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.
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).
Healthy, Wealthy, Smart, AAPT, Healthcare, Impact, Research, Opportunities, Mentorship, Equality, Connections, Education,
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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 health.com 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?
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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 health.com forward slash li T zy to sign up for you a complimentary marketing audit today.
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In this episode, Associate Professor and Associate Chair at the Department of Physical Therapy at the University of Delaware, Prof Karin Grävare Silbernagel, talks about her research into tendonopathy.
Today, Karin talks about her historical perspective on tendonopathy, the future of tendonopathy research, and her presentation at the WCSPT. Is pain really worrisome?
Hear about tendon loading, chasing the shiny new objects, creating expectations with patients, treating different kinds of tendons, and get her valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
More about Karin Grävare Silbernagel
Karin Grävare Silbernagel PT, ATC, PhD is an Associate Professor and Associate Chair at the Department of Physical Therapy, University of Delaware, Newark, DE, USA.
She is a clinical scientist with a strong record of mentoring clinical scientists (primary advisor for 10 PhD student – completed, and 8 current PhD students). Her expertise is in orthopaedics and musculoskeletal injury with a focus on tendon and ligament injury.
She has been a physical therapist for over 30 years and performed research for over 20 years. At University of Delaware, she is the principal investigator of the Delaware Tendon Research Group and the Delaware ACL Research Group. Her work has been directly integrated into the clinical guidelines for treatment of patients with tendon injuries. She has presented her research at numerous conferences and published in peer-reviewed journals (100+ published articles to date). She has also been invited to speak about her research at conferences nationally and internationally.
As the principal investigator of Tendon Research Group at the University of Delaware, she is working to advance understanding of tendon injuries and repair so that tailored treatments can be developed.
The Delaware Tendon Research Group is an interdisciplinary team focused on improving treatment outcomes for tendon injuries. Her research approach is to evaluate tendon health and recovery by quantifying tendon composition, structure, and mechanical properties, as well as patients’ impairments and symptoms.
Her research is funded by the NIH, Foundation for Physical Therapy, Swedish Research Council for Sport Science, and Swedish Research Council.
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Tendonopathy, Pain, Injuries, Treatment, WCSPT, Education,
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Hi, Karen, welcome to the podcast. I'm so happy to have you on and really excited to talk about tendinopathy research and treatment and clinical application. Super excited.
Thank you. I'm equally excited to be here to talk about my favorite topic.
Yeah. And later on, we will talk about, we'll give a little sneak peek to everyone about your topic. At the fourth World Congress is sport physical therapy in Denmark happening August 26, and 27th. So for those of you who want that fun sneak peek, you'll have to wait until the end of the interview for that. Because what we're going to start with is, I really want to know, the historical perspective of tendinopathy research and how it's been translated into the clinic. So us, as we spoke, before we went on 18 years ago, you wrote your thesis. And so you've got a really great vantage point to look back on, what what tendinopathy research was, where we're at. And then later on, maybe we'll talk about where you see it going. But I'll just hand the mic over to you. So you can kind of give us that historical perspective.
Thank you. And I think that, as we spoke about, too, I feel like I'm getting older because more and more my historical perspective kind of comes in. But I think it's important when I started as a physical therapist, so I started clinically in 1990. And when I started, we had in my courses and things you know, talked about muscle, you talked about ligament injuries, and all these things. And then the tendon was just this rope that went in between the muscle and the bone. And that was kind of it. And then when I started practicing, and I worked in Baltimore, and we worked a lot with with baseball players and things, and everybody had tendinitis was super undisciplined ages, tendinitis, Achilles tendinitis. So everybody had this inflammation in the tendon that we never really talked about. So okay, I felt like I was no dummy. I learned medical terminology. So I know itis was inflammation. So obviously, they had inflammation in this tendon, because that was the name was. So I thought our treatments then really, were treating the word. So we were really trying to rest because it was acute inflammation. We tried ice we did I onto freezes and fauna, for races, and they weren't allowed to load and all these kinds of things. And surprisingly, hopefully, some patients got better anyway. But that really sparked my interest into tendon in general, like, what is this? And then later on in the 1990s, that came up more and more research, Korean and Spanish started thinking about, you know, Achilles tendon would hurt more maybe when they were loaded, ie centrically and running, so maybe we need to train that and people are starting more thinking about how do we exercise and mostly maybe the lower extremity, tendon tendinitis. And then we had more research looking at if there was inflammatory components in the tendon. So if you took out cells and things too, there wasn't actually an acute inflammation. So this idea is maybe wasn't true. And that really opened the door for if it's not an acute inflammation, what do we do? So then in the late 1990s, beyond the curve is in Standish, it was another researcher knees and we're Tolman that looked at concentric versus eccentric loading. And then Hogan offense on in Sweden to started to have patients that were waiting to get surgery and he started like, okay, we're really going to load them, you know, we got a heavy load them, because maybe that's what they need, if not an acute inflammation, and started to see people get better if you actually load in them instead of resting them. At the same time we did our I started my PhD things, too, we started looking at, okay, should it be more overload, and we used our pain monitoring model versus the standard treatment that was, you know, circulation exercises, bilateral up and down, but not really trying to load it heavy. And what we started to see those exercise program that loaded more had better effect than the more like generic, protective things kind of things, too. So that's really when things started to change. Right. So I think the historical perspective is we didn't do anything. And we started to do things. And we had these huge jump in outcomes, which is brilliant. And our studies then was, you know, we were looking more at, you know, the Sylvan angle protocol, comprehensive, we use pain monitoring model to guide but also the loading and the exercises to kind of low beyond and not be worried about the pain because if the pain wasn't acute inflammation, maybe wasn't so worrisome, and loading the tendon was painful, but that was also the treatment. So we needed something to kind of understand how much could you really load. So we started with this exercises and being able to load and having kind of achieved this kind of change. I think that was really the the ultimate thing that happened in the late night. 90s, early 2000 And it was the combination of Korean and Spanish hooking out for some did we had programs and kind of moving that forward.
And there's something that you said in that? Well, a lot of what you said in there that I just want to pull out if we can. So, one thing that you just said is, is pain worrisome? And I think that's a really, really provocative question. Because if you ask the person living with the pain, yeah. And so how, as the therapist, if we're treating someone with a tendinopathy, let's say it's an Achilles tendinopathy, and the treatment induces pain, how do we communicate to the patient? That it's not as worrisome as you think it is?
Yeah, thank you for that question. And I think that's why the pain monitoring model that we've had, and really the pain monitoring model started with roll on to me who was my advisor, in patellofemoral. Pain, and that's when we applied it. And I think from the patellofemoral, pain, we kind of seen the same path, right? Just resting, it doesn't help you need to get strong. And then we will the tendons seems to be the same thing. And I think the pain monitoring model has been a lot of discussion is, you know, we go up to five is okay, and those things, to tell you the truth, I really don't care if it's five, or four, or whatever, I think it's that communication to the patient and communication that waiting for this pain to become zero, if that's the goal. And what I say to everybody was my lecture, and you might have heard that too, I'm like, Well, if that's the goal, I can tell the patient come in here, lie down on my nice little plants here in the office, you lie there, and I'm gonna go get a cup of coffee. And when I come back, you don't have any pain. So I've treated your pain, right. So I kind of start, I think, with the education. So the point is, if you just want zero pain, don't do anything. But that's really not what you want, you want to be able to move. So if you want to be able to move, you also need to get this tissue to tolerate more loading. And in order to do that, we actually need to load it. So we recover. So I spent a lot of time kind of explaining talking about this thing, so that there might be some pain when we're loading it, or without load, you're not getting anywhere. And what happened to a lot of people, they had some pain, the rest of it did last and they tried to do something a pain and they just D decline. And I talk a lot about hardening your tissues, right? This is loading, hardening of tissues. So the conversation is my goal with treatment is to increase the tolerance of your tissue over time, while keeping your pain level the same. So that's kind of the thing. So so your pain level, I'm fine with that you're not going to rupture, which is good thing to say for Achilles tendon rupture. That's like the big catastrophe. If that's not an issue, then we can follow it to and then we have the discussion. You know, above five, it's not good, or I don't know, you've seen Twitter, sometimes Twitter, that I use five, right? And I, I really don't care. I think the point is, there is a point of pain when pain goes from, it's uncomfortable to Ouch, I don't want it to be Ouch, I want it to be in five seems to be around in that round, right? And people can understand the difference in that. And it's, you know, you have the other conversation with the people that says, But I have really high pain tolerance. So this might not work for me. Well, you know, it's subjective. So I always tell them absolutely works even better for people like you. So, you know, sometimes maybe I'm a little silly, but that's. So I think that's kind of the point of really using it. So for me, the pain monitoring model is a way for discussing it and then using it. Some people feel like it's focusing too much on the pain, I actually think is does the opposite, right? Because it removes the worry. So I'm going to put a number on it. And it's just a number and everything else. And then we use training diary. So I use training diaries, you write down, you know, morning pain, worst, lowest everything else that you do. And then if I have three or four weeks, we can start comparing, and then people actually start seeing the numbers change with the activity, or the number stays the same. So I'm using it more of a of a descriptor, because if you just ask somebody you have pain, it's like they're gonna ask them what they did earlier. Right? And none of us remember, we don't remember how much pain was when we not painful. And so that's kind of how we using it in my description.
Yeah, I think thank you for that. I think that's great. And that also kind of answered my next question is how much load? How much can you load? How much load isn't? Is is enough? How much is too much? And I think you kind of answered that within that. But you want to expand on that a little bit or I feel Yeah, so I think
I think that's within the pain monitoring model too. Right? We're looking at that. But then you also have knowledge based on how the cells responds how the tendon response and I think that's where the next thing in the history perspective is now we're starting to see you know, which protocol is better. So now they're comparing Silvernail and offer zones or East centric loading, and it's all these. And really when you compare them, it's not that big of a difference. Right? The heavy slow resistance. I just say that you know who canal for some was in northern Sweden, he trained twice a day. I'm from Gothenburg and middle, we do once a day. And then you go down to Denmark, they did the three times a week for heavy slow, right? So Danish people are lazier than you know. But I think the point is, when you're looking at the data, actually, the outcomes are not that difference. You know, there might be some, you know, we can always argue that we're more satisfied with this. But when you're looking at the mechanical properties and things, you don't see that big of a difference anymore. And I think because I think you reached a saturation point, right? We've done no loading to loading now everybody does good. And I think for us as PTS now we're trying to manipulate more and more in that little realm, that for everybody, we might not see it when we do big studies comparing one group to the other, because I think we need to talk about individualized instead of precision rehabilitation and things too. So I think kind of that's where we're getting at. And they've been great studies coming on from unstuffy Agha Gordon Denmark from her thesis looking at moderate versus heavy and patellar tendon. And so I think that for the loading, you need to load them, you need to use the pain monitoring model, we need to do the progressive loading. But I as a PT would less worry about if I if you did two sets too little or five pounds to less, I think that's less of an issue.
Yeah. And when you said individual, I actually just wrote that down individualized care as you were speaking, because if all of the different protocols have basically the same outcome, then does it come down to what can the patient do, given the constraints of their life? Or their schedule? Or you know, their job? So do you have someone who can do something three times a day? Or do you have does this person might do better three times a week with heavy slow resistance, or, you know, it really depends on what the patient can do. Because the best protocol, I would assume is the one that patient is compliant with.
And I think you and I have been around way too long for this too, right? So because, you know, when you started, when you were at least when I started when I was young, right? You were so excited for every exercise. So I guess kept on adding to my poor patients like removing something No, no, that's a really good exercise. And you're adding. And what I'm getting to is that if I can get you to do something consistent with two or three exercises, I'm much better off giving you two or three exercises that you do consistently, than trying to think that I'm going to give you a ton of things. And I have patients now that are you know, they they come back, they come back every four or five weeks and see me or they send me an email and they do their exercise, because I told them to do for Achilles like bilateral three sets of 15. And then do unilateral three sets of 15. And do that for your rest of your life. Like you're brushing your teeth, and I'm like, you could probably go down to doing them less, or you can do heavier in the gym. And some people don't go to the gym, they don't want to do that. So you kind of modify it to kind of get some of the exercises there too. So I think that I think the biggest key is that you need to load you need to do things. And then instead of getting too hyped up for all the specifics, I think that's really where we're moving forward. And I had I had a lady that you know, recently with insertional tendinopathy that had been to the doctor been to all these other clinics, and there's thrown all these things on or didn't get better. And then it was massaging it. And it was like dry needling and the instrument assisted and those kinds of things to me, she was just getting worse. And I'm like, Well, I just think you should do these three exercises once a day. And she's doing and she's like, I'm walking. I'm not limping, you know. So sometimes in our eagerness to do good, I think we get a little crazy.
Yeah, and that brings me to the next thing I wanted to talk about. And it's sort of the shiny new object syndrome that a lot of people will get. And we spoke a little bit about this before going on the air. And I said a lot of it is sort of the theatrics around different kinds of shiny new objects. So how how would you address that to say younger clinicians? In you know, obviously talking about tendinopathy
Yeah, so I think that that one thing and it's still hard, I mean, I teach Doctor physical therapy students and then they go out and they completely forgot what I said. Right? So I think there's certain things everybody wants to go to clinical course and learn something more hands on and something more specific but I think that to me, the attitude is what we really try to teach them is like what tissue is that? How does that tissue respond right? To start understanding the underlying mechanisms because then you have then you have an understanding to build the other thing on instead of not having the understanding and just thinking that you doing things and then then you might be changing the shiny objects without thinking about the mechanism. So I'm very much a mechanism person in to try to think about why would we do it, but you all No need to realize that just putting the hand on somebody is very, very strong treatment effect. That's not, that's the same as listening to somebody and paying attention. And I have a colleague Now Greg Hicks has done finishing a trial looking at strengthening specifically for low back and an older in the control group who got hot, hot pack and massage as the placebo control. And they did really well too, right. So even we have mechanism, we should not be afraid of doing things that might help the patient in that sense. But we the explanations and things for what you're doing, you got to be really careful for right. And I think that I have a great effect on my patients, because I think I have a good program. We know what we're doing. I know it works. But I'm also not under estimating that if you can Google me, you're going to get better just by coming seeing me because he's going to assume that at least I know what I'm doing. So, you know, I utilize that effect too. So you just need to thinking about what we're doing. And I'm very scared of chasing the shiny objects for the wrong reason, because maybe that shiny object would be really good for a specific reason. And if we throw it on everything, we've lost, what is good for?
Yeah, if you beat me to it, I was just gonna say also people probably come to you knowing your background, and the work that you do. So they're coming in, like primed, like, this is she is the expert, I'm in the right hands. I know, this is gonna, you know, this is a person who's going to help me and that's a huge part of the rehab process is that trust that you have in the practitioner and that therapeutic relationship, but it also sounds like you're giving realistic expectations, and describing realistic expectations to your patients, which, again, takes time. And I know a lot of therapists like why only have a half an hour with them, how can I how can I spend 15 or 20 minutes talking to them? So what would you say to that kind of a comment?
Yeah, and I think that's another thing that happens over the years. Like, I feel like I do less and talk more, but that might be just my personality, too. But, but I think that that's without that understanding, when you start that therapeutic alliance or understanding why you're, as you're doing, you're not going to get anywhere. And patients and especially patients with tendon injuries and tendinopathies. I mean, it takes six months to a year, I tell them that right away, it takes six months a year, you can do what I say, I'm pretty sure you're gonna get really well, you might not be 100%, I'm gonna get you definitely to 80 or 90%. If you don't do what I say, we can meet here in a year again, it doesn't bother me. Right? So it's handy because I think when I was younger, I tried to take on the problem and I I'm handing it back right away. I'm like, doesn't bother me if he doesn't do don't do it, you know, you can just come back to understanding and I think the other part from from the young clinicians were tendon injuries is the biggest thing is, this is not a quick fix. This takes time. And what you see a lot with the younger clinicians or maybe younger, my younger self, too, is like your to do treatment for two, three weeks, and they're not there yet. And then you get worried. And when you get worried the patient get worried. And then you start changing things. And then then they get more worried because you don't seem like you know what you're doing right, you know, it's setting the expectations. This is what you're going to do. It's not any cool exercises, this is going to take time, and having the training diaries that I follow over time and they say, You know what, I don't think much of happening. I'm like, Well, you weren't here three months ago, you could only walk one mile, but the pain of five. And now you're jogging for miles. I'm like, I think that's a pretty good improvement. Right? So having those to kind of working on and I think that's really, really important.
Yeah, and my next question is, is are all tendons created equal? So we sort of alluded to an Achilles tendon and a patellar tendon or we can talk about, you know, a golfer's elbow or tennis elbow. So when we're talking about all these different tendons, are they all created equal? And can we kind of throw the same treatments at each one, regardless of the part of the body?
Yeah, so again, it's kind of the same thing that attendance is a tendon in certain tendons structures, right? But all tendons are meant to connect muscle to bone and allow for mobility and that help us however, the design of those tendons are also meant for what they're good for. Right? So the Achilles tendon is the biggest tendon in the body because it's generates a lot of force and helps us move it move. patellar tendon is a little bit different isn't big, but it also tries to help change the angle of force around the knees. So then we put a patella and so all of a sudden we have compression and tendons are not very good for compression. The rotator cuff is more of a flatter tendon, that has a lot of curvature and the compression there is a problem right? So the flatter tendon combines more. Spread the force versus around tendon they kill As tenderness and then you're thinking about tendons in the hand, right, they are really long and thin, to be able to manipulate the fingers really gently build up the force gently. So they have different functions. And soon as you have different function, the tendon has to be slightly designed differently, which makes if it's designed differently, the treatment or the loading might be needed to be very differently. So I think one of the biggest thing is a tendon is really good for tensile forces, but not a good for compression forces. So for example, the rotator cuff, when you're talking about these overload tears is usually an inferior kind of compression that slowly degenerates, a tear. And the Achilles tendon is nothing like that at all. It's a high load, that kind of happen because you pull it apart just like Play Doh, you pull it apart from two different ends, and it kind of can rupture. So I think those are really, really important. What we also see as the lower extremity tendons seem to respond fairly similar. They're not as high in central sensitization indexes and don't have those things versus differently when you're looking at upper extremity tended to So there are definitely differences. So you need to kind of thinking about the basics, that it's not probably an acute inflammation that we need to treat it and then you need to start thinking about what does this tendon do? Is it being compressed as a flat? What are the other structures? Right? So Achilles tendon, you know, that is Achilles tendon. The real problem is, it's right there. There's not much else. That's why I study it, because it's easy to study versus the rotator cuff. We talk less about rotator cuff tendinopathy. And we talk more about shoulder pain, right? More because we not so sure. Is it purely the tendon? That's the problem and other things
add a lot more structures around it than just the Achilles tendon. That can adjust the Achilles. Sorry, but yeah, yeah. Yeah. So the little, a little more complicated area of the body will say, yes, yeah. So, you know, I think it's great to sort of look at that historical perspective. And I love that you kind of talked about where we are now, where do you see research moving towards, in the tendinopathy? field?
So now we're getting little bit into what I'm going to talk about in Denmark, too. But I think, yes, so one of the big things that we're really working on, is that, okay, I felt like we kind of reached this point, we're doing really well with everybody. But again, you know, if you look at average, with a big group, we're still not 100% On average, right? Some people aren't 100% recovered, versus some people are not. And why is that and we can't manipulate the treatment anymore. I need to figure out who do I treat how right we've been there in other areas, too. So really, what we're doing in our in our research now is really trying to use various statistical models and larger group data to really first evaluate, we'll be starting to call a tendon health, I'm really proposing that tendinopathy might be more of a biological disease, more like you're talking about knee osteoarthritis, there used to be just wear and tear, and now it's a biological disease, I think tendinopathy need to be considered the same way. And the reason I say that is because it's not just that the tendons structure had changed, or that you have pain, there's so many other variables related to it, like you have personal factors too, like BMI or diabetes affects them in differently cholesterol do so you have the metabolic factors, you have the personal factors, right. And you have, you know, the fear factors, and all these kinds of things play a role. So we call that our tendon health model. We really started with function, structure, pain and symptom, psychosocial factors. And then I realized it was a person too. So we actually have personal factors. And based on that we're trying to figure out are there different? Because you can't, we can in clinic, you can treat every person in singular, right? But, but we need to also to have more of the precision health understand what we do in the health system understanding are the various groupings. So who should we treat how to be very efficient. And that's some of the research that we're working on now. It'd be looked at my PhD students try and handle and found like, we have different groups, we have what we call activity dominant, which might be the one so we see a lot of them, the runner's active, they don't have a lot of symptoms, they don't have a lot of deficits, tenant is not that bad. versus group that we've called structure dominant, that are heavier, they have really horrible looking tendon, that poor function. And then we have a group that we call psychosocial dominant, that maybe the worst are not the best, but they're people with higher fear, decreasing function, but the tendon might not be so bad. And when we started thinking about that, well, now you can understand maybe how you can treat them a little differently. And then we can start looking at how should we treat them based on looking at randomized controlled trials because from a researcher perspective, if I threw all of those in, and I do the same treatment, some of them might benefit a lot and some of them don't and then the treatment is seared out right. There is no difference. But then I lost Ask the benefit for the ones that might benefit and I lost learning from the ones that didn't benefit the needed something else.
Fascinating. And you're going to be talking about this in Denmark.
Absolutely. And we have new data, how it changes over time and all those kinds of things. Yeah, well
don't give it all away. Now. Will we want people to go to Denmark to see you present this live? Demo? Yeah. Yeah. I mean, it sounds fascinating. I love the idea of a tendon health structure. And I love how it's it is, seems to be evolving to be more about the whole person, not just someone with a tendon injury. Yeah. Right. Because like you said, it could be like, two people can have the same injury. It could be one could be a postmenopausal woman who has the same injury as a young 30 Something male runner, maybe they both have an Achilles tendinopathy. But are you going to treat them exactly the same?
Yeah. And I think that's when we need to start thinking about this, some of the programs are maybe the same, but how do you modify them? And what are the expectations? And then what are the other things that you can add on to that, to really make sure that we get more people up to 100%, and really try to focus on them. And as a researcher, sometimes those things get lost. And that makes that's concerning to me.
But I for one cannot wait to hear that talk in Denmark. Now. Before we start wrapping things up here, what advice maybe give three tips, if you want to give more or less whatever you want. But what would you give to what tips would you give to clinicians who are treating patients with tendinopathy? Injuries? I don't know if I want to say injuries, if that's quite the word, but diagnoses let's say, so what are your top tips?
So my top tip is to kind of think about what that it is the structure and that structure responds differently than muscle structure and bone structure to thinking about it from that from the tissue level when you're designing the treatment program. And I think the number one is tendon takes longer to recover than other tissues. So setting that expectations right away. I mean, it's a clear indication when you're looking at hamstring injuries, is it purely muscle or is it more proximal with a tendon is clearly evidence to show that it takes longer. So if you have that expectation and sitting down to explain, but just because it takes longer does not mean a tendon has poor healing, it has very adequate healing is just healing that takes a little longer. And sometimes I even explain that that is a good thing. Because a tendon can last you for a very long time. Like for marathon runners, the Achilles tendon rebounds you so you can run a whole marathon, if your muscle was doing that, you'd be fatigued way earlier, and you wouldn't be able to do it. So the low metabolism is beneficial. But this is the rehab, it's going to take your time. So that's one of my biggest thing and taking time to kind of thinking through that. The other piece of advice is do not panic. And my clinician in our clinic, they tell me back to others what I say because I always tell the patient right away, you're going to get better. This is going to take time, and you're going to have setbacks. And I want to tell clinicians that to the patients are going to have setbacks, they're going to come but don't panic when they have setbacks. You know, it just is what it is. And if you set the expectations right away, the patient's going to come in and have a setback. Now they're like, Yeah, I have my setback. But you told me I would eventually have it right? Instead of not expecting them because then we react on a dime, oh, they're worse today. What am I going to do? And what am I to change? Like, no, this is part of life that goes up, it goes down and moving. So I think those two things, and along with really using the pain monitoring model, and training diaries are my key things.
Great advice. And I love that do not panic, because they know when you're panicking, yes, right? The eye you know, they see it in your face. And like you said, you start throwing everything in the kitchen sink on there. And they're like, Well, wait a second, what just happened here? I thought you said I could just do this. But I always tell patients like this is not a linear journey. It's not like you're going up a roller coaster and it's going to be linear and perfect. Like it's going to go up, it's going to dip down, it's going to come up maybe dip down but not as much and then you're gonna go up again and you know, it's a little bit more of a squiggly line and that's okay. And people really do appreciate that because setting expectations is paramount. I always feel like if I do nothing else, if they hear nothing else, at least they have an idea of what to expect. So that it's not crazy. Just
And I think the training diary to me, I use it for any patient for anything, I think that was really key too, because that calms all of us down. Let's see, let's go back here five weeks, wherever we're at what you were doing. And then we can see the pattern. And I even had one person that gave me like an Excel spreadsheet, and a color coded the pain. And if you looked over like a year, you can see that red and orange decrease and the green was increased, you know what I mean? Those are the patterns that you want to see. And it's hard to see those in your daily life. So that's why I think that's really important.
Yeah, that is a dedicated patient. Yes,
I do. But yeah,
yes, well, right. Right. But well, this was great. Where can people find you? If they have questions? Maybe you're on social media? Where can people find you?
I am on social media at kg silver Nagel, I think I'm on Twitter, is the main one is that but I also run the Delaware tendon research group, and attend them on a ligament research group. So on Twitter, we also have the UD tendon group. We're also on Facebook, and we're also on Instagram. And I'm easily found the University of Delaware and Department of Physical Therapy to please feel free to reach out and connect with us, you know, on the social media and those kinds of things that we're doing. And I'm very excited to discuss these clinical things.
And if you don't mind, can we talk a little bit about the Delaware attending group because you guys have some projects that you're working on to do you want to tell the listeners about those projects? In case you know, you need recruiting or you need volunteers? So go ahead.
Yes, we always need volunteers. So we actually have we have a lot of ongoing studies, but one of the big ones that NIH funded right now is we're looking at comparing men and women with Achilles tendinopathy. So we're up to 145 recruited patients out of 200, we had a little dip around COVID. So we're actually providing treatment for anybody that is around the Delaware Philadelphia area, please feel free to reach out or send your patients. We're also have ACL studies ongoing. One of the big ones also been relating to tendon is looking at the recovery from patellar tendon grafts to see how they change over time, how does that tend to actually recover? And could that if the doesn't recover fully, can that explain some of the deficits that we do see their ACLs injuries to we're also hoping to soon start more of looking at insertional, Achilles tendinopathy, with treatments we have. And one study with shockwave treatment, we have studies that we're hoping to start now looking more at metabolic factors, and getting a little blood draws and those things. So we have on our website with all of those things going on. So if anybody's interested, please feel free to reach out or look at our website.
Perfect. And we'll have a link to that at podcast at healthy, wealthy smart.com under this episode, so one click and we'll take you right there. So before we end, I have one question. Question 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 you can pick which ever age of your younger self you
would like. So I'm going to pick myself before I even went to PT school, because one of my mantras is to always have fun, and I will stick to that now. And I'll stick to that younger because if it's not fun, it's not worth doing, even if it's research and those things. So do anything that's fun. But I was did not want to go to school in Sweden, I wanted to do sports medicine wanted to go to the US. But I was very worried that if I didn't get in, when I was 20 that I wasn't going to go to PT school because it took four years and then I would be too old when I graduated before I was ready. So I wasn't going to go luckily I got in and I stayed on. So I think to to my younger self. It's a really long working life. So just keep on having fun and plugging along and learning more things. And I have taken the really long path to academia with the clinician for many years and doing those kinds of things. So that I'm happy for so I'm glad I got in and didn't say I wasn't going to do it. Because who cares if I was 2425?
Yeah, and that's so young. Yes, but isn't it funny when you're 1819 20? You're like, Oh, forget it. I'll be an old person by then 25 behind the eight ball when of course, now that were a little older, we can look back on that and be like, Oh my God. Yes. And
I mean, it's like it's, it's a long life to work. Don't hurry to get to the endpoint, right? Enjoy it get experienced during that time, because as I tell our students, I've had a lot of fun during my years and worked with sports workers, clinician travel, research, academia, you know, you got to have fun.
Absolutely. Well, and on that note, I want to thank you for coming on the podcast and having such a fun conversations. Well, thank you so much. And everyone, if you want to get a chance to see current speak live, then join us at the fourth World Congress, a sports physical therapy, it is in Denmark and August 26 and 27th of this year. And not only will you get to see speakers like yourself, but there's also going to be great networking, activity breaks, things like yoga, or running or walking tours, paddle paddleboarding, all sorts of fun stuff. So it's again, not going to be quite your average conference, and a lot of it is going to be clinically focused and clinically based. So I think that's really important. I think a lot of times people think, Oh, we go to these conferences, it's going to be researchers just talking about their research and how's that going to affect me clinically? Well, this conference is all about that. So I think, right? Absolutely agree. Yeah. So come join us in Denmark. Again, thank you so much for coming on. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Aalborg University Professor, Prof Michael Rathleff, talks about his role at the upcoming WCSPT.
Today, Michael talks about how he organized the congress, creating tools for clinicians to educate their patients, and his research on overuse injuries in adolescents. What are the barriers between the research and implementation in practice?
Hear about the mobile health industry, exciting events at the congress, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
More about Michael Rathleff
Prof Michael Rathleff coordinates the musculoskeletal research program at the Research Unit for General Practice in Aalborg.
The research programme is cross-disciplinary and includes researchers with a background in general practice, rheumatology, orthopaedic surgery, physiotherapy, sports science, health economics and human‐centered informatics.
He is the head of the research group OptiYouth at the Research Unit for General Practice. Their aim is to improve the health and function of adolescents through research.
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injuries, WCSPT, Education,
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Read the Full Transcript Here:
Hello, Professor Ratliff, thank you so much for coming on the podcast today to talk a little bit more about your role at the fourth World Congress is sports, physical therapy in Denmark, August 26, to the 27th. So, as we were talking, before we went on the air, we were saying, man, you're wearing a bunch of hats during this Congress, one of which is part of the organizing committee. So my first question to you is, as a member of the Organising Committee, what were your goals? And what are you hoping to achieve with this Congress?
I think my role is primarily within the scientific committee. And one of the things we discussed very, very early on was this, like, you know, when you go for a conference, you go up to a conference, you hear a bunch of interesting talks, and you feel like, I'm motivated, I'm listening, I'm taking in new things. But then Monday morning, when you see the next patient, it's not always that all the interesting stuff that you saw, is actually applicable to my patient Monday morning. So we wanted to try and emphasize more. How can we use this conference as a way to translate science into practice? So the whole program and the like, the presentations will be more about clinical applicability, and less about more p values and research methodology. So not that the research is not sound, but there'll be more focused on how can we actually apply it in the context that were working. That's why also, we had the main title of translating research into practice, which I think will be hopefully a cornerstone that people will see, well, if there's really interesting talk about, it could be overuse injuries in kids, which will be a lecture that I'm having, then they'll also be a practical workshop afterwards to kind of use that what's been presented, and then really drill down on how we can use it in in clinical practice. So the goal is to, to get people to reflect in your network, but also take a lot of the things and think, Wow, this is something that I can use next Monday for clinical practice.
And aside from a lot of lectures and talks, you've also got in informatics competition. And so could you explain that a little bit and why you decided to bring that into the Congress?
Yeah, so this was a major, not a debate, but an interesting discussion on how we can even in the early phases of the conference, when people submit an abstract, make sure that the abstract can actually also reach more end users target audiences for that case. So we decided that people actually had to submit an infographic together with their the abstract. So normally, you send in like, 250 words, for a conference, but for this conference, we wanted them to submit the abstract, but also the visual infographic to go along with Olympic Well, am I making an infographic that is tailored to patient? Is that a patient aid that I'm trying to make? Is it something that's aimed but other researchers? Or is it clinicians, so they have to tick off? Which box Am I infographic actually intended for? So when the audience or the participants come and join the conference, they can actually take these infographics for those that want to print them they can use in the clinic afterwards, just another layer of trying to make some of this research more easily communicated to the audience, but also, the things that can be used in clinical practice, like some of the people have submitted abstract, have some really, really nice infographics that I expect will be printed and hang on, on a few clinic doors around the world afterwards, I hope.
And when it comes to dissemination of research and information from the clinician, to the patient, or even to the wider public, where do you think clinicians and researchers get stuck? Like where is the disconnect between that dissemination of information as we the information as we see, and by the time it gets to the consumer or to let's say, a mass media outlet? It's like, what happened?
Yeah, that's a big a big question. Because it's almost like why are we not better at implementing new research into our clinical practice? And I think there's heaps of different barriers. We've we've done a couple of studies, something new was also in the pipeline where we look specific, get the official context, and we can see that this barriers in terms of understanding the research, that's actually one of the major barriers that the clinicians out there have a really hard time both finding the evidence, appraising the evidence, and also actually understanding is this good or bad science. And then you have the whole time constraints on a clinical practice because who's going to pay you to sit and use two hours On reading this paper, and remember, this is just one paper on ACL injuries. But in my clinical practice, I see a gazillion different different things. So how am I going to keep up with the with the evidence? Is it intended that I'm reading original literature? Or how am I going to keep up with it? So I think there's a lot of different barriers. But at least one of the ways I think we can overcome some of these barriers is that researchers climb out of the ivory tower and think of other ways that we can communicate, research, evidence synthesis, it could be infographics, it could be sort of like decision age for clinical practice, at least that's one of the routes we're taking in terms of also the talk I'm giving at the conference that we're trying to think of, Can we somehow develop AIDS that will support clinical practice something that scene but the physiotherapist something that's aimed at the patient, that will sort of make it easier to deliver evidence based practice? So we've done one, one tool that's being developed at the moment is called the Makhni, which is something that can assist clinicians in the diagnosis, the communication of how do you communicate to kids about chronic knee pain? How do I make sure that they have the right expectation for what my management can be? And how can we engage in a shared decision making process. And we have a few other things in the pipeline as well, where we want to, to build something, build something practical that you can take in use in clinical practice to to support you in delivering good quality care, because just publishing papers is not going to change clinical practice, I think,
yeah, and publishing papers, which are sometimes wonderful papers. But if they're not getting out to the clinicians, they're certainly not going to get out to the patients and to people, sort of the mass population.
I completely agree. It's a bigger discussion, I'm really focused on how to reach clinicians, because I see the clinicians as the entry point to delivering care to patients and parents and, and the surrounding surrounding community. But if you think of, like wider public health interventions, we have the same problem as well. And also we create this sort of like, No, this inequality in healthcare, but that's another
line, although there can of worms. Yeah, we could do a whole series of podcasts on that. Yeah, yeah. And I agree with you that it needs to come from the clinician. So creating these tools to help clinicians better educate their patients, which in turn really becomes their community. Because there's a lot a clinician can do outside of just a one on one interaction with the patient. And so having the right tools can make a big difference.
Like in, if you look at a patient that comes to you for an ACL injury, or long standing musculoskeletal complaint, they're going to spend maybe 0.1% of their time together with you and 99.9%, they're out on their own. And I think it's important that we when we're one on one with them, sort of like make them develop the competencies so they can do the right decisions for their health in the 99.9% of the time that they're out there alone, when they're not with with us, I completely agree with you that there's a lot of things we can do to make them more competent in thriving despite of knee pain, or shoulder pain or whatever it might, it might be. And I think that's one of the most important tasks, I think, for us as clinicians is to think about the everyday lives they have to live when they leave us and say see you next time.
Yeah, and to be able to clearly communicate whatever their diagnosis by might be, or exercise program or, or any number of, of 10s of 1000s of bio psychosocial impacts that are happening with this person. Because oftentimes, and I know I've been guilty of this in the past, I'm sure other therapists would agree that they've this has happened to them as well as you explain everything to the patient, and then they come back and it's, they got nothing zero. And it might be because you're not disseminating the information to them in a way that's helpful for them or in a way that's conducive with their learning style. So having different tools, like you said, maybe it's an infographic that the patient can look at and be like, Oh, I get it now. So having a lot of variety makes a huge difference.
And I think you touched on a super important point there that patients are very different, that they have different learning styles, they have different needs. And I think it's our role to enlist Send the needs of the individual patient and make up something that really meets those needs. So more about listening, asking questions and less about thinking that we have the solution to it, because I think within musculoskeletal health or care, whatever we call it, some clinicians would use their words to communicate a message that might be good for some other patients would prefer to have a folder or leaflet. Others would say, I want a phone, I want an app on my phone, something that's like learning on demand, because at least that's something we see regularly. Now that we have the older population that wants a piece of paper, we have the younger population that wants to have something that they can sort of like, rely on when they're out there on their own one advice on how do I manage this challenging situation to get some good advice when you're not there? When I'm all on my own? So, so different?
Yeah, and I love those examples. I use apps quite frequently. And I had a patient just the other day say, Oh, my husband put this, the app that that you use, because I was giving her PDFs, and she's like, Oh, my husband put the app on my phone. Now it's so much easier. So now I know exactly what to do if I have five minutes in my day. So it just depends.
And I think the whole like mobile health industry, there's a lot of potential there. But I also see, at least from a Danish context, that there's a lot of apps that is very limited. It's not not developed on a sound evidence base, or it's just sort of like a container of videos with exercises. And I think there's a huge potential in like thinking of how can we do more with this? How can we make sure that it's not just the delivery vehicle for a new exercise, but it's actually the delivery vehicle for improving the competencies for self management for individuals? I think there's, yeah, I'm looking forward to the next few years to see how this whole field develops. Because I think there's really big potential in this.
Yeah, not like you're not doing enough already. But you know, maybe you've just got your next project now. Like, you're not busy enough already. So as we, as you alluded to a few minutes ago, you've got a couple of different talks you're chairing, so you've got a lot going on at the World Congress. So do you want to break down, give maybe a little sneak peek, you don't have to give it all away, we want people to go to the conference to listen to your talks. But if you want to break down, maybe take a one or two of your topics that you'll be speaking on, and I give us a sneak peek.
I think the talk that will be most interesting for me to deliver and hopefully also to listen to is is the talk that I'm giving on overuse injuries in adolescence, because I think it's we haven't had a lot of like conferences in the past couple of years. So it will be one of these talks will be meaty in terms of of new date, and some of the things I'm most interested go out and present is all the qualitative research we've done on understanding adolescents and their parents, in terms of what are the challenges they experience? How can we help them and also, we've done a lot of qualitative works on what are the challenges that face us experience when dealing with kids with long standing pain complaints, we've developed some new tools that can sort of like, help this process to improve care for these young people. And I really look forward trying to Yeah, to hear what people think of, of our ideas and, and the practical tools that we've that we've developed. So that's at least one of the talks, that's going to be quite interesting, hopefully, also, we're going to actually have the data from our 10 year follow up of so I have a cohort that I started during my PhD. They were like 504 kids with with knee pain. And now I follow them prospectively for 10 years. And this time period, I've gotten a bit more gray hair and gray beard. But this wealth of data that comes from following more than 500 kids for 10 years with chronic knee pain is going to be really, really interesting. And we're going to be finished with that. So I'm also giving a sneak peek on unpublished data on the long term prognosis of adolescent knee pain and at the conference. So that's going to be the world premiere for for that big data set as well.
Amazing. And as you're talking about going through some of the qualitative research that you've done, and you had mentioned, there were some challenges from the physio side and from the child side in the patient and the child's parents side. Can you give us maybe one challenge that kind of stuck out to you that was like, boy, this is really a challenge that is maybe one of the biggest impediments in working with this population.
I think I think there's multiple one thing that I'm really interested in these in this moment is the whole level of like diagnostic uncertainty and kids, because one of the things we've understood is that if the kids and the parents don't really understand why they have knee pain, what's the name of the knee pain, it becomes this cause of them seeking care around the healthcare system on who can actually help me who can explain my pain. So so at the moment, we're trying to do a lot of things on how we can reduce this, what would you call diagnostic uncertainty and provide credible explanations to the kids and then trying to develop credible explanation for both kids and parents? That's actually not an easy task, because what is a credible explanation of what Patellofemoral Pain is when we don't have a good understanding of the underlying pathophysiology? So there, we're doing a lot of work on combining both clinical expertise, what the patient needs, what we know from the literature, and then we're trying to solve, iterate and test these credible explanations with the kids. And yeah, at the conference, we'll have the first draft of these, what we call credible explanation. So that's going to be at least one barrier one challenge, I hope that some of the practical tools we've developed can actually help
i for 1am, looking forward to that, because there is it is so challenging when you're working with children, adolescents, and their parents who are sort of call it doctor shopping, you know, where you're, like you said, you're going around to multiple different practitioners, just with their fingers crossed, hoping that someone can explain why their child is in pain or not performing are not able to, you know, be a part of their peer group or, or or engage in what normal kids would would generally do. Exactly. Yeah. Oh, I'm definitely looking forward to that. So what give us one other sneak peek? Because I know you've got the, you're also chairing a talk on the first day. But what else I shouldn't say I don't want to put words in your mouth. What else? Are you looking forward to even maybe if it's not your talk, are you looking forward to maybe some other presentations,
I'm actually looking forward to to the competitions we have as well, because I've had a sneak peek of some of the research that's been submitted as abstracts, and the quality is super high. So both the oral presentations but also the presentation that the best infographics because they'll also get time to actually rip on the big screen and present their infographic. And I look forward to see how people can communicate the messages from these amazing infographics. And I think these two competitions are going to be to be a blast and going to be really, really fun to, to look at. And amazing research as well. So I really look forward to the two events as well. And then of course, oh no, go ahead. No, I was just talking about look forward to meeting with friends and new friends and be out talking to people once again in beautiful new ball in Denmark in the middle of summer. It's hard to be Denmark in the summer. We don't have a lot of good weather, but Denmark in August is just brilliant.
Yes, I've only been there in February. So I am definitely looking forward to to Denmark and August as well. Because I've only been there for sports Congress when it's a little chilly and a little damp. So summer sounds just perfect. And I've one more question. Just kind of piggybacking off of your comments on the amazing research within these competitions. And since you know you have been in the research field, let's say for a decade plus right getting your PhD a decade ago. How have you seen physio research change and morph over the past decade? Have you seen just it better research coming from specifically from the physio world?
I think it's the first time someone said it's actually more than a decade. So, but that gives me a time perspective. But yeah, I've actually seen that. My perception is that physiotherapy research in general but also sports physiotherapy research went from being published in smaller journals we published in our own journals to now there's multiple example of sport fishers performing really, really nice trials that have reached the best medical journals that have informed clinical practice. So I think we see this both there's more good research Basically out there. And I also see that we've moved from, like a biomechanical paradigm to being more user a patient center, we see more qualitative research, we see that physiotherapist, sport physiotherapist, they sort of have a larger breadth of different research designs, they used to tackle the research. I think, like looking even at the ACL injuries, if you go back 10 years in time, looking at the very biomechanically oriented research that was primarily also joined by orthopedic surgeons to a large extent. Now, today where fishers have done amazing research, they understand all the the fear of reentry, they're trying to do very broad rehabilitation programs, ensuring that people don't return to sport too rapidly. And and also understanding why they shouldn't return back to his board now developing tools that you can use when you sit with a patient to try and and educate them on what are the phases, we need to go through the next nine to 12 months before you can return to sport and so on. So I think I'm just impressed by, by the research. And when I see the even the younger people in my group now, they start at a completely different level when they start their PhD compared to what we did. So I can only imagine that the quality is going to improve over the years as well, because they're much more talented, they're still hard working. And they have a larger evidence base to sort of like stand on. And they already from the beginning, see the benefit of these interdisciplinary collaborations with the whole medical field and who else is is relevant to include in these collaborations? So yeah, the future is bright. I see. Yeah,
I would agree with that. And now as we kind of start to wrap things up here, where can people find you? So websites, social media, tell the people where you're at.
So I think if you just type in my name on Google, there'll be a university profile at the very top where you can see all my contact information. Otherwise, just feel free to reach out on LinkedIn or Twitter, search for my name. And you'll find me, I try to be quite rapid and respond to the direct messages when, when possible, at least
perfect. And we'll have all the links to that in the show notes at podcast at healthy, wealthy smart.com. So you can just go there, click on it'll take you right to all of your links. So is there anything that you want to kind of leave the listeners with when it comes to the world congresses, sports physiotherapy or physical therapy, sorry.
Be careful not to miss it, it's going to be one of these conferences with a magical blend of practical application of signs, it's going to be a terrific program in terms of possibilities to to network and engage in physical activity, whatever it's running, or mountain biking, and with an amazing conference dinner as well. So I think it's, so this would come to be one of one of the highlights for me this year. So and I think the whole atmosphere around this conference is also that if you come there, as a clinician, you don't know anybody, that people will be open and welcoming and happy to engage in conversation. There's no speakers, that wouldn't be super happy to grab a beer or walk to discuss some of the ideas that's been presented at the conference. So I think it's going to be quite, quite good.
Yeah. So come with an open mind come with a lot of questions and come with your workout clothes. Is is what I'm hearing?
Yes, definitely. Definitely.
And final question, and it's one that I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self, and you can pick whatever time period your younger self is.
So I think in if I had to give myself one advice when I was in my sort of like, MIT Ph. D, time coming towards the end, I would say to myself, that it's okay to say no, you have to make sure to say yes to the right things because it's very easy to say yes to everything. And then you create these peak stress periods for yourself that would prohibit you from from doing things that is value being with friends or family and so on. You don't have to say yes to everything because there will be multiple opportunities afterwards. So practice in saying no and do it in a in a polite way. People actually have a lot of respect for people that say, No, I don't have a time or I'm I'm going to invest my time on this because this is what I really think is going to change the field. And this is my vision. So So young Michael, please please practice in saying no.
I love that advice. Thank you so much. So Michael, thank you so much for coming on the podcast. And again, just a reminder, I know we've said this before, but the World Congress is sports, physical therapy, we'll be in Denmark, August 26 and 27th of this year 2022. So thank you so much for coming on the podcast and thank you for all of your hard work and getting making this conference the best it can be.
Thank you, Karen, thank you for the invitation to the podcast.
Absolutely. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.