And the question I always had with those in particular is, what if it's not your learning style? What if you need a little something different, like something that involves more demonstration, more movement, more, getting up more? Just a different style of learning. So what have Have you seen the current state of continuing education? And do you feel like we're really maximizing professional development? Go ahead, Jen.



Oh, Audrey, go ahead. Oh, well, I feel like what's really interesting is that in a physical therapists are super committed to learning. Just in general, I was actually so we're both huge nerds. So he's doing quite a lot of literature search on this. And if I was trying to write an abstract for CSM, I wouldn't be able to, because you have to have at least five papers within the last five or seven years or something. And there just aren't any, there's no literature on what's going on. With Con Ed, currently, there's a paper just this year about so in the PT and PT J, with continuing education courses for orthopedic and sports PTs in the US often lack supporting evidence. And so they went through and review available intervention courses. So great paper. But there was one by Adrian Lowe this year, looking at the impact of a three hour PMP course, on low back pain, and how people did. It was pretty good. It was really interesting. But otherwise, well, next paper is 15 years ago, that I combined. So we don't really know what's going on in the form of knowing that I'm familiar with, we don't really know, in terms of my anecdotal experience, go, the learning environments that I have experienced are not really set up to maximize learning based on pedagogical evidence. So we know that active learning is important. And it just, it makes it like it's really, really hard. We just don't see a ton of that. And I think what happens is that, then we get where content becomes like a chore, right? It's a box, you have to tick, I gotta get Montana, I have to have 20 hours every two years. So I think 3030 Whatever it is, I have to have it and I have to go and check in order to check them tick that box. And I think it ends up becoming problematic on a lot of different levels. Yeah. I don't know if I answered that question completely.



I think so. Jen, do you need to fill in any blanks there? Yeah, well,



you know, I think what Audrey was hitting on thinking about in our continuing education courses, we can bring in the pedagogical research, just like we bring in to physical therapy research. And until you know, we do this a lot in our entry level program, we're thinking about what are the best ways that adults learned? How can we convey this information in a way that's effective that's going to address our learning outcomes, not just our patient outcomes. And so that's really one of the things that Audrey and I are looking to bring to our Trailhead learning collective courses and retreats is bringing in the research on active and learning mean, and teaching adult learners. And so bringing that in, you know, really minimizing the amount of lecture that we do engaging in active learning techniques, whether it's going through cases together, having discussions, you know, putting up big whiteboards and doing some, you know, throwing out ideas and looking at other people's ideas, you know, that way really kind of shifting the paradigm from being teacher centered to being learner centered. So you know, when you're in that lecture based course, it's about this expert that's standing in front of you talking and conveying to you what you should be doing in clinical practice. We're really trying to flip that and bring all of these learners together, oftentimes have, you know, decades of clinical practice, have all of these pearls all of this knowledge, and asking them to share it with one another. And we'll bring in the evidence on, you know, the the content that we're teaching on. But really, not bringing a group of people together that have years of clinical practice, and have learned a lot and asking them to not talk to one another and just listen to what an expert says. So really trying to kind of flip that model and really focusing in on the learner experience, and learner engagement.



Right. And that kind of leads me to the next question, what a perfect transition is, you know, going from a traditional model, which can be effective in getting information from me, the teacher to you, the student? But is it effective when it comes to information processing integration into clinical life? So can you kind of talk about the those concepts as perhaps not being equal and not being the same? And how can we get better integration of information?



Yeah, can you make a great point, you know, lecture is a really effective way to just transfer knowledge. But that piece of integrating it and making changes is where we see that active learning tends to be more effective. Like Audrey said, there's really not great evidence about, you know, do continuing education courses, impact and change how people engage in clinical practice, we hope and we believe that, you know, if we can effectively teach you something, then you'll use that information. So that's like, that's a gap in the research. But we do know that active learning techniques, improve retention, and kind of consolidation of information, and kind of thinking that information deeper into our longer term memory. And so that's why we use active learning techniques. There's also some really cool, early research coming out on looking at the impact of exercise of aerobic exercise, on learning. And so boom strand and inco, Hall and 2020 published a study and they looked at a single bout of aerobic exercise. And what they found is that it improves attention, concentration, and learning and memory functions and young adults. And so there's some studies like that coming out showing that if we can incorporate this component of physical activity, with our learning, either right before, during or after there's some different sides looking at the different benefits of those, then we can improve learning and retention as well.



And can you give some examples of active learning techniques? Because we've said that a couple of times, and I can just picture people being like, Okay, that's cool.



But what does that mean? It was so fun. Because I mean, we've both been teaching. For so long, both I will say we've taught both in the entry level DPT program. And then we've also we teach continuing ed courses before this as well. And mostly in that lecture based thing, we're like, oh, I don't like to teach that either. And I think we both were like, Okay, we need to change this up. So we've gone to a week long training on for the National Institute of scientific teaching, and just teaching how to teach in this way. In the sciences. It's very, it's pretty easy to do in the humanities. But in the sciences, it can be very, like, Oh, I just need to get this information across. Right. So in STEM fields, it's like, well, I just need to know how to pipette or whatever in chemistry. So there are lots of different ways so we can do like gallery walks, put up things with small groups. They process the information put up different ways and how they would do it around the room the rest of the day, and then their entire group walks around the process, we can do two to one, activities, give a prompt, everyone has a minute, maybe, to think on their own individually, maybe write something down there is that reflective cognitive process that comes from actively hand writing something down, that there are mental changes who have to write it down, turn to their neighbor, talk about the individual thing, and then come back in a larger group and, and everybody has to go around and say what their partner did, and pros and cons thereof. So lots of discussion. Obviously, when Jen, you had a really good one that you are doing,



what are the ones that I do with some of my classes is that I, when I start to teach about a new topic, the first thing I do is kind of the same scenario that Audrey just talked about candidate seat by myself, think with a partner and think with a group. But I prompt the group and the learner is to think about what it is you need to know about this topic. So based off your experiences you've had so far, kind of brainstorm, what are the things that you need to know? So we're really priming them to, you know, what is it that I do know? What is it that I don't know? What are things that are what are those, maybe when we share out to group, then people are going to identify those unknown unknowns that they didn't know, they needed to know. And so we can kind of start off by kind of forming a list of everything we're gonna need to go through and talk about, it's great for me, because then I can be like, oh, I need to make sure that we you know, dig into this some more and, and then at the end, we can go back through that list and be like, did we do we know everything we needed to know going into this? And so oftentimes, you know, instead of just starting off with me, like, hi, welcome. And then I start lecturing, why don't we start with you kind of digging into what it is that you want to learn about a topic, and going from there?



Yeah, I love that that's very similar to a course that I took last year through Goldman Sachs called the Goldman Sachs 10 KSB program, which is 10,000 small business program. And it is exactly what you just described, we would get the information, we would they would give us prompts to do ourselves, we have a paired partner, where we would talk about them, then we go into the larger group and talk about what our partners did. And the partners would talk about what we did. And it was really, really helpful. And that's the first time I've experienced that I've never experienced that at a continuing education course. So in it, it it really, like when you're done, you're like, Oh, I yeah, I know this, I understand it, I get the concepts, it's like rooted in there, because you had so many conversations about it with one on one with your instructor and with the group.



I think physical therapy can be so at work, we are so busy, right? Seeing 12 to 20 people a day, sometimes you have to be going, I know, and getting your documentation done all this stuff. It's rote, you're just going, boom, boom, boom, boom, boom. And so going into a Con Ed course and learning a clinical Pearl for five minutes. And maybe you even talk briefly with your buddy about how you might use that. The sad fact is that on Monday, when you go in your brain, you are going to drop down into habitual levels that just are, especially if you've been in practice for more than six months. And it takes a lot of energy to, to, in the moment, reflect back on what you did and saw and actually incorporate it deeply into your body. But with these techniques, we can get at least a tiny little tendril, of a root. And hopefully that can grow and root a little deeper, so that we see more change in how we're actually working. And we're actually treating patients



and does it sounds like we're becoming a little too robotic. A little too robotic, maybe in work a little too robotic in continuing ed. You know, like, you're okay, I have to go. I'm going to sit, I'm going to listen to these lectures. I'm going to get through it. I'm going to get my CPUs and then I'm going to do this on Monday and then it just doesn't happen. So then what what happens to that continuing education? Does it just fall out of your head like what happens?



Well, how many times have you take learned anatomy of the hip? Every single continuing education course you teach anatomy of the hip? I have taught I learned it. I've taught it many, many times. Each and every single time, I forget it. And I need that review because those things do drop out of our heads so quickly. And it's not bad. It's not saying that we're wrong or awful, that is normal. That is being a human, we can't get away from it.



One of the things that we try to do with these opportunities to really engage with the different people that are there in this in this group with you learning together, is giving you the opportunity to take that that new knowledge, or maybe that review of knowledge you've learned before, and take it and look at it a different way. And think about how you know, the person you're working with is going to use that in their practice, and then really work as a team to think about how can I take this knowledge in on Monday, in my setting, I mean, you know, here in Montana, I have clinicians that are going back to, to dot Montana, and are practicing in the next PT is 100 miles away. So how can they incorporate that into their clinical practice, versus the clinician, you know, that's in a sports specialized clinic in Bozeman, Montana. And so we really want to empower clinicians not just to suck in all the information that we're giving to them, but actually really dig into the material and think about how they can use it. And so one of the things we're trying to do with our courses is challenge the assumption that in these 15, CEUs, that you're going to earn, that we have to pack in as much material as possible. That's really not an assumption that we're working off of. So we're we're going to kind of switch that paradigm and say, instead of having this massive breadth of information, we're gonna give you a smaller amount of information, but we're gonna go a lot deeper. And we're really going to dig into how you can use this in clinical practice. And so it's just a kind of a shift in that assumption.



Yeah. And that leads me into the next question, again, a great lead in how is Trailhead learning collective different? How were you set up differently,



one of the things that we talked about a lot. And going back to when you said, it sounds like we're getting a little robotic. I think one of our kind of prime values, our main values is authenticity and respect. And that's respecting everything from the land that we're on to the humans that we're working with. We are working with humans, our patients are humans, but are we as clinicians are human. And I think it's important to respect that, like taking that much time away is hard. And burnout is very, very real and extremely prevalent. So one of the things that we are really wanting to do is make a trailhead learning retreat, actually, that like it's a retreat, it is the time to rediscover joy. In physical therapy, it's a time to go to a cool place, have someone take care of you. So all inclusive, your housings included, it's delightful, you're on a mountain or on a beach or wherever we happen to be in the desert. In house chef cooking your meals that are delicious, and primed for you. And having active learning where you're an active participant and feeling engaged, and validated and real, and also get to go out and adventure like experience the place. Yeah, I've been to so many cool places for continuing education, and ended up sitting in a plant in a clinic or in a conference room for the entire day. And then, in order to get any exercise at all, I just went for a run on the treadmill in the hotel. And I didn't get to experience anything about that place. So I think one of the thing that is making Trailhead different is we're really trying to treat the learner as a whole human being and make this time worth it both personally and professionally. In kind of all of those different aspects when you go for a cool trail run, we can make that happen. And you can get 15 hours you can tick that box for sure. And we'll make it worth your time. And you get to be taken care of for a little while.



Yeah, kind of reminds me of when you see on social media people saying How come I didn't take Monday off of work after having this continuing ed course it was too much and now I'm like totally burned out. So it sounds like maybe this would quell that a little bit. it. And the other part I wanted to talk about is something that we spoke about before we went on. And that's making a connection with the people in the course with you. Because so often we go to these courses, maybe there's 20 people, maybe there's 100, and you end up knowing no one, when you leave. Right. So how, how are you addressing that?



Yeah, Karen, that's a great point, I went to a continuing education course, a few years ago in San Francisco, and coming from, you know, at the time I was practicing in rural Alaska. And so I really would have loved to get to know more about, like, what is clinical practice, like, in San Francisco compared to, you know, what I am navigating and I left not knowing a single person, you know, part of that is on me, I didn't, you know, I did the thing that a lot of us do it kind of courses, I sat at my phone in the plant, I said, some, you know, small talk at the coffee. And so we're making a really deliberate effort, we're all in the same housing, we're sharing all of our meals together, and engaging in physical activity together, in addition to the time that we're doing the act of learning and getting those continuing ed credits done. And so really creating a space for folks to show up authentically. So I don't expect anyone to show up to her courses, having had 100% success with every single patient they've ever treated, but we want folks to show up and, you know, talk openly and honestly about the places that they struggle in their clinical practice, and, you know, had those conversations and to have this network develop, as we're in this space together. The the course that we're teaching in October is, of course, provincial wellness for the running athlete. And, you know, Audrey is gonna start us off with some really great conversation about bias and how our beliefs about ourselves as runners impacts how we believe and talk to our running athlete, patients. And so you know, being able to kind of explore those parts of ourselves and how they inform our clinical practice, or maybe, at times, potentially cloud our judgment, we can start to have those more intimate conversations as clinicians and people and start to build that network so that when you leave, you have this collective of physical therapists that you know, that you've created some bonds with.



Yeah, so kind of being a little more social. And, you know, off it sounds to me, like business retreats that I've gone on, you know, even if it's a one day mastermind, you leave with these people who, even after one day, kind of stay with you, because you've purposefully made those bonds.



Yeah, exactly. And I think that's one of the things that, that the business role does really well is that if we're gonna bring all these people together, we're going to, you know, put them in spaces and create opportunities for them to network on that deeper level. And in physical therapy, we are so focused on getting our patients better at all are we're so focused on the patient, that oftentimes the time when we gather for continued education, we're not speaking about each other as clinicians. And, and like Audra said those hope people that show up. And so that's one of the ways that we are approaching this differently.



Yeah, it sounds it sounds delightful. And now as we start to wrap things up, what do you want the listeners to take away? What are your big talking points? Or maybe there's only one? I don't know. But what do you want people to take away from? How and why you're doing things differently?



I think one of the one of the things that I want people to understand for themselves is that there is a time and place for everything. And sometimes you need that quick online 30 minutes learning about FAI, or stroke or whatever, because you have a patient who's really like, right, then you need a little bit and you should get some credit for the work that you do in that moment. I think that's excellent. I really like the you know, read for credit that JLS PT does, I had a paper that was a read for credit paper and I was like, This is great. Somebody's gonna like get value, monetary value from reading my paper. That is excellent. traditional lecture has its place but then I think it's fine. I think it's important for people to say you know what, this is what I need. I I need this time and I'm okay with going and getting it I deserve that. I am a value as well. And this is important. So I think you know valuing Oh, that kind of experience a little more. want somebody to take that away? Well, you know, I think that



I have two small daughters. And oftentimes the parenting people say, you know, it's really important to take care of yourself so that you can better take care of your kids. And I think that we have to remember that as clinicians, and so finding ways to really take care of ourselves as, as people and humans, as we're doing this continuing education, certainly there's those times where like Audrey said, you need that quick Con Ed. But there, there is an alternative way to get your continuing education done. That also takes care of yourself.



Yeah, I love it. I love the concept around it. And I, I think you guys are going to be successful in this because it sounds like it's plugging a hole in the continuing education world that people really want. And I also think it's outstanding that you are both been educators for close to a decade. And you can bring all of that to, to continuing education courses. Because I think that's really important. Now, let's talk about when the course is where people can find it social media, where can they find you give us all the details.



Yeah, so our upcoming courses October 7, eighth, and ninth in Whitefish, Montana. So as I said earlier, so of course on prevention and wellness for the running athlete that is paired with guided trail running with our friends and partners with Alpine reading diets. So you can find information about our course and upcoming courses, we're about to announce a winter course that snowshoeing skiing, and biking, fat biking. That's all on our website, Trailhead.,



I wanted to say that we're gonna do 10% off the first retreat for healthy, wealthy and smart listeners, just we so the way we do it is we get your information, and then call you this is a very intimate environment. So we want to start off that way. So you would send us your information that you're interested in the course we call you, we get everything. And at that point, just say that you heard about it from healthy, wealthy and smart.



The last question is what I asked everyone, and knowing where you are now in your life, and in your career, what advice would you give to your younger self and your younger self, let's say maybe right out of PT, school,



you know, the advice that I would give to my younger self, is actually advice that I continue to get to my, I'm not gonna say older self, but current self. And we'll get to my future self. You know, I read this great book, by Adam Grant called Think again. And in the book, he talks about, you know, really staying flexible in your thinking. And I think there's been a lot of times in my life that I've had a five year plan, and I'm going to fix my five year plan. And I think I would encourage my younger self to have maybe a very loose plan, but to not get too stuck on what the five year plan is, there are certainly times in life where that five year plan helps you stick it out, like when you're doing your doctorate or science. But there's been so many opportunities that if I was, you know, had pigeon holed myself into that five year plan, I would have missed them. And so to remain flexible, and keep watching for those various opportunities.



Yeah, I love it. Audrey, how about you?



I think they would give the same advice to myself now that I did, that I would give to my younger self as well. And it's advice that I give to my students. And that would be that it's all worth it. Like all of those experiences are things that you can draw on for your as you're talking to patients. And as you're thinking critically, I teach clinical reasoning, and all of those experiences give you some flexibility of thought. And I think that's really important. So like going and just experimenting and being okay, like it's alright to go do different things that aren't exactly on



your path. Excellent advice from both of you. And I do want to thank you so much for coming on the podcast and talking about doing continuing education different with Trailhead learning collective. I think it's it sounds like a great opportunity, and I encourage all the listeners to check it out. We'll have links at the podcast, follow them on social media. So thank you so much for coming on and sharing all of your fun stuff. Coming up. Thanks so much.



Thanks for having us. Ontarian it's been great to chat with you. Yes. Awesome.



Thanks so much,



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



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

Jul 18, 2022

In this episode, Founder of Enhanced Recovery After Delivery™, Dr. Rebeca Segraves, Co-Founder of Entropy Physiotherapy, Dr. Sarah Haag, Owner and Founder of Reform Physical Therapy, Dr. Abby Bales, and Co-Owner of Entropy Physiotherapy, Dr. Sandy Hilton, talk about the consequences of overturning Roe v. Wade.

Today, they talk about the importance of taking proactive measure in communities, and the legal and ethical obligations of healthcare practitioners. How do physical therapists get the trust of communities who already don’t trust healthcare?

Hear about red-flagged multipurpose drugs, advocating for young people’s education, providing physical therapy care during and after delivery, and get everyone’s words of encouragement for healthcare providers and patients, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Our insurance-based system is not ready to handle the far-reaching consequences of forced birth at a young age and botched abortions.”
  • “We do need to know abortive procedures so that we can recognize when someone has been through an unsafe situation.”
  • “We really need to take into consideration the ramifications of what this will do.”
  • “This is not good healthcare and we need to do more.”
  • “We’re going to have to know our rules, our laws, and what we’re willing to do and go through so that we can provide the care that we know our patients deserve.”
  • “We’re looking at the criminalization of healthcare. That is not healthcare.”
  • “We know who this criminalization of healthcare is going to affect the most. It’s going to affect poor, marginalized people of color.”
  • “We can no longer choose to stay in our lane.”
  • “We need to have a public health physio on the labour and delivery, and on maternity floors.”
  • “We don’t get to have an opinion on the right or wrongness of this. We have a problem ahead of us that is happening already as we speak.”
  • “We need to create more innovators in our field, and education is the way to do that.”
  • “This is frustrating and new, and we’re not going to abandon you. We’re going to figure it out and be there to help.”
  • “Our clinics are still safe. We are still treating you based on what you are dealing with, and we will not be dictated by anybody else.”
  • “If you need help, there is help.”
  • “If we believe in the autonomy of an individual to know all of the information before making a decision, then we still believe in the autonomy of an individual to know all of the information that is best for their body.”
  • “This affects everyone. We’re dedicated to advocating for you.”


More about Dr. Rebeca Segraves

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

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

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


More About Dr. Sarah Haag

Dr. Sarah Haag, PT, DPT, MS graduated from Marquette University in 2002 with a Master of Physical Therapy. She went on to complete Doctor of Physical Therapy and Master of Science in Women’s Health from Rosalind Franklin University in 2008. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health, becoming a Board-Certified Women’s Health Clinical Specialist in 2009 and Certification in Mechanical Diagnosis Therapy from the McKenzie Institute in 2010.

Sarah joined the faculty of Rosalind Franklin in 2019. In her roles at Rosalind Franklin, she is the physical therapy faculty liaison for the Interprofessional Community Clinic and teaching in the College of Health Professions.

Sarah cofounded Entropy Physiotherapy and Wellness with Dr. Sandy Hilton, in Chicago, Illinois in 2013. Entropy was designed to be a clinic where people would come for help, but not feel like ‘patients’ when addressing persistent health issues.


More About Dr. Abby Bales

Dr. Abby Bales, PT, DPT, CSCS is the owner and founder of Reform Physical Therapy in New York City, a practice specializing in women’s health and orthopedic physical therapy.

Dr. Bales received her doctorate in physical therapy from New York University and has advanced training through the renowned Herman and Wallace Pelvic Rehabilitation Institute, Grey Institute, Barral Institute, and Postural Restoration Institute, among others. She also holds her Certified Strength and Conditioning Specialist certification from the NSCA and guest lectures in the physical therapy departments at both NYU and Columbia University, as well as at conferences around the country.

Dr. Bales has a special interest in and works with adult and adolescent athletes with a history of RED-S (formerly known as the Female Athlete Triad) and hypothalamic amenorrhea. A lifelong athlete, marathon runner, and fitness professional, Dr. Bales is passionate about educating athletes, coaches, and physical therapists about the lifespan of the female athlete. Her extensive knowledge of and collaboration with endocrinologists, sports medicine specialists, pediatricians, and Ob/gyns has brought professional athletes, dancers, and weekend warriors alike to seek out her expertise.

With an undergraduate degree in both pre-med and musical theatre, a background in sports and dance, 20 years of Pilates experience and training, Dr. Bales has lent her extensive knowledge as a consultant to the top fitness studios in New York City and is a founding advisor and consultant for The Mirror and the Olympya app. She built Reform Physical Therapy to support female athletes of all ages and stages in their lives. Dr. Bales is a mom of two and lives with her husband and family in New York.


More About Dr. Sandy Hilton

Sandra (Sandy) Hilton graduated with a Master of Science in Physical Therapy from Pacific University in 1988. She received her Doctor of Physical Therapy degree from Des Moines University in 2013. Sandy has contributed to multiple book chapters, papers, and co-authored “Why Pelvic Pain Hurts”. She is an international instructor and speaker on treating pelvic pain for professionals and for public education.

Sandy is a regular contributor on health-related podcasts and is co-host of the Pain Science and Sensibility Podcast with Cory Blickenstaff.

Sandy was the Director of Programming for the Section on Women’s Health of the American Physical Therapy Association from 2012 - 2017. She is now on the board of the Abdominal and Pelvic Pain special interest group, a part of the International Association for the Study of Pain.


Suggested Keywords

Healthy, Wealthy, Smart, Roe v Wade, Abortion, Trauma, Sexual Trauma, Pregnancy, Advocacy, Pelvic Health, Healthcare, Education, Treatment, Empowerment,


To learn more, follow our guests at:





Instagram:       @sandyhiltonpt



Twitter:            @RebecaSegraves




LinkedIn:         Sandy Hilton

                        Sarah Haag

                        Abby Bales

                        Rebeca Segraves


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Read the Full Transcript Here: 


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



welcome back to the podcast. I am your host, Karen Litzy. And on today's episode, I am very fortunate to have for pretty remarkable physical therapists who also happen to be pelvic health specialists. On to discuss the recent Supreme Court ruling in the dobs case that overturned the landmark ruling of Roe vs. Wade. How will this reversal of Roe v Wade affect the patients that we may see on a regular basis in all facets, facets of the physical therapy world. So to help have this discussion, I am very excited to welcome onto the podcast, Dr. Rebecca Seagraves and Dr. Abby bales and to welcome back to the podcast Dr. Sandy Hilton, and Dr. Sarah Hague. So regardless of where you fall on this decision, it is important that the physical therapy world be prepared to care for these patients. So I want to thank all four of these remarkable physical therapists for coming on to the podcast. Once the podcast starts, they will talk a little bit more about themselves, and then we will get right into our discussion. So thank you everyone for tuning in. And thanks to Abby, Rebecca, Sandy, and Sarah.



I, my name is Rebecca Seagraves, I'm a private practice pelvic health therapist who provides hospital based and home based pelvic health services and I teach occupational and physical therapists to provide their services earlier in the hospital so that women don't have to suffer.



Perfect Sarah, go ahead.



I am Sarah Haig. And I'm a physical therapist at entropy physiotherapy in Chicago, and I'm also assistant professor and at a university where I do get to teach a variety of health care providers.



Perfect, Abby, go ahead. My name is Abby bales. I'm a physical therapist, I specialize in pelvic health for the pregnant and postpartum athlete. I have my practice in New York City called perform physical therapy, and I do in home visits and I have a small clinic location.



Perfect and Sandy. Go ahead.



Sandy Hilton. I'm a pelvic health physical therapist. I'm currently in Chicago with Sara entropy. And I'm in Chicago and online. Because we can see people for consultations wherever they are, and we may be needing to do more of that.



So the first question I have for all of you lovely ladies, is how will the recent Supreme Court ruling in the dobs case, which was overturning Roe v. Wade? How is that going to affect people who give birth that we see in our clinics in the hospital setting in an outpatient setting in a home setting? So let's start with Sara, go ahead. I'll start with you. And then we'll just kind of go around. And and and also feel free to chime in and you know, the conversation as you see fit? Got?



That's such a big question. And I get to go first. So the question was how, how is this decision going to affect people who give birth? And I would say it just it affects everyone in in kind of different ways. Because I would say what this will undoubtedly do is result in us seeing people who didn't want to give birth. And and I think, you know, the effects of that are going to be far reaching and that we I think maybe we in this little group can have an idea of, of the vastness of this decision, but I think that even we will be surprised at what happens. I think that how it will affect people who give birth. Gosh, I'm kind of speechless because there's so many different ways. But when we're looking at that person in front of us with whatever they need to do For whatever they need assistance with after giving birth, we're going to have to just amplify exponentially our consideration for where they are and how they felt going into the birth, how they got pregnant in the first place. And, and kind of how they see themselves going forward. We talk about treating women in the fourth trimester. And it's, I mean, I'm in that fourth trimester, myself, and I can tell you that it would be harder to ask for help. And I'm really fortunate that I, that I have that I do have support, and that I do have the ability to seek help. I have a million great friends that I can reach out to for help, but I'm just how the how it's gonna affect the women, I'll say, I'm scared, but it's not about me. I'm very concerned for other women who won't be able to access the care that they that they need.



Yeah, Sandy, go ahead. What do you think? How do you feel this decision will affect people who can give birth, especially as they come to see physical therapist, whether that be during pregnancy? As Sarah just said, the fourth trimester, or perhaps after a procedure, or abortion that maybe didn't go? Well? Because it wasn't safe?



Yeah, so I work a lot with pain. One of my concerns is, but what is the future gonna hold for some people who did not want to be pregnant not added some sort of convenience or concern for finances, both of which, you know, your spot in life determines whether or not you have the the ability to raise another person at that moment. So there are individual decisions that people should make, in my opinion, but also, there's the if something happens to you, that you did not give permission to happen. And then you are dealing with the consequences. In this instance, pregnancy, and you happen to have back pain or have hip pain, or have a chronic condition, or a pelvic pain history, where you didn't not want to be pregnant. How's that going to affect the pain and the dysfunction that you're, you are already happening? And will it sensitize people to worse outcomes and recovery afterwards, because this is a, you know, there's a perceived injustice scale, I want to pull that back out. I hadn't been using it very often in the clinic just didn't seem to change the course of care. But I think that when I'm working with the people pre post, during pregnancy, I think I'm going to pull my perceived injustice scale back out and see if that might be a nice way to find out. If I need to hook someone up to a counselor, a financial counselor, psychologist, sexual therapist, anyone who might be able to support this person, we already don't have good support systems for pregnancy. I just am astounded at how much what a bad choice it is to add more need to a system that isn't currently handling the demand. I know we're gonna need to get creative because these people will need help. But I am a little awestruck at the possible quantum s we're gonna walk into



an abbey you had mentioned before we started recording about you know, some of the folks that you see that may have a history of different kinds of trauma, and how that may affect their abilities are to kind of wrap their head around being pregnant and then being forced to give birth because now they don't have any alternative. So how do you feel like that's going to play out in the physical therapy world, if they even get to physical therapy if they even get to a pelvic health therapist?



Yeah, that's, that's one of the things that I was I was thinking about as everyone was chiming in was, we really are just at the precipice in our niche of our profession, where people who give birth are seeking or even hearing about pelvic health and postpartum care, pregnancy care there. Just barely hearing about it. And my I have, you know, a concern, a very deep concern that these people will go into hiding if they have had an abortion in the past, because are we obligated to report that, and what is the statute of limitations on that, and the shame that they might feel for having had an abortion, or having had give birth and didn't want to, and the trauma that my patients who have, for the most part, not everyone who have wanted pregnancies that either the birth is traumatic, the pregnancy is traumatic, they get to a successful delivery, or they have a loss during the pregnancy, the trauma that they are experiencing, and for the most part, I'm seeing adults, and I cannot comprehend children, because it's this gonna be a lot of children who are forced to give birth, or who are having unsafe abortions, and the trauma that they're going to experience, and how, how much it takes for a person who has sexual trauma or birth trauma to get to my clinic, how these young people how these people who feel that shame, I don't know how they're going to get to me, or any of us, except for a real team based approach with pediatricians, with hospitals, with OB GYN, with your gynecologist with people who might see them first before us. I just don't know how they get to us to be able to treat and help treat that trauma. And like Sandy said, that pelvic pain that might be a result of the trauma if if it's unwanted sexual intercourse, I just don't know how we get to them. And that is something that we struggle with now, with, for the most part, wanted pregnancies. And I don't know how we get there. And I don't think we're prepared as a profession. for that. I think the advocacy for getting ourselves into pediatricians offices into into family medicine offices, is going to be so crucial in getting to these patients. But there aren't enough of us. We are not prepared. And our insurance based system is not ready to handle the far reaching consequences of forced birth at a young age and botched abortions. It is not ready to handle that.



Rebecca, go ahead. I'm curious to hear your thoughts around this because of your work in acute care systems.



Absolutely. I believe that I'm beyond the argument of whether this is right, or whether this is wrong. I think that as a profession, we're going to have to quickly change to a mindset of can we be prepared enough to handle what Abby was saying the amount of trauma, the amount of mental health I think, comes to mind when when someone's autonomy is taken away from them in any regard. I was very vocal as to how dangerous it was to force, you know, mandates on people even last year. And now here we are, we're at a point in our profession where we have to now separate our own personal beliefs and be committed to the oath of doing no further harm because this will result in harm, having treated individuals after an unplanned cesarean section or a cesarean hysterectomy, because of severe blood loss. They had no choice in those procedures. And they had no choice in the kind of recovery or rehabilitation they would get. I had to fight an advocate for our services, physical and occupational therapy services to be offered to individuals. So when you're looking someone in the eye who has lost autonomy over their body as last choice has gone through trauma that changes you it changes me really as a profession, even on this a professional or even on this issue. I'm now pivoting as quickly as I can't decide, do I have the skills that's going to be needed to address maybe hemorrhage events from an unsafe abortion that's performed? Maybe the mental health of having to try All across state lines so that you can find a provider that will treat you maybe the, you know, the shame around, you know, even finding Well, you know, is there a safe space for me to be treated for my pelvic health trauma from you know, maybe needing to carry this pregnancy longer than then I would have wanted to, there's, there's so much around this that we really have to start looking at with a clinical eye with a very empathetic or sympathetic eye as pelvic health therapists because of the fact that there's so few of us. And because now we're in a scenario where there will be more people who will be needing services but not knowing who to turn to. So my my biggest hope from this conversation, and many more that we'll have is that there's some how going to be a way to designate ourselves as a safe space for anyone, no matter what choice they've made for their body, period, I'm really done with being on one end of the spectrum with this, I'm a professional that doesn't have that opportunity to just, you know, be extreme on this, I advocate for the person and for their choice over their body period.



I think we need to, and it's just beautifully, beautifully said, the the getting getting some small systemic procedures in place in the communities we live in, is most likely the first step is reach out to the pediatricians and the chiropractors and the massage therapists and the trainers and the school athletic trainers and whoever you find that can have a connection with people and let them know on an individual basis. So like how do you tell people hey, I'm a trustworthy clinic to come to is not usually by writing it on your website. But if you can make connections in your community and be a trusted provider, that's going to go further, I suspect. I'm assuming there's going to be a fair bit of mistrust. And we have to earn it once it's lost. We've got to earn it back. So yeah, I like the proactiveness of that.



I, I totally agree on something you said Sandy sparked something that I would love for a health care lawyer to start weighing in on is we want, I am a safe space. I think every patient I have ever met who sees me cries. And I hold I hold that part of what I do. Very close to me, it's it's an honor to be someone that my patients open up to. And I know all of you on this call feel the same way because we we are that place that they they I love hearing birth stories. I love it. Even it just gives me an insight into that person into that experience. I feel like I'm there with them. And I understand better what they have gone through. But what happens when the legal system is going to come for us? Or them through us? What happens to that? How do we continue to be a safe space where they can share their sexual trauma, their birth trauma, their birth history, their pregnancy history, their menstruation, history, their sexual history? All of those really, really intimate things? How do we continue to be that for our patients?



I think we've had to do this I've had to do this previously, for in some very, in situations of incest in for the most part, we need a trigger warning on this. But, you know, there you have an individual that is a minor, or, or for some reason not independent that is being abused in what is supposed to be their safe space. And then that person, the abuser can be like, Oh, look, I'm helping you get better. And they're actually not safe. So there's some things and if the person you're treating is a minor, that adult has access to their records. And so I've worked in places not I don't know how to do with an EMR but I've worked in places where we have our chart that we write down the official record and sticky notes, which are the things that will not get put in the official record. But we need to have written down so people know it. And we've had to do that in situations where the patient wasn't safe. We all knew the patient wasn't safe. was being worked on to get them safe, but they were not yet safe. And you had to make sure there was nothing in their records that was going to make them more unsafe. I don't know how to do it as an EMR, if someone has a clever way to do that, that'd be great. Or we go back to EMR plus paper charts.



Even to to add to your point, Abby, if we're looking now at possible, you know, jurisdiction, you know, lead legal their jurisdiction or subpoena of documentation, you know, after having intervened for someone who may have had to make a choice that their state did not condone? Yeah, no, I, I'm completely, you know, on guard against that now, and that those are things that I'm thinking about now and thinking about, well, what would my profession do? Would we back, you know, you know, efforts on Capitol Hill to advocate for, you know, someone who, who has lost their, their autonomy, or lost their ability to, to at least have a safer procedure, and we've had to intervene in that way. You know, I think about that now, and I, that makes me fearful that this is such a hot topic issue that, you know, we might not as an organization want to choose size, but we as professionals on the ground as pelvic health therapists, I don't think that we have that luxury and turning someone away. And so So yeah, I think more conversations like this need to be had so that we can form a unified front of at least, you know, pelvic health specialists that can really help with the the after effects of this.



And I think a big barrier to that legal aspect of it is, you know, what is our legal responsibility. And what happens, if we don't do XYZ is because a lot of the laws and a lot of these states, some of these trigger laws and other laws being that are being passed, the rules seem to be a bit murky. They're not clear. And so I agree, I think the APTA or the section on pelvic health needs to come out with clear guidelines as to what we as healthcare professionals, can and should do. But here's the other thing that I don't understand and maybe someone else can. What about HIPAA? Isn't that a thing? Where did the HIPAA laws come in to protect the privacy between the provider and the patient? And I don't know the answer that I'm not a lawyer, but we have protection through hip isn't that the point of a HIPAA HIPAA laws? I don't know what



you would think so. But unfortunately, one of the justices who shall not be named has decided that abortion does not fall under HIPAA, because it involves the life of another being in so I can only state what has been stated or restate. But yes, the those are the very things that I'm afraid we're up against as professionals.



Yeah, I think they're going to try to make us mandatory reporters. for it. I think they're gonna try to make all healthcare we are mandatory. For some things, the thing that's good for some things. Yeah, the



thing that bothers me about that is the where I'm in Illinois right now, Illinois is a designated, look, we're not, we're not going to infringe on people's right to health care. Just great. But some of the laws and I've lost track, I was trying to keep track of how many have are voting on or have already voted on laws that would have civil penalties, penalties of providers from other states, regardless of the Practice Act of that provider, to be able to have a civil lawsuit against that provider. So that's fun. And then we go back to what ABBY You had mentioned before we started recording about medicine, that that is considered an abort efficient, I have a really hard time with that word. But that is also used for other conditions that we see in our clinics for pain for function and things like that. And then where's our role?



Right, so does someone want to talk about these more specific on what those medications are and what they're for? So that people listening are like, Okay, well, what medications, you know, so do you want to kind of go into maybe what those medications are, what they're for and how they tie back into our profession. Because, you know, a lot of people will say, well, this isn't our lane. So we're trying to do these podcasts. so people understand it's very much within our lane.



Well, I yeah, it's just from a pharmacology standpoint, the one of the probably most popular well known drugs that's used for abortion is under the generic name of Cytotec misoprostol, and that's a drug that's not only only used for abortion, but if individual suffers a miscarriage is used to help with retained placenta and making sure that the uterus clears. What other people don't know is is also used for induction. So the same drug is used for three or four different purposes. It's also used for postpartum hemorrhage. So measle Postel, or Cytotec is a drug as pelvic health therapists we should be very familiar with. And we should be familiar with it. Not only you know, for, you know, this this topic, but it's also been a drug that's been linked with the uterus going into hyperstimulation. So actually putting someone at risk for bleeding too heavily. And all of this has a lot of implications on someone's mental health, who's suffered a miscarriage who's gone through an abortion that maybe was not safely performed, which I have had very close experience with someone who's been given misoprostol Cytotec, it didn't take well, she continued bleeding through the weekend, because she lived in a state where emergency physicians could opt out of knowing a board of medications. So as professionals, we do need to know, a board of procedures so that we can recognize when someone has been through an unsafe situation it is, it is our oath as metal as medical professionals to know those things, not to necessarily have a stance on those things that will prevent us from providing high quality and safe care.



Another one of the medications is methotrexate, and it's used to treat inflammatory bowel disease. And as public health specialists, we'd see people who have IBD, Crohn's and Colitis, who have had surgery who are in flareups who are being treated like that treated with that medication. And it is again used in in abortions. And when you're on that medication, you have to take pregnancy tests in order to still be able to get your prescription for that medication. And as a person who I myself have inflammatory bowel disease and have been on that medication before, I can tell you that you don't go on those medications lightly. It is you are counseled when you are of an age where you could possibly get pregnant, and taking those medications. And it's very serious to take them. And you also have to get to a certain stage of very serious disease in order to take that it's not the first line of defense. So if we start removing medications, or they start to be red flagged on EMRs, or org charts, and we become mandatory reporters for seeing that medication, God forbid, on someone's you know, they're when they're telling us what type of medications they're taking, that there would be an inquiry into that for for any reason is just it's it's horrifying. I mean, it's, we treat these patients and they trust us, and we want them to trust us. But as we get farther and farther down this rabbit hole of, of going after providers, pharmacists, people who help give them information to go to a different state, I just it is. Like I said before, the breadth and the depth of this decision, reverberates everywhere. And if if PTS think that they are in orthopedic clinics, that they are somehow immune from it, you're absolutely not. And for those clinics who have taken on or encourage one of their one of their therapists to take on women's health because it's now a buzz issue. It's really cool. You are now going to see that in your clinic. And you know, like Rebecca was saying before, you know any number of us who have really strong and long term relationships with patients who are pregnant who are in postpartum I have intervened and sent patients to the hospital on the phone with them because they have remnants of conception and they have a fever and someone's blowing them off and not letting them into the IDI and sending them home. And we we are seeing those patients, they have an ectopic they're, they're bleeding, is it normal, they're calling me they're not calling their OB they can't get their OB on the phone. They're texting me and saying what should I do? And they have that trust with me and what happens when they don't? And they're bleeding and they're not asking someone that question and they don't know where to go for help. And so I know I took this in a different direction and we talked about pharmacology, but I just thing that I have those patients whose lives I have saved by sending them to the emergency department, because they are sick, they have an infection, they are bleeding, they have an ectopic, it is not normal. And I don't know what happens when they no longer have that trust with us not not because we're not trustworthy, but because they're scared.



The heavy silence of all of us going



you know, it's, it's not wrong. And I think the like, it just keeps going through my head. It's just like, so what do we do? I mean, Karen, you mentioned like, it'd be great if somebody came out with a list of, of guidance for us. And I just, that just won't happen. Because there's different laws in different states, different practice acts in different states. And no one, you know, like you even if you talk to a lawyer, they're going to say, this would be the interpretation. But also, as of yet, there's no like case law, to give us any sort of any sort of guidance. So that was a lot of words to say, it's really hard. I can tell you in Illinois, like two or three weeks ago, I'd be like, like, I'm happy, I feel like Illinois is a pretty safe space. We have, we have elections for our governor this year. And I have never been so worried, so motivated to vote. And so motivated to to really make sure to talk to people about it's not just like this, this category or this category, it's like we really need to take into consideration the ramifications of what this will do, I think there was a lot of this probably won't affect me a whole lot. But I think I'm guessing I think a lot of us on this call maybe I think all of us on all of us on this call, have lived our lives with Roe v. Wade. And, as all of this is coming up, and just thinking about how it impacts so many people, and how our healthcare system is already doing not a good job of taking care of so many people, the fact that we would do this with no, no scientific, back ground, no support scientifically. Like I pulled up the ACOG statement, and, and they condemn this devastating decision. And I really, I was like, it gave me gave me goosebumps. And this was referred to in our art Association's statement. And it makes me sad that we didn't condemn it. Hope that's not too political. But I'm really sad that we didn't take a stronger stance to say, this is not good health care. And we need to do more. Again, and that's like, again, so many words, to say we're gonna have to make up our own minds, we're gonna have to know, our rules, our laws and what we're willing to do, and go through, so that we can provide the care that we know our patients deserve. And that's going to be really hard. Because, you know, if I talk to someone, and if I call Rebecca in Washington State, she's going to have something different than if I talk to Abby in New York. And you know, that so it'll be, it'll be really hard even to find that support. That support there's going to be so much support, I think, from this community, but that knowledge and that, that confidence, we have to pull together so we have to pull together with all the other providers, but also we're gonna have to sit down and figure this out to



the clarity. So it's, I think a practical step forward would be each state to get get, like, every state, come up with a thing. So pelvic health therapists in that state come up with what seems to work for them get a lovely healthcare lawyer to to work with them with it. And then we could have a clearinghouse of sorts of all of the state statements. I don't know that that needs to go through a particular organization. I I know that they're in the field of physical therapy, two thirds of PTS aren't members. And we need this information to be out there for every single person so that they know



that we'll have to be grassroots there's I don't think that there's going to be widespread Association support from anywhere. But that being said, I think it's a great idea.



What are we going to do about it? Hang on issues that are too divisive, you're absolutely right, individual entities are going to have to take this on and just put those resources out to therapists who need them need the legal support, need the need to know how and how to circumvent issues in their states. And, you know, like I said before, even how to just provide that emotional support, there's going to be needed for their, their, their patients, so, and that's okay, if the organizations that were part of are not willing to take a heavy stance, you know, even like last year, if you're not willing to take a heavy stance, on an issue where someone feels their autonomy, and their choice is being threatened, then it's okay, well, we'll take it from here. But, you know, that's, that's really where these grassroots efforts come from and abound, because there are a group of individuals who are willing to say, No, this is wrong. And I'm going to do something about this so that our future generations don't have to suffer.



Yeah, and I think, you know, we're really looking at the criminalization of health care.



That is not healthcare.



And we also know who this criminalization of healthcare is going to affect the most. And it's going to affect poor, marginalized people of color, it is not going to affect the wealthy white folks in any state, they'll be fine. So how do we, as physical therapist, deal with that? How do we, how do we get the trust of those communities who already don't trust health care, so now they're going to stay away even more, we already have the highest mortality, maternal mortality rates in the developed world, I can only imagine that will get worse because people, as we've all heard today are going to be afraid to seek health care. So where do we go from here as health care providers? I,



Karen, you're speaking something that's very near and dear to my heart, I act as if you had to take this on, I am very adamant that we can no longer choose to stay in our lane, we do not have that luxury. And I as a black female, you know, physical therapist, I don't have the luxury to ignore that because of the color of my skin, and not my doctor's degree, not my board certification and women's health, you know, not my faculty position, I when I walk into a hospital, and I either choose to give birth or have a procedure, I will be judged by none other than the color of my skin. That is what the data is telling me is that I am three times likely to have a very severe outcome. If I were to have a pregnancy that did not go as planned or or don't choose a procedure, you know, that affects the rest of my function in my health. And so given the data on this, you're absolutely right there, there is going to be very specific populations that are going to receive the most blowback from this. And as a pelvic health therapist, I had to go into the hospital to find them, because I knew that people of color and of marginalized backgrounds, were not going to find me in my clinic. And we're not going to pay necessarily private pay services to receive that care. But I needed to go where they were most likely to be and that was the hospital setting or in their home. And so, again, as a field of a very dispersed and you know, not very many of us at all, we're going to have to pivot into these areas that we were not necessarily comfortable in being if we're going to address the populations that are going to be most affected by the decisions our lawmakers are making for our bodies.



You know, there's something that I think about, often when I hear this type of conversation come up in, in sexual health and in in whenever I am speaking with one of my patients and talking about their menstruation history, and, and them not knowing how their body works from such a young age is I just wonder if we should be offering programs for young people like very young pre ministration you know, people with uteruses and their parents, and grandparents and online, online like little anonymous. Yep. nonnamous



for it's just



Yes. Yes, it's it's just, you know, Andrew Huberman talks a lot about having data Back to free content that scientific, that's factual. And I think about that a lot. And I think, to my mind, where I go with this, because I do think about the lifespan of a person, is that creating something that someone can access anonymously at any age, and then maybe creating something where it's offered at a school? You know, it's it's ministration health. And it doesn't have to be under the guise of, you know, this happened with Roe v. Wade, but this it could be menstruation, health, what is a person who menstruating what can you expect? What you know, and going through the lifespan with them, but offering them? You know, I think I think about this with my own children, as our pediatrician always asks the question of the visit, who is allowed to see under your clothes who is allowed to touch you? And it's like, you and my, I have a five year old. So it's Mom, when when when I go number two, a mom or dad when I go number two? And that's it. And you know, I think about that, and I think about how we can educate young people on a variety of things within this topic, and kind of include other stuff, too, that's normal, not normal, depending on their age. Absolutely, there



was what I was excited about in pelvic health. Before this was people like Frank to physician and his PhD students and postdocs are working on a series of research about how if we identify young girls that are starting their period, and having painful periods, treat them and educate them, then that they will not go on to have as much pelvic pain conditions and issues in the future. So we look at the early childhood events kind of thing, but also period pain. And How exciting would it be if we could get education to young girls about just how their bodies work. And to know that just because you all your aunties have horrible periods doesn't mean that you're stuck with this, just like maybe they just didn't know, let's help you out and constipation information and those basic health self care for preventative problems. So I was super excited about all that. And now it's like, oh, now we have to do it. Because in that we can do little pieces of information. So people have knowledge about their body, that's going to be a little bit of armor for them, that they're going to need and free and available in short, and you know, slide it past all the YouTube sensors. This is this is doable, but it's gonna take time money doing, but we can do it. Well, it sounds like, ladies,



we've got a lot of work to do. One other thing I wanted to touch upon. And we've said this a couple of times, but I think it's worth repeating again and again and again. And that's that expanding out to other providers. So it's expanding out, as Rebecca said, expanding out to our colleagues in acute care, meaning you can see someone right after a procedure right after birth right after a C section. And, and sadly, as we were saying, I think we they may start seeing more women, I'm not even set children under the age of 18. In these positions of force birth on a skeletally immature body. So the only place to reach these children would be maybe in that acute care setting. How what does the profession need to do in order to make that happen? And not not shy away from it, but give them the information that they need. Moving forward?



I was just gonna say that I've given birth in the hospital twice. Not at any time was I offered a physical therapist, or did a physical therapist come by and I am in New York City. I gave birth in New York City, planned Solarians because of my illnesses. And nobody came by I did get lactation nurses, any manner of people who were seeing me I was on their service. But that has been something that we needed anyway. We mean to have a pelvic health physio on the labor and delivery and on the maternity floors, who is coming by educating as to what they can start with what they can expect. When can they have an exam if they want to have one? Who is a trusted provider for them to have one. And we need to get the hospitals to expand acute care, physical therapy to labor and delivery and, and the maternity floors. As a routine, it's not something you should have to call for, it should be routine clearance for discharge the same way you have to watch the shaking baby video to get discharged.



I'm happy older than all of you. I don't have it either. But taking baby video is not something that even existed back in the day. But that makes sense. I mean, I once upon a time was a burn therapist, and I was on call at a regional Trauma Center. And you know, it's like you're needed your, your pager goes off, because that's how long ago it was. And you just came in, did your thing, went back home went back to bed. There is no reason other than lack of will, that PTS couldn't be doing that right now.



I'm now of the opinion where it's unethical to not offer physical or occupational therapy within 24 to 48 hours of someone who had no idea who did not have a planned delivery the way they expected it who has now and a massively long road to recovery. After a major abdominal surgery, I'm now of the opinion that is unethical for our medical systems to not offer that those rehabilitative services. And I've treated individuals who had a cesarean section but suffered a stillbirth. So the very thought of not providing services to someone who has any kind of procedure that's affecting, you know, their their their not only their pelvic health, but their mental function. That to me is now given the you know, these these, this recent decision on overturning Roe v Wade, is now now we're never, you know, either we're going to now pivot again as pelvic health therapists and start training our acute care colleagues, as we did with our orthopedic colleagues, as we've done with, you know, our neurology colleagues, whatever we've had to do as pelvic health therapists to bring attention to half of the population, you know, who are undergoing procedures, and they're not being informed on how to recover, we will have to start educating and kind of really grow beyond just the clinics and beyond what we can do in our community or community. But we are going to have to start educating our other colleagues in these other settings, we don't have a choice, we know too much, but we can't be everywhere. And not all of us can be in the hospital setting, we're going to have to train the individuals who are used to seeing anything that walks through the door and tell them get over to the obstetric unit. Okay, there's someone there waiting for you.



Yeah, I totally agree. I mean, when I think back I remember as a student working in acute care and how we had someone who's dedicated to the ICU, we had someone dedicated to the medical floor, we had somebody who was dedicated to the ortho floor, and most of the time they had their OCS, their, their, the one for for, for ICU care, the one for NeuroCare, or they have a specialty. And I think it is just remnants of the bygone era of it's natural, your body will heal kind of BS from the past. It's just remnants of that and it's just, we don't need the APTA to give us permission to do this, this is internal, this is I'm going into a hospital, and I'm presenting you with a program. And here is what this what you can build this visit for here's the ICD 10 code for this visit here is here is here are two people who are going to give you know, one seminar to all of your PT OTs, to you know, so that you are aware of what the possible complications and when to refer out and that kind of thing. And then here are two therapists who are acute care therapists who are going to also float to the maternity floor one of them every day, so that we can hit the we can get to these patients at that point, and that is just that's just people who present a program who have an idea, who get it in front of the board that that it is not permission from anybody else to do it. And, you know, it really it fires me up to to create a world in which you know, when you know people who are the heads of departments and chairs and you know on the boards of directors You know, being in big, big cities or small cities, when you know those people, you know, you can, your passion can fire them up. And if you can fire people up, and you can advocate for your patients and you can in that can spread, you can make that happen. And this is, you know, I feel radicalized by this, I mean, I'm burning my bra all over the place with this kind of thing. And I just feel like, if we can, if we can get to young people, and if we can get to day zero, of delivery, day one, post delivery, or post trauma, then then maybe we can make a dent, maybe we can, maybe we can try, maybe we can really make a go of this for these people. Because, like I keep feeling and saying I, we are not prepared for the volume.



If individuals are going to be forced to carry a pregnancy, that they may not want to turn because it's affecting their health, we're going to have to be prepared for this. Again, this is not an option really, for us as pelvic health therapists, because we know what's down the road, we've seen mothers who have or you know, or individuals who have suffered strokes or preeclampsia or seizures, or, you know, honestly, long term health issues because of what pregnancies have done to their body. And now if they want the choice to say, you know, I'm not ready, they don't have it anymore. So we really don't have a choice. We have to start expanding our services into these other settings, making our neurologic clinical specialists in the hospital, see people before they have a stroke before they have a seizure actually provide services that can help someone monitor their own signs and symptoms after they've had now a procedure or given birth or even had, you know, a stillbirth, unfortunately, because the doctor had to decide, well, yes, now we will perform the abortion because you know, your health is like on the cliff, I mean, we're going to be seeing these and we just have to prepare. And if it's not our organizations that are laying the foundations, we will, we'll take it from here,



we need to reach out across so many barriers, like athletic trainers, they're gonna see the young girls, they're gonna see their track stars that is not reds, it's pregnancy. And it could be a very short lived traumatic pregnancy, in girls that are just not develop. They're developed enough to get pregnant, they're not developed enough to carry a healthy baby to term. Kind of just makes me like. But Rebecca is right as we don't get to have an opinion on the right or wrongness of this, we have a problem ahead of us now, that that is happening already, as we speak, that people are going to need help. I love that we have more technology than my grandma did when she was fighting this battle. And we have YouTube and we have podcasts and we have ways to get information out. But we need to use every single one of them in our sports colleague or athletic trainer colleagues. They need to know the signs. Because they may be the ones that see it first.



Yeah. And Sarah as being the most recent new mother here. What kind of care did you get when you were in the hospital?



I was sitting here thinking about that. And I mean, I will say that the care I had while I was there, that I had an uncomplicated delivery in spite of a very large baby. And I was fortunate enough to leave the hospital without needing additional help. But I wasn't offered physio. Nobody really they're just really curious to make sure you're paying enough. And that's about it if you're the mom and my six week visit was actually telehealth and that was the last time I had contact with a health care professional regarding my own health so it is minimal even if you're a very fortunate white woman in a large metropolitan area and but I'm working now further north and with a pro bono clinic clinic and in an area where we do a lot of work with communities of color and I'm I'm like I honestly don't even know the hospitals up here yet. But I'm gonna I have so many post it notes of things that are gonna start happening and start inquiring because Rebecca like we need to get into the hospitals like if if I can Do that. And honestly, up until now, like my world and entropy was, and pre this decision was it, there's so many people out there who need help with pelvic issues in general, like we can do this forever. And we set our clinic up so that people who weren't doing well in the traditional health care system could find us and afford us. At least some people could, I realized that it wasn't in companies, encompassing everybody who could possibly need help, but we were doing trying to figure out another way. And so again, like, like, again, the offer of assistance I got was minimal. But also I didn't need much. And I was in a position where also, I knew I could, I could ask for it if I wanted it. And I could probably get it if I needed it. And I'm just thinking about, again, some of the communities I'm interacting with now, in some of my other roles and responsibilities, and I cannot wait to take a look and see, how can we get in there? How can we be on that floor? How can we? What What can we make, make happen like, because it needs to happen, these are these, this is the place where I'm scared to start seeing the stats,



wouldn't it be amazing if you can get the student clinic part of that somehow somehow and get, you know, young beyond that bias, but younger, most younger but but like the physicians the the in training the PTs and training the PAs the you know, and get like Rebecca had said, let's get let's get the team up to speed here, because there aren't enough pelvic health therapists already. And they're heavens, we need, we need to get everybody caught up.



And there's so much I was telling you that being around student health care, providing your future health care providers is really energizing and also really interesting. I mean, the ideas that come up with in the in the connections they make and and the proposals they make are just amazing. But two things that I've noticed that I think probably we run into in the real world, real world, outside school world as well, is one. The that's being able to have enough people and enough support to keep it sustainable. So you have this idea, you have the proposal, you made the proposal, how are we going to keep it going and finding the funding or the energy or the volunteers to keep it going. Things ebb and flow, you get a great proposal, you're like yes. And then I literally today was like, I wonder what's up with that one, because it was an idea for a clinic to help was basically for trans people to our tree transitioning and might not have the support that they need. And also I was reached, they come up here for women's health clinic. And I'm going to reach out to them now. Because this again, this decision changes that because it is a pro bono clinic that they would like to set this up in and before it was going to be much more more wellness. And now it could turn out to be essential health care. So that's one thing. But then the other thing is still the education, that in school, we're not taught about what everyone else can do. And I think again, figuring out a way to make sure that future physicians really know what physical therapists have to offer, especially in this space. Most people know that if their their shoulder, their rotator cuff repair, they should send them to pt. But really, we need to get in with OB GYN news, we need to get in with the pediatricians. And I don't want to say unfortunately, but in this regard, unfortunately, we're going to have to really make sure that they know what we're doing. And again, I'm already kind of trying to think like how can we make this just part of how we do health care.



So I think I'm following in your footsteps by going into education and by by being a part of our doctor of physical therapy programs. You know, I especially chose the program in Washington state not because you know, of just the the the opportunity to teach doctors or incoming doctors but it was also an opportunity to teach doctors of osteopathic medicine and occupational therapy therapists. It was you know, very intimate program and opportunity to make pelvic health or women's health or reproductive health apart of cardiopulmonary content, a part of neurology content, a part of our foundations a part of musculoskeletal and not a special elective course that we get two days of training on, I had the opportunity to literally insert our care, our specialized and unique care and every aspect of the curriculum, as it should be, because we are dealing with, you know, more or less issues that every therapist generalists or specialists should be equipped to handle. So in the wake of Roe v Wade, to me, this is an opportunity unlike any other for pelvic health therapists to really get into these educational spaces where incoming doctors are, you know, MDS or PA programs, or NP programs are our therapy practices, and start where students are most riled up and having those ideas so that they can go out and become each one of us, you know, go into hospitals and say no, to obstetric units being ignored, go into hospitals and give and services to physicians. You know, we need to create more innovators in our field and education is the way to do that.



I just wrote down check Indiana and Ohio, and then I wrote border clinics, because Because Illinois is a it's like a not a prohibition state. Having so many flashbacks, because Illinois, is, is currently dedicated to maintaining health care access for everyone. We have cities that are on the border. And I was thought of that when you were talking, Sarah, because you're up next to Wisconsin now. But we have we have the southern part of the state and the western part of the state. And those those border towns are going to have a higher influx than I will see in Chicago, maybe. But I would anticipate that they would,



you know, and again, this is where laws are murky. Every state is different. It's I mean, it's a shitshow. For lack of better way of putting it I don't think there's any other way to put it at this point. Because that's kind of what what we're dealing with because no one's prepared, period. So as we wrap things up, I'll go around to each of you. And just kind of what do you want the listeners to take away? Go ahead, Sandy,



this is this is frustrating and new, and we're not going to abandon you. We're gonna figure it out and be there to help.



I would say that our clinics are still safe, it is still a safe place for you to open up and tell us what you wouldn't tell anybody else. It's still safe with us. And we still have you as an entire person with all of your history. We are still treating you based on what you are dealing with and not. We will not be dictated by anybody else. Our care won't be mandated or dictated by anybody. Sarah, go ahead.



What I would say is I would echo your safe. If you need help, there is help. And I'm sorry, that that this just made it harder than it already was. And I would say to healthcare providers, please let remember, let us remember why we're doing what we're doing. And, you know, we do need to stand up, we do need to continue to provide the best care for our patients. Because to be honest, I've been thinking like, I think it's a legal question. It's a professional question. But ultimately, if we can't give the best care possible, I'm not sure I should do this.



Ahead, Rebecca,



for our health care providers, in the wake of Roe v. Wade, being overturned, wherever we are, you know, as an organization or on our stance, if we believed in the autonomy of an individual to know all of the information before making a decision, then we still believe in the autonomy of an individual to know all of the information that is best for their body. And that is the oath that's the that's the that's the promise that we've made as professionals to people that we're serving, and to the people that we're serving to those who are there listening to this. You have safe spaces with providers that you trust and we're going to continue to educate one another, our field and also you we're going to put together resources that really bring During this education to your families so that you don't have to feel like you're in the dark and you're alone. This is not something that is per individual or per person. This affects everyone. And we're dedicated to advocating for you.



Perfect, and on that we will wrap things up. Thank you ladies so much for a really candid and robust discussion. I feel like there are lots to do. I think we've got some, some great ideas here. And perhaps with some help and some grassroots movements, we can turn them into a reality. So thank you to Rebecca to Sarah to Abby and to Sandy, for taking the time out of your schedules because I know we're all busy to talk about this very important topic. So thank you all so so much, and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.



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



Jul 11, 2022

In this episode, Founder and CEO of Practice Freedom U, Jamey Schrier, talks about hiring and retaining staff.

Today, Jamey talks about changing how business owners see employees, the 3X rule, and digging deep to find clarity. What can business owners do to hire the right people?

Hear about the importance of being inspired by your vision, successful marketing strategies, slowing down the hiring process, and get Jamey’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Besides you, your employees are the most important people in your business life.”
  • “Meet your prospects where they are.”
  • “Employees want to work for a company that has a purpose.”
  • “The first person your vision needs to inspire is you.”
  • “When clarity happens, you get power, you get confidence, and you get dialed in. When you have that kind of focus, that’s where magic happens.”
  • “We’ve become infatuated with advancement. We’ve become infatuated with certifications.”
  • “Hire for traits. Train for skill.”
  • “If you are a business that’s growing, then you can never stop looking for talent.”
  • “Having a process and slowing things down is critical.”
  • “Be vulnerable. Be open.”


More about Jamey Schrier

Jamey Schrier, P.T. is a best-selling author, speaker, and Founder and CEO of Practice Freedom U, a business training and coaching company.

Jamey is a former private practice owner, and his book, The Practice Freedom Method has helped scores of practitioners Treat Less, and Earn More, and enjoy a life they deserve.


Suggested Keywords

Healthy, Wealthy, Smart, Business, Hiring, Employment, Purpose, Vision, Values, Inspiration, Interviews, Focus, Strategies, Marketing,


Get $200 off Jamey’s Course


To learn more, follow Jamey at:


LinkedIn:         Jamey Schrier, PT

Facebook:       Practice Freedom U

                        Jamey Schrier

Twitter:            @JameySchrier

Instagram:       @JameySchrierPFU


Subscribe to Healthy, Wealthy & Smart:


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Read the Full Transcript Here: 


Hey Jamie, welcome back to the podcast. I'm happy to have you on I think you're quickly becoming my most regular guest and I'm really happy and thankful for it. So welcome back. Oh, thanks, Karen. I



appreciate being invited back and I am honored to be a regular it's like the old school while I'm dating myself here with the Johnny Carson Show. I mean, that's, that's going back and I don't want to date either one of us, but it's like, you know, the regular guests that's on there. They can't find anybody. There. Schreier. He's a felon. He didn't come in there and fill up some time.



Oh, that's so funny. I think I was watching Seth Meyers and Rachel Drac was on and that's what they said, Rachel Drac is like, you know, someone else was supposed to be there. But I don't know if they got sick, or they couldn't make it. And so they called her that afternoon. She was like, Sure. Tell me about her.



Oh, I've watched a sports show called PTI. Pardon the Interruption around it takes place right in DC. And one of the guys is called Phil and Frank. It's like, if they ever need anybody, someone's out sick. You know, Frank, I saw he, he jumps in and fills in at any, you know, at a moment's notice. So, you know, I don't know if I'll fill in Jamie. But well, well, you're



not, you're not filling in, you're just a regular guest.



Thank you, thank you,



not a fill in. It's just a regular guest. So today, we're going to talk about something I don't think I've really talked about on the podcast, at least, I can't remember talking about this in great detail. And that is, how to hire people how to retain staff, which, you know, as we were speaking before we went on is a problem, not just in physical therapy right now, but in a lot of industries across the board around the country. So let's dive in. So you have four surprisingly simple ways to hire and retain staff. So let's get to it.



Yeah, I mean, you know, as we know, it's a difficult marketplace. And I think, you know, this shift isn't just a shift that is, oh, they're gonna have a shift, and it's gonna be all fine tomorrow. No, I'm not gonna say it's not a permanent shift, as far as we're always going to have this difficulty, you know, really finding good people. But I do think it's a shift that is going to stay around as far as what people are deeming important, what people are deeming valuable. And I think it's important for us in the hiring marketplace, that we begin to shift how we as business owners, and that's kind of the position, I always come from being a business owner, and you being a business owner, is how we need to shift our way how we think about employees. You know, it's interesting, you know, I speak to so many people every day, every week, whether there are clients or, or just people out and about and in the business industry, and, you know, I can't tell you, Karen, how many times people talk about employees as a cost, right? It's like, oh, how much are they going to cost and, and I don't know if I can afford them, and all they care about is wanting more money, and this and that, and, um, you know, and it, it kind of, it hits me, because I think the first thing we have to do collectively, at least as a group of business owners is start to shift that your employees besides you, your employees are the most important people in your life and your business life. And if you don't mentally look at them as an investment, just like you look at any other investment you're doing, that will bleed into other things. It'll bleed to how you treat them, it'll bleed into some of the things you say are some of the things that you create or benefits or whatever the case is. And I've seen that so often, I used to do that, because I used to kind of think that way is they were a cost come in, do your job, shut up and just leave me alone type of thing. And you know, that is not the right way. It's never been the right way. But now more than ever, that's kind of the premise of all of this is shifting in these people are an investment. And investments are things that you want to nurture. You want to help you want to grow, you want to be assets. And I think it takes that fundamental shift before anything, because if not, everything just becomes an empty strategy or something but it won't hold. It won't have teeth to it. If there isn't that shift and how we think you know what I mean?



I do I do and I think that's a really great distinction that you made that you for employers to look at their employees as a real investment, because if that employee is nurtured and you help them grow, if they can help grow and expand your business in ways that you never thought could even be possible.



Exactly. And it sounds simple, it's easy to read in a book or listen on a wonderful podcast, but actually doing it in the moment is not as easy to do. Because we have wiring ourselves, we have thoughts, we have biases, we have upbringings and influences in our lives, as we all do. And these things, you know, whether you call them, you know, limiting beliefs or negative biases, we have all of these things that start to affect how we think and how we communicate. And how we ultimately, you know, put into action, some of these things. And if you don't feel that way, you don't think that way, it will come out, during how you interview how you post an ad. I mean, you know, I can be very honest with you, I know, you know, my ads used to be going on, I don't even know if it was indeed at the time, but going on whatever the latest thing was Craigslist or something, and just looking at another company and just copying their ad. I mean, I didn't know what to say, I didn't really know what I was doing. But I just thought, hey, if the hospital, you know, put an ad up, they must know what they're doing. Because they got you know, a lot of money and they hire good people. So my ad was basically a hospital ad. And what's interesting is, so many so many people continue to do that they, they put up some vanilla job ad on indeed. And they're like, well, this used to work, it ain't working anymore, you cannot do that anymore. It's not going to get you people, and it's certainly not going to get you the right people. You know, the real, the real thing right now is, you know, truly differentiating yourself leading with the positives. And, you know, I know we'll get into this in a second, but really looking at these people looking at these potential employees as investments and learning, how do you meet them? Where they are, right, there's an old marketing term is, you know, you know, meet your prospects, where they are joined the conversation they're having in their brain, which really means is, understand them, perhaps better than they can understand themselves, do your do your research. And, you know, I never knew anything like that. But I think that that's, that's what we all need to do is pause for a second and really understand the type of person that we're looking for, and learn as much about them. And when you're able to do that, you're able to put together what's what's called an employee value proposition, you know, you've we've heard and and we talk marketing, your unique selling proposition, all kinds of different propositions, but this idea of a an EVP and employee value proposition, yes, our job is to seek out and actually sell people on what we have to offer, why they should buy quotes, what we're selling. And it is a different way of looking at it. And for a lot of people, it's uncomfortable, and it's like, I shouldn't have to do that as as some of the things I've heard, you know, I shouldn't have to do that. They should want to work for me, you know, we give the greatest care and, and we're the best at what we do. And we really care about our people and all that it's like, yeah, but so does everybody else.



That's what I was just thinking doesn't everybody?



Yeah, I'm okay. And I know you care just a little bit more than I do about quality care. And I know that I mean, but that's, that's the mindset we come with. What we don't come with is we need to put our best foot forward. And we need to understand these people that we are trying I know we hate the S word. But we are trying to I'll say the P word and said persuade them for coming to interview with us. And then if we liked them, persuade them to commit to working for us. And you know what, when you have the ability to get pretty much any job you want out there, you put a posting out that you got 10 potential offers maybe 20 You're in competition with A lot of other people, and you have to realize that and have to do the work. It's not hard work. But it's focused work to understand more about who you're trying to get than you ever needed to do in the past. So that's kind of the premise of the whole thing. Yeah. Yeah. So



I was gonna say, Is this part of these, like, we mentioned the top kind of simple ways to hire and retain staff, is this part of it? Or is this the background you need to do to get to?



I think, I think it's the background. I mean, if I mean, you could put it in there. But you know, for this for this conversation, I'm kind of setting the stage of, of the background of where people need to be coming from. I mean, the bottom line is, why should they work for you? It's really that simple. Why should they work for you, because they can work for someone else, no matter what you say, one an hour to an hour. But there's, there's already 10 other people doing the same thing. So you know, one of the things that now we're gonna get into the specifics, you know, one of the things we talked about, you know, we need to treat them like an investment. But it goes beyond that, we need to understand number one thing that every owner needs to do is understand what their worth is. I did some research on this. There's a recent Gallup poll. And they said 60% 64% of employees said that a significant increase in income and benefits. Was there number one won't. Now, which is interesting. It wasn't necessarily number one, a little while ago, it was never number one. For many years, it was never even a top five money was not the focus. Well, it is now and you can't blame them. Because let's say education is a fortune. Right? Some people No, in our industry are saying, it's not even worth it. If you look on paper, just money, you invest in education. And when you get it back, you might be in debt for 20 years before you actually pay it off. Depending if you have 234 100,000, you have inflation, it just cost more to live in some of these cities like yours, and mine, it costs a lot to live wow, you know, you adjust for the insurance that you get, if you do take insurance. It's not covering that. So they expect the employer to do that. So this, this question of, you know, what is their worth? I've heard from so many people that say to me, you know, I can't afford that. And I say, Okay, well, what can you afford? Well, I don't know. And there's the problem. You need to know what this person is worth to your company at the level that you want them working. So for instance, I like to use a three multiple and a typical outpatient example. So if you're a typical outpatient, orthopedics, not, you know, insurance based, most likely, but it really depends. And your multiple of salary, not benefits, not taxes, and it just salary. It has to be at least three times, meaning that if you pay someone 75,000, that person should produce 225,000 in revenue, a three multiple it's just a ballpark. Could it be less than a three? It could be? It really depends how what your expenses are like, what's your rent, like?



You know, your other overhead and all that kind of stuff to make sure that you can cover all that and still have money for profit, let's not forget, profit. If it's greater than that, you should be really clear you should be fine. So it's our job to really dial in, what can this person generate? And then use that ballpark three times to determine what you can afford. So this shines a light. Karen and I and I've had some recent conversations with people and analyzing their business is shines a light on people's business models, some people's business models, they have this altruistic will I want to do one patient an hour, I'm like, hey, you know, we don't tell people what your model should be. We just tell you whether it's going to be profitable. And it's going to achieve the goals that you want, especially especially to financial goals. So if you do one patient an hour at $100 a visit, I can tell you right now there is no way you're ever going to be able to afford the people to work for you. That stay with you. It's It's literally impossible, because there's not enough money. Let's say it's one patient an hour that's at the greatest 808 A day Don't eat everyday, which is not going to happen. So let's say it's 30 or 35, you know, a week at 100 bucks 3500, that's 14,000 a month, that's 120 450 $160,000 Eat, you're gonna afford $50,000 therapists. And most people don't look at it like that care. And they go into this. And they look at it in the Yeah, but I want to deliver, you know, quality care one an hour, but they don't they haven't done all the numbers, whether they can actually build a business on that. Now, can they work for themselves and be like you and I were talking about before the show solopreneur? Sure, they can do that, you can just give yourself a job. And you might be able to make some decent money, but that's the job, right? That's just a self employed job. And if that's what you want, that's fine. But if you want to hire people and actually build a business, where gives you freedom, you're going to have to make a decision. But that's, that's so many times where people kind of have the wake up call and be like, oh, man, I need to change kind of how we're doing No wonder I don't have any money in the bank, even though we're 90% utilization. And that's a horrible feeling. When you're working your butt off, everyone's working their butt off, and there's still no money. That's a fundamental flaw. So that's, that's kind of the surprisingly simple way is just get clear on what you can afford. Use the three times as just a guideline and see what a you expect them, how productive do you expect them to be? Is it 80% 85%, whatever visits you want, multiply that by how much you get paid per visit, and just see what that looks like. That's where you need to start, then you can answer the question how much you can afford, you can answer the question what the therapist is worth to your practice, how much they can generate. And at least it gives you more data to know if the person says 80,000, and you never given anybody more than 72 You know what you might be able to afford that. And it might be a really good hire if they're a good fit. So anyways, that's that's kind of a the the number one thing that I'll start with?



Yeah, I think that's great, practical, easy to understand. What's next, what else can we do to hire the right people?



Yeah. So number two is a biggie. And this is, comes to Forbes magazine talks about this, I call it be on purpose, be on purpose. According to Forbes, employees want to work for a company that has a purpose, right. And we have a such a deep purpose. Us as as therapists, caregivers, we are healers. We're healing the world. And sometimes that message gets lost. Sometimes we forget that message about what we're really doing. Sometimes we speak about metrics and productivity, and we lose the message about what we're doing this for. And other times, it's all about the quality of the quality. And we have a business that is in financial instability. So how do we become on purpose? Well, the first thing is we have to get a vision, we have to get a vision as Simon Sinek talked about a vision as a just cause there was an interesting TED talk that he was talking about, or maybe it wasn't a TED talk, it was just a video, but he was talking about having a just cause a vision needs to be your Northstar. A vision needs to be inspiring. And the first person your vision needs to inspire is you. If you're not inspired by envision, like, you know, caring if it's like, what's your vision, you share a vision and you're like, so, you know, how do you feel about there and like, whatever. If you're not inspired, you're not going to share that vision to others. And if you don't have a vision, we'll put in values. Your values don't have to be these company values that you see in whatever commercials and they're on some rock outside the thing. Values are your beliefs. What do you believe in? What do you believe about the work that you do? Why is this work so darn important to you? People want to be connected to something they can get a job working anywhere. So why do they want to work for you? What are you about? What is your story in your business? I share my story a lot I've shared it on on your podcast many many times. And more people come up to me and say oh my god, I resonated with your story. I didn't have a fire and burned down my place but I've had some really difficult times. We are story people we love movies. We love plays. We love dying. Begin to stories. What is it about your business? How did you get started what it means to you, because during an interview, that's what people are going to connect to. That's what's being on purpose. So take some time and write down what your vision is, what your story is, what your values are, what does this mean to you? And use that with your current team, of course. But also you can use that in your interview process.



Yep, I love it. That was a huge part of what I did. You know, maybe two years ago, I was really being intentional and looking at mission, vision and values, and really understanding why I do what I do, why I started my practice, why I decided to go out on my own. And it was really enlightening, and made me appreciate the business that I have so much more. So if if you are a business owner out there, and you haven't, like maybe you've written down like a mission, vision and values A while ago, just to have it on your website, or just to do it, I would suggest go back, revisit it and really think about who you are as a person why you decided to start your practice what is really important to you. Another thing that I talked about at ascend, and that we did in the Goldman Sachs 10,000 small business program was they had us find like a totem. So this totem could be, it could be a phrase, it could be a physical object. It could be a mythical creature, if you will, whatever you want. That encapsulates why you do what you do or encapsulates your vision. And I remember thinking, told them, I don't know what I don't know what that what do I told them? And they're like, yeah, just let it. And then I was like, Oh, of course I do. Because it's been my sort of guidance for, I don't know, 18 years now. So even before I moved to New York City, before I started my practice, I was sort of obsessed with the cathedral by Rodin, which is two right hands coming together. So when you look at it quickly, it looks like a right and a left hand is actually two right hands. So it's two right hands coming together, not touching. So I always looked at that is like therapist and patient coming together with space in the middle to kind of grow and move. But you could take that into you and an employee, it could be you and a partner, but it's coming together, but not fully. But having that space in the middle having space for new things to come. So that was kind of my totem. And I didn't even realize it until I did this went deeper into this process two years ago. So I highly suggest people if you've already done it, do it again.



Yeah, you know it. I love I love your story in a lovely, what you're sharing, you know, I think that as as highly left brain analytical, very smart people. I think sometimes we have a difficult time going deep. Cal Newport, who actually is here in Georgetown universe, Georgetown, you know, talks about deep work going below the superficial. And we have a tough time with that. I don't know if we have a tough time being vulnerable, which I know we do. A lot of people do. But vulnerability is power. That'll be maybe my next talk here. But I you know, we have a tough time of going below the superficial and going into the real deep, where the real work happens. The feelings, the emotions, the connections of why do you do what you do? You don't have to you can do anything you want. Why this? You don't have to start your business. No one forced you to why it's bigger than I didn't like my boss. That's why he started. It's bigger than that. You have to go deeper. And when you do you get such clarity. And because when clarity happens, you get power. You get confidence and you get dialed in. And when you have that kind of focus, that's where magic happens. Because other than that, it's a noisy world and it's easy to get distracted. I mean it's easy to get distracted by everybody else's stuff. So, so important, because here's the thing when you when you are dialed in on your your vision, your story, what who you are I'll tell you what One thing is going to happen, these people are going to come into your world candidates or whatever they're going to know who you are, they're going to know what you're about, they're going to know where you're headed. Now, whether they choose to be a part of it or not, that's their choice. But there's not going to be a confusion about what you're about. And you know what, give me that every day of the week, because what I don't want is there. They're just there. It's kind of like, everybody else, stand for something, draw a line. And it starts by doing that deep work. So that's number two. My next one is, is one of my favorites. It's higher for traits train for skill. I feel as as an industry, that we have become infatuated with advancement. And I don't, and if



you mean all those initials after your name,



well, we'll carry on, let's just say it we've become infatuated with, with with certifications, with initials with with almost to say, Karen, I got 28 initials. Karen, I'm better than you. I'm a good person. I'm a great therapist, because I'm really, really smart. Well, guess what, Karen, you were smart, when you graduated, you're smarter than better than 1%, you know, then the other 99% of the world, you were already smart? How much more do you need for you to look in the mirror and say, You know what, you're good enough. You're okay, because you can't remember 90% of the stuff that you're learning anyways, I don't know where that certification and that more and more is better. I mean, there's definitely a financial part there. Because, of course, people get paid for the more education and there's people that are doing that, that are highly paid. But you know, this idea of the more letters the better all be. Now, here's the problem with hiring with that, because you're like, Jamie, we're gonna how's the connection? The connection is this. Because you can get enamored with a resume with someone that has two things, one, a lot of experience, we love that. And to a lot of initials, because in our head, we've taken that, and I've had people tell me that on so many occasions, well, will they have experience in a ton of certifications? I go, and well, I just assume I go, Yeah, I just hope that they would, I thought that they would what? Well, I just thought that because of that they would just be this amazing person that walked in, and they would do things the way that I would do them. They would just own it. And they would just be amazing. And I said, yeah, no, that's not what makes them amazing. You see, being a professional is not about having all that stuff. It's okay to have it if you want to have it if you want to learn, but you know, what? What are the traits, the characteristics that you're looking for with a person? Whether it's a front desk, whether it's a therapist, whether it's a clinical director? Who are they? Who are you looking for, because that the person that's going to walk in, and that's the person you're gonna get. The other aspects the skill, let's face it, we can train someone for any skill that's out there. There is a course for it. There is of course, a certification for him. There is a continuing ed for which you can't really change who someone is. If they're not a timely person, then they're not a timely person. If they're an introvert, they're an introvert. I mean, if you want an extrovert people person and you hire an introvert with a great resume, you're gonna get an introvert with a great resume. But if you hire someone hungry, if you hire someone that just has the, the, the, the characteristics, the character that you're looking for, who believes in what you're doing, who shares your values, of integrity, of timeliness, of commitment of just doing what's right. Give me that person every day of the week, and I will train them on the other stuff. But Karen, here's where some of the challenges occur. What if you don't actually have a training process?



What if you don't really have a hiring and onboarding process it's kind of some I don't know just something you kind of do. Their lair lies the problem. The real challenge is you don't have that. And if you don't have that you do the hope and pray method. I hope I the worst that kill me is Jamie. I think I hired a rockstar and I go oh boy. Here we go. Because hiring a rockstar is the hope and pray method. In your mind, they're a rockstar because you are hoping that they are because you don't have time to deal with this. Because you need to move on to something else because you are overwhelmed. Give me someone who's passionate about playing the guitar, and I will turn them into a rock star, but a rock star at my place. I don't need a rockstar at someone else's place. Because rarely, if ever, does that convey in someone being that a player at my place. So that's the biggest thing. really sit down, write down what are the characteristics that you want for this position? Are they outgoing? Hi, Quickstart, you know, talk about their emotional intelligence, are they detailed oriented, they follow through communication skills, you know, relational skills, like really get clear again, on the type of person that you want. And if they're not that person, no matter what their resume says, then maybe they might fit another position. But you want to be really careful about bringing them in, because it's an expensive endeavor that you're making. You don't want to make the wrong investment.



Yeah, absolutely. And I think I'm just gonna repeat that one more time. Hire for traits train for skill, just so people have that embedded into their freight train for skill. Yeah, yeah. Excellent. Okay, what's the last one? Last



one, expand your reach? Look, marketing is about awareness. The more you create awareness out in the world, the more opportunities and people come to you, we are in the marketing, of looking for candidates. So we have to use that same mentality, we're trying to find good people, we need to ramp up our efforts. So we need more effort. And we need to expand our reach, we need to explore every channel and open every door that's out there and apply a massive amount of action for a long period of time, this doesn't end we are all Talent scouts, it never ends. As long as you're trying to grow, you're always looking for talent. And if there's a if you find someone, you'll figure out a way to bring them in, because you'll know what they're worth to you. So what are some things you can do LinkedIn, had a friend of mine do LinkedIn strategy, which is basically connect with with people connect with I mean, LinkedIn is a 24 hour, seven day a week networking site, they just connected with people just generally connected with people. And then, you know, said, Hey, by the way, you know, I'm looking for this particular type of person. Do you know of anybody? Would you mind sharing the this as sharing his job description? With your network? I'd really appreciate it. They're like, sure. Now, all of a sudden, he had 567 people 10 people sharing this. Within a week, he had someone in Texas, saying, actually, you know what, I'm just finishing up my rotation, which was kind of weird, because it was at the same place that he actually did a rotation at, you know, some massive sports place in Texas. And the person's he's flying them up for an interview here. I mean, that costs nothing. It costs nothing. So LinkedIn, your staff, if you have a decent staff, they like working there, well guess what their staff there, your staff has a network of people, especially your therapists, give them a referral bonus. Ask them to reach out to their people, you know, great way to network. And we've hired lots of people through people that already worked for us. Your past patients, your contact lists, you know, again, sounds simple. Put it out there, hey, we're growing we're looking for and be specific. We're looking for someone to join our team, someone that has these qualities. If you have to every state has a list you can purchase. Right? I did this several times I purchased a list. It wasn't very expensive. They give you addresses, they don't give you email addresses. It's funny, I can actually go to your home right now, Karen, because you're on that list. I can go to your home in New York. But God forbid I can email you. And you can just you can just say unsubscribe or or just delete me, but I can go to your house. I never really understood that one. But that's the way it is. You can purchase a list, you can send them a letter, hey, put your best foot forward send them a great letter about the position. Are they interested? Do they know someone and guess what? Nobody really gets any good mail anymore. They're going to open up your letter. So that's a little more expensive, but it's still worth it. And of course your network pass candidates students. A longer term approach would be have a student program it is the best way to do a 12 week interview with them. And then you know, you know, obviously there's there's companies out there, there's recruiters out there, definitely a bit more expensive. But if you know what the value is of them of the person that you're going to bring on board, then it might be an investment that's worth it to you. So the key is, if you are a business that's growing, then you can never stop looking for talent. And once you do that, you will start to bring in people quality people, look, most of us aren't these massive companies that need 1020 therapists, one or two people can make all the difference. So let's shift your mind out of the idea that there's nobody out there, there's no good people out there, there are, you don't need a million people, what you need is to get very clear on who you're looking for. And you need to put a massive amount of effort behind it into networks. And I promise you'll find somebody a lot quicker than you think. But don't just put an ad on, indeed, that you got from another person. And think that's all you need to do. It definitely takes a lot more effort these days.



Yeah. All right. So I'm gonna recap. So yes, understanding what would their worth is. So that's that three times, rule. Be on purpose, make sure you have a purpose, be clear on your vision, values and mission. Hire for traits not trained for skill, and finally, expand your reach. So in all great ways, for owners of any business, of course, here, we're sort of talking about physical therapy. But I think great advice for any business owner in this atmosphere that we are currently in, in an economic downturn in a time where it seems like man, I cannot find good talent, right? So it's looking inward at yourself as to what you're putting out into the world and then putting yourself out there to find those right people?



Absolutely. I got a fifth bonus one if you want. Yeah, let's do it. Bonus one here, slow it down. Kind of contrary, to put massive effort, but hear me on this. So the biggest challenge we have right now, as people, especially as business owners, the biggest challenge we have is a lack of focus. If we could just focus on what we wanted to get done, we'd get it done, because we're doers, and we can get things done. But we can't because of all of the distractions that's going on. Well guess what, most people hire out of reaction of something else happening. Either someone quit, or Oh, my God, we have an influx of people. So you're reacting to that. And when you react to something like that, this becomes emotional. And when it becomes emotional, we basically just want to solve the problem and move on because we're overwhelmed. When you slow it down, you slow it down in the form of a process. It's a hiring process. Right? One of the one of the most important things that I learned that I did is have actually a clear step by step process and not miss any of them. Because when I did this before, quick little story, I didn't have a process for a long time. You know, I had an ad and I put it out there, whatever, and I hired people. But when I was interviewing people, I wasn't interviewing them. I was basically trying to sell them to come in, I would literally ask them a question and give them the answers to it. Hey, Karen, you know, our values is integrity and honesty. And, and you know, we like to have fun. Is that is that? Do you believe in that too? I mean, that's an IQ test. All you have to do is say, Yeah, I do. I don't I thought you did. Hey, this is a great place. I'd love to have you would you want to come on board? I'll give you whatever you want. Like, just, I don't have time for this crap. I got other things to do. Let me bring in probably one of the most important people that I'm ever going to hire. This was for a clinical director job that I did a half hour interview and that was it. That was the entire interview process, half hour hire the person. Unfortunately, the person ends up getting arrested six months later. Why? Because let's see person improperly touched a woman during a screening process. Well guess what my board found out in Maryland. And I was called in an investigation and asked 156 questions and learned a lot about HR learned a lot about having processes, learn a lot about having policies and procedures. And then I started doing much more of a background check than I ever did. Oh, I did his check to see if he had a license in Maryland. Oh, guess what? In another state. He was on probation for doing something very similar. But he didn't report it to me which was on him. He was supposed to but I didn't even check right out of the have, you know, I just assumed that his references were good? So it sounds like well, Jamie, you're a moron. Well, maybe so. But what I ended up creating was a very clear step by step process that slowed me down to make sure I did a resume review, and did a checklist on it. I made sure I did a phone interview, knowing what questions to ask, then I did an in person interview, then I did a work interview on a work shadowing, then we did background checks. And then we did, I slowed down everything to a process. Now you can go through the process pretty quickly. But you're still checking the boxes, because it was a protection for the company. You see this person getting arrested and doing this stuff. That's on me that's on the owner. And then I come to find out that he was a little creepy to the rest of the staff, who of course, never told me anything, because I was very high on this person. So having a process and slowing things down is critical. Because once you do that, you then can continue to do that for every person you're hiring. And eventually, you can delegate that. So that's my fifth thing is, is slowing it down and creating a process in this. Yeah,



great advice. That's a crazy story. Holy cow. Oh, yeah. So it definitely behooves you to do a good background check, and really make sure this is the right person for your practice. Wow. All right. So as we wrap things up, what do you want people to leave with?



Well, I mean, look, this, this is not easy, right now in our world. And, you know, I gave you I gave you, you know, five actual things that you can do right now. And, you know, it's, it's hard. And you know, one of the things that I've that I've created during my turmoil as a business owner for 15 years is I created my own process. And I turned that process, actually into a program into a course called the right fit hire course. And I've used it in my own business ended up hiring really great people, you know, quadrupling my business and ended up selling it. And now I've used it with hundreds of other people. And what I'd like to do is I like to offer that to your audience. The courses is normally for 497. But I'd like to offer your audience take $200 off, you know, just just, you know, you'll, you'll you'll put the link up there. But you know, it's, this is going to save you a ton of time, ton of energy. It's already split up into how to, you know, recruit great people attract great people qualify them, what the interview questions are, how to do the checklist, it even adds job description, sample, job description, sample ads, sample offer letters, it has all the done for you templates, I did all of that stuff. It even has an onboarding process, and even a training process. So it goes through all four of those components, how to bring in people how to qualify them, and onboard and train them. So it's, it's 297, you'll see you'll see all the things that includes on there. But that's, you know, I want to help people during this trying time, and it's just something that I've used, and so many other people have used successfully that I think would be very beneficial



to your people. That's incredible. So again, if you're listening, head over to podcast dot healthy, wealthy In the show notes of this episode, we'll have a link. So one click will take you right to this, this is a great opportunity. So if you are in the hiring mind, I highly suggest for you to check out this course from Jamie, thank you so much. Now, Jamie, where can people find you?



Oh, they can find me at Jamie at practice freedom. If you want to email me personally, you can go to the website, which is practice freedom you the letter You can check that out. And yeah, and I'm all over social media, you don't have to look far. And you'll see me all over there. And yeah, if you want to reach out, say hello, feel free to do so.



Perfect. And again, we'll have all those links in the show notes as well. So last question, what advice would you give to your younger self? Now you got to keep coming up with new pieces of advice.



This is the hard part. No, I mean, the pieces of advice is you know, and I think about this more and more. It's like, Jamie, be vulnerable. Be open. One of the books I read, you know talked about being a broken, broken, open heart warrior. Be a broken open heart where we all are broken, we're not perfect, but just open your heart allow the good stuff coming in. There's a lot of great people in the world who want to help you. But it's hard to be helped when you think you know it all and you're closed off and you're and you're just resistance and And I've been like that for so long for so many years and my world changed when I just started to be open and vulnerable and saying, You know what, I don't have all the answers. And that's when so many good things started coming in to my life. And I always try to remind myself when I start to get a little bit of too much ego and remind myself a little bit of, you know, be vulnerable. It's a powerful thing.



Yeah, I love it. That is excellent advice. Jamie, thank you so much for coming back on the podcast. I know this information will help so many people. So thank you so much.



Thank you, Karen. Appreciate being back. Absolutely. And



everyone. Thanks so much for tuning in. Have a great rest of your week and stay healthy, wealthy and smart.

Jul 5, 2022

In this episode, High-Ticket Mentor, Coach, and Founder, Michelle Hext, talks about creating successful high-ticket offers.

Today, Michelle talks about her story from running Martial Arts studios to high-ticket coaching, the reasons why offers don’t sell, and the importance of keeping it real. What counts as a high-ticket offer?

Hear about avoiding market research and analysis, determining your pricing, the pandemic’s effect on business, and get Michelle’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “The biggest thing that you can do to avoid competition, just always be 100% yourself.”
  • “They don’t want you to look like every other person on social media. They want you to be you. They want you to be real.”
  • “Go into your bubble, and don’t look left or right. Look within because everything you have is inside of you.”
  • “Usually it’s not about the price, but people think it’s about the price.”
  • “If you have to do the mindset work, something’s not right.”
  • “Become a specialist and focus on one thing.”


More about Michelle Hext

Headshot of Michelle Hext For over 30 years, Michelle Hext has been a mentor, and since she was a child, the business of creating, growing, and scaling high-value products has been a part of her DNA. Michelle has a history of building successful brick-and-mortar businesses and online companies.

Her area of expertise is helping entrepreneurs create high-cost brands. This involves launching, growing, and scaling high-cost offerings. So, her clients can only choose to work with high-end clients who want results.

Michelle’s regular audience is people who want Launch & Scale, a high-ticket coaching brand. She’s trained hundreds of coaches and experts a year with her mentor program. So, Michelle has a pretty good idea of the kind of content they listen to.


Suggested Keywords

Healthy, Wealthy, Smart, Business, Success, Offers, Social Media, Branding, Packaging, Confidence, Monetization,


Special Offer: 5 Days to 5K


To learn more, follow Michelle at:


Facebook:       Michelle Hext

Instagram:       @Michellehext


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Hey Michelle, welcome to the podcast. I'm happy to have you on. Thanks for joining me.



Thank you so much for having me. I'm happy to be here.



Excellent. And before we get into, I'm sure what a lot of people are tuning into here is, how do we create and sell high ticket offers, which I promise we will get to. But before we do, let's talk a little bit more about you. So tell the listeners a little bit more about how you got to this point of where you are helping coaches and entrepreneurs create, sell and position their business for high ticket offers.



Yeah, so I started, you know, my very first business was back in like, we're going back to the early 90s, the very early 90s. And my first coaching was in the form of martial arts, I owned martial art schools, and along the way, developed a bunch of other things to bring to my skill set. So in 1991, I started instructing Taekwondo, the martial art of Taekwondo. By the mid 90s, I had my own schools. And, you know, you get to a point where you're instructing and teaching people to fight for contact, and grade for a high belt levels, like black belt and things like that. And you know, you're alive as a coach, because a lot of resistance comes up for people. And so I always, am really happy that I had that that early training in coaching about helping people to overcome resistance. Resistance is resistance, it doesn't matter whether it's whether you're going to launch an offer, or whether you're going to go and fight or grade for about, it's all very, very similar. So it really taught me to help extract the best out of people. And it also really taught me that people are very, very different. And you could instruct one person in a certain way or say things to them in a certain way and draw out the best of them. And it would have zero effect on somebody else. So really got a good education in human nature, and how to read people and how to get the best out of people. So I had my martial art schools for a number of years, still trained today. So it's still a very big part of my life, but it's no longer part of my business life. I outgrew the bricks and mortar business model, it just didn't challenge me anymore many, many years ago. And so along the way, I've always been a bit of a natural entrepreneur. So even when I had my martial arts schools Tibo was the thing. And so I decided I was going to create my own Tibo type program. So I called it power. And I had somebody come in and film me. And this was before even DVD. So they recorded them. And I was selling these in martial arts magazines as cassette tapes, like video cassettes with a with a manual, because I wanted to bring that type of workout into martial arts school safely. I wanted them to be able to leverage this new phenomenon, but I wanted them to be able to do it in a way that they felt confident to deliver it. So I created this syllabus and branding and all that sort of stuff and sold that through magazines. And I was always doing different things like that looking for different angles. I became a personal trainer, I as well, to add to my martial arts school, I, I had a full time center and I added a personal training studio was always just looking for ways to increase my bottom line, and to keep myself interested and inspired in the work that I was doing. And in around the 99, I think it was coaching became a thing, it became an actual industry that was making a noise in the US and it filtered its way back to Australia. And I thought, This is what I do anyway. So I'm gonna go ahead and do this. So I went and got myself qualified as a coach. And I've been coaching ever since. So at one point, I had taekwondo school on one side of the street and my business coaching offices on the other side of the street. And I was juggling both and young children and all that sort of stuff. And just over the years, it's been a very I guess I've followed my nose, but the business that I have now, where I work with, you know, high level clients, they invest quite significantly in me because they they want to create some success pretty quickly. And it's all just been an evolution of the same sort of thing. So my first high ticket offer was off of the back of a book that I wrote called The Honorable martial arts entrepreneur. And it taught people how to niche their coaching business, sorry, the martial arts business, how to market it and all those sorts of things. And that was off the back of me launching a women's only martial art school that was very successful.



And then I moved into the female entrepreneur space and launched a 27 and a half $1,000 mastermind, within like four weeks of launching that brand, and had a $200,000 launch, it did really well, it was a lot easier to sell to female entrepreneurs than it was to martial art school owners. And then I've been doing very similar work ever since that was 2014. But I've just really narrowed my niche now to work with coaches and consultants, because they're, they're the people that I had the most impact over and in this industry specialists who want to move into that coaching consulting space. And so now I work with clients from kind of all around the world. My fee these days is 10,000 us a month for four weeks, which is a long stretch from when I first started, I think I was charging 1200 for 12 weeks or something like that. So it's not necessarily been very strategic, it's just I paid attention to when it was time for me to grow and expand into the next kind of level. And I've just done that, without too much fanfare or drama or anything like that. I've just yeah, really just trusted my instincts along the way.



That's quite the evolution of being an entrepreneur, you know, starting with the martial arts studios to where you are now. It's quite a journey. And thanks for sharing that. And I think it also at for me highlights, what one bout of let's say, education or position, you know, as a fifth degree black belt, correct? Yes. So your training as a fifth degree black belt has really spilled over and helped to, I think inform you going forward. And a lot of people who listen to this podcast are physical therapists, their trainers are entrepreneurs. And I think it's so important, like, you don't give away your let's say, in my case, I'm a physical therapist, I can use that physical therapy education, to improve coaching programs, and to inject it into coaching programs, because of the years of experience as a PT, just kind of like what you did as a coach.



Yeah, and nothing is ever wasted. You know, I, I had online fitness businesses as well. And I remember there were women who were coming along and participating in my online fitness programs. And one of them was in my business mentorship program. Last year, we're talking a span of close to 20 years, you know, these women come along and they they participated in my programs, then they became personal trainers, because they were interested in the fitness space. And then they were using me to help them grow their businesses. So it's, yeah, and all of the things that I've learned, whether it's the fitness stuff, whether it's the martial arts stuff, whether it was the taking myself back to school stuff, and never using the course that I enrolled in and, and things like that nothing is ever ever wasted. And I know you're gonna ask me a question about competition, you know, and saturated markets and things like that. And I'm going to kind of segue into that if you're okay with that, oh, for the what, what, I don't believe there is any competition, I don't believe I have competition, I just don't consider that I never have regardless of the business type I was running. And the reason is exactly what I just spoke about, nobody's had the same education experiences, life experiences, or anything else that I have had, nobody is going to have my unique take on things, or my unique approach to the way that I do things and see things and, you know, am I able to take a big picture and simplify it into the, you know, a three point to do list sort of thing, because that's just the way that I've consumed information and processed it and how I you know, all of the different things. And it's the same for any coach, any consultant, you can have, I love to use this, this example. So you can have somebody that is looking for, let's just say a social media coach, right? Say somebody is in the market for a social media coach. And I want you to imagine that there are 20 Social media coaches all lined up sitting at a sitting in a row. And we have 20 people coming along to hire a social, social, social media coach, and they all sit down and it's like speed dating, they get to go and you know, have a conversation with every single social media coach and choose the one that they want. They're not going to pick the same one. Because what's going to come into play is, oh, you've got young kids as well. Oh, I know what a handful that is. Oh, you like martial arts as well. Oh, wow, I trained in martial arts, they're going to connect with the human being and human beings experiences and things like that. And so the biggest thing that you can do to avoid competition is trying to be like everybody else. Just always be 100% yourself and let all of the weirdness and the quirks and, you know, all these parts of you that make you up, be there, you know, I, I would never say, Well, I'm just not talking about martial arts anymore, because that's just not what I do. Like, people remember that I have a fifth degree black belt, you know, it says something about me. It's not relevant to my business these days, but it's something that people will remember. And so yeah, that's my little kind of rant on that.



Yeah, no, I think that's great. And I oftentimes, we don't, we, we feel like revealing too much personal information could be detrimental. But like you said, that's the way someone's going to connect with you. So it's okay to reveal some personal information, some background information, I'm like, obviously, you don't have to give away like your personal medical history if you don't want to. But it's a way that people can make a connection with another human being.



They want you to be real, you know, I have this this phrase that I, I'm writing another book at the moment, and it's what I say something along the lines of, they don't want you to be another instance step by step and printer, you know, where it's like The Stepford Wives sort of thing. They don't want that they don't want you to look like every other person on social media, they want you to be you, they want you to be real. And if we have a look at people like Celeste Barber, the comedian and we have a look at in Australia, we have a woman called Mia free, Friedman, who has she hosts a website called Mamma Mia. And she's always looking like a hot mess. You know, she's doing her live streams, putting makeup on and the washing powder in the background and things like that, you know, people I mean, you've got to choose your market, right? Mike, you're not going to see that in my space, because I'm operating in a you know, a different brand. But people love those women, you know, they love the relatability. And so, you know, we've got to walk that fine line between depending on our brand. But for me, it's like wanting to be aspirational and inspirational, but also keeping it really real. So people understand that, you know, I'm just a regular being like I'm wearing I showed you before, I've got a lovely top on and earrings, and I've got my workout gear on down the bottom. So I can race out and go to the gym. And I don't hide that, you know, I talk about that. And so I want people to understand that sometimes, you know, things look so polished in brands, that they just not people feel like it's not attainable. They feel like it's just an overload overwhelms people. So we want to be able to keep things real.



Yeah, excellent advice. And now let's get into talking about high ticket offers. First question, what is a high ticket offer? What is considered high ticket?



Yeah, so, um, you know, there are all different, I guess, explanations of what a high ticket offer is. For me, there's no magical figure that you crossed, that puts you into high ticket territory. It's very, very much subjective and individual to the person. So I've worked with clients who were charging $100 for a coaching session. And suddenly they have a two and a half 1000 or $5,000 coaching package, that's high ticket for them. I also work with clients like a client recently sold an $85,000, US dollar paid in full upfront coaching package. And that was a 12 month package. Amazing. She's an E commerce coach. But within about two weeks, I messaged her and I said, we've got to cut that back. That's going to be a six month course you can't be doing that for 12 months. And she's like, Yep, cool. But we sometimes play around with timeframes and things like that to get used to charging the higher prices. And for my clients to feel really confident in selling it because the confidence is a big thing. But coming back to the high ticket offer thing. For me a high ticket offer is a price point that feels really big for the for the for the coach putting it out there. And oftentimes for the prospective client as well. It means that you're purchasing or you're selling a premium offer. The client is expecting a premium level of service and because they get that you have the ability to work more closely with those clients, give them more thought time even if you're not with them. And so the results are better. Always. You know, I had a client sign up. I was in Fiji a little while ago. We had our first session on Tuesday. By Thursday, she had sold two coaching packages two days, you know, which is incredible. So she hit her coaching sorry, her revenue goal within two days. That was the monthly revenue goal that we had set up And so yeah, it's giving them the confidence and all of those sorts of things to go out there and know that they've got a rock solid offer that's going to impact people and all that sort of stuff. And then they, they sell.



And I'm sure that you work with your clients, looking at market research, and whatever the niche it is that you're trying to sell this high ticket offer in? Do you know what I mean? So, you don't



know No, no, no, I don't want my clients looking at anybody else. I don't want them doing any research. I don't want them doing anything like that. Because what that does is it distracts them from what is their zone of genius. So it's almost like, if you imagine my, my clients come to me, and they're a glass of perfect water, you know, it's very crystal clear, it's in a clear glass. And then they start to look outside, and they start to get ideas. And every one of those dumb ideas they bring back is like a drop of black ink that goes into the water, you know, and it muddies the waters, and we don't want that. So it's my job, whether it's one on one or through my programs or whatever to help them extract what is unique and special about them that they can deliver into the market. And then we you know, we shape it into a monetize product. But I want them to get clear about what are they love to do? Where do they have the greatest level of impact? Where can they produce the best type of results? What's the work that feels effortless to them? And then the biggest hurdle, the resistance is helping them to understand that that is enough. You know, because typically, they want to add bells and whistles or go learn something or something like that, but they don't need to. Right. So if we look at, for example, your physical therapist, you've created a an incredibly successful practice. Or maybe it's you've created an incredibly successful podcast in this space. And so if you said to me, you know, I want to, I want to teach this, I want to work with clients so that they can do this as well. I'm not going to send you to do right market research, hell no. I'm going to say, Okay, let's figure out, you know, all know, if there's, if it's the offer makes sense or not. Or if there's a market for it or anything like that. And I will tell you straight away, no, that won't work, or no. Like, I've seen that before it doesn't work or whatever it is, but I'm going to help you figure out how we get to harness what you have. How you would do it. And then yeah, create a way to monetize it.



Yeah, so you don't get into that wheel of like analysis paralysis, right? Where it's just or worse, comparing yourself to others and then get, then maybe you might run the risk of giving up 100%. So



my client that sold two packages within two days, she would never have done that. If she went around and tried to figure out how other people are doing it. And then getting into this comparison itis because somebody's website's prettier. You know, it's like, no, that's not what we want to be doing. So yeah, my advice to your listeners is go into your bubble, and don't look left or right, like look within because everything, everything you have is inside of you. And if you don't know how to get it out of you, in a way that makes sense in a way to package it. That's when you get help but, but ensure that you you find somebody that's going to help you pull out the best of you not say, Hey, I've got this system, let's just mold you to fit this system over here. We don't want that.



And, you know, I was gonna go into sort of five reasons why your coaching offer or your high ticket offer isn't selling, I feel like we might have gotten number one, I think we might have one that we just talked about. Right? Is not looking out and looking towards everyone else.



Yeah. So there are a number of reasons, right? So the first reason is, it's not clear. So they're not clear about what it is that they're actually selling. And the content, whether it's a sales page, whether it's an email, or whatever it is, it's not giving enough detail about what this is about. So we can get in our own head, right? Because we know what we do. We know exactly. And so if we take shortcuts on the explanation, people will miss the point. Another reason people aren't putting enough of themselves on the line. So what I mean by that is you've got to go on, make a big promise and then just back yourself that you're going to be able to back up that promise you're going to be able to deliver it. And so one of my programs is called the for 5k formula for coaches, I first launched this in about 2016, or 2017. It used to be a $5,000 coaching package, four week coaching package. And the way that I sold it is create and sell your first $5,000 offer in four weeks or less. And 90% of the people did, some people didn't, but like, that's the industry we're in, nobody has 100% success rate. And so people were buying that I couldn't keep up with the demand, I had to leverage it as a group program. After that, I couldn't keep up with the demand, because the promise was really frickin clear. Pay me $5,000, I'm going to show you how to make you know, at least that in the first month, most people saw between two and four packages. And like, that's a no brainer, right? It's a no brainer for people to do that. But if I said to them, Hey, you know, I'm gonna teach you how to price and package and position your offer over four weeks, like it's kind of compelling. But it's like they want to sell it like what they want, ultimately, is to make money, they want to be selling this thing. And so for me, that's the big promise, I'm going to show you how to, I'm going to show you where to find that first client and make that first sale. And so a lot of times that that big promise isn't anywhere near compelling enough.



Yeah, got it. So not enough detail of what it's about which I you know, I've seen so many times I'll be on I'm like, What is this? I don't yet, it's just you know, it's the sales page that keeps scrolling and scrolling. And you're like, I don't know what's happening here.



So even if people have spent money on copywriting, the copywriter hasn't got the instruction that you've given them about what this is what this isn't, this is what people get when they do it. Like they're gonna wishy washy it all over the place and have beautiful language, but nobody still has a clue what it is



no clue. Not enough. So not delivering on the promise. Right? So making them not miss making the promise.



Yeah, right.



What else? What are some other reasons why your offer isn't selling?



Usually, it's not about the price, but people think it's about the price. So they'll tell themselves things like, Oh, I think I should charge less for this. And then it still doesn't sell. And it's because of another reason. It's because it's not clear. Or it's because you're not confident in your ability to deliver the offer. And the energy is a little bit funky. And you might be saying one thing, but if all your energy is saying something else, and people pick that up on the internet very, very easily. Yeah, why else be because they're not asking for the sale. It's like, they're creating content to Wazoo all over the place. And they just expecting that people are going to make the the leap from Oh, she's telling me this nice thing that's very useful. Oh, let me go find out if I can work with her. And if there's a way to work with it, and that doesn't happen, right? We're busy, we're scrolling. We've got to stop the scroll. We've got to engage people with our content. But then we've got to say, go buy this thing. Go buy this thing or jump on this call or whatever it is. So yeah, no call to action. There just isn't a call to action.



Yeah, yeah. And circling back to having this funky energy or, you know, not feeling confident. So, in my mind, I think mindset issues. So how do you work with your clients, when they're in that mindset mind set of maybe not being confident and feeling bad about charging money for their services? I'm sure you've heard that in the past.



Yeah, yeah. So I'm just gonna add one more thing, and then I'll jump on to that. The other thing is the sales process. So I saw an offer the other day, and it was like $5,000, for four weeks or something like that. And it was a Facebook ad ran directly to a sales page and a Buy Now button. And it's like, people don't buy like that, like, you know, give them a you know, warm them up with a lead magnet or some sort of content, have a on the on the sales page, have a, you know, book a discovery call, or, you know, message me to find out more or something like that. But it's like that sales process is screwed up. And it doesn't make sense. So the higher the offer, the more usually time you're going to have to spend letting people know especially if you're dealing with cold traffic, warm traffic is different. But a lot of people are trying to point $5,000 sales pages at cold traffic, and it really doesn't work. You're just wasting money. So that's that. And when it comes to the mindset stuff, and you were asking me, so if a client, you know, they're not confident and all that sort of stuff. My clients don't pass go unless they're confident. So there's a reason and it's just because I've been doing this such a long time and I see it so so we've got a client and we've got a package So the one that sold to in within 48 hours, like we could have gone with a $5,000 offer, because that's typically where I start my clients. And she's like, oh, yeah, it's definitely worth 5000. I'm like, I'm not convinced that you're convinced. And I said, How do you feel about just selling the first two for two and a half and just get some sales in? And then we can put the price up? She was like, yep. So she went and sold it. Like, it was like nothing, right? And so sometimes I want to manipulate it so that if they feel like 5000, like, I can do it, I can do it. Yes, I believe it. But it's like, I know, they're gonna have to labor emotionally, and do you know, get themselves riled up to be able to go and do that price? Whereas when I create a $5,000 package, and they're all in with the $5,000? And I say, how about we knock a couple of 1000 off, and you just get some quick sales? They're like, Oh, yeah, I can do that. Because it's not the price. It's the, it's the confidence around the deliverability. And sometimes, if this is the first time you've sold this package, you're going to be telling yourself things like, what if I can't get a result, and I always say to my clients, well, I can put that fear to bed right away, because there are going to be clients that don't get results. That's just the industry we're in. So you're gonna have people who don't get results. So we're gonna stop worrying about that. As long as you can put your hand on your heart and know that you did everything that you could to provide the right framework and to provide the right support to get people help you, you can charge that price, and you can make that offer. So yeah, well, we're sorry, what was your



question? Yeah, that was that was the question. You're talking about mindset? And, and what do you do? If you you're Yeah, you know, you don't want to charge or your Oh, so hesitant?



Yeah. So I guess it's a combination of mindset work, and practical work, right. So sometimes it is more mindset, where it's just like, you know, I feel really, you know, I feel a bit like awkward about reaching out or during discovery calls and like, well, let's not do on like that. Like, I can make use journal and like, you know, try to get your head right for the next week over this, or we just change it so that you feel good about it. And so they might say, oh, yeah, okay, well, I don't want to do this. And I'm like, Okay, well, how else can we do it? And so oftentimes, the resistance, I think this is really important. The resistance and the mindset work. If you're having to do the mindset work, here it is, if you have to do the mindset work, something's not right. It means you're not confident on some level, you don't feel confident in the sales process, you don't feel confident in your offer, you don't feel confident in your messaging. So figure it out. Because 100% confidence will tell you that you've got you're on the right track. And don't be okay with 70%. You know, do the work to get clarity on your offer and to feel really good about it.



Yeah, excellent advice. And here's another question, when do you raise your price? Right? So I'd say okay, I'm really confident, I've got an offer at $2,500. And I had this offer up for six months, people are purchasing it. When do you say okay, I think it's time let's raise it to 35, or four or five, whatever it may be.



Yeah. And so, with regards to my client that I said, let's just go sell a couple, like, the next one will be maybe three and a half, maybe four and a half before we get her up to five, unless she's fully ready. So for me, that's part of my strategy, and she's just going to run with it. But if it was, like me, personally, so back when I was charging 5000 US a month and selling the 5k formula, when people were selling two, three, and for these packages, it's like, I feel like I'm being ripped off charging people $5,000 When they're making this, and then they're gonna continue to make it, you know, they're gonna 20 $30,000 months. It's like, that doesn't feel like enough. So I put my price up to seven and a half. And yeah, and then so my client recently that sold that $85,000 package, I'm looking at my $10,000 a month fee, and I'm thinking it's about time to put it up. So, yeah, I want to get a handful of like, super, super, super high end, ridiculous results, because then that's the same philosophy. I apply to my clients. I want to feel confident, it's like, I know, I'm gonna give them 100 grand, I know they're gonna get 100 grand back in the first couple of months of working with me, so I feel okay about charging 20,000 a month. Yeah,



got it. Got it. So it's sort of based on what results are you getting for your clients and your How comfortable are you moving to the next level? Yeah, for math. So yeah, yeah, got it. And now over the past two years, obviously we are we have lived through the COVID 19. pandemic, we are still in it in most parts of the world. I don't know where Australia is at the moment, but here in the United States, we are still in the thick of it for sure. So how do you think that COVID has changed the online? Offer space? Right? Because you had a lot of people moving online.



Yeah, it was incredible. It was like the early days of the Internet was amazing. So you know, I, I've had a lot of people following me for many, many years and had a lot of people that were not reliant on online, who suddenly had to be like this whole online thing you've been talking about, you know, can we have a conversation, so my business definitely picked up, it was easier to sell anything. There are just a lot more people online. And it was easier for me to, or it was easy for me to attract more clients and feel more programs and things like that. But it was equally as easy for my clients were doing new launches, you know, they weren't launching themselves for the first time, because they had eyes on them. It seems it's settled back down to not quite pre COVID. There's still a lot more people online and a lot more people wanting to move their businesses online, or be, you know, all online now and things like that. But definitely it created, it created a massive boom. And the other thing was, you know, the ads were a lot cheaper. The traffic was a lot cheaper, too, because people just stopped. So yeah, it was it was a great time, business wise, for sure.



And we sort of touched upon this earlier in the interview. But do you think because of that things have gotten overly saturated?



I don't believe in saturation, I really don't. And I look at the amount of people that move into coaching every year. I don't know what the numbers are. But there's hundreds and hundreds of 1000s of people that are coming into the coaching space. Many, many, many, and you know, there are going to be a lot of coaches out there who fail are going to be a lot of them, you know, but they're going to try and they're going to be needing services. And they're going to need coaching and mentoring and things like that. But yeah, I just don't, but I don't believe in saturation for the reasons that I spoke about before. Like, I'm a business, essentially, I'm a business coach, Online Business Coach, but there's not a lot of people that can compare to the way that I do things. Because there's only one me and people will you know, there are business coaches out there who are focused on lots of different things, right. So there would be business coach, as you spoke about earlier, yes, you've got a business coach is going to send you out there to do market research, and all of those sorts sorts of things. And there are going to be clients who are very attracted to that, because they want that information. And that data to make decisions on my people are not those people. My people are very, they feel their way into decisions. You know, they trust their instincts and things like that. And so those people are never going to be attracted to me in the way that I do things that would freak them out. So yeah, it's, there's always going to be people for your market. So rather than thinking of saturation, think about okay, I own a corner of the internet. This is my show, how do I show up on my corner of the internet, with my people on the internet in a way that helps them to pull the trigger on reaching out on whatever it is like, show up, share your message be consistent about the message. I just had to kick a client's but this morning because I'm like, Who are you? And what are you doing? Like two weeks ago, we were this? Like, we need to get back to you know, focusing on this, this? And so give things time. So work out what do you want to be an if you want to be an influential leader in a space, what is your space? What is the message? What are the things that you're saying? Who are your people get clear about all that and show up for those people? And they will come?



Yeah, yeah, yeah. Perfect. And you know, we do the same thing in physical therapy. Right? And we kind of use a lot now in physical therapy. People are niching down. So you're, you know, you work specifically in sports or pediatrics or pelvic health and people come?



Yes. Yeah. I've had three hip surgeries. I'm not going to anybody who doesn't specialize in hip rehab, just aren't doing.



Sure. Yeah, absolutely. Now, before we begin to wrap things up, is there anything we missed any points that you want the listeners to to to drill into their brains when it comes to crafting and selling these high ticket offers.



Yeah, I think the first thing that the timing I think is the thing. So if we talk about the steps, the first thing that you want to do is get clear on like, what is your zone of genius? What is your skill set that we can monetize. Then, from there, create a package that you feel excited about, you feel like it's well priced, you've made your big promise, like spend the time developing the offer concept, until you feel really good about it, and then start talking about it. So don't be showing up on social media and all over the place, sharing a wishy washy washy message with no call to action, and people don't really know what you do. Be clear about, okay, I am the face of this, this is who I am, this is the space that I'm leading now and show up there, then you can talk talking about your offer is very, very easy. So you know, right now I've got a pricing and packaging challenge that's going to come up in a few weeks. And so all I'm going to be talking about is how important pricing and packaging is. You know, that's all I'm going to be talking about. So if you're a social media coach, and you specialize in tick tock, don't talk about other things. If you're an E commerce coach, and you only work on Shopify, don't be talking about other things become the Shopify specialists, be the specialist in the space and keep your messaging narrow, so that people know Oh, that's that person that does that. And 100 people in your space might not need you, but one will. And if you're a high ticket coach, you don't need very many clients to make a lot of money. So forget about having hundreds of 1000s of followers, focus on you know, the 10 that you've got, because your your first client is going to be there. And then build from there.



And love it. So get clear on your zone of genius. Create the package, talk about it all the time. Don't be afraid. And really focus on the audience that you have. Yes. Perfect. All right. Well, that's great. So listen, where can people find you? What do you have coming up? You just mentioned a pricing and packaging challenge. So please tell us all about it and when it starts, and how can people find



you? Sure. So you can find me on Instagram. So I met my name, Michelle hEXt. My website is Michelle headstock calm. And the challenge is it's your 5k, offering five days, create your signature high ticket offer in less than a week. And it starts on the 21st of July. It's going to be it's $97. So it's just a taster program. And over five days, I'm going to be helping people to unpack all of those different bits and pieces so that by the end, even on day five, I talk about building out your digital assets and things like that, like how to sell it how to onboard. So we're going to start with broadly what is your sweet spot uncovering that, we're going to be covering things like building out your offer framework. So the six, the success pathway your clients will take, we do this first, then we do this, then we do this. I'm going to be talking about copywriting and sales page concepts. And so it's very practical. We're going to start from, like the mind set stuff. And then we're going to work all our way down to being really free. Yes, which is Get ready to make that first sale. And we'll do that over five days, and I can't wait to launch it.



Sounds amazing. And I think I may take you up on that. That challenge. So again, that starts on the first of July. And we'll have links Sorry, sorry, 21st 21st of July. And again, we'll have links to all of it in the show notes over at podcast at healthy, wealthy So if you didn't write it all down, just go to the website, and it will have everything on there. Now, last question, it's a question I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self?



I would have focused on one thing instead of 27. Like figured out like what is my one thing, and then I would have taken it all the way because when I did that, that's when everything turned around for me when I was trying to juggle too many things. And I had 75 Facebook pages and 75 accompanying Facebook groups and you know, all that sort of stuff. I was very busy and I was making money but I was exhausted and I wasn't a specialist in anything. So figure out you know, become a specialist and focus on the one thing, take it all the way nothing bad will ever come from that because when I did that with the honourable martial arts entrepreneur, I had my first $30,000 a day it was a it was a massive jump up from what I'd been doing. And then when I went to do it next time with another brand I had called The Art of kicking us elegantly. It was faster, you know, because they'd already done it. And I'd learn. So focusing on one thing is, what is my offer? How am I going to sell it? What is the marketing? What is the lead magnet? You know, I just built that system and took it as far as I could take it until it was time to pivot. And then I knew how to do it. Just change the branding and things like that. So yeah, focus on one thing, take it all the way, don't quit, just keep going. Because you know that that image we see where the the man's like got the Pekinese in the cave and they miss it by just an inch. You never know how close you are. So my rule of thumb is give it your full commitment for 12 months. And don't waver, just figure it out. If you love your offer, and it's not selling, figure out why it's not selling, if it's selling, but it's not selling enough thinking, Okay, how do I get more people to buy it, be thinking about how you can make this bigger, better, stronger and more successful? Not this isn't working, I need to try something else. Like be committed, if you know the offer is solid. And you know, you're good at what you do. Stick with it until you get where you want it to be. Because it is just a matter of time.



I think that is great advice. And I think another takeaway for me, as you were saying all that it's okay to pivot your offer. It's okay to have a different offer. And once you've got the framework in place, it's a little plug and play, right. But it's like you don't have to go to the grave with just one offer.



No, no, no, no. But you've got to make you've got to know how to make that one offer work. And we've got to know how to make that one offer work and be profitable before we start to scale it or bring other products on board. Yeah,



yeah. Yeah. What great advice. Well, Michelle, thank you so much. This was great. There, I took so many notes so much so much for the audience to dig there. dig their heels into here and and really, hopefully start to make a change. Because I know a lot of people that listen to this podcast are in this world of trying to figure out how to make their mark in the digital world. And, but but not only that, really find a, an offer that's unique to them that can help others. And that's where I think a lot of people that listen like they just you just want to help other people succeed.



Yeah, and it's creating that win win, you know, so you're winning, you're signing clients, and they're winning because they're getting the result that they need. For sure.



Exactly. So going in with a win win attitude is everything. And so with that being said, thank you so much for joining me today, and I'm excited for your pricing and packaging challenge. So thank you so much for sharing that.



You are very welcome. Thank you so much for having me.



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

Jun 27, 2022

In this episode, sports chiropractor, certified strength and conditioning specialist, pregnancy and postpartum athleticism coach, and level 2 Crossfit coach, Dr Karlie Causey, talks about exercise during pregnancy and the postpartum period.

Today, Dr. Karlie talks about planning home exercise programs and preparing athletic women for the postpartum exercise phase, and the idea that every mom is an athlete. What are some postpartum conditions or barriers to getting back to fitness?

Hear about setting expectations about postpartum conditions, the story behind Jen & Keri, and get Dr Karlie’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “You don’t need to wait to the 6-week mark to start doing what we consider rehabilitative exercises.”
  • “Tie small rehab activities into your daily life.”
  • “Just ask the patient what works best for them.”
  • “Walking in the postpartum phase is exercise and it does count.”
  • “Starting off slow to get back to where you want to go is always the right choice.”
  • “You can continue being who you were before motherhood.”
  • “If I would’ve had more fun, I probably would’ve been more successful, but also maybe it would’ve been a little bit of a smoother ride.”


More about Dr. Karlie

Dr. Karlie is a sports chiropractor, a certified strength and conditioning specialist, pregnancy and postpartum athleticism coach, and a level 2 Crossfit coach.

More importantly, she is a mom to two, who is ridiculously passionate about helping postpartum athletes and moms-to-be restore their bodies and move with confidence. This obsession led her to establish Jen & Keri, a postpartum activewear brand for athletes, and create her wildly successful Postpartum Restoration Plan.

Beyond being a mom and a competitive fitness lover, she has spent the last 17 years of her life studying the human body and learning how it moves. Earning her doctorate of chiropractic and a master's in human biology were just a start; she doesn't plan to stop learning any time soon! She is certified in the Webster technique and BirthFit, and has served as the team Chiropractor for the Seattle Seawolves and as the local medical director for AVP Seattle.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Pregnancy, Postpartum, Motherhood, Exercise, Rehabilitation, Athletics, Training, Empowerment,


To learn more, follow Dr. Karlie at:



Instagram:       @drkarlie



Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:


Read the Full Transcript Here: 


Hey, Dr. Carly, welcome to the podcast. I am happy to have you on and excited to talk about exercise during pregnancy and the postpartum period. longtime listeners of this podcast will know that that this is a topic we talk about a lot here. So I'm really great to have you on to get a fresh perspective of things. So welcome.



Yeah, thank you so much for having me. I'm excited for for our chat.



So before we get into the nuts and bolts, can you give the listeners a little bit more insight into you and as to why you chose this sort of subset or niche of folks to see?



Sure, yeah, well, I've been a sports chiropractor now for Gwent, this is a will be my 12th year. So I've been doing that for a while. And I've always loved working with women in general, all walks of life, all stages of life. But when I became pregnant, I really as I feel like it happens for many, many healthcare providers, you really start to embrace the stage that you're in a little bit. So I really started to learn a lot about how how women progress through pregnancy, how they can continue working out how we can minimize, sort of, you know, things that can happen to that are detrimental after the baby comes. So I just really, really dove into that area of expertise. And it just hasn't stopped since then. So I found it very helpful to to have someone walk alongside me during my pregnancy, pelvic floor pt. And so now I try to be that person for a lot of my patients, too.



That's great. And listen, the more help we can give to women pregnant, and especially in that postpartum period, or that fourth trimester is, as it is called, I think the more people who can offer help, the better because it's not like people are not going to ever get pregnant again. So yeah, have that help. It's really important, and a lot of women just don't know. Right? They don't, I don't know what you don't know. And so if you're not in the healthcare field, there are so many questions, the body changes so much you're feeling maybe Weird Things You Didn't feel before. So getting back to exercise can be a little nerve racking. So



Oh, go ahead. No, go ahead. I think that, um, you know, it's becoming much more common to talk about this, and that women are wanting to work out more. And what's one of the benefits of social media, you know, is that we're seeing some of this stuff and able to get more info, you know, I talked to friends who had kids 10 years ago, and it just, it doesn't exist at all really, you know, and as far as like, information that was readily available. So I'm happy that, that we're trending in that direction, at least.



Yeah, absolutely. And now, let's get let's get into the nuts and bolts here now. So can you give us some practical ways to introduce rehab, introduce exercise, after giving birth, and I love the that were practical, right? Because we're talking about women who maybe don't have a whole heck of a lot of time, because they have a newborn to take care of. So I'll hand the mic over to you.



Yeah, exactly. Um, I think one of the things that I really liked to stress is that we don't need to wait until the six week mark, to start doing what we consider, you know, rehabilitative exercises. So if with an uncomplicated birth, I often have women starting, you know, day two, day three, especially with just breathing exercises. And what what I see very often is, as women are pregnant as their belly is growing, what happens a lot of times is that diaphragm really gets crammed up there. And so we start to see that they're not breathing as deeply, they're not able to belly breathe. And that diaphragm, we have to remember is the top of the quote unquote, core, right? So their pelvic floor is the bottom, we have our diaphragm on the top, and then all the muscles surrounding but I just like to remind women of that, because that muscle getting so kind of constricted throughout pregnancy is really a big deal. And really, starting on the breath work early on can be really, really helpful. So that's one thing that I really like to emphasize is, you know, at day two, day three, even if you had a C section, you can be laying in your hospital bed, doing some deep belly breathing, diaphragmatic breathing, and you're actually doing a lot more than than you think you are, you know, you're actually starting your rehab journey right there. So that's my first tip that I always like to give. I'm sure you as a PT would would agree with that, right? Like there's just so much we can start with so. So yeah, that's number one. And then the other thing that I really like to emphasize is time small rehab activities. into your daily life. So getting away from the mindset that we have to like set aside 3045 minutes an hour, whatever you used to do, or whatever you think you need to do, and say, Okay, I'm going to do 10, diaphragmatic breaths, and 10, air squats. And every time I set the baby down, or every time I change the baby's diaper, or whatever it is, you know, you can kind of pick what works for you. But I like to do that. Because then it's, it's adding in movement throughout your day, it's giving you a sense of control of like, having these pieces of rehab that you can add into your day and feel like you're working towards a goal. And it's taking away the stress of like, okay, you have to have this time set aside, everything has to go perfect, you have to have the perfect workout outfit on and your water bottle ready and the right tunes and like it just doesn't happen with a newborn baby, you know. So I think taking that stress off is another helpful tip.



Yeah, it's funny, I just did a social media post about this subject when it comes to a home exercise program that, you know, ask your patient in front of you, I because I have a woman who said, you know, I can squeeze in a couple of five to 10 minutes a day. So if you give me two exercises that I can do in between patients, she's a psychologist in between patients, I'll do it. Right. She's like, but if you say, Oh, you have to set aside, like you said, half an hour, 40 minutes to do that. She's like, it's just not gonna get done. Yeah.



Yeah, it depends on the person, right? Because then you also have people who want that 30 minutes, like, give me, I am used to working out an hour every day, whatever it is, I want my 30 minutes of things to do. And so it's yeah, it's just knowing your patient and like taking the time to ask them those questions of what's going to make them more successful. And the other thing I like is, if you've read the book, habit stacking, that's basically what I'm recommending to is, you know, tying an exercise to something else that you're already doing. So you don't have to think about when am I going to do this when you know, it's like, I always tell new moms don't tie it to brushing your teeth. Because sometimes that doesn't happen, you know, if we're being honest, sometimes doesn't happen on a on a day, but, you know, tie it to something like, okay, when you pick up the baby, change the baby's diaper or hand the baby to your partner, those kinds of things that you're you know, you're going to be doing, then that seems to be a recipe for



success, too. Yeah. And like you said, most importantly, just ask the patient what works best for them. Right? We're not them, we're not in their shoes. Maybe this woman gave birth, and she's got a ton of help at home. Right? We don't know. Or maybe it's a single mom who gave birth who doesn't have a ton of help. So always just ask, that is the easiest way to come up with a realistic and like you said, practical home exercise program. Okay, anything else, any other practical tips to introduce exercise in rehab after in those first couple of weeks or months, let's say after giving birth?



Yeah, I think another one is, you know, include the baby is always a good one, right? We tend to forget after we have a baby, depending on the activity level of the person beforehand, we tend to forget that walking is actually exercise, especially in the postpartum period. So I like to remind my patients of that I have a lot of patients who are pretty active, pretty high level of athletics prior to being pregnant. And so I have to remind them that walking in a postpartum phase is exercise, and it does count. And you should be finding time for it. Whatever that looks like with a stroller with a front pack, you know, even if you can get out for a little bit on your own is always nice, too, but not often as doable. But so I like to I like to remind people that and also that we don't necessarily need to jump into walking right away. So it's not something that you know, day 234, walking, probably still doesn't feel very comfortable, whether you have a vaginal birth or a C section. And so remembering that that's just like anything else, you want to work into that slowly, just like any other exercise program, you wouldn't jump right into lifting super heavy weights or, you know, join a competitive athletic league of some kind. So, starting slowly there, too, I think is important. Yeah. And



you hit on something that I want to kind of circle back to is, you said a lot of the women that you work with tend to be really high level athletes. I know you're also a crossfit coach, right. So you're seeing a lot of these high level, athletic women. So how do you kind of prepare them for this postpartum phase where they're not really going to be able to go back to that heavy lifting right away? Because from a psychological standpoint, I would think that would be can be quite difficult.



Yeah, it is yes, good question, I think what I tried to do is really lean into what I sort of call the negative side of it. And I try to stress to them that the things that are going to get them back to where they want to be, are really boring. And they're really slow. And they're going to be annoyed by them. But if they do them, in the short term, it's going to pay off in the long term. So starting off slow to get back to where you want to go is always always the right choice in postpartum with postpartum women. So yeah, that's, that's what I start with. And I really explained the breath work because again, that sounds like boring and sort of silly to a lot of people. And before I had a baby, I think I was less, I was less into the breath work, because I just found it so boring. And I would listen, you know, to pts and chiropractors, and, you know, ortho, all kinds of Doc's talking about how important breathwork was. And I was always like, gosh, it's so lame. But then once you feel how that diaphragm really doesn't expand like it used to, and you can't connect your breath with your body, like you use, do you realize, okay, this is actually where we have to start. And once we get this down and get this kind of Mind, Body breath connection down again, then we can start to progress from there. So yeah, I always start off people really slow. I developed a postpartum restoration plan. That's eight weeks. And it's more developed for the type of person that needs like, you know, they need their 20 to 30 minutes of like, here's my rehab, here's my, this is going to substitute for my workout for the day, you know, since I'm not doing a cross a workout or, or hit workout, or whatever they do. But I think that's been helpful to have those exercises, have kind of a game plan. And then, and then I can kind of shift those things around for people that want to like, you know, kind of fit things in here and there. So,



yeah, yeah, great advice. So really setting those expectations even before the baby comes so that they know what to do. So they know what's coming. And that's huge expectations are everything. Okay, so how about any conditions or barriers to getting back to fitness that maybe some postpartum women may experience?



Yeah, I always like to talk about this. Because there's, there's some things that people aren't really anticipating, you know, I think a lot of women during pregnancy, they sort of anticipate, okay, maybe a little bit of low back pain, maybe some pelvic pain. Even if they're thinking ahead, some upper back and neck and shoulder pain from being sort of hunched forward and nursing and that sort of thing. One thing that people don't anticipate that obviously isn't like a, you know, life ending condition or anything, but I'm sure you've heard of it, and seeing patients with it is the mommy thumb, you know, mommy wrist, however, we want to call it but that's when it really catches people by surprise. And basically what it is, is, can be pretty severe pain and either the wrist or the thumb and it comes from the forearm extensor muscles, and just from holding that baby and kind of that flexed position. So often, women are generally carrying a lot on the on the same side, if you bet shear, they end up sleeping kind of with the arm curled around the baby often, so then they can kind of get stuck in that position. And those muscles get really, really tight. So I like to tell my patients sort of warn them about that prior to giving birth and have them start on some wrist roller, you know, some eccentric, concentric strengthening of both the flexors and the extensors. And nothing crazy, you know, couple of minutes a day, four or five days a week will make a huge difference in that area. So that's one thing that I like to warn about. And if they with new moms that they're starting to feel that right away, I have them try to start some of those loading exercises, because that will, you know, if we catch it early enough, it can nip it right in the bud. But if we let it go, it can be pretty severe, you know, and people end up getting cortisone shots to take care of it and and there's a time and a place for that. But if we can take care of it beforehand, then let's do that.



Yeah, absolutely. I once had a woman who she was like, I think in her early 50s. And she started experiencing you know what they call mommy thumb or deeper veins. And hers was from they just gotten a new puppy. So her kids were grown and she's like, it feels like it does. She's like my thumb feels like it did after I had my second child. And so I look at how she's carrying this dog around the whole time. That's why



Yeah, there you go happens to the best of them, I guess. Yep,



absolutely. So even even to the moms of new moms of our furry, furry children, our little fairy children, it can still happen. So be prepared. What else what other complications or errors have you seen?



Yeah, I think one that gets a lot of you know, buzzword right now gets kind of a lot of play is talking about diastasis recti time and I'm glad I'm glad that it becomes So much more common to talk about it talk about what it is how it happens. But I think there's also a lot of fear mongering that goes on with that. Again, on social media, there's, you know, whoever can post whatever, right, so I do see a lot of stuff about about diastasis recti, what not to do. And what I always like to remind people is that it's, it's a normal, natural thing that needs to happen for that baby to grow and for the abdomen to expand. So I think that's really important to tell our patients and make sure that they know that it's supposed to happen, it's going to happen, you know, some studies show up to 100% of women have diastasis, recti, I think, like, week 36. And so, so just reiterating that, like, it's okay, it's gonna happen, we're gonna, we're gonna rehab you out of it, you know, but I think, you know, learning about it is great, and then understanding, okay, it's the separation of those abdominal muscles, what's gonna cause more stress on those? Okay, well, any of the flexion exercises, of course, so sit ups, and across the world, toes, the bar, that kind of thing. Any sort of kipping motion, anything where you're losing control, right down that linea alba down the center of the core, so are dancenter the abs. Also with heavy weights, like that's another thing that a lot of people don't anticipate as heavyweight overhead. Can Can just overstrain that tissue. And so there, I usually recommend people switch to dumbbells, you know, that's a pretty common recommendation, switch to dumbbells from a barbell, if you're using a barbell, they're just more forgiving, and allow you to, you know, move a little bit more efficiently and keep your core a little bit more stable. And then talking about in the postpartum phase, what we're going to do to rehab that. And understanding that, you know, nothing you do during pregnancy is going to, it's not going to hurt, it's not gonna hurt the baby, it's not going to hurt you, it just potentially makes it harder to rehab it later. Right. And so, we're always talking about minimizing those activities, seeing what we can substitute in, so you can still keep moving and doing what you want to do. But, but, you know, kind of playing that game of like cost benefit analysis, like, is it worth it to be doing this exercise? Is there something I could do that's a little bit safer, and just sets me up for a little bit more success down the road? So yeah, I think it's important to really talk during the pregnancy about that. And then in the postpartum phase, talk about where do we start, you know, and again, it goes back to the breathing, I hate to harp on it, but it does. And then there's some really simple diastasis recti exercises, that sort of work on engaging the transverse abdominus, you know, that big flat abdominal muscle that kind of wraps around and, and then from there, kind of retraining your core that okay, we can stay stable. And we can keep, you know, a nice pressure throughout while we start to learn to move our extremities and move a little bit of weight. And just like anything going through kind of progressive overload. But with with the core.



Yeah. And would you mind giving the listeners maybe a quick example of an exercise that you might work with a patient postpartum? Like, let's say that now, like you said, like 99% of women will have a diastasis after pregnancy? So would you mind giving a quick example?



Yeah, of course. Yeah. So there, there's tons of them out there. And it really depends on what phase of postpartum she's in. Right. So if it's really early on, like I said, we're going to work on some breathing, and we're going to have her one of the cues I really like is, when we're thinking about kind of trying to, to create tension throughout the abdomen, I like to think of kind of pulling the hip bones together, that's one that seems to work well for a lot of people. So you have them take a breath, and let's say they're lying on their back on the ground with their knees bent, have them take a big breath in, feel right on the inside of their hip bones. And then as they breathe out, they're gonna think about trying to pull those hip bones together. And that can start to help engage that transverse abdominus. And of course, you want them in like a neutral spine, in this position. And from there, then we can progress obviously, you know, with some, like heal slides with the leg lifts. Those are pretty sort of traditional exercises. I also like to incorporate when we start talking about, you know, healing through the entire Corps, I like to incorporate some glute work because that's one thing that gets missed a lot. We, we forget that the glutes are connected to the pelvic floor. So when we're trying to heal this whole barrel that is our core, it's really important to, you know, start with some really basic just even if it's glute bridges, some hip thrusts, those sort of things. I think those need to go hand in hand as we work that posterior chain along with the anterior abdomen.



Perfect. Thank you so much for those examples. Just gives people a little taste. So let's talk about Jen and Carrie. I will throw it over to you. Why don't you talk a little bit about Jen and Carrie and your company's logo?



Yeah, thank you. So my company is called Jen and Carrie, and it's sort of funny. My name is Carly, obviously, my partner my business partners name is Jess. So Jess and Carly. But whenever people get our names wrong, which is a lot they call us, they call her Jen. And they call me Carrie. And so as we were talking about what we should name the company, we were like, Jen and Carrie, they sound like you're fun mom friends that like know all the deets and have all the advice. So that's, that's our company name. And unfortunately, it's only further that probably problem a little bit because now you know, email and correspond with people. And they just immediately cost Jen and Carrie, but that's fine. We started the company after my first son. And I was, I believe it was, it was a couple months two or three months postpartum. And I was just getting back into the gym and trying to go back to CrossFit class, I'd done all my rehab, and I was really slowly kind of reintegrating, and I was complaining to her that I just hated all the nursing sports bras out there, I hate the clips, I hate the zipper, the button, like all this stuff, I just hated it. And you know, and across the class, let's say you're doing you're working with a barbell you like kind of dig the barbell into those clips with a PowerClean or a front squat or something or you're running and they pop open. It's like, you know, everyone every mom's worst nightmare. And so we started kind of looking scouring the internet for a sports bra that didn't look like a nursing sports bra, we just didn't find one. So we started kind of toying around and, and playing with a bunch of sports bras, cutting them up and, and it grew into basically the sports bra that we developed, which looks just like a regular sports bra, it has a sort of different technology that you pull up the top layer, pull down the bottom layer, so there's no clips, no zippers, none of that stuff. And really, the reason was, I just wanted to be in my workout class and feel like everyone else, like I wanted to have that hour of time for myself, I love being a new mom, I love being a nursing mom, but I just didn't feel like I needed to be advertising it to the world and my like, one hour class, I just wanted it for me. So that sort of spawned our company. And our goal is basically to just empower women to get back to whatever activities they love. And this is just one way we're doing it, we just feel if if a sports bra is gonna make you feel more comfortable and more confident in your postpartum body, and that's gonna get you moving then that we're all for it. So that's sort of how we started.



And, and the logo, every mom is an athlete. So controversial take may be right, some people may think I totally get where you're coming from, but go ahead and kind of explain that.



Yeah, so we have a couple of different reasons for are a couple of different meanings behind our logo, every mom is an athlete, we, first of all, we want women to feel like they can be whatever they want to be. So they can continue being an athlete, if they were before having kids, they can become an athlete, if they want to, you know, whatever that means for them, you know, whether it's running or Jiu Jitsu, or strongman competitions or whatever, we don't care, we just want to support you in whatever you want to do. And we also the other thing that we think about that is that being a mom is a really athletic job. So when you think about the stuff that moms do, you know, you think about the mom, carrying the car seat on one side with the toddler on the other hip with the coffee and the hand with the backpack with the all the stuff and that takes a lot of athleticism, whether you consider yourself an athlete or not. Putting your baby down in a crib is a hip hinge, right? Picking your baby up to put them into the car and the car see is is a press and a lift. So everything that we're doing, we try to we try to think about okay, what, what our moms doing and how can we support them in active wear, you know, as just one of the many ways to support them. What can we do to help support them in in this really athletic endeavor? That is motherhood?



Yeah, I love it. I think it's great. And I agree I do. I do think every mom is an athlete as well. So not so controversial, although I could see where people are coming from on that. So currently, as we start to wrap things up, what would you like the audience to take away? What are your takeaways from our discussion?



Yeah, that's a great question. Um, I think I would love for them to take away just that. You can continue being who you who you were before motherhood in whatever context that means for you And, and, you know, an entirely different version of that maybe, but like you can continue all the athletic pursuits you had before. That I want women to feel to feel empowered in the postpartum phase. And I try to do that in a lot of different ways, right? Like in my clinic, with my postpartum plan, but doing things like these to just like, talk about, here's some simple things you can do to help reintegrate your core and start building your strength back and just feel stable and confident, comfortable in your new body. That's my goal, really. And so that's our goal, Jen and Carrie, that's my goal, personally, and I think that would be my takeaway.



And where can people find you? You can list social media websites, where can they find Jen and Carrie?



Yeah, so Jen and, it's JdN and ke ri. We're also on Instagram at Jen and Carrie. And then I'm also on Instagram at Dr. Carly, it's KR, li e. Those are probably the best places. Perfect. And



we'll have links to all of those in the show notes for today's episode over at podcast at healthy, wealthy So if you forgot you didn't write it down. Don't worry, just hop on over. And we'll have direct links to everything. So, Carly, last question. And it's one I asked everyone knowing where you are now in your life in your career, what advice would you give to your younger self?



Yeah, I know, you asked that question. And I've been like really thinking hard about it. Um, I think I would give the sounds so cliche and sort of silly, but I think I would tell myself to have more fun, because the research shows when we're having fun is when we actually enter that flow state more right? We can talk about that for hours, I'm sure. But I think I would tell myself that because I look back and see the hard work of school, you know, education, but also in sports athletics, through high school college. I just think I if I would have had more fun, I probably would have been more successful. But also maybe, you know, maybe it would have been a little bit smoother ride. So that would be my advice.



Yeah. And, and as an entrepreneur as well, right? So sometimes, yeah, gets so wrapped up into the day to day that we're like, all stressed out and forget, like, wait a second, we got into this as a business owner, as an entrepreneur, to do things our own way. So why can't that involve having some fun every day as well?



Yeah, exactly like this. Right? We get to just sit and chat about stuff we love to chat about. This is a good time. This is fun. So yes, great point. Even in the entrepreneurial life, especially.



Yeah, especially anyway, and you're Listen, I'd love to have you come back on to talk about that aspect of, of your life as well. Because I love having successful female entrepreneurs and talk about their business and, and how they got things off the ground. Because I know people are always interested in that. So you'll have to come back. I love it. Yeah, I think you'll have to come back. And you'll have to talk about your sports Cairo business as well as the Jen and Carrie. So you know, being in that space of a retail space, which I know is not easy. So, so much to talk about. So we will put a pin in that and we will discuss that maybe in a couple of months. So Carly, thank you so much for coming on. I really appreciate it. This was great. I think you gave people a lot of practical easy tips that they can start integrating whether you're a postpartum mom or someone who cares for them. So thank you so much for coming on.



Yeah, thank you so much for having me. My pleasure. And everyone. Thanks



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

Jun 20, 2022

In this episode, Principal Research Fellow at Latrobe Sport and Exercise Medicine Research Centre, Dr Joanne Kemp PhD, talks about hip pain treatment and research.

Today, Joanne talks about the common causes of hip pain, the difference between men’s and women’s hip pain, and the outcomes for patients that “wait and see”. How can PTs design and conduct evidence-based treatment programs?

Hear about treating overachievers, referring out and using other treatments, and the upcoming Fourth WCSPT, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “It’s important that patients understand that exercise is good for them and is not going to cause damage.”
  • “With any strengthening program, you only need to do it 2 or 3 times a week to be effective.”
  • “It’s probably going to take 3 months for our rehabilitation programs to reach their full effect.”
  • “If you don’t get it right the first time, and if it takes you a little while to find your space, that’s actually okay, because it’s about the long journey, and you’ll get there eventually.”
  • “Don’t stress about failure. It’s about what you learn from that failure and how you adapt and change what you do.”


More about Joanne Kemp

Headshot of Dr. Joanne KempAssociate Professor, Dr Joanne Kemp, is a Principal Research Fellow at Latrobe Sport and Exercise Medicine Research Centre and is a titled APA Sports Physiotherapist of 25+ years’ experience.

Joanne has presented extensively on the management of hip pain and hip pathology in Australia and internationally. Her research is focused on hip pain including early onset hip OA in younger adults, and its impact on activity, function, and quality of life. She is also focussed on the long-term consequence of sports injury on joint health. She has a particular focus on surgical and non-surgical interventions that can slow the progression and reduce the symptoms associated with hip pain, pathology, and hip OA. Joanne maintains clinical practice in Victoria.


Suggested Keywords

Healthy, Wealthy, Smart, Pain, Hip Pain, Pain Management, Injuries, Research, Osteoarthritis, Exercise, Physiotherapy, WCSPT,

To learn more, follow Joanne at:



Twitter:            @joannelkemp



4th World Congress of Sports Physical Therapy.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




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Read the Full Transcript Here: 


Hey, Joe, welcome to the podcast. I'm so happy to have you on. I've been wanting to have you on this podcast for such a long time. So thank you so much.



Thanks, Karen. It's great to be here, finally.



And of course, today we're going to be talking about hip pain, hip pathology, that is your zone of genius. So let's just dive right in. So let's talk about some common causes of hip pain in adults. And does this differ between women and men?



Yeah, look, it's a great question. And I think probably, we, I think we're starting to change our perspective on that difference between men and women and the causes of hip pain. I think that previously, we've sort of been very aware of the burden of hip pain in men and particularly young male athletes that there's been, you know, a growing body of research that's looked at at the prevalence and burden and causes of hip pain in young men. And probably that's led to a misconception that it affects men more than women. But it's only really that the research has been done in men, less and less so in women, like we see across, you know, the whole medical space. So if we think about the common causes of hip pain across the lifespan, when we're looking in sort of the adolescent and young adult population, you know, typical causes can be things like hip dysplasia, and that's actually is more common in women or young girls and women than boys and men so probably affects three times as many girls and women as it does men. And I think the prevalent when we're you know, the prevalence is perhaps higher than we previously thought. So, some studies are suggesting that up to 20% of adults have some form of hip dysplasia are shallow, hip socket shallow, so turbulent, and, and that that does lead to an increased risk of developing hip osteoarthritis in later life in later life. And even as young adults, sometimes we see patients with hip dysplasia, presenting with arthritis who need to go to hip replacement at a really young age in their 20s and 30s. So, hip dysplasia is a really common one. Another one that we've heard a lot about in the last 10 years is femoral acetabular, impingement syndrome, or FAI syndrome. So that's traditionally thought to be where there's impingement between the ball and the socket, either due to extra bone on the ballpark of the hip, which is can morphology or deep or retroverted socket, which has pencil morphology. And that's probably where a lot of the studies have been done, particularly in that young male adult adult population. But what we're now seeing when we look at the big cohorts, particularly of patients that end up presenting to hip arthroscopy is that it's about 5050. It's about 50% men and 50% women. So that burden is pretty equal across men and women. And that's another thing that does lead to an increased risk of hip osteoarthritis in later life. But the risk is not quite as high in FAI syndrome as it is in hip dysplasia. And it certainly is, it tends to be a slower burn. So these patients present for their hip replacements probably in their 50s and 60s, whereas hip dysplasia, we're seeing these patients in their 20s and 30s, with hip osteoarthritis. So that's probably the second most, the you know, the second cause in that younger age group. Then as we move into older adults, so sort of, you know, people 35 Plus sort of middle aged and older adults, that's where we really see hip osteoarthritis presenting itself, and it can be due to dysplasia or FAI syndrome. But it can also just sort of be that idiopathic arthritis that might be due to occupation, lots of different things. And again, that's reasonably equal men and women, but we do see women probably having a little bit more arthritis than men and more women going to hip replacement than men. And the outcomes for hip replacement are not as good in women as they are in men. So that burden is still probably skewed towards being higher in women than men. And then the other cause of hip pain that we see particularly in the middle age and older women is other gluteal pathologies or lateral hip pain, sometimes called you know, TRAQ, enteric, besides gluteal, tendinopathy, gluteal tendinitis, it has lots of different names. But that's a burden that definitely disproportionately affects women, over men. And particularly, once women get into that perimenopause, or menopause or post menopausal age group, there seems to be a relationship with with with hormones and with estrogen levels and the likelihood of gluteal tendinopathy becoming symptomatic as women sort of transition through that change. And so that's another really common cause. And we're now starting to be aware that often these women will present with combined hip osteoarthritis and gluteal tendinopathy. And that's where it can get really, really, really tricky as well. So yeah, look, it does. There's different, you know, different things that you see across the lifespan, but the burden is definitely I think, disproportionately higher in women than in men in a number of those conditions.



Yes, and I am firmly In the last group that you mentioned, I am just getting over, if you will, getting over gluteal tendinopathy, where I have to tell you it that is some serious pain. And, you know, when you're a physical therapist and you have people coming in, and they're explaining their pain to you, and you try and sympathize or empathize now I'm like, it is painful. Like I couldn't walk, I couldn't stand for more than like, four minutes. Yeah,



at least I've had the same thing. And, and I've been lucky that mine, I was sort of able to get on to it, knowing what it was and what to do fairly quickly. But it's very, and I think this is the thing with hip pain until you've had hip pain, whether it's glute tendinopathy, or intra articular, hip pain, it's really disabling. And it really affects everything you do in life, you can't sit without hurting, you can't walk without it hurting, you can't stand without it hurting, you can't lie on your side, without it hurting, you're getting in and out of the car, getting dressed, you know, trying to put your shoes on, it just affects every aspect of your life. And you know, and the pain can be quite intense and severe. So it does. You know, for people who are affected by hip pain, the burden is huge. And we see it reflected in the studies as well, where if you look at outcome scores for quality of life, young people with things like displays your FAI syndrome, their quality of life scores are as bad as people who have hip arthritis who are waiting for hip replacement. So it does, it's very, when you've got it, it's very, very impactful. And I think people until you've experienced it, perhaps people underestimate how bad it can be.



Yeah, and it can be really, like you said, it's very, very disabling. And it also can can make you very nervous. So you know, when these patients come in to see you. So as the physio, when these patients come in to see you, it really behooves you to sit and listen and really get that whole story so that you can make that differential diagnosis as best you can, if you don't have the diagnostic test to back it up, which often happens. Yeah, absolutely.



And I think that's the thing when the patient's present to you, and they're complaining of pain in that hip area, you can't just go to one test or one scan and say, Oh, it's definitely these, it's actually there's lots of pieces of the puzzle puzzle that you've got to put together, it can be really complex, and you absolutely have to listen to the patient. And I think fear, like you just said, is a huge thing. And we've seen this in our some of our qualitative work that's currently under review, but others as well that these patients are terrified to move, or to do exercise because they think it's going to hurt more. And they're really scared that it's going to cause more damage. And, and the irony is that exercise is the thing that we know is like is going to make them better. And once they get moving, they do feel better, but they're so scared to move because they're scared, they're gonna break something or make it worse or end up needing a hip replacement that they they don't they don't move. And it fear is a huge problem, you know, with these people.



Yeah, I mean, even myself as a physio I knew I needed to exercise, I sort of outsource my physio exercises to a friend of mine, Ellie summers, who's on the, on the west coast here in the United States, and she sent me exercises and even doing them, like it's not super comfortable. But within a month, I felt so much better. And now, you know, I'm back to running on the treadmill and doing all the things. But oftentimes, these patients and I may be wrong, but they're not sort of picking up on this within the first month of pain, you know, they might say, Oh, um, it'll go away. Let me give it another couple of weeks and have a couple of weeks. Whereas I was like, Okay, this is really painful. I'm getting to a doctor asap and starting these exercises ASAP. So what have you seen, even through the literature about when patients start to seek out care for this? And how can that affect their outcomes?



I think it's one of the things with hip pain that patients often will just leave it and they'll wait and see. And so we do know that in the younger age group, like if you think about FAI syndrome, for example, people will often not present for two or three years, they will pull up with the pain because it kind of comes and goes so they'll have a flare up, they'll be bad for a few weeks, it'll go away for a few weeks and have another flare up. And so because it's coming and going, they, I guess remain optimistic. It's human nature to be optimistic that it's going to get better by itself. And so it can often be a couple of years. We see this in the literature, you know, two or three years, but I see that in my clinical practice. And I'm sure you do, too, Karen, that patients, they'll come to you and they'll say, oh look, I've had this for two or three years, I was waiting for it to go away and now it's you know, suddenly getting worse and that's when they seek out care. And I think too, you know if we think coming back to what we were talking about with women is that these problems affect women who are really busy so they are often have busy careers. They're looking after families often, they they might be studying as well. They're juggling lots of things. So for them to try and fit in the medical care or, you know, physio care or whatever they need. It's really hard for them to find to make the time to do that. And I think that that's probably why they potentially delay seeking, seeking treatment as well.



Yeah, so many factors go into it. But bottom line is it hurts. Now, how let's talk about the physio side of things. So how can PTS design and conduct an evidence based treatment program? For, we'll say, for adults with hip pain? Yep.



So I think we probably the first thing is to set really good expectations for the patient. So often patients will come potentially looking for the quick fix. And so I think it's important that right up front, we say to our patients, that it does take a while for things to work, you should be starting to improve over that time, but they need to be committed to an exercise program that we know needs to be now at least three months long. So I think both the therapist and the patient need to be prepared for that longer term commitment as well. So I think that's the first thing is setting expectations, right. And then around those expectations, it's also really important that patients understand that exercise is good for them and is not going to cause damage. So you're really trying to get the confident to be able to exercise part of that is an understanding that it will like you just said like when you did your exercises, it's not super comfortable. But that's okay, they need to they don't want to be in a lot of pain, but they will probably have some pain and that that's actually okay and normal to have that. And it doesn't mean that they're causing more damage. That's just a normal part of the body adapting to the exercise process. Sometimes I find with patients to you in order to convince them of that, because sometimes they're a bit skeptical, they don't quite believe you that they give you know, they will do exercises for a week, just look, just have a week off the exercise and see what happens to your pain. And what they find is pain is no better when they're not exercising. But sometimes it's worse, it's usually worse or the same. And so then they're like, Oh yeah, now I understand the exercises and actually making my pain any worse. And so sometimes you might need to do that to get them to buy in. So I think getting them to buy into the timeframe the commitment that they're going to need to do and the fact that they will have a bit of pain, that's probably the biggest thing, then once you've done that, then you can start to develop your exercise program and the foundations of our exercise program. I like to think of it as being sort of two pronged. So the first one is the local exercise that we're doing for the hip joints. So that's where we do a lot of our strengthening exercises. So strengthening up the muscles around the hip. So the hip abductors, and the adductors flexes in the extensors. But then also really focusing on the core and the trunk is important because that controls the acetabulum, which controls the socket. So putting that in and then you know functional exercises as well. So teaching them how to do things like squats and lunges and going up and down stair. So our local rehab exercises should have primarily a strength focus, they might also need to have a range of motion focus as well. But we need to be careful with ranges of motion because sometimes those ranges of motion might be provocative for patients. So going into a lot of rotation or a lot of flexion could provoke pain. So strength is probably our big biggest focus. But then the second prong of our rehab program should be around general fitness in general activity. So you know, we know that the physical activity guidelines say that everybody should be doing 150 minutes of moderate activity a week or 75 minutes of vigorous activity, then that's just to be a healthy person, regardless of whether you've got a sore hip or not. So I think trying to get them to do general fitness, cardio, whatever you want to call it alongside their hip specific rehab is, is the thing that you need to do. And then what I try and do is I try and make that hip specific rehab, sort of normalize it as fitness training, rather than rehab. Because people get, they're going to be like, don't want to do rehab, everyone gets bored of rehab, you know, at home with your little bands. So trying to get them to do things like you know, incorporated as part of their twice a week strength training, where they go to the gym, for example, is really important. And with any strengthening program, you only need to do it two or three times a week to be effective. So people don't have to do it every day. So I think that's important too to for them to know, they'll get they'll have days off where they don't have to do it. But to find two or three days a week where they can commit to this the strengthening component of the program, the cardio fitness component of their program can fit in around their schedule. And something that I really like to do with patients is to sit down and actually look at their weekly schedule and help them schedule it into their diary. So don't just say to them, you go do this, you know, five times a week, you actually have to fight help them find those chunks of time where they can do it and they can find 30 minutes in their day to be able to commit to that exercise program.



Yeah, I really love that you said to emphasize that the strength thing has to be done two to three times a week, because oftentimes Well, I mean, I'm in New York City where you have a lot of is like very driven, sort of type A folks. And they think if you're not doing it every day, then it's not working. Yeah, you know, so to be able to reframe that for them and say, Hey, listen two to three times a week is what our goal is, and be very forceful on almost holding them back. Do you have any tips on how to hold people back? For those folks? Who are the overachievers?



It's hard. Yeah, it's really tricky, isn't it? I think sometimes I think people have to learn for themselves. So you kind of have to let them find out the hard way, maybe, and be prepared with some painkillers to settle things down. But ideally, you don't want to do that, if you can help it, I think, I find that presenting the evidence can be really, really helpful. So you know, talking about the strengthening guidelines that that show that two to three times a week is where you're going to get the maximum effect of strength. And if you do more than that, it's not going to really add to that you'll have already sort of hit that ceiling, and potentially give them something different to do on those other days, if you don't want them doing strength training two to three times a week. If there's someone who wants to do something every day, helping them find other things on those other days, so perhaps, you know, mixing it up with some cycling, walking or jogging, if they are able to do that some swimming, you know, sometimes, you know, it might be appropriate or safe for these patients, if they enjoy things like yoga or pilates, they can do that if it if it doesn't hurt in addition to their other things. So I think those type A personalities, you might need to fill the space on those other days. Give me something else to do.



Yeah, I think that's great advice. And now, sometimes, as physiotherapist we have to refer out. So when is it appropriate to refer out or to use other treatments such as surgery? How do we navigate that as a physio?



It's tricky. And I think the most important thing is that that has to be a shared decision that we make with our patients. And at the end of the day, they will have their beliefs and their priorities that will probably take them in certain directions. Having that three month rule is a good rule, I think that we know it's probably going to take three months for our rehabilitation programs to reach their full effect. But but it doesn't mean to say you keep doing things for three months, if you're not getting any improvement, we really want to see them starting to head in the right direction, probably within around about four weeks. Within, you know, two or three treatments, you should be starting to see some change even though we know it's gonna take longer than that to get the full effect. I think that if you're not seeing change within that first month or so, you have to start asking yourself questions about well, why why why aren't I getting changed? Do I need to look at this and red flags here? Do I need to potentially refer the patient to their GP? For some imaging, we know that, you know, people have a history of cancer, that breast cancer and the gynecological cancers and prostate cancer really caught the hip joint is a really common point from you know, where the cancer metastasizes. So, I think bearing in mind our red flags, you know, women with guide other gynecologic non cancer, but other gynecological issues, you often get pain in that same area. So, being open minded about some of the non musculoskeletal causes of pain and being prepared to refer on if someone's not improving in that time is important. Imaging, you know, we don't want to jump to imaging straightaway, it's not always necessary, but it is sometimes it is necessary. And I think don't be frightened to refer for imaging. If someone's not improving. The one thing that I and it's different in every country and our health systems are all different. But here in Australia as physios, we can refer for imaging, but I if I'm if I'm suspicious that there's a red flag, that's a medical thing that's outside my scope of practice, I will refer them to the GP for the GP to refer for imaging. And the reason for that is I if you refer for imaging, you need to be able and confident to tell the patient the results of their imaging and interpret them and then refer them on for appropriate care now, for those medical things. I think as physios that's way outside our scope of practice and we shouldn't be you know, if the scan comes back with cancer, like we can't that's way outside our scope and we shouldn't be having to to explain those results to patients, I think only refer for imaging yourself with your confidence of what you'll be able to interpret those findings. So don't be afraid to refer to the doctor. Some patients often need pain relief as well or anti inflammatory. So that's, you know, if you're not getting improvements in that four weeks, you may need to refer them to the doctor to get pain relief or anti inflammatory medication. Things like injectables again, we don't want to inject give people lots of injections but we know that the hip joint is often sign up at green flame. So you know a judiciously used cortisone injection can be helpful in in some cases. So I think it's been not afraid to refer on you know, when you just turn the video off, when you need when you need to, to, you know to those other things and then surgery is probably your last resort, but There are a small number of people who will potentially need surgery as well. So, but you wouldn't actually be looking at surgery until you really finish this full three months of rehab.



Yeah, that all makes perfect sense. And now as we kind of start to wrap things up, where there, is there anything that you know, we didn't cover, that you would really like the listeners to know, or to take away, whether that's from the literature or from your experience when it comes to hips?



Yeah, I think, look, I think we've covered most things. But I think what it is, is just being really confident to prescribe a good quality exercise program. And if you don't feel like you have the knowledge or skills to do that, don't be scared to either refer to a colleague who who might have more knowledge or skills, or to, you know, to look up the evidence with, you know, that the evidence is has really grown in the last couple of years. And we published a consensus paper in V jsme, 2020. That was a consensus paper on what physio treatment for hip pain in young and middle aged adults would be. So that's a really good resource, it's got some some good examples in that paper of the types of exercise that you should be doing. And then my colleague from the US might Raman also lead a consensus paper in that same series on the diagnosis and classification of hip pain. So that's another really good resource that you can go to that will help you clarify the different diagnosis in the hip and what what what sort of things you can do to confirm your clinical suspicion and your diagnosis.



Perfect. And now, you will also be speaking at the fourth World Congress of sports, physical therapy in Denmark, which is August 26th, to the 27th, you're doing to sort of 15 minute 15 minute talks repeated twice. So one talk repeated twice. On the second day of the conference, can you let the listeners know a little bit more about that. And if you have any sneak peak that you want to share?



Yeah, so I'm going to be doing that talk in combination with a with a great colleague of mine, a Danish colleague, Julie Jacobson. And so we're going to be talking about hip pain in women specifically. So looking at the common causes of hip pain in women and as as physios, or physical therapists, what we should be doing to manage to manage that, because it's a congress of sports, physio, or sports, physical therapy. It'll be slanted probably towards the younger, more athletic population. But I think there'll be some really great takeaways for anyone treating women in particular with hip pain. So we're going to be really, I think, trying to focus on what it is about women with hip pain that's unique and different to men, and really helping the therapist develop a rehab program that really targets the things that are important for women. So the impairments that women have the physical impairments, but also really targeting some of those, you know, we've got to think about the biopsychosocial model. So some of the psychological challenges that people with hip pain have that we've sort of touched on in terms of being fearful to move, but then the social challenges too, because we know that we do live in a gendered environment. And it's no different for women with hip pain, where they might face additional barriers to, you know, in this the way society is constructed to be able to access the best care. So it's also helping helping the clinician really become an help patients navigate some of those challenges as well.



I look forward to it. It sounds great. Now are what is there anything that you're looking forward to at the conference in Denmark? Have you looked through the program? Are there talks that you're looking forward to?



I look, there's there's going to be so many great talks there. Like it's such a I can't believe how many how much they've packed into two days, like for two day program, I'm actually really excited. by so many of the different tools, I think the thing I'm most excited about is after two years, it'll be nearly three years by then that we've actually been able to see each other face to face, just to have the opportunity to catch up face to face with so many great colleagues that I've worked with before, but also meet new colleagues as well, and have the chance to travel to beautiful Denmark. You know, I haven't been to the conference venue, but it looks amazing being on the coast. In summer, it's going to be beautiful. I know the conference Organizing Committee has got a great social program as well organized and the Danish conference dinners are always a highlight, I think of any program. So I'm really excited about that as well. Yeah, I just I just can't wait.



Yeah, it's it. You have the same answer that so far everyone has said as they just can't wait to be in person and to network and to hang out with people and to meet new people. So you're right along with everyone else that I think a lot of the other speakers that are going to the conference, and now where can people find you if they have questions, they want to see more of your research, where can they go?



So, um, so I'm on Twitter, so my Twitter account is at Joanne L. him. So L is my middle initial. And you're welcome to send me a message via Twitter. But you can also contact me via email. So my email address is the letter And then our sports medicine allotropes sports and exercise Medicine Research Center has a has a webpage and a blog page where a lot of our research is highlighted there as well. So if you just Google up Latrobe, Sport and Exercise Medicine Research Center, that's the first thing that will pop up as well. And we have a lot of, you know, a lot of really good information. We've got a really our Research Center has a really strong knowledge translation arm and so a lot of my colleagues, which credit to all my colleagues who work in this space, have developed a lot of really great resources to infographics, videos of exercises, lots and lots of different things that can be found on our on our research, our centers, webpage and blog page as well. So lots of good resources there.



Excellent. And we'll have links to all of that in the show notes for this episode at podcast at healthy, wealthy So one click will take you to all of the resources that that Joe just mentioned. And last question that I ask everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? So maybe straight out of physio I pick pick a year, any year you'd like?



It's great question. And it's funny because I was actually talking to my son's girlfriend the other night, who's at university, and she's finding it stressful and hard. And I actually shared with her something that I'm not afraid to share that I actually nearly failed my first year of university, because I was too busy enjoying the social aspect of uni life. And I think what I would say to my young, and that stressed me out and really upset me at the time. And I think what I would say to my younger self is if you don't get it right the first time. And if it takes you a little while to find your space, that that's actually okay, because it's about the long journey, and you'll get there eventually. And so if you hit hurdles and bumps and you don't, you're not always successful every time, it actually doesn't matter. Because as long as you keep on trying, you'll you'll get there in the end. So don't don't stress about failure. It's about what you learn from that failure and how you adapt and change what you do.



What excellent advice. Thank you so much. And thank you for coming on to the podcast. This was great. And I think the audience now has a better idea of what to do with their patients when they have hip pain. And if they don't, they can head over to Latrobe, they can go over to the website and get a lot of great resources from from you all and also look up a lot of your research. And if we can also put your Research Gate. Yeah, we can put that up in the show notes as well if that's okay, so that way people can kind of get a one stop shop on all of your research because it's extensive. So we'll have that up there as well. Thanks, Karen. Thank you so much. And everyone. Thanks so much for tuning in listening and we hope to see you in August in Denmark at the fourth World Congress Sports Physical Therapy again, that's August 26 and 27th. If you haven't registered, I highly suggest you get on it and hopefully we'll be able to see you in Denmark. So I look forward to seeing you then. And everyone have a great couple of days and stay healthy, wealthy and smart.

Jun 13, 2022

In this episode, 39th Governor of Wisconsin and Advocate for Alzheimer’s Caregivers, Martin Schreiber, talks about the importance of advocating for Alzheimer’s caregivers.

Today, Martin talks about his book, My Two Elaines, and his experience as an Alzheimer’s caregiver. What can the community do to support Alzheimer’s caregivers?

Hear about therapeutic fibbing, Elaine’s own journals, and get Martin’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “If Alzheimer’s is bad, ignorance of the disease is worse.”
  • “You cannot do it alone.”
  • “Alzheimer’s is a tragic disease. We can’t cure it, but we certainly can learn to live better with it.”
  • “More than 6 million Americans live with Alzheimer’s or Dementia, and more than 11 million people are their unpaid caregivers.”
  • “If people can simply better understand this disease, at that point, they can be more helpful.”
  • “Live and understand, and grasp, and appreciate, and be thankful for the moment.”


More about Martin Schreiber

headshot of Governor Marty Schrieber Martin J. Schreiber grew up in Milwaukee, Wisconsin. Inspired by his father’s example as a member of the Wisconsin State Assembly and the Milwaukee Common Council, Martin ran for public office even before he had completed law school. In 1962, he was elected as the youngest-ever member of the Wisconsin State Senate. He was elected lieutenant governor in 1970 and, in 1977, became the 39th governor of Wisconsin. He recently retired from his public affairs firm in Milwaukee and now is an advocate for Alzheimer’s caregivers.

In addition to caring for Elaine, Martin is passionately committed to speaking out to help caregivers and their loved ones live their best lives possible. He and his wife, Elaine, have four children, 13 grandchildren and seven great-grandchildren.


My Two Elaines: Learning, Coping, and Surviving as an Alzheimer's Caregiver

The Alzheimer’s Association.

24/7 Helpline: 800-272-3900

Suggested Keywords

Healthy, Wealthy, Smart, Alzheimer’s Disease, Dementia, Caregivers, Awareness, Grief, Advocacy, Ignorance, Support, Mental Health,


To learn more, follow Martin at:




Subscribe to Healthy, Wealthy & Smart:


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Read the Full Transcript Here: 


Hi, Governor Schreiber, thank you so much for coming on the podcast and taking the time out today to come on and talk about Alzheimer's disease, which we are in the month of June. It is Alzheimer's Awareness Month. So I thank you for coming on and sharing your story and experience.



Well, thanks, Karen, I want you to know that I'm very grateful for the opportunity to be with you. Because there's so much important information that people should be aware of relative to Alzheimer's disease, both for the person who was ill, and also for the caregiver.



Yeah, absolutely. And now many people listening to this podcast may know you for your service to the people of Wisconsin in the state senate, then you were lieutenant governor, and ultimately, the 39th, governor of Wisconsin. So like I said, Today, you're here to talk about Alzheimer's. So can you tell us a little bit more about the work you're doing as an advocate for Alzheimer's caregivers, and kind of how and why this is personal for you, and how you found yourself here?



Well, very soon. It I tell you, if if I go, my wife humane is now in our 18th year since diagnosis. And if we you and I go back 18 years, at that time, this disease could not be cured, delayed or prevented. 18 years have gone by and this disease still cannot be cured, delayed or prevented. So what happened was, because I didn't understand this disease, I made my life more miserable. For my dear wife, who was losing her memory, I made my life more difficult for myself, as well as for many other people, because I didn't understand this disease. And so I conclude now, that if Alzheimer's is bad, ignorance of the diseases worse, and when I say ignorance of the disease, I don't mean ignorance of the disease just simply by lay people, but I'm talking even the medical profession, I'm talking even caregivers themselves. I'm talking about churches and congregations and temples and so on, there is just not an awareness of this disease, as it relates to how it should be dealt with. Because you can't fight it, you can't beat it. And so if we can learn a little bit more about it, we have a better chance of having our loved one with the disease, living their best life possible. But also we had the chance of having the caregiver also receive their best opportunity of living their best life possible.



Yeah. And you wrote about this in a new book that is published this month in June, called my two lanes. So you depict your wife your wife's battle was with Alzheimer's. And you know, like you said, This disease is progressive. And the person definitely transforms from probably the person you knew into, into maybe someone else. So can you talk about how you dealt with that as, as her husband and as the main caregiver?



Well, first I dealt with it very badly, X extremely poorly. And because of that, we missed out on many moments of joy. What I tried to do in the beginning, because I didn't understand this disease, what I tried to do was to keep her in my world, knowing Lena, it didn't happen on a Wednesday, it happened on a Thursday, it wasn't the Joneses, it was finally, I got the understanding that it is important for me to join the world of the person who now is. And one of the most difficult, difficult challenges that any caregiver has, but which has to happen is what I would call the pivot. And the pivot is when the caregiver gets to the point where you let go of this person who once was. So you can now embrace and help the person who now is because if we don't, first of all, because this disease is incurable at this time, you cannot fight it. There is nothing you can do. And I found out that all of the navies, saline, and all of the armies marching and all of the liquor that's that's distilled and all of the beer that's brewed is not going to stop this disease. And so rather than how do we fight this disease, the question is how can we fight to give our loved one their best life possible? And so within that framework, then there's A number of things that is important for for us to understand about this disease and for us to understand about the challenge of, of caregivers. So as I said, one of the things I learned was to join Elaine's world. Then another thing that I learned was the importance of what I call therapeutic fitting. And again, look here, let me let me just back up before we go into therapeutic fitting, if we can envision a funnel, and if we put the small part of our funnel by your eye, and of course, because the funnel expands, as you look up, you can see the blueness of the sky in the hope of tomorrow. But what happens is, as the disease takes its course that funnel becomes inverted. And now the large part will be by your eye, and you look out and all you see is a little bit that then becomes the world and the life of the person who now is they are not aware of what happened five minutes ago, five hours ago, maybe five years ago, nor are they concerned or aware of what can happen five minutes from now, five hours from now or five years. So it's it's a different world. Now. When I wrote this book, I felt really proud of myself, that I had finally put some of this into perspective. And lo and behold, before we're ready to go on for print, I find a series of notes and diaries that Elaine had been keeping since her diagnosis. Well, I want you to know that we had prayed together. And we had cried together. But Never did I understand the courage that it takes to be diagnosed with this illness, and then that can continue forward. So as Elaine is going through this transition, and now we're here we get to therapeutic phibian. As Elaine is going through this this transition this journey, she asked me once, how are my parents? Oh, I said, Elaine, your parents are both dead. The shock on her face when she realized maybe she didn't say goodbye. The shock on her face, maybe even not attend the funeral. I promised myself I would never put her through that again. So then when she asked me the next time, she said, How are my parents? Oh, I said Elaine, I said your mom is just really doing well. She likes working at church and volunteering. Your dad likes sports. He likes it that makes me feel so happy. Well, that's therapeutic fitting, therapeutic fibbing joining the world of the person who now is now I want you to know that I tried this therapeutic good in the first year of my marriage, but it didn't work so good then, but certainly at this moment in time. But then another experience to give me a sense of this all



the feet, when he lanes still was able to be mobile. We were having lunch at the assisted living memory care. And we're talking and then she starts to cry. I said, Elaine, why are you crying? Well, she said, I am beginning to love you more than your husband. Well, I didn't ask her what's wrong with your jerky husband. I didn't do that. But I tell you what I learned. I learned that it is not necessary for her to know my name in order for our hearts to touch. And so many times, as I talked with caregivers, they become initially so distraught about the fact that their loved one may be married for 5060 years, children so forth. That person with Alzheimer's does not remember their knees. I would tell them understand that your loved ones mine is broken. And sometimes there's no more of a chance to have our loved one remember our names and a person with a broken leg winning an Olympic championship, a gold medal. And so we we just simply have to understand the importance of joining the world of this person who now is one one of the challenges of caregiving, and there are a number of them. But one of the challenges of caregiving is that you work so hard to try and help your loved one but here let me let me just back up a little bit here. So we go back 18 years. The First Tee lane. That was the girl I met when I was a freshman in high school. School, I fell in love right away. We dated and we went steady and we got engaged, and we got married and four children, and 13 grandchildren, now seven great grandchildren. That was the first Delaine, I would run for public office, you will be the hardest working campaigner. If I would lose, she would never let me feel defeated. She was everything in the world. To me as it relates to any good thing that happened. The second lane began to appear. As I said, some 1819 years ago, when she would get lost driving to and from places she had been going to and from for the past 10 years, the second Elaine began to appear when as a great cook, she messed up her recipe so bad that she would cry, she would be so embarrassed. So that was the beginning of the second lane. So now we get this diagnosis. And I took a marriage route to death to as part I'm going to do all these things. And when Elaine was first diagnosed, she was given the mental mini test. And basically the mantium. The mental mini tests is a simple test asking for example, what day it is. When is your birthday? so forth? Very simple questions. And if you scored 30 or above you would be considered Okay, pretty normal. If you scored 30 or below, what the situation would be is that maybe at signs of early onset, well, Elaine's test score at that point was 28. They say that the average person loses four to five points going down almost every year. And it doesn't happen, you know, arithmetic Li from 20 820-726-2524, it may stay at 28 for a while, then maybe drop down to a 25 and then stay at that point, then maybe jump down to 21 and so forth. Well, what is important here is that you then test it out first at one year, you lose four to five points every year 18 years ago, it gives you a sense of where Elaine's life now is. But with that understanding with the understanding that the mentee meant a mental mini test



goes down. What what happens to the caregiver is you devote your time and your talent and your energy and your love to this person. And you just step out thank you have this answer. And then what happens is you wake up the next morning, and it's a new challenge. Well, what am I doing wrong? So what happens then is you devote more time and more talent and more energy. And you Okay, flow and all of a sudden, no. So what am I doing wrong? And so I have seen many instances where caregivers develop this so significant guilt, that they're not able to to help their loved one no matter how hard they work, what are they doing wrong? But here's the other aspect that comes along with it not only the self questioning about what am I doing wrong, but the caregiver is also going through a type of depression, and also what I would call an unacknowledged meeting. So I had a dear friend who retired and enjoying retirement, had dinner one night, laid down on the couch to watch the baseball game. Tragically, he died massive heart attack, just gone. Well, there was a funeral. And friends stopped by to express their sympathy to acknowledge the passing of this of this wonderful person. And there was closure. So what happens in the life of care giver is that there never is closure. You see your loved one dying a little bit every day. You begin to feel just so horrible about your guilt not being able to do anything but you're also getting to the point where you're saying, My my my loved one is is leaving me and then that that grieving, you know, just does it's not acknowledged and that's really one of the challenges that caregivers have to face. And that is to face up to the fact that yes, you are going to be grieving. And you should acknowledge the fact that you're going through this grieving at this moment in time, then there's also the depression that comes with it. And knowing what is the future and worrying about that also breeds anxiety. And so you take the guilt, you're not doing enough, you're not maybe getting enough sleep, you're not necessarily going for the walk, you're not getting any visit with friends, because you're focusing and focusing and focusing? Well, I try and have caregivers understand one of the most important facts about this disease, and that is you cannot do it alone. I do not believe, well, first of all, we men are sometimes really stupid. You know, we're not going to ask for directions, because we know it all, you know, I was going to take care of Elaine and so forth. And I let my ego, my own self centered. passion to do Z to defeat this disease, I let that take control over what was really best for Elaine. Because I did that we really missed out some, some great moments of joy. And



at the time of diagnosis, the doctor said there were four things that we should be doing one of the two drugs, drugs called the Menda and erysiphe. They do not stop the disease, they just simply delay the symptoms. So that was point number one, point number two socialization, you do show to socialization continuing, and then also getting exercise going for a walk, for example, and then also a glass of red wine every evening. Well, you then got three weeks ahead and the glass of red wine every evening and four weeks behind and in the walking. But here, here's the the situation about not joining the life and the world of this person who now is. So I knew we should go for a walk. So in my mind, half an hour walk is sufficient. So we started walking the lane with say, all look at that flower Kimani lane, you gotta get this throw, you know, our look at the bird, no, come on Elaine. And so my focus was not on the here. And the now my focus was getting this work done. So I could go about some other type of, of activity, whether it's trying to work with my business at the same time, and so forth. And the lesson here is Alzheimer's is a tragic disease. We can't cure it. But we certainly can learn to live better with it. And so had I known, then what I know now, I would have stopped with the lane. And we would, we would have admired that flower, watch the bird, we would have even maybe even just stood in the sunshine for a while and felt the warmth of the day. So the life of a caregiver is extremely challenging. We have to know that we can't do it alone. We have to understand that if we if you want to show real courage and real manliness that is shown by asking for help. So gosh, I think you asked a question a while back and I think that that was about maybe three days ago and I still?



Well, I think I think what you have done is your as you were speaking I said okay, I was gonna ask that I was I wanted to talk about that. But I think what you did you do is you really clearly laid out some real big challenges that caregivers have to face and some really great lessons that you've learned that you've passed along and I know that those lessons are some practical takeaways in the book in sections called kind of what you said what I wish I'd known or what I would have done differently. But it sounds to me like if you're a caregiver, you need to check your ego at the door. You need to be present with the person you need to join their world. And and it may perhaps be a more pleasant or at ties would be a happier existence for not only the caregiver, but for the person living with Alzheimer's as well. And, you know, as someone who like we'd spoken before went on the air Mike grandmother had Alzheimer's. And I can only assume my parents feel the same way that you're feeling now that we used to always Correct, correct, correct her, when in fact, we just should have said, Where's where's your grandfather? Oh, he'll be home in a little while, instead of saying no, he died 15 years ago. And then, like you said, it just can make the patient agitated and confused. And if you want to continue to have those happy times, it's best to be in their world. So I think you really outline that very, very well. And I do want to go back to something that you touched upon, but didn't go into great detail, and that is Elaine's journal. Now you, you put this into the book, some of her excerpts where she detailed her feelings and emotions as she was struggling with this diagnosis. So why was that important to include those? And were there anything in those journals that surprised you?



There were a number of things. First of all, I wanted to put Elaine's words into the book. I wanted to do that. So. So caregivers and their families would understand this. Great in internal turmoil, being diagnosed with it, but still knowing your mind, then having my your mind sort of slip as I said, you go from a 28 score, maybe down to a 26 score, but you still think you're sort of all right. But then some days, you're not all right. But with her journals. As I said, I learned the courage that it takes to be diagnosed with this disease and continue forward. But I also learned, we talked about the pivot, where the caregiver gets to the point of letting go of this person who wants was to join the world with a person who now is the person with Alzheimer's also has a pivot. And it's almost by the grace of God. And that pivot is when the person with Alzheimer's finally leaves the real world and enters their own world. And I've got, well, let me just read one or one or two of her of her excerpts, of course, in the book, but I wanted to make sure that the reader would understand that the challenge is that that a person has with Alzheimer's, but also how important I was in her life as her lifeline. And I really didn't know that. And I think that if a caregiver understands how important they are as a lifeline to their loved one, they will take better care of themselves. I was lacking sleep, I was lacking exercise. I wasn't eating well, I was like, My daughter, Christine, gave me an article on moderate drinking. And it wasn't because she thought I was drinking too little. That's for sure. So but anyway, so with her excerpts, I want to give you just just a few examples of, of what what she's going on. So she starts off at when she was sort of diagnosed, she wrote a letter to her to your loved ones. And she writes, it wasn't until a few weeks ago that I really had to say, Yes, I do have Alzheimer's, I read up signs that indicate Alzheimer's, like getting overly upset for no reason, and having trouble with names and directions. But I still didn't think it was a problem for me. But in hindsight, for too long, I've been getting lost driving, having trouble keeping days straight, and difficulties with names and schedules. Still, I still felt like I could handle it, it won't get worse. But this morning, I started reading about the mid stage of Alzheimer's, in hopes of preparing myself better and realize I'm not very far away, that is most scary, but I have to accept it. And so also in some of these pages, she talks about how important I was to her life. She said, Please take care of yourself, for me as well as for you. So then, you know and again she is in a process of, of of losing her memory. And she's in the process of getting to this pivot where she loses the reality of life and goes into her world. But to give you a sense of, of the tugging that's going on within in her she writes this, she writes, I am not enjoying my role anymore as Marty's wife because of his Hammond concerns about My Alzheimer's, he doesn't let me be me. He doesn't let me go for a walk if I want to, or the other store loans, I used to appreciate him what I thought was concerned, but he holds me captive much too much, I'm going to try to have a second opinion because I really don't think I have any problem. I know how to drive or walk anyplace I want to, but he doesn't believe me. And I hate the control he has placed on me, I don't even think I have Alzheimer's, per se. And so we see that, and again, my my, we see a human being going through that kind of turmoil. And we think we could have done a better job, or I think I know I could have done a better job. And because of that I wanted to write the book, so that I could help caregivers learn, cope, and survive. Just I want to just read one, one more here than



that. I don't have the exact date on this one here. But she writes, I wish my Alzheimer's would dissipate. I'd like to be the smart wife and mother I used to be. Now I have to waste so much time just trying to figure out what I should be doing. without seeming as smart as I used to be. I need to rely on Marty for everything. And I'm very lucky, he continues to keep me life gets more difficult every day. So it's it's a bummer of a disease. And again, we can't beat it, we can't fight it. It's not curable at this moment in time, it can be delayed can be prevented. And so what we want to do is fight was our best weapons possible and that is to better understand the disease and better understand the world to which our loved one is passing into. So we can help them on their journey as much as possible.



And you know, According to the Alzheimer's Association, more than 6 million Americans live with Alzheimer's or dementia. And more than 11 people are their unpaid caregivers. So how can people listening right now support those who are caring for Alzheimer's patients and support the patients as well.



One of the best things and most important things I think a friend or family member or neighbor can do for a caregiver. Number one, simply acknowledge what they're going through. And that acknowledgement in and of itself is so important. Because people really don't understand one. And because people don't understand Alzheimer's, they they shy away from it. Now. I call Alzheimer's, not a chicken casserole disease. So hypothetically, I get an operation of my, you know, maybe a higher operation. And so I come home, and I'm laid up people will bring me a chicken casserole, I've fallen I break a hip, I'm recovering, they'll bring me a chicken casserole. Alzheimer's, people don't bring chicken casserole, we a person, a caregiver and their spouse may have had friends that they did many things over a period of 3040 years together as the children would grow up. And let's just assume hypothetically, that it would be camping and canoeing. So for 3040 years, they, the families did this together and the children grew up and so forth. And that was the bind holding them. That was the binding thing for them. So what happens is now the spouse gets Alzheimer's. And because the friends don't know about the disease, they don't know how to handle it, and they withdraw as they withdraw. The caregiver not only is trying to deal with this depression, this anxiety, they are grieving the guilt. Now, the caregiver is also feeling abandoned, abandoned by friends at one of the most challenging times. So if you want to help any caregiver, or even work on creating a dementia friendly community, we have to understand this disease and have to understand how we can best deal with the disease. But then, rather than saying, call me if you need help, because we caregivers won't do that. What we will do however is respond by someone saying oh maybe I could pick up medicines from the drugstore. Maybe I could go shopping for you or maybe in other words specific kinds kinds of things, or maybe even taking the person who was ill for a walk so that the caregiver can get some, some respite. But as I said, if Alzheimer's is bad ignorance of the diseases worse and ignorance of the disease by the medical profession, caregivers, as well as family, friends and neighbors, and if people can just simply, hopefully better understand this disease, I think at that point, they can be more helpful in people living their best lives possible.



Yeah, and thank you for that advice. I think that's wonderful advice for people that are, you know, in the community and in this fear of people living with Alzheimer's. And I also want to mention that there is support, and that's provided to the Alzheimer's Association, or by phone at 800-272-3900. So if people are looking for more resources, they can find them there as well. And of course, your book. Let's talk about that. My two Elaine's, learning, coping and surviving as an Alzheimer's caregiver release is June 13. So we're perfectly within that Alzheimer's Awareness Month and people can get the book, I'm assuming wherever books are sold. That's my understanding. I would assume that wherever books are sold, it's printed through Harper horizon, which is an imprint within HarperCollins. And one last question regarding the book. And this is a more personal question for you. Is it upon writing the book? Did it give you time to reflect? And did it feel cathartic for you? Did it give you any sense of closure around your living with a person living with the disease?



It certainly was cathartic with without a question. But I think that one, one of the main things I got from this book is much I wanted to do something to help other people not both through what I as ignorant caregiver went through, and also what I might be able to do to help caregivers help their loved one with with dementia live their best lives possible. And the because I think back again, on our past 18 years, and I think how it could have been easier, as difficult as it was, it could have been easier. And it's not a matter of getting enough money to fly to the moon and back. It's it's a matter of just simply understand some some some basic factors and, and dealing with some unknown quantities, but no, it was it was quite an experience to write that book. And I'm glad that we were able to do it. And I want to tell you that I'm grateful for for being able to talk about this. And and also grateful that I think, hopefully we're going to be able to help some more caregivers learn cope and survive.



Perfect. And where can people find you? Let's say they have questions they want to talk to you they want to get in touch with with you, what is the best way to do that?



We have a website. That's right, my two Elaine's all one And guys should anything and I have been up until COVID giving talks around the country learning and really everything that I shared with you about what caregivers go through, I can tell you, whether it's it's Newmark, Minnesota, Florida. St. Louis, I don't care where it is, that is simply an overlay of almost every single caregiver as how they're trying to cope with this disease. So but I also wanted to mention you gave the 800 number for the Alzheimer's Association. That's a 24/7 number. And so there are going to be some moments where you're just not going to be able to figure out how am I going to cope with this? Well, if you give them a number, I mean, give them a call, they will be able to help either give you an answer or point you in the right direction.



Perfect. And before we wrap things up. I have one last question. It's a question I asked everyone who comes on the show. And that is knowing where you are now in your life and given your illustrious career. What advice would you give to your younger self, and that may be that younger self was that freshman in high school when you met your wife or maybe it was in the midst of your being the governor? What advice knowing where you are in Now would you give to yourself as a younger man?



Live in the moment. And we, you know, it's not only the fact that I didn't enjoy looking at the bird with the lane, it's probably the fact that I was too busy to take time to enjoy playing ball with my sons are too busy to take time to go to the museum with my daughters, and, you know, just, you know, being with them. But really my mind is someplace else worried about some other kind of thing over which I probably had no control over anyway. But I think to, to, to live in and understand and grasp and appreciate, and be thankful for the moment.



I think that was wonderful advice. Well, Marty, thank you so much for coming on the podcast and sharing, sharing this book with us. And so everyone, again, the book is called my two lanes, it is sold everywhere where books are sold. So I highly encourage you, especially and I'm gonna say this, especially for people in the health care profession. I'm a physical therapist, a lot of physical therapists listening to this, I think, especially for those people, because oftentimes we're with the patient, but we're not with the caregiver. And I think it's really important to get a full view of what the what life is like for everyone surrounding this patient. So I highly encourage you to go out and get this book and read this book. So Marty, thank you so much for coming on.



There. And I'm very grateful. One one thing, as as we, as we sort of parted company here, when I talk about joining the world of this person who now is to make sure that caregivers as well as healthcare professionals know and understand truly that you cannot argue with this disease. If when I took Elaine to daycare, and we would drive up to the door, and she said that she's not going in, there was no way that I would be able to with wild horses drag her out of that car so she could go into, you know, the daycare. And so it's a matter of redirection. So we would drive around a little bit. Some of the neighborhoods come back, here we are, and she would do that. Sometimes we would be at dinner, and she would reach across the table and grab someone else's wineglass. That's not yours. Put it down. No, it's Elaine. Thanks for finding that wineglass. If you wouldn't have grabbed it, it would have fallen off. And now we're able to give you Lena good feeling about being helpful, but at the same time, not creating an awkward situation. No, you can have that scarf. It's not yours. Well, thanks for finding the scarf, and so on. So, anyway, carry on. I'm grateful to you for what you do. I know that you help out people and that's really special and an honor for me to be with you. Thank you.



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

Jun 6, 2022

In this episode, Founder of Focus.CEO, David Wood, talks about his new book, Mouse in the Room: Because the Elephant isn't Alone.

Today, David talks about the importance of naming your mice, the hurdle of instant gratification and being unapologetically authentic. What does it mean to have 30% more courage?

Hear about the art of dealing with rejection, when not to follow your courage, and get David’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “A lot of us are putting on, unconsciously, an act for the world because we don’t want to get in trouble, and we don’t want to be uncomfortable, and we don’t want to make the other person uncomfortable, so we say what’s going to fit into a nice box.”
  • “You can choose the discomfort of wearing a mask or the discomfort of telling the truth.”
  • “If you don’t ask, you’re already starting with a no.”
  • “Every time you name a mouse, it gives you a chance to increase your confidence and belief in yourself.”
  • “You can have anything you want in life if you’re willing to ask 1000 people.” – Byron Katie
  • “Start writing things down, knowing that you don’t have to do anything on those pieces of paper.”
  • “You’re already doing things right. You got this far. You don’t need fixing.”
  • “At times it’s going to get very hard. It might get so hard that you don’t know if you’re going to make it, but you do.”


More about David Wood

Head shot of David Wood David is a former consulting actuary to Fortune 100 companies. He built the world’s largest coaching business, becoming #1 on Google for life coaching and coaching thousands of hours in 12 countries around the globe.

As well as helping others, David is no stranger to overcoming challenges himself, having survived a full collapse of his paraglider and a fractured spine, witnessing the death of his sister at age seven, anxiety and depression, and a national Gong Show! (

He helps business owners and leaders become the badass leaders people want to follow, creating more authenticity, connection, confidence, and revenue.


Suggested Keywords

Healthy, Wealthy, Smart, Courage, Challenges, Confidence, Discomfort, Authenticity, Rejection, Persistence, Commitment, Awareness,


Get Your FREE Gift

Mouse in the Room Book.


To learn more, follow David at:


Twitter:            @_focusceo

Instagram:       @_focusceo

Facebook:       @extraordinaryfocus




Subscribe to Healthy, Wealthy & Smart:


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Read the Full Transcript Here: 


Hey, David, welcome to the podcast, I am happy to have you on to talk about, amongst other things, a new book release that's coming out today, which is for people not listening. Today is June 13. So we will definitely get to the book, and we'll get to a lot of other things. But thank you so much for coming on.



My pleasure. And it's nice to meet you.



Yeah, it's great to meet you as well. So I guess I let the cat out of the bag a little too quickly. We're gonna get to the book towards the end. But let's get to the book in the beginning. And at the end, how's that sound? Yeah, so tell us the name of the book. And I will hand the mic over to you to give us a little snippet.



Sure. And the I would have mentioned the book because it's going to fit in with the topics we want to talk about, like courage, and practicing deliberate discomfort. The books called the mouse in the room, because the elephant is not alone. And I'm writing this book, because we all know about that expression, the elephant in the room, you see it, I see it, no one's saying anything. Well, that's just weird. And I think we should all address the elephant in the room. But for most of us, many creatures in the room are much more subtle. They're not as huge as an elephant, maybe it's something that I see in you don't see it, or I don't know, if you see it. I think a lot of us are actually putting on unconsciously an act for the world, because we don't want to get in trouble. And we don't want to be uncomfortable. And we don't want to make the other person uncomfortable. So we say what's going to fit into a nice box. The problem is when we do that, we can feel disconnected from the world, we can feel more isolated, lonely. And people won't trust us as much, they won't know why. They'll just know something's off because this person isn't being real. So we're writing, we wrote mouse in the room, so that people can start to notice their mice and go all I'm actually upset about that. Or I have a desire I haven't mentioned or I have a confession mouse over here, or you know what, there's some appreciation I need to bring into this space here. When people identify their mice, and then artfully name them, so that they can come into more connection, more intimacy. And then through more trust, there's good business application to people are going to want to work with you and buy from you and, and follow you as a leader. They may not necessarily know why. But they'll be like, Oh, this person's real. This is someone I can count on. So there's the short version of mouse in the room.



Excellent. And maybe we'll get into a little bit of those mice later on. But before we get into that, as you were speaking, you had mentioned the word courage. And it I always think that it does take courage to speak your mind. And should we always be speaking our mind? And should we always be using our courage? So why don't you talk a little bit about how would you say 30% more courage? can double your happiness? We have a lot of people who are entrepreneurs who are listening, so we double your revenue. So what does that mean? Can you break it down?



Yeah. Something my co author said recently that stuck with me was, you can choose the discomfort of wearing a mask, or the discomfort of telling you truth. It's one or the other. And there's a lot more upside associated with one of those things. So I love the concept of courage I found as a kid, whenever I didn't do something that felt right be out of fear. I would like myself a little less. So if I didn't ask that girl out, or if I didn't confront that bully, or if I didn't stand up for myself, I would I just feel smaller. And it's an icky feeling. I don't want anyone to have that. Conversely, I discovered that when I am willing to take a risk and do something that's a little scary, even if I don't get the result that I wanted, I feel better about myself. It's like I went for it. An example of this I went to a conference where I was awestruck by the people that I was hanging out with there was like Jack Canfield from chicken soup and John Gray from Mars and Venus and Don Miguel Ruiz is a member and I'm like, Oh my God. And when I left the event, I look back on it and I realized I made four bold requests that terrified me. Like I asked Jack Canfield if you'd be interested in writing a book together. That was very scary. I figured he probably gets about 100 proposals a day for something like that. I asked someone if she wanted to go out with me and have our first date be a trip to Colombia. I asked an obstacle when Oscar winning producer if, like what it would take for me to do a ride along on his next film shoot. These were all scary things. Now. I didn't get a yes to Everything that I asked for, but I felt complete. I felt like yes, I went for it. They say if you I'm gonna butcher this quote it's, it's something about the trivial quote is, if you don't ask, you don't get you're already starting with a novel. That's the default answer. So I think it behooves us to find our edge like, what is our edge? Is it? If you're an entrepreneur? Is it asking a celebrity to endorse your product? Is it asking 10 people to be affiliate partners that that you think would never give you the time of day? Is it calling 10 people and asking them to become clients? Because you think you could serve them? I don't know where your edge is. But each listener needs to find their own edge, like what would feel uncomfortable and a little scary, but could have some great upside. And again, I'll say the main benefit is you get to feel better about yourself. And as a bonus, you may actually get some yeses, which might surprise you like, Oh, my God, someone said, yes. That's a bonus.



And do you feel like even if you fail, or even if you get these nose, or even if people don't give you the time of day? Does it help to boost your confidence? Because you're asking the question, and you're putting yourself out there?



I think it absolutely does. And this ties into the book really well. Because if you're going to name a mouse with someone, you're going to sit like that what I just mentioned at that conference with desire mice, I had like four desires. And so I named them, I felt better about myself, I felt more confident. And I actually got a yes, one of those four questions got me a yes. And was like, Oh, my God, that's really cool. So yeah, and what what we did have as a subtitle is, this is your pathway to connection, confidence, and becoming a badass leader that people want to follow. Because if you hide what you're tolerating, if you hide what you desire, if you hide what you're ashamed of, then those mice get to breed, and you get more and more of them. And that's where shame can really thrive. Whereas if you bring yourself to the world and say, Hey, this is who I am, every time you do that, every time you name a mouse, it gives you a chance to increase your confidence and belief in yourself. Because it's you. It's like, this is my desire. You don't want to grant that. Okay. Thanks. Hey, this is something that's bugging me. Can we change that? No. All right, gave it a shot. We want to get back to like that. That confidence of when we were five years old, for many of us, and we're able to just go for stuff and we hadn't been beaten down by life. And people get back in touch with what's going on inside and then artfully bring it. Now you brought up earlier on? Do we shall we name everything? No. If you go to someone's house, and it looks like a pigsty and you're uncomfortable there, maybe you suck it up for 20 minutes until you leave. And maybe they don't need to know that. Or maybe if you got a gift from someone, maybe you don't have to tell them. But hey, if they've given you that thing, three years in a row, it might be a kindness stood due to speak up. Well, in one of the chapters of the book, we give you a test to work out. Is this worth naming? Is this something that I should bring and could bring? And if yes, how will they artfully do it so that I'm unlikely to trigger a huge response in the other person? And they can be like, Oh, alright, I get where you're coming from. Yeah, let's, let's work that out.



And what do you say to people who may think well, okay, I can have the courage, I can ask all these questions. But I keep getting no, no, no, no, no, no, no. You know, is that going to kind of reinforce this? I don't want to say, lack of confidence, but maybe reinforce to people that oh, it's not worth it. I keep asking these questions. I keep getting nose and it reminds me of, let's say, actors or actresses who go out for parts because they get a lot of rejection. But they keep doing it. Right. So yeah, what do you say to those people who are like I've gotten enough nose and I don't want to get any more nose.



Did you know that eight months ago I started acting now and I started acting eight months ago and in three weeks I'm moving to Los Angeles to pursue acting so I know a bit about this by I have two answers two broad answers to this one is if you're getting it so you ask Katie says Byron, Katie says, you can have anything you want in life if you're willing to ask 1000 people. So I think there's real value in asking 1000 people. And if you ask 1000 people and get 1000 knows, there might be something wrong with the question. So that might be where some coaching can come in. It's like, how am I asking? And is there a way that I'm, am I selling the sizzle? And this am I like, you know, so there's two answers, and they're both true. You want to ask in a way that's enrolling. But be careful about getting attached to the outcome. This is what people collapse, and I got this from landmark education. A long time ago, people think it's one or the other, you can be committed to something, I am going to make this happen Martin Luther King, I'm going to free the slaves, Gandhi, I'm going to free India, you can be committed to something. Or you can be unattached, but you can't be both. And so as soon as they get committed to something, they think they have to get it. And if it's not coming straight away, or early on, there's a problem. And I'm going to collapse, I'm going to make it mean something about me. Landmark helped me distinguish the two is that there's commitment, and then there's attachment. And they're two separate things. What if you could be committed to something and how you show up every day is aligned with that? And yet you're unattached, or if the universe says yes. Now, that's a powerful place to stand.



Yeah. And that's something that, you know, I'm a physical therapist. So as a physical therapist, you know, I often tell younger therapists that you can't detach yourself to the outcomes of your patient. So you can't be judging your success as a therapist, wholly on the outcomes of your patients. Because sometimes people improve, and sometimes they don't, which may be wholly out of your control. But you have to show up and do the best you can based on the evidence that you have. So kind of the same line of thinking great.



It's a really good example. And I heard an expression recently that I decided to steal because it spoke so well to this. You know, a friend of mine said, Oh, well, it sounds like you're moving the ball further down the field. And I was like, I love that. Because that I can control. I can't control the goal. I can't control what other people say or do. I can't control if I make the sale. But I can move the ball further down the field, I can position it in the best possible way. And I can own Don't ask 500 or 1000 people. If, if, if they want to buy what I have. Recently, I decided to Oh, it's happening in acting all the time. Now, if I was attached to getting a yes to every audition, I'd have to give up after two days. Totally. But the way I'm reframing it for myself is those auditions are my performance that is my acting. And so I'm submitting to 100 plus things a week around the country, and most of them I know I'll never hear back from but I'm playing the long game. I'm playing the law of large numbers. And in the last eight months, I've had a yes to playing the lead in a local paid production of Dracula. I got a yes to doing two commercials that I got paid for six short films for them free to have them paid. Now I had to do a lot of auditioning and submitting because I don't have a lot of experience. And so some of its luck, is keep going until someone says oh, I like the look of you. Let's get that guy in. And when Jack Canfield came to my live event, he got up there and he spoke about the law of large numbers. You need to ask enough people now sure you ask 1000 people you get to know there's something about how you're asking. But don't give up after five or 10 or 50 100. Don't be like that kid in the playground. Say hey, do you want to ride on my tricycle? No. Okay. Hey, do you want to ride on my tricycle? No. Okay. Hey, do you want to ride on my tricycle? Be you that's what the books about like, express yourself. Express your desires. I think at some point someone's gonna be like, Oh, that sounds pretty cool. Yeah, I'll do it in you're like what? Really? I didn't think I get a yes. And then the next time you won't be as surprised and you are you'll hide the shock better.



Yeah, at some point that key fits the lock, right. And I also love kind of that concept of moving the ball down the field a little bit at a time. And I know for myself, I have always been like, well, it needs to happen. If it's not happening now, then it's never gonna happen. Or if it's not happening, the timeline, I perceive something to happen, then that means Oh, well, it's not going to happen. It's not for me, and I used to kind of tend to give up a little too easily. But now, I have come to the realization that, like you said, if you move the ball down the field a little bit at a time that it doesn't have to happen all at once. But as long as you're making forward progress, and you're working towards the goal, it'll happen. Because let's be honest, we're living in a now everything has to happen quickly, this social media, quick, quick, quick decisions. And if it doesn't, then we're losers.



And that's a problem for people who want to be successful. Because if there are any good rewards to doing something, let's suppose you're going to start a big business selling widgets. If there are any good rewards for their business, it's not going to be easy to do. Because if it's easy, then the first three people into the market are going to take all those rewards and, and it's going to be flooded by people doing the easy thing. And there'll be less rewards, the rewards are gone. Seth Godin wrote a wonderful book on this called the dip. And if you're not prepared for any kind of a dip, it might be hard to get any good rewards. Now, don't go overboard, you might not decide on brain surgery as a career. Because that's, that's a really big dip. But if you want to start a business, or go and get a better job, or switch careers, or find a life partner or something like that some of those things are going to have a dip to them. And it's good to just know that going in and say, All right, roughly, how long are we looking at? Like, if you're going to start any new business, if you do it well, and work hard, you're probably looking at at least three years to turn the corner and make a profit. Now, know that going in? And then have someone to remind you, when things look bleak, yeah, this is gonna take some time, you gotta keep going at it. I've been doing podcast interviews for three years now. I think I've done 300 interviews. And I think I might only just be starting to get some some traction and to get get known. And people like, oh, yeah, that guy from that, you know, from mouse in the room. And now I'm about to launch a book. And, you know, I'll do six months of beating the bushes, just Yes, a few days ago, I said, decided to reach out to my colleagues and thought leaders and influences. Some of those people are never going to get back to me. They're not even going to respond and give me the time of day because they're busy, or I'm not big enough on the totem pole. That takes something to reach out to all those people. I got to screw up my courage and be willing to be uncomfortable, and then put it out there. And then be surprised by who says yes. And who says no.



Yeah. And as we're talking about courage, are there times when maybe you shouldn't be following your courage? When are the times that that you say, hey, well, let's pull back for a second?



Great question. When I was growing up, and I realized I didn't like feeling small. I started leaning into my fears, and is a name for it. Apparently, it's so counter phobic. So if you're afraid of something, you lean into it, and that's my style. And that produced a lot of benefits and rewards and a lot of growth. But I didn't know when to say when I didn't know how far was too far. And you can traumatize yourself, you can burn out, you can push yourself too far. I would go into paragliding and hang gliding because I was afraid of heights. And I've had a couple of accidents and even had a slight compression fracture in my spine. Doing a couple of things that were out there. I was afraid of abandonment. So I thought well, let me see what open relationships is like in dating more than one person at once and see if I can conquer this fear. I found that I have limits my nervous system or my psyche has limits that I need to respect and be humble about. So I think it's about finding your sweet spot. You don't want to stay in the comfort zone your whole life it gets very uncomfortable over time. You need to find your edge but don't go way past it to the point where you might be like, you know killing yourself in a motorcycle accident or doing something completely reckless are going on national TV to speak if you haven't even spoken yet, like find your edge. There's a sweet spot for each person. Here's a wonderful exercise It's very practical, you grab a piece of paper, and right at the top of it, if I was fearless, the big capital I f, if I was fearless, what would I do? And you're gonna have one page for business and work. This is what I do. This is who I asked, this is what I go for I do a TED talk, I get to blah, blah, blah, blah, and then another page for personal. This might be what I'd say to my partner. This is what I might say to my kids, this is what I might ask for. This is what I might do, I might move to Brazil, I might go cross country and move to Los Angeles to start acting like whatever it is for you. Start writing things down knowing that you don't have to do anything on those pieces of paper. That's important. Because otherwise your mind might hide these things from you. You just want to find out what would be edgy. And then you don't have to do any of it. But you might like to circle two or three things that would be in the right at that edge like yep, that would be uncomfortable. And I think I'd feel proud that I did it. Do those, you can start with those and work your way up to the biggest stuff. Or if you like me do the scariest one first. And everything else is easier after that.



Right? Oh, that's a great exercise. I have it written down here. So I am going to do it. And it's almost like a way to open up your mind to more possibilities. Maybe things that you you you didn't think that didn't think you could ever even imagine doing but I like that you said listen, you don't have to do it. But let's write some stuff down. Just see what comes out of your mind. Because you never know. We start



with awareness. And it's the same with mouse naming with mouse in the room. You want to become aware of your mice? What are what is going on in your body? What are the confessions that might be looking? What are the desires that haven't been named? The tolerations. The appreciations, you want to become aware of these? Now you have a choice? Am I gonna name it? Well, let me go through the paint by numbers system in the book and oh, okay, yeah, I could do that. And then you're gonna name that mouse, there might be another one. You, you weigh it up, and you're like, alright, I can see the upside. There's also a downside. Like, if you committed a crime, you might be prosecuted, you might be arrested, you could do jail time, your if you if you cheated on your partner, and you decide to go and name a confession mouse, it could be consequences. So it's not for the faint of heart to tell your truth. And you don't have to name all of them. But the book will help you weigh it up and go, Alright, here's the upside. Here's the downside. And here's the downside. If I never seen anything, that's often what we don't address. And so then you can factor it and go, Alright, I think I'm just going to call call this person, we're going to have a chat about it. And we'll see what comes out of it. Even if it doesn't go well. Does that mean it was the wrong move? Just because the first round didn't go well? No. Maybe they need to have their reaction. And then you felt uncomfortable, and you have a bit of space? And then you might say, Hey, can I have a round two? I feel like I could have listened better. And I'd really like to work this out with you. Let's have another one. And then maybe you surprise yourself and you're like, Wow, I feel really close to that person. Now, if you really connected now we've got a great working relationship. Now for closer to my kid. Now I feel lighter. Because I'm being me in the world. That's what I want for people.



And can you give an example of maybe a mouse or two that you've named for yourself? Just so people have a better idea of like, what is he talking about? When you say saying name name, these mice are named this mouse? So can you give an example or two of maybe a mouse that you've named for yourself?



I'll give you an example of one from last night that I wish I had named earlier. And I kept it to myself for too long. I had a poker game, had some friends over and at one stage someone else arrived to the game and there's so much commotion and people getting up and noise and whatever. I got anxious. I had a panic feeling. And so, but I didn't say anything. I just tried to deal with it. I went outside I calmed down a little bit on my own. And then I had the resources to say hey, yeah, I got really activated. And I think I'm okay now but I could have said that in the moment. I said wow, really activate I'm gonna go outside for a little bit with someone come out with me. I could have said that. But I was a little bit too triggered to do it. That's, that's um that's what I would call a maybe a medium sized mouse. was pretty big in the moment effect in the moment was huge. We call them rodents of unusual size. For any Princess Bride fan.



I was just gonna say the RT R O SS. R Us is yes,



yeah, I'm just gonna restart my video because it went all fuzzy for a second. Then there were, you know, bigger ones that might have stayed with you for years, you might have had them for a long time, I was asked by one of my coaches to make a list of anyone I wouldn't want to pass on the street. Anyone I'd feel uncomfortable seeing or anyone I, I still harbored resentment for. And initially, I'm like, oh, there's no one. But as we dug in, you know, over time, I came up with a few people, and one of them was a bully from high school, like 20 years earlier, who had just really not treated me well and made fun of me. And we used to be friends. And the coach said, All right, call him. You know, we didn't have the terminology, name that mouse. But the coach was like, call him and clear it up. And I said, Hell, no. I'm not gonna call this guy after 20 years, he's gonna think I'm an idiot. And she said, and I'm going to translate it to this language. He said, basically, well, that's another mouse. So start with that. And I was like, oh, okay, I could do that. So I tracked down his number, and I called him and I said, I'm so worried you're gonna think I'm a complete idiot for calling you about this after 20 years? And he got curious. He said, Oh, well, what is it? What do you got? What's going on? I said, you always pushed me around and one off to me, and I tried to one up you, but you were better at it. And I really resented you, and I'm letting it go. You don't have to do anything. I just thought I'd let you know. And he said, the most mind blowing thing. This was the jerk. Like for 20 years, I'd been treating him as a jerk in my head. He said, Well, what could I say or do now to help you or us move forward? It just blew my mind. And if I can call him and call the girl who dumped me twice in high school, and call the guy who ran the company that I sued, to see if there are any ill feelings, and cold the person that I committed a crime against when I was younger, and I could have been prosecuted by saying, hey, it was me. And I'm sorry, can I make it right? I've done that twice. Actually, if I can do that, then just consider what could you do? It might be uncomfortable. And you don't have to do it without the paint by number system we outlined in the book that'll make it so much easier for you. But there are really beautiful things on the other side of that discomfort.



Right, so So these, these mice are the mouse that you name is just sort of this discomfort or this uneasy feeling that you've been harboring about topic XYZ or person XYZ, you naming it so that you can confront it and move past it.



Yeah, that might be a there might be a healing for me involved. Maybe the other person's got something going on it that you don't even know. I had my my brother was getting coached. And they gave him homework to call somebody and name a mouse. And he couldn't think of anyone and the coach. And the coach said to him, it doesn't matter how small it is just trust in the homework, go and do it. So he called a girl that he broken up with a year earlier, and said, Look, I just I don't know if you made it mean anything about you. But I want you to know, that was everything about me. I was not in a space to be in a relationship. And I really think you're awesome. And just in case you were thinking anything else. I wanted to let you know. And he said the impact on her was unbelievable. She started crying. And she said she'd been thinking that she was a loser because of that whole thing. And he came back to me and said, Look, I got no money. But that call was worth $10,000 to me. This and he was like 22 at the time. He's like that call was just unbelievable. So the upside of sharing your truth in an artful, ideally blameless way can be extraordinary. Everyone wants to be human. They want to be human and they want to open their heart That's my belief. That's my story. Now it's not going to happen every time you talk with people but even that boss that I called where i i sent a letter of demand and was threatening a lawsuit. We got chatting and he said all look back at the time. It didn't feel very good. I didn't Like, depart with the money, but that's water under the bridge. And I said, Well, how you doing? He told me we never had a personal conversation. He told me about his divorce and what was going on, I felt so close to that guy, I hung up the phone feel like we're buds now, all of it because I just called to say, is there any hard feelings from them? I'm hoping, hoping not. So it's it's a gateway courage in general. And I think particularly courage about the things where we have a bit of charge can be a gateway to connection, confidence, and being the badass leader that people want to follow.



I love it. And where can people find the book gets out today, which is again, yeah, June 13. In case you're listening to this on the 14th, through the 15th, or whenever,



or whenever, whenever, yeah, go to mouse in the And there'll be a link there for you to go to Amazon and get your book, we've got a special going. Special going, we're going to do the Kindle for like something crazy, like 99 cents, because we want to just do a best seller campaign. And so you could get the book for almost nothing, or pay for the you know, pay the 1295 or whatever, whatever for the book. But we'd love you to support the best seller campaign. And the way you can do that is get the book posted on social media that you got the book because it's good idea to have your friends naming mice with you. It's hard to do in isolation. But if your friends and the people around you are like, oh, yeah, this is what can I name a mouse with you? Oh, you got a mouse to name with me? Yeah, shoot. That's what I want for the world. And if you think it deserves a five star review, please leave one because that's what will help us climb in the rankings and hit that lovely bestseller title, which is really just an excuse to bring people together for a party.



Absolutely. And if people want to get in touch with you, if they have questions, maybe they want to work with you. They want to know how you know where you are in life, where can they find you?



Yeah, there's a contact form on my website. So mouse in the, might even redirect you to my other website. But then you'll be able to see contact form, you can request coaching from me, I usually get on the phone with people and we see if, if we're a fit. And if it makes sense. If you're interested in mouse naming for your team, or your company, I'm particularly interested in that because we can start shifting the culture and have people sharing their desires and actually not letting things fester. I think it's wonderful for team building. And so you can reach out through the contact form about corporate trainings, or team team trainings.



Perfect. And before we wrap things up, is there anything that maybe we missed or that you want to really leave the listeners with?



You're already doing things, right? You got this far, you don't need fixing. And there can be a lot more connection in the world for each of us. And I found if you can just go through some of those scary places of discomfort and just screw up some courage. There are some beautiful things waiting on the other side. And I will, I could almost promise you that on your deathbed. You're not going to go I should have stayed quiet. You're going to say I'm glad I read that book. And I'm glad I spoke up my truth more and more often. And I went in that direction. That's how to live. We don't want to watch movies about people hiding their truth and staying small. We want to watch movies about people being themselves in the world. And that's what I want for the world. I think this is what can really heal the planet is people being more of themselves.



Awesome. And last question I asked everyone and that's knowing where you are today in your life and in your career. What advice would you give to your younger self?



At times, it's gonna get very hard. It might get so hard that you don't know if you're gonna make it. But you do you know, even because it's even though it seems like you just can't make it. You're stronger than you think. And you will find something new, you will learn a new way to cope. And then you'll go on and the universe is going to bring you something else. But try to remember when you're in the middle of it. Okay, it feels like life and death, but usually it isn't.



I love it. That is great advice. David, thank you so much for coming on to the podcast. I really appreciate it and again, everyone run out, get the book, get it on a Kindle, get it in and something in your hands if you can as well. The book is out today the mouse in the room. David, thank you so much for coming on.



Sure. I'd also say read it to your kids. You want your kids naming mice, you want to name mice with your kids. So, we didn't talk about parenting, but I think it's very as a chapter on on mouse naming for parents. So, thank you. I am excited and I appreciate the chance to talk about it.



Pleasure and everyone. Thanks so much for taking the time to listen. Get out there, start naming your mice and have and stay healthy, wealthy and smart.

May 30, 2022

In this episode, President and CEO of Sports and Spine Physical Therapy, Inc., Leon Anderson III, PT, MOMT, talks about AAPT.

Today, Leon talks about the history of AAPT, working with his father, and AAPT’s networking opportunities.

Hear about AAPT’s mission, encouraging minority students, and clinical research related to health conditions found within minority communities, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “We are still less than 3% of the profession.”
  • “If you can expose a child and broaden their horizons, it gives them more options of what they can do and what they can be when they’re older.”
  • “Just being associated with this network affords you such a wide array of opportunities and possibilities.”
  • “We’re all connected, and we all need one another at some point.”
  • “You won’t know what hits you until it hits you.”


More about Leon Anderson

Leon R. Anderson III, is a native of Cleveland, Ohio. He graduated from The Ohio State University Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was as a Systems Analyst/Summer Intern for his fathers company Centers for Rehabilitation, Inc. There he discovered a passion for patient care. Subsequently, he pursued a degree in Physical Therapy at the University of Connecticut. After graduating, Leon was selected for a two year manual therapy residency program earning a masters degree in Orthopedic Manual Therapy from the Ola Grimsby Institute.


Leon is president and CEO of Sports and Spine Physical Therapy, Inc. (SSPT) The company operates three clinics in the greater Cleveland area and one in Charlotte, NC. Leon was inspired by his pioneering father Leon Anderson Jr. who was considered a vanguard of the profession for over 40 years. SSPT’s company culture and core values of providing high quality rehabilitation services are a direct result of Leon’s life long tutelage by his father.


Leon is a charter member of the American Academy of Physical Therapy. He served as a Subject Matter Expert for the American Physical Therapy Association's Orthopedic Clinical Specialist Exam. He also served as an on-site reviewer of the Commission on Accreditation in Physical Therapy Education. (The accreditation agency for entry-level physical therapist and physical therapist assistant programs in the US and UK).


Suggested Keywords

Healthy, Wealthy, Smart, AAPT, Healthcare, Impact, Research, Opportunities, Mentorship, Equality, Connections, Education,


To learn more, follow Leon at:



Twitter:            @LA3OSUCONN

Instagram:       @osuconn


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



Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found chosen and get those five star reviews. Right now if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic whim. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net forward slash Li TZY to sign up for your complimentary marketing audit today. Now on to today's episode Dr. Jenna cantor. Cantor is back and being the host with the most for this episode. And we are happy to welcome Leon Anderson the third he is a native of Cleveland, Ohio. He graduated from The Ohio State University's Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was a systems analyst summer intern for his father's company centers for rehabilitation. There he discovered a passion for patient care. Subsequently, he pursued a degree in physical therapy at the University of Connecticut. After graduating, he was selected for a two year manual therapy residency program earning a master's degree in orthopedic manual therapy from the OLA Grimsby Institute. Leon is President and CEO of sports and spine physical therapy. The company operates three clinics in the Greater Cleveland area and one in Charlotte, North Carolina. He was inspired by his pioneering father, Leon Anderson Jr, who was considered a vanguard of the profession for over 40 years. SSP tees company, culture and core values of providing high quality rehabilitation services are a direct result of Leon's lifelong tutelage by his father. He is a charter member of the American Academy of physical therapy. He serves as a subject matter expert for the American Physical Therapy Association's orthopedic clinical specialists specialist exam. He also serves as an onsite reviewer of the Commission on Accreditation, physical therapy, education. So today, they talk about a PT so the history of AAPT networking opportunities and how that branch of our profession that organization within our profession profession came about so big thank you to Leon and Jenna and everyone enjoyed today's episode.



Hello, Jenna Cantor here with healthy, wealthy and smart I am super excited and honored to be here with the Leon Anderson, who is a major leader in the physical therapy community. He is the president and CEO of sports and spine physical therapy and is also a charter member of AAA, PT, the American Academy of physical therapy. Thank you so much for agreeing to come on Leon.



Welcome. It's good to be here. Thank you, Jennifer offering this opportunity.



Oh my gosh, I've just And it's funny, right people, we still we came on, I learned that you were just in Barbados, and you have a bunch of patients there and you were vacationing, that's incredible, you are living a life. There's so many opportunities and you're living that right now. I love it.



Absolutely. There are opportunities all across the world when it comes to physiotherapy. It's known as physiotherapy in most parts of the world, and physical therapy here in the United States. But just in the islands, you know, there's just a huge huge opportunity to bring the kinds of things that we do here to that particular population, because of the all the different technologies and nuances and things that we have, you know, that we have here. So, I was in addition to enjoying the beach in the sand, I was also enjoying given our advice on how to become a more functional individual, and whatever Island or whatever society or community that you live in.



I love that. Thank you. Thank you for your service series. That's incredible. I love that. I wanted to bring you on today to actually talk about a PT specifically talk about the history how it became to be in everything So I would love to just start with your perspective specifically, and how it came into your life.



Well, I grew up with, you can say occupational inheritance. My father was the 16th person in Ohio to be licensed as a physical therapist. He was a vanguard in our profession. He held many, many, I guess positions, if you would say, locally, nationally, even internationally, he was one of the first African Americans to be on the board of directors for the AAPT. In fact, there is a, a room at our headquarters in Alexandria. That is the Black Heritage Room, and it's named after my father and one of his protegees, who's also my mentor, the late Dr. Linda Woodruff, who was just an amazing, amazing mentor, and my father, Leon Anderson, Jr. and since I'm the third, but if you rewind back to when he got started, a PT that started mainly the the PTS of color that were involved in the APTA just didn't feel that their needs were being met, you know, as it relates to our communities. And so there are a couple of different little groups, like blacks interested in physical therapy or charm, I can't remember right now exactly what the term acronym is, maybe I'll think about that. But there are different groups that they would meet at the eight PTA annual conferences. And at some point, I think it was 1989. It was at 1989. In September, in Chicago, about 90 individuals met and I was actually a student, myself, and also donna, donna, it was not a fun doll, then. Now it was done in green Howard, that we were both students at the time. And now these individuals got together and they decided they wanted to do something that was going to be specific for the African American community and meet the needs of those communities that are disadvantaged and poor. And so that's where, you know, it was born out of and we have so many, I mean, just a plethora of talented African American PTS, in academia, in private practice, in the hospital setting, and, you know, in the military, just in all of the different different settings, and very accomplished, very accomplished ones also, I mean, it's just amazing. The BB Clemens, the, I mean, the mayor McLeod's, the Robert Babs, there's just so many that so many people who, who contributed so much to this organization early on, and we've done just many, many, many things to help students and then help our community. So that's, you know, in I hate the Babylon, but that is a kind of how we were born born out of a need, that needs weren't being met by the large the large organization, the APTA.



Oh, my gosh, this is a nerdy question. Okay. The meeting was in Chicago, was it over pizza? You know,



believe it or not see. So once again, we have such an accomplished set of founders. It was at like a, a Hilton, or a Sheraton, a Sheraton Hotel, where we all met. And, you know, they used Robert's Rules of orders, it was extremely, extremely organized. But remember, for years prior, there were these little interest groups that would meet over pizza and over coffee and over tea and you know, different things for many years, at the different organizational meetings, whether it be the annual meeting, or the combined section, or what have you. So at that meeting, we actually they actually established, you know, a skeleton of what our current bylaws are for the AAPT right now, so it was a very, very, very industrial meeting. And productive meeting over that weekend back in September 1989.



Wow, that is so cool. I love it. It really was from the ground up. It just organically. It happened so organically. And it was a major need and it just grew. I love that. That is so cool. And your legacy. Oh, you probably carry it. That was so much pride. I love that for you with getting involved. So your dad's involved. Did you feel pressure at the beginning? Like how did that happen? Because your dad is just so prestigious? And is it doing so many things for the profession? How was that for you?



Well, believe it or not, my first degree is actually in computer science at a computer science degree from The Ohio State University. And what I found was that by my junior year I was doing some statistics statistical analysis where my father during the summertime didn't do my summer off. And I was at a, a facility for the mentally and physically challenged. And while I was, you know, doing fixing the computers and trying to network computers and things, I also was a transportation aide. And I will transfer the patients from their cottages, to the main Physical Therapy Center. And I found that I fell in love with patient care. Although I'm the nerdy, mathematical computer guy and logical guy in my head, I found it to be extremely satisfaction, I found a lot of satisfaction, I should say, in interacting with these patients. And that's why I fell in love with this therapy, my junior year when I was at Ohio State. So I decided I wasn't going to just throw those three years away, I went ahead and finished out my, my, my career there ha state. And luckily, because my parents said they were not going to pay for a second education, I had to do it on my own. Luckily, I got a scholarship and academic and leadership scholarship because I went to our house State, I was on a board of this organization, students together against apartheid. And I was a peer counselor, I won the black leadership award my senior year. So with those along with my GPA, I was eligible for a scholarship. And I ended up at University of Connecticut, you know, on scholarship, so that worked out great, I wouldn't say that I felt pressure, it's my father just wanted to always want me to do whatever I was I was good at and, and to be happy, and to whatever I did wanted me to be the best at what I did, and to strive for excellence. But once again, I fell in love with patient care that that that summer 19, I think was 1985. And I really haven't looked back,



I want to get into the mission statement of a PT, I'm going to read them in sections because so that way it can be discussed each part in more depth, although I think it's quite, quite easy to interpret. So the mission statement is the American Academy of physical therapy is a non not for profit organization whose mission is to provide relief to poor and disadvantaged African Americans and other minorities by and let's talk about this first one, promoting a new innovative programs in health promotion, health delivery systems and disease prevention. Would you mind just talking more on the importance of that?



Well, we just have so many different talented individuals who are in all these different aspects, whether it be neuro, whether it be neurotherapy, whether it be sports and mettam, sports, med Med, whether it be dealing with childhood, obesity, bottom line is, I think it was back in 2010 with the Department of Human Services, Office of Minority Health and Health Disparities disparities came out with all of their initiatives, and we partnered with them. And I think it was probably 20 or $30,000. Grant, but I'm not sure right now. But But the bottom line is, is we partnered with them, because we wanted to really make an impact in our community, as relates to the health care disparities. So whether it's talking about diabetes are having different hypertension, and different organizational would you call them community health fairs, or programs, we even had a program with the Patterson cow foundation that they supported for childhood obesity. Our goal is for our individual members in their communities to make an impact and partner with the organization at large and use us, you know, to help them make the impact in our community using our resources. And our net network.



Yeah, yeah. It's funny as talking right now, everything you're saying is great. My husband's musical theater and he's singing full out right now. So I just want to acknowledge it is what it is love him. And you know what life is a musical? Isn't that great? Next, encouraging minority students to pursue careers in allied health professions. Oh, can you talk about the need there?



And on that note, we'll take a quick break to hear from our sponsor and be right back. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's digital marketing solutions have the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration. Head over to net forward slash Li TZY to sign up for your complimentary marketing audit.



Also keeps me there, I think that we are still less than 3% of the profession. And the goal is to really expose the minority students to the profession as early as we can. So whether that means are different individuals, whether we're at one of our conferences, when we do some of the community outreach, or just someone in their own community, that's exposing individuals by going to health fairs going to speak at the local professional, and career career days, we've had so many opportunities. In fact, my wife and I, in conjunction with the American Academy of physical therapy, we ran a program called Let's Talk About program that did just that it really expose the kids to different professions until to improving their life skills and to becoming excellent and just empowering them to awaken the genius within them. And once again, that was one of those organizations that partnered with the APTA and use the 501 C three, until we got our own 501 C three, but then continue to partner with them. Because the goal is, if you can expose a child and broaden their horizons, it just gives them more options, on what they what they can do and what they can be when they get older. And it makes it makes perfect sense that if you can see yourself doing something, then or someone like you doing something, it increases the possibility that you have in your own mind that you can actually do it yourself. So when you look at Barack Obama, you have you have no idea how many, you know, kids right now can think to themselves that wow, Brock Obama was president I can be president or rob Tillman, or Leon Anderson, is, you know, high in an organization, doing things to help our community, I can do that same thing, I can make that particular impact. We've also had



visual affirmations, literally, yes,



we absolutely. We've also had many educational opportunities to help with our students. And just making sure that once you get into PT school, that you pass the exams, we used to hold many of the exam prep courts of the exam, prep organizations and courses around the country.



That's great. Yeah, it's all there's so much opportunity in this. It's a big one. It's a big one. And no, this speaks to any, any, anybody would like who is black, or in a minority, this speaks to you right away. Absolutely. And if you are wondering apps, yes, definitely reach out to AAPT. This is, this is part of their mission. Next, and finally is performing clinical research directly related to health conditions found within minority communities.



Same thing as as before, we encourage our, our members, and our constituents and our stakeholders, to engage with the professional organizations and do their poster research. And, you know, to really see, you know, what it is that our community needs, because most of the research that's done is just is or has been done historically, has been on the typical, you know, American, which may be a five, seven, you know, 40 year old white male. So the key is, we really want to make sure that we get data that lets us know, you know, what is the optimal amount of vitamin D, for a African American and living in the, you know, the Bible Belt, you know, that has this particular type of, of exercise level. There, this particular type of diet, you know, so, over the years, we've had many of those posters and the different organizations, annual conferences, and also in Chicago, Diane Adams, Saulsbury. And Vinod Rosebery, who's who's actually mayor now, they, in conjunction with the AAPT had a phenomenal he was a kid's fitness health club at an actual health club, and they were able to, to glean data on the health of our community, as relates to our kids and how they interact with an actual exercise routine. And a, a place to go that's safe, and also informative, and getting them to where they need to be. It was just it was just phenomenal. It was it was a phenomenal organization, and a phenomenal, healthy place to go.



I'm so grateful you have this research as part of your mission. I teach people how to treat dancers PTS PTAs. And we had a group discussion, one I, where we, we I pulled research and tried to find research on dancers, black dancers might be, where's that research black female dancers. And there was, there was one and it had clear bias. But it did show a little bit that there needed to be a lot more investigation. And, and then it just it was like crickets, it was crickets, when I was searching on PubMed, trying to find studies, specifically on minority bodies with that purpose for comparative data. And we didn't have in the little time I did to gather, we started talking about vitamin D, like you just mentioned, not from me knowing to bring it up. But from another black physical therapist in the room and other other black PCs in the room. Honestly, that became a topic. And it wasn't from research, it was was just from personal experience is and it's just, yeah, we need we need this information to do better for humans. so badly.



It's funny that you say that, Jenny, because one of my protegees it's interesting, because in when you talk about the academy, one of the one of the things that I think we're really, really famous for is it's an it's an N. It's been unofficial for many, many years. But we have a navigation program that helps not only students get into the profession, and get into school and stay in school, and then in addition to that, pass the exam, once you get into the to the profession, and how do you even navigate the profession. So when you mentioned the dancers, I immediately thought of one of my previous employer, employees and that one of my previous students, her name is Shane, I know I'm messing up her last name. And I think she's married now. So I'm really messing up her maiden name, but it's ojo, Fatima, I believe anyway, she is the she is definitely the TCS, the top physical therapist with the L Navy dance troupe. I think she might even be the medical director right now, I'm not going to be sure about about it. She's actually the medical director, I know that they really lean on her big, big time. But she's somebody who, you know, absolutely should be should be out front, not only giving you the information that you might need for your Google, you know, search. But once again, she's there to let that young girl or guy, you know, who's interested in dance, know that, you know, not only not only can you be involved in the performance arts as a dancer, but also as a medical or healthcare professional, or navigation program. So I think that she was a patient of I mean, a student of mine, at least 12 years ago, but our communication has never waned. We even talked as recently as last month, about her career, where careers going in and also getting other younger physical therapists and other parts of the country hooked up with her because as when they travel, they need to use local services, local physical therapy services, and whether that means, you know, a practice that they can come into while they're in that city or if there is a opportunity for an intern in a particular city where they are to come and spend some time with him. So our navigation program is so wide and it's so varied. When you look at just my career alone. I had my father I had Dr. Linda Woodruff. I had Rob Tillman. I had Robert Babs, I had at least 10 or 15, close mentors, role models, advisors, who could help me navigate where it is that I wanted to be, whether it's whether we're on Capitol Hill, doing some lobbying for physical therapy codes, whether I'm dealing with Ohio State University and their football team, or, or whether we're talking about trying to have a Howard University accredited exam. I remember I met with the president of Howard University because I was on the commission for accreditation for physical therapy, education. And I was there for an accredited accrediting visit. And now one of the people who's come in under our navigation, Vanessa LeBlanc, she is now a captive reviewer. So the reach is so wide and so long, that, you know, just being being associated with this network affords you such a wide array of opportunities and possibilities.



Absolutely. I'm just more than this navigation program. People might be perked up going, what is this? What is this? So I'm going to use some outsider terms on this. So yes, this is a mentorship program, but it's different. And it's really about when you connect with AAPT in court I'm where I'm mixing it up or saying it wrong. So when you connect with AAPT, anyone to a PT is they have a very large network of people with different expertise and you get forwarded to the right person. It's not just within the, the heads of the organization, because, I mean, everybody's doing this volunteer why so not? They can't, they can't, I'll take on everyone. But then from there, you go to this huge web, imagine like, Charlotte's beautimous beautiful web that's extremely expanded and connects you to all the multiple people that would advise you and take you through your journey to really accomplish a lot. It's very cool. And, and, and naturally expanding like you just said, with your your student, how you're now connecting her with students, you know, or people who could use her help. I think it's very, very cool thing that AAPT has going on. Did I explain that correctly?



I think so. I think he did a good a good summary job. Because it's not a instone program, what it is is right, right, exactly the way the way you the way you explained it was very, very, very good.



Yes, score. This AAPT has, has been around since 1989, as Leon was saying, and is an organization either, too, if you want to get involved, please reach out to them. Volunteers are always welcomed, there's plenty of opportunity, as you can hear from the mission statement. And, yeah, anything else you want to add on AAPT? A topic that I have potentially looked over because this is a big organ, this organization is a big deal. And I don't want to miss anything?



Well, no, I think you hit on the major things, I will say go to the website, if you have questions, then, you know, go ahead and submit them through the through the website. It's just a, an organization that I think is just very much relevant and needed to make sure that our community continues to be relevant, and get what get what it needs. That to keep us moving forward and moving in the right direction, because we're all connected. And we all need one another at some point, you never know when you're going to need need someone I remember, there was a member that was I would say he would come to the or to the meetings maybe every other year or something like that. I'll leave him nameless. But when he came, and he was actually being attacked by the State Board for a reason, that was not necessarily his fault. But because we had so many members that were involved in academia and also involved in the state boards that were able to help them out. But once again, you don't know what you need a lot of times until you need it. So just be involved, I would say it'd be involved in your, in all the associations that you can get that are professional associations, because you can glean information from from from everyone. Just because you're a member of AAPT doesn't mean you should not be a member of a PTA or any other healthcare or allied health organization that you think you're a possible stakeholder. And so yeah, I think that it just really makes sense to stay connected to the professional organizations because you won't know what hit you until it hits you. So what you want to do is stay ahead of the paddles, which is one of the terms that we use in our business, there's always a paddle coming after us at every every every point where there's legislation, or COVID It doesn't matter what it is. So the key is to be as prepared as you possibly can for each panels that come and if you can somehow anticipate what a panel you know might be booked for comps and by doing that you can be up on the current legislation you can be up on the current trends in the professor because we become about you know the current pitfalls you know, and then you're much more likely to be a successful individual and happy with your professor. I love it.



Thank you so much for coming on. I appreciate it and definitely to get connected with anyone AAPT like you said check go to that website. Thank you so much for coming on. We absolutely appreciate you Take care everyone.



And a big thank you to Jenna and Leon for a wonderful episode. And of course thank you to our sponsor Net Health. So again if you are looking to get your clinic found online, increase your reputation and your referrals then dead net house Digital Marketing Solutions has the tools you need to beat the competition get found get chosen get those five star reviews. If you sign up now for a free marketing audit digital marketing solutions from Net Health will buy lunch for your office head over to net forward slash li T zy to sign up for you a complimentary marketing audit today.



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