Healthy Wealthy & Smart: Recent Episodes
Dr. Karen Litzy, PT, DPT
The Healthy Wealthy & Smart podcast with Dr. Karen Litzy features top experts in health, wellness and business with a particular focus on physical therapy. We take evidence based medicine and break it down, making it easier to understand and immediately apply to your life. At Healthy Wealthy & Smart our goal is simple: to provide you with the best information so you can live a healthy and pain free life!
In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes Campbell Will, an integrative physiotherapist and breathwork educator, to discuss the significant impact of breath on health and performance. Campbell shares his journey from traditional physiotherapy to specializing in breath work, highlighting the role of proper breathing in enhancing performance and reducing stress. He emphasizes the importance of shifting the focus from disease to health and how breath can serve as a powerful tool for achieving balance and well-being. Tune in to discover valuable insights on how breathwork can transform your approach to health and self-regulation.
Time Stamps:
[00:02:19] Importance of breath in health.
[00:06:13] Defining breathwork and its impact.
[00:06:54] Breathwork and nervous system health.
[00:10:03] Breathing and emotional state.
[00:13:45] Breathing's impact on health.
[00:18:01] Dysfunctional breathing effects.
[00:20:59] Dysfunctional breathing and posture.
[00:26:01] Breathwork and assessment importance.
[00:29:47] Breathing as a present anchor.
[00:31:41] Nervous system and breathwork.
[00:34:18] Nervous system's role in healing.
[00:39:15] Breath awareness and self-empowerment.
[00:41:40] Awareness as a foundational piece.
[00:45:03] Vulnerability in professional practice.
More About Campbell Will:
Campbell Will is an integrative physiotherapist with a primary focus on the role of the breath on human health and performance. His experience spans ICUs, neurosurgical wards, elite athletes and private practice. Across this spread of clinical settings he noticed a widely unaddressed commonality; breathing. When done correctly, it elevates and enhances performance. When done poorly, it drives dysfunction.
Campbell utilises his diverse background and experience to help practitioners shift their focus from disease and dysfunction to health, happiness and freedom. His holistic, multidisciplinary approach focuses on restoring balance to body, mind, emotions and energy. Campbell views the breath as a tool accessible to all, providing the foundation for optimal health and well-being.
Resources from this Episode:
Campbell’s Website
Campbell on Instagram
Free Gift: Fundamentals of Breath : A Self Paced Breath Correction Program (coupon BREATHE20 for 20% off)
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Karen Litzy welcomes back Jamey Schrier, a physical therapist, bestselling author, and CEO of Practice Freedom U. They discuss the importance of helping and impacting others through their professions, as well as the growth and evolution of both Karen’s and Jamey's businesses. The conversation delves into the traps of growth that many entrepreneurs face, highlighting how new challenges can arise as companies expand. Jamey shares insights on navigating these obstacles to ensure continued success and fulfillment in one's practice. Tune in for valuable strategies on overcoming the challenges of business growth and making a meaningful impact in your field.
Time Stamps:
[00:01:39] Growth traps in business.
[00:05:14] Growth phases of business.
[00:10:51] Choosing your own path.
[00:12:36] Overcoming feelings of inadequacy.
[00:19:21] Company values attract staff.
[00:23:25] Draining joy in work.
[00:25:56] Expansion phase challenges in business.
[00:30:22] Business growth and scalability.
[00:35:01] Profitability in business phases.
[00:40:17] Knowing what you want.
[00:41:32] Practice Freedom U quiz.
More About Jamey Schrier:
Jamey Schrier, P.T. is a best-selling author, speaker and CEO of Practice Freedom U, a business training and coaching company. Jamey is former private practice owner and his book, The Practice Freedom Method has helped scores of practitioners Treat Less, and Earn More, and enjoy a life they deserve.
Resources from this Episode:
Practice Freedom U Website
Jamey on Facebook
Jamey on LinkedIn
Jamey on Instagram
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In this episode of the Healthy, Wealthy & Smart Podcast, host Karen Litzy is joined by orthopedic physical therapist Matt Huey to discuss the importance of building independence with patients through effective communication and empowerment. With nearly 15 years of experience in outpatient orthopedics, Matt shares his diverse PT background. He dives into strategies for meeting patients where they are in their healing journey and fostering a collaborative environment in therapy. Tune in to discover how to enhance patient empowerment and promote more effective therapeutic relationships.
Time Stamps:
[00:03:12] Patient empowerment through education.
[00:04:42] Soft skills in physical therapy.
[00:11:23] Building patient independence in therapy.
[00:12:20] Mechanical pain explanation.
[00:18:02] Home exercise consistency challenges.
[00:19:36] Incorporating exercise into daily routine.
[00:23:13] Effective communication in therapy.
[00:27:47] Honesty in patient treatment.
[00:32:28] Special tests in therapy.
[00:35:15] Patient communication and independence.
[00:40:38] Asking questions for growth.
[00:00:00] Health, wealth, and smart living.
More About Matt Huey:
With nearly 15 years of experience as a physical therapist, Matt has established himself as a highly skilled clinician in the realm of orthopedic care, both in patient care and clinical expertise.
Matt earned a diploma in Mechanical Diagnosis and Therapy (MDT), showcasing his mastery in assessing and treating musculoskeletal disorders. He is also a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), which reflects advanced skills in manual therapy approaches.
Matt has demonstrated leadership by operating clinics throughout his career, leading them to deliver the highest quality care and serving the profession through various roles. In his time, he has not only assisted in the passage of the licensure compact bill into law, but also brought about a motion for the APTA to support pay transparency as a way to help improve wage disparities.
Matt has also leveraged social media as a way to not only entertain people through humor, but also educate a wider audience about
Resources from this Episode:
Matt’s Website
Matt on Instagram
Matt on TikTok
Matt on YouTube
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Stephanie Weyrauch welcomes Dr. Jeff Golini, the CEO and executive scientist of All-American Pharmaceutical. Dr. Golini shares his journey from being a lifelong athlete, participating in various sports from elementary school through college football, to becoming a trailblazer in sports nutrition and business innovation. He discusses the foundation of his company, which is rooted in science, passion, and purpose, and highlights some of his globally recognized supplements. Please tune in to learn about Dr. Golini 's unique insights into the world of sports nutrition and how he has built a successful business in this field.
Time Stamps:
[00:01:32] Professional bodybuilding journey.
[00:04:12] Innovation in nutritional supplements.
[00:10:53] Entrepreneurship and patience.
[00:12:55] Patience in business growth.
[00:17:17] Balancing multiple roles effectively.
[00:22:01] Treating employees with respect.
[00:26:55] Quality over profit in healthcare.
[00:30:11] Importance of delegation in business.
[00:31:36] Importance of having mentors.
[00:39:08] Defining success as a leader.
[00:42:07] Importance of exercise for success.
[00:44:19] Advice for young professionals.
More About Dr. Golini:
From his beginnings as a high school All-Conference/All American athlete turned Professional Body Builder, Dr. Golini, knows with hard work and a creatively strategic plan, anyone can take life’s challenges head on and turn ordinary circumstances into extraordinary opportunities. Seeing a need to invent and develop high quality, drug-free supplement, Dr. Golini took his own competitive spirit and performance knowledge from a hobby in his apartment in 1985 to the current multi-million dollar state of the art, 150,000 square foot Research & Manufacturing facility in Billings, Montana.
Dr Golini is a multi-Patent holder, inventor, author and scientist currently working at the helm of All American Pharmaceutical as CEO and Excusive Scientist. Dr Golini has also published several studies and has been the host of National Radio Shows “Science for Humans” and “The EFX Sports Show” heard live on ESPN 910 Radio.
Dr Golini recently founded St Anthony’s Research & Education Institute with the hope to find a cure for such terrible diseases such as cancer and diabetes.
Resources from this Episode:
Dr. Golini on LinkedIn
All American Pharmaceutical
All American Pharm on YouTube
Dr. Jeff Golini on Instagram
https://efxsport.com https://www.facebook.com/EFXSports/ https://www.facebook.com/drjeffgolini https://www.instagram.com/efxsports/ https://x.com/EFXSports https://www.youtube.com/channel/UCInM0NI6qEUwAQHD-2LSHTg https://www.tiktok.com/@efxsports Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes visionary business strategist Kareen Walsh. With nearly two decades of experience, Kareen is an expert in optimizing performance across various industries, helping C-suite executives and entrepreneurs achieve significant returns on their investments. She shares her journey of becoming an entrepreneurial and business executive coach, emphasizing the importance of sustainable leadership and empowering others. Tune in as Kareen discusses her approach to overcoming fear, avoiding burnout, and turning visionary ideas into tangible results through her business, Revampologist, and the Hey Kareen app. Don't miss this insightful conversation, which offers valuable strategies for leaders seeking to elevate their business success.
Time Stamps:
[00:01:15] Transitioning from corporate to entrepreneurship.
[00:05:12] Evolved mindset for business success.
[00:09:05] Seven figures revenue strategy.
[00:11:26] Embracing change and control.
[00:15:32] Leadership qualities for team empowerment.
[00:19:33] Onboarding process effectiveness.
[00:25:26] Embracing vulnerability in leadership.
[00:28:20] Leveraging time for business success.
[00:32:55] Busyness versus business ownership.
[00:34:10] Role identification for entrepreneurs.
[00:40:04] Entrepreneurial challenges app.
[00:45:04] Have more fun and be present.
[00:45:35] Embracing daily gifts.
More About Kareen Walsh:
Kareen Zahr Walsh is a visionary business and people’s strategist, author, podcaster, investor, and a 7-figure business-building entrepreneur, making her the ultimate Business Healer. With nearly 2 decades of experience optimizing performance in the health & wellness, eCommerce,
technology, and finance industries, running top-performing teams in complex environments, Kareen has a proven track record of helping C-Suite executives turn their vision of impact into action, often resulting in 10Xing their investment. Kareen is on a mission to help you integrate your inner business with your vision for external impact so that you can get out of your own way and stand in alignment.
Resources from this Episode:
Hey Kareen Website
Free Gift For Listeners
Kareen Walsh website
Kareen on Instagram
Kareen on LinkedIn
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes TJ Slattery, a seasoned entrepreneur and strategic advisor dedicated to helping small business owners thrive. With over 20 years of experience in small business management, TJ shares insights on how to grow your business while achieving personal and professional freedom sustainably. He reflects on his entrepreneurial journey, which began in his youth with various small ventures, and discusses the importance of leveraging experience and strategic partnerships to propel business success. Tune in for valuable tips and inspiration for aspiring entrepreneurs and small business owners alike!
Time Stamps:
[00:03:25] Strategic leaders vs. reactive operators.
[00:03:48] Importance of proactive planning.
[00:07:30] Delegating roles in business.
[00:12:24] Owner feedback and business growth.
[00:15:24] Transitioning from PT to CEO.
[00:19:00] Team toxicity and leadership challenges.
[00:21:20] System changes and entrepreneurship challenges.
[00:27:30] Celebrating personal business wins.
[00:28:07] The importance of asking questions.
[00:32:07] Take it easier on yourself.
More About TJ Slattery:
TJ is a lifetime entrepreneur, small business owner, and strategic advisor with an insatiable desire to help other small business owners scale their enterprise and gain freedom in their professional and personal lives. With 20 years operating in the world of small business and entrepreneurship, TJ leverages his boots-on-the-ground experience and tenure as a business advisor to partner with small business owners and propel their business to the next level.
A Denverite with midwestern roots and a passion for music, gardening, house-projects, travel, skiing, and spoiling his dog Bella, TJ has a deep appreciation for keeping a balance between running a successful business and pursuing the things in life that make us happy.
TJ earned his bachelor’s degree in Interdisciplinary Business Management from Miami University of Ohio and his MBA from the University of Denver. Gathering more experiences along the way, TJ has worked in multitude of industries. From owning and operating a pedicab service in Vail, CO and a handyman service in Denver, CO, to becoming a partner in a facilities management firm in London, UK and starting Zuni Street Brewing in Denver, CO.
Resources from this Episode:
Crowsnest Consulting
Business Case Studies
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Karen Litzy welcomes Dr. Lilian O. Ebuoma, a Harvard-trained breast radiologist and author of "Love Your Breasts, Love Yourself." With over two decades of experience in health and wellness, Dr. Ebuoma shares her journey from joining the U.S. Navy at 19 to pursuing her passion for medicine inspired by her grandmother, a midwife in Nigeria. The discussion emphasizes the importance of breast health and provides insights into holistic breast care. Tune in to learn more about Dr. Ebuoma 's expertise and her comprehensive guide to nurturing breast health. Links to her book and additional resources are available in the show notes.
Time Stamps:
[00:01:25] Journey into healthcare and radiology.
[00:06:21] Breast cancer mortality disparities.
[00:10:40] Self-examination for breast health.
[00:14:14] Mammography screening recommendations.
[00:15:18] Breast density and screening.
[00:20:46] Diagnostic mammogram process explained.
[00:24:15] Emotional wellbeing and breast health.
[00:27:14] Cultural stigma and breast cancer.
[00:32:03] Emotional impact of cancer diagnosis.
[00:34:39] Complementary therapies in oncology.
[00:39:07] Breast awareness and self-care.
[00:42:06] Love your breasts, love yourself.
More About Dr. Lilian O. Ebuoma:
Dr. Lilian Ebuoma is a Harvard-trained breast radiologist, certified physician executive, social entrepreneur, U.S Navy Veteran, and certified professional coach. She has more than two decades of experience in the health and wellness industry, including in the United States Navy.
She is a Fellow of the Institute of Coaching at McLean, Harvard Medical School Affiliate, and a 2027 Fellow of the American College of Radiology. Dr. Ebuoma is the founder of Lilly Women’s Health and Lilly Cares Foundation (LCF) in Lagos, Nigeria with a primary focus of streamlining breast care to improve breast cancer morbidity and mortality outcomes in underserved areas.
A former Associate Professor of radiology, she has authored multiple scientific publications with a focus on breast health. She also is the Executive Producer of Tufiakwa: Witnessing the Breast Cancer Journey and author of Love Your Breasts, Love Yourself.
The recipient of the Navy and Marine Corps Achievement Medal and Early Faculty Excellence Award from the Baylor College of Medicine, Dr. Ebuoma was named top 50 most influential women in Nigeria by Business Day in 2023.
Resources from this Episode:
Love Your Breasts Love Yourself Book
Dr. Ebuoma’s Website
Dr. Ebuoma on Instagram
Dr. Ebuoma on LinkedIn
Jane Sponsorship Information:
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In this episode of the Healthy Wealthy & Smart podcast, Dr. Karen Litzy welcomes Lee Benson, a seasoned entrepreneur and value creation expert, who shares his insights on building successful businesses by embracing struggle and developing strong business models. Lee discusses how facing adversity is essential for growth, drawing from his experience running an aerospace company where he worked 80 to 100 hour weeks and nearly faced bankruptcy multiple times. He emphasizes the importance of clearly defining and communicating the "Most Important Number" (MIN) for your business, explaining that less than 2% of leaders can effectively articulate their business model. Lee introduces his MIND methodology (Most Important Number and Drivers) and stresses the significance of involving all employees in understanding the business model, pricing strategy, and cost structure. The conversation highlights how creating a culture of transparency and education empowers employees to make better decisions that align with company goals, ultimately transforming them into proactive contributors who act as CEOs of their own roles.
Time Stamps:
[00:02:47] Team matters in business success.
[00:05:04] CEO role evolution in business.
[00:09:08] Embracing struggle for growth.
[00:12:11] Employee understanding of business finances.
[00:16:25] Most important number and drivers.
[00:20:06] Building a community of families.
[00:23:11] Business model understanding.
[00:28:29] Measuring qualitative data in business.
[00:31:19] Measuring employee fulfillment at work.
[00:34:20] Employee inclusion in decision making.
[00:36:42] Value creation potential in workplaces.
[00:40:23] Employee development and struggle.
[00:45:20] Advice to 20-year-old self.
More About Lee Benson:
Lee Benson has spent over 30 years in the business world, focused on one thing: creating value. Today, he is the CEO of Execute to Win, where we help organizations of all sizes accelerate the value they bring to the table. His journey into value creation started way back when he was pulling weeds for just 25 cents an hour.
Since then, he has had the privilege of founding and leading eight companies, including Able Aerospace. What started with just two employees grew into a team of 500, serving 2,000 customers across 60 countries, and we eventually celebrated a 9-figure exit in 2016. It’s been an incredible ride!
Resources from this Episode:
Lee’s Website
Lee on Instagram
Lee on LinkedIn
Free Gift: Your Most Important Number
Jane Sponsorship Information:
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In this Healthy, Wealthy & Smart Podcast episode, host Dr. Karen Litzy welcomes Alicia Murray, a licensed therapist and group practice owner based in New York. Alicia shares insights into her practice, Convenient Counseling Services, a fully virtual practice that serves clients across New York, including those in upstate regions. With a team of five clinicians, Alicia's practice specializes in a variety of areas, including men's mental health, anxiety, life transitions, depression, trauma, and grief. They discuss Alicia's journey into therapy, her motivations for entering the field, and the unique aspects of running a virtual practice. Tune in to learn more about the world of therapy and the importance of mental health support.
Time Stamps:
[00:01:37] Journey into private practice.
[00:05:00] Motherhood's impact on career.
[00:08:39] Hiring based on performance metrics.
[00:14:19] Importance of balance in leadership.
[00:17:49] Imposter syndrome in entrepreneurship.
[00:22:53] Qualities of good leadership.
[00:24:49] Self-compassion in entrepreneurship.
[00:30:04] Building a Therapy Business.
[00:31:29] Educating clients about therapy.
[00:36:03] Taking risks in therapy practice.
More About Alicia Murray:
Alicia Murray, LMHC, LPC, NCC opened her private practice in 2019 when she realized that community mental health wasn’t going to offer what she needed or wanted in terms of balancing her career as a therapist with her desire to be a mom. In 2021, she began scaling her private practice into a group practice, and starting in 2024, began publishing guides, workbooks, and courses to help other therapists achieve their own time and financial freedom through private practice. Through it all, she has remained the primary caregiver for her two boys while balancing entrepreneurship.
Resources from this Episode:
The Therapist HQ Free Resources
Alicia on Instagram
Convenient Counseling Services
Jane Sponsorship Information:
Book a one-on-one demo here
Front Desk @ Jane
Mention the code LITZY1MO for a free month
Follow Dr. Karen Litzy on Social Media:
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Karen’s Instagram
Karen’s LinkedIn
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In this episode of the Healthy, Wealthy & Smart podcast, host Karen Litzy welcomes Robin Valadares, a seasoned physiotherapist with over 13 years of experience and the founder of Financially Fulfilled Physio. Robin shares his journey in the healthcare field and his passion for financial education, specifically aimed at helping healthcare professionals, particularly physiotherapists, achieve financial security without sacrificing their personal well-being. He discusses the importance of blending physical health with financial literacy and offers insights into how healthcare providers can build wealth and find balance in their careers. Tune in to learn valuable strategies for financial empowerment in the healthcare profession.
Time Stamps:
[00:01:34] Financial education for healthcare providers.
[00:03:56] Overcoming money mindset challenges.
[00:07:12] Practice management finances importance.
[00:11:09] Accounting software recommendations.
[00:15:40] Financial habits for practice owners.
[00:17:48] Diversification of revenue streams.
[00:20:11] Common questions for financial advisors.
[00:23:40] Revenue streamed investing.
[00:27:14] Fear and failure in action.
More About Robin:
Robin is a healthcare professional—a physiotherapist. Despite his clinical skills, he realized the education system neglects financial literacy. We often prioritize our clients’ needs over our financial health, graduating with little knowledge of personal finance, investing, or wealth building.
This gap inspired him to become a self-taught financial literacy educator for healthcare professionals. His financial knowledge comes from years of self-education, networking, trial and error, and even failure. He still practice physiotherapy, but has found freedom and fulfillment in financial independence.
Over 13+ years, he has seen healthcare professionals desire financial security but lack resources. We're experts in our fields but often struggle with personal finance. That’s why he created this platform—to share my knowledge and empower you to take control of your financial future.
Resources from this Episode:
Robin’s Website
Robin on Instagram
Robin on LinkedIn
Robin on X
Free Gift: How to Prepare for a Recession
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy and Smart Podcast, host Karen Litzy welcomes back fellow physical therapist Ali Shoos to discuss leadership within the physical therapy profession. Allie, a dedicated volunteer leader since she began her career in 1982, shares her journey and experiences in fostering the potential of future leaders in the field. The conversation explores the importance of mentorship, the impact of involvement in professional organizations, and the role of the community in shaping effective leaders. Join Karen and Ali as they delve into the significance of leadership in physical therapy and how to empower the next generation of therapists.
Time Stamps:
[00:01:21] Leadership journey in physical therapy.
[00:04:11] Leadership and advocacy journey.
[00:10:05] Telehealth leadership during COVID.
[00:14:36] Giving back to the profession.
[00:17:30] Mentorship in professional growth.
[00:22:02] Integrity as a leadership quality.
[00:24:40] Vulnerability in leadership.
[00:28:12] Volunteer opportunities in APTA.
[00:34:55] Be bold and take risks.
[00:35:26] Boldness in leadership decisions.
More About Ali Schoos:
Ali Schoos, PT, graduated with her bachelor’s degree from the University of Puget Sound in Tacoma WA in 1982. Between then and 2000 she worked in a private practice, managed a hospital based sports medicine clinic, opened a private practice in 1987, and worked for a national PT company for six years as their group director in the greater Seattle area. She then returned to private practice in 2000, after co-founding Peak Sports and Spine Physical Therapy with her husband, a group of 8 private practice clinics, practicing in Bellevue, WA. She has been a board certified orthopedic specialist from 1993-2023. She retains a small ownership in the clinics that have largely been sold to the partners she and her husband developed from their employees.
Ali has long been an active volunteer and advocate for the PT profession. She has been the secretary and chair for the Orthopedic Special Interest group, state insurance liaison for APTA Washington for nine years, a delegate to the HOD, past board member for Washington state PPSIG, served on the APTA Private Practice Section Board of Directors for six years, as well as the Covid advisory task force. She served on the APTA advisory group for primary care PT and the development of the APTA telehealth certification series. She currently serves on APTA PPS Nominating Committee, the telehealth subcommittee for APTA PPS payment policy committee, and is an APTA PAC Trustee. She is a key PT for APTA and APTA PPS and active in legislative advocacy in Washington state. She was awarded the Washington state PT of the Year in 1993 for her insurance advocacy and again in 2021 for her work on obtaining telehealth payment and delivery parity in Washington during the outbreak of the Covid pandemic. She also advocates for Alzheimers’ and ALS research, medication access, and patient resources. She has presented on numerous topics, most recently for APTA and APTA PPS webinars on telehealth, advocacy, and marketing, as well as developing and moderating “Chelan Chat” for the Washington State PPSIG annual meeting in 2022 and 2023. Ali has served her local community on the Alzheimers’ Regional Advisory Board, the Bellevue YMCA board, her parish council, fundraising efforts for her children’s school, and coaching her kids in soccer when they were young enough to not be too technical yet! She loves the physical therapy profession and is happy to serve in any way that facilitates our movement forward as a profession and helps us to better meet the needs of our patients, while keeping us financially viable as a profession.
Resources from this Episode:
APTA Private Practice
Peak Sports and Spine PT
Ali on LinkedIn
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In this Healthy, Wealthy, and Smart Podcast episode, host Dr. Karen Litzy welcomes Dr. Nicole Fleischman, a board-certified urogynecologist based in New York. Dr. Fleischman specializes in treating women with pelvic floor conditions, including urinary incontinence and organ prolapse, utilizing both medical and surgical approaches. During the conversation, they explore a paradigm shift in understanding pelvic health—moving away from the traditional view of pelvic weakness and the need for strengthening to a more nuanced perspective. Dr. Fleischman also discusses her book, "The Second Mouth," which delves into these concepts. Tune in to gain insights into women's urinary health and the importance of specialized care in this field.
Time Stamps:
[00:01:26] Urogynecology and pelvic health.
[00:04:32] Pelvic floor muscle understanding.
[00:08:12] Pelvic floor awareness through breathing.
[00:12:19] Stomach sucking and breathing issues.
[00:14:14] Breathing and pelvic floor health.
[00:18:45] Pelvic floor awareness and coordination.
[00:21:51] Surgery necessity in urogynecology.
[00:26:21] Empowering women through education.
[00:29:10] Biopsychosocial lens in medicine.
[00:32:19] Importance of proper toilet training.
[00:34:55] Incontinence awareness and prevention.
[00:38:26] Breathing techniques for health.
[00:42:07] Knowledge sharing in healthcare.
More About Dr. Nicole Fleischman:
Dr. Fleischmann is board certified in urology and Female Pelvic Medicine and Reconstructive Surgery.
She received her medical degree from the State University of New York Downstate Health Sciences University in Brooklyn, NY, where she graduated summa cum laude. Dr. Fleischmann completed her surgery and urology residency at Albert Einstein College of Medicine in Bronx, NY and continued her training in a fellowship at NYU School of Medicine.
She is passionate about practicing an integrative approach to urogynecology, correcting the pervasive, unconscious and paradoxical behaviors which can turn into the structural problems and bothersome symptoms that prompt women to seek care. She is the author of the new book “The Second Mouth”, which addresses the powerful mind-body connection in functional urology.
Dr. Fleischmann serves as Director of FPMRS at White Plains Hospital Center where she has been in clinical practice for the last 25 years. She holds an active appointment as Assistant Clinical Professor in Obstetrics and Assistant Clinical Professor of Gynecology and Urology at Albert Einstein College of Medicine. Additionally, she is a member of the American Urologic Association and Society for Urodynamics and Female Urology (SUFU). Dr. Fleischmann is the author of several research publications and presentations. She lives and practices in New York.Resources from this Episode:
The Second Mouth Book
Dr. Fleischman on TikTok
Dr. Fleischmann on Instagram
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In this Healthy, Wealthy, and Smart Podcast episode, host Dr. Karen Litzy welcomes Patrick Tarnowski, PT, MBA, a physical therapist and chief commercial officer at One Step, to discuss the gait analysis. Gait analysis is the study of how we walk, a crucial area of focus for physical therapists, especially regarding aging and overall health. Pat shares his extensive background in healthcare, spanning over two decades, and describes his journey from patient care to leading innovations in gait analysis and patient outcomes. Listeners will gain insights into the importance of gait analysis, how it changes with age, and what it means for improving health and mobility. Please tune in to learn more about this vital aspect of physical therapy and its impact on patient care.
Time Stamps:
[00:01:51] Gait analysis and biomechanics.
[00:07:28] Gait analysis essentials.
[00:08:35] Observational gait analysis effectiveness.
[00:12:38] Correlating patient goals with analysis.
[00:18:01] Functional assessment in treatment plans.
[00:22:39] Patient confidence and gait analysis.
[00:24:56] Gait speed as vital sign.
[00:31:15] Gait analysis using smartphones.
[00:34:40] Monitoring patients in real world.
[00:38:45] Importance of mobility in health.
More About Patrick Tarnowski, PT, MBA:
As Chief Commercial Officer at OneStep, Pat is accountable for the company’s US market entry through strategic provider partnerships. His deep healthcare experience as a leader in health plans, health systems, medical devices, startups and digital care delivery support and enable OneStep’s growth and scale. As an entrepreneur, Pat has successfully launched and scaled care delivery companies, digital solutions that focused on health and wellbeing, disease management and virtual care and worked with providers to achieve success in value-based payment models. He received his degree in physical therapy from Boston University and his master’s in business administration from the University of St. Thomas. A lifelong learner, Pat has also held several academic appointments and is a grant reviewer for the National Science Foundation’s SBIR seed fund and served as an Industry Mentor for their I-Corp Innovation program. He has been the principal investigator in numerous clinical studies and is the Vice President of Professional Practice of the Minnesota Chapter of the American Physical Therapy Association’s and the Minnesota Cancer Alliance Steering Committee. Pat lives in Minneapolis with his family, dog Maizey and is a committed outdoors enthusiast and endurance athlete.
Resources from this Episode:
One Step Website
Pat on LinkedIn
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In this episode of the Healthy, Wealthy and Smart Podcast, host Dr. Karen Litzy welcomes Dr. Janna Koretz, a clinical psychologist and expert in leadership and mental health. The discussion focuses on managing stress and preventing burnout in high-pressure careers, particularly within the healthcare sector. Dr. Koretz shares her insights on the common challenges faced by professionals, including feelings of being stuck, relationship issues at work, and the impact of high-stress environments on mental health. With her experience running a practice in Boston, she emphasizes the importance of proactively addressing these issues. Tune in for valuable strategies and tips on navigating career-related stress and enhancing overall well-being.
Time Stamps:
[00:01:07] High pressure career management.
[00:07:02] Defining burnout and enmeshment.
[00:09:31] Signs of burnout.
[00:12:20] Unplugging from technology for recovery.
[00:17:35] Rekindling lost interests and hobbies.
[00:21:03] Determining personal values.
[00:23:22] Navigating differing family values.
[00:28:36] The importance of empathy.
[00:30:40] Empathy through diverse experiences.
[00:35:44] Moderation and pacing in life.
[00:39:28] Values-based journaling app.
[00:42:15] Gaining perspective in life.
More About Dr. Janna Koretz:
Dr. Janna Koretz is the founder of Azimuth Psychological, a group psychotherapy and testing practice with locations in Cambridge, Boston, and Nantucket MA. Dr. Koretz’s specialty is in executive leadership mental health — especially around co-founder struggles, impostor syndrome, communication skills, burnout, career enmeshment, and over-achiever trauma.
Graduate of Cornell University, with years of clinical training as a psychologist filtered through the lens of her own entrepreneurial journey, Dr.Koretz is able to engage with leaders on a deeper level while providing the nuance, rigor, and evidence-based practice required to address big challenges. Dr. Koretz’s work has been featured regularly in HBR, BBC, WSJ,Business Insider, NPR, CNBC, MSN and Boston Globe.
Resources from this Episode:
Dr. Koretz Website
The Clearly App
Dr. Koretz on LinkedIn
Dr. Koretz in the Media
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Stephanie Weyrauch welcomes special guest Jen Peters to discuss the impact of inner childhood trauma and the journey toward healing. Jen shares her personal experiences with trauma, beginning with her adoption and the feelings of unworthiness and abandonment that followed. The conversation highlights the importance of trauma-informed care in healthcare and offers valuable insights for listeners seeking to understand and heal from their own childhood traumas. Tune in for an enlightening discussion emphasizing accessibility to healing resources and the significance of addressing childhood trauma in personal growth.
Time Stamps:
[00:01:18] Childhood trauma and healing journey.
[00:07:47] Inner child healing importance.
[00:09:20] Inner child work and healing.
[00:13:04] Healing the "not good enough" wound.
[00:18:50] Healing modalities and their differences.
[00:23:26] Spiritual healing and physical health.
[00:24:47] Connection with our children.
[00:31:33] Healing journey's ongoing nature.
[00:34:42] Healing journey outcome measures.
[00:39:36] Inner childhood healing integration.
[00:41:08] Emotional connection and parenting.
More About Jen Peters:
Jen is a gifted Multidimensional Healer and author of ‘Coming Home. The Path to Healing Your Inner Child.’
Jen is well known globally for specializing in dissolving emotional trauma, childhood trauma and hidden blocks deep within the subconscious mind. Jen has spent many thousands of hours refining her techniques and developing her own, signature healing methods which are part of the Jen Peters Multidimensional Healing System™and are proven to fully dissolve emotional trauma and hidden blocks at the origin. Jen’s signature approach is gentle, loving and highly effective, even with the most stubborn traumas.
Jen’s own personal experience of fully healing following decades of codependency, narcissistic abuse and deep childhood trauma has provided her with the indelible experience and depth of knowing that only comes from walking the path herself.
Jen is also the founder of a large healing community with more than 130K self healers across multiple platforms. You can join Jen’s self healing community Instagram @jenpeters_soulguide_healer.
When Jen’s not creating or helping others on their healing and expansion journey, she can be found soaking up the sun, traversing the higher realms or indulging in a locally made sweet treat! Jen absolutely adores roses and always has the soft scent of rose essential oils filling her home. Jen lives in a magical beach town near the sea in New Zealand, with her precious son Jordan and little black cat, Whiskey.
Resources from this Episode:
Jen’s Website
Jen on Instagram
Jen’s Book
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In this episode of the Healthy, Wealthy & Smart Podcast, host Dr. Karen Litzy welcomes Kevin Surace, a renowned Silicon Valley innovator and the father of the virtual assistant. They discuss how AI can enhance your productivity and happiness.
Kevin introduces the concept of the "Joy-Success Cycle," which highlights the relationship between joy and productivity. By using AI to handle repetitive or time-consuming tasks, individuals can reduce stress and increase their overall job satisfaction. This shift allows them to approach their work more positively, ultimately leading to greater success.
When individuals are less burdened by mundane tasks, they can dedicate more time to creative thinking, problem-solving, and other high-value activities that contribute to their professional growth and fulfillment.
Time Stamps:
[00:01:38-00:02:11] Birth of the virtual assistant.
[00:07:06] Deep learning and virtual assistants.
[00:10:03] AI as a productivity co-pilot.
[00:11:38] AI for analyzing spreadsheets.
[00:16:18] Writing in different styles.
[00:21:46] AI in medical diagnosis accuracy.
[00:25:30] AI's impact on medical practice.
[00:28:03] Joy Success Cycle and AI.
[00:31:10] AI's role in podcasting.
[00:35:30] Artificial agents in conversations.
[00:39:36] Interactive grandmas through technology.
[00:42:50] One complaint a day.
[00:46:50] Advice for younger self.
More About Kevin:
Kevin Surace is a Silicon Valley innovator, serial entrepreneur, CEO, TV personality and EDUTAINER. Kevin has been featured by Businessweek, Time, Fortune, Forbes, CNN, ABC, MSNBC, FOX News, and has keynoted hundreds of events, from INC5000 to TED to the US Congress. He was INC Magazines’ Entrepreneur of the Year, a CNBC top Innovator of the Decade, World Economic Forum Tech Pioneer, Chair of Silicon Valley Forum, Planet Forward Innovator of the Year nominee, featured for 5 years on TechTV’s Silicon Spin, and inducted into RIT’s Innovation Hall of Fame. While he has a technical background with 94 worldwide patents, he is known as a highly dynamic speaker who is a true entertainer that is funny, excites people, educates & energizes audiences to action.
Mr. Surace led pioneering work on the first cellular data smartphone (AirCommunicator), the first plastic multichip semiconductor packages, the first human-like AI virtual assistant (Portico), soundproof drywall, high R-value windows, AI-driven building management technology, Generative AI for QA, supply-chain multivariate auctions, and the window/energy retrofits of the Empire State Building and NY Stock Exchange. He is also an accomplished music director, conductor, Broadway and streaming producer, and percussionist.
Kevin’s most requested talks include ChatGPT, AI and Automation...It’s impact on your life and your company, Bringing Silicon-Valley Disruptive Innovation to Your Organization and Digital Transformation. He customizes each talk to your audience, from 30min to 60min, and is available to expertly moderate conversations and interview luminaries and executives as well as host workshops and events.
Resources from this Episode:
Kevin on Social Media
TikTok
YouTube
Kevin’s Website
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes Sam Brake Guia, co-founder of Podwritten and host of the podcast Mics to Millions. They dive into the world of podcasting, discussing practical strategies for getting on podcasts and leveraging them as marketing tools for health and wellness businesses. Sam shares his journey into podcasting, from his beginnings as a journalist to becoming a leading figure in the podcasting industry. Listeners will gain valuable insights into how to grow their own health and wellness podcasts and effectively engage with top-tier podcast hosts. Tune in for expert tips and inspiration on using podcasts to enhance your business outreach!
Time Stamps:
[00:01:05] Starting a podcast agency.
[00:05:42] Podcast guesting for professionals.
[00:07:24] Connection through podcasting.
[00:12:59] Myths about being a podcast guest.
[00:16:41] Niche podcasts versus large shows.
[00:18:28] Sobriety and emotional eating.
[00:22:00] The importance of a pitch.
[00:25:11] Pitching podcast guests effectively.
[00:28:27] Effective podcast pitching strategies.
[00:35:07] 30-day plan for podcast guests.
[00:36:22] Podcast guesting strategy tips.
[00:41:47] Importance of concise answers.
[00:45:26] Podcast guesting for book promotion.
[00:48:13] Podcast guesting benefits and tips.
[00:00:00] Staying healthy, wealthy, and smart.
More About Sam:
Sam Brake Guia is the Co-founder of PodWritten, a podcast booking agency for health and wellness businesses, and the host of Mics to Millions, a podcast that shares interviews with top-tier hosts, insights from podcasting expert, and solo episodes to help you grow your health and wellness podcast.
Having worked in the podcasting space since 2018, Sam has been fortunate to work with a wide variety of health and wellness business owners, professionals, and entrepreneurs. He helps them share their stories, stand out from the crowd, capture new audiences, and generate revenue opportunities through podcast guesting.
Originally from the UK, he has lived in Medellin since 2017 and runs PodWritten alongside his wife Gozde Brake Guia.
Resources from this Episode:
Podwritten Website
Sam on LinkedIn
Podwritten Podcast Interviews
Free Resource from Podwritten: The Pitch Template
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In this episode of the Healthy, Wealthy & Smart Podcast, host Dr. Karen Litzy welcomes Dr. Sherry Peel Jackson, an expert in tax reduction and wealth building. With over 35 years of experience, including her background as a retired IRS agent and CPA, Dr. Jackson shares invaluable insights on navigating common tax pitfalls and keeping more of your hard-earned money. She emphasizes the importance of understanding deductions and not solely relying on others for tax advice. Tune in to learn actionable strategies to protect and grow your earnings and discover Dr. Jackson's proprietary KPG system designed to empower individuals and businesses financially.
Time Stamps:
[00:02:06] Tax deductions awareness and importance.
[00:05:40] Common tax preparation pitfalls.
[00:09:17] Hiring your children for deductions.
[00:14:10] Augusta rule and rental income.
[00:16:46] Investment strategies for wealth building.
[00:22:22] Risky investments and savings strategies.
[00:25:13] KPG system for financial success.
[00:28:56] Generational wealth and legacy.
[00:32:26] Multiple streams of income.
More About Dr. Sherry Peel Jackson:
Dr. Sherry Peel Jackson is a retired IRS agent, CPA, and Certified Fraud Examiner who has helped over 100,000 individuals and businesses Keep, Protect, and Grow their earnings using her proprietary KPG System. With over 35 years of experience, Sherry is an expert in tax reduction and wealth building. Through her speaking, books and consulting, she has shared her wealth of knowledge not just to educate but also to create lasting wealth and security.
Dr. Jackson is the author of impactful books like "How To Escape The Rat Race." Also, with a social media following of over 44,000, she empowers people every day to achieve financial freedom and legacy. Dr.Jackson is a must-have guest, ready to share actionable strategies for financial success and legacy building.
Resources from this Episode:
Dr. Peel Jackson on LinkedIn
Dr. Peel Jackson on Instagram
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Stephanie Weyrauch welcomes Dr. Joseph Peila, a direct primary care physician based in Billings, Montana. Dr. Joe shares his journey from growing up in the area to completing his medical training in Nevada and Colorado, ultimately returning to serve his community. He discusses his passion for internal medicine and primary care, emphasizing the importance of building relationships with patients to enhance their quality of life. As he reflects on his experiences in a fee-for-service practice, Dr. Joe highlights the challenges posed by decreasing patient interaction time and the need for a more proactive approach to health care. Tune in to learn about Dr. Joe's insights on proactive health and the future of patient-centered care.
Time Stamps:
[00:03:01] Direct primary care challenges.
[00:04:37] Rural healthcare challenges and solutions.
[00:09:49] Innovating in primary care practice.
[00:12:51] Preventative healthcare challenges.
[00:15:14] Developing leadership skills in healthcare.
[00:20:32] Patient-centered care and business success.
[00:23:11] Diabetes care barriers and solutions.
[00:27:14] Small decisions for weight loss.
[00:00:00] Pinnacle Internal Medicine and Billings.
More About Dr. Joe Peila:
Dr. Joseph (Joe) Peila grew up in Shepherd, Montana. He graduated from Montana State University with a degree in Cell Biology and Neuroscience. He then attended medical school at the University of Nevada School of Medicine and did his Internal Medicine residency at the University of Colorado.
Dr. Peila then worked for two years as an outpatient Internal Medicine physician at Kaiser Permanente in Denver while waiting for his wife to finish her medical training. He moved back to Montana in 2017 and worked as an internist at Billings Clinic until deciding to start his own practice.
Dr. Peila has served as a faculty member for the Billings Clinic Internal Medicine Residency program as well as a clinical educator for medical students. He is board certified by the American Board of Internal Medicine and is a Fellow of the American College of Physicians.
In his free time, Dr. Peila enjoys spending time with his wife, Sarah, and their four children as well as outdoor activities like working on the family ranch, skiing, hiking, and hunting.
Resources from this Episode:
Pinnacle Internal Medicine
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In this episode of Healthy, Wealthy, and Smart, host Karen Litzy welcomes Dr. Robert A. Kayal, the founder and CEO of the Kayal Orthopedic Center in New York and New Jersey. Dr. Kayal shares his journey to becoming a physician, highlighting his lifelong passion for medicine and his dedication to restoring an active and joyful quality of life for his patients. He discusses the challenges of navigating the business side of healthcare, reflecting on the limited business education available in medical training. Join Karen and Dr. Kayal as they explore the intersection of medicine and entrepreneurship and learn about the rewarding field of orthopedic surgery.
Time Stamps:
[00:01:25] Becoming a physician and entrepreneur.
[00:06:38] Physician as a business owner.
[00:11:06] Balancing work and family life.
[00:12:45] Balancing personal and professional life.
[00:20:14] Attributes of a great healthcare provider.
[00:21:17] Customer experience in healthcare.
[00:27:11] Employee onboarding and culture.
[00:32:29] Branding through company culture.
[00:34:46] Reinvestment in orthopedic practice.
[00:38:43] Business growth through specialization.
[00:44:48] Growth of medical practices.
[00:49:14] Mastering the Business of Medicine.
[00:52:07] Purpose in life and work.More About Dr. Kayal:
Robert A. Kayal, MD, FAAOS, FAAHKS is the founder, president, and CEO of Kayal Orthopaedic Center located in northern New Jersey and New York. Dr. Kayal is the husband of Kim S. Kayal, RN and father of their six children: Katlyn Madeline, Michaela Noel, Robert Joseph, Shannon Isabella, Mia Grace, and Luke Christopher. Dr. Kayal is the proud grandfather (or "Gido") of their newest family addition, Hope Madeline.
During the last twenty-five years, Dr. Kayal built one of the most successful multi-specialty orthopaedic medical practices in the United States, and in 2021, in one of the most substantial health care transactions ever to close, he partnered with RWJBarnabas Health, the largest and most comprehensive health care system in New Jersey.
Dr. Kayal considers it an honor, pleasure, blessing and privilege to help restore an active lifestyle and joyful life to each of his patients. He gives all his thanks to God for his talents and skills and prays his practice will always be used to honor, glorify, and exalt his awesome Triune God: God the Father, God the Son, and God the Holy Spirit.
Specializing in partial and total joint replacements, sports medicine, and arthroscopy, Dr. Kayal knows the importance of staying abreast of the latest technologies. By keeping his finger on the pulse of innovation, he can provide beneficial treatments to help patients recover quickly. “What you’ll find here aren’t just state-of-the-art facilities. It’s an entire philosophy,” says Dr. Kayal. With both New Jersey and New York locations, the award-winning practice prides itself on offering advanced orthopaedic treatments in a compassionate environment. As a patient, “you aren’t just a number,” says Dr. Kayal. “We’re focused on building lifelong relationships, accelerating rehabilitation, and inspiring quality of life. Besides the Kayal Orthopaedic Center, Dr. Kayal’s practice includes centers for Pain & Spine, Rheumatology, Chiropractic & Physical Therapy, bone metabolism, and advanced, high-resolution, cross-sectional medical imaging. These facilities allow him to provide a wider range of musculoskeletal treatments and therapies. “I believe our patients do their homework and choose this practice because of our training, skill, experience, and innovation,” Dr. Kayal says. “But what they also find from us is patience, compassion, and a genuine concern and commitment to each and every one of them.”
The Kayal Orthopaedic Center is also dedicated to staying abreast of the latest treatments and technologies in each specialist’s field of expertise. Years ago, Dr. Kayal and his team of orthopaedic surgeons began using the Stryker Mako robot, a sophisticated instrument that allows for greater precision and control during partial and total hip and knee replacement surgeries. This customized joint replacement technology, using the Mako robot, in combination with high-resolution cross-sectional medical CT scan imaging and Stryker's proprietary software, ensures accurate sizing, placement, fit, balance, alignment, and rotation of installed components, much akin to being fitted with a "tailor-made suit." At Kayal Orthopaedic Center, this Mako robotic technology has also been used in combination with the minimally invasive direct anterior approach (DAA) for hip replacement surgery. “You can be certain that the Kayal team has done its homework and is ready to provide our patients with the best treatment approaches available,” says Dr. Kayal.
The philosophy of Kayal Orthopaedic Center is to provide every patient with the pain-free, active lifestyle they deserve. With decades of orthopaedic surgery experience, Dr. Robert Kayal and his staff provide comprehensive care that gives patients the one-on-one attention they need. Kayal Orthopaedic Center uses a patient-focused approach that has a proven track record of success. Dr. Kayal has built his practice around highly trained surgeons and specialists, innovative treatments, and state-of-the-art equipment. “Our philosophy is that the most beneficial service is the one that offers the best outcome for each unique patient,” Dr. Kayal says. “We offer everything our patients may need under one roof,” says Dr. Kayal.
As of November 2024, Robert A. Kayal, MD, FAAOS has 666 five-star ratings on healthgrades.com. On the practice’s website, Dr. Kayal says patients aren’t just a number and that the office’s patient experience is second to none. “We’re focused on building lifelong relationships, accelerating rehabilitation, and inspiring quality of life,” says Dr. Kayal.
Kayal Orthopaedic Center is a proud sponsor and supporter of many local non-profit organizations. Furthermore, the office also works to support local and state police departments by sponsoring golf outings and providing meals to the men and women in blue. Also, as a preceptorship for many physician assistant educational programs in both NY and NJ, Kayal Orthopaedic Center offers shadowing opportunities for students as part of its commitment to the next generation of healthcare providers.
Resources from this Episode:
Kayal Ortho Website
Dr. Kayal on Facebook
Dr. Kayal on Instagram
Dr. Kayal on X
Dr. Kayal on LinkedIn
Dr. Kayal on YouTube
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litz7 welcomes Dr. Alan Rosanski, a distinguished professor of medicine at the Icahn School of Medicine at Mount Sinai and director of nuclear cardiology at Mount Sinai. Dr. Rosanski shares his journey from aspiring psychiatrist to a renowned cardiologist, highlighting the pivotal moments during his medical training that led him to specialize in cardiology. With a focus on enhancing vitality through a comprehensive health model known as the six domains of health, Dr. Rosanski offers valuable insights into maintaining and improving overall health in today's world. Tune in to learn how a blend of cardiology, health psychology, and behavioral medicine can empower individuals to achieve better health outcomes.
Time Stamps:
[00:03:12] Six dimensions of health.
[00:04:58] Sense of purpose and health.
[00:08:28] Exercise as depression treatment.
[00:14:00] Preventative cardiology and health behaviors.
[00:15:56] Motivational interviewing techniques in healthcare.
[00:21:43] Evolution of heart disease treatment.
[00:25:46] Sedentary lifestyle and health challenges.
[00:27:41] Redefining health and vitality.
[00:32:05] Importance of staying active.
More About Dr. Alan Rozanski:
Dr. Alan Rozanski is a distinguished Professor of Medicine at the Icahn School of Medicine at Mount Sinai and Director of Nuclear Cardiology at Mount Sinai St. Luke, and he’s has dedicated his career to exploring and pioneering research to help clients understand how to maintain and enhance vitality in their daily lives.
Combining his extensive expertise in cardiology, health psychology, and behavioral Medicine with the guidance of his comprehensive health model, The Six Domains of Health, Dr. Rozanski brings a unique perspective and makes him a compelling voice in the discussion of achieving and maintaining health and vitality in today's world.
Resources from this Episode:
Dr. Rozanski’s Website
Dr. Rozanski’s LinkedIn
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Karen Litzy welcomes fellow physical therapist Jay Dicharry, MPT, SCS, a leading expert in sports rehabilitation and the author of "Running Rewired." The conversation dives into running, covering assessment, injuries, and innovative approaches to help endurance athletes recover. Jay shares insights on the evolution of running advice over the decades, highlighting the need for updated methodologies in training and rehabilitation. Tune in to gain valuable knowledge on running techniques and how to effectively address common injuries while benefiting from Jay's extensive experience in the field.
Time Stamps:
[00:02:20] Assessing body mechanics in running.
[00:03:41] Postural compensations in running.
[00:08:48] Running economy and control.
[00:11:09] Runners' identity and injury management.
[00:14:01] Hip extension vs. lumbar compensation.
[00:17:02] Tech-assisted motor control techniques.
[00:21:15] Wearable tech in biomechanics.
[00:25:26] Asymmetries in runner's performance.
[00:27:34] Strength, power, and running injuries.
[00:30:03] Plyometrics for bone density.
[00:32:28] Tendon rehabilitation techniques.
[00:36:30] Patient engagement in physical therapy.
[00:40:24] Mental focus in running.
[00:42:30] Improve movement quality for runners.
[00:46:08] Strength training for runners.
[00:50:24] Personal growth in physical therapy.
[00:00:00] Staying healthy, wealthy, and smart.
More About Jay:
Jay Dicharry completed his Masters of Physical Therapy at Louisiana State University Medical Center and is a Board-certified Sports Clinical Specialist. Dicharry’s career blurs the line between clinical practice, coaching, and engineering to solve problems and optimize performance. Dicharry built his reputation in biomechanical analysis as Director of the SPEED Clinic at the University of Virginia and is the Founder of MOBO. Dicharry writes for digital and print media and has authored two books on running gait, “Running Rewired” and "Anatomy for Runners." Dicharry enjoys an active research career and has published over thirty-five professional journal articles and book chapters. He also consults for the running and cycling industry, the US Armed Forces, USA Track and Field, USA Triathlon, and athletes across the world. Having taught in the Sports Medicine program at UVA and the DPT program at OSU-Cascades, he brings a strong bias towards patient education, and teaches internationally to elevate the standard of care for Therapists, Physicians, and Coaches. He is excited to share his research-driven focus and expertise to build our students into critical thinkers and push the needle in our profession.
Resources from this Episode:
Mobo Board
Use the code TRN10 to get 10% off Mobo board
Jay’s Website
Running Rewired Book
Jay on Instagram
Mobo Board on Instagram
New York Times Article on Injury Prevention
Jay on ResearchGate
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In this episode of the Healthy, Wealthy & Smart podcast, host Dr. Karen Litzy welcomes back financial expert Joseph Reinke to discuss the critical topic of student loans. As the year comes to a close, many are assessing their budgets and the impact of student loan repayments on their financial planning for the upcoming year. Joe, a CFA charter holder and founder of FitBux, shares valuable insights into managing student loans and offers guidance on financial management strategies for healthcare providers, particularly physical therapists. Please tune in to learn about the latest updates regarding student loans and how to navigate the financial hurdles they present in your career.
Time Stamps:
[00:01:57] Student loans overview and history.
[00:03:41] Student loan forgiveness programs.
[00:10:48] Loan forgiveness program explained.
[00:12:25] Income-based repayment strategies.
[00:15:24] Nonprofit loan forgiveness explained.
[00:20:24] Future of student loan policies.
[00:24:03] Financial strategies for student loans.
[00:27:02] Student loan repayment strategies.
[00:31:44] Loan forgiveness and refinancing options.
[00:33:18] Student loan management tips.
[00:37:15] Money for future self.
More About Joe:
Joseph is a Chartered Financial Analyst (CFA) and founder of FitBUX which has helped over 18,000 young professionals on their journey to financial freedom. Joseph has been personally investing since he was 12 years old. In addition, he has experience in student loans, mortgages, wealth management, investment banking, valuation, stock trading, and option trading. He has been on 100s of podcast and has been invited to 100s of universities to discuss financial planning with their soon to be graduates.
He is currently an adjunct financial wellness professor at 15 universities.
Resources from this Episode:
FitBux Website
FitBux on YouTube
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy, & Smart podcast Dr. Karen Litzy hosted Dr. Tonya Miller and Dr. Laurie Brogan to discuss their new book, Professionalism and the Practice of Physical Therapy. The conversation highlighted the importance of professionalism in the field of physical therapy, emphasizing its relevance not only for students but also for practicing professionals throughout their careers.
Time Stamps:
[00:01:27] Professionalism in physical therapy.
[00:06:01] Professionalism in physical therapy.
[00:10:20] Professional growth oak tree analogy.
[00:12:43] Reflection in professional development.
[00:17:16] Definition of professionalism.
[00:21:10] Management of self through lifelong learning.
[00:24:15] Mentorship's role in professionalism.
[00:30:36] Importance of workbooks in learning.
[00:32:01] Successful writing partnership dynamics.
[00:36:10] Professionalism in physical therapy.
[00:39:26] Health, wealth, and wellness.
More About Dr. Laurie Brogan:
Laurie Brogan PT, DPT is a full-time faculty member of the Physical Therapy Department at Misericordia University, primarily responsible for teaching cardiopulmonary physical therapy, clinical skills, and professional development. With strong interests in the needs of the older adult population and interprofessional education/practice, she is also an American Board of Physical Therapy Specialists (APBPTS) Board- Certified Clinical Specialist in Geriatric Physical Therapy, a Certified Exercise Expert for the Aging Adult, and a Certified Master Trainer for TeamSTEPPS, a program developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense as a solution to improving collaboration and communication in healthcare settings. Her research and writing centers around interprofessional education and practice, socialization in interprofessional settings, and the development of clinical reasoning in PT education.
More About Dr. Tonya Miller:
Tonya Miller, a national speaker, author, and founder of TYM Coaching, is deeply committed to personal growth and developing strong leaders. With over 25 years of executive leadership skills and a Ph.D. in Leadership Studies, Tonya combines real-world experience with academic expertise. She tailors her coaching programs to fit any individual or organization, from coaching front-line healthcare providers to board-room negotiations. Her recent book, “Professionalism in the Practice of Physical Therapy: A Case-Based Approach,” is a testament to her commitment, highlighting key elements of professional development for not only physical therapists but for healthcare clinicians and leaders. Tonya is also committed to integrity, accountability, and self-awareness.
In addition to owning TYM Coaching, Tonya is the Academic Program Lead for the Doctor of Physical Therapy program at Harrisburg University of Science and Technology. In this role, Tonya leads the Doctor of Physical Therapy faculty and guides developing professionals in leadership and understanding the healthcare industry.
Tonya believes in community engagement and is an active community volunteer. She serves on several boards, including the America Physical Therapy Association PT Proud Special Interest Group, where she serves as the Vice Chair, and PA Vent Camp, a camp for ventilator-dependent children, where she serves as the Executive Director.
Resources from this Episode:
Professionalism and the Practice of Physical Therapy book
Tonya Miller’s Website
Tonya on LinkedIn
Laurie on LinkedIn
Relationship between allied health student behavioral style and ideal clinical instructor behaviors- research publication
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes Phyllis Greenberger, co-founder and CEO of the Society for the Advancement of Women's Health Research. They delve into the longstanding issue of bias and discrimination in women's healthcare, a problem that has persisted for centuries. Phyllis shares insights into the historical context of women's health, highlighting how women were often viewed solely in terms of their reproductive capabilities and deemed too fragile for broader roles in society. This conversation sheds light on the systemic challenges faced by women, particularly minority women, in accessing equitable healthcare. Tune in for an enlightening discussion on the fight to overcome these barriers and improve health outcomes for all women.
Time Stamps:
[00:02:06] Discrimination in women's healthcare.
[00:08:07] Women in clinical trials.
[00:09:11] Women's health research disparities.
[00:15:37] Women's health legislation progress.
[00:21:49] Women's inclusion in research.
[00:24:32] Heart health awareness for women.
[00:30:06] Women's health advocacy in medicine.
[00:34:55] Clinical trial accessibility improvements.
[00:35:50] Women's health advocacy challenges.
[00:40:28] AI and sex differences in research.
[00:44:49] Don't take no for an answer.
More About Phyllis Greenberger M.S.W.:
Phyllis Greenberger is senior vice president of Science & Health Policy for Healthy Women. Previously, Phyllis was the president and CEO of the Society for Women's Health Research (SWHR), a national nonprofit organization widely recognized as the thought leader in women's health research, for 26 years. Phyllis was awarded the Trailblazer Award by the U.S. Department of Health and Human Services Office of Women's Health in 2016 and the Perennial Hero Award by the Alliance for Aging Research in 2021. Most recently, she received the Women in Government Relations Lifetime Achievement Award and has published a book, Sex Cells, about the fight to overcome bias and discrimination in women's healthcare.
Resources from this Episode:
Website
Sex Cells the Book
Phyllis on LinkedIn
Phyllis on Facebook
Phyllis on Instagram
Phyllis on X
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy, & Smart podcast, host Dr. Stephanie Weyrauch is joined by Dr. Rachel Wyman Dawson, the owner and operator of PT Mom Boss, a virtual membership community designed for physical therapy moms. Rachel shares her journey in the profession and discusses the resources, community, and tools PT Mom Boss offers to help physical therapy moms balance their careers with family life. The conversation highlights the importance of support and inspiration among women in physical therapy, making this episode a must-listen for those looking to navigate the challenges of being a mom and a healthcare professional. Tune in for insights and motivation from Rachel's experience.
Time Stamps:
[00:01:04] Women in leadership in PT.
[00:07:45] Women's challenges in healthcare.
[00:09:24] Community support for working moms.
[00:12:10] Unique challenges of working mothers.
[00:17:07] Advice to younger self.
More About Dr. Wyman Dawson:
Being a mom and a physical therapist is really hard, and we are losing great women in our profession because of it. PT Mom Boss is a virtual membership platform for physical therapist moms for community, resources and coaching to balance #PTlife #Momlife and #Bosslife.
Rachel is a physical therapist mom who owned her own cash based clinic in North Carolina before life threw a huge curveball, and her family relocated to northern Wisconsin on the shores of Lake Superior, where PT Mom Boss was born.
A physical therapist and entrepreneur who loves to teach, Rachel is passionate about inspiring leadership growth in women of all ages, including her two young daughters. With a focus on critical thinking, clear communication, and creative solutions to real-world challenges, she empowers others to thrive in their personal and professional lives.
Or, in the words of a dear friend;
You lead with strength, heart full of grace,
In every challenge, you find your place.
With vision and passion, you always succeed,
Helping others bloom, watering every seed.
The other stuff;
Doctorate in PT from University of Nebraska Medical Center 2010
Board Certified Orthopaedic Physical Therapist (OCS)
Certified Business Coach with Business Made Simple
Wife since 2009
Mom since 2015 (of two beautiful girls)
Onion hater since birth.
Resources from this Episode:
PT Mom Boss Website
PT Mom Boss Instagram
PT Mom Boss Community
PT Mom Boss Founders Club
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy welcomes Dr. Mike Studer, the author of "The Brain That Chooses Itself." Dr. Studer shares his extensive background as a physical therapist with 33 years of experience, focusing primarily on neurologic therapy while also engaging in pediatrics and geriatrics. They discuss behavioral economics and how it is a powerful tool that can be effectively utilized in physical therapy to create personalized care plans that motivate patients. By understanding how individuals make decisions, physical therapists can implement strategies such as nudges, gamification, and temptation bundling to enhance patient engagement and adherence to treatment plans.
Time Stamps:
[00:03:05] Unique consulting opportunities for PTs.
[00:05:22] Behavioral economics in decision-making.
[00:10:50] Temptation bundling in therapy.
[00:14:55] Health span versus lifespan.
[00:18:32] Lactate's effect on brain health.
[00:21:52] The importance of choice in health.
[00:27:35] Find your passion.
More About Dr. Studer:
Mike Studer,PT, DPT, MHS, NCS, CEEAA, CWT, CSST, CBFP, CSRP, FAPTA, has been a PT since 1991, a board-certified in neurologic PT in 1995, and a private practice owner since 2005.
Dr. Studer has been an invited speaker covering 50 states, ten countries, and four continents, speaking on topics ranging from cognition and psychology in rehabilitation, aging, stroke, motor learning, motivation in rehabilitation, balance, dizziness, neuropathy, and Parkinson’s Disease.
Dr. Studer co-founded and is co-owner of Spark Rehabilitation and Wellness in Bend, OR. He is an adjunct professor at adjunct professor at Touro University in Las Vegas as well as a part-time instructor at UNLV. Mike has led classes in the DPT program at Oregon State University (motor control) and frequently serves in a guest-lecture capacity at several other DPT and residency programs. In 2011, Mike was recognized as Clinician of the Year in the Neurologic and (in 2014) the Geriatric Academies of the APTA.
He received the highest honor available in PT in 2020, being distinguished as a Catherine Worthingham Fellow of the APTA in 2020, joining a group of under 300 persons at the time for the profession's history.
Mike’s professional honors additionally reflect his service at the state and national level, including the Vice President of the Academy of Neurologic PT and the Mercedes Weiss award for service to the Oregon chapter of APTA.
He holds a trademark in dual-task rehabilitation and has a patent pending on the same. Over his career, Mike has presented courses in all 50 states, four continents, and 10 countries. He has authored over 35 articles and 6 book chapters and routinely has clinical research projects in affiliation with one of many universities. He is a consultant to Major League Baseball on the motor control of pitching and hitting. As a very fun and lighthearted note, Mike is the four-time and current WR holder for the fastest underwater treadmill marathon, a mark set most recently in January 2022.
Resources from this Episode:
Mike’s Website
Mike on Instagram
The Brain That Chooses Itself
Jane Sponsorship Information:
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In this episode, Dr. Karen Litzy interviews Michelle Weatherby, Product Marketing Manager at Jane, a practice management software designed for health and wellness practitioners. They discuss Jane's mission to "Help the Helpers," the importance of simplicity and community support, and exciting upcoming features like integrated outbound faxing and a voice-to-chart AI tool. Michelle emphasizes the positive company culture and the value of customer satisfaction in driving Jane's success.
Time Stamps:
[00:03:47] Practice management software benefits.
[00:04:47] Help the helpers mantra.
[00:08:27] Company culture and values.
[00:13:31] Integrated outbound fax feature.
[00:15:39] Time-saving features for therapists.
[00:20:10] No education or experience wasted.
More About Michelle:
Michelle is a Product Marketing Manager at Jane App, a practice management and EMR software designed to help health and wellness providers care for their patients and run their businesses. She began her career as a Registered Dietitian, developing a deep empathy and appreciation for the providers that Jane serves. She strives to live Jane’s mission of "helping the helpers" by continually learning what customers need and showing them how Jane’s solutions can help them thrive.
Resources from this Episode:
Jane App Voice to Chart
Jane App Pricing
Jane Sponsorship Information:
Book a one-on-one demo here
Mention the code LITZY1MO for a free month
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
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In this episode of the Healthy, Wealthy, and Smart podcast, hosts Dr. Karen Litzy and Dr. Stephanie Weyrauch welcome Dr. Rob Worth, the Vice President of the APTA Private Practice Section, live from the Jane booth at the APTA Private Practice meeting in Washington, D.C. Rob shares insights into his early career in physical therapy, revealing that his passion for the profession began at the age of 16. He discusses the criteria he considered when choosing a career, emphasizing his desire to work in healthcare, focus on wellness, and leave a meaningful legacy. Please tune in to learn more about Rob's journey and his contributions to physical therapy.
Time Stamps:
[00:01:03] Early career in physical therapy.
[00:06:36] Building resilience through adversity.
[00:09:20] Finding passion in mentorship.
[00:12:25] Loss of a practice partner.
[00:15:23] Mission trips' impact on life.
[00:20:30] Importance of having fun.
[00:22:36] Opportunities in physical therapy.
[00:26:16] Business Fundamentals program launch.
More About Dr. Worth:
Dr. Worth has been in private practice since establishing Advanced Physical Therapy & Sports Medicine in 1998, with 29 clinics in northeast/central Wisconsin and provides on-site care for 60+ companies and municipalities.
Rob has served in many volunteer and leadership roles within the APTA over the past 30 years and is currently a Wisconsin Delegate to the American Physical Therapy Association and also serves as Vice-President on the APTA Private Practice Board of Directors.
Dr. Worth has received the Outstanding Service Award from APTA Wisconsin and the IndUS International Award for cross-cultural contributions in healthcare.
Resources from this Episode:
Advanced Physical Therapy & Sports Medicine
Rob Worth Instagram
Jane Sponsorship Information:
Book a one-on-one demo here
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In this episode of the Healthy, Wealthy and Smart podcast, host Dr. Karen Litzy interviews Roger Herr, president of the American Physical Therapy Association (APTA), discussing his journey in physical therapy, the APTA's initiatives, and advocacy efforts. Roger shares his career path from PT school to managing home care operations, emphasizing the APTA's focus on improving payment models and transitioning to value-based care through member engagement. He outlines the strategic planning process for the next three to five years, highlighting the importance of addressing unsustainable payment systems and workforce challenges. The conversation also covers recent legislative wins, including changes in Medicare regulations and telehealth access, while underscoring the APTA as a community that supports professional growth. Roger encourages innovation within the profession and expresses gratitude for the engaged APTA members, concluding with a call for continued involvement in advocacy efforts.
Time Stamps:
00:00-05:19: "Insights from APTA President Roger Herr on Physical Therapy's Future" 05:19-09:48: Innovative Payment Models and APTA's Strategic Planning 10:27-11:04: "Collaborative Efforts for APTA's Future Planning" 12:25-14:56: "Transforming Strategic Planning: Engaging Members and Addressing Workforce Challenges" 15:05-18:07: "APTA Strategic Planning and Advocacy Insights" 19:56-23:55: "Advancing Telehealth and Workforce Diversity in Physical Therapy" 25:47-29:55: "Embracing Innovation and Change in Physical Therapy"
More About Roger Herr:
Roger Herr is VP VNSNY Home Care at VNS Health in NYC. A distinguished healthcare leader with over 35 years of experience in post-acute care, quality reporting, health plan, and rehabilitation. Roger has implemented multiple post-acute care regulatory changes in home health, hospice, and long-term care. He has lived and worked in New York, Washington, California, and Pennsylvania. He has served multiple federal technical expert panels and quality and policy reform appointments. Roger is currently President of APTA and has twenty years of board experience in the American Physical Therapy Association (APTA) specialty sections, state chapters, and national board of directors.
An APTA member since 1985, Herr's previous association service includes previous terms on the APTA Board of Directors, serving as chief delegate for New York, and serving on APTA's Public Policy and Advocacy Committee. He has been recognized as Physical Therapist of the Year by the Washington Chapter (2006), and received APTA's Lucy Blair Service Award (2021) and Marilyn Moffat Distinguished Service Award (2021).
Resources from this Episode:
Roger on LinkedIn
American Physical Therapy Association
APTA Advocacy
APTA Strategic Plan 2022-2025
Jane Sponsorship Information:
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In our latest episode, I (Dr. Karen Litzy) was honored to be interviewed by my good friend Dr. Stephanie Weyrauch after receiving the prestigious Robert G. Dicus Award at the APTA Private Practice Annual Meeting. This award recognizes lifetime achievement in private practice, and I couldn't be more grateful for the support from my colleagues and mentors throughout my journey. Join us as we discuss the impact of mentorship, the importance of finding your voice, and the lessons learned along the way.
Time Stamps:
[00:03:26] Robert G. Dicus Award.
[00:04:20] Dicus Award recognition.
[00:09:23] Finding your voice journey.
[00:12:36] Overcoming public speaking fear.
[00:19:30] Learning from negative experiences.
[00:21:18] Business ownership mindset shift.
[00:24:47] Authenticity in professional settings.
[00:30:31] The importance of a support network.
[00:32:21] Healthy, wealthy, and smart life.
More About Dr. Karen Litzy:
Dr. Karen Litzy, PT, DPT is a licensed physical therapist, international speaker and owner of Karen Litzy Physical Therapy, PLLC.
Through her work as a physical therapist, she has helped thousands of people, including Fortune 500 CEOs, royalty, and celebrities, overcome painful conditions, recover from surgery, and feel more vital than ever before.
As the host of Healthy Wealthy & Smart, a top 200 podcast on Apple Podcasts, she has interviewed health, medicine, and entrepreneurship influencers. She also shares how she has prevailed with her own experience of chronic pain.
As a keynote and featured speaker, Dr. Karen has addressed thousands at national and international events, including Columbia University in New York City, the University of Colorado in Denver, and the International Olympic Committee World Conference on Prevention of Injury and Illness in Sport in Monaco.
Karen’s expertise has been featured in magazines, podcasts, TV Newscasts, and websites, including Prevention, Martha Stewart Living, Wirecutter from the New York Times, Time Magazine, The Washington Post, and more. She is a member of Prevention Magazine’s medical Review Board. She lives in New York City.
Resources from this Episode:
Tricia Brouk
Robert G. Dicus Award
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy & Smart podcast, guest host Dr. Jenna Kantor welcomes Dr. Cortland Wyatt, a distinguished physical therapist with extensive experience in the field. The discussion focuses on Cortland’s role as a treasurer for two nonprofit organizations. Jenna and Cortland explore the responsibilities and challenges of being a treasurer, the importance of financial management in nonprofit organizations, and how these experiences contribute to professional growth in the healthcare industry. Tune in for valuable insights on leadership and financial stewardship within the physical therapy community.
Time Stamps:
[00:01:42-00:02:03] Treasurer experience in nonprofits.
[00:06:28] Growing an organization in therapy.
[00:11:59] Importance of communication in finance.
[00:14:21] Technical aspects of organization management.
[00:17:35] Technical challenges with new platforms.
[00:24:50] Treasurer's decision-making in nonprofits.
[00:29:03-00:29:44] The future of finance.
[00:31:23] Cryptocurrency in healthcare payments.
More About Dr. Courtland Wyatt:
Dr. Courtland Wyatt is a native of St. Louis, MO where he learned the value of hard work at an early age. A veteran of the United States Army, he went on to attend Howard University where he was a member of the Dean’s list and obtained his Master Degree in Physical Therapy.
Dr. Wyatt has filled the position of adjunct professor at Howard University, George Washington University and Montgomery Community College in their respective PT departments.
After receiving a Doctorate of Physical Therapy from Alabama State University, he began a non-profit organization aimed at eliminating health disparities in socioeconomically deprived areas across the nation. The program provides scholarships, mentoring, health/wellness and educational resources.
In addition to his roles of CEO and therapist, he is also co-owner of Ergo Solutions, which has developed into the largest outsourcing physical rehab company in Washington, DC.
Resources from this Episode:
Dr. Wyatt on LinkedIn
Ergo180
AAPT Website
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Stephanie Weyrauch welcomes Kristin Revere, founder and CEO of Gold Coast Doulas. Kristin shares her journey in starting Gold Coast Doulas in 2015, initially as a solo birth doula and expanding to a team of 27 contractors, including lactation consultants, sleep consultants, and newborn care specialists. The discussion highlights the role of doulas as non-medical support persons, emphasizing their importance in providing comprehensive care for families during the birthing process and beyond. Kristin also co-authored the book "Supported: Your Guide to Birth and Baby," which explores the various types of doulas and their significance in an interdisciplinary team. This episode is a valuable resource for expecting parents and those interested in understanding the multifaceted support doulas offer.
Time Stamps:
[00:02:03] The role of doulas explained.
[00:06:48] The evolving role of doulas.
[00:10:17] Support during unpredictable birth.
[00:18:08] Doula support for partners.
[00:20:33] Importance of doulas in healthcare.
[00:25:07] Importance of hydration postpartum.
[00:30:08] Emotional support during postpartum.
[00:31:40] Postpartum emotional support challenges.
[00:36:18] Starting a doula service.
[00:44:13] Collaboration in business mindset.
[00:45:46] Connecting with Gold Coast Doulas.
More About Kristin Revere:
Kristin Revere is a woman who has always had a passion for supporting other women, both personally and professionally. In college, Kristin served on the Executive Committee of her sorority and organized events on campus related to breast cancer and other women’s issues. She later facilitated nonpartisan political trainings for female candidates and volunteered for many nonprofits focused on women’s issues. Kristin firmly believes in the power that lies within a woman and has spent her life drawing it out of the women she surrounds herself with.
After the birth of her daughter in 2011, a new passion awoke within her. Kristin began reading and studying birth from all perspectives, philosophies, and medical approaches. She joined organizations like the Healthy Kent Breastfeeding Coalition and used her event coordinating skills to build and promote the organization and create community awareness.
Kristin’s research led her to learn about doulas, and in 2012 she hired doulas herself for the support of her second birth. The level of compassionate care and comfort that she received from her doulas ignited a spark within Kristin that led her to the path of becoming a doula herself.
She earned her certification and began teaching Sacred Pregnancy classes in 2013, but as you’ll see Kristin is a firm believer in achieving the highest level of education available when providing a service. Shortly after, she earned the following credentials.
- Certified Sacred Doula in 2014
- Certified Elite Labor Doula through ProDoula in 2015
- Certified Elite Postpartum and Infant Care Doula through ProDoula in 2016
- Trained in Spinning Babies in 2020
- Newborn Care Specialist through Newborn Care Solutions
- Mothership Certified Health Service Provider
- Certified VBAC Academy Pro
- Certified Transformational Birth Coach through Birth Coach Method
- Certified Pregnancy and Infant Loss Advocate (PAIL) 2022
- Certified Gift Registry Expert through Be Her Village 2023
Kristin’s main passion as a birth and postpartum doula is to offer women and families resources, unbiased support, and understanding. Kristin is a listener, a friend, a confidant, an expert, and women intuitively feel stronger in her presence.
She has a Bachelor of Science in Journalism from Central Michigan University and a Master of Management in Marketing from Aquinas College. Kristin is the host of Ask the Doulas Podcast. Her writing has been featured in Rapid Growth Media and First Time Parent Magazine. Kristin was selected as one of the 50 Most Influential Women in West Michigan by the Grand Rapids Business Journal in 2016 and in 2022.
Kristin and the rest of the Revere Clan, which includes her husband, her step-daughter, and her two children, live in Grand Rapids and can be found taking in the sights at local art galleries, parks, music concerts, and community events.
Resources from this Episode:
Gold Coast Doulas Website
Gold Coast Doulas on Instagram
Gold Coast Doulas on YouTube
Kristin on LinkedIn
Ask The Doulas Podcast
Supported: Your Guide to Birth and Baby
Jane Sponsorship Information:
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Karen Litzy welcomes Dr. Efosa Guobadia, CEO of FFITT Health and co-founder of PT Day of Service, to celebrate the 10-year anniversary of this impactful initiative. Dr.Guobadia reflects on the original vision behind PT Day of Service, emphasizing the core values of community, engagement, collaboration, and service within the physical therapy profession. He shares insights on how the concept has evolved over the years, surpassing their initial expectations and highlighting the limitless potential of service in physical therapy. Join Karen and Efosa as they explore the significance of giving back and the continued growth of PT Day of Service.
Time Stamps:
[00:01:10] Vision of PT Day of Service.
[00:07:24] Burnout during the pandemic.
[00:10:44] Compassion in service and health.
[00:11:27] Community service in physical therapy.
[00:16:05] Falls prevention screenings for community.
[00:21:01] Community involvement and engagement.
[00:23:28] Movement and community service.
[00:26:33] Sustainable systems for movement health.
[00:31:16] PT Days of Service.
[00:34:08] Rejoice in the beginning.More About Dr. Efosa Guobadia:
Efosa L. Guobadia, PT, DPT, is the Founder of FFITT Health; Founder of Move Together, and Co-Founder of the Global PT Day of Service, which has spanned over 80 countries since its inception in 2015. He has contributed chapters to two books: ‘Why Global Health Matters”, edited by Dr. Chris E. Stout; and "Learning to Lead in Physical Therapy", edited by Jennifer Green-Wilson and Stacey Zeigler. He received his BS in Kinesiology from the University of Massachusetts in 2007, his Doctorate of Physical Therapy from the University of Scranton in 2010, and Master of Business Administration from UMass Isenberg School of Management with a focus in finance in 2024.. He is the recipient of the 2017 Distinguished Young Alumni Award given by the University of Massachusetts/Amherst School of Public Health and Health Sciences, is a 2018 American Physical Therapy Association Social Impact Award Recipient, and the 2023 University of Scranton DPT Program Outstanding Alumni Award Recipient.
Resources from this Episode:
PT Day of Service
Move Together
PT Day of Service on Instagram
PT Day of Service on X
PT Day of Service on Facebook
Efosa on Instagram
Move Together on Instagram
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy interviews Ilana Muhlstein, a dietician, nutritionist, bestselling author, and mother of three. Ilana shares her personal journey of weight struggles and how it led her to become a passionate dietitian. They discuss nutrition, mindset around eating, and how to talk to kids about healthy habits. Ilana’s success as a female entrepreneur is highlighted, showcasing her mission to make a healthy lifestyle more attainable. Tune in for valuable insights on nutrition and mindset from this global health and wellness expert!
Time Stamps:
00:00:02 - Introduction and Guest Introduction 00:01:16 - Ilana Muhlstein’s Background and Personal Journey 00:07:08 - Importance of Mindset in Weight Loss 00:12:06 - Setting Achievable Goals 00:17:00 - Changing Negative Mindsets 00:17:45 - Encouraging Kids to Eat Vegetables 00:23:06 - Addressing Pediatric Obesity 00:28:01 - Personal Anecdotes on Balanced Eating 00:30:04 - Teaching Kids About Nutrition 00:34:18 - Strategies for Picky Eaters 00:35:03 - Final Thoughts on Mindset and Health 00:39:22 - Where to Find Ilana Muhlstein 00:40:08 - Advice to 20-Year-Old Self 00:40:52 - Conclusion and Farewell
More About Ilana Muhlstein:
Dietitian, nutritionist, bestselling author, and mother of three, Ilana Muhlstein, MS, RD, is a highly sought-after global health and wellness expert. At the age of thirteen, Ilana weighed over two hundred pounds and struggled with weight loss, emotional eating, and ineffective diets. This molded her passion to become a dietitian with a mission to show people that a healthy lifestyle is easier and much more attainable than they think.
Resources from this Episode:
Ilana’s Website
Ilana on Instagram
Ilana’s Programs
Ilana Meals on Instagram
HWPOD10 for all Ilana Housewares orders over $70 or more. (www.ilanahousewares.com) PODCAST10 to get $10 off your first meal- receive an extra 5% off when you subscribe! (www.ilanameals.com)
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On this episode of the Healthy, Wealthy, and Smart podcast, Dr. Karen Litzy discusses setting boundaries, raising prices, and managing difficult situations with guest Hilary Silver, LCSW, an entrepreneur and thought leader in personal development and relationships. Hilary shares her journey from social work graduate to private practice and offers valuable insights on navigating these challenging aspects of business. Tune in for expert advice on maintaining boundaries and handling financial decisions in your professional life.
Time Stamps:
00:00:02 - Introduction and Guest Introduction 00:01:07 - Hilary Silver's Journey 00:03:00 - Transition to Digital Empowerment Program 00:04:26 - Taking a Leap of Faith 00:04:48 - Importance of Setting Boundaries 00:05:33 - Identifying Your Boundaries 00:07:08 - Expressing Your Boundaries 00:08:01 - Holding Your Boundaries 00:09:05 - Flexibility in Boundaries 00:10:36 - Recognizing Burnout and Overwhelm 00:12:14 - Taking Responsibility for Your Boundaries 00:14:42 - Gently Holding Boundaries 00:15:59 - Bless and Release 00:16:21 - Money and Self-Worth 00:18:18 - Charging for Outcomes, Not Time 00:21:03 - Practical Application in Clinical Settings 00:24:21 - Raising Prices and Ideal Clients 00:27:06 - Expanding Capacity for Success 00:28:42 - Manifesting and Mindset 00:29:12 - People Pleasing and Self-Worth 00:31:13 - Business Training and Mindset Shift 00:32:41 - Key Takeaways 00:33:45 - Where to Find Hilary Silver 00:36:20 - Advice to 20-Year-Old Self 00:37:14 - Conclusion and Thanks
More About Hillary Silver:
Hilary Silver is an entrepreneur and thought leader in the realm of personal development and relationships. After 15 years as a successful clinical psychotherapist, Hilary closed her thriving practice in 2017 to launch “Ready for Love,” an online coaching and wellness company that helps smart, single women become just as successful in their love lives as they are in their professional ones.
She grew her company into an empire, generating over $13 million in revenue in 6 years, helping thousands of women work through her program with an over 95% success rate. Hilary’s passion and deep understanding of the root causes of the struggles of her clients helped her develop her signature methodology, rooted in radical responsibility and being centered in self.
She now works to educate and inspire everyone to radically change the way they think about themselves so they can live a fully liberated life on their own terms.
Resources from this Episode:
Hilary’s Website
Hilary’s Instagram
Hilary’s Facebook
Hilary’s YouTube
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Dr. Karen Litzy interviews Dr. Jared Pelo, co-founder of Bionic Health, about leveraging AI in medicine to improve patient care and physician-patient connections. Dr. Pelo shares his journey from emergency medicine to founding Bionic Health, driven by a desire to address healthcare issues proactively rather than reactively. Tune in to learn more about the intersection of AI and medicine in revolutionizing healthcare practices.
Time Stamps:
00:00:02 - Introduction and Guest Welcome 00:00:42 - Dr. Jared Pelo's Background 00:01:59 - Transition to AI and Medicine 00:03:04 - Personal Tragedy and Founding Bionic Health 00:04:20 - Role of AI in Longevity Medicine 00:06:10 - Practical Application of AI in Healthcare 00:10:18 - AI and Physician Collaboration 00:12:10 - Human Connection in Healthcare 00:13:23 - Benefits of AI for Patients 00:16:38 - Longevity Medicine Explained 00:19:17 - Anecdotes and Studies on Longevity 00:23:20 - Bionic Health's Approach to Longevity 00:24:20 - Importance of Exercise and Lifestyle 00:27:05 - Education and Preventative Measures 00:29:07 - Take-Home Message 00:30:47 - How to Learn More About Bionic Health 00:31:28 - Advice to 20-Year-Old Self 00:32:12 - Conclusion and Farewell
More About Dr. Jared Pelo:
Jared Pelo, MD, Chief Medical Officer and Co-Founder of Bionic Health
Dr. Jared Pelo trained and worked in emergency medicine before founding iScribes, an early ambient AI health tech company. iScribes was acquired by Nuance Communications a Microsoft Company and was developed into Dragon Ambient eXperience. Dr Pelo started Bionic Health after a family tragedy and being inspired by the power of AI in medicine. Passionate about AI in medicine and preventive medicine, Dr. Pelo advocates using advanced AI tools and compassion to enhance patient-physician connection and patient care.
Resources from this Episode:
Bionic Health Website
Dr. Pelo on LinkedIn
Dr. Pelo on YouTube
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On this episode of Healthy, Wealthy, and Smart, host Dr. Karen Litzy welcomes Dr. Torkil Færø, a general practitioner and emergency physician with extensive experience in healthcare. Dr. Farrow discusses the impact of lifestyle stresses on our health using The Pulse Cure, drawing from his 25-year career and thousands of consultations. He shares insights on the evolution of his career and the pivotal moment that inspired a shift in his approach to health. Tune in to gain valuable perspectives on optimizing your well-being.
Time Stamps:
00:00:00 - Introduction and Guest Introduction 00:01:07 - Dr. Torkel Farrow's Career Journey 00:02:01 - Personal Health Transformation 00:03:10 - The Role of Lifestyle in Disease 00:04:16 - The Importance of Preventative Medicine 00:05:45 - Proactive vs. Reactive Healthcare 00:06:43 - Smart Choices for Better Health 00:08:09 - The Impact of Alcohol on Health 00:09:07 - Balancing Stress and Recovery 00:09:30 - Heart Rate and Health 00:12:07 - Using Wearables to Manage Stress 00:14:24 - Alcohol and Sleep Quality 00:16:08 - The Vicious Cycle of Alcohol and Stress 00:17:00 - Personal Experience with Alcohol Reduction 00:18:34 - The Value of Wearables in Monitoring Health 00:19:00 - Potential Downsides of Wearables 00:21:18 - Empowerment Through Wearables 00:21:48 - Strategies for a Longer Life 00:22:01 - Key Lifestyle Changes for Longevity 00:25:08 - Exercise and Muscle Health 00:26:25 - The Importance of Good Relationships 00:28:24 - Balancing Work and Social Life 00:30:08 - Overview of "The Pulse Cure" Book 00:32:02 - Key Takeaways on Using Wearables 00:33:35 - Heart Rate Variability and Women's Health 00:35:00 - Understanding Heart Rate Variability 00:36:06 - Advice to Younger Self 00:36:41 - Conclusion and Contact Information
More About Dr. Torkil Færø:
Dr Torkil Færø is a general practitioner and emergency physician, documentary filmmaker, author and photographer. In 1996, he was one of the first Norwegian medics to work for Doctors Without Borders when he worked in war-torn Angola. Over a 25-year career as a freelance doctor, he has worked all over Norway, had tens of thousands of consultations, and gained a unique picture of the diseases that plague us. He has learned that the cause is most often found in the stresses our lifestyles place on our bodies.
Færø is also an award-winning photographer, author of Kamerakuren (The Camera Cure), and has made documentaries about his pilgrimages to Nidaros and Santiago de Compostela.
An inveterate traveler, he has made his way by bicycle, motorbike, kayak, boat, and car through over 80 countries and speaks eight languages. He lives in Oslo with his wife and two children.
Resources from this Episode:
The Pulse Cure Website
Dr. Torkil on Instagram
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On this episode of the Healthy, Wealthy, and Smart Podcast, Dr. Karen Litzy interviews Steve Farrell, a former Silicon Valley entrepreneur turned advocate for interconnectedness. They discuss Steve's journey from high-tech entrepreneurship to promoting conscious living and business practices. Steve shares insights on creating a more conscious business and the importance of interconnectedness in today's world. Tune in for expert tips on how to infuse consciousness into your business endeavors.
Time Stamps:
00:00:00 - Introduction and Guest Introduction 00:01:04 - Steve Farrell's Background and Journey 00:06:19 - Personal Awakening and Conscious Living 00:07:02 - Translating Consciousness to Business 00:07:42 - Six Tips for Creating a Conscious Business 00:09:39 - Practicing Conscious Leadership 00:13:10 - Engaging Community Well-Being 00:18:31 - Implementing Sustainable Practices 00:24:06 - Fostering an Inclusive and Empowering Work Culture 00:28:05 - Embracing Transparency and Integrity 00:31:04 - Cultivating a Purpose-Driven Mission 00:34:46 - Implementing Conscious Business Practices 00:36:33 - Key Takeaways and Final Thoughts 00:37:54 - Where to Find More Information 00:38:41 - Advice to 20-Year-Old Self 00:39:48 - Conclusion and Sign-Off
More About Steve:
From the pinnacle of Silicon Valley success as co-founder of two high-tech firms, Steve Farrell pivoted to lead Humanity’s Team, a global nonprofit helping people everywhere awaken to our interconnectedness. After contributing to the Gold Nautilus Award-winning book "Our Moment of Choice — Evolutionary Visions and Hope for the Future," Steve details his journey from the American Dream to conscious leadership in his new book, "A New Universal Dream." Steve and Humanity’s Team offer educational programs in business, science, spirituality, creativity, relationships, healing, and conscious living through multiple platforms including their Humanity Stream+ streaming service. Learn more at ANewUniversalDream.com.
Resources from this Episode:
Steve’s Website
Steve's Facebook
Steve’s Twitter
Steve’s LinkedIn
Steve’s YouTube
Steve’s Instagram
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On this episode of the Healthy, Wealthy, and Smart Podcast, Dr. Karen Litzy interviews Dr. William Davis, a cardiologist and bestselling author, about the importance of muscle in successful weight loss. Dr. Davis shares insights from recent clinical trials on losing fat while preserving muscle. The conversation delves into the limitations of conventional weight loss methods and highlights the significant impact of building and maintaining muscle for overall health and weight management.
Time Stamps:
00:00:00 - Introduction and Guest Introduction 00:00:12 - Topic Overview: Muscle and Weight Loss 00:00:23 - Guest Introduction: Dr. William Davis 00:00:51 - Dr. Davis' Impact and Audience Feedback 00:01:56 - Conventional Weight Loss Methods 00:02:10 - Move More, Eat Less: Conventional Wisdom 00:02:53 - Muscle Loss in Conventional Weight Loss 00:03:46 - Health Risks of Conventional Weight Loss 00:05:19 - Importance of Preserving Muscle 00:05:50 - Benefits of Muscle Preservation 00:06:44 - Strength Training and Weight Loss 00:07:33 - The Biggest Loser Example 00:08:27 - Case Study: Danny Cahill 00:09:48 - Beyond Strength Training: Preserving Muscle 00:10:13 - Lactobacillus Reuteri and Muscle Preservation 00:11:08 - Fermentation and Yogurt Making 00:13:05 - Benefits of Lactobacillus Reuteri 00:14:10 - Human Clinical Trial on Skin and Muscle 00:16:17 - Targeting Abdominal Fat 00:17:01 - Potential Negative Side Effects 00:18:01 - Small Intestinal Bacterial Overgrowth (SIBO) 00:19:04 - Endotoxemia and Health Issues 00:20:29 - Oxytocin and Body Composition 00:21:02 - Lactobacillus Reuteri and SIBO 00:22:09 - Air Device for Measuring SIBO 00:23:44 - Surprising Findings in Research 00:24:01 - Restoring Muscle and Targeting Fat 00:25:06 - New Approach to Weight Loss 00:26:07 - Collagen and Hyaluronic Acid in Diet 00:27:27 - Hyaluronic Acid for Skin and Joints 00:29:14 - Benefits of Butyric Acid 00:30:06 - Hyaluronic Acid and Joint Health 00:31:05 - Potential for Osteoarthritis Reversal 00:32:00 - Personal Anecdotes and Family Health 00:33:02 - Duration and Commitment to Supplements 00:34:06 - Preventive Measures for Arthritis 00:34:45 - Microbiome and Health 00:35:07 - Microbiome Manipulation 00:36:00 - Vaginal Microbiome and Health 00:37:26 - Opportunities in Microbiome Research 00:38:27 - Reducing Chronic Disease with Microbiome 00:39:14 - Where to Find Dr. Davis 00:40:18 - Advice to Younger Self 00:41:26 - Closing Remarks and Thank You
More About Dr. Davis:
WILLIAM DAVIS, MD is cardiologist and author of the groundbreaking #1 New York Times bestseller Wheat Belly, three other New York Times bestsellers: Wheat Belly Cookbook, Wheat Belly 30-Minutes (or Less!) Cookbook, and Wheat Belly Total Health, and several other books including Wheat Belly 10-Day Grain Detox and Undoctored. His most recent book is Super Gut: A Four-Week Plan to Reprogram Your Microbiome, Restore Health and Lose Weight that maps out the damage that has occurred with the modern human microbiome and the specific, actionable steps that can be taken to restore it to maximum advantage.
Dr. Davis champions programs that empower the individual in health in a world in which the healthcare system has failed to provide unbiased information and services. He is co-founder and Chief Medical Officer of Realize Therapeutics Corp. in Lake Bluff, Illinois, a commercial project to fund research and develop therapeutic products applying the new science of the microbiome. He is active in various online activities, including his Wheat Belly Blog (33 million visits) which has now transitioned to his Dr. Davis Infinite Health website (www.DrDavisInfiniteHealth.com). He also broadcasts his message through his Dr. Davis Infinite Health YouTube channel (https://www.youtube.com/channel/UCZp4ONYOXZkf92UxxNnAiKQ) and his Defiant Health Radio podcast (https://podcasts.apple.com/us/podcast/defiant-health-radio-with-dr-william-davis/id1591499942). He remains active in social media with, for instance, 400,000 Facebook followers.
Dr. Davis is a graduate of the St. Louis University School of Medicine, with training in internal medicine and cardiovascular disease, and advanced training in interventional procedures at the Case Western Reserve University Hospitals where he also served as Director of the Cardiovascular Fellowship and Assistant Professor of Medicine. He lives in Chicago, Illinois.
Resources from this Episode:
Dr. Davis Website
Dr. Davis on Instagram
Dr. Davis Podcast
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On this episode of the Healthy, Wealthy, and Smart podcast, Dr. Karen Litzy discusses chronic pain with Dr. David Clark, president of the Psychophysiologic Disorders Association. Dr. Clark sheds light on stress-related brain-generated medical conditions and the mission of his organization to end the chronic pain epidemic. They emphasize the importance of looking beyond structural damage in addressing chronic pain. Tune in to learn more about this important topic!
Time Stamps:
[00:02:41] Psychophysiologic disorders definition.
[00:06:26] Abnormalities in spine and pelvis.
[00:09:26] Vacation and stress relief.
[00:14:30] Adverse childhood experiences.
[00:17:03] Stress-related triggers for symptoms.
[00:22:18] Deep stress.
[00:25:36] Brain-generated symptoms.
[00:31:27] The brain generating physical symptoms.
[00:34:00] Transforming healthcare education.
More About Dr Clark:
Dr. David Clarke is the President of the Psychophysiologic Disorders Association (PPDA), a 501(c)(3) nonprofit dedicated to ending the chronic pain epidemic. Dr. Clarke holds an MD from the University of Connecticut School of Medicine, and is Board-certified in Internal Medicine and Gastroenterology. His organization’s mission is to advance the awareness, diagnosis, and treatment of stress-related, brain-generated medical conditions. Learn more at EndChronicPain.org.
Resources from this Episode:
Psychophysiologic Disorders Association
Past Media Coverage of Dr. Clark
PPDA Facebook
Dr. Clark on LinkedIn
PPDA on YouTube
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Stephanie Weyrauch is joined by special guest Dr. Jennifer Hill, a historian from Montana State University, to discuss Dr. Hill's book, "Birthing the West." Dr. Hill shares her background as a historian and a mother of three, explaining how her personal experiences with pregnancy inspired her to delve into the history of birthing. Tune in to learn more about the fascinating intersection of history, pregnancy, and societal perceptions.
Time Stamps:
[00:01:38] History of birthing in Montana.
[00:07:04] Public health in the West.
[00:08:44] Support in caregiving relationships.
[00:14:45] Medicalization of childbirth.
[00:17:02] Birthing practices in America.
[00:21:28] Postpartum support and historical perspective.
[00:25:09] Importance of Listening in Healthcare.
[00:29:00] Challenging medical standards of care.
[00:35:48] Fear of childbirth.
[00:39:06] Valuing the human reproductive process.
[00:44:52] Contraception laws in the US.
[00:46:36] Home birth as a trend.
[00:53:37] Full humanity in healthcare.
[00:56:19] Talking about reproduction openly.
More About Dr. Hill:
With a passion for making the everyday realities of past peoples come alive, Jennifer Hill holds a PhD in American Studies. Her research and writing focus on childbirth, contraception, abortion, venereal disease, and healthcare in the American West – an area with a compelling reproductive history. Based on the belief that history is a powerful tool for understanding current controversies, Hill focuses on interpreting our shared human past in ways that inform contemporary reproductive issues.
Currently an Associate Teaching Professor at MSU, Jennifer works as an interdisciplinary scholar. When she is not researching, writing, or teaching, she can be found trail running, gardening, kayaking, or eating.
Resources from this Episode:
Dr. Hill’s Website
Birthing the West Book
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On this episode of the Healthy, Wealthy, and Smart podcast, Dr. Jennifer Stevens-Lapsley and Dr. Kory Zimney, underscored the crucial role clinicians play in influencing the APTA research agenda. They emphasized that clinicians should be invested in the research agenda as it directly impacts their practice and the well-being of their patients. Here are key takeaways from the episode on how clinicians can actively contribute to the APTA research agenda:
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Data Collection: Clinicians are encouraged to start gathering outcomes data in their clinical settings. This data serves as a valuable resource for addressing research inquiries and refining clinical practices. By systematically collecting data on patient outcomes, clinicians can bolster the evidence base, guiding decision-making at both individual patient levels and broader research endeavors.
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Questioning: Clinicians are uniquely positioned to identify knowledge gaps and areas requiring further research. By posing questions based on their clinical experiences, clinicians can help shape research priorities and initiate meaningful research projects. Cultivating a curious mindset can lead to the formulation of research questions that tackle real-world clinical challenges.
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Collaboration with Researchers: Collaboration between clinicians and researchers is pivotal for advancing the field of physical therapy. Clinicians can collaborate with researchers by sharing clinical insights, participating in research studies, and engaging in discussions on research findings. Through joint efforts, clinicians and researchers can ensure that research remains relevant, practical, and directly applicable to clinical settings.
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Networking and Relationship Building: Clinicians are urged to network with researchers, academic institutions, and other healthcare professionals to foster collaborations and knowledge exchange. Establishing relationships with researchers can provide clinicians with opportunities to contribute to research projects, access resources, and stay abreast of the latest research developments in physical therapy.
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Promoting Evidence-Based Practice: Physical therapists are an evidence-based profession who rely on research to inform their clinical interventions. By actively engaging with the APTA research agenda and participating in research endeavors, clinicians can enhance the quality of care they deliver and contribute to the advancement of the profession.
Time Stamps:
00:00:00 - Introduction and Guest Welcome 00:01:04 - Importance of the APTA Research Agenda 00:03:27 - Development Process of the Research Agenda 00:07:02 - Dissemination of the Research Agenda 00:11:56 - Overview of the Six Key Areas 00:12:14 - Population Health Research 00:12:59 - Mechanistic Research 00:13:19 - Clinical Research 00:17:19 - Education and Professional Development Research 00:21:16 - Health Services Research 00:22:18 - Workforce Research 00:24:36 - Relevance to Clinicians 00:30:05 - Encouragement for Clinician Involvement 00:32:11 - Final Thoughts and Takeaways 00:34:16 - Contact Information for Guests 00:34:42 - Advice to 20-Year-Old Self 00:36:12 - Conclusion and Sign-Off
More About Dr. Jennifer Stevens-Lapsley:
Dr. Stevens-Lapsley serves as a Professor and the Director of the Rehabilitation Science PhD Program within the Physical Therapy Program at the University of Colorado Anschutz Medical Center. Additionally, she is the Associate Director of Research for the Eastern Colorado VA Geriatrics Research, Education, and Clinical Center (GRECC). She is dedicated to the advancement of evidence-based solutions in older adult rehabilitation, achieved through rigorous research methodologies and strategic partnerships. With 25 years of experience in clinical research, her specialization lies in post-joint arthroplasty care and medically complex patient populations.
Dr. Stevens-Lapsley's impactful clinical research has yielded 200 publications, garnered numerous awards, and secured $20 million in funding. She is a frequent presenter at both national and international forums, contributing significantly to the dissemination of her research findings.
More About Dr. Kory Zimney:
Kory Zimney, PT, DPT, Ph.D. has been practicing physical therapy since 1994 following his graduation from the University of North Dakota with his Master in Physical Therapy. He completed his transitional DPT graduate from the Post Professional Doctorate of Physical Therapy Program at Des Moines University, Class of 2010. He also earned his Ph.D. in Physical Therapy from Nova Southeastern University in 2020.
Dr. Zimney is an Associate Professor within the Department of Physical Therapy at the University of South Dakota and the Director of the Ph.D. in Health Sciences program at USD. He also serves as Senior Faculty with Evidence in Motion (EIM) and researcher with Therapeutic Neuroscience Research Group and USD Center for Brain and Behavior Research. His primary teaching, research, and treatment focuses are on pain neuroscience, therapeutic alliance, and evidence-based practice for orthopedic injuries of the spine and extremities. He has published multiple peer-reviewed research articles in these areas. Past work experiences have been with various community-based hospitals working in multiple patient care areas, including inpatient, skilled rehab, home health, acute rehab, work conditioning/hardening, and outpatient orthopedics.
He has completed the Advanced Credentialed Clinical Instructor program through the American Physical Therapy Association and is a Certified Spinal Manual Therapist and assisted in the development of the Therapeutic Pain Specialist program through the EIM certification program, and has a certification in Applied Functional Science through the Gray Institute.
Resources from this Episode:
APTA Research Agenda
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On this episode of the Healthy, Wealthy, and Smart podcast, Dane Johnson joins the host to discuss holistically reversing Crohn's and colitis. As someone who reversed his own battle with Crohn's colitis using natural medicine, Dane shares his journey and insights as a holistic nutritionist helping others with IBD. Listeners will gain valuable information about these gut health issues and find inspiration in Dane's story of turning a negative experience into a positive one. Tune in for expert definitions and empowering discussions on inflammatory bowel diseases.
Time Stamps:
[00:03:01] Gut health central to well-being.
[00:06:24] Diagnosing IBD vs. IBS.
[00:11:03] Our bodies becoming weaker.
[00:12:25] Microbiome and human health.
[00:15:20] Ways to release toxins.
[00:21:28] Polyphenols for microbiome diversity.
[00:25:24] Gut-friendly energy supplement.
[00:29:08] Quality food and self-empowerment.
[00:30:11] Taking ownership of your health.
[00:33:29] Choosing Healthier Wine Options.
[00:39:30] Frozen fruit as convenient option.
[00:41:05] Gut health SHIELD program.
[00:46:53] Advice to my 20-year-old self.
[00:48:14] Wish I did the same.
More About Dane:
Dane Johnson is the Founder/CEO of Crohn's Colitis Lifestyle and a Holistic Nutritionist specializing in reversing Crohn’s Disease and Ulcerative Colitis. Dane’s story ignited through a life-threatening case of Crohn’s/Colitis which nearly took his life December 2014. Since committing his life to natural healing he has remained surgery and medication-free while eliminating IBD symptoms.
To date, Dane and his passionate team of specialists and coaches have created 500+ success stories for reversing IBD symptoms using his signature S.H.I.E.L.D. Program. His international IBD consulting firm is one of the few organizations in the world that only treat IBD, and see roughly 100+ international IBD cases a week despite any unique needs!
Dane and his team have successfully worked with of IBD clients despite surgery, age, medication, past experiences, diet preferences, extreme cases, world location or culture.
His passion, unique experience, and niche in the field of IBD have empowered him to create unparalleled value for real, long-term symptom relief for those suffering from Inflammatory Bowel Disease.
Resources from this Episode:
Dane’s Website
Dane’s Instagram
Crohn’s/Colitis Lifestyle Instagram
The Shield program
Healing Journal Free Gift
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On this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy chats with Dr. Jacob Kendall, a survivor of two open heart surgeries, a public health gerontologist, and a four-dimensional poly thinker. They discuss demystifying healthcare to empower patients and caregivers. Dr. Kendall shares his personal journey through the healthcare system and highlights the importance of being an interdisciplinary thinker. Listen in for valuable insights on navigating the healthcare landscape with confidence and understanding.
Time Stamps:
[00:01:53] A true interdisciplinarian.
[00:06:30] Illusion of Healthcare Autonomy.
[00:09:39] Population growth affecting medical care.
[00:13:36] Communication strategies for patients.
[00:16:30] Disparities in healthcare.
[00:19:27] Medical providers being curious.
[00:24:16] Rethinking retirement and life structure.
[00:27:02] Pet Insurance Benefits.
[00:31:34] Interdisciplinary healthcare teams.
[00:35:44] Self-advocacy in healthcare.
[00:37:28] Following your instincts in career.
More About Dr. Jacob Kendall:
Dr. Jacob Kendall demystifies health(care) so folks can be savvy patients and
caregivers. He is the survivor of two open-heart surgeries in early adulthood and has
formal training in gerontology, public health, social work, biology, and theology. Jacob
believes the key to mastering health is a convergent 4-dimensional approach,
integrating multiple perspectives to show that health and healthcare are more than
individualistic, medical, local, and now.
Resources from this Episode:
Jacob’s Website
Jacob on LinkedIn
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I had the pleasure of speaking with Dr. Jackleen Samuel, CEO of Resilient Healthcare, on the latest episode of the Healthy, Wealthy, and Smart podcast. Dr. Samuel shared insights on the evolution of care delivery and the innovative solutions Resilient Healthcare is implementing to bridge gaps in healthcare. From acute care at home programs to extending services into the community, Resilient Healthcare is revolutionizing the way patients receive care. Here are the key takeaways from our conversation:
- Innovative Care Delivery: Resilient Healthcare offers acute care at home programs, providing hospital-level care in the comfort of patients' homes.
- Collaboration with Hospitals: By partnering with hospitals, Resilient Healthcare is able to extend care into the community and improve access to services.
- Tech-Enabled Solutions: Leveraging technology for continuous monitoring and virtual consultations, Resilient Healthcare ensures patients receive high-quality care remotely.
- Importance of Resilience: Dr. Samuel emphasizes the need to be resilient and push forward in the face of challenges, advocating for positive change in the healthcare industry.
Time Stamps:
00:00:03 - Introduction and Welcome 00:00:14 - Episode Topic: Changes in Healthcare Delivery 00:00:35 - Guest Introduction: Dr. Jackleen Samuel 00:00:59 - Dr. Samuel's Background and Career Path 00:02:05 - Inspiration Behind Resilient Healthcare 00:02:33 - Benefits of Home Healthcare 00:03:25 - Transition from Clinical to Nonclinical Role 00:05:13 - Evolution of Resilient Healthcare 00:07:18 - Acute Care at Home During the Pandemic 00:09:02 - Practical Implementation of Acute Care at Home 00:11:05 - Patient Feedback and Satisfaction 00:12:21 - Business Model and Operations 00:14:13 - Credentialing and Staffing 00:15:09 - Workflow and Coordination with Hospitals 00:17:19 - Benefits of Home Visits for Physical Therapy 00:19:24 - Challenges and Opportunities in Home Healthcare 00:20:02 - Extending Hospital Services into the Community 00:22:16 - Disconnect in Home Health Awareness 00:23:21 - Partnering with Local Providers 00:25:10 - Surprises and Challenges in Healthcare Industry 00:28:17 - Positive Reception of Hospital at Home Model 00:29:16 - Final Takeaways and Encouragement 00:30:16 - Contact Information and Website 00:30:51 - Advice to 20-Year-Old Self 00:31:35 - Conclusion and Farewell
More About Dr. Jackleen Samuel-Kloes, PT, DPT:
Dr. Jackleen Samuel is the CEO/President of Resilient Healthcare (Plano, TX) and a serial entrepreneur deeply passionate about disrupting traditional healthcare delivery. With over a decade in the industry, she consistently drives growth, innovation, and pursues her mission to make healthcare both convenient and transparent for patients.
Beyond her leadership at Resilient Healthcare, Jackleen's entrepreneurial spirit shines through her diverse ventures. She founded a post-acute rehabilitation company, spearheaded a neurology therapy clinic, and co-owned a physical therapy management firm.
Each endeavor underscores her commitment to elevating patient care through technology and innovative methodologies. As a result, Resilient Healthcare stands as a beacon in the health-tech landscape, delivering unparalleled hospital-at-home services while championing operational excellence and profitability.
A graduate of New Jersey Institute of Technology and Rutgers University, Jackleen earned a bachelor's degree in biology, coupled with a tech-centric minor in History, and later pursued a Doctorate in Physical Therapy from Rutgers.
Her influential role in healthcare has garnered notable recognition, including a feature in Becker's Hospital Review's esteemed "116 Women in Health IT to Know." In addition to this, she serves on the Board for Kick Foundation, offers insights as a thought leader for Forbes, and holds titles as a UBS Fourth Effect and UBS Luminary Fellow.
Outside her professional sphere, Jackleen values her moments outdoors, whether that's a camping trip or a hike with family. She resides in Texas, sharing her home with her husband, four children, and two dogs. A sports aficionado, she holds a special fondness for soccer.
Resources from this Episode:
Resilient healthcare Website
Jackleen on LinkedIn
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On this episode of the Healthy, Wealthy, and Smart podcast, Dr. Karen Litzy discusses concussions from a first-person perspective with Andrew Sendejo, a retired 12-year NFL veteran. Andrew shares his personal experience with concussions from playing football, including several complete knockouts and moments of being “out of it.” Tune in to gain insights into the realities of concussions in professional sports and the importance of brain health. He also discusses his latest venture, Braintree Nutrition.
Time Stamps:
[00:00:23] Concussion history in NFL.
[00:05:27] Dealing with concussions in NFL.
[00:07:57] Concussion symptoms beyond headaches.
[00:14:13] Nutrition in concussion recovery.
[00:17:16] Concussion prevention and communication.
[00:19:58] Playing through injuries in football.
[00:23:01] Mental aspects of football.
[00:28:27] Concussion awareness in sports.
[00:31:01] Life after professional football.
[00:33:18] Transitioning from football to business.
[00:37:39] Brain health and supplements affordability.
[00:42:28] Reading supplement labels importance.
[00:44:47] Playing with more confidence.
More About Andrew:
Andrew Victor Sendejo is a former American football safety. He played college football for the Rice Owls, and was signed by the Sacramento Mountain Lions of the United Football League (UFL) as a free agent in 2010. Sendejo was also a member of the Dallas Cowboys, New York Jets, Philadelphia Eagles, Minnesota Vikings, Cleveland Browns, and the Indianapolis Colts.
In the heart of the NFL, amidst roaring crowds and tough games, Andrew Sendejo and his partner at BrainTree Nutrition Scott Solomon had an awakening. The persistent head traumas weren’t just their battle—it was a shared struggle among many.
Determined to rewrite this narrative, they birthed BrainTree Nutrition. Here, science meets dedication: neurologist-developed supplements with evidence-backed efficacy. Our pledge? Pure ingredients, no secrets, and a steadfast contribution to Alzheimer’s research.
Andrew is also the founder of 4th and 1 Ventures.
Resources from this Episode:
BrainTree Nutrition
Andrew on Instagram
4th and 1 Ventures
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The post 674: Andrew Sendejo: NFL Safety Now Tackling Brain Health appeared first on Healthy Wealthy & Smart.
In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Karen Litzy, PT, DPT, talks with Dr. Evangelos Pappas, PT, PhD, and Andrew Gamble about the importance of utilizing a decision aid for ACL ruptures in children and adolescents as a valuable tool to offer evidence-based information for guiding treatment decisions. The decision aid was developed in accordance with international patient decision aid standards, involving a multidisciplinary team comprising physical therapists, orthopedic surgeons, psychology researchers, and decision science experts.
Time Stamps:
00:00:05 - Introduction and Disclaimer 00:00:28 - Shoutout to Jane Practice Management Software 00:02:15 - Episode Topic Introduction: ACL Rupture and Surgery Decision Aid 00:02:58 - Guest Introductions: Andrew Gamble and Evangelos Pappas 00:05:16 - Importance of the Decision Aid for ACL Ruptures 00:07:09 - Challenges in ACL Research for Children and Adolescents 00:09:09 - Misleading Online Information and the Need for Evidence-Based Resources 00:11:43 - Setting Realistic Expectations for ACL Surgery Outcomes 00:13:06 - Impact of Realistic Expectations on Patient Satisfaction 00:15:10 - Lack of Awareness About Long-Term Risks Post-Surgery 00:17:22 - Development Process of the Decision Aid 00:19:34 - Feedback and Refinement of the Decision Aid 00:21:09 - Importance of Visual Appeal and Graphic Design 00:23:45 - Surprising Insights from Interviews 00:25:17 - Considerations for Concomitant Injuries 00:27:07 - Recent Research and Findings on ACL Treatment Options 00:30:37 - Advice for Physical Therapists on Discussing Treatment Options 00:32:49 - Decision Aid as a Conversation Starter 00:35:02 - Benefits of Prehabilitation Before ACL Surgery 00:36:22 - Importance of Discussing Post-Surgery Expectations and Pain Management 00:37:04 - Accessing the Decision Aid and Related Resources 00:38:23 - Key Takeaways and Psychological Support 00:40:42 - Final Thoughts and Advice for Listeners 00:43:08 - Contact Information for Andrew and Evangelos 00:44:15 - Advice to 20-Year-Old Selves 00:48:15 - Closing Remarks and Thank You
More About Dr. Evangelos Pappas, PT, PhD:
Evangelos Pappas (he/him) is currently a Professor and Associate Dean (intoHealth) at the University of Wollongong where he works on the development of the Health and Wellbeing Precinct at the Innovation campus. He teaches in the areas of musculoskeletal biomechanics and anatomy. His research focuses on the aetiology, prevention and treatment of athletic knee injuries. He has published extensively in this area where has utilized biomechanical, epidemiological and clinical approaches to address anterior cruciate ligament (ACL) injuries.
More About Andrew Gamble:
Andrew is a Musculoskeletal Physiotherapist with 10 years' experience working in private practice and with sporting teams in Sydney, Australia. He is now completing a PhD full-time at The University of Sydney and teaching in the Physiotherapy program. His research focuses on improving access to evidence-based information and decision-making in healthcare.
Resources from this Episode:
Evangelos on Twitter
Andrew on Twitter
ACL Decision Guide
Development of a patient decision aid for children and adolescents following anterior cruciate ligament rupture: an international mixed-methods study
Paper: Online information about the management of anterior cruciate ligament ruptures in Australia: A content analysis
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In this episode of the Healthy, Wealthy, and Smart podcast, Dr. Karen Litzy discusses hypermobility spectrum disorders and Ehlers-Danlos syndromes with guest Heather Purdin, a physical therapist specializing in these conditions. They delve into the definitions and management of these disorders, shedding light on the systemic manifestations and ways to address them. Heather, author of "Taming the Zebra," offers valuable insights for healthcare professionals and patients. Tune in to learn more about these important topics in healthcare.
Time Stamps:
[00:03:28] The immune system and mast cells.
[00:05:33] EDS and hypermobility spectrum disorders.
[00:08:44] Signs of Ehlers-Danlos Syndrome.
[00:14:01] The weight of the shoulders.
[00:17:17] Patient sensitization in physical therapy.
[00:20:22] A marathon, not a sprint.
[00:21:55] Physical therapy misconceptions.
[00:26:29] Support groups for health conditions.
[00:30:11] Stabilizing joints during movement.
[00:33:04] Patient trust and communication.
[00:36:33] Advice to 20-year-old self.
More About Heather Purdin, MS, PT, CMPT:
Heather Purdin graduated magna cum laude from Duke University in 1995, with a BS in Psychology. At Duke she explored the biopsychosocial mechanisms of healthcare, an approach that would later become integral to her patient care. She received her master’s degree in physical therapy from Duke (1997), where she won a Special Initiatives Award, “for exceptional contributions to enhance the awareness of cultural diversity in our program and profession.” Heather’s experience and voracious appetite for continuing education helped her develop a holistic set of manual therapy skills to aid tracking, alignment and tissue tension balance as well as an arsenal of mind-body techniques for pain and exercises for stabilization and general strength. In 2016, she became a certified manual therapist (CMPT) through the North American Institute of Orthopaedic Manual Therapy. She has given numerous lectures locally and nationally on the subject of Ehlers-Danlos syndrome and hypermobility spectrum disorders. She has received Portland Monthly Magazine’s Top Doctors listing in 2015, 2018 and 2023. When she’s not working on presentations, writing, or at the office, she enjoys gardening, hiking, walking her dogs, water sports, acting, and playing games with her retired soccer teammates, friends, partner Ken and their children. Heather loves the great outdoors of the Pacific Northwest and resides in Portland, Oregon.
Resources from this Episode:
Taming the Zebra Website
Good Health Physical Therapy
Good Health Physical Therapy Instagram
Taming the Zebra Instagram
Good health Physical Therapy Facebook
Heather's courses on Medbrige
Taming the Zebra’s Courses
Taming the Zebra Book on Amazon
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Stephanie Weyrauch engages in a thought-provoking conversation with Dr. Stacy Menz, the owner of Starfish Therapies. They delve into the challenges and triumphs of balancing motherhood and professional life, touching upon single parenthood, parenting, and achieving professional balance. Stacy's personal journey as a parent and business owner serves as an inspiration for others navigating the complexities of combining parenthood with career goals.
Time Stamps:
[00:02:36] Path to parenthood difficulties.
[00:04:49] Balancing motherhood and business.
[00:10:18] Transparency in leadership and support.
[00:13:05] Maternity leave challenges.
[00:18:42] Building support networks as parents.
[00:20:48] Balancing motherhood and career.
[00:24:43] Seeking mental health support.
[00:29:12] Finding the right therapist.
[00:31:23] Embracing discomfort in growth.
[00:01:28] Parenting challenges and empathy.
[00:06:34] Strategies for meal prepping.
[00:09:49] Balancing life as a practice owner.
[00:14:31] Empowering employees through delegation.
[00:15:37] Parents bringing kids to work.
[00:19:44] Parenting challenges and surprises.
[00:25:03] Balancing work and parenting.
[00:27:04] Parenting and empathy.
[00:31:14] Empathy in leadership.
More About Dr. Stacy Menz:
Stacy Menz, PT, DPT, PCS is a pediatric clinical specialist and the owner of Starfish Therapies. Stacy received her Master’s degree at Boston University in 2000 and her Doctorate of Physical Therapy at Boston University in 2005. She is the founder and owner of Starfish Therapies a pediatric physical therapy company in the San Francisco Bay Area. Their mission is to make a difference in the lives of each child and family that they interact with.
In addition, Stacy has experience as a teaching/lab assistant for Boston University, South College, Baylor University, Bowling Green State University, and Chapman University's Doctor of Physical Therapy programs, has presented at state and national conferences, and teaches continuing education courses for pediatric physical therapy.
She is currently a board member for WAWOS and a past board member of KEEN San Francisco. She is the treasurer of the pediatric special interest group for the California Physical Therapy Section and the past editor of Impact, the Private Practice Section's. Stacy consults with various companies on how their products can enhance development in children. She has been interviewed on various podcasts and radio shows to discuss Pediatric Physical Therapy and Private Practice.
Resources from this Episode:
Starfish Therapies Website
YouTube
Free Gift
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I am happy to have Dr. Lorimer Moseley AO back in this episode of the Healthy, Wealthy, and Smart podcast. In this episode, Lorimer shares insights into his recent research projects and developments in pain science. We discuss the Fit for Purpose model and the evolution of pain education, emphasizing the importance of educative interactions in clinical practice. Tune in to learn more about Lorimer's current projects and his upcoming classes in North America.
Time Stamps:
00:00:00 - Introduction and Welcome
Lorimer is welcomed back to the podcast, and the host expresses excitement about discussing his recent projects and developments since 2021.
00:01:09 - Exciting Discoveries in Recent Research
Lorimer discusses the nature of discoveries in clinical science, mentioning upcoming publications and the streams of research that currently excite him, particularly in pain education.
00:02:04 - Insights from Clinical Practice and Pain Education
Lorimer shares insights from clinical practice data, highlighting significant findings about patient outcomes related to their understanding of pain as a protective feeling.
00:04:05 - Learning About Learning
The importance of learning in clinical interventions and its impact on treatment outcomes is discussed, emphasizing the need to shift focus from education to learning.
00:06:39 - Upcoming Clinical Trial Publication
Lorimer teases a forthcoming paper on a clinical trial for chronic back pain, detailing the innovative approach taken in the trial to improve treatment credibility and effectiveness.
00:10:56 - Research on Social Determinants of Health
Discussion shifts to the impact of social determinants on health outcomes, with specific focus on back pain and the broader implications for treatment accessibility and effectiveness.
00:16:31 - Pain Revolution Outreach and Challenges
Lorimer talks about the Pain Revolution program, its goals, and the challenges faced in reaching rural communities, especially during the COVID-19 pandemic.
00:27:21 - Cognitive Flexibility in Pain Management
The concept of cognitive flexibility is explored, discussing its relevance to pain management and the challenges in accurately assessing it.
00:39:43 - Personal Experience with Pain and Cognitive Flexibility
The host shares a personal story about dealing with potential pain triggers at Disneyland, highlighting the role of cognitive flexibility and support in managing pain responses.
00:50:22 - Recap and Future Directions
The conversation wraps up with a recap of the discussed topics, emphasizing the complexity of pain management and the ongoing efforts in research and education to improve patient outcomes.
More About Dr. Lorimer Moseley AO:
DSc PhD FAAHMS FACP HonFFPMANZCA HonMAPA
Bradley Distinguished Professor
Professor of Clinical Neurosciences
Foundation Chair in Physiotherapy
University of South Australia
Founder and CEO, Pain Revolution
Chair, PainAdelaide
Lorimer’s main interests are persistent pain and other protective feelings. His research group investigates pain in humans, from cognitive and behavioural experiments to clinical trials and implementation studies. He has authored over 410 scientific articles and seven books. His contributions to the science of pain, to the treatment of persistent pain, to pain education, and to public outreach, have been recognised by honours in 13 countries. He has delivered keynote lectures at world congresses in six fields. In 2017, he founded the non-profit Pain Revolution and in 2020 he was made an Officer of the Order of Australia, that country’s second highest civilian honour, for ‘distinguished served to humanity at large in the fields of pain and its management, science communication, education and physiotherapy.’ His public facing pain education videos attract millions of views each year. He lives and works on Kaurna Land in Adelaide, South Australia.
Resources from this Episode:
Pain Revolution Website
Fit For Purpose Model
Pain Science in Practice Courses in North America
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In this episode of the Healthy, Wealthy, and Smart Podcast, we delve into making physical therapy clinics more inclusive for everyone, including the LGBT+ community. Our guest, Dr. Michelle Stauffer, a dedicated advocate for LGBT+ healthcare and a member of the APTA PT Proud Special Interest Group, shares her insights and experiences.
Dr. Stauffer discusses her journey into physical therapy, influenced by her athletic injuries and her identity as a member of the LGBT+ community. She highlights the importance of creating a safe and welcoming environment in healthcare settings, especially for those who often face discrimination and misunderstanding.
We explore practical steps to assess and enhance the inclusivity of a physical therapy clinic, starting from the exterior accessibility and moving inside to the waiting areas, treatment spaces, and restrooms. Dr. Stauffer emphasizes the significance of details such as inclusive signage, diverse representation in clinic decor, and thoughtful amenities that cater to a wide range of needs.
Additionally, we touch on the importance of inclusive paperwork and intake forms that respect all identities by allowing patients to specify their preferred names and pronouns. Dr. Stauffer also suggests resources for continuous learning and improvement in DEI (Diversity, Equity, and Inclusion) practices, encouraging clinic owners and therapists to seek education and adapt to better serve their communities actively.
This episode is packed with actionable advice for healthcare professionals who want to foster an inclusive atmosphere in their practices and ensure that all patients feel respected, safe, and valued.
Time Stamps:
00:00:02 - Introduction and Guest Introduction Host Dr. Karen Litzy introduces herself and welcomes Dr. Michelle Stauffer, discussing her background and expertise in providing care to the LGBT+ community.
00:01:15 - Dr. Stauffer's Journey to Physical Therapy Dr. Stauffer shares her personal journey of becoming a physical therapist, including her athletic background and injuries.
00:05:05 - Creating an Inclusive Clinic Discussion begins on how to assess and ensure a physical therapy clinic is inclusive, starting from the external appearance to internal operations.
00:10:03 - Accessibility and External Clinic Features Dr. Stauffer discusses the importance of accessibility and external features of a clinic that can make it more inclusive.
00:16:37 - Involving Patients in Clinic Decor Ideas on how involving patients in the clinic's decor can help in creating a more inclusive environment.
00:17:03 - Inclusive Paperwork and Forms Tips on how to make intake forms and other paperwork more inclusive, including the use of open-ended questions and preferred name sections.
00:26:05 - Inside the Clinic: Waiting Area and Treatment Rooms Suggestions for making the waiting area and treatment rooms welcoming and inclusive for all patients.
00:33:09 - Restroom and Changing Room Considerations Discussion on how to make restrooms and changing rooms accessible and comfortable for everyone, including stocking necessary supplies.
00:39:02 - Staff Training on DEI The importance of continuous staff training on Diversity, Equity, and Inclusion (DEI) and resources for learning more about DEI practices.
00:45:24 - Final Thoughts and How to Connect Dr. Stauffer shares final thoughts on making clinics inclusive and provides contact information for further resources and personal connection.
More About Dr. Michelle Stauffer:
Dr. Michelle Stauffer (she/her) is a Doctor of Physical Therapy and Board Certified Health Wellness Coach who has spent her career focusing on under-resourced communities. Dr. Stauffer received her Doctorate in Physical Therapy from the University of Colorado Anschutz Medical Campus and upon completion, she began her journey of working with the LGBTQIA+ community. Dr. Stauffer founded Coast 2 Coast Wellness in 2021 with the mission of providing an inclusive & safe atmosphere while receiving affordable & quality care.
Dr. Stauffer specializes in orthopedic and sports injuries and is a Certified Sports Medical Emergency Responder and Level 2 Trigger Point Dry Needling Certified Clinician. Dr. Stauffer is the programming chair of the PT Proud Special Interest Group of the American Physical Therapy Association (APTA); a group whose purpose is to improve healthcare access for LGBTQIA+ individuals. She also is a member of the Colorado APTA PT Diversity, Equity, and Inclusion Committee. When not working, you can find Dr. Stauffer outdoors hiking or camping with her dog, or tending to her flower and vegetable gardens in her yard.
Resources from this Episode:
Dr. Stauffer’s Website
Dr. Stauffer Instagram
Dr. Stauffer TikTok
Simple Steps to Create and Inclusive Workplace
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Jenna Kantor talks with Dr. Alyssa Arms about the pros and cons of niche podcasting. They delved into the world of niche podcasting and the ins and outs of running a successful podcast focused on dance medicine. Dr. Arms shared valuable insights on the pros and cons of niche podcasting, the challenges of time management, and the importance of staying consistent. Here are some key takeaways from our discussion:
· Time Management: Running a niche podcast requires significant time and effort, from recording and editing episodes to promoting them on various platforms.
· Financial Investment: Starting a niche podcast doesn't have to break the bank. Dr. Arms shared that she spent around $200-$300 on equipment and hosting services.
· Audience Engagement: While it can be challenging to gauge audience feedback, engaging with guests and sharing valuable content can help build a loyal following.
· Networking Opportunities: Interviewing experts in the field provides valuable insights and helps expand one's professional network and knowledge base.
Time Stamps:
00:00:05 - Podcast Introduction Introducing the Healthy, Wealthy, and Smart podcast with host Dr. Karen Litzy, including a disclaimer about the content.
00:00:27 - Guest Introduction Jenna Cantor introduces Dr. Alyssa Arms, discussing her impressive background and contributions to the physical therapy profession.
00:00:48 - Alyssa's Multifaceted Career Alyssa briefly describes her diverse roles within the theater and physical therapy sectors, including her private practice and work as a professor.
00:01:21 - Podcast Focus and Value of Time The conversation shifts to the importance of the listener's time and Alyssa's understanding of running a niche podcast.
00:02:08 - Dance Med Spotlight Podcast Alyssa shares the title and theme of her own podcast, which focuses on dance medicine and dance science.
00:02:20 - Decision to Start a Podcast Jenna asks Alyssa about her motivations for starting her podcast and the thought process behind it.
00:02:40 - Alyssa's Podcasting Journey Alyssa recounts her initial hesitations and the support she received from Jimmy McKay of P.T. Pintcast, which helped her start her podcast.
00:04:26 - Support Among Podcasters Jenna and Alyssa discuss the supportive nature of the podcasting community and the importance of not worrying about overlapping content.
00:05:08 - Individuality in Podcasting The hosts talk about the uniqueness of each podcast and how different styles and approaches can attract various audiences.
00:06:33 - Interviewing and Learning from Guests Alyssa explains how interviewing guests on her podcast has been a learning experience and has helped her build a professional network.
00:07:04 - Consistency and Time Management The challenges of maintaining a consistent podcast release schedule and managing time effectively are discussed.
00:08:27 - Marketing and Promotion Alyssa touches on the difficulties of marketing a podcast and ensuring it reaches the intended audience.
00:09:00 - Balancing Podcasting with Other Responsibilities Alyssa talks about the struggle of juggling podcasting with her private practice and teaching responsibilities.
00:10:05 - Financial Aspects of Podcasting Jenna inquires about the costs associated with starting and running a podcast, and Alyssa provides a rough estimate.
00:11:05 - The Challenge of Finding Podcast Guests Alyssa discusses the ongoing effort required to find and secure guests for her podcast episodes.
00:12:21 - Return on Investment (ROI) for Niche Podcasts The hosts consider the ROI of running a niche podcast, including the intangible benefits and challenges of not always knowing the impact on listeners.
00:13:30 - Motivations for Running a Niche Podcast Alyssa shares her personal motivations for running her podcast, emphasizing the dissemination of information over financial gain.
00:14:58 - Building Trust and Networking through Podcasting Jenna shares her own reasons for podcasting, focusing on building trust within the dance physical therapy community.
00:16:54 - The Pros of Interviewing Guests Alyssa highlights the benefits of learning from guests and expanding her professional network through her podcast.
00:17:46 - Content Creation and Social Media Presence The conversation shifts to how podcasting can enhance social media content and increase visibility.
00:19:05 - Flexibility and Adaptability in Podcasting Alyssa advises on being adaptable with podcasting goals and being open to shifts in audience and content focus.
00:20:38 - Advice for Aspiring Podcasters Alyssa offers advice to those considering starting a niche podcast, emphasizing organization, persistence, and self-kindness.
00:22:31 - Ultimate Goals for a Niche Podcast Jenna asks about Alyssa's long-term vision for her podcast, and Alyssa expresses her desire for the podcast to at least be self-sustaining financially.
00:24:45 - Final Thoughts and Contact Information Alyssa provides her contact information and final thoughts on the value of podcasting within the dance medicine community.
More About Dr. Alyssa Arms:
Dr. Alyssa Arms is the owner of Back in Step Physical Therapy, located in Centennial, Colorado. She attended the University of Denver for her Bachelor of Science in Biology. She then went to the University of Colorado Anschutz Medical Campus for her Doctorate in Physical Therapy. She later obtained a board certification as an Orthopedic Clinical Specialist.
Besides her training and experience as a physical therapist, Dr. Alyssa has over 30 years of experience as a dancer, having received training in ballet and pointe, jazz, tap, hip hop, and salsa. She has also been a national circuit competitor in West Coast Swing since 2010.
Dr. Alyssa also loves to teach others. She is a Clinical Senior Instructor at her alma mater, CU Anschutz, in the physical therapy program. She has also been a guest instructor in other programs, including the University of Northern Colorado Dance Education Master of Arts program and the Colorado School of Chinese Medicine. In addition, she provide seminars and workshops for a variety of dance organizations and conferences.
She is passionate about keeping dancers happy and healthy, whether that's through rehabilitation and recovery, prevention and wellness services, or teaching opportunities for dancers and dance instructors alike!
Resources from this Episode:
Dr. Alyssa’s website
Dance Med Spotlight Podcast
Dr. Alyssa’s Instagram
Dr. Alyssa on Facebook
Dr. Alyssa on YouTube
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Karen Litzy is joined by Dr. Mani Kukreja (MD, MPH, IIN), Entrepreneur and Founder of Integrative Health and Wellness Practice Livagewell, to discuss the hot topic of aging well.
Dr. Kukreja shared her personal journey from conventional medicine to a more holistic approach, driven by her own experience with Hashimoto's autoimmune thyroiditis. She emphasized the importance of addressing the root causes of diseases rather than just treating symptoms.
We discussed the multifaceted nature of aging, which Dr. Kukreja defines as a progressive decline in biological functions leading to increased disease risk and reduced lifespan. She debunked the myth that aging is solely determined by genetics, highlighting that lifestyle and environmental factors play a significant role.
Dr. Kukreja provided valuable insights into the processes of oxidation, inflammation, and detoxification in our bodies, explaining how they contribute to aging and the onset of age-related diseases. She stressed that while we cannot stop aging, we can certainly influence how we age by managing these biological processes.
Time Stamps:
00:00:02 - Introduction to the Podcast 00:00:13 - Topic of Aging Introduced 00:00:36 - Guest Introduction: Dr. Mani Kukreja 00:01:08 - Dr. Mani's Background and Interest in Aging 00:02:16 - Dr. Mani's Personal Health Journey and Approach 00:04:36 - Dr. Mani's Experience with Her Father's Health 00:05:08 - Clinical Research Insights on Disease Progression 00:06:18 - Launching Live Age Well Practice 00:06:29 - Defining Holistic Health 00:08:03 - The Aging Industry and Control Over Aging 00:10:03 - Theories and Control of Aging 00:11:09 - Biological Age vs. Chronological Age 00:13:09 - Genetic and Lifestyle Factors in Aging 00:15:18 - Environmental Toxins and Aging 00:16:59 - Addressing Aging in Less Ideal Environments 00:20:43 - Importance of Knowledge and Self-Care 00:21:04 - Supplements and Their Claims 00:23:07 - Proprietary Blends in Supplements 00:24:05 - Frozen Fruits and Vegetables as an Option 00:25:32 - Reducing Biological Age 00:27:10 - Biological Age Explained 00:28:04 - Factors to Improve Biological Age 00:29:33 - Understanding Oxidation in the Body 00:33:08 - The Processes of Aging: Oxidation, Inflammation, Detoxification 00:37:11 - Solutions to Improve Biological Age 00:39:43 - Importance of Sleep in Aging 00:44:35 - Exercise as the Elixir of Youth 00:47:03 - Exercise and Brain Health 00:49:27 - Role of Supplements in Aging
More About Dr. Mani Kukreja:
Dr. Mani Kukreja (MD, MPH, IIN) is an integrative health and wellness expert and the founder/CEO of Livagewell. She has extensive experience helping her clients optimize their overall health, including metabolic, skin, gut, and immune health.
Mani is a health, wellness, and lifestyle influencer, biohacker, and health advocate who is always on a quest to bio-optimize Health and Aging to live a balanced and sustainable life.
Mani is also an ambassador to a few health-optimizing supplement brands that she truly believes in values.
Dr Mani has authored several high-impact publications in peer-reviewed clinical research journals in the medical and wellness field throughout her career.
Resources from this Episode:
LivAgeWell Website
Dr. Mani on Instagram
Clear Skin Chronicles
Intentionally Well Podcast
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I had the pleasure of speaking with Dr. Emily Scherb, also known as the Circus Doc, on the latest episode of the Healthy, Wealthy, and Smart podcast. Dr. Scherb shared valuable insights into the world of circus arts and how healthcare providers can support circus performers in achieving their goals while staying safe and healthy. Here are some key takeaways from our conversation:
- Circus encompasses various performing arts, from aerial silks to trapeze to acro yoga.
- Circus training is adaptable and can be enjoyed by individuals of all ages, with older performers showcasing longevity in their careers.
- Understanding the unique demands of circus movements, such as extreme ranges of motion and strength requirements, is crucial for clinicians working with circus artists.
- Research in circus medicine is growing, providing valuable insights into injury prevention and performance optimization.
- Dr. Scherb's upcoming online training program, Circus Fusion, allows clinicians to enhance their knowledge and skills in supporting circus performers.
Time Stamps:
00:00:03 - Introduction to the Podcast 00:00:14 - Dr. Emily Scherb's Background 00:00:55 - Defining Circus and Circus Performers 00:01:19 - Diversity in Circus Performances 00:02:32 - Professional vs. Recreational Circus 00:02:51 - Expansion of Circus into Fitness 00:03:43 - Circus as an Adult Recreational Activity 00:04:46 - Age and Circus Performance 00:05:13 - Circus for All Ages 00:06:49 - Older Circus Performers 00:07:54 - Longevity in Circus Careers 00:08:33 - Professional Performers Over 40 00:09:04 - Performance Quality with Age 00:09:47 - Pink's Circus-like Performances 00:10:08 - Overcoming Fear in Circus Classes 00:10:39 - Benefits of Trying Circus 00:11:34 - When to Take a Break from Circus Training 00:12:27 - Training Load Issues in Circus 00:13:07 - Assessing Circus Performers in the Clinic 00:14:10 - Testing Strength at End Range 00:15:28 - Specificity in Circus Performer Evaluation 00:16:10 - Using Tools to Measure Strength 00:17:08 - Addressing Deficiencies in Range and Strength 00:18:03 - Educating Circus Performers on Training 00:19:10 - Taping and Bracing in Circus 00:20:07 - Cultural Attitudes Towards Injuries 00:21:19 - Research in Circus Medicine 00:22:07 - Injury Patterns in Circus Performers 00:23:00 - Educating Healthcare Professionals on Circus Medicine 00:24:07 - Circus Fusion Training Program 00:25:10 - Research and Publications in Circus Medicine 00:26:15 - Advice to Younger Self 00:27:03 - Final Thoughts and Encouragement
More About Dr. Emily Scherb:
Dr. Emily Scherb is a physical therapist specializing in circus and performing arts medicine. Through her over 30 years of training and working in the circus arts she has gained deep insight on how circus bodies work in the air and on the ground. Emily owns a physical therapy practice in Seattle, WA in which clinicians specialize in the treatment of circus and performing artists. Emily now teaches workshops for circus artists, instructors, and healthcare providers with the mission of improving health and safety in circus training and performance. She is a board member of the American Youth Circus Organization / American Circus Educators as well as Seattle Dance and Performing Arts Medicine. Her bestselling book Applied Anatomy of Aerial Arts was published in 2018.
Resources from this Episode:
Dr. Emily’s Website
Dr. Emily’s Instagram
Circus Medicine Education
Free Gift: Circus Vocabulary List
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In this episode of the Healthy, Wealthy, and Smart podcast, Dr. Karen Litzy enjoyed speaking with the incredible Maurice Ashley, an international chess grandmaster, analyst, commentator, motivational speaker, author, and Hall of Fame inductee. Maurice shared his journey from learning chess in Jamaica to becoming a grandmaster, emphasizing the importance of the journey over the destination and the value of learning from losses. We delved into the psychological aspects of chess, such as maintaining focus during a game and the necessity of having a coach or a team to hold you accountable. Maurice highlighted the importance of resilience, learning from mistakes, and the danger of complacency.
Additionally, Maurice talked about his new books, "Move by Move: Life Lessons On and Off the Chessboard" and "The Life-Changing Magic of Chess," which cater to both adults and children, respectively.
Show notes:
00:00:02 - Introduction to the Podcast 00:00:12 - Introducing Guest Maurice Ashley 00:00:42 - Maurice Ashley's Career Highlights 00:01:04 - What is a Chess Grandmaster? 00:02:57 - The Process of Becoming a Grandmaster 00:03:11 - Importance of Beating Top Players 00:04:00 - Maurice's Introduction to Chess 00:06:07 - Learning Chess at Any Age 00:06:43 - Chess Lessons for Life and Business 00:07:22 - Maurice's Book "Move by Move" 00:10:05 - Overcoming Setbacks and Learning from Mistakes 00:13:59 - The Importance of Embracing Mistakes 00:17:00 - Maintaining Focus and Motivation 00:20:27 - The Role of a Coach or Accountability Partner 00:23:32 - The Importance of Having a Supportive Team 00:26:15 - Defining a Winner in Competition 00:29:10 - The Impact of Losing on Competitors 00:32:40 - Learning from Recorded Chess Matches 00:35:25 - Maurice's Books and Where to Find Them 00:38:06 - Upcoming Event with Maurice Ashley 00:40:12 - Key Takeaways from the Conversation 00:42:36 - Advice to 20-Year-Old Self 00:43:09 - Closing Remarks and Podcast Outro
More About Maurice Ashley:
Maurice Ashley (he/him) is a Chess Grandmaster, an ESPN commentator, a three-time national championship coach, and an author. In 1999 he earned the title of Chess Grandmaster, making him the first Black Grandmaster in the game’s history, and in 2016 he was inducted into the US Chess Hall of Fame. He lives in Florida.
Resources from this Episode:
Website: https://mauriceashley.com/
YouTube: @GrandmasterMauriceAshley
Twitter: @MauriceAshley
Twitch: @GMAshley
Instagram: @mauriceashleychess
Facebook: Grandmaster Maurice Ashley
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On this episode of the Healthy, Wealthy, and Smart Podcast, Dr. Karen Litzy delves into the world of foot and ankle health with expert Deborah L Walker Goetz, BS., MS., Ed., PT, an educator and healer passionate about getting people back on their feet. DL shares her journey into specializing in the foot and ankle, emphasizing the importance of balance, fall prevention, and the crucial role of the foot as the base of support for our body's center of gravity. Tune in to learn valuable insights on foot mobility and maintaining stability for overall health and wellness.
Show notes:
[00:01:08] Foot and ankle interest sparked.
[00:07:37] Functional corrective diagnosis and evaluation.
[00:10:20] The importance of big toe.
[00:15:24] The importance of foot mobility.
[00:19:47] Foot and ankle surgeries.
[00:24:44] The complexity of the foot.
[00:28:25] Treating patients holistically.
[00:34:16] Alignment dictates function, stability, and mobility.
[00:35:19] Finding PT alignment for stability.
More About DL Walker:
Deborah L Walker Goetz, (DL Walker for short) is a Corrective Functional Therapist, Educator and Health Care Management Consultant, with a specialization in foot and ankle therapy. With over 35 years in health care, her education includes degrees in Physical Therapy, Fitness, Cardiac Rehabilitation, and Exercise Science.
She has completed advanced post professional certifications in Functional Manual Therapy, Health Coaching, and Energetic Medicine.A teacher at heart, DL creates credentialed course work internationally for Physical Therapists (physios), Podiatrists, Podorthists, and Athletic Trainers. Her courses are approved for CPD credit in the UK and continuing education in 31 US states. Utilizing Diagnostic Functional Evaluation, a straightforward, simple, and targeted system to promptly identify the root cause of an issue, combined with a comprehensive corrective functional treatment method, facilitates a fast and comprehensive approach for the prevention, enhancement of performance, and rehabilitation of the lower kinetic chain.
Resources from this Episode:
DL’s Website
DL on Facebook
The Forefoot Forum Facebook Group
DL on LinkedIn
DL’s Email
DL’s Courses
DL on YouTube
Free Gift from DL
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On this episode of Healthy, Wealthy, and Smart, Dr. Jenna Kantor interviews Dr. Veronica Canada, a specialist in sports physical therapy who shares her extensive background in competitive swimming and diving. From starting at a young age to competing in college, she delves into the physical and mental lessons learned from these sports. Today’s podcast will discuss the differences and similarities in shoulder injuries seen within the swimming and springboard diving population. How understanding the biomechanics of each sport, current research, and training regimens can help mediate an evaluation as a physical therapist and create an appropriate plan of care. Tune in to gain insights into the differences between swimming and diving and discover how her experiences have influenced her practice in physical therapy.
Show notes:
[00:02:31] Scuba diving research challenges.
[00:05:46] Shoulder injuries in swimmers vs. divers.
[00:07:37] Shoulder Strain in Competitive Swimming.
[00:12:52] Swimming injuries and accidents.
[00:16:04] Shoulder stability in swimming.
[00:21:46] Swimmers counting strokes for positioning.
[00:22:29] Diving accidents in Sharks and Meadows.
More About Dr. Canada:
Veronica Canada PT, DPT, ATCis an enthusiastic and energized woman who was born and raised in New York. She received her Bachelor of Science Degree in Athletic Training with double minors in Kinesiology and Early Childhood Education from George Mason University in 2018. In 2023, she graduated from Dominican University New York with her doctorate in physical therapy, where she received “The Clinical Education Award”, which is an award given to one candidate that best exemplifies the university’s mission and American Physical Therapy Association’s core values.
Her passion for both athletic training and physical therapy not only stems from being an educator within her local public school system, but also from her 15+ year-long career in swimming and diving. Dr. Canada first started competitively swimming at the age of 7 and competitively diving at the age of 12. She took her talents and competed on a varsity level for her high school swimming and diving team for 5-years. By the time she was 16, Dr. Canada simultaneously competed in both year-round swimming and diving for the New York Sharks Swim Club and West Point Diving Club. After qualifying for New York State Sectionals in both swimming and diving and achieving Most Valuable Player for her high school team, she then moved on to compete at a Division 1 level for George Mason University’s Diving team.
Not only was Dr. Canada a swimmer and diver, but she also participated in softball, gymnastics, dance, and soccer, making her well-experienced with the physical and mental demands of being an athlete and versatile in the sports world. She continues to share and educate her experience and knowledge to the athletic community as she continues to practice as a licensed athletic trainer in New York and New Jersey.
Throughout her career thus far, Dr. Canada has also had the opportunity to speak on multiple national platforms, one being historic, making her the first person in the American Academy of Physical Therapy to teach a continuing education course as a student. In addition to her educational accomplishments, Dr. Canada is currently a traveling physical therapist, a diving coach, a director for Future Stars Diving Camp, and a member of multiple organizations such as the National Athletic Trainer’s Association, the American Physical Therapy Association, and the American Academy of Physical Therapy.
Resources from this Episode:
Dr. Canada’s Instagram
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On this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy discusses remote therapeutic monitoring with Vikram Sethuraman, founder and CEO of PT Wired. They delve into the benefits of remote therapeutic monitoring for physical therapy clinics in preventing patient dropout, improving satisfaction, and increasing revenue. The conversation highlights how remote therapeutic monitoring services can keep patients engaged between clinic visits, providing support and guidance for successful rehabilitation outcomes.
Show notes:
[00:00:24] Remote Therapeutic Monitoring.
[00:07:27] Provider and patient interaction.
[00:11:39] Billing complications for RTM codes.
[00:13:36] Coding gap challenges.
[00:19:11] Managing RTM in Large Clinics.
[00:24:31] PT Wired custom mobile app.
[00:28:27] RTM coding and billing.
More About Vikram Sethuraman:
Vikram Sethuraman is the founder of PT Wired, a 100% custom-branded mobile app service for physical therapy practices. PT Wired is a patient engagement solution that helps physical therapy clinics prevent patient dropout, improve patient satisfaction, and boost revenue through Remote Therapeutic Monitoring. Today, PT Wired powers over 300 physical therapy practices as #1 highest-rated Physical Therapy Software company on Capterra, winning awards for Best Value and Best Ease of Use.
Resources from this Episode
PT Wired Website
PT Wired Facebook
Mention Karen Litzy when you contact PT Wired for 25% off the first 4 months
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Karen Litzy discusses the state of physical therapy with guest Dr. Airelle Giordano, Director of Clinical Services and Residency Training at the University of Delaware. Dr. Giordano, a candidate for president-elect of the American Academy of Sports Physical Therapy, shares her journey from being a former athlete to becoming a physical therapist with a passion for teaching and mentoring. Tune in to learn more about the importance of participating in professional elections and shaping the future of physical therapy.
Show notes:
[00:02:43] Diverse Practice in Sports Therapy.
[00:07:22] The future of physical therapy.
[00:11:53] Knowledge translation in physical therapy.
[00:16:30] Knowledge translation in research.
[00:18:56] Knowledge translation for clinicians.
[00:24:25] Knowledge translation is important.
[00:31:41] Communication challenges in organizations.
[00:34:28] Collaboration among different academies.
[00:39:07] Advice for 20-year-old self.
More About Dr. Arielle Giordano:
Airelle Giordano is the Director of Clinical Services and Residency Training at the University of Delaware PT Clinic. She is Board Certified as a Sports and Orthopedic Clinical Specialist and an Associate Professor in the Doctor of Physical Therapy Program. She is the current Education Committee Chair for the American Academy of Sports Physical Therapy (AASPT) and is a co-chair for the ESKKA-AOSSM-AASPT consensus initiative on meniscus rehabilitation. Her current clinical focus is on complicated knee injuries and gait, post-concussion rehabilitation, and is a current co-author on the multi-Academy Clinical Practice Guideline on Concussion Rehabilitation. She also focuses on mentoring the next generation of sports and orthopedic specialists.
Resources from this Episode:
University of Delaware PT Clinic
Airelle's Instagram
Airelle's X (Twitter)
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In this episode of the Healthy, Wealthy, and Smart Podcast, host Dr. Karen Litzy discusses gut health and bloating with guest Hannah Aylward, a certified holistic health coach and gut health specialist. Hannah shares her personal journey of dealing with chronic digestive issues and trying various diets and supplements to find relief. The conversation explores the impact of gut health on our overall well-being and strategies for managing bloating. Listeners will gain valuable insights into improving their gut health and fostering a healthier relationship with their bodies and food.
Show notes:
[00:02:32] Gut health and bloating.
[00:07:25] The gut microbiome's influence.
[00:09:05-00:09:15] Gut health and digestion.
[00:12:17] Women and restrictive eating.
[00:16:17] Nervous system regulation exercises.
[00:22:00] Non-negotiable health foundations.
[00:25:26] Nutrition and digestive health.
[00:29:32] Digestive issues and skin rash.
[00:32:08] Feelings of inadequacy and catastrophizing.
More About Hannah Aylward:
Hannah Aylward is a Certified Holistic Health Coach, gut health specialist and the founder of HAN. After struggling with her own chronic digestive issues for years, Hannah dove headfirst into the latest in gut health research, seeking answers to her bloating, food sensitivities, and pain. With her science-backed formula, Hannah has overcome her own digestive issues and helped hundreds of other women around the world do the same. Today Hannah leads a team of functional practitioners that help clients transform their gut health and overcome their never-ending digestive issues with functional nutrition, targeted supplementation, and advanced lab work.
Resources from this Episode:
Hannah’s Website
Hannah’s Instagram
Hannah’s Masterclass
Hannah’s Free Three-Day Gut Reset Challenge
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In this episode of the Healthy, Wealthy, and Smart podcast, Dr. Karen Litzy is joined by Sheela Ivlev, an occupational therapist specializing in mental health and wellness. They discuss the importance of global perspectives in healthcare and how they can benefit both businesses and patients. They also talk about the San Diego Pain Summit and the diverse community of healthcare professionals it brings together. Sheila shares her personal background as a Bengali American and how it has shaped her perspective in the field. Tune in to gain a broader understanding of healthcare and the value of embracing different perspectives.
Show notes:
[00:01:06] Global perspectives in healthcare.
[00:06:44] Global perspectives for health.
[00:11:01] Educating healthcare practitioners on cultural sensitivity.
[00:15:44] Asking about people's lives.
[00:20:05] Health care for immigrants.
[00:22:48] Healthcare systems and physical therapy.
[00:27:38] Diversity in healthcare professions.
[00:33:30] Referrals and community connections.
[00:36:03] Building networks and improving outcomes.
[00:43:12] Healthcare on Native American reservations.
More About Sheela Ivlev:
Sheela Ivlev (she/her) is a Bengali American Occupational Therapist and Certified Integrative Mental Health Professional. She is the founder of OT Bay Area, WellWrx Consulting, and DisruptOT, an international grassroots organization disrupting the status quo of systemic oppression in healthcare, building community, highlighting global voices, and providing free education to healthcare users, students, and practitioners worldwide.
Resources from this Episode:
OT Bay Area Website
Well Wrx Consulting
DisruptOT
OT Bay Area Instagram
DisruptOT Instagram
20% off Occupational Therapy Disruptors book
San Diego Pain Summit
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In this episode of the Healthy, Wealthy and Smart podcast, host Dr. Karen Litzy welcomes TaVona Boggs, a physical therapist turned master certified life and business coach. TaVona discusses her journey of helping coaches, consultants, and experts grow their businesses and introduces the concept of minimalist marketing. She explains how she applies her physical therapy skills to diagnose why a business may not thrive and offers strategies to help businesses move forward. TaVona emphasizes the importance of doing less to achieve more and empowering clients to take control of their own success. Tune in to learn how to get more by doing less with minimalist marketing.
Show notes:
[00:01:45] Minimalist marketing.
[00:05:11] Social media marketing challenges.
[00:09:35] Leveraging other people's platforms.
[00:14:21] ABCs of impact.
[00:18:08] Pitching and adding to conversations.
[00:23:23] Getting on other people's platforms.
[00:26:58] Being confident and clear.
[00:30:52] Taking time for yourself.
[00:34:38] Personalized branding and faceless brands.
[00:40:56] Leveraging strengths and weaknesses.
[00:44:00] Have more fun.
More About TaVona Boggs:
Coaches, consultants and experts go to TaVona when their business isn’t moving like it should or it hurts when they try to move it. She uses her unique background as a physical therapist turned master certified life and business coach to help entrepreneurs with big hearts build businesses full of their favorite clients that make lots of money…WITHOUT burning themselves out or giving up their values in the process.
Using her approach to offer creation and Minimalist Marketing™, her clients have generated 6-figures plus with an email list of only a few hundred people and less than 2,000 followers on social media, all while working 4 days a week.
When she is not handling business, you can find her singing karaoke or enjoying the white sands and beautiful blue waters of Mexico which she currently calls home.
Resources from this Episode:
TaVona’s Website
TaVona’s Instagram
TaVona’s Facebook
TaVona’s LinkedIn
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In this episode of the Healthy, Wealthy & Smart podcast, guest host Dr. Jenna Kantor interviews Dr. Sarah Troicky about her journey in physical therapy, specializing in dance. Dr. Troicky shares the obstacles she faced in her early career and how she overcame them to achieve success. They discuss the importance of niching down in a specific area and the challenges it entails. Dr. Troicky also talks about her background in dance and how it influenced her career in physical therapy. Tune in to hear her inspiring story and valuable insights.
Show notes:
[00:04:03] Industry challenges and body image.
[00:05:08] Body acceptance and diversity.
[00:11:06] Overcoming emotional challenges in healthcare.
[00:14:13] The problem with referrals.
[00:21:16] Creating connections with dance studios.
[00:24:03] Overcoming creative roadblocks.
More About Dr. Sarah Troicky:
Sarah Troicky is the owner and founder of Trinity Physical Therapy and Wellness. She is originally from Longmont Colorado and currently lives in Lakewood. Her journey into the realm of physical therapy was shaped by a deep-seated passion for dance, an art form she fell in love with during her formative years.
With a rich background in various dance styles, including ballet, jazz, modern, tap, and hip hop, Sarah's expertise was acknowledged through numerous awards and scholarships. This recognition paved the way for her to dance in Hollywood, CA. During her time in California, she actively participated in a research study conducted by the physical therapy department of USC, focusing on common dance injuries. This unique experience ignited Sarah's desire to merge her two passions—physical therapy and dance.
In 2019, Sarah graduated from Pacific University's doctorate of physical therapy program. Her academic journey included a specialized internship in dance, providing her with hands-on experience in working with dancers. Certified as an athletic trainer, Sarah brings extensive expertise in addressing sports-related injuries, having worked extensively with athletes.
Sarah's approach to physical therapy is holistic, viewing each patient as a complete individual and aiming to address the root of the problem. Her qualities of patience, persistence, and unwavering commitment make her a dedicated ally in helping clients overcome pain.
Beyond her professional pursuits, Sarah finds joy in spending quality time with her husband, Miguel, and their son, Luka. Her leisure activities include cooking, hiking, playing tennis, and indulging in the timeless joy of taking dance classes.
Resources from this Episode:
Sarah’s Website
Sarah’s Instagram
Sarah’s LinkedIn
Sarah’s Facebook
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Karen Litzy welcomes Dr. Jeffrey Gross, founder of ReCELLebrate and a pioneer in the field of regenerative medicine. They discuss the concept of regenerative medicine, stem cell treatments, and their applications in healthcare. Dr. Gross shares his journey from being a neurosurgeon to exploring regenerative medicine and how it allows him to tap back into his undergraduate background in biochemistry and molecular cell biology. He highlights the need for innovation in the medical field and the potential of regenerative medicine to revolutionize healthcare practices. Tune in to learn more about this exciting field and its possibilities for improving patient outcomes.
Show notes:
[00:03:21] Stem cell treatments.
[00:04:16] What are stem cells?
[00:09:17] Regenerative medicine and joint problems.
[00:14:04] Regenerative medicine for joint replacement.
[00:18:17] Surgery and its necessity.
[00:24:31-00:24:41] Biohacking and its benefits.
[00:30:08] Trusting regenerative medicine doctors.
[00:33:28] Expanding clinic with satellite.
More About Dr. Gross:
Dr. Gross graduated from the University of California, Berkeley with a degree in biochemistry and molecular cell biology. He earned his Doctor of Medicine in 1992 from the George Washington University School of Medicine. He contributed to virology research during his studies. After graduating, he undertook a residency in neurological surgery at the University of California, Irvine Medical Center until 1997. He then pursued a Fellowship in Spinal Biomechanics at the University of New Mexico until 1999. Licensed in California and Nevada, Dr. Gross has SPINE practices in Orange County and Henderson, Nevada. A trained neurological surgeon, he specializes in athletic injuries and spine procedures, and offers longevity and biohacking consultations. He's certified by the American Board of Neurological Surgery and is a member of several prestigious surgical societies. Since 2020, Top Doctor recognized Dr. Gross as a leading Neurological Surgeon. He also received HealthTap’s 2022 Top Doctor Award as a top Neurological Surgeon in the U.S. Dr. Gross founded ReCELLebrate, focusing on anti-aging and regenerative medicine. The mission for ReCELLebrate emphasizes offering modern biochemical treatments and considering surgery as a last resort.
Resources from this Episode:
ReCELLebrate Website
Dr. Gross on LinkedIn
ReCELLebrate TikTok
ReCELLebrate Instagram
Dr. Gross YouTube
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Stephanie Weyrauch interviews Eder Garavito about clinical mentorship in physical therapy. Eder, a full-time academician, and acute care specialist, shares his career journey and discusses the importance of mentorship in the field. They delve into the benefits of clinical mentorship and how it can enhance patient care and professional development. Tune in to gain valuable insights into the world of clinical mentorship in physical therapy.
Show notes:
[00:01:21] Acute care and patient interaction.
[00:04:14] Mentorship in healthcare.
[00:09:26] Clinical education and mentorship.
[00:13:04] Power dynamic in clinical education.
[00:16:57] Mentorship and choice.
[00:20:13] Clinical mentorship certification course.
[00:24:20] Vulnerability in healthcare mentoring.
[00:28:07] Balancing mentorship and critical thinking.
[00:33:26] Seeking mentorship as a seasoned professional.
[00:36:17] The importance of mentorship.
[00:39:35] Clinical mentorship and residencies.
[00:43:29] Mentorship for new grads.
[00:48:39] Mentorship and learning from mistakes.
[00:51:35] Lifelong learning and advice.
More About Dr. Garavito:
Eder Garavito is an Assistant Professor at the College of Saint Mary's Doctor of Physical Therapy Program. His responsibilities encompass instructing and organizing coursework focused on managing patients with cardiovascular and pulmonary conditions, delivering care in acute care settings, health informatics, and telehealth/telemedicine. With a background as a board-certified cardiovascular and pulmonary clinical specialist, Eder has a decade of experience working in acute care settings. Presently pursuing a Ph.D. in Teacher Education and Learning Sciences at North Carolina State University, his academic emphasis revolves around learning design and technology. Furthermore, he contributes as a PRN staff Physical Therapist at Duke University Medical Center in Durham, North Carolina.
In collaboration with three partners, Eder co-founded Scholarnetics360, healthcare's first mentorship and knowledge-sharing hub, in the summer of 2023—a pioneering initiative in healthcare education. Scholarnetics360's aims to offer 24/7 access to industry leaders and specialists remotely and believes that a mentorship and knowledge-sharing network for healthcare students and professionals is the most direct and accessible method to access essential information for anyone in need, ultimately improving patient outcomes.
Resources from this Episode:
Scholarnetics Website
Eder’s LinkedIn
Scholarnetics360 LinkedIn
Scholarnetics360 Instagram
Scholarnetics360 Facebook
Special Offer:
Become a Scholarnetics360 beta user for free
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In this episode of the Healthy, Wealthy, and Smart podcast, host Dr. Karen Litzy explores the importance of effective communication in business. She is joined by Joshua Washington, an Organizational psychologist and Senior Executive Coach with a passion for helping people unlock their hidden value through communication. Joshua shares his background growing up in a small town and how it shaped his communication skills. He also discusses his journey from studying music to obtaining interpersonal communication and organizational psychology degrees. With over a decade of experience in the corporate world, Joshua offers valuable insights into the power of communication in business success. Tune in to learn more about how effective communication can make or break a business.
Show notes:
[00:00:52] Small-town communication skills.
[00:04:40-00:04:52] Performance drivers and high performance.
[00:08:36] Conflict resolution in the workplace.
[00:12:53] Society's sensitivity.
[00:16:24] Conversing from the amygdala.
[00:21:43] Value in the workplace.
[00:25:30] Overcoming personal struggles.
More About Joshua Washington:
Joshua Lee Washington is an expert organizational psychologist and senior executive coach, who coaches and trains leaders on his proprietary system called the Mission Critical Performance Method. This comprehensive framework has a track record of transforming leadership and employee performance, which helps you maximize your greatest and most valuable resource in business, your people!
Joshua is based in Orlando, FL with his beautiful family.
Resources from this Episode:
Joshua’s Website
Joshua’s LinkedIn
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Karen’s Twitter
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In this episode, Dr. Karen Litzy is joined by Dr. Liz Letchford, PhD, ATC, to discuss the connection between emotional and physical health and how they intertwine in our human experience. Dr. Letchford shares her insights and personal journey in exploring the intersection of physical and emotional well-being. Tune in to gain a deeper understanding of how these two aspects of health are interconnected and how they can impact our overall well-being.
Show notes:
[00:01:09] Emotional wellness and athletic injuries.
[00:04:16] Emotional catharsis and physical pain.
[00:06:04] Unresolved trauma and somatic release.
[00:10:30] Completing trauma and empowerment.
[00:17:06] Holding safe space for emotional release.
[00:19:22] Empathy and clinician burnout.
[00:20:48] The power of subconscious healing.
[00:29:12] Identity and surrender
[00:30:07] Choosing familiar over less pain.
[00:32:51] Spirokinetics breath practice.
[00:36:41] Holding space for emotional healing.
[00:40:41] Body Church and Archetypes.
[00:47:37] Advice to 20 year old self.
More About Dr. Liz Letchford:
Dr. Elizabeth Letchford is a clinician, researcher, and artist who approaches health and movement through the lens of emotional wellness. With a background in sports medicine and a PhD in Kinesiology and Rehabilitation Science, she has helped thousands of people demystify the body and its functions. Dr. Liz bridges the gap between the measurable and immeasurable to guide others towards a robust understanding of their physical, mental, and emotional landscape. Her current area of focus is on the impact of relationships on the nervous system and how disharmony in relationships can lead to disharmony in the body. Through her work, Dr. Liz helps individuals navigate the landscape of their physical, mental, emotional, spiritual and sexual health, leading to a deeper sense of wellness and vitality
Resources from this Episode:
Liz’s Website
Liz’s Instagram
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In this episode, Dr. Karen Litzy is joined by Joe Friel, to discuss triathlon training for individuals over the age of 50. Joe, who has been involved in triathlons since 1980, shares his journey into the world of triathlon and provides valuable insights and advice for older athletes. Tune in to learn more about Joe's experience and how to excel in triathlon training as you age.
Show notes:
[00:00:19] Getting into triathlon training.
[00:03:32] Starting a coaching business.
[00:07:19] Aging and aerobic capacity.
[00:11:34] Active aging and longevity.
[00:17:08] Bone health in older adults.
[00:19:51] Accessibility of running, biking, swimming.
[00:20:30] Starting with brisk walking.
[00:25:40] The role of a coach.
[00:28:16] Coaching advice for upcoming coaches.
[00:28:59] What makes a good coach?
[00:33:52] Coaching Yourself Successfully.
More About Joe Friel:
With a masters degree in exercise science, Joe Friel was a marathoner and running coach throughout the 1970s and early 1980s. After his first triathlon in 1983 and falling in love with the sport he began coaching multisport athletes becoming one of the first triathlon coaches in the country. The following year he opened a triathlon store in Ft. Collins, Colorado—probably the first in the world. Throughout the 1980s his race management company organized several triathlons in Colorado.
He left retail and race management in 1987 to focus on coaching. The athletes he coached for over 30 years ranged from novice to high-performance amateur to professional to Olympian. In 1997 he was a founding member of the USA Triathlon Coaches Association. He served as co-chair in 1999-2000. In 2000 he attended the Sydney Olympics to assist with team preparation. The following year he was the coach of team USA for the World Triathlon Championships.
Throughout the 2000s he was a frequent speaker at USAT coach seminars. He has written 17 books on training, the most notable being The Triathlete’s Training Bible which is now in its 5th edition and translated into 15 languages. It remains the best-selling book in the world on triathlon training. In 1999 he co-founded TrainingPeaks, online training software for endurance athletes.
As an athlete he competed in hundreds of events including national and world championships, was an All-American Age Group Triathlete several times and a USAT-regional multisport champion. He stopped competing after a bike crash in 2014 restricted range of shoulder movement. He continues to present at triathlon camps and clinics for triathletes and coaches around the world. Joe currently lives and trains in the mountains of northern Arizona and is working on his 18th book.
Resources from this Episode:
Joe’s Website
Triathlete’s Training Bible
Joe on X (Twitter)
Joe on LinkedIn
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On this episode of the Healthy, Wealthy & Smart podcast, host Dr. Karen Litzy is joined by Dr. Stephanie Weyrauch and Dr. Jenna Kantor, co-hosts of the podcast and leaders in the physical therapy field. They discuss the state of physical therapy in 2023 and share their thoughts on the value statement of the American Physical Therapy Association (APTA). Stay tuned as they also reflect on their personal highs and lows of the year.
Time Stamps:
[00:02:48] The value statement by APTA.
[00:02:58] Utilizing media for promoting physical therapy.
[00:07:58] Rise of venture capital firms.
[00:11:54] Monopolization in private practice.
[00:13:37] The importance of relationships.
[00:18:23] Challenges of moving and starting a new practice.
[00:21:36] Challenges in private practice.
[00:26:41] Vet your vendors, ask for referrals.
[00:30:55] Choosing a word for the year.
[00:35:14] Friendship and gratitude.
More About Stephanie and Jenna:
Dr. Jenna Kantor, PT, DPT runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online wellness program for performing artists called Powerful Performer. She is licensed to treat in New York and Pennsylvania.
Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia University.
Dr. Kantor co-founded and runs Fairytale Physical Therapy which brings musical theatre shows to children in hospitals. She hosts the Dance PT Podcast and guest hosts on the podcast Healthy, Wealthy, and Smart. She has served as the NYPTA SSIG Advocacy Chair, the NYC Conclave 2017 committee, NYPTA Social media committee, was the NYPTA Public Policy Student Liaison, and co-founded the NYPTA SSIG. Dr. Kantor won the APTA PPS Business Concept Contest and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media before graduating PT school.
Jenna Kantor currently volunteers with the PPS Marketing & PR Committee and is the website builder for the American Academy of Physical Therapy. She provides complimentary, regular online content that advocates for the physical therapy profession.
Stephanie Weyrauch, PT, DPT believes in a world where anyone can live a pain-free, fulfilling life. She takes a full-body holistic approach to patient care, identifying the underlying cause of your pain to reduce and often eliminate it so you can get back to doing what you love. She considers not just your pain problem but also your mindset and social situation to treat YOU the whole person--not just a body part.
Dr. Stephanie started her career working in a small private practice in rural Minnesota, where providers were so sparse that people traveled across the region to receive care. Many of these patients were new moms, people with pelvic pain, or women suffering from menopausal symptoms who struggled to find a provider who listened to their concerns and addressed the source of their discomfort. When Dr. Stephanie moved to urban Connecticut, she noticed the same problem: People had difficulty accessing the pelvic floor physical therapy they needed--due to a lack of specialist providers, time constraints, and limitations from insurance companies. These experiences influenced Dr. Stephanie to focus her practice on orthopedics and pelvic floor physical therapy and make it convenient for people to access high-quality care.
With MovementX, her physical therapy practice is 100% mobile–she provides care in the comfort of your home, gym, or office. She brings a mobile treatment table and helps you decrease pain, increase strength/mobility, prevent injury, restore function, and coordinate your care plan. Wherever & whenever you need care, she can be there. It's convenient, valuable, & personalized to whatever you need. Call or text the number above to get directly in touch with her, and you can have a free phone consultation about what health goals you want to accomplish with specialized physical therapy care. Or click here to request care with her today.
Resources from this show:
Value of PT
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In this episode, I am joined by Amanda Proscia, co-founder of Lightspeed Public Relations and Marketing. Amanda emphasizes that business owners should not feel intimidated by PR. She encourages them to explore how PR can benefit their business and enhance its success and visibility. Amanda acknowledges that even if business owners are unfamiliar with PR, there are ways they can leverage it to their advantage. She suggests that her book, "PR Confidential, Unlocking the Secrets to Creating a Powerful Public Image," could be valuable for understanding PR and its potential benefits. Ultimately, Amanda's message is that PR offers valuable business opportunities, and it is worth exploring how it can be utilized effectively.
Show notes:
[00:01:40] Writing in PR.
[00:03:49] Earned media in public relations.
[00:09:26] Different components of PR.
[00:12:08] Repurposing information on social media.
[00:16:06] Overly rehearsed speeches.
[00:19:40] Insight in musculoskeletal care.
[00:24:09] The role of technology.
[00:26:22] Press release distribution services.
[00:31:09] Don't be intimidated by PR.More About Amanda:
Amanda Proscia is the co-founder of Lightspeed Public Relations and Marketing. Before founding Lightspeed, Amanda worked in a variety of other agencies and businesses, spanning from the very large ones to the very small. An unexpected part of her experience has been fielding thousands of questions about public relations. Many of them come from business leaders who would benefit from a PR program of their own, if they just understood what it is.
Resources from this Episode:
Website
Amanda’s LinkedIn
Amanda’s book: PR Confidential, Unlocking the Secrets to Creating a Powerful Public Image
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Karen’s Twitter
Karen’s Instagram
Karen’s LinkedIn
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In this episode, I am joined by Lisa Blue, the Chief Clinical Innovation Officer with Providertech. Lisa discusses the intersection between patient engagement and technology. She explains that patient engagement is when patients respond in the expected way, such as reaching out to healthcare providers or responding to calls or texts. Lisa emphasizes the importance of user-friendly technology for healthcare professionals and patients. She addresses the misconception that technology worsens patient engagement and highlights how it can help improve engagement. Tune in to learn more about the role of technology in patient engagement.
Show notes:
[00:02:20] Patient portals and usability.
[00:05:28] Lack of interoperability.
[00:09:33] Challenges in implementing technology.
[00:13:28] Patient interaction challenges.
[00:16:02] Transforming healthcare practices through technology.
[00:19:22] Behavioral economics in psychology.
[00:24:18] Engaging patients through personalized messages.
[00:29:34] A message library for patients.
[00:32:09] Making engagement easy for patients.
[00:36:04] Simplifying healthcare technology.
[00:39:11] ProviderTech and contact information.
More About Lisa Blue:
Lisa Blue is the Chief Clinical Innovation Officer with Providertech, which offers technology solutions to address the complexity of scaling patient engagement while improving operational efficiencies. She is an enthusiastic population health leader who believes that doing healthcare differently, and better, is possible. She is a registered nurse with clinical experience from acute care to FQHCs, giving her the ability to effectively translate and enhance healthcare workflows. She earned her Diploma of Nursing from St Elizabeth Hospital Medical Center in Ohio, her Bachelor of Science in Nursing at Grand Canyon University, and her Master of Healthcare Innovation from Arizona State University, where she also was adjunct faculty from that program.
Resources from this Episode:
Website
Lisa’s LinkedIn
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In this episode of the Healthy, Wealthy, and Smart podcast, guest host Dr. Stephanie Weyrauch interviews Dr. James Denisar-Green about rural healthcare. Dr. Denisar-Green shares his background and experiences growing up in Montana and his journey through medical training in both urban and rural settings. He discusses the challenges and rewards of practicing medicine in smaller communities and highlights the close-knit nature of these communities. Tune in to gain insights into the unique aspects of rural healthcare.
Show notes:
[00:00:23] Rural healthcare challenges.
[00:05:58] Family medicine filling OB gap.
[00:09:22] Challenges in rural healthcare.
[00:12:55] Overcoming transportation challenges.
[00:16:23] The conundrum of patient responsibility.
[00:21:13] Healthy options at the supermarket.
[00:26:38] Getting more providers in rural areas.
[00:27:38] Bringing in rural providers.
[00:32:01] Training physicians to stay.
[00:35:36] Finding Meaning in Primary Care.
More About Dr. James Denisar-Green:
Dr. James Denisar-Green is a dedicated medical professional with a diverse range of clinical expertise, including general preventive medicine, maternity care, and graduate medical education. He currently serves as an Attending Faculty Physician with a Federally Qualified Health Center and Associate Program Director for a Family Medicine residency program located in Billings, Montana. He provides full-spectrum care in multiple settings including outpatient, inpatient, adult, pediatric, and maternity care.
Dr. Denisar-Green completed his residency in Family Medicine with UNLV School of Medicine and holds a Ph.D. in Cell and Molecular Physiology as well as M.D. from the University of North Carolina. He has been recognized for his achievements, including the 40 under 40 award from the Billings Gazette in 2023 and the Resident Teacher Award from the Society of Teachers of Family Medicine in 2019. His research contributions include publications in PubMed and primary care lecture presentations. His passion for improving healthcare extends beyond the clinic, as evidenced by his involvement in hospital committees and community initiatives.
Resources from this Episode:
Website
email: mudphudgreen@gmail.com
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In this episode, I am joined by Dr. Donal O'Gorman, co-founder and CEO of identifyHer, to discuss perimenopause and menopause on the Healthy, Wealthy, and Smart podcast. Dr. O'Gorman has previously focused on exercise science and the prevention of chronic diseases and realized the lack of information regarding women's health and menopause. They talk about the age range for perimenopause, the symptoms women may experience, and the need to address these issues.
Show notes:
00:02:28 Addressing women's health needs.
00:05:55 Early symptoms of menopause.
00:13:11 Understanding perimenopause is challenging.
00:17:32 Menopause increases disease risk.
00:23:42 Empower women with information and options.
00:29:34 Early detection of menopause symptoms.
00:35:35 Perimenopause can be diagnosed.
More About Dr. O’Gorman:
Dr. Donal O’Gorman, PhD is cofounder and Chief Operating Officer of women’s health startup, identifyHer. He is an international expert in exercise physiology and was a Prof. at Dublin City University for 20 years where he studied the impact of sedentary behaviour on the risk of chronic disease as well as the role of exercise in disease prevention and management. In 2022 he left academia to join cofounder Heidi Davis at identifyHer to address unmet needs in women’s health, focusing on the menopausal transition. Donal brings, to identifyHer, his experience in health monitoring and running large scale projects to investigate disease prediction and prevention. He wants to play a role in addressing the health inequalities women face and believes the healthcare of women requires a lifespan approach and not the current disease management model.
Resources from this Episode:
Website
Dr. O’Gorman’s LinkedIn
IdentifyHer Instagram
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Karen’s Twitter
Karen’s Instagram
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In this episode, Dr. Stephanie Weyrauch is joined by Dr. Ken Zweig, to discuss utilizing a holistic approach to treatment, emphasizing nutrition, exercise, and stress management. He focuses on sleep disorders and hypertension and aims to improve patient health through behavior change. The podcast discusses how primary care providers can work with other healthcare professionals, the definition of healthy, the impact of sleep hygiene on health, and tips for optimizing sleep quality. Dr. Zweig's current practice is Northern Virginia Family Practice, a concierge practice that prioritizes personalized, preventative care.
Show notes:
[00:01:33] Primary care providers working with other healthcare professionals.
[00:05:24] Preventative health and healthy eating.
[00:08:29] Preventative health and patient barriers.
[00:12:23] Defining "healthy" is vague.
[00:18:38] Time as a barrier.
[00:19:11] Healthy options for fast food.
[00:23:02] Integrating exercise into daily life.
[00:28:05] The importance of sleep.
[00:30:50] Lack of sleep impacts health.
[00:34:11] Importance of consistent sleep.
[00:38:23] Bedtime routines for better sleep.
[00:42:24] Measuring the process.
[00:45:11] The negative impacts of alcohol.
[00:48:38] Linking habits for success.
More About Dr. Zweig:
Dr. Zweig’s focus on sleep disorders and hypertension go hand in hand with his mission to improve patient health through behavioral change. He also helps patients improve their overall mental and physical health through a holistic approach to treatment that focuses on nutrition, exercise and managing stress.
Dr. Zweig is an assistant professor at both Georgetown and George Washington University Medical Schools. Prior to joining NVFP, Dr. Zweig served 15 years at General Medicine Internal Group, P.C. in Arlington, and was on the board for the HealthConnect Accountable Care Organization. He volunteered with the Virginia Hospital Center Honduras Medical Brigade to provide healthcare to remote villages in Honduras.
Dr. Zweig currently resides in Arlington, VA with his wife and daughter. He enjoys spending as much time outside as possible, preferably with his family. He bikes regularly, often as his commute to NVFP, and skis whenever he gets the chance. Dr. Zweig is originally from Pittsburgh, and loves anything related to that city, but especially loves the Steelers."
He went to undergrad at Univ of Michigan, medical school at The Ohio State University, and residency at Georgetown University.
Resources from this Episode:
Website
Dr. Zweig’s LinkedIn
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In this episode, I am joined by Chad Price to discuss his journey from college to entrepreneurship. After trying out different jobs, he realized that starting his own business was the right path for him. Along with two friends, he founded Kettlebell Kings, a niche brand specializing in kettlebells. The company aimed to be a one-stop-shop for kettlebell enthusiasts, offering a wide range of products and creating a hub for kettlebell-related content. Chad also discusses their unexpected decision to sell the company.
Show notes:
00:01:34 Entrepreneurship journey and niche business.
00:06:42 Building a community is essential.
00:14:39 Tools for entrepreneurial success: Google.
00:14:57 Digital tools and AI revolutionize small businesses.
00:21:23 AI can help improve communication.
00:25:42 Importance of adapting communication style.
00:31:11 Entrepreneurship requires continuous growth.
00:35:05 Hard to build community online.
00:40:43 Relax and absorb life's lessons.
More About Chad:
Chad is a seasoned serial entrepreneur with an impressive track record spanning over a decade. He founded Kettlebell Kings from scratch and orchestrated a remarkable 3 year multi-million dollar acquisition back in November of 2021. Today, it stands tall as a thriving international company, making waves in the esteemed Inc. 5000.
In 2019, Chad pivoted into another passion of his, natural lifestyle products. His new company, Life Grows Green, is uprooting negative stereotypes about hemp and creating new products by only using the elements found in nature. With his background as a student athlete, Chad's passion for sports permeates every aspect of his work.
Chad’s approach to business is the same as his approach to sports. Athletic competition is good, but outside the sports arena, competition takes new heights. His latest project is an upcoming book titled “Preparing for Battle”.
Chad discusses a wide range of topics, from developing a winning mindset to creating a solid business plan, building a strong team, and navigating the challenges of scaling a modern-day business. “Preparing for Battle” is targeted at aspiring entrepreneurs and minority-owned business leaders who are looking for actionable advice and insights that they can apply in their own lives and businesses.
Resources from this Episode:
Website
Chad’s LinkedIn
Chad’s Instagram
Chad’s Facebook
Chad’s Twitter
Chad’s Book: Preparing for Battle
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In this episode, Dr. Jenna Kantor, PT, DPT is joined by Veatrice Cook, PT, MA, to discuss her long career in physical therapy and the incredible legacy she will leave for generations to come. Veatrice is a leader in physical therapy and one of the founders of the American Academy of Physical Therapy. Beatrice shares her journey into physical therapy, which was sparked by watching a physical therapist on a soap opera. She discusses her passion for healthcare and how she found her calling in physical therapy. Tune in to be inspired by Beatrice's story and learn about the impact physical therapists can have on the profession.
Show notes:
[00:01:12] Soap opera inspires career choice.
[00:06:33] Mental health and leadership.
[00:09:42] Lack of representation in leadership.
[00:17:30] The logo design.
[00:19:25] Impact on students.
[00:25:47] Working with the organization.
[00:28:13] Fighting for equal job opportunities.
More About Veatrice:
Veatrice A. Cook is a native East Texan, born in Livingston, Texas, where she grew up and graduated from Livingston High School in Polk County. In her junior year of high school she realized that she wanted to be a physical therapist, and researched more about the profession, only to discover the challenges facing admission into a college program, as an African American student. The number of African Americans that made up the physical therapy profession in 1968 was less than 2%. Ms. Cook received a BS degree in Physical Therapy from Texas Woman’s University, Denton, Texas in1976, and a MA degree in Special Education, from the University of Texas, Austin, Texas in 1981. As a clinician, she has been trained in the John F. Barnes’ Myofascial Release Approach, and continues to use it in her practice setting. Currently she is the Director of Rehabilitation for TeamCareRehab, Inc in San Antonio, Texas. After practicing for over 47 years she is often asked about retiring, and her reply is always, “ I love the work that I do, and it’s really not work when it’s something that you enjoy”.
The limited number of African Americans in the profession of physical therapy, and the lack of mentors was the inspiration that gave Ms. Cook the zeal to help found and organize two professional Physical Therapy organizations: The Texas Network of Minority Physical Therapists (TNMPT) in 1987 and The American Academy of Physical Therapy, Inc (AAPT) in 1989. Ms. Cook, along with Dr. Lynda Woodruff were the organizers, and two of the Founders of the AAPT. 82 African American physical therapists and physical therapist assistants met in Chicago, Illinois on September 16, 1989 to form this great organization, along with 13 others that sent funds to help in the efforts. Ms. Cook, the meeting facilitator was elected as the Charter Treasurer, and served as Annual Conference Chair for 10 years. She was also an active member of the American Physical Therapy Association (APTA) and the Texas Physical Therapy Association, and serviced as Chairperson of the Advisory Committee on Minority Affairs for the APTA. As a community activist, Ms. Cook has served on numerous boards and nonprofit organizations, and has been awarded many honors for her service. In her profession she received the Distinguished Alumni Award from Texas Woman’s University and the Leadership Award from the AAPT.
Ms. Cook often says that here greatest honor is being the mother of three wonderful children, Marcus Lorioun, Vernetha Dionne, and Lawrence Ray Williams, Jr., who are all college graduates and have successful careers. She is also a grandmother of two outstanding grandsons who are carrying on the family tradition of leadership in their high school.
More About Jenna:
Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, Regional Dance America Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre.
Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia.
Dr. Kantor co-founded and runs Fairytale Physical Therapy which brings musical theatre shows to children in hospitals. She hosts the Dance PT Podcast and guest hosts on the podcast Healthy, Wealthy, and Smart. She has served as the NYPTA SSIG Advocacy Chair, the NYC Conclave 2017 committee, NYPTA Social media committee, was the NYPTA Public Policy Student Liaison, and co-founded the NYPTA SSIG. Dr. Kantor won the APTA PPS Business Concept Contest and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media before graduating PT school.
Jenna Kantor currently volunteers with the PPS Marketing & PR Committee and is the website builder for the American Academy of Physical Therapy. She provides complimentary, regular online content that advocates for the physical therapy profession.
Dr. Kantor runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online wellness program for performing artists called Powerful Performer. She is licensed to treat in New York and Pennsylvania.
Jenna continues to perform in musical theatre and lives in Pittsburgh, PA with her husband, doggy, and two cats.
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In this episode, I am joined by Jamey Schrier, PT to discuss how the “gap in the game” can affect physical therapy business owners. Jamie explains that the gap is a concept introduced by Dan Sullivan, which involves creating an ideal vision for the future and then measuring oneself against that vision. This can often lead to feelings of disappointment and inadequacy. Jamie emphasizes how this concept can apply to physical therapy business owners and other entrepreneurs. Tune in to learn more about navigating the gap and finding fulfillment in your business journey.
Show notes:
[00:01:02] The concept of the gap.
[00:05:08] Progress, not perfection.
[00:09:07] Setting measurable goals.
[00:13:09] Moving closer to the ideal.
[00:18:23] Measuring progress towards the ideal.
[00:23:34] Happiness and extrinsic goals.
[00:25:31] Putting yourself out there.
[00:29:41] Belief in "more is better".
[00:35:32] The writing reflex.
[00:37:02] Learned qualities of good leaders.
[00:42:26] Marketing and developing relationships.
[00:46:20] Being nicer to my younger self.
[00:48:04] Stay healthy, wealthy, and smart.
More About Jamey:
Jamey Schrier, P.T., is a best-selling author, business coach, speaker, and CEO of Practice Freedom U, a business training and coaching company. Jamey has helped hundreds of private practice owners Treat Less, Earn More, and live a life of prosperity and fun.
Resources from this Episode:
Freedom U Website
Jamey’s Facebook
Jamey’s LinkedIn
Jamey’s X
Jamey’s YouTube
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Karen’s Twitter
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In this episode, I am joined by Dr. Anthony Balduzzi to discuss how to prioritize health over the age of forty. Dr. Balduzzi shares his personal connection to the topic, having witnessed his father's battle with cancer and subsequent passing at a young age. This experience shaped his perspective on prioritizing health, especially as we age. The conversation explores the key aspects of health that individuals over 40 should focus on and emphasizes the significance of maintaining a lifestyle that supports overall well-being.
Show notes:
[00:01:21] Lessons from losing a parent.
[00:03:16] Aging and health in 40s.
[00:07:30] Daily walking and its benefits.
[00:09:47] The importance of nutrition.
[00:12:35] Breakfast recommendations.
[00:16:30] Lunch and snack options.
[00:19:03] The perfect plate concept.
[00:23:18] Sleep and circadian rhythm.
[00:25:10] Protecting circadian rhythm and melatonin.
[00:29:09] Fasting for optimal health.
[00:31:29] Healthier mitochondria.
[00:34:57] Advice to your younger self.
More About Dr. Balduzzi:
Dr. Anthony Balduzzi, the founder and CEO of the Fit Father Project and Fit Mother Project, experienced a pivotal moment in his childhood when he watched his own father work relentlessly, only to succumb to illness and pass away at the young age of 42. Anthony was just 9 years old at the time. This life-changing event inspired him to dedicate his life to helping busy fathers and mothers aged 40 and above lose weight, build muscle, and improve their overall health for the well-being of their families.
As a licensed Naturopathic Doctor in Arizona, Dr. Balduzzi also holds dual degrees in Nutrition and Psychology from the University of Pennsylvania. In addition to his academic achievements, he is a former national champion bodybuilder. Through his unwavering commitment and efforts, Dr. Balduzzi has successfully helped over 60,000 families across more than 100 countries through his Fit Father and Fit Mother Programs.
Resources from this Episode:
FitFatherProject.com
FitMotherProject.com
YouTube
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In this episode, I am joined by Dr. Darryl Stickel, to discuss the topic of trust. We explore the lack of trust in today's world, from political figures to teachers and the medical world. Darrell shares his motivation for focusing on trust during his PhD studies, recounting his upbringing in a small town where community support was essential. He also discusses his experiences of strangers opening up to him, which led him to pursue a career in clinical psychology. Please tune in to gain insights into the importance of trust and its impact on our relationships and society.
Show notes:
[00:02:37] Building trust in hostile environments.
[00:05:37] Trust and vulnerability.
[00:08:11] Trust and context impact
[00:12:03] Extreme trust in cults.
[00:16:10] Showing benevolence in healthcare.
[00:20:21] Medical insurance company tactics.
[00:23:24] The impact of therapeutic relationships.
[00:28:36] Trust levels are low.
[00:31:12] Uncertainty in relationships.
[00:34:01] Building trust and skill improvement.
[00:37:31] Leading with imperfections.
More About Dr. Stickel:
Darryl is one of the world’s leading experts on trust with over twenty years experience. His Ph.D. ¨Building Trust in Hostile Environments¨ from Duke University established him as a global leader for governments, businesses and NGOs on practical approaches to building trust.
Darryl has worked for Mckinsey & Company in their Toronto office, as well as advised the Canadian Military on trust building in Afghanistan. He has served as faculty for the Luxembourg School of Business and the Center for Effective Organizations at the University of Southern California and recently completed his book Building Trust: Exceptional Leadership in an Uncertain World.
His contribution to the field of trust has been recognized by his nomination to the Top Thought Leaders on Trust by Trust Across America; Trust Around the World.
Resources from this Episode:
Website
Dr. Stickel’s YouTube
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In this episode, I am joined by Dr. Stowe Shoemaker, PhD, to discuss the intersection of hospitality and healthcare and how healthcare providers can learn from the hospitality industry. He defines hospitality as providing an incredible experience that makes customers feel like family and want to return. The conversation explores the critical drivers that create a good customer experience in healthcare. Tune in to discover the valuable insights that can improve the healthcare experience for patients.
Show notes:
[00:02:09] Critical drivers for customer experience.
[00:05:37] Knowing and understanding the cost of service.
[00:08:29] Hospitality deficits in healthcare.
[00:13:08] Building trust in hospitality.
[00:20:16] Redesigning the patient waiting area.
[00:25:37] The Cleveland Clinic's patient experience.
[00:30:08] Evaluation and guest feedback.
[00:32:05] Loyalty and reward programs.
[00:37:24] Providing incredible customer experience.
[00:40:49] Loyalty fundamentals and pricing.
More About Dr. Shoemaker:
Dr. Stowe Shoemaker (Ph.D., Cornell University) served as Dean of the William F. Harrah College of Hospitality from 2013 – 2023. While dean he held the Andrew and Peggy Dean’s Chair at the University of Nevada, Las Vegas (UNLV). He is an acknowledged expert in pricing, revenue management, consumer behavior and customer loyalty programs.
Dr. Shoemaker has served as an advisor to numerous hospitality service providers over the course of his career including British Airways, Accor, Hilton, Landry’s and Hyatt. He has helped game developers test market new casino games (both slots and table games), developed pricing strategies, developed programs to measure customer satisfaction, modeled the success and failure of marketing programs, and developed segmentation strategies based on consumer motivations in the gaming, lodging and restaurant industries.
Dr. Shoemaker has published two marketing textbooks, Marketing Leadership in Hospitality and Tourism: Strategies and Tactics for a Competitive Advantage and Marketing Essentials in Hospitality and Tourism: Foundations and Practices, and his research has won numerous awards.
Since 1996 Dr. Shoemaker has served as a member of the executive education faculty at Cornell University where he has taught courses in strategic pricing, revenue management, strategic marketing for hotels and restaurants, and customer loyalty.
Dr. Shoemaker has also applied his knowledge of hospitality to help healthcare professionals improve patient satisfaction. He has held a joint appointment at MD Anderson Cancer Center in Houston, TX and worked with Memorial Healthcare Systems, Houston. His third book Hospitable Healthcare: Just What the Patient Ordered will be published in Spring 2023.
Resources from this Episode:
Website
Dr. Shoemaker’s LinkedIn
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Karen’s Twitter
Karen’s Instagram
Karen’s LinkedIn
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In this episode, I am joined by Dr. Stowe Shoemaker, PhD, to discuss the intersection of hospitality and healthcare and how healthcare providers can learn from the hospitality industry. He defines hospitality as providing an incredible experience that makes customers feel like family and want to return. The conversation explores the critical drivers that create a good customer experience in healthcare. Tune in to discover the valuable insights that can improve the healthcare experience for patients.
Show notes:
[00:02:09] Critical drivers for customer experience.
[00:05:37] Knowing and understanding the cost of service.
[00:08:29] Hospitality deficits in healthcare.
[00:13:08] Building trust in hospitality.
[00:20:16] Redesigning the patient waiting area.
[00:25:37] The Cleveland Clinic’s patient experience.
[00:30:08] Evaluation and guest feedback.
[00:32:05] Loyalty and reward programs.
[00:37:24] Providing incredible customer experience.
[00:40:49] Loyalty fundamentals and pricing.
More About Dr. Shoemaker:
Stowe Shoemaker, dean of the William F. Harrah College of Hotel Administration photographed for Premier Magazine on August 24, 2016. (R. Marsh Starks / UNLV Photo Services)
Dr. Stowe Shoemaker (Ph.D., Cornell University) served as Dean of the William F. Harrah College of Hospitality from 2013 – 2023. While dean he held the Andrew and Peggy Dean’s Chair at the University of Nevada, Las Vegas (UNLV). He is an acknowledged expert in pricing, revenue management, consumer behavior and customer loyalty programs.
Dr. Shoemaker has served as an advisor to numerous hospitality service providers over the course of his career including British Airways, Accor, Hilton, Landry’s and Hyatt. He has helped game developers test market new casino games (both slots and table games), developed pricing strategies, developed programs to measure customer satisfaction, modeled the success and failure of marketing programs, and developed segmentation strategies based on consumer motivations in the gaming, lodging and restaurant industries.
Dr. Shoemaker has published two marketing textbooks, Marketing Leadership in Hospitality and Tourism: Strategies and Tactics for a Competitive Advantage and Marketing Essentials in Hospitality and Tourism: Foundations and Practices, and his research has won numerous awards.
Since 1996 Dr. Shoemaker has served as a member of the executive education faculty at Cornell University where he has taught courses in strategic pricing, revenue management, strategic marketing for hotels and restaurants, and customer loyalty.
Dr. Shoemaker has also applied his knowledge of hospitality to help healthcare professionals improve patient satisfaction. He has held a joint appointment at MD Anderson Cancer Center in Houston, TX and worked with Memorial Healthcare Systems, Houston. His third book Hospitable Healthcare: Just What the Patient Ordered will be published in Spring 2023.
Resources from this Episode:
Website
Dr. Shoemaker’s LinkedIn
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Karen’s LinkedIn
Subscribe to Healthy, Wealthy & Smart:
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The post 641: Dr. Stowe Shoemaker: Hospitalble Healthcare – It is not an Oxymoron appeared first on Healthy Wealthy & Smart.
In this episode, Dr. Stephanie Weyrauch is back with a great interview with COL Zack Solomon, PT, DPT, OCS, CSCS, to discuss the importance of resiliency in life and in leadership. Colonel Solomon shares his 25-year career journey, starting with his master's program at the US Army Baylor program and his time at Walter Reed and Fort Riley. He also describes his experience as a brigade physical therapist in Iraq during the surge in 2006 and 2007. Additionally, Colonel Solomon discusses his role as a brigade medical officer in a basic training brigade and his time at Aberdeen Proving Ground. Tune in to gain valuable insights on resilience from Colonel Solomon's military experience.
· "The views, thoughts, and opinions presented herein are those of the speaker and do not necessarily represent the views of the DoD or the U.S. Army.”
Show notes:
[00:01:12] Resilience in the military.
[00:07:58] Overcoming acute events.
[00:11:36] Building resilience in the Army.
[00:15:17] Recovering from spinal cord injury.
[00:19:16] Building trust and confidence.
[00:23:16] General Shelton's incredible recovery.
[00:27:06] Setting desired end state.
[00:32:03] Resilience in leadership.
[00:36:00] Autonomy in physical therapy.
[00:42:44] Promoting resilience and reducing burnout.
[00:45:15] Providing constructive feedback.
[00:48:30] Modeling behaviors as healthcare providers.
More About COL Soloman:
COL Zack Solomon earned a Master of Physical Therapy degree from U.S. Army-Baylor University and a Doctor of Physical Therapy degree from Baylor University. COL Solomon also graduated from the U.S. Army War College with a Master’s degree in Strategic Studies.
COL Solomon most recently served as the Branch Chief, Army Medical Specialist Corps, Human Resources Command, Fort Knox, Kentucky. COL Solomon’s previous assignments include Commander, California Medical Detachment, Presidio of Monterey, California; Chief of Physical Therapy, Dunham Army Health Clinic, Carlisle Barracks, Pennsylvania; Chief of Physical Therapy at Blanchfield Army Community Hospital, Fort Campbell, Kentucky; Assistant Program Manager, Army Institute of Public Health, U.S. Army Public Health Command, Aberdeen Proving Ground, Maryland; Brigade Medical Operations Officer, 434th Field Artillery Brigade, Fort Sill, Oklahoma; Chief Physical Therapy and Chiropractic Clinics, U.S. Army Health Clinic, Schofield Barracks, Hawaii; Brigade Physical Therapist, 3rd Brigade Combat Team, 25th Infantry Division in support of Operation Iraqi Freedom; Assistant Chief, Physical Therapy Clinic, Irwin Army Community Hospital, Fort Riley, Kansas; Physical Therapist, Walter Reed Army Medical Center, Washington D.C.
He is a board-certified orthopedic clinical specialist from the American Board of Physical Therapy Specialties and a certified strength and conditioning specialist from the National Strength and Conditioning Association.
More About Dr. Weyrauch:
Dr. Stephanie Weyrauch is a self-employed physical therapist at Movement X in Billings, MT. She earned her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch is a highly sought-after speaker and consultant specializing in burnout, generational issues, and injury prevention programs within the workplace. Her clinical expertise has been featured in various media outlets, including NPR, Kaiser Health News, Glamour, Life Hacker, and NBC News. Dr. Weyrauch serves as Chair of the American Physical Therapy Association Nominating Committee and has served on multiple national task forces for the organization. She has performed scientific research through grants from the National Institutes of Health and National Science Foundation at institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.
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In this episode, I am joined by Susan Bratton, "Intimacy Expert to Millions," to discuss the connection between our overall health and our sex life and intimacy. They discuss the surprising connection between intimacy and health, highlighting the benefits of sex on both physical and mental well-being. The guest shares experiences and insights from years of exploring and understanding the female body. Listeners can expect to learn new perspectives on libido, desire, arousal, and the positive impact of a thriving love life.
Show notes:
[00:02:26] Health benefits of sex.
[00:04:23] Erectile tissue in women.
[00:08:34] Slow arousal and midlife sexuality.
[00:14:02] Vascular health and longevity.
[00:18:08] Pleasure in multiple locations.
[00:23:39] Toys that deeply penetrate tissue.
[00:24:26] The benefits of having orgasms.
[00:28:03] Soft tissue diseases post-covid.
[00:32:09] Arousal ladders and desire.
[00:35:10] Sex gets better with age.
[00:39:10] Vaginal restoration and ageless sexuality.
[00:42:29] Better Lover newsletter sign-up.
More about Susan Bratton:
Susan Bratton "Intimacy Expert to Millions" is a champion and advocate for all those who desire passion their whole life long. She is a spokeswoman for GAINSWave and FemiWave and is co-founder and CEO of two corporations: Personal Life Media, Inc., a publisher of heart-connected lovemaking techniques and bedroom communication skills and The20, LLC., a manufacturer of organic and botanical supplements that enhance vitality.
Susan has been featured in the New York Times and on CNBC and the TODAY Show. She makes frequent appearances on ABC, CBS, The CW, Fox and NBC.
You can find The Susan Bratton Show® at BetterLover.com, her personal shares on Instagram @susanbratton, and her lust-for-life supplements, FLOW and DESIRE at The20store.com.
Resources from this Episode:
Susan’s Facebook
Susan’s Instagram
Susan’s Twitter
Susan’s YouTube
Susan’s Website
GainsWave
FemiWave
Better Lover Website
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In this episode, I am joined by Brandy Mabra, the CEO Savvy Clover Coaching & Consulting and a CEO Coach for private practice owners to talk about the power of owning your CEO status. Brandy discusses her various roles in practice management, consulting, and working with providers and payers. She opens up about her burnout and realizing that climbing the corporate ladder didn't align with her goals. This led her to start her own business and become a coach, helping healthcare professionals navigate their careers and find fulfillment. Please tune in to hear Brandy's insights on healthcare providers as CEOs and the unique challenges they face.
Show notes:
[00:02:05] Pivoting to business coaching.
[00:03:57] Owning your CEO role.
[00:08:07] Cultivating Your CEO Mindset.
[00:09:47] The real side of business.
[00:13:14] Chaos costs money.
[00:18:07] Mapping out systems
[00:21:12] Switching hats as a CEO.
[00:25:03] Every hour of planning saves 10 hours of doing.
[00:28:13] Scale Your Practice.
More About Brandy Mabra:
Brandy Mabra is the CEO of Savvy Clover Coaching & Consulting and a CEO Coach for private practice owners in healthcare.
Brandy has 15+ years of business management and leadership experience, where she has worked in diverse business climates and has turned hot mess practices into well oiled and profitable machines. Brandy has spent her career building, growing and leading multi-million dollar practices and now uses her skill set to help other women private practice owners to scale their practices for growth, sustainability and profit.
Brandy has a bachelors from The Ohio State University and a Masters in Health Administration from A.T. Still University. Brandy is a Certified Professional Coach and Master Energy Leadership Practitioner, receiving her credentials from the Institute for Professional Excellence in Coaching (iPEC).
Brandy was part of the 2022 Forbes Coaches Council, and is a part of Entrepreneur Leadership Network. She has been featured in Forbes, Fast Company, Entrepreneur, PopSugar, Create & Cultivate and several well known podcasts.
She is the founder of Private Practice CEO™ - the CEO school for private practice owners - which empowers her clients to own their CEO status as the leader of their business so they can have a practice with streamline operations and an engaged team that can run without them.
Brandy loves to travel and spend time with her family. She believes you cannot build a business on fumes and CEO breaks are required.
Resources from this Episode:
Brandy’s Website
Free Gift From Brandy to the Listeners
Brandy’s Instagram
Brandy’s Facebook
Brandy’s YouTube
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In this episode, I am joined by Dr. Bill Chun, MD, FACOG, to speak about the healthcare system in the United States, focusing on women's healthcare.
The post 637: Dr. Bill Chun: Ways to Get Healthier Despite our Broken Healthcare System appeared first on Healthy Wealthy & Smart.
In this episode, I am joined by Dr. Bill Chun, MD, FACOG, to speak about the healthcare system in the United States, focusing on women's healthcare. As a medical professional with over 30 years of experience, Dr. Chun provides insight into the challenges women face in accessing quality healthcare. He shares his perspective as both an expert in the field and an immigrant American, offering a comprehensive view of the topic. Tune in to gain a better understanding of the complexities of the U.S. healthcare system and its impact on women's health.
Show notes:
00:02:21 US healthcare system fails women.
00:07:12 Educate women about healthcare options.
00:13:04 Choose your healthcare provider carefully.
00:20:13 Importance of midwives and doulas.
00:27:06 Postpartum care needs improvement.
00:37:00 Prioritize your health and well-being.
00:38:59 Health is the biggest asset.
More About Dr. Chun:
Dr. Byungyol (Bill) Chun is a board-certified Obstetrician and Gynecologist with over thirty years of experience in medicine. A leading provider of robotic gynecologic surgery in New England, he currently treats patients at his practice north of Boston, where he has lived and worked for over twenty-five years. A Korean-American immigrant, Dr. Chun was born at home to a teenage mother with no prior prenatal care, and he credits this humble beginning as a major part of his drive to become a doctor. He is passionate about helping people live better lives through better health. Dr. Chun is the Founder of Doc & Doula, an organization dedicated to improving outcomes for all birthing people by educating women on crucial health matters. He also spearheads Doulas for Everyone, a platform that connects lower-income parents with doula services. His newest venture, Women Only Organics, focuses on natural supplements formulated for women. Dr. Chun strives to use all possible means of communication to help each woman become her own best health advocate, utilizing social media and promoting tools that all people can use to get the most out of the U.S. healthcare system. He is a graduate of the Ohio State University of Medicine and a Fellow of the American College of Obstetrics and Gynecology.
Resources from this Episode:
Dr. Chun’s Website
Dr. Chun on TikTok
Dr. Chun on Twitter
Dr. Chun on Instagram
Women Only Organics (use the code healthywealthysmart for 25% off)
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In this episode, I am joined by Dr. David Weill, a lung transplant doctor and author, about lung transplants. Dr. Weil shares his experiences working with lung transplant patients, including the emotional ups and downs of the job. He also discusses the close relationships formed with the families of patients, which can be both rewarding and difficult. The conversation sheds light on the complexity of lung transplants and the importance of organ donation.
Show notes:
[00:00:46] Emotional experiences as a transplant doctor.
[00:05:00] Shortage of transplant doctors.
[00:11:28] Lung transplant operation complexities.
[00:13:32] Transplant organs kept alive.
[00:19:17] Lung transplant and COVID.
[00:20:40] Lung transplants for COVID patients.
[00:28:30] Gratitude in organ transplant work.
[00:29:21] Kidney transplant candidate selection.
[00:33:33] Preventing Burnout in Healthcare.
[00:40:14] Raw, emotional book about transplant.
[00:44:00] Balance in medical career.
[00:03:38] Chronic pain management.
More About Dr. Weill:
Dr. Weill served as the director of several transplant programs for 20 years, most notably as the Director of the Center for Advanced Lung Disease and Lung and Heart-Lung Transplant Program at Stanford University Medical Center.
In 2016, after serving in his role at Stanford for 11 years, he did the unthinkable and walked away while at the top of his field. Dr. Weill was burnt out from the daily battles of being a doctor: the patients that couldn't be treated because of finances, the operations that failed, and the countless hours spent trying to make the modern miracle of organ transplants a bit more miraculous.
He has written a riveting memoir Exhale: Hope, Healing, and A Life in Transplant, which offers readers an inside look at the immense psychological pressure medical professionals face on the job and the toll a career in transplant took on one of the nation's most successful transplant doctors.
Exhale also dives deep into hospital politics, healthcare system inequities, and ethics that determine who gets life-saving transplants and who doesn't.
Dr. Weill is currently the Principal of the Weill Consulting Group, which focuses on improving the delivery of pulmonary, ICU, and transplant care.
He has twice testified before the U.S. Senate about how various inhaled occupational exposures affect lung health, appeared before various state legislatures, and lectured extensively nationally and internationally at major medical conferences and academic medical centers.
Dr. Weill has also authored many book chapters, editorials, and medical articles, which have been featured in the Wall Street Journal, USA Today, Salon, Newsweek, the Chicago Tribune, STAT, the Washington Post, The Hill, and the Los Angeles Times.
He also has been interviewed by many major media outlets, including Fox, CNN, the New York Times, the San Francisco Chronicle, the Wall Street Journal, and the Doctors TV show.
Resources from this Episode:
Dr. Weill’s Website
Dr. Weill on LinkedIn
Dr. Weill on Instagram
Dr. Weill on Twitter
Dr. Weill on Facebook
Dr. Weill’s Book
Articles by Dr. Weill
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In this episode, I am joined by Jon Paul Crimi to talk about the importance of breath work. We discuss the common question of why one needs to learn how to breathe when the body does it automatically. John Paul explains that breathwork is an umbrella term, and there are different types. He specifically does circular breath work or conscious connected breathing that is aimed at clearing out stuck emotions like stress, anxiety, grief, and trauma.
Show notes:
[00:01:24] Trauma passed through DNA.
[00:03:19] The power of breath work.
[00:06:51] Breathwork's potential impact.
[00:09:11] Transient Hypofrontality.
[00:12:27] Self-improvement and relationships.
[00:15:48] Pain and emotions in healthcare.
[00:19:11] Breathwork for medical professionals.
[00:22:28] Prescription medication statistics.
[00:25:21] Side effects of breathwork.
[00:28:53] Changing your life by trying something different.
[00:32:21] Being kinder to yourself.
More Jon Paul Crimi:
Originally from Boston, in his early 20s Jon Paul Crimi moved to Los Angeles and quickly became one of the most sought-after celebrity trainers and sober coaches in the country. Unexpectedly, he found himself in a breathwork class and had a massive transformation that first time. Knowing he had to share this technique, he not only began teaching breathwork, but developed his own unique style and quickly began selling out breathwork classes all over Los Angeles. Jon Paul currently resides in Bend, Oregon with his wife and two children but returns monthly to Los Angeles to teach sold-out breathwork classes and workshops, as well as lead his in-demand Breathwork Teacher Trainings. What makes Jon Paul Crimi stand apart is his east coast no-nonsense approach. He has removed the “New Agey” aspects of breathwork, and now private companies and organizations are filling his calendar. CEOs and the “Forbes set” have found themselves in his classes and have hired him to teach breathwork to their employees. Jon Paul has broadened his classes to include customized workshops and corporate retreats for groups all over the United States. Jon Paul has appeared on Good Morning America and has been featured in The Huffington Post and The Hollywood Reporter. You can find him on countless talk shows and podcasts both in the United States and around the world, as he continues his work to make breathwork more accessible and mainstream. Jon Paul believes everyone can benefit from this practice, and he has Olympians as well as Oscar, Emmy, and Grammy winners to prove it. Witnessing people visibly transform, often after just one breathwork session, is why he greets each day excited to turn people towards their most authentic selves and he has made it his life work to reach as many people as possible.
Resources from this Episode:
Jon Paul’s Website
Jon Paul’s Instagram
Jon Paul’s YouTube
Jon Paul’s LinkedIn
Jon Paul’s TikTok
Jon Paul’s Facebook
Jon Paul’s Twitter
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Karen’s Twitter
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In this episode, I am joined by Jon Paul Crimi to talk about the importance of breath work.
The post 635: Jon Paul Crimi: The Power of breath: Conversation with Jon Paul Crimi appeared first on Healthy Wealthy & Smart.
In this episode, I am joined by Dr. Tom Walters, DPT, OCS, a physical therapist and social media influencer with over a million followers on Instagram. Tom shares his backstory on how he got involved in posting physical therapy-related content and educating people on pain science. They discuss the importance of disseminating information and how social media can be used to reach a wider audience. Tom also talks about his book, Rehab Science: How to Overcome Pain and Heal from Injury, which is focused on helping people with painful conditions. Overall, the episode provides valuable insights into physical therapy and social media.
Show notes:
[00:01:46] Pain Science in Early Practice.
[00:04:11] Promoting physical therapy on social media.
[00:08:51] Physical therapists' role in education.
[00:10:49] PTs educating the public.
[00:14:56] Measuring social media influence.
[00:17:37] Planting seeds in patient care.
[00:21:07] Using anatomy for clickbait.
[00:26:00] Physical therapy education on social media.
[00:28:26] Simple equipment for video production.
[00:31:56] iPhone filming techniques.
[00:34:42] Physical Therapy on Social Media.
[00:38:06] Treating pain and injury.
[00:41:45] Book retailers and scammers.
[00:45:07] Exercise isn't that special.
[00:47:45] PTs can positively influence people.
[00:51:27] Saying yes to opportunities.
More About Dr. Stockhausen:
Dr. Tom Walters is a board-certified orthopedic physical therapist that specializes in the treatment of pain and movement disorders. He is the founder of Rehab Science and dedicates his time to teaching people about human movement, pain, and how to most effectively recover from injury. Besides running his clinical practice, Tom served as a full-time undergraduate kinesiology professor for eight years where he taught human biomechanics, therapeutic exercise, and pain science. Tom received his bachelor’s degree in exercise science from Montana State University and his Doctor of Physical Therapy (DPT) degree from Chapman University. Afterwards, he completed a residency in orthopedic manual physical therapy (OMPT) and a fellowship in lower quarter functional biomechanics. You can find more of Tom’s content on Instagram and YouTube (@rehabscience) as well as his website (rehabscience.com). Tom lives in Santa Barbara, CA with his wife, Kirsten, and their two daughters.
Resources from this Episode:
Tom’s Instagram
Tom’s YouTube
Tom’s Website
Read the First Chapter of Tom’s Book
Buy Tom’s Book
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Karen’s LinkedIn
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In this episode, Dr. Karen interviews Dr. Amelia Hruby about her decision to leave social media and start a business without it. They discuss the evolution of social media from a platform for personal use to a tool for content creation and marketing. Amelia shares her journey of selling courses, stickers, and self-publishing a book through Instagram and how she ultimately decided to leave social media altogether. They explore the benefits and drawbacks of social media and the possibility of running a successful business without it.
Show notes:
[00:00:12] Starting a business without social media.
[00:04:37] Codependency and Instagram.
[00:09:03] Leaving social media intentionally.
[00:13:43] The dangers of social media.
[00:16:12] Benefits of social media for small businesses.
[00:19:52] Social media distraction.
[00:24:13] Finding clients without social media.
[00:27:23] Networking and selling in business.
[00:31:27] Reframing sales as relationships.
[00:37:51] Business success without social media.
[00:39:01] Leaving social media for business.
More About Dr. Stockhausen:
Amelia Hruby is a writer, educator and podcaster with a PhD in philosophy. She is the
founder & executive producer of Softer Sounds, a feminist podcast studio for
entrepreneurs and creatives. And she’s the host of Off the Grid, a podcast about leaving
social media without losing all your clients.
Resources from this Episode:
Amelia's Website
Softer Sounds Studio
Off The Grid Podcast
Get the Leaving Social Media Toolkit
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Karen’s LinkedIn
Subscribe to Healthy, Wealthy & Smart:
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In this episode, I am joined by John Gallucci Jr., MS, ATC, PT, DPT, and CEO of JAG-ONE Physical Therapy. We discuss the importance of athletic trainers, how they work with physical therapists, and their role in the community. John shares his experience working with various sports teams, including the New York Knicks and the New Jersey Devils, and how he started JAG 1, a sports medicine company. Overall, this episode highlights the crucial role that athletic trainers play in keeping athletes safe and healthy.
Show notes:
[00:00:09] Importance of athletic trainers.
[00:06:02] Multidisciplinary approach in therapy.
[00:07:07] Multisport approach to healthcare.
[00:10:49] Certified athletic trainers shortage.
[00:17:24] Pay of athletic trainers.
[00:18:32] Capitalizing on Athletic Healthcare.
[00:23:49] Emergency Action Plans in sports.
[00:28:21] Physical therapy as primary care.
[00:30:19] Emergency Room Misuse.
[00:34:07] Advice for your 20-year-old self.
More About Dr. Gallucci:
John Gallucci Jr., MS, ATC, PT, DPT, is the CEO of JAG-ONE Physical Therapy, one of the fastest growing comprehensive physical and occupational therapy practices providing rehabilitative care to patients and sports teams in over 110 locations across the Northeast.
Recognized by ROI-NJ as one of the top 20 influencers in healthcare, Gallucci has received numerous additional honors, including the Ernst and Young Entrepreneur of the Year Regional Award Winner and the American Physical Therapy Association of New Jersey Distinguished Professional of the Year for his work. In early 2023, Gallucci was recognized by ROI-NJ on their Power List for Healthcare Life Sciences, and was inducted in his alma mater Dominican University’s Alumni Hall of Achievement. An expert in sports medicine, rehabilitation, and injury prevention, Gallucci serves as the Medical Coordinator for Major League Soccer (MLS), coordinating the medical care of more than 800 professional soccer players. He is also a Sports Medicine consultant for professional athletes in the NHL, NFL, NBA, and MLB. A noted author, Gallucci released his first book titled Soccer Injury Prevention and Treatment in May 2014. His second book, titled Play Ball: Don’t Let Injuries Sideline You This Season was released on May 1, 2018.
Gallucci earned his Bachelor of Science in Political Science from the City University of New York- Staten Island. He then went on to earn his Doctorate in Physical Therapy from Dominican University, and the University later honored him as their Person of the Year for 2018. In 2023, Dominican University officially opened the Gallucci Physical Therapy Research Laboratory. Gallucci committed to donating a scholarship to the school for the next three years, as well as a personal contribution to go towards research and innovation within the Physical Therapy lab. Dually licensed as an athletic trainer and physical therapist, Gallucci began his career within organizations such as the New York Knicks, New York University, New York Red Bulls, and within several major healthcare systems. His start in sports physical therapy inspired him to bring the same level of attention and treatment to every person, so he started his own physical therapy practice, JAG Physical Therapy. In 2018, JAG Physical Therapy merged with One-on-One Physical Therapy creating JAG-ONE Physical Therapy and appointing Gallucci as CEO. Gallucci plans on expanding JAG-ONE Physical Therapy to locations throughout the Northeast, based on the needs of our communities for an in-network, outcome-based physical therapy company.
Aside from his work at JAG-ONE Physical Therapy, Gallucci sits on the governor-appointed New Jersey Council on Physical Fitness and Sports and is the Medical Coordinator for Major League Soccer (MLS), consulting on the medical care of more than 800 professional soccer players. Gallucci is also a member of the President’s Advisory Group for Seton Hall University assisting in the university’s strategic planning process. In the local community, Gallucci’s philanthropic efforts have included a leading role in the fundraisers for The Valerie Fund, RWJBarnabas Health, The Arthritis Foundation, The American Cancer Society, and The Leukemia & Lymphoma Society. He also supports more than 200 high schools, college programs, and athletic clubs throughout the Tri-State Area. Find Gallucci on Twitter or connect with him on Linkedin.
Resources from this Episode:
Jag-One Website
Jag-One Twitter
Dr. Gallucci Twitter
Jag-One Facebook
Jag-One Instagram
Dr. Gallucci LinkedIn
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Karen’s LinkedIn
Subscribe to Healthy, Wealthy & Smart:
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In this episode of Healthy Wealthy & Smart, I am joined by Dr. Crystal Frazee, PT, NBCHWC, CIAYT, to discuss burnout, closing the gender gap, and her transition from being a physical therapist to a wellness coach. Dr. Frazee talks about her background in alternative healing, becoming a physical therapist, and how she transitioned to coaching. This discussion will be relevant to physical therapists and other healthcare professionals who may be experiencing burnout or considering a career change.
Show notes:
[00:00:43] Transitioning to full-time coaching.
[00:06:19] The Perfection Paradox.
[00:08:00] Women and work-life integration.
[00:12:20] Capacity Cascade.
[00:15:08] Regulating your nervous system.
[00:19:02] Body Wisdom and Emotions
[00:22:27] Setting Boundaries in Work.
[00:26:51] The likability trap.
[00:30:21] Setting boundaries for success.
[00:33:50] Body wisdom and self-care.
[00:37:39] Burnout among women.
[00:42:12] Self-worth and body literacy.
More About Dr. Frazee:
Dr. Crystal Frazee, is a PT and women’s integrative health coach turned Executive Leadership Mentor & Burnout Recovery Coach for professional women. She’s the creator of the Somatic Attunement MethodTM and Attuned LeadershipTM help women reach their career potential sustainably and flourish personally. She’s on a mission to teach ambitious, working women that they can have success, sustainability, and satisfaction simultaneously with her proven strategy.
As the author of the upcoming book REVIVE: The Working Woman’s Unexpected Guide to Recovering from Burnout, Dr. Frazee's insights on Attuned Leadership will revolutionize how you navigate work-life demands, pursue your goals, and think about stress resilience. Tune in to the show to learn practical tips, and check out her website for more valuable resources.
Resources from this Episode:
Dr. Frazee’s Website
Crystal’s Instagram
Crystal’s LinkedIn
Crystal’s TikTok
Crystal’s Free Gift: How to Run Your Day Audio
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Karen’s LinkedIn
Subscribe to Healthy, Wealthy & Smart:
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Apple Podcast
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In this episode, I am joined by Ergonaut Dr. Stephen Stockhausen PT, DPT, OCS to talk about the importance of ergonomic evaluations. We also discuss his previous career as a travel physical therapist. Steve shares his experience of paying off student debts and the challenges of working on the road with a family. He also provides advice for younger therapists interested in becoming travel physical therapists. And we also discuss his current position as a physical therapist on a reservation in Colorado working with the indigenous population. Show notes: [00:01:45] Traveling as a Physical Therapist. [00:05:15] Pros and cons of travel PT. [00:08:28] Working with indigenous communities. [00:10:45] Community healthcare benefits patients. [00:16:27] Autonomy for the Elderly [00:19:59] Working with Indigenous populations. [00:22:40] Ergonomic injuries cost billions. [00:28:17] Lean engineering perspective. [00:30:11] Ergonomics in the workplace. [00:35:00] Ergonomics in Concierge Medicine. [00:39:42] Autonomy for physical therapy patients. [00:41:57] Social Media for Physical Therapists. More About Dr. Stockhausen: Dr. Stephen Stockhausen, PT, DPT is a board-certified Orthopedic Clinical Specialist. Initially working in education, he soon transitioned to Physical Therapy, achieving his Doctorate of Physical Therapy from the University of Kentucky. As a therapist, he has extensive experience in orthopedics as well as home care. Aside from helping patients, he has held a variety of leadership positions and serves as an advocate for small businesses as well as clinical and professional excellence amongst his peers. He launched PTAdventures.com in 2016 with his wife where they help guide fellow PTs through the ins and outs of the travel healthcare industry. Currently, he is a full-time clinician and also serves as the COO of Ergonauts Performance Technology, a technology-based start-up specializing in making ergonomics easy and accessible for everyone. Resources from this Episode: Ergonauts Website Steve’s Instagram Follow Dr. Karen Litzy on Social Media: Karen’s Twitter Karen’s Instagram Karen’s LinkedIn Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio
In this episode, I am joined by Dr. Michael Gorman, Ph.D., PT, DMT, FAAOMPT owner of iMove PT, to discuss the evaluation and treatment of TMJ disorders. Michael shares his journey into this sub-specialty and his interest in TMJ treatment. He explains what TMJ is and how physical therapists can help those who suffer from TMJ dysfunction. Michael also describes his experiences treating patients with TMJ, the challenges he has faced, and the successes he has achieved. Overall, this episode provides valuable information for those seeking treatment for TMJ dysfunction or those interested in learning more about the condition.
Show notes:
[00:00:22] TMJ Dysfunction Treatment Journey.
[00:04:08] Treating TMJ Pain.
[00:09:24] Objective signs of TMJ dysfunction.
[00:12:18] Assessing jaw strength and asymmetry.
[00:19:29] TMJ treatment exercises.
[00:20:27] Creative TMJ exercises.
[00:24:46] Marketing a subspecialty.
[00:28:24] Treating TMJ patients.
[00:32:27] Physical therapy and chiropractic misconceptions.
[00:36:28] TMJ pain solutions.
More About Dr. Gorman:
Dr. Gorman graduated from the University of Missouri-Columbia in 1993 with a Bachelor’s Degree in Physical Therapy. His clinical career has focused on orthopedic manual physical therapy. His post-graduate orthopedic manual physical therapy training includes five years of Residency, Fellowship, and Ph.D. training, all through the Ola Grimsby Institute.
As his career has evolved, he has developed a passion for treating the TMJ patient. Millions of Americans suffer from TMJ pain that affects their lives on a daily basis. He strongly feels this undertreated region deserves the same respect as a beloved knee or shoulder patient.
Dr. Gorman previously owned a private practice PT company in St. Louis, MO, before selling to a national rehab provider in 2017. In 2020 he started iMove PT, a mobile physical therapy practice. He loved the mobile model so much that in 2022 he began to franchise the iMove PT brand. Currently, there are 3 iMove PT franchisees located in Kansas City, MO, Joplin, MO, and Tulsa, Oklahoma. His goal is to give PTs with an entrepreneurial spirit the ability to have their own business with the support of a proven mobile PT brand.
For over 12 years, Dr. Gorman has been very involved with the American Physical Therapy Association Missouri Chapter, currently nearing the end of 6 years as Vice President of the Missouri Chapter. He is very involved with state legislation to protect and advance the practice of physical therapy in Missouri. In addition, he has had a PT expert witness practice for the last eight years. He is a true entrepreneur and looks to expand the field of physical therapy at every opportunity.
Last but not least, Dr. Gorman and his amazing wife Sharon have four kids, aged 13 to 30 years old. During his free time, Dr. Gorman enjoys spending time with his family, golfing, and giving special TLC to his dogs, Cooper and Daisy. He is always looking for a good adventure and a great podcast!
Resources from this Episode:
Website
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcast
Spotify
SoundCloud
Stitcher
iHeart Radio
In this episode, I am joined by Dr. Michael Gorman, Ph.D., PT, DMT, FAAOMPT owner of iMove PT, to discuss the evaluation and treatment of TMJ disorders. Michael shares his journey into this sub-specialty and his interest in TMJ treatment. He explains what TMJ is and how physical therapists can help those who suffer from TMJ dysfunction. Michael also describes his experiences treating patients with TMJ, the challenges he has faced, and the successes he has achieved. Overall, this episode provides valuable information for those seeking treatment for TMJ dysfunction or those interested in learning more about the condition.
Show notes:
[00:00:22] TMJ Dysfunction Treatment Journey.
[00:04:08] Treating TMJ Pain.
[00:09:24] Objective signs of TMJ dysfunction.
[00:12:18] Assessing jaw strength and asymmetry.
[00:19:29] TMJ treatment exercises.
[00:20:27] Creative TMJ exercises.
[00:24:46] Marketing a subspecialty.
[00:28:24] Treating TMJ patients.
[00:32:27] Physical therapy and chiropractic misconceptions.
[00:36:28] TMJ pain solutions.
More About Dr. Gorman:
Dr. Gorman graduated from the University of Missouri-Columbia in 1993 with a Bachelor’s Degree in Physical Therapy. His clinical career has focused on orthopedic manual physical therapy. His post-graduate orthopedic manual physical therapy training includes five years of Residency, Fellowship, and Ph.D. training, all through the Ola Grimsby Institute.
As his career has evolved, he has developed a passion for treating the TMJ patient. Millions of Americans suffer from TMJ pain that affects their lives on a daily basis. He strongly feels this undertreated region deserves the same respect as a beloved knee or shoulder patient.
Dr. Gorman previously owned a private practice PT company in St. Louis, MO, before selling to a national rehab provider in 2017. In 2020 he started iMove PT, a mobile physical therapy practice. He loved the mobile model so much that in 2022 he began to franchise the iMove PT brand. Currently, there are 3 iMove PT franchisees located in Kansas City, MO, Joplin, MO, and Tulsa, Oklahoma. His goal is to give PTs with an entrepreneurial spirit the ability to have their own business with the support of a proven mobile PT brand.
For over 12 years, Dr. Gorman has been very involved with the American Physical Therapy Association Missouri Chapter, currently nearing the end of 6 years as Vice President of the Missouri Chapter. He is very involved with state legislation to protect and advance the practice of physical therapy in Missouri. In addition, he has had a PT expert witness practice for the last eight years. He is a true entrepreneur and looks to expand the field of physical therapy at every opportunity.
Last but not least, Dr. Gorman and his amazing wife Sharon have four kids, aged 13 to 30 years old. During his free time, Dr. Gorman enjoys spending time with his family, golfing, and giving special TLC to his dogs, Cooper and Daisy. He is always looking for a good adventure and a great podcast!
Resources from this Episode:
Website
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcast
Spotify
SoundCloud
Stitcher
iHeart Radio
The post 629: Dr. Michael Gorman: How Treating TMJ can Transform your Patients and Your Practice appeared first on Healthy Wealthy & Smart.
In this episode, I am joined by Dr. Jay Shah, the Chief Medical Officer of Aktiia, SA. and a non-traditional cardiologist who discusses his journey from a full-time practicing clinician to a full-time non-clinical clinician. Dr. Shah explains how every step on his training and practice journey was crucial in making the turn towards a non-clinical profession possible. He shares his experience of growing up wanting to be a doctor, going to medical school, and then to a residency at Massachusetts General Hospital as a senior resident, then to private practice and the Mayo Clinic. Listeners will gain insights into the importance of every step and experience in their career journey. He also discusses the importance of monitoring, interpreting, and treating your blood pressure.
Show notes:
[00:02:55] Running a medical practice.
[00:06:43] Non-traditional pathways for physicians.
[00:07:42] Clinical perspective in healthcare.
[00:12:12] Physician Burnout and Time.
[00:16:40] Monitoring blood pressure.
[00:20:20] Blood Pressure Over Time.
[00:24:12] Blood pressure measurement accuracy.
[00:29:24] Wearable blood pressure measurement.
[00:31:53] Personalizing patient care. [
00:35:43] Transforming healthcare through technology.
[00:40:00] Taking Risks in Career.
More About Dr. Shah:
Dr. Jay Shah has 15+ years of medical expertise and 11+ years of leadership in the medical practices at city general hospitals, to community settings, to the Mayo Clinic. He has brought his experience and expertise to the Swiss startup Aktiia, to change the paradigm of how the world’s most common disease – hypertension – is understood and managed. Also an angel investor and advisor, he is passionate about applying technology to solve practical problems in medicine and believes strongly in the power of positive thinking and collaboration.
Resources from this Episode:
Website
Aktiia on Instagram
Aktiia on Facebook
Aktiia on Twitter
Aktiia on YouTube
Aktiia on LinkedIn
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcast
Spotify
SoundCloud
Stitcher
iHeart Radio
In this episode, I am joined by Dr. Jay Shah, the Chief Medical Officer of Aktiia, SA, and a non-traditional cardiologist who discusses his journey from a full-time practicing clinician to a full-time non-clinical clinician. Dr. Shah explains how every step on his training and practice journey was crucial in making the turn towards a non-clinical profession possible. He shares his experience of growing up wanting to be a doctor, going to medical school, and then to a residency at Massachusetts General Hospital as a senior resident, then to private practice and the Mayo Clinic. Listeners will gain insights into the importance of every step and experience in their career journey. He also discusses the importance of monitoring, interpreting, and treating your blood pressure.
Show notes:
[00:02:55] Running a medical practice.
[00:06:43] Non-traditional pathways for physicians.
[00:07:42] Clinical perspective in healthcare.
[00:12:12] Physician Burnout and Time.
[00:16:40] Monitoring blood pressure.
[00:20:20] Blood Pressure Over Time.
[00:24:12] Blood pressure measurement accuracy.
[00:29:24] Wearable blood pressure measurement.
[00:31:53] Personalizing patient care. [
00:35:43] Transforming healthcare through technology.
[00:40:00] Taking Risks in Career.
More About Dr. Shah:
Dr. Jay Shah has 15+ years of medical expertise and 11+ years of leadership in the medical practices at city general hospitals, to community settings, to the Mayo Clinic. He has brought his experience and expertise to the Swiss startup Aktiia, to change the paradigm of how the world’s most common disease – hypertension – is understood and managed. Also an angel investor and advisor, he is passionate about applying technology to solve practical problems in medicine and believes strongly in the power of positive thinking and collaboration.
Resources from this Episode:
Website
Aktiia on Instagram
Aktiia on Facebook
Aktiia on Twitter
Aktiia on YouTube
Aktiia on LinkedIn
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcast
Spotify
SoundCloud
Stitcher
iHeart Radio
The post 638: Dr. Jay Shah: How to Make the Transition from Clinical to Non-Clinical Medicine appeared first on Healthy Wealthy & Smart.
In this episode, Dr. Karen interviews lawyer and owner of the law firm Conscious Counsel Corey Sterling about how he landed as a lawyer in the healthcare and fitness space. Corey shares his journey of creating a career for himself that merges his love for law with his passion for health and wellness. He discusses finding creative solutions for people in the health and wellness industry and how he started a yoga festival while also teaching group fitness at Equinox. Corey also talks about his challenges as an entrepreneur and how he navigated his first year of starting his business.
Show notes:
[00:01:03] Creating a niche law practice.
[00:04:18] Duty of care and liability.
[00:07:34] Your legal position.
[00:10:24] Legal protection for the business.
[00:14:43] Employee vs contractor classification.
[00:18:57] Pure contractors vs. employees.
[00:20:56] Contractors and employment law.
[00:25:03] Misclassifying contractors as employees.
[00:28:23] Non-compete agreements.
[00:32:02] Waivers and Standard of Care.
[00:35:24] Enjoying the journey as an entrepreneur.
[00:38:51] Cats on YouTube.
More About Corey:
Cory Sterling is an attorney and Founder of Conscious Counsel, a health and fitness law firm, which won the Legal Elite 2021 Award for Most Innovative Fitness and Wellness Law Firm, and Most Innovative Legal Document Drafting and IP Firm.
The legal concerns for any business are never-ending. For fitness entrepreneurs, the list of considerations can be even more daunting, from employee contract disputes to injury lawsuits from clients, there's a lot that can go wrong.
Cory is the go-to person for business owners in the health and fitness industry who need help navigating this legal minefield and avoiding getting sued.
He has nearly ten years of experience in the legal and fitness industries and has assisted hundreds of entrepreneurs in drafting service agreements, privacy policies, independent contractor agreements, terms and conditions, disclaimers, and other important legal protections they require.
Cory is also a group fitness instructor, yoga teacher, and author of The Yoga Law Book, which outlines business law basics for yoga professionals and business owners.
Resources from this Episode:
Website
Corey’s Facebook Page
Corey’s Instagram
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcast
Spotify
SoundCloud
Stitcher
iHeart Radio
In this episode, I am joined by Dr. Chris Damman, Chief Medical & Scientific officer at UR Labs, and Marc Washington the Founder & CEO of Supergut. We discuss gut health and why it's essential for overall health. They explain that the gut is not just about digestion but a portal to whole health. They also discuss how what we eat and breathe can affect our gut and body health. The episode highlights the importance of understanding gut health and how healthcare professionals should incorporate this information into patient care.
Show notes:
[00:01:01] Gut health and whole health.
[00:04:34] Gut health and total health.
[00:07:45] The gut and immune system.
[00:12:23] Gut health and nutrition decisions.
[00:15:11] Four F's of Longevity.
[00:19:03] Probiotics and Gut Health.
[00:24:51] Different types of fiber.
[00:28:00] Blood sugar spikes and fiber.
[00:31:11] Chronic conditions and mind-body connection.
[00:36:10] Double burden of disease.
[00:40:23] Gut health and interconnectedness.
[00:43:46] Following your passions.
More About Dr. Damman:
Chris Damman is Chief Medical & Scientific officer at UR Labs. Prior to joining UR Labs, he was Initiative Lead of Gut Health in the Enteric and Diarrheal Diseases team at the Bill & Melinda Gates Foundation. He holds an M.D. from Columbia University and an M.A. in Molecular Biology & Biochemistry from Wesleyan University. He moved west to complete his residency in internal medicine and fellowship in gastroenterology at the University of Washington. Chris continued on at the University of Washington with a joint appointment in the Division of Gastroenterology and The Fred Hutchinson Cancer Research Center. He maintains an academic appointment with the University of Washington with research interests focused on investigating the role of diet and microbiome-directed therapies as treatments for inflammatory bowel disease. Past research activities have included early drug discovery work at Pfizer’s Discovery Technology Center in Cambridge, MA and epidemiological surveillance work characterizing Plasmodium drug resistance genes at the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand.
Outside of work, Dr. Damman likes to spend his time running, cooking, eating, and spending time with his wife and three daughters.
More About Marc:
Marc Washington is the Founder & CEO of Supergut. His background spans a wide variety of consumer health businesses, including serving as the CEO of Irwin Naturals, a $100M+ supplements company and leading producer of soft-gel herbal formulas sold in over 90,000 retail outlets; President & COO of Beachbody, a $1B+ nutrition and fitness company with products including Shakeology health shakes, P90X, and the Beachbody-on-Demand digital platform; and working 9 years at The Wonderful Co, a $4B agriculture and food & beverage holding company, where he served in a variety of roles including CFO (corporate), EVP Sales (Teleflora), and Direct of Strategy & Operations (FIJI Water). Marc’s deep experience in the wellness industry inspired him to found Supergut to help people regain control of their health by harnessing the powerful science of the gut biome. Marc holds an M.B.A. from Harvard Business School and B.S. from Princeton University.
Marc’s areas of expertise: Entrepreneurship, Health & Wellness, Gut Health, Metabolic Health, Nutrition, Prebiotic Fiber & Resistant Starch, Food As Medicine, Nutrition & Public Health, Multicultural Health Disparities, Diversity & Inclusion
Resources from this Episode:
Website
Our recently peer-reviewed and published clinical study
SuperGut on Instagram
SuperGut on TikTok
SuperGut on Twitter
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
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Website
Apple Podcast
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In this episode, I am joined by Dr. Chris Damman, Chief Medical & Scientific officer at UR Labs, and Marc Washington the Founder & CEO of Supergut. We discuss gut health and why it’s essential for overall health. They explain that the gut is not just about digestion but a portal to whole health. They also discuss how what we eat and breathe can affect our gut and body health. The episode highlights the importance of understanding gut health and how healthcare professionals should incorporate this information into patient care.
Show notes:
[00:01:01] Gut health and whole health.
[00:04:34] Gut health and total health.
[00:07:45] The gut and immune system.
[00:12:23] Gut health and nutrition decisions.
[00:15:11] Four F’s of Longevity.
[00:19:03] Probiotics and Gut Health.
[00:24:51] Different types of fiber.
[00:28:00] Blood sugar spikes and fiber.
[00:31:11] Chronic conditions and mind-body connection.
[00:36:10] Double burden of disease.
[00:40:23] Gut health and interconnectedness.
[00:43:46] Following your passions.
More About Dr. Damman:
Chris Damman is Chief Medical & Scientific officer at UR Labs. Prior to joining UR Labs, he was Initiative Lead of Gut Health in the Enteric and Diarrheal Diseases team at the Bill & Melinda Gates Foundation. He holds an M.D. from Columbia University and an M.A. in Molecular Biology & Biochemistry from Wesleyan University. He moved west to complete his residency in internal medicine and fellowship in gastroenterology at the University of Washington. Chris continued on at the University of Washington with a joint appointment in the Division of Gastroenterology and The Fred Hutchinson Cancer Research Center. He maintains an academic appointment with the University of Washington with research interests focused on investigating the role of diet and microbiome-directed therapies as treatments for inflammatory bowel disease. Past research activities have included early drug discovery work at Pfizer’s Discovery Technology Center in Cambridge, MA and epidemiological surveillance work characterizing Plasmodium drug resistance genes at the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand.
Outside of work, Dr. Damman likes to spend his time running, cooking, eating, and spending time with his wife and three daughters.
More About Marc:
Marc Washington is the Founder & CEO of Supergut. His background spans a wide variety of consumer health businesses, including serving as the CEO of Irwin Naturals, a $100M+ supplements company and leading producer of soft-gel herbal formulas sold in over 90,000 retail outlets; President & COO of Beachbody, a $1B+ nutrition and fitness company with products including Shakeology health shakes, P90X, and the Beachbody-on-Demand digital platform; and working 9 years at The Wonderful Co, a $4B agriculture and food & beverage holding company, where he served in a variety of roles including CFO (corporate), EVP Sales (Teleflora), and Direct of Strategy & Operations (FIJI Water). Marc’s deep experience in the wellness industry inspired him to found Supergut to help people regain control of their health by harnessing the powerful science of the gut biome. Marc holds an M.B.A. from Harvard Business School and B.S. from Princeton University.
Marc’s areas of expertise: Entrepreneurship, Health & Wellness, Gut Health, Metabolic Health, Nutrition, Prebiotic Fiber & Resistant Starch, Food As Medicine, Nutrition & Public Health, Multicultural Health Disparities, Diversity & Inclusion
Resources from this Episode:
Website
Our recently peer-reviewed and published clinical study
SuperGut on Instagram
SuperGut on TikTok
SuperGut on Twitter
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcast
Spotify
SoundCloud
Stitcher
iHeart Radio
The post 626: Dr. Chris Damman & Marc Washington: What People Misunderstand About Gut Health appeared first on Healthy Wealthy & Smart.
In this episode, I am joined by Dr. Rebekah Griffith, PT, DPT, NCS, FiT, physical therapist, to discuss physical therapy in the emergency department. She explains the origins of this work, as well as what PTs do in the emergency department. Rebekah also provides advice on navigating the process of becoming part of the emergency department in a hospital, emphasizing the importance of understanding the hospital's mission and how physical therapy plays into that mission.
Show notes:
00:03:09 Find the pain points, fix them.
00:06:35 Access to PT should not be a luxury.
00:09:29 Provide patient-centered care.
00:17:30 Physical therapy can triage patients.
00:22:48 Preventative care is essential.
00:23:05 Collaborative care improves health.
00:30:33 Trust yourself and pivot.
More About Rebekah:
Dr. Rebekah Griffith, The ED DPT, specializes in care in the Emergency Department. Dr. Griffith believes physical therapist practice in the Emergency Department is a critical way to move upstream in healthcare that supports patients during their most critical moments. Dr. Griffith has been an invited lecturer, regular presenter, podcast guest, & article contributor on this topic. Additionally, she was instrumental in passing two motions within the APTA House of Delegates in support of Emergency Physical Therapist practice and is a founding member of the Emergency PT Steering Committee within the Academy of Acute Care. The ED DPT will prepare you to successfully practice in the Emergency Department so that patients have access to the right provider at a critical moment in their healthcare journey.
Resources from this Episode:
Website
Rebekah’s Twitter
ED DPT Twitter
Top of Scope: The Emergency Department Physical Therapist Practice Handbook
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcast
Spotify
SoundCloud
Stitcher
iHeart Radio
In this episode, I am joined by Dr. Rebekah Griffith, PT, DPT, NCS, FiT, physical therapist, to discuss physical therapy in the emergency department. She explains the origins of this work, as well as what PTs do in the emergency department. Rebekah also provides advice on navigating the process of becoming part of the emergency department in a hospital, emphasizing the importance of understanding the hospital’s mission and how physical therapy plays into that mission.
Show notes:
00:03:09 Find the pain points, fix them.
00:06:35 Access to PT should not be a luxury.
00:09:29 Provide patient-centered care.
00:17:30 Physical therapy can triage patients.
00:22:48 Preventative care is essential.
00:23:05 Collaborative care improves health.
00:30:33 Trust yourself and pivot.
More About Rebekah:
Dr. Rebekah Griffith, The ED DPT, specializes in care in the Emergency Department. Dr. Griffith believes physical therapist practice in the Emergency Department is a critical way to move upstream in healthcare that supports patients during their most critical moments. Dr. Griffith has been an invited lecturer, regular presenter, podcast guest, & article contributor on this topic. Additionally, she was instrumental in passing two motions within the APTA House of Delegates in support of Emergency Physical Therapist practice and is a founding member of the Emergency PT Steering Committee within the Academy of Acute Care. The ED DPT will prepare you to successfully practice in the Emergency Department so that patients have access to the right provider at a critical moment in their healthcare journey.
Resources from this Episode:
Website
Rebekah’s Twitter
ED DPT Twitter
Top of Scope: The Emergency Department Physical Therapist Practice Handbook
Follow Dr. Karen Litzy on Social Media:
Karen’s Twitter
Karen’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcast
Spotify
SoundCloud
Stitcher
iHeart Radio
The post 625: Dr. Rebekah Griffith: Harnessing the Power of Physical Therapy in the Emergency Department appeared first on Healthy Wealthy & Smart.
In this episode, I am joined by Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD, to discuss diagnosing and rehabilitating gluteal tendinopathy.
Show notes:
00:01:06 Painful gluteal tendons.
00:06:11 Recognize gluteal tendinopathy.
00:15:50 Load gluteal tendons actively.
00:21:03 Education and exercise first.
00:28:43 Reduce provocative positions.
00:34:44 Improve patient-specific function.
00:35:07 Listen and tailor the program.
00:45:17 Insurance limits treatment options. 00:50:01 Invest in continuing education.
More About Alison:
Dr. Grimaldi is an Australian Sports Physiotherapist and the practice principal of PhysioTec Physiotherapy in Brisbane, Australia, with over 30 years of clinical experience and a special interest in the management of hip, groin and pelvic pain. She has a Bachelor of Physiotherapy, Masters of Sports Physiotherapy and a PhD through the University of Queensland, Australia. Alison was a key investigator on the multicentre LEAP randomized clinical trial comparing the effects of treatment for gluteal tendinopathy. She has had involvement in research for over 20 years and continues her research interests as an Adjunct Senior Research Fellow at the University of Queensland, and in collaborative international research. She has contributed to three leading clinical texts, conducted over 100 clinical workshops worldwide and presented over 50 keynotes, invited or podium conference presentations. Alison also runs a Hip Academy with online learning and live mentoring at www.dralisongrimaldi.com.
Resources from this Episode:
15% discount on Hip Academy joining fee for Healthy, Wealthy & Smart podcast listeners : Use coupon code: HWS2023
Website
Alison’s Twitter
Alison’s Instagram
Alison’s Facebook
Alison’s LinkedIn
Dr Alison Grimaldi's Hip Academy
May 13-14 New York Hip Workshop Registrations
Key Papers: Wilson R, Abbott JH, Mellor R, Grimaldi A, Bennell K, Vicenzino B. Education plus exercise for persistent gluteal tendinopathy improves quality of life and is cost-effective compared with corticosteroid injection and wait and see: economic evaluation of a randomised trial. J Physiother. 2023 Jan;69(1):35-41. doi: 10.1016/j.jphys.2022.11.007. Epub 2022 Dec 14. PMID: 36526564. Link: https://www.sciencedirect.com/science/article/pii/S183695532200114X?
Mellor R, Kasza J, Grimaldi A, Hodges P, Bennell K, Vicenzino B. Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. J Orthop Sports Phys Ther. 2022 Dec;52(12):826-836. doi: 10.2519/jospt.2022.11261. Epub 2022 Oct 28. PMID: 36306175. Link: https://www.jospt.org/doi/10.2519/jospt.2022.11261?
Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018 May 2;361:k1662. doi: 10.1136/bmj.k1662. PMID: 29720374; PMCID: PMC5930290. Link: https://www.bmj.com/content/361/bmj.k1662.long
Subscribe to Healthy, Wealthy & Smart:
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In this episode, I am joined by Taylor Elyse Morrison, a self-care and personal development expert and founder of Inner Workout. She shared her journey as a workaholic and how she had to build self-care skills to not get burned out. Taylor believes the impetus for her journey came from within but noted that both nature and nurture played a role in her ambition and how society's expectations of her were extra pressures.
Show notes:
00:02:25 Practice self-care and balance.
00:07:16 Listen and respond lovingly.
00:12:05 Flexible structure for success.
00:17:41 Set clear goals and accountability.
00:23:34 Connect with others for support.
00:29:05 Slow down and enjoy life.
More About Taylor:
Taylor Elyse Morrison turned being bad at self-care—and being firmly convinced of every human’s potential—into a career. She’s the founder of media company Inner Workout, and the author of a book by the same name. Recently named one of Fortune’s 10 Innovators Shaping the Future of Health, Taylor is tired of aspirational 'wellness as usual.' Instead, she builds businesses, content, and experiences that make well-being and personal development more accessible. You're just as likely to see Taylor facilitating a workshop at a Fortune 100 as you are to see her talking about TikTok and body image with a high school class. Wherever she goes, Taylor's sure to use her coaching, mindfulness, and movement training to meet people where they're at and offer actionable steps towards creating a world without burnout.
Resources from this Episode:
Website
Inner Workout Instagram
Taylor’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcasts
Spotify
SoundCloud
Stitcher
iHeart Radio
In this episode, I am joined by Taylor Elyse Morrison, a self-care and personal development expert and founder of Inner Workout. She shared her journey as a workaholic and how she had to build self-care skills to not get burned out. Taylor believes the impetus for her journey came from within but noted that both nature and nurture played a role in her ambition and how society’s expectations of her were extra pressures.
Show notes:
00:02:25 Practice self-care and balance.
00:07:16 Listen and respond lovingly.
00:12:05 Flexible structure for success.
00:17:41 Set clear goals and accountability.
00:23:34 Connect with others for support.
00:29:05 Slow down and enjoy life.
More About Taylor:
Taylor Elyse Morrison turned being bad at self-care—and being firmly convinced of every human’s potential—into a career. She’s the founder of media company Inner Workout, and the author of a book by the same name. Recently named one of Fortune’s 10 Innovators Shaping the Future of Health, Taylor is tired of aspirational ‘wellness as usual.’ Instead, she builds businesses, content, and experiences that make well-being and personal development more accessible. You’re just as likely to see Taylor facilitating a workshop at a Fortune 100 as you are to see her talking about TikTok and body image with a high school class. Wherever she goes, Taylor’s sure to use her coaching, mindfulness, and movement training to meet people where they’re at and offer actionable steps towards creating a world without burnout.
Resources from this Episode:
Website
Inner Workout Instagram
Taylor’s Instagram
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcasts
Spotify
SoundCloud
Stitcher
iHeart Radio
The post 623: Taylor Elyse Morrison: Harnessing the True Meaning of Self-Care appeared first on Healthy Wealthy & Smart.
In this episode, I am joined by Dr. Madison Oak, PT, DPT, to discuss vestibular rehabilitation therapy (VRT) - a form of rehabilitation designed to help people with vestibular disorders regain their balance and alleviate dizziness. She explained how the inner ear works, what can go wrong, and the most common diagnoses associated with vestibular disorders.
Show notes:
00:01:51 Vestibular rehabilitation therapy helps.
00:09:00 Migraine is a neurological disease.
00:11:05 Get medical advice for symptoms.
00:18:41 Ask for detailed descriptions.
00:20:04 Treat dizziness holistically.
00:27:51 Treat vestibular migraine with lifestyle.
00:29:15 Lifestyle changes can help.
00:35:28 Team sport: vestibular rehab.
00:40:30 Work for yourself and have fun.
More About Madison:
Dr. Madison Oak is a physical therapist who specializes in treatment of Vestibular Migraine, Persistent Postural Perceptual Dizziness, and other vestibular disorders. Madison is the founder of Vestibular Group Fit, @thevertigodoctor, and Oak Physical Therapy & Wellness PC. Madison strives to provide excellent, educational, vestibular resources that are thorough, helpful, and actually make sense to people who have vestibular disorders.
Migraine, headaches, dizziness, and more affect SO many people in the US and the world. When she isn't talking about the vestibular system, you can find Madison out skiing in Jackson Hole, baking chocolate chip banana bread, and hanging out with her dog, Hugo.
Resources from this Episode:
Madison’s Website
Dr. Karen Litzy’s Social Media:
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcasts
Spotify
SoundCloud
Stitcher
iHeart Radio
In this episode, I am joined by Dr. Madison Oak, PT, DPT, to discuss vestibular rehabilitation therapy (VRT) – a form of rehabilitation designed to help people with vestibular disorders regain their balance and alleviate dizziness. She explained how the inner ear works, what can go wrong, and the most common diagnoses associated with vestibular disorders.
Show notes:
00:01:51 Vestibular rehabilitation therapy helps.
00:09:00 Migraine is a neurological disease.
00:11:05 Get medical advice for symptoms.
00:18:41 Ask for detailed descriptions.
00:20:04 Treat dizziness holistically.
00:27:51 Treat vestibular migraine with lifestyle.
00:29:15 Lifestyle changes can help.
00:35:28 Team sport: vestibular rehab.
00:40:30 Work for yourself and have fun.
More About Madison:
Dr. Madison Oak is a physical therapist who specializes in treatment of Vestibular Migraine, Persistent Postural Perceptual Dizziness, and other vestibular disorders. Madison is the founder of Vestibular Group Fit, @thevertigodoctor, and Oak Physical Therapy & Wellness PC. Madison strives to provide excellent, educational, vestibular resources that are thorough, helpful, and actually make sense to people who have vestibular disorders.
Migraine, headaches, dizziness, and more affect SO many people in the US and the world. When she isn’t talking about the vestibular system, you can find Madison out skiing in Jackson Hole, baking chocolate chip banana bread, and hanging out with her dog, Hugo.
Resources from this Episode:
Madison’s Website
Dr. Karen Litzy’s Social Media:
Subscribe to Healthy, Wealthy & Smart:
YouTube
Website
Apple Podcasts
Spotify
SoundCloud
Stitcher
iHeart Radio
The post 622: Dr. Madison Oak: A New Approach to Chronic Dizziness Management appeared first on Healthy Wealthy & Smart.
In this episode, I am joined by Emma Jack, physiotherapist and coach, to discuss her journey from burnout to breakthrough. Emma was overwhelmed and unsatisfied with her career path until a panic attack in 2016 led her to reflect and make a change. Emma decided to take a step back and focus on herself to build a more sustainable, fulfilling career. This is her story and her advice for other healthcare practitioners.
Show notes:
00:05:17 Check in with yourself.
00:12:17 Fill yourself up first, serve others.
00:17:05 Take time for yourself.
00:26:28 Our worth is not outcomes.
00:30:49 Take care of yourself.
00:40:22 Lean into your true self.
00:40:40 Stay curious and evolve.
More About Emma:
Emma is a sport and orthopedic physiotherapist and owns her own practice Press Play Physiotherapy and Pilates in London, Ontario, Canada. She holds a Masters of Physiotherapy as well as a Masters of Clinical Science, has her Sport Physiotherapy Diploma, is a Fellow of the Academy of Manual and Manipulative Physical Therapy and is a lead therapist with the Canadian National Women’s Hockey Team.
Sounds pretty cool, right? While those accomplishments and credentials do bring a sense of pride, Emma also recognizes that many of those things are ultimately what left her feeling intense anxiety, chronic stress, overwhelm and burnt out. Her credentials may span two lines on a business card, but in recent years Emma has totally transformed her practice and life in order to ensure that her accomplishments no longer define her. Now, much of her time is spent working as a Co-Active coach helping other clinicians show up fully for their lives and careers in a way that feels authentic, sustainable and most importantly, fun!
Resources from this Episode:
Emma’s Resources
Website
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
In this episode, I am joined by Emma Jack, physiotherapist and coach, to discuss her journey from burnout to breakthrough. Emma was overwhelmed and unsatisfied with her career path until a panic attack in 2016 led her to reflect and make a change. Emma decided to take a step back and focus on herself to build a more sustainable, fulfilling career. This is her story and her advice for other healthcare practitioners.
Show notes:
00:05:17 Check in with yourself.
00:12:17 Fill yourself up first, serve others.
00:17:05 Take time for yourself.
00:26:28 Our worth is not outcomes.
00:30:49 Take care of yourself.
00:40:22 Lean into your true self.
00:40:40 Stay curious and evolve.
More About Emma:
Emma is a sport and orthopedic physiotherapist and owns her own practice Press Play Physiotherapy and Pilates in London, Ontario, Canada. She holds a Masters of Physiotherapy as well as a Masters of Clinical Science, has her Sport Physiotherapy Diploma, is a Fellow of the Academy of Manual and Manipulative Physical Therapy and is a lead therapist with the Canadian National Women’s Hockey Team.
Sounds pretty cool, right? While those accomplishments and credentials do bring a sense of pride, Emma also recognizes that many of those things are ultimately what left her feeling intense anxiety, chronic stress, overwhelm and burnt out. Her credentials may span two lines on a business card, but in recent years Emma has totally transformed her practice and life in order to ensure that her accomplishments no longer define her. Now, much of her time is spent working as a Co-Active coach helping other clinicians show up fully for their lives and careers in a way that feels authentic, sustainable and most importantly, fun!
Resources from this Episode:
Emma’s Resources
Website
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
The post 621: Emma Jack: From Burnout to Breakthrough appeared first on Healthy Wealthy & Smart.
In this episode, I am joined by Dr. Abby Gordon, PT, DPT, SCS, CSCS, to discuss treating and managing chronic pain in adolescents. We discuss chronic teenage pain and how it’s often not given the attention it deserves. Dr. Gordon, who works at Seattle Children's Hospital, explains the types of symptoms, diagnoses, and treatments typically found in teenagers suffering from chronic pain. She speaks about the interdisciplinary team that examines and plans treatments for each patient and the importance of providing peace of mind to families. Finally, Dr. Gordon shares her advice on communicating with families of teenagers. Show notes: 00:01:06 Treat pain holistically. 00:11:56 Take breaks from activities. 00:12:07 Teach kids to advocate for themselves. 00:20:02 Nutrition is essential for healing. 00:29:36 Mental and physical health connected. 00:30:22 Pain is physical and emotional. 00:39:10 Believe and listen to kids. More about Dr. Gordon: Abby Gordon is a Sports Physical Therapist at Seattle Children’s Hospital and has served as the Team Physical Therapist for the Seattle Storm for the past eight seasons. She owns a mobile PT practice primarily working with women with chronic pain and body dysmorphia, body dysphoria, and/or disordered eating. She is an APTA Washington Delegate and helped develop her first legislative motion, RC 16-22, the APTA’s Position Statement for Inclusion of the LGBTQIA+ community, which the House of Delegates passed last summer. Her blog, “Abby’s World,” is where you can find physical therapy- and women’s basketball-related thoughts. Resources from this Episode: Dr. Gordon's Blog Dr. Gordon's Twitter Dr. Gordon's Instagram Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
In this episode, I am joined by Dr. Ginger Garner and Dr. Joe Tatta to discuss Integrative & Lifestyle Medicine in Physical Therapy. They are the co-editors of the book of the same name. They explain what integrative and lifestyle medicine encompasses and that physical therapists are uniquely positioned to implement integrative and lifestyle medicine effectively.
Show notes:
00:05:30 Practice intentional health promotion.
00:07:05 Integrate lifestyle into care.
00:19:57 Engage in healthy movement.
00:20:11 Empower patients to choose.
00:30:39 Model healthy lifestyle behaviors.
00:38:36 Behavior change is empowering.
00:40:00 Integrative medicine heals holistically.
00:53:15 Trust your instincts and succeed.
00:54:13 Cultivate diverse skills.
More about Dr. Ginger and Dr. Joe:
Dr. Ginger Garner PT, DPT, ATC/L is a therapist, author, educator, and advocate for improving access and equity to pelvic health physical therapy services. She is the founder and CEO of Living Well Institute, which certifies healthcare providers in Functional; Integrative Lifestyle Medicine and also offers wellness classes to the public on the same topics. She is also the creator of the Medical Therapeutic Yoga; Professional Yoga Therapist Certification, the only certification of its kind worldwide for medical professionals. Dr. Garner practices at Garner Pelvic Health, which she founded to offer integrative telehealth and in-person pelvic and orthopaedic care. Ginger is the author of multiple books and book chapters published in several languages. She has presented internationally at over 20 conferences, teaching on a range of topics about pelvic and orthopaedic health. Ginger is an active member of APTA, APTA North Carolina, APTA Private Practice, and Academy of Pelvic Health. She lives in Greensboro, NC with her family. Visit Ginger at www.integrativelifestylemed.com and on Instagram and YouTube.
Dr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development. For 25 years he has supported people living with pain and helped practitioners deliver more effective pain management. His research and career achievements include scalable practice models centered on lifestyle medicine, health behavior change, and digital therapeutics. He is a Doctor of Physical Therapy, a Board-Certified Nutrition Specialist, and Acceptance and Commitment Therapy trainer. Dr. Tatta is the author of two bestselling books Radical Relief and Heal Your Pain Now and host of The Healing Pain Podcast.
Resources from this Episode:
Dr. Ginger's website
Dr. Joe's website
Buy Integrative & Lifestyle Medicine in Physical Therapy
Free Therapeutic Yoga Video Library
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
In this episode, I am joined by Dr. Ginger Garner and Dr. Joe Tatta to discuss Integrative & Lifestyle Medicine in Physical Therapy. They are the co-editors of the book of the same name. They explain what integrative and lifestyle medicine encompasses and that physical therapists are uniquely positioned to implement integrative and lifestyle medicine effectively.
Show notes:
00:05:30 Practice intentional health promotion.
00:07:05 Integrate lifestyle into care.
00:19:57 Engage in healthy movement.
00:20:11 Empower patients to choose.
00:30:39 Model healthy lifestyle behaviors.
00:38:36 Behavior change is empowering.
00:40:00 Integrative medicine heals holistically.
00:53:15 Trust your instincts and succeed.
00:54:13 Cultivate diverse skills.
More about Dr. Ginger and Dr. Joe:
Dr. Ginger Garner PT, DPT, ATC/L is a therapist, author, educator, and advocate for improving
access and equity to pelvic health physical therapy services. She is the founder and CEO
of Living Well Institute, which certifies healthcare providers in Functional; Integrative Lifestyle
Medicine and also offers wellness classes to the public on the same topics. She is also the
creator of the Medical Therapeutic Yoga; Professional Yoga Therapist Certification, the only
certification of its kind worldwide for medical professionals.
Dr. Garner practices at Garner Pelvic Health, which she founded to offer integrative telehealth
and in-person pelvic and orthopaedic care. Ginger is the author of multiple books and book
chapters published in several languages. She has presented internationally at over 20
conferences, teaching on a range of topics about pelvic and orthopaedic health.
Ginger is an active member of APTA, APTA North Carolina, APTA Private Practice, and
Academy of Pelvic Health. She lives in Greensboro, NC with her family.
Visit Ginger at www.integrativelifestylemed.com and on Instagram and YouTube.
Dr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development. For 25 years he has supported people living with pain and helped practitioners deliver more effective pain management. His research and career achievements include scalable practice models centered on lifestyle medicine, health behavior change, and digital therapeutics. He is a Doctor of Physical Therapy, a Board-Certified Nutrition Specialist, and Acceptance and Commitment Therapy trainer. Dr. Tatta is the author of two bestselling books Radical Relief and Heal Your Pain Now and host of The Healing Pain Podcast.
Resources from this Episode:
Dr. Ginger’s website
Dr. Joe’s website
Buy Integrative & Lifestyle Medicine in Physical Therapy
Free Therapeutic Yoga Video Library
Subscribe to Healthy, Wealthy & Smart:
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The post 619: Dr. Ginger Garner & Dr. Joe Tatta: Integrative & Lifestyle Medicine in Physical Therapy appeared first on Healthy Wealthy & Smart.
In this episode, Founder of Hearth Healing, Laura Williams, talks about postpartum care after leaving the hospital.
Today, Laura talks about the harms of finding generalized information online, setting postpartum expectations, and optimizing care to the mother and the baby. What is the difference between common and normal occurrences in the postpartum period?
Hear about virtual postpartum healing, the outcomes of Laura’s virtual consulting, and get Laura’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “There isn’t a one-size-fits-all approach to recovery, and we need individualized information.”
- “The key that unlocks that resilience is knowledge.”
- “There should be an equal attention to both the baby and to the patient.”
- “It may not be life-threatening, but it can still threaten your quality of life.”
- “Giving people knowledge can help them move forward in a meaningful way.”
- “Imposter syndrome is real but don’t take your knowledge for granted.”
- “Be brave.”
More about Laura Williams
Laura Williams is a Doctor of Physical Therapy (DPT) and Board-Certified Women’s Health Clinical Specialist. She lives and practices in Salida, CO, with her husband, 3-year-old daughter, and second child on the way.
Laura founded Hearth Healing, a 100% virtual postpartum healing service, in 2022, as a pelvic health consultant. Though not a substitute for in-person healthcare, postpartum healing consultation should be viewed as a vital way to bridge the gap in maternal care. People deserve information about how to improve symptoms that impact their quality of life after childbirth, without having to wait months, or feel limited by lack of childcare or transportation.
At Hearth, Laura provides individualized answers to postpartum healing questions, early healing strategies, self-management advice, and guidance on appropriate resources, products, and providers.
Suggested Keywords
Healthy, Wealthy, Smart, Pelvic Health, Postpartum, Education, Knowledge, Virtual Care,
To learn more, follow Laura at:
Website: www.yourhearthhealing.com.
Facebook: Hearth Healing.
Instagram: @yourhearthhealing.
Free gift: Sign up for the newsletter and get a free video on a breathing technique to quickly calm the nervous system.
Subscribe to Healthy, Wealthy & Smart:
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In this episode, Founder of Enhanced Recovery After Delivery, Rebeca Segraves, talks about physical and occupational therapy care after childbirth.
Today, Rebeca talks about why this work is important, the ideal OT-PT-patient ratio, and the major mental health component. What should PTs and OTs be assessing in a person after childbirth in the hospital?
Hear about hospital discharge criteria, preventing readmissions, and get Rebeca’s words of advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “A full evaluation by both disciplines is recommended after any type of delivery.”
- “A caesarian section is the most commonly performed surgery in the US.”
- “Among the most developed nations in the world, the US has the highest maternal mortality rate, and it’s climbing.”
- “The leading cause of death postpartum is now suicide.”
- “If we offered our services in the hospital after birth, we would see the maternal mortality and morbidity rate go down.”
- “Change is going to be person-driven.”
- “Don’t leave the hospital without an OT, without a PT consult.”
- “Get out and have some fun.”
More about Rebeca Segraves
Rebeca Segraves, PT, DPT is a physical therapist and Board-Certified Women’s Health Clinical Specialist who has served individuals and families within the hospital and at home during pregnancy and immediately postpartum.
She has extensive experience with optimizing function during long-term hospitalizations for high-risk pregnancy and following perinatal loss and pregnancy termination. In the hospital and home health settings, she has worked with maternal care teams to maximize early recovery after delivery, including caesarean section, birth-related injuries, and following obstetric critical care interventions.
She is the founder of Enhanced Recovery After Delivery™, an obstetrics clinical pathway that maximizes mental and physical function during pregnancy and immediately postpartum, with hospital and in-home occupational and physical therapy. Her vision is that every person will have access to an obstetric rehab therapist during pregnancy and within the first 6 weeks after birth, perinatal loss, and pregnancy termination regardless of their location or ability to pay.
Suggested Keywords
Healthy, Wealthy, Smart, Physical Therapy, Occupational Therapy, Childbirth, Surgery, Maternal Care,
To learn more, follow Rebeca at:
Website: enhancedrecoverywellness.com.
Twitter: @RebecaSegraves.
@pelvicnetwork.
Instagram: @enhancedrecoveryandwellness.
@pelvichealthnetwork.
LinkedIn: Dr. Rebeca Segraves.
Transform Recovery After Birth Program.
Subscribe to Healthy, Wealthy & Smart:
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In this episode, Founder of FitBux, Joseph Reinke, talks about financial freedom. Today, talks about understanding financial freedom, developing and implementing a financial plan, and FitBux. How long should you be focusing on one thing? Hear about student loan updates, budgeting vs financial planning, and get Joseph’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “A budget is not a financial plan.” “You’ve got to have intangible financial freedom before you have tangible financial freedom.” “If you focus on one thing, you’re going to achieve it much faster.” “Keep saving.” More about Joseph Reinke Joseph Reinke is a Chartered Financial Analyst (CFA) Charterholder and is the founder of FitBUX. In the past 5 years, FitBUX has helped 15,000 rehab therapist manage over a $2.2 billion in debt and assets using their innovative financial planning technology. Suggested Keywords Healthy, Wealthy, Smart, Financial Freedom, Student Loans, Planning, Finances, Budgeting, Cash Flow, To learn more, follow Joseph at: Website: www.fitbux.com. Instagram: @fitbuxofficial. Facebook: FitBux Official Group. Financial Freedom Webinar: Sign up here using my affiliate link. Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
In this episode, VP of the APTA Connecticut Chapter, Dr Stephanie Weyrauch, CEO of Inclusive Care, Dr Krystyna Holland, and Obstetrics and Gynecology faculty member at Denver Health, Dr Jennifer Hyer, talk about bottom surgery and gender-affirming care.
Today, we talk about vaginoplasty complications, pelvic floor goals post-vaginoplasty surgeries, and setting post-operative expectations. What are the barriers that trans people face when trying to access gender-affirming healthcare?
Hear about pre-operative education, hysterectomy versus vaginoplasty outcomes, trauma-informed care, and hear their advice to healthcare providers, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “You only have one time in your life to be post-op.”
- “The only way out of this is through.”
- “Give yourself grace, because you need to heal.”
- “Trauma-informed care is a commitment to continuing to try to reduce our own propensity for perpetuating harm.”
- “Once you start, you’re going to see a lot of folks that need this care.”
- “Be honest about who you can help and what feels good for you.”
- “Not everyone currently is a safe person for trans and non-binary people, and that’s okay. We are not all for everybody.”
- “We are seeing patients who are gender-diverse, and we need to be able to provide good care to people.”
- “If you don’t change your environment, it’ll change you.”
- “The hard work is always worth it.”
More about Dr Stephanie Weyrauch
Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis.
Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA)—most recently, she was elected to the APTA Nominating Committee—and actively lobbies for healthcare policy issues at the local, state, and national levels of government.
She currently serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at institutions including Stanford University and Washington University in St. Louis.
Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.
More about Dr Krystyna Holland
Krystyna Holland, DPT (she/her) is the founder and CEO of Inclusive Care, a physical therapy office in Denver, Colorado specializing in the provision of trauma informed pelvic floor care to individuals across the gender identity spectrum. Krystyna’s journey as a provider started as a patient. Traumatic experiences in her own medical treatment inspired her to open Inclusive Care.
In addition to helping folks feel confident in their ability to live without leaking and have intimacy without fear, Krystyna aims to change the fundamental patient-provider relationship from one that centers the provider as a problem solver to one that focuses on collaboration between the patient and the provider.
She is a well-known Instagram educator (@Krystyna.Holland), an instructor of trauma-informed care trainings, and a healthcare consultant.
More about Dr Jennifer Hyer
Jennifer Hyer, MD joined the Obstetrics and Gynecology faculty at Denver Health in 2007. She is an Associate Professor of Clinical Practice in Obstetrics and Gynecology at the University of Colorado School of Medicine. She completed medical school at the University of Tennessee Health Sciences Center and completed her Obstetrics and Gynecology residency at the University of Colorado. She is a Fellow of the American College of Obstetrics and Gynecology and a Diplomate of the American Board of Obstetrics and Gynecology. She is a member of the 2017 class of the Association of Professors in Gynecology and Obstetrics (APGO) Academic Scholars and Leaders Program. In 2022, she joined the Denver Health Medical Staff Executive Committee.
In 2021, she was honored by her peers with the Denver Health Outstanding Clinician Award. Her clinical activities include full scope practice of Obstetrics and Gynecology at Denver Health Medical Center as an attending physician. She has been providing surgical management for transmasculine patients since 2016. In 2018, she expanded her surgical skill set under the direction of Dr. Marci Bowers and Dr. Chris Carey to include vaginoplasty for transfeminine patients. She continues to provide these surgical services and is the only transfem bottom surgeon at Denver Health. She has presented Denver Health gender affirming surgical data at both national and international conferences. She hopes to expand the Denver Health Gender Affirming Surgical Program and participate in research opportunities to improve care of all LGBTQ+ patients.
She also has a research interest focused on maternal mental health, and she has presented on this topic at both the national and international level. She has received grant funding from the Denver Health Foundation and Zoma Foundation to support integration of behavioral health into obstetrics clinics. Additionally, she has partnered with colleagues at academic institutions within Denver to collaborate on projects to improve maternal mental health and access to support services.
Suggested Keywords
Healthy, Wealthy, Smart, Gender, Transgender, Surgery, Gender-affirming care, Education, Advocacy,
To learn more, follow Drs. Weyrauch, Holland, and Hyer at:
Website: www.inclusivecarellc.com.
Dr. Stephanie Weyrauch.
www.denverhealth.org.
LinkedIn: Krystyna Holland PT, DPT.
Stephanie Weyrauch DPT.
Twitter: @TheSteph21.
Instagram: @thesteph21.
@krystyna.holland.
Subscribe to Healthy, Wealthy & Smart:
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In this episode, Founder of Andro Brands, Corey Hiben, talks about marketing and websites.
Today, Corey talks about the website do’s and don’t’s, optimal website design, and creating an offer. What should you look for when having a website built?
Hear about the value ladder, building relationships, and get Corey’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Be 90% clear and 10% clever.”
- “What do you do, what problem do you solve, and what action do you want them to take next?”
- “Confused customers don’t buy.”
- “As long as your intentions are pure of trying to help people, you should never have resistance around marketing yourself, building a site, or any of the things you’re trying to do.”
- “You have the option to choose yourself and to do what you want to do, regardless of what other people tell you.”
More about Corey Hiben
Corey Hiben is the host of The Health Hustle Podcast. He is also the founder of Andro Brands, which is a marketing agency for health & fitness professionals.
Corey used to work as both a personal trainer and a healthcare professional and so he understands the challenges of providing incredible service to your current customers while also trying to attract new customers.
Through many years of trial and error he realised that he is best suited to put all of his time and attention in helping other health & fitness professionals grow and market their businesses.
His mission is to help as many of his fellow health & fitness entrepreneurs to build a business that fits their lifestyle.
Suggested Keywords
Healthy, Wealthy, Smart, Marketing, Website, Offers, Value, Niche, Entrepreneurship, Business,
Resources:
FREE GIFT: From Followers To Clients in 7 Easy Steps.
To learn more, follow Corey at:
Website: www.coreyhi.com.
LinkedIn: Corey Hiben.
Instagram: @coreyhiben.
Facebook: Corey Hiben.
Podcast: The Health Hustle.
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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SoundCloud: https://soundcloud.com/healthywealthysmart
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Read the Full Transcript Here:
00:03
Hey, Cory, welcome to the podcast. I'm happy to have you on today to talk all things marketing and website, which is something that is not intuitive for a lot of healthcare and fitness professionals because we didn't really go to school for that. So thanks for coming on and talking us through it. Yeah, that's exactly how I got into it is I solved a problem I had myself and now I help other people with it. So yeah, yep, that's always the way. So we're going to talk about website design, and we'll kind of see where it goes. But can you give the listeners, maybe some must haves and maybe must have nots? I don't even think that's a word on when it comes to website design. So let's talk about things that one should have, or maybe what a site what a good site should have, that will want people to come to see you. Because that's the point of the website. Well, for starters, something very funny and quirky to begin with. No, I'm just kidding. But uh, but just to give people some context, like, Yeah, I'm an occupational therapist, by trade, I really got into this marketing, website design and development thing purely through just a place of pain is somebody who understands the challenges and the struggles of really trying to get new clients and leads and customers and how challenging that can be to both see patients, do your documentation, keep up with emails, do everything you have to do from a practitioners standpoint, or even a fitness practitioner standpoint, and then also trying to figure out how do I also Garner leads and get get attention. And I think so many of us have felt the pain and struggle of like, I don't feel like I have time to do this. And so that's really where I fell back on to okay, how do I create the systems and the marketing and all those pieces in place have to get leads and to get new customers and to keep people coming in the door and in the clinic, and still have time to treat patients at a really high level. And that's really where I landed on this, this pocket of website design development and why it became something that was so interesting, and become so passionate for me is because like, I always tell people that your website is really, it's your mothership, it's your home base, it's your backbone, it's the thing that like, if you can get a lot of traffic and a lot of attention to that place, specifically, assuming it's designed correctly, which we'll talk about in a second, then you can essentially take all these people that are paying attention to you into somewhere down the road, hopefully clients and customers or even referral sources, because like all the other platforms out there, whether you use tick tock or Facebook or Instagram, or whatever your thing is, is you don't own any of them. The only ones that you own, or the ones that are on your email list are the ones that you have phone numbers to, or even maybe an address to if you want to write them a letter if people still do that today. But to answer your question of like, what are the must haves and shouldn't do is have a website? I would say first and foremost is
02:43
you have to have a compelling reason for somebody to want to reach out to you is the biggest mistake that I see is that so often people think if they just build a website and throw a contact form on there, that there's somehow going to get somebody to reach out to them. And I can tell you very unlikely, if not, will they ever reach out to you or ever fill out your contact form if you don't give them a compelling reason to do so. And that's why like the topics of like freebies and offers are something that you can offer a value to somebody is so so important, because the the pushback that I always get from people is that will I'm just asking for their email address, it doesn't cost them anything to give me their email address wrong, it costs them a lot to give somebody an email address. And what I mean by that it costs them their trust, it costs them their attention, it cost them the risk of maybe you spamming them. So if you're not giving them something of value in return for that email address, there's no way they're gonna give it to you unless it's your mom or your sister, or somebody that already knows and trust you. But if it's some random person perusing the internet, it's very unlikely. Or if you built up a lot of trust on your social media platform, and have some sort of ask them there that drives them back to it, that might be a way to get it. But I'd say that'd be the number one biggest thing is having a compelling reason for somebody to reach out to you. And unfortunately, I can't just tell you what that is that comes down to really tapping into a really deep layer of empathy of understanding the people that you're working with and how you're ultimately trying to help them. Because like, if you can really speak their language and understand who you're talking to you and have something that's very specific to their needs, then that offer becomes very obvious to you. And that's really what I tell people is like you want it to be a no brainer. It should be they're gonna look at it, they're gonna see this as an offer, and they're gonna go, Oh, my God, that's free. How is that free? Why would I not do this? Right? It's a no brainer offer. That's the biggest one. The one I would say the thing that people get wrong the most is that are the don'ts of a website is they try to do too much. They try to put all their photos and all the copy and they have the world's longest backstory about themselves, not even the person going to the website. And they have all these pages that are redundant and irrelevant and they have way too many colors and way too many buttons and it just becomes ugly and sloppy. And whether you like it or not, people have a judgment on you based on your website, no matter what. And if see
05:00
If you've a see a sloppy website or website that has really just way too much wording or something that just doesn't resonate with them, they're gonna assume that you're also sloppy or wordy or don't have a lot of structure into this. And so they will judge you on your website no matter what. And so like if you can have something that shows your authentic self, and I'm not saying it should be professional, I'm just saying, it should show up authentically as you and the people that you want to work with. And on top of that, it shouldn't even really be about you, it should be about them. That's the other mistake that I say, I see as well is that we, when we build sites, we really use what's called the story brand model, which I'm sure you're familiar with. So essentially, it's understanding that the client is the hero of the journey. That's the whole point of a website, right? It's for them to come to that to that site and go, Oh, they get me they understand me. Now there's a compelling offer that I can reach on connect with them. Kind of a long winded answer to your question, but those are some of the biggest things. Yeah, no, that wasn't long winded at all. That was great. When someone is looking to design a website, right? What advice do you have for people? If they're looking, let's say they're looking to hire someone to do their website for them? Are there questions I shouldn't? Let's say I'm the therapist, and I'm looking to have someone design my website. Are there things that I should be looking out for? From the designer before I hire them? Great question. I would say like most things in life, you get what you pay for. And so I think you if you wanted to go, the more simple or an easy route, obviously, there's always the Upwork or the the fibers where you can go on there and hire somebody. But I think what's really important for people to get from your question is that it's one thing to have a website, it is something completely different to have a website that actually attracts and converts customers, right. And that's where we get into the whole game of like SEO ranking on Google, having a compelling offer. Walking a person through a story, like these are all very intricate things that people don't fully recognize and understand. And so like, I would say, the first thing I would do is I'd be asking for referrals and references is like, there's obviously going to be people in your network that you know, that have had good experiences with it. Like, for example, I have a really good friend of mine here in town, I live in Austin, Texas. And she her whole thing, she's a PT, but she does purely pelvic floor in Austin, Texas. And basically, we're able to get her to rank very high specifically in Austin, Texas for the practice on that keyword search term, because we understand who her target market is, and how we're going to actually help her Garner and get leads from that specific population versus if you go to Fiverr and Upwork, which are totally fine, it's very unlikely that they're going to take that level of understanding of like how to actually build a site that actually gives you value to your business. Because like, just so people know, like a really, really good converting website, which people don't realize, is actually roughly maybe 5%. At most, right. And so like most people who have websites, I would argue if they either did it themselves, or they just kind of went the cheap route, which is fine, just so they have a presence on the Internet, are probably converting less than 1%. And if you understand just like basic statistics of how big of a difference that can make, do, how much more leads, you can get into your business from 1% to 5%. If you're getting, on average 1000 views a month, or whatever it is. That's a massive difference, right? And so like when you're researching people I, I've always told people to is like, if you if you don't have a reference to somebody that has shown proven results through data, which is very easy to prove the data, like you can look up Google Analytics, you can look up how well the website is converting, like if they can't show you that they're actually getting people results. That's probably a red flag.
08:48
Yeah, that's, that's great. So because I think it's important that the listeners know like, What do I look for? Do I just pick someone and ran at random? Or what questions you have. So that was really great. Okay, let's get back to the website design itself. So everybody wants to have a good user experience, right? Like you said, you don't want to have a million buttons where you don't know what's going on. Let's talk about when people first get onto your website, right? They're going to see live there. Let's say you're on a computer, and they're going to see kind of what's above the fold. Right? So above the fold is what you see before you start scrolling down. So what needs to be above the fold? Because some people might go on and what be on your website? For what three seconds? Yep. And be like, Nope, it's that quick. Right? So what do we need? When people first get onto that website? It should answer three questions, and it should answer them very clear. I always tell people be 90% clear and 10% Clever. And so like people always try to do like the quirky thing like me, as a web designer in the world. People are always like, I'm a website wizard. And it's like, cool, that's clever. But what the hell does that mean? That doesn't really give any context what you actually do.
10:00
So to answer your question is three things specifically, it's what do you do? What problem do you solve? And what action do you want them to take next? Those are by far the most important things you could do. And so for you, for example, it could be
10:13
physical therapy in Where do you live, New York City, New York City. So physical therapy in New York City, we help females with pelvic floor issues, click here to schedule a consultation, right? Very straight to the point, you could get a little bit more clever, quirky with it. And you can sit down a little bit, but it's pretty straight to the point. Like if you don't answer those questions right away, people are already going to leave. And I see that my own searching behaviors, if I land into a website of somebody that like refers me to their site. And if I can't figure out what it is they even do, there's no way I'm sticking around to continue to check out their content. I will say the other thing, too, that isn't often talked about is how important the, the image slash or maybe video at the top of the website is, is like this goes back to my original point is that people are going to judge you based on your website, whether you like it or not. And so like, if you have, let's say, some background video of people working out at what looks like a CrossFit gym, what does that tell people about? It's gonna it and that may turn off a lot of people 100% Right, just fine, right? If you only want CrossFit people, that's great. But that's a slim amount of people, even in a city as big as New York City. Exactly. It's not a lot of people. Exactly. Which could be a good thing, right? Because like, you equally want to turn people on as you do want to turn them off. Right? Is because like, not only are you trying to attract leads and get customers, you're also filtering the people that aren't a good fit for you. Right? Like if you right, you don't want to work with, for example, the 60 year old grandma, which I'm sure is a wonderful human, then probably having a CrossFit type workout in the background is a good thing, you're gonna filter out that human because she's gonna go there, and she's gonna go, oh, no, this isn't for me, right? So it always comes back to back to just like, really deeply garnering empathy, which PTS OTS trainers are all really great at in that realm. And so like, the more you can understand them, and the more you can build this, this home shipper, this backbone to talk to them and to understand them as a human, the more likely you'll be to convert somebody into a lead or a customer. Right? Yeah. And can you I want you one more time to repeat those three things that everybody must have above the fold. I really want to drill this in. What do you do? What problem do you solve? And what action do you want them to take? Next? Right, exactly. And that action is normally in the form of a button. Right? So it's either schedule here, call here, something like that. But it should be really clear. And it shouldn't be a teeny, tiny little thing off to the side. You want you want people to notice it.
12:57
Yeah, you definitely want people to notice it. So if you can answer those three questions, when you look on your website, kudos to you, if you cannot figure it out,
13:07
Figure Figure out how you can answer those three questions. Because I know when I redid my website a couple of years ago, it was like a total, like I had a website that I kind of did myself on Squarespace, which is fine. You know, in the beginning, I understand like, everyone's got a budget, and certain things need to be budgeted in a certain way.
13:30
But then when I hired people to do it, it what it also did for me is it forced me to look at my business and do a deep dive into that, and dive even deeper into the people that I want to work with. So that things became a lot clearer for me as well. So I think it's important for whether you're a therapist or healthcare or a fitness professional, when you're doing your website, it's your turn, it's your chance to really do a deep dive into who you are as a business owner, who you want to be the people you want to attract and how you want to present yourself to the world. Yeah, I think it's important to just be as authentic as possible to is like, that's the very first thing we do with every project with every client that we work with is that we really get to your point, we understand exactly who we're talking to. We go through all the exercises to dive really deep into who they are as a business who we're trying to attract. And how can we differentiate so ourselves in the market because there's of course, there's millions, if not, I don't even know billions of websites, maybe at this point. And if you're not finding your uniqueness, whether it's funny or quirky or weird or you like doing workouts with cats, in cat sweaters, whatever whatever your thing is, is like as long as you can be authentic to who you are and who you want to attract. That's the most important thing and so like really understanding like, who you jive with and how you help them is so important. Right right and and a website doing a deep dive into website is a great way to figure all that out. And and then what will happen is like
15:00
You said, You'll filter out people. And all of a sudden the people that you really like to work with will be coming to you. And it'll just make your life so much better.
15:11
Yeah, it's always fun when you get a contact message or somebody signs up in a newsletter, and you recognize that they're like, they're your people. And they're like somebody that you get, and they get you. And it's like, oh, okay, this is fun. Like, that's where things honestly get. So fun is like, when you start building that community via through your website, and contact forms, or however else you want to build it. It's like, that's where things get really fun. It's like when you realize you're connecting with the right people, because again, even to that original point of like, you could garner a lot of tension from people that you're not a great fit for. And that's not fun, right? Is that like, then you got to refer them to other people, which is great for other people. But at the end of the day, like, if you're a PT, or training or whatever, like you're really trying to build a community, honestly, right, and the throw everything at the wall and steel, see what sticks marketing technique is not a good one is that what I'm hearing you say? I literally just today actually finished a whole article about that entire topic, I had somebody have a podcast show as well. And I had somebody on that show recently, that just reminded me of, I think that there's a stage in most people's journeys, where that's kind of the initial part of where you have to throw some stuff at the wall. But really, the whole spray and pray approach is not a useful method to getting people. Like I always, I always compare it between, like, the difference between being a hunter and a farmer, is that as a hunter, you're just like, you're going out and you're shooting everything and you're attacking everything, and you're trying to get them and you're going over here and you're throwing spears this direction, versus a farmer just waters their seeds in their area of the people that they're trying to nurture and connect with and have relationships with. And I feel like the farmer approach is way more fun and way more fruitful. And way more. Just no pun intended. Yeah.
17:00
Exactly. Just way more helpful for everybody involved in that entire situation of like, so I always give people grace of like, yeah, there's a stage of prayer, spray and pray. But like, if you came to me, and you talked to me, and I was consulting you, I'd probably be like, not probably not right approach to this. But Right, right. Not, not the best. Not that not the best, not the best way to go. So is there anything else about websites? Let's talk about like maybe what you see, that drives you insane, that you're like, oh, my gosh, I want to jump through the computer or my phone. And I need to change this. And actually, for me, it's non responsive websites. So websites that are that when you look on your phone, you're like, Come on, man, like make this this this should be better. Right? So when I say like non responsive, it means they didn't like optimize it for a phone or an iPad. It's only on the computer. That is like one of my biggest pet peeves. What are yours? Yeah, considering the fact that I think it's now 70% of people that browse the internet, use it on a mobile phone. And so like we we design every website now with mobile first knowing that the majority of traffic is going to come from there. So for anybody listening, keep that in mind and to your earlier point of like, if you are somebody listening, and you're in that situation, where doing it yourself is kind of the avenue you want to go. I think to your point about Squarespace is a good option, because they have a lot of great templates that make that very simple for people to just write on their own. So anybody in that situation, that's usually where I refer them if they're not ready to invest in something like that.
18:32
But other than exactly what we're talking about, of not knowing who you're talking to. That is my number one pet peeve. But other than that one, because obviously I feel like we beat that one. Yeah, I would say that the other one is, is
18:47
they tried, like I was saying before is they try to do too much is that they have multiple buttons, multiple offers multiple links to things is like, just understanding just to help people from context of basic human psychology is confused, customers don't buy. And so if you go to your website, and if it's confusing at all, if it's confusing to a seven year old, if a seven year old goes to your website, and they don't know what to do, that's a problem. They should then we need to talk about what is the one no brainer offer that you can present to this audience that will get them to actually make a connection and to make a decision. They've done so many studies on it, we don't have to beat it down. But basically less choices is better. It's the same reason why we get like, what is it called? Analysis paralysis. It's like, you go to the shopping aisle in the grocery store, and there's 8000 cereals. And so you choose the one that you've always chosen because you don't want to have to make a decision on a new one. Right? This is true for the websites and the internet as well. Right? It's like if there's too many options, you don't make a decision. And that's not what you want on your website. And so don't make the mistake of having too many offers have one very straight and simple offer.
20:00
And then even just repeat it is like I think people feel like this, I see this in marketing all the time is people feel like they're saying the same things over and over again, and they're being redundant. And it's like, you gotta understand the first 10 times you said it, they probably didn't even notice it, it's very unlikely that they even noticed it. And so like, if you feel like you're being redundant, you probably need to say more, honestly. And so like, if you can repeat that offer, again, multiple times throughout the course of the website, that'll one increase the odds that they'll even see it in the first place. And two, it'll make it very clear to them. This is what I want you to do. This is how we can continue to move forward. This is the next step in the process of how we can even start a conversation, whether it is signing up for a contact, whether it is a newsletter, a freebie or whatever it is, but like, make it very clear on what your one offer is. And be a little redundant about it, honestly. And yeah. Thanks for elaborating a little bit more on what the offer is. Because that's because when people hear offer, they're like, What do you mean? Would I have to like, does it? Is it a video? Is it can it just be like book with me? Can it be? So when you say an offer? Can you be a little more specific on maybe some different options that people can use as that offer on their website? Yeah, great. I'm glad you brought that up. Because like that is a whole discussion and of itself is like understanding even how to create an offer. I think so often, that's the thing. The problem that I see in marketing just in general as well is that
21:29
people often think that they have a marketing attention problem when really they have an offer problem. And so really an offer at its core level is it's whatever is going to compel them to click to say Yes, right. And so that could be that could be a freebie, like we talked about, it could be an ebook, it could be a free course, it could be an email chain, it could be an email chain, it could be, it could be actually buying the product, depending upon what it is, if you're some sort of product based service, it could be you see it in SAS companies all the time, it could be like, try this free trial for 14 days, I actually have a trainer, a good friend of mine here in town who's doing two weeks for free. And then at the end of the two weeks, you can decide if you want to work them with him or not. And it's actually for any other trainers out there. It's worked out great for him. Because then they get to experience what it's like to work with them for a few weeks, and they often choose to buy but that's his offer right now. Right? says two weeks free, no charge to you. To me, that's a no brainer if you're somebody that concerning our trainer, right? And so like the best piece of advice I can give to anybody who's considering what sort of offer I should do, and I'm stealing this quote from the guy that everyone seems to know about these days is Alex from Mozi. But basically,
22:45
it should be so good. People would say dumb to say no to it.
22:49
Right? Like, yeah, two weeks for you with a trainer. If I'm looking for a trainer? Hell yeah. Why would I not do that? Right? Like something that something?
22:58
Yeah, that's definitely a no brainer. Now when it comes to, let's say, healthcare professionals, where maybe we can't kind of, we can't really give away our services, because as you know, we're a little more regulated than the personal training business.
23:15
So what have you found that works best to convert? People, let's say convert emails for wanting to get people on our email list? What have you seen in your experience that works really well is like a lead magnet or an offer? Yeah. And so I want to frame this so that this can be helpful for everybody listening to the show. And I think what's important to first understand is the basics of what a value ladder is. And so a value ladder is essentially like the lowest possible hanging fruit is the thing that you want to offer first, and then you work your way up the ladder. So for example, it could be something of free. And then your next offer is like a $20. Offer, your next dollar is like your $200 offer. And then your next offer is like I buy three months for $2,000. Right, is that you work them up the ladder, you never it's very rare that it works to start at the top and go the other direction. That is That is a thing. It's called an ascending model. But we don't talk about that. But like it's really about understanding, okay, what is my premium offer, and everybody should have a premium offer. If you are listening to the show, and you don't at this point in your business have a premium offer you need to start thinking about that right now today, you need to know is like what is the ultimate crazy priced thing that you could offer somebody that if somebody was willing to buy it, you'd be like, hell yeah, that would be an awesome thing for me to sell to this person, whether it's like a six month package, if you're a trainer or whatever it is like some sort of very high premium style offer. And now what you do is you basically take that and you work backwards from there to get to what is that smallest piece within that giant premium offer that if if your ideal client came to you, and they were like, Oh, I just want this one little tiny problem solved. That's what you love.
25:00
Looking for like, for me, for example, I'll just use myself as an example, is that somebody who does marketing, website design development, that's essentially what I do for business, is that my premium offer is like the whole package, right? It's the funnel. It's the website. It's the newsletters. It's the marketing campaign. It's the content. It's everything, right? That's a very big premium package. Right? Well, within that, when I distill it all the way down to its very base level is one little tiny thing in there that people often get wrong, is how to define your niche.
25:31
Right. And so my little tiny, very just stepping stone offer for people, which we can talk about at the end of this episode, is like, it's how do you define your niche, right. And so I created this tiny little thing, it's totally free, I can give it to your audience for free. It's called the niche test, there's three pieces that go into it that really talks into, it's not as simple as just picking your niche because everyone in their mom just says, just like pick a niche, and then they'll throw money at you. And unfortunately, it's not that easy. There's actually a lot that goes into it. And but I basically broke down how to do that. But that's my tiny little offer just to get people into my community and very transparent. That's purely the reason that I built it was that just to get them onto my newsletter so that I can obviously continue to offer and garner value to their inbox and continue to talk about marketing things specifically for the health and fitness professional. And through that, we work up the funnel, right. And so for anybody listening to the show, is understand just to break it down really quickly, when we're last time is like understand your premium offer, break that all the way down to the micro thing within that that you can offer your ideal clients. And then that's your freebie. That's your offer. That's you're getting them into the door just to start a conversation, essentially. I love it. Thank you for that. And now, as we kind of start to wrap things up here, what would you what are the main points you want the listeners to take away from this discussion around websites and marketing and how to make them work for you.
26:50
I think it's really easy to complicate a lot of it. And I think that the biggest thing I really want people to take away from it, though is that like, if,
27:00
in the years that I've been doing marketing, what I've realized time and time again, is that all it is, is another way of saying building relationships. That's really literally all it is, at the end of the day, if you look at all good marketing, for that matter, not your spammy, annoying, slamming at your door, I literally just had to deal with this the other day, it was like some auto deal. It's always auto dealers. But like that type of marketing does not build or Garner relationships. And that's not fun for me. And that's not fun for them. And it's very unlikely that I would buy from them. Right? He's world, it's all built on the back of like, how can we build relationships, and that's really all marketing is, is it's how can I put things out into the world, that's a value to my audience, or that your audience or whoever's listening to the show, that's helpful for them, that will help us build a relationship to support and help each other. That's all it is. And we can complexify it all we want. But like, as long as your intentions are pure, of trying to help people, you should never have resistance around marketing yourself or building a site or any of the things that you're trying to do as long as your intentions are pure of like, I'm just trying to help people and build relationships. That's really all it is. Yeah, it takes out the creepy marketing the slight, you know, because people are like, Oh, I don't want to feel like just slime ball being like marketing to people. But like, if you're not a slime ball in real life, you're probably not going to be slimy with your marketing either. You know, like, if your intentions are pure, you're okay. I always tell that to people. So thanks. I love that now. Last question. It's when I ask everyone and that's knowing where you are now in your life. And in your career? What advice would you give to that young guy ran out of OT school, I would have chose myself sooner. And what I mean by that, just to give people context is I like I said, I used to be an occupational therapist. And there was a point in my career in my journey, where I was very burnt out on patient care, I was struggling with this whole marketing thing, the website thing, all this stuff, I had no idea what I was doing. It didn't know where I wanted to go. And there was a really a point in my career where I was actually trying to get into the tech industry and into the marketing industry and actually get out of being an OT, because I was just so burnt out on insurance model health care, which anyone listening to show can obviously understand. And it's it took the I was in a spot where the pain outweighed the fear of the unknown. And I read a book at that time was called choose yourself by James all teacher. And the title basically says it all is that I was like I was looking for permission. I was asking tech companies would you hire me or I was like reaching out to other facilities or other entrepreneurs or whatever it was that people have like hire me or take me out or metro me or whatever. And I realized after reading that book is like, I can just choose myself and decide to start putting myself out there and start doing what I ultimately want to be doing, regardless of what anybody tells me and it's the greatest thing about modern day society in the world that we live in today is that anybody now can step up and grab the microphone, no pun
30:00
intended and choose themselves right and start putting value out in the world, the very first person I ever started building website for I did it for completely free. I helped her for $0 because I just wanted the relationship and I just wanted to show her that I could help her. And so talking to my younger self, or anyone fresh out of school, or whatever it is early stages is like you have the option to choose yourself and to do what you want to do regardless of what other people tell you. Right. Great advice things first time I heard that one. And I've been I've been doing this for a long time. So I thank you so much. That was great. Now where can people find you? And where can they get the free offer you alluded to earlier? Sure. So it's on my website. It's Cory high.com/niche is where the offer would be. You can find me and Cory had calm I'm most active on LinkedIn and Instagram. I also have a podcast show called The Health hustle. I talked to a similar audience that you do is other health and fitness entrepreneurs, specifically little people in Austin, Texas. So if anybody's listening to show in Austin, Texas and you want to grab a coffee, by all means, let me know I love connecting with people in your in town. It's my favorite place in the world. But yeah, that's my plug. Excellent. Well, thank you so much, Cory, for coming on and giving us your time and your information. I really appreciate it. Thank you so much. Appreciate it. Thanks for having me. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, CEO of Practice Freedom U, Jamey Schrier, talks about pricing your services appropriately.
Today, Jamey talks about the guilt surrounding pricing, accessibility and luxury, and the 3X model. How should we express the outcomes of our services?
Hear about job security, pricing according to the market, and get Jamey’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “You don’t strengthen the weak by weakening the strong.”
- “We need to charge appropriately for not what we do but benefits that we provide.”
- “Always get paid for R&D.”
- “People will pay for your results.”
- “I would’ve gotten help from an outside source sooner.”
More about Jamey Schrier
Jamey Schrier, P.T., is a best-selling author, business coach, speaker, and CEO of Practice Freedom U, a business training and coaching company. Jamey has helped hundreds of private practice owners Treat Less, Earn More, and live a life of prosperity and fun.
Suggested Keywords
Healthy, Wealthy, Smart, Pricing, Money, Quality, Experience, Value, Business,
Resources:
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To learn more, follow Jamey at:
Website: www.practicefreedomu.com.
LinkedIn: Jamey Schrier.
Instagram: @jameyschrierpfu.
Facebook: Jamey Schrier.
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Read the Full Transcript here:
Unknown Speaker 0:02
Hey, Jamie, welcome back to the podcast, one of my most frequent guests, and I love you for coming on. It's so great. I love seeing you. If only your wife would were here, that would make it so much better.
Unknown Speaker 0:14
Well, thank you so much, Karen. And she couldn't be here. But I think she's having fun with her friends, because it's around the holidays. And that's what she does.
Unknown Speaker 0:23
Oh, wow. Next time she's coming on. So let's see, last time we saw each other was that PPS in Colorado? And you had you did a pre con there, right? What was that pre con about just kind of tell the audience in case you do it again, we can get some you know,
Unknown Speaker 0:44
it's it's one of my it's one of my best pre cons. It's one of my best workshops, it's five steps to additional five figures. And what I do is just grab, like, a few key areas in every business needs these. So for this one, we did a lot of foundational stuff around vision and values. We then went into messaging like, actually, how do you communicate what you do we always complain, no one understands what we do. Chad went into a whole thing on you know, how to develop your message and how to put this message everywhere. So people actually understand what you do. And let's see, we did delegation. Who not you. So to get that stuff off your plate that we all hate doing. You and I are talking about behind the scenes, video editing, it's, we all have things that we hate doing, you hire someone else. And we did some other things around development of systems. So it was four hours, and it was awesome. And it went like just like that.
Unknown Speaker 1:52
I'm sure it did. Well, it sounds great. And if you do it again, hopefully at PPS people you'll get I know you had like a sellout crowd, right?
Unknown Speaker 2:02
Well, yeah, I mean, we had it sold out in like a few days. And I thought that we're going to expand it, because we had plenty of room but there was some mix up or whatever. So I'm hoping I can get back there next year and literally do the same talk. I think we could probably get 150 people in there without without a problem. Because it was it was great. I got people still reaching out to me saying, oh my god, I did what you said I, I tweaked my my ad and all of a sudden people reached out to me, they want to work for me. Amazing. There's no secrets, but there's definitely some certain principles that can can always help us. Right, right.
Unknown Speaker 2:38
Absolutely. And so today we're gonna talk about pricing our services. So this is a question I get a lot, I'm sure it's something you get a lot. And I have a feeling it's what a lot of people struggle with is how do I price my services appropriately? So what is your best advice? Let's just start with that. So how do we how do we properly price our services? And before we even start, I'll also say, I think a lot of physical therapists, maybe you may disagree, are uncomfortable around this conversation of pricing. Because
Unknown Speaker 3:19
therapists are uncomfortable around the conversation of money. Right?
Unknown Speaker 3:23
Right. So let's start. Let's start. Let's start with that. So what do you say to those people who are like, Oh, I don't know, I feel bad. I feel bad charging people for what I do. How many times have you heard that?
Unknown Speaker 3:37
A lot. I heard today, I had three conversations. One too, with clients, current clients and one with someone that was interested in our program. And they all brought up the same word guilt. Guilt is a word I hear so often. And it's the guilt of whatever making money, the guilt of what I should be charging the guilt of, you know, I feel like it should be in with my team and working all the time with them. Or, you know, it's just this idea of this guilt is a motion that isn't a rational emotion. Right. It's an irrational emotion. And that kind of leads us to making some decisions that aren't beneficial for anyone. So, you know, when people say, you know, I, I feel bad about charging and, you know, my, my response back is, you know, what, specifically do you feel bad about? And that's when they kind of stop and it's more of, well, why don't really know, like, they don't know why they feel bad. It's almost like a default mechanism. Right? It's just, it's if you say you feel bad, it's, I kind of refer to it almost like I feel bad. So I'm a good person. Like if I feel bad about charging people, I'm a good person. Now you and I would do a reframe on that. If I don't to charge you, then you don't get to experience my services in a way that you get to pay and feel the value of what I deliver, like that reframe all of a sudden changes the whole relationship. But we don't look at it from that way, a lot of times, I mean, obviously, if we really wanted to become multimillionaires, we probably wouldn't have gone into physical therapy. So we would be, you know, right down the street from in Wall Street. So, you know, many of us do have this idea that helping people and doing good in the world somehow means we shouldn't make money or can't make money. I mean, there's some deep money blocks that that are going on there. And I think that's what interferes, when we try to determine how much do we charge for our services?
Unknown Speaker 5:50
Mm hmm. Yeah. 100%. And, you know, I think early on in my career, I had those feelings of like, wow, I don't know, I don't feel right about this. And then, and then you realize you have that mind shift of like, well, wait a second. If I am not charging appropriately, to keep my doors open, then I'm doing a disservice to my community, because I can't reach the people I need to reach.
Unknown Speaker 6:20
Yeah, I mean, I say this all the time. It's, you don't, you don't strengthen the weak by weakening the strong, we are the strong, the business owner is the strong, we're the one that's taking this risk. We're the ones that is, you know, trying to create this vision is something that we want to do and help other people. And yet, we're the ones that work more hours than anybody in our business. Typically, if you add up the hours, you work by what you pay yourself, you're making less than your therapists that you're that you're paying. And you're stressed out, it affects your relationships at home, it's like you give your best to the people that you work with. And you give whatever energy is leftover to the people that you love and that are at home. Right, the whole model screwed up. And it has a lot to do with kind of kind of going back to either our childhoods or what schools kind of teaching us or whatever our influences are, that is screwing us up when we go into this business of physical therapy.
Unknown Speaker 7:24
Right, right. Because, for me, what was the biggest aha moment or a change in mindset, if you will, is going from being a physical therapist who happens to own a business, to being a business owner, who happens to be a physical therapist. So once you're in that business owner mindset, you need to keep your doors open, you need to know what you need to make to turn a profit to gosh, I mean, at least pay your bills, right. But you should want to pay your bills and turn a profit. So you know, when it so let's talk about when it comes to pricing. Is there a formula? Is there something that people can look at or can plug and play? That gives them a better idea on what they can charge?
Unknown Speaker 8:18
Yes. So I like to share a little story with you. Um, New York has some beautiful hotels, right? What's What's the nicest hotel you know, of in New York? What's the peninsula?
Unknown Speaker 8:33
Peninsula, you're like, I don't know. flippin insula.
Unknown Speaker 8:36
I don't know. Okay, the peninsula. Pretty
Unknown Speaker 8:38
nice place, right? Right charges. Who knows how much per night but it's not. It's not like 150 bucks. And then there's the opposite end of the peninsula, there's probably, you know, maybe a red roof or something floating around there, maybe a small little Fairfield inn or whatever the case is. Right now, the peninsula probably does pretty well. And I know the Red Roof Inn, they do pretty well as it also. So these are two hotels. These hotels have to make a decision about what is your avatar? What are you about? What do you stand for? And if the peninsula thinks that they're trying to be a red roof in and do some of the things that the Red Roof Inn does, then you as someone that loves peninsula will be turned off. And of course, if the Red Roof Inn starts charging $20 for water in the room, which I imagined the peninsula will do minimum, then you're going to turn off that ideal client. So it is not about what you charge, you first have to answer the question, Who is the audience you're trying to track? And even before you answer that, you have to go in too, what are you about? Where do you put yourself from the peninsula, the high end, Four Seasons Hotel even higher, and the Red Roof Inn, because it isn't bad and isn't good. They're just very different in how they identify their avatar, and how they deliver deliver services and how they market and how they deliver the experience of the Avatar, they both have an avatar, and they both do financially very well. That's where we have to begin, we have to begin with identifying well are we going to be more of a place that might be, hey, we're a little bit more of a volume business, we accept insurance, we're only getting paid 50 bucks a pop, we got to see three people an hour, we do pretty good service, the beds are clean, the pillows work, you know, we keep the place clean, we keep the lights nice, but it is it's like you're going to stay the night and it does the job. Versus Are you going to be a high end boutique, high touch kind of place, you're going to do things that most places don't, you're gonna get that call, the person is going to have your cell number they're going to reach out to it's just a different experience. Each of those places has to charge a different amount they have to write this is really an exercise on clarity. This is an exercise on you looking in the mirror and saying what is this place about? And you have to be honest, because if you're like, well, we deliver the greatest care in New York and where the best work, okay, then that means you have to align your business to demonstrate that don't say you're the greatest, and you got a leak in the ceiling. Your carpet hasn't been changed in 20 years. Right? You know, you got some water fountains sitting outside. One of my one of my clients, he's in Brooklyn, he, you know, we did this exercise years ago, and I said, Lou, what are you about, and he goes on Equinox, I go, um, hi. And he does PT he does ot he does, you know, a little bit of rehab stuff. And by golly, you walk into his place, it is high. And that is his whole way of doing things from the towels he gives in the bottle of water in the art, everything is for that person that appreciates that. And yes, many of his non insurance prices reflect that. So that's, that's where you have to start, you have to determine where you are on that spectrum, let's say make it easy. Let's just say it's one to five. All right, the wine is solid, nice. Probably a little more volume ish, lower price, the high end Peninsula, that's where you have to start.
Unknown Speaker 13:06
Yeah. And that's when I sort of started my business, I sort of coined the phrase like a concierge practice, because I patterned my business after a high end concierge is like at the peninsula, or at the Four Seasons, or at the, I don't know, the Andaz or something like that, right, these very high end, hotel chains that go above and beyond, you know, they go the extra mile. And so that's how I created my practice and what my practice is, you know, we're all about excellence in every sense of the word.
Unknown Speaker 13:47
And if you said that to me, and I'm like, Oh, my God, that's great. I love that because I'm status, right? Yeah. When someone tells me the peninsula, it's not because the beds are really that much better. They probably are. But it's not because of that. Let's face it, Seth Godin talks about this all the time, it's connecting with status on a certain status. Now, if you said, I'm the greatest, and you told me you charge $75 a visit, I wouldn't go to you, right? Because that's not enough. I need to be connected with the best, right? Let's face it, the best usually has the biggest price tag. That's why Mercedes, that's why BMW are a different level than some of the other car companies, right. That's what people expect, even if they pay a lower amount, because they started bringing their prices down to fit a different type of it still has that element of oh, I drive a Mercedes.
Unknown Speaker 14:43
Right. And I think it also comes down to you know, you're looking at that word luxury. Right. So I and I often wonder, I do I think physical therapy is a luxury item. I don't I mean it Well, it could be, but I do think physical therapy should be accessible to everyone. But why can't you be accessible and be luxury at the same time?
Unknown Speaker 15:11
Well, that's interesting. So you're going to start now moving towards a little bit of the heartstrings that you and I have talked about many, many times. This is where people get into trouble, right? I'm working with a client right now. And he's coming out of a really bad situation for the last couple of years, because he made a decision and impulsive financial decision to accept Medicaid, his businesses, typical outpatient, ortho, you know, one of those types of places, whenever be a half hour type of thing. And he did this because he said, Oh, my God, there's nobody doing Medicaid. The money's not too bad. And we don't even have to mark it, we can get a million people. Well, what he failed to really go through is realize that this population didn't align with everything else that he's doing. It was a completely separate population. It doesn't mean he couldn't have them in, but it was just mixing everything up. almost cost him his business. So he realized, oh, yeah, it was it was seven figures, it was costing him. So he realized, Oh, my God, this is a disaster. Now, he said, like you said, I wanted to try to help and serve more people. So I can help them serve more people. It was easy to generate a referrals. And we can see the population. But the population that came in the type of services that were delivered, the type of culture, not bad or good, it was just very different. What they had, so it caused a lot of internal strife. And of course, the amount of work it took to actually get paid from the government.
Unknown Speaker 16:56
Right, right. Yeah.
Unknown Speaker 16:59
So when you start doing things out of alignment, just like our spine, when your spine is out of alignment, it starts to create a problem, it starts to break down. So this this a question about what should I charge? The question is, what are you about? What do you believe in? And then you start to do research, not comparing yourself what someone else is charging. You do research around? I'm similar to Karen. I feel like I'm that place. What is Karen charge? She charges 250 a visit? What is someone else? HR 300. This purchase this person charges? Two. So now, you know, anywhere from two to 300 is in that world?
Unknown Speaker 17:42
Yeah, you're in the right ballpark,
Unknown Speaker 17:44
you're in the right ballpark. Now that number can be I don't know, I mean, people that say, Well, I charge 125 of this, like, Okay, the first question is, is that number going to get you what you want? And that's a hard question to ask, right? Why would you want to make? Well, I want to make 200,000 I go, Well, 125 an hour is not gonna get you there. I don't care where you live. Right. Right, right. These are really difficult questions that we have to answer. But the idea is, value is not about. It's not about the techniques. It's not about all that stuff. You're learning all that stuff that our profession sells us, you got to learn more about this stuff, you got to have the fancy technique. It's not about that values, really about the big result. You help people plus the benefits that you add the result or the outcome, and the ancillary benefits. That's ultimately what we're selling, all of us are selling. And if you do this exercise, right, you really start looking at Karen, well, what is the big result that we're giving people? Yes, we're getting them out of pain. But what are they getting back to? They're getting back to running, they're getting back to work. They're getting back to living their life in full. You tell me what that's worth. Because if you dig down deep enough, guess what it's worth? It's priceless. Right? If you truly think about what we do, it's priceless. Because of our health because we only have one body. And you know, if you don't feel good, it's just a miserable, miserable way. So if the value that we provide is really priceless. Then we're just using the the hotel model to figure out where we want to be. And then we align our business and we align everything else we're doing in that way. Right the alignment that's the biggest issue. Because we all say we want to be the boutique, especially the cash base programs, we want to be boutique but our heartstrings, in the way we run our business is the red roof in one's not bad ones not good. It just doesn't aligned. And that creates stress.
Unknown Speaker 20:10
Right, right. Yeah. So I think if, as when you're thinking about pricing, and correct me if I'm wrong here, but I think you want to look at quality, like, what is the quality of the product you're delivering? What kind of experience and reward are you creating for your patients? Is it through like a controlled sort of channel? Or is it chaos? That makes a big difference? Nobody wants chaos. And then finally, is it a personalized service? Or is it cookie cutter? And I think you have to think about all of those things before, as you're thinking about your pricing. Don't you think?
Unknown Speaker 20:56
I'll push back a little bit on that? Yeah. I've never met anyone that told me they had a cookie cutter practice, ever. We everyone knows people. But when you look at yourself, right, says they have a cookie cutter practice. Right. Right. So you know, you said you said something about experience. I'll push back on that. I don't really care how much you know, I know. I
Unknown Speaker 21:22
don't I don't mean, my experience. I mean, greens for the patient. Oh, their experience? Yeah. Have creating a good experience for your customer? I've heard that before. Yeah, that's my experience. No, no, no,
Unknown Speaker 21:36
I got 10 years and 20 years. I'm like, No, it's the value you provide?
Unknown Speaker 21:41
Yeah, no, I mean, the, like the patient experience, I should have been more specific the experience that you provide for for them?
Unknown Speaker 21:50
Exactly. I mean, you know, look, if you're providing if you feel you're providing a higher service, and part of that higher service is creating an experience that really meets people where they are and meets their physical needs, their emotional needs, and all these other needs that they have, then you need to price it appropriately. So you need to look at other places that do something similar, and get an idea of where you should be. Right. I can tell you right now, nobody does that. What they do is they just pick a number out of the hat based on their internal guilt system. Am I feel okay with this number, or if I feel too guilty with it, it's a completely irrational system. And that's how they do because I've seen people people come in our program, and I go, how much you charge? And I like 121 30. I'm like, is that what you're worth? They're like, No, I'm worth 180. I go in charge 180. They're like, really? I can do that. I'm like, Sure can. And then you start getting into, well, what if they say no, what? Every single time very few people ever lead, they just gave himself a massive raise. And now they feel better about the services are providing, right? Let's face it, I guarantee when you were a little younger, as a therapist, you charge less, there's a slight little resentment, I care and just a slight, just a little resentment, like, I'm so freaking good at what I'm doing. And I'm only charging this amount. I know with me there was because I spent a fortune on my education, continuing it hours upon hours learning to get paid the worst paying insurance that I accept it. Right. I mean, it's it's a tough thing. But you need to really look at, you know, a great exercise I like to do is what are the benefits your service or program provides? Like, if you're trying to figure out what are the benefits? What is what is the model? Like, what is the treatment model? We refer to it as the business model. You know, this is the revenue you make for the program or for the service. And then what does the market charge for a similar thing? Now I know people listening will be like, well, no one does it quite like me. No one will ever do it quite like you. But let's face it, there's other people that do something similar to the outside public. It may not be similar to you, but if you're looking outside, it's similar. That will give you an idea of where where you can play, whether you get the high end, the middle end or the low end, not service or anything, just the lower end of what you're going to build for the services. And typically, like you said before, the lower end you charge, you're going to have to do more volume. I just did a masterclass and financial unit We're talking about this yoga program around financials and financial statements and how to look at what's a profitable model. And I like to use the three times model, meaning whatever you charge, per, whatever you charge, whatever you make per hour, has to be three times of what you're paying the person to deliver it. So if you're paying someone $50 an hour, that person has to generate at least $150 an hour. If not, there's not enough money for profit, and for overhead, and salaries and labor costs and all that. So that three times model was always a good model, you can use that really easily in the cash base model, right? Because typically, in a cash base model, you're literally just paying because a lot of cash base is an hour. But hey, if you're paying the person $50 an hour, you can charge less than 150. That makes it really easy to figure out. But I know your model, you're like, I'm not doing three times my models five times, even better. And as long as people are willing to pay it, and you feel good, and they feel good. This is more of a mind a mindset. What do you value, your own services. And the challenge we all have Karen is, once we learn all this stuff, once we go through all the heartache, once we go through all that stuff, all the money and everything, we typically forget about how much we put into doing this. And we only look forward, we only look at other people that we think are better than us. And they know more, and who am I to charge more, they don't even charge that much. When we get into that whole world. And that's tough. We need to to charge appropriately for not what we do, the benefits that we provide. Right? Right. That's what we're billing out. We build out outcomes benefits results.
Unknown Speaker 27:02
100%? And how do you? What do you advise people to? Or how do you advise people sorry, to? To express that, to whether that be on their website? Or when they're talking to a patient on a sales call? How do they express what they do for them? So what those outcomes would be? Because in the end, everyone's always like, How much is it? Which is normal? Like if people are coming for your services, they should know how much it is right? So how do you so now we're getting
Unknown Speaker 27:41
into the sales conversation? Well, you know, my favorite topics. Yeah.
Unknown Speaker 27:48
It's up to you how deep of a dive you want to go on this.
Unknown Speaker 27:51
But I love I love the sales conversation because it can be really, really simple. Right? I don't have a complicated sales process. I had three calls today. They're the most genuine, authentic just conversation, here's the thing. Step one, identify where the person is, what trouble what pain, what difficulty, are there have it step one be? What are those? What are the problems that they're having? How are they affecting their lives? So in our world, in the marketing world, it's called pain points. What are their pain points. This is not just physical pain points. These are emotional pain points. It could be spiritual pain points, it could be financial pain points, think about financial pain points for a second. So you're working with someone, and you're helping them potentially to avoid a $35,000 back surgery. So there's huge benefits to this, right, you're also potentially avoiding them because they don't want to take medication. So they're now not going to be hooked on oxy. So what's the benefits of that? What's the results of that? So you always start with where people are, have the problem that they're having. So we call them you start in the pain. And then you transition to their desires, their aspirations, their wants, what do they want? And I've had people say to me, well, Jamie, of course, they want to be out of pain. I go, No, they want more than that. Getting out of pain is one part of it. But to do what, like I've had chronic back pain for 30 years. Now when my back pain flares up. First of all, I'll write a check. I don't care how big 100% Right Second of all, what I want is not to get out of pain, necessarily. I want to go back and play basketball. Now of course, it's a hell of a lot easier to play if I'm not in severe pain. Now the question was, or the question is, so what is it about basketball? Well, it's social. It's physical. I stay in shape. I stay connected with my friends. What happens if you can't play basketball? Well, frankly, I'll get a little depressed. I'll just be a slob. I you know, a walk around the neighborhood but that's I'd like to talk smack with my buddies. So you get people into this emotional place of where you are now. And where they want to be where they want to be. The only thing that you need to provide, besides a sense of trust, which is, what's the biggest thing you provide, is you're providing a bridge from what I like to refer to as the House of Pain. Because I like to house the pain. Sure, jump around to play. Yeah,
Unknown Speaker 30:30
of course, that was that was House of Pain, right? jump around,
Unknown Speaker 30:33
I know you you got the House of Pain, to Pleasure Island, are going from pain to pleasure. The thing that gets us there, the bridge that gets us from pain to pleasure. That's what you provide. Now, if they want to know the specifics of what you do, then you can share the specifics you could share Well, step one, we do an intake evaluation, and we go through ABC, step two, we determine what's going on step three, we turn the player of the plan, step four, we get you better. So 1234, that's our plan. So because when I trust you caring, if I trust you, I don't need to know every little thing that you're going to do. I really don't care. All I care about is can you help me get what I want? And get me out of this place that I'm at right now. This is the, quote, sales conversation. I have. I mean, I tell people what the sales conversation because people think this is like some bait and switch, some coercive, the best sales conversation in the world are the ones that are most authentic, most genuine, and you actually care and you want to understand where they are. And you want to understand where they want to go. And you have confidence in what you do. If you don't have confidence. You show up weak weaknesses in something people trust, and you show up. I don't know if you're gonna be they really helped me. So if I asked you well, how much do you charge? Well, I don't I mean, kind of I mean, is 100 too much? I mean, I mean, I'll see you a couple of visits, like, you start almost apologizing, right? I've done it.
Unknown Speaker 32:21
I've done it. I've done it a million times. 100. Yeah, absolutely.
Unknown Speaker 32:26
But I've gotten over my emotion towards money, because that was my issues. And now it's just very clear. Well, here's what the program is, here's what we do, here's how much it costs. Hey, whatever, you know, credit card, check, whatever worried. And, yeah, I mean, this, this is where, you know, when we do an exercise around sales, you come out of this, not thinking twice about it. But we have to appreciate the fact that we went into physical therapy, we do have some money issues, we do have some guilt issues. But we can address those, because those aren't helping us get create the life that we want. And that's not going to serve the people we want to serve. And that's not going to attract the people that want to work for us either. Right? Because your staff, as much as we like to say, well, the generation, whatever generation we're on Z, Y, whatever, they don't want to work, they don't want to do anything they don't want to nobody wants to work for a boss who's broke. Because you know, why selfishly speaking? Karen, if you're broke, that means my job's unstable. My security is unstable, right? I want you to do well. So it's not that I don't want you to do well. But let's face it, it's it's it's expensive out there. And I want to make sure that I'm secure. So most of the people that bitch and complain about the people out there, they volunteer about his money. Well, the problem is, why can't you afford to pay them? And it's because you're not running an efficient business. Because of some of the things we talked about. Your services aren't priced correctly, you don't know actually how to position and sell your services. But those are skills. Those are skills you can learn there's nothing magic about it.
Unknown Speaker 34:15
Right. And you can practice those skills. Absolutely. You have
Unknown Speaker 34:19
to practice Yeah, well, how many when I worked with my, one of my first coaches in this business and in the coaching and training business on my nine years ago, he had me do this extra because he I had so much damn money stuff in my head. He goes, what what's the most you've ever sold in a program is like $500 Like, okay, so you're gonna charge $5,000 for your upcoming 90 Day Program. This This was the first thing I sold. I didn't sell a $97 program or $7 The first thing I was selling despite that I was sweating. And I go what do I say because you say exactly this. You ask them about this, you ask smell that. And then you say, here's what the price is, and you shut up. And I was scared I was sweating up for people said, Yes, I made more money in that thing. And they ended up being clients for a long time. Right? So what he had me do here was the exercise. He goes, I want you to practice doing the sales on your phone. And then I want you to send it to me. I'll give you some feedback. You do it again. So I practice 10 times. give me feedback. I practice 10 more, I knew the sales close. Right? Hey, so what are your thing? All right. So this, what do you that? So I kind of practice that, that thing. And by the end, I'm not saying I still didn't have some issues and butterflies when I said it, but it was a lot less emotional for me. And, of course, the people came on and they they loved it, they did well. So this is what we get to do we get to increase our skill levels and capabilities by practicing for sure.
Unknown Speaker 36:06
Right, right. And and it's okay to not be perfect right out of the gate.
Unknown Speaker 36:12
You're not going to be perfect, you're gonna screw this up, of course, you're gonna mess it up. And you know what, they're still going to pay you.
Unknown Speaker 36:20
That's right. That's right.
Unknown Speaker 36:22
Another mentor of mine told me always get paid for r&d. And everything's r&d. In other words, everything we're doing, we're just practicing, right, we're gonna practice this, you might as well practice it on people that can write new checks and come in as, as a patient. So, lean into the fear, lean into the worry, practice the the conversation and all that figure out where your price point is, and be confident people, people will pay for the results. Now, that's not your population. If your population is $125 a visit, that's fine, that's fine. People will pay for the results. That's right, you get to choose where your thing is, the only advice I would give you is just make sure you're at that three times multiple, do not charge and we're not talking about you because nobody pays themselves. We're talking about if you are someone if you're just a solopreneur. If you are someone to deliver services, just make sure what you're charging is three times what you pay them. If not, you're gonna you're gonna buck up on some on some issues there.
Unknown Speaker 37:38
Right, right. And I think that's really good advice, and kind of a one. One have a really good solid takeaway from our conversation. Are there any other takeaways that you want the audience to remember?
Unknown Speaker 37:54
Decide whether you're the peninsula or the red roof. Look for the people in that level of your market. Look at where they are and what their services are, and charge and price accordingly. Absolutely,
Unknown Speaker 38:11
yeah. Yeah. I couldn't agree more great advice. Did we miss anything in our conversation? I feel like we hit a lot of really solid points. Was there anything that you were like I really wanted to get this point in? And we didn't hit it?
Unknown Speaker 38:26
No, I don't think so. I mean, you know, you and I have lots of conversations around this. wish this was more complicated. It's not. It's not complicated. We make
Unknown Speaker 38:38
it complicated.
Unknown Speaker 38:39
I don't want to make it more complicated. Because I'm really good at doing that. I don't want to make this complicated. By giving all this other stuff. Here's the biggest problem we have with this. It's not that we're great at delivering what we do. The problem is we have our own internal issues around money around pricing around guilt. That's the part we have to address. No amount of fancy strategy, this subnet is going to change that. So the thing I gave you with the hotels with the this and that, it gives you an idea where you feel comfortable, make sure it's three times what you would have to pay someone to do it and try it. See they'll thank you. They'll thank you for doing that because your issues your own stuff is all in your head. So the only way you can address it is by addressing it so you don't need any more fancy stuff. It's just figure out where you are who you are. Charge it and go get
Unknown Speaker 39:43
it right kiss keep keep it simple, stupid, right?
Unknown Speaker 39:47
Keep it simple.
Unknown Speaker 39:48
Keep it simple. absolute love it now. I know you know this question. So what advice would you give to your younger self? You've given plenty of advice here to your younger self, and I feel like it's a never end Doing well, sources. So give us another one.
Unknown Speaker 40:03
What advice would I give to my younger self? Um, I probably I would have, I would have gotten help from an outside source sooner.
Unknown Speaker 40:19
I love it. I just said that the other day, I think that's great advice.
Unknown Speaker 40:23
You and I, you and I have a value system very similar when it comes to learning. You and I are lifetime learners. Mm hmm. And I wasn't always like this, I learned in my profession. But when it came to the business of physical therapy, I did not invest one 100 of what I invest in my, you know, manual skills and stuff, I, I wouldn't, I wouldn't, I would buy a book. And my younger self, I would have invested much more in my business acumen, I would have hired a coach, I would have went through the uncomfortableness of writing a check to my coach, which I eventually did. But then on the other side of that, you know, you get so much back of that, because you have to go through the fire, all of us have to go to the fire, even the overnight successes, which there's no such thing goes through the fire. So I would have gone through the fire sooner so I could get on the other side instead of through the torment that I did for for pretty much nine years.
Unknown Speaker 41:27
Right? Right. I couldn't agree more. And now where can people find you? And what is your free gift for the listeners? Because I know there is one here. So they can you can follow me quiz. Ah, your PT practice quiz.
Unknown Speaker 41:46
Yeah, I mean, look, the first thing you want to do is really understand kind of where you are in your business, you might think you understand where you are. But this this, this pte practice quiz and I have asked you questions that you're not asking yourself. So there's it only takes about five minutes to do it gives you a score kind of rates you where you are in your business, and then I provide resources to help you overcome those challenges that you're having. Because business really comes for most of us, you're really in three different areas of your business, you're in a Stage One Business stage two, stage three. And really what that means is where your income is your your total revenue, whether it's zero to 400,000 400,000 to a million or million to 3 million, that's where 90% of all of us are. So this quiz kind of will ask you some questions and really kind of teach you a lot about your business. So that's definitely something that I would highly recommend taking you want to reach me you know, best way to do is just follow me on LinkedIn. You know at Jamie Schreier. You can reach out for my you know, shoot me an email if you want to shoot me an email Jamie at practice freedom you. I'm all over the place. I'm like you, Karen. I'm all over social media. I tried to get myself out there and try to deliver good, good resources for people to try to help them.
Unknown Speaker 43:07
Cool and I'll just remind people of the website it's practice freedom you the letter u.com
Unknown Speaker 43:14
Yeah, practice u.com And then yeah, there's there's a quiz right there or you can leave the link to the quiz.
Unknown Speaker 43:20
Yes, everything will all of Jamie's information will be at the podcast, website at podcast at healthy wealthy smart.com. In the show notes under this episode, one click will take you to anywhere you want to go. Jamie Schreier related. So I think that's pretty good, right. That's great. Great. So Jamie, thank you so much for coming on. Again, as always a great conversation. I really appreciate you. So thank you so much. Thank you, Karen. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Award-Winning Entrepreneur and Speaker, Julie Bee, talks about leveraging burnout.
Today, Julie talks about her experience with extreme burnout, how burnout affects business owners, and how to document your burnout. What is the good side of burnout?
Hear about how to explore burnout leverage points, accepting the fact of burnout, preventing burnout, and get Julie’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Burnout forces you to really evaluate what is most important to you.”
- “You’ve got to go through it. There’s no going around it.”
- “The big things come from big work.”
- “When you get to the other side of something really hard, you realize how resilient you are and how powerful you are.”
- “If you’re not taking care of yourself, who’s going to take care of everybody else when you’re not there?”
- “Embrace burnout. Accept that it’s probably going to happen to you at some point, if it hasn’t happened already.”
- “Schedule time to read and time to think, at least once a week.”
More about Julie Bee
Julie Bee is an award-winning entrepreneur, compassionate and empathetic leader, and engaging storyteller. Julie has spoken for 14+ years on topics including leadership, management, employee engagement and morale, workplace culture, small business ownership, and entrepreneurship. Julie’s leadership insights have been featured on FastCompany, Forbes, Thrive Global, and many more.
Her forthcoming book with Matt Holt Books, The Business Owner’s Guide to Burnout, is scheduled to hit bookshelves in early 2024. Matt Holt Books is an imprint of BenBella Books, publishers ofTraction.
Suggested Keywords
Healthy, Wealthy, Smart, Burnout, Priorities, Leverage, Resilience, Entrepreneurship,
Resources:
FREE GIFT: 30 Ways To Say No Guide.
Join the Key Employee Coaching Program.
Julie’s VIP Consulting For Business Owners.
Watch Julie’s Speaker Reel.
Read: Addressing the Risks of Manager Burnout.
Read: A Founder’s Journey Requires Prioritizing Sleep and Defining What Success Looks Like, with Julie Bee.
Read: 10 Crisis Communications Do’s and Don’ts During Covid-19.
Read: How To Ask For More Support As You Return To The Office.
Read: The Ultimate Guide To Succeeding in the New Workplace.
Read: Why Successful Entrepreneurs Need To Be Calculated Risk Takers.
Read: Should Companies Take A Stand On Social Issues?
To learn more, follow Julie at:
Website: www.thejuliebee.com.
Podcast: They Don’t Teach This in Business School.
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In this episode, Co-Founder of the Nav.it Money App, Maia Monell, talks about entrepreneurship and navigating finances.
Today, Maia talks about the shortfalls in financial education, planning business KPI’s, and the results of financial inequity. How does the Nav.it App address these concerns?
Hear about financial planning in the world of instant gratification, success milestones, how to keep financial stress low, and get Maia’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Healthcare doesn’t understand finances, and finances doesn’t understand healthcare.”
- “Money is dollars and cents. Anybody can figure it out.”
- “The biggest quality of an entrepreneur is adaptability.”
- “You still have to work to be lucky.”
- “The results of financial inequity are far-reaching and persistent.”
- “Patience and adaptability are key.”
- “Do not act on a TikTok influencer.”
More about Maia Monell
Maia is the Co-founder and Chief Growth Officer of the Nav.it Money App. Nav.it is the fitness app for finances, providing personalized financial coaching to build good habits and live financially well.
When she's not pitching, selling, and creating for Nav.it, Maia is working with her family's two foundations. She's devoted to closing wealth gaps perpetuated by a system not built for the majority of America, and believes that financial wellbeing is an integral part of creating a healthier and more equitable society.
She’s an avid tennis player, skate skier, and runner, with an obsession for physical, nutritional, and financial health.
Suggested Keywords
Healthy, Wealthy, Smart, Entrepreneurship, Finances, Inequity, Patience, Adaptability,
Download the Nav.it App on iOS and Android.
To learn more, follow Maia at:
Website: navitmoney.com.
LinkedIn: Maia Monell.
Instagram: @letsnavit.
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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In this episode, Founder of Say It With Gratitude, Scott Colby, talks about creating a happier workplace through gratitude.
Today, Scott talks about the 5 languages of appreciation in the workplace, staying connected with handwritten notes, and how gratitude affects the bottom line. How can you infuse gratitude in the workplace?
Hear about gratitude journaling, the gratitude toolkit, and get Scott’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “It starts with you first.”
- “Find out how each teammate likes to be appreciated at work, and then appreciate them in that language on a consistent basis.”
- “Write down one thing that you’re grateful for each day.”
- “Almost 50% of workers choose Words of Affirmation as their first way that they like to receive appreciation at work.”
- “61% of all US employees are lonely.”
- “Start now. Do something. Compliment somebody. Flash somebody a smile. Do something different.”
- “Do some of this unplugged.”
- “Don’t take things personally.”
More about Scott Colby
After an eye-opening experience in Guatemala, during which Scott witnessed firsthand the power of gratitude, even in poor living conditions, he launched Say It With Gratitude, which helps companies create happy workplaces by having gratitude as a core value.
In addition to delivering his message of gratitude around the world, Scott promotes the power of thank you notes, leads gratitude adventures in the wilderness, authored a book called The Grateful Entrepreneur, and developed The Grateful Deck, a card game consisting of questions that spark meaningful conversations.
Suggested Keywords
Healthy, Wealthy, Smart, Gratitude, Appreciation, Connections, Affirmation, Quality Time, Service, Gifts, Touch,
Recommended Reading:
The 5 Languages of Appreciation in the Workplace.
FREE Gift: Gratitude Toolkit.
To learn more, follow Scott at:
Email: scott@scottcolby.com.
Website: sayitwithgratitude.com.
Facebook: Scott Colby.
Instagram: @scottcolby.
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Read the Full Transcript Here:
00:05
Welcome to the healthy, wealthy and smart podcast where healthcare meets business with your host me, Dr. Karen Litzy. And just as a reminder, the information in this podcast is for entertainment purposes only, and is not to be used as personalized medical advice. Enjoy the show. Hey, everybody, welcome back to the podcast. I am your host, Karen Litzy. And today's episode is all about gratitude. So often we talk about gratitude in the context of our personal life, which is great, there's nothing wrong with that. But today, in this episode, we challenge you to start practicing gratitude in the workplace. So to talk us through is Scott Colby. After an eye opening experience in Guatemala, during which Scott witnessed firsthand the power of gratitude even in poor living conditions. He launched say it with gratitude, which helps companies create happy workplaces by having gratitude as a core value. In addition to delivering his message of gratitude around the world. Scott promotes the power of thank you notes, leads gratitude adventures in the wilderness, authored a book called The Grateful entrepreneur and develop the grateful deck a card game consisting of questions that spark meaningful conversations. So into the in today's episode, we talk about the five languages of appreciation in the workplace. So if you are a manager, or a CEO, or you own your own practice, you're gonna want to know what those five languages are. Because that's how you're going to want to speak to your employees, how to stay connected with handwritten notes, and how gratitude gratitude affects the bottom line. So I want to give a big thank you to Scott for coming on and talking about gratitude in the workplace. And so I'm very grateful for him. Everyone enjoyed today's episode. Hey, Scott, welcome to the podcast. I'm happy to have you on today.
02:01
Hey, Karen, thank you for having me. Looking forward to a great conversation.
02:06
Yeah, it's my pleasure. And today we're going to be talking about happiness and how to create a happier workplace through gratitude. So before we get into the meat and potatoes of our conversation, can you let the listeners know a little bit more about why you came across this topic? Why this is like your expertise. So go ahead and give the listeners a little bit more backstory, if
02:31
you will? Yeah, certainly. So back in 2014, I took a trip to Guatemala, I was there to build schools with an nonprofit called hug it forward. And we were building schools out of plastic bottles. And one of my first memories of that volunteer experience, it was about a week long experience was I was riding a bus with 25 other volunteers. And we pulled up to the site. In a community called Chinook stay in Guatemala, we pulled up to the site where we were going to be volunteering, and I didn't know really what to expect. And I looked out the window of the bus. And it looked like the entire community had come out to greet us. And there was people of all ages, kids and parents and grandparents. And as I stepped off the bus with the other volunteers, the community had formed two lines. And we walked in between the two lines of people. And we felt like rock stars, or at least I did, walking down the red carpet, there were people waving the American flag, there was music blaring over the loudspeaker, just they were hugging us and just had smiles all over their faces. And I really learned that they were just being grateful for the volunteers that we had taken time out of our schedule to take that trek to Guatemala. And the other thing that I learned over my week long experience there in genetics day, was that the community had very little, very little clean water. They don't have the smartphones and the internet that we take for granted very little food, cramped living conditions. But they had community they had each other. And again, they had gratitude and appreciation for just other human beings. And as I thought to myself, when I got back, I was living in Denver at the time, when I thought to myself, after I return home, like cash, like how am I living my life, I'm living a life filled with complaining, thinking about all the things that I don't have. And in stark contrast to just what I experienced, and also looking at my life and other people around me, are always on our phones and we're always have our head buried in screens, and we're anxious and we're overwhelmed and we're not making deep connect actions anymore. It seemed like so that was kind of the first start that I had in my head, that, hey, I wanted to do something different in my life to make, to really live in gratitude, and to live with an attitude that I learned from the community and nginx de Guatemala. And then also, I think, and we'll probably get to this a little bit later in the conversation, just my experience in the corporate world of, yeah, you know, I've had jobs where I don't feel appreciated in the workplace and how much of an impact that made to my to my happiness, we spend a lot of time at work. And if you're not happy with your job, and a lot of that is not feeling valued or not feeling listened to that can really impact your your mood and your attitude. And really, whether you want to stay with a company or not. So kind of putting all that together that led me to start a brand called, say with gratitude. And it started with thank you cards, and now it's morphed into where I speak on the topic of workplace gratitude.
06:05
And you alluded to this, but I want to dive right in. So how does this translate into the workplace? How does that action of gratitude, that feeling of being appreciated? How do you translate that into a corporate setting, or, in my case, I'm a physical therapist, so maybe into a healthcare setting where people right now are really stressed out and burnt out. And, you know, and carrying a lot of student debt, and empathetic loads, and everything else? So how do you infuse gratitude? What are your recommendations? Yeah, and
06:46
that's a lot. And I, I'm glad you brought that up, I actually just came back from Wisconsin, where I was speaking at a healthcare conference on this very topic. I'm a big believer that it starts with you first. So start with the person before we can maybe bring it into the workplace, because we need that. We need to have that right attitude. It's hard to it's hard to spread gratitude around the workplace, if you're feeling, let's say, depressed and overwhelmed and stressed. So what can you do to start your own personal gratitude practice? I also have a health and fitness background. So I love that you're in, in physical therapy. And yeah, so I, I always talked about the analogy of, you know, when you're on an airplane, and they're given the safety instructions, if the oxygen mask comes down, please put it on yourself first, before helping others. And I talked about that, because if you're passed out, how are you going to help other people, but we can maybe not literally get passed out. But we can have the feeling of like, Hey, I just can't do it anymore. So I think we have to take care of ourselves first with self care. And there's a lot of different ways you could practice self care, but for this conversation, what how can you practice gratitude, and help you feel better gratitudes got that kind of magical powers that it can help you be more optimistic, feel less stress, more energy and things like that. So where do we begin here? There's various ways to practice gratitude. Probably the one that people maybe, you know, they think of when they think of the term gratitude, just keeping a gratitude journal and writing down what you're grateful for. I've got a tip there, though. I know a lot of people that do do that just kind of go through the motions. And then you don't really feel that difference. Like if you're just saying like, Hey, I'm grateful for my cat Oliver, which we now know as parents cat's name. I'm grateful for all of her my health and my job. And then you turn the page and you fill out the gratitude the next day. What does that actually mean? It probably is not going to get you into a frame of mind where you're living in gratitude. So we're, I suggest people take it further is if you're writing down, you're grateful for somebody or some something in your life. Follow that up. By writing down why you're grateful for those things, or that person, what is it about that person that you appreciate that you love? And then I take it even deeper and I teach people think about what your life would look like without that person? Or that that thing without that job without your teammate? What would life look like then? And then when you do that, you say what, why and what would your life look like without then it creates a more emotional response. So I'll have people do this in my breakout sessions. And that's usually the hears, people have tears because they start to think, oh my gosh, my life without this person, I couldn't even imagine it. So I think that is one way to start a personal gratitude practice. So you're actually like, Okay, you're, you're reminding yourself of the good in your life. And then what does that mean for work and work, we could talk about two different things. One is like, leading with gratitude, which, in a sense, I take that to mean creating a culture of gratitude and kindness. So in healthcare, trading, treating your patients, like real people, and that have a heart and not just transactional. So I like to, you know, give examples, so people can really think about what this might look like in the real world. So I my favorite coffee shop in Denver, when I lived, there was a coffee shop called fluid. They, they got to know me by asking questions. I went there on a regular basis. So it wasn't just like, hey, here's your coffee, give us money. It was people that took the time to get to know me a perfect example. There was one day when one of my other cats we had talked about cats before we hit record. My other cat, Nomar who who's not with us anymore. He was having two teeth pulled. And so I was a little bit anxious and the barista the manager there, she asked me like, hey, you know what's wrong? I told her, her cat was having a tooth pulled that day as well, just coincidentally, and she just said here, your coffee is on the house today. And it was just just a little thing. But something like that can go a long way. Chewy. Speaking of animals, they're a company that sells pet food and pet accessories to pet owners. I know a lot of pet owners will get their food from chewy on an auto order subscription basis, they automatically send the food every month, and they take money out of your credit card. So there's a lot of stories, but it goes like this. A lot of times when a pet owners, dog dies, let's say or a cat dies, and they'll call you and say hey, please stop my shipment, my dog has passed away. Chewy, of course will express sympathy. And then they'll say, okay, all those unopened bags that you may still have, we will refund your money for all of that. Don't send the food back, we will, we would love for you to donate that food to a local shelter. And then a lot of times in a few days, sympathy flowers and a sympathy card will show up on the doorstep in just as a as an expression of condolences. So chewy is a company that leads with gratitude. So they're not saying like, we need your money back or we need the food back or we can't send these flowers because it costs too much. They're treating their customers like human beings that have a heart.
13:06
And then we've got appreciation in the workplace in the sense of all right, we need to appreciate our teammates, right? There's an interesting statistic. This is kind of a old statistic, Karen, but it's still relevant and maybe worse today. 79% of people in a research study a few years ago said that they left their job, in part because they didn't feel appreciated at work. So it wasn't like, hey, we need more money. Or we need to be you know, get promoted. It was really just not feeling valued, not feeling heard or listened to and not feeling like they mattered. So that's why I like to talk about Okay, starting with yourself first and then spreading it to other people like your customers or patients but also your team. And a great book is the five languages of appreciation at work. It's kind of a follow up book to the five love languages, which is was a popular book that talked about relationships, personal relationships, and we all have a preferred way that we like to receive love. We also have a preferred way that we like to receive appreciation at work. And the languages are the same five languages as the original five love languages book. So think of things like words of affirmation, quality, time, acts of service, tangible gifts and physical touch. We all have a way that we like to be shown appreciation at work usually follows one of those five. And so basically the idea here is find out how your each teammate likes to be appreciated at work, and then appreciate them in that language on a consistent basis. So somebody likes words of affirmation. So you want to appreciate that person, by affirming them with words that can be written, it can be verbal, the idea is to do it consistently. Be very specific. Don't always make it tied to performance. Maybe make it you know, give them a shout out on why you like them, kind of like we talked about earlier, when we write down like, Why do you like somebody's work? Somebody that is loves words of affirmation will love hearing good things about them? So yeah, so that's just kind of a basic rundown. I know, that was a long answer. But I think it's important to, to get all three of those in personal gratitude, leading with gratitude, and then spreading appreciation to your team. Yeah,
15:46
that's three, kind of an easy framework for people to follow. And circling back to that gratitude list or gratitude journal. I used to keep one and then I did it. And then I did and now you know, it kind of goes in cycles. Do you have any advice for people on how to be consistent. And as a follow up, I think it's important for people to know that it doesn't always have to be really big things. I remember when I started, the coach that I was working with was saying, Well, you know, it doesn't always have to be big, grand things. It could be like, I'm grateful that I have an umbrella because it was raining today, or I'm grateful I have a warm jacket, because it's 30 degrees today. So it doesn't have to always be a person or an animal or a relationship.
16:39
Yeah, yeah. Great point. You want to keep it simple, right. So don't get overwhelmed. So I love your point there. So my first thought to your question was, you know, you've mentioned that you weren't super consistent with your gratitude journaling. I know, I'm not I'm actually not either. You know, I'm seen as gratitude guy. But gratitude journaling never has been something that I've been consistent at. So what I do want to I'll give a tip on how to be consistent. But before I do that, I do want to encourage the listeners to find something gratitude related that you do enjoy doing. So maybe your thing isn't keeping a gratitude journal, but maybe like complimenting somebody. So that is a sign of gratitude. Or a way to show somebody gratitude. Gratitude could be just sending a quick video to somebody. So maybe like, I'm not really much with written but I'll send them a video or an audio. And that could be your thing, or writing handwritten notes, could be your thing. But in terms of if you did want to start with gratitude journaling, and trying to figure out a way to be consistent with that right off the bat, you could do some things that can help you form a new habit, much like forming a new habit to exercise or something like that. setting yourself up for success. So breaking down the habit into the smallest thing possible. So maybe you just write down one word each day instead of trying to form an entire sentence. So that could be a way to break it down in a small, small miniscule habit. But also think about something that you're already doing, and stacking this habit on that and creating a trigger point. So suppose you make coffee every single day. And that's kind of a routine you're already in. So maybe you leave your gratitude journal by your coffee pot or your coffee maker, and just have that next to it as a reminder that oh, yeah, because a lot of times not keeping a habit is just we forget about doing it. So create a way that you will remember to do the habit by having something that you already do be that trigger that reminder, right.
19:02
So your habit, habit stacking.
19:05
Exactly, yeah, habit stacking. Yep. So you've heard of that. If you're doing something like if you're doing something like writing a handwritten note, I've tried to do like, writing handwritten notes every day, which I've been successful at for a while. That is a little bit more involved. But what I could do is think about the night before who I want to write the note to find the address, get the envelope out, get the card out, get the pen out, get the stamp out and put it all out. So I'm actually see it and everything's not like hidden away in a drawer. So make things visible. So I think yeah, those are my best advice to find something that you like doing so it might not be a gratitude journal. Once you find it breaking down in the smallest component possible. So it's one word versus a list of 10 things and then finally have it stack you know, do Do it while you're doing something that you already do every single day anyway.
20:05
Got it? Yeah, much easier makes it much more digestible than like, well, I don't know if I can write the journal and then write the why. And gosh, take me 30 minutes. And do I have time for this? And yeah, so that makes a lot of sense. And I can also, I should also say, like, you can do it on your phone, too, like the notes section of your phone? Yeah. Yeah. You know. So that's, that's a possibility as well. So if you have like, a commute after work, where you're not driving, you can, you can like make that a habit at the end of your day to just throw something into your phone or something like that.
20:42
Yeah, I got one more. Yeah, it's similar to a gratitude journal to gratitude jar, which is huge. It's just take any jar. And you can just cut out slips of paper and just write down one thing that you're grateful for. Each day in the paper, maybe you have a family, and you get the whole family involved. And I like this idea. Because the jar can be visible. And it's fun. It's almost fun to watch the stacks of the slips of paper grow in the jar tilde, Giorgio stuffed, filled with gratitude, then you could pick a day, Thanksgiving Day, New Year's Day, maybe go and bring your family together, you sit in a room, on the sofa in the living room, and you go through like hay who said they were grateful for you know, chocolate, and then somebody raises their hand. That was me. And then you said, then you can go into more of the Hey, why did you pick chocolate? What is it about it? And then you can have these amazing conversations as a family. Or you could even do something like this at work as well.
21:50
Yeah, I was just thinking that if you have, you know, maybe a smaller to medium size, like a small company, or I know a lot of physical therapy offices. They don't have hundreds and hundreds of people in the same office. So this is something that's actually like, doable. You know, because I think if you had like, if you're in an office with like, 300, people, like it might be a little overwhelming. But most, I think healthcare offices, you know, if you have 20 people, I think that would be like quite a bit. So if you're in a smaller office, it's a great way to stay connected with your co workers. And another way of staying connected is and you'd mentioned this here, and there are handwritten notes. So how do you incorporate handwritten notes in the workplace? And are you only doing this if you're the boss?
22:44
Yes, I so handwritten notes I love it's how I started my company, say with gratitude, I, I had kids draw pictures. And I turned them into thank you cards that I sold to individuals and companies. But I love handwritten notes because it provides a connection point between you and the recipient of the note. So it's a way to not only appreciate somebody but actually connect to them on a deeper level. So whereas you know, writing in a gratitude journal, you might be the only one that sees that a handwritten note to people can see it or maybe even more in the workplace. You can use it a couple of different ways. One could be if you start to learn, who in your company likes words of affirmation, right, we talked about the five languages of appreciation. If you find out who likes words of affirmation, then you can make it a point to write a handwritten note to those people and know it doesn't need to only be the boss. I think if you're creating a culture of gratitude, I think everybody should be involved. If you're trying to figure out like, hey, I want to start this gratitude at work thing, not sure where to start, handwritten notes, I think can be a great place to start before you kind of fine tune your your appreciation, tools that you want to use. The kind of latest research shows from the authors of the five languages of appreciation and workplace that almost 50% of workers choose words of affirmation as their first way that they like to receive appreciation at work. So it's a great place to start. Of course also, you can easily write handwritten notes to your, your your patients to appreciate them. We talked about appreciating your customers patients, more is more than just a transaction, like make them feel good. And there's a company that I interviewed the HR had a few years ago, I love what they do every week, like once a week, they would, as a team, they would get together at lunchtime for about an hour. And they would write handwritten notes to their customers. And I liked it two reasons. One, they were expressing gratitude to their team, or excuse me, to their customers, but to they were bonding over the act of writing gratitude notes as a company. So just imagine there's a few people in a room, they're grabbing lunch, they're writing notes, they were being creative, they were putting stickers on the notes. And they were able to kind of chat with their the co workers on a level that they don't normally do, because they're normally just focused on work. So they got to know their team, on a deeper level, just having these conversations as they were writing note to their customers. So it could be a great way to, to bring your team together to just bonding over the act of writing handwritten notes.
26:02
And here's the question that I think a lot of business owners are going to want to know. And you may, you may have an idea of what I'm going to ask here. But what does this do for the bottom line of a company? So you're spending this time you're bringing in people from your company? How does does this improve the bottom line? Will this help the company make more money?
26:28
Yep. So that one statistic that I mentioned that 79% of people left a job because they didn't feel appreciated at work? Turnover finding new workers as a high cost of business for a company. So anyway, the Yeah, the the research is showing that. Doing things like infusing gratitude at work, appreciating your team, connecting with them on a more deeper level. So a lot of people feel disconnected at work, because they've got a lot of emotional stuff, you know, in their lives are overwhelmed or stressed. But when they get to work, they don't chat about any of that. So there's a lot of research now that shows workplace loneliness is high. Six, up to 61% of all US employees are lonely. So lonely workers and workers that don't feel appreciated, they're disengaged, they're not as productive. They're calling in sick, they're stress. They're thinking about leaving their job, or they're actually leaving their job. And connecting with a team and showing appreciation to your team can change all of I don't know that there's actually hard numbers that are out there yet, but just know that there are studies have shown there's productivity increases, turnover decreases, sick days decreased. So all of this leads to companies that can actually save more money.
28:10
Yeah, no, I understand that. Yeah, that makes sense. But I had to ask that question, you know, because people are going to be like, Well, this sounds great. But what's it gonna do? Yeah, it's
28:20
the biggest probably, you know, obstacle in doing something like this, because a lot of businesses are like, well, you know, I know if I spend, you know, $100 on Facebook ads, I'm gonna get this exactly. Yeah. Right, and $1 for dollar return. And for something that's more of a soft skill like this, you might not exactly have that data, but just know that there's a lot of money being lost due to low productivity and high turnover. Yeah. And with appreciation and connecting can really solve a lot of this. Yeah,
28:56
no, that makes perfect sense. And now, before we wrap things up, I want you to one more time. Yes. Do you mind repeating the five languages of appreciation in the workplace?
29:06
Yeah, the five languages of appreciation are words of affirmation. Quality time. So that's the second, the one that second most popular quality time. So two people basically, spending time together like you and I are acts of service. So that could be like helping somebody with a time sensitive project. Tangible gifts. So that could be somebody that actually likes to receive a gift. And that's how they like to be appreciated. The thing is, they're the best you can make the gift. It doesn't have to be expensive, but the more personal, you can make it the better. So a gift of a pair of socks with my cat's face on them is better than handing me a Starbucks gift card because somebody that knows I'd like my cats has done their homework and that would be a really meaningful gift to me. And then physical touches the last one That's not seen very much in the workplace that's like, you know, high five pat on the shoulder for obvious reasons. Yeah, yep. Yeah, that one is usually not somebody's primary way they like to receive appreciation. So the first four are the ones that most things, you need to focus on those four languages. Right,
30:19
right. And speaking of gifts, you actually have a free gift for our listeners. So it's gratitude. toolkit.com. Can you talk a little bit more about that?
30:28
Yeah, that's really a toolkit with a bunch of goodies. So what'd you get there? I wrote a book called The Grateful entrepreneur, which I know you mentioned in the intro, that you get a digital copy of that book, that's all about creating meaningful relationships at work. I've got something else that I created called the grateful deck, which is 120 questions to start meaningful conversations, great to use to start meetings at work to just get to know your team a little bit better. And then I've also got 47 ways to practice personal gratitude, and 29 ways to use gratitude to grow your business. So that's all in this all digital downloads in the gratitude toolkit.
31:15
Perfect. And that's awesome. So if you want to go a little bit deeper into what we've spoken about today, then you're going to want to check out that gratitude toolkit. And again, it's www dot gratitude toolkit. All one word.com. All right. So is there anything that we didn't touch upon that you want to hit on? Or is there something that you want the listeners to their big takeaway here?
31:43
Yeah, big takeaway, I think, is just to start now, do something, compliment somebody flash somebody a smile, do something different. If you want to go a little bit deeper than that, write a handwritten note. And do those three, do the three things that I talked about in the journal, do it for your note? Who do you appreciate? Why do you appreciate them? What would your life look like if they weren't in your life and read that note to them, it's even more powerful than just handed it to them is to read it to them, the connection will be amazing. And the one thing one thing that we didn't hit on, that's kind of near and dear to my heart. Do some of this unplugged. So don't you know if somebody is talking to you Don't be on your phones, pay attention to them. That's a form of gratitude, a form of connecting is just listening. So I if you want to start a gratitude practice, think about doing this, like write your note without like, put your phone in a different room, you'll be more engaged. And you're going to think more clearly. So yeah, that's a I think a good good takeaway for that for the audience. Yeah,
32:55
that's great. I love it. And now, I have one more question. It's a question I asked everyone. Okay. That's knowing where you are now in your life. And in your career? What advice would you give to your younger self?
33:07
Oh, that's a great question. Lots of advice. I could give my younger self. So I was thinking about this, I would say, and this is I was trying to think of what am I still working on? Because and there's a lot but I was I'm gonna go with don't take things personally. So good. Something I still work out. I don't think I'll ever be like completely perfect with that. But yeah, if I could give my younger self that advice. Because I do take things personally, I'm sensitive. If somebody you know, I could have 100 compliments, and one naysayer, and I'm focused on that naysayer, I think it's human nature. And I take it personally, but but I think like, we don't know, like, at least for me, personally, I know I'm doing good in the world. And I'm changing lives. And I need to not be sensitive and not read social media sometimes and take that own advice of unplugged right and just hanging out with the people that I love. And I know that love me and, and, and really, I think just continue to connect with other human beings in a meaningful way. Get rid of the technology. Don't let negative comments bring you down. Because then it can affect your day, your week thing that affects your performance at work that affects how you relate to your loved ones. And so yeah, so don't take things personally. Advice that I would give my younger self but I would also continue to take that in my older self.
34:54
Yeah, I love it. That's so good. And now where can people find you? Where can they connect with you,
34:59
too? your main website is saved with gratitude.com you can always email me Scott at Scott colby.com. And then even on Facebook, my most probably active social media platform at Scott Colby.
35:13
Perfect. And we'll have links to all of this over at the podcast at podcast at healthy, wealthy smart.com. So you can always hit up the podcast website, and one click will take you to all of Scott's info. So Scott, thank you so much for coming on the podcast and sharing with us how to have gratitude and how to infuse that into our workplace in our jobs. So thanks so much. Thank you, Karen. My pleasure. Anytime and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. Thanks for listening. And don't forget to leave us your questions and comments at podcast dot healthy, wealthy smart.com
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In this episode, Founder of Focus.CEO, David Wood, talks about his new book, Mouse in the Room: Because the Elephant isn't Alone.
Today, David talks about the importance of naming your mice, the hurdle of instant gratification and being unapologetically authentic. What does it mean to have 30% more courage?
Hear about the art of dealing with rejection, when not to follow your courage, and get David’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “A lot of us are putting on, unconsciously, an act for the world because we don’t want to get in trouble, and we don’t want to be uncomfortable, and we don’t want to make the other person uncomfortable, so we say what’s going to fit into a nice box.”
- “You can choose the discomfort of wearing a mask or the discomfort of telling the truth.”
- “If you don’t ask, you’re already starting with a no.”
- “Every time you name a mouse, it gives you a chance to increase your confidence and belief in yourself.”
- “You can have anything you want in life if you’re willing to ask 1000 people.” – Byron Katie
- “Start writing things down, knowing that you don’t have to do anything on those pieces of paper.”
- “You’re already doing things right. You got this far. You don’t need fixing.”
- “At times it’s going to get very hard. It might get so hard that you don’t know if you’re going to make it, but you do.”
More about David Wood
David is a former consulting actuary to Fortune 100 companies. He built the world’s largest coaching business, becoming #1 on Google for life coaching and coaching thousands of hours in 12 countries around the globe.
As well as helping others, David is no stranger to overcoming challenges himself, having survived a full collapse of his paraglider and a fractured spine, witnessing the death of his sister at age seven, anxiety and depression, and a national Gong Show! (https://www.youtube.com/watch?v=YgKwAJieQes).
He helps business owners and leaders become the badass leaders people want to follow, creating more authenticity, connection, confidence, and revenue.
Suggested Keywords
Healthy, Wealthy, Smart, Courage, Challenges, Confidence, Discomfort, Authenticity, Rejection, Persistence, Commitment, Awareness,
Get Your FREE Gift
Mouse in the Room Book.
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Website: https://focus.ceo
Twitter: @_focusceo
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Facebook: @extraordinaryfocus
YouTube: https://www.youtube.com/c/ExtraordinaryFocuswithDavidWood
LinkedIn: https://www.linkedin.com/in/focus-ceo
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Read the Full Transcript Here:
00:02
Hey, David, welcome to the podcast, I am happy to have you on to talk about, amongst other things, a new book release that's coming out today, which is for people not listening. Today is June 13. So we will definitely get to the book, and we'll get to a lot of other things. But thank you so much for coming on.
00:23
My pleasure. And it's nice to meet you.
00:25
Yeah, it's great to meet you as well. So I guess I let the cat out of the bag a little too quickly. We're gonna get to the book towards the end. But let's get to the book in the beginning. And at the end, how's that sound? Yeah, so tell us the name of the book. And I will hand the mic over to you to give us a little snippet.
00:42
Sure. And the I would have mentioned the book because it's going to fit in with the topics we want to talk about, like courage, and practicing deliberate discomfort. The books called the mouse in the room, because the elephant is not alone. And I'm writing this book, because we all know about that expression, the elephant in the room, you see it, I see it, no one's saying anything. Well, that's just weird. And I think we should all address the elephant in the room. But for most of us, many creatures in the room are much more subtle. They're not as huge as an elephant, maybe it's something that I see in you don't see it, or I don't know, if you see it. I think a lot of us are actually putting on unconsciously an act for the world, because we don't want to get in trouble. And we don't want to be uncomfortable. And we don't want to make the other person uncomfortable. So we say what's going to fit into a nice box. The problem is when we do that, we can feel disconnected from the world, we can feel more isolated, lonely. And people won't trust us as much, they won't know why. They'll just know something's off because this person isn't being real. So we're writing, we wrote mouse in the room, so that people can start to notice their mice and go all I'm actually upset about that. Or I have a desire I haven't mentioned or I have a confession mouse over here, or you know what, there's some appreciation I need to bring into this space here. When people identify their mice, and then artfully name them, so that they can come into more connection, more intimacy. And then through more trust, there's good business application to people are going to want to work with you and buy from you and, and follow you as a leader. They may not necessarily know why. But they'll be like, Oh, this person's real. This is someone I can count on. So there's the short version of mouse in the room.
02:37
Excellent. And maybe we'll get into a little bit of those mice later on. But before we get into that, as you were speaking, you had mentioned the word courage. And it I always think that it does take courage to speak your mind. And should we always be speaking our mind? And should we always be using our courage? So why don't you talk a little bit about how would you say 30% more courage? can double your happiness? We have a lot of people who are entrepreneurs who are listening, so we double your revenue. So what does that mean? Can you break it down?
03:14
Yeah. Something my co author said recently that stuck with me was, you can choose the discomfort of wearing a mask, or the discomfort of telling you truth. It's one or the other. And there's a lot more upside associated with one of those things. So I love the concept of courage I found as a kid, whenever I didn't do something that felt right be out of fear. I would like myself a little less. So if I didn't ask that girl out, or if I didn't confront that bully, or if I didn't stand up for myself, I would I just feel smaller. And it's an icky feeling. I don't want anyone to have that. Conversely, I discovered that when I am willing to take a risk and do something that's a little scary, even if I don't get the result that I wanted, I feel better about myself. It's like I went for it. An example of this I went to a conference where I was awestruck by the people that I was hanging out with there was like Jack Canfield from chicken soup and John Gray from Mars and Venus and Don Miguel Ruiz is a member and I'm like, Oh my God. And when I left the event, I look back on it and I realized I made four bold requests that terrified me. Like I asked Jack Canfield if you'd be interested in writing a book together. That was very scary. I figured he probably gets about 100 proposals a day for something like that. I asked someone if she wanted to go out with me and have our first date be a trip to Colombia. I asked an obstacle when Oscar winning producer if, like what it would take for me to do a ride along on his next film shoot. These were all scary things. Now. I didn't get a yes to Everything that I asked for, but I felt complete. I felt like yes, I went for it. They say if you I'm gonna butcher this quote it's, it's something about the trivial quote is, if you don't ask, you don't get you're already starting with a novel. That's the default answer. So I think it behooves us to find our edge like, what is our edge? Is it? If you're an entrepreneur? Is it asking a celebrity to endorse your product? Is it asking 10 people to be affiliate partners that that you think would never give you the time of day? Is it calling 10 people and asking them to become clients? Because you think you could serve them? I don't know where your edge is. But each listener needs to find their own edge, like what would feel uncomfortable and a little scary, but could have some great upside. And again, I'll say the main benefit is you get to feel better about yourself. And as a bonus, you may actually get some yeses, which might surprise you like, Oh, my God, someone said, yes. That's a bonus.
06:12
And do you feel like even if you fail, or even if you get these nose, or even if people don't give you the time of day? Does it help to boost your confidence? Because you're asking the question, and you're putting yourself out there?
06:28
I think it absolutely does. And this ties into the book really well. Because if you're going to name a mouse with someone, you're going to sit like that what I just mentioned at that conference with desire mice, I had like four desires. And so I named them, I felt better about myself, I felt more confident. And I actually got a yes, one of those four questions got me a yes. And was like, Oh, my God, that's really cool. So yeah, and what what we did have as a subtitle is, this is your pathway to connection, confidence, and becoming a badass leader that people want to follow. Because if you hide what you're tolerating, if you hide what you desire, if you hide what you're ashamed of, then those mice get to breed, and you get more and more of them. And that's where shame can really thrive. Whereas if you bring yourself to the world and say, Hey, this is who I am, every time you do that, every time you name a mouse, it gives you a chance to increase your confidence and belief in yourself. Because it's you. It's like, this is my desire. You don't want to grant that. Okay. Thanks. Hey, this is something that's bugging me. Can we change that? No. All right, gave it a shot. We want to get back to like that. That confidence of when we were five years old, for many of us, and we're able to just go for stuff and we hadn't been beaten down by life. And people get back in touch with what's going on inside and then artfully bring it. Now you brought up earlier on? Do we shall we name everything? No. If you go to someone's house, and it looks like a pigsty and you're uncomfortable there, maybe you suck it up for 20 minutes until you leave. And maybe they don't need to know that. Or maybe if you got a gift from someone, maybe you don't have to tell them. But hey, if they've given you that thing, three years in a row, it might be a kindness stood due to speak up. Well, in one of the chapters of the book, we give you a test to work out. Is this worth naming? Is this something that I should bring and could bring? And if yes, how will they artfully do it so that I'm unlikely to trigger a huge response in the other person? And they can be like, Oh, alright, I get where you're coming from. Yeah, let's, let's work that out.
08:49
And what do you say to people who may think well, okay, I can have the courage, I can ask all these questions. But I keep getting no, no, no, no, no, no, no. You know, is that going to kind of reinforce this? I don't want to say, lack of confidence, but maybe reinforce to people that oh, it's not worth it. I keep asking these questions. I keep getting nose and it reminds me of, let's say, actors or actresses who go out for parts because they get a lot of rejection. But they keep doing it. Right. So yeah, what do you say to those people who are like I've gotten enough nose and I don't want to get any more nose.
09:38
Did you know that eight months ago I started acting now and I started acting eight months ago and in three weeks I'm moving to Los Angeles to pursue acting so I know a bit about this by I have two answers two broad answers to this one is if you're getting it so you ask Katie says Byron, Katie says, you can have anything you want in life if you're willing to ask 1000 people. So I think there's real value in asking 1000 people. And if you ask 1000 people and get 1000 knows, there might be something wrong with the question. So that might be where some coaching can come in. It's like, how am I asking? And is there a way that I'm, am I selling the sizzle? And this am I like, you know, so there's two answers, and they're both true. You want to ask in a way that's enrolling. But be careful about getting attached to the outcome. This is what people collapse, and I got this from landmark education. A long time ago, people think it's one or the other, you can be committed to something, I am going to make this happen Martin Luther King, I'm going to free the slaves, Gandhi, I'm going to free India, you can be committed to something. Or you can be unattached, but you can't be both. And so as soon as they get committed to something, they think they have to get it. And if it's not coming straight away, or early on, there's a problem. And I'm going to collapse, I'm going to make it mean something about me. Landmark helped me distinguish the two is that there's commitment, and then there's attachment. And they're two separate things. What if you could be committed to something and how you show up every day is aligned with that? And yet you're unattached, or if the universe says yes. Now, that's a powerful place to stand.
11:44
Yeah. And that's something that, you know, I'm a physical therapist. So as a physical therapist, you know, I often tell younger therapists that you can't detach yourself to the outcomes of your patient. So you can't be judging your success as a therapist, wholly on the outcomes of your patients. Because sometimes people improve, and sometimes they don't, which may be wholly out of your control. But you have to show up and do the best you can based on the evidence that you have. So kind of the same line of thinking great.
12:22
It's a really good example. And I heard an expression recently that I decided to steal because it spoke so well to this. You know, a friend of mine said, Oh, well, it sounds like you're moving the ball further down the field. And I was like, I love that. Because that I can control. I can't control the goal. I can't control what other people say or do. I can't control if I make the sale. But I can move the ball further down the field, I can position it in the best possible way. And I can own Don't ask 500 or 1000 people. If, if, if they want to buy what I have. Recently, I decided to Oh, it's happening in acting all the time. Now, if I was attached to getting a yes to every audition, I'd have to give up after two days. Totally. But the way I'm reframing it for myself is those auditions are my performance that is my acting. And so I'm submitting to 100 plus things a week around the country, and most of them I know I'll never hear back from but I'm playing the long game. I'm playing the law of large numbers. And in the last eight months, I've had a yes to playing the lead in a local paid production of Dracula. I got a yes to doing two commercials that I got paid for six short films for them free to have them paid. Now I had to do a lot of auditioning and submitting because I don't have a lot of experience. And so some of its luck, is keep going until someone says oh, I like the look of you. Let's get that guy in. And when Jack Canfield came to my live event, he got up there and he spoke about the law of large numbers. You need to ask enough people now sure you ask 1000 people you get to know there's something about how you're asking. But don't give up after five or 10 or 50 100. Don't be like that kid in the playground. Say hey, do you want to ride on my tricycle? No. Okay. Hey, do you want to ride on my tricycle? No. Okay. Hey, do you want to ride on my tricycle? Be you that's what the books about like, express yourself. Express your desires. I think at some point someone's gonna be like, Oh, that sounds pretty cool. Yeah, I'll do it in you're like what? Really? I didn't think I get a yes. And then the next time you won't be as surprised and you are you'll hide the shock better.
15:00
Yeah, at some point that key fits the lock, right. And I also love kind of that concept of moving the ball down the field a little bit at a time. And I know for myself, I have always been like, well, it needs to happen. If it's not happening now, then it's never gonna happen. Or if it's not happening, the timeline, I perceive something to happen, then that means Oh, well, it's not going to happen. It's not for me, and I used to kind of tend to give up a little too easily. But now, I have come to the realization that, like you said, if you move the ball down the field a little bit at a time that it doesn't have to happen all at once. But as long as you're making forward progress, and you're working towards the goal, it'll happen. Because let's be honest, we're living in a now everything has to happen quickly, this social media, quick, quick, quick decisions. And if it doesn't, then we're losers.
15:54
And that's a problem for people who want to be successful. Because if there are any good rewards to doing something, let's suppose you're going to start a big business selling widgets. If there are any good rewards for their business, it's not going to be easy to do. Because if it's easy, then the first three people into the market are going to take all those rewards and, and it's going to be flooded by people doing the easy thing. And there'll be less rewards, the rewards are gone. Seth Godin wrote a wonderful book on this called the dip. And if you're not prepared for any kind of a dip, it might be hard to get any good rewards. Now, don't go overboard, you might not decide on brain surgery as a career. Because that's, that's a really big dip. But if you want to start a business, or go and get a better job, or switch careers, or find a life partner or something like that some of those things are going to have a dip to them. And it's good to just know that going in and say, All right, roughly, how long are we looking at? Like, if you're going to start any new business, if you do it well, and work hard, you're probably looking at at least three years to turn the corner and make a profit. Now, know that going in? And then have someone to remind you, when things look bleak, yeah, this is gonna take some time, you gotta keep going at it. I've been doing podcast interviews for three years now. I think I've done 300 interviews. And I think I might only just be starting to get some some traction and to get get known. And people like, oh, yeah, that guy from that, you know, from mouse in the room. And now I'm about to launch a book. And, you know, I'll do six months of beating the bushes, just Yes, a few days ago, I said, decided to reach out to my colleagues and thought leaders and influences. Some of those people are never going to get back to me. They're not even going to respond and give me the time of day because they're busy, or I'm not big enough on the totem pole. That takes something to reach out to all those people. I got to screw up my courage and be willing to be uncomfortable, and then put it out there. And then be surprised by who says yes. And who says no.
18:08
Yeah. And as we're talking about courage, are there times when maybe you shouldn't be following your courage? When are the times that that you say, hey, well, let's pull back for a second?
18:22
Great question. When I was growing up, and I realized I didn't like feeling small. I started leaning into my fears, and is a name for it. Apparently, it's so counter phobic. So if you're afraid of something, you lean into it, and that's my style. And that produced a lot of benefits and rewards and a lot of growth. But I didn't know when to say when I didn't know how far was too far. And you can traumatize yourself, you can burn out, you can push yourself too far. I would go into paragliding and hang gliding because I was afraid of heights. And I've had a couple of accidents and even had a slight compression fracture in my spine. Doing a couple of things that were out there. I was afraid of abandonment. So I thought well, let me see what open relationships is like in dating more than one person at once and see if I can conquer this fear. I found that I have limits my nervous system or my psyche has limits that I need to respect and be humble about. So I think it's about finding your sweet spot. You don't want to stay in the comfort zone your whole life it gets very uncomfortable over time. You need to find your edge but don't go way past it to the point where you might be like, you know killing yourself in a motorcycle accident or doing something completely reckless are going on national TV to speak if you haven't even spoken yet, like find your edge. There's a sweet spot for each person. Here's a wonderful exercise It's very practical, you grab a piece of paper, and right at the top of it, if I was fearless, the big capital I f, if I was fearless, what would I do? And you're gonna have one page for business and work. This is what I do. This is who I asked, this is what I go for I do a TED talk, I get to blah, blah, blah, blah, and then another page for personal. This might be what I'd say to my partner. This is what I might say to my kids, this is what I might ask for. This is what I might do, I might move to Brazil, I might go cross country and move to Los Angeles to start acting like whatever it is for you. Start writing things down knowing that you don't have to do anything on those pieces of paper. That's important. Because otherwise your mind might hide these things from you. You just want to find out what would be edgy. And then you don't have to do any of it. But you might like to circle two or three things that would be in the right at that edge like yep, that would be uncomfortable. And I think I'd feel proud that I did it. Do those, you can start with those and work your way up to the biggest stuff. Or if you like me do the scariest one first. And everything else is easier after that.
21:15
Right? Oh, that's a great exercise. I have it written down here. So I am going to do it. And it's almost like a way to open up your mind to more possibilities. Maybe things that you you you didn't think that didn't think you could ever even imagine doing but I like that you said listen, you don't have to do it. But let's write some stuff down. Just see what comes out of your mind. Because you never know. We start
21:40
with awareness. And it's the same with mouse naming with mouse in the room. You want to become aware of your mice? What are what is going on in your body? What are the confessions that might be looking? What are the desires that haven't been named? The tolerations. The appreciations, you want to become aware of these? Now you have a choice? Am I gonna name it? Well, let me go through the paint by numbers system in the book and oh, okay, yeah, I could do that. And then you're gonna name that mouse, there might be another one. You, you weigh it up, and you're like, alright, I can see the upside. There's also a downside. Like, if you committed a crime, you might be prosecuted, you might be arrested, you could do jail time, your if you if you cheated on your partner, and you decide to go and name a confession mouse, it could be consequences. So it's not for the faint of heart to tell your truth. And you don't have to name all of them. But the book will help you weigh it up and go, Alright, here's the upside. Here's the downside. And here's the downside. If I never seen anything, that's often what we don't address. And so then you can factor it and go, Alright, I think I'm just going to call call this person, we're going to have a chat about it. And we'll see what comes out of it. Even if it doesn't go well. Does that mean it was the wrong move? Just because the first round didn't go well? No. Maybe they need to have their reaction. And then you felt uncomfortable, and you have a bit of space? And then you might say, Hey, can I have a round two? I feel like I could have listened better. And I'd really like to work this out with you. Let's have another one. And then maybe you surprise yourself and you're like, Wow, I feel really close to that person. Now, if you really connected now we've got a great working relationship. Now for closer to my kid. Now I feel lighter. Because I'm being me in the world. That's what I want for people.
23:40
And can you give an example of maybe a mouse or two that you've named for yourself? Just so people have a better idea of like, what is he talking about? When you say saying name name, these mice are named this mouse? So can you give an example or two of maybe a mouse that you've named for yourself?
24:02
I'll give you an example of one from last night that I wish I had named earlier. And I kept it to myself for too long. I had a poker game, had some friends over and at one stage someone else arrived to the game and there's so much commotion and people getting up and noise and whatever. I got anxious. I had a panic feeling. And so, but I didn't say anything. I just tried to deal with it. I went outside I calmed down a little bit on my own. And then I had the resources to say hey, yeah, I got really activated. And I think I'm okay now but I could have said that in the moment. I said wow, really activate I'm gonna go outside for a little bit with someone come out with me. I could have said that. But I was a little bit too triggered to do it. That's, that's um that's what I would call a maybe a medium sized mouse. was pretty big in the moment effect in the moment was huge. We call them rodents of unusual size. For any Princess Bride fan.
25:07
I was just gonna say the RT R O SS. R Us is yes,
25:12
yeah, I'm just gonna restart my video because it went all fuzzy for a second. Then there were, you know, bigger ones that might have stayed with you for years, you might have had them for a long time, I was asked by one of my coaches to make a list of anyone I wouldn't want to pass on the street. Anyone I'd feel uncomfortable seeing or anyone I, I still harbored resentment for. And initially, I'm like, oh, there's no one. But as we dug in, you know, over time, I came up with a few people, and one of them was a bully from high school, like 20 years earlier, who had just really not treated me well and made fun of me. And we used to be friends. And the coach said, All right, call him. You know, we didn't have the terminology, name that mouse. But the coach was like, call him and clear it up. And I said, Hell, no. I'm not gonna call this guy after 20 years, he's gonna think I'm an idiot. And she said, and I'm going to translate it to this language. He said, basically, well, that's another mouse. So start with that. And I was like, oh, okay, I could do that. So I tracked down his number, and I called him and I said, I'm so worried you're gonna think I'm a complete idiot for calling you about this after 20 years? And he got curious. He said, Oh, well, what is it? What do you got? What's going on? I said, you always pushed me around and one off to me, and I tried to one up you, but you were better at it. And I really resented you, and I'm letting it go. You don't have to do anything. I just thought I'd let you know. And he said, the most mind blowing thing. This was the jerk. Like for 20 years, I'd been treating him as a jerk in my head. He said, Well, what could I say or do now to help you or us move forward? It just blew my mind. And if I can call him and call the girl who dumped me twice in high school, and call the guy who ran the company that I sued, to see if there are any ill feelings, and cold the person that I committed a crime against when I was younger, and I could have been prosecuted by saying, hey, it was me. And I'm sorry, can I make it right? I've done that twice. Actually, if I can do that, then just consider what could you do? It might be uncomfortable. And you don't have to do it without the paint by number system we outlined in the book that'll make it so much easier for you. But there are really beautiful things on the other side of that discomfort.
27:56
Right, so So these, these mice are the mouse that you name is just sort of this discomfort or this uneasy feeling that you've been harboring about topic XYZ or person XYZ, you naming it so that you can confront it and move past it.
28:13
Yeah, that might be a there might be a healing for me involved. Maybe the other person's got something going on it that you don't even know. I had my my brother was getting coached. And they gave him homework to call somebody and name a mouse. And he couldn't think of anyone and the coach. And the coach said to him, it doesn't matter how small it is just trust in the homework, go and do it. So he called a girl that he broken up with a year earlier, and said, Look, I just I don't know if you made it mean anything about you. But I want you to know, that was everything about me. I was not in a space to be in a relationship. And I really think you're awesome. And just in case you were thinking anything else. I wanted to let you know. And he said the impact on her was unbelievable. She started crying. And she said she'd been thinking that she was a loser because of that whole thing. And he came back to me and said, Look, I got no money. But that call was worth $10,000 to me. This and he was like 22 at the time. He's like that call was just unbelievable. So the upside of sharing your truth in an artful, ideally blameless way can be extraordinary. Everyone wants to be human. They want to be human and they want to open their heart That's my belief. That's my story. Now it's not going to happen every time you talk with people but even that boss that I called where i i sent a letter of demand and was threatening a lawsuit. We got chatting and he said all look back at the time. It didn't feel very good. I didn't Like, depart with the money, but that's water under the bridge. And I said, Well, how you doing? He told me we never had a personal conversation. He told me about his divorce and what was going on, I felt so close to that guy, I hung up the phone feel like we're buds now, all of it because I just called to say, is there any hard feelings from them? I'm hoping, hoping not. So it's it's a gateway courage in general. And I think particularly courage about the things where we have a bit of charge can be a gateway to connection, confidence, and being the badass leader that people want to follow.
30:37
I love it. And where can people find the book gets out today, which is again, yeah, June 13. In case you're listening to this on the 14th, through the 15th, or whenever,
30:48
or whenever, whenever, yeah, go to mouse in the room.com. And there'll be a link there for you to go to Amazon and get your book, we've got a special going. Special going, we're going to do the Kindle for like something crazy, like 99 cents, because we want to just do a best seller campaign. And so you could get the book for almost nothing, or pay for the you know, pay the 1295 or whatever, whatever for the book. But we'd love you to support the best seller campaign. And the way you can do that is get the book posted on social media that you got the book because it's good idea to have your friends naming mice with you. It's hard to do in isolation. But if your friends and the people around you are like, oh, yeah, this is what can I name a mouse with you? Oh, you got a mouse to name with me? Yeah, shoot. That's what I want for the world. And if you think it deserves a five star review, please leave one because that's what will help us climb in the rankings and hit that lovely bestseller title, which is really just an excuse to bring people together for a party.
31:53
Absolutely. And if people want to get in touch with you, if they have questions, maybe they want to work with you. They want to know how you know where you are in life, where can they find you?
32:05
Yeah, there's a contact form on my website. So mouse in the room.com, might even redirect you to my other website. But then you'll be able to see contact form, you can request coaching from me, I usually get on the phone with people and we see if, if we're a fit. And if it makes sense. If you're interested in mouse naming for your team, or your company, I'm particularly interested in that because we can start shifting the culture and have people sharing their desires and actually not letting things fester. I think it's wonderful for team building. And so you can reach out through the contact form about corporate trainings, or team team trainings.
32:45
Perfect. And before we wrap things up, is there anything that maybe we missed or that you want to really leave the listeners with?
32:56
You're already doing things, right? You got this far, you don't need fixing. And there can be a lot more connection in the world for each of us. And I found if you can just go through some of those scary places of discomfort and just screw up some courage. There are some beautiful things waiting on the other side. And I will, I could almost promise you that on your deathbed. You're not going to go I should have stayed quiet. You're going to say I'm glad I read that book. And I'm glad I spoke up my truth more and more often. And I went in that direction. That's how to live. We don't want to watch movies about people hiding their truth and staying small. We want to watch movies about people being themselves in the world. And that's what I want for the world. I think this is what can really heal the planet is people being more of themselves.
33:55
Awesome. And last question I asked everyone and that's knowing where you are today in your life and in your career. What advice would you give to your younger self?
34:10
At times, it's gonna get very hard. It might get so hard that you don't know if you're gonna make it. But you do you know, even because it's even though it seems like you just can't make it. You're stronger than you think. And you will find something new, you will learn a new way to cope. And then you'll go on and the universe is going to bring you something else. But try to remember when you're in the middle of it. Okay, it feels like life and death, but usually it isn't.
34:42
I love it. That is great advice. David, thank you so much for coming on to the podcast. I really appreciate it and again, everyone run out, get the book, get it on a Kindle, get it in and something in your hands if you can as well. The book is out today the mouse in the room. David, thank you so much for coming on.
35:03
Sure. I'd also say read it to your kids. You want your kids naming mice, you want to name mice with your kids. So, we didn't talk about parenting, but I think it's very as a chapter on on mouse naming for parents. So, thank you. I am excited and I appreciate the chance to talk about it.
35:20
Pleasure and everyone. Thanks so much for taking the time to listen. Get out there, start naming your mice and have and stay healthy, wealthy and smart.
In this episode, President and CEO of Sports andSpine Physical Therapy, Inc., Leon Anderson III, PT, MOMT, talks about AAPT.
Today, Leon talks about the history of AAPT, working with his father, and AAPT’s networking opportunities.
Hear about AAPT’s mission, encouraging minority students, and clinical research related to health conditions found within minority communities, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “We are still less than 3% of the profession.”
- “If you can expose a child and broaden their horizons, it gives them more options of what they can do and what they can be when they’re older.”
- “Just being associated with this network affords you such a wide array of opportunities and possibilities.”
- “We’re all connected, and we all need one another at some point.”
- “You won’t know what hits you until it hits you.”
More about Leon Anderson
Leon R. Anderson III, is a native of Cleveland, Ohio. He graduated from The Ohio State University Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was as a Systems Analyst/Summer Intern for his fathers company Centers for Rehabilitation, Inc. There he discovered a passion for patient care. Subsequently, he pursued a degree in Physical Therapy at the University of Connecticut. After graduating, Leon was selected for a two year manual therapy residency program earning a masters degree in Orthopedic Manual Therapy from the Ola Grimsby Institute.
Leon is president and CEO of Sports andSpine Physical Therapy, Inc. (SSPT) The company operates three clinics in the greater Cleveland area and one in Charlotte, NC. Leon was inspired by his pioneering father Leon Anderson Jr. who was considered a vanguard of the profession for over 40 years. SSPT’s company culture and core values of providing high quality rehabilitation services are a direct result of Leon’s life long tutelage by his father.
Leon is a charter member of the American Academy of Physical Therapy. He served as a Subject Matter Expert for the American Physical Therapy Association's Orthopedic Clinical Specialist Exam. He also served as an on-site reviewer of the Commission on Accreditation in Physical Therapy Education. (The accreditation agency for entry-level physical therapist and physical therapist assistant programs in the US and UK).
Suggested Keywords
Healthy, Wealthy, Smart, AAPT, Healthcare, Impact, Research, Opportunities, Mentorship, Equality, Connections, Education,
To learn more, follow Leon at:
Website: www.SportSpine.com
https://www.aaptnet.org
Twitter: @LA3OSUCONN
Instagram: @osuconn
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Read the Full Transcript Here:
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found chosen and get those five star reviews. Right now if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic whim. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net health.com forward slash Li TZY to sign up for your complimentary marketing audit today. Now on to today's episode Dr. Jenna cantor. Cantor is back and being the host with the most for this episode. And we are happy to welcome Leon Anderson the third he is a native of Cleveland, Ohio. He graduated from The Ohio State University's Fisher School of Business with a Bachelor of Science degree in Management Information Systems. His first job was a systems analyst summer intern for his father's company centers for rehabilitation. There he discovered a passion for patient care. Subsequently, he pursued a degree in physical therapy at the University of Connecticut. After graduating, he was selected for a two year manual therapy residency program earning a master's degree in orthopedic manual therapy from the OLA Grimsby Institute. Leon is President and CEO of sports and spine physical therapy. The company operates three clinics in the Greater Cleveland area and one in Charlotte, North Carolina. He was inspired by his pioneering father, Leon Anderson Jr, who was considered a vanguard of the profession for over 40 years. SSP tees company, culture and core values of providing high quality rehabilitation services are a direct result of Leon's lifelong tutelage by his father. He is a charter member of the American Academy of physical therapy. He serves as a subject matter expert for the American Physical Therapy Association's orthopedic clinical specialists specialist exam. He also serves as an onsite reviewer of the Commission on Accreditation, physical therapy, education. So today, they talk about a PT so the history of AAPT networking opportunities and how that branch of our profession that organization within our profession profession came about so big thank you to Leon and Jenna and everyone enjoyed today's episode.
03:15
Hello, Jenna Cantor here with healthy, wealthy and smart I am super excited and honored to be here with the Leon Anderson, who is a major leader in the physical therapy community. He is the president and CEO of sports and spine physical therapy and is also a charter member of AAA, PT, the American Academy of physical therapy. Thank you so much for agreeing to come on Leon.
03:42
Welcome. It's good to be here. Thank you, Jennifer offering this opportunity.
03:46
Oh my gosh, I've just And it's funny, right people, we still we came on, I learned that you were just in Barbados, and you have a bunch of patients there and you were vacationing, that's incredible, you are living a life. There's so many opportunities and you're living that right now. I love it.
04:03
Absolutely. There are opportunities all across the world when it comes to physiotherapy. It's known as physiotherapy in most parts of the world, and physical therapy here in the United States. But just in the islands, you know, there's just a huge huge opportunity to bring the kinds of things that we do here to that particular population, because of the all the different technologies and nuances and things that we have, you know, that we have here. So, I was in addition to enjoying the beach in the sand, I was also enjoying given our advice on how to become a more functional individual, and whatever Island or whatever society or community that you live in.
04:42
I love that. Thank you. Thank you for your service series. That's incredible. I love that. I wanted to bring you on today to actually talk about a PT specifically talk about the history how it became to be in everything So I would love to just start with your perspective specifically, and how it came into your life.
05:09
Well, I grew up with, you can say occupational inheritance. My father was the 16th person in Ohio to be licensed as a physical therapist. He was a vanguard in our profession. He held many, many, I guess positions, if you would say, locally, nationally, even internationally, he was one of the first African Americans to be on the board of directors for the AAPT. In fact, there is a, a room at our headquarters in Alexandria. That is the Black Heritage Room, and it's named after my father and one of his protegees, who's also my mentor, the late Dr. Linda Woodruff, who was just an amazing, amazing mentor, and my father, Leon Anderson, Jr. and since I'm the third, but if you rewind back to when he got started, a PT that started mainly the the PTS of color that were involved in the APTA just didn't feel that their needs were being met, you know, as it relates to our communities. And so there are a couple of different little groups, like blacks interested in physical therapy or charm, I can't remember right now exactly what the term acronym is, maybe I'll think about that. But there are different groups that they would meet at the eight PTA annual conferences. And at some point, I think it was 1989. It was at 1989. In September, in Chicago, about 90 individuals met and I was actually a student, myself, and also donna, donna, it was not a fun doll, then. Now it was done in green Howard, that we were both students at the time. And now these individuals got together and they decided they wanted to do something that was going to be specific for the African American community and meet the needs of those communities that are disadvantaged and poor. And so that's where, you know, it was born out of and we have so many, I mean, just a plethora of talented African American PTS, in academia, in private practice, in the hospital setting, and, you know, in the military, just in all of the different different settings, and very accomplished, very accomplished ones also, I mean, it's just amazing. The BB Clemens, the, I mean, the mayor McLeod's, the Robert Babs, there's just so many that so many people who, who contributed so much to this organization early on, and we've done just many, many, many things to help students and then help our community. So that's, you know, in I hate the Babylon, but that is a kind of how we were born born out of a need, that needs weren't being met by the large the large organization, the APTA.
08:08
Oh, my gosh, this is a nerdy question. Okay. The meeting was in Chicago, was it over pizza? You know,
08:17
believe it or not see. So once again, we have such an accomplished set of founders. It was at like a, a Hilton, or a Sheraton, a Sheraton Hotel, where we all met. And, you know, they used Robert's Rules of orders, it was extremely, extremely organized. But remember, for years prior, there were these little interest groups that would meet over pizza and over coffee and over tea and you know, different things for many years, at the different organizational meetings, whether it be the annual meeting, or the combined section, or what have you. So at that meeting, we actually they actually established, you know, a skeleton of what our current bylaws are for the AAPT right now, so it was a very, very, very industrial meeting. And productive meeting over that weekend back in September 1989.
09:12
Wow, that is so cool. I love it. It really was from the ground up. It just organically. It happened so organically. And it was a major need and it just grew. I love that. That is so cool. And your legacy. Oh, you probably carry it. That was so much pride. I love that for you with getting involved. So your dad's involved. Did you feel pressure at the beginning? Like how did that happen? Because your dad is just so prestigious? And is it doing so many things for the profession? How was that for you?
09:47
Well, believe it or not, my first degree is actually in computer science at a computer science degree from The Ohio State University. And what I found was that by my junior year I was doing some statistics statistical analysis where my father during the summertime didn't do my summer off. And I was at a, a facility for the mentally and physically challenged. And while I was, you know, doing fixing the computers and trying to network computers and things, I also was a transportation aide. And I will transfer the patients from their cottages, to the main Physical Therapy Center. And I found that I fell in love with patient care. Although I'm the nerdy, mathematical computer guy and logical guy in my head, I found it to be extremely satisfaction, I found a lot of satisfaction, I should say, in interacting with these patients. And that's why I fell in love with this therapy, my junior year when I was at Ohio State. So I decided I wasn't going to just throw those three years away, I went ahead and finished out my, my, my career there ha state. And luckily, because my parents said they were not going to pay for a second education, I had to do it on my own. Luckily, I got a scholarship and academic and leadership scholarship because I went to our house State, I was on a board of this organization, students together against apartheid. And I was a peer counselor, I won the black leadership award my senior year. So with those along with my GPA, I was eligible for a scholarship. And I ended up at University of Connecticut, you know, on scholarship, so that worked out great, I wouldn't say that I felt pressure, it's my father just wanted to always want me to do whatever I was I was good at and, and to be happy, and to whatever I did wanted me to be the best at what I did, and to strive for excellence. But once again, I fell in love with patient care that that that summer 19, I think was 1985. And I really haven't looked back,
11:47
I want to get into the mission statement of a PT, I'm going to read them in sections because so that way it can be discussed each part in more depth, although I think it's quite, quite easy to interpret. So the mission statement is the American Academy of physical therapy is a non not for profit organization whose mission is to provide relief to poor and disadvantaged African Americans and other minorities by and let's talk about this first one, promoting a new innovative programs in health promotion, health delivery systems and disease prevention. Would you mind just talking more on the importance of that?
12:26
Well, we just have so many different talented individuals who are in all these different aspects, whether it be neuro, whether it be neurotherapy, whether it be sports and mettam, sports, med Med, whether it be dealing with childhood, obesity, bottom line is, I think it was back in 2010 with the Department of Human Services, Office of Minority Health and Health Disparities disparities came out with all of their initiatives, and we partnered with them. And I think it was probably 20 or $30,000. Grant, but I'm not sure right now. But But the bottom line is, is we partnered with them, because we wanted to really make an impact in our community, as relates to the health care disparities. So whether it's talking about diabetes are having different hypertension, and different organizational would you call them community health fairs, or programs, we even had a program with the Patterson cow foundation that they supported for childhood obesity. Our goal is for our individual members in their communities to make an impact and partner with the organization at large and use us, you know, to help them make the impact in our community using our resources. And our net network.
13:54
Yeah, yeah. It's funny as talking right now, everything you're saying is great. My husband's musical theater and he's singing full out right now. So I just want to acknowledge it is what it is love him. And you know what life is a musical? Isn't that great? Next, encouraging minority students to pursue careers in allied health professions. Oh, can you talk about the need there?
14:17
And on that note, we'll take a quick break to hear from our sponsor and be right back. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's digital marketing solutions have the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration. Head over to net help.com forward slash Li TZY to sign up for your complimentary marketing audit.
14:59
Also keeps me there, I think that we are still less than 3% of the profession. And the goal is to really expose the minority students to the profession as early as we can. So whether that means are different individuals, whether we're at one of our conferences, when we do some of the community outreach, or just someone in their own community, that's exposing individuals by going to health fairs going to speak at the local professional, and career career days, we've had so many opportunities. In fact, my wife and I, in conjunction with the American Academy of physical therapy, we ran a program called Let's Talk About program that did just that it really expose the kids to different professions until to improving their life skills and to becoming excellent and just empowering them to awaken the genius within them. And once again, that was one of those organizations that partnered with the APTA and use the 501 C three, until we got our own 501 C three, but then continue to partner with them. Because the goal is, if you can expose a child and broaden their horizons, it just gives them more options, on what they what they can do and what they can be when they get older. And it makes it makes perfect sense that if you can see yourself doing something, then or someone like you doing something, it increases the possibility that you have in your own mind that you can actually do it yourself. So when you look at Barack Obama, you have you have no idea how many, you know, kids right now can think to themselves that wow, Brock Obama was president I can be president or rob Tillman, or Leon Anderson, is, you know, high in an organization, doing things to help our community, I can do that same thing, I can make that particular impact. We've also had
16:51
visual affirmations, literally, yes,
16:54
we absolutely. We've also had many educational opportunities to help with our students. And just making sure that once you get into PT school, that you pass the exams, we used to hold many of the exam prep courts of the exam, prep organizations and courses around the country.
17:19
That's great. Yeah, it's all there's so much opportunity in this. It's a big one. It's a big one. And no, this speaks to any, any, anybody would like who is black, or in a minority, this speaks to you right away. Absolutely. And if you are wondering apps, yes, definitely reach out to AAPT. This is, this is part of their mission. Next, and finally is performing clinical research directly related to health conditions found within minority communities.
17:49
Same thing as as before, we encourage our, our members, and our constituents and our stakeholders, to engage with the professional organizations and do their poster research. And, you know, to really see, you know, what it is that our community needs, because most of the research that's done is just is or has been done historically, has been on the typical, you know, American, which may be a five, seven, you know, 40 year old white male. So the key is, we really want to make sure that we get data that lets us know, you know, what is the optimal amount of vitamin D, for a African American and living in the, you know, the Bible Belt, you know, that has this particular type of, of exercise level. There, this particular type of diet, you know, so, over the years, we've had many of those posters and the different organizations, annual conferences, and also in Chicago, Diane Adams, Saulsbury. And Vinod Rosebery, who's who's actually mayor now, they, in conjunction with the AAPT had a phenomenal he was a kid's fitness health club at an actual health club, and they were able to, to glean data on the health of our community, as relates to our kids and how they interact with an actual exercise routine. And a, a place to go that's safe, and also informative, and getting them to where they need to be. It was just it was just phenomenal. It was it was a phenomenal organization, and a phenomenal, healthy place to go.
19:47
I'm so grateful you have this research as part of your mission. I teach people how to treat dancers PTS PTAs. And we had a group discussion, one I, where we, we I pulled research and tried to find research on dancers, black dancers might be, where's that research black female dancers. And there was, there was one and it had clear bias. But it did show a little bit that there needed to be a lot more investigation. And, and then it just it was like crickets, it was crickets, when I was searching on PubMed, trying to find studies, specifically on minority bodies with that purpose for comparative data. And we didn't have in the little time I did to gather, we started talking about vitamin D, like you just mentioned, not from me knowing to bring it up. But from another black physical therapist in the room and other other black PCs in the room. Honestly, that became a topic. And it wasn't from research, it was was just from personal experience is and it's just, yeah, we need we need this information to do better for humans. so badly.
21:09
It's funny that you say that, Jenny, because one of my protegees it's interesting, because in when you talk about the academy, one of the one of the things that I think we're really, really famous for is it's an it's an N. It's been unofficial for many, many years. But we have a navigation program that helps not only students get into the profession, and get into school and stay in school, and then in addition to that, pass the exam, once you get into the to the profession, and how do you even navigate the profession. So when you mentioned the dancers, I immediately thought of one of my previous employer, employees and that one of my previous students, her name is Shane, I know I'm messing up her last name. And I think she's married now. So I'm really messing up her maiden name, but it's ojo, Fatima, I believe anyway, she is the she is definitely the TCS, the top physical therapist with the L Navy dance troupe. I think she might even be the medical director right now, I'm not going to be sure about about it. She's actually the medical director, I know that they really lean on her big, big time. But she's somebody who, you know, absolutely should be should be out front, not only giving you the information that you might need for your Google, you know, search. But once again, she's there to let that young girl or guy, you know, who's interested in dance, know that, you know, not only not only can you be involved in the performance arts as a dancer, but also as a medical or healthcare professional, or navigation program. So I think that she was a patient of I mean, a student of mine, at least 12 years ago, but our communication has never waned. We even talked as recently as last month, about her career, where careers going in and also getting other younger physical therapists and other parts of the country hooked up with her because as when they travel, they need to use local services, local physical therapy services, and whether that means, you know, a practice that they can come into while they're in that city or if there is a opportunity for an intern in a particular city where they are to come and spend some time with him. So our navigation program is so wide and it's so varied. When you look at just my career alone. I had my father I had Dr. Linda Woodruff. I had Rob Tillman. I had Robert Babs, I had at least 10 or 15, close mentors, role models, advisors, who could help me navigate where it is that I wanted to be, whether it's whether we're on Capitol Hill, doing some lobbying for physical therapy codes, whether I'm dealing with Ohio State University and their football team, or, or whether we're talking about trying to have a Howard University accredited exam. I remember I met with the president of Howard University because I was on the commission for accreditation for physical therapy, education. And I was there for an accredited accrediting visit. And now one of the people who's come in under our navigation, Vanessa LeBlanc, she is now a captive reviewer. So the reach is so wide and so long, that, you know, just being being associated with this network affords you such a wide array of opportunities and possibilities.
24:40
Absolutely. I'm just more than this navigation program. People might be perked up going, what is this? What is this? So I'm going to use some outsider terms on this. So yes, this is a mentorship program, but it's different. And it's really about when you connect with AAPT in court I'm where I'm mixing it up or saying it wrong. So when you connect with AAPT, anyone to a PT is they have a very large network of people with different expertise and you get forwarded to the right person. It's not just within the, the heads of the organization, because, I mean, everybody's doing this volunteer why so not? They can't, they can't, I'll take on everyone. But then from there, you go to this huge web, imagine like, Charlotte's beautimous beautiful web that's extremely expanded and connects you to all the multiple people that would advise you and take you through your journey to really accomplish a lot. It's very cool. And, and, and naturally expanding like you just said, with your your student, how you're now connecting her with students, you know, or people who could use her help. I think it's very, very cool thing that AAPT has going on. Did I explain that correctly?
26:00
I think so. I think he did a good a good summary job. Because it's not a instone program, what it is is right, right, exactly the way the way you the way you explained it was very, very, very good.
26:12
Yes, score. This AAPT has, has been around since 1989, as Leon was saying, and is an organization either, too, if you want to get involved, please reach out to them. Volunteers are always welcomed, there's plenty of opportunity, as you can hear from the mission statement. And, yeah, anything else you want to add on AAPT? A topic that I have potentially looked over because this is a big organ, this organization is a big deal. And I don't want to miss anything?
26:45
Well, no, I think you hit on the major things, I will say go to the website, if you have questions, then, you know, go ahead and submit them through the through the website. It's just a, an organization that I think is just very much relevant and needed to make sure that our community continues to be relevant, and get what get what it needs. That to keep us moving forward and moving in the right direction, because we're all connected. And we all need one another at some point, you never know when you're going to need need someone I remember, there was a member that was I would say he would come to the or to the meetings maybe every other year or something like that. I'll leave him nameless. But when he came, and he was actually being attacked by the State Board for a reason, that was not necessarily his fault. But because we had so many members that were involved in academia and also involved in the state boards that were able to help them out. But once again, you don't know what you need a lot of times until you need it. So just be involved, I would say it'd be involved in your, in all the associations that you can get that are professional associations, because you can glean information from from from everyone. Just because you're a member of AAPT doesn't mean you should not be a member of a PTA or any other healthcare or allied health organization that you think you're a possible stakeholder. And so yeah, I think that it just really makes sense to stay connected to the professional organizations because you won't know what hit you until it hits you. So what you want to do is stay ahead of the paddles, which is one of the terms that we use in our business, there's always a paddle coming after us at every every every point where there's legislation, or COVID It doesn't matter what it is. So the key is to be as prepared as you possibly can for each panels that come and if you can somehow anticipate what a panel you know might be booked for comps and by doing that you can be up on the current legislation you can be up on the current trends in the professor because we become about you know the current pitfalls you know, and then you're much more likely to be a successful individual and happy with your professor. I love it.
29:08
Thank you so much for coming on. I appreciate it and definitely to get connected with anyone AAPT like you said check go to that website. Thank you so much for coming on. We absolutely appreciate you Take care everyone.
29:23
And a big thank you to Jenna and Leon for a wonderful episode. And of course thank you to our sponsor Net Health. So again if you are looking to get your clinic found online, increase your reputation and your referrals then dead net house Digital Marketing Solutions has the tools you need to beat the competition get found get chosen get those five star reviews. If you sign up now for a free marketing audit digital marketing solutions from Net Health will buy lunch for your office head over to net health.com forward slash li T zy to sign up for you a complimentary marketing audit today.
30:03
Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media
In this episode, Associate Professor and Associate Chair at the Department of Physical Therapy at the University of Delaware, Prof Karin Grävare Silbernagel, talks about her research into tendonopathy.
Today, Karin talks about her historical perspective on tendonopathy, the future of tendonopathy research, and her presentation at the WCSPT. Is pain really worrisome?
Hear about tendon loading, chasing the shiny new objects, creating expectations with patients, treating different kinds of tendons, and get her valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “If you just want zero pain, don’t do anything, but that’s really not what you want. You want to be able to move.”
- “Sometimes in our eagerness to do good, we get a little crazy.”
- “This is not a quick fix. This takes time.”
- “Just because it takes longer, does not mean a tendon has poor healing.”
- “Always have fun. If it’s not fun, it’s not worth doing.”
- “It’s a long life to work. Don’t hurry to get to the endpoint.”
More about Karin Grävare Silbernagel
Karin Grävare Silbernagel PT, ATC, PhD is an Associate Professor and Associate Chair at the Department of Physical Therapy, University of Delaware, Newark, DE, USA.
She is a clinical scientist with a strong record of mentoring clinical scientists (primary advisor for 10 PhD student – completed, and 8 current PhD students). Her expertise is in orthopaedics and musculoskeletal injury with a focus on tendon and ligament injury.
She has been a physical therapist for over 30 years and performed research for over 20 years. At University of Delaware, she is the principal investigator of the Delaware Tendon Research Group and the Delaware ACL Research Group. Her work has been directly integrated into the clinical guidelines for treatment of patients with tendon injuries. She has presented her research at numerous conferences and published in peer-reviewed journals (100+ published articles to date). She has also been invited to speak about her research at conferences nationally and internationally.
As the principal investigator of Tendon Research Group at the University of Delaware, she is working to advance understanding of tendon injuries and repair so that tailored treatments can be developed.
The Delaware Tendon Research Group is an interdisciplinary team focused on improving treatment outcomes for tendon injuries. Her research approach is to evaluate tendon health and recovery by quantifying tendon composition, structure, and mechanical properties, as well as patients’ impairments and symptoms.
Her research is funded by the NIH, Foundation for Physical Therapy, Swedish Research Council for Sport Science, and Swedish Research Council.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Tendonopathy, Pain, Injuries, Treatment, WCSPT, Education,
World Congress of Sports Physical Therapy
To learn more, follow Karin at:
Website: https://sites.udel.edu/kgs
https://www.udel.edu/academics/colleges/chs/departments/pt/faculty/karin-gravare-silbernagel
Twitter: @kgsilbernagel
@udtendongroup
Instagram: @udtendongroup
Facebook: Delaware Tendon Research Group
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Read the Full Transcript Here:
00:03
Hi, Karen, welcome to the podcast. I'm so happy to have you on and really excited to talk about tendinopathy research and treatment and clinical application. Super excited.
00:14
Thank you. I'm equally excited to be here to talk about my favorite topic.
00:18
Yeah. And later on, we will talk about, we'll give a little sneak peek to everyone about your topic. At the fourth World Congress is sport physical therapy in Denmark happening August 26, and 27th. So for those of you who want that fun sneak peek, you'll have to wait until the end of the interview for that. Because what we're going to start with is, I really want to know, the historical perspective of tendinopathy research and how it's been translated into the clinic. So us, as we spoke, before we went on 18 years ago, you wrote your thesis. And so you've got a really great vantage point to look back on, what what tendinopathy research was, where we're at. And then later on, maybe we'll talk about where you see it going. But I'll just hand the mic over to you. So you can kind of give us that historical perspective.
01:20
Thank you. And I think that, as we spoke about, too, I feel like I'm getting older because more and more my historical perspective kind of comes in. But I think it's important when I started as a physical therapist, so I started clinically in 1990. And when I started, we had in my courses and things you know, talked about muscle, you talked about ligament injuries, and all these things. And then the tendon was just this rope that went in between the muscle and the bone. And that was kind of it. And then when I started practicing, and I worked in Baltimore, and we worked a lot with with baseball players and things, and everybody had tendinitis was super undisciplined ages, tendinitis, Achilles tendinitis. So everybody had this inflammation in the tendon that we never really talked about. So okay, I felt like I was no dummy. I learned medical terminology. So I know itis was inflammation. So obviously, they had inflammation in this tendon, because that was the name was. So I thought our treatments then really, were treating the word. So we were really trying to rest because it was acute inflammation. We tried ice we did I onto freezes and fauna, for races, and they weren't allowed to load and all these kinds of things. And surprisingly, hopefully, some patients got better anyway. But that really sparked my interest into tendon in general, like, what is this? And then later on in the 1990s, that came up more and more research, Korean and Spanish started thinking about, you know, Achilles tendon would hurt more maybe when they were loaded, ie centrically and running, so maybe we need to train that and people are starting more thinking about how do we exercise and mostly maybe the lower extremity, tendon tendinitis. And then we had more research looking at if there was inflammatory components in the tendon. So if you took out cells and things too, there wasn't actually an acute inflammation. So this idea is maybe wasn't true. And that really opened the door for if it's not an acute inflammation, what do we do? So then in the late 1990s, beyond the curve is in Standish, it was another researcher knees and we're Tolman that looked at concentric versus eccentric loading. And then Hogan offense on in Sweden to started to have patients that were waiting to get surgery and he started like, okay, we're really going to load them, you know, we got a heavy load them, because maybe that's what they need, if not an acute inflammation, and started to see people get better if you actually load in them instead of resting them. At the same time we did our I started my PhD things, too, we started looking at, okay, should it be more overload, and we used our pain monitoring model versus the standard treatment that was, you know, circulation exercises, bilateral up and down, but not really trying to load it heavy. And what we started to see those exercise program that loaded more had better effect than the more like generic, protective things kind of things, too. So that's really when things started to change. Right. So I think the historical perspective is we didn't do anything. And we started to do things. And we had these huge jump in outcomes, which is brilliant. And our studies then was, you know, we were looking more at, you know, the Sylvan angle protocol, comprehensive, we use pain monitoring model to guide but also the loading and the exercises to kind of low beyond and not be worried about the pain because if the pain wasn't acute inflammation, maybe wasn't so worrisome, and loading the tendon was painful, but that was also the treatment. So we needed something to kind of understand how much could you really load. So we started with this exercises and being able to load and having kind of achieved this kind of change. I think that was really the the ultimate thing that happened in the late night. 90s, early 2000 And it was the combination of Korean and Spanish hooking out for some did we had programs and kind of moving that forward.
05:10
And there's something that you said in that? Well, a lot of what you said in there that I just want to pull out if we can. So, one thing that you just said is, is pain worrisome? And I think that's a really, really provocative question. Because if you ask the person living with the pain, yeah. And so how, as the therapist, if we're treating someone with a tendinopathy, let's say it's an Achilles tendinopathy, and the treatment induces pain, how do we communicate to the patient? That it's not as worrisome as you think it is?
05:53
Yeah, thank you for that question. And I think that's why the pain monitoring model that we've had, and really the pain monitoring model started with roll on to me who was my advisor, in patellofemoral. Pain, and that's when we applied it. And I think from the patellofemoral, pain, we kind of seen the same path, right? Just resting, it doesn't help you need to get strong. And then we will the tendons seems to be the same thing. And I think the pain monitoring model has been a lot of discussion is, you know, we go up to five is okay, and those things, to tell you the truth, I really don't care if it's five, or four, or whatever, I think it's that communication to the patient and communication that waiting for this pain to become zero, if that's the goal. And what I say to everybody was my lecture, and you might have heard that too, I'm like, Well, if that's the goal, I can tell the patient come in here, lie down on my nice little plants here in the office, you lie there, and I'm gonna go get a cup of coffee. And when I come back, you don't have any pain. So I've treated your pain, right. So I kind of start, I think, with the education. So the point is, if you just want zero pain, don't do anything. But that's really not what you want, you want to be able to move. So if you want to be able to move, you also need to get this tissue to tolerate more loading. And in order to do that, we actually need to load it. So we recover. So I spent a lot of time kind of explaining talking about this thing, so that there might be some pain when we're loading it, or without load, you're not getting anywhere. And what happened to a lot of people, they had some pain, the rest of it did last and they tried to do something a pain and they just D decline. And I talk a lot about hardening your tissues, right? This is loading, hardening of tissues. So the conversation is my goal with treatment is to increase the tolerance of your tissue over time, while keeping your pain level the same. So that's kind of the thing. So so your pain level, I'm fine with that you're not going to rupture, which is good thing to say for Achilles tendon rupture. That's like the big catastrophe. If that's not an issue, then we can follow it to and then we have the discussion. You know, above five, it's not good, or I don't know, you've seen Twitter, sometimes Twitter, that I use five, right? And I, I really don't care. I think the point is, there is a point of pain when pain goes from, it's uncomfortable to Ouch, I don't want it to be Ouch, I want it to be in five seems to be around in that round, right? And people can understand the difference in that. And it's, you know, you have the other conversation with the people that says, But I have really high pain tolerance. So this might not work for me. Well, you know, it's subjective. So I always tell them absolutely works even better for people like you. So, you know, sometimes maybe I'm a little silly, but that's. So I think that's kind of the point of really using it. So for me, the pain monitoring model is a way for discussing it and then using it. Some people feel like it's focusing too much on the pain, I actually think is does the opposite, right? Because it removes the worry. So I'm going to put a number on it. And it's just a number and everything else. And then we use training diary. So I use training diaries, you write down, you know, morning pain, worst, lowest everything else that you do. And then if I have three or four weeks, we can start comparing, and then people actually start seeing the numbers change with the activity, or the number stays the same. So I'm using it more of a of a descriptor, because if you just ask somebody you have pain, it's like they're gonna ask them what they did earlier. Right? And none of us remember, we don't remember how much pain was when we not painful. And so that's kind of how we using it in my description.
09:23
Yeah, I think thank you for that. I think that's great. And that also kind of answered my next question is how much load? How much can you load? How much load isn't? Is is enough? How much is too much? And I think you kind of answered that within that. But you want to expand on that a little bit or I feel Yeah, so I think
09:39
I think that's within the pain monitoring model too. Right? We're looking at that. But then you also have knowledge based on how the cells responds how the tendon response and I think that's where the next thing in the history perspective is now we're starting to see you know, which protocol is better. So now they're comparing Silvernail and offer zones or East centric loading, and it's all these. And really when you compare them, it's not that big of a difference. Right? The heavy slow resistance. I just say that you know who canal for some was in northern Sweden, he trained twice a day. I'm from Gothenburg and middle, we do once a day. And then you go down to Denmark, they did the three times a week for heavy slow, right? So Danish people are lazier than you know. But I think the point is, when you're looking at the data, actually, the outcomes are not that difference. You know, there might be some, you know, we can always argue that we're more satisfied with this. But when you're looking at the mechanical properties and things, you don't see that big of a difference anymore. And I think because I think you reached a saturation point, right? We've done no loading to loading now everybody does good. And I think for us as PTS now we're trying to manipulate more and more in that little realm, that for everybody, we might not see it when we do big studies comparing one group to the other, because I think we need to talk about individualized instead of precision rehabilitation and things too. So I think kind of that's where we're getting at. And they've been great studies coming on from unstuffy Agha Gordon Denmark from her thesis looking at moderate versus heavy and patellar tendon. And so I think that for the loading, you need to load them, you need to use the pain monitoring model, we need to do the progressive loading. But I as a PT would less worry about if I if you did two sets too little or five pounds to less, I think that's less of an issue.
11:29
Yeah. And when you said individual, I actually just wrote that down individualized care as you were speaking, because if all of the different protocols have basically the same outcome, then does it come down to what can the patient do, given the constraints of their life? Or their schedule? Or you know, their job? So do you have someone who can do something three times a day? Or do you have does this person might do better three times a week with heavy slow resistance, or, you know, it really depends on what the patient can do. Because the best protocol, I would assume is the one that patient is compliant with.
12:12
And I think you and I have been around way too long for this too, right? So because, you know, when you started, when you were at least when I started when I was young, right? You were so excited for every exercise. So I guess kept on adding to my poor patients like removing something No, no, that's a really good exercise. And you're adding. And what I'm getting to is that if I can get you to do something consistent with two or three exercises, I'm much better off giving you two or three exercises that you do consistently, than trying to think that I'm going to give you a ton of things. And I have patients now that are you know, they they come back, they come back every four or five weeks and see me or they send me an email and they do their exercise, because I told them to do for Achilles like bilateral three sets of 15. And then do unilateral three sets of 15. And do that for your rest of your life. Like you're brushing your teeth, and I'm like, you could probably go down to doing them less, or you can do heavier in the gym. And some people don't go to the gym, they don't want to do that. So you kind of modify it to kind of get some of the exercises there too. So I think that I think the biggest key is that you need to load you need to do things. And then instead of getting too hyped up for all the specifics, I think that's really where we're moving forward. And I had I had a lady that you know, recently with insertional tendinopathy that had been to the doctor been to all these other clinics, and there's thrown all these things on or didn't get better. And then it was massaging it. And it was like dry needling and the instrument assisted and those kinds of things to me, she was just getting worse. And I'm like, Well, I just think you should do these three exercises once a day. And she's doing and she's like, I'm walking. I'm not limping, you know. So sometimes in our eagerness to do good, I think we get a little crazy.
13:49
Yeah, and that brings me to the next thing I wanted to talk about. And it's sort of the shiny new object syndrome that a lot of people will get. And we spoke a little bit about this before going on the air. And I said a lot of it is sort of the theatrics around different kinds of shiny new objects. So how how would you address that to say younger clinicians? In you know, obviously talking about tendinopathy
14:14
Yeah, so I think that that one thing and it's still hard, I mean, I teach Doctor physical therapy students and then they go out and they completely forgot what I said. Right? So I think there's certain things everybody wants to go to clinical course and learn something more hands on and something more specific but I think that to me, the attitude is what we really try to teach them is like what tissue is that? How does that tissue respond right? To start understanding the underlying mechanisms because then you have then you have an understanding to build the other thing on instead of not having the understanding and just thinking that you doing things and then then you might be changing the shiny objects without thinking about the mechanism. So I'm very much a mechanism person in to try to think about why would we do it, but you all No need to realize that just putting the hand on somebody is very, very strong treatment effect. That's not, that's the same as listening to somebody and paying attention. And I have a colleague Now Greg Hicks has done finishing a trial looking at strengthening specifically for low back and an older in the control group who got hot, hot pack and massage as the placebo control. And they did really well too, right. So even we have mechanism, we should not be afraid of doing things that might help the patient in that sense. But we the explanations and things for what you're doing, you got to be really careful for right. And I think that I have a great effect on my patients, because I think I have a good program. We know what we're doing. I know it works. But I'm also not under estimating that if you can Google me, you're going to get better just by coming seeing me because he's going to assume that at least I know what I'm doing. So, you know, I utilize that effect too. So you just need to thinking about what we're doing. And I'm very scared of chasing the shiny objects for the wrong reason, because maybe that shiny object would be really good for a specific reason. And if we throw it on everything, we've lost, what is good for?
16:12
Yeah, if you beat me to it, I was just gonna say also people probably come to you knowing your background, and the work that you do. So they're coming in, like primed, like, this is she is the expert, I'm in the right hands. I know, this is gonna, you know, this is a person who's going to help me and that's a huge part of the rehab process is that trust that you have in the practitioner and that therapeutic relationship, but it also sounds like you're giving realistic expectations, and describing realistic expectations to your patients, which, again, takes time. And I know a lot of therapists like why only have a half an hour with them, how can I how can I spend 15 or 20 minutes talking to them? So what would you say to that kind of a comment?
17:02
Yeah, and I think that's another thing that happens over the years. Like, I feel like I do less and talk more, but that might be just my personality, too. But, but I think that that's without that understanding, when you start that therapeutic alliance or understanding why you're, as you're doing, you're not going to get anywhere. And patients and especially patients with tendon injuries and tendinopathies. I mean, it takes six months to a year, I tell them that right away, it takes six months a year, you can do what I say, I'm pretty sure you're gonna get really well, you might not be 100%, I'm gonna get you definitely to 80 or 90%. If you don't do what I say, we can meet here in a year again, it doesn't bother me. Right? So it's handy because I think when I was younger, I tried to take on the problem and I I'm handing it back right away. I'm like, doesn't bother me if he doesn't do don't do it, you know, you can just come back to understanding and I think the other part from from the young clinicians were tendon injuries is the biggest thing is, this is not a quick fix. This takes time. And what you see a lot with the younger clinicians or maybe younger, my younger self, too, is like your to do treatment for two, three weeks, and they're not there yet. And then you get worried. And when you get worried the patient get worried. And then you start changing things. And then then they get more worried because you don't seem like you know what you're doing right, you know, it's setting the expectations. This is what you're going to do. It's not any cool exercises, this is going to take time, and having the training diaries that I follow over time and they say, You know what, I don't think much of happening. I'm like, Well, you weren't here three months ago, you could only walk one mile, but the pain of five. And now you're jogging for miles. I'm like, I think that's a pretty good improvement. Right? So having those to kind of working on and I think that's really, really important.
18:45
Yeah, and my next question is, is are all tendons created equal? So we sort of alluded to an Achilles tendon and a patellar tendon or we can talk about, you know, a golfer's elbow or tennis elbow. So when we're talking about all these different tendons, are they all created equal? And can we kind of throw the same treatments at each one, regardless of the part of the body?
19:10
Yeah, so again, it's kind of the same thing that attendance is a tendon in certain tendons structures, right? But all tendons are meant to connect muscle to bone and allow for mobility and that help us however, the design of those tendons are also meant for what they're good for. Right? So the Achilles tendon is the biggest tendon in the body because it's generates a lot of force and helps us move it move. patellar tendon is a little bit different isn't big, but it also tries to help change the angle of force around the knees. So then we put a patella and so all of a sudden we have compression and tendons are not very good for compression. The rotator cuff is more of a flatter tendon, that has a lot of curvature and the compression there is a problem right? So the flatter tendon combines more. Spread the force versus around tendon they kill As tenderness and then you're thinking about tendons in the hand, right, they are really long and thin, to be able to manipulate the fingers really gently build up the force gently. So they have different functions. And soon as you have different function, the tendon has to be slightly designed differently, which makes if it's designed differently, the treatment or the loading might be needed to be very differently. So I think one of the biggest thing is a tendon is really good for tensile forces, but not a good for compression forces. So for example, the rotator cuff, when you're talking about these overload tears is usually an inferior kind of compression that slowly degenerates, a tear. And the Achilles tendon is nothing like that at all. It's a high load, that kind of happen because you pull it apart just like Play Doh, you pull it apart from two different ends, and it kind of can rupture. So I think those are really, really important. What we also see as the lower extremity tendons seem to respond fairly similar. They're not as high in central sensitization indexes and don't have those things versus differently when you're looking at upper extremity tended to So there are definitely differences. So you need to kind of thinking about the basics, that it's not probably an acute inflammation that we need to treat it and then you need to start thinking about what does this tendon do? Is it being compressed as a flat? What are the other structures? Right? So Achilles tendon, you know, that is Achilles tendon. The real problem is, it's right there. There's not much else. That's why I study it, because it's easy to study versus the rotator cuff. We talk less about rotator cuff tendinopathy. And we talk more about shoulder pain, right? More because we not so sure. Is it purely the tendon? That's the problem and other things
21:40
add a lot more structures around it than just the Achilles tendon. That can adjust the Achilles. Sorry, but yeah, yeah. Yeah. So the little, a little more complicated area of the body will say, yes, yeah. So, you know, I think it's great to sort of look at that historical perspective. And I love that you kind of talked about where we are now, where do you see research moving towards, in the tendinopathy? field?
22:12
So now we're getting little bit into what I'm going to talk about in Denmark, too. But I think, yes, so one of the big things that we're really working on, is that, okay, I felt like we kind of reached this point, we're doing really well with everybody. But again, you know, if you look at average, with a big group, we're still not 100% On average, right? Some people aren't 100% recovered, versus some people are not. And why is that and we can't manipulate the treatment anymore. I need to figure out who do I treat how right we've been there in other areas, too. So really, what we're doing in our in our research now is really trying to use various statistical models and larger group data to really first evaluate, we'll be starting to call a tendon health, I'm really proposing that tendinopathy might be more of a biological disease, more like you're talking about knee osteoarthritis, there used to be just wear and tear, and now it's a biological disease, I think tendinopathy need to be considered the same way. And the reason I say that is because it's not just that the tendons structure had changed, or that you have pain, there's so many other variables related to it, like you have personal factors too, like BMI or diabetes affects them in differently cholesterol do so you have the metabolic factors, you have the personal factors, right. And you have, you know, the fear factors, and all these kinds of things play a role. So we call that our tendon health model. We really started with function, structure, pain and symptom, psychosocial factors. And then I realized it was a person too. So we actually have personal factors. And based on that we're trying to figure out are there different? Because you can't, we can in clinic, you can treat every person in singular, right? But, but we need to also to have more of the precision health understand what we do in the health system understanding are the various groupings. So who should we treat how to be very efficient. And that's some of the research that we're working on now. It'd be looked at my PhD students try and handle and found like, we have different groups, we have what we call activity dominant, which might be the one so we see a lot of them, the runner's active, they don't have a lot of symptoms, they don't have a lot of deficits, tenant is not that bad. versus group that we've called structure dominant, that are heavier, they have really horrible looking tendon, that poor function. And then we have a group that we call psychosocial dominant, that maybe the worst are not the best, but they're people with higher fear, decreasing function, but the tendon might not be so bad. And when we started thinking about that, well, now you can understand maybe how you can treat them a little differently. And then we can start looking at how should we treat them based on looking at randomized controlled trials because from a researcher perspective, if I threw all of those in, and I do the same treatment, some of them might benefit a lot and some of them don't and then the treatment is seared out right. There is no difference. But then I lost Ask the benefit for the ones that might benefit and I lost learning from the ones that didn't benefit the needed something else.
25:07
Fascinating. And you're going to be talking about this in Denmark.
25:12
Absolutely. And we have new data, how it changes over time and all those kinds of things. Yeah, well
25:18
don't give it all away. Now. Will we want people to go to Denmark to see you present this live? Demo? Yeah. Yeah. I mean, it sounds fascinating. I love the idea of a tendon health structure. And I love how it's it is, seems to be evolving to be more about the whole person, not just someone with a tendon injury. Yeah. Right. Because like you said, it could be like, two people can have the same injury. It could be one could be a postmenopausal woman who has the same injury as a young 30 Something male runner, maybe they both have an Achilles tendinopathy. But are you going to treat them exactly the same?
26:01
Yeah. And I think that's when we need to start thinking about this, some of the programs are maybe the same, but how do you modify them? And what are the expectations? And then what are the other things that you can add on to that, to really make sure that we get more people up to 100%, and really try to focus on them. And as a researcher, sometimes those things get lost. And that makes that's concerning to me.
26:26
But I for one cannot wait to hear that talk in Denmark. Now. Before we start wrapping things up here, what advice maybe give three tips, if you want to give more or less whatever you want. But what would you give to what tips would you give to clinicians who are treating patients with tendinopathy? Injuries? I don't know if I want to say injuries, if that's quite the word, but diagnoses let's say, so what are your top tips?
26:59
So my top tip is to kind of think about what that it is the structure and that structure responds differently than muscle structure and bone structure to thinking about it from that from the tissue level when you're designing the treatment program. And I think the number one is tendon takes longer to recover than other tissues. So setting that expectations right away. I mean, it's a clear indication when you're looking at hamstring injuries, is it purely muscle or is it more proximal with a tendon is clearly evidence to show that it takes longer. So if you have that expectation and sitting down to explain, but just because it takes longer does not mean a tendon has poor healing, it has very adequate healing is just healing that takes a little longer. And sometimes I even explain that that is a good thing. Because a tendon can last you for a very long time. Like for marathon runners, the Achilles tendon rebounds you so you can run a whole marathon, if your muscle was doing that, you'd be fatigued way earlier, and you wouldn't be able to do it. So the low metabolism is beneficial. But this is the rehab, it's going to take your time. So that's one of my biggest thing and taking time to kind of thinking through that. The other piece of advice is do not panic. And my clinician in our clinic, they tell me back to others what I say because I always tell the patient right away, you're going to get better. This is going to take time, and you're going to have setbacks. And I want to tell clinicians that to the patients are going to have setbacks, they're going to come but don't panic when they have setbacks. You know, it just is what it is. And if you set the expectations right away, the patient's going to come in and have a setback. Now they're like, Yeah, I have my setback. But you told me I would eventually have it right? Instead of not expecting them because then we react on a dime, oh, they're worse today. What am I going to do? And what am I to change? Like, no, this is part of life that goes up, it goes down and moving. So I think those two things, and along with really using the pain monitoring model, and training diaries are my key things.
29:04
Great advice. And I love that do not panic, because they know when you're panicking, yes, right? The eye you know, they see it in your face. And like you said, you start throwing everything in the kitchen sink on there. And they're like, Well, wait a second, what just happened here? I thought you said I could just do this. But I always tell patients like this is not a linear journey. It's not like you're going up a roller coaster and it's going to be linear and perfect. Like it's going to go up, it's going to dip down, it's going to come up maybe dip down but not as much and then you're gonna go up again and you know, it's a little bit more of a squiggly line and that's okay. And people really do appreciate that because setting expectations is paramount. I always feel like if I do nothing else, if they hear nothing else, at least they have an idea of what to expect. So that it's not crazy. Just
29:59
And I think the training diary to me, I use it for any patient for anything, I think that was really key too, because that calms all of us down. Let's see, let's go back here five weeks, wherever we're at what you were doing. And then we can see the pattern. And I even had one person that gave me like an Excel spreadsheet, and a color coded the pain. And if you looked over like a year, you can see that red and orange decrease and the green was increased, you know what I mean? Those are the patterns that you want to see. And it's hard to see those in your daily life. So that's why I think that's really important.
30:32
Yeah, that is a dedicated patient. Yes,
30:35
I do. But yeah,
30:38
yes, well, right. Right. But well, this was great. Where can people find you? If they have questions? Maybe you're on social media? Where can people find you?
30:51
I am on social media at kg silver Nagel, I think I'm on Twitter, is the main one is that but I also run the Delaware tendon research group, and attend them on a ligament research group. So on Twitter, we also have the UD tendon group. We're also on Facebook, and we're also on Instagram. And I'm easily found the University of Delaware and Department of Physical Therapy to please feel free to reach out and connect with us, you know, on the social media and those kinds of things that we're doing. And I'm very excited to discuss these clinical things.
31:26
And if you don't mind, can we talk a little bit about the Delaware attending group because you guys have some projects that you're working on to do you want to tell the listeners about those projects? In case you know, you need recruiting or you need volunteers? So go ahead.
31:42
Yes, we always need volunteers. So we actually have we have a lot of ongoing studies, but one of the big ones that NIH funded right now is we're looking at comparing men and women with Achilles tendinopathy. So we're up to 145 recruited patients out of 200, we had a little dip around COVID. So we're actually providing treatment for anybody that is around the Delaware Philadelphia area, please feel free to reach out or send your patients. We're also have ACL studies ongoing. One of the big ones also been relating to tendon is looking at the recovery from patellar tendon grafts to see how they change over time, how does that tend to actually recover? And could that if the doesn't recover fully, can that explain some of the deficits that we do see their ACLs injuries to we're also hoping to soon start more of looking at insertional, Achilles tendinopathy, with treatments we have. And one study with shockwave treatment, we have studies that we're hoping to start now looking more at metabolic factors, and getting a little blood draws and those things. So we have on our website with all of those things going on. So if anybody's interested, please feel free to reach out or look at our website.
32:53
Perfect. And we'll have a link to that at podcast at healthy, wealthy smart.com under this episode, so one click and we'll take you right there. So before we end, I have one question. Question I asked everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self, and you can pick which ever age of your younger self you
33:14
would like. So I'm going to pick myself before I even went to PT school, because one of my mantras is to always have fun, and I will stick to that now. And I'll stick to that younger because if it's not fun, it's not worth doing, even if it's research and those things. So do anything that's fun. But I was did not want to go to school in Sweden, I wanted to do sports medicine wanted to go to the US. But I was very worried that if I didn't get in, when I was 20 that I wasn't going to go to PT school because it took four years and then I would be too old when I graduated before I was ready. So I wasn't going to go luckily I got in and I stayed on. So I think to to my younger self. It's a really long working life. So just keep on having fun and plugging along and learning more things. And I have taken the really long path to academia with the clinician for many years and doing those kinds of things. So that I'm happy for so I'm glad I got in and didn't say I wasn't going to do it. Because who cares if I was 2425?
34:14
Yeah, and that's so young. Yes, but isn't it funny when you're 1819 20? You're like, Oh, forget it. I'll be an old person by then 25 behind the eight ball when of course, now that were a little older, we can look back on that and be like, Oh my God. Yes. And
34:34
I mean, it's like it's, it's a long life to work. Don't hurry to get to the endpoint, right? Enjoy it get experienced during that time, because as I tell our students, I've had a lot of fun during my years and worked with sports workers, clinician travel, research, academia, you know, you got to have fun.
34:53
Absolutely. Well, and on that note, I want to thank you for coming on the podcast and having such a fun conversations. Well, thank you so much. And everyone, if you want to get a chance to see current speak live, then join us at the fourth World Congress, a sports physical therapy, it is in Denmark and August 26 and 27th of this year. And not only will you get to see speakers like yourself, but there's also going to be great networking, activity breaks, things like yoga, or running or walking tours, paddle paddleboarding, all sorts of fun stuff. So it's again, not going to be quite your average conference, and a lot of it is going to be clinically focused and clinically based. So I think that's really important. I think a lot of times people think, Oh, we go to these conferences, it's going to be researchers just talking about their research and how's that going to affect me clinically? Well, this conference is all about that. So I think, right? Absolutely agree. Yeah. So come join us in Denmark. Again, thank you so much for coming on. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Aalborg University Professor, Prof Michael Rathleff, talks about his role at the upcoming WCSPT.
Today, Michael talks about how he organized the congress, creating tools for clinicians to educate their patients, and his research on overuse injuries in adolescents. What are the barriers between the research and implementation in practice?
Hear about the mobile health industry, exciting events at the congress, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “The clinicians out there have a hard time both finding the evidence, appraising the evidence, and understanding [if it’s] good or bad science.”
- “There’s a lot a clinician can do outside of a one-on-one interaction with a patient.”
- “It’s our role to understand the needs of the individual patient, then make up something that really meets those needs.”
- “It’s okay to say no. You have to make sure to say yes to the right things.”
More about Michael Rathleff
Prof Michael Rathleff coordinates the musculoskeletal research program at the Research Unit for General Practice in Aalborg.
The research programme is cross-disciplinary and includes researchers with a background in general practice, rheumatology, orthopaedic surgery, physiotherapy, sports science, health economics and human‐centered informatics.
He is the head of the research group OptiYouth at the Research Unit for General Practice. Their aim is to improve the health and function of adolescents through research.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injuries, WCSPT, Education,
IFSPT Fourth World Congress of Sports Physical Therapy
To learn more, follow Michael at:
Website: https://vbn.aau.dk/en/persons/130816
Research: https://www.researchgate.net/profile/Michael-Rathleff
Twitter: @michaelrathleff
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Read the Full Transcript Here:
00:02
Hello, Professor Ratliff, thank you so much for coming on the podcast today to talk a little bit more about your role at the fourth World Congress is sports, physical therapy in Denmark, August 26, to the 27th. So, as we were talking, before we went on the air, we were saying, man, you're wearing a bunch of hats during this Congress, one of which is part of the organizing committee. So my first question to you is, as a member of the Organising Committee, what were your goals? And what are you hoping to achieve with this Congress?
00:35
I think my role is primarily within the scientific committee. And one of the things we discussed very, very early on was this, like, you know, when you go for a conference, you go up to a conference, you hear a bunch of interesting talks, and you feel like, I'm motivated, I'm listening, I'm taking in new things. But then Monday morning, when you see the next patient, it's not always that all the interesting stuff that you saw, is actually applicable to my patient Monday morning. So we wanted to try and emphasize more. How can we use this conference as a way to translate science into practice? So the whole program and the like, the presentations will be more about clinical applicability, and less about more p values and research methodology. So not that the research is not sound, but there'll be more focused on how can we actually apply it in the context that were working. That's why also, we had the main title of translating research into practice, which I think will be hopefully a cornerstone that people will see, well, if there's really interesting talk about, it could be overuse injuries in kids, which will be a lecture that I'm having, then they'll also be a practical workshop afterwards to kind of use that what's been presented, and then really drill down on how we can use it in in clinical practice. So the goal is to, to get people to reflect in your network, but also take a lot of the things and think, Wow, this is something that I can use next Monday for clinical practice.
02:09
And aside from a lot of lectures and talks, you've also got in informatics competition. And so could you explain that a little bit and why you decided to bring that into the Congress?
02:23
Yeah, so this was a major, not a debate, but an interesting discussion on how we can even in the early phases of the conference, when people submit an abstract, make sure that the abstract can actually also reach more end users target audiences for that case. So we decided that people actually had to submit an infographic together with their the abstract. So normally, you send in like, 250 words, for a conference, but for this conference, we wanted them to submit the abstract, but also the visual infographic to go along with Olympic Well, am I making an infographic that is tailored to patient? Is that a patient aid that I'm trying to make? Is it something that's aimed but other researchers? Or is it clinicians, so they have to tick off? Which box Am I infographic actually intended for? So when the audience or the participants come and join the conference, they can actually take these infographics for those that want to print them they can use in the clinic afterwards, just another layer of trying to make some of this research more easily communicated to the audience, but also, the things that can be used in clinical practice, like some of the people have submitted abstract, have some really, really nice infographics that I expect will be printed and hang on, on a few clinic doors around the world afterwards, I hope.
03:48
And when it comes to dissemination of research and information from the clinician, to the patient, or even to the wider public, where do you think clinicians and researchers get stuck? Like where is the disconnect between that dissemination of information as we the information as we see, and by the time it gets to the consumer or to let's say, a mass media outlet? It's like, what happened?
04:15
Yeah, that's a big a big question. Because it's almost like why are we not better at implementing new research into our clinical practice? And I think there's heaps of different barriers. We've we've done a couple of studies, something new was also in the pipeline where we look specific, get the official context, and we can see that this barriers in terms of understanding the research, that's actually one of the major barriers that the clinicians out there have a really hard time both finding the evidence, appraising the evidence, and also actually understanding is this good or bad science. And then you have the whole time constraints on a clinical practice because who's going to pay you to sit and use two hours On reading this paper, and remember, this is just one paper on ACL injuries. But in my clinical practice, I see a gazillion different different things. So how am I going to keep up with the with the evidence? Is it intended that I'm reading original literature? Or how am I going to keep up with it? So I think there's a lot of different barriers. But at least one of the ways I think we can overcome some of these barriers is that researchers climb out of the ivory tower and think of other ways that we can communicate, research, evidence synthesis, it could be infographics, it could be sort of like decision age for clinical practice, at least that's one of the routes we're taking in terms of also the talk I'm giving at the conference that we're trying to think of, Can we somehow develop AIDS that will support clinical practice something that scene but the physiotherapist something that's aimed at the patient, that will sort of make it easier to deliver evidence based practice? So we've done one, one tool that's being developed at the moment is called the Makhni, which is something that can assist clinicians in the diagnosis, the communication of how do you communicate to kids about chronic knee pain? How do I make sure that they have the right expectation for what my management can be? And how can we engage in a shared decision making process. And we have a few other things in the pipeline as well, where we want to, to build something, build something practical that you can take in use in clinical practice to to support you in delivering good quality care, because just publishing papers is not going to change clinical practice, I think,
06:45
yeah, and publishing papers, which are sometimes wonderful papers. But if they're not getting out to the clinicians, they're certainly not going to get out to the patients and to people, sort of the mass population.
07:02
I completely agree. It's a bigger discussion, I'm really focused on how to reach clinicians, because I see the clinicians as the entry point to delivering care to patients and parents and, and the surrounding surrounding community. But if you think of, like wider public health interventions, we have the same problem as well. And also we create this sort of like, No, this inequality in healthcare, but that's another
07:30
line, although there can of worms. Yeah, we could do a whole series of podcasts on that. Yeah, yeah. And I agree with you that it needs to come from the clinician. So creating these tools to help clinicians better educate their patients, which in turn really becomes their community. Because there's a lot a clinician can do outside of just a one on one interaction with the patient. And so having the right tools can make a big difference.
07:58
Like in, if you look at a patient that comes to you for an ACL injury, or long standing musculoskeletal complaint, they're going to spend maybe 0.1% of their time together with you and 99.9%, they're out on their own. And I think it's important that we when we're one on one with them, sort of like make them develop the competencies so they can do the right decisions for their health in the 99.9% of the time that they're out there alone, when they're not with with us, I completely agree with you that there's a lot of things we can do to make them more competent in thriving despite of knee pain, or shoulder pain or whatever it might, it might be. And I think that's one of the most important tasks, I think, for us as clinicians is to think about the everyday lives they have to live when they leave us and say see you next time.
08:51
Yeah, and to be able to clearly communicate whatever their diagnosis by might be, or exercise program or, or any number of, of 10s of 1000s of bio psychosocial impacts that are happening with this person. Because oftentimes, and I know I've been guilty of this in the past, I'm sure other therapists would agree that they've this has happened to them as well as you explain everything to the patient, and then they come back and it's, they got nothing zero. And it might be because you're not disseminating the information to them in a way that's helpful for them or in a way that's conducive with their learning style. So having different tools, like you said, maybe it's an infographic that the patient can look at and be like, Oh, I get it now. So having a lot of variety makes a huge difference.
09:48
And I think you touched on a super important point there that patients are very different, that they have different learning styles, they have different needs. And I think it's our role to enlist Send the needs of the individual patient and make up something that really meets those needs. So more about listening, asking questions and less about thinking that we have the solution to it, because I think within musculoskeletal health or care, whatever we call it, some clinicians would use their words to communicate a message that might be good for some other patients would prefer to have a folder or leaflet. Others would say, I want a phone, I want an app on my phone, something that's like learning on demand, because at least that's something we see regularly. Now that we have the older population that wants a piece of paper, we have the younger population that wants to have something that they can sort of like, rely on when they're out there on their own one advice on how do I manage this challenging situation to get some good advice when you're not there? When I'm all on my own? So, so different?
10:57
Yeah, and I love those examples. I use apps quite frequently. And I had a patient just the other day say, Oh, my husband put this, the app that that you use, because I was giving her PDFs, and she's like, Oh, my husband put the app on my phone. Now it's so much easier. So now I know exactly what to do if I have five minutes in my day. So it just depends.
11:21
And I think the whole like mobile health industry, there's a lot of potential there. But I also see, at least from a Danish context, that there's a lot of apps that is very limited. It's not not developed on a sound evidence base, or it's just sort of like a container of videos with exercises. And I think there's a huge potential in like thinking of how can we do more with this? How can we make sure that it's not just the delivery vehicle for a new exercise, but it's actually the delivery vehicle for improving the competencies for self management for individuals? I think there's, yeah, I'm looking forward to the next few years to see how this whole field develops. Because I think there's really big potential in this.
12:12
Yeah, not like you're not doing enough already. But you know, maybe you've just got your next project now. Like, you're not busy enough already. So as we, as you alluded to a few minutes ago, you've got a couple of different talks you're chairing, so you've got a lot going on at the World Congress. So do you want to break down, give maybe a little sneak peek, you don't have to give it all away, we want people to go to the conference to listen to your talks. But if you want to break down, maybe take a one or two of your topics that you'll be speaking on, and I give us a sneak peek.
12:48
I think the talk that will be most interesting for me to deliver and hopefully also to listen to is is the talk that I'm giving on overuse injuries in adolescence, because I think it's we haven't had a lot of like conferences in the past couple of years. So it will be one of these talks will be meaty in terms of of new date, and some of the things I'm most interested go out and present is all the qualitative research we've done on understanding adolescents and their parents, in terms of what are the challenges they experience? How can we help them and also, we've done a lot of qualitative works on what are the challenges that face us experience when dealing with kids with long standing pain complaints, we've developed some new tools that can sort of like, help this process to improve care for these young people. And I really look forward trying to Yeah, to hear what people think of, of our ideas and, and the practical tools that we've that we've developed. So that's at least one of the talks, that's going to be quite interesting, hopefully, also, we're going to actually have the data from our 10 year follow up of so I have a cohort that I started during my PhD. They were like 504 kids with with knee pain. And now I follow them prospectively for 10 years. And this time period, I've gotten a bit more gray hair and gray beard. But this wealth of data that comes from following more than 500 kids for 10 years with chronic knee pain is going to be really, really interesting. And we're going to be finished with that. So I'm also giving a sneak peek on unpublished data on the long term prognosis of adolescent knee pain and at the conference. So that's going to be the world premiere for for that big data set as well.
14:36
Amazing. And as you're talking about going through some of the qualitative research that you've done, and you had mentioned, there were some challenges from the physio side and from the child side in the patient and the child's parents side. Can you give us maybe one challenge that kind of stuck out to you that was like, boy, this is really a challenge that is maybe one of the biggest impediments in working with this population.
15:06
I think I think there's multiple one thing that I'm really interested in these in this moment is the whole level of like diagnostic uncertainty and kids, because one of the things we've understood is that if the kids and the parents don't really understand why they have knee pain, what's the name of the knee pain, it becomes this cause of them seeking care around the healthcare system on who can actually help me who can explain my pain. So so at the moment, we're trying to do a lot of things on how we can reduce this, what would you call diagnostic uncertainty and provide credible explanations to the kids and then trying to develop credible explanation for both kids and parents? That's actually not an easy task, because what is a credible explanation of what Patellofemoral Pain is when we don't have a good understanding of the underlying pathophysiology? So there, we're doing a lot of work on combining both clinical expertise, what the patient needs, what we know from the literature, and then we're trying to solve, iterate and test these credible explanations with the kids. And yeah, at the conference, we'll have the first draft of these, what we call credible explanation. So that's going to be at least one barrier one challenge, I hope that some of the practical tools we've developed can actually help
16:25
i for 1am, looking forward to that, because there is it is so challenging when you're working with children, adolescents, and their parents who are sort of call it doctor shopping, you know, where you're, like you said, you're going around to multiple different practitioners, just with their fingers crossed, hoping that someone can explain why their child is in pain or not performing are not able to, you know, be a part of their peer group or, or or engage in what normal kids would would generally do. Exactly. Yeah. Oh, I'm definitely looking forward to that. So what give us one other sneak peek? Because I know you've got the, you're also chairing a talk on the first day. But what else I shouldn't say I don't want to put words in your mouth. What else? Are you looking forward to even maybe if it's not your talk, are you looking forward to maybe some other presentations,
17:26
I'm actually looking forward to to the competitions we have as well, because I've had a sneak peek of some of the research that's been submitted as abstracts, and the quality is super high. So both the oral presentations but also the presentation that the best infographics because they'll also get time to actually rip on the big screen and present their infographic. And I look forward to see how people can communicate the messages from these amazing infographics. And I think these two competitions are going to be to be a blast and going to be really, really fun to, to look at. And amazing research as well. So I really look forward to the two events as well. And then of course, oh no, go ahead. No, I was just talking about look forward to meeting with friends and new friends and be out talking to people once again in beautiful new ball in Denmark in the middle of summer. It's hard to be Denmark in the summer. We don't have a lot of good weather, but Denmark in August is just brilliant.
18:31
Yes, I've only been there in February. So I am definitely looking forward to to Denmark and August as well. Because I've only been there for sports Congress when it's a little chilly and a little damp. So summer sounds just perfect. And I've one more question. Just kind of piggybacking off of your comments on the amazing research within these competitions. And since you know you have been in the research field, let's say for a decade plus right getting your PhD a decade ago. How have you seen physio research change and morph over the past decade? Have you seen just it better research coming from specifically from the physio world?
19:20
I think it's the first time someone said it's actually more than a decade. So, but that gives me a time perspective. But yeah, I've actually seen that. My perception is that physiotherapy research in general but also sports physiotherapy research went from being published in smaller journals we published in our own journals to now there's multiple example of sport fishers performing really, really nice trials that have reached the best medical journals that have informed clinical practice. So I think we see this both there's more good research Basically out there. And I also see that we've moved from, like a biomechanical paradigm to being more user a patient center, we see more qualitative research, we see that physiotherapist, sport physiotherapist, they sort of have a larger breadth of different research designs, they used to tackle the research. I think, like looking even at the ACL injuries, if you go back 10 years in time, looking at the very biomechanically oriented research that was primarily also joined by orthopedic surgeons to a large extent. Now, today where fishers have done amazing research, they understand all the the fear of reentry, they're trying to do very broad rehabilitation programs, ensuring that people don't return to sport too rapidly. And and also understanding why they shouldn't return back to his board now developing tools that you can use when you sit with a patient to try and and educate them on what are the phases, we need to go through the next nine to 12 months before you can return to sport and so on. So I think I'm just impressed by, by the research. And when I see the even the younger people in my group now, they start at a completely different level when they start their PhD compared to what we did. So I can only imagine that the quality is going to improve over the years as well, because they're much more talented, they're still hard working. And they have a larger evidence base to sort of like stand on. And they already from the beginning, see the benefit of these interdisciplinary collaborations with the whole medical field and who else is is relevant to include in these collaborations? So yeah, the future is bright. I see. Yeah,
21:50
I would agree with that. And now as we kind of start to wrap things up here, where can people find you? So websites, social media, tell the people where you're at.
22:04
So I think if you just type in my name on Google, there'll be a university profile at the very top where you can see all my contact information. Otherwise, just feel free to reach out on LinkedIn or Twitter, search for my name. And you'll find me, I try to be quite rapid and respond to the direct messages when, when possible, at least
22:25
perfect. And we'll have all the links to that in the show notes at podcast at healthy, wealthy smart.com. So you can just go there, click on it'll take you right to all of your links. So is there anything that you want to kind of leave the listeners with when it comes to the world congresses, sports physiotherapy or physical therapy, sorry.
22:52
Be careful not to miss it, it's going to be one of these conferences with a magical blend of practical application of signs, it's going to be a terrific program in terms of possibilities to to network and engage in physical activity, whatever it's running, or mountain biking, and with an amazing conference dinner as well. So I think it's, so this would come to be one of one of the highlights for me this year. So and I think the whole atmosphere around this conference is also that if you come there, as a clinician, you don't know anybody, that people will be open and welcoming and happy to engage in conversation. There's no speakers, that wouldn't be super happy to grab a beer or walk to discuss some of the ideas that's been presented at the conference. So I think it's going to be quite, quite good.
23:45
Yeah. So come with an open mind come with a lot of questions and come with your workout clothes. Is is what I'm hearing?
23:56
Yes, definitely. Definitely.
23:59
And final question, and it's one that I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self, and you can pick whatever time period your younger self is.
24:13
So I think in if I had to give myself one advice when I was in my sort of like, MIT Ph. D, time coming towards the end, I would say to myself, that it's okay to say no, you have to make sure to say yes to the right things because it's very easy to say yes to everything. And then you create these peak stress periods for yourself that would prohibit you from from doing things that is value being with friends or family and so on. You don't have to say yes to everything because there will be multiple opportunities afterwards. So practice in saying no and do it in a in a polite way. People actually have a lot of respect for people that say, No, I don't have a time or I'm I'm going to invest my time on this because this is what I really think is going to change the field. And this is my vision. So So young Michael, please please practice in saying no.
25:11
I love that advice. Thank you so much. So Michael, thank you so much for coming on the podcast. And again, just a reminder, I know we've said this before, but the World Congress is sports, physical therapy, we'll be in Denmark, August 26 and 27th of this year 2022. So thank you so much for coming on the podcast and thank you for all of your hard work and getting making this conference the best it can be.
25:36
Thank you, Karen, thank you for the invitation to the podcast.
25:39
Absolutely. And everyone. Thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Owner of Access Physical Therapy, Clarence Holmes, Jr, talks about generational differences in physical therapy.
Today, Clarence talks about burnout, the idea of value, and the different ideas of pay structure. Why is the measurement of productivity problematic?
Hear about the promise of mentorship for lower pay, the problem of toxic positivity, and finding the better way in each new generation, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “The reason why things are fluid and changing with every generation is because there’s always a better way.”
- “We have to be open to that better way.”
- “No one loves PTs as much as PTs love PTs.”
- “It is so heathy to have a full well-rounded conversation that points out the bad and the good, and you don’t have to finish with a positive statement in a conversation.”
- “Get comfortable with being uncomfortable.”
- “It’s become an expectation in this country to overwork.”
More about Clarence Holmes, Jr
Dr Clarence Holmes, Jr is a native of Cleveland MS. He attended Mississippi State University for his undergraduate studies and received his Doctor of Physical Therapy degree from the University of Mississippi Medical Center in 2014. Dr Holmes then completed an orthopedic residency with Mercer university in Atlanta GA in 2015. He has worked in various settings to include sports/outpatient orthopedics, acute care, and the state jail system. Now, he owns and operates Access Physical Therapy, a concierge cash based physical therapy practice in the Atlanta metropolitan area. He also works as a staff physical therapist with Kindred At Home.
Dr Holmes has been involved with APTA at various levels to include 2 terms on the Student Assembly Board of Directors, delegate for the state of Georgia to the House of Delegates, and currently serves as a board member for the Georgia Foundation for Physical Therapy.
In his free time, he also owns and operates The Travel Doctor, a full service travel agency as well as tackling small woodworking projects. He also scuba dives and enjoys traveling the world with his beautiful wife, Turquoise and their golden retriever and chihuahua/terrier mix puppies.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Burnout, Generational Differences, Productivity, Mentorship, Improvement,
To learn more, follow Clarence at:
Website: https://www.accessptatl.com
Twitter: @matterundrmined
Instagram: @caholmes6
Facebook: @clarenceh3
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Read the Full Transcript Here:
Hello, this is Jenna Cantor with healthy, wealthy and smart. I'm really excited. I am interviewing Dr. Clarence a Holmes Jr. Just wrote on Zoom, or we're doing the interview. And Dr. Clarence who said, just call me clearance. I'm like, Okay, hi, Clarence, said that he works with home health and is the owner of a concierge cash based practice, which everybody who listens knows I'm cash based. I'm like, Yeah, hello, Conrad. I love that so much. Let's serve our people, our patients. We are coming on because we met at a conference. And there was a discussion on generational differences in physical therapy. And Clarence had some real interesting thoughts on this. And I was like, this is a podcast in the making. So I approached him right away. And I said, Can we do this topic and a podcast? And fortunately enough, he said, Yes. Like a proposal. It was beautiful. So here we are talking about generational differences in physical therapy. I think this is a really, really important topic. Now. I just let's just start diving in to one we're saying general racial differences, everyone, please don't refrain from getting offended with how we, how we try to describe this, because this is one we're differentiating between ages. And I saw I saw individuals struggling with that trying to be appropriate. So if we do say anything in our descriptions, inappropriate, feel free, please absolutely correct us. But be nice, because we're doing the best we can. But this is a very important conversation. So we'd rather take the risk in in really diving into the topic. So yeah, just let's all be nice. Okay. So regarding generational differences, I'm assuming that we're talking about the more seasoned crowd, people who have been around for a long period of time, compared to newer people in the physical therapy. Oh, right. Correct. Am I missing anything? Or is there any other way we need to define it?
02:39
No, I mean, and honestly, you're talking about me when you said if you recognize people being uncomfortable, trying to differentiate between these these generations, in conversation without trying to fin that was me at our conference. I didn't want to say the boomer generation, I didn't want to say the millennials simply because a lot of people tie a lot of negative connotations to those. And we're
03:03
also missing Gen X, because Gen X is actually the y'all are the youngest practitioners right now. Not millennials. Yeah.
03:09
Yeah. And I think there's a lot of similar Z
03:12
is Z. Oh, my God, ie, Z. Oh, my gosh, I missed the letter in the alphabet. Yeah. It might
03:17
be x. I don't don't hold me to it. But But, but yeah, so that was one. But But no, you captured it perfectly. I do think there is a a riff between the older generation and the younger generation to just put it put it lightly. Yeah. Just simply because and I mentioned it in the conferences that the older generation are the ones who are owning these practices, traditional practices. And the younger generation, our generation are the ones who tend to be more of the employees. And that's natural. But what's what's unnatural? Well, this is also natural to have some generational difference was unnatural is the riff, the, the battle that kind of comes along with it, and how we respond to it. So
04:03
yeah, so let's, yeah, I love that. Let's do what we're aware. I was very interested. Let's go back and and just do one general generational difference at a time and then if we okay, I feel like that's what pops in our head for now. And that's it. That's great. So one, just named one at the top of your head one Gen. Gen. Oh, my gosh, why is this? So? General? generational difference, let's start with one.
04:29
So I mean, there's two big ones that stick out to me. One is just this idea of pay structure. And specifically in the PT realm of, of how long has someone been here? versus what is this person doing for my company? And the best example I can give is me personally, of working in a job my first job post residency. I'm an ortho I'm a lover, or I will consider myself an ortho PT, even though I work in the home health arena, and the concierge cash base, I will consider myself an orthopedic physical therapist. My first job post residency was at a private practice in Atlanta, and I was paid the least amount of all the therapists across the entire company, which was four practices in Atlanta. But I was the second highest producing therapists in the company. And so, you know, generational differences comes down to the old way of doing things was, who has the most experience, they get paid the most? My personal opinion is, that's not logical, we're, I'm a logical being and a lot of my generation are, if it doesn't make sense to us, we're going to be vocal about it. And it didn't make sense to me that I was producing one paper, more money, better outcomes than the majority of the therapists and I was paid the least, that's one major win. And it kind of feeds into the second you asked for one, but this kind of feeds into it. Younger generations, older generations value loyalty. You know, they expect somebody to come in and work for them for 10 to 1520, almost 30 their entire careers. And my generation just, we're not happy, we're going to move on. And so that puts a lot of responsibility on the employer to find out what makes us happy. And sometimes that just doesn't, that doesn't translate well.
06:39
Yeah, I see where these connect, let's focus on the first one, because that is a really good, interesting point, I have definitely mentored some dance PTS who are burnt out, and they are in a situation where, Oh, Gosh, darn it, what is it productivity, productivity is measured. And that has been very problematic for them, because they'll come in, and they see that they are, they know, they're getting paid less. But they're not more because in your case, you actually saw the data, but they're seeing the, they are seeing the exact number of patients as a seasoned professional, there, and they're just they don't understand why they're getting paid less, if they're seeing the same amount, then they were there, they would imagine, I would be seeing less patients, then that would make more sense, you know, but no, that's not the case. And therefore, that income would still be it is assumed that income would still be made. So it's almost like they're being profit, they're more of a profit is being made off of them. They're exhausted, you know, but they're not getting a lighter load to feed that exhaustion, that adjustment, they're getting treated just the same. And so they don't understand that pay difference when they come in. And I'm going to bounce off this a little bit more because of what the reasoning so it's going to get a slightly off topic, but I'm always okay with that is the promise of mentorship as a reason for why they are paying less that can be a reasoning behind it, which still, there are some clinics that actually provide mentorship, but the majority of them do not actually provide that mentorship, so it's more verbage. Or they have some sort of automated system, that's there maybe videos or something. So there, it's not really an extra effort. It's something that's already there that can help streamline what's going on. Especially if you're in a place that measures the productivity. You can promise it as a as a somebody owns a clinic, however, who's the physical therapist, and how much time do they actually have to really mentor? So if there really, it doesn't make sense, right? This reasoning of oh, why, you know, and these are generational, different thoughts, but for I think that's what you're hitting is that the younger generation will speak their minds and say, hey, you know, they're not getting that mentorship, they're not getting that value for them to go. Oh, that's why then because they get oh, you know what, I'm getting great mentorship, kind of like where people think residencies, getting great mentorship that get one in paying less I get it. I totally get it. That's not the case. No, no, in a lot of circumstances.
09:33
Seven years, I think I've been out seven and a half years for a PT school. And I've never been in an environment outside of residency that that had any type of formal mentorship. But you're correct in that I've have had several interviews with several companies that have promised mentorship because that was important to me. I kind of did less the reason I worked at the job that I did that I'm mentioning in this in this interview. This conversation. The reason I took that job, and I knew I was getting paid less than I was worth. Um, the reason I took it was because my clinical manager and the only person who was more productive than I was a personal mentor, who was my was one of my direct mentors in residency. And so I saw it as an opportunity to continue getting mentored. And so I'm getting an exchange of additional mentorship. I will take less pay.
10:32
Okay, yes. And your, your through your apps, you're like, Oh, yes, yes.
10:36
Correct. But there was no formal mentorship. Now, I did continue work with this guy. I did learn a lot from him. But there was no formal.
10:45
That's a big, that's a big deal. It's not exactly,
10:48
exactly. And there's no when is the end point? I mean, when is the point where I say, Okay, I've received enough mentorship now I'm ready to get paid. Okay. Right. There has to be some kind of trade off there. So. But you're absolutely correct that that is there is a common promise of these employers to employees, younger, generational PTS, of mentorship, in exchange for, you know, lower, less than ideal pay, but is delivered upon.
11:20
Right, right. And I think that's the thing, because there's different ways to work around depending on the clinic, and everything that can happen in these rooms for negotiation. So when these different mindsets come into the room, for it to work out, but you got to follow through on both sides. One is providing the mentorship and the other side is accepting, that's what you accepted, and knowing that owning that. So, but it can be I mean, you know, what I was about to go into different things you can negotiate, but this is not a lesson on negotiation. So I'm going to skip over that. So yeah, when you when you are going into a clinic, I feel like that is a way to potentially solve the problem, but it's just not being solved right now. It's it's still, these gentlemen are the we have people who own these businesses who are getting annoyed about the the younger generation talking about money, but then they're not looking at, they're not really listening and taking in what is being said, because it's it's a block that we can get our own bias on how we lived our lives. And, and we need to get out of ourselves. I say that, as a practice owner, myself, we have to always work to get out of ourselves all the time, in order to better listen, to be with the changes of the world. And the reason why there are changes, but the reason why things are fluid, and it's always changing with every generation and so on, is because there's always a better way. Right? And we may not answer to it. But But there's always a better way. And and you got to figure out, you know, what's what's going to if you really care so much about keeping them around for a long time. And that's, that's a big deal for you. And absolutely, totally get that it's great to have somebody there for a long time, then what is it that they care about? What is it that they care about? You know, and how do you and then if you want to do something that is not financial? Because your your clinic can only afford so much? What are those intangibles that you can bring to the table? Or even the physical therapist coming into work for them? What are those intangibles, and that's where you can really come to the table for a better exchange with those generational differences. I think, you know, and,
13:36
you know, and one of the things that you kind of touched on is that we have to be, there's always a better way, and we have to be open to that better way. And I think that's where we run into an issue of when a younger generational PT says, well, this doesn't make sense to me, I want this amount of money. That's not us complaining. And I think that can be perceived as, as as, as a complaint, US whining, because we were known as the whiny generation. We you know, we complain a lot and what compared to what we're told is that we complain a lot, we're whining, we're never satisfied. And it's not that we're whining. It's not that we're sad. It's just that we grew up in the information age, we know what the PT next was making. Well, we know what the average PT makes. And so we come to the table and ask for this. It's not as whining and it shouldn't be perceived that way and we shouldn't be promoted as the whining generation is annoying. Having the information available to us and trying to benefit on or not even benefit just just be pay. We're given what we're worth. You know, we're rainbows and clouds profession. I mean, we we are a just a happy, just beautiful people and we just love people love everybody. And we're so happy go lucky and lovey dovey and I love that about us. But one thing that we do tend to forget is that the word can mean that we are healthcare practitioners first, but this is also a business. We have to be sustainable, to be able to provide the jobs for our employees, we have to be fulfilled in our careers to be able to provide the care the level of care that our patients deserve. And some of the ways that we do that is to ensure that our employees are happy. Somebody brought up at the conference, the idea of valuing your employees. And value in itself. I think, for us as this lovey dovey profession means so many different things, but value in itself as a word is a financial word. What is the value of me as a a physical therapist? I know my financial value, if you cannot meet that, as you've already touched on, if you can't meet what I'm asking for what else can you meet me, meet me halfway meet me with increase vacation days, maybe with an increase a formal mentorship program. We're supposed to meet and you're supposed to meet me where I am as an employee. And so I think that's where there's a big barrier as well. And that sometimes we're a little bit too focused on intangible things where a lot of or several of us are looking for tangible benefits in my generation. So I think that's a big riff. And it's a it's got to do with our identity crisis in our profession that I said this at the conference. Nobody loves pts. As much as PTS love BTS. And that's our issue as as a profession that we have to address. And I think that kind of that kind of flows over into this this generational difference. Oh, my God, it does. It does. Absolutely. Absolutely. And so that's, you know, I don't want to get too deep here, but I want I actually
16:55
want to bounce off you because, yes, because they popped in my head earlier. And I was like, I just let the idea, you know, because I just want to listen to you. But yes, it's the Pete, the best thing to T PTS, you know, and there's nothing wrong with us, the more seasoned professional that I mean, yes, ever. When I say this, I know they're seasoned. Like, I know, they're sick, we're not perfect. But the C's, they they live on this rainbows and clouds. I'm just saying, I know, it's a harsh way to say it. I hear I hear what I'm saying. But whatever I'm gonna say it. And then we have where the younger generation, I think it's Gen Z, because Gen X is before. So okay, so we have the Gen Z, and the millennials are newer in the profession. And they're not afraid to point out things that they think are wrong. But I think then with that in mind, I think from higher up there is toxic positivity. And I think that's where that comes in. Where it's pushed upon, you cannot say anything bad. But then we lose this honesty and transparency in what's going on in the communication. And, and God forbid, something bad is said, you know, boy, and guess who's on social media, everyone? So if you're talking about, you know, like, oh, there's younger people are complaining. Facebook is older people, man, Twitter is older people. Like there's some younger on there too. Yeah. But like the hotspots to be at are tick tock and mostly ticked in my opinion. Tick tock. Yes. And then I think I never looked at the data. So yeah, but I think Instagram is secondary, but that also has to do with like, how I like to watch the videos personally, I can I can scroll through the Tick Tock thing and then I can go to Instagram Instagrams a little bit not as smooth I go back to tick tock okay. So um, but but that's you know, that's where it's so far talking about all the younger they all they do is complain that's, that's all ages baby. That's all ages, we all we we all like don't I think it is so healthy, to have a full well rounded conversation that points out the bad and the good and you don't have to finish with a positive statement in a conversation about it's okay to end in a gray area. It's okay to end in a dark area and both see it you know, yeah, that is I don't have a solution. Like that's actually that's not a good thing. It's okay. But we but this toxic positivity puts anybody going through anything on the spot if you're anybody who might be oh gosh, dealing with somebody who is has poor health in your family and you can't talk about it or mention it at all and you're yet to put on this face. I get it. That's you know, I'm putting in air quotes professionalism, but professional professional only means literally other profession. Everything else is defined by you. Or defined by me. So literally, that's all perfect. Like everything else is like up in the air up for grabs. however you interpret it. So the you know, took like, place these these random rules on what professionalism, professionalism is from that point on is is purely subjective. And that's where that toxic positivity comes in. Yeah. And then in then we get these risks these butting heads, because everybody has different core values, which is great. And I think that is a huge generational difference and where we lose and miss out on opportunities to listen and hear more.
20:29
Correct, correct. And that's where the issue becomes. I spoke on generational differences, as in the context of what is leading to burnout in early career professionals are the career pts. And I spoke on generational differences as one of the things that I thought was a key key difference. And one thing to note to note is that this isn't specific to pt. It's not burnout is not specific to PT, these generational differences is not are not just specific to physical therapy. This is a doula globally, this is definitely an issue in our country. There are, you know, I'm gonna make this a political conversation. But you know, there are, you know,
21:16
whatever all's fair game when you're with me,
21:20
you see, there's a group of people that believe that, you know, there's no, this is the greatest country on Earth. And that this is there, they would, they would know, they would not live anywhere else. And to say anything bad about our country is anti American. And then there's another generation that says, this is a good country to live in. This is, hey, I'm happy to live here. But there's a crap ton of issues that we need to address to make this country as great as it could be. And so that is, I say all that to say that there is no, I don't think we solve this issue. I don't know if there is a solid solution to the issue. But as I stated before, I do believe there are pptx, specific generational difference issues that we can address. And we should address. And as long as everybody is willing to hear each other out. Yeah, compromise, which is kind of where my conversation was with with the gentleman at the conference that we spoke about earlier. I had an opinion, but I heard him out. And I still don't agree with him. 100%. But I can identify a little bit more with where he's coming from. And I think that's key, I think it's important to have these conversations get uncomfortable with being, you know, get comfortable with being uncomfortable. And have these uncomfortable conversations to say, yes, these are the issues we have with your generation. These are the issues y'all have with mine. Where is that common ground? You know, is they always is, like you said better than we are? And so So, you know, I don't know, I don't know, I'm not the visionary, I see that you I can't give you the solution. I
23:08
don't know where I know, it's just to have a conversation. So that's all we're just having a conversation about this, which I think is great. You know, to get your minds and everyone's minds to start to think you know, are there you know, generational differences and everything. And be careful as you listen, it can be very hard because we there are a lot of people we're going to people help, we're a service business. And with that we get these people pleasing mindsets, where we can lose ourselves. And I would actually say definitely big time in the younger, newer generation. And in order to please the generation that has been around longer, we don't listen to ourselves and just agree it's okay to disagree. It doesn't mean you have to disagree. But really keep challenging yourself to get more and more in tune with what you believe in. And greater conversations can happen, greater solutions, greater growth and progress between all of us can happen, which is so cool. And it may not happen overnight, where you feel comfortable to talk about it. But keep I definitely agree with what you're saying. It's just if you can just keep even if it's a little bit challenge yourself a little bit more every time to just, you know, get there, you know, not easy, not easy. No. I love it. Any any other generational differences that you think oh, Jenna this or have we reached kind of your like, those are kind of the main ones where we
24:41
Yeah, no, I I do think those are my, you know, very inter intertwine those two that I talked about. I don't think that as as a this is sort of like a final word if you Yes, yes. I do think that specifically to this country, we value overwork For example, I, you know, I think that we value the the clinician or the co worker, not just in PT, but in general, we value the person who does the things that they're not required to do as a part of their job. That's what we use to determine who is who's that shining employee, who's the one that that goes above and beyond. Right. And it shouldn't be that I mean, for example, I remember, at this same job, we hit a low point, we hit a low point, always in January, it's an outpatient clinic, deductibles reset, so we're January, it was a low period, had a lot of openings on my schedule, so that everyone else and I was sitting in and getting caught up on documentation, going over some things with my mentor, learning new skills, in walks the owner, are asked, What are we doing? I tell him, you know, I'm trying to learn some things. And he says, Well, why don't we are marketing? I say, What do you mean? He said, you know, your patients, your schedule is low, why aren't you are out, you know, getting us new clients. And I'm like, that's not my job. Is that is you are the employer, you hired me to see the patients that frequent your establishment. Okay, I'm not the one to go out and beg these physicians to send us, okay, how much begging you do, the deductibles reset, that's going to be a phenomenon that happens every single year. So, but that's what the expectation from some employers have. Yes, I hired you to see patients and turning the documentation on time. But in also, I expect you to do these things, these these things that I didn't tell you about in your interview, but we expect you to do these things is become an expectation in this country, to overwork to do things that are not required to view and that is how we measure our employees and not on the job that they do. If you see all the patients on your schedule, go home on time, get your documentation in on time, and it's all you did for the rest of your life as a PT you'd never be promoted and you know in traditional practices so I say that's that's another generational thing is that I think we older generations value overwork working you all you need to be busy all the time. And we value we being the younger generations, a healthy balance of work and home life. I think that is another riff all of these are intertwined, but I think that's a another riff that's that's that's causing an issue, not just in our not just in our profession, but but across this whole country.
27:42
Now, yeah, definitely. I love it. Thank you so much for coming on to talk about this. If you are listening to this podcast, and you have some other ideas and stuff, feel free to write in the comments, just keep the conversation going. I think it's always good to just talk about it. And then And then if you're somebody who's about to go in for job interviews, write these things down for you to consider what you're going to bring to the table for your negotiations track on both sides, what was discussed in that interview? So it's very clear. If things come up that are that we're not included, it's so you can have a better chance of being on the same page. Yes, you're correct. We didn't bring that up, or you know what we need to make sure we bring that up, because that does come up, the more we can be on top of that transparency in the communication can better help address generational differences right off the bat, do keep in mind seasoned professionals owning your own practice when these students are graduating, they have a very low sense in general sense of self worth. So for the overwhelming majority, they usually jump at a job faster than they should. Because they are so excited. Anyone wants them. And that is a big thing that happens often at clinics. So just be aware of that them saying yes doesn't necessarily mean they were listening to what they wanted in the first place. Because they feel so grateful that they were not rejected, they were accepted. And that takes over everything. It helps it feeds into them eliminating what their core wants are because they struggle with self value. Alright, that's it. Where can people find you on the social or email, whatever you feel comfortable with sharing.
29:40
So I laugh when you say the old people are on Facebook and Twitter because that's really what I use is
29:48
and I'm in that category. So I feel comfortable saying
29:51
I'm not a Snapchatter I do have an Instagram. My Facebook name is just mine. That's what I'm primarily on. That's where I'm most entertaining. Book
30:00
is it clearance a home's nobody's claiming homes, clients homes,
30:05
parents homes as well. I'm the one that's scuba diving in my photo.
30:11
If it changes to hiking, everyone's gonna get confused.
30:14
I know why it's not going to just all my photos are nice. And then my instagram name is CA Homes six ca h o l mes the number six. Oh, I
30:27
love it California. You're not from there. But it's fun to say. Wonderful. Thank you so much for coming on. Everyone. If you're listening, please be nice. Be nice. Yeah, you can communicate but be kind. If there is any possibility that what you wrote might be in a way interpreted in a mean tone. Don't write it. I just don't I don't see. Like, honestly, it's just why and I'm not being toxic positive. I'm just being real. Like it's only going to just why why? Like go speak to your legislative representative about it, you know that you can actually make changes. Alright, that's it. Thank you for coming on.
In this episode, Owner of Access Physical Therapy, Clarence Holmes, Jr, talks about generational differences in physical therapy.
The post 588: Dr. Clarence Holmes: Generational Differences: Can They Contribute to Burnout? appeared first on Healthy Wealthy & Smart.
In this episode, President of IFSPT, Luciana de Michelis Mendonça, talks about her research and the upcoming World Congress of Sports Physical Therapy.
Today, Luciana talks about the importance of the WCSPT and the results from her research. Why are organisations like IFSPT important?
Hear about why sports PTs are important in injury prevention and reduction programs, pre-season assessments, implementing prevention programs, and get Luciana’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “We should assess our athletes to make the most amazing tailored prevention program.”
- “Injuries happen, but if you can decrease the time that the athlete is spent outside the game, then that is a win for the team.”
- “Warm-up sessions with the physical therapist were the methods used to prevent injuries.”
- “Be lighter, less stress, [put] less pressure on yourself.”
- “I am where I am because I’m good at what I do.”
More about Luciana de Michelis Mendonça
Luciana is a professor in a federal university in Belo Horizonte (Brazil) and develops research in the field of sports physical therapy.
She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organisation of physical therapy services for the Rio 2016 Olympics and Paralympics Games.
She was the first female president of the Brazilian Society of Sports Physical Therapy (SONAFE), in a country with many restrictions to women's participation in sport and politics. Since 2017, she has been an executive director of the World Physiotherapy subgroup International Federation of Sports Physical Therapy (IFSPT) and is now IFSPT's president.
She is committed to enhancing the dissemination of sports physiotherapy good practice and knowledge globally and to increase equity in sports physiotherapy.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Prevention Programs, Exercise,
Recommended Reading
- How injury registration and preseason assessment are being delivered: An international survey of sports physical therapists
- How injury prevention programs are being structured and implemented worldwide: An international survey of sports physical therapists
Sign up for the Fourth World Congress of Sports Physical Therapy
To learn more, follow Luciana at:
Website: https://ifspt.org
Twitter: @luludemichelis
Instagram: @lucianademichelis
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Read the Full Transcript Here:
00:07
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today I'm very honored and excited to have on the program Dr. Luciana de mckaela Mendoza. She is a professor in a Federal University in Belo Horizonte in Brazil and develops research in the field of sports physical therapy. She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organization of physical therapy services for the Rio 2016 Olympics and Paralympic Games. She was the first female president of the Brazilian society of Sports Physical Therapy in a country with many restrictions to women's participation in sports and politics. Since 2017, she has been the executive director of the world physiotherapy subgroup, International Federation of sports, physical therapy or ifs PT, and is now IFSP T's president. She is committed to enhancing the dissemination of sports physiotherapy, good practice and knowledge globally, and to increase equity in sports physiotherapy. And in today's podcast, we will talk about some of her research into injury prevention and the role of sports physiotherapist in those programs. And of course, we will also talk a lot more about the fourth World Congress is Sports Physical Therapy, which is happening in Denmark this August 26, and 27th. That's 2022. So if you want to find more information about that, you can click on the link at podcast at healthy, wealthy smart.com. To find out more about the fourth World Congress is sports physiotherapy, again, taking place in Denmark. So we will talk a lot about that. And we will also get a sneak peek of some of Luciana has talks there. She's speaking and she is moderating. So she's got her hands full for sure. So I want to thank her for coming on the podcast and everyone enjoyed today's episode. Hi, Luciana. Welcome to the podcast. I'm excited to have a conversation with you today. Hi, Carrie. Thank you very much for having me. Yeah, it is my pleasure. And now before we get into the meat of our interview, can you tell the listeners a little bit more about you about your history in sports, physical therapy. And as I mentioned, you are the current president of ifs pts. You can talk a little bit about that as well. So I will hand the mic over to you.
03:06
Okay, Karen, so I'm from Brazil. I'm a sports physiotherapist and I graduated in 2003. So I'm 20 years as a physiotherapist. And I'm also a professor in diversity here in Brazil. I'm based in Belo Horizonte. And
03:28
I started to work. Since the as a students and sports team, I wanted to do physical therapy because of sports. I am passionate about it. And I, I started in this political scenario in the Brazilian society of sports, physical therapy. And I started it was in 2016, it was the year of real to tastic significant part Paralympic Games. So it was a really big challenge. I also work in the physical therapy services during the Olympics and Paralympic game here. And I started being part of the Executive Board of the IFSP CI in 2017. So I learned a lot during the presidency of Anthony Schneider's in Christian torborg. And now I have this big challenge to be IFSEC. President so I'm balancing this actions related to if activity and also with teaching and also research about sports, physical therapy. And my research is mainly directed to injury prevention, and also injury risk profile. So I think that's perfect. And can you talk a little bit more about IFSP T and kind of the importance of having these organizations and what they what they do, what are they there for
05:00
Yes, so the International Federation of Sports Physical Therapy is a subgroup of the word physiotherapy. That's our main our mother organization. So as a subgroup, we have to engage countries all around the world that have specific group related to sports, physical therapy to join the IFSP team. So nowadays, we have 34 member organizations in the SSP T. And our main mission is related to disseminate good practices, support research on sports, physical therapy, of course, and also promote actions to support our members, the whole community. So improve the practices around the world. And also it's a good it's an important way to connect with people. So I think the most amazing gifts that I had, being in IFSP T board is to network with people around the world. So it's a really
06:18
important way to have our professional, our profession, organize it. And so I probably will be in the presidency for the next four years. That's the plan. Yeah, that's, that's amazing. And one of the things that, like you said, as part of the organization is networking, and we'll say this will probably repeat this a couple of times, but the Fourth World Congress is sports, physical therapy is coming up August 26 27th, of 2022 in Denmark, and obviously, you will be there and you are a part of several presentations.
06:57
But like you said, your research is around injury prevention and assessment in sports, in sports. So can you talk about why the sports physical therapist is an important component of these injury prevention programs or injury reduction programs?
07:19
Yes, I just want to stress that, yes, the Congress of sports, physical therapy, it's important action that IFSP t also have, we are one of the main organizations, the main sub groups of world physiotherapy that deliver International Congress. So we have the first one in Bern, the second one Belfast, the third in Vancouver, and now illegal in Denmark. So I, I went to Belfast to Vancouver, and now I will be enabled for sure. So
07:55
I'm sorry, Carrie, I forgot your question. Oh, yeah. No, so my, my question, like I said, you're doing you're doing a ton. You'll be doing a ton in Nyberg. But one of the things that I know you are talking about is about your research that centers around injury prevention, and something that you're passionate about as if the sports physical therapist should really be involved. So why is that?
08:19
Yes. So I always thought that the main action as a sports physical therapy in a sports team, of course, I should be aware that, for me, I need support all athletes available to the coach to the head coach to train. So for me, it's, it was always a good time to have like the physical therapy department, empty without athletes there, because all athletes should be on the fields playing and training.
08:56
So for me, prevention was always important action that we as therapists should be aware of. So I, when I finished my PhD and start to be a teacher in university in Brazil, I started to wander, especially after I started to work in the IFSP. Board, I started to wonder if the prevention, the role that the Sports Physical Therapy had in prevention, and I know that how this works in Brazil because I was sports physical therapist and the volleyball team and soccer team. I was wondering if it was like the same, or I was wondering if it should be the same. Or if we are here in Brazil, we're doing like similar things that other professionals data around the world. So I have a sabbatical year in 2020 and I went to Belgium to work with Eric FitPro.
10:00
I was there in Uganda, the University of Ghana, as a visiting professor. And we started to develop a surveying to understand what role the sports physical therapists had in injury prevention. So I will talk about some of our results, we have two papers about this survey that were that are published in physical therapy in sports. And this helped me to have
10:33
sort of idea about the role. And we have really interesting information about this, that, of course, I will share here in this podcast, and also in the World Congress of sports, physical therapy. And also we develop a Delphi design to establish a consensus on sports injury prevention programs. So this is also an interesting
11:01
study that we could deliver an IFSP participated to, with this Delphi study linking
11:09
people from different countries. So I'm really excited to talk to you about this caring and say something that should make people a little bit curious and participate in the Congress. In Denmark. Yes. So when can can you give us a little bit of info, you don't have to give it all away? Of course, people can go and read the the
11:36
published papers, but in this
11:40
in this study, you had, how many people? What did you find? How did you do it?
11:50
So yes, for sure, I can share some of the data that we had the papers are published. And also you can indicate for your audience, I can send you the links. It's important, I totally understand caring that sports injury prevention area, we need to move forward related to research, we need to understand a lot of things. But I think it's interesting to understand what the professionals what the sports physical therapists are doing, because this can bring up some questions for future research. So
12:29
on the survey, we
12:32
we had 414, sports, physical therapists participating around the world. So I think we had like, people from 32 countries. So I know that the amount is not so high, we could have more people participating, but it was delivered in 2020, during the pandemic. So this is one thing that I should stress because, yes, we had 32 countries participating, but I, for sure, I expected to have more people there. But we had questions in this online survey that was related, link it to the synchronous sequence of prevention that were Matalan delivered, and maybe it's the the most use it, model or to make decisions about prevention. So we ask it if this sports physical therapists participated on injury prevention, sorry, injury registration. It's common here, Brazil, but I didn't know if my colleagues in other countries participating in the injury registration. We also asked if they assess it, the athletes to build the prevention program. So if they did, for example, preseason assessment, that's the more common way at least in Brazil. So I was curious about that. And also, I we asked about their prevention program. So if the pieces participated in this action or not. So about equal registration, the first thing this I think this is an amazing result, because we had more than then 80% of the sports physical therapists that participate in this study, were responsible for me to reverse the situation. So we can now say that maybe the sports physio are the are the person like more important more responsible to properly register injury in their sports team? So this brings brings up a lot of other questions. So for example, maybe we should IFSP T should deliver some actions to maybe
15:00
increase the knowledge and maybe the competence on this matter on our community. Because of course, if we are responsible for this, we want to do an amazing job. So it's, it's interesting. And it's good also to exchange some experience and learn from good examples. So this is really good. And we also ask about the main barriers.
15:29
So for sure now register the injuries. So more than a half of this physios said that lack of time in their routine was the main factor to not properly register injuries. So maybe we need to discuss also about the sports physio routine, inside the sports team. I think we talk we should talk more about this, especially in conferences that we can get together a lot of professionals from different countries, and we can learn from their experience.
16:08
So can I move forward? You have a comment about registration? Nope, I think I think that's good. And I do like that. You said, Hey, maybe this is a chance for us to get together learn from each other. Because perhaps there are ways to streamline this that people just haven't thought of that other people are doing. So you're right. It's a great opportunity for sports organizations, like if SPT to bring sports physical therapist together and say, Well, wait a second, some of you are doing this with some of you aren't. And if it's a lack of time, what can we do to give you a structure that can streamline your process? Yes, exactly. And it's one thing that here needs to be done. We just We can't like, Okay, I'm not going to register injuries, because how can I be sure if I'm going to prevent the injuries if I'm not registering? So if you're not registering, is it like they didn't happen?
17:09
Yes. And another another thing that is really interesting, what is the injury definition? That is sports, physical therapists are using my understanding, we can select different definitions, because this maybe rely on the sports modality.
17:32
But we need to talk more about this, I think we should
17:37
exchange and learned and maybe from this, maybe if aspartate can deliver some guidelines, I don't know, because it's one of our missions. Also to make the FSB T is the main resource for the Sports Physical Therapy community. So I think we will maybe in the future, we are going to have more actions based on the findings of so I'm really excited about this. Okay, so let's move on to preseason assessment. So how many are performing? And what are the barriers? I know that this is this, topics of little bit controversial, I know that we have a group that thinks that we should assess, and another group of sports physio, or research thinks that we, we don't need to. But our survey shows that 77% of the participants perform preseason assessments in their athletes.
18:45
So 222 sports fields, said that they do. This is amazing information. And I didn't expect for this high percentage.
18:59
And I was happy because I believe that we should assess our athletes to make the most tailored, most amazing tailored prevention program for our athletes. I know that this is a challenge. I totally understand this. But if I think about myself as a sports, physical therapy, if I'm working in a sports team, I will like I will do my best to assess the athletes and try to deliver
19:30
into an individualized prevention programs. So but we have like, opposite side here because only 30% of these sports physical therapists that do preseason assessment, customize the provincial program bases in the results of the assessment.
19:54
So this is a point that we need to understand better. We need to understand what is happening. Why
20:00
They sports fees you give energy to assess the athletes, but they don't apply the results to build the prevention program.
20:11
So we didn't
20:14
ask it like specific questions about this. To understand this, we only asked about the barrier. So the main barrier
20:23
that was indicated to not before assessment, it was lack of structure and organization of the sports team.
20:33
So about half of the participants indicated this barrier.
20:38
I understand makes sense, but I'm not sure if this barrier explain 100% of the reasons to not perform the precision assessment. And I think maybe this is also relied on the evidence that we have related to these. We have big discussions about injury prediction probability. So maybe we need to make some advance in research about this topic. And maybe we need to talk more about this to make more like have this issue more clear to everyone, specially the clinician.
21:22
Because I think so now, it's my opinion. Okay. I think we need to assess our athletes, and maybe maybe even the process of assessment should be discussed. Because if we, if we are here in a roundtable with sports, physical therapists, and we ask how you assess your athletes, which tests do you select, probably carrying, we are going to have different answers. So I don't I'm not sure what this means. It means that we don't have standards. We don't have like a protocol. Should we have a protocol? I don't know. But what I know is that we need to talk more about this. Yeah, I mean, oh, go ahead. Sorry. No, no, I just like, I just want to say that I was really happy with the the results that sports fields with a majority is performing a preseason assessment. But on contrary, I was I get a little sad to see that not like 1/3 of them are really applying the Results to Build provincial programs. And yeah, and so I brings up a couple of questions for me, and that is, have you seen preseason assessments? Decrease injury, are they and again, this goes on? I think what you just said that sort of prediction and probability. So if you do a preseason assessment, does that predict less injuries? I don't know. Have you seen? What are your thoughts on that?
23:06
Thank you for asking this caring, I think
23:10
preseason assessment. The main propose is not to predict injury, they may propose is to identify those athletes with more susceptibility or probability to get the injury and then we can act before this happened. I'm not saying that if we perform a preseason assessment and beta prevention program on the results, our athletes not going to get into I'm not saying that injury, always going to happen sports, but we can, for example, decrease the severity.
23:52
So if I have one athlete that I can, for example, I apply the stars question balance test, and I see that this athlete have a really low stability, functional stability in the lower league. So I can include in their provincial program, exercise to improve the stability, and maybe he will, he will, like have the ankle sprain, but I can decrease the severity.
24:26
So I will decrease the time loss. I will make this athlete more available to the head coach at the end. That's my reasoning on preseason assessment. And I think there is a misconception about this issue also. Right? Because I think, you know, if we're playing devil's advocate, some people may say, well, the preseason assessment isn't going to eliminate injuries. Why am I why am I doing it? Right? But like you said, injuries happen. But if you can decrease the severity if you can decrease the time that the athlete is spent out of the game
25:00
Yeah, then that's a win for the team. And it's a win for the coach in the organization. But if only 30% If if you have all of these sport physiotherapist doing a preseason assessment, then only 30% customize the program. Now we have to come up with some incentives for that physiotherapist to customize
25:19
the program for the athlete. And again, that may be like you said resources available to them, if it's one person and 50 players,
25:30
that it's difficult, you know that that's that that's quite difficult. But
25:37
I can understand how this can be a very frustrating part of research, because there's a lot of moving parts. And it's not just the sport physiotherapist, who has all best intentions and at at the heart of, of of their work. But there's a lot of external factors that need to come into play. But
26:03
I do I also like your that idea of being on a round table with sport physiotherapist and saying, Well, what do you do? What do you do? And maybe like you said, I don't know if a protocol is right, but maybe some sort of a roadmap where you have some basic assessments, and then you have the freedom and the ability to get creative, but to have certain certain things in there that makes sense for that sport?
26:31
Yes, I totally agree with you. Here in Brazil, I have a lot of colleagues and friends that came from the Brazilian society of sports, physical therapy. So we talked a lot in exchange a lot. So I, I myself, I have my challenges related to really delivering the prevention program that I i understand that would be like the best thing to do. But of course, this also relies on the relationship with the head coach, district parenting coach. So it's a lot of factors variables that we need to understand. And that's, that's really individual. It depends on the context of each sports team. So that's what I when I say that maybe we don't, we will not have like a protocol, because it depends on the sports team reality. But I agree with you that we can give maybe some roadmap to help everyone to organize better, considering the context, right? Yeah, exactly. Exactly. Oh, that's yeah, that's that really opens up a can of worms for people. That being said, let's move on to prevention programs. So what did you find with that?
27:53
Yes, so about the prevention program, we see that warm up.
27:59
sessions with the physical therapists were the methods more use it to prevent injury. And I think about warm up this was already expected because it was one roadmap that FIFA 11 Plus gave to everyone, not only for soccer, we have evidence on basketball, handball players. So FIFA 11 Plus really helped in this maybe this
28:31
basic organization, and how to deliver some preventive action in a more easy and accessible way. So I think it's really interesting that this survey, like confirm that one map, it's a really good strategy to include the provincial probe on athletes routine, because the athlete will need to warm up. So we have this moment, and why not. So instead of make the athlete do like,
29:06
whatever exercise or just running on the field, why not to be more specific and includes exercise that the athletes really need to do based on the sport modality.
29:20
Epidemiology. So for example, we know that in soccer, we have a lot of famous hamstring strain, we have a lot of ankle sprain, knee sprain. So why not to include some melodic at the size it some balance exercise? I think this is a really
29:38
important action that every old sports physical therapist needs, so be engaged and participate and about the individual sessions with the sports physical therapists. It's important to us and then I really expected some information around this
30:00
because we know that we have some time zone athletes that need a specific exercise that needs to be delivered by the physical therapist. So I was happy to say this because this was the methods more use it more indicated by our participants. And above the barrier, we saw that lack of time in athletes routine was the main barrier to perform the provision. This was indicated by 66% of the participants.
30:34
Of course, I expected results. And that's why warm up, it's important action because this is already in adults routine, we don't need to change the routine to include one more time and period to do
30:51
the exercise related related to prevention. So again, carry I don't know if this only this area only about athletes routine, we can understand why we can't perform major prevention. And as I said, Before, I understand the challenges. I think it's not easy. But I think it's a wonderful, it's a wonderful action that sports physical therapists participate. And it's really, of course, important for our athletes health, not only performance, because we have evidence that provincial programs also increased performance. But also I'm concerned about athlete's health, we need to, of course, help the athlete because no one wants to get into it. So this is really, it was really important.
31:49
For information that is the also indicated and these information helped us. So sort of build the questions related to the consensus, that was our second step during my experience in Ghent University with Eric.
32:11
Right. And so at W CSPG. You're going to show some data about the Delphi consensus, so you don't have to give all that away, people can go to the conference to hear more about that. But if you want to give a little preview, now's your time. So you what are the main topics investigated?
32:31
So about our Delphi, we organized the consensus in three parts. So the first part was related to how the thesis should plan the provincial programs. So this planning was about the information or the reasoning to develop the injury prevention program. So this is interesting, because we have information that, for example, sports, physio, use the reasoning related to biomechanics, or the base decision only on evidence and injury, Epidemiology, or athletes, injury history. So we have this kind of information and result and this is really brings up some discussions. So I hope that on the conference, I can, we can have this moment to discuss about our information, our data. The second part was about the organization. So how work environments before the implementation, how this affects the delivering the injury prevention programs. And the third one is about the implementation phase that I know that there is a lot of discussion and research, we have a specific we have specific groups of research that really go deep in this matter of implementation. So in this third phase, we identify barriers and facilitators to implement the injury prevention programs, and also related to compliance, if visibility. So this is how we organize the Delphi. It was a huge amount of work from all the core authors that participated in this study, and really happy that we can now say that this is accepted in physical therapy in sports generally, we can now really disseminate
34:39
this information, and I'm really happy to be part of this. Yeah, well, congratulations because that is a ton of work. And again, if people want to learn more about this, then you can come to Nyberg August 26 27th The Fourth World Congress is Sports Physical Therapy in Denmark.
35:00
And I mean, who doesn't want to be in Denmark in the summer? Right? I mean, amazing. Yeah, this will be my first time in Denmark. So my I am excited. So of course, no Denmark, but also to meet my friends from Sports Physical Therapy community, specifically before this, sorry, after this pandemic. Yeah. So I really miss my friends. And I really excited to talk more about injury prevention. And so our consensus results, and exchange and networking with everyone there. Yeah. And where can people find you? If they have questions? If they you know, we'll have the links to the studies that you mentioned in the show notes. So if people read that, and they have questions, where can they find you?
35:53
Yes, Carrie, so I am on social media. So I have my Facebook profile, Instagram, it's with my name, no change at all. And also in Twitter, is Lulu the chalice so you can find me there. And we can keep talking about information. IFSEC. I invite everyone for be like in the World Congress of sports, physical therapy, it's in August. So I'm really excited to be there. And I hope to see you there all for caring. Yeah, I will be there. I'm looking forward to it. And now final question that I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self? Good question. Okay. So maybe, first, I would say to my own self, congratulations, you are an amazing woman in you accomplished a lot.
36:52
For sure, I never thought that I would be where I am now. As IFSP President working in federal, probably the most important federal university here in Brazil. So I'm really happy. If I could give her some advice should be be more lighter, less stress, less pressure on yourself, Luciana.
37:23
But at the end, we don't don't care if this increased pressure or stress, help in a way.
37:31
me to be here where I am. Or if I could go through this path. Be more.
37:41
I don't know light. I think the word is like, Yeah, I think so. And, and I love the fact that you said you know, you would congratulate yourself. And I think celebrating wins and celebrating what we do are things that women don't often do. Right? We're always sort of congratulating others and putting others up, but we never sort of congratulate ourselves and celebrate our wins. And, and I think if I were to go back and tell my younger self, something that would be it, like stop making yourself smaller so that other people can be bigger. It's a constant exercise. I didn't accomplished my winnings, my victories so often, but now I can see clearly that I am where I am, because I'm good in what I do. So perfect. What a way to end the podcast. I think that's great. So again, people can see you live in Nyberg, August 26 and 27th. At the fourth world, Congress is sports, physical therapy, you again will have the link on the conference and how to sign up. And we certainly encourage everyone to do that. Like you said, What a great way to meet up with colleagues to get some really great information and be in a beautiful place while you do it. Yeah, exactly. And on August 25, five, we are going to have a network session delivered by FFTT. So we are going to have also this moment to get together and exchange. Perfect. Is there anything else? You know, you're the president? So is there anything else that we missed? Talking about the conference that you want to let people know is is also happening? We are going to have an interesting conference because it's going to be I think the first World Congress of sports, physical therapy that we're going to have specific moments to do sports in the program. So we are going to have this more serious moments to talk more about our practices and research but also light moments to practice sports and be more friendly there. Yeah, so basically bring your workout clothes is what you're saying. Yeah,
40:00
Oh, yeah, that's exactly perfect. Perfect. And I don't think I mentioned that when I spoke to Katie so I'll be mentioning that moving forward that bring your sneakers bring your workout clothes, that traditional
40:13
well here in the US for whatever reason, people like always wear suits to these things.
40:20
So don't don't worry about the suits, but definitely bring your workout gear. Yes. Perfect. Perfect. Well, Luciana, thank you so much for taking the time out today and coming on to the podcast to talk about all the great stuff you're doing. Thank you so much. My pleasure, Kara. Thank you so much, and everyone thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
40:43
Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media.
In this episode, President of IFSPT, Luciana de Michelis Mendonça, talks about her research and the upcoming World Congress of Sports Physical Therapy.
The post 587: Dr. Luciana De Michelis Mendonça: Sports Injury Prevention: What is the Role of the PT? appeared first on Healthy Wealthy & Smart.
In this episode, Nigerian Sports Physiotherapy Association Founding Member, Ummukulthoum Bakare, talks about her important research and advocacy of sports physiotherapy.
Today, Ummukulthoum talks about her research on women’s football, the issue of compliance and adherence, and the next steps in her research. What are the challenges for women football players, and how are they mitigated?
Hear about her experience advocating for sports physiotherapy, her presentation on The Unbreakable Young World Athlete, and get her advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Passion will drive you.”
- “The increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football.”
- “Coaches need to understand that they can be empowered to take charge.”
- “You don’t have to think of injury prevention as this thing that is separate. It needs to be integrated.”
- “Nothing is impossible. If you can dream it, you can do it.”
- “The sky isn’t the limit anymore.”
More about Ummukulthoum Bakare
Ummukulthoum Bakare is a Doctorate Candidate in Sports Physical Therapy at the University of Witwatersrand in South Africa. Her research is focused on women’s football and injury prevention.
She is a founding member of the Nigerian Sports Physiotherapy Association and is active in disseminating the FIFA11+ injury prevention programme in her native country and across Africa. Her passion has centred around the sports of football, basketball, and para-athletes and injury prevention. She received her Bachelor of Physical Therapy and her Master of Physical Therapy from the College of Medicine, University of Ibadan, Nigeria.
Ummukulthoum has worked as a physical therapist since 2001 and has won several awards for her service locally, regionally, and internationally. She is a member of the Medical and Scientific Commission of the Nigeria Olympic Committee and an Associate Editor for the British Journal of Sports Medicine.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Women’s Football, Empowerment, Advocacy,
Third World Congress of Sports Physical Therapy
To learn more, follow Ummukulthoum at:
Website: https://www.facebook.com/nspa.org.ng/
Twitter: @koolboulevard
Instagram: @koolboulevard
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Read the Full Transcript Here:
00:07
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everyone, welcome back to the podcast. I am your host Karen Litzy. And in today's episode, I'm really honored to welcome UMO cooltone Bukhari she has a doctorate candidate in Sports Physical Therapy at the University of Witwatersrand in African South Africa. Her research is focused on women's football and injury prevention. She is a founding member of the Nigerian sports physiotherapy Association, and is active in disseminating the FIFA 11 Plus injury prevention program in her native country and across Africa. Her passion has centered around the sports of football, basketball and para athletes and injury prevention. She received her Bachelor of physical therapy and her Master of physical therapy from the College of Medicine University of Ibadan in Nigeria UMO kooltherm has worked as a physical therapist since 2001, and has won several awards for her service locally, regionally and internationally. She is a member of the medical and scientific commission of the Nigeria Olympic Committee, and an associate editor for the British Journal of Sports Medicine. So in this episode, we give you all a sneak peek of what she is going to be speaking on as one of the guest speakers at the fourth World Congress of Sports Physical Therapy, which is taking place August 26, to the 22nd 2022 and Nyborg Denmark. If you want more information on the WC SPT conference, head over to podcast at healthy wealthy smart.com. Click on the link in the show notes under this episode. If you can, I highly suggest signing up and joining us in August in Denmark. So Lumo coutume is just one of many speakers that we're going to be highlighting over the next couple of months. We have a great conversation today about the unbreakable Young World athlete which she will be speaking about Nyberg. So everyone enjoyed today's episode and be on the lookout for more speakers coming up in the next couple of months. Hey, Katie, welcome to the podcast. I'm really happy to have you on.
02:43
It's lovely to be here, Karen. Thanks for having me. Yes. And like I said in the intro, gosh, you are a real rock star in the physiotherapy world. So you are a founding member of the Nigerian sports physiotherapy Association. You are a member of the medical and scientific commission of the Nigerian Olympic Committee and an assistant editor for the British Journal of Sports Medicine. And so that leads me to my first question is How important do you feel these associations are for the profession?
03:20
Thank you, Karen. It's is really very important, especially from my side of the
03:27
of the continent where we have very limited resources. And it's always a good opportunity to connect with other colleagues from around the world. When we first started the the Nigerian sports physiotherapy Association, were just a handful of people who, you know, came together to say, look, if we did start an association like this, it would help us be able to connect with other colleagues and associated other associations from around the world. And then we connected with IFSP T, which also given us a lot of opportunity to connect with the rest of the sports PT world globally. And that has kind of enriched us over the years. And I'm happy to say that Nigeria was also the first African country to be affiliated with IFSP T. And we still have a great relationship till today. And I'm also actually, I think, the first African and the IFSP T board. The executive board. I was elected in 2019 in the last Congress in Canada, for the Nigeria Olympic Committee. That took a lot of work because it's actually by appointment. And over time, it had only just been physicians. There hasn't been any room for physios to get on board, but I think for somehow I just kept well with the National Society. I'd be the Nigel site of physiotherapy, I just kept pushing to get on visit
05:00
ability for physios get us to get, I mean, get the Olympic Committee to also organize specialized training for physios and all of that, and I was doing all this work, making sure that where they were conferences happening, I wanted them to, you know, support people to attend and all that, and a former vice president of the Olympic Committee, and as I look, I think you'll bring your loved one on board. And I'd like to nominate you to be on the on the medical commission. And I was like, Okay. And
05:34
when I got in, I was the only female and I was the only physio. But I am glad that we time a lot of things have changed. Because one of the key things I'm passionate about is to give room to allow upcoming and early career sports medicine stakeholders, be it physio psychologists, you know, doctors, physicians, but give room for the younger ones to be supported and, you know, have access to all the IOC courses and things like that. So I it's been, it's not been an easy journey, but I think you can change a lot more from the inside than the outside. And that's, that's why I took on the assignment. And so far, so good. It's, it's worked out. Yeah, it's slow. But it has worked out a bit. Yeah, amazing. And I was going to my next question was going to be what, what has it been like for you to kind of be the first to have a seat at the table? Right, the first woman which I'm not surprised, and the first physio to kind of have that seat at the table, what has that been like for you? And what lessons have you learned?
06:43
Um, to be honest, it was not a really easy thing to do, especially when you are in the middle of about, you know, 12 other people who, and you probably also are the youngest. Let me add that, even though I don't consider myself young, per se, but in that tool,
07:06
I was the youngest. So but I think luckily, I What sort of helped me was that I spoke with the chairman. And I told him Look, this is
07:18
this is the ideas that I have. And I feel like I know there's a lot of work that needs to go on behind the scenes, I'm happy to do all the heavy lifting, or writing and all that, but we need to push for more things to achieve our mandate. And he was very happy with that. And later, a lot of a lot of the other board members just felt like Okay, it looks like we have somebody who's willing to do all this heavy lifting with you know, writing proposals and stuff. And we just kind of make things work. And somehow they just realized that I wasn't really doing it for any self. For myself, as it were, I was trying to get us to have a better a wider ecosystem for sports medicine resource, be it physios, doctors, you know psychologists, pharmacists, nutritionists and stuff like that. And so far, so good. We've we have quite a sizable number of young, early career people coming on board, a lot more people are not interested in sports, physio and all that. And which is because before now, nobody really wanted to do sports physio, they felt like,
08:26
you know, you're, you're never going to be rich. Like you're always just
08:31
the government is always owing you money. And so why are you a physio per se but then I tell them that look, passion will drive you it is just a calling and you really need to understand that.
08:44
What can in any another prefer in any other specialty or physio? It's quite rewarding as a sports physio as well, if you if you're driven by the right
08:55
circumstances. So yeah, it's not going to be easy, because half the time you'll find yourself like a fish out of water, especially being a female
09:05
where you're working multisport settings and you have to work with male team and all of that you have to hold your own. But it's it is rewarding. And yeah, so yeah. And it sounds to me like some of my students. Yeah, some big lessons. There are one, being willing to put in the work and to opening the door so you can help bring other people in. It's not opening the door for yourself and closing it on everyone behind you. No, no, because there definitely has to be a transitional plan. What is the sustainability of whatever you're doing? Because at the end of the day, your time is going to come and go. So who are the people that you're empowered to continue that journey, the vision and to be able to achieve
09:51
you know, the end goal of making sure that there is that continuity, and that you have, you know, so they pay forward and they can
10:00
didn't pay forward until, you know, for as long as as needed. And we would have a big pool of sports physios because I can tell you that Nigeria is over 200 million people, and maybe about 10 million active Lee involved in sports at a competitive level. And we still don't have enough physios to cater for that number.
10:27
So there's still a lot of work to be done. I can't do it alone. It's a collective team effort. Yeah, I mean, you have to increase the capacity. Exactly. Right. So that that all of these 10 million people, which is a huge number of people cannot be seen by estimating. It could be more, right. Definitely. Yeah. So obviously, you don't have the capacity for all of that. So if you can open that door and bring in a lot of like enthusiastic, like you said, physios, physicians, psychologists, nutritionists to help you continue to build up the capacity of a sports medicine program across the country, you'll be able to reach more people. Exactly. And that's what it's all about. And now, let's talk about your research. So you've got this passion of building up the capacity for sports medicine in Nigeria, let's talk about your research, which I know you're also passionate about. So I'll hand it over to you.
11:31
Okay, so I'm currently working in women's football. I mean, it is what it is because women really don't get much attention for anything, even in football, and for research specifically, as well. But as we all know that the
11:49
increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football. And we know that for women's for women, we are more or less we have certain
12:08
certain factors, that puts us at higher risk of injuries. We know football has burden of you know, contact injuries and all that but can reduce the injury rates of non contact injuries. Now, because women I hire, that when population were what areas due to biomechanical factors, biological factors as a result of hormones and stuff, biological become biomechanical because of, you know, pelvic hip ratio, you know, being at higher risk of ACLs. So you want to be able to minimize that risk. And how to do that is to actively engage in injury prevention. So trying to bridge the gaps, especially in a low resource setting where we don't really have much human resources, infrastructure and all of that, and people still want to play football. So my research is trying to bridge the gap with the population of women playing football, and the use of an evidence based, comprehensive warmup program, which is the FIFA 11. Plus, it is a basic injury prevention program, but it works. But it's not going to work if people don't know about it and compliant with using it. So it's trying to find out what are the challenges in the setting? And how can we mitigate these challenges to be able to improve compliance and adherence, and be able to achieve injury prevention goals, because even on a global scale, compliance, and adherence is a big issue with anything. So, um, since we also know that we have to always tailor things to the broader ecological context, or whatever we're doing. It's not one size fits all, because you have to figure out what are the things that can work in this setting? How can we adapt that can we adjust certain things and whose responsibility is going to take the leadership of the injury prevention philosophy, how this behavioral change is gonna affecting? So this is this is a research that I was working on, or I'm concluding at the moment. And I'm really excited because now I think FIFA also is doing trying to do a lot of stuff for women's football. So hopefully, that can help. You know, in the next five years, we'll see women's football going to a different level than we are right now. Yeah. And you know, as you're talking about that and talking about the resources or lack thereof, it really makes me think I'm in New York City. I'm in the United States where we have an abundance of resources, and people still don't comply with injury prevention programs, right. And so I can't imagine being in
15:00
In a part of the world where you don't have the the manpower, the end all of the things that we have here, yeah, yeah, in order to make these programs stick.
15:13
Exactly. So this is one of the things that I found out is, along the course of my research, is that coaches need to understand that they can be empowered to take charge, rather than coach to see me as a medical person, like trying to take over their job, I'm not trying to take over your job, I'm only trying to help the team so that he can have more players available for selection and team can do better because at the end of the day, it's inversely proportional, the less injuries in the team, the more the team, you know, can can can progress and be successful. So at the end of the day, I think the messaging also matters, the messaging about, Okay, Coach, if you do this, you're going to have more players available for selection. And when you do have more players available for selection, then your team has a better potential to fight for the title to get to win a trophy. And when that happens, you get a bonus or something in your pocket. And it all everybody sort of it's a win win situation when your players do or injury free. They have longer carrier carrier longevity and so many other things. So the reason begins to change, you know, begins to change and at the end of the day. And then another thing I say to them that look, you don't have to think of injury prevention as this thing that is separate. It needs to be integrated. And there is no flexibility to adapt
16:45
and just integrate, it will still work. The most important thing is that you are committing at least twice a week for these exercises to be done. And you will see the difference that it brings to your team. Yeah, it's all about incentives. Right? How can you how can you meet the people where they're at with the incentives they need? And like you said, it's all about the messaging? Yes. Okay, wait, mindset changes, right. And that kind of takes us into I think what you're going to be speaking about at the fourth World Congress is sports physiotherapy, which takes place August 26 and 27th of this year in Nyborg, Denmark, and that is the unbreakable Young World athlete. So talk to us a little bit about that, and a little bit about your presentation. We don't give it all away, of course, you know, we want people to come and see you live, so we're not giving it all away.
17:46
We can dangle some highlights out there.
17:50
Okay, so the first thing is, I think that right now, everybody knows the potential of sports. So
17:58
everybody wants to start young. Now the pressure there on the young athlete is to begin to perform at a professional level at a young age. And that impacts a lot of things in terms of because you know, the type of dedication that you need to, to perfect, whatever sport that you're doing. And, you know, many parents and guidance, everybody wants, oh, I want my child to be Cristiano Ronaldo, I want my child to be messy. Now the pressure is much on these kids. And one of the biggest challenges that then these the burden of having to deal with that kind of pressure, whether physically, psychologically, and every other thing that makes up these young athletes would really be a huge load for young athletes out there. How can we balance that? Now, I will be talking from the perspective of law resource where I'm coming from a lot of many people.
18:57
In the developed countries, they have a lot of support for young athletes. And be it nutrition wise psychology, and so many other things that you we don't have the luxury of that. And many times, the kids who just want to play like they don't want to do anything serious or anything like that. But there's still the pressure and demand on them to excel. Because people see that if you if you're a good sports person, or you're able to make a break in either football or basketball, which is one of the top spots in Nigeria, then we can change our economic situation. And that helps us out of poverty, and all this kind of and all this type of thing. So I'm just going to be talking from that perspective of low resource and how the young athletes
19:50
as much as you want to encourage sports participation, but there has to be that striking balance to enable them to succeed
20:00
That's a lot of pressure on a young kid.
20:03
Yes, yeah. Yeah. Well, I mean, I know I'm definitely looking forward to that talk in Nyborg. Is there anything else that you're working on projects moving forward? Anything you're looking forward to in the future, whether it's future research, speaking gigs, getting more involved in in the profession as a whole? What do you have coming up?
20:30
Okay, so I'm trying, I'm rounding up my doctorate right now. So hopefully, I can get a postdoc position as well to continue to work in women's football.
20:44
That is what I'm hoping for the next maybe six months there about, but other projects that I'm passionate about involves power athletes, I'm very, very passionate about walking with our athletes, because also they too, were like a minority
21:01
group. But I see that they are really the super humans, you know, with everything. And with the limited resources and everything you can think of the still strive very hard I want to get on on the world stage. They are the ones who put Nigeria on the on the on the map for medals, because I was with the team in 2016, in Rio, and
21:27
we won eight gold medals, set new eight world records.
21:33
So I feel like yeah, there's a lot more that I want to learn. And
21:39
I'm also trying to do some technical courses. And
21:44
there's something called classification for power athletes, where it's like, you're trying to make sure that all the athletes are classed,
21:53
in in the desired classes that they can compete on a level playing ground. So apart from the technical officials, they also need the medical people to come and do all the assessments of you know, movement, muscle power, and all these things, just to be sure that, okay, we have classes athletes properly, and they can compete without having undue advantage over the other colleagues in a similar category. So yeah, so I think that's really the next thing that I want to do. It sounds amazing.
22:27
Some of my students trying to move on to postgrads. I've just provide them some of my own shares, some run experience, support them along the way as well. And so that's, that's what I think I'll do. Amazing. Well, it sounds like you have a busy time coming up and doing really, really great work. So congratulations on all of that. And now where can people find you? If they want to reach out to you? They have questions. They have thoughts, where can they find you?
22:56
Okay, so you couldn't find me on social media? You'll see on Twitter, it's at cool Boulevard.
23:04
And it's also the same handle on Instagram at cool Boulevard. So and that's cool with a K, correct? Yes. K with the K Yeah, yeah. And we'll have all of that information and links directly to all of your social media in the show notes for this podcast, so people won't have to search too far. And now as we wrap things up, one last question that I asked everyone, it's knowing where you are now in your life and career, what advice would you give to your younger self?
23:35
Um, nothing is impossible. If you dream it, you can do it. So just surround surround yourself with people who will always find your flames. People will always ginger you to keep going. And I think, you know, the sky isn't the limit anymore.
23:55
You can keep going so that I'll give to my younger self. Excellent advice. And just if people want to see Katie speak in person, like I said a little bit earlier, she will be speaking at the fourth World Congress is sports, physical therapy, August 26, to the 27th of this year, 2022 and Nyborg, Denmark. So again, we'll have a link for that as well. So you can go on and take a look at the whole program and sign up and come to Denmark in the summer, which I'm assuming is going to be great. I've never I've only been there in February when it's pretty chilly and snowy and rainy. So I'm excited for I'm excited to go. And I'm excited to listen. I have never been to Denmark. This will be my first time. So yes, I am looking forward to meeting you. And the rest of the delegates from around the world. Yeah, it's gonna be great. So Katie, thank you so much for taking the time out and coming on today and talking about all the great work you're doing. We are all inspired. So thank you so much. Thank you for having me.
25:00
and looking forward to see you soon. Yeah and everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
25:08
Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy smart.com. And don't forget to follow us on social media
In this episode, physiotherapist, Ummukulthoum Bakare, talks about injury prevention research and advocacy of sports physiotherapy.
The post 586: Ummukulthoum Bakare: The Unbreakable Young World Athlete appeared first on Healthy Wealthy & Smart.
In this episode, Physiotherapist and Sports Injury Researcher, Kerry Peek, talks about sports injury research and the neck. Today, Kerry talks about her research into sports injuries, developing training programs, and evaluating feasibility and adherence to programs. How can greater neck strength assist in reducing head and neck injuries?
Hear about measuring neck strength, defining “normal” neck strength, and get Kerry’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “You wouldn’t send an athlete out without doing knee exercises, and yet we do it quite regularly with the neck.”
- “We need to do some isometric exercise but with ballistic intent.”
- “I don’t think isolated neck exercises is going to give you the best bang for your buck.”
- “The best exercise is the one they’re going to do.”
- “We need to make sure that the research in this space is high-quality research.”
- “We need to be more critical in the way that we apply research in neck strengthening.”
- “If you’re really good at designing exercise programs, get creative.”
More about Kerry Peek
Dr Kerry Peek (PhD) is a physiotherapist, behavioural scientist, strength-and-conditioning coach, and sports injury researcher with the University of Sydney. She has over 20 years of clinical experience in both Australia and the UK working with many athletes across a range of sports, age groups, and playing levels, including elite athletes in football (soccer), rugby, motor racing, American football, and athletics.
Her current research is focussed on mitigating sports related head and neck injuries and has just completed a project on neck strengthening and heading funded by a FIFA Research Scholarship. Kerry has presented to the UEFA medical committee and assisted in drafting UEFA's heading guidelines.
Kerry is the Chair of the New South Wales State Council for Sports Medicine Australia.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Injury Prevention, Neck Strength, Exercise, Training,
Recommended Reading
- The Effect of the FIFA 11 + with Added Neck Exercises on Maximal Isometric Neck Strength and Peak Head Impact Magnitude During Heading: A Pilot Study
- Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review
- Purposeful Heading in Youth Soccer: Time to Use Our Heads
- Higher neck strength is associated with lower head acceleration during purposeful heading in soccer: A systematic review
- The effect of ball characteristics on head acceleration during purposeful heading in male and female
- Heading incidence in boys’ football over three seasons
- The incidence and characteristics of purposeful heading in male and female youth football (soccer) within Australia
- Neck strength and concussion prevalence in football and rugby athletes
To learn more, follow Kerry at:
Website: Kerry Peek
Twitter: @peek_kerry
ResearchGate: Kerry Peek
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Read The Full Transcript Here:
Hey, Carrie, welcome to the podcast. I'm so happy to have you on.
00:06
Thank you so much for inviting me.
00:09
And just so people get our connection, I was in Monaco for the IOC conference, and I went to one of the platform presentations, and you were discussing your research, and I found it to be fascinating. So you do a lot of work with the neck and head and I just absolutely loved it. I loved your presentation. I learned so much about it. And then as I dug deeper into you, I realized that you and my friend Evangelos Pappas, there was a connection there. So I texted Evangelos. And I said, you know, Carrie peak? He said, Yeah, I'm like, Oh, cool. Could you like, tell her that? You know, I really liked her presentation, because I was like, and, and I'm, I'm sitting right behind her. I don't know if he texted you that you're like that. It was like a psycho or something. I'm like, I'm sitting behind her.
01:01
He did text me that and it was just really funny to have this funny conversation between Australia and we're in Monaco, and you're American. And yeah, saying, oh, Karen sitting behind you make sure that you introduce yourself. Yeah. After the presentations are finished.
01:15
Yeah, that was funny. But I loved your presentation. So now I can't wait to talk about your research on this episode. So I'll just kind of throw it over to you to talk about kind of the body of your research and why you chose the topic that you did.
01:30
Yes, I am. I'm a physiotherapist. And now a sports injury researcher and I started in the early 2000s, working with Don gatherer, who is the former England rugby physio, and was the Chief Medical Officer The is the Chief Medical Officer. Sorry, I'll start that again. So yeah, so I started as a physiotherapist, I graduated in the late 90s. I graduated in the UK and I worked with Don Gajraj, who was a real mentor to me, and he was the former England rugby physio and also went to two Olympic Games. And he'd really developed a practice which specialized in neck rehabilitation. And this was an area that I don't really remember studying an awful lot at university, like we did manual therapy. And really, as soon as you got patients pain free, they were free to go like I don't remember really doing a lot of neck exercises. And so we had lots of players that played rugby, we had OpSite athletes, and we had Formula One drivers coming into the clinic, who had had a history of head or neck injuries. So concussion, which wasn't really talked about much in the 90s. But looking back, a lot of them work and cast. And we started doing a lot of rehabilitation, and I really am an exercise based physiotherapist. I really like doing manual therapy. And so it was just fascinating to to really come from that perspective to see, okay, what's the mechanism of injury? And how can we replicate this, you know, doing various exercises are really sports specific. I then moved to Australia and had children and got distracted bit by doing other things for a few years. And it wasn't until my son as an eight year old was heading a football, that I thought, actually, we should probably be looking at neck exercises in this cohort, considering they're using their head to you know, deliberately redirect the ball. And that really sort of got me down this, I suppose research rabbit hole, because at that time I was doing my PhD. And since then I've moved to the University of Sydney. And so really what my research is focused on now is how we can mitigate sports related head and neck injuries.
03:39
And so of course, you know, my next question is, what is the rationale for why training the muscles around the neck can play a role in reducing sports related head and neck injuries? Because, boy, it seems like some low hanging fruit right doesn't cost a lot of money, easy to implement. So what's the rationale there?
04:02
So I mean, first of all, I want to say that I don't think that next month is going to solve every head and neck injury. You know, I think it's part of a multifactorial approach where we will look at more changes and look at, you know, whether that's body checking or collision. But it when we're talking specifically about neck exercises, I mean, the notion that greater neck strength can reduce head acceleration, particularly during heading or during collision sports is that stronger, stiffer, next, increase the coupling of the head to the body, and then help to stabilize the head on contact. So whether that's body contact or head contact, and so really, we're looking at the stiffness, which is the ability to resist defamation, and then the strength which is then you know, being able to increase neck stiffness. And so it is really that coupling between the head, neck and torso.
04:54
And how do you explain this to a patient that you're giving these exercises As to increase neck stiffness, because I know a lot of people might think well wait a second, I don't want my neck to be stiff. So how do you can? And I love that you define that? Would you mind repeating it? Because I think it's really important. And how do you explain that to a patient.
05:14
So I tend to explain to my patient by using sort of the picture of a bubble head, so I do call them bobble heads. So you've got this figure, and then this head that moves really freely. And you think if you, if you nudge the, the head, it wobbles, you know, quite a lot. And so that's a lot of head acceleration, even if you touch the body, the head will also move. And so if you think if you are being tackled in sport, or you're heading the ball, then there's a lot of head acceleration there. And we use sort of head acceleration, we measure it, you know, with inertial measurement units, thinking that you know, this, if the head is moving a lot, the brain is moving a lot. And so if you can reduce the amount of head acceleration by increasing the strength and the stiffness between that bubble head and that fixed body, then that's a way to hopefully reduce some of the movement of the brain within the skull.
06:08
And that makes a lot of sense. And I think that is a great way to say that your patient, because they'll better understand what you mean by neck stiffness. Because I can just see, like, eyes getting wide, like, I don't want a stiff neck. But you're like, Well, when I wait a second, that's not what we're saying, We want you to be able to the neck is still mobile, but we want you to be able to accept those forces when they're placed upon you. Right?
06:35
Exactly right. And, you know, we know that head injuries and things are getting more prevalent in, in sport, and whether that's because of increased reporting, or whether it's just because the athletes are getting fitter, faster, stronger. And so some of the hits that you see in American football, and in rugby league and rugby union, I mean, they're horrendous. And, you know, if you've got this head that is really not well connected to the body, and you're being hit by a, you know, 100 kilo athlete, then that's such a vulnerable component. And I think that the neck, really working in this space, it's the last area of the body that we routinely exercise, you know, you would never send an athlete out, whether they're that's a prevention or whether they're post injury, without doing the exercises, you know, you wouldn't have an ACL and say, right, there's no pain there, off you go. And yet we do it quite regularly with the neck.
07:29
Yes, very much. So. And now when we're talking about strengthening the neck, how do you measure this, the strength of the neck.
07:40
So there are lots of ways that you can measure the strength of the neck. And a lot of these different methods have been shown to have good reliability. My issue is whether they're valid, and they're valid within particular sports cohorts. So when you're looking at assessing neck strength, I mean, generally, when you're looking at any assessment of muscle strength, there's reasons why you do this, you might be using it as an outcome measure. But generally, you're doing it to inform the load that you will input you you will apply when you're then exercising. So when you measure neck strength, it has to have some carryover to the position that the athlete is going to be in for their sport. And it also has to have some carryover to what you're trying to resist. So in with the neck, for example, you're trying to resist lots of head accelerations. So generally, you need to assess the neck using isometric or maximal isometric contractions, because you want to resist movements. Most sports are upright, you know, they're running, jumping, walking, running, and, and so you need to be upright when you test them. If that's how you're also going to exercise them. Now there may be differences. So if you're a rugby forward, you're going to be in a scrum position. So there may be reasons why you want to replicate a scrum position to test an athlete. But some measurements of neck strength are done in a supine and prone position. And these can often give you very different neck strength profiles, to when you actually assess somebody's upright. And there's problems if you are assessing someone in supine or prone, but you want to exercise them upright, because because you just don't know what the actual maximal strength score is in that sport specific position. So the way that I mentioned extreme is that I get them fixed in a seated position because I can standardize that position much better. And I use a break technique. So this is really looking at eccentric loading in an isometric position until you can break the contraction, I guess, of the neck. And this is shown in lots of different areas of the body that a brake technique will yield much higher scores than a mate technique. And so again, if you're using the brake technique, particularly because you're generally trying to keep the head and neck still when there's contact placed on the head or body, and then that is sort of like an eccentric load. So this will give us our maximal score, for which Has the flexes extensors left or right side flexes. And then this gives us a much better maximal result that we can use for percentage of one rep max when we're thinking about load.
10:14
And are you using a handheld? dynamometer? for that?
10:18
Yes, I probably should have said that first. Yeah, but I am using a handheld dynamometer with a load cell in series that's placed on the head with a with a head harness. And so yes, you do incrementally load that.
10:31
Yeah. Nice. And now, how, how do we know what normal is? Like? What's a normal strength profile for NEC? And and then how do we know what's normal for a position within a sport?
10:43
And that's a great question. Because when you when you look at the literature that's out there, the first thing I always do is I look at what was the method to assess neck strength. And if it is in a lying position, then I take the results slightly with a pinch of salt, because they too tend to give you a different neck strength profile. So there are a lot of studies particularly in rugby that have been tested using the same method that I that I use. And this was first developed by by Don gatherer. So it's not any great surprise that I use that because we used in clinic for a very long time and tested hundreds of athletes. But now having moved into that research base and had a look at all the different ways that you can test neck strap, it's still my preferred method. And so we've tested rugby athletes, we've tested football players. And what we're generally finding, and this is sort of consistent with the literature. And what we expect a neck strength profile to look like is that the extensors should be the strongest. So if you look at a result, and the extensors are not the strongest, is it related to the testing technique or the position that they're tested in? Or is there a problem there, so it isn't an injured population, that might give you something that's a bit different. So extensors should be strongest flexors are generally the weakest. And side flexors will sit somewhere in the middle there, depending on the population. So in rugby and American football, you often do want to have the side flexes to be stronger, and a lot stronger than the flexes. So they tend to have a very wide sort of neck radar if you were to plot this on a graph. Whereas if you have football players, for example, because of the conditioning from hitting a ball, they may actually have quite strong flexes. So I always have a look and plot the results on a radar. And then I also calculate the flexure to extensor ratio to see what that looks like. And so in the literature, normal is often considered around point six of a flexor extensor ratio, but I have seen it as low as point five as high as point seven. But I always think if in a sporting population, if it's below point six to me, that's that's honestly a red flag, but it's certainly a yellow flag.
12:47
It's problematic, or can lead to can lead to more problems. Yes. And where can people if they're wondering like, hey, where can they find the method that you use to strengthen? Is there a paper? Is there something you can point to because we can sort of put it in the show notes?
13:04
Yeah, so I do detail the the method for assessing neck strength and a paper that we published earlier this year in sports medicine. So we looked at the neck strength of football players, adolescent football players from 12 to 17. And then we implemented an X strengthening exercise program and to see whether by strengthening the neck this actually had an impact on reducing head acceleration during heading, and we found that it did so that the neck strengthening method is is detailed in that paper.
13:34
Perfect. So we'll have that paper, we'll put it in the show notes a link to it so that people can read it at their leisure. Now, we talked about why you're looking at it, how you're evaluating it, what does a training program look like?
13:50
So that's, that's really interesting as well, because I think, because there's not a lot of published literature on neck strengthening, I think you tend to find that you have different camps of people, some that are very pro neck strengthening, and that that certainly is myself. And, you know, a bit like you were saying earlier is that it's low hanging fruit, you know, why wouldn't we try and strengthen it because the potential gain is huge, and it wouldn't not strengthen any other area of the body. So I kind of think what, you know, why wouldn't you do it? But on the back of that, we also have to think what's the best way to strengthen the neck and I think some people are quite negative towards neck strengthening, because some of the papers that have been published, the exercises that they use are sort of self resisted exercises where they're pushing against their forehead and holding that and doing isometric holds. And a number of studies have shown that this doesn't really have an impact, it may not even impact in which increasing strength and it may not have an impact in reducing injury risk as well. And that makes sense. You know, I don't implement those exercises because When you're talking about reducing something like concussion or heading in football, those hits happen in fractions of seconds. So we don't need to have high insurance of the neck or just isometric control over a long hold, what we need to be able to do is fire those muscles really, really quickly. And so we've been playing with some neuromuscular exercises. So it isn't our paper that was published in sports medicine, but I'll try and describe it, but you're kind of in a setup position, but you're rolling backwards and forwards, and you're trying to stop your head from hitting the ground. And so the idea from that is really to try and contract the neck flexors really quickly if the heads in neutral, and then we turn the head to the side and the other side, and we do the same exercises. But the idea is that you've got that anti gravity strengthening, but you've also got, you know, you're trying to stress the muscles to fire really quickly. And that's what they have to do. So most of the the literature that is talking about neck strengthening is sort of indicating that we need to do some sort of isometric exercise, but with ballistic intent, and that's the bit that is often missing, for most of the neck exercises in the literature.
16:10
Yeah, and that's the exercise you described in Monaco, sort of, for people, if you've ever taken Pilates, it's rolling, kind of like rolling like a ball is kind of what that's kind of, you know, that's, that's at least what I got from it. And I remember I got back to my room, and I was like, we're gonna try and see what happens here. And it is it not as easy as it sounds.
16:32
No, and, and it does, it does work the net quite hard. And you can see it, you can see the net contractions in somebody else that's doing it. But the way that we sort of played with this exercise, and I will just credit to bursting, but also, we meet on a regular basis. And we talk about neck exercises. And he's also widely published in the neck strengthening arena, and was part of this paper as well. But what we were trying to do was come up with an exercise that use no equipment that didn't take long. So these exercises take 90 seconds. And that could be added to an existing neuromuscular program. So in this case, we added it to the part two of the FIFA 11 plus. And this is really important because I actually don't think isolated neck exercises is probably going to give you the best bang for buck either. I think we need to integrate it into, you know, other strength and conditioning programs. And again, this is sometimes where you see in the literature that they're just adding neck neck exercises without thinking about, or what is that neuromuscular control to the trunk as well. And how are we stimulating that?
17:31
Yeah, that makes so much sense to not just do things in isolation. I mean, gosh, especially when you're talking about athletes who rare? There's not many athletes that do things in isolation?
17:45
No, no. And and I think that that's just really important to get that adherence as well. Because if they think it's an add on program, and it's going to take ages and 10 minutes to an athlete is actually quite a long time when they're doing so many other areas of the body, that if we could integrate it into existing programs, or integrating into multi joint movements, then it makes sense to them. And it and it's, it's it's integrated. It's not an add on.
18:09
Right? Because of course, as we all know, as physio therapist, one of the hardest things through a rehab process is the patient that doing the rehab. Right, so the best exercise is the one they're going to do. So if you explain it well. And you integrate it, you're more likely to have that patient do the exercise. Have you found that? Have you found difficulty patients adhering to the program?
18:38
So, so we didn't, we did, we did look at the evaluation of feasibility. So my PhD is actually on adherence to exercise. So it was something that was really at the forefront of my mind when setting any exercise intervention, that we need to have some sort of process to evaluate it and see whether the, you know, the players and the coaches found it feasible, and did it take too long could they see the benefits of it, and it's generally scored really, really highly. And I think that is the fact that we tried to just minimize the time that it took that it was complex. So you know, the youngest athletes were sort of 12 years of age, and you know, they all understood what they needed to do, but also to make it you know, applicable to their sport. I think that's really important.
19:21
And what are your thoughts on different kinds of strengthening you know, we see things on YouTube people will see things on YouTube and I don't mean to go down a rabbit hole on that, but you know, tying weights around their head bands around their head doing things with bands and weights with movement of the neck. What are your thoughts on that?
19:44
So there's certainly some crazy stuff on on YouTube or Tik Tok and I think that's not necessarily specific to the neck. I just think that again, what you've got to try and do and, you know, I think exercise therapists, whether that's physios or exercise physiologist that do exercise really well, they understand the sport and they understand the mechanism of injury. And so if you're going to add a weight to your neck, you've got to think, Okay, well, how am I adding the weight? And how is it replicating, you know, the risk of injury, or what I need to do within my sport. And so if you're in a crouch position, which I've seen in lots of videos, where they've got a head harness, touch the neck, and then there's really, really heavy weight at the end. And I kind of think, why you're doing that, what's that for? And maybe in the scram, maybe that's applicable, but you know, I can think of very few reasons why you would need to do that. And when they hang weights off the top of their heads, you know, you think of that, you know, that axial loading that they're doing. Again, why would you want to do that?
20:51
Yeah, I don't know. That's why I asked, and so we got an answer. I don't know, I really do not know why you'd want to do that. But now now listening to you talk about your research, it just makes so much more sense to integrate it in a neuromuscular based exercise, you know, integrating it with other muscles within the body and making sure that it makes sense for the position and the sport of the person. Yeah, absolutely.
21:21
And I think this is about knowing, knowing your patients, knowing your athletes, and, and if you apply that sort of methodology for any exercise, you know, whenever you see someone, so I've been invited to do some work with the RW F here, so the Air Force, and I don't know a lot about PILOTs, but you just go in here, talk to the pilots, and you say, okay, so what do you do? And you know, when does your neck hurt? And? And how long are you in that sustained position? And how much G force are you being exposed to when you're in a fighter jet? And you just kind of start to understand, you know, what, what's happening to this person? And how is that potentially, you know, making them at risk of injury? And then how do we need to train those muscles in a way that stimulates, you know, what they're exposed to as part of their job or part of their sport? I mean, you do that with every other joint of the body? You know, I think we routinely do that. But we just need to do it at the neck as well.
22:19
Yeah, and great advice. And now is there anything as you know, throughout our conversation today that we didn't touch upon, about your research, maybe about your PhD work that you think would be audience would really love to hear more about?
22:37
Um, I think that it's important. I think it's important than I think I sort of said this a bit earlier on that, we really need to make sure that the research in this space is really high quality research, and that we understand, you know, the mechanism of injury, particularly things like concussion, that we don't think that neck strength is going to solve everything. But you know, when we're reading papers, it's understanding, you know, what method did they use, you know, are the results actually believable, or didn't the way that they measured neck strength have given you such an unusual profile that actually shouldn't read any further in the paper, or it's just not applicable to your athletes, for example. And so I think that we need to be much more critical in the way that we apply research in neck strengthening. And I think that, although I'm very passionate about next trend thing as an intervention, you know, I don't think we should overplay what we can potentially do in this space, either. It's just part of our toolbox, but it's not going to be everything.
23:38
Yeah, there. It's not the panacea for all ills having to do with head and neck injuries.
23:44
That's right. And I think that if you don't understand about how to integrate a neck strengthening program, I mean, I'm very happy for people to reach out to me, but, you know, talk to people and, you know, as I say, critically appraise what's going on. And I think, you know, if you're really good at designing exercise programs, get creative, you know, have a little bit of a play of what you're trying to do. And I think that's often how we get really innovative in the way that we approach exercise programming as well.
24:11
Yeah, and it also sounds to me like there's not a one size fits all. Approach, exercise or program. No,
24:21
I mean, I think there's things you don't do. And then everything else is kind of open to Yeah, depending on your athlete. So yeah, don't hang away off your head.
24:29
Yes, that is fabulous advice. And now as we start to wrap things up, I'm going to ask you the question that I asked everyone, and that's knowing where you are now in your life and career. What advice would you give to yourself as a new grad right out of physio school, your younger self?
24:50
I think that's a great question. And I don't regret anything that I've done in my career, but I would say that I've probably come to really specializing in neck strength is a bit too late. So we started in the early 2000s. So my first paper was published in 2005. And as I say, I got distracted doing other things. And I wish I'd continued with it. And I didn't partly because I was having children, and I'd moved to Australia and just life got in the way. And when I came back to it in the probably about 2015 16. So 10 years later, and nothing had moved forward, really. And I just thought that was a really missed opportunity. And so I if I could go back in time, I would probably, yeah, I would probably want to squash those 10 years into maybe 18 months.
25:40
Well, that would be pretty amazing time traveling. So where can people find you? If they have questions, they want to follow you on social media, where can they go.
25:51
So the best place to find me is on Twitter. So I'm at peak underscore Carey, I don't tweet about anything other than my research. So that's the best place to find me. And then you can always drop me a message through there. Otherwise, you can probably find me via Google, at my email address at the University of Sydney.
26:09
Perfect. And just so everyone knows, we will have a link to the papers that we've mentioned today. So if you want to read up on those that don't worry, they will be in the show notes at podcast at healthy, wealthy, smart, calm. And Carrie, I want to thank you for coming on. Like I said, I really loved your presentation in Monaco, which was just a short snippet of kind of the amount of things that we talked about in the podcast today. So thank you so much for taking the time out and coming on.
26:36
No, thank you actually went to your presentation in Monaco as well. And you've informed a lot of what I do as well about, you know, I think that most research is quite ego driven. And I'm not an exception to that. And we think that if we publish a paper that somebody is going to read it and we're going to change the world. And that rarely happens because players and coaches don't read research. And so your presentation was about you know, engaging with the media and doing a lot more in the social media space. And that really hit home to me that we have to try and bridge that gap if we can to translate research to practice. So no, thank you.
27:10
Oh, well, that's nice. I'm glad to hear that I will pass that along to my partner Osman, as well. So thank you for that. And again, thank you for coming on. I really appreciate it. And all of you listening. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Physiotherapist and Sports Injury Researcher, Kerry Peek, talks about sports injury research and the neck.
The post 585: Dr. Kerry Peek: Neck Muscle Training to Reduce Sports Related Head & Neck Injuries appeared first on Healthy Wealthy & Smart.
In this episode, Owner amd Founder of Goldsmith Therapy Solutions, Dr. Philip Goldsmith, talks about value based purchasing in home health. Today, Dr. Phil talks about the pros and cons of value based purchasing, and prioritising results over productivity. How will value based purchasing in home health turn out?
Hear about OASIS assessments, the difficulties of working with insurances, and get Dr. Phil’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “It looks like value based purchasing in home health is going to be a good thing.”
- “Home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training.”
- “Professional communication is where the good are going to be separated from the bad.”
- “Most of the private insurances base their policies on payment on what Medicare does.”
- “You’ve got to be involved with advocacy if you want to see change.”
More about Dr. Philip Goldsmith
Philip Goldsmith, PT, MSPT, EMT, DScPT, COS-C, is the owner and founder of Goldsmith Therapy Solutions, a provider of high-quality management, consulting, and clinical solutions for home health providers.
Dr. Goldsmith has been a practicing physical therapist for more than twenty years, with experience in home health, skilled nursing, and outpatient orthopedic environments.
Dr. Goldsmith received his BS in Health Studies from Boston University in 1996, his MSPT from Boston University in 1998, and his DScPT from University of Maryland School of Medicine in 2011. Additionally, Dr. Goldsmith has extensive experience in leadership and financial management of small and mid-sized not-for-profit corporations and has won more than $200,000 in grants for public safety organizations with which he is affiliated.
Dr. Goldsmith lives in Hanover, PA, with his wife and son.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Results, APTA, Home Health, Value Based Purchasing, Insurances, Advocacy,
To learn more, follow Dr. Phil at:
Email: pgoldpt@gmail.com
LinkedIn: https://www.linkedin.com/in/philip-goldsmith-a81a692
Twitter: @pgoldpt
APTA Home Health: https://www.homehealthsection.org/leadership
Subscribe to Healthy, Wealthy & Smart:
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Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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Read the Full Transcript Here:
Alright, let's go. Hello, healthy, wealthy and smart. I am Jenna canter here with the Dr. Philip Goldsmith, who we're going to refer to as Dr. Phil, don't you love it? I'm so grateful to have Phil here, because he has a small business owner who runs a business in which he provides Oh, I'm gonna mess this up. And I'm so excited to where he brings stuff to the home health people and they're happy and they smile and say thank you. Without it and I get it.
04:05
That's pretty close.
04:08
Would you mind summarizing in that perfect sentence you just said a second ago of what it is you're more details on your business, like
04:14
elevator speech. It's called Goldsmith Therapy Solutions. And I provide high quality clinical consulting and management services to the home health industry.
04:26
I love it. And that's an elevator speech we all need to have you know for each of our own individual businesses, anybody who interviews with me knows I don't spend too much time going into the bio stuff because that will just be in the people can read it and then Wounaan go oh my gosh, I love Dr. Phil, you know, look at this. Wow, incredible. We are going to dive right into the topic which I know nothing about. I'm a cash pay cash based out of network PT working with performers. So I'm going to ask all the base questions to fully understanding the situation so everyone can better get on the on the same page with this apparently, and I I'm, I'm not saying it's not but just for me, it's new, apparently topic that's like a hot topic, and that is value based purchasing in home health. I know nothing about it. So let's talk about what is that? What is the value? What is that
05:21
value based purchasing is Medicare's new payment model for certified home health services provided to Medicare party beneficiaries.
05:33
Why is that important right now,
05:36
because it's different, how Medicare is moving away from the you go do a visit or provide a service and we pay you for a service to a model where they pay you based more on your outcomes, and how good a job you do at taking care of those Medicare beneficiaries that have chosen to avail themselves of your services.
06:05
That sounds great to me from a physical therapy standpoint, because that's what we care about. So how was this? Let's start with how this is good. And then we can go how this is potentially something that could get in the way of providing care to people fully. So how is this good?
06:20
This is good, because it removes a lot of the artificial drivers that were skewing utilization. Meaning, excuse me until about three years ago. The more visits you the more therapy visits you made, the more money you got. And that was unfortunately driving practice patterns and everybody Medicare, not Medicare kind of agreed. This isn't working. Yeah, yeah. And
06:55
because that's about productivity, not about results. Yeah.
06:59
Right. And it was it was too much widget counting, and a lot of home health agencies were making a lot of money on providing therapy visits that weren't necessarily necessary. Hmm, Mm hmm. So, you know, the the interim step on the way was this thing called pdgm that we're in now where it's all based on functional states and diagnoses? And that's about it.
07:28
Yeah, it's not nothing to push getting them to where we need to get them or to protect them from getting worse. If we're talking about home health. Yes, yes. Okay. Okay. So then let's talk about where this could potentially be problematic.
07:45
So the, the concern is, are you comparing apples to apples, meaning they're dividing the agencies up by state by geography and buy large versus small volume, to try to make apples to apples. But the big issue is, this system works literally by robbing Peter to pay Paul, somebody is going to make money. And somebody is going to lose money. So the other people at the other end of the scale can make money.
08:25
Where could you go and give some details on this? Because I'm not really following on on how this could be? Yeah,
08:31
Medicare is gonna say, Okay, we're gonna take all of the large volume agencies in the state of Pennsylvania. And we're gonna line them up by the outcomes we've chosen, they haven't told us the outcomes yet.
08:46
Deciding what the outcome what outcomes matter,
08:49
they are in the process of that now, who are the consulting
08:52
with doctors?
08:57
So there is what's called a technical expert panel, and we could do that alone. The concept of technical expert panels could be its own podcast, where basically they bring in people in the industry and ask them, What do you think is important? Um, do they pay them? They cover their expenses, do they? Do
09:25
they start to get a financial interest to sway certain ways and their responses? Okay, okay.
09:32
They're representing their industries. So, you know, they can, I could volunteer to be on a technical expert panel. And my job is to bring the perspective of the physical therapy industry. Hmm. They also do us, you know, these big beltway consulting firms that you hear so much about, and they have policy wonks that work at CMS that do this stuff. A lot of its actuaries accountants and lawyers? Because one of the big rules is this is supposed to be budget neutral, meaning the pot of money doesn't change. It's who gets how much of that pot changes, specifically, the agencies that are the bottom performers, they're going to lose it as much as 5% of their reimbursement, so that the top performing agencies gain 5%. See,
10:25
there we go. That's where I think a financial interest could sway what people say, because this could be less money towards their industry. Well, it's problematic,
10:37
home health in general. I mean, this is, it's already, you know, you're already getting paid a lump sum for the care of each individual. And that varies based on those clinical and diagnostic factors that that I talked about before. Right. The scuttlebutt is,
10:55
I don't, but I just need to highlight that. I know I love that you said scandal, but this is great. That means rumors, love it scuttlebutt, I'm going to start using that every day.
11:06
One of the big outcomes they're going to look at is readmission to the hospital, did you keep your patient out of the hospital? Because that costs Medicare more money. And they're gonna look at functional outcomes, like transfers and ambulation. And there may even be a patient satisfaction component because did you know that Medicare mandates patient satisfaction surveys in most settings, you get those annoying Press Ganey surveys? Because Medicare says Thou shalt, and they track those, and those are actually publicly reported data.
11:41
That's actually great. I think the patient what their happiness is everything. Yeah, I think that's great. That's, yeah. Okay. Okay.
11:52
So it's your secrets here.
11:54
So it's it sounds though, like it's a bit of a gamble on where things are going to lie. And what's going to be decided on what these outcome measures are? That sounds like the biggest concern, what are these outcome measures that we're going to be using? Because if we're talking about movement stuff, you
12:15
aren't talking about movement stuff. But, you know, they've already established that all of the measures, the outcomes that are going to be looked at are either Oasis based Oasis being the clinical assessment that's done in homecare at a minimum every 60 days. Okay, Mission recertification discharge, hospitalization, return from hospitalization. That standardized assessment gets done. I have
12:47
a question about that, actually. And this is just from my own experience, it's a completely different audience that I work with. So when I'm working with my performers, I'm reassessing every single time I work with them. I'm a niche practice, though. I'm, I'm small and keeping it small. And so therefore, they get like real top, you know, I know them inside out what's going on in their lives and stuff, so I can best help them. So that is very, very specific. And and I'm lucky to be in that position. So when you're saying 90 days, that sounds like a long time for like a formal reassessment. I believe in oh, gosh, PT, school, it was it was a matter of like two months. So is it because of the the age where things may take longer to see results? Why it's a 90 day spot? Like, why is that? I'm honestly asking, it's not for judgment, I'm trying to be very transparent on my own bias. So I can learn
13:37
that every 60 days, well, every 60 days, that OASIS assessment gets done. However, that doesn't change, that your state Practice Act still applies that you may have to reassess every 30 days or every 10 visits or every 14 days, whatever your state Practice Act says, and Medicare still has the every 10th Visit reassessment requirement in home health, where they expect you to be using objective functional measures, and looking at your plan of care and your goals and saying, Are we getting where we need to be,
14:16
which is what we do in physical therapy. That is we're always asking ourselves that question.
14:19
Okay. This is more of a you know, it's more of a big picture thing. Yeah. Okay. For example, the emulation question. There's independent, there's independent but needs a one handed device independent but uses a two handed device can walk but need supervision at all times. And then there's a couple of answers for wheelchair bound, or bed bound.
14:46
Yeah, I'm not familiar with this, but I'm learning as you're talking about, is there anything about risk of falls because that's like the big a big one.
14:53
They look at that from a process measure standpoint, meaning they ask you, did you assess for fall risk, and there's criteria given a multifactorial objective. So really, it's got to be a two pronged thing. They're not looking at the results. They're looking at. Did you do it? Yeah.
15:17
Yeah. Is there room for? And this may be you don't know, because this is a bit of mind reading. As far as you know, right now, is there room for measurements for neurological disorders where we know that things may they're going to decline over time? You know, are immune immune? Am I saying the wrong thing? I think he's doing the wrong thing. But is there room for that where they have a health situation where things are going to decline? We know that but we're trying to keep them functioning their best as they're going through their process?
15:50
The answer is yes and no. Okay, the questions and answers don't change. What changes is, they can tease out by diagnostic grouping and by what they call risk adjustment, where if your agency has a high population of clients with progressive neurologic disorders, that's the the term in favor now. Okay, thank you, they're going to risk adjust your statistics to reflect that, meaning, we see that you have a larger population of people who probably aren't going to get better. And we're going to do some statistical mumbo jumbo in the background to adjust for that. But that doesn't change the answers that the clinician is using. Okay. There's no, I have to pull a different document because I have a different diagnostic group. There's no, I answer these questions for this diagnosis. And that questions for that diagnosis? Yeah. Yeah, the people who very much a big picture of
17:03
the people behind the scenes, I think I know the answer this question, but I'm still going to ask it, the people behind the scenes who will be assessing the the progress progress, and, you know, if it's fitting, looking at the outcome measures and what we need for that patients, are they medical professionals? Are these just people who are trained to work for this company? Who are the Who are these people?
17:28
So field clinicians who work with clients answer the oasis for each client, the agency, then submits it electronically to CMS. And the risk adjustment is baked in to the computers at CMS that process all this information.
17:50
Also, it's a computer thing. It's all very,
17:53
and that's part of the reason the assessment is somewhat limited in big picture. Yes, it's a it's a computer thing. Ah, it's a i. i, maybe maybe not. But it's a lot of higher level statistics. That's way above my head.
18:11
Right, right. Yeah. Oh, wow. That's what this is so negative for me to say, but what an easy way as a person in CMS to point away and go, Oh, no, it's the system's. That's what they computed. Like, I can't. I'm like, Who created it? Who designed the code? Fine. We'll look at the code person I need to understand. Okay. Okay. So, I mean, it just sounds a little bit like a trip to Las Vegas, where you studied a little bit. So you know, a bit about gambling, you say, let's say you're very educated about that, and you but it's still gambling? You don't really know. I don't know, I just I,
18:53
you know, it's, it's pretty well known how they do the risk adjustment. You know, it's just the statistics of how it's done is pretty high level, but we have a good feel for what they're risk adjusting for and what questions they used to do the risk adjusting.
19:15
I mean, do you think the physical and physical therapy industry home health for this, because that's what we're focusing on? Do you think what the way we have things set up now, the way I mean, that's the whole point is to be measuring their outcomes? That is literally what we're doing all the time. Do you think we're pretty safe with this adjustment? If anything, it'll probably be for the better if you're just overall? I mean, because we did the good versus the bad. Where do you think it's, it's gonna turn out for us?
19:46
It looks like value based purchasing a home health is going to be a good thing. It is going to reward you for doing your job well, and being aware of your outcomes and delivering good health. Quality physical therapy that drives the outcomes? Yeah, there's going to be, it's going to challenge the physical therapist and the PTA to work at the top of their license and to collaborate with the other professionals. Because some of these measures don't happen in a vacuum for lack of a better term, they don't happen unless you're working as a team, and everybody's on the same page. Yeah. And that's really that interprofessional communication is where the good are gonna be separated from the bad.
20:40
Yeah. This isn't my world. Oh, continue,
20:44
there's, you know, definitely the agency is going to have to be very aware of their outcomes and their data. And the understanding of that data is going to be huge. Yeah. And I can tell you, that there are consulting firms and companies, and that can look at those outcomes at a clinician level. And they're going to tease out high performing clinicians and low performing clinicians.
21:16
Yeah, yeah. Yeah. And I'm assuming that's where the concern is, what is, oh, I'm gonna backtrack to actually what I was originally thinking of asking. What is the hot talk on the streets regarding this? What are the big things that other physical therapists and people in the industry are going like, hey, about it? Or do we already cover those things?
21:41
We've covered a lot of it. I think there's a lot of optimism around this. Because the more recent changes over the past couple of years, starting in October 2019 really pulled back on the number of visits. We were seeing clients. And some of that is real. And some of that is artificial. Yeah. And it's gotten me up on my soapbox a number of times, because home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training. Oh, yeah, you want to get me started? Don't get me started.
22:34
Yeah, yeah. So it's, it would force that that push, I would love. It
22:39
forces us to understand how to deliver strength training, how to deliver the most the best outcomes we can in in fewer treatments.
22:52
Yeah, how to get trust, motivation.
22:55
really gotta understand you've got to be a high performing clinician, yeah. To survive in this market. Yeah, because a home health agency literally cannot afford to have lower performing clinicians that can't deliver the outcomes. Yeah. And a lower number of visits.
23:16
Yeah. Yeah. Absolutely. Absolutely. I definitely get that. So I I mean, I'm all about the outcomes. I've had people a different dance physical therapists asked me about how I do my outcomes and it really does depend on my patient and everything but I have a very I have a special circumstance you know, like I'm very lucky to have this niche that I have. i There are from an outpatient not out push out. Yeah. Out not outpatient. Wait, I'm getting so confused. Ortho. From an ortho standpoint, I'm calling because I'm not, I'm not home health. So I'm just like trying to get back to my my world. There are definitely I'm gonna choose my words specifically. So if you are a person who does own a clinic, that sees a lot of patience, you are a mill, there is no way to paint that there is a reason why there is a name for that. That's like saying, I, you know, I was you know, born from two Jewish parents and I grew up I have my Bar Mitzvah and then and like, I still observe Passover, and then be saying, I don't I'm not Jewish. Like what? Like, no, I'm Jewish, you know. It's very weird comparison. But whatever. That's what I chose. And I'll go with it. We
24:41
get to the point of mills.
24:44
I've always thought that the it was because of the problem with insurance and reimbursement and it's one of those like chicken or the egg kind of thing. What happened first, which I use in defense for any clinic. I'm like, hey, they're trying to figure out how to get reimbursed but at the same time, does in this horrible circle of terrible reimbursement trying to communicate what you did and everything, and people are trying to make money, which is fine, it's okay to want to make money Hello. Is
25:15
we as a profession do wrong to allow an industry to devalue our services like that?
25:24
It's because when trying to guess this is me, because I'm not a network. So, but from what I've seen, it's it's clinics trying, they're doing their best to report what they're doing. They outcomes with the patients, while at the same time speaking the language that the insurances say, they will reimburse. And then also these insurances saying they're going to reimburse, but they're not actually reimbursing, then there are administrative staff calling over and over again, fighting to get those reimbursements, you know, getting better at that. So that's why you have certain people working on the at the front desk, and then and so then they increase the number of patients during that time, because while they're gambling per patient on honestly, this is how I look at it for a patient on getting that reimbursement. Through, you know, the paperwork we've we've been trained to do to report outcome measures and everything. They're not they're not getting paid for it. They're fighting to get paid even on the basic level. So I think, but I don't know what happened first if insurance happened first, or, and, or the, you know, provision of the services, and they decided for it to be a lot of people that's the chicken or the egg thing. I mean, I'm sure somebody could look up the history, but I think that's where people just say, Oh, the healthcare system is messed up needs to be fixed. I, that's where I kind of lean back on to kind of be fair to everyone. Not that there has to be a middle ground. But I mean, that is kind of the truth. If I owned a big business, you're constantly you're like, Okay, I've hired this, these EMR systems, you know, we're we're gonna track and write down things. I hope this is the right system. Okay, this one's not working. Let's do a new one. And then you have your clinicians going, Ah, dang it, we have a new one, I have to readjust. But it's because we're trying to do it. Honestly, we're trying to do it legally. And then insurances just go, now, we're just not gonna reimburse you, we're not gonna explain why. And we're gonna be difficult to get in contact with to discuss and figure things out. So I don't know it's a random tangent, I'm sure people will go be like, Jenna said something wrong. I'm not the person to attack here. I'm just speaking. If you have problems, go talk to the insurance companies and figure it out if you already know how it works. But that's kind of how I look at it being problematic in the Ortho world specifically, because there is a lot of measuring of my brain out there. There's a lot of measuring of what was the word that we use, the more patients you see.
27:56
Counting widgets, counting widgets.
27:58
It happens, it does happen at the larger clinics. But yeah, can you I mean, I'm not saying I'm not saying I'm not saying I agree with it. But also, can you blame on? You know, like,
28:12
you started this to make money. I get that, you
28:17
know, but, but I mean, what I am in the business to hear, I mean, that's what I'm doing my own thing, is it easy to do what I'm doing, is it easy to get the patient Oh, my God. But that's I that's where I put my energy where I put my energy. But I feel like what is happening in the home house, like, Oh, my God, this is hilarious, full circle, but I'm going to connect it, it's going to be amazing. Feel like the Home Health what you're doing with pushing that pushing forth. The outcomes, I would love that I would, but I would love to actually be that not than just saying that. We love their beat. Let's make it all about the outcomes. And honestly, I feel like that's what we've been trying to do the whole time. It's just people aren't. insurances aren't saying there aren't following through with it, what they say they're going to reimburse, they say, We can reimburse up to this amount. It doesn't mean anything. It's horrible. So I would love there to be fixing in that way.
29:13
And I think someday Medicare will come around to a value driven system for outpatient therapies. And until Medicare does, nobody else will mean, Medicare very much still drives that bus.
29:31
Yeah. Wow. I never realized that. That's yeah. How do you know how do you I mean, honestly, asking, How do you know that they're the ones driving the bus?
29:43
Because most of the private insurance is based their policies on payment on what Medicare does,
29:53
because they're so huge. Yes. Mm hmm. Oh, gosh. Not saying it. It's easy to say there's no easy road.
30:02
That's where all the that's the root of all the CPT codes and everything else. Medicare needed a common terminology to wash claims through a computer to pay people. Let's boil everything down to a five character code.
30:21
Right, right, right. Wow. Huh? She's What a hot mess. It just gives me a headache thinking about all of it. I don't like it. It makes I need cake. Or pizza. Oh, not chocolate though. My dad loves chocolate cake. Are you a chocolate cake person?
30:43
I am a chocolate person head on.
30:46
We only put like chocolate cake is so different from chocolate bars come on.
30:51
Yes. But they both have their merits
30:54
F No. Disagree? Absolutely not. All right, if you are a person that if you would handle your stress from chocolate cake, just as much as chocolate bars. Okay, your team Dr. Phil. If you're like No, chocolate, just chocolate actual chocolate, your team? Jenna. I'm interested to see if there's going to be any written debate on this or discussions I'm sure there already has, which is why you were meeting Dr. Phil was like, let's do this topic. And like, I don't know anything about this, which is good. I think it's good because then I get to learn everybody else who listens gets to learn. And oh, I'm going to just say this just because I am not a fan of meanness. Don't attack either of us in this discussion. If that's in your if that's in, if that's in your intention in in hearing this and your response, oh, just at this as a message just for you get out of here. Well, we got to be better together, we need to be able to have these discussions, talk about it, totally fine to speak on your concerns about it or all that stuff. But we're just attacking each other that is not helping out the patients at large. This is about the people we serve. So we're discussing this to see what's going on to better understand what's going on. If you are in an estate, you are close to somebody who is in legislature, the then do talk to them, or see if there's a pre written letter from a PTA right now regarding this through their app, if you're in a PTA member or see if you can get a hold of that letter through a friend or something or I'm sure it's honestly on their webpage for you to easily access to advocate sending a letter to fight this or fight for it, whatever it is, because there's there's positives and negatives and everything. I mean, sometimes there's you know, it's leaning one way, obviously, but we got to just take action. If you want to see something you got it don't just reply on here take action. Well, I just gave so many different messages and one thing at the end, but that's okay, I'm fine with it. Any last words you want to say on this matter that you that we haven't covered? Dr. Phil?
33:15
I think the take homes are twofold. You just said the first one. You've got to be involved in advocacy if you want to see change. Second, value based purchasing, like we're talking about it today is just in the home health arena right now. It is what Medicare wants to bring across the board across all settings. And, you know, they don't they want to get away from fee for service. They want to get away from ID to units. If they're x and a unit. If they're X, a unit of East M and A unit of manual therapy and you need to pay me for it. They want to know a client walked in your clinic with this problem. They had these issues that we're able to quantify. And at the end of it, the client left our clinic and the issues were gone and here's how we've quantified it. That's what they want to be able to pay you for. And if you can't be excellent with that. You're not going to have a successful practice 510 years from now.
34:34
Thank you. Thank you so much. Where can people they wanted to get in contact with you Where can they connect with you on either social media or email?
34:44
I am P gold PT on Twitter. I do have a personal Facebook. I am not fancy or cool enough to have Instagram or Tik Tok or any of those. I have LinkedIn. My email is Easy it's P gold pt@gmail.com. The other place that's really easy to find me is if you go to a PTA home health.org on the leadership page, you'll find my name. Currently the treasurer of APGA Home Health formerly known as the Home Health section. And in two weeks in two days I become the President
35:29
didn't say that at the beginning. I was like, I wonder if you want me to and you didn't say bring it and bring it out? So yes, this is a person. This is a person who's very involved with fighting and spin keeping on top of what's going on for home health. So thank you so much, Dr. Phil, for coming on for your name. I love just saying Dr. Phil over and over again. And just sending you the biggest hug from afar. We got a meet at a conference recently and you are a gem. Thank you so much, and everyone send love to Dr. Phil for for his time.
In this episode, Owner and Founder of Goldsmith Therapy Solutions, Dr. Philip Goldsmith, talks about value based purchasing in home health.
The post 584: Dr. Philip Goldsmith: What’s Your Value? A Novel Payment Model for Home Health appeared first on Healthy Wealthy & Smart.
In this episode, Sports Physiotherapist and Researcher, Loïc Bel, talks about his experience as an up-and-coming sports physiotherapist and researcher in the industry.
Today, Loïc talks about complexity and uncertainty, clinical work and mental health, and the importance of having a team around the patient. How does Loïc deal with imposter syndrome?
Hear about Loïc’s experience in Monaco, why he decided to keep getting more degrees, his thoughts on Physiotherapy Associations, and get Loïc’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “You can’t just use one factor to influence the whole situation. You have to accept the complexity. You can’t control everything.”
- “Nobody puts the bad stuff up on social media. It’s only all the successes.”
- “To be successful, we have to fail.”
- “Sports and physical activity as a whole is one of, if not the best, tool for health.”
- “As health professionals, we have to think about what we do, because it has a cost on society.”
- “Knowledge a collective thing.”
- “Don’t give up and don’t blame yourself.”
- “If you believe in your profession, try to get involved.”
- “Communication is everything.”
- “Try to ask yourself more questions. Don’t think that everything you learn is true, even at school. Question things a lot more.”
More about Loïc Bel
Loïc Bel is a physiotherapist since 2.5 years ago. He graduated with a Bachelor degree in physiotherapy in Switzerland and is now in the last semester of his Master Degree in sports physiotherapy, also in Switzerland.
He currently works in an outpatient clinic in a small city in Switzerland for 3 days a week, and during the other 2 days, he studies in Bern towards his Masters degree.
He is currently involved in the ‘Commission for the Promotion of Physiotherapy’, that is a branch of his regional physiotherapy association. He is also a board member of ‘Le Réseau’ – which can be translated as ‘The Network’, which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity.
On an international level, he currently is a board member of ‘Long COVID Physio’ as an education co-director.
A recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Ducrest, Nicolas Mathieu, and Mario Bizzini. The paper was about injury prevention in sports related to performance. Injury prevention is a subject that he tries to develop an expertise in, and he really fell down the rabbit-hole during his Bachelor graduation work that developed into that paper.
His professional goals are to end his Master Degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Injury Prevention, Sports, Exercise, Research, Knowledge, Education, Mental Health,
Read the paper:
Lower Limb Exercise-Based Injury Prevention Programs Are Effective in Improving Sprint Speed, Jumping, Agility and Balance: an Umbrella Review
To learn more, follow Loïc at:
LinkedIn: Loïc Bel
Twitter: @bel_loic
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript Here:
00:07
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a new offer. If you sign up complete a marketing audit to learn how digital marketing solutions can help the clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net help.com forward slash li T z y to sign up for your complimentary marketing audit today. Alright, so a big thanks to Net Health now on to today's podcast. So my guest today is like Bell. He's a physio therapist since two and a half years ago, he graduated with a Bachelor degree in physiotherapy in Switzerland and is now in his last semester of his master's degree in sports physiotherapy, also in Switzerland. He currently works in an outpatient clinic in a small city in Switzerland for three days a week. And during the other two days he studies in Bern towards his master's degree. He is currently involved in the commission for their promotion of physiotherapy, that is a branch of his regional physiotherapy Association. He is also a board member of labor. So and I'm sure I butchered that, which can be translated as the network which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity. on an international level. He is currently a board member of long COVID physio as an education co director. Our recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Newcrest, Nicholas Matho, and Mario Barzini. We talked about that paper in this interview, and it was about injury prevention in sports related to performance. Injury Prevention is a subject that he tries to develop an expertise in and he really fell down the rabbit hole during his bachelor graduation work that developed into that paper. His professional goals are to end his master degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention. And in today's episode, we talk about a little bit more about the IOC conference that was back in November. And also we talk about clinical uncertainty, mental health of new graduate physio therapists dealing with imposter syndrome, and the importance of our physiotherapy association. So a big thank you to Luke for coming onto the podcast and being so open and honest and sharing his experience as a newer graduate in the physiotherapy field.
03:23
Hey, Lloyd, welcome to the podcast. I'm so happy to have you on and it's so nice seeing you again after it's been a couple of months since we met in Monaco. So welcome. Yeah, thanks for having me. I'm really happy to be to be here enough time to. Yeah, and I'm, I'm so excited to have you on to talk about.
03:43
We'll talk a little bit about your experience in Monaco and your big takeaways from that and tell me your what what you thought and what your takeaways were. Yeah, it was it was a last minute chose to go to Monaco. And, and don't forget that actually.
03:58
It was the second big Congress for me. So it was a bit of euphoria. I went to Geneva when there was the World Congress to So second bit Congress on sports physios. So kind of specialization I'm doing right now. And it was it was bigger than I thought it would be actually. And it was really hard to do some take home, because there was so many things to, to take with so many new ideas, maybe so many new ideas about all ideas that were totally deconstructed. So that was a goal of mine to go in. And be like, Yeah, I want to unlearn what I what I had learned during school and during my students. And I know we discussed it together quite quite some time about the takeaway. So there was one word that came a lot during the Congress. I think it was the context, context matters. So you can have
05:00
The best exercise you can have the best the best plan you can have the best program you want. If people don't do it on buying it's, it won't matter much, actually.
05:12
I think one big thing is that maybe we don't know, as much as we think we did. It discussed it with a smart non on a recent Muscats podcast to
05:25
lots of talk, discussed some things that we thought we knew. And maybe they don't work as planned, or they don't work
05:35
in the nation an efficient way, like we started did. And it was a great, great symposium on the complexity, like everything interacts, you can't just use one factor to to influence the whole situation you have to you have you have to accept the complexity, you can't control everything. And, and yeah, you go home and you don't really know what to do anymore. You don't really know if if you did things right, you don't really know if you will do things, right. So that's kind of the takeaway I took from like for me.
06:13
Yeah, and I would agree, I left like God, I feel like I don't know anything and stuff that I didn't know, I had now have to sort of deprogram myself to
06:25
reprogram with new information and new research, which, I mean, if you asked me that's a sign of a good conference. Yeah, I said the same. If I, I'd be pretty, pretty sad to go to a conference and go with only a big confirmation bias, you know, like, Okay, I did everything right. That's fine. So it's a good thing. Yeah. Like you learn something, if you unlearned things. So yeah, it was great.
06:55
Yeah, I agree. And let's, let's kind of dive into this idea of complexity in practice. Right. So like you said, there's so much more to an injury than just the injury, right? So if someone has an ACL injury, it's more than just the physical rupture of an ACL and then knee. So can you talk a little bit more about complexity in practice, whether it be your personal experience?
07:25
And and how you tolerate that uncertainty in the clinic? I mean, if if we speak about Monaco, the big thing was when when you come home is Watson, how do I apply the things I learned? And what I feel like when I when I go to Congress is or to any symposium that speak about research, I'm always like, Yeah, but in research, we control so many things. We want to control the most things we can to better understand the mechanism. And then you arrive in practice, and it's the chaos. You can't control everything you've gone through in research.
08:03
I have a pretty young conditions, I ended school like two and a half years ago. And every time I discussed the topic with some more experienced clinicians, they always answer with the Yeah, experience helps.
08:20
Yeah, but what do you do when you don't have, you don't have that much experience, you have to build some. So you try to rely on research, you tried to, to you try your things, basically, you have some tools, try to use your tools.
08:37
That gives you some idea when you try what should be best practice in research. But sometimes it doesn't work as planned, and you have to deal with it. So you try to adapt. You try to modify things a bit. And you have to go with intuition sometimes. And
08:54
yeah, it can be a hard feeling to deal with. I mean,
08:58
I tweeted like, a few weeks ago about that, because I had a rough day, I really have a rough day. Like I had three patients, it didn't go as planned. We had to go back to the search, and we had to discuss things. And it's really exhausting. I feel like to come home and nothing worked as planned. You go like with 1214 patients a day. And this tree will stay on your mind like the whole evening the whole evening. You don't know you're just thinking about how could I help? What's next try to plan for you and for them.
09:35
Yeah, I don't know we can you can deal with it. You have to acknowledge that it can happen. And you have to. Sometimes you have to take a step back and be like, yeah, what did I do? Did I do something wrong? Or not? Because maybe you did nothing wrong actually. And how could I figure out a new strategy to to advance and do better? Yeah,
10:00
It sounds to me, like what you do when you have those days, and we all have them where you're like, I'm a loser, like, I can't help anyone, no one's getting better, what am I doing? But that instead of going back and sort of wallowing in it for the whole night, I think you can wallow for a little. But it sounds to me like what you do is you kind of reflect on that re reassess how you did things, and really look at what can I do differently? I don't want to say better, but what can I do differently. And if it's something, then you always have another time to try. And if it's, you know, I think that I did what was appropriate, then maybe it's let's go in and have a deeper conversation with this patient, you know, let's see what other part of this complex person in their ecosystem will allow us to move forward. So that's what I got from what you just said that you really take that time to kind of reflect, reassess, and then move in the next day, or the next time you see them. So they agree, and complexities are also about how it works with the with the other colleagues to other professions around the patient. So you have to reach out for other people, you have to discuss things with them. And you have to you have to explain what you did you have to, to also be confident about what you did. And and that's that can be quite confronting to, to do. So. Yeah.
11:39
Many things to deal with. But in the end, you have to go forward and keep on keep going.
11:45
Absolutely. And you know, as a newer ish grad,
11:49
you know, you kind of
11:52
knowing what you don't know. And maybe knowing what you do know, how do you sort of keep putting one foot in front of the other because I'm assuming imposter syndrome may come up
12:05
every once in a while. So what do you do to keep moving forward? And maybe what advice can you give to let's say, a new graduate that's graduating tomorrow, given the experience that you have over the past couple years?
12:21
You're right, it happens from time to time. And and I mean, social media don't don't help with that. I think, as a whole, yes. Because there are lots of success story. There are not much stories about failure. Well, I mean, here's the thing. No, nobody, nobody puts the bad stuff up on social media. It's only All successes, right? So you have to take that step back and be like, yeah, maybe maybe they fail to. And to come back to Monaco, there was a great great one. That was about the biggest mistakes. So did a motor compress was something about learn from our biggest mistakes. So it was with Yvette for Heigen Carolyn, a bullying Caroline Emery to.
13:09
And I think it was great to have like to be in a Congress with what you can call like, a camera like her from speakers in the world about injury prevention, and, and, and hear them like, we failed. But we kept on moving. We kept on trying. And we did really, really better and we try every day to do better. So it was one good thing is that for once there was there were people that acknowledge that they failed, but they kept on going in and it was it was yeah, they deal with things with the tools they had at that moment and that you can't have everyday data you you want at every moment. So you have to try. And another thing I'd say is that personally, I try to really reflect and reflect on on on what I don't know I try to Yeah, we can speak a lot about metacognition and and identify your knowledge identify your lack of knowledge in some in some topics, so I try to identify my weaknesses. And then I try to read because I can't just be with patients 24/7 So I have to read about them and and and try
14:29
that said so I said I see the things
14:32
there's a quote I like that that say what I believe is a process rather than a finality. I don't know who Who is this this from but I like it a lot like you have it never stops you have to keep on moving don't stay like in a stone try to tie traveled. Yeah, and that's how I said things. Yeah, and I I missed that talk at Monaco. Now, I really wish I went to it on the
15:00
You know, yes, we failed at these things, learn from our mistakes. And I would argue that the most successful people in the world have failed more times than they've been successful. Right? Because they're taking chances. They're putting themselves out there and, and they're making mistakes, learning from them and then pushing forward, which can be your stepping stone to success. Yeah, I'm a pretty firm believer that to, to be successful, you have to fail. Because if you just have success, I mean, first of all, it's not realistic. But I feel like if there was only on the success, and you couldn't fail,
15:42
you'd stop working. You don't anything to do anymore. You. You're not on this planet. So yeah, I think that's you. But every, every failure you have is a small break towards the Big House of success. Basically.
15:59
I couldn't agree more. And you know, in talking about all of this, you know, we're talking about failures and imposter syndrome and not knowing, and you're in a clinical setting, you're working with people. With all of that on your mind, it can certainly take a toll on your on mental health as a clinician. So what what do you do? Or what advice do you have when it comes to that clinical work? And mental health? Your own mental health?
16:28
Yeah, so I feel like we have a really demanding job, from a psychological perspective, because like I said, sometimes you fail, you have that bad day, and you come home, and you're like, Yeah, rethink, everything is worthless. So you have to do to overcome that. And with that, you have to, to add all the pressure about knowing things, because patients want answer answers. So you have to know things, you're the professional they want, they want to know, as sometimes you don't.
17:02
Now to, to put less pressure on me, I am honest with the patient, when I don't know, at the beginning, during my internships, I was always trying to find the right answer. And sometimes I didn't have it. And I try to find the thing to say. And now I feel like yeah, it was really unethical. First of all, and
17:27
no idea, say, I don't know, but we'll try to figure it out, basically. And one phrase I do, I do say a lot, when situations are complicated is that we'll try to improve the best we can. But I don't know until when we can, until what level we can improve, we'll figure it out. But maybe it will be only only a small portion and, and you'll have to try other things and physiotherapy.
17:58
And basically, you have to take care of your mental health and health professional for that. So I'm not ashamed to say that I wanted to psychologist and I discussed this topic, too. I didn't go for that. But I discussed it because it was really taking a toll sometimes my on my health. And now I learned to take a step back to be honest with the situation and discuss
18:24
discussing with patients and be open to criticism from patients to isolate them, you can tell me if if something isn't right, will change what we do. Finding yourself and being confident enough in yourself to say I don't know, is very, very beneficial for everyone involved, because you don't want to make something up.
18:47
Right. So if you don't know, I think what you said, you know, I don't know, but let's figure this out together. I'll look up some research, we'll figure this out. And if we can't figure it out, then I think it goes into another topic that you wanted to cover. And that's having this sort of entourage around the patient. Right? Because it's not your the two of you aren't on an island together, and there's no one else around, hopefully.
19:14
So can you talk a little bit about the importance of that, that team or that entourage around the patient? Yeah. So I think that I'm really lucky because
19:26
I met some awesome people in Switzerland during my studies and when I went to congresses,
19:33
I can mention someone It's Susan God that was in Monaco too.
19:38
She she's she's helping me on a daily basis. Basically. I'm often writing to her and and some other colleagues, some of the friends and colleagues that are my age we try to we try to figure out stuff together too.
19:55
I think
19:57
we are in a profession where
20:00
You can't have all the knowledge and some people already belt, some strong knowledge on some specific topic. So when I have a situation, for example, with Suzanne from with the shoulders, I write to her, because she's the experts in my, in my network, she's the expert on shoulder, so I don't hesitate to, to to write her to ask the patient if I can take, for example a video of or picture of the problematic I have. And I asked, I tried this, I tried that I have this situation right now. It's not have evolving, it's yeah, it's it's staying the same. We don't find a way to, to overcome the situation. What do you think about it, and then we discuss it and, and sometimes she she has some really great things that I never would have thought about. And I do the same with with friends.
20:56
I have some friends with my part time studies. They have the same problem as me. Sometimes they write to me and I try to help sometimes they do say I do thing with them. And sometimes nothing comes out from it. But at least we tried. And
21:15
and yeah, I try to do the best with the tools I have right now. And I feel like they are getting sharper every month, every year. But right now, yeah, it's not the best strain to get the tree with the knife the moment sometimes so. So yeah, it's gonna get better.
21:33
So what made motivates you to kind of to keep going and keep learning and keep sharpening those tools?
21:40
Right now, I think that's the first thing is that I want to help the people I work with, I don't I don't often tell the term patient. I think I work with people not with patient, they're productive. So yeah, I want to help them. So that's, that's one of the reason. And the other reason is that I don't like not know, to not know. So big. So I'm really curious. And I want to know, and yeah, again, you have to cope with not knowing but but I try to dig it always a little deeper and try to understand the mechanism of what I do have of I don't know, special battleship or stuff like that.
22:24
These are the two things, I'd say, drives me the most. And then I fell into sports physio. And I was like, yeah, it can be fun because I, I always liked sports. And I always did some. But it was also because I believe that sports and physical activity as a whole is one of the if not the best tool for health. And you have to understand what you do. I mean, we speak a lot about sickness size, about active therapy, you have to understand what you do. If you just give some exercises and you don't know what consequences can be.
23:05
Again, it's not the best gear you can provide. I feel like so I don't I don't like and it happens sometimes. But I don't like when people go home and they and they come I don't know, two days, three days after the treatment. And they tell me Yeah, I was feeling horrible for for two days. Because we because I did something that was too much volume or too intense. I don't know. But yeah, basically, that's it. And I feel like you have to be a Swiss knife, you have to add some tools to your toolbox. You have to add communication, for example. That's that's one that's the most important tool in in relationship
23:47
with these people and, and personal experience, I feel like is a is a big driver, too. I feel I felt right when I went to the psychologist and I could discuss and I could communicate. So
24:01
understanding what it feels like yourself, drives me to do better for the people that come to. I think it's it's important.
24:12
Yeah, and I'm so happy that you said communication is I would say the communication is most important any relationship period. That's true, whether that be personal professional, client patient, it is number one, and that that is a skill that can be learned. You know, there are books, there are classes that you can take on how to be a better communicator.
24:35
But I think it starts with knowing what you know, and being able to admit what you don't know and learning more. So kind of everything that you said throughout this podcast, I think really comes down to that piece on communication and it's huge. I'm so happy that you brought that up. And on that note, we're going to take a quick break to hear from our sponsor and be right back with more
24:58
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25:00
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25:35
Why move on to higher and higher degrees? Right? So for you, why do a master's degree in Switzerland when a bachelor degree is enough here in the US? We had started with a bachelor's, I went to a master's. Now we're at a doctorate level clinical doctorate. So why move forward through all of that when Hey, maybe if a bachelor's is enough or a master's was enough, why why keep pushing forward on the degrees? I think it's a big topic in Switzerland too, because we have the other countries around us that all go to the master degree level, we are maybe one of the only country left in Europe that doesn't ask for a master's degree to be in the clinic, maybe I don't know not the last bit. We're not like in the best situation right now. And that's that's me. That's me, critics from our colleagues and other students in PT school actually, to to that I wanted to go further. And some some told me that I wanted to prove that I was better than them, or that I wanted to be paid more, so I can be paid more. I can't ask for more money, because I got a master's degree. So these are not the reasons. But the main reasons from me with were like when I went into my internships, during my degree, I was really feeling clueless. And I felt like I didn't have the tools to do anything.
27:06
I was a big, big, big manual therapy for years. For three years at school until the I was lucky in the last year there was the Geneva Congress, the World Congress in Geneva, and I went to the to the conference from Peter Sullivan and Jeremy Lewis. And it really blew my mind. And I was like, that's what I want to do. And it really changed my perspective on things. And I was like, Yeah, I want to upgrade my skills, I want to get a better understanding of everything. And, and that's, that's what drives me, it drove me in the first place.
27:44
provide the best care.
27:47
And I think you have to, like I said, to better understand that. And I feel like, as health professionals, we have to, we have to think about what we do, because it has a custom sort of site society, basically. And I was happy to go to that conference, because I realized what I what I participated in, when I was only providing passive, passive treatments. And now I think it's like I have to participate in reducing the costs. I have, it can be by by encouraging people to move more it can be by maybe avoiding a surgery, you can you can have ACL conservative treatments, more and more, it becomes a big bigger trend than before. And that's how I see things right now. And
28:43
one other things with the master degrees, that I like to research and you have to have a master degree to do research in Switzerland. So you I mean, you don't have to, but it's way easier with a master's degree. And I always wanted to add my break to the brick house because I really liked doing my beach law, graduation work. And I think that knowledge is a collective thing I published with the with the colleagues of mine, Mario pizzini, the kilometer in France and UK recently the my first paper and I don't feel like it's only my paper. It's like we did this. We did it us for and it's only for people that come and add just a break to injury prevention and non subject so
29:38
that's what I want to do. Basically I want to I want to add Matt, just my break. I don't want to be remembered for it. But I want to help things move on and go further. And domestically. We can help me understand the research better and help me to understand how to conduct it's basically so that was one of the reasons and
30:00
As, as a young clinician
30:03
research I rely a lot on.
30:09
And if we speak about the funnel model from
30:14
evidence based practice, you have best evidence on the top. You know, it's better than me with the conference at that spot physio. So I think that's that's an agreement.
30:26
Research is at the top. Great. But if you can't read research, you can't use it. So that's that's one of the reasons.
30:35
Yeah, well, I think that's a fabulous reason. And just so people know, we'll have a link to the paper that you just mentioned in the show notes at podcast at healthy, wealthy, smart, calm. So we'll have a link to that. Do you want to talk briefly about what give give the abstract, if you will, of that paper? That's exciting. By the way, congratulations. Thank you. It was I worked on it during my master's degree during two years, I didn't think it would last this long to publish it. But we finally made it. But the idea was, was that
31:12
was that we thought that injury prevention programs for the for the lower limbs could improve performance. And the we evaluated that through a numpy review. And the logic behind it is that
31:29
we have a big utterance problem with these programs. So how could we improve the utterance and there was a talk, we can come back to Monaco, again, about never mentioned prevention, we only speak about performance, you know,
31:42
it's it's the main driver of sports, affiliate sports. And I'd say even off amateur sports, you want to you want to win. So how do you sell it to these guys and women's? So elite athletes, athletes wanna want to be the best. So performance is a key things.
32:02
So it was the logic behind it. We want to we wanted to explore that. Does it affect performance, just by doing these programs? And we can say it has, it has an effect, it doesn't have the best effect. I think
32:17
you better trend for performance than doing these warm ups, for example, if you want to improve performance,
32:23
but it's, you can you can say that it could help. But I think more on on not much level, not knowledge level, it won't be strong enough stimulus for them.
32:39
Excellent. Well, thank you for that quick, abstract, or quick synopsis of that paper. And again, it'll be in the show notes for this podcast. Now.
32:49
As we start to kind of wrap things up, I'd love to talk a little bit more about physiotherapy association. So we have in the United States, the American Physical Therapy Association, we have world
33:04
confederation of physical therapy, which was that was hosted in Geneva a couple of years ago, I was there as well. Do you think they're important? Do you think they serve a purpose? Or no,
33:17
I think they are a big key to, to promoting our profession. Actually, I don't know how it is in other countries actually, with the with the contact with the public with maybe the politics too.
33:34
But they out. I mean, you can you can go and ask the politics and the public everything that you want. If you only one, it won't work. If you come as a group, and with tons of people, maybe it will change things. And that can come back to to the master degree. Step. Two, we need people with an expertise to push the job. And that can be made through associations. We have to actually make the knowledge and then we have to do a diffusion of knowledge. And that's a great way to help people we see so many things that are
34:14
pseudoscience on I don't know a low back pain for example, that goes to the public maybe that's if we could promote what we think is best care and what would help people it would it would be great and I think we have to do it as a group as an association, our gateway for that. And I'm on the I'm a board member of the local zoo that can be translated as the network
34:41
I'm one of our I'm one of the if not the youngest, and with the less experienced in the group but
34:49
we want to promote like physical activity for for health. We want to regroup every everyone you don't have to be a physio but everyone working in sports in
35:00
In movements, and oh, by now and go and promote that for everyone. And
35:09
and I'm also on the commission for the promotion of physiotherapy,
35:14
in my region, Switzerland, so we do, we do some, some really versatile stuff. So we are going to public conferences for everyone to attend. So we want to disseminate knowledge in an understandable way for everyone. So we invite speakers, and they tried to keep it short and simple for everybody to understand. And we have some more professional conferences.
35:43
For example, we did one a year ago, a small workshop with Darren brown on long COVID. It was not really discussed at that moment. So I wanted to have people in Switzerland health professional,
35:58
better understand they had the occasion to discuss with Iran for like, nearly an hour. And
36:06
he answered every question, and I Big shout out to them. Because he He's He's amazing. Everything he does seem to push. Yeah. Everything it does. Yeah. I don't have any words to describe him. Yeah, I don't have amazing, but yeah, that's the thing I think we have to do. And again, it's about accumulating, and if diffusion, you have to accumulate the knowledge, you have to defer to big diffusion to concern people. And I couldn't have done it without an association. And it's rich, it's stretched, maybe, I don't know, 120 feet do
36:49
that could treat lung COVID patients better. And that wouldn't just use exercise.
36:59
To try to to improve things, skirted codes, wasn't everything. So it's important to have that and it's it offers a big platform to reach public your wants. So that's why I think that you have you have to go in this association. You don't have to agree with everything. I don't agree with lots of things in the Swiss physical physiotherapy Association, and quite vocal about it. In my regional Association, I say that I don't like lots of stuff. And I tried to make things move from the inside. Not always easy. But you have to try. But yeah, the problem with that is that I'm on the board with the Huizhou. I'm on the board with the promotion of physio, I'm I don't do much to be honest. I'm on the board from long COVID physio to. And that's can be tons of projects, actually.
38:03
With all the side projects with the clinic,
38:07
with my students who have to write my thesis, I only have a few months left, and I'm crawling compare workloads right now. But yeah, you have to deal with it. And that's, that's kind of the situation right now.
38:21
Yeah, I mean, I agree with you on Darren Brown. He's outstanding. I interviewed him for the podcast about lawn COVID. And it was a wonderful interview. We're going back and forth. And I finished I said, Do you have notes in front of you? He's like, no, yeah. He's like, That's, like, yeah, I met him in Geneva, at the Indaba. Part was where everyone can come and just speak, and there were topics, didn't have a clue on the topic. And it was like you everything.
38:54
And at the end, I discussed with him and I was like, yeah, do you know something on the topic? And he was like, no, no, I was just going with the flow and okay.
39:04
But
39:05
he's just like that. He's, he's, he's an awesome speaker is a wonderful person, and I can't, I can say, Yeah, and it's more about him. That's only praises for him. I agree. I'm with you. I have 100% only praise for that man. And I think he's, he is pretty remarkable. And what a great asset to the profession of physiotherapy. And he has that ability to disseminate information to the public very well. So he knows how to simplify things, not dumb them down, but simplify them to make the average person understand and that's a very special skill. And I think he has it inherently so that he can sleep good. Yeah, it. Yeah, it's a great skill to have. Okay, so now that we're really wrapping things up here, what would you like for let's say two or three times
40:00
takeaways of our conversation to be for, let's say, younger physical physio therapists or even physiotherapy students that you can impart to them after being out in the world for the last two and a half years or so. Yeah, the first one I think would be
40:24
don't give up. Could it be an advice? I don't know. But don't give up and don't blame yourself could be a good one, I think
40:32
you have, I think that you have to deal with the situation with the tool you have at the moment you live it.
40:42
Sure, that's now some situations I had like two and a half years ago, I would deal with them better right now. And some that I have right now, I will deal better with them in a few years. But you only have these tools in your toolbox right now. And try to do your best and don't blame yourself you fit doesn't go like you planned it would go if it doesn't go like you would have liked to go.
41:12
You can you can fail then like we said it will help you change the way you do it the next times. And you'll do better. Basically, that would be the first I think
41:26
with that with the mental health. So don't blame yourself because don't take a toll on it.
41:33
I think it's important.
41:36
But to be a second ones.
41:40
Get involved. I think if you believe in your profession, if you believe in physiotherapy, if you believe in health movement communication, tried tried to get involved. You don't have to do every project like like, I think I do, or like I think many people that came on that podcast do, I think you you should choose. Just quick on that. I think that maybe we have culture and physiotherapy where we think we have to accept everything. Don't do it.
42:13
Better, choose the projects, better choose to and do it, do them greatly. And then choose eight and fed them. Choose your projects, but try to get involved. If you if you believe in it, try it, try it, it will be worth it, you will meet some awesome people, you will make some connections and it will be worth it in the end. Anyways. So I think there's that and I think that's that maybe
42:41
maybe to come back on that we should find a way to to propose these projects to young clinicians as at least into a salon. We don't have anything to anything to get them involved. Maybe we should find a better way to propose the projects to to ask them. I think they have an I have a fresh vision on lots of things. And I think that's one of the reasons why we should we should have younger clinicians come in and express themselves. Because we live in an era where things go really fast. And if we only have the same old people that do it for 50 years, maybe that won't make it.
43:26
And let think I don't know, actually, what would be the last thing? Do you have an idea?
43:34
I mean, I think what you said was great, the only thing I would just like to reiterate from this conversation. So the big thing that I took away is that communication is everything. And that really finding a mentor finding, like you said an entourage of people to help you sharpen those tools. Those are my big two takeaways from, from our discussion today. And finally, I always ask, but you probably just answered this, but I'll ask it anyway, since I asked everybody is knowing where you are now, what advice would you give to yourself as a new grad? So not random? New Grad, but you yourself going back in time? What would you say to yourself? So as a new grad?
44:26
I'd say accept, say, say no to lots more things. I say that because sometimes I get really overwhelmed, overwhelmed with the things I do.
44:39
I think I would say that. And if I go back in time even more, maybe like in my first year of PT school, I'd say try to
44:50
try to ask yourself more questions.
44:54
Don't think that everything you learn is true even at school.
45:00
Question things, lots more, even even if it's teachers, even if it's school, a question things, it's not always the best, the best that you learn our school question lots of things.
45:14
Excellent advice. And now where can people find you if they want to follow you? They want to ask you questions they want to get in touch where's the best place for them to reach you? It could be kind of on like on social media, where wherever is best for you. I think that Twitter is the best for everything physio related. You can go on what is it like Bell B, L underscore like, Oh, I see.
45:38
I think it's the best way. Oh, by all by email, if you text me on Twitter, it's my DMs are open. I think I can give you my email if you perfect problem. I think I don't think we need to give give your email.
45:54
Yeah, well, we'll we'll stick we'll stick to the Twitter app for now. So people can find you on Twitter, we'll have a link to that. Well, I want to thank you so much for coming on the podcast and you know, as a newer ish grad, if you are indicative of others in the field. And I think the future of physical therapy is looking really bright. So I want to thank you for coming on and for sharing all this great information with us and your takeaways from Monaco and everything else in between. So thank you for the invitation. It was really great. It was fun. I had lots of fun, at least it's got my pleasure. Good. That's all I liked to hear my pleasure. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Lloyd for being so honest and open with us about his experiences as a newer grad physio therapist and of course, thanks to Net Health. So again, they have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit today to get your clinics online visibility, reputation and referrals boosted
47:10
Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media
In this episode, AAPT President, Rob Tillman, talks about leadership and diversity in physical therapy.
Today, Rob talks about being a leader, effective delegating, and the problem of bad advice by industry leaders. How Does Rob balance his life?
Hear about Rob’s journey to where he is today, advocating for diversity, and the shortfalls of the industry, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “You can’t get anybody stronger by giving them opioids. You can’t correct biomechanics by having somebody on muscle relaxers.”
- “Change doesn’t happen overnight. Attitudes can happen overnight. Mindsets take a little bit longer to change.”
- “Competency burns down barriers.”
- “The key thing in business is to manage as many variables as you possibly can.”
- “Not only do we not have diversity when we’re looking at the body types we have to work with, we’re not having systemic diversity at all in medicine.”
- “You can treat everybody fair, but it’s impossible to treat everybody the same.”
- “The outcome is when you get them back to doing what they want to do in their lives.”
- “The best leader shows people how to do it.”
- “There’s a difference between believing in something and living something.”
More about Rob Tillman
Rob Tillman is the president of Ortho Rehab & Specialty Centers. In 1986, he received his degree in physical therapy from the University of Missouri. Rob immediately saw the need to attain a level of clinical competence that would allow him to effectively address the complex needs of his patient population. With this in mind, he enrolled in a post graduate residency training program with the Sorlandets Institute which later became known as the Ola Grimsby Institute. He is a Fellow of the American Academy of Orthopedic Manual Physical Therapy and American Academy of Physical Therapy.
Rob attained the highest level of clinical certification available in the field of orthopedic rehabilitation. Since then, he has received international recognition for his research on the lumbo pelvic system and has written benchmark works on the thoracic and cervical regions, as well. Rob has presented at several national and international conferences on a wide range of healthcare-related topics. He is also a recognized authority in the arena of sports medicine, having been credited with the rehabilitation design and training programs for many professional athletes and organizations including professional baseball, a Superbowl MVP quarterback, an NBA championship-winning power forward and a four-time golf world long drive champion.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Rehabilitation, AAPT, APTA, Priorities, Education, Diversity, Leadership, Advocacy,
To learn more, follow Rob at:
Call the office: 501-975-4040
Website: https://www.pt-orthorehab.com
AAPT: https://www.aaptnet.org
LinkedIn: Rob Tillman
Facebook: Rob Tillman
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript Here:
00:00
Hello, this is Jenna cantor. I am here with the ROB Tillman who is currently the president of a PT and also is in charge of the ortho rehab and specialty centers. He is just a top physical therapist in the profession. We got I had the major pleasure of meeting him in person for the first time at the APTA 100 years Gala. Was it 100 years? It was, yeah, yeah, we were all dressed up, I got to freak him out with my excited energy, because I was so excited to be meeting you, Rob. And I, by luck convinced you to come on this fun ride and do this interview with me on healthy, wealthy and smart. Thank you so much for agreeing to come on. My pleasure. It same. It absolutely is just wonderful. So um, I would love to just start with if people could learn more about how you got to these leadership positions, start from wherever you feel comfortable. But I would love to hear how you got to now. I mean, you're heading these things. Of course, I mean, so many things. So please share.
01:10
Well, to be honest with you, I I didn't really seek to be president or leader of anything. I just really wanted to I went to physical therapy school and I wanted to do sports medicine. So I learned that while I was trying to do sports medicine and orthopedics most patients have that come to an outpatient physical therapy clinic have neck or back pain. So I decided to go ahead and learn something about how to deal with neck and back pain. So I did a residency with a group called Restore Landis Institute, which is now the older Grimsby Institute for four years and did a residency and passed by competencies and became what's called a level two manual therapist by the Norwegian standards. And I think it's still the highest level of competency, internationally recognized in orthopedic manual therapy, started teaching courses, and orthopedic manual therapy after I gained my level of competency and start working with the group was held South back then it was the world's largest healthcare Corporation geographically. And I started troubleshooting clinical operations, and learned how to do the administrative things. And then next thing you know, I'm a vice president. And then I'm a senior vice president, and then they have their accounting scandal. And then, so I started my own company about 18 years ago. And all the while while I'm doing my, my, my core competencies and working, you know, to make a living and moving up in the in the company I was with. I'm at a group called the American Academy of physical therapy that was established about 30 years ago. And
02:54
it was in 1989. Yeah,
02:57
it was it was a black folks that had concerns about access to physical therapy, school and quality care in the black community. And I learned about them through who is now my best friend, Leon Anderson, the third, his dad, Leon Anderson, Jr. is the founding president of the American Academy of physical therapy. And I just really started teaching what I had learned to the group and expose them to the specialty of manual therapy, and I just kind of hung around and enjoyed myself with them because that's the first time I really experienced unconditional love, professionally, in physical therapy, because they just made me feel welcome. A lady who's deceased now named Diane Ellsbury. I call her my PT mom. She'd says, Hey, Rob, baby, how you doing? And just hug me and just what do you need anything? Are you taking care of yourself? You're not working too hard. Are you just like an auntie type thing. And then I became more involved in the operations and joined a committee called the innovative services committee. And innovative services was that's exactly what it does. It does cool and innovative things like create programs, we established a navigation program for mentorship for for our young folks coming through an advocacy wing that was concerned about practice acts and access to care and licensure issues and things like that. In the process, I somehow got appointed to the Arkansas State Board of physical therapy. So that's how I ended up wearing these hats. And while I'm on the board and Arkansas State Board of physical therapy beginning about 1617 years ago, I'm currently still on the board. And it's it's rewarding. It's rewarding. It's a lot of work, but it's rewarding, and I'd rather be at the table than not be at the table for a lot of the things that are going on because our profession continues to evolve. The physical therapy profession continues to evolve. And as an E involves then we have to be able to apply the clinical concepts that we are. In general learning in physical therapy school. State practice acts can hinder your ability to perform the things that you've learned if you're not careful. So we really have to make sure that all of the practice extra current and access to physical therapy is available because we are the most green profession. In healthcare. It's all hands on care and exercise. You can't get anybody stronger by giving them opioids. Okay, you can't correct biomechanics by, you know, having somebody on muscle relaxers, you know, it's kind of hard to strengthen somebody while on muscle relaxers also, by the way, but as we're looking at all these things that I'm doing at the same time, it's just when people ask me to do something, I don't want to be the person that's complaining about things not being done appropriately. I want to be the person that's kind of like a catalyst, or at least an advocate or participant in moving things forward and making things better. And sometimes you don't get paid for. Okay, but but, but that's why I love the Academy because it's the service academy. It's, you know, it's a place to come and serve and love the people that you're with and be loved, have a positive attitude and move some things forward.
06:21
I think sometimes people get caught up into looking at the AAPT or the APTA as something that needs to serve them. The APTA is also a giant service group. If we look at it appropriately, and as we come together, and share concepts and ideas, the current leadership of the APTA has done a lot better on sitting down and really trying hard to understand the challenges of the black community, just so my my hat's off to past president, Sharon Dunn, and also the current president, Roger Ver, and, and Justin Moore, the CEO, and Carmen Elliott, who's vice president over Dei, I think that they're really putting their best foot forward on working towards things. I think that we all have to be patient, and monitoring the progress as we do blend initiatives and work together on things. Because change doesn't happen overnight. attitudes can happen overnight, mindsets take a little bit longer to change as far as our train of thought. But behavior patterns take a lot longer than that, and coordinating behavior with other groups and other people take even longer. So I've learned to be a bit more patients in my practice, and my working with folks. And I've also learned that not everybody that doesn't understand the EI or the hardships that other groups are having. They're not all necessarily opposed to other folks doing well, or what somebody would call a racist or something like that. They just don't get it. And sometimes people want to get it. And those are the ones that we have to engage in conversation with and share ideas and have our thick skin on, to work together on things and not be so easily offended because we've all got pasts. I try not to be so easily offended and angered by things. But also, I have still pretty good intolerance of people that are in denial about other people's hardships. That's a little bit tough to be in full denial about other people's hardships. And there's current legislation that's going through several states that actually don't want America to tell America's full story. Because some people aren't comfortable with hearing about America's past and some of the impressive things that have taken place in this nation. But while we're deleting some truths that need to be spoken about America's past, we're deleting the chance for especially when in this case, black people to tell our kids and society in general, the challenges that we've had, and the reality of how we got to where we are and what we need to do collectively about. So that's another thing that's happening in today's society, but I do believe in general things are moving forward. As far as being president of the Academy, I never wanted to be president of the Academy. I wanted to be the guy that shared the cool clinical stuff. And just got to hang out with people that were just loving folks. I became chair of the innovative service committee. When BV Clemens retired, one of our founding presidents. He was later President second president of the Academy. And when he retired and took a step back, I took over the innovative services committee. And then I was asked to run for the director position, which the innovative services committee reported reports through the director director's position. It's now under the director, our current director, Renee crater Dr. Crater, great lady. Man few years ago, they asked me if I would consider being president of the Academy. Are you sure you want to do that? But my skill set on big A former officer in a large company and my background and all the things that I've been working on and still doing, including being on boards and things like that fit the skill set that was needed for the president at that time. And again, I'm humbled and honored to serve as the president of the Academy. I've done it for the last three and a half years, I can't wait to get the next crew of people trained up and ready to take over as we're pushing forward on things. But right now, it still currently fits my skill set and and and I hope that the academy is satisfied with my leadership and innovation and my quirky ways of dealing with things but it certainly has been my pleasure still serve as president of the Academy.
10:46
I'm so everything you shared, i Nobody sees me. But I have this very excited smile, listening and everything. And I love hearing things. In your own words, you are a very, very humble individual and the amount of service you have provided to the physical therapy profession at large. Thank you.
11:06
So it's my pleasure. It's my pleasure. It really is. It doesn't even seem like work.
11:12
Right? And and that shows anyone who works with you, like I've known you for a blink of an eye. I mean, it's been, gosh, half a year now. Yeah. But like it from for you are so kind you know how to like enter a room, whether it's on email, or text or whatever, in the friendliest way. You are. So I find you to be so approachable. And very, as a leader, it's still no denying what your position is. I just really think you are really, you said, I love what you bring to the table. Love it, just enjoy very much. Yeah, from the from the amount of time I've known you. How do you handle things with being what doing what you're doing? And I've never asked you this before. And that life balance, you know, people talk about work life balance. How do you do that? From what I've seen, you have specific times, you're like, I am not replying back, which is great. Could you talk about that a little bit more where you kind of set boundaries and stuff. So that way, you're able to handle everything and not overwhelm yourself.
12:20
Sometimes I My wife's a surgeon, she's a breast cancer surgeon, the Chief Chief of breast cancer at the University Hospital here. She's comfortable multitasking and doing a bunch of stuff. I really want to make sure I'm a perfectionist and whatever I put my hands on. So if my attention is split, if my attention is split, I know that I'm not going to do the thing that I'm working on, as well as I could. So I do one thing at a time. I do one thing at a time. When I'm in clinical notes. Sometimes I can reply to a text sometimes I can't. But I want to make sure when I fix a problem, that problem that has my undivided attention, my total undivided attention and I'm giving it my best that I possibly can. As I'm trying to resolve the issues that I have in front of me. I love that I feel
13:15
like it's a very attainable way to approach life rather than just going just one thing at a time. Do that. Good. All right. I love that. I've actually even been doing that this week. Not even purposely because you said but now I'm going to be like Rob said this I'm inspired. I've been doing that this week where I I had it upon me to finish up the project we're working on together and I was like nope, let's hone in and now like it's at a really good spot you know now and then I moved on to it. I've already moved on to other things because again,
13:47
that's it's because even in relationships if I know I'm doing the best I can with that relationship even if it goes awry. At least I know for sure I did the best I could with it. Oh I love that. I love that so much that way you don't have any regrets. Yeah, yeah, yeah, it
14:03
makes me think of what that tattoo that that tattoo where it says no regrets but regrets is spelled in properly regards because I love that I kind of want I'm not into tattoos but if I got one it'd be either Disney or that. I love that so much. So now as when you are a leader of a as a leader of a PT how is that different from being a leader at a clinic? Like a clinic owner? How is that different?
14:38
I'll say it's the same it's just the objectives are different. Objectives are different. Okay. Now when when you're dealing with a clinical situation it to me if you're doing it the right way you're focused on your outcomes. Yeah. I'm not in a silo to where you know the orthopedic surgeons are upstairs and they own my my practice you They're gonna send me patients regardless of company, you know, so we're outcome oriented. And we get the things that are a little bit tougher than the guys that have the automatic referral that own their own PT practice. I've learned that competency, burns down barriers. You know, people don't care if your margin, if you know what you're doing and they got back pain, they're going to come and see you. That's true, that's true. But key thing in the key thing in business is to manage as many variables as you possibly can. Because they're variables that you can't manage. So being timely looking professional, okay, incompetent, having the tools that you need to get people better. I mean, how many PTSD see that, that work for a group that owns the practice that doesn't even have the tools to get the outcomes that they need, and they're working with the only resistive equipment they have is exercise to me. You know, you have to have what you need. And I'm our chief proponent of physical therapists independent practice, but I'm also a huge proponent of us owning our own businesses. And not working for groups that own you.
16:14
Yeah, we do. Uh, you know, I really see and feel what you're saying there, I have my own practice. And there's a lot to be said, because we all shine in a different way. We're all doing evidence based, but when we're able to come through as a as the autonomous decision maker that we've been trained to be, we can really help those patients, we can be a best service. I truly do believe that.
16:40
Yeah, I think so. But, you know, by the same token, we have to go the next step, and do what's defined by the way that the APTA is going, and the different academies and specialization. Oh, yeah, I've heard somebody give the worst advice at a three state meeting once and I'm not going to get the states because it might tip it off, it will. But this guy stood up and said, to the students, when you graduate, don't worry about training anymore. You already know enough, you know, you know, everything you need to know, to really make it. And I sit there. And then I asked the question, I said, Well, I think that the APTA is going towards specialization. So how does this fit in with that, but I know darn good. And well, after serving a four year residency in orthopedic manual therapy, that I'm a far better and more competent clinician. Also, you know, even being a co author and co author in some textbooks and defending my my thesis internationally at the First and Second World Congress on low back pain. It helped me to learn more, always active clinician, because I've learned more. And I have a more diverse patient population, because I'm a specialist in orthopedic manual therapy that's paid his dues. And and I believe we get superior outcomes when you go through residency training. Of any comment. Yeah, of any kind. So that was the absolute worst advice I've ever heard anybody give some young kids right out of school.
18:10
I think there's been a lot of advice out there that can be off, but I definitely think that's really, it's off. I'm thinking you got me thinking of I grew up as a ballerina. And ballet is impossible to perfect, however, that every ballerina is trying to perfect it what we're doing with our lines or bodies, you know, it's definitely out of the anatomical positions. And when you first start out like that, you learn all the dance steps, you learn all that, does that mean? I'm done? No. I'm always taking class, I'm always working to get better. And I learned so much from my life as a ballerina, I was pretty intensively in it at one point for a good portion of my life. And I learned the importance of always learning, always practicing and having to be passionate about it. Because if I wasn't passionate about it, I wouldn't be showing up and putting in my best. So having that background and then going into physical therapy as my new profession. Definitely was in line the idea of, of course, I'm always going to be learning Absolutely. What Why would that would make me the worst person to work with if I was start in one year of Tottenham?
19:22
No, I'm haunted by what he said. But it motivated me to teach something different to people in that. Yeah. With me, because I hear somebody saying something in full. He said it in full sincerity. He really didn't think anybody need to learn anymore. Yeah, but that's terrible. So let me go and teach people why they need to learn more. Yeah. Because especially when you're minority or a woman, you had better have it together. If you're out there on your own, you have better have a superior product because you're not in that good old boy network. Well, you're an outsider, also, if you better do it better.
19:56
Yeah, it's yes. And also If we're going off that you're going off with the research at the time that you learned it, we did not do diverse bodies, we do not have diverse bodies in research, we are massively lacking that, you know. So we need to be open and ready and seeking and creating more of that information to learn from to better serve.
20:20
I'm glad you're saying that because not only do we not have diversity, when we're looking at the body types that we have to work with, we're not having systemic diversity at all in medicine, because different people, the guy named D'Amato wrote a book a long time ago called Eat right for your blood type. And he talked about how different types of blood types have different types of foods that they can metabolize, and using their systems and have it not function in a fashion that's detrimental to the person. And lo and behold, different people can eat different things and perform differently. I'm gonna type O blood time, I need dense protein. Some people that are more of a type A blood type may not need as much dense protein, they may be able to make it by carb loading and eating pastas and things like that. If I eat a bunch of pasta before I go into an athletic endeavor, I'm going to suffer versus somebody else may be able to metabolize that and move forward with it. So everybody's different. And I think we're just now getting to the point to where we're paying respect to the difference in the different physiologic physiologies that different people have. And it just so happens that certain physiologies are grouped together in different ethnicities. Yeah, and because of because of that, because of that, then we have we have an evolving ability to specialize care to specific individuals. Yes. When When, when it's all mainly designed for just one certain group, or one certain physiology. Mm hmm. Body Type one certain athletic performance level?
21:59
Yeah, no different different, different, different, different levels of stress and anxiety, depending on what your background is. The stress and anxiety, someone gets the food, the blood type, that all affects healing. Yes. And it can definitely take away from the exercises they're doing.
22:18
Or give you a specific example of that, I'll give you some with COVID. With COVID. They're finding the people that get most sick from COVID have low vitamin D levels. Okay? Now, black people can't synthesize vitamin D, vitamin D is actually more of a hormone than it is a vitamin. Okay. And when you're exposed to sunlight, your body synthesizes its own vitamin D, which is a vital hormone for the basic function of your system, in your in your body. Okay? Well, black people can't synthesize as well, because we have more melanin in our skin. And the melanin reflects the sunlight. And so we have to have an increased exposure to sunlight to have the appropriate vitamin D level. Well, everybody was told to stay home for first three or four months during COVID. And lo and behold, black folks died at a higher rate than everybody else did. Okay, sky like, wet, your black folks have a more problem with high blood pressure, isn't it, and we eat the same thing that everybody else eats. But just so happens that affects us differently. And it may be because certain ethnic groups can't metabolize that metabolize the same foods the same way that other folks can. And so I think as we look at those things, and be more specific with it, we can teach through the whys. We're talking about, you know, masking up and what to do to not get COVID. But we're not telling people in specific you need to have this number of these nutrition nutrients every day. Okay, to where your system is more healthy. And your hydration level needs to be exactly this. I think that we could have done a far better job and still can have telling people what they need to have in their systems to be healthy.
24:07
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24:50
I agree. I absolutely agree. And for me, I I haven't even gone into the nutrition stuff in massive detail with my patients and now you're opening up another door I've actually been getting into cognitive behavioral therapy, right now learning about that not to become a therapist, not at all. But to better compliment how I communicate with people who could do well with it or watch out for trigger words, all that kind of sensitivities. Because the individuals I find my patients really do open up to me a lot. They have been through or going through some of the most jaw dropping things in their lives. And yes, that affects their healing. So I need to make sure I'm not triggering them. By my, the way I speak, if anything, complimenting a journey of healing, as we are working towards a healthier, healthier movement, decrease pain in their life. So yeah, yeah, I definitely get it from from where I've been with the anxiety stuff. Yeah,
25:51
you're dealing with people in their complexity. Journey, people that deal with people in the same with patient care. Now, let's go back to them. You know, zoom out zoom. And you've heard me say that, Oh,
26:01
I love that. Yeah.
26:02
So the deal is, okay, let the we've zoomed in so tightly, let's zoom out so that we can see everything again. And now let's zoom back in. Because, you know, you can teach a kid how to hit a baseball, and he can hit every type of baseball pitch at every speed. But what if he gets hit in the ribcage? Oh, you don't want to get hit the ribcage again? Right? So is that going to alter his ability to perform? Well, if he's so afraid of getting hitting and hurting, then it may be in the back of his mind that he's gonna have problems. So you know, it can alter his performance. So yeah, but the mental aspect of performance of any time. You know, my daughter suffers from anxiety disorder. And and it's hard. But we have to work through it. Because, you know, let's let's be sympathetic to us. But we need to be more patient with some folks and see what we can do to integrate them into a functional position in society. You can treat everybody fair. But it's impossible to treat everybody the same. Ah,
27:06
amen. Amen. All right, I'm going to switch completely into another because it just popped into my head. And I was like, oh, I want to ask regarding leadership. I was talking with another business owner, she's actually new to owning her own private practice. And, and then there's another person who's much more seasoned with his pride, like, yeah. And he said, I'm working on delegating more. And further, and I cringe, because we like to really Oh, that is that's it? How could you talk about your journey with delegation, because as you get, you know, the more of the leader, the higher leadership position, you do have to delegate more. How do you do you know, like,
27:51
Well, yeah, yeah, but here's what needs to happen is you've defined your clinical product, okay? You have to replicate that product, either you have to do it or somebody has to be able to produce the same clinical product that you produce. And it just so happens with mine. It's it's specific care in orthopedics with a high level of differential assessment of Neurophysiology histology and Arthur kinematics, and the appropriate prescription of hands on care and exercise from that. So if somebody comes to work for me, especially in the main office, they're not going to have their own patient load for six months. Until they go through the readings. And they they learn the basic clinical practice for dealing with an upper cervical problem, a lower cervical problem, ribcage issue. Problem with a hyper lordotic spine, a problem with a hyper mobile spine, problem with pelvic issue, be it internally, as far as pelvic floor issues, or biomechanically, when the sacred tubers and sick response ligaments are a little bit loose, and they can't withstand the normal loading. But they should be able to, they have to be able to do all those differentials in there to be a predictable application based upon that assessment and diagnosis, to where we're replicating the outcomes that we need to replicate with patients that present with those pathologies. And that takes time. So now let's go back to the guy that says that the students don't need to learn anymore. Well, they're going to get their lunch eat. All right. There are guys out there that then and ladies that have been doing this forever, that have the highest level of competencies, that'll run them out of business. If the playing field is indeed level, and there's access to the same level of referrals, and getting a good outcome doesn't mean that a person comes and says, Well, I hurt when I'm riding a bike for a long period of time. Well, why don't you take a walking instead? Now that's not an outcome. The outcome is when you get them back to doing what they want to do in their lives. Yes, that's it not modifying their life but getting them back to doing what they want to do so that they can maintain the quality of life that they desire, not telling them that well, if it hurts to bend forward, quit bending forward. No, that's not. That's not an outcome. Right? Right. modification.
30:09
Yeah, yeah. And it's so interesting you say that, because always learning, I have my practice where I'm 100% virtual. And that happened from the pandemic, I was not expecting that, and my performers love it for access everything. And it got me very into, you know, I'm not going to go into the details of what I do. But regarding outcome measures, I literally, that's what we very intensely focus on what they ultimately want to do not just like, oh, I have no shoulder pain, you know, they want to know if they can do this arm movement. And when they dance, you know, every time can they do that without having to worry about it. And then we get them there. And that is why I have a massive increase in satisfaction, because we are fully getting them to that to that their specific goals. I love them for
31:01
that. I'm very, very slow to accept praise for anything that I might do. Because the patient's the one that's got to do most of the work at the end. In the very end, and you're really is only as good as your last patient. You're only as good as your outcomes. Say that you are, yeah, doesn't matter how much you walk around talking about how great you are and how smart you are, if the patient didn't get better than you fail?
31:23
Well, because it's not about us. It's not about us,
31:26
it's about them, it's about getting them better, you know, and that is the most rewarding thing. You know, like, it's, it's,
31:35
I've built my company, we've got five facilities now. But it's one patient at a time, one outcome at a time. And most of the patients that we get come by word of mouth. Nice. Yeah. So you just get after it and handle your business and maintain and be a good steward of the opportunities that come to you. And take care of people the way that you'd want to be taking care of yourself. But back to the point of leadership. Yes. Your best, the best leader shows people how to do it, instead of trying to do
32:05
Yeah, and that's a skill. That is a skill. Oh, well,
32:11
the funny thing about it is I've always gone to church, and I've you know, I've always gone to church, and different people have different ideas of spirituality and religion. But there's a difference between believing in something. And living something. Yeah. Okay. There's a big difference in believing something and living something. And I go to church now, the preachers, my brother in law, and I was kind of skeptical because my sister in law married this guy, and he's preaching, I was like, you know, just because you got to church doesn't mean I'm gonna be hanging out at church on time. That's such a good guy. He's such a good guy, and he lives it. So now I went from saying that to actually being a part of the service every Sunday and doing devotion at the start of service. So you know, if somebody sees you living something sincerely, and not saying one thing, and then doing another and behaving in a way that's totally outside of what's your professing in a crowd, and I think that's a lot. That's, that's what a lot of people away from spiritual base. Community, is, people are observing what people are saying. And then they're observing that person's application of what they're saying. And seeing if it adds up. And a lot of times that, yeah, you know, a lot of times does, yeah, and I think that's led to a whole lot of skepticism and a lot of our religious organizations. Yeah,
33:35
yeah. Actions do speak louder than words they do. It's just like, exercises,
33:41
exercises. Think about it. Think about it, you know, you know, the only Torah or Qur'an or Bible that people see in public are the behaviors of those people that profess those religions a lot of times, hmm. So, you know, are we living testimony to the Torah, or the Quran or the Bible? Are we are we living testimony to because if we were as diverse as we are with religious beliefs, if it's obvious that we're living, right, you know, everybody, I think would get along a whole whole lot better if the Pharisees were zeroed out. Yeah,
34:19
yeah. But that's where that's where you you jump in for this leadership and for all this volunteer work, because you want to start being the change you want to see in the world and be rather than just being an outsider. Like, let's take action for this change, which I so appreciate that about you.
34:35
Well, I just I'm slow to accept it. But if I do, I'm all in. Yeah, yeah. If I do, I'm all in. Yeah. It's It's It's humbling to be asked to serve in a leadership role of any form of any form, to be called upon to serve because that means somebody thinks enough of you to ask you to think about doing something and being an agent of change or or a vessel of service. Yeah, and that's what I always think about my wife gets a lot of a lot of requests to serve as well. And so we're very understanding of one another's roles. When we're asked to do things that might eat away from our our family time.
35:16
Yeah. Yeah. Kind of hard. Yeah,
35:19
it's rewarding. It's rewarding. I love that.
35:23
Thank you so much for coming on. I know this can inspire so many people. Just when you speak if you ever are at an event and you see Do not be afraid to approach Him, He is the nicest human. Like, go say hi. Ask questions, everything like you're like, Oh, God, no, I'm gonna get
35:42
this better than others.
35:44
Well, yes, you are still human. Of course, of course. But you're very good at communicating that you're like, Hey, you said that with me. You're like, now's not the time. Let's connect another so we did, which was incredible. So yeah, it definitely just a great leader to know to learn from and just, you're just good people. So just thank you for being you.
36:05
Thank you. Thank you for having me. Yes. Turned out to be the way that you wanted it to be this time.
36:09
Oh, my gosh, this is all every time. I feel lucky.
36:13
We'll do it again, if we need to. Oh, my God, I
36:15
would love to. And then, um, how if people want to reach out and connect with you? What is the best way if somebody wants to reach uncle? Oh, I want to I want to ask them a question.
36:25
Well, they can call the main office here in Little Rock 501-975-4040 Or you can look us up on our website at ortho rehab comm and leave a message there, somebody will check it.
36:41
Wonderful.
36:42
Thank you so much. And also don't forget about the American Academy of physical therapy. If people are curious about that. It's a wonderful service based organization designed to deal with healthcare disparities in the face of black community, but we're trying to help everybody, but our leg laser focus for us is to work with the black community and then try to help everybody else as we can.
37:03
I love it. Thank you.
Episode Summary
In this episode, Co-Founder of Aivo Health, Melissa Farmer, talks about the mind-body approach to treating chronic pain.
Today, Melissa talks about the mind-body approach, getting patients to be more receptive to the mind-body approach, and how practitioners can recommend psychological care for chronic pain. How can psychology work to treat people with chronic pain?
Hear about the gaps in chronic pain measurements, the psychology behind farming pain out, the Aivo Health App, and get Melissa’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “The body and mind aren’t separate. They work together, they interact, and that impacts the experience of someone who lives with chronic pain.”
- “Just because we can’t measure it with an existing tool, doesn’t mean it doesn’t exist.”
- “A patient saying that they’re in pain is all the proof that you ever need to believe that they’re in pain.”
- “We all have a collective responsibility to empower people who have been living with chronic pain.”
- “One of the most powerful tools for pain relief is between peoples’ ears.”
- “Your identity is not your accomplishments.”
More about Melissa Farmer
Melissa Farmer is a veteran chronic pain researcher-turned-entrepreneur. During her graduate studies at McGill University, she trained with a world-class multidisciplinary team at the chronic pain center founded by pain research legend, Ronald Melzack. She earned a doctorate in clinical psychology and neuroscience. Dr. Farmer went on to pursue postdoctoral training with neuroimaging pioneer Vania Apkarian at Northwestern University, where she specialized in brain imaging of hard-to-treat chronic musculoskeletal and pelvic pain.
In 2018, she left academia to co-found Aivo Health, a startup with Vania Apkarian and a chronic pain patient/entrepreneur. Their mission is to bring insights from the top tiers of pain science directly to people living with chronic pain.
On twitter, Dr. Farmer has an international following of influencer physiotherapists who appreciate her ability to translate basic pain science research into understandable language.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Chronic Pain, Psychology, Treatment, Mindfulness, Meditation, Therapy, Trauma, Pain Relief, Mind-Body,
To learn more, follow Melissa at:
Email: melissa@aivohealth.com
Website: https://aivohealth.com
LinkedIn: Melissa Farmer
Twitter: @Farmer_MindBody
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Read the Full Transcript Here:
00:02
Hey, Melissa, welcome to the podcast. I am so happy to have you on I have heard raving reviews from Sandy Hilton and Sarah Haig about you. So it's great to have you here.
00:15
Thank you so much, it is a pleasure to be here with you. And today we're going to talk about treating patients living with chronic pain from a mind body approach. So before we get into the meat of the interview, can you define what a mind body approach to the treatment of chronic pain is? Sure, a mind body approach to the treatment of chronic pain acknowledges that we are embodied in these, you know, this skin, muscle bone, that we feel emotions in our bodies, that sensations have emotions that are attached to them. And it also acknowledges that all of these conscious experiences like pain and chronic pain arise from the brain. So they're conscious perceptions that are shaped by our thoughts and emotions and feelings and past experiences. So it's an acknowledgement that the body and mind are separate, that they work together they interact. And that impacts the the experience of someone who lives with chronic pain. And now here's here's the hard part as clinicians, what can we do to help our patients be more receptive to this approach when it comes to pain management, because chronic pain, any clinician will tell you is not an people living with chronic pain, excuse me, it's not a it's not an easy road. So what can we do to allow our patients to be more receptive to this? Because oftentimes people will say, so you're saying it's all in my head? And that's not hopefully not what we're saying. So got it? Oh, not at all. So one of the most powerful things I think, that we as clinicians can start with is a simple statement, I believe you, which is something that many people with pain don't ever hear. And it can be such a powerful statement, because then instead of coming to an appointment with, you know, evidence that they've prepared to prove that their pain is real, you know, tests, scan results, etc. You push all that off the table, you say, I believe that you're in pain right now, and I'm ready to help you. That's, that is, I think, one of the first pieces of resistance that we can remove, just by validating their experience.
02:53
And I think especially whenever people have lived with chronic pain, and have seen many, many, many, many doctors, they get used to this feeling that they need to
03:08
convince the person in front of them that their suffering is real. And if we just if we
03:19
if we get up that out of the way, just by acknowledging that common humanity, I think there's there's one level of resistance that's removed quite quickly. And what about providers, or medical professionals who our education, whether it be formal education school, our clinical rotations, has sort of trained us to look at scans and say, Oh, this is it. This is what's causing it. So what can we do as providers to? To break us out of that, if it's in the scan, then that's, that must be what it is. Do you know what I mean? Mm hmm. I think getting in touch with some humility. So crepe is a great way to start. Because one of the issues with scans and test results is that these are things that
04:14
scientists and the medical professional has decided these are measurable, objectively accessible, indices that we've all sort of mutually agreed, indicate that something you know, there's some sort of structural abnormality or whatnot. In other words, we're testing to look for what we know might exist. Another way of saying that is that we're only testing for the things that we've thought about before, and that we know how to measure and there's a lot of things that we don't know about and we don't know how to measure. And just because we can't measure it with an existing tool, doesn't mean it doesn't exist. And, you know, from a basic science perspective, right
05:00
My background is in basic science of chronic pain, we do not know a lot about chronic pain mechanisms. And so having sort of the humility to recognize that
05:18
the nervous system is incredibly complex, the brain is incredibly complex, there are many things we don't know how to measure, and it doesn't mean that they aren't there,
05:30
we tend to cling to tests that reflect our particular training. And from a patient perspective, what that means is that they get different types of snapshots. For instance, if someone has
05:45
lower back pain, they may get MRI scan to one, you know, from one doctor, if there's comorbid, visceral pain, which could be referred, for example, they might get a colonoscopy from another doctor, each of every every, you know, we've talked about silos before, you know, in the general field.
06:06
Each of these silos have their preferences for these different tools, and they all provide small snapshots. And it's sort of like the, you know, the blind men feeling on different parts of the elephant, you know, that really handy metaphor, just because you're a trunk expert, or you're a, you know, a, an, an elephant foot expert doesn't mean that you're able to see the entire picture. So Humility is a great attribute. Yeah. And where do you think this kind of false dichotomy between the body and mind originates from? Is it that, you know, Decart Deyan? Theory, you know, that happened centuries ago that we continue to accept? Or is it that we put more weight to the objective and less weight to the subjective? Or is it both? Or is it all the above and more,
07:06
all of the above, for sure, especially in the pain field, Decart has, he said, really strong influence, and he suggested that the body is like a machine. And you can sort of causally identify almost like a, you know, knocking down a line of dominoes. A cause effect, cause effect cause effect. And that's how you understand a more complex organism. But
07:34
what he, he sort of, it's interesting, he, he essentially said that, you know, like the body, the material, it works on different rules than consciousness. And he sort of made this blanket statement that we all accepted. So in a sense, relying on the words of a philosopher 400 years ago, is the basis for our logic today is a little a little surprising. But it's something that many people haven't questioned. And, unfortunately, in the, in standard medical training,
08:09
I'm sure you're familiar that like, especially in Northern America, in medical school, they receive anywhere between four and 11 hours of pain education,
08:21
there isn't enough time to go into the depth, the proper depth that this subject deserves. So I think that it's a, unfortunately, a reflection of these overly simplistic heuristics that medical professionals and other practitioners receive.
08:40
That that just doesn't do justice, to pain at all. Yeah, and like you said, because pain is so complex, because pain is an emotional and
08:54
physical state
08:57
that I think people are always looking for the answer. I know, patients are always looking for that one doctor, that one test that one scan that will say, Oh, this is it. This is the problem because people like logical things, right? People like well, point A, here's the problem. I can do B and I will end up with C feeling better. But when it comes to chronic pain, we can't look at the body and mind as separate. And I think a lot of people do and that does really is a recipe for some really ineffective treatments for pain. So what what can we do if a patient comes to us and they have sort of accepted that their mind body and mind are totally separate? And their kindness I must have done something I've got I've had this pain. I you know as a practice, I'm sure you've heard it. I hear it all the
10:00
Time, I'm sure I did something again, or I must have done something to flare it up. So how can we respond to that in a way that's accurate and helpful.
10:12
One of my beliefs, and this may not be a popular belief is that
10:19
the body has done nothing wrong, whenever it creates chronic pain, the body and mind it that chronic pain isn't a mistake.
10:29
And I say that from a scientific perspective, because whenever I've studied the mechanisms from the nerve ending on the skin, you know, whenever pain signals or nociceptive signals are transmitted from the surface of the skin, to the spinal cord to the brain, the body is naturally designed in a way that amplifies pain signals. So amplifying pain is how nature works. And it works that way. Because pain is a really important thing to notice. Pain is a primary reinforcer. And that means, by definition, it's aversive, you don't need to condition or to pair it with anything for an animal or for a person to try to avoid something, it's painful. And that's why it's always sensory and always emotional. It's always aversive.
11:23
And whenever, you know, as I've studied chronic pain populations over the years, and I've looked and really considered and reflected on the biological changes that I see all of these, these mechanisms that sort of turn up the volume of pain, whether it's at the nerve and the surface of the skin, or in the spinal cord, or in the brain, they're all there for a reason. And it's because the signal is incredibly evolutionarily important to respond to.
11:55
And the division happens in the brain where once it gets to the brain, and creates a emotional memory, or a fear memory. That's whenever the brain adapts and changes in response to that incoming signal. So in a sense, that's the point where the brain begins to adapt to accommodate the pain in someone's life, rather than just being passively responding to the environment. And that's one of the
12:31
one of the main features of chronic pain, where it's no longer just a, you know, whenever you see a patient to
12:42
has pain that still increases and decreases in response to external stimuli. That's a great sign because it means that the nervous system is still really closely linked with the environment. Once pain fluctuations start to vary independent of the environment, that means that it's become
13:01
more hard coded into the nervous system.
13:05
So that whenever I see patients who you know, who do have pain that's responsive to seeing the environment, I congratulate them.
13:15
But again, the idea that
13:19
it's adaptive to remember what causes pain means that it's also adaptive to create pain memories. It's also adaptive to change how you move in relation to pain. And it's adaptive, to feel depressed, and to feel anxious. Those are all completely normal, understandable responses to pain. And the
13:44
thing that isn't as natural and healthy is the inability to go back to baseline after you've hit that new state. And one of the reasons is that whenever you have chronic pain, so many experiences during your daily life, reinforce that cycle that you don't have many opportunities to learn what the lack of pain is like.
14:07
And something this is something I call relief learning. So it's natural for us to pay attention to periods of escalating pain. It's something it's a skill that can be learned to pay attention to periods of pain relief. And that's something that a lot of patients don't naturally do. And it's something that
14:31
if you don't come at it from a brain perspective, you might not see the importance of it. But anytime pain is decreasing, or it's lower than it normally is. That's the time that you should be focusing on positive emotions, relaxing the body, learning new skills, that's optimal learning time. So of that, one of the reasons I bring that up is that the the brain even though it's responsible for creating this chronic state
15:00
It's also the key to changing it and shifting back and reversing to the pain free state. The plasticity of the brain is is just a never ending thing of beauty. Absolutely. Absolutely. Well, now let's talk about, because it sounds like, and I love what you just said, it sounds like we're really focusing on sort of psychological care, which is part of care for chronic pain. And I love something that you wrote in that if mind based treatment helped my pain, then my pain must not be real. Hmm. Right is maybe something that might be in the back of someone's mind someone living with chronic pain are in the forefront. So how, how can
15:45
psychological care? Whether that be CBT, or mindfulness, or you know, there's a million different kinds of, I'm sure scientists, psychological care. So
15:58
how can people use psychological care, but not D legitimize their pain experience, not make them feel like, well, if, if this helped, then
16:10
my pain wasn't real, because if it were real, then that injection would have taken it away, or that movement or that stretch, etc, etc.
16:20
One of the things about trading
16:25
one of the things about psychology is
16:30
that sort of inherent in this illusion that the mind and body are separate
16:37
is that
16:40
whenever you have a new experience, there are measurable neuronal changes in the brain, there is a physical change that occurs, there is a measurable change that occur that occurs, even if you know we don't have the tools right away to measure it.
16:58
psychological changes are biological changes. And there's what 4050 years of science that reinforces that. So just because a psychological treatment can help doesn't mean that it isn't biological, it just reinforces that this source of the biological change is different from what you expected it to be. So I know that a lot of people with pain
17:27
you know, if for instance, their lower back hurts, or if a certain limb hurts, they assume that the source of the pain must be in that body part.
17:38
And although this is getting a little high up,
17:44
in terms of mechanisms, one of the reasons why we can even tell where our body parts are, is that there are maps in the brain. For instance, you know, one of the examples of this is the homunculus. But there are actually four different maps in different parts of the brain, that help us understand where our body is in space, and where our hand is where our lower back is. So you don't know where your lower back is, unless your brain helps you decipher where in the body map it is. So, you know, in multiple levels, this this idea of separation is really artificial, it really doesn't serve the experiences of people with pain.
18:25
I understand that.
18:28
Also, that one of the reasons why patients may adopt this kind of thinking is because they're
18:37
trying to work with the perspective of the provider who's treating them. If the provider has these assumptions, patients naturally, just to adapt, they have to play the same bowl game they have to in you know, they might do this through Google searches, or educating themselves on the web, or looking into pain, neuroscience education.
19:03
In order to be heard, I need to study the way that this is described online and in the literature, I need to be able to talk to my doctor in a way that they can understand.
19:16
And even that
19:19
even even that point where it's like I need to interpret my internal experience into something else so that someone else will believe me, I feel is sacrificing their internal experience of pain. No doctor
19:35
I almost think that like
19:38
a patient saying that they're in pain is all the proof that you ever need
19:45
to believe that they're in pain. You don't need a test. I really believe this. And so much the point that you know, I've I've I worked with Dr. Vani up caring for many years. The reason why his research
20:00
has been replicated so many times and has been published in such higher to high tier papers is because he looked at the patient's perception of pain and mapped brain signals to that perception.
20:17
He listened to the patients from the very beginning, he didn't say, Well, you have to finish the standardized questionnaire. And that'll tell me, that'll be the way that I measure whether your pain is there or not. He had a moment by moment, measure of pain intensity that he used to extract the signals from the brain during these brain scans. And that's how he found his fantastic findings that have been replicated again, and again, by different by different groups. And those are the findings that reinforced that as pain becomes more chronic, the brain regions that are correlated with the perception of pain change from sensory related regions early on, to emotional related regions within a year. In other words, after a year of living with pain, emotional brain regions are correlated with the sensory perception of pain.
21:15
Another way of saying that is that the sensation becomes emotional.
21:21
And that isn't saying that it's not real that saying that it's so real, you can measure it on a brain scan, you can see the pictures, you can replicate it across studies. It's that real?
21:34
So I feel like I've sort of No, no, gone in a few directions to answer your question. But
21:44
all all patients,
21:47
all we need to do is take patients word for their pain, we don't need any extra evidence that it exists, we just need to take them seriously. And to reinforce that, it's not your fault that you have this pain, you did not cause your illness, your body was doing exactly what it was designed to do exactly what we would expect a healthy person's body to do. It's not your fault. So let's, let's work together and find
22:19
your own path to pain relief learning. Right. And obviously, everyone's path is different and individualized. And I think we can all agree on that. There was something that you had said,
22:31
as you were speaking, that popped something that caused me to think that sometimes I don't know if you've seen this, but is it easier for patients to sort of farm their pain out to sort of third person their pain, versus first person their pain, meaning they may describe it, or they may listen to the way the doctors describe it, and not think of it as their first person pain, but think of it more as third person. And I'll give you an example of what I mean by that. So I have a long history of chronic neck pain
23:07
during my 30s, like, literally, the decade of my 30s For the most part. And I had I was giving a keynote talk a couple of years ago. And so I joined a speaker salon, or speaking group to help with this talk. And it was about they wanted me to talk about my experience with pain. So I went out there and I started it like imagine a patient walked in and had all these symptoms, right. And the woman who is not a clinician, a health care practitioner in any way. She is a writer, director and speaking coach, her name is Tricia Brooke. She said, Well, hold on a second. I'm gonna I'm gonna stop you for a second. I said, yeah, yeah. What is it? She's like, Is this about you? And I said, Yes, it is. And she's like, Well, why are you talking about it in the third person?
23:57
I said, Oh, well, because at the end is the big reveal that it was me and she's like, people know, it's you. You're up there talking about it. Like so why don't we change it to the patient and change it to me. And I started and within five minutes, I was crying so much I couldn't continue.
24:15
And I was like, This is why it's not first person because it was so hard. For me it was a lot easier to sort of third person it out or farm it out. And then going through this for eight weeks, I was finally able to get through the whole talk and someone came up to like, you know, I really liked those parts when we were first doing it when you were crying a little bit. I'm like, that wasn't part of the bit. That wasn't a bit that was me not being able to talk about my experience with pain, because it's emotional and sensory. So the although at this point now I had not had pain in years. To the extent I had it when I was speaking about it right, but to your point
25:00
The emotional attachment was still there.
25:04
So what do we do with that?
25:10
That's such a great
25:13
question.
25:18
I think it's self protective. Initially, whenever just just as you described, it's self protective and that you live with the pain every day.
25:30
It's a way to distance yourself from the suffering.
25:36
So on one hand, I understand 100% Why people do that. And in a lot of the patients that I've seen, over the years have done that too.
25:50
I think that
25:58
something that comes up for me right now, is that the words that one person uses for their own pain are the most therapeutic words that they could
26:10
use.
26:12
In that, engaging in the pain memory, from a psychological perspective, is one of the things that allows you to change that memory.
26:23
And I kind of wasn't planning on going here. But it's, it's an opportunity.
26:29
One of the reasons why psychological approaches to
26:34
chronic pain care have the potential to be so effective is that if pain is an emotional memory,
26:45
we know from 20 years of basic science, neuroscience, that emotional memories can be fundamentally change. There are rules, there are very clear rules.
26:59
The rules are you revoke the memory, on purpose as fully as possible.
27:07
You ideally introduce some type of contradictory experience something surprising, because that really makes the
27:20
the brain state more salient, it makes the brain pay more attention to what's happening. And then within three hours, you induce relief, psychological relief, deep breathing, I've worked with patients where we administered propranolol under the guidance of their you know, their doctors, but deep breathing is enough. And that if you are able to induce in sort of controlled conditions, these experiences where you fully experience pain, how it is for you, using your words, the emotions that come up in your body. That is how you fundamentally changed the memory structure of chronic pain.
28:06
Fascinating, you can do that in little bits across time.
28:12
Under more controlled conditions, you can do it in one big whammy exposure session.
28:17
Interesting, I think I did it in little bits over an eight week period in front of an audience
28:23
in front of a very safe audience of 14 amazing women. And you were also in a sense, potentially reshaping your pain narrative, as you're going through this, too. So you know, per Gillette Abelton.
28:38
You know, working with the pain narrative, and changing the meaning of the pain story over time is one of the another way that
28:48
that your pain story itself can be really therapeutic. Yeah, yeah, it was. It was wild. But it's it's a good example, I think of how even though I had not had pain for years, but the emotional attachment to it was so strong that I couldn't even get through a paragraph of this talk without crying. I was like, I think I need to come off the stage. And then each time it got, you know, it took more and more time, I guess before I would have like a really emotional response. But I have to say since then it was like,
29:28
like a weight off my shoulder. You know, and this is years after not years, maybe like six years after I really had more consistent chronic pain. So it was years and it was it was years after the pain had the chronic pain had subsided.
29:45
That's interesting too, because it suggests that there's a larger memory structure underneath there that even if the sensory aspects have been remodeled, the emotional attachment can still remain. And so in a sense, perhaps
30:00
that experience helped to heal the entire memory structure in a way that it you know, it wasn't quite complete just with the sensory pain being gone. Yeah, yeah, maybe it closed the circuit a little bit, so to speak. But anyway, it was it was highly, that's fantastically effective. But it just goes to show and again, I wasn't working with a professional perhaps if I were maybe I would have closed that circuit a little earlier. Or maybe not. Maybe this was the time, we don't know, too many questions to answer. So it's just right, you didn't just write for us at the right time. So, you know, just goes to show that when we're when we are treating chronic pain, we need to target the brain. Right? I think you need to have psychological care. So what do treatments look like? Obviously, reminding the audience that everyone is different, and everyone is individualized. But what are some examples of how psychology can work with people with chronic pain?
30:57
Well, so there are a number of evidence based approaches.
31:01
So cognitive behavioral therapy is one that everyone knows about Acceptance and Commitment Therapy, Mindfulness Based Stress Reduction, even pain, neuroscience education for some people. And whenever I think about these things that I typically look at the biases of the person in front of me, is the person in front of me a highly logical, rational type of person, I'll direct them to cognitive behavioral therapy, are they more embodied emotional person, they might be more open to mindfulness meditation approaches, or Acceptance and Commitment Therapy.
31:38
I think, especially people who have been in the healthcare system, go around for years and years and have some trauma related to being a chronic pain, patient benefit from pain, neuroscience education, just because it helps them get a better understanding of what they've been working with. So in a sense, you know, we have sort of a number of different tools that we know of in the literature, and adjusting each tool based on the the worldview of the patient is the best way to go. I think that's such a great way to look at it. And what advice do you have for let's say, physical therapists, occupational therapists who are working with patients with chronic pain? What is your advice to us to recommend psychological care? How, how can that conversation initiate?
32:36
And what is the best way for us to refer out?
32:46
I think that one of the best ways to initiate the conversation is by expressing empathy, and compassion, it looks like you're really having a tough time with this.
33:01
And from what you've described, it seems to impact many areas of your life, I see that you feel anxiety, I see that you've experienced some depression, I see that this stresses you out,
33:16
have you thought about support some sort of psychological support? To help you through this, that's, I think one of the most open ways that that this can, this can happen and a lot of physical therapists that I'm that I've interacted with, have taken it upon themselves to learn some of the psychological purchase, because it's almost
33:41
because they've sort of found themselves in the position of being the psychologist whether they liked it or not, or whether they had the training or not. And I've really admired a lot of the physical therapists that I've interacted with, because they've gone extra steps to learn what it is that they might need to know in order to provide better psychological care, as you know, as a physical therapist.
34:09
However, there are lots of times whenever the degree of distress or the degree of suffering, it is beyond training, you know, the training that you might have as a, as a physical therapist. So that's whenever it's time to bring in a professional
34:29
in terms of identifying
34:32
the optimal type of treatment or making referrals. That's very tricky of because there aren't a lot of pain psychologists in North America.
34:47
Even if I were to come up with a list of them, a lot of them that I know of are in academia and the people that
34:55
are in sort of the private sector. They have that specialization just
35:00
because they have lots of experience there. So it's, I kind of, I don't have, I don't have many suggestions. In this case, I do have a suggestion of a tool that I've helped to develop, that could supplement that in a way.
35:19
But in terms of finding the optimal,
35:25
as per the optimal psychologist, I think it would come down to therapeutic alliance. And that's something that each person has to feel out for themselves. And that, okay, you have a person who's highly rational, logical CBT might be the thing for them, have them talk to three different suggests they talk to three different people who feels right.
35:45
Because I'm a firm believer of therapeutic alliance, in the larger sense. And the the foundation of therapeutic alliance was best articulated by drum Frank, in his book, persuasion in healing. And one of the things he described is the healer suffer relationship. And one of the core tenants of the healer separ relationship, the healer believes that they can heal, the suffer, believes that the healer can help them. And they come together and interact with a number of rituals together, that are intended to relieve the suffering. So if you have someone who's on your side, even if they don't have the right training, but you trust them, you feel like they get you, that's more therapeutic than their training proper.
36:35
And that's, it's it's tricky. But for instance, even just talking on the phone for 15 minutes, to three different practitioners is enough to be able to get that feeling. Yeah, that's great advice. Thank you for that. And now, as we wrap things up here, what would you like the listeners to take away from this conversation? If you could wrap it up in a bow? What would that what would that present look like?
37:06
I think
37:08
we all have a collective responsibility to empower people who have been living with chronic pain.
37:20
And I think that,
37:22
you know, based on our conversation, one of the most powerful tools for pain relief is between people's ears. And I really think that that's the most empowering approach as well. And that I, at my core, I don't believe that we, that people need to rely on
37:40
doctors or medications or even approaches nearly as much as their own brains.
37:48
I, I know that it's difficult to get access to tools and psychological approaches that enable that. One of the things I'm doing,
38:00
you know, just from a, from an entrepreneurial background, is working on tools that will help people with that. But the key to long term pain relief, is teaching people to attend to patterns of pain relief, and what really feels like even if it's just a few moments every day. So my overall bold statement would be the key to your pain relief is paying attention to whenever the pain is less whenever you have time, to enjoy things in life to engage in positive emotional learning. Those are the keys to pain relief, because the more you focus on those moments during the day, and the more we encourage our patients to focus on those moments, the better they'll get, and the more quickly they'll get better.
38:50
I love that. And now where can people find you? What do you have going on? What's coming up? Let us know. Yes. So one of the things that I've done in the past few years after leaving academia, thank goodness, is I co founded a startup with Vanya, up Korean and a chronic pain patient, make Mika Michalak. So he's an entrepreneur, finished entrepreneur who has had chronic pain himself. And we
39:18
created a tool that is essentially insights from Bonniers research in an app form.
39:29
And it contains Mindfulness Based CBT exercises and tools that I wrote, and pain neuroscience education that I wrote. So in a sense, it is a expert created tool that is designed to give all of these insights directly to a patient without them having to rely on doctors or any formal care.
39:56
Because one of the apps Oh, the app is
40:00
Ava health app.
40:02
So if you go to www dot Evo health.com, you can learn more about it. And one of the one of the things that I it's a real conviction of mine, the science that's needed to heal chronic pain exists today.
40:21
You know, this is work that Vanya has been doing for years. And the time that it takes to sort of for that knowledge to trickle down to clinicians and to, you know, clinical guidelines, is 10 to 15 years. And one of the reasons why we decided to do this was because if it exists today, patients deserve to have it today.
40:42
So it's, it's a labor of love.
40:46
And I invite anyone listening to this podcast, to recommend to check it out yourself, to recommend it to your patients. And to contact me directly at Melissa at Ava health.com. If you'd like some more information about how to use it to help your patients. I'm very open to that. I love it. And we'll have the link to that in the show notes at podcast dot healthy, wealthy, smart, calm. And again, that website is www dot A i V as in Victor Oh health.com Just so people have the spelling of that.
41:27
And now one last question that I asked everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self, let's say a fresh face out of grad school or maybe undergrad wherever you want, wherever you want to take that starting point.
41:45
I would say Melissa,
41:49
you're either identity is not your accomplishments.
41:55
Think about what
41:58
drives you what creates the most passion in you. It's to help people get better. And to support people while they're healing.
42:08
instead of chasing after the shiny ego cries that other people applaud you for take a step back and focus instead on what makes people feel better now make choices to help people heal.
42:32
Now, don't worry about long term research because long term research won't help people now.
42:39
I love that advice. Thank you so much. This was a wonderful conversation. I always learn such I always learned something new. And this was a lot of new so I want to thank you for coming on. Thank you so much for having me. And I really appreciate it was wonderful and everyone thank you so much for tuning in. Again. If you have any questions for Melissa you can reach her at a vo help calm and have a great couple of days and stay healthy, wealthy and smart.
In this episode, Dr. Jenna Kantor talks with Dr. Drew Contreras about the rigors of working as a PT for the President of the United States.
More about Drew Contreras:
Drew Contreras, PT, DPT, SCS – received his Master of Physical Therapy from Gannon University in 1998 and his Doctorate of Physical Therapy from the University of North Carolina at Chapel Hill in 2008. He is board an APTA board certified Sports Clinical Specialist since 2003. His professional interests are sports medicine; manual therapy; blood flow restriction; bio-technology; musculoskeletal injury prevention, diagnosis and rehabilitation as well as human performance optimization.
Serving over 20 years on active duty as a career military officer and practicing physical therapist within the US Army & Department of Defense, Drew has served in a number of settings and military units throughout his career before his retirement in 2020. He spent his early career at Ft Benning, GA and then moved on to Ft Bragg, NC. His skills were put to work extensively in 2006-2007 during a 15 month continuous deployment during Operation Iraqi Freedom where he was the first physical therapist to serve in sustained combat operations with the 82nd Airborne Division. After returning Drew moved to Washington DC to work at the Pentagon Health Clinic where he served as the Director of Wellness and Physical Therapy. During this time he served as a consultant to the White House Medical Unit and was then chosen as a by name selection by President Obama to serve as the first ever full time physical therapist at the White House. There he served as the Physical Therapist to the White House Medical Unit and President of the United States Barack Obama from 2010 until the end of the administration in 2017.
To learn more, follow Drew at:
His Website
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Read The Full Transcript Here:
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everyone, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, net Hills Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using NET Health's private practice EMR, be sure to ask about his new integration, head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today. All right onto today's episode, Dr. Jenna Cantor is back and today she is interviewing Dr. Andrew contrary us he received his master of physical therapy from Gannon University in 1998 and his doctor physical therapy from the University of North Carolina at Chapel Hill in 2008. He is board certified sports clinical specialist and has served over 20 years on active duty as a military officer and practicing physical therapist within the US Army and Department of Defense. He has served a number of settings and military units throughout his career before retiring in 2020. After retiring drew moved to Washington, DC to work at the Pentagon health clinic where he served as the director of wellness and physical therapy there. During this time, he served as a consultant to the White House medical unit and was then chosen as a by name selection by President Barack Obama to serve as a first ever full time physical therapists at the White House. There he served as the physical therapist to the White House medical unit and President of the United States, Barack Obama from 2010 till the end of the administration 2017. He has worked with a wide variety of government officials as well as police and law enforcement agencies. And today he's going to talk a little bit more about his experience. And it just goes to show you that there are so many options and so many settings that physical therapist can work in. So I think Drew and I think Jennifer great episode. Hello, this is Jenna canter so honored to be hosting this podcast for healthy, wealthy and smart. I am here with Dr. Drew Contreras who just said Just call me Drew. And I was like, Oh, that's so cool. So Drew or gesture is one you want to get his autograph when you know what he has done. This is the the physical therapist for Brock Obama and Michelle Obama. And then the current president and first lady, which is just not and as soon as I learned this, and then got to hear him speak at a conference. I was like, this is somebody that I am desperate and enamored, inspired by must feature on this podcast. And I approached him a complete stranger. At this conference, I sat right next to him dinner and as he didn't know me, and he said, Yes, this superstar said yes to doing this podcast. So Drew, thank you so much for agreeing to come on to this podcast. My pleasure. Right, like
03:54
it
03:55
is I appreciate the kind words thank you very much. Absolutely. And that's how I'm going to be approaching this this podcast as a young professional in the physical therapy industry that saying, How did you do this? How did you get to this point, and we're just talking about executive medicine here to really understand point a point B, I feel like from the conversations I've had with people outside this podcast, there isn't one way to eat a Reese's. It's not some clear pathway if you want to get this way you you're gonna fit in this box and it's very much like the performing industry. It's like there's no it's not one agent that's going to get you that movie. So we're here to just hear hear your story where where you got started and how that led to such a
04:43
prestigious and how honor what an honor, I have a position to get to do. Yeah, um, so I think that
04:55
I think that regardless of like what you're pursuing, right, whether
05:00
That's, you know, working in executive medicine or like you said, working with a performing arts group or, you know, working with a traveling band or a sports team or whatever, right, I think the thing that people
05:14
really de emphasize, which is the exact opposite of what should happen is, you need to be really, really good at what you do. Right, there needs to be no question that you are exceptional about what it is that you provide. And I think that people get lost in wanting the end state. And they, they don't go through the process properly. Right. So just just to be blunt, right? Like, if you've got, you know, 18 months of experience, you probably shouldn't be the person on the sidelines on a high contact sporting event, who's the only person that's available? Right, that's probably not the best plan. And likewise, right, like, you probably shouldn't be the sole healthcare provider on a plane someplace when like, you barely really know what you're doing it. So I think that people get confused with, in order to get to the end state, right, I need to go through these, like, I need to know somebody or I need to, I need to have a, like you said, there's a person who will get me there.
06:17
The only thing that will ever get you there is is being exceptional what you do, right? Because when you start talking about things, especially like executive medicine, you have to realize that the people that make it to this point or this level up are exceptional at what they do, right. And they have made a living off of calling people out on the BS card. Right? Like, they know when you are not exceptional at what you do, because they they've seen it for so long. So if you're not at least there, right, if you haven't found your, your, your apex of your skill set, it's not a place you want to be. Right. So first get there, right, get really, really good at what you do. And then if that's if you've made it to that point, opportunities will unfold themselves, right? If you're prepared if you're really good at what you do. So I think that's the best thing I can say to people is, like you said, there's no, there's no cookie cutter path to getting into this, as there shouldn't be right, because it's certainly not for everybody.
07:23
Yeah, I think that's really well said, and I want to tap on the assessment of what it means to be good at what you do. And this is my opinion, but I'm going to put it in here. And then I would love your thoughts. But don't base your success off of other PTS opinions based off of other patients opinions.
07:47
I think we really mix that up. I think we really do. And it's just not everyone. What are the patients saying? What is your success rate? There are the ones that if they do get do they come back to get I would base it off that I think we worry too much about what our
08:02
comrades that's the word that's in my head right now are thinking. I think you're absolutely right. Right. Like if
08:11
I think there's a difference between
08:15
external validation, right, which is kind of what people say about you. And that can be rewarding, right. It can also be incredibly destructive, but but it can be rewarding for some people. And that's different than than defining
08:31
a level of expertise or level of success. Right. That should be pretty objective. You should be able to measure that with clinical outcomes. You mean, like you said, even just sheer recommendations and referrals from existing patient? Right, or sources? Right. That's it. That's a better
08:51
litmus test than who said, what about you on Twitter? Yes, yes, yes. Or if you're, if you're there a different way. So what about you or say you go to a conference like CSM, and everybody has been in this industry for certain periods of time. And when we create relationships with people, the ones where we are really more connected to we just generally bond with just like our friends in life outside of the business? Are even if they're not, you're not friends with the right people. It doesn't mean anything. It doesn't mean anything. I have a friend who just got on Broadway, she had zero friends who are on board, you know, like, she wasn't like, let me see of friends on Broadway, but not like close, close. You know, I just I think we can get stuck in that. Like, I'm associated with them. So therefore, like I can't, in the, like I said the reality is, even if that association gets you a conversation or a phone call, right? It won't sustain you for very long. Yeah, yeah, absolutely. What is the schedule and
10:00
Life, like in regards to when you're doing such a high profile job? Yeah, you know, I bet
10:12
I think I would average it out to people would call me get a hold of me at least two or three times a month and say like, they wanted to be the White House physical therapist, and I finally got it down to like, okay, um, that's, that's great that you're interested, I need to know, if you're okay with this, you will not have any vacation days throughout the year zero, you can never buy a ticket. That's non refundable to anything, you must be okay, giving up attending any sort of family event, kids sporting games, whatever it may be.
10:47
In the event that you actually do get to go on vacation somewhere, you must be okay with it, they call you you have to leave immediately and come back. If you're okay, with these basic things, we can have a conversation, right? And most people immediately are like, well, that's not what I wanted. I just wanted to fly on a jet. You know, and, you know, have people think that I'm, you know, in this prestigious environment, like
11:11
all these things come in a price, right? It's, it's not, it's not an easy price, right? I will forever
11:19
hold Brock Obama responsible for the fact that we both started there with black hair, and ended up with gray hair.
11:28
super stressful environment, it's long hours, it's unpredictable at times. chaotic, and it's just not an easy place to to exist in, if you aren't already comfortable in your own skin, right? So to basically understand is that
11:47
your professionalism has to supersede what your personal goals are, or your personal life is if you're going to be successful in that environment. And that's just the level of dedication that it takes. When you say professionalism. Would you mind defining that? Because professional means of a profession? And so that can be very vague. Yeah, I think that it means right.
12:12
I think that it means that you need to be willing to put forward
12:19
your best on any day in any place, and do the best you can for those patients, or those people that you're serving. And it's really, you know, kind of a, a selfless service attitude that would make you successful. And that's what I mean by professionalism. Right? It has to come first, right? It doesn't matter if you had, you know, plans to do a thing, or you were supposed to be going out to dinner with your spouse or whatever, right? Like, that's the level of professionalism that's expected. Absolutely. I like thank you so much for that. I was thinking it was singing, it actually really reminded me of swings on Broadway, they have a very similar situation, except they're not the main person, but they have to be available at a moment's notice. So just like and during the Christmas breaks that the leads or the ensembles take, they're the ones that jump in, and if anything comes up, they're the ones that are, I mean, if I want to say somebody who truly has probably the least brake, in the run of a Broadway show, it's the swings. So that's it. That's just where my brain went. because theater is my background theater is my sport, my sport. Absolutely. So I like that. That's so interesting. And, and I think it's always good to know the full picture of what it means to do something. I'm going to compare it to Broadway and musical theater because that's what I know. It reminds me when including myself when you first graduate school and you're a performer, singer, actor, dancer, you're like, oh, I want to make it on Broadway. However the schedule on Broadway, it's six days a week, one day off, the main holidays you are going to be performing that's when you have the most people attending. You're going to miss on so many things that go on in your life for being dedicated to the Broadway show. So knowing that you're going to miss so much of life not just a little like a lot like your nephew's events, whatever you're going to miss everything. And in in your downtime the days that you have one show your whole day is revolved subconscious or consciously around putting on your best performance that night so you have to be careful with your energy everything because that is there that is your main job that's your main go to so it it really does sound so reminiscent of that you got to have a passion for it as much I do think there's a little bit more selfish and that's okay to be selfish. It will regarding performing because you are a person who loves applause loves that stage and everything you are of course giving I would say it's like
15:00
5050 But I do think it would be different compared to the physical therapy job that you're doing. Because the only reason why and we discussed this before, the only reason why we can even say your name in association with a be with these people is because they have publicly said your name, you know, and that's that's an end. But if you didn't have that we would not that's that would we would be doing all this other words to go around it appropriately, you wouldn't talk about in the reality of it is
15:33
another, I was doing something else. And somebody asked me, they were like, What would you consider one of the biggest achievements that you've done professionally? And I would say that
15:44
until after 2017. Right? Nobody knew who I was and what I was doing. Right. And that was that was my goal, right was that nobody knew that. I was a White House physical therapist, nobody knew who I was where I was at the things I was doing, because that was the job. Right? The job wasn't to be. It's not it's not the world's business. Right. Right. And then so, and I think that that's fair. Right. I think then that and I think that that's really important. And then so like you said, you kind of have to understand that like,
16:16
the people who are concerned with the trappings, right with, like, what do I get out of it? Right, will be severely disappointed. And executive medicine, because that should never be what it's about. Right? It should never be about what are you getting out of it? Because if that's the case, you know, you won't be doing it for very long, right? There's, there's a saying in the in the Gulf PT community is, you know, if you want to be around a long time, you don't want to be around all the time. Right. And basically, what that means is like, you should not be trying to be, you know, the inner circle person. Right? You shouldn't try to be the best friend of these, these high profile individuals, if your goal is to, you know, be of service and do your job for a long time. Because you because that's just not the way it works. Right. So that's just kind of a reference point that I, I found, just like you said, very similar to performing arts, right. It's just kind of there's there's parallels and all these different sub communities. I mean, it really goes back to just loving truly loving what you do, and it's okay, if you don't, it's okay. Not every job, or every specific thing is meant for everyone. That's why we have so many different options and more options keep popping up after the pandemic now.
17:34
Yeah, you have to love what you do. You have to love what you do. See, I love being the center of attention, because I'm a performer and a physical therapist. So I know, right off the bat, that couldn't be for me, because for me not to be able to be like them. And the way that I was in like, doing a whole photo shoot there trying out different heels for the photoshoots. All that stuff. Like that would be the I would be the worst person because I'd be mourning getting to do that. It's so right. So there's always the question, people would ask, like, Oh, can you do this there? Or can you do that? Or can you do this? And the answer is always you can do whatever you want on your last day. You want today to be your last day. Feel free to do that. Yeah. Yeah. I mean, it's HIPAA compliance. I mean, that's the biggest thing. It's a HIPAA compliance. And then we have people they're just taking care of the United States.
18:29
That's such a high level. It's such high level, you know, I mean, wow, wow.
18:35
I was wondering for you, because it's this level of executive medicine is very
18:45
high profile. There's a lot going on there. I'm not asking for details behind the scenes. That's none of our business. But I'm, I'm curious about how it affected your stress levels and your anxiety while there and how you manage that during that time to make sure you were able to be fully present and helpful, even though it may have kind of fallen on your shoulders a little bit. And on that note, we'll take a quick break to hear from our sponsor and be right back with Drew's response
19:17
when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about this new integration. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.
19:53
You know the best way
19:58
to kind of describe that
20:00
Is is, I think that it's important to surround yourself with, with people that are understanding of your situation, right? Because because
20:13
it's inevitable that you will have conflicts or that you'll have to back out of things, right. And if people don't understand your situation and the level of service and dedication you have, they just think you're selfish, right? So like the, I'm sorry, I know, I said, I was gonna come to your barbecue, but I just can't, I can't make it now. And, and I need you to be okay with that, and may not provide you an explanation of why. Right? And that's a hard thing, right? And you will find out pretty quickly, like, who, who's accepting of you and who's not? Right, because because most people will just stop inviting you to things right? Or they'll just, they'll just cut you out of their life. And there's some degree rightfully so. Right.
20:52
So I think it's just important to make sure that you surround yourself with that. And if you're a person with the family, right, like, this has to be an honest conversation that you have upfront.
21:02
This is not something that you kind of tiptoe around or like, make it up to you. Like, you'll be saying that forever, you'll never make it up, right? It just needs to be an acceptance of like this is this is part of what's acceptable.
21:17
And that's not like you said, That's not for everybody, right? It's absolutely not for everybody. So I just think that in order to be able to perform at a sustained sustainable level, right, for a duration, not just like,
21:31
once, or like, twice, right, but to continue to do that, you have to accept that. So I will. Another thing that comes to mind is, I once saw an interview with Michael Jordan, who is, you know, arguably one of the greatest basketball players of all time, regardless of what you think. Right? And Michael Jordan was interviewed and, and, and he said, you know, what's, what's it, what's difficult about it, and he said, you know, people who want to be Michael Jordan for a day or a game, you know, like, of course, I'd love to be Michael Jordan for a day or a game. But being me for a season, right? Or for a year, or for a couple of years of a championship run year after year after year, right? The commitment and sustainment that that requires, like, people don't want to do that. Right. And that's what I would say to people to like, it's super cool to work at the White House for a day for a weekend. Right, right. But do it for do it for a year, or an administration. Right? Or be stupid enough to come back and do it again. If somebody asks you, right, like, that's, that's a whole different level. Right? So it's super exciting. You know, it's interesting for for a weekend or a day or whatever, but like, but long term, right? Like, it's a commitment. Yeah, that makes me think of certain roles. I'm always going to bring it back to theater because that's my brain. It makes me think of Elphaba in in Wicked or Vita in Aveda, where Aida and Aida where they are literally doing like vocal aerobics, they don't stop singing. So when they are outside of the show, from
23:09
what I've learned, and especially if you're talking about a Broadway one, so they are doing what is it seven to eight shows a week, they get the one day off, they are not talking much outside of that show. If you want to reserve like or if they do they know what they can and cannot handle. Because the amount of singing. Elphaba I've learned is such a difficult track because of how you're, you're going from one part even if you're not in a scene for a moment you're rushing doing a costume change it's it's a very non stop role. So if you are looking to lose weight, no,
23:47
no but it so it just makes me think of that, you know, different things can cut you out of living your life, which is why I've always said I would love to do Elphaba at a regional theater for three weeks.
24:03
done done like like he's like Michael Jordan said for temporary. I think it's so good to take in this perspective and take things in as a whole. We were talking when we met the group was discussing how really understanding in this is a bigger picture thing but really understanding what physical therapy is before you even decide to join the profession as a big deal that needs to be much more transparent. And we can sit there and see all these shiny other things like oh, I want to trade for Broadway or I want to do executive medicine or oh, I want to work for this sports team. But really asking yourself all the tough questions on what goes into that? Well, I mean, if you're talking about money, great, but like, Have you ever had money and then like how fast did that money go? Did it really make you happy? So many so many things on that.
24:52
But
24:53
the details of the job will that will you enjoy that? That's your life. You're going to spend the majority of your time on the job not
25:00
off the job. So you got to make sure it's something that you like and really do your due do your due diligence in that. But I think it can be very difficult to give and provide the full picture to for anything. I don't know, I don't really know, have a clear way to make it clear.
25:20
I think that
25:23
I think that like part of that, I think is our own fault is PTS, right? I think that the general public struggles to understand what we do as a whole, right? It's, it's easy to do it in in subsets. Like it's easy to understand. Okay, well, I was on crutches. And I had a cast, and then I had to see a PT because my ankle was broke, right? Or the, you know,
25:52
mom had a stroke. She's in rehab, she sees a PT every day, so she can get better and come home. But the hard thing is like,
26:03
the professions bigger than that, right? It's, it's more and we've overcomplicated it instead of really kind of simplifying it down. Because the reality is right. What do PTS do? Well, we help people do whatever it is they want to do. And we get them back to or allow them to do the things that they want to do.
26:24
And that's it, that that's the that's the big selling point of it is, if you're not interested in doing that, I'm, like you said just about every day of your life, this is not the right profession for you. Right? Like, if you thought that, well, I would, I will have a very nice car, and I will have these set hours and I will you know be able to do these things like you're going to be miserable hate because I think that people didn't get into the profession for the wrong reasons, just like any job. When eventually, right? It will be taxing to you. And if you're not down with whoever that person is, it's you're talking to and working with, if you're not okay with, I'm here to get you to where you want to be. So that whatever that thing is, whether that's walking your kid down the aisle at a wedding, whether that's going on a hike, again, whether it's walking the dog, right or like putting your shirt on by yourself, right, whatever those things are. Now in a handstand, of course,
27:26
like if you're not okay doing that,
27:29
we're never going to be happy with with what PT does, right? So I think that that's the thing that people need to kind of understand if I wish, if I had anything to say to anybody who's listening who's like thinking about it, think about that. Are you okay with doing that, that be your role in life? And if that is not appeal to you, you need to find something else. Yeah, absolutely. Absolutely. It really is a
27:55
job board, you're of service, but you have to love being of service in this manner. Like if it doesn't feed your soul, like then how, like no money can ever pay you enough. It's never never enough. It'll never be enough. And that's okay. That's okay. It's I take like, exactly, you got to figure out what you love. I feel pretty lucky. Because I went into school, dreading that I was going to school and I felt like public embarrassment in the musical theater world because I entered school as a quitter. Because that's what it looks like, like, I'm leaving my profession. And so I had people offering me get professional gigs while I was in my first year of school. And I was embarrassed. Meanwhile, other people were posting and going, Oh, I started up in school, because it was a prestigious school and everything. And I was like, quiet for the first at least a year, if not more about what where I was.
28:52
I mean, it's all perspective. But then I learned I got a sometimes don't just take that one experience. And for me, I had that which was beautiful, seeing how it can change people. And yeah, yeah, but if that doesn't work for you, it doesn't work for you. I love that. Yeah, so for you. In executive medicine, I don't know if you know, the data on this. I don't even know if it exists. But is there kind of an average of how, how long medical professionals usually stay within executive medicine? Or is there kind of like, usually it's about five or 10 years or something just because it is such a commitment and you're talking about family and all these things. Just wondering, I think that there's a there's a there's it is a
29:38
Oh, I think there's a short hump and a long term home. I don't think there's a lot of people in the middle. Oh, interesting. Yeah. I think that if most I would probably say two thirds right. It's a short
29:55
I don't know. I'm guessing you know, five to seven year experience, right? The people
30:00
Do that short. Yep. And then
30:04
yes, yes. I think there's nobody that's kind of in that like seven to 15. Year. And then I think you get another the the last third is in the 15. year plus right. So wow, a career choice, or have made that shift for whatever reason. In that direction. I think they kind of stay there.
30:28
But I don't think it's, yeah, yeah. I don't think it's a mid career thing. It's either a stop along the way, or eventually it becomes your, your pathway. The business side, I have a real dorky question here. It's not dorky. And because there are people who be curious, I'm curious about documentation. For some reason, I feel like it's gonna be theirs. Let's compare to a Rite Aid receipt versus a CVS receipt. I feel like it's probably a CVS receipt, am I wrong?
30:59
Here's what I would say. Right?
31:03
If you treat everybody the same, and document the same, you're always okay. That's it. Right? In, that's where you have to be, again, like you got to be good at what you do. And you got to be very comfortable with that, right? Because
31:18
you people, you'll be second guessed right, there will be consultations with other providers. That's just the nature of executive medicine, right. And so you need to be okay with what you're doing. And documentation is part of that, right, making sure that you're you're very clear about your plan of care and the things that you're doing and why you're doing them.
31:37
But if you, you know, if you do it the same, it doesn't matter, right? It's universal precautions, right? If you if you do it the same no matter what you're good to go. So that that'd be my two cents on that. And then we also think it might differentiate and regarding plan of care, because we're talking about exercise adherence, which is something that physical therapists are was talking about, it's one of my biggest passions is getting exercise. And it's so great when it works.
32:03
For your patients in general, that have a high anxiety life, lack of sleep life, how do you achieve that adherence in a realistic way to get results? Does that make sense? I'm trying to generalize, even though every patients different, but this is we're talking about a very specific level of high stress. Right? I think that you have to understand that when you're working in this kind of subset, the biggest commodity for people, their biggest asset, the thing that is the most valuable to them is time, time is their most valuable asset, right? It's not money, it's not, you know, I have stuff do I have, you know, it's not the resources of equipment, or what, like, it's time, their time is very valuable.
32:55
And you have to, you have to be a good steward of that, right? You have to respect that. And so you have to,
33:04
you're not going to give somebody you know, a printout with 15 exercises, that's going to take an hour and a half for them to do and tell them to do it three times a day, right? Like, this is not how this how it's gonna work. Right. So I think that if you understand that concept, in build your plan around that about what is the most effective thing I can do with you, or this amount of time, which is limited, and then you have to understand that that's, it's finite, right? There's not It's not unlimited, that there's a million priorities that are trying to take that time. And if you are, are good about using it and understand that it's a limited resource, then they'll appreciate it.
33:49
I just realize you have unusual, wonderful access to collaboration over there. And I started to think about food. Could I mean, you could No, here's, here's No, there's a purpose, because digestion, if their digestion is off, that actually can have a big effect on their healing process. Have you had opportunities to collaborate with the the shatter? That is so cool. Oh, that is like the best. Right? And again, right, like you, you have to get the most value out of the things that you can write. And it's really interesting in this world is that like, it's, it's usually a matter of making sure that you know, that people are meeting the caloric minimum, right that there because again, they're so busy, or figuring out what is the more effective way of doing this or how can we provide the requirements despite a busy travel schedule, right, or all the other you know, things that are demanding and then right and then also right, like, yeah, work with chefs nutritionist. Work with other
35:00
With personal trainers, massage therapists, you know, other health care providers like you just so cool. Like you're part of the bigger picture.
35:11
If you're there for that it'll work itself out. Yeah, it sounds like I mean, I'm sure there are discussions that have to happen. But it sounds like the dream collaboration because you have access to literally everybody in the picture that you would want to be present in the picture there. That is just so cool.
35:28
Like, Oh, yes. Oh, God, if I said that to any of my performers, hey, can you connect me with your, your nutritionist or your chef, so I can work? And be like, Are you kidding? Get out of here.
35:40
But wow, that's that's really, really cool. That's, that's getting the opportunity for next level. Next level stuff. Um, I was wondering if you have any fun memories from your first day on the job without getting specific about the individual, but just any? Yeah. So. So the very first day,
36:04
you know, I'm working with President Obama, right. It's a
36:09
White House is an interesting place, because
36:13
there's the work areas, there's were offices and whatnot. But then there's also an area called the residence, and that's where the family lives. And it's off limits to the staff, like people don't, nobody goes into the residents. That's their home. Right. So I was going to see the President and
36:33
in order that we were going up through to the president, so we get into their private elevator, right. And it was, you know, people that Oh, my God, he's getting in the elevator with them. And I didn't know any better, right? So I just, I just introduced myself to him. He's like, okay, hey, come with me. We're gonna go on the elevator and go upstairs. And, you know, I'll get changed up and then we'll go start work. I was like, Okay, great. So I come in the elevator, and he's like, you know, Hey, man.
36:58
What part of the island are you from? And I was like, I'm sorry. He's like, You. You're from Hawaii right? Now, in context. He's Hawaiian. Right? And people probably can't see me, right. But, you know, I'm absolutely a Pacific Islander. And I said, Actually, man, I'm from Cleveland. And he was like, wait, what? I said, Yeah, I'm, I'm from Cleveland. He's like Cleveland. And this was big, right at the time, where LeBron James had just left Cleveland to go to Miami. And if anybody knows anything about Obama, he's quite the basketball fan. So he turns to me and says, Cleveland, ah, that's too bad about LeBron. Like, without, like, I just met this man. Like, and, and so like, you know, growing up in Cleveland, like, I immediately got defensive. And I was like, well, that's too bad that Chicago sucks and everything. Right? So like, immediately, like, and then I was like, oh, oh, I'll be shooting that right. Like, but like he put, I just was completely caught off guard and put me on my heels. And I got defensive about clean. He was like, looked at me, and was like, we're gonna be okay, like, we're gonna get along. All right, right. So that's great. Then people always ask, like, What are you talking about? What you know, what things and things I would tell people is, like, we talked about three things for the majority of our entire interactions, sports, weather, and kid. Those are the three topics that we could talk about, if the conversation ever went somewhere else, right? My answer was usually, like, there's probably somebody who could talk about that, but it's not me. But you mean, referred to. And I think the weather is going to be crappy today, right? Like, and I kind of focused on that right to make sure that I was doing my job, right. And those topics we kind of came to through through just general conversations, these topics are safe and easy for us to talk about, and allowed him to be a patient and allowed me to be a clinician. Yeah, because if you want into anything else, Woof woof. Yeah, yeah. Yeah, too much. That's really cool. I like I like how you found a way to be sensitive and helpful with that sensitivity, you know, to give a human a break.
39:20
For real Oh, that's so magnificent. I think this is perfect. We're going to end here thank you so much for coming on. I'm not sure if there is is there a way for people to reach out to you and contact you if they wanted to? I don't know somehow connecting you can probably the easiest way for the general audience is just find me on on social media. Right? You can find me on Twitter, you see on Twitter. Yeah. DC underscore PTS easy to find me. You know, and eventually I'll, I'll look at it and get back to people but that's probably the easiest way for Pete for this audience to get a hold of me if somebody you know, is interested or just wants to you know,
40:00
Here's something else let me know. Thank you so much for coming on and looking forward to people. Hearing this interview I have learned so much and grown so much and honestly just left very, very inspired. Thank you so much drew for coming on. Thank you. A big thank you to Jenna and drew for a wonderful interview. And of course, thanks to Net Health for sponsoring so again they have a new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net help.com forward slash li tz y to sign up for your complimentary marketing audit so you can boost your clinics online visibility, reputation and referrals. Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media
In this episode, Founder and CEO of CARR, Colin Carr, talks about commercial real estate for healthcare professionals.
Today, Colin talks about the top mistakes healthcare providers make with their office leasing, the financial side of real estate transactions, and important considerations when making decisions on lease agreements. Should business owners buy their space or lease their space?
Hear about how and when to negotiate, the importance of having representation, and hear Colin’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- The best time to negotiate the lease is typically 12 months before it’s going to expire.
- “If you were serious about capitalising, you would’ve engaged an expert.”
- “You should not be telling the landlord anything that hurts your posture or position.”
- “When it comes to real estate, talk to real estate professionals. Don’t talk to other doctors about that stuff if they don’t know what they’re doing.”
- “Realise what’s on the line. If you make a mistake in it, the world’s not going to end, but it will cost you hundreds of thousands of dollars in additional payments that you could have avoided.”
- “Surround yourself with the most successful people that’s you can get around.”
- “There’s no substitute for hard work.”
- “Work it as hard as you can and then learn from your mistakes.”
More about Colin Carr
Colin Carr is the founder and CEO of CARR, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to help them achieve the most favorable terms on their lease and purchase negotiations.
Colin has been involved in commercial real estate for over two decades and has personally completed over 1,000 transactions. Colin educates thousands of healthcare professionals, administrators, business owners and students on an annual basis through national meetings, conventions, study clubs, associations, universities, and webinars.
Suggested Keywords
Healthy, Wealthy, Smart, Healthcare, Commercial, Real Estate, Negotiations, Representation, Leasing, Finance, Business,
To learn more, follow Colin at:
Website: https://carr.us
LinkedIn: Carr Healthcare
Facebook: CARR
Instagram: @carrhealthcare
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Read The Full Transcript Here:
00:02
Hey Collin, welcome to the podcast. I'm happy to have you on today.
00:06
Glad to be here.
00:08
And so today we're going to be talking all about commercial real estate for healthcare, healthcare practitioners. So this is something that you've been doing for quite some time now since 2009. So before we get into the top mistakes healthcare practitioners make when it comes to their office space, can you give us the quick version of how you got into this space working particularly with health care professionals when it comes to their commercial real estate and office needs?
00:38
Yeah, absolutely. So started in 19, Managing apartment complexes back in East Lansing, Michigan, little bit away from where I grew up, moved to Colorado, my early 20s started managing some mid rise, high rise complexes, downtown Denver, and I got into brokerage about 23. And I worked for a gentleman that did a lot of large national retailer. So Walmart's Wendy's blockbuster. And that's how I got into brokerage over the years, I started doing more industrial, more office. And a couple years in, I started doing medical office buildings and working on hospital campuses, Class A medical buildings, and just fell in love with working with healthcare providers. And after a number of years of doing that, I realized that the healthcare industry was one of the largest, most unrepresented segments and all of all of real estate, you know, every time there was a listing, there'd be four or five brokers trying to get that listing, whether it was office or medical. But when it came to actual doctors running around town trying to find space or trying to negotiate, I didn't see anyone doing it. So I've made a focus made an intentional effort to start helping more healthcare providers, and then in 2009, launched our company.
01:47
That's excellent. And as most health care providers can say, we did not go to school for any of this stuff. I can say, as a physical therapist, I didn't go to school to understand how to negotiate commercial leases, and office space and things like that. So having professionals with the best interest of the healthcare provider in mind is so incredibly helpful. And I'm sure you're quite busy. But now let's get to what are the top mistakes healthcare providers make with their office space and their leasing needs, so I will hand it over to you.
02:20
Okay, so we'll have a couple there's, there's more than a few. The first mistake that healthcare providers make is they don't know when to start the negotiation. You've got healthcare providers that are trying to negotiate with two, three years left on their lease, and there's no leverage, there's no incentive for the landlord to do anything for them, the landlord knows they're locked, and they're on the hook in that lease contract for another two or three years. And so they have no posture, they have no leverage. Other side of the coin is they try to negotiate when there's two, three months left in the lease. And the landlord is assuming that they're not paying attention. They haven't hired representation. They don't know the market, they're behind the eight ball. And so you can start the transaction too early. And it's a it's a sign that you don't know what you're doing. And you can start it too late, which is a clear sign you don't know what you're doing. And either scenario, the landlord is gauging how serious you are. How savvy Are you? Do you have other viable options? Are you willing to move? Do you really understand the market? And are you going to fight hard for the terms that are commensurate with the type of property with the the market you're in with the economic climate? Or are you just bartering or bluffing? Are you just hoping for a better deal and guessing? So starting the transaction at the wrong time? That's a that's a big one right there. And
03:38
where and where is the sweet spot then? So it's like, it's like, what is that? Is it the the three bears? Goldilocks and the Three Bears like one bed was too soft, one was too hard to kind of have to find that sweet spot in the middle. So when it comes to negotiating, when should healthcare providers be thinking, Alright, now it's time to reach out to my landlord and start this process?
04:01
That's great question typically is right around 12 months from when your lease is about to expire. If you go outside of 12 months, again, the landlord's just don't have any real incentive to negotiate, because in their mind is I'll deal with it later. They can't go anywhere for 12 months or longer, and so they don't pay attention. But again, if you get too close, if you need to relocate, you don't have time to make that transaction happen. If you need to go to a new property, the negotiation process, the site selection that can take several months on average, you know, getting landlords to respond and negotiating the terms, getting an architect involved to look at the floor plan that takes a few months, it can take a month or two just to negotiate the actual lease contract Once you agree on terms working with the with the attorneys. And then if you need build out and you have to pull a permit or get contractors involved that can take another three or four months as well. So the ideal time is right about 12 months, that gives you enough time to handle each one of those steps that I just mentioned, but it's not too far out there.
04:56
Right. Excellent. All right. So Mistake number One not knowing when to negotiate. Now we have a better idea. What's another mistake?
05:06
Another mistake? And I'd say it's probably the top mistake. It's the do it yourself approach,
05:11
do ya probably be that would probably be was something I would do? Yeah.
05:15
Well, and there's a lot of reasons people take the DIY approach. Number one, it's typically because they're so busy, they don't know who to contact, they don't have time to do the research or due diligence in their opinion. And then it just comes up if the lease agreement shows up in the form of a landlord knocking on their door or property manager saying, Hey, listen, your lease is coming up, what do you want to do, and they just say, hey, send me a proposal. And that that starts the process of them doing it themselves. Or maybe you're looking for a new location or your first office, he started driving around, and you pick up the phone, and you start calling the listing broker landlord, asking questions, and all of a sudden, you have engaged and start the process all by yourself. The problem with this is that that is not the game plan for successful companies. If you take any national retailer that people would respect and say, hey, they do a great job, you take a Starbucks or Chipotle, they don't have some random person calling on properties or asking for proposals. They have a team of in house professionals and they utilize outsource experts that all these people do is negotiate professionally for a living. So when a landlord gets a phone call from a doctor or an office manager, no matter how well meaning that person is, the landlord is going to assume they don't know what they're talking about. And it's not, they're not trying to take shots at the person, they're just going to assume, Hey, you don't know the market, you've not want to look at 10 or 15 properties, you're probably not negotiating with three or four landlords simultaneously going three or four rounds of negotiations. And at the end of the day, if you were really serious about capitalizing and saving $100,000, on your next commercial lease, you would have engaged an expert, it's it's similar to, if you get audited by the IRS, if you don't get a really good CPA involved, you're probably not too serious about getting the outcome you're looking for. If you go to court, and someone's bringing a claim against you, or they ask you to go to mediation and arbitration, and you show up by yourself, you get your signaling, I'm probably willing to accept a much inferior result because I don't have the time, the money, the resources or whatever. And so when a landlord sees a tenant show up on representative, it doesn't matter if it's health care, or, or retail or office, they just assume that that person doesn't know what they're doing. And so that's, that's gonna cost the person a lot of money.
07:31
Yeah, so you really want to have the right professional at your side, so that you're not getting taken advantage of you're not prolonging things. And like you said, I love how you said that they're there thinking that you're willing to accept an inferior result. And as as a health care provider, or a physical therapist, like if, if someone broke their leg, and they need to rehab, well, they're not going to go to their account, and they're going to want to go to a physical therapist, that you don't want to do it on your own, because you're not going to get the right results. So same thing, right? You always want to have the right professional at your side.
08:08
Yeah, I mean, this would be much different than if a patient you know, if you talk to a patient or potential patient, and they needed to rehab something, and you knew it was an advanced rehab, and it's a time you have you have instruments, you have technology of equipment. And their response is, Well, I'm just going to head and figure it out. Like I'm going to search the web and just do some research, your response would be well, there's, there's a better game plan like you can, you can do that. And you can get some type of result or some type of an outcome. Just like a landlord knows, hey, you can you can lease a space without representation, but it's probably not going to be the most effective approach, you're probably gonna waste a significant amount of time. It's probably gonna cost you quite a bit of money. It's very similar.
08:41
Yeah, yeah. Okay, so don't know when to negotiate the DIY approach. What else? What's another big mistake?
08:51
Yeah, another big mistake. And I mentioned it briefly. It's negotiating on only one property. And this is different when you when you compare residential versus commercial real estate, okay. And residential. If you're going to buy a house or buy a condo or townhome, you go look at properties, you search online. And then when you find the property you're interested in, your agent writes a contract for you and they deliver it to the seller. If the seller signs it, you're under contract, you have the ability to cancel that contract with inspection, objections, financing, deadlines, and so forth. But you submit an offer towards one property and if they say yes, you're under contract, it's a binding contract. Commercial Real Estate works on what's called a letter of intent and loi, or a request for proposal and RFP. In either scenario, those are typically non binding. 99.9% of are non binding. There's, there's ways you can make them binding, but they're intended to be a non binding negotiation. And so in commercial real estate, the most strategic gameplan is you go look at X number of properties that meet your criteria. you narrow it down to the top three or four properties that are the best fit, even if one or two property One of your properties are the clear winners, alright, but you still negotiate on three or four properties. And you might even go two or three rounds of negotiations. The reason you do this is because it gives you the true picture of the market. You can't just go off what they're asking as a quote and lease rate on a brochure, because there's too many variables. Is the lease going to be a three year term? Or a 10? year term? Are you asking for no money for improvements? Are you asking for a couple? $100,000? Do you need a free build out period? Do you need free rent Upon moving? Or the annual increases? 2% 3% 4%? Are you going to personally guarantee the lease Are you trying to have your practice or business guarantee it, there's all these variables that are there. And so you've got to negotiate with multiple landlords to get a real feel for what the market offers. And when you do that, a couple things happen. Number one, landlords get more aggressive and competitive when they know they're competing. If a landlord thinks that this is the only property you're interested in, and you tell them, hey, this is my dream location, or you show them your cards, you're not going to achieve the best terms possible. And so being able to leverage multiple landlords against each other, again, respectfully with dignity, not you know, not not doing things in a way that's that lacks integrity, or cuts corners. But if you do it properly, you're going to know if that lease rate is market below or above, you're going to know if that's the right TI allowance, the right free rent package. And if you're getting three or four landlords to do something over here, and another, and another one over here is not one that you can leverage those against each other. And that, ultimately, is how that's one of the top ways that you achieve the most favorable terms possible.
11:31
Got at first, I thought you meant Wait, how many properties Am I getting, but it's not negotiating. It's not for you to have multiple properties. But it's for you to negotiate a single property, but through a lot of different through a couple of different landlords so that you you're kind of getting a better idea of the landscape,
11:52
you're you're gonna pick three or four properties to negotiate with, you're only going to choose one of them at the end of the day. But again, every landlords motivations are different. And so you might have two properties that you like equally, one landlord might be much more aggressive than negotiation. And if you add up all of the economic terms, you might find that two properties that appear very similar, that start out with pretty similar starting or quoted lease rates, you might end up with 100 $200,000 savings on one, or 100 or $200,000, in increased costs on the other. So just because the properties look similar, because they have close to starting lease rates, by time you actually work through all those economic terms, you can end up in a very different economic situation. Oh,
12:34
my God, I love that that is such a good tip. And I'm sure that's something I would never even think about. I would just think, well, I guess I'll just go with one property. So that is a great, great tip. Anything else? What other big mistakes and I know you said there's probably so so many, but maybe we'll keep it to like four or five.
12:52
I'll do two more of this. Okay, you quit, okay, I'm gonna kind of hinted at it. The next mistake healthcare providers make they tip their hand to the landlord, they tell the landlord, this is the property I want, or this would be the perfect space for me, or during a lease renewal negotiation, which is by which is by the way, that's the number one transaction in all commercial real estate, more lease renewals happen every year than any new office or purchase or relocation, okay? The number one mistake they make there is they talk to the landlord, landlord comes their office, the landlord might even be a patient, you know, property manager stops by and they say, Hey, your lease is coming up for renewal, what do you want to do, and the doctor says something along the lines of why don't want to move, or the space works great, send me a proposal. And again, what you have just signal to the landlord is you're not looking at the market, you're not hired representation, you don't know if it's going to be a good deal or a bad deal. And most likely you will accept an dramatically inferior deal. So signaling to the landlord again, you should not be telling the landlord anything that hurts your posture position, and they're looking for you, they're going to ask you questions, trying to get you to tip your hand. So that happens all the time. Here's why healthcare providers get into health care typically, because they want to help people. They're fascinated by the science. They're fascinated by the ability to transform people's lives to help protect lives, save lives, enhance lives. And they're not getting into health care, because they want to be a stone cold killer negotiator. Yet they're going up against landlords that are not playing games that have buildings that are worth 10s of millions of dollars. And those landlords get into real estate because they wanted to be a professional negotiator. So just be very careful what you say the best way to avoid this is to hire representation, let them talk to the landlord for you. And they will keep a very tight posture in the entire process.
14:43
Excellent. Okay, what's number five? Five, the
14:46
last one? Yep. Five. The last one is healthcare providers love talking to their peers and colleagues. And then they take that information that becomes the standard. And that's a really bad way of doing business. So So you might be in a building with with other tenants might be a dry cleaner could be another healthcare provider could be a restaurant. And they'll ask those tenants or neighbors, Hey, what are you guys paying? Or what did you get on your last negotiation, and then they share that information. But what they don't realize is they're asking people who may or may not have gotten a very good deal. We had this scenario, once we were helping a doctor in a building, it was a completely medical building two floors, six or seven doctors on one floor, six, seven doctors on the second floor, and we were talking to the doctor, we were looking at his lease, and he was significantly above market. And we said, hey, who's negotiate and what the last two or three renewals you've done? And you said, Well, I've done it myself every time. And we said, you know, how do you feel about these terms? Because this is exactly where the market is. And I said, How do you know that he goes, Well, I'm, I'm good friends with three out of the six doctors on this floor, we talk to each other all the time, we refer patients back and forth, we've we've swapped leases, everyone's paying the same thing. We're all paying $30 per square foot. And I said, well, like just so you know, their marketing space in the building, way lower than that. And we just negotiated a brand new lease on the first floor for a doctor at $21 per square foot. So you're gonna dollars a square foot above market, okay? And you haven't got any free rent your last couple of renewals. You haven't got any tenant Premadasa, renovate your space, and you're telling me you didn't get those because no one gets those I'm telling you right now, you and your three or four friends have been consulting with each other, you just have no clue what you're doing. So taking advice from somebody who is bad at negotiating or getting a really bad deal is super common. And so people share stories. They're on all these, you know, Facebook groups throughout all these threads, and everyone's sharing their experience, and it is their experience, but it might not be the best gameplan. So that's another big one we see too is talk to your friends about things clinically, when it comes to real estate, talk to real estate professionals when it comes to legal things, talk to attorneys comes to financials, talk to CPAs don't don't talk to other doctors about this. If they don't know what they're doing.
17:05
What a gut punch is, right? That guy must have been like, what $9? Over? Oh my gosh, what a Yeah, what a kick in the pants. That is. Okay, so those are really great. Five Great tips, five mistakes that people often make with their commercial real estate. And throughout that one theme certainly seem to emerge. And that is having representation on your side. So when it comes to commercial real estate agents, let's start with number one. How do you choose the best commercial real estate agent? And then how much does it cost? Because the cost is probably why people end up doing mistake number two, the DIY approach, right? Okay,
17:48
both both great questions. There's a handful of ways to find a really good real estate agent. Number one, if you're a healthcare provider, you want someone that has healthcare experience, it's very different talking to a real estate agent that focuses on million square foot distribution centers for Amazon, than it is someone who's working on a 2000 square foot physical therapy space, very different transaction. And commercial real estate, you got people that all they do is apartments, all they do is Office, all they do is retail, you want to find someone that understands healthcare that works in the healthcare space, number one. Number two, you want to find someone who's only going to represent your interests, commercial real estate, and residential real estate are known for agents that try to work what we call both sides of the deal. They're trying to represent the lammeter seller, and also the tenant or buyer, that is a clear conflict of interest. You can't negotiate for two opposing parties. It doesn't work that way. And so this is the idea of saying if somebody is suing you and you're going to court and you're asking the prosecuting attorney, if they'd give you advice, like that's literally what's happening, their client, the landlord or seller, they have a fiduciary to help that person or that group, make as much money as possible in the transaction and protect their interests, they cannot do the same for you. So you need to find someone that's not going to have a conflict of interest, someone who works in the tenant buyer side, who doesn't have listings with landlords in the area that you're looking because you want an unbiased approach with someone who's going to protect you right now. So those are two really important things. The next thing you say is, well, how do I find those people? You can search online, but typically, in any healthcare industry, you're going to have people that if you ask them, Hey, who do you know that specializes in healthcare, real estate for doctors, you're gonna have lenders that tell you, hey, this person or these people do, you're gonna have architects, contractors that have worked with these agents on a number of deals. And so there's a lot of referral partners in the industry that can weigh in on the topic. And so if you ask a handful, you should be able to get a few names very quickly, people that specialize in that area, and then what you need to do again, and that process only takes a little bit of time. It's not it's not no one's asking you to take a whole week off to spend dedicated towards that. But once you find a couple names, you need to speak with these people. You need to interview them, you need to talk them and say, what would your strategy be to help me maximize my profitability in my next transaction? How are you going to protect my interest? How can I know that you are the best fit for me? And like any other relationship or service provider, you're going to know quickly? What their responses just like a patient would say to you. Hey, how are you going to? How are you going to get me healed up? What is your game plan for me to get restored? Or to get you know, rehabilitated? What do you want to do, and you've got to earn their trust, it's the same way in real estate. And I tell doctors this all the time. If you talk to an agent, and you don't think that agent is the best fit, move on to the next one. And I mean, that's what we do for a living, I tell doctors, then if it's not us move on to the next person. Like it's, there's too much on the line for you to for you to just take whoever's there, don't settle in this area, find the person that you trust that you want to work with, that you believe has your interests in mind. And then that's how you get engaged. Yeah,
20:55
great advice. You beat me to the punch, I was going to ask you what questions to ask how do you vet and you just gave us those answers. So that was amazing. Now, let's talk about the money side of things. Because health care practitioners, yes, we get in to help people, we have our own business, it's also a business. So we want to make sure that we're maximizing our earning potential, if you will. So let's talk about one How much does it cost to hire a Commercial Real Estate Agent?
21:24
Okay, so that's one of the best parts of this entire conversation, it will not cost you as the doctor any money to hire a real estate agent. It's just like residential real estate. If you are a buyer, or a tenant residential real estate, you engage an agent as your exclusive agent, and they receive a portion of the commission from the landlord of the seller. So commercial works just like residential, again, for anyone in residential that's ever owned a house, when you hired an agent, you agreed to pay two Commission's one to your agent, and one to the buyer's agent, Sandman commercial real estate. And this is one of the biggest mistakes that healthcare providers make as well, we could put this as number six, if we wanted to, is they assume they're going to save money by not having an agent. And so they say, You know what, I'm not going to hire an agent. So I'm going to save money. But here's the reality, you're not determining whether or not a commission is paid or not paid. You're not determining what that commission amount is, when you go to a property, that landlord already has money set aside for every transaction. Even if they don't have a listing agents, they're doing it internally, they still have a commission set aside for every transaction. And if you do a deal as a doctor all by yourself, the listing broker gets a double commission, not one, but two, they double up to take both sides of it, or the landlord just keeps that money. And this is this is what happens is, you know, a lot of doctors have this like the do it yourself mentality. I always joke, it's like, every time you see a U haul moving truck, it says move yourself and save, right. But if you're moving yourself and give you a U haul, yes, you save money because no one's offering to pay your $3,000 movie bill. In commercial real estate, there's a commission set aside for the listing agent, and for the tenant or buyer's agent. And when the doctor the tenant doesn't have an agent, listing broker takes a double Commission, or the landlord just pockets that money. So it's 100% free service, it's not going to increase the lease rate for you, it's not gonna cost you money, it'll save you a significant amount of time. It'll help you avoid costly pitfalls, and it should save you a significant amount of money as well.
23:27
Okay, and that leads perfectly into my next question. So you had said earlier that lease negotiations or lease renewals, I'm sorry, are the thing that happens the most when it comes to commercial real estate? So how can healthcare providers or anyone for that matter, save $100,000? Or maybe more on their next lease renewal?
23:52
Great question. So we're gonna take, we're gonna accumulate my prior answers, and we're gonna, those are all the ingredients in that. And then here's what it looks like. So 12 months prior to your lease expiring, and you're going to look at your leisure going to figure out when you're when your dates show that you expire 12 months before expiring, you're going to start the process of finding an expert, commercial real estate agent in your area that represents healthcare, attendance and buyers that knows your industry, you're going to you're going to, you're going to call x number of people until you find the right person that you want to go forward with, you're going to engage that agent and you're going to have an exclusive relationship with that person, okay? That agent is going to take your requirement, and they're going to go to the market and we're going to find every property that meets your requirement. And they're going to whittle it down to the top three or four properties, even if you don't want to move. Even if you think that moving would be a convenient, they're still going to do their due diligence, and they're going to they're going to take their time energy and they're going to negotiate with three or four landlords simultaneously. And they're going to get to what's called best and final term so we're you know, if you were going to move to the property across the street, or down the street or across the city, you're going to know exactly what it would cost to do that, and you're gonna know what the economics would look like if you wanted to transact there. Once you have that information, you can now go to your, that agent can now go to your current landlord, and can negotiate with factual data, and with a very specific game plan. And here's why this is so important. Again, you can get this thing backwards. If you go to your landlord, and you ask them for an offer, you start negotiating. Here's the question, compared to what, how do you know if it's aggressive? You can compare it to what you're currently paying. But again, what if you're above market, and they say, well, I'll bring you down $2 a square foot, you can say why just save a bunch of money? Well, if you can move across the street don't say $5 a square foot. Or if you get a better landlord, or a better space or a larger space, you can't compare your current economics unless you are comparing them to other properties. So your agent goes, the market gets the top options negotiates, and then goes to your current landlord, and says, Listen, we brought to the market, we know what's happening. I'm a market expert, my clients now educated, and we got three or four other viable options, we'd like to have a negotiation and discussion with you, but it's gonna have to meet our criteria, because we've got two or three other properties, that could make a lot of sense for us, if you don't want to get competitive. And when landlords know that you're not an idiot, you know, you're not, you're not ignorant, you're not, you're not, you're not just gonna take whatever they give you, they come to the table with a much different approach. And when they know you're represented by an agent that is an expert, they're not going to waste their time trying to convince an expert that their deal is good if it's not good. So that that's the process. In a nutshell, there's a lot more to it than that. But that's how you get to the landlords, that will actually give you a good deal. Because at the end of the day, if you do move out of that property, they're not going to get the next tenant to pay above market, they're not going to get away with not giving them a tenant proven allowance or not giving them free rent, or trying to gouge them, because the new tenant won't take it, they'll just have go somewhere else. And so the landlord, if they think they've got you know, pushed into a corner, you have no other options, they will stick it to you. If they think that you have the freedom to move that you're willing to move, you got the help to move, they will come with a much more aggressive offer. And typically, at an average space of two 3000 square feet on a five or seven year deal. Those those numbers add up to usually a minimum of $1,000. And oftentimes hundreds of 1000s of dollars, that can be one in
27:23
your favor. Amazing. Again, having the right people in your corner doing your research coming to the table with facts and figures so that you have leverage to negotiate. All makes perfect sense. And now as we start to wind things up here, I just have a one, I think really interesting question, because I hear this quite a bit chatter on social media, when it comes to at least physical therapy business owners is do you buy your space? Or do you lease your space? So can you talk about that?
27:54
That is a great question. That's probably one of the top questions that we receive. The answer to that is you should look at both your options, don't pray determine one or the other, because every markets different, every economic climates different. And you could be in some markets where where you have multiple options to own and it's phenomenal other markets, there's not one option to own. So I mean, if you're doing real estate in a suburban Tulsa, that's different than if you were downtown Manhattan. I mean, you've got to know the different markets. What we tell healthcare providers is listen, we're going to go to the market for you and find the top properties that meet your requirements. And we're going to look at office options to lease and options to purchase, we're going to look at retail options, we're going to look at office options. And we're going to show you the top of what's available, you then are going to choose which properties that you're the most excited about. And then we're going to negotiate on three or four properties simultaneously. And then economics will tell you very quickly which property is going to make the most sense for you. If you can find a property to purchase. That's that's a top property if you love it, and the economics makes sense. We are a huge proponent of owning commercial real estate, you're building an additional asset, if you sell your practice, you can lease out the space. And typically that real estate is going to sell for more than your practice will sell for. We track this across the country, we work with 1000s of providers every year, and the real estate sells for more than the practice over 75% of the time. So if you could be an immediate to pay rent or mortgage either way, you've got to pay a landlord or or pay a company a mortgage company. So you're basically paying yourself in certain aspects of it. You got to make a payment either way, if you can own real estate and economics work phenomenal. A lot of times what you'll find is are you willing to pay more to own than to lease because of the upside. And so you might have scenario where it costs you an extra couple $1,000 a month to own and you get you have to decide is it worth that? Is it worth the extra expenditure to pick up some additional tax deductions to pick up that principal pay not every month you got to check X number of dollars go to pay down principal on the loan, your net worth goes up every month. And so we have those scenarios, if it's if it's 6000, or 6000, at least that's a no brainer at the back, right? If it's 10,000, or 6000, at least, you got a decision to make there a lot of times it's, you know, 12, or $15,000, or 6000. The least. And you have to decide which makes the most sense for your practice. And then you get in another 10, different evaluations, what's the downpayment? What's the cost of entry? What are the economic financing terms available to you? Is this space gonna fit you for three years? Or five years? Because if so, we don't want to purchase that we'd rather lease for three or five years, and then have you purchased the next location, if it's gonna fit you for the next 20 years? Again, that's a different story. So there's all these different variables, there's no one size fits all. There's there's groups that we help lease a couple spaces for that purchase, purchase couple spaces, then lease a lot of variables there.
30:48
Yeah, and and again, that's where coming together with your team makes a lot of sense, and and doing your pros and cons. But I hear that quite a lot. So thank you so much for your input on that question. And now, if you could put a bow on this conversation, what are the top things you want healthcare providers to walk away from when it comes to their commercial real estate questions?
31:17
Yeah, that's a great question. I would say, just realize what's on the line. We're not talking about, you know, did you overpay for a box of gloves, you weren't paying attached, you ran out and you know, you overpaid by $2, for a box of gloves, and you can go, you know, buy in bulk next week, or you have your supplier set, you know, whatever, we're talking about a transaction that you engage in every once once every five, seven or 10 years. If you make a mistake in it, again, the world's not going to end. But it will cost you 10s, or hundreds of 1000s of dollars in additional payments that you could have avoided. And there's a lot of other things that are on the line. Like there's economic terms, there's also business terms, what happens when you want to sell your practice, can you get off the lease, or you get stuck guaranteeing a lease for the person that buys your practice, because you don't have the right assignability class. So I would say this, make sure that you're treating your commercial real estate with the respect that it's still again, I mean, you can still do a lease, you can still stay in practice, etc. But again, the world's not gonna end. But there is a cost or a penalty to messing up here. And it's pretty high. Find a good agent, find someone that you trust, and that person will save you literally 3040 hours of your valuable time, they'll save you a significant amount economically, it's usually usually a minimum of 10s of 1000s, if not hundreds of 1000s. They'll also help you avoid complications and delays that come up all the time in commercial real estate when people are not paying attention. And then the last thing I'll say and I think this is more important than all these is that person's going to give you peace of mind. You're not going to have to wander every night you go to bed and put your head on your pillow for the next 10 years, you're not going to wander Did you get a good deal or a bad deal? You're going to know exactly what what terms you negotiate and how they compare to the market, you're not going to wander if you miss seeing a better property and you should leave somewhere else you chose, you chose the third or fourth best product in the market, he's just would have gone to market you would have known better, you're gonna have that peace of mind. So we can talk about saving time saving money, avoiding complications, delays, pitfalls, but I think ultimately, that peace of mind is invaluable. And for me, that's that's what I'm trying to deliver every time that I work with a client.
33:19
Yeah, you had me at saved 30 to 40 hours of your time. You could have ended it there. But I love having that peace of mind being able to sleep at night knowing that you really got the best deal that you possibly could because you started 12 months ahead of time you hired someone you had a team by your side. So perfect sense. So now, Collin, where can people find you? If they want more information? They have some more questions. What's your contact?
33:49
Absolutely, the best way to get ahold of us is our website. And that is car that US ca rr.us. On our website in the upper right hand corner, we have a couple options on our navbar that are of importance. Number one, you can click the Find an agent in your area. We've got agents coast to coast, we represent 1000s of healthcare providers every year, and we are working, we're working literally in all 50 states plus DC. So click Find an agent in your area. And then that's a great way to start. Another thing we have is a free lease evaluation. If you want to know where you stand in the market, even let's say you signed a lease last year and you got nine years left, we can still do a free lease evaluation for you. And we'll tell you where you stand based upon the market currently, if the market corrects, as we've seen some crashes last two years, who knows what we're going to be tomorrow, let alone five years now we can update that over time. So if you want to know where you stand in the market today, in a few years, we do that all the time, we can do it very quickly. And again, we can give you the peace of mind knowing where you're at and if you're way above market, then we're gonna try to capitalize on the next transaction. If you did a good job in your last deal, again, that gives you peace of mind knowing that you're in a pretty good position. We want to protect that or reserve that in your next negotiation. And then the third thing is we have a ton of resources if you want to study up, if you want to get educated, we got literally hundreds of articles, blogs, educational videos. And if you're interested in commercial real estate because it affects your practice, and you want to know more, we will give you information that will make you the subject matter expert.
35:21
Excellent. That was perfect. Now I have one more question that I asked everyone. And that is knowing where you are now in your life and in your career. What advice would you give to your younger self? So let's say that 19 year old in Lansing, Michigan, what advice would you give to him knowing where you are? Now?
35:39
That's a great question, I would say, surround yourself with the most successful people that you can get around. If you can get around them personally, and they'll spend time with you then do it. If you can't, then get around them through watching their podcasts through reading their books, you know, following their history. And then I would say that there's there's no substitute for hard work, you're gonna make mistakes, you're gonna fall down, you're gonna you're gonna do things that in hindsight, were less than intelligent to say them politely. But you just that's part of the process, owning a practice, you know, becoming a professional, anything in life, working as hard as you possibly can, and then learn from your mistakes.
36:17
I love it. This was so great. Thank you so much for taking the time out. I mean, I was taking notes furiously over here because I think this is such great information for certainly for healthcare providers, but I would say anyone that is looking to get into a commercial space, this was wonderful. So thank you so much. Absolute. It's been a pleasure to be with you. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Dr. Jenna Kantor interviews Dr. Sherrill Williams about diversity, equity, and inclusion in physical therapy.
Mabout Dr. Williams here:
A lifelong dancer and lover of the performing arts, Dr. Williams committed most of her life to studying Ballet, Modern, Jazz, and Hip Hop. It was not until her commitment to losing 90 lbs that she fell in love with fitness, and wanted to find a way to fuse her love of dance with health and wellness. This new mission sparked a fire that led to Dr.Williams receiving her Doctor of Physical Therapy degree from New York University. Shortly after she founded Leg Up Fitness and Wellness, an online fitness company for performers that want their workout to feel less like exercise and more like dance. Leg Up's client credits include but are not limited to The 1st US National Tour of Aladdin, Hamilton, Lion King, Lizzo, Jidenna, John Legend, Todrick Hall, and Complexions Contemporary Ballet. Dr. Williams is a passionate advocate for dance injury pre-habilitation and rehabilitation and loves helping dancers around the U.S. virtually and in person.
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Read the Full Transcript Here:
00:07
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everybody, welcome back to the podcast. I'm your host Karen Litzy. Today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net house digital marketing solutions, has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how Net Health Digital Marketing Solutions can help your clinic when they'll buy lunch for your office. If you're already using that health private practice EMR Be sure to ask about its new integration, head over to net health.com forward slash li tz why to sign up for your complimentary audit today. And like I've said before I actually use this product it works man did a bump me up in the Google search was awesome. Now on to today's podcast, which is being hosted by the ever wonderful Dr. Jenna cantor. And in today's episode, she interviews Dr. Cheryl Williams, a lifelong dancer and lover of the performing arts, Dr. Williams committed most of her life to studying ballet, modern jazz and hip hop. It was not until her commitment to losing 90 pounds that she fell in love with fitness and wanted to find a way to fuse her love of dance with health and wellness. This new mission sparked a fire that led Dr. Williams to receiving her doctor physical therapy degree from New York University. Shortly after she founded leg up fitness and wellness an online fitness company for performers that want their workout to feel less like exercise and more like dance leg UPS client credits include but are not limited to the first US national tour of Aladdin, Hamilton Lion King Lizzo Jidenna John Legend Todrick Hall, and complexions contemporary ballet. Dr. Williams is a passionate advocacy for dance injury, pre habilitation, and rehabilitation, and loves helping dancers around the US virtually and in person. So big thank you to Jenna and to Sherelle for coming onto the podcast so everyone enjoys today's interview.
02:42
Hello, healthy, wealthy and smart. This is Jenna cantor. I'm here with Dr. Sharon Williams, and I cannot be so grateful. So much more grateful right now to be on here with you. First of all, thank you, Sharon, for coming on to talk. Thank
02:54
you. Thank you for having me. I'm excited to be Yeah,
02:59
I love it. I'm really grateful on so many levels, the one we're friends to. And I think this is where I'm starting with where I'm comfortable and where I need to expand. So I'm just owning up to this. In physical therapy. I don't know a lot of black physical therapists, like holy crap. And so you're one of my few. And when I really took account, I took accountability. And I was like, Oh my God, a few people that I know who are black. So I'm starting with people I know. And then I'll expand out to more and more and more and more and more people and increase my network. But that is sad. After calling myself out. I am really excited to be talking about diversity equity inclusion. I feel like that was a pretty good segue because that is yeah, that is legit. So let's go back. You are a new grad congratulations. Thank you. We made it. We made it made it Sherelle is one of those people who thinks big and then achieves the big. So she's a nice person to be regularly inspired by and I'm super grateful to know you Sherelle. So diversity, equity and inclusion. What rehearing that whole statement in as one what are some first thought that comes to mind when it when it comes to physical therapy? There is no wrong answer. I just want your truth.
04:29
Well, I was gonna say when you like yeah, you're like one of the few black people I know that's a physical therapist. I was like me too, girl. Oh, no, me neither. Oh, I didn't know. Yeah, um, to be honest, I think it was CSM where they had a, a networking event and I was like, oh, there is a little community of us but we're just all scattered or you know around the world. But when I think of the Diversity, Equity and Inclusion within physical therapy, you know? No, I don't want to say non existent, but it's just, it's very small. You know, when I went to NYU, you know, I did visit a few schools. When I was doing the audition process when I was
05:22
Joe and I both are performers, as well. So that's what why audition process came to her mind. That's hilarious.
05:31
When I was going through, like the interview process, and I was looking at different schools, and like NYU, you was one of the few schools that you know, I did see quite a few black people. And I had, there was seven of us in my class, and two men, two black men, which is like crazy that I'm excited about to black men. But like, you don't see it at all.
05:59
No, you don't.
06:02
And it's an it's unfortunate, because it's such an amazing field. And I'm still kind of at the point where I'm like, is it that we are not applying? Because we don't know? Or is it that? You know, they're not letting us in the door? And I haven't really figured that out yet. But I do I do feel like a part could be, we don't know. Because a lot of times I feel like especially in the African American community. And you can also say African because those communities are very different. Culturally, you know, people No, go go be an ND nd ND, ND, ND nd? Or what do we need to do to get more people of color in or black people. Because I think that's going to do wonders when it comes to the community and getting people up. And, and healthy. Because unfortunately, in our culture, not many of us, I think my generation is more, it's a lot more active, but the older generation, not move until I think when we get more more people of color in into the field, and then we're talking about it. And we're excited about it, you know, then the community will come to and we'll see, you know, more people being active. And that's just my theory. That's what I've seen based on, you know, my family when I started school, that's what I'm talking about. I'm talking about moving. And my mom is like, oh, yeah, I'll go get a trainer. Or I'll do this or I'll move or they you know, they see me we can lead by example.
07:42
This is so helpful. Because everything and what you're calling rambling I call a more clear insight into what's true in your mind regarding diversity, equity and inclusion. And it's not just one component that it there's a need to be looking upon. First of all, with defining diversity, equity inclusion for you, like it seemed as though we're talking about black people, right now, we're just in which is that's absolutely, we're not seeing it. i There were very few in my class, and I didn't think anything of it. You know, to me, the fact that there were some people who are black, there were some people who were Asian, there were some people of some sort of Indian descent was like, wow, look at us, but there could be more. I agree from what, yeah, I still as a white person, I did not feel like a minority at all. In that group. In that setting. I felt just like, you know, hey, which is Yeah. My point is, from all these little things, let's start separating out different things that you were mentioning, first of all, with getting people in getting people into the profession, how did you get reached?
09:05
I, to be honest, I sort of think I got into NYU, praise God, I did apply to like 13 schools. I only got into NYU, and I honestly think it's because they had an interview process. Because on paper I didn't have like a four Oh, and I had some C's and I had to retake some classes. But when you get me in person, I can tell you and and why you happen to have an interview process and and I was able to shine in that way. And I think that speaks volumes. I hope that maybe other schools can adopt that because sometimes our paper with we don't, you know, I mean like but that doesn't have anything to do with, you know, how compassionate we are or how smart we are what will be Be like as, as a physical therapist, especially based oh my god, we had the GRE, I
10:08
didn't do the grade on that either. It's interesting, you're saying that because everything on paper only shows part of the picture. So when the schools are making it like that, and they're just looking at paper, I mean, right there, we are automatically going to be leaving a lot of people out, because our school systems are not equal. Yeah, what people are learning are not equal. So if you're just going off of what they happen to be born into, we're really cutting people off. We're really, really cutting people off from opportunity, and therefore, just continuing the cycle of a lot of whiteness in our field.
10:47
And something that I saw that I think would be also be great, like, okay, let's say we don't have time for the interview process, some of the HBCUs. Or if you don't know, historically black colleges and universities, they did like a video, like you had to send in a video and answer a prompt. And that way you get you get to show yourself. And I thought, you know, that was that was great. You know, I mean, it's something that could also be adopted by other schools. To give us a chance, you
11:24
know, I mean, absolutely, I think I think that that's a great idea as a way to be the change be the change. I don't know if you've ever heard this where it's, you know, God, it's a very I don't like this rhetoric, but it's the one where people are saying, not everyone, but people are saying, Oh, well, now people are just getting in because they're black. Can you share some thoughts to that? Because for so you know, I have an angry look on my face and Sherelle rolled her eyes. We're not shy about that. All right, would you mind response to that? Because, I mean, it angers me, but let's talk about this.
12:08
And on that note, we're gonna take a very quick break to hear from our sponsor, and be right back with Shirelles response. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net help.com forward slash li tz y to sign up for your complimentary marketing audit.
12:52
Wow, I've also never discussed this. I mean, if I was just to like speak, honestly,
12:57
yes, please.
13:01
White people get things because they're white all the time. Like not based on merit, not based on skill based on who they know. Or a back door. You know what I mean? And I as
13:17
a person who has benefited in that way, I can absolutely agree. It's Yes, yes. It's true. It's legit happened to me. I like I'm grateful. That's amazing. But like, also, that's so true.
13:32
And, and we're like we said this, the schools are not always even, we don't always have, you know, these connections. But a lot of times when you give us a chance, we go above and beyond, because we're like, hey, my ancestors didn't die for this. So I mean, like, and we deserve the chance, I just think we deserve the chance. The playing field is not going to even and this is our opportunity to try and be able to own probably, I think it kind of goes deeper than just Oh, black you let Black people in. But for so long. We couldn't get education. You know, we were enslaved. We built this. We literally built the US, you know, we couldn't own property. So now it's like, Hey, we're trying to get in these professions, so that we can make something of ourselves we can start building generational wealth. Like for me right now. I am like the person. I am the person right now and 2021 that is trying to start building generational wealth for my family, but why people have had this opportunity to do this and save and know about mutual fund all these different things and I'm just now learning and having the opportunity to get to you've been able To do that,
15:01
oh, for a very long time, and for anybody who says, Oh, the history that you're mentioning, I'm just acknowledging this history that you're mentioning from a bit ago that how black people came into, it's still not 100% there for basic rights for black people, they don't have access to the education that I got, you know, in this, I grew up in California, in a small town, California, if you don't know, if you buy a shed of your own, it can be worth a million cost a million dollars. It's ridiculous. It's a running joke. California is not it's just a well off area to be living, and which is unfortunate. And from that, we are lacking diversity in our areas, and they are people are not getting getting that access. I also feel like that there's an assumption when people are saying, Oh, now black people are getting in just because they're being black. What if? Let's say this black person, maybe it's just one? Oh, you know, come on, like, you know that Gatson is extremely intelligent and more intelligent than you and has had to put a lot more work in to get into prove themselves just to get in? And you actually don't belong? What if? What about what that? What about that? What about that consideration that there could actually be a lot of people of color, who are more intelligent than a lot of people who've been regularly led into school.
16:30
Everything that you just said? That was awesome. Like,
16:36
I love that we're sitting on this for a bit, because getting people into PT school is like the base, you know, how do we reach them? How do we access them and everything. And if then we have people saying it's because they're black. They're people who are black are already dealing with so much this is from what I've learned not experienced, obviously, like you're already dealing with so much discrimination on a regular basis. So to So to finally get that opportunity to come in and then be discriminated against, you've worked your tail off more than the average white person is just preposterous, and we need to call ourselves out on it, in order to be the change. Sure, I was just gonna read this smile. She's
17:25
emotional mom, because you know, it's like, these are the conversations and these are the things that are said within our circles. But then when you have the ally, say, and you see it, and it's like, oh, it's just so nice to be seen and heard. Oh, and then somebody gets it.
17:42
Oh, my God, I do. I do make mistakes. As I go. I've made I've made plenty. And I will continue to do stupid things. But I keep learning and making the changes as I go. But I so grateful that you're on to talk about this. What have you seen, that you think schools are doing that is working to bring in dei and that in schools versus we're taught we've talked a lot about what's not working? What are the schools doing that is working? And what could we do more of pull it out of your buttons fine. Just like brainstorm like, what are the things?
18:15
I mean, like I did say the video. I'm having professors,
18:22
oh my god, I had a black professor. That was the most amazing thing I had ever had one. I remember
18:29
it was so funny. She came in and I was like, Are you a grad student? And she was like, no, actually, I'm a new professor. I remember Mike, one of my classmates, she walked out. We were like in the computer lab. And she was like, now that I see this woman as my, I know, I can do anything. That's what she said. Yeah, so having more black African American ever, professors. If if there can be some type of outreach, I know with my class, so my class isn't good class because I graduated in the middle of a pandemic. So our plan was like, we had many plans and COVID killed the plans. But one of the conversations that I had with a good friend, classmate of mine, she wasn't black, she was a Puerto Rican. And she was like, Oh, I would love to go out to high schools. Let's get a group together and go do it. And then COVID happen and killed everything and we couldn't go anywhere. But I do think in the future. And I know you know, PT school as hard as it is and stressful, but doing some type of outreach in in PT schools and just saying, Hey, this is what you know, get to make it like
19:47
a career day kind of thing. When people come and visit and say, Hey, this is a career you can I do think yeah, definitely. Especially in neighborhoods where my dad's a dentist, okay. I have a family of dentists do Wish total stereotype halacha just brush your teeth, Jenna. So what's my upbringing? Look, I oh my god,
20:10
I missed you.
20:13
The the, but because I had, I grew up with that with people living these amazing careers, I didn't need somebody to come visit because I was surrounded by their neighbors doing a chiropractor friend, one of my best friends her dad was a chiropractor. This was just commonplace. Just in my world. People don't have that. So, uh, yeah, I can even see more. Having people in the profession, someone like my dad even coming and saying, Hey, this is something you could do is great. I think that's, I think that's a really great idea, just literally coming to the schools coming to them. And people don't like if you sit there and just do a social media post and be like, here come to us. Like, it doesn't work that way. Nobody, including any listener, or Sherelle, or myself, we'd like people to just come to us, as we're living our lives.
21:06
This is something I just thought about. I don't even know if it could actually happen. Ooh. Like, can we have like a work study? or some type of like, even be volunteer like work study. And like a student? A student runs an Instagram and it's specific for that school. And it's specifically for, like, adding teens or, you know, people of color and and making content that's relatable. Yeah. So that it's, you know, a track. It's attractive, so people learn more you know about it. I think social media is just such, it's just a force right now.
21:54
It really is it really,
21:56
I don't know what that really looks like. But, you know, yeah. But in talking about, you know, I don't know it just in a creative way.
22:08
No, I get what you're saying. I just, I just recently had a big screening with a ballet company. And I contact a local school and had PT students come volunteer and take measurements and everything was awesome for them to get to experience that would have killed for something like that as a student, but things like that, that other businesses are doing schools are doing, they can have events of some kind to bring that in that that could be I don't know what but because we're like in the like, no mode. But I love that. I love that. Let's let this lay as like the EU, we just let this kind of drop as a potential idea. I have only a few more minutes left with you. I would love to two more things. What have you personally been doing to help bring more dei into the profession?
23:00
I don't know that I necessarily have because I was so engulfed in school by having this conversation. Literally while you were saying that I was like, Oh, I have some ideas. Like I want to start doing this. But I definitely you know, I speak within my family on my social media. You know, I I talk about, hey, let's be more active, I do a lot around how we can move instead of having to go to the MD The MD is going to tell me to take a pill and then sit you don't have bed rest. But I definitely can do more. I can call myself out about that. You know, when I'm back up, you know, hey, I'm going to be very intentful about a purposeful about doing this. I'm excited actually, unfortunately, I passed my boards. I I kind of had this injury and then I wasn't able to do everything that I wanted. So when I'm back up and I'm full, I'm like, Ah, let's go. Let's add this to the list. I'm happy that you asked me that question, which made me get you know, the juices going and Right,
24:09
right. Uh, yeah, I love it. I love it. I give complete credit to Lisa van who's for that question. She said ask this question. I said okay, okay. Where can people we are now coming down to an end. Where can people find you? Sherelle on social media. They can follow you connect. Where can they find you?
24:29
You can find me on Instagram at Lego fitness. I believe Oh, well. I do search my name on Facebook, which is Sherwin Williams. Those are the two places that I live right now. At my website is you know is what is it like up pt.com If you want to see a little bit more about me there.
24:56
And then if anybody might want to email you some people do prefer the email
25:00
Oh yes, my email is right now is just Sherelle w@icloud.com
25:08
I love it. Wonderful. Thank you so much for coming on. You are a force. I frickin love you.
25:16
Thank you for having me. This is so amazing.
25:20
A big thank you to Jenna and Ciara for a great interview on D AI initiatives in the world of physical therapy and of course a big thanks to Net Health. So again when it comes to boosting your online visibility, reputation and referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition they know you want your clinic to get found, get chosen and get those five star reviews. They have a fun new offer if you sign up and complete a marketing audit, so they can help your clinic when they'll buy lunch for your office. Head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today.
25:57
Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media
In this episode, Founder of FitBUX, Joseph Reinke, talks about financial planning.
Today, Joseph talks about financial planning technology, the three buckets of financial planning, and the importance of focus. How can FitBUX help people with financial planning?
Hear about thinking about percentages, self-employed financial planning, and get Joseph’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Money is always relative.”
- “The big takeaway is percentages.”
- “If I focus on one, maybe two things, I’m going to accomplish things much faster.”
- “The more you concentrate on something, the sooner you’ll realize it.”
- “This should be complementing your life, not dictating it.”
- “Focus.”
More about Joseph Reinke
Joseph Reinke is a Chartered Financial Analyst (CFA) Charterholder and is the founder of FitBUX. FitBUX has helped more than 11,000 PTs manage $1.6 billion in debt and assets. In addition, FitBUX recently partnered with the APTA to provide APTA members with awesome discounts on their technology.
Joseph has appeared on numerous industry podcast, been an author for various industry publications, and has done over 200 student loan workshops at university graduate programs, SIGs, Conclaves, and annual conferences throughout the country.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, Finance, Financial Planning, Income, Expenses, Debt, Money, Technology, Retirement,
Resources
FitBUX Investment Round: https://republic.com/fitbux
To learn more, follow Joseph at:
Website: https://www.fitbux.com
LinkTree: https://linktr.ee/fitbux
Instagram: https://www.instagram.com/fitbuxofficial
Facebook: https://www.facebook.com/groups/FitBUXOfficialGroup
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript Here:
00:03
Hey, Joe, welcome back to the podcast. I'm happy to have you on again.
00:07
Yeah, I'm glad to be here. It's been a long time. It's the very first time. I think there's like a third time, maybe the fourth time. But yeah, it's been quite a journey. So glad to be back.
00:18
I'm happy to have you back. Especially because today we're going to be talking about financial planning. Now, I know a lot of people might be like, oh, gosh, this is so boring. But regardless of whether you own your own business, you're working for someone else, you have to have a good financial planning, because you want to be able to get through the rest of your life and have the security of knowing you're financially sound. Right.
00:46
Exactly, exactly. So we'll make it we'll make it exciting. We'll give you some, some tidbits that you don't hear anywhere else. So
00:54
yes, excellent. Well, let's let's start out with what are a couple of tips for the audience, that you counsel people on when it comes to financial planning?
01:06
Yeah, so a lot of us to help is all about the technology, and we're there to guide them through it. And it's really geared around a lot of stuff that I learned when I was in wealth management. You know, everybody always talks about, oh, the problem in financial planning and financial education, and this and that. And basically, what I look at used to look at is everybody in the financial industry, they just double down on using the same stupid stuff. And then when the technology comes out, they just put some cute interface to it, and it just doesn't work. Okay. And there's, there's two areas that I could, you know, illustrate on that. One is like, on these apps, so like these budgeting apps, I won't name any names, I won't pick on anybody, but there's a lot of big popular apps out there. Or maybe you just use Excel. And a lot of times what they do is they just throw a bunch of stuff in basically an Excel sheet, and they put a user interface around that. And it's like, okay, well, where does all my money go? Like, this doesn't make any sense. So that's the first issue that we've seen in the second one, I used to joke around about this, this is where financial technology that I used to have, like, you know, a 60 year old client would come in with like, a stack of paperwork with like, an inch or two thick and say, Okay, what am I supposed to do? And to me, all FinTech did was take that makes file and put it on the internet. And just make a pretty little graph around it. It's like, okay, this doesn't tell me anything. Like, what if I want to buy a house versus rent? What if I want to pay off my loans versus well forget? How am I supposed to look at these things? Like, am I supposed to decide this? And so those are the two big areas that is like, how do you do this. And so the first big tidbit on financial planning to satisfy that first problem, just one big thrill plus, you got to think of things in almost buckets when you start stretching out your plan. So you have things like your income and your expenses. And I'm not talking about like your debt expenses. I'm literally talking about your day to day expenses, like food and rent and utilities. So that's like, step one is your income and your day to day expenses that is happening today. The second step is to say, Okay, how much is going towards investments and how much is going towards debt? And that's the step two is over the long term. And then step three is, well, what am I doing to protect my financial plan? Those are things like insurances. So life insurance, long term care, insurance, disability insurance, home insurance. And so the way you can think about it is, this is day to day, this is long term. And and this is risk management, because protection. And when you start thinking about it that way, it makes life a lot easier to do it. And then you know, we'll pause there, and then go into also, you know, what happens like, Well, what about projecting? What about managing this over time? What's an easy way to set this up from there, but that's the primary the main component of in terms of just setting up the plan itself, of those three buckets when you start thinking about this stuff?
04:09
Yeah. And so you suggest people kind of sit down and look at all of those things and kind of write them out. So they have they know their income, they know what their expenses are. They know what they have asset wise, debt wise. So when you're talking debt, can you be a little more specific? Are we talking long term debt like loans or short term debt like credit cards, or bony
04:32
any real debt, I mean, credit card. So with credit cards, if you're paying them off monthly, we don't even consider it that we just consider that day to day stuff. But we're talking about where like you have a monthly payment, so car loans, student loans, mortgages, if you do have credit card debt, and you refinance it, for example, into a personal loan, and you're paying that off over time, if you have business debt, whatever it may be, that's the debt that we're that we're talking about in that step two.
04:56
Yeah. Thank you. Thanks for the clarification on that. And then of course, All the insurances and things like that, that we all need, that we all should have moving forward, I would say especially if you're a physical therapist, and especially if you're in private practice, boy, do you need those insurances to be on point?
05:16
Yeah, exactly the biggest, like the most overlooked one is disability insurance. Because it's like, what do you do if you go to say, well, I can't do my profession anymore. It's like your financial plan completely just ruined if you don't have that. And that's the way you can think about insurance is okay, well, I did my step one, I did my step two. Step two happens over time. What happens if I don't have time because of whatever it is. So like, what happens if I become disabled? My financial plan crumbles. What if I'm married, and I pass away or my spouse passes away? Like we have children like our plan crumbles? What happens if I have a car and I don't have the proper car insurance and I get in a car accident? I don't, I can't buy another car. Now my plan crumbles because I gotta get all this auto debt for another car. So that's what you can think about insurance is protecting just in case time doesn't happen?
06:03
Yeah, fair. Okay, so great. Tip number one, just to recap is to break up into three areas, income expenses, assets, debt, and the third protection, or, and that's where all your insurances come in. Okay, what other what other tip do you have when it comes to financial planning?
06:22
This one is one of the most important and this, this makes life so much easier, both when you're setting up a plan. And also when you're actually like monitoring your plan. Oftentimes, somebody will come to me and say something like, you know, I'm paying $1,500 a month on my student loans. Is that a lot of money? And it's like, I don't know, like, Well, what do you mean, you don't know you're an expert? Don't you know if that's a lot? It's like, well, no, what I mean by that is, do you make $300,000? Or do you make $30,000? Because it's all relative to your income. And money is always relative. Another example of that, like investments, somebody can't come to me and says, I made $10,000 on my investment. And it's like, okay, is that good? It's like, I don't know, like, Did you invest? 20,000? I'm like, Yeah, I'll just do that. But if you invested a million and only made 10,000, like, that's horrible. Like, don't quit your day job, like, what are you doing? Right? So it really just depends on percentages. And you can take that knowledge and apply it to your financial plan. So when you're actually setting these things up, especially on step two, where you're saying, where's What am I investments? Or what am I debt, when you look at percentages of where your money is going and allows you to say, hey, like, I want to focus on, you know, paying off my mortgage? Well, if that's not your biggest percentage of where your money is going, and you're not focusing on that, okay, and this is like, it's funny, because people like, how did you come up with that percentage thing? And I'm like, well, one of the ways I did was when I first started working, I put all the percentages there. And I realized how much money was going to taxes. It was like, Holy crap, like, what can I do to reduce that? So I'm the financial dork that I am, I went and read the IRS tax code. But it's like, those percentages that I assume realized, from a financial planning aspect, it makes life easy, not just setting up your plan, but actually following it. Because if you say, Look, I have 20% going towards my student loans, I have 5%, going towards savings for a down payment for a house, I have 4% going towards my 401k. Over time, your income should be going up. So it makes it very easy. You don't have to think about how much of my money should be going where you just keep the percentages the same and increase how much you're doing in those categories. Or if you get a bonus or a tax return, say great, I take the percentage, I put it to those categories. If I want to do more, I'm fine. But I don't need to I can go out and actually enjoy this money if I want to and not feel guilty about it. Cuz I know I'm following my plan. And then once you're following that plan, let's just say you have a good life event happened. Like let's just say you paid off debt, you paid off a student loan, you paid off an auto loan, well, then great, you just look at the percentage and say, Okay, where do I move this now to meet my next goal? Very quick and easy. Or maybe you have a negative life event, like you get a car accident, You wrecked your car, and you need to buy a new one, where it's like, okay, well, I have I was focusing on this. But if I've moved this percentage and this percentage here, I'm good to go. And that's it. And then you can actually go out and simulate that and I'll talk about simulating that in a minute. But that's the key thing. One of the biggest takeaway that you can take from this podcast as percentages, what percentage of my money is going where and then from there, instead of tracking your dollars and cents, every single place that goes track the percentages are my percentage is going to where I said they're going to especially going towards your investments and your debt. Some people really like looking at those percentages on their day to day expenses too. That's fine if you want to go that into it for me, as long as you're following the assets and debt sureselect don't enjoy. That's the way I look at it. Because that second floor of the building assets and debt, that's the financial plan. So that's the key thing. There's that percentages, percentages, percentages. And, you know, I wish I could talk to everybody that's like 40 and 50 and 60 that have been doing like the dollar amount their entire life. And it's like, I just switched to this. It's easier, like, do that. Yeah. So that's the big takeaway is percentages.
10:26
Yeah, I switched over to percentages a couple of years ago, and it's like a no brainer. You know, so like, when, like you said, for example, a tax return comes in. So I had a tax return. I know it was last year, the year before. And I knew exactly where all of that money was going. Because it was in my percentages. Yep. So it just makes life so much easier. And you'll see you'll accumulate wealth in the places that you need to, because that's your plan.
10:53
Yep. And you'll realize, while if I focus on one, maybe two things, I'm going to accomplish things a lot faster. And so that's where the the behavioral side of finance comes in to. And it's a proven fact that more you concentrate on something that the sooner you're able to realize it. And so one of the big mistakes that we see people make, especially on that step two, they're like, Alright, I'm going to save in a Roth, I'm going to save in a 401k, I'm going to save for my child's 529 plan, I also need to save for a house and I want to save or pay off my student loans. And it's like, you're going to do none of those. Like, if you're trying to do all that good luck. Like seeing the percentages and how thin they are, and how long it's gonna take you to accomplish those is a red light to a lot of people, it's like holy cow, like, will instead I just focus on like, paying off my loans, for example. And your my retirement for the time being, you're gonna be able to accomplish a lot more sooner. And then you can get to those other things down the road. So that's another big takeaway is focus, focus, focus, focus.
11:55
Yeah. And it's okay to move those percentages around as your life changes. And as things change in life. It's good. Yeah. Okay, cool. Yep. So now, yeah. What I mean, this all sounds great. And I'm sure a lot of people are wondering like, oh, okay, how am I supposed to keep track of all this? How am I supposed to do all this? This sounds complicated. I don't work in Excel. QuickBooks makes me nauseous. What can I do? Like, so explain to us how fit books, can I help people with some of this financial planning stuff?
12:28
Yeah, this is where I'm so personally excited. Because this is where we always wanted to take the company even like, it was one of like, five years ago, I first came on the show on your podcast, we specifically we knew this technology was gonna take a long time to build. And so we specifically started the first piece of the technology around student loans to help students, new grads, and then we've been building it, especially during COVID, we've been building out more and more, as long as we don't lose engineers that COVID Every other week. But we've been building out more and more, and we launched the first version out of beta last November. And it literally does all that for you. So when you go to build your plan, like step one is income expenses that two is is your asset contributions, your debt contributions, that three goes into risk management. And then we took it a step further, actually, on step four, you can add in goals and life events. So everything from like getting married or buying a house, or whatever it is that you're going to do. And what that allows you to do is it allows you to say, Hey, this is the plan that I want to follow. And you can actually build out the entire thing and see in the long run what it does, or you can run simulation. So if you're trying to say Hey, should I pay off my loans versus loan forgiveness, or should I rent versus buy, or I'm married, and we just had a child should myself or my spouse stay at home instead of working so we don't have to pay for daycare, you can simulate all those to decide what you want to do. Okay. And then with the technology, once you say this is what I want to do, we take all these complex components, so like your income and your expenses and your assets and your debt. And we bought them all into one data point we called the fitbug score. So you can really easily compare everything and what the fitness score is in the short run, it looks like your risk and your profile and everything else. And then by the time you hit retirement is basically the probability of you hitting retirement and not running out of money. Okay. And so once you say this is the plan that I want to follow, you can then link your financial accounts into the hitbox profile, track yourself right on your profile, and it literally tells you step by step each month, are you doing this right or not. And then if you have one of those life events where you have to change your percentages around you just go back in and have your plan with the percentages around hit save and go back on with your life. So that's why I'm so excited because we've been building that literally for like two and a half years that that bigger technology and it's finally out. So I can actually smile and have a few more gray hairs because of it but it's out So that's where we're at right now.
15:03
Yeah, it sounds it sounds like definitely makes life a little bit easier. And now does this connect to your bank accounts or to your QuickBooks and all that kind of stuff so that it's constantly updating? How does that
15:17
work? Yeah. So it doesn't connect to QuickBooks, it connects to bank accounts, credit cards, some debt. So it connects almost everything not, you know, there's some credit union stuff that it doesn't link into. Some accounts are more thorough. So like the bank accounts, or the savings accounts are all in there. Some debts, like some companies, like first of all, some companies are there, some aren't. Even if they're not, you can still manually put them in. And I just tell people updated like once a month with your transactions. So it can up to date tell you, the big thing is, is making sure that your gross income is in the technology? Because that's how we base everything, are you following your your plan, based on these percentages, and the only way we know that percentage is if your gross incomes, they're not your net, your gross income. Because we want to see, we want you to see where your taxes are going and everything else in your entire paycheck. And so yeah, you can link your accounts, we do it through a company called plaid, which is, you know, the other major banks use them and everything. So that is who we use to link the accounts.
16:17
And can you quickly just for people who don't know, define gross versus net income?
16:24
Yeah, so gross income is what you get from your employer on quote, unquote, that top line, so it's what you're actually paid. And then from there, they deduct out things like your taxes, your Social Security taxes, your unemployment taxes, your Medicare taxes, any contributions to your 401k that you're making, anything that you're paying in terms of like medical care, dental care, whatever it is. And then after that is your net pay. So when you get a deposit into your bank account, that's what we see as net pay. And so you have to reconcile that the gross income. And so what we try to do on the technology to make it easy is is once you put in one of your gross incomes, so like if you get a net pay of like two grand, and then you reconcile it to say 3000. Next time we see $2,000, we automatically reconcile it for you. So you don't have to keep doing it. But yeah, we need that done a few times. So that way the technology updates and can start learning what that is and make those adjustments for you. But yeah, that's the difference between gross and net income.
17:27
Perfect. And let's say you're self employed, and maybe you're so you're not getting a steady paycheck, but maybe your pay can fluctuate slightly from month to month. So how does the technology work with that? Is it like, on our end, when it comes to a little
17:45
bit more, yeah, a little bit more, because you don't know what that income cash flow looks like. But what I tell everybody, like when you're setting up your plan, and you have variable income, so you might not even be self employed, you know, just be based on commission or commission. And what we tell people on that is be very conservative. So like, if you typically make like 80 grand a year and commission or self employed income, do your financial plan based on 60 grand, and do those percentages. And then every month, when you get those waves of money coming in, just take the percentages, and that's what you do. And so again, it makes life very easy. Like if you're putting money to the SEP IRA, or whatever it is, you just know what those percentages are. And that's what you put in. Instead, try where I see a lot of commission based or business owners where they make mistake is actually on twofold. They try to do everything monthly. And then they ended up in a month. It's like, oh shit, I don't have any money. Like, oh, or they go the opposite. They say, I'm gonna do this every six months, I'm gonna see where I'm at, I want to put money into these things. And then six months go by and they're so busy, they just forget. No, they don't do anything. And then all of a sudden, they have 50 or 100 grand sitting in cash, just not doing anything for them. And they don't even realize that it's sitting there. It's like, fantastic. And so, yeah, that's another place where those percentages come in into play big time.
19:09
And do you suggest people looking at, look at all of these percentages every month.
19:16
If they're following the percentages every month, the only real time you need to change them is when one of two things happen. The first one would be is if you have a major life event happen. So things like you get married, you have a child, there's a debt, you're inheriting money, whatever it is, those are major life events, that's when you go in and change it. Or you hit a major goal. So you pay off one of your debts or something like that, and you have a lot of money now that you need to move around. So those really are the two times and that's one of the big reasons why I'm so excited about the technologies because when I was in wealth management to me, it's like this whole model is messed up like you pay 1000 to $3,000 to a person to come up with a plan and then you walk out and it's completely obsolete. And in some of these guys charge $100 a month, but they don't track anything. They don't have any technology to actually even track anything. So what the hell are they doing for $100 a month? So we were like, Okay, well, we give out the financial planning technology, it's free to build your financial plan, you can even talk to a coach, and it's free to build it. And then when you track it, we could charge a monthly subscription fee, that's, you know, 20, or $30, whatever we charge on that. And it's there, you don't have to worry about spending $3,000 a year, any of that garbage. It's like, oh, it frustrates me so much when I talk about it, because the whole model is just like, completely upside down. And actually, the stuff we're coming out with Next, we just started working on it. As far as investment recommendations for allocations and how you had your investments allocated. And I had heart, I'm an investor, I mean, that's what I've been doing since I was like 12. And so I'm just starting to get my tea sharpened on that one, I'm hoping to have it out by March or April this year, where you can literally build your profile. And then it will tell you how your allocation should be on your investments, how much risk you shouldn't be taking. And the big part that's different, we didn't touch on this. We factor in this thing called human capital into our analytics. We ask everything from like, what's your profession to things? Like do you run marathons? Because that all goes to speak about behaviors. And just like healthcare 80% of outcomes and behaviors, it's the same thing in finance. And so there's no point in our technology saying, Hey, you should do this complex plan, when the behavior is not necessarily there yet. And so we factor all that into our algorithm. And that's part of what we're going to be coding next with the investment allocation. Which that's a whole minefield that to me, is that all traditional advice, like, Hey, you're young, like you can afford, you know, to put everything in the stock market. It's like, No, you can't like you know, what happens if you have $5,000 in emergency fund, and you have $5,000 in a 401k and COVID hits and your 401k goes down 50%. And you also just got laid off that $2,500 that just went out the door might be pretty valuable. So why were you aggressively invested at that point in time? Like, it makes no sense? Yeah, so I, yeah, I can go off for hours on that investment allocation stuff. But that might be a far whole nother podcast.
22:27
And that's okay. We'll have you back on. That's not a problem. Well, it sounds like a lot of exciting stuff and a lot of stuff that's really user friendly, and really good for people who aren't financial planners, right? Who like they didn't go to school for this. And they need a little bit of guidance, a little bit of coaching. And this certainly sounds like it makes it very easy for people to do that. Now, what are I know that you said this before? But I'll have you repeat it. If people take away anything from this, what is a big, big thing that you want people to take away from this talk?
23:01
Yeah, keep it easy in terms of how you set it up. So again, today, what's your expenses? What's your income today? What are you doing over time with your investments and your debt? And then the third piece is what am I doing to protect my financial plan, that's insurance. The second big takeaway is following your percentages of your income, it will make your life extremely, extremely easy. And then to your key point, caring. This stuff should be complementing your life not dictating it. And it should be easy. And again, that's one of the hours that retirement of it for a PT when I decided, yes, I'm going to launch the company. And the main reason was because I was like, I always wanted to invent something in terms of technology to help people like, but I'm not. I can't like I'm not Elon Musk, I'm not gonna build neuro link or some of these other companies, right? It's not gonna happen. But I know finances. And it's like, okay, well, if we can develop a technology that reduces the amount of time you need to think or stress about money, that means you can do what you're supposed to be doing when you're going to school, like being a PT. Or if you're an engineer, and you're the next Elon Musk, you don't have to think about money because that part of your life is actually taken care of. So it's my small contribution, if you will, to the technology world. Just funny because everyone's like, you're a founder of a technology company. I'm like, I'm a finance guy. I know algorithms. I know math, and I know money. And I'd like I give it to coders and engineers, right? They do it. Right, right, right.
24:31
Hey, listen, that's why it's we always work better as a team, right? It's hard to do everything on your own, if not impossible. And now where can people find more about all of this info and how to sign up and how to start using this?
24:45
Yeah, so Bostock comm just go on build, your profile is free to go on and you can build like all the tools are accessible to you to build your plan. You can schedule a call with a coach which we highly recommend because this version of the technology We built specifically for people to actually call us and have them help us walk you through the technology to make sure you're using it correctly. And then as we grow, we're building out more and more automation. So that way, it's easier. And then once you want to sign up and say, This is the plan I want to do, that's where you start the subscription and go from there.
25:19
Perfect. All right, so that's fit bucks fit bu x.com. Yep, you're right. All right. So before we end, before we wrap things up. Last question, I asked everyone, and that's knowing where you are now in life and career, what advice would you give to your younger self? I know you've answered this question before answer it again, come up with a new piece of content, you get to say more advice to your younger self instead of just one piece.
25:47
Yeah, this one, I touched on it earlier, and I can't stress it enough as focus. You know, I'm the type of person that like I was at CSM last week. And I pretty sure that I wrote down like seven or eight business ideas. And I'm the type of person that just wants to start working on everything. Like, I used to joke around with my wife. I was like, you know, this was back when I was doing my investment trading. I was like, if I come up with something, I will literally be up for 72 straight hours researching this and figuring out if it works or not. And sure enough, the very first time like, I came up with something, I stayed up, I was on our 71 I thought it was gonna work. And then our 72 is when I found out that it will work. But focus is we're so distracted with things. We're so distracted. You know, that's one of the behavioral things I'll share is like, when you start saying, This is what my focus is, and you have a fundamental reason of why you're doing it. And it's not because you're, you think you're gonna make a lot of money or you think you're gonna do this, but you have a real fundamental, real reason why you're doing it. Focus actually becomes very easy. Like you no longer care about watching TV, like I'm a big sports person. I haven't watched sports in about eight years. Just because there's like, I won't play I was watching a football game. I'm like, Well, this sucks. I'm wasting four hours. And the game's only an hour and a half and watching commercials. So let me TiVo it. And I started TiVoing. And I'm like, wow, they're still wasting an hour watching this thing. Like, I'd rather be doing something else, which I stopped watching sports. And so it's like, if I could go back, I just think about it. Like if I had that same mentality when I was like, 20, instead of getting that mentality when I was 28 or 29. I'm like, my life would be looking a lot different right now. So focus, focus, focus, focus.
27:36
Great advice. Joe, thank you so much for coming back on the podcast, giving us great tips for financial planning. I'm sure everyone will take a lot away from this podcast. So thanks so much for coming on. Yeah, thank you for having me. Anytime and everyone. Thanks so much for tuning in and listening and have a great couple of days and stay healthy, wealthy and smart.
In this episode, Pain Scientist, Clinician, and Distinguished Professor at the University of South Australia, Lorimer Moseley, talks about pain and research. Today, Lorimer talks about his many streams of research, assessing cognitive flexibility, and his MasterSessions. What is cognitive flexibility and how does it affect pain?
Hear about the social determinants of pain, COVID’s impact on Pain Revolution, the complexity of chronic pain, and the responsibility that comes with doing pain research, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “One of the biggest determinants of your health in the US is your zip code.”
- “[Cognitive flexibility is] the ability of your system to change its behaviour when the task requirements or conditions change.”
- “If you’re going to label something, it should be what it says it’s doing.”
- “[chronic pain] is one of the most burdensome health conditions in the world.”
- “There’s genuine, realistic, scientifically-based reason to hope things will keep improving for people with chronic pain.”
- “Love and be love.”
More about Lorimer Moseley
Lorimer is Bradley Distinguished Professor at the University of South Australia. He is a pain scientist, clinician and educator. He has made seminal contributions to how we understand pain and why it sometimes persists and has developed treatments that are now considered front line interventions in clinical guidelines internationally.
He has authored 370 research articles and seven books. His contributions have been recognised by government or professional societies in 13 countries.
In 2020, he was made an Officer of the Order of Australia for distinguished contributions to humanity at large in the fields of pain science and pain medicine, science communication, pain education and physiotherapy.
He lives and works on Kaurna Country in Adelaide, Australia.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, Pain, Research, Cognitive Flexibility, Chronic Pain, Perception, Responsibility, Recovery,
Notable Mentions
Caitlin Howlett.
Dan Harvie.
Pain and Perception, by Dan Harvie and Lorimer Moseley.
Epiphaknee, by Lorimer Moseley, David Butler, and Tasha Stanton.
Participate in research (it takes just 20 minutes).
MasterSessions.
To learn more, follow Lorimer at:
Website: https://www.tamethebeast.org
https://www.painrevolution.org
https://people.unisa.edu.au/Lorimer.Moseley
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read The Full Transcript Here:
00:03
Hi, Lorimer, welcome back to the podcast. I'm so excited to have you back on.
00:08
Good. Thanks for having me.
00:10
And so today we've got a lot to cover, because we are going to be talking about some of your current projects, new developments that maybe happened since 2021, where you had well over 30 publications. So you had a very, very busy year, I would say. But as we go, as we kind of go through and talk about some of the things that you're working on, I just want you to let me know if there's anything that you're like, Whoa, hey, I can't talk about that. Or if there is reason to be a little vague, because things might be ongoing trials and things like that. So we'll definitely keep that in mind. Now, let's say you've had a lot of publications over the last year, what are some current projects, or discoveries or developments that really stuck out for you in your most recent research?
01:08
Ah, nice question. Um, one of the things about being a scientist in a clinical field is that here, it's not often that you get a revolutionary discovery, it's quite unusual. So what I think the things that I'm most excited about are not, not so so much particular papers, although there, there are some really tiny phones, there's one that's not published yet, but will will be out in the next couple of months that I'm particularly excited about. And I can allude to that. But I think sort of like these, these streams of research in which I'm involved that are turning me on a bit, the moment and one of those is a continuation of the whole explain pain thing. But over the last sort of four or five years, we have discovered, we've looked really closely at but at the the outcomes of clinical practice in where people are delivering great educative interactions and, and I've had a fair degree of, of influence over them. So I feel really confident that I did, they're supposedly doing well. And those data from a big cohort of people suggests that, in about half of the people with chronic pain, they see they have this shift in understanding of the problem, but a real flip. And it's in a predictable way, you know, shifting towards really deep in your belly can conceptualizing pain as a protective feeling that's being produced for a reason. And we need to work out what that reason is, and it will almost well, it will certainly not be a single reason, there'll be all these little contributors. So real flipping, understanding. And, and I guess, understanding that as pain persists, the system becomes over protective, and, and really embracing that as a reality. And that's a really hard thing to do. But those those half of the people who do it has great outcomes a year later. That's a for me, that's a really exciting discovery. The half of the people who don't don't have great apples. So for me, again, it's a really exciting discovery. The problem is that we're only winning in half the people. You know, we're only nailing it in half the people and the interventions good across seems to be good across everyone. So clearly, our markers are what's good intervention, they're not accurate. So my gut feeling about that was not accurate. So we've been looking deeply at how, how can we expand that group from half to bigger and, and unexpectedly for me, doubling down on the on the criticality of learning. So I've been learning a lot about learning. And that's been infiltrating our research and infiltrating the whole way we go about helping people with chronic pain or at risk of chronic pain. And so I'm really excited about that. And we're seeing its scientists talk about seeing a signal amongst the noise. And in chronic pain, there's just so much noise, right? Because chronic pain is this truly, in my view, truly bio psycho biggest and it's more or less social thing. And if we can intervene and see a signal in that group, that's a really exciting development. And
05:03
I, I'm more excited than I was maybe seven or eight years ago about the potential power of of new and better ways to get people to give people understand. And I started banging on about this in conferences and stuff maybe three or four years ago. And I have this slide that that is intentionally slightly provocative, particularly to the physical therapy world. And that sort of pain science education world, I think in in the US the brand name as popular as paid in neuroscience, education, p and E. These are all brand names, right? PMA expired pain is a brand name. So I like to avoid the brand name. So I call it sort of pain science education or modern pain education. So this slide is meant to be slightly provocative, in say, has education become the objective, instead of learning being the objective, and I think for me, education became the objective. And that was a mistake that, that I made. And I think my research made that mistake, and my clinical practice probably made that mistake. And my own outcomes over the last 10 years, and I get I keep really tight audit data, I can see the benefit of my own development as a, as a clinician, educator, and probably as a human on outcomes. So I'm excited about that, for sure. And I can give a little, a little teaser to the paper that we expect to come out the next couple of months in a big journal near you, which looks at a clinical trial of chronic back pain, where we have done two things that I think are really unusual for our field. One is we've tested, I think, a new complex intervention. And it's made up of less new interventions, but they're all sort of put together into a package if you like. And the other thing that was different that we did that, that are Yeah, I think I'm really proud of the team led by James McCauley is the senior author on it. And Ben once and I were important in sort of formulating the treatment, but Ben's been really critical. But we were all very keen to make the control group the best placebo intervention, we could. So we put a lot of effort into credible brain targeted treatments, matching the educative component. And testing whether people had different expectations or perceived credibility or beliefs about whether they are in treatment or not. So from my perspective, it's a very tight trial. And James and I were fully expecting that we would not see a signal in this. But we would be interested in secondary analyses which tell us mediating effects like what, even though there wasn't an overall effect, where what worked, what what might have been helpful. So that's what we were expecting, but in fact, we saw a clinically important signal. And that's very unusual in back pain trials. It's if you have a control group where you've got a waiting list or usual care, or you've gotten there's been a couple of trials published slightly, or you've got open labeled saline injections, you know, these treatments that will have some sort of effect, but they're no match. Right? So you're not really asking, are the particulars throughout this treatment? Important? All of those treatments will show a signal they all they always do they show exactly the same signal. I've done those randomized control trials. So that's one thing, you can design a trial in a way that you'll show signal. But it's a bit meaningless to us as real world clinicians. Or you can design a trial that we would call an explanatory trial that says, Okay, we've kept all of these things the same in the two groups and the things that we kept the same were as much of that nonspecific therapeutic alliance engagement, credibility expectation, which, which I think is a big part of the whole pain science education thing. So I do think we have to monitor that. You might hear my dog the other
09:38
room. Right. All right. We're pet friendly around here. What's exciting
09:42
about that is that it means there's some sort of delivery bandwidth to be won, I think it might be this new piano that I discovered even better. Yeah. So anyway, so that will be coming out. I can't say anything more about that, but, but it's a really exciting development. And we've got we've got a few trials that are testing versions of these sorts of things for for different conditionals. But uh, going at the moment and the way we're constructing the education component and integrating it with the movement and loading and anti inflammatory component. So that is three pronged approach. Really exciting for me, as I, you know, I've been doing this for quite a while that feels like, I still feel like a kid. But, you know, I have been researching for a while. And this is a really exciting time, I reckon, in the chronic pain world, because I think we're starting to chug forward again, I feel like the field was stalled a bit. But jumping forward. That's one thing. And then then on the other other side research streams, one of our team called Dr. Emma Karen is doing really difficult and really important, work really well investigating the influence of social determinants of health on chronic pain outcomes. First focusing on low back pain. She's published a couple of systematic reviews, and mixed method study on that, that is pretty intimidating. For those of us trying to move the the outcomes in a positive direction, because as we were talking about before, caring that the social determinants of health are very powerful, and they're powerful in back in back pain and pain outcomes. They're really hard to shift, you know, they're very hard to do much about so. At our field, the pain, field musculoskeletal, the the sort of arthritis field has or has engaged with, it's way better than then the non Arthritis, Musculoskeletal pain, pelvic pain, Fibro fields, we, you know, it's remarkable how little attention, it gets the biggest social and when we talk about the biopsychosocial model, we nearly always conceptualize that as a smallest session and the people around you social, which is important. But we haven't really integrated the biggest social Yeah, the world in which you live in your access to health care, illiteracy. Poverty.
12:29
Yeah, that sort of stuff. Absolutely. And I think you kind of hit the nail on the head as clinicians, oftentimes when we talk about the bio psychosocial, we think of the socials, what's your support system at home? You know, do you have, you know, can you get to, can you get to therapy? Do you have access to therapy? But what we're not asking is, do you have access to other medical care? If you need it? Do you have access to fresh foods and vegetables, which we know can play a part in, let's say inflammatory responses in the body? Do you have access to a pharmacy? Do you have access? I mean, all of these things make a huge difference, you know, or do you? Is your social part of that bio, psychosocial? Are you working three jobs and raising children and not having time to fit some of this stuff in? Right? So social part becomes a really big S for a lot of people. Certainly in the United States, like I said before, one of the biggest determinants of health of your health in the United States is your zip code.
13:37
Yeah, it's remarkable.
13:40
So social determinants of health is is high priority. And I think maybe people shy away from it, because it's can be so overwhelming. So I don't know what you guys are finding research wise, if there are way and how you can address that?
13:56
Oh, it's it's overwhelming, for sure. And I totally understand why there is a reluctance to go there. And there are also I think there's very complex ethical considerations about going there. We've we've been planning a study in the northern suburbs of Adelaide where I live, which is an area that's really different to the say, the inner suburbs of Adelaide with respect to all that sort of predictable social determinants. But one question that we've had to look in the mirror about is if if we develop this so we're working on developing a screening tool. If we start to identify people that have significant unmet social needs, and we can't do anything about it, is that is that a ethically defensible position? Yeah, we were able to say to people, okay, we know what the problem is, you know, this, you can't have because we got no mechanism Have of meeting that need. So it's quite a challenging area to move into. Because if you if you imagine that the understanding and overcoming persisting pain is a very slow step by step journey. And now we really have to imagine that instead of going in a straight line, we're almost going in a circle, and we're making slow step by steps of the entire circumference of the circle, you know, and you move a little bit, then you have to stop and move a little bit more somewhere else. Otherwise, you're going to break. And the people who suffer when you break will be the same people, you know, the, the more vulnerable people. So it's a really challenging field. And yeah, I can't, I'm excited to be getting dragged along by Mr. and her colleagues on on this. But I'm also so impressed with how, how robust the approaches to it. So yeah, there's a couple of her papers out already and more, more coming. And I think there'll be really influential in the field. Because no one there are people there. There are people who are engaging in this, but very few people are thinking to themselves, I'll take on that challenge. Yeah,
16:28
yeah. Very, very difficult.
16:31
It's relevant to it's really relevant, or I guess my interest in it was sparked by our work with pain revolution, which is an outreach project program for rural areas. And it sounds like it's similar in the US. But there's there's areas in Australia not far from big cities, what we would call a big city of Adelaide a million people. There's areas two hour's drive from Adelaide that cannot get a GP or a physio, or a psychologist or an occupational therapist, to worth it. And they've got, you know, wanting four of them have a persisting pain problem that affects their lives. There's no, what do we do? What do we do about that. And so pain revolution is, is really trying to ultimately build workforce capacity. In giving people health professionals have some description, when I care what description, in fact, we were, were looking for money to try our non healthcare professional, being coached and becoming a rural coach. But the idea of that is that if people we know I think from other areas of the pain field that if if a healthcare professional of any persuasion, understands deeply contemporary pain, Science and Management, and takes a defendable, scientific, and now evidence based approach, then outcomes can be better for sure. And outcomes will be promoted by engaging in in care locally, the moment the only model we've got is a fly in fly out model, which is where, you know, the health professionals go from the city and spend a day in the country and come back a month later, in my view, of very limited benefit. Or we've got a full five model where the patients, that consumers come down to the city. And in many cases, that's a 810 12 hour drive. Get an assessment? Yeah, there's no there's no way of training those people or providing effective care for these people. So yeah, yeah.
18:55
And I, you know, yeah, no, no, you know, it this, this conversation about this kind of rural outreach and, and maybe training someone who's not in the medical field, reminded me of a documentary that I saw, Oh, gosh, I can't remember the name of it, if I can ever And i'll put it in the show notes. I can't remember it right now. But it was on it was more psychology based around loss and trauma. And there was a woman in Africa, who was not, not a psychologist, she was not trained. But she, she, I think she was trained in some basic coaching skills, but she lived in the community. And people there were more likely to go to her because she understood the community. She was part of the community and they had really good outcomes. So I'm wondering even if training someone who is not a medical professional, but if it's possible to train them even in you know, you don't have to be there in person, but would that person because they're part of this rural community, maybe have better results and someone just flying in for the month and flying out where you have someone who knows the community understands the struggles, and maybe has known some of these people their whole lives. You know, we talked about therapeutic alliances and trust and beliefs. So with people they're more likely believe someone who's part of their community than someone who's doing a fly in fly out. I don't know, it just reminded me of that documentary.
20:24
Yeah, I totally get that. And I guess we were really embracing that in, in one aspect with pain revolution, because we're training rurally based healthcare. And that was the impetus you know, they're connected to their communities and their communities are really well connected more so than certainly in Australia, in the cities. You know, you're the physio, if there is a physio will be on the sideline at the Netball day or the football game, way with the consumer, you know, these, these people's normal lives and accessibility and those things that I think reduce the power differentials that that contaminate a lot of healthcare interactions. Was it a part of our drive to drive pain revolution rurally, to tap into this already, and you know, the vision that we state, the pain revolution is that all Australians and I think we're going to change that to all people will have the skills, the knowledge and access to local resources to prevent and overcome persistent pain. And that's the real emphasis that we embed the knowledge and skills locally. And, you know, that's, you know, I've been talking to 1010 years about recovered consumers being coaches, not the healthcare person, but recovered consumers, because they have all this knowledge and expertise that no one else can have. Right.
21:56
They're very deep understanding of pain.
21:59
Absolutely, yeah. And pain, and not not only the lived experience of pain, but the lived experience of recovery. And I think that's a untapped massive resource. But there are significant regulatory medico legal barriers to us just pushing forward on that, that we're still negotiating. So that's yeah, that's been at least a decade. My perspective. But paint ray of is is so exciting. It's, it's really cool. Like, we are doing it on a shoestring. And I think we now at the end of this year, we will have, I think we'll have about 35 Local pain collective. So these are networks of healthcare professionals around geographical regions that get together, learn more about how pain works, and the best ways of treating it collectively problem solve pain, rave feeds them. curricula, but really, it's a collective problem solving facilitated group. And yeah, I think the panorama was responsible for delivering around about around about 400 community outreach sessions, amazing Australia, in the middle of COVID.
23:17
I was gonna I was gonna ask, How has COVID affected? What pain revolution has been able to do, let's say last year, as opposed to previous years?
23:29
Yeah, it's, well, it's had its impacts, for sure. And depends where you live in Australia. So two of our states have had a longer period of of living in a COVID world I guess. And in those places, there's there's been no face to face. stuff. They are 2021 outreach tour that we do. So we run this circus that gets a lot of attention raises a fair bit of money on our level of what a fair bit of money is, it's got in the commercial sector be like someone's bonus for the week. But in our sector, it keeps us alive. And we go from town to town, and we run these public outreach and health professional outreach events. We're all dressed up in library, we ride our bikes, and it's all this cool thing. And that's part of a wider program with two other projects that dovetail into that dedicated to the region. And we didn't run that in 2021. And we won't run that in 2022. And that's a big hit for us because it's our main fundraising Avenue. So that's that's a real challenge. Some states in Australia have had basically no COVID And one state still basically there's no COVID Western Australia they They pay us closed to the rest of Australia in the world. And I think they're aiming to reopen in February. Tasmania has recently reopened and they're starting to get cases. But now we're where I live. We are, we're at the beginning of our wall of Omicron. And we really don't know what this year looks like. So we don't have the experience that a lot of places do. And we're very grateful for that. But we also clearly like deer in the headlights at the moment. Federal governments are going everything. Rules are changing all the time, we and you know, we're not as prepared as you would expect us to be having had a month's notice. So that will impact pain revolution for sure. The we're a really small outfit we have I think we have 1.5 full time equivalent staff delivering hundreds of programs, or events, and we're very resilient. And yeah, well, yeah,
26:11
we'll you'll get this done. And And if people want more information, they can go to pain. revolution.org, correct. Correct? Yes. All right. So pain revolution.org, if you want more information about what pain revolution is doing, and maybe how you can help or contribute, if you so if you see if it if it aligns with what you believe in, then I suggest go for it because it is a very worthy cause for sure. And now, it's kind of switching gears a little bit something that we were speaking about sort of before we hit the record button here. And it's a concept that I had to kind of look up a little bit before our talking here. And it's that concept of cognitive flexibility. I think it's interesting. I think it's worth talking about. So I will hand the mic over to you to sort of talk a little bit more about what that is, and how does cognitive flexibility fit in with people living with pain and maybe with practitioners treating those living with pain?
27:21
Yeah, well, thanks. And again, yeah, I feel like I don't actually actually do much of the good work, it feels a little bit like because this work is has been done by Caitlin halat, who's a PhD student about to finish and has a background in psychology. We embarked on a new direction probably three years ago, with with a really sensible prediction, I think that possible contributed to not recovering after an acute episode of pain based on if people familiar with Bayesian or other predictive processing models, based on the idea that the outputs that we generate predictions and the system is influencing itself according to predictions, then we need to update the internal models of the models in order to resolve so if I was to cover that really quickly, if we, if we said, when you bend over and you don't have pain, that what what could be happening there is that your brain predicts that this will be safe, your brain produces a feeling that's consistent with that mn let's say you tweak the annulus of a intervertebral disc or something, you get no sensitive data that are that are within the sensory load. And I like to say within the Tampa symphony of Dallas, extraordinarily complex, beautifully evolved system of of information about what's happening in the tissues, we get data that says this is not what I predicted. The evaluator for this is not what I predicted. So we update the internal model to say the back is vulnerable in some way, let's say. And then the new prediction is, well, let's make pain. And let's influence the system differently. And then if we go in the other direction, and every time we've been able to get this nociceptive data within the symphony, and then one day you don't I know you've been over and and you don't get that. And now the theory is the system detects that error says Hang on. That's not what I predicted. So it updates the internal model to say the back is less vulnerable. And now your brain doesn't produce as much pain or produces no pay, and then you've recovered fantastic. So one potential barrier to recovery according to that theory is failure to update yourself. Title model. And and that should happen. If, excuse me, that shouldn't happen if you if you don't detect the error. So if for some reason you don't, your system doesn't detect that the predicted data, the predicted data, which was not receptive, in part hasn't been hasn't eventuated. And therefore you don't update your internal models. So on the basis of that, we became quite interested in this broad field of flexibility, cognitive flexibility, which has been defined in many ways. But I guess the way that we were thinking about it was the ability of your system to change its behavior are when the task requirements or conditions change. So in the language of have that sort of Bayesian idea, and to your ability to update your internal model of things. So we started digging around in this field, or Kaitlyn really started digging around in this field. And often in a PhD, you'll start with a systematic review of the literature on a question that's most most aligned with what our hypothesis will be driving. So. So Caitlin took on what we thought would be a reasonably straightforward job to review the literature in cognitive, mental and psychological flexibility. So the barrel phrases that are used, often interchangeably, particularly cognitive and mental flexibility. And with the question that would help us determine which is the best way to assess it's what's the best way to assess flexibility. And there's two broad approaches to assessment. One is self report, questionnaires. And they have they were developed out of a line of research, starting with personality tests in the 1960s. And that's this sort of this long line of stuff. And someone I can't remember who but in the, I think in the 60s or 70s.
32:18
proposed that I think it was empirically based but propose that good communicators perform the answer these sub questions in a certain way. And that research would describe them as positive and flexible people and are good communicators. And then that infiltrated the field. And we eventually got to this situation, we've got cognitive, cognitive flexibility scales, things like that. The CFS or, and there's a few of those, completely independently from that was the development of behavioral tests. The most famous and most common is a thing called the Wisconsin card sorting test. In that, in that test, you you sort cars according to one of three criteria, shape, shape, or number, I think, sorry, shape, color, or number. And the rules for sorting change, and you only realize that change when you make an error. Yeah, that so you put a card in a certain pile, and the tester or the machine goes about anything, what should work, and you have to work out what the next set of rules. And the people doing these studies somewhere in the 80s. Or maybe it was a bit later than that, call this cognitive flexibility. So we've got two independent lines, joining a company flexibility, and then that's then all the whole field just went nuts cross contaminating and all that. So Caitlin has now published and once just been accepted last week, to systematic reviews that are massive. And she had to contact authors for nearly every single one of these studies to get data, asking the question How well do those two approaches to testing 100 Flexibility correlate? Because if the system the same thing that should correlate quite well, one of those systematic reviews is in Healthy People. And one is in people with a diagnosis clinical groups. And in both of those studies, there is absolutely no relationship between those two approaches.
34:39
So you have two different tracks on how to assess cognitive flexibility, and there is no correlation between them.
34:47
Not at all. And actually a lot of the tests, there's no reliability data for them. Now, there are some cognitive psychologists who won't be surprised at that finding. And they're the informed one Who, who have been working in this field? I guess. But for people like Caitlin and I and the rest of the team on this project, where clinically, it's such an attractive hypothesis, right? Like if if people can't change their, that if people don't easily change their beliefs, explicit beliefs, their implicit beliefs about the vulnerability of their body, what pain means that the targets of pain, science education, then we know those people who don't, don't change some of those targets of pain science education, don't do as well, when we know that. So it's such an attractive hypothesis that they might be less cognitively flexible. But the barrier with hit is so how do we find out? Because we don't actually know what any of these tests are actually.
35:56
What are they actually test
35:57
measuring? Yeah, yeah. So so the direction for that, and I've asked for money haven't got it yet to do that is to devise a a new way of assessing the ability to change your decisions when there is some sort of risk evaluation involved, because I think for, for pain, I think we talked about the meaning of things being important for painting. And I think one way to distill the meaning is about just a risk profile, that every nanosecond, our system is evaluating risk, and its risk, that determines our feelings. And I would categorize pain as a feeling bad. So my anxiety, fear, fatigue, lead to the toilet, lead to a thirst, all these things, in my view, feelings generated on the appraisal of risk. And, and if we don't have any risk, in an evaluation of our ability to change your behavior, under changing circumstances, and I'm even, I'm nervous to use the phrase cognitive flexibility now, because I know that whoever he is that there are three or four main ways that you understand that. And some of those would be totally different from otherwise. So I would prefer to say, if we keep assessing the ability to change your behavior, according to changed demand or environment. without risk, then I think we might not capture what we need to capture for understanding a potential contribution to the development of chronic pain or recovering from initial pain. So so that, you know, that was one of those, one of those PhDs where it's such an important discovery, actually, and and Caitlin's contribution to the field is very important. But it won't get the citation impacts and the Roth IRA. Because what the country contribution says is, hang on everyone. Why, you know, there are a whole journals dedicated to this. But what is it? What is it, we almost have to go back and start again and say, Okay, let's get really clear on what we're talking about. Let's use these phrases. Anyway, so but that's relevant to the very first question, what are you most excited about? I guess I'm, you're tired to be excited about, clearly, deflationary discoveries like that, but they're so important. They're really important, and they're harder to publish. But they shouldn't publish, in my view, they should publish top journal. In your face. Journal. Yeah. Well,
38:49
it's, it's like, yes, it's sort of this deflated response, if you will, to, to the systematic review, but it is important because it's important to use the right words, and to if you're going to label something should be what it says it's doing. Otherwise, why are you doing these tests? And why are you you know, labeling someone as very highly flex cognitive flexibility or low cognitive flexibility when you don't really know. And then exactly, so how do you then so then your treatment, I look at it from a clinician standpoint, how do you formulate a treatment plan around something that's, that's not accurate or unknown? So I think it makes it really difficult but it's it just underlines the importance of this kind of research.
39:41
And oh, go ahead. No, I was just gonna say I think that um, it Kayla's research doesn't doesn't tell us that these tests are uninformative. But what it does tell us is that we don't We don't know exactly what they what they mean. So that speaks to your point exactly Karen, that that. So what do we do about it? That's a difficult thing, because we don't actually understand them well enough, I think. But can I put in a plug for? Yes, a research project of Caitlin. So final project for a PhD that we desperately need participants form? Yeah. Because it's an online study. Okay. And it's, it's to do with this kind of flexibility. And we need people without pain, as well as people with pain. Well, that's a lot of types of it. But basically, everyone, anyone who has 20 minutes spare. It would be great if they just went and did Caitlin's experiment online. And maybe I could send you the link.
40:48
Yes. Yeah, you send me the link, I'll put it in the show notes. And also put it out on social media. So that girl can can take this online study. So if it's people with or without pain that takes in quite a lot of people, like you said, like, one? Yeah, so I'm assuming she wants a robust number.
41:11
We need lots. Yeah. Because we think the signal will be small amongst the noise. Yeah, but yeah, if we did it, and then ask one of their family members or mate, yeah, that'd be fantastic.
41:25
Yeah, I'd be happy to send you the way about that. Yeah, definitely do. And as I was, you know, as you were talking about this cognitive flexibility, or the ability of to adapt your behavior, and let's say cognitive strategies in response to a changing task, or to a threat or something like that, it, it always reminds me of this experience that I had. So most people who listen to this note that I had a very long history of chronic pain, I think you're well aware of that as well, about 10 years or so of neck pain, chronic neck pain. And it was this was a couple of years after I could say I was recovered, you know, of course, those times when you have flare ups and things like that, but largely recovered. And I was I was at Disneyland with Sandy Hilton and Sarah Hague. And we had waited in this long line, like an hour to go on what I thought was like a jungle cruise. You know, this very, like, get on a boat and cruise around the water kind of thing. Yeah. And we get up there. And all everywhere. Once we get inside, plastered everywhere was date, big danger signs, you know, the yellow dangerous sign, the red X, if you have neck or back pain, you know, this guy. And I was like, you know, so talk about a threat, right? So my normal behavior, and like, my hands were sweating, my heart rate was up, my eyes were dilated. My normal response, I guess, would maybe show my inflexibility would have been to find the nearest exit and leave. Yeah, yeah, get out as fast as possible. Right. And so I think, Sarah, and luckily, I was with two very incredible women who are very well versed in pain science, and I think I am as well, but when it's you, you're you're like, a big, you know, mashed potato, you know. And Sandy and Sarah just looked at each other and looked at me, and I was like, almost shaking. And Sandy's like, Okay, listen, it only tilts about 12 degrees, and it stops and goes, you're in taxi cabs, they stop and go, you're fine. It's this much of a tilt, you'll be fine. And then Sarah's like, yeah, and the person in front of us like six, you know, there's nothing over your shoulders. It's not that dangerous. And they kept playing down the danger. And so I did end up getting on it very, very nervous. And then I got off and I was fine. They were right. Then it allowed me to be flexible enough to then go on another ride after that. Whereas if I went with my original strategy, which would have been to leave, then I wouldn't have done anything else for the rest of the day. Yeah, so that threat, if left to my own devices would have gotten the, I don't want to say gotten the better of me, but I would have reverted back to the behaviors I had during the that sort of 10 years of living with pain.
44:24
Yeah. And, you know, I respect I respect both of those approaches where it makes sense for an organism when you see credible evidence that this is a dangerous situation to take a variety of action. Yeah, makes total sense. And I guess the, I think about the flexibility thing was evident, as Sandy and Sarah are problem solving with you gathering more data. And, and then your choice changed. That's the stuff that seems consistent with in quotation marks flexibility, you know that right? In the face of new data. So the new data, it could work both both ways. And I think there are some people with persisting pain problems where they behave the same way, even in the presence of significant danger cues. And that works against them because they the danger, for example, right, right. Yeah, can work both ways. Yeah, I think I think there's a rich there's there's a rich stream of, of understanding in there somewhere for us to, to uncover. But it does feel a little bit like that's going to require the the archaeologist among us to get out. This is a metaphor, obviously, to get out our brushes and blowers and slowly reveal what that stream of gold is, as distinct from the earth blasters obviously just want to revolutionize in a in a rapid way. And I fit more into the second category. You know, I lose steam on the very slow, the finite, made tool discovery thing. I'm very pleased to be around researchers who are excellent at that. Yeah, it's not so much.
46:25
And I always always think about that. What did I think David Butler said they were what did he call them? Oh, I don't know why I'm blanking. I have the book right here. Super. Ah, I'll think of it. It'll come up. It'll come up later. It's from explain pain supercharged, you know, the graph and everything leads. So if you have more, yeah. Dangerous safety Sims. He called them Super Dungeon Sims. Yeah. Jensen says, so he was like, Oh, I think Sara and Sandy were your super Sims at that moment, which is maybe what you needed? Maybe? I don't know. But like you said, it would have been just as valid as if I was like, I can't do this. It's too stressful. You know? Yeah, it's too dangerous. Too dangerous. Yeah. Because those
47:14
were the cues that you were, you're getting? Yeah, yeah. And just take it off. I always say it's important in a situation like this to take a moment to reflect on the contrast between the resources available to you in that moment. Right. Which, okay, Sandy and Sarah? Unique, exceptional, exceptional resources. Like, yeah, scrub exceptional. Yeah. But even without them, take your own resources. You know, you're informed, you're, you're resourced with intellectual and other capacities and understand how things work and biomechanics, you've got incredible resources, and then just take a moment to reflect on the contrast when you and most people? Yeah. And is it? Is it any? Is it any wonder at all that people face those situations? And yeah, there'd be a lot of people with chronic neck pain, even if they're on a recovery journey, who would get into that situation and their neck pain would flare up, they wouldn't even do the rod, that's right, leave and they kind of flare up and, and the rest.
48:24
And everything that comes after that, go back
48:27
to the doctor, get a new script, you know, and we do we attempt to, or they I think there's a tendency in our field to, to look, look down on that approach in some way. But, you know, as they are, that's substantive people. But it's totally predictable. And an excellent, excellent biological organism doing that. And we have to overcome, we just always have to remember the resource differential.
48:58
Yeah. Oh, that's, I never even thought about that. But that is so true. And, you know, it just goes to show you why people living with chronic pain, why the burden of disease is the high one of the highest in burden. It's the most one of the most burdensome health conditions and diseases in the world. In most countries. I mean, just low back pain alone, the burden of disease in the United States, I think is third, that's just low back pain. We're not talking about oh, a and other knee or neck pain, other chronic conditions. It's third Well, I mean, things might be different now with COVID. I don't know. But um,
49:38
you know, it's usually with disability. And they usually for disability metric for iPads way out in front. Yeah. Yeah. Yeah. I mean, on other metrics to use last year's lost, which includes mortality, then it drops down, right, just a bit.
49:56
Right, right. But you know, it just goes to show all of the things that you that you've been working on in 2021 and that you're excited about coming up, let's say in 2022 and all the incredible researchers and PhD candidates that you get to work with it just shows how complex and complicated chronic pain is. And that one or two sessions of pain science education in clinic cut it for most. No, absolutely. And it just shows the complexity of it and how difficult it is from a research standpoint, a clinician standpoint it is a tackle these problems on an individual basis and society as a whole. So I mean, keep keep doing that. Keep fighting the good fight, as they say.
50:40
That's scary. Because yeah, gobsmacked, nice weeks that I get to do this for a job and I get paid for it.
50:52
Yeah, speaking. And speaking of helping people around the world, you've got master sessions coming up. So you did this in 2021. So now you're doing it again in 2022. It's going to be May 13. To the 16th. Depends on where you live in the in the world. But you want to talk a little bit more about the master sessions, who's involved and what it's all about.
51:13
Well, yeah, that I mean, that was that was really cool. We sewing in 2021. No one's traveling, obviously. And noi group UK put, to me this idea of doing something a bit different. And it was really different like I was so that it it, we had two broadcasts, and they were timed friend friendly time zones for Europe or for the Americas. And then Australia and Asia sort of could go to one or the other with not quite as friendly. So for one broadcast, I was starting, I think at 6am. For another broadcast, I was finishing at about 11pm, something like that my time, but it was really well planned really well resource like they are, I'm in a studio basically, I was in that it was in the NOI group offices in Adelaide, but set up like a studio with a producer and sound people and a couple of cameras and Tim Cox working as emcee does a beautiful job on that. And we had a team of people downstairs ferreting around for the papers I was mentioning and all that sort of stuff. And it we were we didn't know how it would go because it was it's not like it's not like a zoom conference. Or, or cause it's really quite different from that there's a fair bit of interaction and it went, it went really well was really good fun, really well received. And the feedback has been overwhelmingly positive. I, I was joined by two people for 2021. social pressure Tasha Stanton came to speak. And she so she did a about a 30 minute talk. And then she and I chatted for about 45 minutes and and then we open it up to q&a and and that conversation between Tasha and I and then the other person who contributed that our two people were Mark Hutchinson, who's professor of everything. Adelaide University, one of the one of the exceptional communicators on neuro immunology, related to pain and defense, personal defense. And so same sort of format with him. And then with David Butler, who everyone knows, if you don't know, David, you, you're missing a key part of life you should have. So it was amazing. It was yeah, it was a really well, it's lots of comments like, I never thought online education could be like this and that sort of stuff. So that was really positive. So in 2022 in, and I think the dates you mentioned are probably the Americas day, so that we're doing to broadcast again, where we got feedback that we're responding to, so the schedule is changing slightly. Mark Hutchinson and Tasha are both coming back to do longer stints. And then we're also having in people with really interesting research and great clinical engagement. So for example, Dr. Jane charmers who's done some excellent work in pelvic pain. So she'll come and she'll do a talk and then we'll, I sort of interview them. So it's the massive sessions are a massive amount of work for me because I need to have my head around everyone else's stuff as well. So I can ask meaningful questions, but the, the feedback is is about how useful those conversations are as well. So yeah, so this Jen channels there's Haley leak, Haley leak has has started working with investigate what people who are recovering from paying value in learning about to publish one paper on that in pain, a beautiful paper, I think that I think should shift research direction of a few groups. Haley also has the probably unique among pain scientists brag point of winning the Australian survivor 2021. So she, she survived. And part of the reason for her survival, I think was her deep understanding of how pain works. And there was some great episodes where she there was one where she I think she was standing on like Pogi point things, Poles, they were all doing this with a with another thing coming slider down lower and lower for six hours.
56:08
And lead athletes x s as people have already fallen out and and so she's she's actually done an incredible job in disseminating modern understanding of pain to the wider community because they've all said, How did you do that. And she's able to talk about her understanding of pain. And pain does not mean damage pain is because it was a thing. So no wonder the host is making these comments like that they're trying to rev up my payment system. So incredible impact and she's got a high profile among the people who watch on Survivor on telly. So she's able to integrate that experience with her research. And she's very interesting person. So she's she's coming Sarah wall works doing really interesting work with younger kids. Looking at how how we can engage with young kids on everyday paints in a way that will help them be resilient later. So really fascinating work that she's doing. And then I'm on there as well. So I think I'll cover about half of the time. And it's great fun. Yeah. And you know, people go look at the reviews and all that sort of stuff. But yeah. Love people to to get involved in that. That's in that's in May. Yeah.
57:30
And is there? You may not know this, but is there like a cutoff date for signups? Or can you sign up like the day before? If you wanted to?
57:39
I think there's a right shift. Okay. I think there's an early bird, right. I think I actually don't know much about that sort of stuff. But they they do have to. I mean, the earlier they get a feel for numbers that they they're able to judge sure how to do it, because it takes a lot of bandwidth and all that sort of stuff.
57:59
Right? Yeah. All that behind all the behind the scenes production stuff. You're the On Air talent, you don't have to worry
58:05
Exactly. Worry about any of that. But But noi group, if they get annoyed by it, they'll learn everything
58:12
about it. Yeah, yeah. And again, I'll put the links in the show notes here. And we'll put it out on social media as well. So that if people are interested, then I highly suggest signing up because it what a great, what a great lineup. And it's not until May. So you have plenty of time to shift your schedule and try and figure out, you know, kind of block the time off so you can be part of it. And one other thing, I believe this is true, you can correct me if I'm wrong. But if you if you're in the Americas, and you you paid for it, you live in New York City, let's say I pay for I live in New York City, I can also watch the other, also get the recordings of the other broadcast.
58:55
That's correct. So you get both and you you don't have to be there live watching it in bed. But if you're not you, you're not engaging in the q&a and all that sort of stuff. Yeah, but you get access to both broadcast and you get access to the thing called the Padlet, which is it was an amazing resource from the first time because this is all of the stuff that the team downstairs is getting while the master sessions around. So let's say Professor Mark Hudson mentions this are really exciting new study from so and so which show this then someone downstairs will get that study put the paper on the Padlet. So it's some incredible resource as well. And they have access to that. I don't know for how long afterwards
59:40
Yeah, yeah, but you but you have it Well, it sounds amazing. And I think it's so great that this is probably something if not for COVID Maybe you would not have done and it's made a big impact, right so
59:54
and and when COVID no longer what it is I'd prefer to do it this way.
1:00:02
Yeah, yeah, amazing. Amazing. And now, I don't want to monopolize any more of your time. But is there anything that we didn't cover that you were like, Oh, I really want the listeners to know this or, or is there a big takeaway?
1:00:18
Ah, I think the takeaway is, it's really consistent over years, actually. Whenever I have an opportunity like this to chat, with such an informed and, and clever interviewer, like you, I'm always struck by how, how important people like you are for our community, because I see my role sort of knowledge generation and, and dissemination in sort of conventional ways, you know, books and articles and things like that. But we need people like you, to spread it, to play the critical role and getting it out to the, to the world in a way that's accurate and engaging and, and it's people like you who put in so much so much effort for your community. And whenever I think about takeaway, I just am reminded of of the potential benefit we can still bring to humanity by doing this chronic pain thing better. And we have made progress, know that we made progress. But it feels to me like were climbing up a really, really tall mountain. And now when we look back, we can see we've actually come quite a long way. But when you look ahead, there's still still a bloody big mountain. So all of these things would have hope. I think there's genuine, realistic, scientifically based reason to hope things will keep improving for people with chronic pain, that will people will have better outcomes. So that's my take home. But can I give a plug to a book that I'm an author on? Yeah, it's a self plug. But I'm not the main author. So Dan Harvey, a truly innovative scientist. And I don't say that lightly. There's not many innovators out there. But Dan Harvey is an innovator. And he's the first author on a book called pain and perception. And the Americans can get that through IPTp. Elsewhere, you can get through no group. And it's a I think it's a beautiful book. It's all about understanding through illusions, and sensorial experiences, more about how pain works, sort of like a coffee table, book waiting area book. The feedback has been fantastic. So yeah, I'm really excited to be involved with that with Dan. And I'll just mention another book that's available in in North America, but not in Australia. And it's called Epiphany. And test Stanton has joined Dave Butler and I to, to write a consumer focused book around the osteoarthritis.
1:03:17
And I will say, I, when I first saw this epiphany, it's not how you would normally spell epiphany. It's, it's, it's an what do they call it? It's an acronym an acronym? Yes. So it's explaining pain to increase physical activity in knee osteoarthritis.
1:03:39
Correct. It's spelled AP IPH a knee,
1:03:45
right? Yeah, very clever. Cuz I was like, epiphany. What did I say? Episode? I don't even know. What's epiphanies? And you're like epiphany. I'm like, oh, yeah, that definitely makes more sense. That definitely makes more sense. But yes. And we'll have we'll have links to all of this stuff, again, in the show notes. And, you know, one last question and talking about, you know, all of the work that you do that isn't in very important work, and it can impact not one or two people but millions of people living with chronic pain. So do you as a researcher, how do you deal with maybe feelings of overwhelm with the responsibility that that place is on your shoulders? Or do you think about that at all? Or am I just projecting what I would feel if I were in your position?
1:04:36
I think you're projecting. I don't, I don't feel overwhelmed in the slightest. I don't feel any sense of responsibility to humanity. That's, that's changed because of what I do. I feel I feel that I have a responsibility. I don't know if I feel I have responsibility. I want to use my resources and my knowledge and my skills, and my connections and my relationships to, to be the best Lorimar I can be if that makes any sense and, and the values by which I judge that are not at all on chronic pain outcomes. I'm a very sort of process driven person, I want to make sure that today I did the best thing I could do. And I don't have any illusion that I, I could use outcomes as a marker of, of how well I've lived my life. Because I just think there's too much noise for, for me to have a measurable signal in the world. So I want to make sure that in this moment, I'm being authentic and true and real. And today, I'm doing my very best, I do my very best. But I do that, because I like myself more when I'm doing my very best. But I feel any burden to humanity. That's different from the burden that I think anyone who grew up in my in my world and life with my skill set, and my influences would have.
1:06:24
Yeah. And I think that's great, universal advice for for anyone. And, you know, normally when we finish the show, I always ask people, What advice would you give to your younger self? So I don't know if any piece of what you said would be maybe part of that advice. But is there anything else that maybe you would give to a young a young Larmour? fresh out of university for first time University, not? Subsequent?
1:06:48
Yeah. I think that I would, I think there would be advice, I don't think it would be remotely relevant to my work, I think it would be love a beloved, look for that, and express and, and value that with the entire depth and breadth of your being. And for me, that includes being a neuroscientist and paying dude with a extraordinary fortune of being able to do the things I enjoy doing for work and resonate with my values and all that sort of stuff. And ultimately, I think we're such a sophisticated organism that, that we may want to one one day discover that it's all just to love and be loved. And I don't know, great advice.
1:07:43
Great advice. Thank you. I'm sorry, not a sage. But no, no, it's amazing advice. I appreciate it. Thank you so much for taking the time out to come on and talk about all the stuff you have going on. And is there a place where people can find you? If I don't know they have questions, websites, something like that.
1:08:07
Yeah, so finding and I've got a homepage at the University of South Australia they can find out about personal pain revolution is doing some good stuff on Annabelle, what we're doing that I I get a lot of emails and I just can't possibly respond to them.
1:08:26
We're not here to give out your your emails, or your personal phone number or anything but I think pain revolution, Oregon and the University of South Australia are great ways for people to find out a little bit more about you because as we said, before we get on the air you are not on social media. So there is no Twitter handles or Instagram or tic TOCs none of that stuff. None of that. So people can find you again, pain revolution.org or University of South Australia's website or you can just do a Google go to ResearchGate read all your papers. There's plenty of ways to find out more about your research and and what you have coming up. So plenty of ways to do that. So again, thank you so much for coming on. I appreciate it.
1:09:12
Oh, thanks so much for having me. You're a legend. Keep it up.
1:09:17
Thank you. Thank you so much and everyone. Have a great couple of days and stay healthy, wealthy and smart.
More About Osman Ahmed:
Dr Osman Ahmed is a Physiotherapist at University Hospitals Dorset NHS Foundation Trust (Poole, United Kingdom) and a Visiting Senior Lecturer at the University of Portsmouth (United Kingdom). He trained as a Physiotherapist at the University of Nottingham in the United Kingdom, before undertaking his Postgraduate Diploma in Sports Physiotherapy and subsequently his PhD at the University of Otago, New Zealand. He is employed by the Football Association (FA) in England to work as a Physiotherapist with their elite disability squads and has been a member of the Team GB medical staff at both the 2008 Beijing and 2016 Paralympic Games. He teaches on the FA’s Advanced Trauma Medical Management course and has recently been appointed the Para Football Classification Lead at the FA.
His PhD was focused on sports concussion and Facebook, and since then he has both published and presented widely (primarily on concussion in sport and technology in healthcare). He holds several governance roles within Para Sports federations including Medical & Sports Science Director at the International Federation of Cerebral Palsy Football, Medical Unit Co-Lead at the Para Football Foundation, and Medical Committee member of the International Blind Sport Association. He is a Co-Chair of the Concussion in Para Sport Group, and a Board Member of the Concussion in Sport Group.
Osman holds Associate Editor positions at the British Journal of Sports Medicine and at BMJ Open Sport & Exercise Medicine and sits on the Institutional Ethics committee of World Rugby as an external member. He is also a Scientific Committee board member of the Isokinetic Football Medicine Conference.
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Read the Full Transcript Here:
00:03
Hey, Jasmine, welcome back to the podcast. I'm so happy to have you on and so happy to see you again.
00:09
Hi, Karen. Thanks for having me. Really good to be back.
00:11
Yes. And so Osman and I both at the International look, Olympic Committee conference in Monaco, a couple of weeks ago, we actually did a talk together. So for the first part of this interview, we'll talk a little bit about we spoke about what we spoke about, and and then get into some of your big takeaways from the conference. And then of course, some of your upcoming projects, papers and all that kind of fun stuff. So why don't I give the microphone back to you, and tell the audience what our talk was, and kind of what we spoke about it IOC? So go ahead.
00:52
Thanks so much, Karen, I probably first thing to say is that we've Omicron raging around the world in the week before Christmas, it feels a bit surreal to think back to what was less than a month ago when we're actually out in Monaco presenting together. So the world has changed very quickly. Hopefully, it changes just as quickly back to the nice, stable world that we were getting towards before then. So I have to see what happens in the coming weeks. But yeah, it was great to present together it was something I think that we've both been speaking about for a while in our respective areas about how clinicians can engage with the mainstream media and social media for injury prevention, and athlete welfare, and just generally for spreading positive public health messages to our patients and clients. And so how we did it, for those of you that weren't in the room, we started off by looking at some different examples of how the mainstream media discusses different injuries and issues. And we took the lens of sport concussion, because that's an area that I'm fairly familiar with. And I've got a bit of an interest in from a research perspective. So I talk through some of the different examples of how concussion had been discussed in the mainstream media starting way, way back with Charlie Chaplin, hitting people over the head, progressing through to the movie concussion, more recently with Will Smith, and also touching upon some South Park episodes, the office and new girl. So other examples of concussion being in the mainstream media. And we had a bit of a brainstorming session, really, it was a nice interactive workshop that we did to everybody. That wasn't a room there. Thank you for contributing so much. He made it a lot of fun and asked a lot of questions and stimulated a lot of discussion between the group. And yeah, I mean, it was quite a nice flowing dialogue between everybody there. And there was some really good examples that people in the crowd shared in terms of their experiences with either engaging in the mainstream media or seeing some negative examples, and some less than perfect discussions and injury representations and illness and medical representations, either in TV shows or in news reports and things like that. So yeah, I mean, session was pretty good. I thought I'm obviously I was one of the CO presenters. But yeah, that was a fun session to be part of. And then obviously, from your angle, Karen, it was really good to hear your thoughts in terms of how clinicians can engage with the media, coming up with some really practical tips for people that would be interested in doing that in terms of how to pitch to journalists, sort of things that you should do when you're reaching out to journalists, and some good examples of how clinicians have worked and engage with journalists in order to get positive, evidence based, accurate, scientifically valid information out to places like the Washington Post and New York Times and kind of upmarket newspapers in that regard. So yeah, it was a fun session to be part of and had some nice feedback afterwards, which was made it worthwhile. And yeah, it was a pleasure to be part of it.
03:51
Yeah, I really enjoyed the discussion within the workshop from with the participants, because a lot of the workshops and we know, we go to all these conferences, and it's usually the person up on stage speaking, and there's not a lot of interaction during the talk, except for maybe someone gets up and asks a question, they sit back down. But what I really loved is that, like you said, people were sharing their experience with maybe being in the media, or really asking the question of like, hey, is this movie concussion? Was this positive or negative? And it was interesting that people had a lot of different views on what they believed as was as positive was this negative? You know, I think we can all agree on some of the things like Charlie Chaplin hitting someone on the head or, or a head injury being the butt of the joke. We can all agree that's not great. You know, that would be a maybe a not so great representation of that. But with the movie concussion, I think they it brought a lot more conversation to the group. I don't know what do you think? Yeah,
04:58
absolutely. I think the noise thing about the topic that we discussed as it's something that everybody's got an opinion on. I mean, arguably, you don't even need to be a clinician to have an opinion on how injuries represented in the mainstream media. But certainly, I've seen lots of workshops and conferences and sessions where I'm not particularly ofay, or knowledgeable about the area that's been speaking about. And I probably wouldn't feel that comfortable in terms of sticking my hand up and joining into discussion in front of lots of other people. But because it was a mainstream topic about the mainstream media, there was lots of people that felt comfortable to do that. So yeah, it was great from that regard.
05:34
Yeah. And I think it gave people some tools moving forward, to maybe reach out to a journalist or to maybe even reach out to say, hey, this article wasn't the best. And do you think you can? Like, I'd be happy to contribute to give you a little bit more evidence to that. And I think that's something that instead of going on social media and complaining about an article or a video, instead, why don't we empower therapists and researchers with the tools, they need to reach out to the journalists to say, Hey, I appreciate you, including physio, therapist, researcher XYZ. But what they shared is probably the not not the most accurate or evidence based. And I'd be happy to give you some resources or speak to you or write a and an article follow up article.
06:31
Plenty, absolutely. And I think we're completely on the same page here. I mean, it's so easy to read something that you disagree with, get angry about it. So you may it's about a coffee time, and then maybe sharing a whatsapp link to your friends and laugh at it, it's a little bit more challenging, but a lot more productive to actually reach out to those people. And like you say, do something constructive, take control of the narrative, as we kept saying, so who is controlling the narrative, we can control the narrative. And that's a good way of controlling that narrative is by reaching out to those people, and suggested some of the things that you said there. So putting some evidence based links in talking about proper scientific evidence, correcting in a nice, gentle way, some of the inaccurate information that may have been shared in the article, there are really, really good things to do. I think so. Hopefully, if people in the audience doing that, and anybody listening, that's picking up between the lines of what we're saying here can do that as well. That'd be great.
07:24
Yeah, and it's easy. It doesn't cost any money. It just costs a little bit of your time. And I mean, like, a tiny bit of your time.
07:32
Yeah, absolutely. I mean, time is money to a lot of people work, especially if you work in private practice. I don't, but I'm sure a lot of people listening here well, but yeah, well, it doesn't really take that long, just drop a quick email or a note to a journalist, to tee up some potentially better ways of reporting on what they've reported on, maybe serve as a link for any future articles. I think it was one thing that we both touched on that, I think is a really nice way of sort of crossing that divide. And bridging that gap is by getting in contact with a journalist or newspaper and saying, Look, I'm a clinician, I work locally, if you've got any pieces that you're putting out about a health related issue or a medical condition, or if you want to check anything with me for accuracy, drop me a quick email, send me a quick text message or WhatsApp. And I'll get back to you about that. And then you're then in a position not to create content for the newspaper, you're not writing their article is not a freelancer for them. But what you are doing is kind of member checking and fact checking and steering the journalists towards more medically accurate correct reporting. So yeah, I think that was a key take home for for me and hopefully, for anybody listening today as well.
08:35
Yeah. And I think that's, that's a great take home from our talk. So from and also a nice transition into what were your other big takeaways and take homes, from some of the other sessions you went to? So if you want to maybe describe the session, and then what your biggest take this session, the speakers and your biggest takeaways?
09:00
Yep, so the one that definitely made a big impact on me was the session on hashtag metoo. So it's about abuse in sports, intentional abuse in sport, and I came up the topic from different angles. So my mount Joy talks about the Larina SAR case that I'm sure everybody listening will be familiar with, which is horrific. And I suppose, because it's maybe slipped out the media attention for a few months now, I wasn't completely familiar with a lot of the graphic and horrific details relating to it. So that was a real eye opener again, for me in terms of how endemic that was and how that could have been nipped in the bud at several stages earlier from the information that we were given there. And I think the other speakers in this session, we're fantastic as well. So Shree Becca, I'm a big fan of sharees work. I went to most of our sessions IOC in Monaco, and, again, she helped deliver a fantastic session around The similar areas as well. And yet, sir to a lackey, who is based at Yale in the US did a really good session about Ghanaian Paralympians, and the perceptions and abuse that they suffer as well back in the home country, with regards to being disabled, essentially, and being an athlete and the barriers that they face and the challenges they overcome. And I thought one thing that was really nice from yesterday's talk specifically was the fact that she sampled the video interviews, and she wove those into her presentation. So you can actually hear and see the Paralympians talking about those things. So unfortunately, like, you can't transport lots and lots of people to the conference to speak as part of your panel. But yes, I did the next best thing, I think in terms of getting the athlete voices literally embedded into a presentation. And that really did magnify and sort of hammer home the points in a really strong way. So for me, that's something that I've since gone back to some of the sporting federations I work with. So I'm involved with the if CPF, which is the International Federation of cerebral palsy, football, and power Football Foundation. And I've spoken to both of those organizations about this and the resources that were provided in that thought were really helpful, just to make sure that we're on top of all safeguarding issues in our sport, I think, for a lot of people listening, I mean, it might sound like quite a boring thing, and quite a basic thing. But ultimately, it's the most important thing I think we can do is to protect our athletes when they're in our sport, and make sure that we've got the right policies, the right procedures, and the right steps in place to look after them. Because as the Larina SRK, showed, I mean that the impacts of getting those sort of basic steps wrong or underestimating those sort of areas of sport are huge and can have profound and very long lasting effects to the athletes involved today. Yeah, for me, that was that was probably the session that had the biggest impact on me. Again, I'm qualitative in my research background, so I was really pleased to be a part of the session with Eva bahagian, Caroline barley, and Christina farga. I thought all three did a really good job of talking about qualitative research. And I think, looking at other talks as well, during the whole conference series, there's a lot more awareness. Now, I think that with athletes and with patients, generally, we don't just need numbers, we don't just need hard cold quantitative analysis, which undoubtedly, is very, very valuable in terms of what we're doing with our athletes and patients, we also need some context to that. And I do feel quite strongly that a lot of that context does come from qualitative research and listening to our players listening to athletes, getting that extra depth to their experiences to either layer on top of the quantitative data or to stand alone and just be independent data that we look at and say this data has got numbers, it's got words, but these are the patient's words. And these are what the patients and players think. And we're going to look at that data, we're going to analyze it, and we're going to respect that data, we're going to act on that data. So Alan McCall, I was in Alan session as well. And he's at Arsenal Football Club, and they do a lot of work there with readiness and return to play. And they collect a lot of data as part of that. But it's really pleasing for me to see some of those high profile as Alan, talking there about the importance of quantitative data and listening to play as the qualitative sorry. Data are listening to players and getting that information as well. So yeah, I mean, I wouldn't call it a revolution in terms of qualitative research. In sports medicine, I think it's a gradual evolution. I think, as we evolve and move through the 2020s as we are, I think there's going to be a greater appreciation, really of the power that qualitative research can bring. And we're going to see a lot more of it, hopefully.
13:43
Yeah. And in comparing IOC 2017 to this one, I don't know that there was much talk of qualitative data in any in any of the talks in 2017.
13:58
I can't remember why for dinner last week.
14:03
I don't. I don't I don't believe there was. And so I think there is this definite shift in thinking that, hey, if we want to keep our players safe and healthy, and reduce injuries, then we have to listen to them. And we have to incorporate this qualitative data into how we as clinicians, because you and I are clinicians, how we work with our patients, you know, it's a little more than, Oh, you just have to listen to them. Because I think you have to listen, and you also have to understand what their words mean.
14:43
Oh, yeah. Listening processing, as well. So you're not just a set of ears, you've got something between your ears as well. And that's the thing that you have to use to process it and then also, act on it. I mean, it's not just a case of listening and processing you need to be Some actions off the back of that change that results from that. So, yeah, completely agree.
15:05
Yeah. Because like you said, from the me to talk with Margo and Sheree, and policies and procedures, yes, of course we need to have those in place. But if you're not listening to your players, you can have all the policies and procedures you want. If the Larry Nasser case says anything, right, they had a lot of policies and procedures in place and USA Gymnastics. Yeah. But they weren't listening to the countless girls and women who are abused by this man over many, many years. Because they did speak some of them did tell people, nobody listened.
15:42
Again, it's the acting management if you're listening, maybe process maybe haven't. But is the acting that needs Yeah, as well. And that's a key part of it.
15:51
Yeah. And I think placing that that athlete in the center. In that case, in particular, it wasn't about the athlete, it was about all the money and all of the prestige that comes with those athletes in your program. So you don't want to blow up the program, they apparent from looking from from an outsider perspective, it's like they didn't want to blow up the program to help save the girls.
16:17
Nine. I mean, in an ideal world, nobody should go to an international sports medicine conference and listen to a talk about that scale of abuse. But I mean, if if there is a positive about sitting in a session like that, so that you can spread the word about it. Take action to make sure that never happens again, in any sport ever. Exactly. Absolutely. abomination that happened.
16:38
Exactly. Exactly. And, you know, one of my biggest takeaways from the whole event is that context is, is everything. If you're not taking, whether it's quantitative data, qualitative data, exercises, application to the, into the clinic, if you're not looking at the context, around the person in front of you, then I feel like it's all for naught. And the other thing, my other big takeaway is like, I don't really know anything. So those are my two big takeaways.
17:11
I think that's always a good thing. If you go to a conference and come away realizing how little you know, I think you've been to a good conference. Generally, I think there's always so many clever people that you listen to and learn from. I went through a cardiology session as well as on absolutely not expert at all. But you go into sessions like that, and you learn a little bit and hopefully take stuff back. And you can apply some of it to your practice. And yeah, it's good that you felt that way. So I did as well.
17:38
wasn't just me, then. Yeah, I left. Oh, I'm the worst.
17:42
How do I not know anything? What am I doing in this job? It really spiraled down on the plane ride home.
17:49
Yeah, so any Junior clinicians or researchers listening, trust us. We're old in the tooth, myself and Karen. So if we feel like this, our stage of our career, then don't ever worry that if you're a new grad, and you don't know everything about everything, but there's something wrong with you, because it really is not, because you get to the end of your career, and there's still a lot of things you don't know, more things you don't know, at the end of your career than you did at the start of the career. So yeah, yes, definitely. Definitely a message I want to share.
18:14
Yeah. Excellent. Anything else from the conference that was for you? You know, a big takeaway from any part of it. Or do you think we covered it all?
18:27
For me, it was just how lovely and nice it was to actually see people face to face again, it just been such a rubbish. 1819 months leading up to that conference had been postponed two times. It was just lovely to actually get to a place. See people do want to give a lot of thanks to the people that hosted the conference. But the organization was next level in terms of how well run it was. Our safe, everybody felt everybody had masks on. I think we were talking about how good it was in terms of the COVID checks going into the venue, everything like that. So although there were, I think, seven 800 people there, there's a lot of people there. It never felt unsafe. And everybody there was glad to be there. And I think everybody seems to have a good time.
19:10
Yeah. And that's what Sheree and I spoke a cup of Sri Becker knights a couple days ago. And we said, you know, the thing that was so great was that everyone there, it felt like, people were there to support each other, and to support sessions and support individuals and, and maybe it's because there hasn't been like, a larger conference like this in quite some time. But it did feel like very inclusive and supportive, and that's kind of the vibe I got and Sheree said the same thing. It sounds like you might have felt the same. So maybe that an NF three is it's it's, it's true then.
19:52
Well, I'm a qualitative researcher, so I'll take those quotes and agree with those quotes. Yeah, I think it was just it was a nice nice yeah. place to be I think for a lot of people that first time they've left their country since COVID. It certainly was for me. And me too. Yeah, I think it'd be nice if that's the that's the vibe going forwards if we do go to a concert and can support each other's research, and there's not academic snobbery, or thankfully, I've not really been to any conferences that have been like that. But I'm aware that every now and again, there can be that element of needle two speeches and feedback and those sort of things. So hopefully, it will stays nice and constructive and supportive and positive objectives.
20:36
Agreed. Now, what do you have coming up? What do you have going on any new projects in the pipeline papers? If you can give us a preview? Obviously, can't give it all the way. But if you can give us a preview as to what you're working on, for 2022 and beyond?
20:55
Oh, okay. Well aware, a few different hats. So one of the hats that I wear is at the BDSM, the British Journal sports medicine. So I think it was announced on social media a little while ago that we're having the first BDSM Live, which is a in person, conference day that's being held in Brighton in the UK in May 2022. So we're quite excited about that. I'm hosting that with Fiona Wilson from Ireland. So it'd be really great to co chair the day with her. And that's certainly something I'm looking forward to. I am also off to the IPF spt. So the International Federation Sports Physical Therapy conference in Denmark in August, where I'm presenting a session with yourself again, Karen, so great to see you there. And again, that's following up on some of the BDSM work that I've done in terms of patient voices and athlete engagement. So I'm really looking forward to that one as well. A lot of 2021 was involved with the concussion and parasport group that I'm a member of so working with international colleagues are involved in Paris sports main concussion. So we released our position statement last year. And hopefully off the back of that there's going to be a lot more studies that take place in 2022. So one of the co authors, in fact, the lead author, Dr. Richard Wheeler, who's very passionate about the area, he's currently doing study looking at the perceptions of blind footballers towards concussion. And so he's done a lot of data collection from that. So I'll be working with him and the other co authors on that paper in the new year, which is exciting. And I'm also looking forward to working with Dr. Mark Murali in Australia, who's a digital health physiotherapist might be one of the best ways to describe him. He's very involved in the tech side of what we do is a professional physiotherapy and physical therapy. And he's got a grant that's been accepted on physio, digital health capabilities, and a model related to that. So I'm going to be working with him looking at that and looking at the digital side of physiotherapy as well. So got plenty of things to keep you busy. And I'm looking forward to hopefully a better year than last year.
23:05
Yes, well, you certainly have a lot to to keep you busy as well. And I should also say that you also work to your clinician.
23:14
Yeah, so my full time day job is at University Hospital, still on the south coast of England, and I'm a full time clinician, I also work part time for the Football Association as a clinician with their elite power football squad. So that's disability football. And in the new year, I'm also going to be starting a part time role there is the power classification lead for the elite disability football program. So looking after the classifications across all the athletes, power football, sports, I'm looking forward to that role as well.
23:44
Nice. And obviously, you'll eat and sleep at some point in between.
23:51
If you ask my wife, there's a lot of eating, and we missed out on those too.
23:56
Good and a little bit of relaxing and a little bit of fun, right?
24:00
Definitely. Always got time for fun. Excellent. Well,
24:03
before we wrap things up, where can people find you if they want to join some of the things you're doing? They want to have more information, they just want to say hi, where can they find you?
24:14
Yep, so probably the easiest way to get ahold of me is on Twitter and my handles, Osman H. Ahmed. And I think you'll probably share the link in the podcast. So that's probably the best way to find me and I'm pretty responsive on there if people do want to get in touch. Certainly if you're interested in concussion in disability sports, or want to talk more about our work that we've done with the mainstream media and how we can engage with them, then I'd love to hear from you.
24:39
Excellent. And yes, that will I will have that link at podcast at healthy wealthy, smart calm in the show notes in this under this episode. And finally, I think I've asked you this question before, but I'll ask it again because maybe you have new advice, but what advice would you give to your younger self knowing where you are now in your life and in your career?
25:03
For a couple of things really, don't take yourself too seriously. I think that's probably a key thing for any young clinicians that certainly when I was working in university, there was a lot of people that were really stressed and anxious to make a mark in the profession. And obviously, that is good. And that's commendable when you want to keep that about you. But also, I think, being relaxed in terms of the way that you do that, and doing it in a collegiate way, I think is probably a really good way to progress your career. I like to think I did that. So that that's less advice to me and more advice to other people. forced myself when I was younger. I'm not really sure to be honest, I'm, I'm pretty happy with the decisions I've made through my life so far. So yeah, probably. I don't know. Pass. Sorry, Karen,
25:52
know that the piece of advice that you gave, don't take yourself too seriously, is perfect. It's perfect. And I think that a lot of people will enter into we're both physio therapists into physiotherapy or healthcare. And kind of like you said, they really want to move their career forward. And so I think it's important to remember Yes, you want to move your career forward, but your underlying Why should be to improve the health of everyone to improve the health of your community, your population that you see, versus getting best of XYZ, or award for this and award for that. I did this look at how great I am. But instead, how are you really impacting your community through your work?
26:38
Absolutely. So keeping everything patient centered. I think that's basically what you're saying there. I think probably the other thing as well is your career is a marathon. It's not a sprint. So you don't have to achieve all of your career goals by the age of 30. spacings out and don't be afraid to reinvent yourself if you find you're in a career or a job that you're not massively enjoying. It's a big profession out there. You're not wedded to one job for your career or your life. There's other places that your career can take you with a degree in the skills that you've got.
27:11
Perfect. That is great advice. Well, thank you so much for coming on to the podcast again.
27:16
I really appreciate it and look forward to seeing you again in person in August. So thank you so much for coming on. Thank you, Karen. And everyone. Thanks so much for listening today. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Founder of Taylor Insurance and Financial Services, Eszylfie Taylor, talks about balancing and prioritizing the mind, body, and money.
Today, Eszylfie talks about wearing many hats, how yoga has changed his life, and his work on Mind Body Money. How is short-term gratification hindering our progress?
Hear about how Eszylfie fits so much into his life, how he picks himself up after a failure, and get his valuable advice for 2022, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “You miss 100% of the shots you don’t take.”
- “Only something good comes from being bold. Either you’re going to get something you didn’t have, or you’re going to continue not having what you didn’t have anyway.”
- “Pay yourself first.”
- “If you aim at nothing, you’ll hit it with amazing accuracy.”
- “You have to give up smaller short-term instant gratification things for the long-term greater thing.”
- “Ease is a greater threat to progress than hardship.”
- “Those who think they can do something and those who think they cannot do something are both right.”
- “The most successful people in life are those who can endure the most pain.”
- “No one is on their deathbed wishing they had more money.”
- “Never give up. You never know how close you are to your dreams.”
- “The road to walk a mile begins with a single step.”
More about Eszylfie Taylor
Eszylfie Taylor is the president and founder of Taylor Insurance and Financial Services, and serves as financial advisor to individuals, business owners, and high net worth families. Over the past decade, he has been widely recognized as one of the most accomplished producers in the industry, receiving the National Association of Insurance and Financial Advisors (NAIFA) award, “Agent of the Year: Los Angeles" in 2010-2012. Additionally, Mr. Taylor is a 15-time "Million Dollar Round Table" qualifier, the last four of which he has been a "Top of the Table” producer, ranking him in the top 1% of all producers worldwide, and was the recipient of the 2015 Top Four Under Forty Award by Advisor Today Magazine.
Mr. Taylor began his career at age 22 with New York Life Insurance Company, where he soon ascended to the Chairman's Council, reaching the ranking of #1 Broker in Los Angeles (2006-2013), and #1 Agent for the Company's African-American market (2006-2013). In 2007, he began building his own firm, Taylor Insurance and Financial Services.
Mr. Taylor currently sits on the board of three non-profit organizations dedicated to business empowerment, children's health, and social services.
He is the founder of the non-profit, Futures Stars Camp, which provides basketball training and life coaching skills (www.futurestarscamp.org) for kids. In addition to his passion for business, Eszylfie loves being a hands-on dad.
Eszylfie holds a Bachelor’s Degree (magna cum laude) in Business Management from Concordia University. He has also earned the Series 6, 63, 65, and 7 licenses, and a Life and Health Insurance license.
Suggested Keywords
Healthy, Wealthy, Smart, Finance, Financial Freedom, Success, Perseverance, Yoga, Mind Body Money, Long-Term Goals, Consistency, Resilience,
To learn more, follow Eszylfie at:
Website: https://www.mindbodymoney.com
https://www.taylormethod.com
https://www.futurestarscamp.org
Instagram: @EszylfieTaylor
LinkedIn: Eszylfie Taylor
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Read the Full Transcript Here:
00:02
Hi, Eszylfie welcome to the podcast. I'm happy to have you on.
00:07
Thank you for having me.
00:08
And I'm excited to talk about you and your journey and all the different hats that you wear in your, in your professional and in your personal life. So let's break all of this down. So you are a financial advisor. You're a yoga instructor, you're an entrepreneur, and you're a girl, dad, and I have a soft spot for I'm one of three girls, you've got three girls, I totally I get it. So if we can, let's first talk about how does all that happen in one life? How do you put that all together?
00:43
Yeah, I think, for me, when I was graduating college, I made a promise to myself that I would never look back at my life and say, what if what if I did this? Or what if I try this? And what if I went here? I just say I just say yes. Right? And as as as a result of that I'm a huge failure, probably arguably, the biggest failure you've ever met in your life. And that's also why I succeed, right? So I would rather try something and fail miserably might fall flat on my face and say, Okay, that wasn't for me and check the box, then just wish or assume. Right? And because, you know, again, I think I didn't want to be a grizzled old man sitting on my porch one day thinking of all the things that I could have done with my life that I should have done with my life and then look back with regret, no, no, no regrets?
01:32
And how do you pick yourself up after each one of those failures? Because, I mean, maybe my skin's a little bit thinner. But I would just I don't know that I would have the fortitude to continue to pick myself up and move forward again. So how do you do that?
01:48
I think for me, you know, sports sports played a big role in helping me create grit. You know, I have a nonprofit that I founded called future stars. And then I teach kids and I'm actually doing a camp right now for kids. And, and I told the kids today, I said, you miss 100% of the shots, you don't take this 100% of the shots you don't take. So my contention is, is I just tell myself, I tell others to be bold, right? Because only something good comes from being bold. Either you're going to get something you've never had, or continue, which you didn't have what you didn't have anyway, right? You're going to get something you didn't have or continue not to have what you didn't have anyway. So what do you lose? To your point? It's really just ego. Right? That's, that's right. Right. And so I'd rather hear or know, or face rejection and say, Okay, well, I didn't have it anyway. So what have I lost? That, you know, nothing, right? Yeah, I look at it, you know, it's, it's only it's only greed, right? It's only only upside.
02:50
And so you've so you say you've had all these failures, okay, I believe that, but you're also incredibly successful in multiple areas of your life, one of those being a financial advisor. So talk about how you got into the financial advising game, and then we'll maybe get since we're in the beginning of a new year is 2020, to maybe get a couple piece of pieces of advice from you, on how to set yourself up for success from a financial standpoint. But first, let's talk about how you became a financial advisor. And we'll take it from there.
03:29
Yeah, I started my career fresh out of college, I'm in the business which is unique, right, so the average financial advisors probably a 55, six year old white male, right, so I'm anything but that I had one simple, you know, modest dream coming out of college that was to become a millionaire by the time I was 25. Right. So 22 I figured what three years is that's that sample time, right? It's reasonable, you know, by three years, that's, you know, that's, that's that should happen. Um, and, you know, I was at a job fair at my university and you know, I'm going from from booth to booth and all the companies are kind of telling me the same thing. I'm gonna make somewhere between 4050 grand a year, and I'm scratching my head and I'm like, okay, like, I'm not the smartest guy in the world. But that doesn't add up, right? Like I get to a million bucks that way and so you know, by by chance, uh, you know, I found my way into this world of financial services and what drew me to the industry was that it was an industry as a field where I was paid for my work I work ethic and aptitude not my age or tenure. Right and so at the end of the day, I was gonna eat what I kill right I was gonna I was gonna I was gonna make as much money I was going to have as big an impact in the community in the world as I worked tap right and so you know, it's funny against the against the better advice of my father who told me no, you know, get go work for someone else get a job right? Go get a paycheck on the first and the 15th and I just like i Dad, I think, I don't know I like You know, I can't even tell you how I'm gonna do it. But I just believe doing it this way me being in control of my fate is just a better way to go. And 20 years later, you know, here I am.
05:12
And I, I can totally relate with the just get a job and get the paycheck. And because I remember leaving college, I thought I would get a job and a hospital or a clinic and I would work there until I retired. Right, because sometimes those worlds aren't open for you right away, and you have to kind of really forge your path. Now you were very successful, as are are very successful as a financial advisor. And then you moved into becoming an entrepreneur, starting your own brokerage. So we'll get to that in a second. But before we do, let's give people a little bit of advice for their financial success in 2022. What's your best advice for us?
05:55
Yeah, I mean, one of the guiding principles of creating financial security is the idea of paying yourself first, right? And, you know, tell people you if you work for a company, right, and and and they didn't pay you, would you continue to go to work? Virtually everyone says, Well, no, rather not go to work, have a good day. But my contention is, you get your paycheck, and you pay rent, and you pay your car lease, and you pay your credit card, and you pay your cell phone bill, right, and you don't put any money away, right? No money in savings investments for you, you just work for free, because none of that money went to create wealth for you. Right. So the the one thing that I would tell people is to pay yourself first. And this really comes first and foremost with creating a budget. Right? You have to have a plan, right? I would say if you aim at nothing, you'll hit it with amazing accuracy. Right? So you have a certain amount of money coming in. Okay, so if I make five grand a month, okay, well, what are your bills? My bills are three grand a month. Okay. That that gap between your income and your expenses? That's called your discretionary income? That's do I make dinner at home tonight? Or do I go to that steak house? That's do I, you know, do I go on vacation? Right, you know, to to Hawaii? Or do I just go camping, you know, down down down the road, right. And so those are your choices, right? Those are your choices. But I always tell people pay yourself first. And the reason and I wanted to drive home the importance of this, you want to get to the point where you can live off of interest, you want to get to the point where you've saved, you've accumulated so much money, that the yield the earnings from your money covers all of your expenses. That to me is retirement. It's not about being 65 or 67, or 70. It's the point at which you remove the half twos from the equation, you do things because you want to do them not because you have to do them. And the more money you put away, right, the longer it's working, the greater rate of return you're earning than the faster you get to that point, right. And so I don't care where it is, it could be a savings account to start. It can be a brokerage account, stocks, bonds, mutual funds, insurances, whatever, right? But something you must pay yourself first. Right? And that's, that's the first guiding, no first guiding principle.
08:10
And I love that I started doing that a couple of years ago has changed my life. Yeah. And it's like, it's so I feel like I have like less worry and less burden on my shoulders. Does that make sense?
08:23
Well, it does make perfect sense. And the challenge is, is people go oh, well, you know, I, my lifestyle will be, you know, be interrupted. And no, it won't, right. And if you think about this, and I love breaking down, and this is maybe a challenge that the listeners can can join in on, take the amount of money you're looking to save on a monthly basis, and break it down to the day makes it even more palatable. So you think about it. If I go, Hey, I want to save, you know, I want to save $1,000 a month. That's my target. Right? So what's that roughly about $33? A day. Right? So you get a lunch every day, Karen, you had to take me to lunch, right? Would that change your life? Would your life suffer? We just ended a living change? Probably not right? You're ready to retire? If I said you have $2 million in your retirement account. Would that help you with that? Would that change your life? I probably wouldn't hurt.
09:19
Yeah, it would be good. I'd be I be okay with that.
09:22
Right. And that is what you're giving up. So it's like we have to give up smaller short term instant gratification things for the long term greater good.
09:31
Yeah. And I think that's that mental shift is so important because we live in a world now where instant gratification is everything right? And so how do you counsel your clients who are used to an instant gratification world to be like, Hey, listen, this is going to come to you but you have to wait. Well,
09:50
I think the principle of saving and investing or paying yourself first doesn't mean you can't have fun. It doesn't mean you can't enjoy the fruits of your labor and I think people tend to, you know, live in these extremes, right? Like either save everything you must, you know, not spend don't have any fun like your life is over right? Or, or like, we only live once I'm gonna spend it all right and, and the reality of is there's a balance, you know in the middle, right? And so what I'm saying pay yourself first in that example if I make five grand a month and I have $3,000 a month of expenses, and I decide I'm gonna put away $500 Well, there's still 1500 bucks to go to the movies to go to dinner to go buy that, you know that handbag to go buy those shoes. You want it right, like, but you made yourself first.
10:36
Yeah, yeah, I love it. Like I said, that mentality has just changed and shifted everything for me. So hopefully, the listeners will take that and hold on to it through 2020. Now, like I said, you wear a lot of different hats. So financial advisors, one new or very successful financial advisor working for someone else. Right? And then you kind of made a shift, you kind of reached the point where, oh, I feel like I've got all this stuff. But I'm not sure that I'm happy in the place where I'm at. Is that right? Yeah, I
11:12
think, you know, for me, I realized I draw the analogy, I felt like I was a shark in a fish tank. Right. Like I had, I had outgrown, you know, the system that I was in. And in order to continue to to flourish, I needed to swim in larger waters, right? I believe in life, you know, you're green and you're Brown, you're growing and you're dying, you're getting better, you're getting worse, there's no staying the same, right? And so for me, I'm always looking to grow, I'm always looking to get better. I'm always looking to be pushed, and challenging. So you know, what better thing than, you know, leaving a 13 year career, you know, and multi multimillion dollar practice than to go out break out on your own and try to build something bigger. So that's exactly what I did.
11:57
And again, not easy. Now, was this around the same time that you started getting into yoga and becoming a yoga practitioner? And how did that change? What you do as a financial advisor and even as a dad and as a person? Kind of connecting that mind and body?
12:18
Yeah, I think it was somewhat around the same time I've been been practicing yoga for about 14 1415 years and and I've been independent now my own brokerage about 910 years and I think what yoga taught me not only what it did for me physically, but it I was very idealistic visit undermanned, right, this will happen, this lab, this will happen, right? I was very rigid, right? This, this, this. And what yoga taught me is it taught me to detach myself from outcomes. It taught me to detach myself from outcomes and to just focus on process. Right. And so there's a little Mater that I that I shared in the listeners can can take part in this as well. And you got a challenge in your life. Right? You got an issue in your life, you ask yourself questions, three questions. Do you have a problem? No. Okay. Don't worry about it. Right? No problem doesn't worry about. Do you have a problem? Yes. Can you do something about it? Yes. Okay. Don't worry about it. Do you ever problem? Yes. Can you do something about it? No. Oh, great. Don't worry about it. Which basically means all paths lead to not worrying about it. Right? So I believe that everything happens for a reason. And it's exact, perfect timing, even the crappy stuff. Right? Even the stuff you're like, This isn't fun. This hurts. Right? And, and, and, and one of the things that yoga has taught me is this just changes my mantras. I mean, even teaching it right, I have all these intentions and things that I that I that I share with with my students and that I have to also live by I can't say it not believe it or not live with it, right. And even this past week, my watch for classes that ease is a greater threat to progress than hardship. Right? And so through adversity through challenges, that is where we that is where we grow, that's where we get product progress, that is where grit is developed. And so for me, Yoga has softened me in so many ways. And let me accept things right, except that sometimes I will get exactly what I want. And sometimes the door will be slammed in my face and it's okay because if a door gets slammed in my face it was supposed to get now now the challenge is in the big so do you need me Sophie, every time you get rejected, you just accept it like know what I mean by trusting the processes. If I have done what is required of me, if I have done everything that I can do, then I can detach myself from the outcome. I don't mean that I'm sitting at home flipping TV. going like, I'm going to make a million dollars this year. Are you working today? Like no, but it's coming to me I'm manifesting. There's two keys to success in life. Number one, you have to believe that's the first part, those that think they can do something and those that didn't, they could not do something about usually right, then the second piece, then you have to do the work. Right. So what I always had was a tremendous work ethic that I always had. But what was flawed, flawed, or what was underdeveloped, if you will, was that mindset that, that that that positivity, that manifestation? That that, okay, this, this is what will happen, okay? This is what I want to happen, okay, and then go out and do the work.
15:38
Yeah. And boy, that second parts, the tricky bit, right, having to do the work. That's the hard part. And I know, and then, what I see a lot, and you probably see this on social media is people will say, Oh, I put it on my vision board, and it just happened. Or I manifested it, and it just happened. And then you're sitting there like, what, like, if that work is
16:02
because people people typically aren't posting their losses, right, people are posting their wins, you know, and the reality of it is, is that, you know, you take any anyone in any any arena sports, entertainment business, right there, they're all failures, all of them. They just were too stubborn to stay down. Right. And that's, that's the difference. I've come to believe that the most successful people in life are simply those who can endure the most pain, who can endure the most rejection who can in you know, indoor, and I think that's how I became successful in my business. I think, I think that I coined the phrase at the time when I was new advisor, I put in the phrase, tactical persistence, right? I'm going to be persistent tactfully. I think, in the first couple years of my career, people ultimately just did business with me, because I like, if I don't buy something from this guy, I think he's ever going away. Like, I don't think he is ever. Right. And so, you know, I was just there, they're there. And they're like, fine, right? I mean, you've developed a relationship and people know, right, then he's not going anywhere. He's gonna be here. Right. And, and, and, and I think I think that's, that's, that's important. I mean, anyone, uh, any one of the listeners, you know, of this program can tell you what is the easiest way to put off a salesperson or a telemarketer the easiest way to um, one simple phrase, call me later. And 99.9% of the time, they will not and you're off the hook. You don't even have to reject it. You did. So call me later because they didn't follow through. Right? Right. They didn't follow up. So you didn't have to actually, you know, say no, even right. And so, that's the thing for me, like, No, I'm gonna follow up and I'm gonna follow through and I'm gonna do everything that is required of me. Right. And if you ultimately type he's not right or my services are right then. Okay. Right. But I will not fail because I didn't do what was required. That will happen.
17:52
Yeah, yeah. That makes perfect sense. And, you know, speaking of tactful persistence, the other hat that you were is a dad to three girls, so I can only imagine tactful persistence comes in handy. So how has all of this your experience in business, your experience in yoga, your experience in life? How does that come together when it comes to raising three, three gals?
18:17
Yeah, um, you know, I, when I was a younger man, I used to pray to God that he'd sent girls to hang all over me. And he took me literally and it's like, here you go, here's three of them. Right? So be careful what you ask for my kid. I've got these three girls. And this is a prime example of you don't always get what you want, but you get exactly what you need. Right? me growing up as an athlete, I was a force for Letterman. In high school, I went on to play college basketball. You know, I recently got inducted into the Hall of Fame in my high school for sports. Right? So of course, I want Boys, boys continue to legacy and go on. And then I get three tall girls, two beautiful girls like oh, man, like God, why? But you know, just, I'm a different man. I'm a different father because I have these three girls. And I think, you know, my, my role and the one thing that I say is like as as a as a man, right of girl, Dad, if you will, I'm the first man they fall in love with. So it's my responsibility to show them, you know, respect and true love and chivalry, because that's where they're going to carry on in their relationships as they get older. And so I think, you know, I feel very blessed. Although, they are sisters and they're they're all flesh of my flesh and blood of my blood. There are three completely different people that represent three completely different sets of challenges and, and, and things to deal with. But I've been blessed because they're good girls, right? And I wish I could say it was because I'm such a great dad. But, um, you know, I think that they're they're just inherently they've got good sweet spirits, which is, which is a blessing to have. And then I'm just doing the best I can to guide them. I think we all can attest to this being as we get older, we become adults, we look back at our parents, and we realize every one of us has said this at some point, like, wait a minute, our parents didn't know what the heck they were doing. Right. Like, and some of us even called our parents out, right? Like, you were just winging it. They're like, Yeah, you know, and so I feel like, you know, I feel like, we're just all doing the best we can, you know, and that's, I'm doing the best we can as much as I feel like, you know, I'm doing all the things from I can from my, my daughters, I'm sure they'll tell you. Yeah, but he didn't do this, or this or this, but, but what they will definitely say is that, you know, I'm president and that I'm, I'm, I'm, I'm consistent, I'm a consistent, you know, consistent force in their life. Right. And that's, you know, that's the most important thing to me. I don't need them to always like me, I don't I don't need them to always agree with me, but I do need them to, to respect and honor Me and then with the love that we have, you know that that's something that you know, is so special, and then I feel blessed to be there for their father. Yeah.
21:20
Amazing. And you're putting all of this together, your financial advisor role your entrepreneur role, your community mindedness, your girl, Dad, your yoga, into mind, body money. So what is it? And what can we expect?
21:42
Yeah, Mind Body money is a docu series that I created. I have actually filmed all of season one, I'm in the process of talking to a variety of networks now to get it placed on on national television COMM And q1 Next year, so stay tuned. I've also created an app that's on the App Store mind dot body dot money that's on the app store as well. But the idea is that how do we become the best versions of ourselves? And we become the best versions of ourselves balancing those three areas in that order. Mind. Body, money, right? Mindset first manifestation, manifestation. Every day when people ask me how I'm doing I Thomas, the best day of my life, I say that every single day. Now, does that mean that everything is going well in my life at all times? Nope. But that's what I say. I'm manifesting positivity. Right. But health alone is so important. We're getting one body, right? Never no one's ever on their deathbed wishing they had more money. Right? So you got to take care of yourself. And then money, good stewardship of your money, right? Money can't buy you happiness, but it can pay your bills. So I can do a lot of stuff by hand. And so typically, what I find is people are unequally yoked right you might have the money hungry driven person and And admittedly, I was that person coming out of school, I want to be a million dollars. I want to, you know, you know, have a nice house nice car and buy stuff, right? But lacks substance lacked connectivity. Oh, right. And, and, and when I got all this stuff, what I realized, like, oh, an empty because it's not about the stuff. It's not about money. Right? It's about connections about love. Okay, and then you got the other people that understand spirituality? No, it's about mindset and in spirituality, and, and peace. And that's great that you feel like that you want to go on this yoga retreat. But I got a question for you. How do you pay your bills? Right. And so it's that it's the balance between those three areas. And that's what the show features different athletes, celebrities, entertainers, all the way down to your common men and women, and how the journey in life, right, you know, is navigating those three areas. And the one thing that I'll tell you, between all of the people, there is always a story of failure. There's always a story of doubt, or uncertainty that they all press through. And that's the one thing that I say common thread, like the most successful people, right that I've met in my life all can tell you a story where they were down and out or they didn't know what's gonna happen next, but they persevered, right? There's a, there's a, there's a little meme that I that I share when I'm doing my my talks and it has it's a photo of a goldmine that you can envision this in a person with a with a with a pitchfork, and they're digging in, they're digging, and they've dug like a 10 foot ditch and they get frustrated, and they turn around like, like I'm finished right? And they were only one foot away from actually hitting goal but they're like I've done so much And then the mantra here is don't don't ever give up. You never know how close you are, to, to your, to your goals to your dream. So So you swing away, you swing away until you get it. Right. And maybe maybe you'll get there in a week, they will take a year, they will take 10 years, right? Maybe Maybe it's not meant for you. Right. But But again, right, don't leave this earth wondering what if?
25:25
And out of all of the episodes that you've done and the people that you've met through mind body money? Is there a particular story that sticks out for you that you can share with the audience?
25:40
Yeah, there's two stories that come to mind. Actually, I'll share first one guest we had was on the show was Jordan sparks. She was the youngest American, I
25:51
love her. She's great.
25:52
She's awesome. Just as lovely. Off off screen as she is on screen. She shared with me so she goes on American Idol. She comes here to actually to Pasadena where I live, she cheats. She auditions at the Rose Bowl and gets cut. She didn't even make it to go see Simon and all those guys, right? She gets cut, right? And she says she remembers walking out, you know, through the parking lot with all these girls. And at the time, she was young. I think she was like 17 or so. But at the time, she said she remember seeing all these older girls and older by but I mean like 2526 year olds, I thought, Oh, my life is over. This is my only chance to make it big. And I'm done. And she thought to herself like, no, like, I'll come back don't get another way for me. So she goes back, she lives in Arizona. So she goes to a regional regional competition in in in Phoenix and wins, right and wins. And the prize for winning was a chance to go to the next city, which was in Seattle, and try again, audition again. And on that second audition, she gets picked up and then ultimately wins
26:58
the show. Amazing.
27:00
And so that story is when we're like wow, you know, like, wow, you know that what level of perseverance and just believe that like not this, isn't it? And how many of us would have faced that rejection or or stumbled in the live live? Yes, it wasn't in the cards for me. Right? But again, as long as you have breath in your body, keep pushing. Right. The other story I'll share is I had David Hasselhoff he was on my radio show my Ask the Experts radio show. And we're interviewing him. And David Hasselhoff was one of the principals of one of the first billion dollar TV franchises Baywatch, right? Um, I personally think that Knight Rider was cooler but for the for you. Gen Xers with me. But anyway, but but the US, you know, first building our franchise Baywatch, right, and we're talking about that. And again, what a lot of people don't know is that they watched initially was cancelled. It was cancelled after the first three episodes. Because yeah, they killed like five people in the first few episodes and and the viewers didn't like it. So the show got canceled. So in an attempt to revitalize the show, because like I need financing, so in little known, but David Hasselhoff in Germany is like he's huge, right? Like he's like, he's like, yeah, he's like, the biggest thing he's Yeah, yeah. Right. So he goes to Germany's like, they'll give you money, right? It goes in Germany. He raises some money. He gets like 1,000,005 to bring back the show, and comes back and does the show, right? Well, what happens is, they run out of money. They run out of money, they can't finish the episode. So like, man, we got 22 minutes of content, we need 25 And we don't have any more money. What can we do? How can we make the episodes longer slomo that is where slomo comes in. Slo Mo was to stretch out the scene so that they can get their minutes so funny that the most iconic part of the show was really a mistake was really because they didn't have money right? So story after story after story like that, that I've heard in my 22 year career most certainly in filming this Docu series is follow doc that like wow, like so many times people put a lay down so many times people could have you know, given a peck Jeff basals worked at McDonald's guys. You have like, like, like so so when somebody next to you when you're when you're working in Starbucks and the barista next to us like I'm going to be a billionaire and all scoff right you never know.
29:34
It can happen you never know. I love these like insider stories. I think it's so cool. So as we start to wrap things up, where can people find more about you about mind body money? Maybe see some little clips things like that. Where can where can people go?
29:53
Yeah, I'm pretty easy to find. My name is so unique. There's not a lot of me out there. He Sophie Taylor, Mama variety of social media platforms Instagram, Facebook, LinkedIn, that's at a selfie Taylor s ZYLF ie Taylor at the Sophie Taylor. For the show, we actually have a website, in addition to the social media platform. So we have a website Mind, Body money.com. So mind body money calm, you can also get information on the app store as well. You can download the app, the app store at mine dot body dot money, as well. And so yeah, we're out here we're continuing to push out new content, and, and keep everyone posted on the release of everything. But I'm super excited for what 2022 is going to bring and look forward to sharing. I feel like the bottom line for me is like when do you watch television? And and learn something? When do you watch television and feel better? And that's what I'm going to bring? That's what I'm going to bring to the world?
30:56
Well, the world certainly needs it at this point in time. So it sounds perfect to me. And now before we end, I asked everyone this same question. And it's knowing where you are now in your life and your career. What advice would you give to your younger self?
31:12
I would remind my younger self, that the road to walk a mile begins with a single step. No shortcuts. No matter how talented you are, no matter how smart you are, no matter how ambitious you are, right hard work is undefeated, you must do the work, right foot in front of the left one step at a time you'll get there. I think one of the biggest reasons that I'm successful today, it's all the slow, boring stuff. All the get rich quick, I'm gonna make a million dollars in a month and change the world all that stuff crashed and burned.
31:47
Right? So you mean all the stuff you see on social media?
31:51
Yeah, all that stuff crash and burn. It was it's the slow and steady. You know that? That is why you know, is why I'm here. Right. And so that's why I remind my younger self and it's hard, right? It's hard to listen, my long term plan at 22 was 25. Right? That was my long term plan. Right? I love that. Right? I mean, I was like, man, three years, that's 25 years old. Right? And so, you know, I can still couldn't even see past 30 like, well, what is what is that? You know, and, and then you you you blink? Right? You blink and you're like, well, 10 years has gone by 15 years gone by 20 years has gone by, you know and so that's what I would remind myself is just stay the course. Don't get you on the highs don't get too long. The lows the road to walk a mile begins with a single step. Just go.
32:37
I love it. Great advice. And Sophie, thank you so much for coming onto the podcast one more time. Where can people find out more about you?
32:48
Social media at ie Sophie Taylor, Facebook, Instagram, LinkedIn, at Mind Body money, Instagram as well. And at the mind body money.com site as well as a mind body about money on the App Store.
33:03
Perfect. Thank you so much for coming on. I appreciate it. I appreciate you. And I wish you all the best in 2022, including your show.
33:13
Awesome. Thank you. Thank you. I'll take all the well wishes and blessings I could get. Thank you very much.
33:18
You're welcome. And everyone. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Social Justice and Sports Medicine Research Specialist, Sheree Bekker, talks about social justice in sports, medicine, and research.
Today, Sheree talks about the conversations around physiology and injuries, and the different environments that affect the ACL injury cycle. How do clinicians implement the findings in the research?
Hear about Sheree’s qualitative research methods, the importance of recognising the social determinants of injuries, tackling systemic experiences, and get Sheree’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “We have to recognise the human at the centre of those experiences.”
- “Gendered language that seems like everyday language in sport can be really harmful to both men and women.”
- “[Be] cognisant of, and [be] able to have those conversations with athletes, patients, people that you work with all the time about their social conditions of their lives.”
- “The social conditions of our lives play into our injuries and our rehabilitation.”
- “It is about not simply seeing rehab as a biomedical issue alone to solve, but thinking about it as socially, politically, and materially oriented is a practice that you might incorporate in your way of thinking.”
- “Injury prevention, and a contemporary vision for injury prevention, needs to be athlete-centred and human-focused.”
- “We need to have those uncomfortable conversations about our complex, messy realities.”
- “Context is everything.”
- “Sport isn’t neutral. It isn’t apolitical.”
- “We can start to ask these questions, start to have these conversations. The answers aren’t going to come tomorrow.”
- “These ripples will take some time.”
- “Connection is greater than competition.”
- “Hold on to the power of connecting with people who are at the same career stage and doing work with people who are at the same career stage as you.”
More about Sheree Bekker
Dr Sheree Bekker (she/her) was born in South Africa, grew up in Botswana, completed her PhD in Australia, and now calls Bath (UK) home.
She is an expert in ‘complexity’ and research that links social justice and (sports) injury prevention. She has a special interest in sex/gender and uses qualitative methods. This underpins her work as an Assistant Professor in Injury Prevention and Safety Promotion in the Department for Health at the University of Bath. At Bath, she is Co-Director of the Centre for Qualitative Research, and a member of the Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), and the Gender and Sexuality Research Group.
Internationally, Sheree is an Early Career Representative for the International Society for Qualitative Research in Sport and Exercise, and a founding member of the Qualitative Research in Sports Medicine (QRSMed) special interest group.
In 2020 she was appointed as an Associate Editor of the British Journal of Sports Medicine, and in 2021 she was appointed Qualitative Research Editor of BMJ Open Sport and Exercise Medicine.
She completed a Prize Research Fellowship in Injury Prevention at the University of Bath from 2018-2020, and received the 2019 British Journal of Sports Medicine Editor’s Choice Academy Award for her PhD research.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, Social Justice, Injury, Prevention, Gender, Sexuality, Physiology, Sociology, Environment, Research, Change,
Resources:
Anterior cruciate ligament injury: towards a gendered environmental approach
To learn more, follow Sheree at:
Website: https://sites.google.com/view/shereebekker/home
Twitter: @shereebekker
Instagram: @sheree_bekker
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Read the Full Transcript Here:
00:02
Hi, Sheree, welcome to the podcast. I'm so excited to have you on. I've been looking forward to this for a long time. So thank you so much for joining.
00:12
Thank you for having me. Karen. I am delighted to be talking to you today.
00:16
And today we're going to talk about some of now you had a couple of different presentations at the International Olympic Committee meeting in Monaco a few weeks ago, and we're going to talk about a couple of them. But first, I would love for you to tell the audience a little bit more about you, and about the direction of your research and kind of the why behind it. Because I think that's important.
00:43
Mm hmm. Yeah, I've actually I have been thinking about this a lot recently, over the course of the pandemic, and thinking about where my research and my work is going and why I'm so interested in in kind of social justice issues in sports injury research in Sport and Exercise medicine. And I guess for me, there are two reasons for that both of them related to my background. First of all, I was born in South Africa. And I grew up in Botswana. And I think, you know, growing up into countries that have interesting pasts, you know, South Africa having post of apartheid and Botswana having been a colonized country, I think I grew up in places where we were used to having difficult conversations about social justice issues on a national level. And I think, you know, that is something that has influenced me definitely in the way that I see the world. The second part for me is I studied human movement science at university. And my program was in a Faculty of Humanities and Social Sciences. And I didn't realize at the time that most people get their sport and exercise medicine, sports science, human movement, science training, in medical faculties, or in health faculties, whereas mine was very much social sciences and humanities. And I only realized this later that my training in this regard was quite different in terms of the way that I see the work that we do. And so now, I've landed here at the University of Bath, and I'm in a department for health. But once again, I'm back in a Faculty of Humanities and Social Sciences. So it's been a really, really nice connection for me to come back to these bigger social justice questions, I guess, that I'm interested, you know, in our field. So for me, that's really the why I think of why I do this work.
02:42
And, and kind of carrying along those themes of social justice and really taking a quat. Know, a quantitative, qualitative, sorry, qualitative eye, on athletes and on injury, let's talk about your first talk that you gave it at IOC, which is about the athletes voice. So take us through it. And then we'll ask some questions. So I'll, I'll shoot it over to you.
03:17
Yeah, so um, my first talk, the first symposium that I was involved in at IOC this year, we had titled The athlete's voice, and those of us who were involved with it, we're really proud to be able to get this topic, this kind of conversation onto the agenda in Monaco. I had so many people comment to me afterwards, that this was the first time that we've been able to have this kind of discussion at this specific conference. And, you know, previous editions, I think, have been very much focused on that biomedical that I was just talking about, given that it's Sport and Exercise medicine. And it was the first time that we've been able to bring athlete voice into this space. And so this symposium in my talk in particular, was really focused on qualitative research. Even though when we pitched the symposium, we kind of decided that we couldn't call it qualitative research, because it wouldn't have been accepted at the time. And, and now, it's amazing to me how far we've come that we can actually talk about qualitative research in these spaces. So what I spoke about, and what I was interested in is, you know, what are the kinds of different knowledges and who are the people that we might listen to in Sport and Exercise medicine and sports injury more broadly, that traditionally we maybe haven't scented and haven't listened to? And I was interested in those kinds of social meanings of injury and of injury prevention and how we might do things differently. So you know, for me, it was that Recognizing the value of alternative perspectives, and working across disciplines and advancing our research and practice in this way. And so that's really what I spoke about was, you know how we might do these things differently by actually listening to the people at the center of our work and listening to athletes themselves. And that was really the focus of that symposium.
05:26
And in looking through some of the slides from the symposium, some of the quotes that I'm assuming we're taking from the qualitative work are, gosh, they're kind of heartbreaking. So what do you do with that information once you have it, right? So you're conditioned not to quit, you turn off your emotions, you become a robot as soon as you step onto the field or the pitch or the court. So how do you take that qualitative research? And what do you do with that once you have it?
06:01
Yeah, so you know, my talk, the way I kind of structured my talk was to talk about how we generally do injury prevention. And what we generally do is we, you know, figure out what the issue is what the injury problem is, we develop an intervention, and then we implement that in intervention and hope that it works. And, and some, you know, that's the kind of general cycle that we use. And what I decided to do in my talk, which was only a 10 minute talk was to dedicate two of those minutes to a video that I showed, that was just set to music that flashed up all of these quotes from athletes. And there were quotes that I'd collected from a number of different sports, a number of different athletes and spaces over the years, that really speak about their experience in sports and these toxic environments, which is something that I think we tend to kind of put to the side, maybe sometimes and ignore, sometimes in sport, when we put sport up on a pedestal and only think about the good things that happen in sports. And those quotes are also, I guess, a throwback or connection to one of the other talks that I had at IOC, which is not something that I think we'll speak about today, but about safeguarding and recognizing safeguarding as an injury prevention issue. And so we had these, like two minutes of these quotes from athletes. And I think that video really signaled a palpable shift in the room in recognizing what athletes are actually saying, and what their experiences are in sport about needing to, I guess, you know, put their their kind of robot hat on and be this strong person within sport where they can't break down where they can't have injuries or anything like that. Otherwise, they're going to be the team. And just for us to come back and to recognize that humanity in that experience, within sport, I think is really, really important, especially when we're at a conference where we're talking about injury prevention and interventions, we have to recognize the human at the center of those experiences. And so for me, coming back to your question about what do we do with that information? I think that's really powerful information, in terms of how we think about what injury prevention is, and does. And I guess we always focus on bodies, and you know, body parts, the ankle, the knee, the hip, the growing. You know, that's, that's kind of been a big focus of injury prevention. And I think we often forget that injury prevention is and can be so much more than that. And that there are these social factors, or social determinants, that to play into injury and its prevention. So the social aspects of our lives in terms of, you know, abuse that might happen in these spaces, or just being exposed to toxic spaces, you know, how that does actually render us more susceptible to injury, and how that can thwart our injury prevention efforts in these spaces. So for me, it's about integrating both of those two things I think together, and that's what I'm kind of getting at with qualitative research.
09:19
And, and that leads me into something else I wanted to talk about, and that is a review from the British Journal of Sports Medicine that you co authored with Joanne Parsons and Stephanie Cohen, anterior cruciate ligament injury towards a gendered environmental approach. And what you just said, triggered in me something in in reading through that article was that there's intrinsic factors and extrinsic factors that can lead to injury and injury prevention programs, if done well, should incorporate both of those. Right but they often concentrate on the biomedical part of the The, whether it be strength training, or landing, or, you know, whatever it may be when we look at a lot of these injury prevention programs, but there are so many contextual issues and extrinsic issues that can impact any of those programs. So I'll kind of let you sort of talk through that a little bit and talk through some of the main points that you found in that paper. But gosh, it really gets you thinking like, Well, wait a second, it could be, like you said, if you are, depending on the environment in which you live, can have a huge impact. And it's, it's more than just, especially when it comes to girls and women, it's more than just oh, it's because you have your period. And that's why this happened. Or if your hips are wider, that's why you got injured, right? So go ahead, I'll throw it over to you. And you can kind of talk through that paper a little bit, and then we'll see what comes up.
11:04
Mm hmm. You know, I'm so happy to hear you say that, because I'm so I'm not a clinician, but it has been amazing to me to hear how this paper has resonated with clinicians and people working in this space in terms of your own experiences and what you see and what you hear from the people that you're working with. So yeah, you're absolutely right. I mean, this paper was born out of conversations that Steph and Joanne and I had in terms of how we were frustrated by I guess, the discourse around sports injury, particularly for girls and women, often being blamed on our physiology on our bodies, right. And to us, that seems like a bit of a cop out. And just to say, oh, you know, girls are more susceptible to ACL injury, because they have wider hips, so there's nothing that we can do about it, you know, so that's really pitched us that intrinsic risk factor that girls and women are just inherently weaker, or supposedly more fragile than boys and men, and there's nothing that we can do about it. So we're just going to have to kind of live with those injury breeds. Right. And, and we found that this kind of thinking had really underpins so much of the injury prevention work that we'd seen over the last 10 or 20 years. And we wanted to problematize this a little bit and to think through what those kind of other social and I would say structural determinants of sports injuries are. So I'm starting to talk about this idea of the social determinants of injury. So not just what are those intrinsic things, but actually, what are the what are the other other social modes, I guess, that we might carry that might lead to injury. So in this paper, we speak about how we, as human beings, literally incorporate I think, biologically, the world in which we live. So our societal or ecological circumstances, we incorporate that into our bodies. And so we can start to see how injury might be a biological manifestation of exposure to that kind of social load. So for girls and women, how our gendered experience of the world might render us more susceptible to injury, rather than just positioning ourselves as being more weak, or more fragile. So we were interested in how society makes us and skills in women more weaker, and more fragile. And so in this way, we speak about how you know, from the time that we're babies, girls are not expected to do as much physically we are brought up differently to young boy babies might be when we go through school and play sport in school, we play different kinds of sports, and again, you know, on average, or in general, and girls, goes out, you know, not encouraged to be as active and to do as much with our bodies as boys. And we then go in right to have this kind of that cumulative effect of less exposure to activities and doing things with our bodies. Actually, that is what leads to us being more susceptible to things like ACL injury over time. And this is carried on in the kind of elite sports space as well. So we see how girls and women's sports are devalued in so many ways and how we're not expected to do as much or to perform as well. Or to train as hard I guess, as boys and men So an example of this that actually happened a couple of weeks after we published the paper was the NCAA March Madness. I don't know if you remember, there were those pictures that were tweeted all over social media, about the women's division, only being supplied with one set of teeny, tiny Dunda. Whereas the men's division was given, you know, massive weight room with everything that they needed to be able to train to be able to warm up and do everything that they needed to do in that state. And the first that was just an excellent example of what we're talking about in terms of girls and women being expected to and actually being made, I guess, weaker than boys and men are in exactly the same sports spaces. And so that's kind of a rundown, I guess, of what we wrote about in the paper.
15:53
Yeah, and I look back on my career as I was a high school athlete, college athlete, and not once was it, hey, we should go into the gym and train with specific training programs, because it will help to make you stronger, maybe faster, better, less prone to injury, but the boys were always had a training program. You know, they always had a workout program. So I can concur. That is like a lived experience for me as to what training was like, comparing the boys versus girls college straight through or high school straight through to college. And yes, that March Madness thing was maddening. Pun intended. I couldn't you could not believe couldn't believe what we were seeing there. That was that was completely out of bounds. But what I'd like to dive in a little bit deeper to the article, not not having you go through everything line by line. But let's talk about the different environments that you bring up within the article, because I think they're important. And a little more explanation would be great. So throughout this kind of ACL injury paradigm, you come up with four different environments, the pre sport environment, the training environment, the competition environment, and the treatment environment. So would you like to touch on each of those a little bit? Just to explain to the listeners, how that fits into your, into this paper and into the structure of injury prevention?
17:31
Yeah, sure. So um, yeah, what we did with this paper was we take we take the the traditional ACL injury cycle, and that a lot of us working in sports injury prevention are aware of, and we overlay what we called gendered environmental factors on top of that, so we wanted to take this this site, call and think through how our gendered experiences and girls and women, again render us more susceptible, and over the course of a lifetime, or a Korean. And so starting with the pre sport environment, you know, that goes back to what I was just saying about girls and boys being girls being socialized differently to boys, when we're growing up. So that kind of life course effect, gender affects over the life course, in terms of what we're expected to do with our bodies. That really starts in that pre sport environment when we're babies and young boys and young girls. And then we track how that works throughout the ACL injury cycle. So moving into the next step, coming back to this NCAA example, you know, what the training environment looks like, and how it might be gendered in ways that we might not even pick up on. So another example here, and this is a practical example that we've given to some sports organizations, since then, is, you know, the kind of gendered language that seems like everyday language and sport that can actually be really harmful to both men and women. So for example, you know, talking about girl push ups, you know, that really does set a precedent for what we think about girls and women in sports spaces. When you say, Oh, you go over there and do some girl push ups, it really does render girls and women as being more weak, you know, weaker and more fragile than boys and men. So those kinds of gendered experience in sports spaces, and you're an example there is really key. But then we also talk about kind of during injury and post injury as well. And this comes more into the kind of rehabilitation space and so on how, again, expectations of girls and women's bodies might play into what we expect when we go through rehabilitation as well and, and how that plays into that ACL injury cycle of recovery, as well. So that's really for So it was overlaying gender, across all of those spaces. And I think that gives us a really powerful way of looking at ACL injury differently and to, to conceptualize what we might do both in injury prevention, but also once injury has happened to help girls and women differently.
20:20
And in reading through this paper, and and also going through the slides that you graciously provided on Twitter, of of all of your talks at IOC, as a clinician, it for me, gives me so much more to think about, and really sparked some thoughts in my head as to conversations to have with the patient. So what advice would you give to clinicians, when it comes to synthesizing a lot of this work? And taking it into the clinic, talking with their patient in front of them and then implementing it? Because some people may say, oh, my gosh, I have so much to do. Now, I have to read all of this. Now I have to incorporate this, do you know what I mean? So it can some be somewhat overwhelming. So what advice do you have for clinicians? Yes,
21:13
so I really do think and as I said earlier, I think a lot of what we're seeing here is what clinicians are doing all the time anyway, I think, especially people who are already connected to this kind of idea of this social determinants of health. And so I guess, for me, it is really just being cognizant of, and being able to have those conversations with athletes, with patients with people that you work with all the time, about their social conditions of their lives. So not again, not just reducing people down to bodies, but recognizing that people have you know, that the social conditions of our lives play into our injuries and our rehabilitation, and holding space for that, you know, when I'm teaching, that's what I say to my students all the time, but I know that that you know, this, and clinicians know this better than I do. You, you know, it's not just about saying to someone, go away and do these exercises, and come back to me when you know, that person might have a full time job with three kids to look after. And, you know, a lot of other things on their plate as well that that one exercise or exercise program isn't necessarily going to be the silver bullet or the answer to, you know, the way that they need to be dealing with that injury. So I think for me, it's again, that re humanizing and being able to have those those conversations and recognizing those social determinants of injury or recovery, and so on. And so I think for clinicians, it is about not simply seeing rehab as a biomedical issue alone to solve, but thinking about it as socially and politically and materially oriented as a practice that you might incorporate in your way of thinking. That's really it. It doesn't need to be any more than that. We don't need to complicate it. Any more than that.
23:10
Yeah. Perfect. Thank you for that. And as we start to wrap things up, is there a, are there any kind of key points that you want to leave the listeners with? Or is there anything that we didn't touch on that you were like, oh, I need I need people to know this. This is really important. Hmm.
23:36
Yeah, I think, you know, if we kind of connect the conversations that we've kind of had today with the different points that we've connected to, I think, you know, what I saw in IRC at the IOC conference in Monaco is I really felt especially on day one at that athlete centered symposium that we had, I really felt like a palpable shift in that room. And in the conversations that I've had afterwards, with people I've had so many people come up to me to say that, you know, that it was really inspiring, and it's helped them to be able to go away and have different kinds of conversations, incredibly have different kinds of conversations about the work that we're doing in injury prevention and in Sport and Exercise medicine more broadly. And so I really think that we need to focus on that idea that injury prevention and a contemporary vision for injury prevention needs to be athlete centered and human focused. And I think if we truly committed to this, I think the ways in which we develop our interventions, and the ways in which we might go about our work, more generally in Sport and Exercise medicine, in physiotherapy and so on, it needs to reflect the socio cultural, so meaning those social determinants of injury in cluding the ways in which things like sexism, and misogyny, and racism, and classism, and ableism, and homophobia and transphobia, how that all can and does actually lead to injury. I think those are larger conversations that we need to be having enough field that we've started to have very slowly, but they are difficult conversations to have. And we often cut them out when we only think about injury as a biomedical thing, again, only thinking about bodies. And so for me, I think those are the those are the thing that we now need to get uncomfortable, you know, about, we need to have those uncomfortable conversations about our complex, messy realities, and that we're dealing with that athletes are human beings, that these are our experiences of the world, that sport and exercise medicine needs to reflect that as well. In terms of our composition, we need to reflect the communities that we serve as well. And Tracy Blake talks about that often. And you know, those are the conversations that I'd like to see our field having going forward. And I do think there was a shift in being able to say those things at Monaco this year.
26:16
Yeah. And so what I'm hearing is, was the big takeaway for me from Monaco is context is everything. And we can't, we can no longer take that out. And focus, like you said, just on the biomedical aspect of this person in front of us as if they don't have past experiences and emotions and thoughts and fears and concerns. And context is everything. And for clinicians, it sounds like a challenge to start having these conversations at more conferences. I know it's this little kind of bubble of clinicians, but if it can start there, perhaps it can make a ripple out into the wider public and into having these conversations with your athletes and patients and not be afraid to have these difficult conversations, or to ask the probing questions to the person in front of you. Because they're more than just their ACL injury, they're more than just their back pain. So I think challenging clinicians to have these conversations, whether it be one on one like this, or within large groups at conferences, and then take that back to your, to your practice and really start living it and understanding that this can is as important, maybe, in some cases more important than the biomedical injury in front of you.
27:41
Oh, I could not agree more with that statement. I mean, something that I've spoken about a lot before is that, you know, sport isn't neutral. It's not a political. And it's the same for the work that we do. It's, you know, for far too long, it's been positioned as a neutral science thing that we do. And I think we're now starting to recognize the context around that, that our values and our principles and people's lives and experiences, you know, as you say, play as much as if not more of a role in their experience of sport, and injury, and rehab, and all of that. So I would agree with you completely, we need to be having more of these conversations, we need to recognize this within our research, we need to recognize this within our practice. And we can't keep going on as if you know, none of so if we can remove all of that from the practice of working with human beings and being human beings as well. You know, all of this is connected for me. And as you know, as we're seeing now, it's for all of us who work in this space, once we start to have these conversations, we can start to ask different questions, we can start to think about things differently. And I think that that's really powerful for the future of our work in this space.
28:55
Yeah. And I think it's also important to remember that we can start to ask these questions start to have these conversations that the answers aren't going to come tomorrow. So that instant gratification that has become the world that we are now living in that if it doesn't happen within the next couple of days, that means it's not going to happen, but that these ripples will take some time. Yeah, absolutely.
29:19
And, you know, so a lot of my work is in complexity theory. And what I say about that is, you know, there probably are not going to be hard and fast answers here. But it will bring up new considerations and it will bring up I think, I'd like us to move away from this idea that we can solve things, but actually move closer towards the idea that this is an ongoing practice. And that that's always going to be I think, more powerful for me when we see things like injury prevention as a process or a practice. That's not necessarily going to solve things. But that is you know, really To the context in which we live in our lives is an ongoing thing. And I think that's what we brought into the ACL injury cycle. Papers. Well,
30:09
yeah, I think it takes away from the clinician as being the MS or Mr. Fix it to, okay, we are layering ourselves into people's lives. And we need to be able to do that in a way that fits the person in front of us as best we can.
30:26
Yeah, exactly. Beautifully said exactly. We can't necessarily solve those things for them. But these provide considerations, things that we can do. And yeah, we can move with that.
30:39
Yeah, absolutely. Well, Cherie, thank you so much. I mean, we can go on and talk for days on end about this stuff. And perhaps when one of these days we will we'll have a bigger, wider, broader conversation and and make it go on for a couple of hours, because I'm sure it will bring up a lot of questions, maybe some answers, and perhaps some changing of minds when it comes to injury prevention and what our role is as clinicians. So thank you so much, where can people find you?
31:13
Thank you, Karen. And I love that I think broader conversations are so helpful in this space. So people can find me on Twitter at Shree Becker, that's probably the best place to find me. I'm always over there and happy to have broader conversations with everybody. So please come and find me on Twitter.
31:32
Perfect. And we'll have links to everything, including the paper that we're talking about. From BDSM. We'll have links to everything at the show notes at podcast dot healthy, wealthy, smart, calm. So one question left that I asked everyone and that is knowing where you are now in your life and in your career? What advice would you give to your younger self?
31:51
Oh, so that's a really good question. And it's I think it's my Elan series, again, connected to what we saw in Monaco. And something that I've said for many years now is connection is greater than competition. And something that I live in that I feel like I wish I had done earlier is to hold on to the power of connecting with people who are at the same career stage and doing work with people who are at the same career stages as you especially someone who has and is an emerging researcher, or researcher clinician in this space, because I think the exciting new conversations that we're seeing in this space are coming from people who are you know, recently merging, I guess, in these researchers faces and so it's okay to collaborate rather than being in competition with people who are doing great work in your area. So that would be my advice.
32:54
I love it. I love it and couldn't agree more. So Sheree, thank you so much for coming on. Thank you again. I appreciate it.
33:02
Thank you so much, Karen. And everyone. Thanks
33:04
so much for tuning in and listening and have a great couple of days and stay healthy, wealthy and smart.
In this episode, Founder of the Rizing Tide Foundation, Heidi Jannenga, returns to the podcast to talk about fostering diversity in the physical therapy industry.
Today, Heidi talks about the incredible work being done by the Rizing Tide Foundation, the process of awarding scholarships, and future Rizing Tide developments. Which changes still need to be made in the industry?
Hear about the growing student debt problem, how you can get involved with Rizing Tide, and get Heidi’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Almost every single one of them [students] were working full-time jobs at the same time as going to PT school. Some of them, more than one job.”
- “There’s a huge segment of the folks that answered that survey that have more than $150,000 of debt post-graduation.”
- “It takes a lot to try to balance the price of education to what we actually are getting paid as clinicians.”
- “A rising tide raises all boats.”
- “Be open-minded to a path that you may not have thought that you might go down.”
- “If something aligns with your vision and values, then go for it.”
More about Heidi Jannenga
Dr. Heidi Jannenga, PT, DPT, ATC, is the founder of the Rizing Tide Foundation, which seeks to inspire more diversity and inclusiveness in the physical therapy industry. Each year, Rizing Tide presents scholarships to five promising BIPOC (Black, Indigenous, and people of color) students who are on the path to earning their Doctorate of Physical Therapy (DPT) or furthering their PT education by pursuing a residency program.
In addition, Heidi is a physical therapist and the co-founder and Chief Clinical Officer of WebPT, a nine-time Inc. 5000 honoree and the leading software solution for physical, occupational, and speech therapists. As a member of the board and senior management team, Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for rehab therapists, women leaders, and entrepreneurs on a national and international scale. Since the company launched in 2008, Heidi has guided WebPT through exponential growth. Today, it’s the fastest-growing physical therapy software in the country, employing over 600 people and serving more than 90,000 therapy professionals - equating to an industry-leading 40% market-share.
In 2017, Heidi was honored by Health Data Management as one of the most powerful women in IT, and she was a finalist for EY’s Entrepreneur of the Year. In 2018, she was named the Ed Denison Business Leader of the Year at the Arizona Technology Council’s Governor’s Celebration of Innovation. In addition to serving on numerous non-profit leadership boards, Heidi is a proud member of the YPO Scottsdale Chapter and Charter 100 as well as an investor with Golden Seeds, which focuses on women-founded or led organizations.
Heidi is a mother to her 10-year-old daughter Ava and enjoys traveling, hiking, mountain biking and practicing yoga in her spare time.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, Representation, Scholarships, Diversity, Inclusivity, BIPOC, Student Debt, Education, Opportunity,
Resources
Higher Education? By Andrew Hacker and Claudia Dreifus.
Apply for a Rizing Tide Scholarship.
To learn more, follow Heidi at:
Website: https://rizing-tide.com
Twitter: @HeidiJannenga
LinkedIn: Heidi Jannenga
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Read the full Transcript Here:
SUMMARY KEYWORDS
rising tide, scholarship, pt, students, people, heidi, industry, physical therapist, foundation, profession, podcast, scholarship program, year, works, residency programs, physical therapy, pts, residency, crest, education
00:07
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everybody, welcome back to the podcast. I'm wishing you all a very happy New Year and welcome to the first episode of 2022. We've got a great one in store. But first, a big thank you to Net Health for sponsoring today's podcast episode. So when it comes to boosting your clinics, online visibility, reputation and referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and get five star reviews. So they have a new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using NET Health's private practice EMR, be sure to ask about his new integration, head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit. Okay, on today's episode I'm really excited to have back on the podcast Dr. Heidi J. Nanga. She is the founder of the rising tide Foundation which seeks to inspire more diversity and inclusiveness in the physical therapy industry. Each year rising tide presents scholarships to five promising bipoc students who are on the path to earning their doctorate of physical therapy, or furthering their PT education by pursuing a residency program. In addition, Heidi is a physical therapist and the Co Founder and Chief Clinical Officer of web PT, a nine Time Inc 5000 honoree and the leading software solution for physical occupational speech therapist. As a member of the board and senior management team Heidi advises on web PTS, product vision company culture branding, efforts, and internal operations while advocating for rehab therapist women leaders and entrepreneurs on a national international scale. Since the company launched in 2008, Heidi has guided web PT through exponential growth. Today, it's the fastest growing physical therapy software in the country employing over 700 people serving more than 90,000 therapy professionals, equating to an industry leading 40% market share. In 2017, Heidi was honored by health data management as one of the most powerful women in it. She was a finalist for he wise Entrepreneur of the Year in 2018. She was named Ed Dennison, Business Leader of the Year at the Arizona Technology Council's governor's celebration of innovation. In addition to serving on numerous nonprofit leadership boards, Heidi's a proud member of the YPO Scottsdale chapter and charter 100 as well as an investor with golden seats which focuses on women founded or led organizations. She is also the mother's 10 year old daughter Ava enjoys traveling hiking, mountain biking and practicing yoga in her spare time when that spare time is I don't know. So today we are talking about the rising tide Foundation. And if you are a physical therapist and you are hoping to go into residency or you're in your residency, you must listen to this episode because you can win a scholarship from the rising tide foundation. If you're listening to this today, Monday, you have until Friday in order to to submit an application to the rising tide foundation to get a scholarship for your residency. So get on it people a big thank you to Heidi and everyone enjoyed today's episode. Hey, Heidi, welcome back to the podcast. Happy to have you back on.
04:02
Hey, Karen, so great to be here. Thanks so much for having me.
04:05
And so today we're going to be talking about a foundation called the rising tide foundation. So what is it and why did you decide to start this foundation?
04:19
Well, thanks so much for having me on. And to be able to talk about this because it really is a has been a labor of love. And a true way for me to give back to a profession that has given so much to me. The Rising Tide foundation really started after a few years of us doing the real estate of rehab therapy industry report which you and I have talked about on this podcast, and every year. There doesn't seem to be a change into two major things that we ask the serve the people that we survey, one was what you mentioned student debt, and actually, not that it hasn't changed, it's actually increasing. And that's a big burden, as you can imagine, to an industry. And then second was actually the biggest emphasis, which is the the, the lack of diversity within our profession. And being a person who identifies as a person of color. The fact that we have this lack of diversity has been a real, real issue, that hasn't made much change, despite, you know, the APTA and others sort of bringing attention to the issue. But the percentages as far as what the makeup of our profession looks like, has not changed has not really changed at all, in the last five years that we've been doing that survey. And so that was really the two major impetus behind me starting this foundation, I've been lucky enough to have financial success with web pt. And so had started the rising tide Foundation, not knowing what I wanted to do with the foundation back at the end of 2019. And then with everything that happened through 2020, it just sort of hit me over the head that this is something that I can personally make a difference in, within our profession. And
06:39
what exactly does the rising tide foundation do?
06:45
It is a scholarship program. So we have two tracks of scholars. We have the crest Scholarship, which is actually geared towards new and new students coming into the profession. And so we provide $14,000 scholarships to three participants, or three scholars, three scholarship winners, that is renewable for the three years PT school, and then we have to serve scholarships, which actually is for physical therapists who are going on to residency programs. And those are $10,000 each, for the one your usual one year program of residency. How, how
07:41
are these winners chosen? What give us a peek sort of behind the curtains, if you will, as to how the process works, so that if people listening to this, whether you are a physical therapy student, or you are one of those people like Gosh, I really want to do a residency, but I don't know how I can make it work financially. So how can these folks apply to the program and and like I said, gives a little peek behind the curtain on how it all works?
08:12
Sure, well, first and foremost, you have to qualify and so if you go to rising dash tide.com, you will find all of the specific sort of qualifications that are required. So for example, for the crest scholarship, you are either an undergraduate who is applying or an undergraduate who is applying to PT school. So you have will have graduated from an undergraduate with an undergraduate degree going on to DPT program, or you're a PTA that's entering into a PTA Bridge Program, which is there's only a couple of schools that do that. But we are also providing scholarships for any PTA who they want to go on to get their DPT so there is a actual physical, like documentation style application, which you have to fill out as well as writing three short essay that include questions like What inspired you to become a physical therapist? And, you know, what does it mean to be a community member? And then also, you know, we really wanted to dive into the essence of who the scholars are. Because we feel like we want to invest in professionals who who are really going to want to make a difference in the profession. So the last question is talking about sort of a failure that you've experienced in your life and what you've really learned from that training. Did you know dive into a little vulnerability and understanding of who they are at the core of the person. And so you also need some letters of recommendation, and transcripts in the normal sort of thing that you might think about in going through a scholarship. So once you you send all of that information. We have a selection committee, which I'm really, really proud of. I was honored to gather quite a few thought leaders from the industry including a fossa, Joe Badea, Maria Gonzalez seen Sharon Wang is actually not from the industry. We wanted to bring together our selection committee, which I call our Beachcombers, hopefully see that sort of nautical theme here. Wendy HARO, who is a software engineer actually works with me with PT, Moyer Tillery, who is also a PT, and then Jean shamrock rod. And those folks make up our our base comers who were to which our selection committee, so we scour all of the applications that come in for each one of the scholarship programs. And we narrow it down to around 10 finalists, and each of the finalists and have to go through an actual live video interview with the selection committee. And from there, we then get the really tedious and hard, difficult decision to narrow it down to the three winners. We just went through the crash scholarship selection process, and it was absolutely amazing. And, and we we were able to narrow it down. But having been our first process, it was just an incredible experience. And we had so many great applicants that we actually ended up awarding five scholarship winners, three of the full scholar, scholarship cross winners, and then we actually started two new sub winners, which are the what we're calling our rising stars, which actually got $5,000 scholarship towards their tuition and, and fees, they might be paying towards PT school.
12:35
That's amazing. And how many people applied for the crest scholarship?
12:44
Yeah, you know, Karen, you know, all about startups right in that first, first year, you kind of are working out the kinks, you're trying to figure out the right processes to have in place. And we had a fairly short window of about 60 days, 45 to 60 days that we opened up the application process this year, for our first cohort of crest winners. And our goal was to get 20 applicants. And after a social media polish and the PR, including, you know, me talking on a few podcast, we actually got 40 applicants which I was so so thrilled about. So we doubled the number that we wanted, then, obviously through that process, it's was so great that we couldn't actually just narrow down to three. So we actually awarded five scholarships and I I just wanted to give a shout out to the amazing scholars that did winner that are part of this first first cohort we had three winners from Northwestern University, Ruth Morales Flores is actually a second year students. Ricky Loki, who is a first year in Jackie Hua, who was a first year as well, just phenomenal, phenomenal students. And Alicia lead from Washington, St. Louis University and Tyrrel McGee, from Regis University. So a really broad spectrum of really interesting and thoughtful students who I know are going to make huge impact on the industry moving forward.
14:29
And you know, you had mentioned that part of the application process was interviews. So a lot you had the members of the committee interviewing 10 Different students and you're reading through 40 different essays. So what did you learn about the PT education system through hearing from all of these applicants and the eventual winners of the scholarship program?
14:59
Well, for First and foremost, as I mentioned, one of the goals and the mission of rising tide is all about improving the diversity of the workforce within our industry. And so, obviously, you know, the number of students that have been accepted to PT school in order to really receive this scholarship and qualify for the scholarship has to be people of color. And so the fact that we were able to get the number of scholarships applications that we did, in such a short period of time, was amazing to me. And, and I attribute a lot of that to the physical therapy, schools really putting diversity as a high priority in terms of their recruiting process of really also trying to change the face of who we are, and to become less homogenous, and more reflective of the society in which we live in. And so that was a real, I want to say, eye opener, but but pleasant surprise, that, you know, despite the fact that we haven't seen the numbers change, that it is something that is a huge priority, and is now after a few years of changing processes, and changing how the recruiting, where they're recruiting from and how they're actually going through the actual student selection process. For example, there are many schools now that are either eliminating, or D prioritizing SAP scores as an entry component, or GRE scores as it goes into graduate school, as a as a component of the process, and putting a higher priority on interview and essays and other things and more more, I guess, tangible areas of interest as they go through the, the selection process for their incoming classes. And so that was a that was really positive for me to really hear that. But it more than that, it was the passion that the students had for the industry. You know, I don't think much has changed in terms of why people get interested in the PT field, most of them had had experiences, whether it was personal or with family members, that really sparked that inspiration to to go into the PT field. Some of the other things that were just amazing about these students is almost every single one of them were working full time jobs, at the same time as going through PT school, some of them more than one job. We heard stories of, you know, students who basically had to decide whether they were going to pay for food, or pay for a book. And so the determination and just the sheer passion around why the and what they're able to do in order to accomplish their goals, was just astounding. And I don't know that, you know, most people understand the sort of path that, you know, underserved populations sometimes have to take in order to accomplish those goals.
18:54
Yeah, that's amazing. What a great group that you you got to meet. Now, after talking with these students, aside from the fact that hey, schools are kind of changing the weight of inclusion criteria, what further changes do you think need to be made within the industry? And on that, we'll take a quick break to hear from our sponsor, and be right back with Heidi's answer. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing Audit?
20:01
Well, we know as, as we you, you started talking about in the beginning of the show is the student debt ratio that pte students are coming out with post graduation. We've seen that time and time again, in our state of rehab therapy industry report, as we surveyed, you know, 1000s, of therapist to understand their biggest woes, as they are navigating through this profession. And, you know, I, there's a huge segment of of the folks that answered that survey that have more than $150,000 of debt post graduation. And that was a 5% increase over what we found those numbers to be in 2018. So just in a few years, that number has grown significantly. And so that's to me, it's just not sustainable. When you compare what the compensation is, for an average, you know, new grad, being somewhere between depending on the type of PT services that you're delivering anywhere from 60 to 90 grand. That's just not commensurate to be able to be able to live and then pay off that debt, which you know, $150,000 in PT school usually means on top of another 100 grand at minimum that you you've accumulated through undergrad. So we're talking a huge, tremendous amount of debt. And so what I know is also happening is looking at shortening the timeframe in which it takes to get a doctorate degree, there are universities and colleges like South College, that are changing the way we think they're trying to change the way we think about PT school, where it doesn't have to be 100% in person that, you know, a large portion of the time spent can be done online. So that cuts down significant amount of debt in terms of having to pay for housing and other things. And it just becomes more accessible to more people, and decreases the cost of the overall educational process. So I really think that the cost of education, rethinking how we do the curriculum, of what truly is necessary to be in person are things that that really need to be looked
22:40
- Yeah, and when we talk about that sheer amount of, of debt, when I speak about that to other people, I always preface like, you know, like you said, Pts are coming out of school 50 to $90,000. It's not like we work at Goldman Sachs, where in two years you get like $500,000 Bonus, do you know what I mean? And and why law paid off? Right? So it's a little bit different PTS are not usually getting a $500,000 bonus. May I don't want to, I don't want to get yelled at by people on the internet. But I'm pretty sure that doesn't happen often.
23:21
No, I don't think that happens very often. As a matter of fact, I think, you know, especially in the times that we're in right now, you know, the the 5%. Five to maybe 10% increase year over year is probably what's on average. So, you know, it's gonna take you a while, especially if you're you're starting out as a new grad in that maybe 60 to 70 range to even get to the, you know, the six digit. Right. And so, yeah, it takes a lot to try to balance the price of education to what we actually are getting paid as, as clinicians.
24:05
Yeah. And and if there's a really great book, Heidi, I don't know if you've ever heard of heard of this book, but it's called Higher Education question mark. And it's by Andrew hacker and Claudia Dreyfus. And they talk about the cost of higher education. And what are some of the extraneous things happening on college campuses that aren't going directly to the education of the students, but yet is being reflected in the price of admission. So if people want to learn more about that, I would highly suggest reading that book.
24:40
Yeah, absolutely. There's a lot of debate happening right now around higher education and the need for it. You know, I know even within our own profession, there's a lot of question marks around the DPT on whether it was worth it or not. But at the end of the day, we are here we are At level professionals, but we do need to figure out if we are going to continue to grow and have an attract the top talent that we want to continue to have our profession, you know, be recognized as adding, you know, tremendous value to the overall healthcare system. We definitely want to, you know, remain viable and relook and relook at how perhaps we're doing some of the things because I just don't think that the way the path that we're on today is truly sustainable.
25:38
Yeah, I agree with that. And now, let's say you're a student out there, or you're going into residency, how can they get more information to apply for upcoming scholarships? And is there are there any scholarship applications that are due soon?
25:55
Yes, I mentioned we have the crest scholars, but we also have the search Scholarship Program, which is for residency programs. And that current application process is open right now. And so it will be closing on January 14. So if you are a current resident residency program participant, and would like to apply for the surge scholarship, and you are a person of color, you can apply at res rising dash tie.com. If you go to search scholarship on there and just hit the Apply button, it will take you right to the page in which you can fill out all of the information, upload any documentation that we're requiring. And then we will definitely take a look at the application and put you into the process.
26:55
Yeah, so that means if you're listening to that, listening to this podcast today, on the 10th, you have until the end of this week, so get on it if you want money to help you get through your residency, so you've got like you've got five days, so get on it.
27:14
And this is an annual annual renewal process. So we will launch a new cohort every year. So if you miss out this year, but you're going through your residency programs, this year, you will get another chance at the end of this year to apply for the scholarship. And definitely any students out there who might be listening or interested in the field of PT, and you are going to be a new grad in this upcoming year of 2022. Or I'm sorry, a new student to PT school this year. And please, please, please think about offsetting some of that student debt through a scholarship program like rising tide.
27:55
Excellent. And now what's new with the foundation? What do you have coming up aside from these amazing scholarship opportunities,
28:03
while being part of rising tide means you're part of our community. And so one of the really awesome things that we are going to we are doing with our cohort is getting them together annually for sort of rising tide retreat in which we're going to have thought leaders from the industry come together to help be mentors to these students. Each cohort will be building on itself. So as we have this first group of 2021 Slash 2022 go through this year, they will then come back and be be mentors to our next cohort of students that will be coming through so part of the sort of surge and crafts together where you've got, you know, physical therapists going through residency programs will help to be mentors to these up and coming students. And so creating this community of connection, and education is really what we're planning through 2022.
29:15
I see what you did there. I like it, I like it. And now let's say you're a physical therapist like me, and you're like, wow, I am loving this rising tide. How can I can I donate to this? Can I be a part of this? What can I do?
29:32
Yeah, that's a great question. Karen and I, since launching this this past year in 2021, I just been so honored by the amount of outpouring of support that people have wanted to give to this program, including financial. I mentioned that it was self funded. And you know, We've had many, many years of scholarships that are going to be awarded. But with this outpouring of support of people who wanted to donate financially, I, I went ahead and change the 501 C three status to allow me to have donations. And so in March of 2022, we will be opening up the rising tide foundation to people who want to donate. And my hope is to actually double the number of scholarships that we're going to be able to award in 2022, that we we were able to do in 2021. And so if we can continue to do that every year, so that would mean we would award 10 scholarships in 2022, rather than five for at least the cross scholarship and then four of the search scholars, I think that would be absolutely amazing. And as you can imagine, if we did that year over year, we would be funding almost every PT student in let's say, 20 years.
31:05
Exactly. Hey, that's that big blue sky dream, right? The be hag? Yes, yes, the big big dream. And and, and it's a great dream to help future physical therapists not be saddled with the amount of student debt that a lot of students over the past couple of years have, unfortunately, had to deal with. So I think it's a wonderful foundation. And I applaud you for taking the initiative to putting this out into the world. And again, where can people find Oh, you said it a couple times, and we will have a link to it in the show notes. But where can people find more about the scholarship and about rising tide?
31:49
Yep, it's www dot rising with a Z r i v i n g dash tide.com. And I'm sure many of you have heard the saying rising, a rising tide raises all boats. And that's really where it came from. It's something that has that thing has really meant a lot to me, in how I perform as a leader, and what I sort of prescribed to as sort of my own personal culture of wanting to help people. And so that's where sort of the name sort of stems from. But yeah, go to rising tide.com. And you can learn all about our foundation and scholarship program, you can sign up for our blog subscription, we have a monthly vlogs, coming out about all kinds of things that has to do with how students can improve sort of how they think about becoming a physical therapist, too, just thought provoking ideas as we go about wanting to sort of change the face of the PC profession.
33:05
Perfect. And I'll also add that you're also on Instagram, and on Twitter. So if you go to the website, you can go down to the bottom and click on the little icons, and you can follow rising tide on Instagram and Twitter and LinkedIn as well. That's right. Yeah, perfect. All right. Well, Heidi, as we start to wrap things up, I know, I asked you this before, so you're gonna have to think of something new. What's another piece of advice you would give to your younger self?
33:41
Well, I would just say be open minded to a path that you may not have thought that you might go down, go down. I will just say that, you know, starting a nonprofit, and a scholarship program was really not on on my radar. And as things have unfolded, just like starting in that entrepreneurial mindset, like it works in your professional life, as I'm sorry, it works in your personal life, as well as your professional life in terms of finding problems that need to be solved and figuring out a way to do that. And so stay staying really open minded to things that come your way that may not be necessarily what you think, or had planned to do. To find ways to just try to try new things and be open minded to those options and they can take you down path of trim adding tremendous value and to others but also just in, in in to yourself as well.
34:58
Yeah, excellent advice. keep your mind open. And if something aligns with with your vision and values, then go for it. Great advice. Heidi, thank you so much for coming on to the podcast today talking about rising tide. And again, if you're going to mention this one more time, if you're going into your residency program, check out rising tide, check out the website. We mentioned it several times, also in the show notes at podcast at healthy, wealthy, smart, calm and apply, because you've got a couple of days if you're listening to this on the 10th of January 2022. You've got until the 14th to apply for the surge scholarship. Is that That's right, right.
35:44
That's right. Okay. Well, you got until the 14th until the midnight of the 14th and mentioned that you heard it on rising tide or on the healthy wealthy podcast. And we'll just move you to the top of the stack.
35:56
Yes. So So do it. People get on it be a part of the rising tide. Heidi, thank you so much for coming on.
36:04
Karen, it's always a pleasure. Thank you so much. Yeah,
36:06
of course. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Dr. Heidi Jenga for coming on the podcast to discuss the rising tide foundation and of course, thank you to Net Health. So again, they have a new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net health.com forward slash li te zy to sign up for your complimentary marketing audit to get your clinics online visibility, reputation and referrals increasing in 2022
36:45
Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media
In this episode physical therapist and podcast cohost, Dr. Jenna Kantor talks about the highs, the lows, and everything in-between from the past year.
We talk about:
- The effects of Covid-19 on life and the practice of physical therapy
- Online bullying in the physical therapy world
- Realizing the importance of friendship
- The mental shifts we experienced over the past year
- What we are looking forward to in 2022
- And much more!
More about Dr. Jenna Kantor:
Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, Regional Dance America Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre.
Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia.
During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media.
Jenna Kantor currently holds the position of the NYPTA Social Media Committee, APTA PPS Key Contact, and NYPTA Legislative Task Force. She provides complimentary, regularly online content that advocates for the physical therapy profession. Jenna runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online course for performing artists called Powerful Performer that will launch late 2019.
To learn more, follow Jenna at:
Website: https://www.jennakantorpt.com/
Fairytale Physical Therapy
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00:00
Hey. Hey, Jenna, welcome back to the podcast for our annual year and Roundup, if you will. And I want to thank you for being a great addition to the podcast and for pumping out really amazing podcast episodes, you're great hosts, the energy is fantastic. And the podcast episodes are always great. So I want to thank you for that.
00:27
Oh, my God, you're so sweet. I like I was definitely not as much of a podcaster this year, I acknowledge that. But hey, listen, we've all been adjusting this year to pandemic and now pandemics still happening, but also recovery. And I'm just grateful to still be a part of this podcast in any manner to be in this interview right now. Because I really, you and I are very much on the same page regarding remaining evidence based and speaking to people that we respect in this industry, and also people that we want to see just rise and have great success. So I'm just grateful to be honestly, I am humbled to still be in the room here with you.
01:11
Thank you. That's so nice. So kind. Now, let's talk about this past year. So 2021, obviously dominated by the ups and downs of COVID, which is still going on as we speak. We're we're both in the northeast, so we're experiencing an incredibly high surge at the moment. So COVID is obviously a big story. And I think part of the COVID journey that isn't being talked about as much. But I think general public, certainly the mainstream media, are people now living with long COVID. It is just something that seems to be skimmed over. And we know that at least at least the bare minimum is 10% of people diagnosed with COVID will go on to have symptoms of long COVID. And instead of some of the studies that I have read recently, those percentages are much, much higher. So what I guess, what is your take on all of that? And what do you think we as physical therapists can do to keep this in the in the forefront of people's minds.
02:23
We discussed this before, but I think there's going to be bias within this. So I want to acknowledge that we all have our biases. That being said, I think we need to first acknowledge there was a phase where there was a part of the world that did not think COVID was real. So based on the research that is out there, and personal experience of a lot of people getting it, as well as personal friends very close personal friends working in hospitals in New York, specifically COVID is real. So I want to say that first. I'm not going to differ from that I really wish there I'm I think we're past that in the world. I think there was never a clear cut of like, Oh, I got it, I see that it's real. I was wrong. I would have liked that moment, because that hurt people in the process. But I just want to say that first. So COVID is real. Okay. Now, let's not belittle it. And I think in regards to the patient care. I think this, the reality of long COVID needs to be just as respected. Just like when you have a patient that comes in the door and says they're in pain, and you don't believe them. We need to stop that. So we need to believe them and their symptoms, and what they have and what it's from and treat it accordingly. Because if we go in the door to help out these individuals who are struggling with this, they're not going to get better. What are your thoughts?
03:59
No, I agree. I agree. And I've heard from people living with long COVID that people don't believe them even their own family members, people in who work in medicine, they don't believe them. So I think that's a huge takeaway that if as clinicians we can do one thing sit down Listen, believe because the symptoms that they're having are real. We did a couple of episodes on long COVID thing was back in August and spoke with three amazing therapists and they're all involved with long COVID physios so if anyone out there wants more information on living with long COVID I would definitely steer you to long COVID physio on Twitter and and their website as well. Because they're a wealth of knowledge. These are people living with long COVID their allies, they are researchers and I think they're putting out some amazing information that can help not just you as the clinician, but if you know someone that maybe you're not doing directly treating maybe it's a family member living with long COVID I think the more information you have, the more power you can kind of take back to yourself.
05:10
I love that. I love that. It's the biopsychosocial model. I mean to that I from working because I work specifically more with performers, the psychosocial component, my my patients, my people I call my people, my people would not be getting the results they're getting if I didn't have to deal with that, with them standing by their side, holding their hands helping them through and out of their pain. There's symptoms every day and this that goes for anything.
05:41
Yeah. And and we now know, speaking of performers that a lot of Broadway shows are being sort of cancelled, and then restarted and canceled and restarted because of COVID outbreaks within the cast. So this may be something people might think, Oh, I work with performers. I don't have to worry about long COVID Well, maybe you do.
06:01
Yeah. Yeah. And for them, it's the, from the performance that I'm in contact with on Broadway that, you know, it's I'm, I'm, I'm very connected. I've been in the musical theater industry for a very long time. So for the people who are on Broadway, the individuals I spoken to, they're doing okay, which I'm really, really grateful for. It is a requirement for the performers to be triple vaccinated, and now they're getting triple vaccinated. I know one performer on Broadway, who was about to get her booster shot, and then ended up getting COVID, which was quite unfortunate. She's doing okay, though. Grateful, no signs of long COVID Right now, but for the performers, you're talking about dance, there's endurance and breathing that is necessary. If the singers even if they're, they're not dancing, they still dance, they're still asked to do things, they still have out of breath, emotional moments, were breathing is challenged. So I'm just bringing up one component with long COVID. But that's, that's a big standout for performers specifically, that need, it needs to be kept out for them. I remember one time during, oh, goodness, during 2020. And it was the latter portion of the year. And I was doing virtual readings with performers. That's how I was staying connected with my my friends and people in the industry. And it was our way of being creative. In the meantime, while we're waiting for things to open back up. And one individual is she what I just cast her to read as the lead in the show, and she was so good. It was my first time hearing her perform first time meeting her. She was Outstanding, outstanding. And at the end of it, we were going around checking in with each other how we were doing and she started to cry and opened up about losses and her family due to COVID. And that she didn't think she would be able to sing like that again, because she had been dealing with her breathing problems for so long. And so then we all get emotional with her. I'm getting emotional just thinking about it. So yeah, it's it's a it's a real thing. We didn't have the vaccination then. So I'm interested to see statistically where we are at with long COVID with having the antibodies in our systems. Obviously, everybody is different, but I'm hoping that there's less of it because of the vaccine.
08:25
Yeah, time will tell right? Yeah, we have we need those data points. So aside from obviously COVID being, I think the biggest story of the year, certainly within healthcare and even within our field of physical therapy. What else have you seen over 2021? Or maybe it was in an interview you did or a paper you read that really stuck out for you as as a big part of the year you know, it made it's made it it made its mark for you.
08:58
Oh, I'm going to focus just on the PT community. And I want to emphasize with community I see our community at really, we've always butted heads there's always things that we butted heads on. But I'll just give the instance that really made me go whoa, I was in a room with a bunch of intelligent wonderful human beings and discussing something I said a term that I thought was really common especially because in the musical theatre industry. We are fighting for dei diversity, equity inclusion all the time. Like if this is a topic of conversation all the time. It is a huge thing in regards to casting what is visually out there the most at like the highest level and, and bipoc the phrase bipoc was unrecognized by a good portion of physical therapists in this room and I was disappointed Did I was it said so much it doesn't. It's not saying that a person is evil for not knowing no. And that is not my point. But it is a problem that it's not being discussed to the level where these common extremely common thing phrases are not just known. That just says a lot to me, because it's in regards to people getting in the door access and being reached, in lesser, lesser affluent areas, that to me, it shows that it's not being discussed, it's not being addressed. If it was, then bipoc would be, and this is just one instance. But I thought that was very eye opening. Because it's just like saying, I'm going to eat today, someone saying, I'm not going what you're not eating, I don't know. And that was a bad example. But just something that is or you wake up you breathe, that is how known the phrase bipoc. Same thing with LGBTQIA. Plus, in my community, like, for me to go into another room and for things to need to be defined. I know we all have different worlds. But I think as physical therapists, there, there's a disconnect, unfortunately, depending on wherever we are from, and we need to fix that. Because I can't live everywhere. I can't treat everyone in the world, I can't treat all the performers in the world, I don't want to I like having my niche practice and treating select individuals, and boom, my people do very well. And if it gets to a point that it starts to grow, I'm going to be passing them along because I don't want I don't want that I don't want it to be huge like that. And with that in mind, I need more people who know and therefore are our allies. To me, it's a lack of ally ship, of just not knowing the basic language. And I and I apologize to anyone who's listening on my intention is not to sound like a white savior at all. It's not. But with my limited knowledge at this point, I'm already seeing something that is really, really lacking amongst each other and we need to fix it. I don't know if it's books or I don't know, I don't I don't know the answer to that. But I'm just addressing that was that was the biggest standout thing for me this year.
12:27
And it for those of you who maybe are not familiar with the American Physical Therapy Association, they have what's called House of Delegates. So they had a meeting in September of this year during the APTA centennial celebration. And in that they did pass a resolution that the APTA would be an anti racist organization. Now, were you in the room when that passed? Jenna?
12:54
No, I was not in the room, I was actually there at the House of Delegates a bit discouraged this year, I know. i The fact that they were able to figure out any manner to put it on is is a feat to be had after 2020 20. However, the in person when you go and if you are not a delegate, which I was not this year, you can usually sit in the room, and just be in the back and listen, because the because of the space that they got in the way it was set up, there were chairs in the back of the room, but there weren't that many and it filled up. So they already preemptively set up another room where you could watch what was happening on a TV, which did not sit well with me. Because I could have stayed home instead of flying in for that. So I was definitely not in the room. I definitely was less present this year. Because of that I was I was bitter, I was bitter. I was bitter. I felt like I I already know you it's through elected and know who you know, to become a delegate, but I really felt disrespected and unimportant. Being in a separate room, watching from a TV rather than actually getting to be in the room because there are ways that they hold the meeting where you can stand up to say a point of order to speak on some points from the from the back of the room. And I just wasn't even going to wait to see how they figured that out. I just felt like not a not an important voice. So I wasn't present for that. But I do know about that. I think it's wonderful to get that on the docket. But the same thing when we voted in dei unanimously. How?
14:41
What comes next? You mean? Yeah, well, yeah.
14:45
What is the game plan? Because for me, I can say a sentence like that. But then what are the actual actions and that's where it's like, is that going to happen? Two years down the road three years. What are we at what are we actually doing? What are the measuring points and take action? and not meetings on it, not being hesitant on making mistakes. Let's make mistakes. Let's just go for it. That's the only way we're gonna learn. There's no such thing as a graceful change, no matter how hard you try,
15:11
right? Yeah, yeah, I agree. I think like you said, what comes next is? Well, I guess we'll have to wait and see what are the action steps they're going to take in order to create that and, and live up to the, the words of being an anti racist organization? Because it was passed overwhelmingly.
15:32
Right? And then I'm sure they applauded for it, you know, like, this is great. But to me, I think it's, I it's just like, okay, you know, like, what, but now what? Because from DJI and the I heard that they're trying in the battle in this behind the scenes, trying to move forward, but I have not seen action there. And maybe I'm missing something, you know, feel free to call me out Call me whatever. Like, I'm, I would love to be wrong.
16:07
Yeah, these big organizations are slow ships to steer. That's not any excuse whatsoever. But I understand there's a lot of layers that one has to go through to make things happen. As you know, you've been volunteering for the APTA for a long time. So you understand that, but I think a lot of people who don't don't, so that's why I just wanted to kind of bring that up and saying, like, yeah, it takes it takes a long effing time to get stuff done, you know?
16:33
Yeah. And I mean, you can hear it, I'm frustrated by I'm not, I'm not happy about it. And but it's, it's because of my friends, the conversations I have, and I, I'm, I'm lucky, I'm a sis white, stereotypical female. So like, the way the world has been made, and the way it caters to humans. It fits me, but it doesn't fit everyone and I'd like I can't imagine what it would be like to just be left out of a lot of things in everyday life. I think that's horrible.
17:05
Yeah, agreed. What else? What else do you think was a big something that you saw within the profession? Or even trends in health and fitness that might have really changed over this past year? For better or for worse? I can think of one I think and this is just my opinion that the the communication via social media has gotten a little too aggressive. Is that a nice way of saying it? Like I don't understand it, I don't get it. I took like a little break because I was Oh, can't say I was bullied because I feel like bullying. It's that sort of like you know someone is having like a sustained go at you. So I don't know
18:01
it's bullying is bullying. Yeah, bullying is bullying. That's the thing is that we have a lot of bullying that happens but then they gaslight you about their bullying. It's like Whoa, it's next. It's almost like a strategy. Like they're playing a game of Monopoly, and they have down how to win. Like, yeah, people barely there is a lot of bullying.
18:20
Yeah, a lot of bullying. A lot of threatening, like, I get like threatening DMS or people threatening me, you know, on their Instagram stories or whatever. For I can't imagine I look back at that interactions. And I'm like, I don't get it.
18:38
Yeah, I don't get it. Yeah.
18:41
So I and my first reaction was to like, when people will do this and be so aggressive as to send like a Taylor Swift GIF. Of her song, you need to calm down. And then I have to take a step back and be like, that's not gonna help the situation any. Right, right. Right. Don't do it. I just sort of back off. But I think because of that, bullying or threatening behavior, I've
19:05
really like I'll say it bullying continue. I've,
19:09
I've just like, for the past couple of months, I've really taken a backseat to any kind of social media just to like, give myself like a mental health break, you know, like meeting I don't comment on things. I might post some things here and there, but I don't really make any comments, unless it's to. And that's mainly and I'm going to say this because from what I can tell it's true, is it happens to be men in the profession who are a little more aggressive than the women, like women can seem to have a bit of a nicer conversation around whether it's a question or, you know, something, but when a lot of the men it's just become so like ego driven, that there's no resolution, and it's just mean. Mm hmm. And so I was like I need to take a break. So I saw a lot more of that this year. I don't know if it's because of lockdowns and because of a heightened sense of what's the word? Stress to begin with? And then yeah, or something else on top of it? I don't know. But I, I saw that this year, definitely for the worse, because I just think, gosh, if people outside the profession are looking in and watching these exchanges, what are they thinking?
20:28
Yeah, yeah, I've definitely seen it in sis males specifically.
20:33
Yeah, yeah.
20:34
I'm not it honestly. doesn't it's not a specific color of skin. But specifically sis males.
20:43
Yeah, I would I would agree with that. Yeah.
20:46
I have. I have experienced a little not not to the level, but I've definitely experienced that. And it's for 2021. And it's not okay. No, it's not okay. However, I ever look at it as a blessing. And this is where I get I love looking at it like this. Yes, please, please, thank you. Thank you for identifying that you have no space in my room, my shelf my space at all. I will not take advice from you in the future. And I will not heed any, any value to what you have to say, because of your willingness to chop me down. Thank you for identifying yourself. I'm now in the debate of blocking you from my mental health. And that's it. And that includes in person. That's it. That's it. And I really don't look as blocking as like, wow, for me, I'm going like, No, I don't want to know you. I don't want to know you. And my life is so much better because of it when I was at the PPS conference, because of just going No to the to the people I don't want to know and just saying like, just straight up like I like I don't need you, I don't need you. I want to be a service to people who need physical therapy period. So people are going to just, you know, find ways of you know, and spend their time writing some angry thing. Have that that's on them that's on them. Like I'm like, like, and if it and honestly I will likely block you.
22:18
I love that I love like you're you're it's not just that you're blocking the person. You're blocking the energy blocking the energy they're bringing into you and draining you down. So then you're not at your best well, or with your friends or loved ones patients, even with yourself. Yeah, you know, if you have to ruminate on these people. I love that. Yeah, it's not it's not just blocking you from social media, it's blocking the energy that you the the bad vibes, if you will, that you're Brown. And that affects you that affects your mental health that affects you emotionally. And it can carry through to a lot of other parts of your life and who needs that? Yeah,
22:59
and, and for anybody who's trying to saying like, I can a bully did it or like it. Okay, let's, let's look at it this way, when you're messaging an individual something, first of all, we all know this. When you write in text, everybody's going to interpret it with different tone. So as soon as you write in text, we all know this, and we're taking advantage of that fact. So that way, you can later go, oh, I said it in a nice tone, Bs when you're typing it, it can be in whatever freakin tone and you know what you're doing. Also, when you're not talking to a person, the only time you show up is to say something negative. Yeah, that's you're not your voice is not important. And you know, your voice isn't important.
23:39
It's so true. What I've actually seen is a lot of these, these kinds of people, they're not getting the attention they used to get. Mm hmm. Do you know cuz I think more people are of the mindset of like, I don't need this anymore. Like this was maybe this was funny. Maybe this was cute a couple years ago. Ah, not anymore.
24:01
And also I love I don't like having down moments, but we all have our down moments in our career and in our life. But I what I do love about the down moments in the career in life, the people who are around at that time, those are your friends, those are the people you want to know. So I love my moments in the PT world. When I'm in a down moment because the people who want to talk to me then those are the people I want to know. Whereas when I'm you know, can candidate for the private practice section, you know, which is awesome. And then people want to actually talk to me then. Oh, wait, I'm gonna wait and see when you know, I'm not that. Am I still someone you want to speak to? That is those are the people I want to invest time in. Those are the people I want to invest time in. I want to see you you do well and vice versa. I want to be able to get to know you as a human more and more and more. I just want the children Relationships, it doesn't mean I'm going to have time or you know, we're gonna have time to talk every day. But I want those true relationships. So for me, those downtimes, when I might not look the most graceful, I might be messing up or maybe not messing up. Maybe I'm actually making a change here speaking on something or getting people to think differently ever thought of that, you know? Awesome. Like, are you gonna be here to chop me down? Or just be here to have a conversation and having a conversation? Set up a phone call? If you really care? Like if you really could you don't? People don't care that Oh, reaching out, they don't care about you cannot be when they're reaching out to give feedback. Let's have a comfort. No, they just want to get into an attack mode. No, we No, no, don't try to decorate it. We know that's what's happening. And yeah, that were to town. There's enough going on.
25:52
Yeah, there's enough going on. And you know, this conversation really made me reflect on the past year, and I think what's been a good thing has been the deepening of good relationships. So like, nobody has time for that other, like bad stuff anymore. Like there's enough bad stuff happening. I don't have time for that. But what you do have time for is the relationships that are two sided, you know, a nice bilateral relationship that you're willing to invest in, and allow that relationship to come deeper and grow. And I feel like, you know, and like, you don't have to be friends with 1000 people, you know, you can be friends with a handful you can be friends with one person. And if that person, it's it's real and deep and meaningful, then isn't that wonderful? And I think years ago, I used to think, oh, the more
26:46
people you know, the better. Me too. Me too.
26:49
And now I think because of the upheaval of the last couple of years now, I'm really finding like, you know, I need like couple of good people that I can count on to have my back to, like you said, lift you up when you need to, and maybe to like, give you the honest truth when you need it as well. Right? Exactly. So I've been really, really happy that over the past year, I've made some really nice deeper connections with people than the physical therapy World Sports Medicine world. And I'm really, really happy about that. So I think that's been a real positive for me,
27:26
I totally agree with you, I mean, that our relationship is naturally growing over time, which I appreciate and, and I really do I completely on the same page completely on the same page. And and for me, when I go to conferences, like I'm really isolating more and more, who are the two are the people that like I must spend time with? And and then if other people want to join sure, you know, absolutely. But I I'm not overwhelming myself, oh, I need to be friends with that. No, I don't need to. And you know what, like, that became very apparent when I seen people speak, even at PPS, where the goodness, they were showing slideshows with their friends, and it was like, literally all people who are elected in the higher positions are all best friends with each other. It is it's true, you can't deny it. If you're up there. If you're one of those people. It's true. And you know what, I look at it like this, my friends may go up there to that, mate. That's not why I'm friends with you, though, you know, in friendship through because I like you as a person. So I'm gonna let that lay and not even explain and go into more depth and let people interpret that how they want and the right people will stay in
28:44
my life. Exactly. So what are they? What are they? Let's, let's sort of wrap this up on a positive note. What are their positive things came to you this year, whether it be professionally, personally,
28:59
oh, I think being more comfortable in my skin at conferences. So I had the I mean, absolute honor. Like I was really overwhelmed with happiness at the private practice conference this year. It was just so cool to be nominated. And I felt so much more comfortable in my own skin going up there. I you know, there there are a couple naysayers not realizing there'll be naysayers that, you know that I had to deal with but going up and it was a small moment. But we had you have this rehearsal. I don't know if it's done the same way. For the nominees where they go, you practice when your name is called going behind the podium and then walking down the stairs so you know what to do when you're asked to go out there and give your speech. And I went out there and I did a great vine to my spot. And I mean, I was so happy I did that because I was feeling it and that's what I would do. I did a great fine. And I know that silly, nobody else paid attention to me honestly probably knew that I was doing it. And some were probably like, Oh, but I didn't care. I was like I am on this freakin stage right now, this is the coolest thing. And to be at that place of like more self acceptance, because I know I don't have the stereotypical personality and energy, you know, that that is normally accepted amongst the vast community. So to be more me in that moment, I felt very proud. I felt very proud of myself. And that was really cool. I'm really, really happy about that. And then I like Dan, you know, sat down and ate some more bacon, it was great.
30:46
Well, and you know, being comfortable in your own skin that then comes across to the people who are in front of you. So when the speech actually came about, I'm sure people picked up on that picked up on the fact that you're now more comfortable in your skin that you're more comfortable, perhaps as a physical therapist, and because you found you're not that you've, you've already had this niche, but you sort of found your niche. You know, what, you what you're in the physical therapy world to do. Does that make sense? Yeah, yeah. Yeah.
31:19
Absolutely. Absolutely. And I got a little bit picked on for being too perfect with my speech and everything. And I was like, I you know, in reflection on that, I was like, they just haven't fully accepted my energy. That's okay. Don't get there. Okay. That's it. Don't get there. I'm like, I'm a performer. So it's gonna happen. You know, do you want to join a British company dialect? That's,
31:47
that's a weird comment. That's a weird criticism. Yeah, but yeah, you know,
31:53
but I felt I felt I felt like I had to reflect to go No, I actually felt really good, because I've definitely put it on before. No, I practiced it to be to deliver it. Me as me. And now it's so fun. So fun. Oh, my God. Yeah, I was just that that was a big, positive. Awesome, awesome feeling. I work with so many people who are in the PT industry, who want to be dance physical therapist or physical therapist assistants and imposter syndrome is super real. And so I like that I'm practicing what I preach and self love. And and it's awesome. How are you doing all that this year?
32:36
I'm better. I mean, imposter syndrome, I think, for me is always there, like always kind of underlying the surface, if you will. But I think that's pretty normal. You know, the more and more I listen, or I read about, like, these famous people who are up on stages and in movies, and you know, people who think oh, they have no, they must be like, amazing. And no, they it's the same thing. So I think for me, accepting that it's normal has actually helped decrease it a little bit. Instead of feeling like, oh, boy, everyone else here is like, amazing. And I'm like the loser trying to keep up. And then I think, no, that's pretty normal, because I think everyone else feels that way as well. Yes. And then once once I was able to accept that it makes going up on stage, like, I don't get as nervous as I used to, and it's been. It's been much, much better for me even speaking. Like I was joking, I could say I now I shared the stage with FLOTUS, because at the future physical therapy summit, I spoke for literally a minute and 45 seconds as a spokesperson for the brand Waterpik. So Waterpik has these wonderful showerheads. And they sponsored the future physical therapy Summit in Washington, DC back in September. And so the sponsors got to go up and say a little something. So you have literally less than two minutes, and I had to get all their talking points in. But I also like, decided to make it funny. So I was just saying things off the cuff. And afterwards, everyone's like, that was a great bit. I love that bit about your parents. I'm like, I didn't think of it as a bit. But okay. But then the good news was afterwards, people came up to the table, the Waterpik table, you know, in the, in the hall area, and like the one guy was like, I wasn't gonna come up, but then after that talk, I had to come up and see what you guys are all about. I needed to find out what you were doing and hey, can you do this? And so, for me, I felt as nervous as I was to go up and speak be mainly because it wasn't about me, it was about Waterpik. So I wanted to do them proud, you know, and afterwards, they got so much great feedback and possible partnerships selling through clinics with 700 locations? And can we do a study with Waterpik? On wound care? Can we do a study with Waterpik on people living with CRPS and using these, like, and that's exactly what they were looking for. So that made me feel like much better and gave me a little bit more confidence. And it was also fun to be able to do such things kind of off the cuff. You know,
35:25
that's so cool. Yeah, I love that. You should definitely be proud. That's so cool.
35:29
So that was really fun. And then the next speaker, it was it. The next speaker a two speakers after me was the First Lady of the United States Dr. Joe Biden. So yeah, there you go. No big deal. No big deal. Yeah. FLOTUS. So that was really fun. And was that yeah, for me, I think that was a big highlight of of the year for me, I guess professionally, which was really cool. is cool. That is so cool. It was it was cool. Anything else that for you? Did we miss anything that you wanted to get in?
36:02
Yes. For the Yes, yes. Yes. Okay. I now live in Pittsburgh and and was visiting New York had a great time. I got to see Karen at one of my favorite salad places, although I didn't get my normal favorite salad, which now I'm in regret until I go back again, to get my favorite salad from Sweet greens. It's the kale salad. It's so good. Caesar kale salad. I highly recommend it if you're going and you want to save some money because I love to be cheap in New York. Okay. said that. Now I'm not sponsored by sweet green. I just love sweet green. Okay,
36:31
I know we're dropping. We're dropping a lot of like,
36:33
I know. Like suede. And also get Levine's cookies. Okay, yeah. When you go, I never have gone to the tourist areas. I avoid it. But I spent a lot of time in Times Square because I was going to see Broadway shows. And it's also one of the few Disney Stores that still is open. So I had to go in there. I got a wreath I didn't need but I needed you know, and Okay. Rockefeller Center. So I go there to meet Stephanie. Why rock as you and I didn't have enough time with your Stephanie. But while we were waiting, there's a whole show of lights. A GG know that you knew this that like it's with music and everything like Disney. I had no idea. What's the store that darkness said yes Avenue, Saks Fifth Avenue. And it's like castle and lighting. It was I was just joking. If you don't know, I love Disney. I love Disney so much. And this was a Disney experience. And I just we weren't waiting in the cold. I'm like, all bitter. You know, I just I'm not happy in the cold. So I'm like, and then the light show on Japan?
37:45
Yeah, it's spectacular. It was
37:47
so great. I had no idea and it goes up like every few minutes. It's quite regular. So if you like oh, we miss it. You're fine. Just wait a few minutes. It'll start again. i Oh, go see it. Go see it. Don't stand in Time Square for New Year's. But go see that that was such a wonderful, positive, beautiful moment. And, and just great. It was great. Also, there are a lot of great photographers in New York. So if you're visiting New York, and you want to get stuff for social media, that is the spot to get it. There are so many talented photographers you can get reasonable prices and and build your social media real fast. All right, that's it.
38:26
Perfect. Well, before we wrap up the year, where can people find you if they want more information about you in any of your programs? And also let us know what you have coming up in 2022?
38:38
Okay, well, most immediately, you're going to find me at Disney Land in February this year in 2022. Because I'm going to be there my birthday. If you go there on the 16th of February. Just let me know. And we'll like meet up with you. But no, I'm going to be eating junk food all day. So if you're expecting me to be held a healthy influence, I will not be alright. For me, I'm going to be continuing with my private practice, working with performers and continuing with helping people live their lives as dance PTS helping you on the business and treatment side with my dance PT program. But most importantly, because I'm always like I'm a performer and physical therapist. I'm doing all this work right now. I am getting back into performing which I'm really happy about so I'll be submitting a lot more which I'm just super stoked. I feel like all my work stuff is is being is much more easier to handle now I've got it down. And the systems are in place if you will get to audition more than I'll be a movie star just like that because it's so easy. It'll be great, but I'm really excited about that. What about you Karen?
39:55
Oh, that's exciting. Gosh, I'm not gonna be a movie star. Anything So what do I have coming up? Let's see, um, this past year I finished the Goldman Sachs 10,000 small business program, highly recommend anyone to apply to because it's really amazing. How many more plugs can we drop in this episode? And so I'm going to this year, I'm looking to hire another PT for my practice, right? Mm hmm. Which is very fun. Exactly, it grows, but
40:31
you're like, I'm not going to take all the patients. It's gross,
40:34
but time to bring on someone else. Right. And then continuing to work with just a couple of people. With business coaching, I like take four people at a time for me that I get it handle, it's good enough for me, I'm happy to do it. So that will open back up again. Maybe end of January of 2022. Because like you said, when you know what you can handle and you know that you can help the people who want to be helped, then it becomes so much easier. So now I feel like I've got this under control. I know how to split up my time and manage my time. And so I'm really looking forward to that in 2022 and we'll see what happens.
41:24
I love that. That's awesome. Yeah. Yeah, are so cool. I love what you do.
41:30
Where can people find you? Oh,
41:33
yeah, so I have the dance physical therapists Facebook group. So that's one specifically for PT so you will find me in their active conversations once talking about performing arts research all that stuff. You can find me at CSM Oh yeah, social media, dance physical therapists on Instagram. I am also musical theater doc on there. But I really associate people more regarding musical theater, not other pts. So dance physical therapist, is that and then on Facebook, Jenna cantor. And yeah, pretty much Jenna Cantor from Twitter and Jenna cantor. Yeah, your website. Jenna cancer, PT, calm.
42:18
Perfect. Perfect. Excellent. Well, Jenna, thank you so much for coming on and wrapping up 2022. And for all of your help and friendship throughout the year. I really appreciate it. And appreciate so
42:31
much. I have to just say that joke that keeps coming to my head every time you keep saying wrapping up. I feel like I should be wrapping a present. I just it's a stupid joke. But I just need to put that in there. Thank you. I said it.
42:43
Tis the season when in Rome, right? Yes. All right. Well, thank you again, so much. And everyone. Thank you so much. On behalf of myself and Jenna, for listening to the podcast all year and for supporting it. And you know if anyone has any suggestions on anyone they'd like either one of us to interview please let us know. You can find us on social media. I'm on Twitter at Karen Litzy. NYC and Instagram at Karen Litzy. You can email me Karen at Karen Litzy. Calm it couldn't be any easier. Or you can find me at Karen Litzy calm. We're super easy over here. So let us let us know if there's any topics or people that you're like man, I really want to hear from this person. We'll be more than happy to see if we can get it done. So thanks again. Everyone have a very, very happy new year and a healthy 2022 And of course stay healthy, wealthy and smart.
In this episode, Specialist Sports Physiotherapist, Morten Hoegh, talks about pain and injury management and research.
Today, Morten talks about his workshop on pain, the problems in the research around pain and injuries, and embracing the patient as the expert. What is nociplastic pain?
Hear about the injury versus pain narrative, treating the perception of injury during pain, the problem of over-treating pain, and get Morten’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “There is a difference between having an injury and being in pain.”
- “You will have injury and pain on one end, but you will have pain without injury on the other end.”
- “Just because we know something doesn’t mean we know everything.”
- “Pain prevention is well-intentioned, sometimes unrealistic, and possibly unhelpful.”
- “All pain is real. It’s always experienced as pain.”
- “People who live their life with pain, they are experts.”
- “We have different aspects and different competences, and we should bring them together.”
- “We should definitely try and cure pain from the planet, but maybe not by opioids.”
- “Things take time to cope with.”
- “Make sure you stick to good ideas if you think they’re good, but also leave them if they’re not.”
More about Morten Hoegh
After qualifying as a clinical physiotherapist (1999) and completing several clinical exams, Morten was granted the title of specialist physiotherapist in musculoskeletal physiotherapy (2005) and sports physiotherapy (2006). It was not until 2010-12 he made an entry to academia when he joined the multidisciplinary Master-of-Science in Pain: Science & Society at King's College London (UK). From 2015-19 Morten did his PhD in Medicine/pain at Center for Neuroplasticity and Pain (CNAP), Aalborg University. He is now an assistant professor.
Having spent more than a decade as clinician, teacher, and business developer, he decided to focus on improving national and international pain education based on the International Association for the Study of Pain (IASP).
Morten was vice-chair of the European Pain Federation’s Educational Committee from 2018-20 and has been involved in the development of the Diploma in Pain Physiotherapy and underlying curriculum, as well as the curricula in nursing and psychology. At a national level, Morten has been appointed to several chairs and committees, including the Danish Medicine and Health Authorities and the Danish Council of Ethics.
He has co-authored a textbook on pain, and written several book chapters, clinical commentaries, and peer-reviewed basic science articles on pain and pain modulation. Morten’s first book on pain in layman’s terms will be published in January 2021.
Morten is regarded as a skilled and inspiring speaker, and he has been invited to present in Europe and on the American continent. He is also a prolific debater and advocate of evidence-based and patient-centred approaches to treatment in general. Morten is motivated by his desire to improve management of chronic pain, reduce stigmatisation of people with ‘invisible diseases’, and to bridge the gap between clinical practice and neuroscience research in relation to pain.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, Neuroscience, Pain, Injury, Rehabilitation, Research, Experience, Treatment, Management,
Resources:
#IOCprev2021 on Twitter.
To learn more, follow Morten at:
Website: http://www.videnomsmerter.dk
https://p4work.com
Twitter: @MH_DK
Instagram: @mhdk_drmortenhoegh
LinkedIn: Morten Hoegh
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Read the Full Transcript Here:
00:02
Hi, Morten, welcome to the podcast. I'm very excited to have you on. So thanks so much. Thank you for having me, Karen. It's a pleasure to be here. Yeah. And today, we're going to talk about your really wonderful, wonderful workshop at the IOC conference in Monaco. That was just a couple of weeks ago. And you did a great workshop on pain, which is one of my passions.
00:27
But I would, I think
00:30
the best thing for us to do here is to just throw it over to you. And let you give a little background on the talk. And then we'll dive into the talk itself. So go ahead.
00:43
Thank you. And, you know, I'm really happy that you liked it. It was a great pleasure to present that the IRC was my first time there as well. A lovely place to be and very lovely people. And he really well organized conference as well. Well, back to the background. So the tool was, the workshop, as it were, was actually originally something I planned with Dr. Kieran or Sullivan, who is now in Ireland. Unfortunately, he couldn't come due to turn restrictions and all of that for COVID. So we had to change it slightly. But over the period of the last sort of year or so I've been working with colleagues at all university where I'm affiliated and test Denton and Steven George of Adelaide and, and to university respectively. And together with them, we sort of have written up this idea that there is a difference between having an injury and being in pain. And the reason we came about that was because we wanted to try and look into what is actually the sort of narrative definition of a sports injury. And and some one of my colleagues are actually two of my colleagues Kosta, Luke, and Sabine Avista. We're looking into this and trying to sort of find out what the consensus what they came up with, when they were looking at the last 10 years of of sports related research is that the same articles could use injury and pain for the same thing. So it was being used almost as well, not almost, but as sentiment synonymously throughout the program, or the manuscript, and others will stick to pain and others will stick to injury. But if you then try to go down into the methods and find out what is an injury, really, some would have definitions, but there weren't really anything. And definitely, there wasn't a clear distinction between when is the tissue injured. And when is the athlete suffering from pain that is keeping them from not doing what they want to do.
02:50
So we came up with this idea to write an editorial for the BDSM. We couldn't get it accepted as an editorial, we were under the impression that maybe the topic was a bit too narrow. So it really wouldn't have any impact. But we had a we had some some help from from
03:12
sorry, you can cut that bit out. I was just losing her name. Let me just get it here.
03:21
Oh, that's she was such a great help. I'm really sorry for not being able to I definitely think we should put her name in there.
03:32
Oh, here we go.
03:35
So we wanted to do the editorial first. But we were under the impression that we couldn't get the editorial through because the topic, you know, is probably a bit too narrow. But fortunately, Madeline Thorpe, who is working with TAs in Adelaide, she helped us create this infographic that sort of conveyed the message of the difference between what we call a sports related injury and a sports related pain. So after a few revisions, the BJs took it in as an infographic with a short text to describe what we mean. And and it's been. It's been, you know, quite well cited afterwards. So we're very happy with the the attention that this idea has got. And then of course, what we really are trying to do here is to create two new semantic entities as we say, Where where it's clear when we do research, but also when we talk to athletes, are you really injured? Is the tissue injury that needs healing and where you might need you know, specific treatment for that injury versus Are you having pain as a consequence of an injury or even without an injury, which is what we call sports related pain. So that's sort of the broader concept and and I hope I've I've done right with my co authors.
05:00
because they've Of course, been been a huge part of both the development and the writing of these, these, this infographic.
05:09
Yeah. And can we now sort of dive in a little bit deeper? So, injury versus pain? Right. I think a lot of people will think that every time you have an injury, there's pain. So used a really nice example in your talk. So does tendon tissue damage lead to pain? Yeah. But is the pain in the area of the tendon equal to damage to the tendon?
05:38
Maybe not. Yeah. Right. Oh, so yeah. So let's, let's have you kind of dive into this injury versus pain narrative. And if you want to go into those pain mechanisms that you spoke about, we can dive into that as well, because I know that that people had some questions on that on social media. So let's first talk injury versus pain. Yeah, again, my my perspective on this with my background, being a physio and, and sort of a neuroscientist is that I come from it, I would say from a pain, scientist pain mechanistic approach. And what I try to do is to understand what goes on in the human that could explain why they feel pain. And in some instances, and for instance, in low back pain, we we think, in about maybe 80 to 95% of the cases, we don't know what's going on. So we're pretty sure that the risks are mechanism, perhaps are quite complicated. One there has multiple factors that are interrelated, but there's probably something. So that's really difficult to study. Again, consider consider, you know, if you were tasked to, to come up with a, you know, a model where you could study this model would be, for instance, an animal model. So not that I would encourage people to go out and, you know, do bad things to other animals. But just, you know, for the sake of the example, let's imagine that you wanted to do an animal model of low back pain, or even a herniated sorry, a groin injury, you could say, in sports.
07:20
If you know, the most basic thing to do would be to create an injury. If you don't want to create an injury injury, what you could do is induce inflammation, you know, inject capsaicin, or put something under the skin or down into the tissues, and that makes your immune system go, you know, make inflammation. And that inflammation makes your nervous system respond more powerful. We call it sensitization, I think many people have heard of that word by now.
07:49
And that's a really good way to create that sensation of pain in humans as well. So we can inject capsaicin again, and people will usually feel pain.
08:00
In that case, that's what happens or that's how we understand what happens in the case of a tissue injury. So when there's a tissue injury, there's inflammation, and we understand that pain. So when the tissue hit healing period, is sort of crossing from what you could say, the inflammatory phase, into the prolific face, pain should go down. And in most cases, that's what happened. But what when the pain persists after the inflammatory phase. You know, from the science perspective, we don't know that. But we still know that this person is in pain. So whether that be an athlete or non athletes, they're still in pain. And in this in sort of the pain research world, we have a definition of pain that doesn't necessitate any type of injury, not even any activation of those, we call them nociceptors. But nociceptive system you could say.
08:53
So we acknowledge that people can have pain and not be Do not be damaged, not be injured, not have pathology. And that's sort of the idea that we are trying to bring into sports medicine as well, which has been over the you know, many last decades I've you know, I've been in in sports medicine or as a sports physio, for 20 odd years and sort of dominating belief. And also perhaps, trajectory has always been sort of the orthopedic sports related and to some extent, also pharmacological approach, combined with and that's important, combined with a non pharmacological physio, perhaps approach. So there's been this interrelationship collaboration between doctors and physios and other health professionals, which is quite unique. As I see it in the musculoskeletal system. We don't see that to the same extent, for instance, for low back pain or neck pain, but sports has done that. But maybe there has also kept people within the realms of sort of orthopedic approaches trying to understand what goes on. It's
10:00
tissues, and why did they hurt, and then when you couldn't find out why they hurt, we've just looked deeper into the tissues, which is, of course, a good idea from a scientistic or scientists perspective, because there are definitely things in the tissues that we don't know today, which will, you know, make us become more aware of what goes on, you know, as, as late as in the beginning of October, wasn't it where the Nobel Prizes were given out, there was given a Nobel Prize out for the person, I might do violence to his name, but it's part of Putin, I think he's last name it.
10:36
I didn't, I suppose a Putin or something like that. I do apologize for not being able to pronounce it. But he got the Nobel Prize was shared the Nobel Prize for his work on a peer to two receptors, which is a quite new phenomenon and sort of the longer perspective, but it might learn us over time, why could movement hurt? Which is something we don't know today? So if there's no sensitization, why does it hurt to be moving? And that's really interesting. But again, coming out in the clinic, we don't know enough. So we will have patients in the clinic where we simply do not know why they hurt.
11:14
And you could say that doesn't matter. We can call it anything. But then if you take a clinical look at what goes on what happens again, if you look at the signs, what does it mean, when people are hurting, and they think they're injured? They This is what a percentage again, they seem to be thinking that they're being in pain is the same as being weak. If you're weak, you're not, you know, you're not allowed to be in on the team, you might lose your position. So it has a lot of negative connotations. And I mean, that in itself is wrong. But what if it's based on a misconception that just because you're hurting, you are also injured? And couldn't we help people who are hurting with their pain,
11:59
just as well as we could if they are injured with a tissue injury. So what we are saying is that the two are different. They're both real, they should both be addressed. And they're not, they're not opposite ends of a dichotomy, you will have injury and pain in one end, but you will have pain without injury on the other end. So we need to pay attention to both of them separately. Yeah, it's because sometimes a person has a pain problem
12:29
may not be a specific tissue problem, but they have a pain problem. And so this pain problem may, like you said, cause certainly a an athlete to catastrophize. And to really play out to the point where maybe now they're fearful to get on the pitch or the court or the field. And so where does that leave us as physio therapists when it comes to their care? How do we help manage someone, or I should say, help someone manage their pain in order to play their sport, knowing that their every time they go out and play, they're not compounding, quote, unquote, tissue damage?
13:14
Yeah, and interesting, let's say someone has the perception that their tissues are injured, and every time they move, that's a sign of their tissue injury, or even when they hurt more, the injury is bigger, then that person, I mean, if that's a person like me, I would think that I should do something about that injury so that I don't hurt. But pain is always a symptom of something underlying it. Whereas we know from pain research in for instance, low back pain, that pain can in itself, be the disease, what the ICD 11 is now describing as chronic primary pain. So you can have that in your body, you can have it in your tendons, you can have it all way where your tendons are, you can have it where you know, where the bones are, where the where you feel the muscles are. And it's the pain itself is the problem. So rather than looking specifically at a tissue, which needs strengthening or some sort of treatment, then we can look at the person and say, What is it really that you need? A very, very simple example here, which is unlikely to be, you know, the case for everyone. But let's imagine we have someone with knee pain. And the thing that happens is that when they start running, their knee pain gets worse. But if they've been running for a kilometer, or two kilometer or miles, whatever, you know, whatever metric you use,
14:40
then the pain might be the same. So it sort of comes from nothing to let's say, five in the first mile, and then it stays at five, maybe six, and that person wants to run two miles perhaps. But what's the problem in that? I mean, the problem of course, is if pain in this case is a sign of an injury
15:00
that we should attend to. So we need to understand that it's not an injury.
15:06
Once we've done that, why not help this person, deal with the pain and maybe deal with it when they run, just like we would say to someone, if they have, again, back pain, for instance, and they have pain when they work, but their pain is not necessarily worse when they work, should they not be working? I mean, of course, if, if your pain can go away by two days of rest, and graded exposure, that's fine. But in some cases, and they're not as rare as I think most people believe they are, that we just need to work with that person and help them do what they need or want to do with that pain. And why is that, you know, of course, it's not the optimal it would be much nicer is if we would just kill the pain. Or if they could kill their own pain. But we're not there yet, we are still working to get it. And we're not giving up, there's a lot to do. But currently today, and tomorrow, we need to help people work with their pain, that's the best thing we can do now, and and, you know, giving people that agency to actually manage their pain. So in the case of the runner before, maybe the best thing we can help them do is share with them ideas and make them take agency over their pain by you know, using perhaps a cold pack or heat pack or a rest regime or watching you know, something that takes off their mind of their pain for a minute look at you know, watching dope sick on Disney, whatever they need to do to get their mind off, you know, the pain that they have, so that they can recharge, and they can be as you know, their normal again, before they go out for another run. So all of these things would make absolutely no sense if we didn't acknowledge that pain in itself is the problem, because it's not helping anyone's tissue injury, if there was a such to become better. So again, that's the infographic in its essence is that on one end, you use those inspiration to how to manage pain, what that means and how pain is influenced. And on the other side, you will have tissue injuries, and how to manage that, for instance, loading. In sports medicine loading is a big issue. It's probably the one thing that you know, everyone is doing when you're rehabilitating some someone after an injury or pain. But pain doesn't necessarily necessarily sorry, pain doesn't necessarily respond to loading. So you can have the same pain, whether or not you're loading. But there could be tons of other things such as the way you think about your pain, the way you respond to your pain experiences you've had before the context your work in. So you can run in one context without too many pains or problems. But in a completely different context. For instance, when you do a competition, or if you know, if you need to do something, because that's the bar to get onto the competition you want to do, then pain can be a much, much bigger problem. So we need to understand that context of beliefs and experience really influences pain, whereas loading may not. But it could have caused, but it doesn't have to. So pain is a much larger, much more complex topic of which we still don't know too much. We do know quite a lot. And as long as there's an injury, we understand the pain that goes with it. But when it comes to these pains that are there by themselves, the ICD 11 type chronic primary pain, then that's the type of pain that we you know, we've really, we don't have the sort of blueprints on that. So we can't help everyone. And we can't say this is right for you or wrong for you. We need to do individualized care for all of these people and help them find the best tools to support themselves. Yeah, and I think that was something that people who weren't at the conference and kind of reading through tweets,
19:08
that certainly brought up some questions, one of which was the pay mechanism, no sub plastic pain, where we can't fully explain it. And so then there was a question of, we can't fully explain it, why even bring it up? So I'll throw it over? Yeah. It's, again, it's a good question. And especially if you're a clinician, why would you use it, though, they're basically what they are. They're ways that scientists understand the pain. So again, imagine you're standing at one end of the road and you're looking at the other end by the end of that road, a very long road, you have pain. And then the way the place you're standing at is how you explain how to get to that end point. And if you're standing at a place and you know there's a tissue injury, there's inflammation. We understand that as
20:00
Part of the normal normal nociceptive system. So we would call it nociceptive pain.
20:05
Underneath that there is a range of different changes and modulator modulators of the system that leads to, for instance, peripheral and central sensitization. So they're not unique to anything that is there also in nociceptive pain, but it's induced by, for instance, a tissue injury.
20:24
If you have a different tissue injury, the one that hits your nervous system, we call it a neuropathic pain, so you have a nerve damage, along with pain, we call that a neuropathic pain. So again, you're standing on this long road, but in this case, the road itself is sort of gone wrong. But we still know what's going on. Again, if you want to use the study metaphor, you can, you can design a study, you can just take an animal, and you can compress or do something to the neurons, and you can create this similar pain experience, or at least the behavior that it assimilates this pain experience in animals, other than humans. And then finally, we have this new, we call it a mechanistic descriptor knows a plastic pain, which is much much blurrier. And perhaps it's more like a waste bin. As it is now it's, it's where you would say we acknowledge that people have pain.
21:24
And a lot of things goes into it. So just like in nociceptive, and neuropathic pain, sensitization is definitely part of it. It could also be part of the note of plastic pain. But unlike the other two, you don't have the inflammatory response that could explain it. And you don't have the neuron damage that could explain it. But the person experiencing the pain could have a similar experience. So what is it really? How do we a scientist tried to understand that pain, and that's what most plastic is at the moment. And there is a little bit of debate that whether or not you can actually use algorithms to diagnose or, you know,
22:09
maybe
22:11
justify at least that you yet the person in front of you are experiencing this type of pain mechanism or pain related to this mechanism, we definitely have a very, very, you know, widely embraced algorithm used for neuropathic pain. And some very, you know, high profile researchers has just recently come up with a paper suggesting that the same can be done for noisy plastic, sorry, for noisy plastic pain. But personally, I don't think we should, because unlike so nociceptive and neuropathic pain, they're both well understood by signs and we can separate them, they are different. So you can have both, but you would have different qualities to it, there'll be a nerve damage in one and there wouldn't in the other, for instance.
23:02
But we don't know about most plastic pain. So it could be changes in your nervous system, it could actually be, you know, increased responsiveness of your immune system in interaction with your nervous system. It could all be all of that. So it could be sensitization, but it could be tons of other things as well. So how can we start when we don't know what the mechanism is? How can we start to clinically differentiate? So I don't personally think we're quite there yet. Although I like the idea that maybe we can at some point, what I'm afraid of, if we start to use these clinical descriptors, sorry, these mechanistic descriptors, as clinical guidelines, is that what happens to the people who are now embraced and validated in their pain experience by scientists saying, Well, we know what you have, it's mostly plastic pain. But what if we made up an algorithm? And we used it for people? What about the people who fall out? Do they need, you know, a fourth descriptor? Are they just weird? Do they have unknown pain? Are they back to the psychogenic pain? So we've come quite a lot of way, embracing the clinical aspects of pain into the pain research world. And I think using you know, these three mechanistic describers, as you know, trying to really differentiate them and create perhaps treatments that is directed at either one. At this point, or especially anatomy is specifically directed at most aplastic point pain. Just because we know something doesn't mean we know everything.
24:34
So yeah, that's that's the issue. There was a bit of off topic. I'm sorry. But it's such an interesting topic. And I think that the most important thing about no plastic pain is that it is a construct that researchers use. It's embraced by the IRS, the world pain Association, the pay Research Association, and it validates that all pain is real. And there's, you know, it's still real even though we can
25:00
not understand it from a science perspective. I think that's important. And I would hate to see that we misuse it. To say that some really has it. And some don't. Because that's just, you know, that'll be I'll be sad. Yeah. And and can't one's pain experience?
25:20
Everybody's pain experiences individualized. But one person's nociceptive pain experience may be exactly like someone's neuropathic pain experience or someone's no support plastic pain experience, because it's in so then to categorize the persons Oh, well, my pain is like this. So it means this, so I can't have this. And I think it can get people a little confused. And when you have more long term or chronic pain, it's like, the the pain is there. Pain is pain. Some people need the the label or categorization, but like you said, Is it is it really helpful? And it kind of leads me to the one of the last slides in your presentation, and it was like pain prevention is well intentioned, yay, thumbs up, sometimes unrealistic, and possibly unhelpful? Yeah. So do you want to expand on that a little bit? And what you meant by that slide?
26:23
Yeah, that's slide was. That was actually the whole idea when, when I started to talk with Dr. Kieran Sullivan about workshop is that we see a lot of people, athletes. So both of us are still clinicians. And we see and we hear stories of a lot of athletes who have been treated and treated and treated again, or assessed and assessed and assessed again. And again, because they have a pain that we cannot objective eyes. So we can't find anything on scans or blood samples or clinical tests. So rather than acknowledging that pain can be there, so let's say nosey plastic pain, those are, there's something going on in your nervous system that gives you this pain, and we don't know what it is, we can't see it, that will be the, I would say the proper thing to do. So rather than doing that, we tend to keep sending people off. And it ends up with too many scans and too many assessments and too much worry. And in that process, we know the athlete is unlikely to be performing optimal during that period of time. Partly, of course, due to the pain, but also due to the insecurity to you know, if nothing is found on the first scan and a second scan that at some point, they probably start to wonder whether or not they're completely broken, or if it's a really rare disease or even if it's gonna kill them. And these are things that we might feed into by overtreating. So, of course, we should try and prevent pain. Statistics suggest that that's quite tricky. And we, you know, it would be great if we could or even perhaps what we can do is give people tools so they can take agency over their pain when it flares up. But having this idea that when you are in pain, you are damaged is very unhelpful. We think. So we really wanted to highlight the fact that sometimes pain is is that it is pain is still disabling. It's that feeling of pain, and nobody can feel whether or not their pain is due to an injury or not, it feels just like pain. But we identify all pain as if there was an injury, when in fact, it's it's quite unlikely that the majority of cases would have an injury attached to it. And just coming back to one thing you said before that it was quite subtle, but I think it's a really important point you made there, which is that all pain is real, it's always experienced as pain, whether that be of any of the descriptors or for any reason, it always feels like pain, and the quality that we attached to it, it's a muscle pain, or it's whatever is something we do it's our perception is our belief about what the pain is. And maybe that's what we need to also address in sports medicine is that disbelief about what your pain is caused by is a potential target for treatment, we call it psychotherapy or psychoeducation. Or, you know, and that doesn't have to be paying neurobiology education that's unlikely to be better than any other good education and listening and embracing. So there's a range of different interventions that are combining or embracing the fact that you need to talk to your athlete or your patient and help them make sense of their pain in a way that gives them empowerment will give them agency over their pain.
29:51
And something that came to my mind as you were saying, oh the pain it's it's in the muscles, the tendons, the bone, it's the joint and can't that all
30:00
So be a coping mechanism of the athlete. So they may say, oh, it's, you know, this is just a muscle strain. It's so it's their way of coping of saying it's nothing I can continue to to move forward. Do you know what I mean?
30:16
Yeah, absolutely and, and I think as long as it empowers them, if you know if you have the pain that you again, think about Dom's, or delete onset onset muscle soreness. That's an empowering pain, isn't it? I mean, I have Dom's, I was doing exercise yesterday. And if you really want to, you know, be good at something, then perhaps Dom's is your sort of reward even, even though it's painful, it should be awful, it might actually feel like a reward. So in that case, you interpret the pain that you are experiencing, as a reward or something you want it to happen. And I definitely think that some would say that this is just a minor thing, again, think about general health and male, you know, older men, like myself, tend to not go into, you know, the GP for what we consider to be minor things, but in fact, that might be killing us. Because we say, no, no, that's nothing, no, that little spot, that's not cancer. And I would say I don't, I don't think it's a lump, it's probably just something that's here this week. So we should be much better at listening to it, and giving it you know, you know, the quality or the, you know, the meaning that it should have. So it's on both ends of the spectrum, sometimes we neglect that pain is there for a reason, and we should listen to it. And sometimes we should understand that the pain is there without anyone really knowing what it is. But it doesn't mean just because we don't have a universal tool that can treat all pain, which is what we say when we say there's no treatment for chronic pain. In fact, there's quite a, you know, a variety of well established evidence based treatments, that can reduce pain, but they need to be targeted, and individualized so that each one find their, you know, their way through their pain. And of course, one way to do it is to go to everyone you know, who has a, you know, any background in health and ask them what to do, probably the best thing to do is to talk to someone who knows about pain, and then get advice about what seems to be working for you. Embracing that the one in this case, the athlete with pain, they have perhaps one or two years experience with their pain, they know much more about their pain than I do. But I can act as a consultant, I can listen to them, I can help them structure, I know what you know, patterns out there. So I can listen for that. And then together, we can try a few things. But over a period of maybe weeks, they should know as much as I do about pain generally, but with their focus on it. And and that should give them you know, with a bit of practice the ability to find out what works and what doesn't. And rather than thinking of pain management, in the case of a sports related pain, as an on off thing, so either it works and the pain is not there, or it doesn't work, it only reduces the pain a bit, we probably should be realistic and say that most people can have reductions in their pain, perhaps 2030, perhaps more percent. But the majority of people will experience from some sort of management of pain reduction. But it doesn't mean that the pain is going to go away. And it doesn't mean that thought is going to be absolutely pain free. But we need to find a balance between the two so that we understand when pain is actually a sign of either injury or possible injury. But also understand when pain is something that might just be part of life. And the best way we can do the most evidence based approach to that would be to find your way through it, you know, in perhaps, together with a
33:56
clinician of some sort? Yeah. And my gosh, I was just gonna say as we wrap things up, would you like to put a bow on it on your talk and at at the IOC conference and to this talk today, and I think you've just done it? I think you'd beat me to the punch. But is there anything else that you'd like to add?
34:18
That, that you want the listeners to take away?
34:22
I think the most the thing that I always want to stress is that people who meet or live their life with pain, they're experts. And we as clinicians, and researchers should embrace that much more. So the patient as an expert, is something I feel deeply about.
34:44
And I think we should be able to understand that as you know, as a scientist, you might know, you know a lot about groups.
34:51
As a clinician, you might know a lot about people who come to you with a similar symptoms, but as a person who have pain, you have two or three years
35:00
perhaps have experience with your own pain. And I think the best way to you know to get all of these together is by everyone being aware that we have different aspects and different competencies, and we should bring them together. And I think that's the best we can do right now. But still, don't give up hope we should definitely try and cure all pain from the planet, but maybe not by opioids. Yes, I would agree with that. And now more and where can people find you if they want to learn more about what you do? Read your research, where can they find you?
35:39
I think the easiest way would probably be to either find me on on Facebook, or go on Twitter. My handle is at MH underscore DK. And I'm also on Instagram. It's at MH DK underscore Dr. Moulton. Whoa.
35:57
Excellent. And one last question. It's a question I asked everyone is what advice would you give to your younger self, knowing where you are now in your life and in your career?
36:09
Remember, things take time to cope with sometimes you have a good idea. And you can't imagine, however, too, you know, you hear something and everyone else knows it. And you're like the only one who doesn't get it. But give it a bit of time. And, you know, I we have a saying that Rome wasn't built in one day. I think it goes in English as well. So give things time and and make sure you stick to good ideas if you think they're good, but also leave them if they're not.
36:37
Excellent advice. So Morton, thank you so much. This was a great conversation. And like I said, your talk at IOC was really wonderful. There's if people want to see his slides, there are tons of tons of tweets with all of his slides and great descriptors. You could go to IOC p r e v 2021. That was the hashtag for the conference. And as you look through, you'll see a lot of tweets from his from Morton's workshops. So thank you so much for coming on and expanding on that for us. I appreciate it.
37:13
Amazing. Thank you. It is a huge pleasure and privilege to be here. Thank you, Karen. Thanks so much. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Bryan Guzski, Director of the Orthopaedic Residency Program at the University of Rochester Medical Center, and Tim Reynolds, Clinical Assistant Professor of Anatomy & Physiology at Ithaca College, talk about their work on Movers & Mentors.
Today, Bryan and Tim talk about their book, Movers & Mentors, and they get the opportunity to be the interviewers for a portion of the episode. Why is it important to have mentors?
Hear about the motivation behind the book, some surprising interviews they’ve done, the value of having a team, finding your ‘why’, and choosing when you say ‘yes’, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “From an entrepreneurial standpoint, from a business standpoint, your partner is everything.”
- “Invest in [yourself] and take care of [yourself], physically and mentally, so that you can take care of your patients better.”
- “Challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you’re willing to try.”
- “Find a mentor and don’t fear or stray away from the imposter syndrome. Use that as fuel.”
- “If you never ask the question, the answer is always no.”
- “Trying to do it all will keep you small.”
- “You have to really only say yes to things that align to your values.”
- “Take a step back, know who you are, know your values, know what your individual mission statement is.”
- “He who knows others is wise. He who knows himself is enlightened.” - Lao Tzu
- “If you don’t have the capacity for it, then don’t do it.”
- “Stay curious.”
- “Continue to search for the ‘why’. It’s okay not to know.”
More about Bryan Guzski
Bryan Guzski PT, DPT, OCS, MBA, CSCS, is an outpatient orthopaedic physical therapist practicing in Rochester, NY working primarily with patients with spine related issues and persistent pain.
Bryan earned his Doctor of Physical Therapy degree from Ithaca College in 2014, completed an orthopaedic residency program through Cayuga Medical Center and received his Orthopaedic Clinical Specialist certification in 2015, and earned a Master of Business Administration degree from Simon Business School at the University of Rochester in 2021.
More about Tim Reynolds
Tim Reynolds PT, DPT, OCS, CSCS, is a Clinical Assistant Professor of Anatomy & Physiology at Ithaca College and a part-time physical therapist practicing at Cayuga Medical Center in Ithaca, NY, where he predominately treats patients with spine or lower extremity impairments.
Tim earned his Doctor of Physical Therapy degree from Ithaca College in 2014 and completed both his orthopaedic residency and spine fellowship through Cayuga Medical Center, and currently helps mentor and teach in both of these programs as well.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, Academia, Movers, Shakers, Mentors, Prioritizing, Self-care, Self-improvement, Values, Motivation,
To learn more, follow Bryan & Tim at:
Website: https://www.moversandmentors.com
Twitter: @moversmentors
@timreynoldsdpt
Facebook: Movers and Mentors
Instagram: @moversandmentors
@bryguzski
@timreynolds10
LinkedIn: Bryan Guzski
Tim Reynolds
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here:
00:03
Hey, Brian and Tim, welcome to the podcast. I'm happy to have you guys on to talk about movers and mentors. So welcome.
00:11
Thank you, Karen, thank you for having us today. We're sharing this sit down chat with you.
00:15
This is great, Karen, thank you so much.
00:17
Well, thank you guys for including me in your book with over 70 Other pretty illustrious folks in the Movement Science physical therapy world. So let's start with the basic question that I'm sure a lot of listeners want to know. What is the why behind the book?
00:40
Yeah. So Karen, Tim and I were going through residency orthopedic residency together. Back in 2015. We both graduated from Ithaca College in 2014. And we both entered into a residency program at ethika are in Ethica, in 2015. And as we were going through the coursework there, and kind of taking different classes and really kind of immersed in the PT literature and physical therapy, space and various different content. We started noticing a lot of reoccurring names and reoccurring themes. And so, you know, different names like Tim Flynn, Josh Cleveland, surely sermon, Stuart McGill, you know, all these all these names that, you know, names in our rehab space that I've done a lot of really cool things and have put out a lot of different research that that, you know, we follow to this day. So we started noticing those names. And Tim and I were also reading a book by Timothy Ferriss called Tools of Titans at the time. And we really liked that book. And we enjoyed it. We got a lot out of it. He interviews people like, you know, Arnold Schwarzenegger, and Oprah Winfrey. So various different industries and various different spaces. But we like the model that book and we started to ask ourselves, well, I wonder how, you know, individuals and movers and shakers within our industry would answer questions that we have. So fast forward two years. That was 2017 2018 at that point, and Tim and I started putting together a list of questions and a list of names. And at that point, you know, we kind of we kind of took it from there. And Tim has a little bit more info on how we how we came up with the names.
02:29
Yeah, so it's one of those things that we could have written a 5000 page book in regards to the movers and shakers within the physical therapy industry. And I think one of the most important things that Brian I have tried to stress is that this is a living project. This is not a one and done situation where there are movers and shakers that are currently developing and changing the practice. And so I think that's one of those things that, yes, there are people within the pages that I'm that are, we're happy to have there. But at the same time, there's so many other people would want to reach out to, and we look forward to have the opportunity to potentially talk to those individuals in the future, and are excited to see how does the profession change in the next five to 10 years and who are going to come up and literally shake the industry that we have the opportunity to be part of. And so as we started to go about this, like Brian said, we're diving into this literature, I had the opportunity to do spine fellowship after doing my orthopedic residency. And so the amount of Tim Flynn articles that I've read over the past three years was obnoxious. And so we started to make this almost like PT Dream Team, if you would, where we said okay, from, from a literature standpoint, who do we do we invest ourselves into a lot of, and like Brian mentioned, John John Childs, and we have Josh Cleveland. And then we have Tim Flynn, and the surely SARM and Gwendolyn Joel, there's these names that we have read multiple articles from and so kind of selfishly, we put together this list of people that we would really appreciate reaching out to, because we've been so invested in their in their literature over the past several years. And then from there, we kind of spread our net a little wider, because we had to see who's moving the industry from a clinical practice standpoint, right. So not necessarily from an academic or research standpoint, but from clinical practice. And who's moving it in regards to social media influencers? Because as someone who works in academia and works with the up and coming physical therapy generation, those are the people that they're following on Instagram and on Twitter, and so they're moving and shaking the industry in that format. And we looked at who's been guest speakers at recent conferences and who's putting out podcasts and how He was really trying to have the opportunity to get our profession to move in a positive direction. And so from there, we created this sort of master list, we reached out to all of them, and some have the opportunity to participate, which we're super thankful for. Some respectfully declined based on the fact that they had other stuff going on. But I think one of the things to remember, Brian is sort of given us timeframe, this was right pre pandemic, that we started to reach out to all these individuals. And what's been such a blessing is that we've been able to cast a wide net across multiple different countries across multiple different professions. But at the same time, we reach out to people in Australia, and there's Australian wildfires. And so we're trying to really respect individual's personal physical well being while navigating global pandemic while trying to also conduct interviews. And so it took us a little over two and a half years to be able to accumulate everything and be able to put everything out into a book format. But I'm super thankful to have those people within the pages. And like I said, I'm excited to have the opportunity to reach out to more in the future.
06:14
And so it takes, you know, a couple of years to get all this together. How did the two of you kind of keep the momentum going? Number one, because that's hard. And then number two, how did you kind of kind of temper your excitement and your expectations? Because I know, I'm the kind of person who's like, let's just get it done. Let's go, go go. But here, you know, you've really taken your time, over two plus years. So can you talk a little bit about that?
06:52
Yeah, I think from the outset, Tim and I both thought, I will send out some emails, you know, we'll get a handful of responses. It'll be a cool book, maybe we'll sell to maybe, you know, five, including our siblings, and parents, that sort of thing. And it really from the first batch of emails that we sent out, you know, Tim and I were really, every time we got a response, we would text each other, shoot each other an email immediately, Hey, Peter O'Sullivan responded, or David Butler responded, or Karen Litzy responded, you know, this is awesome. Like, we're actually doing this thing. So I think it you know, you spoke to momentum, Karen. And that's one thing that Tim and I, you know, we've never really hit a point where we were at a lack of that, or hit a dull moment, if you will. Because every time we got we did another interview, or we got another email, or we set up a, you know, maybe a podcast, it was definitely adding fuel to the fire. And, you know, they kept us pretty engaged and pretty excited throughout the whole thing. So, yeah, I mean, to I think if you asked us when we first sent out our emails in 2018, hey, you know, this is you're going to publish this in 2021, we'd say, No, it's going to be next year. And then life happens and pandemics happen and several other things. And, you know, it turned into a two and a half year project. But you know, it's been a lot of fun the whole time. And Tim and I still are still excited about it and excited about about the future, too.
08:16
And I think that's one of the things. There's kind of like Christmas every single time we had a response because it was super cool. You send out these, these emails, or you give a phone call to people that you've literally have had as your mentor from afar for years. And it's like, oh, my gosh, I cannot wait to have the opportunity to sit down. Like Peter, I saw that I've watched a lot of Peter softened videos from pain science standpoint, from spine fellowship work. And having the opportunity to sit down with Peter resolve them for an hour and 15 minutes was like, amazing. I was super stoked. And so so all those opportunities to talk to these people definitely continue to keep flame burning. And at the same time you talk about how do we sort of balance that, that excitement and try not to do too much too quickly. Brian and I have known each other for years, this has been such an amazing project to be able to find a partner that you want appreciate and to after two and a half years don't hate. So I think that's like a really good thing. And I think we balance each other out very well, where we're both skilled in a variety different formats. And then at the same time, after reading your draft manuscript, probably like five times through and through, you really do not want to read one more time. And there's points where we're like, I think it's good. I think we just just push it out, call it a day. And then Brian could probably agree that I'd say well, let's just read through it one more time, and then you catch one or two small mistakes. And so I think it's one of those things that just finding the right person that's willing to invest and stay motivated to push you and challenge you From an entrepreneurial standpoint, from a business standpoint, your partner is is everything. And so I think that's been one of the blessings that we've had this for this project.
10:11
Yeah, I love it, I think that's great advice is to have that person who complements you. Right and because you don't want to have just like a yes person, but instead you want something that's going to complement you and push you in, in a positive direction. And, and I will second the Peter O'Sullivan, he is just what a nice person and giving and charitable and gosh, I had an interview with him at CSM a number of years ago. And I had to ticket it. Because it was live at CSM. And we actually had to ticket it so that only 25 people could go and I it was only for students. And by the end of the interview, he was laying on the ground, you know, students and stuff. It was just so it was such a great experience, because he's just one of those very kind of electric personalities.
11:08
Definitely. very warm, very electric.
11:10
Yeah. Were there any interviews that you did that surprised you?
11:20
Um, in
11:21
a, in any way that doesn't have to be good or bad. Just surprise you because perhaps the persona that this person has, whether it be their research, social media clinical that you thought they had, and then when you interviewed them? It it surprised you?
11:46
Yeah, I would say. Obviously, when you when you interview over 75 individuals, you get a variety of different responses, you talk to a variety of different personas, devided different characteristics. And I think going into it, knowing the background of someone's, I use the metaphor of like the front cover of a book, we all have like front cover worthy attributes or accomplishments. And then it's like, well, what's on the inside of those pages. And so we see everybody's bio, and I've been on X, Y, and Z shows or published this many papers and, and so we see all that stuff. But we never really hear some of those people talk or talk personally about some of their successes and some of their failures. And so I think everybody had the opportunity to have some elements of surprise. But I think what was also cool as Brian, I made up this master list, and it was basically just based off of accomplishments and achievements, or their influence on the profession. And so, for instance, I was looking through and like talking to Michael Radcliffe, who is who is a researcher that I've read your research, but I, I never really pictured what you would look like. And I never really perceived that you would have such amazing responses within this book. So I think it was those individuals that I might not have been so invested from like falling on social media, or have watched your YouTube videos, and really getting a chance to know them in an hour, hour and a half. Those were the interviewers that really caught me by surprise, but at the same time, I think I walked away with so much more, because there is so much unknown that they're willing to offer me. Um, and so I think I think that was the most exciting part or the most surprising part for me.
13:42
Yeah, I think kind of, because of the types of questions that we asked, we really intimidate joke about this, if we want to know, you know, surely Simon's recommendations for motor control. We can find that online. We can we can Google that. Right? If we want to know, you know how David Butler opens his pain talks, we can probably find that somewhere and explain pain or explain pain Supercharged. But you know, how Heidi genetica who's the CEO of versio Excuse me? Why pte how she structures her day. And what her favourite failure is it those are things that you can't find you can't find that in textbook you can't find that online. So the types of questions that we asked really opened, opened it up to knowing these people from a different perspective, which we thought was pretty cool. I'd say that one of the individuals that really stands out in my mind, Tim actually did this interview, but I transcribe it so I got to listen to everything, literally word for word was Stanley Paris, who's one of the founding fathers of orthopaedic manual physical therapy and then the United States and North America for that matter. And I mean, this guy is is just incredible from sailing around the world to swimming the English Channel to founding St. Augustine to being, you know, a founder and president of various organizations like the guy has done it all to owning a winery or several wineries. I believe he's just, you know, a jack of all trades. And I think listening to that interview, I was like, you know, he's, I think 83 Now, and my jaw was dropped to some of the some of his answers and some of his experiences. So that was, that was really cool. But, I mean, we had so many so many great interviews, Jeff Moore was a terrific interviewer. Peter O'Sullivan, like we talked about Kelly star it gave, you know, exceptional answers. So we were really, really lucky. And, you know, positively surprised, I should say, surprise, in a positive way with with all of our guests.
15:55
Yeah. And it it, it does kind of, like an education for you. Right,
16:02
definitely. Yeah. 110% Yeah, I mean, it was one of those things. I had the opportunity to speak with Michael shacklock. Um, and such a well spoken. Such a thoughtful, mindful person. And back in residency, Brian Knight did some research with neurodynamics and your mobilizations. As I was like, Oh, my gosh, like, you're the Dude, that was like, given us all this information. And now we have the opportunity to actually speak to the source. So I think back to being like eight or nine years old, and have all these posters of Major League Baseball players up on the walls, and just like, thinking about how cool it was to have their pictures, and to think about what it would be like to play baseball with them. And now to be able to communicate with some of these movers and shakers within the industry, and have them be peers, and be able to carry out a conversation with them learn from us as much as we're learning from them in that conversation is just such a rewarding opportunity.
17:08
And do you feel like it has changed your clinical practice at all? How you are with patients? Did any of the answers or just even the interactions with some of these folks change the change the way you practice? Um,
17:24
I think yes. I would say I've slowed down, and I'm more intentional. Just based on a few, I guess, specific responses, but one that comes to mind is oh, shoot, pause. This might be a Karen, you might have to take this this out. And then wait,
17:48
wait, wait a mess up. Or 25? I
17:50
know. We were crushing it. Dude. Millet mark. I don't know. I want to say more. Mark Milligan. So we'll jump back in. Yes, I would say more mindful and intentional. And I've slowed down in my practice, one response, or several responses from Mark Milligan definitely kind of changed the way I think and operate within the clinic. And I've definitely tried to be more intentional and kind of think about my thinking a little bit more in the clinic from a specific, you know, tactical exercise prescription perspective, not so much. Because that wasn't really the focus of our book. But just, you know, Mark's mindset, and kind of his, his recommendation to all young professionals to really kind of invest in themselves and to take care of themselves mentally and physically so that you can take care of your patients better, I thought was really powerful. So yeah, I'd say, a little bit more intentional, focused, and I've slowed down.
19:00
Yeah. And I think sort of piggybacking off of what Brian was saying, less so about the actual clinical approach to what sort of treatments are you providing? And I think that was one of the the most exciting things about the book was we were not talking about what's your favorite three exercises for X y&z Because there's so much saturation, I'd say from a social media standpoint, which is great. I think that's one of the things that's challenging the profession, that anybody has the opportunity to put out content, and it's one of the curses of the profession that anybody has the opportunity to put out content. And so I think the opportunity for young graduates and PT students, and individuals interested in the Movement Science field that is sift through a lot of information to be able to find out what is truly valuable for them. And like Brian was saying, These are the answers questions that aren't necessarily within a textbook, but also probably not necessarily on people's social media channels also, right? No one really steps up to the plate and says, you know that one time when it took me three tries again to PT, school, Dad was really a good important point in time, my life, or, yeah, I remember when I failed the boards. Those are things that I think can really influence and the sort of career life changing for these individuals, who, as a current college professor, writing final exams, getting ready to watch by an influx of tears in my office in the next bout 48 hours, who perceive a failure as such a detriment to their potential growth, and well being as a person, I got a B plus on this test, all my friends got A's, I cannot necessarily navigate that situation. That's like conversation that I hear all the time. And so talking about how has things changed in my practice, I'm currently part time in the clinic, more time from an academia standpoint. So I think it's changed my communication opportunities, with the next generation, being able to literally use this book as an encyclopedia. And knowing the responses that people have given flipping to their name, and saying, I need you to read this chapter from Mike Reinhold, where he talks about becoming an expert, because you're not there yet. Because you shouldn't be there yet. Because you haven't gained clinical judgment and clinical experience. And it's going to be okay. But go read this come back in five minutes. And so I think that's how I've been able to sort of benefit from this, from this experience and how I've taken it influenced my own practice.
21:51
Excellent. And, and as a side note, Tim, the, my podcast episode coming out tomorrow, my podcast is with Silvia Zubaan. And she's a clinician 50% clinician 50% academia at St. Louis University in Washington, Washington University in St. Louis. Sure. And surely, sermons. Yeah. And it was a really nice conversation on how to navigate. She's been doing it for 15 years now. clinician and academia and academia. So it was a really nice, really wonderful conversation on how to navigate that those two worlds successfully and how to be vulnerable when you need to be and with whom, and because it can't always be great and perfect, like you just said. So if you have a chance, I would come out tomorrow, I would listen, I'm excited. Currently to edit this part out. I don't need to plug my own podcast within a podcast. He was a little self indulgent. But because you, you're kind of in a similar position. She's just been doing it for a lot longer.
23:10
That's awesome. I appreciate that. So
23:11
check it out tomorrow. It was really, like, such a good conversation. She's super cool. She should be in your next book. There. Yeah, like it. She's super cool. Yes, Silvia it's CZ you PP o n. Yeah. And she does some research and and she's written some papers and things like that, but she's super cool. Okay. So, um, is there anything? Before we sort of flipped this a little bit? Because I know you guys were like, Hey, would you like to expand on some of your answers, which, you know, is fine. So we'll flip this in, in a bit. And I'll have you guys host and I'll be your guest. But before we do that, is there anything else kind of about the process of of compiling and publishing the book, that you would love people to know, because it made such a big difference in your lives?
24:23
I think one of the blessings of our profession is the lat orality component to your growth as an entrepreneur, but also as a professional. We graduate with a clinical doctorate, or and this can be transcribed across multiple professions, but you go to school to be able to learn how to learn right and in our profession where you sit for a board certification, which gives us the opportunity to practice as a clinician within that. You can wear multiple different hats and I think what was nice with this is That title allowed for us to speak to a variety of different people and have this mutual commonality, which was physical therapy, or Movement Science or the treatment of individuals with certain pathologies. And I think this would never have happened if we didn't make ourselves vulnerable and uncomfortable. Because who are Brian and I? And why should we have the opportunity to talk to Karen Litzy? Or why should we have the opportunity to talk to David Butler? Or why should in so we had this idea, and it all stemmed from the courage to be able to reach out and ask because you never know, unless you try. And so I think sharing one of these thoughts with your listeners is, I think we all have dreams and aspirations that are slightly beyond our scope of practice. And sometimes we can limit that opportunity for us to navigate those ideas, because we are either potentially afraid of failure, or just don't know what the outcome is going to be. And so since that's an unfamiliar territory, we just assume, and therefore we never attempt. And so I think the one of the best things that I've learned from this is accepting failure for what it is, what's the worst that they're going to say? No, I do not want to be part of this, thank you for the opportunity. And the best thing that we could do is create a relationship, create a mentorship opportunity, and have sort of this professional friendship that stemmed from a cold call email. And so I would, I would recommend, at least my thoughts would be challenged, challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you're if you're willing to try.
27:02
Yeah, Brian, right. Yeah.
27:04
Yeah, I think there's some level of kind of normalization of failure and imposter syndrome within this book. And I think when you dive into it, and you dive into the responses, everyone has been there, everyone, I'm speaking to, you know, students, new graduates, young professionals here, but guess the message kind of spans anyone in any part of the PT space or industry with however many years of experience, you know, everyone's felt that level of imposter syndrome, or, or fear of failure, and the kind of ability to, to kind of push through that, overcome that and almost use that and leverage it to, to push further or overcome obstacles is really powerful. So I think of it like if you're ever kind of at the top of a mountain, in terms of, you know, imposter syndrome, if we look at it, like, like a curve or like a mountain, if you're at the top of it, then you know, what's really driving you and what's what's pushing you forward, if you're kind of somewhere along along the line on the slope, then you have some level of uncertainty, some level of fear, or some level level of imposter syndrome, and that's actually going to feel fuel you to learn more and be better be more effective. And again, one of the main themes of this book was finding a mentor and the importance of that and how valuable that can be in any, any track or any, you know, facet of our profession. So kind of find that person that's doing something similar or doing exactly what you want to be doing. And, you know, don't hesitate to reach out to them. Because we're in the, we're in the business of helping people and thankfully, we have a lot of professionals around us that that want to help other people but also want to help you know, students, young professionals, so don't hesitate to reach out. I think you'll be surprised with with, you know, the the feedback or the the return on that. So, definitely, definitely find a mentor and, you know, don't don't fear stray, stray away from the imposter syndrome use that as fuel.
29:20
Yes. And I will say I got a piece of advice several years ago from a fellow physical therapist, son. So her name's Cecily de Stefano. She's a physical therapist outside of DC. And we were in Chicago for a one night q&a With Lorimer Moseley. And the next day, we were walking around, she had her five year old six year old somewhere around there, young son with her, and she was sort of walking up ahead and he was walking Next to me, and he said this, Karen, would you like to have a play date? And I said, Well, I don't. I don't have any children. And he was like, no, just you. And I said, Oh, um, okay, well, I think we should probably ask your mom first. And then he gave me a great piece of advice. He said, Yeah, because if you never asked the question, the answer is always no. And I was like, and I said, that's the best piece of advice I've gotten in years, and you're like, five. So just to begin with what you guys said, If you never ask the question, the answer is always no. And I've never forgotten that, since he said that. And so now I just always add, ask the question, because the worst that can happen is it's no and so okay, you move on. But you never know. Unless you try. Okay, so true. So let's, uh, we'll start wrapping things up here. But now I, again, thank you for including me in this book. It's a real honor. So if you want if you guys have any questions to I guess I can expand upon or, you know, anything else that that may be? I don't know, you go ahead. Talk about being out of your comfort zone. Go ahead. And you asked me, I'll hand the mic over to you guys. And I'll see, we'll see what we can do here.
31:21
Sure. Karen, thank you, again, for being a part of this. I really liked your response. We were speaking about failure a little bit before. And I really liked your response on failure in the last comment, here you have, I'll read it right from the book, it says, failure has taught me to be more introspective to have an open mind to trust in others more. And to know that in the end, it will all work out the way it is supposed to. I was wondering if you could expand on the to trust in others more? Do you have a specific example that you're thinking of, or examples, or just, you know, have other people come in at really important times to help you out when you're, you know, in a in a, you know, event of a failure?
32:07
Well, I can't think of one person or one incident in particular, but what I will say is, I am personality type a driver. So someone who likes to get things done, who likes to be in the driver's seat who I don't need help, I don't need help, I can do it on my own, I can do it on my own. And as a result, I think that yeah, I've had failures, because I tried to do it all by myself. And it just doesn't work. You know. And so there's a great team building exercise called lost at sea. Google it, I won't go into detail as to what exactly it is. But you have to you fill out. They give you a list of things that maybe you need when you're lost at sea, and you fill them out what you think you would need from one to 15 or 16 or something like that. So you do it on your own. And then you you do it as a group? And then you find out, like, did you do better on your own? Or did you do better when you had someone helping you? And better meaning like, did you survive? lost at sea? Or were you eaten by sharks? Right? And time and time again, and the group that I did it with? Everybody did better with the group. Right? And so for me, and I learned that I took the Goldman Sachs 10,000 small business program, and it was part of that program. And the big part of that program is learning how to be part of a team and learning how to have people around you that make you better. And so I think my biggest failures came because I didn't ask for help. Because I always thought no, no, I can do this on my own, or I can handle this and quite frankly, I couldn't. And so it resulted in a failure resulted in a less than optimal outcome. It resulted in stress on me and and perhaps some mental and emotional anguish, when in fact, I could have just had a team around me ask for help. And that task probably would have been done better than if it's just me and so yeah, I always so when I said that line, I didn't have one particular person or event in mind, but rather that like sometimes you have to like suck it up, you know, and admit that you can't do things and it's okay. It's just part of life. Like I had interviewed a woman Her name's Stephanie Nikolaj and she said you know trying to do it all will keep you small and she's right. You know, you can it's hard to grow as a person as an entrepreneur as a clinician, my God if you just did everything I Your Own I mean, you'd be like, I don't know you'd stop growing from the day you graduated from college right from your PT program. So you you need the these people around you need people around you, who can lift you up and and make you a better person, a better clinician, a better entrepreneur, whatever it is. But you'll never be that evolved person if you're on your own, it's just impossible.
35:26
Yeah, I think, Karen, like the number of hats that you wear as a business owner, a podcast as a volunteer and advocate, right? You, you kind of need people like that in your ecosystem, and it for so many projects, and especially the bigger the project, it really does take a village, and you need people that specialize in certain aspects to come together as a team. You know, Tim and I have talked about this kind of checking, checking your ego at the door sometimes and just kind of leaving that, as you said, Karen, you know, kind of admit that you can't, you can't accomplish it all by yourself. So I that was a that was a really great answer. And, you know, I think you spoke to some of the points about being more introspective and having having an open mind as well.
36:09
Yeah, and being able to trust people, clearly, I have trust issues. But you know, I think finding like, like you guys said, like you found each other, you knew each other for many years, you have this really nice trust and bond. And I don't know, maybe it's like 20 years in New York has made me a cynical New Yorker or something. You know, but really finding those people that you can connect and trust that they have your back and you'll have theirs. I think it's really important.
36:37
I think, another question that I would have just to sort of elaborate on, obviously, we have a variety of individuals that are listening, right now clinicians, non clinicians, entrepreneurs, and one of the questions that we asked within the book is, what advice would you give to a smart driven college student or a young professional entering the quote unquote, real world? And I think one of the things that you mentioned, that was really valuable was that it is easy to say yes to everything, when you believe it will further your career, I would advise you to only say yes, the opportunities that align with your values and goals, as the saying goes, saying yes to one thing is saying no to something that might be a better fit. I think that's really powerful. Because I think we're in a society of more is better, or the perception that doing more is better. So knowing knowing who is listening to this and having the microphone if you would, for for a minute baseline question. Can you elaborate on that? Or if you had to give that sort of monumentous speech regarding that topic? I think that can be really valuable for a variety different people this?
37:48
Yeah. And I think that saying that saying yes to everything, or only saying yes to things that align with your values? I mean, yes, you have to really only say yes to things that align to your values. But I think that speaks to speak to that 30,000 foot view of society in general, and of social media and what we're seeing everyone else do, right, so you may scroll through your Instagram or Twitter, Facebook, Tik Tok, whatever it is, you're on. And you may say, Well, gosh, this person just, they wrote another article, or Gosh, this person speaking here, and they're doing this and they're starting an app, and they're, they've got a podcast, and how come I'm not doing all that? Should I be doing all of that, so I should be set? Why, you know, I need to be doing XY and Z and, and, you know, you've got that, that FOMO disease, you know, your fear of missing out, and then you bombard yourself with things that you think you should be doing because other people are doing them. But it's not even something you believe in, but you think you should believe in it? Because Because other people in the profession are doing it and look at how many followers they have, or, or look at all the success and I use that in quotation marks because we don't really know someone's true success out on social media, right? Because we only put the good stuff on social media, you're not going to put the shitty stuff on social media, right? And so I think this saying yes to everything. I think a lot of it is based on societal pressures, what you're seeing on social media, maybe what a colleague or someone that graduated with you like, oh my gosh, they already started their own practice. And I didn't do that yet. So I guess I have to do that. And I have to say yes to this, that the other thing and it's, I think you really have to especially now like take a step back. Know who you are, know your values know, know your what your individual mission statement is, right? I know you guys said you have a mission statement for your book, but I would challenge everyone like you have your own mission statement as whether it's a clinician or you're in academia. But really you have to know deep down what your values are, what you're willing to take and what you're not willing to take, and, and really know yourself in a very deep, meaningful way. And I'm not saying I know myself in a deep meaningful way yet, but I'm trying, right? It doesn't mean and again, it doesn't mean you have to know that. So again, that's another thing people think, Oh, I have to do this now. But you know, in researching a talk for CSM that I'm actually doing with how do you Janemba my, the part of my talk is increasing your self awareness as an entrepreneur, and how do you do that, and I came across a really great quote, he who knows others, as wise, He who knows himself as enlightened by louts Lao Tzu, la Otz, you I hope I'm pronouncing that correctly. And I saw that quote, and I thought, Oh, that's so perfect, right. Because as, as clinicians, and as physical therapists, our job is to get to know the patient in front of us or the student in front of us or whoever it is in front of you that oftentimes, I think we give away big parts of ourselves without taking it back and looking inward.
41:16
And so you kind of get this like, drain on your empathy, and your energy goes on as the day goes on. And I think that happens a lot. And in these kind of giving professions that we are in, whether you're a professor or a clinician, or even a researcher, right, you're going to give all of your energy to that. And then you see you're always looking outwardly all day. And do you take the time to come back at the end of the day and look at yourself inward? And say, Well, what, what am I doing? Like, why am I doing this? Am I doing it for the likes? Or to get more followers? Or like, what is your goal? Right? And so I think that's kind of where that saying no to things comes in, if you know, your why behind what why you're doing things. It will make it easier for you to say yes, and to say no, because it's going to align with with who you are. But that takes time, you know, so as a new as a student, or a new professional, maybe you do have that all figured out. And if you do awesome, come on the podcast, let's talk about it. How did you do it, but you know, if it takes time, and you have to kind of find your groove and, and really know, where you want your career to be headed. And some people do know that right off the bat, I didn't. But it doesn't mean that other people don't have a very clear path of where they want their career in life to go. You know. And, and there's obviously that changes here and there. But I think that's what I meant by that, quote is looking for those opportunities is to really know yourself, and what your How much are you willing to take? How much capacity do you have for XYZ? And if you don't have the capacity for it, then don't do it? Because it's going to be done like half assed, you know, and nobody wants
43:19
nothing. That's great. Yeah, great advice. Yeah, finding, finding your why and staying true to your why and finding things that that sort of line up with that to allow for you to not have that emotional, physiological draining. If you would find things that fill your cup not not dump your cup out.
43:37
Yeah, exactly. Exactly. Yeah. It's a nice way to put it.
43:42
Um, yeah. So Karen, thank you so much for, you know, kind of expanding and elaborating on some of those. You know, as Tim and I mentioned in the, in the beginning, I think when we were chatting probably before we were recording, Tim, and I want to probably get a podcast started at some point in the future. And, you know, we'd love for you to come on and be one of our guests, so we can talk more about this stuff.
44:06
Yeah, I'd be happy to. And now before we wrap things up here, where can people find you guys? Where can they get the book? Let's go. Go ahead. The floor is yours.
44:18
So we have a website. The website is movers and mentors calm on there is all of our social media information and links directly to Amazon where you can find both our Kindle version and paperback version. If you have questions, comments, please tag us send us stuff on social media. Tim and I love that we you know, we've been very fortunate we've had really engaged you know, an engaged audience up until this point and so you know, we're looking or looking for more of that and shoot us an email if you want and with with comments or feedback. We love to hear that as well.
45:00
Great. And how about where can people find you on social media? Oh, yeah. Yeah,
45:08
it's in those that thing tendons got our handles there.
45:11
Yeah. So my, you can message me on Instagram. But Tim Reynolds DPP would be my thing. That's my Twitter routes, and would be my Instagram. And we'll send you that Karen. So you can sort of tag along for the podcast. But I like Brian was saying, I think the opportunity to interact with our, with our audience is one of the most exciting things, getting somebody that reading the book from South America and is so excited to receive the book is one of the highlights of our day. And I think having the opportunity to have our our audience also send us Who do they think should be the movers and shakers in our potential upcoming volumes of this would be something that we'd really appreciate. There's so many people within the profession that we do not know of yet. And so obviously, appreciate having their insight and input in that as well.
46:08
So I'm at at Bryan, Bryan, Gaskey, and Instagram and then we're at movers and mentors, both on Instagram and Twitter.
46:16
Perfect. And all of that will be in the show notes at podcasts at healthy, wealthy, smart, calm. So before we wrap up, what is question I asked everyone, what advice would you give to your younger self? So let's say fresh out of PT school at Ithaca? What advice would you give yourself?
46:36
I would tell myself, stay curious. Because I find that when I'm curious and asking questions, that means I'm engaged. And I think engagement. If it aligns with your your purpose and your passion, then you have kind of all three things in alignment. And that, you know, lends itself to a happy, fruitful and hopefully, you know, effective career.
47:05
Excellent. Tim, go ahead.
47:08
And I would say sort of piggybacking off what we were talking about earlier, Aaron would be continue to search for the why. And it's okay not to know. And I think that's one of those things where finding your why and staying true to the values is one of those things I'll add to life journey, continue to search for that throughout the lifespan. But I think actively checking back to is this lining up with my Why would be one of the things that I would want to do, either from a journal reflecting standpoint, or just from like a quarterly check in. But then also, the acceptance of it's okay, not to know not necessarily not to know what your y is, but not to know certain things in part of your life. Um, and I think being 20 to 2324 and try to navigate your 20s. And I'm thinking that everybody in that sort of FOMO aspect is having the solutions and answers. And it is okay that you do not know yet you are enough, you will be enough, challenge yourself and have the opportunity to allow for that growth and expansion.
48:23
You guys, that is great advice. Thank you so much for coming on the podcast and sharing your book. Again. It's movers and mentors, and it's available on amazon.com. Go to their website, go to the social media. Everything again is that podcast out healthy, wealthy, smart, calm. One click, we'll take you to any thing you need for both Brian and Tim. So thank you so much, guys, for coming on.
48:49
Thanks for having us, Karen. Yeah, thank you, Karen.
48:53
Pleasure and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Dr. Sylvia Czuppon, Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine, talks about balancing her role as an academic with her role as a clinician.
More about Sylvia Czuppon:
Dr. Sylvia Czuppon received her Bachelor of Arts in Psychology in 2000, Master of Science in Physical Therapy in 2002, and her clinical Doctorate in Physical Therapy in 2011, all from Washington University. She received her Certification as an Orthopaedic Clinical Specialist from the American Board of Physical Therapy Specialties in 2010. Her work has been published in British Journal of Sports Medicine, PM&R, Physical Therapy, and Journal of Orthopaedic & Sports Physical Therapy. Dr. Czuppon is currently an Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine in St. Louis, Missouri. She divides time between outpatient clinical practice treating musculoskeletal pain patients and teaching orthopaedic content in the professional DPT curriculum at Washington University. She has given local, state, and national presentations on lower extremity injury rehabilitation and return to sport. She volunteers her time educating coaches, parents, athletes, and the community about youth injury prevention strategies.
To learn more, follow Sylvia at:
Twitter: @czuppons
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Read the Full Transcript Here:
00:03
Hey, Sylvia, welcome to the podcast. I'm so happy to have you on.
00:07
Thanks for having me, Karen.
00:08
Of course, of course. And, you know, we were talking before we went on the air about, you know, not seeing people in person and going to conferences. And the last time we saw each other was in Vancouver, at the third annual World Congress of sports, physical therapy.
00:30
Yes, right. That's right. Yeah,
00:32
I think that's correct. Yeah.
00:33
I can't believe it's been that long.
00:34
I know. I know. 2019. Right. Beginning of 2019.
00:39
I think it was. Yeah, it was COVID. Year, but it was before all that stuff. Yeah, yeah,
00:43
exactly. And, you know, shameless plug, the fourth annual World Congress on sports. PT is going to be outside of Copenhagen in August of 2022. Absolutely. So I encourage people to try and and your fingers crossed, it'll work. I keep saying 2022. It's gonna be the year. So shameless plug for that. Now, let's move into you. So today, we're going to be talking about life as a clinician and academia. And I love this topic, because I think there's a lot of clinicians out there who are wondering, well, how do I get into academia? How do I how do I do that? So why don't you give the listeners a little bit more about your background and how you did it? Sure. Yeah. So
01:38
I've been fortunate to be on faculty at Washington University in St. Louis for 15 years now. I think, approximately, it's been a while. And yeah, I sometimes I'm like pinching myself. I'm like, How is time flown that way? How 15 years? Yeah. 15 years? I graduated in 2002. So yeah, yeah, it is, oh, my gosh, I
02:05
can't believe it, I can't believe it.
02:07
So. So when I, when I joined the faculty, honestly, it was it was a nice, it was a nice mix of events. When I came out of PT school, I knew I wanted to do a little bit of teaching, but the Washington University at least, recommends that you have about a year of clinical practice under your belt before you join an academic institution. Like lab assisting. So that's how I got my start, I started lab assisting in classes that had orthopedic content. And when a position on the faculty opened up, I, I basically jumped at the opportunity got lucky enough to be hired. And away I went. So when I first started, my split, I think was 90% of my time was in clinical practice. And about 10% of my time was in, it was in teaching and it was all a lab assisting. And over the years, that is at has morphed considerably. I'm about 5050 right now. So I spent 20 hours a week in the clinic and 20 hours a week, teaching or doing teaching related things. And it's been a I don't think I'll ever go below that. But who knows what will happen. But I like that balance that I've struck right now, I can't ever see myself coming completely out of the clinic into teaching, like some of my colleagues have done, you know, you go to PT school to become a clinician, you don't go to become an educator, otherwise I go to, you know, to get my teaching degree. And I think that's probably been one of the biggest challenges is I am a PT, learning how to provide high quality education without an education degree. So there's been a bit of a learning curve associated with that as well.
03:42
And what do you feel are the advantages of being a clinician and, and working in academia? So what does your clinician hat bring to your students?
03:55
Yeah, you know, I think it's interesting. So, um, as a clinician, what is nice is I can give them I don't want to call it real world application, but it really is. So they students, we teach them in the ideal scenario, like, Okay, your your patient comes in, they have this positive test this positive test this positive test, what must be their diagnosis? Is any patient ever that cookie cutter clean No, 99% of the time, they're not right. So we teach our students in the best case scenario, the easiest ways to understand and so being a clinician, I can still give them a little bit of perspective, but like, here's where the gray areas come in. And this is why we teach you that ideal scenario so that you recognize the ideal, but here's how you can kind of think more with the clinical hat on it's a little bit similar to being like a clinical instructor. I think that's the greatest part about being a clinical instructor and shameless plug for those of you that are out there that are not clinical instructors. We need a lot more of them there. You know, our students are. It's such a rewarding experience. It really is. It's time consuming, don't get me wrong, but it is very, very rewarding, but I'm so be so being a clinician and being able to, to give the clinical the true clinical perspective on some of the things that students is learning, I think can be, can be invaluable. Like I have students all the time. They're like, Sylvia, this this sounds like a load of hooey like this doesn't even make sense, like help me understand when I would ever do this, and to be able to tell them look, you know, this is exactly why you need to know this level of detail, or this is why as a, even though, you are determined to go into sports, physical therapy, or you're determined to go into orthopedics. This is why you need to understand neuro for example, like, this is why they teach you neuro related things. I think I posted on Twitter, you know, like a couple of weeks ago, I've been to patients this year, that I think I'm, you know, not to toot my own horn or anything, but it's unfortunate, these people fell through the cracks, I think, in referring them out, both of them have gotten a diagnosis of ALS that nobody caught before this point. And it was based on what history they had given me, as well as some of the signs and symptoms that I saw with it within them. They referred to me like one had scoliosis, and horrible back pain, and another one that was a total knee replacement. And those are not diagnoses, you would expect to have ALS diagnoses associated with them. But some of the other things they were describing, it was terrifying. And just, again, like these are things to help students understand that they all do go together, you're treating a person that doesn't come in with a strict diagnosis, you're treating a whole person. And they don't always get that in the education setting when we're giving them fabricated cases.
06:27
Yeah, I couldn't agree more. And that's, that's amazing, by the way, from a clinical standpoint, that you were able to refer them to the right people to get the right diagnosis. Yeah. And that's, you know, and again, that's where physical therapists come in. And I'm sure that this is part of your teaching to your students that, you know, we can be that kind of primary care provider, you know, and even the second opinion,
06:56
sure, sure, yeah. And it is, it is one of those, you know, Missouri is not a direct access state. And so it's interesting, like teaching in a non direct access state, because we do typically get the patients they have the referral, it's generally pretty accurate, but you get some of these that fall through the cracks. And it's why we get the training that we get as physical therapists, you know, for those scenarios. But even again, in a non direct access state, these patients had been screened by other physicians, and it possibly just the complexities of their care, it just things got missed. So
07:33
amazing. Well, now, let's talk about what your responsibilities are, as a clinician, educator, so if you want to break it apart clinician educator, separately, or just let because I think it's important if people are interested in in, going in this direction, they need to know what it entails and what their responsibilities. Sure.
07:59
So I think it's a little bit different if you're so so my position is a faculty member means that I split my my time, assume a 40 hour work week, you know, nobody who actually works that when they're a faculty member on any any academic program, but, um, so I split my time for many people that come from a physician, whether lab assistant, in addition to holding a full time job, that's usually hours, in addition to whatever your hours are in a week. So when I was working as a lab assistant, before I joined faculty, I was working 40 hours a week plus lab assisting X number of hours a week, so there was a little bit of that, because very few employers will give you that time off and say, Oh, you want to live six, eight hours, we sure only work 32 hours here, like, it's very difficult to get that. And then depending on when the classes are during the day. So we have labs from like one to three, some people couldn't do that it's smack in the middle of prime, you know, treating hours. So that is definitely a consideration that people want to make. If you're working part time, it becomes a whole lot easier. Your schedules are a lot more flexible, as a faculty member, so I have 20 hours a week, again, dedicated to patient care, 20 hours for teaching. So in my patient care responsibilities, I basically have a set schedule that is has to be designed around the times that I'm supposed to be in class. So that has to probably be the worst for the person for my for my clinic boss who has to come up with the clinic schedule. He's working around everybody's class schedules and the times that we can actually physically be in the clinic. And so I treat in our clinic, we have a one on one model, so we don't overlap patients, you know, and so that's, that's really nice. We do have physical therapy assistants that we work with as well. And so I balance my caseload, I feel like any like I would anywhere else, I have autonomy to decide when I want to delegate when the patient needs, needs to come back to CV, frequency, duration, all of those kind of standard, standard types of things. Um, I am fortunate because I've been there long enough that I do get a little bit of flexibility and asking for the patient. Two types that I want to see. So I love the postoperative knees and any knee, really. So I do get a little bit more of those than maybe some others do seniority, it's great. And then my academic hat is complicated. So I'm depending on what semester in the year that we're in. And we're also going through a curriculum renewal right now, which is a whole nother whole nother topic of discussion. But in some semesters, I am a course master for for a class. And so that entails doing everything you would expect from a course to making sure the syllabus is up to date, to organizing exams, practicals, lab assistants, supplies, outside lectures, patient labs, etc. to an other the other semester I am, quote, unquote, just a course assistant, so facilitating the course master with all of those duties. So those hours are kind of wrapped up in our actual academic time. So if I have 20 hours a week, and I'm only in lab for 12 hours, my other eight hours are supposed to be spent doing all these other behind the scenes things which are, which easily kind of add up. So it is a little bit of a mix, and the curriculum renewal that I was talking about. So Wash U is going towards more of competency based education, which I think is the movement in education as a whole. And so we're we're in the beginning stages of that our first year classes going through the start of our new revised curriculum, and I am helping to craft the second year curriculum. So that's a huge task, taking what we currently have reorganizing it, restructuring it into an even better product than what we currently have. So there's a lot going on, that is certainly more than 20 hours a week. So yeah.
11:49
And can you explain competency based education versus what's currently happening? I don't know if that's like opening a huge can of worms. But let's go for
11:59
Yeah, yeah. It's also challenging my my full understanding of this, because it's all it's all this is like a complete foreign language. It's like going through, as I as I kind of alluded to earlier, I'm going through, I'm becoming like, I feel like I'm going through to get my education degree in the process of learning how to teach the this material better. So with the competencies, it's essentially like saying, Okay, you're competent in gosh, there's domains, there's, there's all sorts of terminology, but basically saying that, like, okay, that you have this one domain of patient and client care, within that you have different competencies, like, I'm able to take a, I'm making stuff up, because I don't know them off the top my head, but like, able to take a complete history for like, able to do communicate with respect and dignity for the patient and care provider, like things like that. So there's different things that this student is now having to pass and show competence in these competencies, a pass individual competencies, versus getting a grade in a class to say, you're good enough for that grade, it could be really strong in one area, but really not great and another, but their overall grade is enough to move them forward. We want to kind of raise the bar a little bit and say, You know what, that was good. But we can do better. And taking it to like each one of these competencies you need to pass in order to continue on curriculum. Got it?
13:15
Got it? Well, that makes actually makes a lot of sense.
13:19
Does now trying to make every lesson plan, every lecture that you give mapped to every competency that you have is a whole nother topic of discussion. Yeah,
13:32
good luck. Yes. Yeah. Good luck with that. And now something that you kind of alluded to before, which I want to dive into is, so your 20 hours practice care, 20 hours teaching, and I put 20 hours in quotation marks, right? So we know as clinicians, it's always more than 20 hours, right? And in teaching Gosh, it's definitely more than maybe what you signed up for. So how do you and here comes the question, how do you balance all of that with the rest of your life? Because you've got kids?
14:09
I've got two teenagers. Yes, got a dog.
14:12
I've got two dogs, actually two dogs, you've got a home, you have got a life outside of all of this. So what do you do to balance it all?
14:22
Yeah, so that was probably the most challenging thing that if I could have gone back in time and talk to my younger self, I would have been like, don't say yes to everything. That was probably the first thing that nobody really ever told me. Because I thought that if I said, No, nobody would ever asked me to do anything again, you know, you feel like this. Oh, this is a fantastic opportunity. I don't know where the time is gonna come out of but I really want to do it. And so I just started I would say at the time yes to pretty much anything that sounded interesting. And even yes to some things that I was like, I'm not sure if this is what I want to do, but I feel like if I don't say yes, I'm going to lose this. They're going to think I'm not interested in it. Think so, naively when I was when I was a younger faculty, um, that's what I did, I said yes to literally everything and almost put myself in a horrible spiral of I had so many issues in terms of that work life balance, I didn't have any it was work, work work. And then life was like a tiny fraction of that. And that was when my kids were little, I've got teenagers that are 17 and 14 now. Um, but what I discovered over the years was that those opportunities are at least and I still believe this, if those opportunities were meant to be, they're going to come around again, if people really want you, they value your expertise and your knowledge and your skill set, they will come asking around again. And you know, just saying no, one time, and just even saying like, No, you know, what, now is not the right time, I'd love to help you out. Can you come back again, like, you know, if you have another project, just ask me. I mean, hopefully I'll have time at that point, you know, there's no, there's good ways to not just firmly shut the door right to leave that still open. Um, so I've found a better balance for myself now, because I've figured out what is super important for me, and what is not, like really important. So I started saying no to different class commitments that I had previously done, because it was it was stuff that was okay. But it was not my passion in teaching. And so I started whittling down to the things that that made me honestly, the maybe the most happy to think about teaching or be involved in. And when I started doing that, I did become happier with with how that balance was shaping up, because some of that work really wasn't work anymore. You were enjoying doing it, versus looking at it and saying, Man, I got three more hours of this that I've got to prepare for, and I'm just not feeling it. You know, there's a reason nobody's ever asked me to be an anatomy lab assistant. And it's, I mean, enjoy anatomy. Don't get me wrong, but the level of detail I just, that would that was not my forte. No, that was not my forte. And it's like, I want to know the applications and things that I'm interested in. But some of the things that they have to learn for PT school, it just wasn't wasn't in my wheelhouse. You know? Yeah. So it's like, things like that, where, where I just prioritize a little bit better.
17:06
Yeah. And I was gonna follow up question I was going to ask is, How did you? Like, what methods did you use to decide what was best for you? And what methods did you use to break down? Like, no, like, this is a No, maybe not forever? But uh, no, for now, this might be a no forever. This isn't a solid? Yes. Do you know what I?
17:30
Yeah, yeah, it wasn't in certainly not easy. Um, it came again, across several, several years to try to figure that out. So part of it came down to okay, I was lab assisting in multiple classes. And did I really want to stay lab assisting in that context? If the context, if there was a, there was an immediate hesitation in my answer, then I thought, okay, that can't be the number one priority that I really want to stay in that class. So then I started adding up hours, and how many hours a week? Or really, am I spending in that class? What could I replace it with? Um, is there another opportunity right now that I want to replace it with? So it was sort of like, figuring out the timing of things would be one thing? And then some of it was just just deciding, okay, well, I know it's gonna throw me over the, the 20 hours or whatever that I have right now. Am I okay with that for a little while. And for a period I was and then now that I'm older, I'm not, you know, I've got I've got a, I've got a teenager that's going to be leaving the house in two years. And I've decided, you know, what this would, this is the time I actually I want to spend with her, you know, not that I didn't want to spend it with her as a little kid. But now I'm like, feeling that like, empty nest feeling starting to grow. And I'm like, I don't want to miss, you know, all the things that she's doing. And, and so I've just prioritize, you know, what, no, I'm gonna say no to that. Or I'm gonna say, you know, I can't do this this year, or I can only do this for part of the time, like, admissions committee, you know, figuring out who we accepted to our program. Like, well, I can't do it the whole year, but I can do it for part of the year Will that be okay, you know, and try to work out compromises with the people that are there looking for my time.
19:11
I love it. And, you know, so often women have such a hard time with this. Yes, you know, yes. Because we think if we say no, like you said, That's it, we're done, or we're gonna be labeled difficult, or, you know, someone that you know, she doesn't, she's not interested. We'll never get back to that. Right. So I think it's, as a woman, we really have to kind of get over that kind of thinking and and realize like, Hey, if you say it's a no for now, but not a no forever and the people are like, Oh, God, she was setting it up, well, then they're probably not your people. Right? And that's okay to let that go as well. Right.
19:52
I think what also complicates it a little bit is this whole Superman thing, right, like women that believe they can literally do everything. So you've got to be the best parent, you've got to be the volunteer at all the PTO, whatever school stuff, the sporting team, the in then at school, and then it works the same thing, I got to be able to handle this whole load and show nobody a crack in my facade, you know, so that they can see that I can do it, you know, and if I do you crack, then they're gonna think that I'm weaker, you know, just stereotypes that way. I think that's obviously it's really unfortunate that that still exists. Um, but, uh, I, we're not super human, like we have, you know, we have breaking points too. And we need to know what those are for ourselves for our own sanity, you know, for the sanity of our family members, our friends, all the people around us, you know, the pets, yo, all of that. So,
20:43
yeah, and your students as well, like Have, have you ever kind of displayed that vulnerability, whether it be to your employer, obviously, your family, and that's a different story, but maybe to your employer or to the university, to say like, I'm reaching a breaking point. And so how did you do that?
21:04
Yeah, definitely. to the employer. Um, yeah. So So there have been times where and unfortunate our program director, gammon Earhart is amazing. And her predecessor, the CCD singer, was was great, too. And they've always been wonderful with this sort of open door policy. So when you hit that point, or you feel like you're coming up to that point, I felt 100% comfortable going to them and saying, Hey, guys, look, I am, I'm over my head right now. And I don't know what to do. Like, I really need some help. And they kind of talk you down a little bit and say, Okay, well, how can we make this better, I have been very fortunate to be supported in that role. Same thing with even my immediate supervisors within the clinic. Same kind of idea. I had some personal struggles earlier this year, unrelated to COVID. And having and knowing that I had that support system, by being in a good place, I think this is true of any job. But being in a in a in a supportive environment, where they were like, take the time that you need to get your your self. Right. You know, it was it was very nice to know that I had that kind of support.
22:12
Yeah. And so I think the moral here is, it's okay. Absolutely, to let people know that you're not okay. And it's okay to be vulnerable. And if you're the people you're working with or for don't accept that, then I think it's a clear sign to say, Well, wait, wait a second, what am I doing here?
22:38
Right, right. Yeah. And I would love to say like that, I have been fantastic. And always being vulnerable. That is definitely a lie. Nobody, nobody, nobody, nobody is and I, I, you know, grew up in a, in a, in a household where perfection was like, required, it wasn't even, you know, it was it was an expectation, just as you know, my hair is black. And it will say, well, it's gray now, but that it'll say one color like it was the expectation you will be perfect you will be you will not show or have any flaws. So bringing that into a scenario like I am in right now and telling somebody I'm not like I'm vulnerable, I'm hurting, I need help, like even asking for help was was a huge, huge deal for me. But again, I had I had a good support structure, even within my workplace environment to allow me to do that.
23:24
Yeah. And it is, it's hard to ask for help, you know, because because you don't want people to think you can't handle it. All. Right. Right. Right. So asking for help is I know, I have a really hard time asking for help. But I'm getting better at it. Yeah. But it is, it's hard to reach out, it's hard to ask for help. Because you're afraid that someone will maybe think of you as less than or incapable or whatever, you know, all those bad things that spin around in your head, right?
23:55
Or just that if they're thinking about asking you to help out with something that you really want to do, they're not going to ask you anymore, right? Like, you know, and kind of where I'm at as a as an associate professor trying to rise to the professor level in a couple of years, trying to take a larger leadership role in our curriculum, there was definitely a fear of well, wow, if I tell them that I can't handle what I've got right now. There's no way they're going to ask me to do X, Y, or Z. So do I risk doing that? Or do I just drown? And I wasn't willing to drown? No, no, no job is worth that. My personal happiness was not worth that. And again, fortunately, everybody was very understanding the the fear that I had built up in my head was no near nowhere near what I experienced at all. Like it wasn't there. They were like, You know what, we get it. Take the time that you need, it's fine. We'll figure it out. And we'll help you figure it out. We'll give you whatever resources you need, whatever support you need. So it was wonderful. It's really wonderful.
24:47
Yeah. And it's so important to kind of voice that because like you said, you're trying to kind of climb up this academic ladder. So if you never voiced that maybe you would never, you would never reach that Professor level. because you would have burned out left. Absolutely. Yeah. Right. So why not put those fears out there and and find the things that like not to use Marie Kondo here. I don't know if you know Marie Kondo she's so Marie Kondo is like this organizational guru. And her thing is if it doesn't bring you joy, get rid of it. Yeah. And so I wrote that down when you were talking about how, you know, anatomy lab, not for me doesn't bring me joy. This does. So I'm sticking with this. And and what you find is when you do the things that bring you joy, this sort of Marie Kondo method, I mean, she doesn't like, you know, does this shirt bring you joy? And if it doesn't know, this book, this, you know, tchotchke, whatever it is, but you can you can apply those principles, I think, in this scenario, when deciding what to say yes, and what to say no to? And even if you have nothing else on your plate at the moment, you can still say
25:58
no, sure. Absolutely. Absolutely. Right.
26:02
You can still say no, and that's okay. Absolutely, well, this oh my god, I'm so glad that we talked about this is so good. So let's, let's talk about now, I would love to get from you, maybe two or three pieces of advice that you would give to a clinician who's trying to break into the world of academia. Yeah,
26:27
so, um, I think with with clinicians, the first thing is that you've, you've got to know what your, what kind of teaching you want to do, right. So like, if you're, if you're an orthopedic just being happy with, I'll take any orthopedic class, that could take you from going geometry and manual muscle testing, to examination and treatment kind of thing. So knowing sort of what level you want to be involved in helps. Because when you're then approaching the education division director of a program, that's usually who you send your resume or your CV to, when you're interested, they can have a better idea of whether there's a need honestly, in the in the curriculum, for another lab assistant for another lecture, if there are certain topics that you know very well, that you are passionate about, that he would love to lecture on. I'm even offering that up, like, hey, you know, I have a special interest in blood flow restriction training, but I'd love to be able to share that with your students. You know, this is my experience and background with that, let me know if there's there's any any availability for that, I think that's that's another part of it. I do think that it is, um, it is nice if you have a connection to the school, I mean, obviously, like, I got fortunate, I graduated from Washington at school, I'm now in faculty here. So I already had a connection to the program, it made it easier for me to get my foot in the door, because they already knew me as a student. And then as a clinician, because I was in the area. I do believe it is harder when you don't have those connections. But that's where I think networking in general is huge, right? So like you and I, we met through the Twitter verse, and then of course in Vancouver, but like making connections because people that you connect with have connections elsewhere, right. And they might know, just in talking to you. They might say, Oh, wait, I remember Sylvia said that they were looking for X, Y or Z at their at Wash U, maybe you should reach out and talk to her and see if there's anything going on. You know, I think connections are the other part that that people value, but you don't necessarily value maybe as much as you should. As a clinician, I think I take for granted that. And I don't know, if you feel the same way, we travel a lot, we get to go to a lot of conferences, we get to get a lot of all these pre COVID, we went to a lot of conferences. And that's where a lot of the networking happened, right. Clinicians do have to take continuing education in order to keep their their licenses active. But I feel like clinicians are probably taking the cheap local easy place near them to take on it because they don't probably have the benefit, always a funding behind it like I do at an academic institution. And I think that's, you know, you do what you have to do, but finding other ways to network, whether it's through your state organization, like the Missouri Physical Therapy Association here, through the national organization through some of the sections like sports section, ortho section, you know, getting involved that way to make connections, you don't have to attend conferences to do this, but you can get involved. I mean, everything's through zoom right now, you know, and so being involved that way to make connections can get you in the door in other ways. And I think that's probably an underappreciated part of the whole, how do I get my foot in the door?
29:41
Yeah, I would agree with that. And I love all the options that you just gave for clinicians and even students who are thinking, hey, one day I want to do both. Sure, right. So let's know what kind of teaching you want to do. Reach out to people in the school if you have a connection if you don't have a connection start making those connections. Absolutely right. And as a student, I think connecting through whether it's a PTA in general, or the components or your state is a great way to do that. And I would also say, stay in touch with the with your professors.
30:17
100% 100%. Yeah, I mean, and your clinical instructors as well, I mean, for me, my first job coming out of PT school, was because I went back to talk to one of my clinical instructors, and she's like, Hey, by the way, we have a job opening, would you be interested in applying? And I said, Oh, I'm not sure. And she goes, Well, I already submitted your name. And literally, that's how I landed, my first job was like, Okay, well, I guess I have to like, contact them now. So it was great. Yeah.
30:41
Yeah. I love it. I love it. Okay, so now, as we start to kind of wrap things up, is there anything that maybe we didn't hit in the conversation that you came in? Like, ooh, I definitely want to talk about this. Did we miss anything?
30:55
The one thing I will say is, is being on faculty, what did help me was naturally meshing and getting myself a mentor on the faculty. So not all academic institutions, like I know why she didn't have it at the time. They didn't really have like sort of a mentoring program for new faculty joining. And I don't know if this is true for all academic institutions. But for anybody that's interested in doing that, or joining an academic institution, as a clinician, academic, or as a researcher academic, is understanding if there is some kind of mentoring program because without the guidance of my mentor, Marcy Harris, Hayes, there is no way I'd be where I was at today, Marcy was like, kind of like my voice of reason, she was the one that was just like, Okay, you your interests are like humongous Sylvia, you need to narrow it down a little bit, you cannot keep saying yes to everything. She was the one that pushed me in certain directions, because she knew that a gentle nudge would help me get to where I wanted to be, even if I didn't want to take that leap for myself. If I was doubting myself, she would be the one that would say, you can you can do this. She was the first person that put me in front of a crowd of 300 people at CSM. So I have a lot to say, and I never would have, I genuinely never would have done that without for encouragement. And her understanding that I was ready for it. As well as it was something that was going to help me in the future. And that I'd appreciate it later on down the line versus my fear, again, of doing it on my own, would have prevented me from getting that far. So so definitely identifying a mentor. And again, this is for clinicians, even to in the clinic, like don't go into a clinic, and just expect to just learn it all just on your own or through Con Ed guy, I would hope that whatever clinic somebody joins into, has some kind of mentoring program as well. So that you can learn you can shadow you can get experience from other people. And it's different than just being able to say to your your pod mate, hey, I had this patient that was a little complicated. What do you think like truly having a mentor, I think is a big, big thing. To help enhance the level of clinician you are as well as again, if you're an academia, how to get up that level ladder and how to navigate it to I think that was the other thing Marcy gave me was some advice on how to how to get a little bit further because she was ranked ahead of me, and she had some great personal experience. Pros and cons, I guess you could say, to navigate that.
33:25
I love it. I think that's great advice. And I love how you said not only get up the ladder, but navigate it as well. Right? Because there's a lot of things that are gonna push and pull you along each rung of that ladder. Absolutely. So I think that's amazing advice. Okay, where can people find you if they need a mentor? Or they have questions?
33:47
Yeah, so Twitter's the easiest place. So I think you've got my contact information, but I am on Twitter, and an email is perfectly fine as well. So they can find my email address just to the washi website. Or really, if you just Google my name, it's pretty impossible to miss. There's not that many Soviet coupons out in the world. There's none, in fact, so it's pretty easy to find me I come up readily on a Google search.
34:10
Excellent. And we will have all the all of those links in the show notes. And now I have a question that I asked everyone at the end, but you already answered it, but I'm gonna ask it again. And that's what advice would you give to your younger self?
34:27
Yeah, totally. My younger self would be learn how to say no, and how to prioritize what you really want to do. prioritize what's going to make you happy. What's going to make you the clinician, the person that you wanted to be when you grew up, you know, because if you sacrifice what you want for what everybody else wants, you're not going to be happy. Perfect, I
34:52
love it. Thank you so much. I appreciate this conversation so much. I appreciate you for coming on. This was wonderful. So thank you so much.
35:00
Yeah, thank you so much for giving me the opportunity to be on I appreciate it
35:03
too, of course, and hopefully we will see each other in person soon. That
35:07
would be fantastic. Indeed, indeed. All right, and everyone,
35:10
thank you so much for listening, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Physical Therapist at Kelly Hawkins Physical Therapy, Meagan Duncan, talks about creating safe spaces for the LGBTQ+ community.
Today, Meagan talks about trauma-informed care, navigating trauma during the subjective exam, and the importance of consent. How can PTs make clinics safe spaces for the LGBTQ+ community?
Hear about the discrimination faced by the LGBTQ+ community, doing community advocacy work, and get Meagan’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Gay men can undergo sexual violence at twice the rate of straight men. 50% of transgender people will experience some kind of sexual violence in their life. It’s even more if they’re a minority.”
- “Being trauma-informed is important in any discipline because you don’t know what somebody has been through.”
- “I think it’s about really small gestures.”
- “Starting with paperwork, gender has every option you can think of. If it’s a paper form, gender’s a blank space.”
- “We have small flag stickers for every flag that you can think of with all the colours that represent different parts of the LGBTQ+ community.”
- “Be more vigilant about asking for consent.”
- “Asking for consent is something that should be ongoing and all the time.”
- “Education is a big part of asking for consent, because in order to consent to something, people have to understand what it’s going to entail.”
- “Providing options Is a really important part of consent.”
- “It’s not patient-directed care. It’s patient-centred care.”
- “Don’t just go around touching people without consent.”
- “Find a niche. If you can find a niche that you are passionate about and that is needed, you are never going to struggle for work or for satisfaction.”
More about Meagan Duncan
Meagan Duncan is a Chicagoland native who earned an associate degree as a Physical Therapist Assistant in 2013 from Kankakee Community College. She then worked for six years in an orthopaedic setting while earning a Bachelor's in Interdisciplinary Studies from Governor State University in Illinois. Later, she moved to Las Vegas to earn her Doctor of Physical Therapy degree from the University of Nevada Las Vegas in 2020.
As a PTA, she developed and ran a pro bono clinic at her first post grad job in her hometown of Joliet, Illinois. She now practices in Las Vegas and specializes in pelvic health after completing a specialty clinical rotation with the VA Hospital in Las Vegas.
Duncan currently works at Kelly Hawkins Physical Therapy, a prominent outpatient physical therapy company in the Las Vegas area. At Kelly Hawkins, she built a successful pelvic health program that she has overseen and grown over the past year and a half.
Duncan also works for NPTE Final Frontier, a premier national physical therapy exam preparation company that works with domestic and foreign trained students to help them pass the board exam. In this role, she tutors PT and PTA exam candidates and assists them with content development. She advocates for students and professionals to balance life outside of physical therapy.
Outside of her profession, Duncan enjoys hiking, biking, paddleboarding and anything she can do outdoors with her husband and dog. She is excited to welcome a new addition to her family soon, as her first child is due in a month.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, LGBTQ+, Inclusion, Trauma, Pain, Discrimination, Sexual Violence, Advocacy, Consent, Pelvic Health,
To learn more, follow Meagan at:
Email: mduncan@kellyhawkins.com
Website: https://www.kellyhawkins.com
LinkedIn: Meagan Duncan
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Read the Full Transcript Here:
00:02
Hey Megan, welcome to the podcast. I'm happy to have you on.
00:06
Hey, Karen, awesome to be here. Thank you for having me.
00:09
Yes. And like I said in the intro, today, we're going to be talking about creating physical therapy space, a safe spaces for the LGBTQ plus community. So before we talk a little bit more about that, can you let the listeners know where your passion for this community comes from?
00:27
For um, so I guess I feel like I'm just kind of a fan of the underdog in any situation. And I can't say that I have personally experienced, like so much in this community, aside from having a lot of relationships with people, and seeing what they go through and what life looks like on that side of our world, because it's a very different experience from what I've had as a heterosexual, white female. So when I was in high school, I just kind of ended up best friends with a gay man. And he kind of brought me into the circle of his friends, which ended up being just a really large, wonderful welcoming circle of people on all spectrums of the LGBTQ plus community. So I got really interested in just kind of gay rights and things like that went to marches and did all of that. Tried to advocate for the community as whatever I need to do as a 16 year old, which was not very much. And now I found myself in this position that I can do something which is awesome. And it's not even necessarily something I thought about when I went into the niche that I'm in. But I am really happy to be able to finally say that there's like some baggage behind this lifelong commitment that I kind of said that I had towards the community, but was never really doing anything about it other than like, your like Facebook posts here and there that talk about, you know, advocacy or supporting a community that's not well supported. So I'm happy to be able to do something about it now.
01:56
And let's talk about what you can do, or what we can do as physical therapists to help support this community, because I'm sure a lot of people may be listening to this and say, Well, what does the community need? That's so different from the rest of of other communities? So what is it about this community in particular, that perhaps they're more exposed to certain things? Or do they not get the care that they need? So go ahead, I'll pass the mic over to you.
02:27
Yeah, absolutely. So just discrimination in general, it's a problem in so many realms of social issues, being gender and sexual preference, of course, is one of those huge ones. So people feeling like or actually having less access to healthcare, getting denied health care, or getting given less than optimal treatment, or not really getting the best of their provider because of discrimination or because of biases that those providers have. Likewise, they might be afraid to go to facilities or go get treatments for things that are going through because they've experienced poor care before. So my niche actually, is pelvic floor physical therapy. And in this, there is so much that I can do for the community and physical therapists as well. And I was thinking about this podcast and thinking, what actually makes my job so different from the way everybody should be treating everyone. And I think there's a lot to learn, aside from just treating in pelvic floor PT. But in pelvic floor PT, I see a lot of people in the community because they are much more exposed to sexual violence and sexual trauma. And that correlates really significantly with pelvic floor dysfunctions. So we know from studies that gay men can undergo sexual violence at twice the rate of straight men, transgender people will usually experience about 50% of people will experience some kind of sexual violence in their life, which is a huge number 50%. And then it's even more if they're a minority. So that's a huge community of people where like, most of them need our help or need pelvic floor PT, or need more support than they're getting. So I think that we can play a big role in advocating for people and making spaces where they feel like are welcome. Or be that person that they can come to and after bad experience, bad experience or bad experience in healthcare, they can come to you and feel comfortable. And that's a really great feeling from my end. And I hope that other physical therapists out that out there feel better experienced that because it's awesome.
04:29
And you know, when you're talking about sexual trauma, or sexual assault within this community, I mean, the thing that sticks out to me is trauma. And so there is more and more research. And I think more and more people are now aware of trauma informed care. So can you share with us some of the principles of trauma informed care and why physical therapists should care?
04:56
Yeah, so this is kind of one of those things I was thinking about. trauma informed care and pelvic floor physical therapy is like, every class every time, we're always talking about every continuing ed course, because the nature of the work is so intimate, and very personal. And we're asking questions that make people uncomfortable, and hopefully not too much, but putting people in uncomfortable positions a lot of times, and it takes a lot for somebody to even come into my office to tackle these issues. But I think we should all be kind of treating in that same way. Because we don't really know like, of course, I know, when people come in for pelvic floor PT, they're probably uncomfortable. Like most of the time, people don't really like, want to be there. They're there because they need it. But that goes for a lot of things in physical therapy, right? Like people don't want to have back pain and come in and like, a lot of people don't want to get like touched and massage like, that's not what they intended on doing. But here they are, because they need it. So being trauma informed in any discipline is really important, because you just don't know what somebody has been through. So talking about trauma informed care, I think understanding a little bit more about trauma is probably a good place to start. So I do kind of think everybody should
06:10
reflect a little bit on what that means. So I was thinking of a good example. And I think that trauma can be kind of like pain, where we don't have a measurable, like objective measure for like, what pain is or what trauma is. So I know if a patient comes in says they're in six out of 10 pain, I have a patient with that same diagnosis that might say they're in two out of 10 pain. Or maybe I see, let's say I see somebody with a knee replacement. And I know that like a good healthy knee should have zero degrees extension, right. Or before they leave the hospital, we want them to have 90 degrees of flexion. But like I can't say to somebody, like you have a 15 degree trauma contracture. Like that doesn't make sense. There's no reference point that we know of other than what that person's experienced. So it's important to understand that trauma is different for each person. And some people could be really traumatized by an event. And some people could not really be traumatized by the same event. And that could depend on what factors they have in their cultural background in their other life experiences or the lens that they see things through. So somebody could experience their parents getting divorced, and maybe they came out of that fine. And they're like, Well, I came out of that fine. I don't know why it's so hard for everybody else. But you don't know what it was like to experience that with these other issues around you with being a minority or having financial distress or anything else like that. So understanding traumas is the most important part first. And then when we talk about trauma informed care. And this is from a Substance Abuse and Mental Health Services Administration, there's kind of the principles of trauma informed care, what does that mean? So the first part of that is to realize that trauma is a widespread issue. And it is invasive, and pervasive, and it affects people in a lot of different areas of their life. And then also realizing that there are pathways to potential recovery. After that, we should be able to recognize the five signs and symptoms of trauma. So recognize what is trauma look like? Sound like? How does that patient act? How can we pick up on if they're a traumatized individual. So seeing a patient being uncomfortable in your clinic, they might not make eye contact with you, they might not want to face you directly, you might see their body language is a little bit off, their arms are crossed. Things that we've all seen. We all have patients probably every day ranging anything from like that super bubbly, happy patient to the one that comes in and has done PT before and had bad experiences, and they're really unhappy. So recognizing what does that look like, and then responding by implementing that knowledge into practices and policies within just not just yourself, but the the facility as well. So using what you know, to actually change or adopt practices better, going to be more inviting or more informed and make more comfortable spaces for people that are traumatized. And then we have resisting retraumatization. And this, I think, is the most important part for us as clinicians. So thinking about what we can do to make an environment that does not correlate with any kind of trauma, anybody has had to make them have to revisit that. So and that could be anything again, like there's traumatic events that range from, you know, like really terrible sexual violence, and these are maybe things I hear about, but then there's also the trauma of like, having been misdiagnosed or having been told this or that by that provider or getting a hopeless diagnosis or being told that there's nothing that can be done for them. Those are things that we can actively try to resist re traumatizing that patient in. So being on honest and informative, making sure that we're not making false promise promises, but also that we're providing hope. And then thinking about what our space is like. And this is probably relative, maybe a little bit more for like LGBT, t plus LGBT plus community, where I am making sure that my space has signs that say All are welcome here. And things that make people feel invited, because they very possibly have had an experience before where they walk into a facility and like, immediately feel discriminated against or immediately feel like, this is not a place that I want to be here, this is not a place that's going to give me good care, and maybe the Carolinas without a dentist, but at any rate, they've experienced that and probably are very likely more than once. So I want to make sure that whatever I'm doing is not recreating any of that for them.
10:54
And when you are, understanding what trauma is, and really trying to understand the trauma of the person sitting in front of you, right, I would assume a lot of that comes through our subjective exam. So do you have any advice for therapists who are navigating these waters, even newer therapists perhaps are navigating or who maybe aren't, are not as well practiced in the art of the interview? Or in that process of, of that subjective exam? So do you have any like, what types of questions do you ask that kind of stuff?
11:34
Yeah, sure. Um, so I asked a lot of questions and pelvic floor PT. But I think the more important concept around that is, um, sometimes instead of asking questions, I, and that's not that we're talking at patients. But I do take a moment to do this. And if I am getting a sense from a patient, that they may have experienced trauma, that they're not going to share that with me. And that is probably more likely than not, especially on the first day, when I'm doing my initial evaluation, they don't know me, they don't trust me, they don't really want to share any of this with me, let alone even be there. So, a lot of times, I'll take the opportunity to talk about how trauma or how other experiences can relate to pain. So I might say to, let's say to my pelvic floor patients, I don't need to know or I don't need you to tell me any details or anything. But I am aware that trauma increases pelvic floor dysfunction increases pain, and it can really affect the way that people recover. So if there's anything that I can do during this treatment to make you more comfortable in any way, let me know if we need to stop anything. We're doing them, you know. So I might just take it as a piece of information, instead of asking a direct question, like making them tell me, maybe they'll do that later on in another session or two. Maybe I might need to know more at some point. But I've really never ran into that situation. A lot of patients will tell me the extent of it right there. They might do it another session or two. But it's not something that I really want to force out to people like day one, because if if I do that, like are they going to come back? Because that re traumatizing them? Have they been forced to talk about it before. I'm not a psychologist, I'm not a psychiatrist. I'm maybe not the person that they want to share all that with. So I want to make sure they have the open door to tell me about it. But I'm not like dragging it out of them.
13:22
Yeah, that's, that's wonderful advice. I really love that. And the other thing is, that I heard a couple of times during kind of these principles is creating that safe space, creating that space, where like you said, Everyone is welcome. How do you have any other tips and it could be from the person at the front desk all the way to, to the therapist and every employee in between? So are their conversations with the all the employees who work at the within that space? And and this may seem kind of like a silly question, but I think it's important, but colors on the wall artwork, things like that. I think it makes a difference. Right. So what do you what do you think?
14:10
Yeah, so I think that maybe places are a little bit hesitant to, like, fly this giant rainbow flag outside their door, right? Like, I would totally do it if I have my own clinic, but I recognize that I'm like, you know, working we're still working in a world that like from a business model. Maybe we don't want to do that because we want everyone to feel welcome, right? But it doesn't really take much. I think it's about really small gestures. So in our clinic, starting from paperwork, like they fill out paperwork online. And gender, for example, has every option that you can think of. If it is a paper form, gender is a blank space, so that blank space leaves people the option to write how they identify. And I love that option because That's even better than having to choose from like an overwhelming amount of options, or not finding the option that you're looking for. So a blank space for gender is fantastic. And then what we have in our clinic, like I said, small gestures, I think small gestures are really the thing, we have very small little flag stickers, like on the Plexiglas from our front office. Just little flag stickers for like every flag that you can think of, or it has like all the colors that represent different parts of LGBTQ plus community. So that little flag makes such a big difference, because I'll tell you, a lot of our patients are not going to notice it, like your patients that don't identify in any of those ways are not even going to notice it. But those people that do are going to see it, and they're going to love it. And we get compliments on that all the time. They think like, Oh, my God, people are so thankful for this little tiny sticker, we got like four pack on Amazon for like, probably a couple bucks, you know, just doesn't take much. And then another thing that we have in our waiting area is a sign that says All are welcome here. And that's such a simple thing, because that's not offending anybody that's making all people feel welcome. And people that are looking for that in their space, they know exactly what you're talking about when they see that fine. And everybody else is just like, oh, that's a nice thing. And they might not think very much of it. But it's certainly still a good thing to hear like, older people are welcome. Younger people are welcome. Everybody's welcome here. So it's really easy option.
16:29
And I love that these are all really easy, inexpensive, and accessible ways to show that you are working hard on creating a safe space for everyone. And like you said, a safe space for the LGBTQ plus community who oftentimes can't find those safe spaces.
16:48
Yeah, yeah. Another another small thing that I do personally, because I want my patients before I even go into their room maybe to like understand that I'm an advocate, I just have like a rainbow water bottle. And that's what I drink out of that work. And they see that sitting on my desk, and maybe some other stickers on like my laptop and stuff like that. But something that they might see like, Oh, that's my therapist, and they see like a rainbow water bottle. And it's just like a little thing that makes them feel more comfortable. I love it. I love my water bottle, so everybody's happy.
17:19
And do you go out physically into the community for advocacy work or as part of the clinic just so that people know that you're there? You know, like, how, how does that work within your community? Because I'm sure there are people who I mean, I'm in New York City, right? So I talk about like a large amount of people, right? So how do people know how to find? So how do people, especially in these marginalized communities know how to find the people who are creating spaces for them? Yeah,
17:49
so most communities, I'm in Las Vegas have support centers or community centers that support or provide or refer to services like my own or other providers that they know, create these safe spaces. So we have a support center here in Vegas, I've spoken to a little bit, I'm not necessarily within everybody's insurance providers. So that makes things a little bit harder. I'm in pelvic floor PT, I get so many patients from all over. And I've had a very long wait time, it's been tough to go out and mark it. And I'm also leaving for maternity leave actually in a couple of weeks. So I have plans for when I come back to reach out a little bit more, but I have been swarmed with what I have. But going out into these community centers, just letting them know who you are dropping off some cards, I have done that. And that is a really good way to at least get started. Get your name or your clinic out there. And maybe you're not what every person is looking for. But if they have your card handy, and they are providing social services to somebody, they might say, it sounds like you could benefit from this I know a great physical therapist that you could go to. And then, of course, we're a little bit bound by insurances. And that's definitely something I see in my future is trying to provide a little bit more preventive care to people that are uninsured or under insured. But that's probably a future problem for me at the moment. Right.
19:18
Right. And I think that's great advice. So if you're in a city, reach out to local community groups, community centers, things like that, and I think that's a great way for you to get out and in the community and really make a difference. And now there's one more thing that I want to talk about before we start wrapping things up. And that is the importance of asking patients for consent. So you touched on this a little bit, right? But especially in the pelvic floor world. Where does this explained explain to the to myself and to the listeners, how you go about asking for consent And why this
20:01
is yeah, this is definitely like if we can take home anything from if listeners could take home anything, it's to be more vigilant about asking for consent. And I can kind of trace this back to like how I've evolved in asking for consent. And I think about an IC O I think probably hope I'm probably not the only one guilty of this. But when I started, I started as a physical therapist assistant. So way back, when I graduated as a PTA, I went to work at a facility where the, the clinic was pretty manually aggressive, a lot of manual therapy, a lot of kind of aggressive manual therapy, which can be a little jarring for patients that are maybe not prepared for that. But I think about how many patients, I just went into the room and like started palpating, or like, Okay, I'm going to check this and then just like put my hands on them. And I think now about like how strange it would be to just like, grab somebody like psi SS without like telling them where you're going, like grabbing the back of their hips or having them like face a wall and then touching their back. And that can be like a very, that can like reiterate some traumatic events for people being grabbed from behind. That's, it's, I can't believe that I did this being the person that I am now. But I did, I did it every day all the time. And I never really thought about consent, I just figured the patient was there, maybe the provider before me had probably done similar the same things as a PTA, so I assumed PT had done the same. And I just think how crazy that is. Now, to me, it just is like so out there that I would have done that. Um, but asking for consent is something that should be ongoing and all the time. So from the initial evaluation, and education is a big part of asking for consent, I think too, because in order to consent to something, people have to understand what it's going to entail. And for me and pelvic floor, that's certainly relevant because I do do internal pelvic floor exams. So they need to know exactly what I'm going to be doing. And I use a model to demonstrate and to talk about what that's going to entail, and then discuss that they have the option to consent to that or to not consent to that, if they don't, there's other things that I can work on that I can help with. So I don't want them to feel pressured, that they have to consent to anything that I asked for. So consent, those should be informing the patient pretty much every step of the way. So instead of saying, I'm going to check your pelvic alignment, nobody knows what that means, like our patients don't know what that means. So I might ask, Is it okay with you if I touched the front of your hips, and then that's how I started just kind of simple and explaining in layman's terms, what I'm going to do. And a lot of times, I'm asking a patient or giving a patient options. And this is kind of part of trauma informed care is enabling or empowering the patient to make choices or have options. So instead of saying, say I want to do soft tissue work, instead of saying, I will be right back, I'm going to go grab some lotion, and then the patient knows I'm going to do soft tissue, but they didn't get an option to consent to that. I just went to go grab it. And now they feel like they're stuck there. And I'm going to come back with lotion and they're going to get a massage and they don't have a choice. So I might say, I would like to work on this. This is why. So we can do that. If you don't want to do that. We can work on mobility in this other way. So that way they have an option for what they want to do or how they want to do it. So providing options, I think is a really important part of concern. Um, I think yeah, I think that's mostly what I mean with consent.
23:42
Perfect. Yeah, I think that's great. And listen, I used to do the same thing. And I can't believe I did that either. Yeah, just like walking into a room and just like touching. Like, I wouldn't want someone to do that to me. I can't believe I did that.
23:55
I know. And I wonder is that like, a time? A time thing? Like 10 years ago? Was it just more like then we're just more informed now? Or was I just like totally oblivious? Because that's certainly
24:05
possible. I think it's just we're more informed now. I'm gonna I'm gonna go with that, you know, and yeah, and and maybe a little bit of a being oblivious? I don't know. But you're right. Like, I would just come first of all stand up and you just be like, hands on the pelvis. And it's like, what is like, how, what, what was?
24:25
And like next to I think, like, we were just yeah, like not grabbing,
24:30
grabbing onto people's heads and everything. What's that about? I would never do that. Now. You know, even if I'm just going to touch someone's arm. I was like, I'm just gonna put my hands here if that's okay. And we're gonna. Yeah, it just makes so much more sense. And I love the fact that you tied that in with the patient education component. Because I think like you said, you can't have one without the other. It's just so important.
24:55
Right? And I think that we underestimate like how much the patient wants to be educated about things. So and that's a lesson, I think I've learned pelvic floor PT, because so many people did, like they don't even know they have a pelvic floor or what it does. So education's been a huge part of my practice, like the whole first session is really education and training, and bladder and bowel training and things like that. But patients want to know, they want to know all the details, like they love it, tell them so they know what you're doing. So they know if they want that done or not.
25:24
Yeah, absolutely. At your right patients want to know, and it doesn't matter the age, they want to know, what's going on with their bodies and and what they can do to be a part of it. So it's also a great way to empower your patient to understand and take control over their, over their bodies. You know, and and give, give the patient some autonomy and some confidence.
25:49
Yeah. And to give that the patient the opportunity to, like collaborate with you, instead of be told what's happening. So to have the opportunity for them to feel involved and to have a voice in their decision making and understand even why they're making a decision, like so that they might know. Yes, I do want this internal pelvic floor exam done. Because I want to know more about the tone of my pelvic floor so that I can know why I have pain or why I have difficulty emptying my bladder. I want them to be able to make that connection in their head and be able to consent to it. Knowing why.
26:21
Yeah. And it's all part of patient centered care. I mean, that's what we're all supposed to be doing. Right? Yeah, absolutely. It's not patient directed care. It's patient centered care.
26:33
Right. And just as relevant as it is for me and pelvic floor. I think it's the same anywhere else across the board.
26:39
Yeah, across the board. Absolutely. Well, I, you know, I want to thank you. I think this was a great conversation. I feel like I've definitely learned a little bit more about trauma informed care. So I thank you for that. Now, where can people find you? If let's say they have questions, they, you know, they want to know how they can implement some of the things you're doing in your clinic in their own clinics.
27:06
Yeah, sure. So I typically use my work email for anything like that. So that is M Duncan at Kelly hawkins.com. And I like I said, I'm not much of a social media person I wish I could say I was that's probably not the best way to contact me.
27:24
I know you're not missing anything. Don't worry about it.
27:27
Yeah, but I'm always happy to check emails and respond that way. For people trying to figure out where to start. I did want to mention CSM has a lot of great topics on this, I've certainly gotten a lot of information, or directed myself onto what things I'd like to learn more about by going to CSM and going to these discussions. There is some information on trauma informed care at CSM this year, as well as introductions to pelvic floor PT, for those that are interested. And there are always platforms and other lectures on what we can do for the LGBT Q plus community. Excellent.
28:04
Thank you so so much. And before we wrap up, I'll ask you the question I asked everyone. And that's knowing where you are now in your life and in your career, what advice would you give to your younger self?
28:14
That's fine to not just go around touching people.
28:18
Yeah. That advice to each other.
28:21
I think I'm fortunate that never really panned out to be anything too negative, but I would love to go back and not do that. But what I do tell people and recommend as far as career is to find a niche. So my niche is pelvic floor PT. Within that my niche is being passionate and treating the LGBTQ plus community treating patients that are transgender, that is a great niche to be in, not everybody is doing it, it is so needed. If you can find a niche that you're passionate about, and that is needed, you are never going to struggle for work or for satisfaction. Um, it really is kind of been if you build it, they will come situation. And people told that to me when I began pelvic floor pt. And that's what I did, I built a pelvic floor program, the company that I work for now. And like I said, I am very busy, very satisfied with the way my career has gone in. So find a niche and it's not something that every new student is going to know right away. But get out there and explore like go shadow and go find places that are outside your comfort zone. Like I wasn't I didn't think I was going to go into pelvic floor PT. I don't think a lot of us that end up in it do. It's maybe not something I would have thought to shadow I would have been like, that does not sound good. I don't want to do that. But again, outside your comfort zone, go shadow and find therapists that are doing things that you don't think you would ever do, and see if you can find somewhere that you're going to land and be successful.
29:50
I love it. That is great advice. Thank you so much, Megan. I really appreciate your time and your knowledge sharing with myself and the Audience So thank you so much yeah thank you and everyone thanks so much for tuning in and listening have a great couple of days and stay healthy Wealthy and Smart
In this episode, Associate Professor at the University of the Sciences and Director of BTE Laboratory, David Logerstedt, talks about monitoring and responding to load injuries on the knee.
Today, David talks about the most common loading injuries on the knee, difference between external and internal loads, and how to improve tissue capacity. What is mechanical loading?
Hear about David’s most recent research paper on mechanical loading and the knee, how therapists can monitor and respond to loads, how clinicians can apply the information in the paper, and get David’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “A lot of the stresses that cause the injury also are some of the same stresses that you can use to rehabilitate the injury.”
- “Most of us have enough tissue capacity to walk, but we might not have the tissue capacity to run a 10k.”
- “You really are trained to look at how the joint is reacting to the loads that you’re placing on it. Measuring irritability is probably the best way to describe it.”
- “Even just asking how they feel can give a lot of information.”
- “If people understand the ‘why’, then maybe they’re more likely to do it and follow through.”
- “Don’t say no. Always say yes to opportunities. Especially in that early career, if an opportunity comes along, take it.”
More about David Logerstedt
David Logerstedt, PT, MPT, PhD is tenured Associate Professor at University of the Sciences and Director of BTE laboratory. He graduated with a Bachelor of Science degree in health and human performance from the University of Montana and a Master of Arts degree in exercise physiology from the University of North Carolina. He earned a master’s degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and movement science from the University of Delaware.
Dr. Logerstedt has been a practicing rehabilitation specialist for over 25 years and is board certified in sports physical therapy. He has presented his research on knee disorders at national and international conferences and has published in high-impact sports medicine journals on ACL injuries. He has co-authored several clinical practice guidelines on knee disorders.
His goal to improve the implementation of clinical research into practical and accessible for all clinicians.
Suggested Keywords
Healthy, Wealthy, Smart, Knee Injuries, Loading Injuries, Tissue Capacity, Stress, Research, Rehabilitation, Recovery, Physiotherapy
Resources:
Effects of and Response to Mechanical Loading on the Knee
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Read the Full Transcript Here:
00:07
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.
00:35
Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health so when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration, head over to net health.com forward slash li tz why to sign up for your complimentary marketing audit. And it's great, I use it and it works. So I highly recommend it. Now onto today's episode. So I'm really really happy to have Dr. David lager stead on the episode today. And we are talking about monitoring and responding to load injuries on the knee. So Dr. Lager stat is a tenured associate professor at the University of sciences and director of the BT EE Laboratory. He graduated with a Bachelor of Science degree in Health and Human Performance from the University of Montana and a Master of Arts degree in exercise physiology. from the University of North Carolina. He earned a master's degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and Movement Science from the University of Delaware. He has been a practicing rehabilitation specialist for over 25 years he is board certified in Sports Physical Therapy. He has presented his research on knee disorders at national international conferences and has published in high impact sports medicine journals on ACL injuries. He co authored several clinical practice guidelines on knee disorders. His goal is to improve the implementation of clinical research into practical and accessible, make it practical and accessible for all clinicians. So yeah, so today we're talking about a new paper, that he co authored the effects, the effects of em response to mechanical loading of the knee to great paper, you can go to podcast at healthy, wealthy, smart calm, to find a link to the paper. And a big thanks to Dr. Lager stead for breaking it down for us and everyone enjoyed today's episode. Hey, David, welcome to the podcast. I'm happy to have you on.
03:04
Thank you for having me. Yeah, and I'm excited. Today we're going to talk about a new paper that your co author on that came out on to be very precise, October 20, of 2021. And it's the effects of response to mechanical loading on the knee. So of course, my first question, I'm sure this is the first question everyone asked you is, why write this paper? What is the why behind it? You know, as a, as a clinician, as well, as somebody who is now in academia, I've always kind of had this question myself, you know, what kind of loads are on the knee? And I've always had this, you know, concern about dosing and trying to figure out like, how can we can best dose exercise around the knee. And as I, as I really started to think about this more, really started to find that there hasn't been any review, or any kind of clinical commentary kind of brings at least the concept of mechanical loading, kind of in one place. And the knee is always a good model, because it does seem to have a lot of a lot of research around it. And it's an area I'm familiar with, because of my work in ACLs. And so I, we, you know, we just started, started thinking about, okay, how can we best talk about what kind of loads are being placed on the knee and, and some of it kind of kind of came out of some conversations I had with another colleague of mine, where we've really started to talk about the use of inertial measurement units and how those can start to give at least some general indications of what loads are occurring through the lower extremity. And so we decided to just kind of put a team together
05:00
who had expertise in in loading? And then expertise in specific structures related to the knee? And so that's kind of how it kind of came together. And when we're talking about loading of the knee, so in this, in this paper, you're talking about mechanical loading. So let's, let's go with some more definitions here. So what is mechanical loading? And why is it important in respect to the knee will stick to the knee? Yeah. So, you know, in the paper, we really describe mechanical loading, this is the physical forces that act on are free to make demand on the body, either at the system's level, or even on structures at a specific organ or tissue level. And so if you think about mechanical loading can kind of subdivided into different variables, such as, like the magnitude of the load, how long the load is being applied, how frequent it might be applied, or even maybe the direction or the nature of that load. So
06:05
so when we think about loading, though, all those components kind of interact, can interact with one another, and then create different loading patterns that can impact again, the knee is the organ itself, or specific structures within the knee. And when we're talking about loading, I think most people think of loads as external, so something that we are placing on that knee, but there are external loads in their internal loads. Can you kind of differentiate those for the listeners? And how, and why are both important? Yeah. So when we think about, you know, external loads, to kind of think about is like, really kind of that work that's being performed? So like, how far did I run today? Or how high did I jump? So when we think about like, like that, it's almost, it's almost kind of like that outcome in, in an essence when we think about external load. But when we think about internal load, you can either think about what what's the physiological process that's going on inside the body related, potentially related to the external load, or maybe even the psychological. And again, maybe even that biomechanical response to that external load? So So usually, when we think about internal load, it's like, you know, how what, you know, what is your heart rate doing related to how far you run? Or what is the extra? Or what's the amount of stress that's being placed on the knee after you land from a jump? Yeah, so so both are important, especially when it comes to knee injuries, and loading injuries. So let's talk about what are some of the common loading injuries on the knee?
07:54
Yeah, so if you think about some of those different types of loads, you can kind of really subdividing at least at Deneen to kind of three major categories. In essence, whether it's a compressive load, a shear load, or a, you know, a tensile load that occurs, there's some other loads that can occur, such as some hydrostatic pressure loads, but the primary ones are really related to that. And so then if you break that down into specific structures, such as a ligament, you know, like the ACL, which is one of the more common injuries that occurred the knee, you know, that's usually related to some kind of tensile load that's occurring on that ligament, it can occur either from, you know, cyclical loading, where you can continue to put stress on that ligament until that ligament ultimately fails. But usually, it's one usually large load that occurs that relates in, you know, a traumatic tear. That's probably an example of kind of one of the more common ones. But, you know, we, you know, we commonly see other tissues damaged, you know, the meniscus is another common injury. And that's usually again, that's really related more to some compressive with shear load. And then, you know, cartilage also kind of was kind of relies on
09:24
a shear load to be damaged. So
09:28
all those different loads occur on the knee, it just sometimes it depends on again, all those other variables that we've talked about, you know, the nature of it, or the compressive versus the shear versus the tensile load, but then again, how quickly does it occur? Maybe at what angle your knee is bent that can impact all those types of things? Yeah, I would think angles, speed, fatigue levels, hydration levels, you know,
10:00
All of that I can only imagine goes into
10:04
a type of injury from one of these loads, right? And you say, you know, and if think about, you know, again, you have that that external load, but then, you know, think about some of the other internal loads, you know, the muscles around the joint contracting, to maybe unload the knee at a specific time, because, you know, we have, you know, you've seen many athletes like they cut and pivot 1000s of times in a career, why is it that one certain time, they do the exact same maneuver, they've done 1000 times before, their ligament tears or their meniscus tears. So there's, there's so many other underlying factors that lead to it.
10:50
And so part of this papers, at least trying to describe some of those things, so people have an understanding of what is the underlying loads that can can lead to an injury. But then,
11:03
what can we do after that? How can we use those exact same parameters of same loading parameters to rehabilitate them? Because the same, a lot of the same stresses that caused the injury
11:17
also are some of the same stresses that you can use to rehabilitate the injury? Right, and I would think have to use to rehabilitate the injury. Right? Right. Yeah. So so they, so they can adapt to that stress and be ready to handle the stress the next time it occurs. Exactly, exactly. And now what one of the figures we were talking before we went on the air within this paper is figure four. So for everyone who is listening to this, we'll leave a link to the paper in the show notes. But when you go through, you'll see there's one figure it's figure four, it's a conceptual model of loading of the knee. And it's like a monster of a figure like it is. It's large, it looks very intimidating, and very complicated. So can you break it down for us? Yeah. So this is how, you know, we started to think about taking a lot of these other models that have been out there that have described, you know, maybe the physical stress model, or many people have commented on the,
12:24
on the die model, related to the envelope of function, and also the dynamic recursive model related to injury, probably the, is the best one, best way to describe it. But you got to take into all those factors that can influence or just leave somebody susceptible to an injury,
12:52
as well as including this their underlying physiology. And again, that could just be related to those non modifiable factors such as your age and your sex.
13:04
And then again, your underlying physiology, you know, your genetic makeup, maybe even just some kind of a little bit of your underlying fitness level. And then what are some things that can predispose that tissue to injury? And again, it could be, you know, do you have a strong tissue or a weaker tissue? Does the, you know, do you have certain types of muscle fibers, you know, that can influence again, things like fatigue? And then what are the external factors that lead into it? So, some of these models have already been kind of described in the ACL related literature, you know, you know, shoot a surface interactions, whether that occurs out there is, is it turf versus grass. So, those types of things can all potentially influence an injury and then,
14:00
you know, moving into the next part, then you just think about the mechanical load. So, again, all those factors related to magnitude and duration and frequency. And then we wanted to kind of
14:15
try to articulate that, again, if you took, you know, just conceptually took it is looking at each of the different major structures in the knee that could be impacted, and then talked about how those tissues respond to some kind of stress and strain. So, you know, if you put it,
14:39
again that load under a specific type of compressive versus shear strain, how does it respond to that, and William Thompson did a really nice review in ptJ a couple of years ago, looking at some of the Meccano therapy and McKinna biology that occurs at specific
15:00
tissues that Karim Khan had kind of initially proposed back, God 10 years ago or so. And then if you take all those things account, and the stresses and strains, so then you start to look at how that impacts how the tissue adapts to those stresses and strains. And, you know, using kind of the fitness model, or the fitness fatigue model is, is if you apply the right stresses at the right time. And you do that consistently over time, it basically builds up into tissues adapt to it, and it gets stronger, and fitter. But if you don't do it, or you do it at a delayed time, it may stay at a homeostatic level, or than if you do it too infrequently, or the loads are too much, too frequent, then you can actually fatigue the tissues. And, of course, if you get too much fatigue, and you get the right amount of load placed on it, then that can result in injury. And then you kind of go through, go through again, and go through it again. And again, that's part of the rehab process is taking all those things into account. And so
16:22
that's how we tried to really try to conceptualize it and think about, you know, and so we really kind of focused more on the the tissue levels and the response to injury, and how you can use that kind of this conceptual model of kind of stress and strain along those other factors, too. I think it's important to note that we're not only talking about ligaments or meniscus when we're talking about the tissues around the knee, ligaments, meniscus tendon, articular, cartilage bone. It's not just, we're not just talking about ACL 10. Lien, you know what I mean? There's, it's really the all the structures that that make up that knee joint, correct? Correct. Yeah. And, I mean, I think that's even a really important point to like, when we're rehabbing. You know, somebody and you know, you take somebody with a meniscus tear, not only are you impacting the meniscus that you're working on, you're also impacting a lot of the other structures around it. And so you can influence the all that rehab, or that rehab impacts all those tissues, depending on how you're providing the specific load. Right? Absolutely. And, you know, one of the the words that's in that figure is tissue capacity. And so during the rehab process, certainly after injury, but even, let's say, without injury, right, I think one of the goals is to always improve tissue capacity. So can you kind of talk about what exactly that means? What that What does tissue capacity mean and as physical therapists, what where do we stand in the improvement of that capacity. And on that note, we'll take a quick break to hear from our sponsor and be right back.
18:18
When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about this new integration, head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.
18:55
Kind of an in a general layman's term, you think about just tissue capacities, it's all related to the under I think sometimes so the underlying tasks that's being performed, right, you can have a certain level of tissue capacity that allows you to, to walk or run the tissue can meet the demands of that load placed on placed on the body by that specific task. Right. But if the task is too high, or the load is too high, relative to what the tissue can handle the tissue than this doesn't have the capacity to handle that load. And again, it may be able to handle that load one or two times. But over a repeated bout, it may fail much quicker. And so I think sometimes tissue capacity is it's also related to the task that's being performed. may know most of us have enough tissue capacity to to walk community levels and things like that. But you know, we might
20:00
not have the tissue capacity to run a 10k, even though that we may have the underlying structure that we could build up to that, I think those are the things you have to take into account. And from a rehab perspective, you know, you always have to think about kind of that starting point of what people can handle, and then how, how you can adjust the rehab process to improve that capacity over time. So that that leads into what are some ways we can monitor load and respond to that load? So we're the therapist, we're taking care of our patients, how can we monitor and and, and change that load as necessary? Yeah, so.
20:46
So from, you know, a clinician standpoint, you know, most of us probably in the clinic, you know, we don't have high tech equipment, like global GPS units are inertial measurement units to measure
21:01
acceleration, and
21:04
you know, how far people have gone
21:08
a certain amount of distances they walked or jogged or done the whole thing, like you have seen with some of the devices like catapult or, or
21:18
I measure use IMU units. But I think from a clinician standpoint, we still have a lot of great tools that I think are that we still under utilize, to some degree. So,
21:32
you know, I, I always like to tell my students
21:38
that you really are kind of training to look at how the joint is reacting to the, to the loads that you're placing on it? And are you making the tissues more irritable or less, irritable, measuring irritability is probably the best way to describe it. And the knee, you know, you can see things like, you know, increase swelling, you know,
22:02
which is a common, probably a common measurement to see for, for increased irritability, but it can also be, you know, is the joint getting sore versus the muscle getting sore, right? And so trying to be very clear,
22:20
with
22:21
the person you're working with is, you know, does it hurt inside the knee, or is it just hurt in the muscles around the knee, because we'd expect to see some muscle soreness if you're working those, right, but you don't want the, you know, the irritation to be in the knee. Um, so those are probably the two major major, major ones that I like to use. But
22:44
you can also look is, you know, do Did they have a sudden decrease in a range of motion, you know, which can be an impact, or, you know, a factor of them, having some irritability, has their strength gone down, which is probably a little bit harder to assess more consistently, but those are probably the major things I would consider looking at is, if you're starting to see some of those means the tissues become a little bit more irritated. But if you don't see those, then you know, the next, you know, maybe the next session, the next couple sessions, you can start to slowly increase the load a little bit, and see how they respond. And I think that's always the challenging part. Like, I like to challenge my students with is, but that's one of the great things about being a therapist, who is we get to see them again, and see how they respond to our treatments. And we can regress or progress them as needed. Yeah, and and I think that's a really great thing that you said at the end, we can regress or progress as needed. So if someone if you give someone some exercise or some loading, and they come back with like an angry knee, it doesn't mean stop everything and go back to passive range of motion. It means okay, let's just take it down a notch. But continue. Yeah. Yeah. And I think when the the last one I meant should have mentioned is, you know, just even just ask them how they feel. Mm hmm. You know, how are you how do you how does it feel today can give a lot of information then you can use things like you know, a session RPE schedule, you know, scale, say, Okay, your knees a little bit angry. Let's back, let's back your exercise session down two or three today, instead of working at a seven. Mm hmm. So you can still do something still keep the knee moving. Still keep it kind of moving forward, but you've kind of backed off in gave it a little bit time to, to calm down. Yeah. So it's, it's sort of this combination of what you're seeing objectively and then asking them how novel What a novel idea you're doing or you're having
25:00
Having trouble? Yeah. The other day you were doing stairs really well. And now you're having trouble doing stairs, you know, some of these functional day to day things? Yeah, exactly. I mean, I think, like you said, those are just really simple tools, I think we, we get so focused on, you know, what we like to call the objective data, instead of just asking people, how do you feel today? Yeah.
25:23
Absolutely. And now, how can we and I say myself, we, I'm a clinician, how can how can we clinicians use the information in this paper to start applying load to a REIT to the rehabilitation of an injured knee? Or post surgical knee? Or what however you want to categorize? Yeah, yeah. I think, you know, as we were talking before, there's a, there's a, there's a lot of data in this in this paper, too, that the clinicians can think canoes, and so I don't want them to get overwhelmed with all the numbers in the data, but it's really there to be is it as a resource for clinicians to say, Okay, I have somebody who has a pretty irritable knee, and these are the activities that we're doing before, you know, and we can get a sense of, okay, that that activity, you know, was, you know, three times body weight, I need to find an activity, that's maybe two times body weight.
26:27
So we can regress them a little bit. And this is an activity that kind of fits that or this was an activity that put this amount of stress on the ligament, we know that that stress is still within us safe range to, to push it a little bit to the next level.
26:47
Because, you know, I think some of the, some of the fear is, is that if we're putting stress on the ligament that we're going to injure it, or even on any tissue, right. But we, as we know that, especially after the initial inflammatory phase, you need to start putting a little bit of stress on the healing tissues, because that's how tissue gets stronger is that it has to respond to stress. But if you're putting, you know, if you're putting state and I'll put an air quotes, safe, safe stresses, or stresses that are below kind of the the below the failure rate, and you're monitoring the knee for those inappropriate responses, then you can use that information to slowly progress them through a rehab safely and adequately the healing structure to then kind of into the next level of repair. The one of the tables, we talked about this, again, before we came on, was table seven, within this paper, where you have some activities where it's like this is like you said, maybe it's 1.4 times body weight, or this is 20 times body weight, or this is eight times body weight. And I think that's a really nice guide for clinicians. But I think it's also a really great educational tool for the patient. So you can show this too, because most patients get it. I think a lot of times we underestimate our patient's ability to understand. Yeah, a lot of these concepts, you know, and and so I think if we can say the patient, hey, listen, this is X amount, your body weight, this activity is less than that. And let's say you're a month out of like some sort of surgical procedure, hey, let's go with the one that's less times body weight than this. And because people say, well, what's the big deal? It seems like it would be fine. But I love that because I think it's a great way for clinicians to use the paper also is a great educational opportunity. Yeah, no, no, I think that's a that's a really valid point, is it? I think if we can educate the patients on, you know, these are the activities that you should be doing right now. And as you strong, get stronger and get better than you can move into these activities the next time, right. And so they're always asking, patients are always asking, like, what can I do now? What can I do now? And so, you know, this table can give them some insight of, okay, this is where you're at. These are the things that you start doing now. And these are the things that probably wait a little bit longer. I think that the patient will really understand the why behind, you're giving them the exercises that you're giving them. Yep. And that's really important, because if people understand the why then maybe they're more likely to do it. Yeah. And follow through. Yep. So I mean, I think it's great. I think this paper is great. Is there anything
30:00
thing that we didn't touch upon in the paper, the process of doing this paper that you would like to share before we start to wrap things up, no, you know, I'd really like to, you know, first of all, thank my co authors who were willing to, to sit down and write this, it was, it was no small feat, you know, pulling together, clinicians from around the world to, to do this. And so, you know, definitely want to, you know, think tour MacLeod, Brian higher shyt, J uebert. Tim Gavitt and Brian eckenrode, for, for agreeing to do this, you know, this, like I said, this was a paper that had been mulling around in my head, probably since I was in PT school, you know, for a long time. And, you know, this just felt like the opportune time to pull it together. And fortunately, you know, in the last several years, last 20 years or so, we have, we have the data now to support a lot of the things that we do is physical therapist that I think intuitively, we've always done. But I think now that we can, we can demonstrate a lot of what we do, and some of the value that we bring to, to rehabilitation into to patients and to clients. Yeah, and and I mean, I like this paper from a rehab standpoint, but I think it's also really great from a strength and conditioning standpoint, right? Because as physical therapists, we don't have to just be the people there when the athlete or the person is injured, we can also be the person that helps to keep them strong and kind of improve, especially in I know, in a lot of professional settings. You've got strength and conditioning coaches, and athletic trainers and pts. But for the average physical therapist, like if you're in a small town, maybe you're it. Yeah, you're doing it all. Yeah. So I think this paper is really helpful not only to progress, people after injury, but to kind of look and say, Hey, this is the load that we can place on you that will hopefully help to decrease your chances of getting injured. Yeah. So I appreciate that in this paper. And now, where can people find you? And like I said, we will have a link to the paper in the show notes. But where can people find you if they have questions of you specifically? Yeah, I'm fairly active on Twitter. And so that's primary, my primary social media outlet so you can find me It's Dave, log PT. You know, if there's any questions or anything like that, that's probably the best, best way to reach me is either directly through DMS, or, or through my Twitter feed. Perfect. And now before we wrap things up, I have one more question. And it's a question I asked everyone is knowing where you are, in your life and in your career? What advice would you give to yourself? Let's say as a new grad, right out of PT school, I would probably, I would say, at that early stage advice, actually was given to me before is don't always don't say no. Always say yes to opportunities, especially in that, that early career, that if an opportunity comes along, take it, it may or may not be the perfect opportunity. It may not be what you dreamed of, but it more likely or not, will
33:32
be the a value to you. And many times it's a huge stepping stone. I would say you know, an opportunity comes along, say yes. Especially when you're young. Yes, yes. Young and full of energy. I think that's great advice. So listen, David, thank you so much for coming on the podcast breaking down this paper. It's a great paper. So congratulations on that. So thank you for coming on. You. Thank You, anytime and everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Dr. David lager stat for coming on the program and talking all about load parameters around the knee joint and of course, a big thank you to Net Health. So again, their digital digital marketing solutions can help your clinic win by allowing you to get found get chosen and get those five star reviews on Google. They have a new offer if you sign up and complete a marketing on it to learn how digital marketing solutions can up your clinic when they'll buy lunch for your office. Head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today.
34:41
Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media
In this episode, Founder of the Concussion Corner Academy®, Jessica Schwartz, talks about the nature of concussion treatment.
Today, Jessica talks about her concussion experience and how it has shaped her work leading up to the Concussion Corner Academy®, the reality of long-term concussion symptoms, and some of the top concussion myths. Is it ever too late to have your concussion symptoms treated?
Hear about treatment barriers, some of the surprising statistics in concussion and TBI research, and the importance of education, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “When you’re young, make sure you have extended disability on yourself.”
- “There’s no evidence-based, agreed upon international definition of concussion or traumatic brain injury.”
- “There’s been zero phase 3 trials on TBI and concussion in over 30 years.”
- “Up to 30% of folks now have persistent symptoms of concussion.”
- “If we can teach one, we can serve many.”
- “2012 was the first year the International Consensus Statement discussed the cervical spine in terms of examination treatment.”
“2015 was the first academic year in which there was a formal training for both TBI and concussion if you were a neurology resident.”
“2017 was the first year on the International Consensus Statement that we identified concussion as a rehabilitative injury.”
- “The injury of concussion is an injury of loss. It’s a loss of your ‘I am.’”
- “Join Twitter.”
More about Jessica Schwartz
Jessica Schwartz PT, DPT, CSCS is an award-winning Physical Therapist, a national spokeswoman for the American Physical Therapy Association, host of the Concussion Corner Podcast, founder of the Concussion Corner Academy®, and a post-concussion syndrome survivor, advocate, and concussion educator.
After spending a full year in rehabilitation, experiencing the profound dichotomy of being both doctor and patient, Dr. Schwartz identified the gaps in concussion treatment and management in the global healthcare community. Her role has been to identify the cognitive blind spots and facilitate collective competence for healthcare providers, physicians to athletic trainers, focusing on comprehensive targeted physical examinations, rehabilitative teams, and concussion care management.
Suggested Keywords
Healthy, Wealthy, Smart, Concussion, Research, Statistics, Physiotherapy, Neurology, Concussion Corner, Myths, Healthcare, Rehabilitation, Injury, Loss,
To learn more, follow Jessica at:
Website to Join the Program: The Concussion Corner Academy®
Facebook: Concussion Corner
Twitter: @ConcussionCornr
Instagram: @ConcussionCorner
LinkedIn: Jessica Schwartz
YouTube: Concussion Corner
LinkTree: https://linktr.ee/ConcussionCorner
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Read the full transcript here:
00:02
Hey Jess, welcome to the podcast. Finally, I'm so excited to have you on.
00:07
Thank you so much for having me. I can't believe we haven't done this yet.
00:10
I know it's like absolutely insane. And just so people know Jessica and I both live in New York City, and we actually see each other quite a bit. And this is the first time I've had you on the podcast. But I'm really excited to have you on today because we're going to be talking about concussion, persistent post concussion symptoms, and you'll talk a little bit more about that name changed in the bulk of the interview. But before we get into some common myths around concussions, I would love for you to let the listeners know a little bit more about why you decided to really specialize in this niche within medicine and rehabilitation.
00:52
Awesome. Well, I thank you for the softball pitch care know. For those that don't know, Karen used to play softball on Central Park quite a bit. But yeah, no, I mean, I thank you so much for having me on. First. I've been listening to healthy, wealthy smart forever. So just thank you again. And yeah, I mean, gosh, I think back to I was a we were one of the first six residents actually, we were the first six residents in orthopedics at NYU in 2010. When I finished up grad school and all that jazz, and we I had it, I got the dream job, right, got the dream job. I had to leave New York City for it, which sounds crazy. But I think a lot of folks can connect to that, you know, working in, you know, the old adage, Jay, we used to call mills and things like that are seeing three or four patients plus per hour. And I was like, this isn't why I went into physical therapy. This is not why I wanted to do this. And I found this great clinic out in New Jersey during residency and we saw one to two patients per hour. And we had a support staff and they were emotionally intelligent. They were physical therapy owned, and they let us grow. And keep that like use of excitement, right? I don't know about you. But I'm hopped up on caffeine and too little sleep as we launched a new business this week. But it was great. And it really it fed my soul. It was wonderful colleagues and we ended up I ended up starting kind of in the opposite end of things, a civilian prosthetics program. So I was, you know, volunteering and showing up at the Manhattan VA, which has a wonderful prosthetics program. And then we also launched a breast cancer program and be launched a concussion program. So that was kind of like my first entree into concussion about 1011 years ago. And we were the only really only office in New Jersey with that type of rehabilitative practice at approaching concussion. And so very Dunning Kruger ask, it was like, you know, you don't know what you don't know until you kind of are made self aware of it. I got hit by a car. So I was hit by a car in October 3 of 2013. And right before then, oh, actually, it wasn't even right before then care. I'm sorry about that. But it was two years before it was our last day of residency. We saw that there was a conference at NYU at the hospital. And it was on concussion and it was NY us first concussion conference. Now this was 2011. So my best friend from Italy Beatrice, you know, hi, BIA. She's in Lucca. She's a great physio, if you're out in Italy listening in. And we were like, What do you want to go and it was our first weekend off for residency. I mean, we were exhausted, excited. And we're like, let's do it. So we went to this conference, I fell in love with it. And so we were at least aware of what this program was at NYU. Fast forward two years from there. And I was actually hit by a car here in Manhattan. So that's really where it's my life's work and passion is to become because I actually live with persistent symptoms. So and went through quite a recovery. So that's kind of how it all kind of came together and coalesced.
03:49
And when you suffered a concussion, and this was in 2013 It did you did you have kind of the self awareness at that time to think, well, you know, I've been learning a lot about concussions, I think I can I can kind of help myself here and did that then really propel you to learn more and to dive in even more.
04:19
So when I was hit, I was hit by an unlicensed driver from behind and my airbags did not go off. I was in my Toyota Prius you may have even been in that car at some point. And I didn't think anything of it but I knew I when I said the story is I I got out of the car. I want to get out of the car. I got hit so hard. I was stoplight at a red light wasn't looking behind me because we were stopped. And it was the traditional traffic right care like we're just inching forward. And I was probably on that block of 12 Street between Fifth and Sixth Avenue for about two or three light cycles because of traffic. So I just got Walt from behind and so the New Yorker in May right so born and raised New Yorker You know, unbuckle the seatbelt and get out of the car to give this guy the business. And I was just so dizzy care. And I held onto the top of the hood of my roof of the car and I was like, I gotta sit down. Fast forward. I thought this was quote unquote, just going to be a concussion. And at that time, we really thought concussions were pretty much resolved spontaneously within seven to 10 days based off of the literature from 2002. From Brolio and McCrea at all from the NCAA study. But we don't have that's false. And we have so much updated information we can chat about if you'd like. So I thought it was just going to be seven to 10 days. I went back to work for for a week, I thought, you know, I would just be sore, kind of like a whiplash or like a Dom's. And now, I just kept D compensating and then from there went from 10 to 14 hours of rehab a week for 14 months.
05:53
And how did you continue to work and continue to function during all this time?
05:58
I did not. So I went off of I went out of work, mind you, I was just promoted to junior partner the week I got hit. So I remember I was like directing a prosthetics program, we had all these other programs, I just became junior partner, which would have been a profit share with a company and I loved my job, I would still send people back to that clinic, those four clinics in New Jersey in northern New Jersey. So essentially what happened was, it was a conversation that went on for months. So I was on short term disability for six months. And I say this to all physical therapists, physicians, OTs, PTs, whoever's listening to this, when you're young, make sure you have extended disability on yourself, because our bodies are so fragile at the end of the day. And again, I was an athlete, I was a cyclist I was training for, for a century bike ride and life changes in the blink of an eye. And I was underinsured with a $50,000 policy policies for car insurance to go up to 300,000 to 3 million for certain policies. And it would have been an extra $12 a month. But again, you're a new grad, you're just out of residency, just out of DPT school and you know, you're thinking about student loans and just being out of school. And so you don't really plan that far. So that's a whole other conversation we can have on another podcast. So I was on short term disability and we all know the legality of and we all have our own cognitive biases about this, right? So when people are involved in litigation, we know that their care tends to go a little bit longer. So I just I knew that. And I didn't want to, I almost didn't want to set myself up for failure, right? I just wanted to be a good soldier, show up for therapies, neuro psychology, vision therapy, talk therapy, vestibular therapy, regular musculoskeletal for the whiplash therapy, and just be a good soldier and show up as a good patient, just thinking that I would get better and slightly different than a musculoskeletal injury. The difference is with with brain injury is that there are cognitive and behavioral impairments that differentiate those from brain injury from musculoskeletal injury and rehab. On top of that, add the environmental aspect, and that's a whole other aspect of the injury. So there's no finite, you know, six to eight weeks of tissue healing or things like that, when it comes to brain brain injury, that it's a very gray area. So I was on disability for six months. And then that ended and that was petrifying. So two weeks before disability ended. I wanted to burn it down. That's when I got angry. And I think that's when I really went through that whole grief cycle, because I just kept showing up to therapy thinking I was going to get better, and then I did not. So went back after 14 months, I had the no fault car insurance, which helped pay some bills back home with mom at the time. And that was it. So after that, when I went back to work, I actually realized I had a vision handicap with overhead LED lights. So I still live with persistent symptoms, I still live with neuro fatigue, I still have an ocular motor disorder. But we learn how to manage and cope and I have wonderful support systems and definitely a grit that a lot of people don't have as well, I think I'm missing a chromosome there somewhere.
09:03
And you know, and this was eight years ago. So I think it's important for the people listening to understand that, you know, when one is diagnosed with a concussion, it's not just like you said over and seven to 10 days or maybe a week or a month or even a year, and that there are symptoms that can persist. And I think that's a great segue into what are some common myths around concussions. So I asked Jessica give me like maybe your top three common myths that surround concussion and and post concussion. So Jessica, I'll throw it over to you. So what would be Myth number one that is circulating out in whether it be layman's world or even the medical world? Well,
09:53
um, I was actually I'm going to give you something that we didn't speak about. I'll kind of combine one of them with three but One of them, actually two that we didn't speak, I'll surprise you as well. But there's actually no evidence based definition agreed upon international definition of concussion or traumatic brain injury. And that kind of will segue a little bit into two is that there's actually been zero phase three clinical trials on TBI concussion in over 30 years. So, when we're talking about research, I mean, talk about ground floor ground level, I mean, we were in the basement 10 years ago, just not having any idea what we were looking at. So I even I try to tell people like when we're talking about this, and looking at the literature, the medical legal literature got ahold of this injury 50 plus years ago, and it's been in the trapped with closed head injury and medical legal literature, but really not until 22,004. And on how we've been talking about this as a rehabilitative injury, and things like that. So, you know, historically, when we don't know what to do with someone in medicine, we tend to send them down to trajectories, we send them, we allude that they're milling, lingering, or looking for a secondary gain, or we tell them that's all in their head, and it can't be real, right. So that's what's kind of happening with these patients that we know up to 30% of folks now have persistent symptoms of concussion, they don't just spontaneously. You know, in even two weeks, we even actually, because we didn't really know what we're looking for right care. So we didn't have an agreed upon definition. So how can you know what you're looking at unless you know where you're looking for. So that's so very important to connect to is that a lot of the mismanagement of concussion was so much more prevalent in a well cared for patient.
11:38
That's wild. And so before 2004, basically, if you had persistent persistent symptoms after a concussion, it was like, good luck.
11:50
Yeah, you were allude that you're faking it. You were looking at this, that it was a psychological injury. Yeah. You know, and
11:57
that, that in and of itself is crazy making?
12:00
Yes, well, that's the whole thing and the chicken or the egg, right. And you can't deny psychological conversations when it comes to the brains like Hello. However, you know, it's really the chicken or the egg, you have these somatic things that we have the ability today in 2021, in a well versed clinician to validate the patient's symptom profile by doing targeted, comprehensive physical examinations as it pertains to concussion. So we actually the best thing that we can do for a patient like this, and I'm sure you've had all the chronic pain people on your podcast and things like that is validate their symptom profile. Listen, you're not crazy for seeing words coming up off the page. No, you didn't drop some LSD or an illegal drug. You have an ocelot Xia? You know, but the difference between the moderate and severe TBI is is that these folks have the self awareness to know that something's not right. But they do not have this objective language to express the what or how they feel with brain injury. So what do we do all day care? And how are you feeling? What's your pain level? What's your number? How are you feeling? But brain injury folks do not have the subjective language to express that so when they go to the mall and our fear avoidant of that, or they go to the supermarket, and they are don't like to be in a complex visual sensory environment, because the colors may blur, and things like that, that is then looked at as a fear avoidant behavior. And that's been sent to psychological counseling for decades. So how can we as physios how do we get these guys first and gals? So not to Detroit too much to keep you on track. But those are two. The first two is that there have been there are over 43 working definitions of concussion. One of them is evidence based. And to that there are zero phase three clinical trials in over 30 years for TBI concussion.
13:42
Wow. Wow. Wow, those are two biggies. Two big myth.
13:46
I would think so then I'll combine the last three because there are points. So the third one is, you know, I really, I'm really into education care. And I really believe that if we can teach one we can serve many, okay. And that's just what I've been privy to. And this implicit trust in the last, like eight to 10 years with this injury, that I've been invited to all different conferences for emergency physician athletic training, PT, you name it, because we all need to be on the same page here. So folks really need to I always say that we need to have a really humble approach when we come here because and I say this with kindness and I but I say this very firmly, is that with concussion, we have infinite ports of access to entry to care. Okay, you can go to the urgent care the emergency department, you could even be at your OB GYN appointment and you might have had this fall and a ski injury over the weekend and in your annual or biannual you know OBGYN appointment if you're a woman. And you know, you could have had you could have pre presented with signs and symptoms of concussion and not be aware of it. So I see that because there's infinite ports of entry on like cancer or unlike cardiology, you have a heart attack, where do you go care and you go to the emergency room, right? And then you see the cardiologist just right or you get diagnosed with cancer or your PCP or you start losing weight, you have some red flag showing up. Where do you go? Yeah, young colleges right to the oncologist, right. So that's a, that's a defined pathway. With concussion, we don't have a defined pathway. And that's not necessarily a bad thing. However, it's where a lot of this mismanagement has come up over the last few years and decades, and that's where patients start to suffer. And that's where it healthcare, we've actually imparted something that's called AI atherogenic suffering, which is where actually the health care system where your doctor is actually part of a way of suffering on a patient. So I bring that to our attention with these three quick facts. I'll say them quickly, and then we can chat about them. Go for one 2012. That's the number you got to know. 2012 was the first year the international consensus statement discuss the cervical spine in terms of examination treatment, that whole stick that connects the central nervous system to the peripheral nervous system and runs the autonomics up and down, right 2012. We just started talking about the cervical spine internationally. 2015 was the first academic year in which there was a formal training for both TBI and concussion, if you are a neurology resident. So if you were a brain physician in 2015, that was their first formal didactic year, they had training in concussion and brain injury. So just let that settle in there for a second because that's, that's just wow. Again, this is a place to build up, not tear down, but that was taking place within the behavioral neurology section of the American Academy of Neurology. And the third one was that 2017 was the first year on the international consensus statement that we actually identified the concussion as a rehabilitative injury. 2017. So, like, what? So if you think about it, as physical therapists, congratulations, happy 100 years care. We just had our centennial, right. So we were rehabilitation aids, literally in the trenches 100 years ago, like now, and we were treating what we were treating brain injury, what are we doing in the ICUs for treating brain injury? We're getting them up, we're getting them moving. But what do we prescribe when we don't know what to do with someone and healthcare rest? So we now know that that's not the ideal thing to do beyond the first 72 hours, but yeah, 2012, cervical spine 2015, brain physician started learning how concussion and 2017 was we call the rehabilitative so that's my third.
17:29
Wow, that's, it just seems like that cannot be possible.
17:33
Yeah. And, and it seems like that and because we know better, right? But imagine then being, you know, having deficits and having trouble thinking and processing, and what's our most valuable resource attention, but then you can't process. So it's, it's so horrible when you're a patient, and you have to negotiate the system, if you go through a no fault, or you go through a worker's comp, and there's all these other aspects, you know, of that of, of the injury. So I always say, sorry, I always say is that concussion as an injury of loss of it, I am, so you have to really pay attention to where your patients are in space and time when you when you meet them.
18:10
And it all seems to me like just not having a clear pathway. To me sounds like barriers to treatment, and barriers to to improvement. And then my question, I just one quick question. It. If you if the patient doesn't quite know who to go to, they don't know that they're they they have a concussion? Because some people like oh, you know, he got his bell rang, or whatever. And they don't even go to see a doctor, but they're having some symptoms, but they're not quite sure who to go to? Is it that the longer your symptoms go on, the less likely you are to recover?
18:50
So there's a yes or no answer to that. I don't want to say it depends. But the good news is, is that we have folks five and 10 years out who may have not sought treatment, like the patient you just alluded to, or sought treatment, then kind of plateaued, the brain wasn't ready yet. And that's totally fine. And we've got to tell patients that No, hey, maybe we need to take three to six months and just kind of let this settle. Let's reset, regroup, and then let's come back. Because the brain just may not be ready. You cannot force this. This is not about grit and resilience, in terms of being sore and pushing through. You've got to listen to the brain and I talked about it with like the knee effusion principle. You know, we have residency in orthopedic so I talk ortho all the time, although I love the neuro, neuro world these days as well. But you know, it's like the knee effusion principle, right? You do too much the knee fuses, we want to give it if it doesn't come down in two days, we did too much. Let's cut in half, right. So it's the same thing with concussion except the difference that is super frustrating to both patients and clinicians that aren't in the know is that you can have delayed symptom onset. So you can do something within the therapy office or they can do something like for example, have a vestibular migraine, where they feel good while they're walking outside and they feel okay walking But as soon as they stop their body like isn't really caught up to them yet. And then they get this distributor migraine within 20 to 60 minutes, and then they feel like garbage. But then they don't know what even to associate with. And that right there, Karen will make you feel crazy. So so it's very important to have somebody in the know, but you said something right before that question about barriers? And you're absolutely right, there are barriers, but I'll do you one better is that we're not only have barriers to accessing quality care for concussion, we also have i atherogenic, suffering, where they come and I, as a provider may not know enough about concussion to look at this from 360. So we have providers that don't know, they may be maybe in 2021, we'll be able to pull up the international consensus statement. But that's only for sport, and it's very limited. So it doesn't go through the nuance of the suffering and the delayed symptom onset and things like that. It's very white paper esque, right? So we actually then cause harm by quote unquote, just treating the neck, not looking at the vestibular system, not looking at sleep, not looking at the ocular motor system, not looking at is the the migrant or aspect of it, not, you know, all these other things and aspects that make concussion concussion. So from a symptom profile standpoint, so if you feel typically I should say,
21:15
yeah, and, and, you know, like you said earlier, you're all about education, and getting people to therapists, and whether you're a physical therapist, occupational therapist, you've been a personal trainer, physician, really understanding the ins and outs of concussion. And so I'm going to, I'm going to plug your educational entity that is that is launching, and it's concussion, corner Academy. And so now, I really like that you're coming at this from the patient and the provider standpoint. So talk a little bit more about concussion, quarter Academy, and what separates it from other educational programs. Because, you know, as you know, there's a lot out there in the world, right? So how, what, what is it about this that makes it different, and that you're really proud of as you should be?
22:08
Oh, I appreciate that care. And, golly, I mean, talk about like, your life's work, right? And I really, I just get goosebumps thinking about this. And I'm like, wow, this is this is really just a dream. And I'll be very honest with you, this is a we're in a pandemic, still, some people may not want to admit that. But we're, we're still in a pandemic. And we all kind of went through something, right, especially in New York City, we really went through it initially in the acute phase of this pandemic. And I did, I lost a good chunk of my practice, and I had to really sit with myself and I said, Gosh, just what do you want to keep doing? You know, what do you want to do with your life, I had patients no less than four years, some 11 years as patients. And I was like, I'm not doing this again, I just don't have the energy. And that was from just a like a, like, almost like a burnout aspect. I just couldn't imagine re building up my my practice again, I have no problem seeing patients, if they call me but I have no desire to market. Now. I was like, Well, my ideal life based off of my symptoms and persistent symptoms. You know, I really work every other day. So yeah, I can push through every five days and do a regular work week if needed, but I don't feel well. And then I'm not pleasant. And it's just, you know, I just know my limits. So with the neuro fatigue and the stuff that I live with, I said, Well, what's, uh, what's, what's something I can do? Well, if I could work remotely, that was kind of it. And I said, How can I help the concussion community? So we decided, and my partner is a graphic designer and in to animation and editing and all of this stuff. We said, how can we make this beautiful, and deliver it? Because the user experience was so important to us? And then how can we deliver it internationally to where it's accessible? So we're, we formed the academy, and essentially, the goal has always been to promote healing, decrease suffering, increase support, and deliver it with kindness to this mismanage patient population, but we need to have access. So I have a tremendous faculty. We're launching we are we have a nonprofit partnership. We have the faculty are actually the people on the international consensus statement. They're the people treating the the boots on the ground, their clinician scientists, and they get it, they get concussions, and they're vested in concussion. So it's going to be a 12 week online course for our first cohort. It's fixed. It's from January 16 to April 10. It's going to be two hours per week one posted for you and one live on Sunday mornings at 10am. Eastern which will allow for our European friends and our California friends as well on the West Coast. And it's going to be 24 hours of CEU activity for for for physical therapists and athletic trainers. As long as we have 10, ot speech pathologists, neuropsychologist, psychologists, social workers, we can see you them as well, but it's the first round so it's kind of a lot of investment here. So I'm just going with PT and 80 to start unless we have 10 of the others. And we're going to have a nonprofit partnership, but the the beauty of it all is already I'm actually going to have, we're going to be doing research on our students. So we're actually going to be looking to change outcomes based off of evidence based practice and education. So we're going to be able to study our students, and then link up with our nonprofits as well to support them because it's really an underfunded sector of research where cancer gets billions and trillions and and TBI and concussion tend to get hundreds of millions. So we're really going to try and support the folks you know, who are boots on the ground.
25:29
I love it. It sounds so great. Where can people find more information about it?
25:34
Sure. It's going to be it? Well, it's already at it's at concussion corner.org.org. If you follow the podcast, we tried to give things away just like you do with healthy, wealthy smart. So we've had the concussion corner podcast is 2018. I hosted the Super Bowl concussion are moderated, I should say, the Super Bowl concussion conference in Minneapolis and we launched it then it's been around in over 50 countries, it's been so well received, we have a lovely community. So we're going into education, and how can we have a supportive community with open office hours and open office hours and things like that, that will what will provide our students with, with eventually a rehabilitation video database, where that's going to be searchable for folks as well. So they can search, you know, cervical spine examination intervention, what's the referral process look like. So it'll be a robust program, but we're going to be beta in January with I just want to point out, we're going to have a referral program. And, again, I'm a person and have one right, so we're not going to have an early bird special, like we're used to at conferences. But the whole thing is to spread this word of mouth. So instead of taking $100 off, we're going to give a $75 referral. If you have seven to eight people that you refer your whole tuition is paid for Plus, you get your 24 hours of CEU. So we want to really just want this to be word of mouth, from from like grassroots, let's build it by conversation and internal marketing and get people in who are invested in wanting to learn about this injury.
27:02
Awesome, awesome. And of course, we'll have a link to it in the show notes here at podcast at healthy, wealthy, smart calm for anyone who wants to learn more about the program and about the modules and how it's set up. Or you want to just get some more information. Or if you're ready, you heard this and you're like, I see people with concussion all the time. I'm not 100% comfortable, I need to learn more, or this is something I want to learn more about, I think now you have the perfect opportunity to learn. So we'll have a link there in the podcast notes for anyone who is ready to pull the trigger and join Jessica in January. So now just is there anything that you really want the listeners to take away from this conversation around concussion and rehab of concussion?
27:58
Yeah, so I'm sure there's, there's so many things off the top of my head, really connecting to that concussion is a rehabilitative injury. And if we can connect to that the injury of concussion is an injury of loss. It's a loss of your I Am your I am funny, I am husband, I am wife, I am Doctor, I am surgeon, you're I am. So if we are sensitive to that and connect to that concussion is an event, it's not an event there, it has to be a mechanism of injury, don't get me wrong, but it's not an event, it's an actual process. And we have this neuro metabolic cascade. And then we tend to have this loss of function in our in our environment. So that is really what I want folks to connect to. Because we have to make sure we're meeting our patients where they are and their moments of recovery. So that's really the big thing to connect to is that folks tend to really connect to the event of the concussion, you know, the post traumatic amnesia, the domestic event, the loss of consciousness, and less than 10% of those folks, but they're not connecting to where those folks are in their trajectory. And how many folks have they seen before you on average, people see six to 10 providers before they walk into my door. Okay, connect to that. Do they trust healthcare providers before they've talked to you? Did they have physical therapy in a hospital gym that wasn't really, neurologically sensitive to their needs, their smell, their sound, their lights, things like that. So connect to your patients in a different way. I can guarantee you if you're a new grad, this is going to this is going to get you excited. And if you're a little more seasoned, like Karen and myself and you're feeling a little burnt out, this is a great way to look at your patients 360 We're looking at autonomics we're looking at neurology, vestibular ocular motor. The physiological aspect of its sleep, nutrition, neuro endocrine, let's talk about sexual dysfunction and concussion. That's a whole other podcast. But it really is something that you can hear my passion about, or these patients are being mismanaged much more probably than they're being well cared for. And we can change that and there's no reason that we can't change that for next day. Not Knowledge Translation in the clinic, so I challenge your listeners to that care.
30:03
Amazing, amazing. And now I have one more question to ask. And it's one that I asked everyone. And that's knowing where you are now, in your life and in your career, what advice would you give to your younger self, let's say, you know, straight out of straight out of Ithaca physical therapy school.
30:21
Um, let's see here, straight. So I've honestly joined Twitter, I have had so many, I've had so many positive experiences, the 99 that I've had positive and the one negative, you know, and you really have to conduct yourself in a certain way, of course, but I joined Twitter, I've had so many amazing opportunities. I was invited to the Super Bowl, I was asked to be one of our spokeswoman like you for American Physical Therapy Association, I've been invited to speak at conferences and, and just network with people who I would never have access or touch points to. And I really think it was the most powerful thing I've done for my education, besides, you know, maybe a residency postdoc, really. So I really do and we wouldn't have met the same way either. So I think it's been great.
31:05
All right. Well, that I think that might be the first time I've gotten that. What advice would you give to your younger self is to join, join Twitter and join social media. So thank you for that. And like you said, you have to make it your own, and you have to approach it, approach it in the right way. So I think that's great advice. And now, again, people can go to concussion corner.org. To find out more. And of course, like I said, we'll have all the links at podcast at healthy, wealthy, smart, calm. So a big thank you, Jessica, for coming on the program busting some concussion myths. So thank you so much.
31:42
Oh, thank you so much for having me and to all your listeners. Thanks so much for your time and attention. I really appreciate it.
31:47
Of course and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart
In this episode, Creator of Practiceology, Paul Wright, talks about 7 critical mistakes that healthcare professionals can make that can hurt their bottom line and their business in general.
Today, Paul talks about Perfectionist Syndrome, the implications of discretion, and doing your own PnL. What is the true role of your business?
Hear about the danger of falling in love with your product, packaging an outcome-driven solution, and maintaining effective recruitment and internal systems, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “If it’s [your business] robbing you of your life, it’s not what it’s there for.”
- “Find the hungry market and satisfy that need.”
- “If you’re not embarrassed by the first launch of your product, you’ve launched too late.”
- “To the blind man, the one-eyed man is king.”
- “If you haven’t upset someone by midday every day, you haven’t said anything really important.”
- “One of the single biggest and most effective things you can do in your practice is to tighten up the reporter findings conversation.”
- “Remove discretion at the operating level of your business.”
- “Once you are the only person that has that program, you can’t be compared on price.”
- “You can’t put a monetary value on family time.”
- “There’s no such thing as quality time with your family. Family time is quantity time.”
More about Paul Wright
Paul Wright is a Physiotherapist and former owner of multiple allied health clinics in Australia (which he rarely visited). He is the author of the Amazon Best Seller "How to Run a One Minute Practice", founder of the Practiceology™ health business freedom program, and has helped thousands of allied health business owners across 57 countries, earn more, work less, and enjoy their lives.
Suggested Keywords
Healthy, Wealthy, Smart, Physiotherapy, PT, Business, Practiceology, Supply, Demand, Mistakes, Solutions, Healthcare, Entrepreneurship,
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Read the Full Transcript:
00:02
Hey Paul, welcome to the podcast. I'm happy to have you on.
00:06
Absolute pleasure to be here. What a boss.
00:09
I know it's so we're doing a little podcast swap here which I love. I love being able to swap podcasts with other hosts where you come on mine I come on yours and we get to know each other better. So it's been really great leading up to these podcasts. And today, you are going to talk about seven critical mistakes that healthcare practitioners can make. That can really hurt their bottom line and their business in general. But before we get to that, can you tell us your story of your career and how you ended up where you are so the listeners get a better idea of who you are?
00:52
Well, I'm I was born for a young Karen. Now I'm from from a small country town. I'm obviously Australian by my accent. I live in beautiful Newcastle but an hour north of Sydney. But I grew up in a small town about seven hours northwest of Sydney in the middle of the outback. They talk about Australia next so I'm in the outback. And what does what does a young kid do as in a small country town he Bhikkhu like sport, he becomes a physical education teacher. Because that was all I thought you could do as as a kid. I love sport. So I went to Newcastle University studied my physio, field education qualification, and then didn't even know what a physio was, but I met a physiotherapist at a party. And I liked anatomy I liked physiology. I thought, gee, that sounds cool. I don't think I could be a teacher for a long time I had an entrepreneurial streak I think so I didn't know I could work for someone else for my rest of my life. So I'll get into this physio course went to Sydney Uni did my physiotherapy degree and within two years after graduating I had started my first practice I then ended up with six of them in Sydney, one in Newcastle and five in Sydney. And I think my claim to fame Karen is I as I went through this journey I didn't go to them I was fortunate that I stumbled across the E myth by Michael Gerber very early in my business career and and I'm trading at my window counter in my practice and and looking out on the road that goes past in Sydney and there's a bus keeps going past one on the side of the bus why most small businesses fail and what to do with that is on the side of the bus and I'm getting there watching the sun come up in the morning watching the sun go down like most most help business owners and this bus kept going past and I'm getting better now I wasn't good there but I'm better now that the universe was telling me something followed up with this with this he ended up getting it to a Michael Gerber seminar read the book EMF and then I created then systematize the practice and as I said eventually had six didn't go to any of them and I then sold them which is a lesson for all of you guys the major role of a business is eventually to sell it and then started teaching other health business owners how I did it how I was able to run the remotely and how how you can still be a great health professional and have a successful business and still have a great quality of life which I think most of us miss out
03:19
yeah that's a great point talking about quality of life and I think that we'll probably get into that throughout this interview so without yeah without further ado, why don't you share with us these seven critical mistakes that can reduce your profits increase your stress and really not allow you to live your life outside of your business. So let's start with number one.
03:47
Well the first one having said I've done all of these by the way so you have earned the right to
03:52
I can't I kind of I kind of assumed that so I've done
03:57
I've done all of them but the smart people learn from other people's mistakes so hopefully you'll listen to what's happening now. That Mistake number one that I identified early is failing to understand carrying the true role of your business and if you think about what what does what does your business do for you and if it's robbing you of your life it's not what it's there for the role of your business is to serve you it's your certain needs to give you more life yet when you ask most health business owners why they started this I I wanted to be my own boss or I wanted to make my own decisions or the guy was working for before was an idiot. Whatever they like to say but is this really happening now and as Gerber talked about when I first read it you're now doing the hands on work of the practitioner plus you're also doing the business stuff the marketing the recruitment in any wonder we get overwhelmed so early. And and that's why Gerber talks about it's true. I was probably better off opening a plumbing business because I couldn't do it. plumbing work I was better off opening a business that I couldn't physically do then I could list run the business and that's the whole idea of this. My brother who's a plumber would be staggered because I'm hopeless with power tools and I he's banned me from using any sort of manual labor things but the idea of the businesses to serve you and one thing I suggest you look at guys, his his work out what I call your freedom score. And your freedom score is simply how many hours per week on average? Do you spend treating patients at your practice? How many hours per week do you spend physically treating patients and if you're telling me that we've done this in seminars, 50 6070 I've heard I've had one guy doing it five hours. And they're still trying to run the business, you just, you just can't do that. So and we talk about this thing between practice ology, right is law, which is, which is as your number of team members increases, your freedom score must decrease, you can't keep adding team members to your roster, because they time suck, they have to take energy out of you, and still see all the patients, there's going to be this balance. And that was how I was able to run it. But when that being said, you have the choice of how you run your business. Now my model was to replace myself, get therapists in do the work for me. So I had freedom of time and freedom of money. But some of our clients have a Mr. X. Mr. X is the guy that runs healthcare practice, but he runs it on his own terms or her own terms. Doesn't work, school holidays, start at nine finishes at two sets his own hours or her own hours charges, what they feel it. And guys I'm thinking about that don't even have sometimes receptionist though, sometimes if the surfs up, they don't turn up at the practice, they just gave surfing. But the patients know that's the deal. If you want to see this person, that's the model. But even in that case, Karen, the business is still serving that person. It's, it's it, you're the master, but not the other way around. And I don't know if you've ever made that. But that's understand what you want your business to do for you. And make sure it does it. Otherwise it'll suck the life out.
07:17
Yeah, and I think that's why when you look at your business, whether you're just starting, you've been in it for a couple of years, you've been in it for 20 years, if you've never written down what your goals are for your life, not what your business goals are, but you know, do you want to spend, do you want to be able to watch a movie a week workout five days a week, spend dinner with friends, pick up your kids from school, drop them off, you have to write those goals down while you're looking at your business. Because that's that's how you're going to have that freedom. And that's how you're going to have your own life outside of the business.
07:58
And the natural recourse for all health business owners is typically to see more patients, regardless of what happens in their business. Regardless, they need more money, they see more patients, team member leaves, I'll see more patients. So that that's that's the recourse their natural recourse is to go back to what they know. We teach our clients sometimes that's the worst thing you can do. You need to do something exactly the opposite. And one point also to this is that this is probably one of my worst moments. You've got understand to the concept of current bank and future neck when you think about your business. Now I had a current bank business meeting. I had one of my practices earlier was inside a fitness center. So I had a physiotherapy practice inside a fitness center in Sydney. And it was a good business. It was a cash cow. But what I didn't realize at the time was it was fragile. So it was it was making me lots of money at the time. How I knew was fragile. I got a phone call from one of my clients would have been a Thursday night. He said, Paul, I've got some news for you. The owner of the gym I've heard hasn't paid rent for three months. Okay, this is a $300,000 business like I'm running here. Oh, that's the good so I ring the owner who when you will do the gym tonight what's the deal? He said it'll be sold out Don't worry about Okay, I arrived at the practice the next day cancer that patient list hard to track proceeded to put everything inside the trap that day. So by Friday, five o'clock, I've been everything inside the event saying what are you doing wrong? What are you doing? Well, I said I'm taking everything out because I don't know what's happening here. This is all a bit unstable because I went to give the owner the gym my rent check for the month and he didn't accept it. He said hold on to that for a second. Roger, you might need it. So okay, the writing's on the wall, drove off in the truck and everyone's saying Ronnie, another another gym Chad's gonna buy this place, you'll be back open on Monday. So when I open on Monday, I'll bring the truck back and I'll check everything back in then I'll be fine. But I'll tell you, I never again set foot inside that building. It shut that day and I never will went back in there. So overnight, a business goes from 300 grand to zero. What's the lesson I had a current bank business, there was nothing. I was relying on someone else's rent someone else's tenancy. If you're leasing a space in a Medical Center in a fitness center in something else, you think you've got a business you can you can sell. There's no real future banking, that you are at the mercy of your landlords. So it's not a bad way to test the market to see if there's available market. But that's not your long term gig. Because there's a problem with it, and I've suffered badly. Anyway, yeah, yeah, start number one.
10:41
Big mistake, mistake number one. So let's talk about Mistake number two.
10:46
All right, we do this all the time. We fall in love with our product. We fall in love with the idea of being a therapist, like I fell in love with the idea of being a physio, but I didn't know was there a market for that? Was there a need for more physios, I just wanted to be one. But we do that all the time, we fall in love with our product of therapy, what we got to fall in love with is, is the market, you got to fall in love with the market once, so you might have a passion for trading on that elbow pain in one arm. Gullfoss, that might be your passion. But if there's not enough one arm golfers out there, you're not going to do any good. So the market doesn't care what you want, find what the market wants. So your job is to listen to all of your patients, listen to the doctors, listen to the community, what's missing, your job is to fill the need. And if you do that, you'll be successful in business. My favorite one, hope you guys watch Shark Tank, you guys have shark tech in the States. That's shark tank with a my favorite one is the guy that turned up with the pad for guys shirts. So now that so you put up your stick to pads on the ROM so your shirt didn't get all sweaty, there was his product. The Sharks wouldn't touch it. I said I'm not really interested. And they said how many have you sold? I've been doing it for seven years now. I've sold about 500 so in seven years, and out the back the entity in there. So what are you gonna do now he said, Our, I believe in this, I'm gonna keep going I fell in love with this product, the market had already said they didn't want to move on. So find the hungry market and satisfy that need. If you do that, you will be okay. And you see that lock county if people so they open a practice in, in a country town or regionally because they might have identified there's a market for that service. So they've done well. But the part that missing is the available labor supply. Because there's two drivers of every business available market available labor, you haven't got enough labor, you're going to be staffing that thing yourself for the rest of natural life. And that happens all the time. So be very aware, don't, don't fall in love with a product, fall in love with the market, what's the desperate need in your community? solve that and you'll be halfway there. And that's that's kind of what I did in my second my next career because I I knew help business owners struggle with business and finance and marketing and other things. And it happened to marry up with something I liked and was good at. So that was a fortunate thing. But you've got to find the hungry crowd first.
13:18
Yeah, do your research. If you don't do your research first. You're in big trouble.
13:22
I had a guy come to me once and he said, Paul, I want to open seven practices on the northern suburbs of Sydney That's what he said to me in the seminar. I said oh is there is there enough market for that automatically sell so i think so he said he just he cuz he wanted to do it. Karen he wanted to open I saw Kenya available. I was a bit tired. Can you staff those seven practices? Will you find your start? I'll just advertise. There's a guy with his head in the sand. It's not funny. But I think the key thing I want to do I want to do this. Now that's okay, if that's a passion project. But if you want to generate a revenue and a business successful and you can sell it down the track if that's what you want to do, solve solve the desperate problem. Yeah, yeah,
14:14
turn it around. It's not about you. It's about you, but it's not about you all the same time, right.
14:21
If you get married up, it's great if you can find that that thing but be careful of what you do. So make sure there's a hungry market for an audit this we found out in one of our practices, there was a real market for lymphedema treatment. So massive market lymphedema and we had a guy who knew all about it the therapist and knew all about it. So we got him doing the lymphedema program. It was great. But But don't be Dora here didn't get him to train everyone else on how to do you know what happened? The guy leaves. Three years after we're still getting phone calls from people wanting lymphedema treatment and every time they rang it killed me. So Solve the desperate problem. Yes. But then protect yourself with the viable labor supply if you're doing something like that.
15:06
Yeah, absolutely. That's a great example. Okay, what's number three. So we've got failing to understand the true role of your business falling in love with your product, your product number two, what's number three,
15:18
we'll do this falling in love or falling victim to our own perfectionist syndrome. I was probably fortunate, I had some good mentors early in my career, and they'd tell me, Roddy, it's better to be 80% and out the door than 100%. And in the drawer. And it's so true, we just worry so much about putting something out there, because it's not quite perfect yet. Reed Hoffman, I think, was the founder of LinkedIn. one of the founders, he said, if you're not embarrassed by the first version of your product, you've launched too late. If you're not embarrassed by the first version of your product, you've launched too late. Meaning put your put something out there and you see if it's got traction, is it going to get some market share? Is it going to work for me? If it does, then you can then do version two, then do version three. But so many health professionals I get so caught up in making it perfect. I just want to do this, I just want to finish this, I just want to do this. And they end up not doing it. They wait that long, and they just slowly implement. Maybe it's because we're analytical thinkers, we're sometimes slow to implement, and we just, we drag the China bit. And I like this expression to, to the blind man, the one eyed man is king. But one of my mentors said to me, Roddy, you don't have to be the best in the world. You just got to be the best in their world. Say there might be a nice specialist down the road, who's who's a superstar does all the courses and is on all the all the seminars and other things and you've got your own new program. That's great. But don't let that stop you from what you're doing. Just be the best in your clients world at it. You don't have to be as good as that guy. You just have to be the best in the client's world. And, and that also, I think, Karen, sometimes maybe it comes from our universities that that we want to be anointed or we want to be awarded, or we want to wait for someone else to recognize me. Don't Don't wait to be anointed by your profession. Don't that's too slow, anoint yourself. Someone. Someone says to me, Roddy, who's the best health business mentor in the world? Well, I want to do wait for the National Association of physical therapists to make the announcement I'm not going to wait for that I am. And I think we're going to have some balls do that. But people take you at your own appraisal aren't going away in? And if not, that's your choice. But that's it again, don't wait to be annoyed because it's just too slow to do it that way. So don't fall victim to perfectionism because it's just a curse
18:12
for us. Yeah, very, very common. Especially I think I see it more in women than men. Men will often center feel like I'm just gonna do it and see what happens and women are more like, okay, it needs to be like this, it needs to be perfect. And I think sometimes our women judged more harshly than their male counterparts for things. There aren't as many women in leadership positions so you don't have that person that looks like me in those leadership positions as a point of reference, and so I think oftentimes women tend to keep putting things off because it's got to be as almost perfect before it goes out because we don't want to get judged harshly on something. And I see that consistently. Again and again. And a lot of men will just throw shit out there and it's like, yeah, this is fine. Who cares and women are like a
19:12
you got to remember littering once I was I did electric in the fitness industry years ago and in the in the personal training space. And I remember doing anatomy lecture one day to a group of trainers and I in the audience was my anatomy tutor from uni, like a superstar like this person, you everything about everything and I'm at the front talking anatomy and and it was a pivotal moment for me because I'm so self conscious about what I'm saying in front of this, this mentor. But no one asked her any questions. They all asked me the questions. I was at the front of the room. I had the clicker. I was in charge. I was the best in their world. She was the best in mind, but I was the best. There's that's it. I'll leave all of you to make the comments about Gaza girls, I can't say that sort of stuff. So knock yourself out cam
20:05
Yeah, yeah, I'm just that's just what I've seen, you know, over and over again, is, is that women tend to be a little more hesitant at putting themselves out there. And I get it, you know, as someone who has and who does put themselves out there, the criticism is harsh people can be mean, mean spirited, especially when it comes to social media can be a little toxic and, and you are judged very harshly and people say really mean things. So you have to grow a thick skin, I think if you're going to want stepping into kind of those leadership positions
20:43
that was published one of the key things, I think my management style of the business that you had to have a thick skin to work for us. I mean, maybe I was more suited to being an owner back then that I would be now I don't think I'd be as quite as sensitive as I'd need to be now. Anyway, that's if one of my mentors said to. And I love that when I say this, if you haven't upset someone by midday every day. You haven't said anything really important. What everyone's gonna agree with you You don't you don't have different doesn't have to agree with you. You just you haven't you have the right to have your opinion in this, but I think you need to do you'd have to agree with me, that's just what it is. But if everyone's agreeing with you, are you really saying anything of any importance possum?
21:24
Right, right? Very true. Very true. You don't want to surround yourself with Yes, people all the time, that's for sure. Because then you'll never move forward because you're never kind of grow and challenge yourself. Okay, let's, let's move on to number four.
21:40
Number four, ineffective, non existent. And unsupervised internal systems. You we've seen it, we've seen it, countless times someone goes to a seminar or they or they get an idea and they launch it into their practice. And, and they seem so excited about it. But the team have seen this before they've seen you come in with an idea and they've seen you launch it and they know you'll just it'll blow over. Once you get you'll see more patients and get busy so so that sometimes they do it for a while and you can see this owner because you'll say to them, do you have for example, you have a follow up system in your practice? I think we did here we look we did do something like that. Ryan, are we still doing that follow up system so that they haven't followed up and measured it. So one of the best things give you the tip, one of the single biggest and most effective things you could do in your practice is to tighten up the report of findings conversation. That's that's after I've done your history of January, your examination, and I'm saying what we're going to do to fix you that's the chiropractic wellness report the findings in their words, it's the action plan or it's our treatment plan, get get that script, right? Get that conversation, right? Write it down, sit the person next to you and write it down Mary to get you back running in that marathon in two weeks time. You need to see me three times a week for the next two weeks. I'll reassess you then and we'll get you ready for that race. How does that sound like that? Does that conversation that that currently is not done? Well in most practices? And and because I'm an analytical guy can often How do I measure that? How can I control that conversation. So I created an action plan a written plan. And, and the penny dropped for me when there is a number at the bottom. So the numbers at the bottom was how many how many sessions, how many times a week for how many weeks. So that's three times a week for two weeks, I had a number six, so that person needs at least six sessions before the next assessment. So I then made it mandatory that every patient would walk out at the front counter with that sheet that would give it to the admin person who and would verbally hand over that patient current to get married back to her run in two weeks time she's doing a marathon she's gonna do it really well. She needs to make three appointments for the next three weeks for the next two weeks and we'll get there admin to person books in in. And then I then got a spreadsheet that we created that has consults on plan. So that would be a six, the column next to it, consults booked. So you recommended six and how many were booked. Now if I if I then log into that spreadsheet and I see that my therapist has recommended six and a booking one so 616151 to one with it's a one on that on that booking column. I've either got a therapist problem or I've got an admin problem. Has the therapist not been good enough to get the confidence in the patient or is the admin under pressure and hasn't got time to book those sessions in advance. And you will know the dangers of a session by session appointment diary. It's just it's a recipe for disaster it's but that's that's an example of a system Karen you've got to put in to your business that you can then measure and stay on top. And you'll love this. So in true Polaroid style there was only one time in All of my practices where the therapist did not have to do one of those sheets written physical shit. And I get them all in a room and say guys, what's the only time that you can get away without doing one of these things? And they'd say, the person need to go and see a specialist or I ran at a time or whatever else that said, Now none of those things. The only reason I'll accept the no completion of this form is if the patient dies during the consultation and they've got a chuckle it's a chocolate gets a check. I want to talk about it now. But there's an element of truth to it. Everyone else gets one. Now that's that's the problem with most health businesses, we don't enforce our systems, we don't put them in and we don't make them mandatory. One of the keys to business success, remove discretion at the operating level of your business. Remove discretion, remove the chance for seminar I was going to give them a plan but I didn't think they needed it or the Garda see the surgeon or like, I want to look at the that report and say, Okay, what happened with Mrs. Johnson yesterday said news about Mrs. Johnson. She didn't make it through the consultation. And the therapists were Hi, can I get it ready? And then I can say, Man, I've noticed Mrs. Jones didn't get an action plan either. What's happening here is, is something that I'm wanting to do not sinking in, is there, imbalance here? And if it happens a third time we're gonna have a serious discussion. Now that's that may be used multiple that's hardcore. But
26:37
would you tolerate a therapist turning up without a shirt on? Would you tolerate that? horrifically bad breath? Would you tolerate them being late all the time? What are you going to tolerate? removed discretion?
26:53
Yeah, yeah, she just, Yep. Yep. That's a great system. Yeah. So really making sure that you've got systems in place that work for your practice, because every practice is different. And so you have to know what works for you. What are the KPIs that work for your business?
27:12
And quints of non compliance? What if you don't do it? Unfortunately, can we notice it now with with available library a bit short? Too many owners don't enforce this systems because they worried the therapists will leave so they're trapped they're trapped because they can't enforce this system. So what if they leave Well, what are they costing if they stay you know there's a cost for them to stay you're happy to where the cost make the decision. We've got a client in practice soldier now he's got an admin person just off sorry, a therapist, but just might want follow that action plan system to the letter, but he's got a labor supply issue. We know our numbers, we know what she's worth to the practice. We just made a decision to tolerate it for the moment that we could jump on if one day but it's not worth the fight because we're gonna have trouble with that off. Better Off fighting our battles in the right order. But it's a decision. It's a strategic decision.
28:07
Yeah, yeah. makes sense to me. Okay, let's move on to number five.
28:13
Number five, using your accountant to do your p&l for you. is a mistake because most accountants on average your account but assuming even give you a p&l, like most accountants, their job is to keep you out of out of jail and to make sure you pay enough tax and that's pretty weird. But what we want to know is, is a down and dirty profit loss for your practice. We want to know take out all the dodgy expenses take out the trip you took to the conference in New York take out all that. Even the year there was a conference there, but it's a bit dodgy like what take everything out of the car, all the other things that are legally claimable, but aren't really required for the business, get a down and dirty profit loss on a calendar month basis. Revenue we build, this is what we spent a know your numbers every month, and you shouldn't be able to wait for the end of the month to come to track your numbers. And one thing you must allocate Karen, you must have an owner consulting wage in there. Which is not the amount of money your accountant told you to take. It's not the dividend. It's a reflection of your consulting effort. So how you do that freedom school, so how many hours per week you're at the practice, multiply that by what it would cost to replace you, as a therapist, assistant your replacement costs, that money is not changing hands, by the way, the accountants looking after that. But this is we've got that in our p&l as a reflection of your consulting time. Because I can tell you now from having done this a long time, the only way sometimes you can get over practice to drop their consulting is to show them a down and dirty profit loss and show them that it hasn't changed or has improved if they dropped their consulting hours. Then you got it and you don't do that with your accountants p&l because it's a different spreadsheet, you got to deal with a down and dirty p&l. But because our natural recourse, Karen is to just consult more, whereas as a result of that we're not mentoring our team. We're not recruiting, we're not marketing. We're not with the kids, all these other things we're not doing.
30:17
Right? Yeah, no, that makes perfect sense. Yeah, I yeah, yeah, it's different. I mean, my accountant does do my p&l. But I also do monthly p&l is for myself. So on a month to month basis,
30:32
it can work if you're if you're doing a percentage of grossmith. But I just the problem with most therapists, we don't know their personal contribution to consulting and the overall scheme of things and we've show owners if you if you cut your hours, 20 hours a week, we can maintain your profit. Would you be happy to do that and see it because they're their natural recourse is to see more patients that just happens all the time. Sure. Anyway, can do it? He's know the numbers, the numbers will set them free.
30:58
Yeah, absolutely. Absolutely. No, I like that. And so when you're saying putting your consulting numbers in, you're talking about not just the time that you're with patients, but time that you're working on the business as well. Or just time when you're
31:14
just you're just you're face to face consulting time, because everything else is part of your profit margin. Right? Right. But the other thing is product and it's the other stuff is discretionary. You You can do your marketing when you want you can cancel a staff track you can you can you've got freedom to that, but your patient list. That's that's the one that use you're stuck in. So that's when you would change your business. Got it? Yeah. And, and most of ours, we try and get that down to zero. We try and get your owner consulting wage to zero maintaining your profit, then they have discretion. They can go to work if they want to say they're doing they're seeing patients because they want to not because they have to. Yeah, that's a differentiation. Not enough of us, Mike.
31:55
Got it. Okay, that makes sense. All right. So let's go on to number two to go six.
32:02
ineffective recruitment systems is a is a classic problem. And I know what it is we just we take it personally if they don't, if they leave we we don't get the right people always stuff this recruitment stuffs a nightmare. And I think it comes back a lot of it. As an owner, you have to make make a big decision regarding your team. Do you want to be liked? Or do you want to be respected, to be liked, or to be respected. I believe too many health business owners worry so much about being liked by their team, they can't have those difficult conversations, they don't have the respect of the team. And you're not always going to be like just accepted as an item of business. You know, there was going to be popular, you control the way ours you control the wages, you control everything in the business. It's important to be liked all the time. And if you're trying to be liked, it's going to be very difficult for you. Everyone is replaceable, except that and if they're not you want to make them replaceable. You need to think about the systems in a bit like my lymphedema God big mistake. I, I had an epiphany one night, I often have these epiphanies there. So there I am. And my admin, I had an admin superstar one of the practices and she knew everything. And she was so good everything she just did everything. And I had an I'm in there in bed one night, when I bought up right? What happens if something happens to Gina and I remember I couldn't sleep the rest of night. So I rang Gina, June at nine o'clock in the morning, I want you to come in, I've got someone to replace you at front desk, I've got my camera, you're going to show me everything. And we sat in the back room with the camera, show me how to do this show me how to do that show me and we just that we did that for a whole day. And I had all this stuff so if something happened you can watch the Gina file that someone can do. If you aren't doing that you are you are in all sorts of trouble. So recruitment systems, people are replaceable, except they're going to move on Don't take it personally. One of my mentors, we did a recruitment training program recently and one guy said, Just accept the fact that people are gonna, your business is like a train journey. People are gonna get onto certain station, get a bit down the track and then they get off the train. That's just that's what this journey is like they're not going to stay with you till the end of the line. Don't expect them to that's just just accept they will move on. And the final one and are running in the time, final one, not packaging your services, not packaging it into into an outcome driven solution. The bite write program for TMJ, the run marathon pain free program, whatever you do, we had a corrective orthopedic rehab program with exercise so name it something because once you are the only person that has that program, you can't be compared on price. If I'm bringing around the practices and you're charging 80 bucks and someone's charging 75 you're commoditizing yourself but If you're the only person with the x y Zed migraine program, because no one else has got that you can't put a price on that. So So you got to make sure you don't you have to package your services as a solution driven outcome, not just as a session by session deal. If you do that you're reducing the church have been caught up as a commodity. Now we've got time for one bonus mistake, I think. Yeah, all right. This is one bonus mistake. And too many owners do this. They, they think, well, they put a monetary value on their family time. They put a monetary value on their family time. Meaning I could finish at four o'clock in the afternoon. Or I could I could if I stay I'll make an extra $1,000 whenever I stopped but but I'll miss my daughter's concert. There's there's a so we put a monetary value if I do that, it'll cost me this. You just there's some things in life, you can't put a monetary value on. You just you can't put a monetary value on your family time. And people who told me that it's that it family time, I don't have much but I have quality time. And again, I don't want to guilt you into this stuff. But there's no such thing as quality time with your family. Family time is quantity time. things just happen. When you're around them. things just happen. I'm on. I'm on the back porch of my house. My second youngest daughter was about 17 on home a lot as I was on the on the back porch in she comes in she stands at the door. Not a crier young Jade. She's a very, very stout young lady. And she I said okay, down, and she dissolves like just the tears coming up. Right? a Cadillac for five minutes. Yeah, Caden are just a few things happening at school done. Um, right now, as you took off, yeah. I couldn't plan that.
36:59
I can't, you can't. You can't plan that. That just happens because you're around. And again, I'm not I'm not guilting you guys. Yes, you have bills to pay, they have other things to do. But the business is there to serve you. You do what you need to do to make sure your family is happy and fed and everything else but don't put a monetary value on it. Because it's it's a it's just not a fair comparison. You can't price it. It's just ridiculous to even think about it. Anyway. All right. Sorry to guilt everyone into something but that's the deal. Now I've lost you can you muted yourself.
37:40
There's a loud siren going by sighs just
37:44
could not go to Yes.
37:53
That was allowed one. Well, obviously edit this out. But I was like, I couldn't even I couldn't even It was so loud. Because it must have been like right in front of my apartment. So we'll edit that out. So annoying. That's that has not happened in a while that was allowed one. And didn't I don't even know what it was. Anyway. So we'll just sort of I'll do a little clap, and then we'll start. So this helps me for editing. But uh, you're killing me. I know, he's, I don't like it's fine by me. You know, I don't even realize he's there. But okay. So all right, so we went through seven mistakes, plus a bonus, which is great. And, you know, if you weren't taking notes, don't worry, we'll have all of these written out in the show notes to make it really easy for you and to follow along. But now, where can people find out more about you get some more resources so that they don't make all these mistakes.
38:59
best place to start, we do a monthly demonstration of practice ology. It's a webinar we do every month. And we'd basically show how our clients across 54 countries earning more, working less and enjoying their lives, even during a pandemic. So we talked about some of the principles to talk about today. And it's really a very interactive demonstration of how we do it. So if you go to my practice, ology.com forge forward slash Litzy li Ts Ed, why obviously. So my practice ology.com forward slash, let's see, you'll get the you can log in and register for the next next session. And if you want to get a copy of the book, I wrote a book how to run a woman a practice, as Karen explained at the start. It's not a it's not a big book, I didn't want to write it. It doesn't make sense to have a massive journal for how to run a woman in practice. It's got to be a woman's book, you should read that in less than an hour. Just covers a lot of the action plans and the bookings and there's great resources sample action plans you can get from the book If you just get to one minute practice.com forward slash book sales. So one minute practice.com forward slash book sales. And if you just put in the code, Karen Oh s for overseas. So if you're not Australian, which I don't imagine you will be if you're not Australian, do Karen r West. And it'll take 15 bucks off and you get it for $4.95 Australian which I think's about $1 us. That's a bit more than that. But it's not it's a pretty good deal. If you happen to be Australian, listen to it put in Karen, au, s t. So I'm going to practice.com forward slash Bob sales. Karen Oh s get it for if you're if you're outside Australia, or Karen a USD if you're Australian, and you get that for $4.95. And we'll post it out for you. And my social media platform is LinkedIn believer not I'm an old school, LinkedIn. So follow me on LinkedIn. Paul, right, Newcastle, I'd love to have a chat. And I hope you can join it for join us for a webinar and get some of those great resources from the book. And posted sorry, posters is a bit slow, I think we've covered but once you, once you buy the book, you do get the PDF of the book straightaway. And there is a second page, a link to all the resources and the action plans and all the scripts and stuff. So that's perfect.
41:16
And we will have links to all of that at podcast at healthy, wealthy, smart, calm. So one link will take you to the webinar to the books and to your LinkedIn page. And before we wrap things up, I'll ask you one last question. And it's one that I asked everyone knowing where you are now in your life and in your business and in your practice. What would What advice would you give to your younger self?
41:40
Oh, you love this one? Okay. I would probably be a podiatrist or an optometrist. You're sitting thinking, Okay, what are those things got in common? Well think about it. They've got a product arm. They've got a range of products, because I, I did what we talked about earlier, I became a physiotherapist because I wanted to be a physiotherapist. I didn't know I could be limited in what I can sell our products. So if I could go my time again. podiatry, I would, but I don't like feet. So maybe it's a problem. optometry, I'd be okay. Maybe orthodontics? I'd want a product range. That would be that would be why don't go and say all my diamonds done. Put a product range in your current business, if you can. That helps. But the idea of relying on your hands and trading time for dollars, I'd probably do differently.
42:38
Right? Well, great advice to your younger self, for sure. Thank you so much for Paul, for coming on and sharing seven mistakes that you've made and probably a lot of us who have been in business for more than a couple of years or more than a year have made and hopefully all the listeners out there you will not make those mistakes because we have covered them here. You've got them in your head. You'll sign up for the webinar and you won't make up and it'll be clear sailing. Fingers crossed. So thanks, Paul, for coming on and sharing all of that with us. I appreciate it.
43:14
Absolute pleasure, your superstar. Thanks for having me.
43:17
Thank you and everyone. Thanks for listening, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Founder of PT Crab, Luke Hollomon, talks about the importance of reading, dissecting, and understanding research.
Today, Luke talks about how PT Crab can help PTs, the most common research-reading pain points, why reading the abstract isn’t enough, and how to make the whole research process easier. What does it mean to keep up with the research?
Hear about how to find exactly what you’re looking for, how to understand what the research says, and how to apply the research to your clinical population, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Research has shown that, in our specific field, over 90% of the abstracts are at least misleading, if not inaccurate, relative to the paper.”
- “It’s important, when you’re reading a paper, to read it a little bit critically.”
- “A lot of times, research is written for researchers. It’s really important for researchers to write for physical therapists.”
- “If you have a paper that doesn’t specifically address your patient population, you can translate that to your population with good communication.”
- “Try to make [your] favourite journal one that you have access to.”
- “Get focused in on something a little bit earlier.”
More about Luke Hollomon
Luke Hollomon is a writer, teacher, and student from Richmond, Virginia with a special interest in sharing complex information with those who need it. Using his background in physiology and education, he started PT Crab, a newsletter that brings physical therapy clinical research, awesomely brief to the inboxes of thousands of physical therapists every week. His true passion is helping people understand and use scientific information.
When not writing The Crab, he writes science and technology articles as a freelancer and is currently finishing his degree in physical therapy from Virginia Commonwealth University. Afterward, he plans to pursue a PhD in exercise physiology and study the limits of human endurance. When not doing all of that, he’s a bikepacker, rock climber, and trainer of his deaf adventure dog, Kiwi. If you’re ever in Richmond, look for her in her trailer behind Luke’s bicycle as they explore the city together.
Suggested Keywords
Healthy, Wealthy, Smart, PT Crab, Physiotherapy, Research, Papers, Reading, Keywords, Critical Thinking, Science, Knowledge,
Resources:
https://www.researchgate.net
To learn more, follow Luke at:
Website: PTCrab.org
Facebook: PT Crab
Twitter: @lukehollomon
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
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In this episode, Managing Director of Sagesse Lumiere, Dr. C. Adam Callery, talks about small In businesses in the wake of the Covid-19 pandemic.
Today, Dr. Callery talks about the implications of the pandemic on future business strategies, the importance of agility, and understanding cashflow. How often should a business of any size check their financial status?
Hear about some emerging trends, three critical activities for success, how Dr. Callery helps other entrepreneurs, and get his valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Never confuse faith that you will prevail in the end.”
- “If you want to be successful moving forward, you have to be ready for these unexpected changes.”
- “You can’t be afraid to act fast, but you don’t want to be reckless.”
- “You have to take a step back sometimes and attack a problem formally.”
- “I cannot just assume that because my bank account has money in it that I’m actually in a good position.”
- “You have to position yourself, or maybe carve out specific time, for you to really learn your industry.”
- “You have to be close enough to the operations to know what’s going on.”
- “It is extremely important, whether you’re an existing business owner or a new business owner, to truly understand what cashflow means.”
- “You can do it. You can actually be an entrepreneur. Just go out and do it.”
- “Bring people around you who have the knowledge that you need, because you’re not going to know everything, and if you adapt that knowledge, you’ll be successful.”
More about Dr. Callery
Dr. Callery is an entrepreneur and higher education educator. For the past eleven (11) years, Dr. Callery has worked directly with the start-up and emerging business communities at a national level. For ten of the eleven years, Dr. Callery has held the roles as facilitator and trainer for two (2) nationally recognized small business growth programs, the US Small Business Administration’s Streetwise MBA Program in Chicago and the Goldman Sachs 10,000 Small Businesses Program. His company, Sagesse Lumiere, a small business coaching and consulting firm, was established seven years ago to complement the work he was doing in these programs. To date, Dr. Callery has advised over one thousand small business founders while participating within the national programs cited above.
Dr. Callery, as a coach and consultant, works with small business owners on approaches to effectively build value by deploying new business practices and processes to improve financial performance and operational efficiency.
Prior to working with small business owners as a business coach, Dr. Callery worked for several Fortune 1000 companies such as IBM, Dow/Dupont, Pepsi, United Airlines, and First National Bank of Chicago. His broad industry experience has prepared him to be a capable business consultant. Since leaving the corporate arena, he has become a trusted advisor for many small business founders. As a higher education educator, he has served as an Associate Dean for workforce development programs and currently works as a tenured faculty member for Harold Washington College, one of the City Colleges of Chicago.
Dr. Callery has earned a Bachelor’s in Chemical Engineering from Illinois Institute of Technology; a Master of Business Administration from University of North Carolina, Chapel Hill; and a Doctorate in Higher Education from National Louis University, Chicago.
Suggested Keywords
Healthy, Wealthy, Smart, Small Business, COVID-19, Research, Success, Cashflow, Entrepreneurship, Mentorship, Finance
Resources:
The Goldman Sachs 10,000 Small Businesses Program
WSC1998: AVOIDING THE BLUES FOR AIRLINE TRAVELERS
To learn more, follow Dr. Callery at:
Website: https://sagesselumiere.com
Twitter: @callerysagesse
Instagram: @callery_sagesselumiere
LinkedIn: Dr. C. Adam Callery
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here:
00:03
Hi, Dr. Callery. Welcome to the podcast. It's an honor to have you on. So thanks so much for joining me.
00:10
I'm so happy to be here. And so glad you invited me to attend your podcast.
00:14
Oh, this is great. And you know, like I said in the, in the intro, you were our lead instructor for the Goldman Sachs 10,000 Small Business program. So I owe a lot of my being a therapist and having to be a business owner to now being a business owner who happens to be a therapist to you and the rest of the staff and business advisors. It was really life changing. So thank you so much.
00:40
Well, I think I thank you for being a participant in the program. It's a hard program, we asked a lot of you for an extended period of time. And I have to say, I cannot do it solely by myself. It really is just a good strong team that covers so many different areas of business management that's needed for most small business owners. So I'm just having to have good people around me, that helps make the process very smooth.
01:05
Yeah, absolutely. And today, we are going to talk about sort of small business owners, and the effects of COVID-19, which we have been in for the last 18 months and doesn't look like it's ending anytime soon. But we are back to work. There are mitigation factors in place. But now, how do we position ourselves for the long term in this new world? So my question is, what are some of the lessons you have learned over the past 18 months? And what are the implications for your future business strategies?
01:50
Well, I think that's a great question. Because myself, I'm also a business owner, I am a small business coach. And I would have to say for the last 18 months, that's been a question that's been raised many times, I can think back to March, when we first moved into COVID. Everything shut down. And to be honest, it seemed very dark at that time. And then for the next three to four months, I was working with a lot of small business owners, and we were having those discussions, what are what's next, you know, how do I get out of this. And in fact, if you started to look at the newspaper, you'll see headlines saying this is the worst crisis since the depression or behind closed doors, there's calamity. And when you read those phrases, it actually diminishes your ability to be a leader, and organizer of your business. And so what I had to do as a coach started having different discussions and say, we must look forward. And the way I did that was having a time with individuals to stop and say, Hey, if we take a look at the Great Depression, or the great recession of 2008, those same phrases were being said then, yet, we were still standing in 2020. So we have to believe that we're going to pass through this period as well. And so the discussion became, how do we do that, and in most cases, and then bring back or I should say, shorten your horizon from looking out two to three years, to just make it now bring it down to three months down the six months, make it manageable, it was easier for you to see out three months, it's easier for to see how six months, and then just be very tactical. And so during that last quarter of 2020, through the beginning of the initiation of 2021, many of the conversations with business owners have centered on that, how can we focus on some short tactical goals that keep the lights on, they keep my current employees satisfied, so they stay with me to make sure the customers I do have still like the services are providing or the product that they're buying from us. Therefore, we have to maintain the same level of quality. So just being very tactical that way. And then hopefully, when we're on the other side, we can then return to a posture where we're thinking longer term.
04:06
And all that, to me just sounds like a small business owners that we have to be really agile, and we have to be able to pivot. And so can you speak to a little bit more about agility as a business owner, and how we can foster that if it's something that we're not used to?
04:28
Well, agility, you know, it's a strong word, right? So it means that we're flexible. But again, coming through this COVID period, it didn't seem like flexibility existed. Everywhere I turned, something was shutting down. So I've seen closer to the end, then something that was gonna be an opportunity in the future. And I came across a quote, it came out of the book called Good to Great. That was written in 2001. And I wrote it down someone just read it verbatim because it's a unique quote, but I think it addresses issue. It says never confused. That you will prevail in the end. So that saying this thing of, I have faith that I'm going to win, I have faith that my business is going to win, it's going to be successful, and I'm gonna make a lot of money from it, or I'm going to be fame, I'm going to become famous from it, you have this faith, you got to have this confidence, that's probably a better word, I got to have the confidence that I will make it through. But here's what the rest of the quote says it says, I can never lose that confidence. However, I must have the discipline to confront the most brutal acts of your current reality. So the current reality of 2020 was, everybody's impacted at the same time, my competitors, my peers, people across the ocean, everyone is getting hit with this calamity. So now I have to think out of the box, and I also have to think very practically, so that's where the agility comes in, I didn't have a lot of time to wait six months to see if it's gonna work, because I may not be here. So I may have to take some cost cutting measures that are going to be very draconian, but necessary, I may have to talk to my staff and negotiate with them, and maybe get them to take a cut and pay, letting them know I'm trying to keep everyone alive here, I may have to talk to my customers in a different way and find out, are you still here? You know, are you still viable, because my customer is also impacted by this. So then I can sort of forecast what my sales potential could be. Because many of the customers went out of business for many of my clients. So agility means that you are being sorry, that you're focusing on today. And you're being very practical, very tactical, you're using your experiences, from your I should say, your past experiences as a business leader, and a business owner. But you also are willing, and here's the key, you are willing to take in advice from subject matter experts who are in your industry, and also outside your industry to help you navigate this because this was so unknown, a lot of unknown territory that we were crossing through.
06:55
Absolutely. And I would also think that in that time, I'll use the example of the physical therapy profession, but kind of acknowledge acknowledging emerging trends during this time. So for the physical therapy world, certainly here in New York City, we were close, literally shut down ghost town from March to almost June or July of 2020. So what do you have to do to keep things going? So the emerging trend was telehealth? Yeah, telehealth has been a trend and it has been coming up and coming up. But I think as a PT, if you didn't acknowledge that that trend existed, and didn't hug that trend, like it's your best friend, you you were in trouble, right? So what other kinds of trends Did you see within the small business world that people had to acknowledge and embrace in order to not only bring them through 2020. But I'm sure a lot of those trends have continued well into this year.
07:56
I agree 100%, the hardest trend, and I don't know if I can call it a trend, that's probably more of an action, the action that I may have to return to what I was before. And what I mean by that is, maybe we're a sizable business, you had 50 employees, or maybe employees and contractors working for you that accounted for about 50 people that you're responsible for, had a fairly good customer base that you're working with COVID hits and everything shuts down. Now, you may have to go back to what you were three years earlier, that's when you started the business where you were a smaller company, not as nimble because you were smaller, but you were very focused and very targeted. And that was the trend, I was saying that people say I'm at the roll back to where I was before. And that by rolling back doesn't mean I'm failed, which is another trend element. It doesn't mean I'm failing, it means I had to adjust, you know. So it's realizing that businesses aren't always going to go up with hockey stick and grow, grow, grow, grow without interruption, that there will be these troughs. And if I hit a trough, I may have to back up a little bit. In this case, people have to back up a lot. A great example of that would be the restaurant community. Here in Chicago, I've seen it all over where people physically had to change the menu, they may have 30 items on the menu. And they just took duct tape and started covering over things and reduce the menu down to something that they could manage based on staff based on a cost of the ingredients based on just pure demand, because now they're doing just takeout services, no longer doing to sit in services. why they do that, because I have to still pay the rent, I still have to pay some utilities, I still have to pay something. So I have to have some money coming in. And I want to be here for the next day. So I may have to swallow deeply. And Take another deep breath and say I have to go back to where I was maybe when I started the business so I can survive this period not knowing if you remember not knowing back in April, how long is this going to go? Because the predictions were two months, six months, two years, five years. Nobody knew. So You had to be very specific and very intentional about how far you will go back in time in order to survive and be here for the future.
10:09
Yeah, I mean, gosh, back in March, when New York City shut down, I was like, ah, six or eight weeks, we'll
10:15
be back up and running. Let's see, 18 months later,
10:21
not quite back to where we were. But getting closer. But to your point, yeah, I thought it would just be like six or eight weeks. And this will be a little adjustment that I'd have to make in my business. But it, it actually turned into a long term adjustment that I love. And I'm glad now that it's part of my business. So that ability to pivot quickly actually turned into a big positive for my company, because now I can actually see more people because I don't have to see them in person.
10:51
I agree. I agree. And I stole something else out to you. It's not so much of a trend, but it's probably a revelation. So we know a lot of business owners have different backgrounds, and they come from different walks of life. And so if we put an academic hat on, we have individuals coming out of MBA programs, and they have knowledge around business. The key is what does an MBA program teach? What MBA program teaches is that you need to go out and look at the environment that you're in. So that means you research on what some of these latest trends are. When we have a situation like COVID, I know many business owners typically don't worry about what the trends are, they worry more about what's going on in their daily environment in their community, and their marketplace, and they're just focused on can I sell something tomorrow, I think COVID has opened up a new reality that if you want to be successful moving forward, you have to be ready for these unexpected change as well. How can I reduce the number of unexpected changes, I start to do some research, I start to do some reading in my industry and also outside of my industry. So I can see those trends that you were talking about earlier. So telemarketing has been or tele health rather, has been around for a long time. People talk about it, but it wasn't economically feasible. Then when I need it, those who knew about it jumped on it. So but I had to know about it, I needed to have that information. So this is an important time as business leaders now to say, what else do I need to know? Do I need to join my industry associations? Do I need to go out and and go to conferences, go to particular training programs, where I can start to learn about what is going on around me so I can be better equipped for the next situation may not be a pandemic? Or it could be droughts, if you're out west? Who knows? It's going to be something so how can I be prepared for the next something?
12:39
Yeah, because you know, something that you had brought that you brought up in our kind of communication before we recorded this is and I like this phrase you put in quotations, you can't be afraid to act fast. But you don't want to be reckless. Yes, yeah, right. And so by doing the research, you can act quickly, and not in a reckless manner. Because you know where you are, you know, what the industry is holding, and you've got that research. So you can act quickly with authority. And with some sense of operation.
13:15
I agree. And ask where, you know, we want to say, you want to be intentional. And that's what that word really means. And especially when we're in our programs, we use that word a lot. But it's good to unpack it. So you just mentioned and that reckless, and I'm not trying to be strong willed. So when I'm talking to my employees, I'm trying to hit them over here with a club, but I'm intentional. So I have I know where I want to go, I've taken the time to do some research. So I've set a goal in mind, I've also decided on a path that we can take, but I'm also willing to ask around to see if that's the best path. So that's where I'm not being reckless, I'll go ahead and qualify it by talking to other subject matter experts, talk to other people in the industry and say, This is what I want to do based on my capabilities. What do you guys think? What do you people think? And that can help me then to minimize risk? Because we'll never eliminate it. We're just trying to minimize risk. So we can be successful.
14:10
Absolutely. And so now, we've we've sort of identified research we have we spoke to people, we got advice. Now we want to move forward. So we need some sort of formal operations. So these operations, as you said, they kind of revolve around three critical activities. So can you share with the listeners what those critical activities are, to make that those formal operations successful?
14:38
So I can that'd be beautiful. We've met through the Goldman Sachs program and what I've learned over the last 10 years in that program, is that you have to take a step back sometimes and attack a problem formally. And so we start off with the purpose, what is your business purpose? And what that means, of course, is what do you think? to do in your marketplace, who you're trying to sell to, why you're doing it, why are you actually involved in this work? The second thing we try to do is examine how we actually do the work. And this is the operational piece. So how do we actually do the work? How do we earn our revenues? How do we manage our team? How do we actually produce the product or service? Are we doing it efficiently? And then the last piece I call her reflection, but that's the research piece. I've been doing this for five years, I've been doing it for 10 years, is this the best way to do it now, based on the changes in the business environment, changes in government regulations, changes in social trends, changes in the number of competitors, or the type of competitors that so the three pieces are looking at my purpose? Why did I get into this business? Why do I want to do this or continue to do this kind of work, I look at my model my business model in general, and think about how I currently conduct business and see there's a better way I can do it more efficiently, more effectively. And then last but not least, I have this reflection or research activity that I do continuously continuous learning to make sure I understand my marketplace, understand my industry, understand what's happening with competitors around me also start to probe and find out are my customers still satisfied with what I'm doing? And if not, what do I need to do to reach them?
16:21
Yeah, and I'm glad that you said that you're continuously looking at this, because this isn't something that you do when you start your business, you assess your purpose, your model and solutions and reflect. It's not like you just do it once. Yes. Like how often would you say do you recommend even the business owners that you work with, kind of go through these three critical activities?
16:47
Well, I think we can take the model from the corporates. Now you understand corporations are huge, billion dollar places, but they are billion dollar places for a reason. And that is because they do take the time to annually look at what they do, and assess whether or not is making sense. So if I was any business owner, I don't care what size you are, I would make it a point to say maybe in the fall, that November period, Christmas period, when it's kind of quiet, people focused on vacation or focus on the holidays, you take that time, sit down with your management team and say, hey, let's think about how our last year went. Is there something that we want to do better, right doesn't mean that you did anything wrong? Is there something that I can improve upon? Or are there some new things coming down the pipeline that I need to be aware of, or we'd need to be aware of, that we need to plan for starting in January. So doing an annually isn't a bad practice. And if you do it formally, and you do it every year, it just becomes part of your routine. And you'll start to think about the questions you want to ask each other during those sessions. And you'll be able to flesh out what is happening with the business. In fact, you probably want to go ahead and bring in some of your key employees that sit them around a table, get some insight from them on what they're experiencing, when you're engaging your clients, when they're engaging your suppliers, or if what they see, in general, they may see some things in the market that you have missed. And it's a good time to sit back and get their feedback as well.
18:16
And how often would you say suggest to a business owner small of any size, but let's say a small business owner, to really look at the financials of their business once a quarter every month, every week, every night before you go to bed? Like is there overkill? Or? Or what? What are your thoughts on that?
18:40
That's a tough question is a tough question, right? Because Is there any should you have any limit on when you look at your numbers, because for instance, everybody will tell you, you need to know your numbers. So if I'm sitting in front of an investor, or a banker, they're going to say you need to know your numbers. But I guess the question is, what are they really asking me? They're probably just asking, do you know enough about your numbers to tell me whether or not you're profitable? That's really the question they want to know. And they want you to be able to tell them that, tell them you're profitable in a confident manner. And they can easily see if you're sort of dancing around the question, right? Because you really don't know your numbers today. They can sense that in the way you respond, your eye contact, and so on. So to your direct question, how often should I look, if I put on my accounting hat, we typically look once a month. So every month we take a step back, and we see how the business is performing financially. In order to do that, we probably need to have some type of system in place. That could be a QuickBooks system, or it could be a cell spreadsheet. It depends on the complexity of your business. And that's when we have to define a small business. So small business can be defined as any business with less than 500 employees. That's a big business. But let's say I'm a mom and pop I have less than 10 employees. In fact, I am the key employee and everyone else is a contractor. If I'm that size, once a month is probably still appropriate, I need to take the time to stop. And look, I cannot just assume that because my bank account has money in it, that I'm actually in a good position. So if I take the time, look at it once a month, that's probably enough. The furthest I would like to go out is probably three months, you know, quarterly, but want to go beyond that. Because a lot can happen to a business in two days, let alone in 90 days. And if I'm not keeping track of my numbers, I may find myself in a very dire cashflow position, and maybe find myself going out of business fairly quickly.
20:42
Yeah, excellent advice. Excellent advice. Thank you for that. And you know, as we start to wrap things up, what would be if you could give one or two pieces of advice to let's say, a new small business owner, so their business is less than a year old? What is your best advice for those business owners?
21:04
I think it's extremely important for the person just getting started to do some of the things we're talking about earlier, you have to position yourself or maybe carve out specific time for you to really learn your industry. So that could mean joining an industry association, going to those industry association meetings. So that's gonna take time, read some of their white papers that they generate about your industry. So for instance, I was at one time I was looking at buying a limo service, I love this guy service used to take me to the airport all the time, all his drivers were professional, his cars were clean, well maintained. And all I knew about the business at the time was the fact he took me in a limo to the airport. But that's not knowing the business. So I went ahead, I contacted limo Association, they sent out to me information on the business, you know, on the industry, the cost factors, the maintenance issues, some of the trends in the industry. After reading all those materials, and learning that it was a very highly capitalized business, I realized that it wasn't for me, at that time, still like the business. But I knew I was not in a position where I had enough capital to keep the cars up to spec to meet the requirements of running a limo business. So if I'm starting a business, whatever it is, I need to know as much as possible about that industry and the business model itself. How's the business make money? What are the cost factors? What are the what are the cost influencers, I need to know that like the back of my hand, then when I'm running the business on a day to day, I need to be in the business to see how it really operates. I've met some people that have started a business. And I've started another one that started know when I started another one. And I now ask them I said, Well, how do you possibly run three businesses at the same time? Well, I got people working for me. And what comes to mind is something someone told me many years ago, is that you have to smell the people. And what this is gain from Business School, and the professor was saying, you have to be close enough to the operations to know what's going on. And if you're too far away from it, there's too many things that can happen to the operations that will shut you down. And so if you're just getting started, your focus needs to be in the business and getting the business to a place where it's stable, and is sustainable. That usually means creating cash reserves, that usually means bringing in solid employees, it usually means having a great understanding of your customers so that you know you have returning customers that'll help keep the business afloat.
23:42
Excellent. Thank you so much. I know a lot of people that listen to this podcast or maybe budding entrepreneurs, they've been in business for maybe a year or two. So I think that advice is really great for that group. Now, is there anything have we not covered something that you were like, I want to hit this point during this podcast?
24:02
I think it's important, we haven't used that key phrase. And that's cash flow. It is extremely important whether you are a existing business owner, or a new business owner to truly understand what cash flow means. And so when we talk about cash flow, what it means in general, is that we're talking about the money that's coming in. And that's where most people focus is, Hey, I'm making revenues, things are going well. But you can't just stop there, you got to think about the cash outflow. And people say I write the checks every day, I know how much money is going out. The third piece is timing. You have to think about when the money has to be paid out. When does that liability has to be paid out, and whether or not I'm going to have enough cash on hand to pay it on time. Because once I default on that payment, I'm now in trouble. The bank is knocking at the door. My creditors are knocking at the door, my investors are knocking at the door and I'm going to have problems paying my employees so on and so on. So cash flow is very important. And it's important from the standpoint of you have to truly understand the definition of it. And what it means is inflow is outflow. And it's also timing. When is the money coming in to pay those current debts that I have? Will I run into a situation where I don't have enough coming in to pay those debts? And if I do, what am I going to do about it? Am I going to reach into my personal account and pay it? Am I going to run down to the bank and ask for a line of credit? Do I need to run out and find investors? Who can give me additional cash to help me close that gap? So cash flow is critical?
25:36
Yeah. And I think, as you were saying that the thing that popped into my mind is, ooh, this is why Ponzi schemes ultimately fail.
25:44
Yes, yes. Because the money stops coming in. And their commitments outweigh our Yeah, extend beyond the, the amount of money that's coming in.
25:54
Right. Right. Yeah, that is why a Ponzi scheme fails. And, and I agree that cash flow is so important. And it's something that I didn't really wrap my head around fully until the Goldman Sachs program. You know, I knew like, yeah, money's coming in. But once I started doing cash flow statements, I was like, Ah, okay, yeah. Now I got it. No, I know, I can now I understand this as, as one of the three sisters, you know, your cash flow statement, your balance sheet, and your income statement.
26:32
Exactly, exactly. And it's the cash flow statement, and we never talk about, you talk about it. If you again, be school, we talk about all the time, but most people just stop at the income statement. In particular, they stop at the income side, then when you introduce the balance sheet, I don't see why I really need it. I don't have any assets. But they don't combine the two to come up with the cash flow. And that's what you really want.
26:53
Yeah, yeah. Excellent. All right. Now, where can actually let's talk before we before I asked, Where can people find you? Why don't you talk a little bit more about your business? And how you help other entrepreneurs, your coaching business and what you do to help entrepreneurs?
27:12
Well, what I do is I focus in the business development area, as well as the operations or organizational development area. And what does that mean? So I come in as a business coach, not as a consultant, I sit down with my clients, and we have discussion. So it's like we're doing now and we focus on the issues that are facing them. So in a business development side, for instance, such as a marketing issue, we're not talking about social media, what we're talking about is more around a target market. Have they identified the right persons, or the right audience? When it comes to marketing? Also, you got to think about the delivery of the product and service. Are there some challenges in terms of quality, some challenges in terms of delivery, that they're facing? And then we start to peel back a little bit? And this is where we get into the operations? Why are you having those challenges? Is it a capability issue is a capacity issue, these things have to be fixed, or the marketing, social media really won't matter? So I focus on a business development sort of working backwards? What are you trying to sell? What are you servicing? How are you working with your clients? And what are your business capabilities, what is what is your business capacity, in order to essentially achieve the goals that you've set for the business or to meet your current demand for your customers, those are all very important pieces, because most businesses will suffer or in a trough when they get to that third and fifth year when they try to scale up. And they always find, hey, I have this resource deficit. And I usually think it's money but it's not so much money, it's really capacity and capability, they may not have the right people on hand, they may not have the skill themselves in order to scale up and they need to go back, build up those skills so that they can grow. And that's where the coaching comes in and sort of help the build up those skills.
28:57
Awesome. Now where can people find you?
29:00
Well, they can find me right on the internet. I have a website out there, my, my company has a very unique names, it's called suggests luminaire and will suggest and stores wisdom, and then luminaires light. And so right out there on the internet, I have a web page where you can contact me through that or you can come back contact me through LinkedIn. So I do have a LinkedIn profile out there. That's probably the best way most people will contact me through LinkedIn. And then we'll set up an appointment and we go from there.
29:29
Perfect and we will have direct links to all of that at podcast at healthy wealthy, smart, calm and the Show Notes for this episode, so don't worry if you didn't have a pen you can take it down. totally get it we will have one click direct links to all of that. And now, Dr. calorie for the last question, which is a question I asked everyone, knowing where you are now in your life and in your business, what advice would you give to your younger self
29:57
so what I would tell my younger self I'm fully invested in entrepreneurship, I would tell my younger self is that you can do it, you can actually be an entrepreneur. To be honest, when I came out of school or coming came out of undergraduate, my mind wasn't there, my mind was I had to go through this career track, because that's the only possibility that entrepreneur thing, or that small business thing was just too far out there. You have to literally be born into it. It has to be a legacy relationship in order to start a business. Today, I recognize after meeting so many people in this space, that's really not it is really tied to have any interest. People use the word passion, but I go beyond the same passion, you really have that ambition that you're willing to give all in order to accomplish this. And so I would tell my younger self, that you do have that ability, you do have that ambition, just go out and do it. Bring people around you who have the knowledge that you need, because you're not gonna know everything. And if you adapt that knowledge, you'll be successful.
31:03
And I think that's great advice. And especially for a lot of the physical therapists who listen to this podcast, because so often we graduate, and we think, well, I'll work at a clinic, I'll work at a hospital, I'll do that for 40 years, and then I'll retire. You know, it's like, it's never it. Because in school, we're not really given any entrepreneurial mentorship or classes, you really have to seek it out on your own. And so I think that's great advice for any students listening or newer graduates, who think, Well, my mom wasn't wasn't an entrepreneur, my dad or I don't, I don't have any real role models in my immediate family, but that you can do it if you surround yourself with the right people, and you have the ambition and passion to do it. So I think that is excellent advice. So thank you for that. Well, and thank you again, for coming on the podcast and for being a great instructor in the Goldman Sachs 10,000 Small Business program, I can put a link up to that too, if people are interested in learning more about the program because it is a life changing program. It was for me and I'm sure as an instructor, it must have been for you as well.
32:13
Oh, it hasn't. It hasn't, I have to say, I never, I never thought I'd have this experience. It's been now going into my 11th year and I've actually set before 1000 business owners never thought that could happen in my wildest dreams and having the ability to have conversations like we're having now. Again, it's opened up my mind to say the The possibilities are limitless in this country when it comes to being able to create something that you want to create. And that's the beauty of it. So it's it's a fantastic opportunity. Fantastic country fantastic. Time, even though it's difficult time, it's a fantastic time to to do something that you want to do.
32:57
Excellent. And on that note, I will wrap things up by saying thank you again and thank you to all of the listeners for tuning in today. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Managing Partner of XPAN Law Partners, Rebecca Rakoski, and Senior Account Manager at Contango IT, Schellie Percudani, talk about cybersecurity, especially for small businesses.
Today, Rebecca and Schellie talk about business privacy and security practices, cost-effective steps that you can take to protect your business, and the importance of cybersecurity insurance. Why do small businesses have to worry about cybersecurity?
Hear about ransomware attacks and how to react to them, data privacy laws and how they impact your business, and the value of hiring lawyers, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “What we all have in common between the small businesses and the large businesses is we’re all human.”
- “You’re only as good as your last backup.”
- “You can’t have privacy without security.”
- “You definitely don’t want to be fudging any kind of information. You definitely want transparency.”
- There are four basic things that you can do as a business owner: enable multi-factor authentication, provide security awareness training, monitor and patch your systems, and enable software and hardware encryption.
- “Encryption is your Get Out Of Jail Free card in most jurisdictions.”
- “60% of small businesses will go out of business within 6 months of a data breach without liability insurance.”
- “The first thing that businesses need to do is take a proactive posture.”
- “If you look at data breaches, if it’s not caused by an employee in the company, it’s caused by an employee at one of their vendors.”
- “Make sure you put yourself in a legally defensible position.”
More About Schellie Percudani
Schellie is a Senior Account Manager at Contango IT located in Midtown, Manhattan. With 75 people, Contango IT services their clients through 4 key areas of technology.
IT Service/Support - We offer unlimited onsite and remote support for all covered users and devices with up to 60-90 second response time. In that same fixed monthly price, we also include asset management, budgeting breakdowns, disaster recovery planning, compliance requirement review and planning, technology road mapping, and a lot more.
IT Infrastructure / Cabling - Moving offices? Contango IT handles the technology side of the move through Cabling and IT setup.
Cybersecurity - 45 people strictly in Cybersecurity keeps Contango IT on top of the biggest buzz In technology. Risk? Compliance? Reach out, looking to help in any way possible. Even if it is just second opinion or advice.
Custom Programming - Front-end or Back-end development, Android, iOS, Web-based and much more. Winners of the Microsoft Best Use of Technology Award and the NYU Stern New Venture Competition
Any technology questions, reach out! With hundreds of clients over 4 services, Contango IT has seen it before.
More About Rebecca Rakoski
Rebecca L. Rakoski is the managing partner at XPAN Law Partners. Rebecca counsels and defends public and private corporations, and their boards, during data breaches and responds to state/federal regulatory compliance and enforcement actions.
As an experienced litigator, Rebecca has handled hundreds of matters in state and federal courts. Rebecca skilfully manages the intersection of state, federal, and international regulations that affect the transfer, storage, and collection of data to aggressively mitigate her client's litigation risks.
Rebecca is on the Board of Governors for Temple University Health Systems, and an adjunct professor at Drexel University’s Thomas R. Kline School of Law and Rowan University.
Suggested Keywords
Healthy, Wealthy, Smart, Cybersecurity, Small Business, Privacy, Security, IT, Insurance, Legal, Hacking, Ransomware, Malware, Data, Technology, Data Breaches, Encryption
To learn more, follow Schellie and Rebecca at:
Website: https://www.contangoit.com
https://xpanlawpartners.com
Twitter: @XPANLawPartners
@RRakoskiesq
Instagram: @schellie00
LinkedIn: Schellie Percudani
Rebecca Rakoski, Esq.
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
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Read the Full Transcript Here:
00:02
Hello, Rebecca and Shelly, welcome to the podcast. I'm very excited to have you on to talk all about cybersecurity. So welcome, welcome.
00:13
Thank you for having us.
00:14
Yes, thank you. And
00:16
so this cybersecurity this for me as a small business owner, is brand new to me. Although it probably shouldn't be, but it is, but that's why we're talking about it today. But before we get into it, can you guys give a little bit more detail about yourself and what you do so if the listeners understand why I'm talking to you guys today?
00:41
So I, Rebecca McCroskey, I'm a co founder and managing partner of x Pam law partners, we're a boutique cybersecurity and domestic and international data privacy law firm, which is a really fancy way of saying we help organizations with their cybersecurity, and data privacy needs, right? I have been a practicing attorney for almost four years. I hate to admit that sometimes I'm like, I'm dating myself. But what's great is we really help businesses, small startups, all the way that big multinational corporations because right now businesses are it's, it's really a brave new world that we're facing today. And businesses are getting attacked literally from all different sides. And so we started x pant to really help businesses understand what their legal obligations are, and what their legal liabilities are. And I tell my clients, my job is to avoid those problems for you, or do my best or put you in the best position to address them if and when it becomes an issue. So that's
01:48
what I do in a nutshell. Great, thanks, Shelly. How about you?
01:53
Yes, my name is Shelly perky. Donnie, I am an account manager with contango it and we help businesses and our end organizations if I could speak, we help them manage their day to day it to help build a strong security posture. We also help them with cybersecurity, we have 45 people strictly in cybersecurity, we have 25 penetration testers, eight ethical hackers. So we have a strong, you know, posture to help businesses build a posture so that they at the end, I wouldn't say that they're not going to be attacked, but they are prepared for anything that could happen. And so we help them with that. Got it.
02:43
Well, thank you both for being here to talk about this, because we are seeing more and more things in the news lately about ransomware and cyber attacks. And so oftentimes, we think of that as only happening to the big businesses, right? So why should small businesses, which a lot of listeners that listen to this podcast, are entrepreneurs or small business owners? Why should we have to worry about this?
03:10
So, you know, from a legal perspective, obviously, anybody who's ever come into contact with the legal system knows, it's not just for large businesses. So from a legal perspective, you're going to be subjected to liability from your people who whose information you're collecting, call them data subjects, you can, you're going to have contractual obligations with your vendors and third parties that you use and share data with. So put that and then just put that aside for a moment, then you also have small businesses have a reputation. And in the small business community, I am myself a small business, I'm a small law firm, Chief law firm. And you know, your reputation is everything. And so part of your reputation nowadays is how you're handling security and privacy. What are you doing the data. And so it's really important for small businesses to realize it's not just the big guys, we hear about them in the news, the colonial pipelines and the JPS foods and the Equifax is of the world. What you don't know is that every single day law firms like mine are getting a call from small businesses going help. We just clicked on a bad link, we just got ransomware, what do we do? And that happens all the time. It really you hear about the big guys, but it's the little guys that are really, you know, bearing the brunt of it, I think.
04:32
Now, I would agree. And what we all have in common between the small businesses and the large businesses is we're all human. And like Rebecca said, it's human error. Somebody clicked on an email, and they didn't know you know, they weren't trained. Hey, this is a spoofing and phishing email. This is what they look like, this is what you need to look for. And so that's where we come in, and it's we're all human and we all make mistakes. It's just no Like, you know, you this is what to look out for.
05:04
Got it. And so what are some of the issues facing businesses today, when it comes to cybersecurity?
05:12
What ransomware is obviously one of the biggest issues, right. And for your listeners who don't know what ransomware is, it is, what happens is somebody clicks on a bad link, download the bad, you know, attachment to a file, and the ransomware is downloaded to the system. Depending on how sophisticated the hackers are, they can either deploy it immediately, which means your system starts to, they start to encrypt your files, or it can be that they sit in there and wait for Oh, I don't know, the most inopportune moment that your business has. And then they deploy the ransomware. I've had clients where they deploy ransomware, or they first delete backups before they deploy the ransomware to really add insult to injury there. So but so that's one of the big things and then the your entire system gets encrypted and you can't unencrypted it without the encryption key which you then have to pay for the ransom part of it. And, you know, we hear about the big ransoms, again, the 4.4 million from colonial the 11 million from JBS. But you know, I was speaking with a colleague the other day, and a law firm got ransomware for $50,000. Now, that's a lot to a small business, it's a lot to any business, but they try to make it it's almost like it's commercials with what they think that they can afford and pay and so that they'll pay because they want you to pay the ransom. So that's I think, I think that's probably the
06:35
number one I would say so too. And then you now you're on their list, because you've paid your
06:41
SIR now. Wow, they paid
06:44
from now you're on a list of this hacker of like, Well, you know, was easy to get in before. Yeah. So let's see how we can get in again.
06:55
Right? Oh, my goodness. Hang in and you know Rebecca's right.
06:59
And that's where you know, also patching and monitoring your systems having a good strong it. posture is important. Because they see that stuff, they see little inklings of, Oh, well, something's going on here. somebody's trying to get in, you know, so they can see that. And you know, you're only as good as your last backup, and where is your backup being stored? And you know, is that in a secure location? Because if not, guess what? It doesn't matter. Because your information is gone.
07:33
Oh, my gosh, yeah, that makes so much more sense. Now, even just explaining what ransomware is. I didn't realize so they hold the encryption key ransom. And that's what you're paying for.
07:46
Correct you in order to get your data back, you have to pay to get the encryption key. And people think Well, okay, so I'll pay the ransom. And I'll get the encryption. I'll get the encryption key. And it's like, like magic? Yeah. You do, to some extent, although there used to be honor amongst thieves. It's not always the case anymore. No. But the other thing is to keep in mind encryption is not perfect. So you're not going to get it back exactly the way it was before. And a lot of laws have been changed now. So the fact that you were ransomware, it is in and of itself, a reportable event for a data breach. So that's another aspect to it. I mean, we're talking more about the technical aspects with the ransomware. But this is the other part where you know, I always say like, ransomware is like three explosions. The first one, oh, my God, my computer has exploded, but yeah, my computer's, what do I do? And then the second one, which is how are we going to, you know, get back up and running. And then the third is really the legal liability that flows from it and holding it together.
08:55
Also to I mean, Rebecca, are you finding that now, too, they're not only holding it, they're selling the data? Yeah. So they're still older data copied it, they're giving you back access to it, but now they're gonna sell it?
09:12
Yes. So what it comes down to is yes,
09:15
there's a lot to do. At that point to now you've got to tell your clients, hey, I've been
09:23
hacked. And that's where that whole reputation part comes in, you know, where you're, you know, these are people who are interesting information to you data. You know, I mean, as a law firm, we obviously hold our clients data. But you know, if you're a business, you could be holding personal information of your clients and business partners. You could be holding sensitive data on your employees or social security, financial information, information about their beneficiaries, which could be kids and things like that. So it really is a problem that just expands exponentially. It's a rabbit Well, I guess you're falling down that rabbit hole for a while.
10:04
You're like Alice in Wonderland.
10:07
Right? Oh, my gosh. Well, now you mentioned Rebecca about laws? And does that? Could you talk a little bit more about like certain data privacy laws and how that works? And if you're a small business, what does that mean?
10:24
Sure, so different. So there are two sets of laws that you need to really be businesses need to be concerned about, right. So one of them are your your data breach notification laws, which won't really be triggered unless and until there is a data breach, there are 50 states, there are 50 different laws, it's super fun for businesses who have to deal with us, then you have data privacy laws, and because nobody can seem to get their act together to come up with a federal law, we are stuck with, again, a patchwork of laws. So different states have passed different laws. And that is in and around a data subjects rights, about the data that's being collected about from them. So for example, California has a law, Virginia passed the law, Colorado passed a law recently, I know there's a proposed one in New Jersey in New York, Pennsylvania, Texas. So you name the state, and it's probably considering Washington State has tried to have made several passes into data privacy law. And what's interesting about this privacy laws is it they're usually, there's usually a threshold, sometimes small businesses will meet that threshold, but you need to understand that and it's all about the data that you're collecting. So the data you're collecting is going to trigger or not trigger requirements under some of these laws. That same data is the attractive nuisance, if you will, to the hacker they want to, they want to so you know, I always say you can't have privacy without security. So they really do go hand in glove.
12:00
What would be like an app if you know this at the top of your head, but an example of data privacy law from one of those states that has them on the books like what would be an example.
12:13
So California has the California consumer Privacy Act, the ccpa, which was amended in November, when the good citizens of California had a ballot initiative to pass the California Privacy Rights Act or the cpra. And those types of so in and around that you have different rights, the right to deletion, the right to correction, or right to a ratio of three, you know, the right to be forgotten is what's commonly known as, or just some of the rights that you're entitled to. And so businesses that fall under the within the purview of the ccpa, which is in effect right now, the cpra, which will go into effect in 2023. And so if you are a data subject, and the business is is under those laws, you can, you know, say to the pay, I want to know what you're doing with my data, hey, I need you to correct or delete my data. And the business has a set statutory period of time to respond to that data subject Access Request. It's about transparency. So anybody who saw all those updated privacy policies online, that's all driven by privacy laws, there's one in Europe called the GDPR, the general data protection regulation. And it really is in and around transparency, and data collection, storage and sharing practices. So that's, I could go much deeper, but I don't want to put anyone to sleep as I talk about loss.
13:42
I think I think that's really helpful just so that people get an idea of like, well, I don't even know what that is, you know, and if you're a small business owner, you've got a million other things on your plate, because you probably don't have a dedicated IT department, you don't have a dedicated cybersecurity department, oftentimes, you're a solopreneur. Or maybe you have less than 10 employees, you know, so all of a sudden, all of this stuff has to come on to somebody. So I think just getting an awareness out there that it exists, is really important so that you can maybe look it up in your own individual state.
14:20
Yeah, and one thing I would say and I know that this is a problem amongst entrepreneurs and startup is within the startup community is that they think well, we can do this ourselves. We can like cut and paste the privacy policy online and somebody Shelley's laughing at me over here. But you know, the purpose of these laws is to provide information about what that business is doing with data. So if you're borrowing it from somebody else, you could be in trouble twice because you're now you're not accurately reflecting what your laws are, what you're doing with the data. And you've basically taken this information and maybe obligating yourself under other laws of regular So for people who are listening, I know nobody likes talking to lawyers. I swear we're not that bad. But hiring a dedicated privacy or security attorney who understands this is really important because you told what to, you know, have an Ono moment on top of it. Oh, no moment when you're you know,
15:19
exactly. You definitely were Rebecca Sade is absolutely correct. There are people that do that they try to manipulate it and do it themselves. What they don't realize is once you're hacked, it's not just, Oh, no, they've got my information. Now I have to pay this ransomware. But guess what, oh, if you weren't following those privacy acts, you're also gonna get fined on that data, too. So you definitely don't want to be fudging any kind of information. You definitely want transparency.
15:47
Yeah. So hire lawyer. I'm a big fan of lawyers. I hire lawyers for for everything, because I don't I'm not a lawyer. I don't know how to do any of it. And I want to make sure that I am protected. So I 100% get it. Now, what? So we're talking about the pitfalls of what could happen if you have a breach, or issues facing businesses. So what can businesses do to help with cyber security? What are some things we can have in place to give us some protection and peace of mind?
16:20
Well, I would like to answer that this is Shelley, I'm someone who's there for simple and very effective basics that you could do as a business owner. And they're very cost effective. In fact, you know, you already have some of them in hand, as far as like Microsoft Office 365, all you have to do is enable your multiple factor authentication, that's a huge one, it's like leaving your light on in your house, if you're going out to dinner, they're gonna move on to the next house, because you have that layer of protection. And then, you know, security awareness training, educating your employees, educating yourself a lot of spoofing and phishing email looks like, that's huge that you know, it, it makes them aware. And that also, you know, it shows your employees that you're protecting them, you're protecting your clients, you know, it shows stability. And then also, you know, monitoring and patching your systems, you know, making sure that someone has an eye on what's going on. I'm looking for those little ticks that someone may be trying to get into your system, because a lot of people that you can have websites, you can tell by is your website going slower, that's usually a sign that someone might be trying to hack into your system. You know, so it's little things like that. And then also, you know, software and hardware encryption, that's a huge one. A lot of people, I know we have all our devices, it's our fingerprint or face that opens it. But if your hardware is not encrypted, they could just steal your laptop, pull out the hard drive, plug it in somewhere else, and guess what the data is theirs. And it's just the simple things that can help a business.
18:10
Yeah, so So to recap, the multiple factor identification that I get, and I do security awareness training, what what are these emails look like? What not to click on? monitoring and patching systems? So when you say patching systems, what exactly does that mean?
18:27
Well, that's where someone is patching in and they're, you know, they're making sure that your system is secure. And it's going somewhere in that secure like firewall, everything like that. So that is exactly
18:39
the basic there. There are systems like so for example, the Equifax data breach was a vulnerability in an Apache struts operating system. And when they found this vulnerability, it was it was a problem. People write code, people make mistakes, you need to fix it. Once they discovered the problem. They went, they were like, Oh, you need to apply this patch. It basically fixes the code. Well, if you don't apply the patch, if you don't have somebody who can help you do that you're not you're leaving your back door
19:11
open or even Yeah, or even like software, like it needs to be updated. So they're patching and updating, they're constantly monitoring, updating any software so like have you ever had where your phone doesn't work and because you haven't upgraded your system? Well that's kind of like it is for monitoring and patching. They make sure that everything is up to date everything is to code
19:34
right because if you're not patching and updating like Shelly said, you can actually leave a hole Yeah, and you're not the it's a lot easier for them to get in because you would not that system isn't being supported anymore by the Microsoft's or the Googles because they've moved on. You got to move on with them. Otherwise, you're you're gonna have a problem.
19:52
Got it. Got it. Okay, that makes a lot more sense.
19:55
They could do that themselves. Like oh, I can do this. I can do this. But as they're growing Their business, they don't have time to focus on that. And that's how little cracks happen.
20:04
Got it? Okay, that makes a lot of sense. And number four was making sure that your software and your hardware was encrypted. Right? And does that. I mean, this might be a stupid question. But does it come that way?
20:19
No, that's not a stupid question. I mean, a lot of us think that because, you know, I mean, we're on a computer right now that if I shut it and locked it, I opened it again, I could put my finger on it, it would open it, I wouldn't have to type my password in. But if my hard drive wasn't encrypted, didn't have that same protection on it, where someone could steal it, and then just pull out the hard drive, because these people are very talented, plug in the hard drive. So you need to make sure that your hard drive has that same protection with your fingerprint of code that, you know that if they would have to, they wouldn't plug it in somewhere else, they're gonna have to know that code, because it's not going to work.
21:06
Keep in mind, too, that encryption, like we're always talking about is, in most jurisdictions, if you have an encrypted hard drive, if even if they get it, they can't access it. It's not a data breach. So I like to say encryption is your get out of jail free card in most jurisdictions, okay. There are 50 of them. There's a lot, but in most of them, that's your get out of jail free card. So it's one of the biggest, that multifactor I guess, are probably two of the biggest bang for your buck. There they are. And how do you
21:37
know if your software and hardware is in is encrypted? Again, perhaps another silly question, but I just don't know.
21:43
So first of all, I don't encrypt my own hard drive. I know a lot about technology. But I, you know, I don't go to my dentist for brain surgery. professionals, who are IT professionals, like Shelley's company, and I say, here, encrypt my hard drive, and they take care of it for you. So having it's really important
22:06
night. Yeah, I can. And does that literally mean you hand your computer over to someone and say, encrypt my hard drive? Not necessarily No, no, okay.
22:16
No, no, no, a lot of times what you know, like our text can do, they can come in, they can work in remotely in and you know, just like when they have when we monitor and patch, they do it remotely. You know, if you don't even know what's going on. It's just and it shouldn't, it shouldn't interrupt your day, it should then to wreck your workflow. It should be seamless. And usually, you know, it's something that, you know, our techs are very, you know, highly educated, I love text, I always think, Oh, my gosh, what they do is so cool, because they can just, they can fix everything, and they just go in and they're they're magicians.
22:56
Got it? Got it. Okay, how it should be you.
22:59
I mean, a lot of times, and this is true, too. I think Rebecca, a lot of rules now are making sure that you actually have a credible IT team. Because if you don't, you can now get fined. Or
23:14
Yeah, there are different laws where you can if you're not doing the things you're supposed to be doing, if you're not monitoring if you don't have your asset, you know, management, those kinds of things. I mean, one of the classic examples of that is is HIPAA. Now they don't say you have to have it on teaching but they do say you have to encrypt your heart you know, encryption, or they say you show it or they say you have to monitor monitor your devices and let's face facts, do you want to be I don't want to be monitoring my devices, I want my IT guys or gals to be monitoring my devices, I want to be practicing law. So that's the beauty of it is that it's it's Charlie says it's running seamlessly in the background, and you're doing what you should be doing much with running
23:55
your business. Got it? All right. Now let's move on to so let's say you have all of this in place. You've done your basics for cybersecurity. Do you have to have cyber security insurance? Or can you just say, Well, I did all this. So what do I need the insurance for? No,
24:15
that's like driving around without your seatbelt on. Like, you know, I, I frequently wanted to ram the car in front of me, but I don't I don't do that. So cyber insurance. When I will tell you this as when I started my own law firm. The first thing I bought was malpractice insurance. The second thing I bought was cyber liability, a separate standalone cyber liability policy. They are getting more expensive, but for a small business depending on the data you're collecting, they can be very reasonable. But I sleep at night because I know that if something goes horribly wrong, it's there. All of the things you're doing. me that all The good cyber practices that Shelly and I have been talking about that just means they're going to cover you when the when the stuff hits the fan. Because if you're not doing all of that, you've probably told they've sent you a questionnaire with your cyber liability policy and you filled it out and you're like, Oh, do I have multi factor authentication? Oh sure. I encrypt my hard drive. If you lie to them, they don't cover you. But if you're doing all these good cyber practices, and you have insurance, it's you know that every single one of my clients first thing I ask, Where is your data? What is it doing? Where is your cyber liability policy? Those are the
25:35
those are the big three Yeah. Okay. To help you too, because how are you going to get that money out? Right, how do you get that money back? How do you recoup your business? I mean $50,000 is a lot Oh yeah. And you know, you're a small business and yeah, you you could take a hit you can take a loan but wouldn't it be better if somebody covered it for you it's kind of like you You get a car accident you know, it was like that rental car where your car is getting fixed. You would like to get a new car that new car smell
26:11
Yeah, cyber liability insurance is absolutely critical for small business every this statistic might be a little bit old, but I will pull it out anyway for just as an example 60% of small businesses will go out of business within six months of a data breach without live liability insurance. So that's an I know that statistic has gone up it's a it's a little stale, but I think that's about a year old and every year they put out new stats I just haven't brushed up on my statistics today. But
26:41
well that is true because as many business owners as I talked to in everything, you would not believe how many of them I've had friends that had successful businesses and everything was going great. They got hacked, and they just couldn't recoup the money that they need it breaks my heart because they never thought it would happen to them because they weren't trading money they weren't doing anything like that. It was just common goods like e commerce that they were just like, yeah, and then something happened.
27:09
I mean, I get a call at least once a week from a crime business person literally tears I don't know what am I going to do? I have a little bit of a policy or something. It's like a rider on my my general liability policy, but now it's going out because it runs out like that and so quick, and they're like now what do I do? I don't I don't have an answer for them. They're gonna have to you know, they have to pay for it out of pocket. A lot of them can't It is really heartbreaking.
27:37
Yeah. Oh my goodness. Well, so you know, we talked about some issues facing businesses today. basics for cybersecurity, the need for cybersecurity liability, which I am in the process of getting after speaking with Celli a couple of weeks ago, so I'm there I'm doing it I'm in. You don't have to I You don't have to tell me twice when it comes to important insurances, I will get it. So is there anything else that you guys wanted to let the listeners know when it comes to cybersecurity for their businesses?
28:14
Um, I think the first thing that businesses need to do is take a proactive posture. So doing the technical things that Shelley's talking about, shoring up some of their legal obligations, like I'm talking about with, you know, appropriate privacy policies, contract language and things like that. The other thing is, they have to also be aware of their vendors, which I think is another big issue facing organizations if you look at data breaches, it's not caused by an employee in the company it's caused by an employee at one of their vendors. And so you know, it's a big issue and so I would say that for all small businesses, all of the technical aspects and then make sure your your legal, you put yourself in a legally defensible position because unfortunately, these things are going to happen. And you want to make sure that you not just survive but thrive after after an event like this.
29:09
Yeah, and I agree with Rebecca, those are the key things that you need to do as a business owner, but it's also helping yourself to educate been growing your business and I know at times it can be scary because like, Oh my goodness, I got to talk to a lawyer. That's more money. Oh, I gotta have someone you know, outsource it person. When I've had my cousin, he knows computers, he knows everything. You know, everything's going but if you're looking to move your business to that next level, and you're looking to flourish, you really just like anything else, you need to make sure you understand and you are doing what is required of you to do to help your business flourish.
29:53
Got it. Well, this was great. I mean, hopefully people listening to this, it will set a match under them. To get them to really take a look at this in their business because like you said when you're a small business owner you've got a million things going on. But this is super important and I think something that people really need to focus on so I thank you for bringing this topic to me Shelly and for bringing Rebecca on because I think this is really great and I do hope that all the listeners out there will now start to take a better look at their businesses and are they protected Do they have the right things in place so thank you thank you now where can people find you? if they have questions? If God forbid they have a breach and they need a lawyer or they need someone to help do an IT assessment of their business so where can people find you? So
30:47
I obviously have a website expand law partners com Also you can follow us on Twitter and on LinkedIn please connect you can connect connect with me personally and my business we put out for small businesses out there who have a lot of questions we are constantly pushing out different topics raising issues bringing attention to different ones so please act x Pam law partners connect with us and hopefully will will provide you with some of that information that Shelley was talking about
31:23
excellent Shelly Go ahead.
31:24
You can reach me at contango it calm is our website I can also link in with me you know I love to meet new people and I always like to offer any kind of advice or second opinions I can help with if I if there's anyone I can point you into the direction to you know help your business I would love to do that.
31:46
Excellent. Shelley is a great super connector for sure. So definitely reach out to them now ladies one last question and I asked everyone this is knowing where you are now in your life in your career. What advice would you give to your younger self?
32:01
see somebody asked me this I'm gonna have to steal from my prior answer was start my law firm earlier. I wish I had done it earlier. I cherish the time I spent at a large law firm but I love what I do now. I love helping businesses so this I would do it earlier. So amazing. I would become an ethical hacker. Love that. I want to change my answer. That's a great answer. I love it.
32:35
I love it. Well, ladies, thank you so much for coming on the podcast sharing all this vitally important information. I do appreciate it. Thank you so much for having us. Pleasure and everyone. Thank you for listening. Reach out to these ladies if you are a small business because you may need some cyber help. Thank you for listening, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Physical Therapist and Educator, F Scot Feil, talks about understanding and eliminating student loan debt.
Today, F Scot talks about the different kinds of student loans, his different revenue streams, and the value of having a diverse set of skills. How does the debt-to-income ratio affect student loans?
Hear about eliminating student loans, managing multiple revenue streams, and get F Scot’s most important piece of advice for students with debt, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “The debt-to-income ratio is the amount of student loan debt you have over your current income.”
- “The best way to learn about this stuff, and what’s right for you, is to talk to a certified financial planner that knows about student loans.”
- “The biggest thing to try to do, if possible, is not to privatise your loans. Try to keep as many of your loans federal as possible.”
- “You make your own luck. You have to work hard, and you have to network and leverage with the right people at the right times about the right things, and then you’ll start to see those opportunities open up.”
- “The one key takeaway that I’ve had with all these revenue streams is you’ve got to do one at a time, and you’ve got to get it flowing, and then you can step on to the next stream of revenue.”
- “The money is nice, but the time-freedom is really what you’re looking for.”
- “You don’t have to work as hard, you can scale back, charge what you’re worth, and make a lot more money in a lot less time.”
- “Your career just has to be the tip of your iceberg.”
- “There’s a whole lot more out there than just going to an outpatient clinic every day and seeing your patients.”
- “Don’t worry as much. Just leverage the heck out of your career and your degrees. Use them to do what you want to do and what you enjoy doing.”
More about F. Scot Feil
Dr F Scott Feil is a husband, a father, a physical therapist, a professor, and, most recently, an amazon best-selling author. F Scott is also a business coach and mentor, despite starting his journey as an English major before landing as a Physical Therapist.
He is one of three co-hosts of the Healthcare Education Transformation Podcast, which aims at breaking down the silos between healthcare professions and trying to find best practices in teaching and learning throughout healthcare academia.
His goal is to help at least 222 professors (one from every PT School at the time of publication of his book) and clinicians pay off their student loans quicker by using multiple revenue streams. If he helps some others with terminal degrees, or other healthcare clinicians, along the way, then it’s a bonus!
Suggested Keywords
Student Loans, Student Debt, Financial Planning, Education, Skills, Income, Revenue, Profit, Opportunities, Physiotherapy, Healthy, Wealthy, Smart
Resources:
FREE PT Educator’s Revenue Idea Generator
Professors Of Profit Facebook Group
PT Educator's Student Debt Eliminator: Multiple Streams of Revenue for Healthcare Clinicians and Academicians
To learn more, follow F. Scot at:
Website: https://pteducator.com
Podcast: Healthcare Education Transformation Podcast
Facebook: PT Educator
Twitter: @FScottFeil_DPT
Instagram: @PTEducator
LinkedIn: F Scott Feil
YouTube: PT Educator
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full Transcript Here:
00:02
Hey, Scott, welcome to the podcast. I'm happy to have you on. It's great to see you and to speak with you.
00:09
Yeah, Karen, thank you so much for having me. I'm a longtime listener, first time caller here. So this is exciting. I've been waiting to do this for quite some time now.
00:17
Yeah. And I'm happy to have you on. And today we're talking about a topic that is near and dear to many, many physical therapists. And that is we're talking about student loan debt, and not only talking about it, but how to maybe understand it a little bit better, and how to eliminate it. So let's start with some definitions. And what is the debt to income ratio? And how does that affect your student loans.
00:50
So, you know, I'm not a student loan expert, by any means. I'm more of an elimination expert. That's that's where, you know, my specialty comes in. So I've had to learn this stuff, too. And, you know, one of the best ways that I've gone about doing this is going to certified financial planners, especially once you understand student loans, and talking through, you know, where I'm at what what plan looks like, it's going to work for me, what are my plans in the future? What is, you know, my vision look like? You know, do I want to start a family, buy a house, buy a car, all those things kind of factor in to your big plan. And then from there, you've got to come up with a foundational blueprint or a roadmap that you're going to follow based on what your student loans are. So the debt to income ratio is very simple, you know, it's the amount of student loan debt that you have, right? over your current income, and you just, you know, do the math and divide, right? So, realistically, the highest that you would want your debt to income ratio to be is approximately 1.01. To one, right. So if you had $100,000 worth of student loan debt, you're making $100,000 salary. That's not a terrible debt to income ratio, right? Unfortunately, especially in the field of physical therapy, we're finding that students are graduating with 150 175 200,000 plus worth of student loans, and they're coming out and they're getting jobs at 65 75,000 a year. And those are some pretty risky debt to income ratios, right? those, those get a little heavy, because, you know, if you don't know anything about it, and you you have all this debt, and you've accrued this debt, that's just massive, your payments are going to be massive, right, your student loan payments, if you just do the standard repayment, mine started out at 1700 a month, right. And I only had 140,000, when I graduated, that was with two doctoral degrees. So you know, it was one of those things where I got a little nervous at one point, because I didn't even know that I wanted to use the doctoral degrees, the way they were kind of meant to be used. But then I kind of settled down talk to a couple people both both on the business side of things, and on the Certified Financial Planner side of things, and created that roadmap, I went from the generic, you know, repayment plan at 1700 a month down to the income driven repayment plan, which for me, looked like about 700 a month. And then again, after really doing a deeper dive with the Certified Financial Planner, where I was at in my life and how I was planning on attacking my student loans, we've finally got it down on the repay plan or the revised Pay As You earn plan. And that's about $135 a month. And that stretches it out over 20 years now. So the difference that I'm making between the, you know, 135 a month and the 700, I was paying, I can now take that and have more liquid assets to do something with right I can have more cash in hand to invest or to start a new project or, you know, to make payments on other stuff, you know, so it's taken me some time to kind of learn this stuff. And again, like I said, I'm by no means a student loan expert, but I am learning through the bumps and the bruises and going through it and being in the thick of things there. And realistically, like I said, the best way to learn about this stuff and what's right for you, because it's going to be different for everybody is to talk to a certified financial planner that knows about student loans. So that would be my first recommendation.
04:15
Yeah, and that is great advice. Great advice. I've been working with a certified financial planner myself. And it really, it's really great to have an outside view of your finances and everything that surrounds them by a professional who can go in and not be emotional about it, and not have biases built in because we all have emotions around our money and around our debt and our loans. And so it's great to have that outside perspective. Yeah, you
04:45
hit the nail on the head there, you know, especially when it comes to business and money. We tend to be very emotional beings and you really have to be objective when it comes to that. And that was that was you know, a big takeaway that I found when when starting up businesses and you know, figuring things out. I've had a bunch of deals in the last couple months kind of crumble and fall through and it's like, Man, that's a bummer. But at the end of the day, you realize it's just business like, it's not a big deal. Not personal, that, you know, can't get emotional beat up over, you just got to move on it's business, you know?
05:15
Absolutely. It's it. But I mean, it does suck.
05:20
It does. It does. And it's okay to kind of recognize that, you know, you know, exactly, but at the end of the day, okay, it's business. What's my next step? How do I pivot? How do I recover? What comes next? You know, I think that's really what entrepreneurs are doing these days is trying to figure it out, you know, just keep rolling with the punches until they, they get it right. Yeah,
05:38
absolutely. And now, you spoke a little bit about those different kinds of student loans. And so I'm assuming there are different approaches one can take, can you speak to that?
05:50
Yeah. So you know, again, like I said, I'm not exactly a student loan expert, there's several different kinds of student loans out there, the biggest thing to try to do, if possible, is not to privatized your loans, right, try to keep as many of your loans federal as possible, because the federal plans are the ones that work with you a little bit more, there's a little bit more give to them, right? You can restructure them a little bit. Like I said, I went from just basic repayment plan to income driven repayment plan, which is based on, you know, the amount of income that I would make as a new grad, down into the revised Pay As You earn plan, which, like I said, that one kind of starts you at a lower bracket. And year over year, as you make a little bit more, it creeps up a little bit, you know, but it also, again, it stretches it out over a longer period of time. So you know, they're their differences are time dependence, you know, how quick you have to pay him back. But you know, things happen, like COVID, right, and all of a sudden, the Federal plans have all kind of stopped, they put a, you know, a pause on them until the new year. So, you know, that's one of the ways that they can give you grace, you can go into a deferment plan, if you need a month or two, you know, though, they'll work it out with you, and they'll tack it on to the end or whatever, you know, there's just a lot of forgiveness. And then at the end, there's a big forgiveness. But with federal loans, you just have a lot more grace, right? Once you privatized the loans, you're stuck, that's it, they are what they are, and you've got to pay him back, there's, there's no getting rid of them, right. Because, you know, student loans are loans that we just, we can't go bankrupt on we can't, you know, get out of there just gonna be there forever until you pay them off. So, you know, it's super important to recognize the difference between a private loan and you know, a federal loan. So big takeaway there is try to keep as many of your loans federal as possible for as long as possible, because those will have the most options for payoff and forgiveness and forgetting, you know, you know, any sort of programs that are available that may come and go, right, there's the one program where if you work for a nonprofit for 10 years, right, X amount is forgiven. Now, there's been kickback on that saying that, like 99% of people don't get approved for it at the end, they cross the finish line, then all of a sudden, the finish lines moved, right. So you know, there's some fine, fine print, you've got to read there with all these. But you know, at the end of the day, most of the federal loans will give you a certain time period. And as long as you make your payments all along that time period, at the very end, there will be some form of forgiveness. Now, the only caveat with that is the way you're forgiving those loans is you get taxed on the amount of forgiveness as if you made that income that year. So, you know, for me, it'll probably be a 20 year repayment plan, at the end of those 20 years, I'll have $100,000 left, it'll be forgiven. And then it'll be like I made that extra 100,000 on my salary that year, so I get taxed on it. So in those 20 years, I have to come up with some sort of plan to save up and to make money to repay that one year, when I have that influx in salary, even though it wasn't there. It was a loan forgiveness. So just something to think about there, too, when you're planning out your loans and your repayment plan.
09:04
Yeah, yeah, I don't think people realize that you have to pay taxes on that loan that is left. So each year, you want to make sure that you're putting money aside and putting money aside so that you're in an account that maybe you can't touch so that when it comes you're not like, Oh my gosh, where am I gonna get this money from, but you're like, Oh, I know exactly where I'm gonna get it from. Because I have this account of money I haven't touched for 20 years, you can pull it out from there. And that can be like, it doesn't have to be a savings account at the bank. Exactly. That could be an account that is actually generating, maybe, you know, 4% or something like that, right? So you're making money on it, especially if your loan is only like 2.3%. So you could take that money that you would be paying toward that loan, put it into an account that's maybe making even if you're making 4% You're still making money on on that money in there so that when the time comes to pull it out to pay your taxes, is number one, you're not penalized. So it's not like you're putting into a 401k plan or an IRA or something like that, but just putting it into some sort of an account that can make you some money on the way.
10:12
Exactly. And that's where a certified financial planner comes in, because they can set you up with a savings plan over those 20 years that can get 810 12%. So you're actually saving a ton more money, and you're paying way less when it comes to it. And the you know, the rate the APR is, is even lower. So I don't, I don't want to throw out a bunch of like, you know, terms and, you know, definitions and stuff that are just kind of boring and not very sexy, to be honest with you. But we do have to kind of know a little bit about this stuff. You don't have to be an expert. Again, I'm not. But I know enough. Now I'm educated enough, because I took the time to talk to that certified financial planner and figure this out and sit there, it only took maybe an hour or two, to sit there with them and go through the plan and look at it and say, Alright, here's where I am. Here's my goals and plans. Which program is best for me. Okay, great. Let's get on that program. And then you know what, now let's figure out how we're going to pay it out. You know, and there's several different ways to do that, too. Right? You just have to come up with that number at the end of those 20 years. So how do you want to do that? And, you know, that's where my expertise kind of comes in? Is the elimination part of it? Yeah.
11:17
Yep. So let's talk about that. Let's talk about how do you eliminate that debt. And I know one thing that you speak about is having multiple income streams, I'm sure that's part of this conversation, but I'll throw the mic over to you. So you can talk about the elimination part. What does that mean? Yeah, so
11:33
originally, when I wrote my book, right, peak educator, student debt eliminator, I thought I could just start a side business or to write and make a bunch of money, and then throw all that money that I made toward the student loans and pay them off in a year or two and be done. That was my plan. And realistically, I probably could have done that, I probably could have knocked them out in about three to five years total, and been done. But that's kind of what the banks want you to do. Right? That's what these loans, processors wants you to do. They want you to pay all your loan off as quick as possible. So they get all the money and make all the interest, right? Well, after talking to the Certified Financial Planner, I said, Okay, well, if my loans are gonna go down from you know, 700 a month and 135 a month, that leaves me a good extra chunk of money that I can do stuff with, right? And he's like, Yeah, absolutely. He's like, in truth be told, as long as you're putting your a lot of money every month into your savings plan, or whatever, you know, investment plan, if you will, to pay off that 20th year, you can do anything with the money, right? So I figured, okay, well, could I invest it in stocks? And he's like, yeah, you could do that. I said, What about crypto? And he said, you could do that? What about real estate? Can I do that? Yeah, absolutely. So that's been kind of my plan is like, Okay, let me start a couple of side businesses that generate income and revenue for now. So that I can put it toward investments that don't kind of take me on the long term. Right. And I think realistically, you know, I think almost every millionaire has several different streams of revenue, right. And I think that we need to start thinking about that, as soon as we either enter grad school, or immediately after we finish grad school, you know, what is our plan for long term wealth? Right? How are we going to take care of ourselves, as well as our family, you know, that might not even exist yet. As well, as, you know, future generations, you know, we're talking generational wealth here. And it's not like, you've got to be a millionaire, right? But you know, a couple of six figure incomes, that can help a lot of people, right? I mean, you can take care of a family, or two or three down the line, even, you know, making several six figures over the course of many, many years, you know, and then if you invest it, right, you can put it in places, like we talked about, like rental properties, or something like that, where, you know, once those pay off, the mortgages are done on those in 15 or 20 years? Well, now you're going from making two or $300 a month in rent, up to, you know, 18 or 2000 a month, per per house, right? And that's where you get into that generational wealth. So, you know, for me, it started out as a simple mobile PT practice, right? I was by myself in a car with a table and some sheets and a bag with some equipment in it. And I was just driving around, you know, Waco, Texas, just kind of helping people in their homes or their offices or the gyms. Because I knew I could do that. I knew I could start that business, right? I had enough expertise in the physical therapy world to be able to run a small practice on my own. And I didn't really want to be tied down to the brick and mortar. I didn't want to have a high overhead. I didn't want to do any of that, you know, so I just started my own little business. And it started out with a crossfitter, too, you know, and that was not my demographic. It was just people in the community that I knew that asked if I can help, and so I did. And then Luckily, one of the women that I worked with, her husband had some shoulder and elbow issues and he was a big tennis player. So she said, You treat the arm in the elbow and choice it. Yeah, absolutely, I can do that. So once I started talking with him, he's a CEO of a small business in Waco there. We got him better, we got him back in the tennis court, he was feeling great. And so then he started referring me to all his other CEO buddies, and the CEO buddies and C suite level execs, right, and all these busy businessmen and business women. And it was great because I was I was selling them time, right, it wasn't so much about the physical therapy, or whatever it was, it was, I was buying them back time because I could come to their home or their office or their gym, and they love that. So it was just the right niche for me in the right, you know, they had expendable income, most of them because they were, you know, own their own business. So it was a really good group to get into, and a really good niche to break into. And, you know, word of mouth spread. And that kind of took off? Well, once that kind of happened, I really started having to figure out how to like market myself better, and how to do some, like digital marketing, you know, Facebook ads, Google ads, stuff like that. And I just didn't know that I didn't have that skill set, you know. And so I had to take a course in that and learn from it and kind of invest in myself. But once I did get better at that, you know, I even took a copywriting course and read a bunch of copywriting books as well. And once I started getting better at that a bunch of my buddies that I graduated PT school with saw what I was doing with Facebook ads, and they said, Hey, could you do that for our business? And I was like, yeah, I'm sure I could probably figure it out. They said, We'll pay you and I was like, Okay, great. That sounds awesome. You know, and that's where my agency kind of started, right. But one of the second pillars of revenue for me. You know, I kind of started a little bit of a digital marketing agency unintentionally. And so I did that for you know, that a year or so. And that even brought me outside of the field of physical therapy as well. I did it for a couple local businesses, some home renovations, some roofers, pool builders, stuff like that. And it was really working pretty well.
16:58
And then, you know, COVID, started hitting and things kind of got a little crazy. And I was still working full time in the clinic, too. And so with my wife being a type one diabetic, and already being immunocompromised, I had to kind of step back from that a little. And I stepped away from the clinical side of things. And that same week, the head of the program at university, St. Augustine emailed me and said, Hey, are you still interested in teaching because I spoken to him at the ETD graduation in 2018. And, you know, I said I wasn't, but now it's actually looking like a pretty good option. So I stepped out of clinical work, I headed into academia. And while I was doing that, you know, it really became a good fit for me, because, you know, I talked online most of the time, and then I had to go up and be there for labs. But it also gave me a lot of free time to work on my side hustles, and my side businesses, you know, and that's kind of how I fell into the consulting gig as well, like, that wasn't something I ever thought I'd be doing either. But I worked for workman's comp company as well up there in Waco. And I said, Hey, we should be educating these businesses to injury prevention and wellness and how to properly lift and ergonomics and all that. They said, Oh, no, we're not going to do that, you know, that's gonna eat into our PT numbers. And I said, No, it won't. Because I can't stop somebody from running over someone's foot with a forklift, it's gonna happen, accidents are gonna happen, you know? And they said, Well, no, we're not going to do that. So I said, Alright, fine. I'll do it myself, you know. And so I just went around to all the companies locally there that were sending us workman's comp people. And I said, Hey, would you like to lower your workman's comp numbers? And they were like, Yeah, sure. And so I go in, and I educate the workforce. And, you know, you can charge good money for consulting. I mean, I was able to charge you know, 1000 bucks to 1500 bucks an hour for two hours worth of work. So now it becomes a matter of, Okay, do I want to see patients at $200 an hour, which is a pretty fair rate for physical therapy, right? Cash pay at a network? Or do I want to work two hours and just, you know, educate these people and use my add my education background combined with my PT background, to kind of help them with injury prevention and wellness. Right. So again, it just kind of one of those things that fell into my lap, that wasn't ever something I thought I would do it just the opportunities were there. And I just kind of sees, you know, it was like, seeing like these opportunities out there and just realizing that holy cow, this is where I knew I was fine. Having a PT, you know, DPT and an add, not necessarily wanting to use them even though now I am, you know, more traditionally. But being able to leverage those degrees into other opportunities. You know, I'm not a huge believer in luck, I kind of feel like you make your own luck, you have to work hard and you have to network and leverage, you know, with the right people at the right times about the right things. And then you'll start seeing those opportunities, you know, kind of open up and you have to be ready to jump on those opportunities when they present themselves. So, you know, that's, that's kind of where a lot of these streams of revenue started from. It just kind of happened, you know, and I fell into them and I got better and better and better at it. I went, and then I was able to help more people with them as well.
20:04
Yeah, it sounds like you've gone from one to the next to the next to the next, which is, which is good. You're sort of keeping yourself open and you're learning and, and understanding like, Hey, I don't know how to do this. So I'm going to educate myself and learn a little bit more, and be able to do things that may not be at face value, what you went to, quote unquote, school for, but yet they are.
20:32
Yeah, I mean, we learn so many amazing skill sets throughout grad school, you know, whether it be the DPT program, or the ed d program, systems, right processes, standard operating procedures, things like that, like clinical development, and, you know, clinical thinking skills, critical thinking skills, all these things that we learn, are a lot higher level than a lot of the general public already know and deal with. So we can help by kind of bringing those things down and simplifying them, just like we would talk to a patient, right, if you're using layman's terms, you know, and I think the key here is to realize that we have a lot of these skills already, you can keep one foot in the healthcare boat already. Or you can diverged and go a different route. And you know, some of these skill sets, you're gonna have to learn because not everybody's, you know, born a natural with a lot of these skill sets. And that's okay, I've done that. But it's a good combination of taking as much as you already know, and pushing in on that. And then adding and supplementing a little bit here and there, when you find that you need it. You know, and that's where I think taking courses and paying for mentors, and doing all that stuff speeds up your timeline a little bit. You know, and that's why I'm a big believer in that I've had many coaches, many mentors over the last couple years, and they've totally sped up my timeline and showed me mistakes that they made and made sure I didn't make the right, you're still gonna make your own mistakes, there are a lot of them are going to be different than what your mentors went through, right? That's totally normal. But it's, it's realizing that they're not failures, they're just learning opportunities, you know, and I think we as pts are really good at being lifelong learners. And so it really shouldn't be a problem to dive into a skill set you're not familiar with, and just, you know, put your ego aside and being like, Alright, I don't know this, I need to learn it, here's a good resource, here we go, you know, just keep kind of attacking it until you get it right. You know, and I think at the end of the day, these multiple revenue streams now that are kind of growing are great, I love them, I'm very passionate and energized about them. They're definitely like passion projects for me, you know, and zones of genius for me, but it's a good way for me to get an outlet of creativity, I think, because I was an English major before I was a PT, right. So, you know, that to me was was a big transition in itself. But that's also helped me monetize blogs, monetize my book, right? monetize, SEO, and email sequences and copywriting. So, you know, again, all those things kind of fall into that consulting, revenue stream. But, you know, I had to learn how to adapt that English major into copywriting or into email marketing, or whatever it may be, you know, and I think the one key takeaway that I've had with all these revenue streams, is you've got to do one at a time, and you've got to get it flowing. And then you can step on to the next stream of revenue, then get that up and running, then get that flowing. And then step onto the next one. And again, you know, if you don't do that, you're going to fall for that shiny object syndrome, right, and you're going to be kind of chasing around, Ooh, that looks cool, that looks cool. I could do that, oh, I could do that, oh, that person's doing that, Oh, that looks really good. They all work. And you can do all of them, for sure. But you've got to get one down first, and then move on to the next and there's going to be you know, arguments and debates over what number is the right number to walk away from the first one and go on to the second one. I don't think it matters, I really don't just get it up and running, make sure it's making you some money, make sure it's profitable. And then when you're ready to step on to the next project, you're still gonna go back to the first one, you know, you're still who knows, you may even hire somebody to take over that portion for you. You know, but just knowing that there's multiple opportunities out there for physical therapists for healthcare providers, I think it's a great stepping stone for you to kind of open your mind a little and get out of that nine to five clock in clock out clinician mindset, you know,
24:15
and where are you now with? How many streams of revenue Do you have at the moment? And if you could put it in a pie chart, what is what makes up what? Because I think people would really be curious as Jeff, you mentioned a whole bunch. So where are you now? And what does it look like?
24:32
So I essentially what I teach, you know, all my students, I have what's called the feelgood method, right? Which is not just a clever play on my last name. It's also you know, how I make my students feel good about staying organized with their streams of revenue, right. So there's an umbrella on top and that's your holding company, right? For me, it's feelgood industries. pllc. Texas recommends if you have a professional license that you get a pllc it's different for every state. But, you know, doctors, lawyers, dentists, they all have pllc Alright, so since I started as a mobile clinic, I started as a pllc. then underneath that I had about four or five different revenue streams or tubes of revenue, that each of those was a DBA, or doing business as underneath the pllc. Eventually, I'm probably gonna have to turn some of those into their own individual LLC and make the pllc an actual holding company, but I'm not there yet. So, you know, with each stream of revenue, like I said, I have a couple little numbers next to each stream. And those are the checklists, things that you have to get done in order for that stream to start running. So I made a shift recently, because of my changing career, you know, like I said, the goal is to try to, you know, kick the bucket of the nine to five and do your own thing, you know, and go all in on entrepreneurship and your own business eventually, right? That's the hope. For me, my story's a little bit different, because my wife is a type one diabetic. And we need not just medical benefits, but good medical benefits, right? My nine to five might always be there. And I'm okay with that. I've learned how to kind of find the best possible job with the best possible benefits. and academia has afforded me that right now. So I'm able to do that, you know, at a little bit lower rate of like 32 hours a week instead of maybe 40. And that gives me more time then to work on the businesses. So while I was doing a lot of the mobile PT at first, that's kind of decrease now, because like I said, it's like, do I want to treat patients for $200 an hour do I want to do consulting at 1500? An hour, right. So I would say overall, you know, I've got the mobile business, I've got my online business and PT educator Comm. And then I've got my consulting, business, FTI consulting, and those are kind of the three main revenue streams. Now in those revenue streams. There's probably, I don't know, three or four different services, if you will, that are offered. You know, the consulting can be anything like injury prevention and wellness, because I've got that systemized. And I've got templates for that now where I can just come in, do the tour, see what's what, and then put together a presentation overnight. And then that also will have my copywriting little digital marketing. It'll have you know, Facebook ads, Google ads, it'll have copywriting, email, all that stuff underneath the consulting. And those I can charge, you know, for just one little piece, or put together a package where I'm like, Hey, here's what you need, here's what I recommend, you can go ahead and do it based on my outline, or if you need my help, here's my price, right, my fees. And then PT educator comm is just like I said, my online site where I do a lot of my blogs, I have a lot of the courses for sale and stuff like that. And that's just really to kind of keep me up to date on my writing. And, you know, my blogging skills and stuff like that just recently passed them the mark for 1000 subscribers and 4000, watch hours for YouTube. So I cannot monetize that as well. So the vlog cast, which I do one episode a week of an interview with somebody who's done that particular side, hustler side gig, starts out on YouTube, and then eventually makes it to the podcast in audio form. And that actually, the podcast hasn't even come out, that'll start September 1. With the first few episodes, I'll probably release three or four and the first one, and then do one a week after that. So if you want the new fresh content, you go to YouTube and watch the video if you want to catch up, you go to the podcasts. But if we're if we're giving it a breakdown, you know, I would say we're probably at about 60% of consulting at this point. And coaching, I kind of put coaching underneath that as well. And then I would say, you know, the the online business is probably about 30% at this point. And then treatment is just at this point, word of mouth, close family and friends here in the Wimberley area, you know, 10%? If that?
28:54
Yeah, got it? Yeah, I think that's really helpful for people to hear so that they're like, wait, I don't understand how, how is someone doing all of this at one time? Do you know what I mean?
29:03
Yeah, and let me make this clear, too. So 32 hours a week is still dedicated to my full time job and Right, right. So that gives me maybe eight hours extra to get to a 40 hour week, and then I work 50 or 60 hours a week, there's you know, I love that stuff, though. I would do that for free if I could all day every day, because that's what gets me excited, you know, the passion projects, helping people figure out a business model. So you're, you know, figure out what they can do for side hustles and side gigs. Even if it's just making an extra 500 bucks, you know, a week or something like that, you know that that could be huge for somebody who's having to pay 2000 bucks a month for student loans, right or 1500 bucks a month for student loans. So if we can figure out a side hustle or side business to get you started, at least, maybe you grow it big enough to the point where you can walk away from that nine to five and that's great if that's what you want to do. You know, but but I'm also to the point where I was working 60 or 70 hours a week for someone else and trading time for money and just wasn't cutting it. So I've scaled back, I've been able to, you know, increase my value on certain things and, you know, raise the prices on things enough to where I'm working less time and making more money. So it's like PRN rates don't even, you know, don't even cut it for me anymore. It's not even something I would look at. It's just not worth my time, because the money's nice, right. But the time freedom is really what you're looking for, I think, you know, I think people are, are looking to claim back a lot of that time with their family, not having to work weekends, not having to stay, you know, all hours at night at an outpatient clinic, doing notes and trying to, you know, stay on top of things. So, I know I've been there, man, it's a grind. And, you know, it's nice to be able to use my add and teach and to use my DPT and use that knowledge toward you know, something as trivial as a fantasy football injury course, right? That was one of the first courses I ever made. And then, you know, video gamers eSports, I did an Esports ebook on injury prevention for gamers, right? Like, that stuff is just fun to me, you know, I love that stuff. And we can use our knowledge to help those people and solve those problems. So why not do that? Right? Why not find a hobby or something you like? And just go all in on it, you know, and use your knowledge to help people. You know, so that's been a big a big finding for me over the last year or two, it's just that, you know, you don't have to work as hard. You know, you can scale back, you know, charge what you're worth, and make a lot more money in a lot less time. You know?
31:29
Yeah, that all makes sense to me. And what would be your says, we kind of come come to a close here, what, what is your biggest, your most important piece of advice for people listening, if they could take one, if you were like, oh, man, if you just took one thing away from this talk, this would be it.
31:51
Yeah, I think physical therapy or your profession, your career just has to be the tip of your iceberg, right? I mean, again, like I said, we as physical therapists can do so many things, we can help so many people, and it's like, if I go and treat a patient, you know, one on one, that's great, that one person gets better in that hour, maybe times eight hours a day, there's eight people, right? If you want to have a bigger impact, and you want to affect more people, right? Then maybe you coach somebody or teach somebody, you know how to start their own business. And now that person's treating, you know, 50 people a week. So now you're impacting 50 there, and the few that you were teaching, then you coach somebody else on something else, and they're helping, you know, 20 businesses, you know, with their patient intake model, and they're, you know, they're doing things, you know, at a higher rate. So now you're helping 20 businesses with 50 patients each, right. And so I think more impact can come if we realize that we're more than just a physical therapist that goes in and treats eight people a day, or 20 people a day, or 30 people a day, or whatever you're treating, right? Like we can do so much more. And we just need to think outside the box a little bit, you know, and be a little bit more than that nine to five clinician that clock in and clock out, you know, and then again, by having a bigger impact by helping more people, right, and then coming at it with a servant's heart. Money is just a byproduct, you can then take that money and pay off your student loans quicker if you want or invest in things that are going to make you more money down the line so that you can pay off the student loans, should you want to do it over a longer period of time. Either way, you know, it's just about opening your eyes and seeing that there's a whole lot more out there than just you know, going to outpatient clinic every day and seeing your patients.
33:29
Excellent, excellent advice and great takeaway. Now, where can people find you if they want to learn more about you what you're doing and how to get in touch with you?
33:37
Yeah, sure. So all of my tags are pretty much at p key educator on all the social medias. And then the book is on Amazon. It's available in softcover. And in Kindle, it's called PT educator, student debt eliminator, multiple streams of revenue for healthcare, academicians and clinicians. definitely have a second edition coming out pretty soon. So check it out, out while you can. You know, I'd love to see people hop on the second edition as well, because there are a couple of key changes with all the stuff that's going on nowadays, with cryptocurrencies and, you know, all sorts of investing strategies and stuff like that. So I'm still learning, you know, lifelong learner for sure.
34:13
Absolutely. And last question, what advice would you give to your younger self, knowing where you are now in your life and in your career? Yeah.
34:22
Don't Don't worry, as much, you know, just leverage the heck out of your, your career and your degrees. You know, use them to do what you want to do and what you enjoy doing, you know, leverage the heck out of it, you'll be fine.
34:37
Excellent, great advice. I've heard that many times on this show. So, Scott, thanks so much for coming on. This was great. I think you really gave people a lot to think about and some inspiration on maybe how they can use their passions and and think outside the box a little bit. So thanks for coming on.
34:57
Absolutely. Thank you, Karen. It's been a pleasure.
35:00
Absolutely and everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Physical Therapist and Owner of Healthy Phit Therapy & Wellness Consultants, Dr. Lisa Folden, talks about diet culture.
Today, Lisa talks about the pervasive nature of diet culture, how to reconcile diet culture with physical therapy recommendations, and how to support patients who are on their weight loss journey. What is diet culture?
Hear about weight biases and phobias and how to deal with them, the Health At Every Size movement, and get Lisa’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaway
- “Diet culture is this pervasive thought process that we’re born into, that fosters the belief that we’re never enough – we’re never thin enough, we’re never healthy enough, we never got it right.”
- “Diet culture is the constant reminder that something’s wrong - you need to fix it all the time.”
- “Even if weight is causing some of the issue, the reality is, the research shows that weight loss doesn’t really work for most people. 95% of people who lose weight gain it all, plus more, back.”
- “Weight loss is a by-product that some people will experience, and other people will not.”
- “We think in our society that no one should be fat, and if they are fat, it’s because of poor health choices.”
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How to challenge the weight bias:
-
Unlearn the idea that people in larger bodies are inherently unhealthy. It’s not going to help you make them feel better, and it’s not true for many people.
- Think about accessibility. Considerations are made for people with various degrees of mobility, so ensuring that there’s appropriate furniture is a consideration for those with larger bodies.
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Reassure patients. Especially when dealing with patients who have dealt with the weight stigma, it’s important to reassure patients that size variation isn’t a problem.
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“I assume that their condition is caused by something other than their weight, and I treat them based on that.”
- “We’re supposed to be different sizes, and we don’t have to lose weight to be healthy. You can be healthy at any size.”
- “Stop telling your patients to lose weight, offer people in larger bodies the same treatment options you offer people in smaller bodies, and don’t shy away from manually and physically examining them because of their body weight.”
- “It’s going to be okay.”
More about Lisa Folden
Dr. Lisa N. Folden is a licensed physical therapist, mom-focused lifestyle coach, and the owner of Healthy Phit Physical Therapy & Wellness Consultants in Charlotte, NC.
As a body positive women’s health expert and health at every size (HAES) ambassador, Dr. Folden assists women seeking a healthier lifestyle by guiding their wellness choices through organization, planning strategies, and holistic goal setting. Dr. Folden is a mom of three, published author, and speaker who understands the complex needs of the modern busy woman. Therefore, she considers helping busy moms find their ‘healthy’ as one of her of top priorities.
Dr. Lisa is a regular contributor to articles on topics related to physical therapy, health, wellness, self-care, motherhood, body positivity, and pregnancy, and has had the distinct honor of being featured in Oprah Magazine, Shape Magazine, Livestrong, Bustle, and several other local & national publications. Additionally, she is a member of the National Association of Black Physical Therapists, the Association of Size Diversity & Health, The Know Women, Alpha Kappa Alpha Sorority, Inc., and serves as an expert panelist for H.E.R. Health Collective (2021).
Suggested Keywords
Diet Culture, Weight Loss, Body Positivity, Acceptance, Stigma, Body Size, Fitness, PT, Physiotherapy, Symptoms, Healthy, Wealthy, Smart
Resources:
Health At Every Size Community
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Read the full Transcript Here:
00:02
Hey, Lisa, welcome to the podcast. I'm happy to have you on today.
00:07
Thank you so much for having me. I'm so excited to be here.
00:11
Yeah. And today we're going to be talking about diet culture, in health care, and specifically in physical therapy, which is not something that I've ever spoken about on this podcast. And so I'm really happy to have you on to talk about this. And I remember speaking with Dr. Lisa van who's, and we were talking about biases in health care. And she said, one of the more accepted biases in health care is against overweight people. Yes. And so I'm happy to have you on and dive into that a little bit deeper. And so let's, let's talk about first diet, diet culture, you know, its impact on our not just our physical health, but also our mental health as well. So why don't we first start with what do you feel diet culture is? Let's define that.
01:13
Sure. So it's nuanced, of course, but essentially, diet culture is it's this pervasive thought process that we're kind of born into, that fosters the belief that we're never like enough, we're never thin enough, we're never healthy enough, you know, we've never gotten it right. And so it feeds into, you know, this multibillion dollar industry that says, you know, buy this tea, by this waist trainer, by this weight loss program by this because you always need to be getting smaller, shrinking yourself, doing something to change yourself, because, you know, you couldn't be healthy, you know, there's no way you're healthy, especially if you happen to be someone who was born into or developed into a larger body, there's no way you're healthy. So diet culture is sort of the constant reminder to you that something's wrong. You need to fix it all the time. And it's a deep part of our healthcare system. It's a deep part of, you know, like Hollywood and television, things we watch every day. So it's it seeps in without anybody really knowing that it's happening. And it's so common and so accepted, that we just look at it as you know, health, like a lot of things that are really diet culture, a lot of us would just look at as Oh, that's health, that's fitness. And it's and it's not, because it's actually corruptive. And it, it breaks us down. And it's not good for our mental health or for our physical health. It results in a lot of weight cycling and bingeing and restrictive in disordered eating. And so, you know, it's really bad. I mean, that I don't call a whole lot of things good or bad, but diet culture is one that I kind of just categorize is bad and unnecessary,
02:53
really. And so looking at that through the lens of a physical therapist, how do you reconcile that culture with what we do as physical therapists, because so often, if someone is, let's say, an example, someone is coming to us with osteoarthritis hips, knees, one of the recommendations is weight, weight loss of whatever that weight loss is, I don't think the recommendation is to be a size zero or two. But that recommendation is weight loss. So how do you? How do you kind of blend these two this diet culture, which knows very bad, but yet, in certain populations, it can be helpful to take off some weight to unload those joints. So how do you reconcile with that as a PT?
03:40
Yeah, that's a great question. And it's obviously something I've had to kind of deal with head on as a physical therapist still treating in the clinic. You know, like I said, in the standard outpatient practice. So here's the thing, there's physics, right? physics exists, when there's more pressure, you know, from gravity and weight, you can feel more pain. Like that's, that's a fact. But there's also, you know, this idea that we all have different sort of thresholds for our pain. And, you know, you know, like, I know, you can look at someone's, you know, x rays to people, and they can have identical things happening there, you know, at the structural level, and have completely opposite symptoms, one with severe symptoms and one with none. So, when I address the issues of pain that could be could be contributed to from weight, I just, I approach my patients from the lens that even if weight is causing some of the issue, the reality is the research shows that what weight loss doesn't really work for most people. 95% of people who lose weight, gained it all plus more back within one to two to three years, and they don't really have research beyond the five year point because nobody typically makes retains it. So the reality is, even if if you know if that is the suggestion, that's kind of what we've been taught as physical therapists, I know that it doesn't work. So I'm not helping my patients by saying, hey, you really should lose some weight. So I approach it from the lens of I'm going to treat them as if this osteoarthritis, this this issue, whatever they're dealing with, has nothing to do with their weight, and everything to do with all of the other possibilities in my toolbox as a physical therapist. So are we dealing with, you know, restricted, you know, soft tissue, tight muscles, you know, imbalances, muscle imbalances, are we dealing with, you know, just lack of flexibility and other things, can I do some manual therapy that can help, like, what other things can I do, because even if weight is a contributing factor, me telling them to lose weight is in the long run, not going to help them because for like I said, most people aren't going to maintain that weight loss any way, or if they ever achieve it in the first place. And it can be so daunting, when people in larger bodies go to health care professionals, and no matter what is going on with them, if they are in a larger body. The suggestion is weight loss literally across the board, not just you know, in our profession with, you know, things regarding the joints and osteoarthritis, you know, other things like that. It's literally everything, I'm having stomach pain, lose weight, I'm, you know, they literally here for everything. And so I just don't want to be a part of that. And I don't think I don't think that it helps our clients to get better in the long run.
06:28
Yeah, and it, might it add one more thing to this person's plate, so to speak to maybe, then they will say, Well, I'm not even gonna go back to this PT. Yeah, is there a way to meet people where they're at, and through exercise and other modalities, if they were to lose some weight great, not make that the singular focus?
06:54
Absolutely. And that and that's just what it is. Because, you know, adopting new health behaviors is good for everybody, whether you lose weight or not. And you know, just just just increasing the synovial fluid in the joint from, you know, more activity can be great, you know, so weight loss really is a byproduct that some people will experience and other people will not. And, and coming to terms with that has been a journey for me as a professional, and then in my own personal life and my own, you know, struggles from the past with weight loss and diet culture, but it's really freeing, and it helps people eat, I can just this year alone, I've had at least four clients, all of them were women, but they all had the same story, like severe trauma, from interacting with other healthcare professionals, like figuring out something's going on with them, and then being told, like, Oh, yeah, you just got to get that weight off, you just got to keep that weight up, and just kind of hearing it over and over again. And so coming to me was like a, sort of a breath of fresh air for them. It's like, you're the first person, it's like, not telling me I need to lose weight. And it's like cash. Like, I couldn't imagine that being the discussion. Every time I go to the doctor, every time something's bothering me, you know, as if to say, thin people, and people in larger bodies don't experience some of the exact same diagnoses and issues, you know, if weight were the problem, then that would be the situation then people and, and fat people would not have the same diagnosis. And we know that's not true. So yeah, you're right, it adds a whole nother layer of trauma that they have to deal with.
08:28
Yeah. And, and sticking with that theme, let's go into some of the the biases. So the weight bias, fat phobia and healthcare, we could talk about PT in general, like I said, and speaking with Dr. van Who's she sort of said, Hey, listen, this is apparently one of the accepted biases that you can have, you know, so let's talk more about that. Go ahead. I'll give the mic over to you and just kind of what's the situation on the ground here?
08:58
Yeah. And, and she's, she's right with that. It's like, it's like the legal bias. It's like it's okay. And, and even people, what's disheartening to me is interacting with people in larger bodies, they often will just accept it, because it is the norm. And they begin to believe that inherently something is wrong with them. They haven't figured out the magic formula, they're not doing something right. And so there's something wrong with their body. And they're almost Okay, in a sense being discriminated against or dealing with the biases because it's just so much a part of what we do. So it you know, it shows up in everything, like literally from the time you're born. You know, I had a great discussion on my Instagram with some people we were talking about, I did a summer body challenge. So I had everyone like, put on a sports bra and black bottoms and just show it and be proud of your body and we said it was the Being confident and proud of my body this summer and always, you know, not feeling like I gotta lose weight, two summers coming, you know, warmer weather doesn't mean I have to get to the gym and lose some weight or cut back on my calories. And a recurring theme in those conversations was just this idea that like, it starts at home, like my mom, you know, said, Oh, you're putting on a little weight, or you're getting a little chubby, or it's, it's this pass down fat phobia, it's like, do whatever you do, don't get fat. And it's like, oh, my gosh, we, we think we literally think in our society that no one should be fat. And if they are fat, it is because of poor health choices. So we create this hierarchy, where I'm better than you, I must make better health choices in you, because I am thinner, and you are fatter. And it just couldn't be farther from the truth. Because, you know, we, a lot of us like to believe we have a whole lot of control over the size, shape and weight of our bodies. But so much of that is genetic, you know, so much of that has a genetic component, we only have so much control. And even within the window of our control, without going into disordered eating patterns, it's still a very small, you know, amount of change that you can expect to see. So, you know, we hear it from our parents, we hear it at home, we see it on television, you know, when you get on a plane, and the seats are barely big enough for an average adult, you know what I mean? Like, barely, like we're squeezed in there. So imagine that humiliation, you know, as someone in a larger body having to either buy two seats or figure out how to squeeze into that seat. You see it in doctors offices, there's small seats and doctor's offices, even though we treat a huge variation of people in their body sizes, the lobby looks like everybody should be the same, you know. And so those are, you know, things that I want to see changed and considerations I want to see being made, especially in healthcare, because, you know, we we have the privilege of working with people, you know, from largely diverse communities, especially as it relates to their size. So, at the very least, that should be a comfortable experience, you know, you're going to your doctor should be a comfortable experience, you're going to your physical therapist, it should be a comfortable experience. So yeah, there's more I could say, but
12:36
I have a question for you that. So as a physical therapist, so let's say you're talking to you're talking to a group of pts about this, what advice do you have, that they can put into action to challenge these biases, and to make their spaces more inclusive?
12:55
Yes, that's a great question. So the first thing is to start within, and just avoid all of those assumptions that we like to make. So just you know, unlearning, that's where it starts like unlearning this idea that people in larger bodies are inherently unhealthy, or have inherently made bad decisions. Because one, it's not going to help you get them better, or make them feel better. And to it's not true for a lot of people. So getting rid of those, those preconceived notions about what someone in a larger body, you know, has going on, or what kind of health status they have. Also, if you're in a setting, where you have the privilege of sort of, you know, making decisions about the clinic setup, you know, thinking about the furniture, thinking about, you know, having things that are accessible, we think about this, and we're talking about people, you know, with varying levels of ability, if they're in a wheelchair or on crutches, you know, we think about making sure the doorways are wide and this and that, and height, adjustable seating and things of that nature, we should do the same thing for people in larger bodies, people come in different shapes and sizes, and we should do as much as we can within our power, you know, to accommodate them. The other thing is, especially when we're dealing with people who have dealt with the weight, stigma and all that trauma, we need to reassure them, we need to let them know like my patients are literally floored when I tell them like there's nothing wrong with you. You know what I mean? Like we have to abandon this thin ideal, like everybody is not gonna be thin, no matter how hard we work, no matter how hard they work, no matter how many calories we cut, everyone in the world will never be thin, nor do we need to be. It's okay to have variations in size. I truly believe in the concept of Health at Every Size, which is an excellent book by Dr. Linda bacon. But you know those things so I'm learning, reassuring your clients, you know, avoiding the assumptions. You know, there are people in large bodies that can do just as much as you can do or more, you know, but then when you do encounter someone in a larger body that is having trouble because of You know, their mobility issues or their body size, you need to be quick with the modifications, you know, we're good at that, like that. That's what pts do. So you know, give them the opportunity to try it full out. And if they can't, or you see them struggling, jump right in with a modification and you reassure them and you let them know there's nothing wrong with this, like exercise movement is for every body. And if you can't do it this way, well, guess what? I got another way you can do it, oh, that didn't work, I got another way you can do it. Or let's try this one. instead. It's, it's okay. And people need that reassurance. Because in the healthcare setting, especially if they've had that trauma, they're so nervous and so uncomfortable. And again, they feel like there's something wrong, you know, with them. And so, you know, we learn this in PT school, we treat the whole person, you know, we don't see a person and this is a knee, no, we're treating the entire person and all of that all of their preconceived notions, all of their trauma, all of their hardships that comes with them into the clinic. And so we have to figure out a way to work with them, ease their you know, their minds and give them the tools that they need to get better. And so I typically, I take weight out of the equation, I just, I assume that their condition is being caused by something other than their weight, and I treat them based on that
16:14
period. Now, here's the question, how about if you have a patient or client coming to you, who they want to lose weight, or they're in the middle of this weight loss journey, and they're committed to it, because they want to feel better? for themselves? Not for anything else. But you know, we're coming off of a really difficult year where a lot of people might have gained weight over COVID. And so how do you or how would you suggest PT support the patients that are coming to you, they're saying, Hey, listen, I, I'm on this journey, this is what I'm doing. I'm moving, I'm exercising, I'm eating better? How can you give them a little extra support? With out perhaps leading them into an extreme version of that?
17:04
Yeah, what I find in those cases, your role is more of a, I don't want to say a silent partner, but you're there for the supporting piece of it. But the goal is to not. Okay, I'll say it this way, I respect body autonomy. So essentially, I know the research, I don't think that, you know, chasing weight loss is a great idea, really, for anyone, despite COVID I know, people are like I gave the quarantine 15. I'm like, Listen, you're alive. That is such a blessing with the year we've had, you know, the year plus we've had at this point, so but I respect body autonomy. So if you believe like, this is not a weight I'm comfortable with I'm not, I don't feel good, I don't think I look good, I want to do something different, then by all means, go about, you know, the process that you feel comfortable doing, I am going to be here to support you by way of giving you evidence based solutions. So if you tell me, Hey, I'm doing this, you know, 30 day detox, I'm only going to be drinking lemon water. And shakes, I'm going to tell you, I don't think that's a great idea. And here's why. But ultimately, you are an adult. So you get to make all of these choices for yourself. Before I became you know, haze or Health at Every Size aligned and anti diet, I did, I did all kinds of things. And I would not have taken kindly to someone telling me, oh, you're wrong, you need to stop it. So people need to have the freedom to do what they want. And I just as a therapist, I just want to be there. And in my role as a health coach, I want to be there to support them, but provide them with the evidence that's out there. And then, you know, as they go through their process, I'm happy to fine tune, I love to give people workouts, you know, that's, that's what we do is PT. So yeah, I can give you some workouts. If you talk to me about like, I feel really weak in my glutes, I want to be able to do this or I want to be able to benchpress or daily, oh, I've got you, I can give you a great program, you can work on it, you know, we can follow up with me. But whenever you're talking about extreme dieting, and crazy restrictions and weighing yourself incessantly and you know, tracking your movement on your Fitbit all day, I'm gonna kind of bow out and give you the, you know, the freedom to do what you choose. But just let you know that I don't think that's going to really support your goals
19:26
overall. Yeah, and, you know, it's the same as as if we would talk about a return to sport after an injury. So we can help guide the patient through their rehab process. And when we get to that decision making point, it's a shared decision making point where it's you, the client, maybe it's a spouse, a child, a partner, the doctor, whomever might also be within that decision making framework, and exactly what you just said, You're giving the best evidence based information. You can to that patient, and then that patient can make an informed decision on what they can do next, or what feels good, what is the best decision for them? So I just want the PTS out there listening to understand that this is not unlike any other shared decision making that we would do. And it's not a you do what I tell you to do. Because we're biased against people who are fat. Yeah. Because you're overweight, you clearly can't make a good decision. Right? which is not the case. And it's maybe they need information to make a better informed decision, just like someone coming in after an ankle sprain or an injury or low back pain.
20:43
Yeah. And you know, and that that's a great point that you bring up because you're right, it comes up with injuries, people will Google it. And listen, I love Google, no disrespect to Google, I google things all the time. Know when somebody is coming in, and they're dealing with some type of injury or medical condition. And they're going solely based off Google. It's like, Yes, we have a responsibility as a trained professional to say, Hey, here's what I think you should really know. But ultimately, you're right, they they're going to have to make the call. You can't you know, get someone better in physical therapy, just you know, when they come to you, it has to be their follow through at home and their decision making. So that you're absolutely right. That's a great analogy, for sure.
21:27
Yeah. And now, you said this a couple times. But I just want you to talk a little bit more about the Health at Every Size movement. You mentioned it a few times tell the listeners exactly what that is, and what its significance is to diet culture.
21:43
So the health and every size movement is it was sort of tagged by Dr. Linda bacon. I don't really know the lifespan, how long it's been around, I don't think it's been before, like the 90s. But it's essentially a movement that believes in body respect, and body positivity or best body neutrality, and respecting and understanding that we're supposed to be different sizes. And we don't have to lose weight to be healthy, you can literally be healthy at any size. So it's it's really the antithesis to diet culture. It's everything that diet culture is not it's not a movement that is rooted in, you know, being sedentary and eating McDonald's every day. But it is a movement that's rooted in people making their own individual health choices, and and creating health habits that improve their health without any focus on weight loss. So the Health at Every Size movement sort of omits the idea of like, let me check my way, let me weigh in this week. Let me let me measure this week, let me see where I am. It's it kind of throws all of that out of the window. And so the book is actually Health at Every Size by Dr. Linda bacon, that was sort of my introduction to it. And it's been life changing for me again, personally and professionally. So I recommend it to essentially everyone.
23:03
Nice. And because I think oftentimes when people look at someone who's overweight, they think, oh, they must have heart disease. They must be a diabetic, they must have this, but you can have normal labs and be overweight. Yeah, yeah. So and I think that is one of the biggest biases not just in healthcare, but in society in general.
23:27
It is it is. And that is the premise behind Health at Every Size is recognizing that you can't look at someone's physical body and know what their health status is. And we're just so used to making those assumptions and it's so counterproductive to true health and it's so damaging, you know, to people, you know, I personally know people and my own personal story. I'm only 411 I know we've never met in person, but I'm very short.
23:55
A short and you come across way taller.
24:02
It's the hair.
24:04
The hair gives you an added oranges.
24:07
I am short. I've always been short. But genetically, my family my mom's side of the family, they're more like apples shape. So they carry weight in the stomach. They're usually just you know, they got big solid legs. My dad's family was a little bit more Hourglass OR pear shaped so very lower, larger lower bodies. And so literally my entire life here and I have never, ever, ever ever not been overweight. Ever according to BMI which is a whole nother topic but I believe it's trash. So I have always my entire life they considered in an overweight category. I have never had high blood pressure, high cholesterol. AB issues doing any physical activity I used to run once upon a time I ran 25 K's I've never had an actual health issue, but I have always been considered over weight, and that stigma because that you know, value was created by a mathematician, you know, that really even said that it wasn't supposed to be used to like actually measure health into BMI, the BMI. But because of that, being sort of what our healthcare system is run on in our insurance markets, kind of, you know, utilize for everything. I have never, for my whole life, I felt like something was wrong. It's like, I'm not running enough, I must be eating too much. Let me stop having carbs. Let me switch to this diet. Let me and that is it. You know, it's not just my story. That's a lot of people's stories, especially here in this country. And it's like, if we could just stop for one minute, and ignore the weight and ignore the BMI, and just focus on health activities, health behaviors that make you feel good. If it's walking for you, if it's running, if it's skating, if it's dancing, if it's height, whatever it is, for you know, joyful movement, that's kind of you know, that's a part of the Health at Every Size, mantra, it's like joyful movement. Eating when you're full stop eating when you're hungry, stopping when you're full, trying different foods and just living a life and, and managing the other aspects of your health, like your mental health, your emotional health, your spiritual health, if we could just focus on that, instead of the scale, or the measuring tape, BMI, we will be so much healthier. So so so much healthier. So yeah, I, like I said, I could talk about BMI forever, but I just I really, I love what health and every size stands for because it, it's really about valuing body diversity, that's what it is. Because the bottom line is, we're not all going to be the same size, we're not all going to be thin, we're all going to have different dimensions, and our bodies will change over the course of our lives, age, stress, hormonal things, pregnancy, you know, all kinds of stuff. And so we have to get more comfortable with that fact. And not try to create this, you know, there's the whole snap back movement with pregnancy, like, have a baby lose the weight. It's like, wait a minute, let's just be you know, let's adjust to motherhood and whatnot. Um, so yeah,
27:08
yeah, it's it. I can't even get into the BMI. Because I cringe when I when people start talking about their BMI is and what it should be. I mean, for my height for BMI. I am right now, like a tick away from being overweight. And I would if you saw me, you wouldn't think oh, she's overweight. But according to the BMI, I'm like, a tick away. And for me to be in that sweet spot. I would look emaciated. Yeah, exactly. You know, so, like, 100 pounds. Let's like, stop with the BMI stuff. You know, and, and I just had all my labs and I could not be healthier. Absolutely. So there you go. But yeah, I'm with you on the BMI. We could talk. We can go on about that for a while, but we won't. So let's talk about, you know, we talked a little bit about what, what can physical therapists do to look at their own bias and fat phobia in health care? Is there any Do you have any other tips for health care providers out there, when it comes to their bias and phobias?
28:30
Yeah, I would say, you know, in addition to what we talked about earlier, and then on learning practice, you know, we have to just stop telling people to lose weight, it's counterproductive, it's not effective. And again, most people aren't able to even do that consistently and maintain it. And then we have to offer the same treatment options we would offer offer someone who was thin, like it, you know, we just have to treat them with some, you know, equality or you know, equitably, and giving them the same options. And then I know in physical therapy, this has come up before and that's one of the sort of issues that the fat acceptance community has expressed in dealing with with healthcare professionals, is they are less likely to be examined to be physically examined, because of their body fat. And I get that, you know, when you go to physical therapy school, and we learn all these manual techniques, oh, it's much harder to try to palpate things, you know, when there's more adipose tissue, of course, but that doesn't mean you don't do it. You know, so my advice is to do it, it might be uncomfortable, it might be awkward, it might be challenging, but guess what, you grow as a professional and then you at the very least give that patient the the decency and the respect of trying what you know best to do, you know, in that you know, situation. So, um, you know, just being being supportive and not being demeaning that playing into the weight biases. And first really acknowledging that you have them that that's that's the first part because a lot of people don't think that they have until they're put in a situation where they have to face them head on. So recognize them. And then stop telling your patients to lose weight offer people in larger bodies, the same treatment options. You offer people in smaller bodies, and then don't shy away from manually and physically examining them because of their body weight.
30:19
Yeah, great advice. And hopefully people listening to this podcast will take that advice to heart. Now, where can people find you on social media websites? All the good stuff? If they want to reach out to you they want to work with you. Where can they find you?
30:37
Yes, well, my favorite social media is Instagram. I'm pretty much on everything. But if you really want to reach me, you can find me on Instagram and I'm at healthy fit. And that's h EA l th y pH it. I'm also again on YouTube and everything else. But I live there. I'm on the peanut app, which is kind of new. If you're a mom, and you want to have talks about body positivity and changes to your body through motherhood. I'm on that app. You can find me there Dr. Lisa folden. And then my website is www dot healthy fit that calm.
31:10
Awesome. What is this the peanut app? Yeah, this
31:15
is really cool. It's like club friends, but it's for moms. And so they have tons of discussions on there. But um, I was requested by the I think the creators to serve as like a professional and do talks on things in the health realm. So yeah, so I go on there every, every other Friday, and I host talks on things related to body positivity, Fitness, Health, Exercise, things like that.
31:38
Fabulous. Congratulations. It's awesome. Thank you. Now last question. It's out when I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? Maybe like fresh out of PT school?
31:53
Oh, yes. Oh, fresh out of PT school that changes things, let's see, or high school or undergrad or whatever you want somewhere in there. I think you know what I think the best advice I would give to myself is it's going to be okay. That's really it. Because I was one of those like type A planners, like let me figure everything out. And I just remember being stressed all the time, like wanting my life to work out a certain way. And so it would have been nice. If you know, my older self this Lisa could reach back to that Lisa and just pat her on the back and say it's gonna be okay, honey, you're going to be fine. You can calm down. I just Yeah, that would that probably would have helped me relax a bit more during that process, you know, going through PT school and like, I felt, I just felt this heavy, you know, weight on my shoulders to like, get through and pull through and be great. And so if I could say anything to myself, it would be to just you know, relax. It's going to be okay. Enjoy the ride. You know, for sure.
32:51
Yeah. It's a very common piece of advice from a lot of people on this podcast. Obviously not hard to believe. Right. Right. Right. Lisa, thank you so much for coming on the podcast. It was a great discussion. And, you know, my hope is that people will take away from this all of the great tips to really examine your biases, and just start treating everybody like the people they are. Absolutely. Thank
33:18
you so much for having me.
33:20
Anytime. Anytime. You want to come back. You are welcome. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, CEO of CS Thrive, Kirsten Franklin, talks about mindset.
Today, Kirsten talks about what mindset is, why we should care about it, and how it affects our outcomes, results, and everyday life. How can we leverage mindset to change the results of things we don’t like in our lives? How can we change our core beliefs?
Hear about Kirsten’s four questions, her stopwatch strategy, and get her advice on how to manifest as a conduit, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “What you deeply believe will always play itself out for you.”
- “Sometimes just the awareness of the thing makes the thing go away.”
- “When you’re really in the moment, just throw a big red stop sign in your head. What you’re doing is actually stopping the subconscious chatter. That alone can elevate you.”
- “If you’re still trying to get to that next level, then you have to pay attention to what you’re saying to yourself at this level. You have to hear what you’re saying, because it’s dictating your reality.”
- “It’s the ‘taking action’ that’s the hard part.”
- “None of it is a big deal. Relax.”
- “There’s two ways to manifest. There’s the manifest by force versus when you open up and let the universe and all of its power flow through you.”
More about Kirsten Franklin
Kirsten is a world-class rapid transformation coach who has helped change the lives of over 1000 individuals. She is the brains behind the unique MVP method that is responsible for helping her clients rapidly transform their Mindset, raise their Vibrations, and modify their Processes, so they can achieve their dream lives.
She helps people overcome fears, adversities and traumas while improving their clarity, focus, performance, communication, relationships and thinking, so they can fulfill their ambitions. Many of her clients are seen as being highly successful and seek her out to help them define and achieve their next-level.
She has spent over sixteen years studying mindset, positive psychology, behavioral science and neuroscience and she is a master of techniques such as Neuro-Linguistic Programming (NLP), Strategic Intervention (SI), Cognitive Behavioral Therapy Coaching (CBT), Timeline Therapy, Mindset, Mindfulness, Meditation and more.
Kirsten received her Juris Doctorate from St. John’s University School of Law in 2001. Now retired, she owns multiple companies and is the CEO of CS Thrive, a coaching and consulting company that helps executives, founders, small business owners and athletes become unfu*kwithable in their business and lives. In free time, she is the host of the podcast Girl on Fire; writes for “Mind-Flux,” a publication she created on Medium.com; writes fiction and non-fiction books, and hosts live events. She has been featured in Thrive Global, NBC, CBS, and Fox.
Suggested Keywords
Mindset, Mindfulness, Fears, Psychology, Behaviour, Therapy, Awareness, Manifest, Conduit, Abundance, Action, Reality, Subconscious, Liberty, Results, Outcomes, Positivity,
To learn more, follow Kirsten at:
Website: https://www.kirstenfranklin.com
https://www.csthrive.com
Podcast: https://bleav.com/podcast-show/bleav-in-girl-on-fire
Facebook: Kirsten Franklin
Instagram: @kirsten_franklin
Twitter: @CSThrive
LinkedIn: Kirsten Franklin
Clubhouse: @kirstenfranklin
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript:
Speaker 1 (00:01):
Hey, Kiersten. Welcome to the podcast. I'm so excited to have you on. So thanks for joining me today. Thanks Karen. It's great to be here. It's nice to see you again. I know, just so everyone knows I was on Kirsten's podcast a couple of weeks ago, and we will talk all about that podcast and where people can find it a little bit later, so you have to wait to get the good stuff. But in the meantime today, we are going to talk about mindset. So I feel like mindset can mean a lot of things. So what is it really? Yeah, so that's a great question because it's one of those words like coach or like this, or like that, that we hear all over the place and for me in the way that I use it. So it was actually originally coined by Carol Dweck and she was talking about eight thought process, like being fixed or growth mindset, meaning you believe that you were given a certain sort of limitation and that's the highest you can go and that's fixed.
Speaker 1 (01:04):
Right? And that no matter what you do, you'll never going to go and surpass that level of ability. And growth is one where you feel as though, you know, you have the ability to change it, right? You can, you can go beyond the quote limitations. There are no limitations. And the way that it's sort of been more used frequently is in discussing the subconscious mind. And that's something she references back to because that's actually where all the magic happens. And you know, the way I use it is really talking about that subconscious language. It's about the core beliefs that you hold about yourself. It's almost like the rule of law that you have decided is true for you and you're going to live by it no matter what, Hey, even though you don't really know, you kind of created those laws. So it gets a little tricky in that people understand the difference between conscious and subconscious, but as you talk to them, they really believe many times that they know what they're thinking.
Speaker 1 (02:02):
And the funny thing is is you don't until you catch it and you really kind of latch on and you're like, oh, why did I say that that way? Right? And, and you kind of have to dig into it, but you can, you can understand your deepest core beliefs by the language. And actually just take a look around you. Is there something in your life that you don't like, or maybe you're kind of feeling attracted towards or repelling against, then there's something out of alignment in those core beliefs, because whatever you believe is what you're going to see in your reality. And so when we use the term mindset, is that dependent upon our core beliefs? You know, or is this, I mean, obviously mindset is something we can change, but if people say, oh, well I have these core beliefs and they're not going to change.
Speaker 1 (02:51):
So then how can the mindset change? Does that make sense? Yes. And actually there's a perfect example. So a lot of times I like to ask for questions when somebody is in a certain emotional pattern, right? Let's say, oh my God, I have anxiety. I can't drive over bridges. Right? Like, or, or whatever it is. So I'll ask four questions and I ask the first question, like, could you let that feeling in like, are you willing to just feel it? Because if you're not willing to let it in and you're constantly pushing it away, well, you can't get rid of it because you're, you're, you're not willing to work with it. Right. The second question I'll ask is, do you believe it's even humanly possible for you to eliminate the feeling of anxiety? Could it ever just go away? Right. And these are just yes or no questions.
Speaker 1 (03:35):
And if the answer, yeah, I think I could get rid of it. Like that's totally possible for me. Right. The next question I would ask is, would you let it go? Are you willing to let it go? Okay. And again, it's a yes or no. The reason I ask these questions is a yes or no fashion is at any point when you say no, no, I'm not willing to let it in. Then you can't let it go. No, I don't believe, I don't believe it's possible that I could just eliminate it then. Guess what? You will not eliminate it. Right? No, I don't. I, you know, I'm not really willing to let it go. Okay. Well then, you know, you're going to keep it for some reason, right. Or if you say yes, all the men in the last one says, okay, well, when, when are you going to let it go tomorrow?
Speaker 1 (04:15):
Okay. There's a reason why you're not today. Right? So, so the thing about what you had just said is that whatever you believe is going to be true. So if you believe it's not possible, it's not going to, it's not going to, it's not going to be possible for you. Right. And so, so it's a, it's a, it's a tricky little thing, you know? And so how can we, how can we change our beliefs? How does that work? That's a, that's a long process and a short one. So you can actually just change them. That's the fastest way to change them is to literally just change them. What is it that you wish you believe? What is it that you hoped you live? How is it that you would hope things would be, and then just believe them? And it's actually that simple. Now I know a lot of us thinking like, yeah.
Speaker 1 (05:06):
Okay. You're funny. I, I that's. I'm like, yeah. Okay. Yeah. Right. But I want you to think of the moment. There has to be a moment in your life where you're so off. So fed up, so done with something that it was done. You're never going to take that, do that, see that, feel that again, and you walked out on it. Like it typically happens in relationships. I'm never going to have that. You don't, you're done, never happened again. Right. Because you're done because whoever you were that got yourself into that situation, you were done with it and you were not willing to accept it and you won't ever accept it again. Right. Whether it's like somebody who speaks to you in a certain way or does something or whatever, or even the way the grocery bag of groceries, you know, bags of groceries.
Speaker 1 (05:47):
You're like, yo, you like it. You know, it's just done. That's the same thing in our head. Sometimes we can just be so over something that we're done with it. And it changes right there in an instant. Right. and then more typically it's we think a lot about how we wish it could be how we wish it should be, should be as a, as a dangerous one for me, because it's a comparative thing. Oh, I should be here, but I'm not, oh, like, I shouldn't be married, but I'm not, oh, this should be this way. And that starts a spiral of depression because your life doesn't look the way you want it to, then it's no good and it's all wrong. And then it comes down. And as you know, when we have these stressors and emotional things, they come out physically. Now you have neck pain.
Speaker 1 (06:33):
Now you, now you get headaches. Now, all of a sudden, your knees hurt. Right. If it's not a physiological difference, then it's typically coming from an emotional space it's coming from inside. Right. So how do we change them? I mean, look, I'm going to be totally honest. You can like, go, am I allowed to swear? I'm going to try not to sweat. You could like Google this stuff. Okay. Like there are affirmations, there's hypnosis. There's, self-hypnosis, there's positive cycles. There are a million different ways. And I don't believe in one size fits. All right. So I could lay down some techniques right now. And you know, a third of y'all will get it, do it, try it. It'll work. A third of you will be like, yeah, I'm not even bothering. And a third of you will try it and it's not going to work.
Speaker 1 (07:13):
Right. But even that is in your head. So if you are someone who doesn't believe that talking things out helps anything. Then if my method is talking things out, then it's not going to work for you. So that's the power of our brain. Let me tell you how powerful our brain is. I was just having this conversation. So, you know, I was talking to somebody and there's a blind spot. So meaning your eye, witness identification, all stuff, all bad. Why? Because we interpret things so differently and we can create blind spots. So you ever had that moment where you're like, oh, can you get me that book on the shelf? Right. And the person's like, I don't feel like getting you up, but you're standing right next to the shelf. Just grab it to me and give it to me. Okay, fine. What's the book it's not here.
Speaker 1 (07:55):
Right. And all the fighting goes back and forth. You finally get up from your seat. You walk over to the shelf right in front of the space is the book he or she literally couldn't see it because somewhere the command was given no book. You don't have to get it. You don't want to get it. It's not there. This is stupid stuff. Right. And so it literally happened. And so it's kind of crazy. Like, I can't tell you all the science behind it because we're studying it every day. In fact, you and I, before this, this packets were just talking about how they figured out. They think the, the place in your brain that lights up when you're deciding whether something is going to get stored in your subconscious mind. Now that's a really interesting place to play because I mean the magic that we can make happen right there, who knows.
Speaker 1 (08:40):
Right. But you know, it's, it's many different techniques to change it. You know affirmation again, you can Google that, you know, but it's really important because what you deeply believe will always play itself out for you. So I always tell people, take a look around your life. If there are areas or places that you are just simply unhappy, you really need to dig into your beliefs about yourself, the way it's supposed to look how it's supposed to be, and you'll see how that's playing out. Yeah. So I, it sounds to me that you're saying not, there's no one size fits all for this. And I think that's the realest answer. You know, like you said, I can tell you this or this, and it might work for some and not others. And so it sounds like you need to figure out what is going to work best for you and then seek that out.
Speaker 1 (09:42):
Yeah. And it's a testing thing, right? I mean, you really do have to go through things. Like I have a mindfulness email that I send to everyone it's 52 weeks. And why, because it's literally 52 different ways to practice the same thing. Right. Mindfulness. Right. But the goal is, is that okay? You try it one week. Some people get bored with stuff really easy. Right now it's a new thing they could do every week. Right. But the goal is that at the end of it, it doesn't matter whether you picked up or found your thing, you just did it for an entire year, 52 different ways, but you did it. So at the end of the year, you still have the result, even though you didn't realize you were kind of doing that, you know, here I'll, I'll tell the audience one thing that they can do that works for everyone period.
Speaker 1 (10:23):
And it's only if you do it. So just remember you have to do it, actually do it. And it's something I do with all my clients. And it's called no negative and try it for a week. Try for a few days, it's really about awareness. And what I started them off doing is I literally have them take their phone, their stopwatch feature on their phone. When they wake up, they started the very first instance where they feel, say, or do something in the quote negative. They have to hit the stopwatch button, record the time, write down kind of what it is. They were doing, what it is, they're feeling what it is or how I was saying. So you wake up, you hit this, do you start the thing? Like, oh crap. I got to go to work. Gosh, 12 seconds, 12 seconds elapsed. All right.
Speaker 1 (11:06):
Oh crap. I have to go to work. All right. Start the button again. Okay. Brushing my teeth, got to pick out clothes. I got dressed. All right. Hit the button. Right. And, but that's it because you'll see, even by the end of the first day, people are shocked at how many, how many, but also how often and frequent things come because you live your life on autopilot all day. You don't realize that you're living sometimes in this hugely negative space. You think you're fine and you can't figure out why you're grumpy by the end of the day. Well, if you're telling yourself, oh, every five seconds, this isn't good. That's bad. Oh no. We've got to think about this. Yo of course, you're going to bring your vibration down. And your day is going to suck by the end of the day, every day. You know what I mean? It just is. So, so that's a technique I like to do. And that's only part of the technique, but that, that, that level of awareness, just as eye-opening most of the time. So that's a fun one to do. Oh, that's great. I'm going to try that. Oh gosh. Look, I'm already negative. No, no, no, no.
Speaker 1 (12:08):
Yes. All my new Yorkers let's do it. We all know how we are. We think we're funny. We're really like sarcastic and negative. Yeah, exactly. Oh my gosh. Yeah. I'll try that tomorrow. And we'll see what happens. I will report back to you. So, so obviously we know mindset is something that can be altered. Can't be changed. It can be positive. It can be negative. So how does that affect our outcomes and in how we live our life every day? Yeah. So, so let me give you an example. I call it the kindergarten story because I think it's kind of common for a lot of us. So I want you to imagine that you're in kindergarten. If you're listening to this outside of the country, it's a one year about four or five years old. It's the first level of school you go to here in the United States.
Speaker 1 (12:58):
And we have this thing called Valentine's day. And at the kid level, we just, you know, get a bunch of candidates together, throw a bunch of cards and give one out to each member of the class. But sometimes there's that special Valentine. Right? So, so let's say little care. It's kindergarten. And she's all excited. Turned her mom made all the little Ballantine things she's handing out. But Joey, her best friend, well he's has the special Valentine. And she's going to ask him to be his, be her beer Valentine. Right? So Karen goes up to Joey, we made a special bone. That'd be, will you be my Valentine? Joey loves comedy. He says, oh my God, Kimmy just asked me. And she's super cute. I'm going to totally be here Valentine. Now little Karen's like, wow. Now little Karen's had picked up this message, but it wasn't said, but this is what you heard.
Speaker 1 (13:46):
You're ugly. You can't get the guy. Oh, and Kimmy with brown hair and purple eyes. She's that's that's that's the ultimate cuteness. Like that's that's it. Now she's four. She goes home cries. Mom, mom fixes it. Everybody has dinner next day. You're for you, Joey and Camy. By the way, you're all besties. You're hanging out. Like nothing happened. You, you feel like you don't feel it. It was a split-second. It was a moment it's gone. It's not really gone because let me tell you what happens now. She matriculates she's in middle school and Karen has to ask a boy to a dance. It's one of those Sadie Hawkins thing. So the girls have to ask the guys. And so her and her bestie and most people at this age have faced some kind of rejection, whether it's in the girlfriend, boyfriend, lover section or, or any other part, like not getting the baseball, you know, position, whatever it is.
Speaker 1 (14:34):
So we understand rejection. So we're fearing a little bit and we're nervous. So it's natural. Right. And everybody will tell you that. Oh yeah. It's natural. Don't worry. Just go ask anyway. So you and your Bessie, of course, it's Kimmy go. And you're like, okay, all right, we're going to ask our guys. So Kimmy goes first. Can we ask the boy? And he's like, yeah, sure. What out? Right. So Carrie was like, yeah, I'm going to ask Tony. She goes up to Tony. She asks him. Tony was like, man, I wish I could go. But I can't. Now what Karen doesn't know is that Tony is a son of the local preacher and he's not even allowed to go to school dances. Tony is secretly actually in love with her. But he has to say no anyway, but all Karen hears, not consciously, but subconsciously because she doesn't remember five years ago, she all she hears subconsciously is yo dumb.
Speaker 1 (15:19):
Don't you know, you're ugly. Why you try to do this? That making a fool of yourself. You know, you can't get the guy just stop. You are not pretty. You are not enough. You can't get him just up. Okay. Underlying, underlying thought the overlying crunch thought, oh man, I can't believe it. I'm so to the point and maybe he doesn't like me, right? Like, why is it so easy for Kimmy? Why isn't it the same for me? Like, it becomes that now you can't leave Karen out. Karen's like, all right, she's going to high school. She's like, you know what? I don't even care anymore. I'm bringing to the new high school, new me, everything. She goes out, she becomes a head cheerleader. Everybody loves her. She's popular. She's gorgeous. She's smart. She's funny. She's nice to everyone. And so she's, she's the girl, there goes Joey from kindergarten.
Speaker 1 (16:08):
He's the captain of the football team. And you guys are of course still talking. So Hey, what up? You start dating on the outside. It it's like the ultimate thing. Like, you know, you've made it right. You've arrived. Like this is it. Like, this is everything that everybody dreams of. Right? Prom, king prom queen. We're going to do it. You know, Joey's all happy. But Karen Karen's like, dude, Tom feels weird. Why doesn't it feel right when you think he's cheating on me? Like you think like, what's going on? Like, like I know we, we look so good together. It looks, it looks like it should be perfect. This is actually everything I ever wanted since kindergarten. But I dunno. I think, I think, I think he talks about, look at, look at him, smile. Look at him, smile at that girl that just walked by.
Speaker 1 (16:51):
Look at him, say hi to everybody. Right? She starts going, yo crazy lady. I take taken his phone, looking at his text messages. Eventually poor Joey. Now she's creating damage and Joey, but you always like, all right, forget it. I can't, I'm done. Right. And then Karen thinks, oh yeah. That's because you're right. Your cheater, you're doing something right. And she has to solidify in her mind. What's going on? So now Karen gets smart in college. She's a psych major. She's not going to play this game. She thinks she's good. She finds herself a man, they get married. They have kids. But again, something's not right. Like it feels wrong. Like it doesn't feel good. It's supposed to feel amazing. Right. But, and then she starts picking on things like, why can't you take the garbage out? Why can't you take it on time? Why can't you put it in the bin?
Speaker 1 (17:36):
Right. Right. And all this weird things has nothing to do with the garbage in the bin. And it has to do with this internal, emotional strife that she can't release because she's not quite sure why she doesn't feel right. But the truth is it's because she's too ugly to get the man, this man she doesn't deserve. It's not right. He couldn't possibly be there for the right reasons because she's not good enough like that. And it plays out in this way. That's why it's important. Because every day when you wake up and you have those negative thoughts and you enter these scenarios and things come crashing into your universe, it's usually in your head, that's created it at some point or is receiving it in some way. Right. And you're being reactive, like a five-year-old to it. And you don't even know you're doing it.
Speaker 1 (18:18):
So if you want to have a nice, happy, easy, joyful life and wake up bounding out of bed, like if a kid on Christmas, this is the head game you got to play with yourself. It takes work. Right? No. Yeah, yeah. Yeah. I mean, you know, just like anything else, it does take, it takes consistent effort in, in getting it done. And actually to be honest, sometimes it doesn't sometimes just the awareness of the thing makes the thing go away. But you have to remember, you have been imprinted every second of every day, since before you were even born in utero with an impression and emotion, something okay. To date. So if your brain decided to take all those impressions and make a big deal out of them, well, you're going to be undoing a lot of stuff. And that's why it's layers. That's why it's kind of like, you know, when I'm working with CEOs that are, you know, in multimillion dollar companies, and now they're about to go into something and like close to a billion and they have all this stuff going on.
Speaker 1 (19:13):
Or, you know, I was just talking to an athlete who started a business and he was like, I should have been so much further. And you know, and you know, we broke it down that the work that he did to become an athlete, to become an MMA fighter is not the same level of work he's doing in his business. Right. He, he, he practiced every day. He, you know, ran, kicks every day. He had people watching him, critiquing him, helping him, mold him. He spends like three hours a day in his business, but he wants it to be a superstar rocket, you know? And it's like, well, you didn't get into the octagon and fight and win your first fight by, you know, being around for three months. You've been in this business three months. But you think you should be like a millionaire, like where is that coming from?
Speaker 1 (19:54):
Right. So it's, it's, it's all it's, it's it's in your head. Yes. I, I understand. I get it. I get it. I do. Now let's talk about, if you have something let's say in your life that is not going maybe the way we want it to, which let's be honest. I think that happens too. Can we say everyone at some point? Oh, of course. How can we leverage our mindset to change this so we can change our results? Okay. So I'm gonna, I'm gonna, I'm going to go a little woo on you here. So it's a combination of your thoughts and your energy, right? And so you know, just to, to focus on the mindset aspect of this, you can really dig into, you know, how would I deal? You have behaved, have responded, have done something. And how did you, you do it.
Speaker 1 (20:55):
What's kind of the difference. And how do you step into ideal you? How do you make decisions from that higher place? Right. just taking business, you know, let's say you're going to go into, I don't know, marketing and you have to pay marketing people. Well, you, you might say yeah, that's really expensive. I'm not doing that, but higher, you might say, Hey, actually I understand the long-term game. I'm willing to wait it out to six months. It'll probably take for me to recoup money back and let's go for it. Right. I would ask the right questions and it would know the right information and it would make the right decision. Right. So, I mean, when it comes to mindset and looking around your life and finding the things that you don't like, that's the start, but now what are you kind of leaning towards and what are you pushing away from?
Speaker 1 (21:41):
What have you settled for? Okay. Like notice that, because a lot of times in our lives, we settle for certain things. We want this ideal image, but then we're like, oh yeah, it's okay. You know? And so look at all these things because they all add up. I mean, there's a, there's a bunch of questions you can ask yourself, but I would really just start with, where are you, where did you want to be? Why did you want to be there? That's a big question. Okay. So, you know, think about all the people that go to college at, went to college and pick a major that had nothing to do with them. Right. you know, I wanted a big house in New Jersey when I first became a lawyer because I grew up and that's what everybody had. I didn't realize I don't even want to live in New Jersey.
Speaker 1 (22:25):
And I don't think Jesus, you know, I mean, like it, but because it was so familiar to me, I thought that's what I should be doing. And I wanted nothing to do with it. And so it caused every time I wanted to go look at property or do something, it always fell through, it always didn't happen. Well, it was the universe saying peace woman. Like, what are you doing? Just stop. But in the, my reality in that moment, it was frustrating. Like I tried so hard trying so hard and it's not working out. Right. And it was just like but you do get the signs. I mean, I think the biggest thing is, you know, again, with no negative, you start to look at your stressors too. You start to see the common themes of what you're saying to yourself, what you're hearing and really stop.
Speaker 1 (23:08):
You know, one of the, one of the, another thing that I love doing is when you're really in it in the moment. And when you're super about to be reactive, you know, about the Chuck that, that coffee across the room, just throw a big red stop sign in your head. It's called a pattern. Interrupt to stop, throw the sign in your head, just see it and just stop, stop, stop, stop, stop, stop, stop, stop, stop. And just stop. Because what you're doing is actually stopping that subconscious chatter. When you do that, and that's like an immediate thing that you can do that you don't have to deal with everything that's going on around you, because sometimes you can't because it's so in your face. But as long as you stop, as long as you stop that thought pattern, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop.
Speaker 1 (23:49):
Right. That actually just practicing that alone starts to stop the mental pattern that you have going on. All you have is a mental pattern, a little talk pattern, a little, you know, little repeat on loop, right? That's what you're stopping that alone can elevate you like everybody listening to this, you know, if you think of your life right now on a scale of one to 10, 10 million, like, oh, yo upper rockstar, one being like, dude, am I still alive? Like, how am I even still here? Didn't I like do something last week. That caused me to not be here because it's so miserable, right? Like that level. Okay. So on a, on an overall one to 10 rate yourself, then do no negative and stop just the pattern. Interrupt. Stop yourself every time. You're when the, when the bar reset. Isn't fast enough. Stop. Stop, stop, stop.
Speaker 1 (24:33):
Stop. When the dog just, you know, somebody else's dog ran across your foot. Stop, stop, stop, stop. Stop. When a door closes on your dress, your skirt, and you're about to get stop. Stop, stop, stop, stop. Just stop. You don't even have to think any further, just stop that's at the top. Move on, do it for a week. Now again, one to 10, how do you feel rate yourself? Your number is going to go up and then your brain is going to start with this. Oh, but nothing changed. Why do I feel? But, and then you're gonna question it don't it just is. And it's actually just that easy. So excellent. That's a great exercise and very, very easy. Anyone can do that. It takes nothing. You just have to stay, say stop. Yep. And those, when that those thoughts start rushing in and we all have them every single day.
Speaker 1 (25:24):
Yes, we all have them. I think that's great. So now, as we start to wrap things up, what do you want the audience to take away from our conversation around mindset? Well, I mean really just the basics. I mean, the fact that it is important, you have to pay attention to it. The reason you're here, wherever that is in your life is because you didn't, maybe you didn't know, maybe you didn't care to, maybe it wasn't as bad yet, but if, if you're still trying to get to that next level, then you have to pay attention to what you're saying yourself at this level. And I don't care what level you're going to or where you're coming from. That's just it, you know, where they're coming from, coming off the streets to your next level, or you're coming from your, your $50 million company and you want to make it a hundred million.
Speaker 1 (26:10):
It's the same thing. You have to hear what you're saying, because it's dictating your reality period. And so it's really important. And that there's a lot of resources out there. I mean, I can give you some resources as well, but you know, there's tons of stuff out there and it really is simple. It's just, it's, it's simple and taking action and everything changes and it can change in minutes. Yeah. It's the taking action part. That's the hard part, right? Everybody can read. You can understand the action that has to happen. Let me tell you, let me just really quickly tell you that that's my too. So you have to live into the being. So let me just give you an example. So I was very athletic when I was younger. You know, I didn't work out at all. When I had my child, my child is now 12.
Speaker 1 (26:52):
At the time that I had to do this to myself, she was 11. And I was like, oh, I'll kind of get into that place where you still look good with clothes on, but not so much when you take them off. So I was like, maybe I should work out. And I thought, oh, this is second nature. I'll just go work out. I live on central park here. So I'll just now. And I did everything. The micro habit, the be dressed in your sleep thing, the sneaker girl, if I tell you that at some point I felt proud that I got out the front door and want a cup of coffee to come back. And that was my workout. And I had to do my own techniques myself, which is what is it? I believe like what happened? I obviously no longer believe I'm an athlete because if I did, I mean, this is easy.
Speaker 1 (27:30):
Right? And that's what I thought I believed consciously. Well, when I dug down to it over the past, you know, 10 or so years, my friends had been getting a little snappy with me saying things like, oh, you eat like an a-hole, you still look good and I didn't work out. So then they knew that like, how do you not work out? And, and we work out 10 hours a day and what's going on. And there was part of that, that seeped into me that was like, oh, that's right, girl, eat whatever you want. Look good. You don't, you don't need that. Right. And well, it worked for 10 years, but obviously I needed to change. And the second I realized that I was letting those things come in, that it was easier to hang out in bed that I always had tomorrow that, and I changed that core belief.
Speaker 1 (28:11):
And I, and I really had to dig down into why, like, I want to be the grandma who like flies through the trees on zip lines with her grandkids. I can't do that in 10 years. If I don't exercise now. Right. I had a drill into my head. Oh my God, I love running by the way. Don't really, but I love running. I love running. I love running the second I did all that stuff. Right. And it actually took overnight. That's all I did. I did it one day. I wrote down the thing. I said it to myself again and again. I said it to myself in the mirror and I was like, yo, you, you have this, like, what's wrong when you have this right now woke up the next morning. I actually ran a whole mile. Now it doesn't sound like much, but 10 years sitting on my.
Speaker 1 (28:47):
Pretty good. That's great. Yeah. That's nice. So it's really convincing yourself that you are the person who does the thing. If you are the person who loves to do all this weird, you know, personal development stuff, and you'd love to say stopped yourself and you've loved it. Guess what you're going to do. You're going to do it. That's it? It's that simple. Yeah. Yeah. Oh my God. That's such a good example. Thank you for that. Now, speaking of resources, where can people find you, your podcast? Talk about the podcast, your resources, everything else. Yeah. Awesome. I mean, you guys can go to just my name.com. So it's Kiersten franklin.com. And I don't know if you're able to put that in the description. And then the podcast is just girl on fire. So if you want to just Google girl on fire, it's unbelief B L E V network.
Speaker 1 (29:36):
You can find it anywhere, apple, iTunes, all that good stuff. Yeah, that's it. Yep. And D and we will have links to everything, to all of her information at podcast dot healthy, wealthy, smart.com and the show notes under this episode. And we'll have your on social media. Do you want to give a shout out to your social media handles really quick? So someone can find you really easily. That would require me to know what they are. Well, it's all on your website. Yeah, we got it. We got it. No problem. We will have, I will put them all in the show notes individually. We're good. Don't worry about it. Now, the last question I always ask everyone is knowing where you are in your life and in your career, what advice would you give to your younger self?
Speaker 1 (30:29):
I would tell myself that none of it is a big deal. It's not as big a deal as you think it is, you know, all that lost time on stressing out and trying to make things happen and living by force, as opposed to living as a conduit where everything's flowing through you. Massive difference. My whole life has been lived by force winning, winning, winning, getting by force. I probably could've gotten the same exact stuff, Ben, the same that, and just nice and easy, you know, massive difference in life. Let me tell you. Yeah, I was relaxed. I love it. And I've heard that several times from people guests on this podcast. So there's clearly something to that. So for all of you, new new grads out there, college kids listening, relax. And I love, can you say that again? You want to be sort of a conduit versus a forest.
Speaker 1 (31:25):
Can you repeat that one more time? I mean, I, you know, listen, there's two ways to manifest, right? There's the manifestor force, right? Like, like you're going to get it. You're going to get it. You're gonna do everything class. We're going to fight, fight, fight. It's by force and you're gonna get it versus actually when you open up and you let the universe and all of his power flow through you, you're going to get the same things only. It's nice and easy, right? When, when something doesn't happen or someone candles or it moves when you know that it's okay, that it's all just going to be fine. It's your life flows through you. You are a conduit. I it's true about finances, about love, about anything, right? If you, if you're having financial difficulties, right. And this is going to sound crazy, I know it's gonna be painful for some, but if you open up and you just let it flow through you, all of a sudden you're going to just have more and more and more money, right.
Speaker 1 (32:15):
Because it's not about you getting money. You're the conduit. So the university saying, all right, I'll throw money at you because you're giving it here. You're helping people there. You're doing this. Right. And it just, just like, love like energy. It's just things you're, you're, you're a vessel it's supposed to come through the gifts that God gave. You are not for you. They're supposed to float through you so you can help others. If that makes sense. Yes. It, and thank you for that. I love it. So Kiersten, thank you so much for coming on the podcast and spending the time with us today. I really appreciate it. Absolutely. Thank you so much for having me. It's so fun. I always love seeing you. Yeah, my pleasure, my pleasure, and everyone tell the listeners out there. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, CEO and Founder of Practice Freedom U, Jamey Schrier, talks about creating success by changing mindsets.
Today, Jamey talks about developing a growth mindset to achieve greater success, what the biggest problems are that owners face, and how to ‘fix’ those problems. What’s your goal for the next 30 days? How do you keep your energy tank full?
Hear about the different growth mindsets that owners get wrong, reacting versus responding, and get some valuable advice on how to grow and become more successful, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “How someone thinks determines the actions they take, and the actions they take produces results.”
- “The eyes only see, the ears only hear what the brain is looking for.”
- “You have got to look at a yourself as the owner, the CEO, the entrepreneur, the head honcho.”
- “Being busy is not an owner mindset.”
- “You have to slow down. You have to pause. You have to spend more time getting out of the immediate present.”
- “The biggest problem with the overwhelmed operator is there’s not organisation in place, there’s not systems in place, there’s no control over one’s time.”
- “The more you can bring people in an organised, systematic way, the less overwhelmed you’ll be later on.”
- “The best is yet to come. The future is brighter than the present and it’s brighter than your past.”
- “Business is all about trying things, failing, learning, and trying again.”
- “What you focus on, what you pay attention to, grows.”
- “You don’t know what you don’t know, and you never will no matter how smart you are.”
- “It’s not enough to be busy - so too are the ants. The question is, what are you busy about?”
- “Keep your tank full.”
- “Reacting is an emotional response. Responding is a rational response.”
- “When things get busier at the office, there’s one thing that you sacrifice more than anything else - that’s your self-care.”
- “You don’t strengthen the weak by weakening the strong.”
- “Overcome your ego. It’s okay you don’t know everything. Enlist some help. Invest in your business. It will pay off dividends in your future - not only to you, not only to your family, but for everyone that’s around you.”
More about Jamey Schrier
Jamey is the founder and CEO of Practice Freedom U, and the best-selling author of The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion. He is a sought after speaker on systems, marketing, and elevating the patient experience. Over the past decade, Jamey has helped hundreds of physical therapists, occupational therapists, speech therapists, and mental health professionals build their highly successful practices and create more financial security without working longer hours.
Suggested Keywords
Owner, PT, Physiotherapy, Business, Entrepreneurship, Purpose, Mindset, Success, Actions, Thoughts, Leadership, Freedom, Productivity, Busyness, Progress, Reacting, Responding, Self-Care,
Jamey’s Book: The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion.
Discovery Call: https://www.practicefreedomu.com/discoverycall
To learn more, follow Jamey at:
Website: https://www.practicefreedomu.com
Facebook: Practice Freedom U
Twitter: @jameyschrier
LinkedIn: Jamey Schrier
YouTube: Practice Freedom U
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Read the full transcript here:
Speaker 1 (00:01):
Hey, Jamie, welcome back to the podcast. I am happy to have you back. I always love having you on, well,
Speaker 2 (00:08):
Thank you Karen. I am so happy to be here.
Speaker 1 (00:12):
And so every time you come on, we talk about some aspect of the physical therapy business, which is great because I know a lot of the listeners want to know more about how to run a business, how to be successful, what's going on in the market. So let's kick it off with what is in your opinion, the biggest problem facing physical therapy, practice owners today,
Speaker 2 (00:42):
Karen, you're just going, you're just right out of the gate. Like you're just like, you know what? We're not messing around. Hey, Jamie telling me about yourself or, or give it. It's just, I'm going fast ball down the middle either. You're going to hit it or you're going to strike out and we're going to be done.
Speaker 1 (00:57):
Yeah. They, they, they know who you are. You
Speaker 2 (01:01):
That's a good sign though. Right? what's the biggest problem facing practice owners today? That that's a really great question. And the answer may not be what people might think the answer is. The biggest province, really what, the topic that we're talking about simply put it's how we think it's just that simple. There, there's a, there's a simple formula that, that I've been following for years now, years and years and years. And basically it's just says how we think, how someone thinks, determines the actions they take and the actions they take, including their communication and their stuff. They do produces results. And too many times I've heard people that are not happy with their results, whether it's referrals, whether that's revenue, whether it's profit, whether it's hiring, whether it's retention, whether it's time, God forbid, people want time and control. They don't have that.
Speaker 2 (02:03):
So if you reverse engineer the result back to, well, why isn't the result we want? Is it some strategy? Is it some technique and answers? No. It's how an owner thinks. I mean, let me, let me give you an example. We went to school, right? All your listeners went to school. We are highly educated, very smart people. Now who educated us, right? We had professors in school and we, and, and, and PT school. We had professors who were educating us on what they were educating us on how to be a clinician, more specifically, how to pass the boards, because that is what schools do. They help you pass the boards. So then you can become a licensed clinician, licensed physical therapist. So you do that, whatever one year, you're five years, 10 years, and you have this urge, you have this thing inside you that says, I want to be a business.
Speaker 2 (03:07):
Now I want to run my own thing. So do you go back to school? Most people do not go back to school care and they don't get an MBA. They don't get any kind of, maybe they read a book, hopefully my book, right? The practice, freedom method, plug, shameless plug, but they, they just signed the dotted line. And now they're an LLC. And what are they doing? They are making decisions with the brain that was built and created with all of the information of how to be a talented clinician, which they are. But now that same brain is making decisions around business and there lies the problem.
Speaker 1 (03:48):
Okay. So you just described most physical therapy owners. So how do we fix this? How do we, what do we do if this is, if this is our mindset or if this is where we are, this is where we're thinking. And you know, everybody gets, I think people start their own practice because they want to help people. They want to see patients the way that they feel they should be seen, et cetera, et cetera. Right. So how do we take off the clinician hat and put on the owner hat? Or, or do we split it into, how does that work? How do we fix it?
Speaker 2 (04:27):
Yeah. So there's a great quote by one of my mentors, Dan Sullivan, and it says the eyes only see the ears only hear what the brain is looking for. And we've seen this, right. You know, you're, you're thinking about buying a car. You know, the last car I bought was a Jeep. Right. I bought a Jeep. I've never seen Jeeps on the road. Oh my God. I feel like the whole world has a Jeep. Right. You're seeing them everywhere. Did they magically all of a sudden become more Jeeps in Maryland? No, because you started your, you started to tell your brain Jeeps, Jeeps, Jeeps. So it really starts with recognizing that this is an issue and you don't know what you don't know. And Karen that's, that's hard for a lot of people that was very hard for me because I'm a smart person.
Speaker 2 (05:24):
I did really well in school. So did you, so did everyone, I haven't really made a million mistakes in my, at least academic life course. We wouldn't have been through school, but then you get in the business and you realize that, you know what, I, I don't necessarily know how to do this. Maybe I should get help, whatever that means. Like, I think it's just recognizing that I shouldn't be an expert at all this business stuff, because I'd been taught. I've never been trained. I haven't done self-development and work on that. I think that's one of the biggest things we just need to recognize. We'll get into, you know, I have some specific things that people can do, some tangible things they can do. But I think I just want to get people just to recognize that that's the issue, because if you don't think that there's a problem, even though you're working 50, 60 hours a week, you're not making the revenue you want your, your staff is coming and going, or you can't get them to actually do what you want them to do.
Speaker 2 (06:30):
So you're taking on some of their job, all those things that we complain about, if you don't actually say, look, you have created this model. So the only way to uncreate this model is to start to change how you're thinking about the business. And that starts with how you think about yourself. You have got to look at yourself as the owner, the CEO, the entrepreneur, the head honcho. You have to see yourself like that. That's scary, right? I don't think myself, I'm just a PT. The problem is that's how everyone else is looking at you. And you have to own that. Now you are playing multiple roles here. I've said one time, multiple personalities. It's not really multiple personalities. It's multiple roles, but your role as a clinician own it when you're treating treat. But when that ends, you have got to shift your mind to perhaps the role as the director, and then you have to shake.
Speaker 2 (07:36):
It shifts your mind. The role as the owner, the mindset you have for each of those three is so different, especially between the clinician and the owner, how you see your business, how you see your staff, how you communicate to people. That's very different than a clinical mindset. So I think that's the first thing we have to own it. The, the, the other big thing is success is 90% preparation and 10% perspiration people may have heard that they may have heard it in different types of things. 99%. This 1% that I've heard that before, never really understood what it meant. What does that mean? It means that we are by human beings. We are naturally doers. We do do, do I call up the home Depot model, you know more savings, more doing we're here to help the doers. So doers like to do they get off on doing stuff.
Speaker 2 (08:38):
And then those people like to be busy, busy, busy, busy, which is, seems to be the mantra of everyone nowadays, what are you doing? I'm really busy, but that is very different than being productive. That is very different than being efficient. So being busy is not an owner mindset. An owner mindset is how can I be more productive? How can I run things more efficiently? How do I utilize my time? Better? That alone will change what you focus on and how you start putting your business together. So this 90% preparation stuff is all about. How about having time to think about your business. If you're busy all the time, constantly filling your schedule with patients, with meetings, with putting out the fires in your business, just constant stuff. Where's your time Karen, to just think about what is it, where's my business going in the next month or three months or week.
Speaker 2 (09:39):
You don't have that time. You're just on the hamster wheel of doing, doing, doing busy, busy, busy, and the results don't really significantly change or worse. They start to improve a little bit, but they improve only because of the effort and the work that you're doing. So now you're trapped because if you shift that all of a sudden the results will, will go down. So you get trapped by that. So that, that, that motto of 90% per preparation and 10% perspiration and having this shift of you have to slow down, you have to pause and you, we have to spend more time getting out of the immediate present. And that is my first mindset shift.
Speaker 1 (10:30):
Yeah. It's hard to sometimes get out of your business so you could work on it, you know, and how, if you can make that mind shift, I think you still, so you can make the shift of like, Hey, I'm the owner. I need to not just work in my business, but work on it. Be creative, things like that. So what advice do you have for people to, let's say once they've gotten that mindset, okay. I am a business owner. There are other things I have to do here. What, what can they do to get to that, that area of creativity and of, well, let's look at how we can streamline things and be more efficient if you're always like, well, I have to treat patients because if I don't treat any patients that don't have any revenue coming in and that's not good because I don't have a business. Right?
Speaker 2 (11:26):
So unless you bought an existing practice, we all come in as what we call it at practice freedom, you a committed clinician, right? Your solo preneur, that's it. Maybe you have an, a, maybe you have a part-time PT PTA or somebody, but it's really just you. Okay. That's how we all come in. That's how I came in. That's how you started your business. We all do that. Now committed clinician. The biggest challenge, because the challenges are different between the two examples I'm going to give the challenges with that person is, well, you got to get busy and most of your bills, dizziness is going to, or you got to get busy, meaning you got to generate more work referrals and get your schedule busy. So your job is to start delivering great care, maybe going out, meeting some different referral sources. That's what most of us do.
Speaker 2 (12:17):
And your schedule will get busier. It always happens. Then there's going to come a point where you're like, I'm running at a time. Every time I start to mark it by place gets busy. And when I stopped play starts to go down. So we call that kind of, that role of poster. And you start teetering on the next slide level of business ownership. And the next level is called overwhelmed operator. Love that term. I coined that term years ago because it just describes that type of owner. This owner has hired people. And when you start hiring people, you probably don't have a lot of organization and systems in place. You just kind of doing it. You're trying to, you know, I got some good people. I know how to judge people, but you're you still have your schedule. You're still doing your stuff. When you hire people, now you're responsible for them.
Speaker 2 (13:12):
So now all of a sudden this whole HR there's human resources stuff comes into play. Ignorance is an excuse. It doesn't matter if you're ignorant. Like I broke the law department of labor, reached out to me and say, Jamie we got to investigate you because you're doing some illegal acts. What? Well, you're supposed to be paying overtime to certain employees. I'm like, I didn't know that. I thought they were a exempt from that. Like, no, these are exam these. I mean, then all of a sudden I'm like, well, I didn't know that. And I'm like, well, you're going to find out, cause we're going to find you. And I'm like, okay, from now on, I will make sure I have someone on my team that knows that stuff. So what happens with the overwhelmed operator? You start bringing in staff, not only do you have your job now, Karen, but you start taking on other people's jobs.
Speaker 2 (14:01):
Maybe not the whole thing, but you're taking on a little bit of it. Right? And there's reasons for that. The biggest problem with the overwhelmed operator from I call it crossing the street crossing well sometimes. So it's a big, big, huge river crossing over to more of this idea of practice freedom, which I'll get to that in a minute is there's not organization in place. There's not systems in place. There's no control over one's time because you're busy, busy, busy. That's why I started with the idea of the problem is we're not thinking like an owner. You are still an overwhelmed operator thinking like maybe not only a clinician, but you're probably playing the role of clinical director is not an owner director. So leadership position in your company, but it's not where the practice owner needs to be. Right? If you're a director, you need to remove yourself from that position.
Speaker 2 (14:58):
That's where people are. They're in one of those two categories. So if you're, if you're a committed, if you're an owner, if you're a committed clinician, your job is to start bringing people in. But the more you can bring people in, in an organized systematic, having some things in place way, the less overwhelmed you'll be later on, there's still going to be somewhat overwhelmed. It's just kind of part of growing a business, but there's a way to do it where it's not so much. So one of the things that we that, that, that I want to share with the group, one of my mindset shifts that nobody spends any time on. I never did. Cause I thought it was a waste of time, whether you're committed clinician, whether you're a overwhelmed operator is the mindset shift of the best is yet to come.
Speaker 2 (15:52):
The best is yet to come. I won't get into the story around this, but really what it means is the future is brighter than the present. And it's brighter than your past. The future is brighter. You have a vision, you, you have something that you want. Is it written down? Have you taken the time to describe it? John Lennon CRA wrote, imagine, right? Talking about peace and unity. Martin Luther king has I have a dream, not, I have a project plan. I have a dream little kids go to Disney world and Disney land. But when you get older, you think that's stupid. Why? Because you're too busy doing it, doing it, doing it, doing it. You don't step out of the fray and say, where is this all leading to you? And I, before this call, we're talking about you know part of, part of the program that you're taking is focusing on, well, what are your personal goals?
Speaker 2 (16:58):
What's your purpose about what are you about Karen? See, we all have something we're about. And when you start to create that and develop that, that gives you your north star, that starts to give you direction. That's a shift. We all have to have to make, you know, I love Bruce Springsteen like the next person, but let's not have glory days. Our favorite song. Cause that means the best is in the past. So we have to shift that. Why is that important? Because it gives you a a plan. It gives you kind of like the horizon to know the direction you're moving the company. What, it also does, little known secret. What it also does is let people that you're hiring, know what they're a part of. Most of us, most of the owners, at least I can share my own story. Most of the owners I've talked to Karen. They don't have a clue, dental have anything written down a lot of a plan. They don't have a vision. They don't even have, they couldn't even articulate just a dream. Like the, you know, I just imagined the place being like this. It's usually a half a sentence of kind of, sort of, because they're just overwhelmed and busy and that's the place we have to start.
Speaker 1 (18:17):
Yeah. And, and I think getting, making that shift in the beginning, I know I can speak, well, I can speak for myself. Is uncomfortable of like, well, wait a second. I'm not in the, in this role.
Speaker 2 (18:34):
So Karen, why I agree with you, but is it uncomfortable?
Speaker 1 (18:39):
And, and again, I think it's, it's I, and again, I'm just speaking for myself. It's hard to like, let go of that control. It's hard to step away from being the clinician because part of my identity as a person and an owner is wrapped around being a really good physical therapist, not an entrepreneur.
Speaker 2 (19:01):
So what you're really saying is a there's some fear there. And the fear is, and this has been my experience working with hundreds of practice owners. What if I'd only achieve it? Yeah. Karen, I'm not used to failing. What if I don't achieve it, then I'll feel like a failure. I'm already overwhelmed. I'm already feeling bad about myself. I'm already feeling ashamed that I didn't deliver what I said to my spouse and my friends, what I would do when I opened my practice. See, I think it's more about that fear of failure. And that's one of the things we have to learn to embrace because this isn't school, business is all about trying things, failing, learning, and trying again. That is business. And if we want to protect ourselves in a little too Kuhn, you're going to be miserable. And I hate to see that I was miserable for so many years.
Speaker 2 (20:03):
You'll never hear anyone say it because I've been there. I've been in the private practice section. Now for 10 years, I've never heard one person ever telling me they're not doing well. Even though the odds are 85% of them are, how is that? Because it's pride and you don't want to tell people that stuff, but it's really happening. So by writing it down just for you, this is the exercise. Just write it down, create what's your vision. I don't care if you use six months, a year, two years, something reasonable, but just write it down. If anything was possible. And remember anything you want to do has been done a hundred million times before. There's nothing you're going to want that some other company hasn't created. So it's not like it can't be done, but anyone that helps you, you come to me, first thing I'm gonna say is, well, what do you want?
Speaker 2 (20:58):
Well, I don't know. Then how can I help you? I don't know what you're trying to keep. If you're going to hire someone, a good somebody, a good person that is going to work for you, better ask you. So what's your vision? Where are we going with this? Because they're looking at themselves as what is my growth opportunity here. So it is your duty as an owner. And to your point, yes, we as practice owners have an identity crisis. We actually don't know who we are. We have to embrace the fact that we are in owner. I know I'm going against what probably people have said before. You will always be a PT. Yes, you will always have a license. You always be a PT, but mentally you have to embrace it. You're an owner because you chose to go into business ownership. You didn't have to, it's a free country.
Speaker 2 (21:49):
You chose it. And there is more that you want. So how about we embrace it? And when you embrace it, it's amazing what you're going to be able to achieve. And you're going to make this whole process a lot more easier right now. You're making it difficult because you are battling these two kinds of brains. You're battling that clinical brain, that kilt brain that I don't know who I am. I'm just a PT and all, but I want this. I want to go on vacation for three weeks. Oh, I want him, I want to make money so I can put money away and write a check for college or, or have this or buy this. I want to help more people than I'm doing right now. And right now I'm not helping enough people. So it's your purpose. Your impact has to be the keys to this.
Speaker 2 (22:32):
So that's one thing. I do want to share a, another one. If I may. The other a growth mindset shift is focus. First one is the best is yet to come. The next one is focus. What you focus on, what you pay attention to grows. Now here's the caveat. It includes crap. You focus on a flower. You cultivate that flower. You put that little seed in there and you water it and take care of it. You're going to get a nice blooming flower. You cultivate that piece of crap and make it really nice. That maneuver is going to wreak real good. So whatever. So what does that mean? What's the manure stuff. It's the stuff that you're doing. That's not moving the needle in your business and in your life. It's the things that, although may be important. It's not what you should be doing because you can't do it all.
Speaker 2 (23:42):
And having the mindset of, I gotta do it all. I'm a great multitask. If I get one more person, tell me how great of a multi-tasker they are. Do you realize we are all researchers and science people? There's no, it's impossible for the brain to multitask. It can only focus on one thing at a time. All you're doing is focusing on a lot of one things really, really quickly. And then there's this thing called residue. This delay, right? If you're focused on something for a while and you focus on something else that delay, that thing stays with in your brain for a period of time, come on. You're not going to have a badge of honor saying what a great multitasker you are. Now. I'm not talking about the moms out there. And I, yes, yes. That's a whole nother world and I've seen it with my wife, but I'm talking about business owners, oh, I'm doing this, I'm doing this. I'm doing this. When they do that to me, they do it like they're bragging. And I go, why, why, why would you want to do that? You don't even like half the stuff you're doing. Why can't you get rid of it? And then we get back to the identity crisis. Well, I can't let it go. And there lies the issue. So focus having laser focus is like taking a magnifying glass to your business, letting the sun come in and dialing that energy. That is so strong. It can burn through wood.
Speaker 2 (25:07):
You have to have as an owner. And I've never met a successful business owner, entrepreneur, CEO that didn't have laser focus, never in any industry. Never because they couldn't be in that position. They couldn't have the level of success. I've met CEOs that their company wasn't great. Oh, they're all over the place. I've seen that plenty of times. So I don't necessarily what I had my practice. I didn't call myself the CEO. I couldn't get around that day. Those two corporate is it doesn't matter what you call yourself. Just think of yourself as you're the leader. This is your business. This is your thing. But it doesn't mean Karen that they have to do it all. No one said to dude, do it all. You're making this up. You're taking it all on. And it ain't working. If it was working, I'd be like, keep doing more, do more.
Speaker 2 (26:07):
Don't worry. We'll add more hours to the day. Do more. We'll take more time away from your family. Do more. It's not working. So focus. How do you, do you ever see the video? The invisible gorilla talk about focus, type invisible to grill. It's also called monkey business illusion. So here's what it is. There's six people, three in black shirts. I believe three. And white shirts. They're passing a basketball, right? And the, the, the exercise is count. How many passes? The white shirt? People throw to each other. That's it? That's all the directions is. I've seen it before. The first time I saw it at the end, the person goes, did you see it? And I'm like, see what? That was 18 passes. Yes. The number of passes were 18. Did you see the gorilla? And I went gorilla fricking no gorilla. There was a gorilla that come out.
Speaker 2 (27:09):
I'm gonna ruin it for people, but you have to see it. There is a grill that comes through the screen that starts dancing around and then walks off the screen. 50% of the people that see it, don't recognize it. Gorilla. This was a psychology experiment by, by the person that who the psychologist who did this. So being the smart Jamie, I just watched this the other day too. I've watched another version of it. Here's what's crazy. Of course. I saw the gorilla cause I was looking for the gorilla, but you know what? I didn't see. I didn't see the background completely changed colors. I didn't see one of the people that were passing the ball leave, like it's wild. What the brain is looking for the brain will see. So we have what's called and I don't want to get too technical here, but we have, what's called a bias. Our brain has a bias. Every single one of us, more specifically, it's called a negative bias. No matter how much we think we know, we can't think outside of our own bias.
Speaker 2 (28:17):
So the way you can kind of play with this a little bit is getting very clear at what you are focused on. Thinking through what you're focusing, then executing the plan. That's the only way to get through the bias except to have. And this is what I absolutely recommend. Someone else, someone else that's mentoring or coaching you, you don't know what you don't know and you never will, no matter how smart you think you are. And that's one of the problems we have because we are very smart people, but intellectually smart around physical therapy and anatomy. Yeah. That's great. But that's not going to help you with your business, right? So what you focus on, what you pay attention to grows. If you want more referrals, if you want more time than focus on the things that are going to help you do that.
Speaker 2 (29:17):
But the mindset shift is you have to be very honest with yourself. You have to ask yourself, do I like the results I'm getting? Do I like the income? Do I, I know we feel really weird about money and income, but it does pay the bills. Right? Can't pay the bills in likes, right? Oh, I got a thousand likes. Okay. Well how much you make nothing. Okay. You know, it does take money. It's okay to make money. What about time? Do you have control of your time? We call it freedom of time. Are you controlling your schedule? You're missing your kids' games. Are you missing events with your friends? Are you doing notes on the weekends? And so I was talking to someone yesterday, say, Jay, man, I do notes until 12 o'clock at night. I go, this is your business. And he goes, yeah, I'm working for a lunatic right now.
Speaker 2 (30:06):
Right. But that was kind of funny. So so that's, that's the thing. So I like to break it down for most of the committed clinicians and overwhelmed operators out there. 30 days, we, we have, we have a tool called a 30 day sprint. You can use that to 30 day goals. What's your goal for the next 30 days? Not 90, not a year, 30 days. What does it do you want to accomplish and choose one thing. Karen, just blend it because it's going to be hard for you to choose one because you're used to doing 20 and not achieving really any of them at least completed. So that's, that's an exercise that everyone can do. What area do you want to improve? Like I said, I gave you, I gave a bunch of examples. There's one, there's one code. I'm not monopolizing this conversation about, you know, that you're like, this is great. I have Jamie on 32 minutes. I'm like, thank you.
Speaker 2 (31:06):
I'm still answering the first question. Right? Henry David Thoreau. Great, great quote. It says it's not enough to be busy. So two are the ants. The question is what are you busy about? So by focusing more, you change your busy-ness to being intentional with what you're doing, that moves to being productive. The difference between productive and busiest productive is moving towards something that is desire busy. It's just activity. And there's a whole dopamine thing that we all have in our brain that, oh, but when I'm busy and I, I, you know, I take a post-it note and I throw it I feel so good about myself. I'm like, I know it's that quick dopamine hit that you achieve something. But the reality is you throw all of them away. You keep creating new ones and then you step back a little bit and you realize you haven't moved anywhere.
Speaker 2 (32:02):
You're still kind of doing the same stuff you were months ago or even years ago, you know? There's a, there's, there's, there's one more thing that we have, do we have time? Are we good? We're good. There's one more thing I wanna, I want to leave your audience with a growth mindset tip. And that is and this is probably now not probably it's the most important one and that is keep your tank full. And when I re referred to the proverbial gas tank, I'm referring to your energy level. We have all been in places where we are exhausted. Our energy is zapped. Our brain is fried and we just want to be left alone. If you have kids, you've been there many a times. If you have lots of patients, you've been there many a times. If you are running a business, you've been there many a times. If you've got annoying friends, you've been there many a times.
Speaker 2 (33:05):
And if something happens when you are in that state of just exhausting fed up, what's happening is your energy take low, near empty. A problem happens. How do you see that problem? Well, according to research in our beautiful little amygdala or my daughter calls it, the Amy, the gala, when emotion is high, such as when you're exhausted, fed up too much, intelligence is low. Your brain is hijacked. This goes back millions of years ago. When the Tiger's coming after you, you're not going to rationalize the tiger. Your body's going to go into overdrive and start running. However, what hasn't changed, even though we've transformed and we've we've, we've, we've, we've got all this new way. And in the neocortex, this is all old school brain stop. Something can happen. And you'll still get that feeling. You'll still get that emotional, like, oh my God, I got to react to something.
Speaker 2 (34:12):
And when your energy is low and your tank is low, you start to make really bad decisions. And when you make a bad decision with your friend, you yell at her, right? You yell at your friend, you yell at your kids, you yell at your spouse. You yell at your boyfriend and girlfriend, whoever you yell at people. And then later on you say, I wish it ends. I apologize. I shouldn't have said that. But when you make a bad decision in your business, oh boy, this is a decision that will, that could cost you thousands of dollars or tens of thousands. I've seen hundreds of thousands of dollars with literally one decision. It can cost you employees. It can cost you culture. It can cost you time and it can cost you a hell of a lot of frustration. Now imagine you're making these types of decisions, some grander than others, all the time, that's what's happening.
Speaker 2 (35:10):
Karen, we are making way too many decisions when our tank is well below halfway, and we're doing nothing to bring our take back up to full. What is a full tank? A full tank is your highest, most creative, innovative place. It's the place that you just feel on top of the world. It's the place of the highest level of confidence. It's the place that your friend says something stupid. And you're like, oh, you're foolish and come on. But that same person says something. When your tank is empty, you're going to bite our head off in business. You have someone asking you a question or someone coming to you for the umpteenth time that so w w if I want to take off next week, what do I have to do? And you just blow up on the person next day. You're like, yeah, yeah. You know, I'm sorry, whatever that person doesn't forget.
Speaker 2 (36:09):
Something like that. And when you start doing that and you start reacting, there's a difference between reacting and responding. Responding is what we do when the tank is full. Reacting is what we do when the tank is near empty. Reacting is an emotional response. Responding is a rational response. So what can we do? The fastest thing you can do when your tank is down is evoke physiology. What we do. So what's going to turn around deep breaths, count to 10, take 10 deep breaths. I guarantee whatever the problem is, it will subside. And you will think differently about it. Exercise. I know for me, when I exercise, God, I feel great, right? Anytime. And I've, I've, I've infused as I'm not perfect at it, but I've infused as, especially the last few years, especially last year during COVID when I think I might've come on here.
Speaker 2 (37:20):
And you're like, Jamie, what's the secret to dealing with. COVID pause. Just pause. Just stop. Just take care of yourself. Take care of your team. Like just personally. So I'm a great thing to do is don't make any decisions until after you exercise. I don't care if it's a walk. I don't care if it's, you know, basketball, I'll give it a round of golf. If you consider that exercise whatever it is running, you will think differently about the issue. If you have a problem with an employee, take some deep breaths and pause, do not address it in a high level of emotional state. This, if you just stop doing this so often, I will promise you, your business will get better. I promise because you'll just stop making these decisions that you don't even realize. We don't even realize we make these decisions, but then all of a sudden problems happen.
Speaker 2 (38:16):
And then we justify why. And I guarantee, at least with me, the justification was well, Jamie it's because you're in a high emotional state. That's why this problem. No, I started looking for someone to blame. I look for the prop, the answer to the problem, somewhere outside of where it really came from, that gets expensive. That causes you then to hire people you shouldn't hire to pay. I mean, I paid so much money in marketing and stuff like that. Why I was in a really bad emotional state. And I was just trying to solve it, writing a check on it. Wasn't it, it wasn't, it, it wasn't a rational thought through issue. And I did that again and again, and I did that with a lot of other problems too. So you know, when emotions are high intelligence is low. Karen, this is an opinion.
Speaker 2 (39:09):
This is a fact. We like facts as PTs. This is a fact. So pause 10 seconds, 10 deep breaths exercise before decision. And you don't have to wait for your, for your tank to get low. I know we do that. Like I'm, I'm one of those. Not only does the light come on, but that, that thing gotta be at the line. Or even below the line for me to go to the gas station. We can't do that with ourselves. When that thing gets around half, half full it's time, start, start doing some things, put this into your regular routine. Here's what I've learned over the years. I didn't realize this. So I started talking to a bunch of people around this particular point of keep your tank full. And I don't know the exact number, but it's overwhelmingly more than I would say, 80%. When you, when you get busier, when things get busier at work in the office, there's one thing that you sacrifice more than anything else. That's your, self-care you exercise. Normally you stop going to the gym, right? You do yoga, you stop it, you meditate, you stop it. You go, you stop. The thing that actually is keeping you sane and keeping you mentally strong and mentally fit. That's when you have to pause and saying, I'm the most important person in this company, my thinking and how I think about this business affects everyone in the business, including the staff and the patients and the community. So when I'm feeling like that, I know it's time to do some serious take care of me time.
Speaker 1 (40:57):
Yeah, absolutely. So now, if we start to, we'll start to kind of wrap things up here. So I just want to review some of the things that you said that physical therapy owners can do to kind of change their mindset around them being clinician, a PT an owner, to help them be successful. So you just talked about not making decisions on an empty tank or a near empty tank. We talked about changing we talked about some little like mindset tricks and tips and things like that. What else?
Speaker 2 (41:40):
Well, the, the three things that specific thing could be talked about, cause a lot of them have to do with that is growth mindset tip number one, the best is yet to come. The exercise for that is take 15, 20 minutes. You can, you can, you can handle that. Write down what the heck you want one year from today, one year from today, if you and I had a conversation and we were going to look back on to this moment, what would happen for you to feel happy about your business, about your bank account, about your family, about your personal life, what would you, what would have to happen? Write that down. I don't care if it happens or not. No, one's going to call you on it, but I want you to go through what it feels like to actually put that down on paper.
Speaker 2 (42:27):
Don't type it out on the computer. There's something special about writing it out on paper, right hand to paper. That's number one, that's number one, number two, focus, growth mindset. Number two, focus. What we focus, what we pay attention to grows. So what are you focused on? One thing for the next 30 days? What is one outcome? One goal that you want once you do that reverse engineer, that and then say, okay, in order to achieve that goal, what happens? What do I have to achieve this week? Say that exact line. What do I have to achieve for this week? Do that four weeks in a row. And I promise you, I promise you, call me out. If I'm wrong, you will be either hit the goal, go way past the goal or make significant progress, which you won't be is where you are. Excellent is the 80 tank.
Speaker 2 (43:28):
Keep your tank full. If you get into a high level of emotional state resist making decisions, or if you have to make a decision deep breaths count to 10 exercise, something that helps you increase your energy level. And then of course the second part of that is incorporate that on a regular basis every day, maybe a couple days a week, three days a week, but on a regular basis. And for whatever you do, no matter how busy and crazy life gets, do not sacrifice your time, your self care is the most important thing. There is you are not a hero by killing yourself. You don't strengthen the weak by weakening, the strong you killing and sacrificing yourself is not helping anyone. You don't need to do that. And then of course the overarching thing that we've talked about is, you know, some of the ideas around really thinking of yourself and considering yourself and talking about yourself as a business owner, right. If you're treating tree, that's great. But other than that, you own a business.
Speaker 1 (44:49):
Yeah. Perfect. All right. Where can people find you?
Speaker 2 (44:55):
Yeah, learn more. You can just go to my website practice freedom, U the letter u.com. I got some goodies on there. You can download my book on there. What I would recommend if people want to dive in deeper with me and, and just kind of, you know, you want to have a conversation. I am offering a, what we call a discovery call and we'll see kind of where you are mentally. We'll see where your mindset is. We'll see where your business is and we'll see if there's ways we can help you. We do have programs. We'll see if it's a, if it's the right fit for you, if not definitely give you some things that you can do in the meantime, maybe point you in some other directions. So you can go. I'm sure you'll put that in, but you can go to practice freedom, u.com/discovery call.
Speaker 1 (45:41):
Perfect. And yes, this will all be in the show notes at podcast out healthy, wealthy, smart.com under this episode. So last question, Jamie, what advice would you give to your younger self?
Speaker 2 (45:53):
Oh my God. Overcome your ego. Jamie it's okay. You don't know everything enlist. Some help invest in yourself, invest in your business. It will pay off dividends in the future. Not only to you, not only to your family, but for everyone that's around you, including your staff and community.
Speaker 1 (46:15):
Excellent advice. I love it. I love it. And I feel like you've given different pieces of advice each time you've been on very impressive. Cause I've asked this question before and the advice is always different, so well done. You so thanks so much for coming on and sharing. This was great advice for anyone who is a current owner or who's maybe thinking about becoming an entrepreneur. So I thank you very much.
Speaker 2 (46:41):
You're welcome. Thank you so much, Karen.
Speaker 1 (46:42):
Yeah. And everyone who's listening. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Co-President of the American Association of Pain Psychology, Dr. Rachel Zoffness, talks about treating chronic pain.
Today, Rachel talks about the failed biomedical model, pain neuroscience, and effective non-pharmaceutical pain treatments. When is the right time to refer someone to a pain coach? What are some multidisciplinary approaches to pain management?
Hear about the biopsychosocial nature of pain, how pain treatment in the US is actually about money, how thoughts and emotions affect pain, and The Pain Management Workbook, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “What science tells us is pain is not purely biomedical. It’s actually this different and more complex thing, which is biopsychosocial.”
- “Pain is complex, and doing one single thing over years and years that has not worked, is probably not the right way to go.”
- “Pain is never purely physical. It’s always also emotional.”
- “Unless we’re taking care of our thoughts and emotions, we’re actually not really treating this thing we call pain effectively.”
- “If it’s okay to go to soccer coach to get better at playing soccer, it is surely okay to go to a pain coach to get better at living with chronic pain.”
- “96% of medical schools in the US and Canada have zero dedicated compulsory pain education.”
- “Pain, by definition, is a subjective experience.”
- “Keep doing exactly what you’re doing and follow your gut. Trust your intuition, and know that following the path of the thing that you love is the thing that’s going to bring you to where you need to be professionally.”
More about Rachel Zoffness
Dr. Rachel Zoffness is a pain psychologist and an Assistant Clinical Professor at the UCSF School of Medicine, where she teaches pain education for medical residents. She serves as pain education faculty at Dartmouth and completed a visiting professorship at Stanford University. Dr. Zoffness is the Co-President of the American Association of Pain Psychology, and serves on the board of the Society of Pediatric Pain Medicine.
She is the author of The Pain Management Workbook, an integrative, evidence-based treatment protocol for adults living with chronic pain; and The Chronic Pain and Illness Workbook for Teens, the first pain workbook for youth. She also writes the Psychology Today column “Pain, Explained.”
Dr. Zoffness is a 2021 Mayday Fellow and consults on the development of integrative pain programs around the world. She was trained at Brown University, Columbia University, UCSD, SDSU, NYU, and St. Luke's-Mt. Sinai Hospital.
Suggested Keywords
Pain, Psychosocial, Emotional, Physical, Neuroscience, Treatment, Thoughts, Management, Healthy, Wealthy, Smart, Coach, Physiotherapy, Healing,
Dr. Zoffness Latest Podcast: Healing Our Pain Pandemic
Dr. Zoffness’s Book: The Pain Management Workbook
To learn more, follow Rachel at:
Website: https://www.zoffness.com
Twitter: Dr. Zoffness
Instagram: @therealdoczoff
LinkedIn: Rachel Zoffness
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the full transcript here:
00:00
Okay, so whenever so I, you will know when we're recording because like I said, I'll do like I'll do a quick clap. And then I'll just say, hey, doctor's office. Welcome to the podcast and off we go. Okay, ready? Perfect. Okay. Hi, Dr. softness. Welcome to the podcast, I am excited to have you on today to talk about chronic pain and treating patients with chronic pain. So this is a real treat. So thanks for coming on. I think you are very cool. Karen Litzy. And I'm excited to be here. Excellent. So what I what we're going to talk about today, just so the listeners knows, we're going to talk about kind of treating chronic pain from a bio psychosocial standpoint versus a biomedical standpoint. So I know a lot of people have no idea what those terms mean. So doctor's office, would you mind filling in the listeners as to what a biomedical model is and what a bio psychosocial model is? to kind of set the tone for the rest of the podcast?
01:10
I totally Can I talk about this all the time, because it makes me so mad. Okay. So the biomedical model is the one that we all know the best, because it's the way we've been treating pain for many decades. And the biomedical model of treating pain and health in general, is essentially viewing and understanding and treating pain as a problem that is purely the result of bio biological or biomedical processes like tissue damage and system dysfunction, and on anatomical issues, and then throwing pills and procedures at it. That is how we've been treating pain for many decades. And of course, we know it isn't working, we have an opioid epidemic, the opioid epidemic is getting worse during the COVID pandemic. People are really suffering, chronic pain is on the rise. It's not being cured. It's not magically disappearing. incidence isn't even decreasing. So the way we're doing it is broken, and also very expensive for people living with pain. However, what science tells us is that pain is not purely biomedical. It has never been purely biomedical. It's actually this different and more complex thing, which surprises nobody, which is bio psychosocial, which is a big and complicated word, but makes intuitive sense, once we start talking about it, I think to people who have experienced pain, which means that yes, of course there are biological processes at work when we're living with pain, acute and chronic. And I can say what those mean to short term pain versus long term pain, longer term pain.
03:02
Yes, and there are also many other processes that work too. So if you imagine this Venn diagram of three overlapping bubbles, which I draw a lot, but I cannot draw right now, we've got the biological or the biomedical bubble on the top. And then we've got the psychological bubble. And that's the one that I struggle to explain to people the most, because I think there's so much stigma around this idea that cognitive and psychological processes might be involved in this experience we call pain because there's so much shame and embarrassment and stigma around anything to do with psychology, which is so unfortunate. But in this psychology bubble of pain, there's a lot of stuff that I think people know intuitively can amplify or reduce pain. So there's thoughts about your body and about your pain and just thoughts you're having about life in general. There's emotions, like stress and anxiety and depression, even suicidality. And we know that negative emotions amplify pain. And we know that positive emotions can sort of turn pain volume down, there's memories of past pain experiences. And those are stored in a part of your brain called the hippocampus. And we know research shows that memories of past pain experiences can change your current experience of pain. And also in the psychology bubble, we've got coping behaviors. So that's quite literally how you deal with the pain you have. And a lot of us who have lived with pain, and that does include me engage in a lot of coping behaviors that make sense in the moment. But actually, they can make pain feel worse over time. And a great example of that is the resting indefinitely plan or the doing nothing plan, as I like to call it which is totally, you know, normal and natural for those of us who pay into Engage in because when your body is telling you, you know that you're hurting, it's understandable that the thing you think you're supposed to do is stop all activity. But ultimately, what we know about that particular coping behavior is that it makes chronic pain in particular worse over time. So the do nothing plan or the stay home or rest indefinitely plan is a coping behavior that lives in the psychology bubble that can actually make pain feel worse. And of course, there's coping behaviors that can make pain feel less bad, like the counterintuitive things like leaving your house and seeing people and walking and getting out into the sunshine. And, you know, these things that we don't necessarily know can help pain. And then the third, overlapping bubble, and our bio, psychosocial Venn diagram, is the social or the sociological domain of pain. And that's what I like to call the everything else bubble. So it's socio economic status. And family and friends have culture and race and ethnicity and access to care, and socio economic status, and history of trauma and early adverse childhood experiences, and culture, and context. And environment, like quite literally, everything else your environment, believe it not changes the pain you feel. And in the middle of those three things, and I know that's a lot of things, is pain. So when we try and pretend that pain is just this simple biomedical thing, the treatments don't work. And I think all of us who have lived with pain know that our pain is much more complicated and sticky. I know that was a lot of words.
06:44
No, and, and I'm glad that you described everything in the way that you did, because I think that gives the listeners a really good idea of what's in each of those bubbles. Number one, and number two, how complex pain actually is. Exactly, it's not. So if I think if the listeners take away anything from this conversation, if pain is complex, and doing one single thing repeatedly over years, and years and years and years, that has not worked, it's probably not the right way to go.
07:15
That's right. And you know, the other misconception that we all understandably have is that, you know, the way to treat pain is just by going to your physician. And, of course, that makes perfect sense. But we have this misconception in western medicine, that either you have physical pain, and you see a physician, or you have emotional pain, and you go to a therapist, or a psychologist, someone like me, and the really fascinating thing about pain, and the reason I love studying it, and treating it and talking about it so much is that neuroscience tells us that pain is never purely physical, it's always also emotional, because the part of your brain called the limbic system actually processes pain 100% of the time. So pain is always both physical and emotional. But most people don't know that most people have never been told that. But the limbic system plays a huge role in the experience of pain. And we know that, you know, emotions are always changing pain volume all the time. So this idea that pain is either physical or emotional, is not actually a thing, you know, and the way we treat pain by going to a physician exclusively is not actually nine times out of 10, probably more than that going to actually, you know, be the answer for any sort of chronic pain problem.
08:37
And so I'm glad that you brought that up that yes, we know emotions play a role in pain. And as a matter of fact, the International Association for the Study of pain, change their definition of pain in 2019, I believe to include that it is an emotional experience. And I think that really set the stage for greater discussion and research, which I think is amazing. But when you say to someone,
09:05
let's see, can I interrupt the flow to say, they did change the definition, but the the word emotion was always in there? Oh, was it? It was? Okay.
09:16
Let me so when we talk about kind of the emotional part of pain, and I have had patients say this to me, which probably meant I was explaining it incorrectly, and I take full responsibility for that. And I'm sure you've heard this before his patients saying, so you're saying it's all in my head. Totally. And how do you react to that?
09:42
Yeah. I love that. You asked that question. I think probably the worst thing about being a pain psychologist is you know, you're the last stop on the train. You're the last person anyone wants to see nobody wants to go to a psychologist or a mental health professional for a physical experience like pain. And I know you can't see me, but I'm putting air quotes around the word physical. Because again, pain is not a purely physical experience. It's physical and emotional. But of course, no one wants to go to a pain psychologist for pain, right? You think you're supposed to go to a physician, and a referral to a psychologist means you must be crazy or mentally ill or the pain is on your head. And no, that's not what it means at all. And I find that the way that I most effectively target that is by explaining, believe it or not pain neuroscience. And I, I usually do that in the simplest way, I know how just by distilling down that, that, you know, it's easy to believe that pain is something that lives exclusively in the body, right? Like, if you have back pain, it's so easy to believe that that pain lives exclusively in your back. But what we know and what neuroscience has taught us is that actually, it's your brain working in concert with your body that's constructing this experience we call pain. And we know that because of this condition called phantom limb pain, wherein, you know, someone will lose a limb like an arm or a leg and will continue to feel terrible pain in the missing body part. And if pain lived exclusively in the body, no limb should mean no pain. So if you the fact that you can continue to have terrible leg pain, when you have no leg tells us that pain can't possibly live exclusively in the body. And I find that when I explain this to the patients who come see me, first of all, there's more buy in that the role of the brain in pain is really significant. And second of all, it sort of gives me some leverage to then explain that, again, one of the parts of the brain. And one of the most influential, influential parts of the brain that processes pain is your limbic system, which is your brain's emotion center. So unless we're taking care of your thoughts and emotions, we're actually not really treating this thing we call pain effectively, we're just treating one small component of it. So that's, you know, and I also always, by the way, validate that, of course, you have, you know, of course, it feels like someone's saying that the pain is on your head, or that it's a psychological problem. Because of this, again, this like false and ridiculous divide we have in western medicine between physical pain and emotional pain, when neuroscience has known for decades that that's not actually a real distinction, like your head is connected to your body 100% of the time, you know?
12:24
Yeah, absolutely. And as let's say, as a practitioner who's not a pain psychologist, a physical therapist, occupational therapist, maybe your yoga Pilates, and you are working with someone with persistent pain? How, how can we encourage our patients or recommend to our patients, that, hey, you might really benefit from seeing a pain psychologist, without them thinking that we're telling them they're crazy? Yeah.
12:57
I do think that taking 30 seconds, or maybe even 60, to explain, you know, this basic painter science thing. And the phantom limb thing is a really, really effective strategy. So anybody can use that. That piece of information. You don't have to be a pain psychologist. So that's thing one is just like taking a few moments to talk about how pain works in the brain. I think patients are so grateful to learn that no one's ever told them this before you're going to be the first person to ever let them know. And then the other thing that I always do is a trick that I learned from a really nerdy journal article I read years ago by a guy named Scott powers. And he said that one trick that we can use is to call pain psychologists or you know, therapists who are trained in things like cognitive behavioral therapy for pain, pain coaches, and I love that. So I usually tell physicians and other allied health professionals to refer to me as a pain coach. And the way I pitch that to families and tell other health care providers to pitch it to their patients is to say, if it's okay to go to a soccer coach, to get better at playing soccer, it is surely okay to go to a pain coach to get better at living with chronic pain. Because living with pain is so hard. And you deserve support. You know, and usually that removes the stigma and the stigma, especially when you present that in conjunction with some science that supports the role of the brain and the role of cognitions and the read the role of emotions and coping behaviors. In the experience of pain, I find that that really is super effective.
14:41
Yeah, that's really helpful and a great way to frame how to frame that recommendation to someone coming from someone like me coming from a PT because people often come to physical therapists I mean, it's in the name Because they want us to heal or to fix their physical problem, which in this case is persistent pain or chronic pain. And so then that leads me to my next question is, as a physical therapist or as someone who's working with the body, when do we refer this person to a pain coach or pain psychologist?
15:25
I'm curious to know what you're going to think of my answer. Ready? Here's my answer. I once had a friend who said to me, man, like, everyone's always going around talking about how many miles they ran today. And you know, how you like the Strava app, like, you know, how many miles they biked? And how many hours they did yoga this week? And can you imagine what it would be like if everybody, you know, came, came to each other and started bragging about how many hours they spent working on their shit? Like, what I spent three hours working on my anxiety today, or like my family stuff? Or like, my complicated relationship is, like, just why do we prioritize working on the body over working on our minds? You know, it's so strange. So my honest answer is if you're ever treating a patient who's living with chronic pain, and again, that's pain that's lasted three or more months, I think it's worth a referral to a pain psychologist or therapist who's trained in cognitive behavioral therapy. I just, I can't imagine any human being who wouldn't benefit from the opportunity to navigate the complicated experience that is living with pain and having someone in the role of support and coping behavior coach is just, you know, and partner and in processing, the experience of it just just seems to me like such a great gift to be able to give to patients.
16:51
And my answer to how I react to it is I agree. And, and again, this takes into a takes into account really this multi discipline, multi disciplinary approach to pain and approach to pain treatments and management. And so in your opinion, what makes that multidisciplinary approach effective for that patient?
17:20
I mean, what the research shows is that trying to approach and treat pain from just one angle is usually not sufficient, because as we were saying at the beginning, pain is such a complex, bio psychosocial thing. So if we're just looking at the biomedical components, we're not really doing our job, if we're just looking at the psychosocial components, we're not really doing our job. So, you know, a multidisciplinary team as a team made up of, you know, psychologists and pts, and OTS and physicians and nurses and biofeedback providers, and all these different people who are sort of coming at this complicated things from maybe slightly different angles and perspectives. And when we do that, what the research shows is, we have the most robust outcomes, the care is most effective, and the most comprehensive, and people walk away with a whole tool belt of tools to use when treating their pain, you know, across scenarios and across symptoms. So multi disciplinary is really like, how can we all come together as a team with our unique backgrounds and our unique training because, you know, as you know, trainings, especially in the United States, the disciplines are also siloed. You know, like, psychologists are trained in this one way, and pts are doing this thing over here. And OTS are over there. And anesthesiologists are over there as physiatrist. Or, I mean, it's just it's so fractured. So a multidisciplinary team is hopefully working together to target this complex animal that we call chronic pain. And what's really interesting is, you know, I have a private practice, where I see a lot of patients with chronic pain. But I feel like the bulk of my work sometimes is coordinating care with this really complicated treatment team. And I'm seeing a really complicated patient right now who has crps complex regional pain syndrome, which is a really tricky, chronic pain syndrome. And, you know, the way that we his case has been so complicated. It's been many years of treatment. And I think today as a team, we finally decided upon a treatment plan. And it really wasn't until we all were talking that that came together and jelled. So I think that's one of the most important components of treatment actually.
19:38
Yeah, I, I agree. And and when you're in private practice, like you said, sometimes it can be a little bit more difficult, but the more communication you have with people on that team, again, we're doing all of this for the person in the center and that's the patient and so being being able to provide vied so much coordinated care for that patient. Like you said, the research has shown that this is that this works versus a piecemeal, one person's doing this over here. And someone's doing this over here, and they're hearing, and then the patient's hearing contradictory treatment plans. And so it gets really confusing.
20:21
Yeah, it gets super confusing when there's, it's almost like too many cooks in the kitchen, if you're not working together, because they're getting all this different advice from all these different people. And oftentimes, and I'm sure you've seen this, too, they're on, you know, 40, they've tried 40 different medications by the time they've gotten to you. And, you know, I mean, I think what it leads to is like, this treatment, burnout, where like, our patients are just so burned out on all the treatments they've tried, and they have this sense of hopelessness, like, nothing's gonna work. Nothing's working. So far. I've tried all these things. I've seen 40,000 million doctors, and, you know, I've, yeah, I've tried herbs. And yeah,
20:58
I've heard that from people like, they're like, I don't want to go to one like I'm all doctored out, if I have to go see one more doctor, or take one more medication, or do one more procedure, or one more scan, like I'm done. I don't want to do this anymore. Yeah. And I blame them. Yeah, it's exhausting. It's totally exhausting. And you know, we've been talking about things that don't work. Right. So we talked about all that being on medication after medication, opioids, we know these, they don't work for people with chronic pain. So let's talk about non pharmacological treatments. And what does work or what can work for people with chronic pain, so I'll throw it over to you.
21:44
Yeah, so non pharmacological treatments, there's like a whole host of them, there's a wide range of them. And there's a lot of literature on a bunch of different things. So what I use the most in my practice, because I really love it and have found it to be so effective is cognitive behavioral therapy, or CBT, which is different by the way than CB, cb, D, that's something different CBT cognitive behavioral therapy. And an arm off of that is a treatment called Act, which is acceptance and Commitment Therapy, which is become very big in the PT world, which by the way, originated from CBT, and was adapted for pain. There, there's also Mindfulness Based Stress Reduction, or mbsr, which has a huge literature base for the treatment of chronic pain. And there's other things too, like biofeedback, I happen to really love as a treatment for pain. And there's a whole host of other things, too. But, yeah, God,
22:43
I was gonna say, could you explain briefly what biofeedback is so that people understand what that is? Exactly.
22:50
I'm so glad you asked. I've been doing this for so long that I forget. I just forget that. Certain things are not known entities. But I also did not know what biofeedback was when I first started treating chronic pain. And so I'll someone said to me, oh, you're treating patients with pain, you should refer them to biofeedback. And I said, You know, I don't refer my patients to things that I don't understand. So I did a buttload, of reading about biofeedback for pain, and I got a bunch of books. And then I found myself a biofeedback provider. And I went to this gentleman, his name is Dr. Eric pepper. Dr. Pepper is just a great name for any doctor. And He is a professor at the University of San Francisco and I admired him right away, he was obviously very smart. And he sat me down in a chair. And he hooked me up to this machine. And he said, This machine is going to read a bunch of your biological outputs, it's going to read muscle tension, galvanic skin response, your finger temperature, and a bunch of other things, your heart rate. And I was like, what that's really interesting. And he showed me which monitor was, you know, giving me feedback about which thing and hopefully you're picking up on the fact that there's biological processes that you're getting feedback about? And he said, and now I'm going to teach you to raise your finger temperature to 90 degrees, using your mind. And I said, Excuse me, sir. I am a scientist. And I do not believe in Voodoo. And he said, Well, how about you just try it out and see how it goes. So he did a couple of techniques with me had me close my eyes, he did some relaxation strategies, and diaphragmatic breathing, and he used imagery of like hot soup and hot air flowing down my arms from my shoulders into my fingertips, and autogenic training and autogenic phrases and that's when you say things to yourself that are suggestive like my arms are heavy and warm. My hands are heavy and warm. And as I was doing, as I was doing all these things, I noticed, because the machines were giving me feedback about my biology, that my hand temperature was going up. And within two sessions, I was able to warm my hands using my mind. And I am a person with chronically cold hands, because I'm stressed out all the time. And no one had ever told me that cold hands and feet, by the way, are a sign that you are stressed out. So I can now warm my hands on command, which is absolute magic. And when I teach it to my patients, they oftentimes say things like, Oh my god, I can make fireballs with my hands with my mind, what else can I do? And that's exactly what we want. For people living with pain, this idea that the mind and body are connected 100% of the time, and that you have more agency and control over your body than you thought you did. And you can make changes to formerly unconscious biological processes like skin temperature and muscle tension and pain. And biofeedback teaches you some skills to do that. Which is why I really like it so much.
26:13
Yeah, it sounds so like sci fi doctor who kind of stuff. Dr. Pepper. Exactly. Yeah, right. Exactly. Right. But yeah, it just sounds like Wait, what? But yes, I mean, I've never I have not done biofeedback myself, but it is something that I'm just constantly interested in for the exact reasons that you just said, like, Whoa, I can control what my body does. This is pretty cool.
26:41
It's worth it, I highly recommend it. It is so worth it. It's it makes you feel like, you know, it's this sense of like, if you almost feel like the Incredible Hulk like gotta have all this untapped power and potential that I just didn't even know about.
26:55
Yeah, it's, it's wild. Thank you for giving us that kind of definition of biofeedback, because I guarantee a lot of people who are listening did not know that at all. I didn't either, I totally didn't either. Very, very cool. So now, all of this, these non pharmacological treatments, CBT, a CT, biofeedback, we can maybe put physical therapy, occupational therapy into that as well. I mean, obviously, all of these things, cost the system money cost the patient money. But let's talk about the money aspect of treating pain, especially here in the United States. So what, you know, when people think about treat treatment of chronic pain, they often don't think about the money involved. So I will throw it over to you to kind of elaborate on that, and what does what that means for the patient and for the system.
27:52
You're actually making me realize that when you asked me about non farm approaches, I of course, immediately went to like, you know, like psychological treatments for pain. But yeah, of course, you're right, PT, OT, all these things, of course, are all the things and approaches. Yeah, absolutely. So yeah, it was a really sad day for me, when I realized that the treatment of pain historically has actually been about money. That was a really sad wake up call for me. So I used to be a member of this organization called the American pain society, it was very well established, very well known organization. And they went belly up after it came out. And I don't know if this is proven or not. But I should say, after they were accused of taking money from Big Pharma, to promote the use of opioids for the treatment of pain, despite the fact that it was known that opioids a were highly addictive, and habit forming and B sensitize the brain to pain over time and are therefore not actually effective. Because if you go off of them, as most people who have tried this, no, pain feels worse, your brain is actually more sensitive to pain. And so they went belly up, and they were, and then I read this book that was formative for me, by Anna Lemke. Le MBKE, who is now a friend of mine, called drug dealer, MD, drug dealer, MD, a very controversial and very compelling title. It is a thin, little book, I think it came out in 2016. If I'm not mistaken, I read it. Or I should say, I consumed it in a couple of hours. And I am not someone who writes in books. But I must have written on every page of this book. You must be joking. Oh Mfg. Like curse words and exclamation points. Because essentially, it's the story of how pain medicine has been about earning a buck off of people who are suffering and as we all know, with these lawsuits that are now how Like with the Sackler family and a lot of and also big pharma, you know, what we're learning is that despite the fact that these people and these companies have known for many, many years that opioids are highly addictive, highly habit forming not actually effective over time. And, you know, especially in high doses. Yeah, it's sort of this story of like, you know, follow the money. It's sort of horrifying. So, you know, I also have had conversations with physician colleagues who say things to me, it's a true story that, you know, it's clear that pain psychology plays a huge role in pain and pain management, and would be hugely helpful as with all of these psychosocial treatments, but that a lot of the times because insurance doesn't reimburse these treatments, they either don't get recommended, or they don't get integrated into pain management programs, even at hospitals sometimes, because insurance reimbursement is so crappy, which is just like another eye opening moment like we wait. So you're saying that, you know, these things work? You say that, you know, they're effective, but we're not recommending them and we're not hiring pain psychologists, because insurance doesn't reimburse. So again, it's a money thing. What? So the effective treatments are out there, they're known entities. But, you know, big pharma has billions of dollars to, you know, promote this idea that pain is a purely biomedical problem that requires a purely biomedical solution. So as long as you believe that you're going to buy into that model, and you know, as long as insurance companies are not reimbursing non farm approaches to pain, then you know, we're going to say stay stuck in this loop of treating pain, like a biomedical problem when we know it's a bio psychosocial one. So it's really complicated. Just this discovery that pain medicine has historically really been about the dollar. And it's sort of nauseating and horrifying.
31:56
Well, I mean, I think you can take away pain from that and just say medicine.
32:00
Yeah. Insert health condition here.
32:03
Yeah, yeah, I think it doesn't matter what it is, right? Because it's always going to come back to following the money and where, where can you get the biggest bang for your buck? And unfortunately, that, like you said, Those non pharmacological treatments are oftentimes not covered. So you're getting zero bang for your buck. So as a business, which a hospital is, even if it's not for profit, or an outpatient clinic, are you going to do things you're not going to get reimbursed for? Right, you know,
32:35
no, you know, that's true. And like, I don't mean to sound on empathic. Like, of course, yes, hospitals are businesses, and they have to stay open, and they have to earn money. So so the question for me, like, as I roll along, in this world of this totally insane world of pain medicine, and build my own business, by the way, like, how do we change the system? Like, yeah, we really are patient, patient centric, and like our goal, actually, at the end of the day, is to help our patients get well, what needs to change first, like, does public perception and understanding of pain need to change first? Like, do we need to be training our healthcare providers across disciplines better, like in PT, school, and in OT, school, and in psychology programs like mine, where By the way, I was in school for 40 100 years, and I got zero training and pain, like in my undergrad, brown neuroscience class, we learned about pain, and I became obsessed, and then like, wrote papers and stuff, but but that was it, like not, I have two master's degrees never learned about pain. At no point in my PhD program, did we get training and pain? So? So like, do we need to go, you know, backwards and insert pain education programs in medical schools? Yeah, I know, I know, you and I have talked about this, like the statistic that I'm obsessed with, like 96% of medical schools, in the united in the United States and Canada have zero dedicated compulsory pain education. So it's like, where do we start with this problem, isn't it? Do we like go after the insurance companies and reimbursement rates? where like, where the it's the system is so broken, I sometimes get discouraged, like, where do we start? But I think I actually think what you're doing is a really great place to start, like educating healthcare providers, and the general public about pain, and getting enough people riled up and angry about the way pain has been mistreated, and the way we're Miss educating our health care providers are just not even bothering. Maybe that's the place to start. Like maybe if there's enough of a clamor, and enough people are pissed off about it. Something will change.
34:38
Yeah. And and I agree, I think education, education, education, it has to start there. And especially in medicine, in medical school, especially with the physicians who are oftentimes they are the frontline providers, right, your your regular, your local PCP, primary care physician is often your frontline person and But they're also the people who were traditionally prescribing opioids for everyone, when they would come in with back pain instead of saying, Hmm, maybe maybe you need to see a physical therapist or a pain psychologist, let's sit down and talk to you. How can we let's find out what your needs are, what your bio psychosocial needs are. And so I think if, as the practitioner if you're not getting any education in that you don't know what you don't know. So you're not going to do it. And then I agree, I think, and I think insurance companies need to reimburse doctors and therapists across the board to talk to their patients. Talking doesn't get reimbursed procedures get reimbursed. Right. Right. What's the most important part of diagnosis when you're with a patient? talking to them, understanding what's going on with them, like that is paramount, and that needs to be reimbursed. But insurance companies won't do that they won't reimburse you for talking with your patient. Especially if you're like a PT, we get reimbursed by codes. And and none of those codes are, I'm going to really sit down and try and get into the nuts and bolts of what my patient's problem is. So
36:20
yeah, we need to code for pain, education, community, healthcare provider to patient.
36:25
Yeah, yeah. And some people say, Oh, you could use like the neuromuscular, neuromuscular treatment code for that. But there should be a code for let's talk to our patients, there should be a code for the subjective exam. Yep. Yeah. Oh, yeah. Because how were you supposed to learn about their bio psycho social situation, if you can't talk to them? And ask those probing questions, ask those open ended questions, like you said, In the beginning, bio, psychosocial, a lot of things go into that bucket. And we as the practitioners need to learn as much as we can about all those things that go into that bucket, if we're going to treat this patient efficiently.
37:10
There's so many things in the bucket. And I think, when we assess issues that have to do with pain, we really are assessing the biomedical bucket like 99% of the time. And, you know, if we really are thinking about this as this Venn diagram with three bubbles, if you're only assessing or looking at the biological domain of pain, you're literally missing two thirds of the pain problem. It's just wild to think about it that way. Yeah, if not more? Yeah, yeah, exactly more right now. So like, maybe all of us should be assessing for history of trauma. And maybe all of us should be assessing for aces, the adverse childhood experiences, which we know there's like this slew of studies that show that aces impact, you know, the development of chronic pain and illness and adults, maybe we should all be assessing for, you know, abuse and, you know, poor access to care. And just like so many things that we need to assess for if we're actually going to, you know, do a workup of pain, and instead of just this, you know, tell me about your anatomical issues. And let me do some scans.
38:14
Right, right, on a scale of zero to 10. How would your pain? Oh, it's a 10 out of 10? Well, this is like my little soapbox is what I hate. I see this a lot in physical therapy, student Facebook groups, things like that. Yep. And you know where I'm going with this? They'll say, Oh, well, if someone comes to me, and they're 10, out of 10, I'm going to call the ambulance because they must need to be in the emergency room. Poor education, that therapist was not educated on pain. No, I've not. No, that's wild. Yeah, I hear this all the time. Or those similar Sam 10 out of 10. It's a really, because if like I chopped your hand off, that would be 10 out of 10. So what's your pain now?
38:57
Right? Like this? Right? This lack of awareness that pain, by definition is a subjective human experience. And whatever your patient says it is, that is what it is. And you you actually don't get to argue with them about it. You don't negotiate down someone's pain. Right. And I mean, I think what I've learned over time about pain is there's really valuable clinical information when your patient tells you, like I hear a lot of times like 11 out of 10 literally what your patient is communicating to you is I can't handle this anymore. It's beyond my capacity to cope with this level of suffering. That is what they're saying to you. And usually also, at least for me as someone who really, really likes and appreciates the pain catastrophizing scale, the PCs, which is a potentially controversial term, some people don't like the term catastrophizing, I happen to appreciate it. I think it's very valuable, but don't want to go down that rabbit hole. But the pain catastrophizing scale, but they're also telling me is that when people tell me their pains, Out of 10 or an 11 out of 10, there's a high likelihood that their thoughts around their pain are very intense and catastrophic, and that they're having very intense emotions around their pain too. So it's good clinical information. You know, like you said, You can't bargain with someone about their pain number. Yes, we don't pain haggle. Right. Right. It's not like being at the market. No, like a price price that you get on fish. But but there's rich clinical information in there, if you're willing to, like, Listen for it, they're telling me that they're having an emotional experience that's beyond their ability to
40:37
navigate. Right to cope. And, and that's where I think like, I'll ask that question to all of my patients, because for me, that's my window to crawl in, and really get down to maybe the psycho or the social part of their pain experience. So like you said, if someone says to me, oh, my pain is like, it's at 12 out of 10. Today, and I'll say, Okay, well, can you tell me a little bit more about that? You know, what are you? What are you? What are your feelings around that? Or what's going on at home? What are your responsibilities at home? How does, you know? How does that play into why this pain is? 12? out of 10? Today, right? Right, you know, so it is, like, I always ask the question, but it's a nice way to kind of get in and be able to ask more questions. And, and just because someone says their pain is 12 out of 10, it doesn't mean you call the ambulance, they shouldn't be in the emergency room, they probably worked all day have to go home and have two kids to take care of. Yeah. And they're doing all of this at a 12 out of 10. because like you said, they've reached the end of their way to the ladder. And our job as clinicians is to increase their capacity to handle that. And how and to do that, like you said before, through a multidisciplinary approach to pain management is really the way to go. Because now you have more people who can add to that capacity. Yep. So anyway, that's my soapbox. I will come down stepping down from the soapbox. I appreciate your soapbox. I think Kevin, I'm Sherif share box, but it drives me crazy. Okay, so we talked a lot about different treatments. And I want to talk about treatment that you have created the pain management workbook. So let's talk about that. And how this book that you wrote, can help people who are experiencing pain.
42:40
One of the nicest emails I got in the last couple of weeks was from someone named Karen Litzy, who responded to my email and said that she really liked the pain management workbook and was referring to her patients. And I happen to admire Karen Litzy. So I was really flattered by that. So so the pain management workbook isn't on its own, like some new fangled treatment plan. But rather, I got really frustrated by what I felt like was a lack of resources out there for people living with pain, and also for healthcare providers. In particular, you know, I am a nerd, like a real nerd. And I think pain is just so interesting, and complex and fascinating that I have like, amassed all of these books and journal articles and, you know, resources. But I felt like there really wasn't something that synthesized it in language that all of us can understand and easily give to our patients. So I took a lot of stuff that I loved and was reading, like there's a book called pain, the science of suffering, that I happen to really love. And there's all this work by Lorimer, Moseley, and Adrian low in the PT world, I happen to really love the way I love the language they use for explaining pain. And there's all this neuroscience literature out there that I think is so fascinating and so useful, like melzack, and walls, gate control, theory of pain, and all the things that have evolved from there. You know, and there's all these workbooks on cognitive behavioral therapy for pain, but I couldn't find something that, in my mind, put together all of it into one resource that, you know, anybody with pain can pick up and use right away and use have exercises and guided audio and handouts and all that stuff. So So I wanted to create something that was very user friendly, and I felt like especially during COVID, having accessible and affordable resources could not be more important because here we are talking about how pain at the end of the day is often about money and care is so expensive, and you know, cognitive behavioral therapy and these other things that are not easily or readily reimbursed, end up costing families and patients, sometimes many 1000s of dollars and it should Then be that way. So I literally took everything I was doing in my practice, and everything I was reading and stuck it in a workbook. So it's a lot of pain education. And I have to say, you know, a big thanks to Lorimer Moseley, and Adrian Lowe, who both of them were kind enough to agree to read through my pain education content and give me feedback and consultations and edits, which was like, so kind, and they didn't even charge me anything. And I offered to pay them both. And I wish they had taken my money. But yeah, I wanted them to vet the content. So there's this pain education piece, and then it's a series of chapters of tools. So, you know, again, affordable, accessible care isn't just, by the way, here's how pain works. It's now what can I do about it? So I wanted to make sure that I was offering, like a tool belt of options for healthcare providers to offer their patients like here are 17 different pain management strategies that have evidence of effectiveness that come straight out of the literature, you know, pick a few that work for you, whether it's mindfulness or using guided imagery, or, you know, cognitive strategies, or, you know, sleep hygiene and nutritional tips, like, how do we put this all together to create a unique pain management plan for each one of our unique patients who walk through our door with a unique profile of suffering. So that's how that happened. And I should also say that the book almost did not happen, because my deadline was in 2020, which, as everyone knows, was a shit show of the year. My, my bandwidth was zero, I would sit down to edit, you know, my lovely publishers would send me a couple of chapters, and they'd say, here are some edits, go ahead and make some changes. And I like, couldn't even read through the work I had written, I like my brain just was on overdrive. And I was trying to process what it meant that we were in the middle of a global pandemic. And I sent them an email, and I was like, you guys, I don't think I can do it. So the book almost didn't happen. But in December, it was actually shockingly painstakingly born. So I'm more proud of it than anything I've ever done. I don't know if anyone will ever read it. But I, I'm very proud of it. So I hope it's of use to health care providers to people living with pain.
47:21
Yeah, absolutely. And is this only for adults.
47:25
So the pain management workbook I wrote in language that's usable for everybody. I mean, it's not only for adults, it's. So the book I actually wrote first is called the chronic pain and illness workbook for teens. So it has a lot of similar content, but I wrote it for kids, because there just isn't anything out there for kids. And there's even less for health care providers who are working with kids with pain. So this is adapted from that it has like twice as much content, I would say and is expanded content. So the pain management workbook is sort of intended to be for everybody. And the chronic pain and illness workbook for teens is more specifically for kids in the health care providers working with them. But I've been told by people who just have that book that they have used it successfully with adult patients, too. So
48:14
yeah, so excellent. And where can people find all of this and find you if they want to get in touch with you? They have questions. They want the book, they just want to chat, where can they find you.
48:24
So the pain management workbook. And the chronic pain and illness workbook for teens are both on Amazon. And they're like 20 bucks, which is so much less expensive than around of cognitive behavioral therapy. But I do recommend oftentimes to healthcare providers that they offer the book to their patients, and then offer to go through it with them. Because it's just so nice to have a pain coach to be going through a treatment protocol with. But of course, it can be used as a self help book, you know, on your own. I
48:50
just like love that. I
48:51
love the supportive model. So yeah, there are those are on Amazon. And yeah, I have a really dorky website that has a ton of resources on it. It's just my last name. It's softness, calm. And there's a resources page with like, apps and websites and books and podcasts and guided audio and all sorts of stuff for people living with pain and their healthcare providers. And I also joined Twitter during the pandemic, because I don't know, it seemed like social media was where everybody was, and I couldn't see any of my friends and I couldn't go to conferences. I couldn't have conversations with cool people like you. So I joined Twitter and Twitter, my Twitter handle is at doctors office. That's been really interesting and fun. It's been a really interesting platform. That's I think that's actually how I found you. And then I'm also on Instagram where I post some pain education content too. And that's at the real Doc's off, because I couldn't think of a better name and I got really nervous because social media makes me nervous. So
49:49
well, at least now people know where to find you. How to get in touch with you where to get your book. So this is great. This was a great talk. I you know, I could keep going on and on and on too. about this, I could do like a 10 hour podcast, just on on pain alone. Because it's something I'm passionate about. And it's there's just not enough good information out there for people to access. So hopefully people listening to this will then access some of your resources and education, education education right. Now, before we end, I have one last question for you. And that's knowing where you are now in your life. And in your career, what advice would you give to your younger self?
50:33
What advice would I give to my younger self? Oh, wow, you know, the advice I would give to my younger self is keep doing exactly what you're doing and follow your gut. And trust your intuition and know that following the path of the thing that you love is the thing that's going to bring you to the place you need to be professionally. Like, I wanted to live at the intersection of medicine and psychology, and education and science writing. And I couldn't figure out how to do that. So I had all these different jobs. You know, I was like, a science teacher at the Wildlife Conservation Society. And I was a science writer at a Science Magazine, and I worked at the NYU child Study Center, and I got a PhD and I just couldn't, but but I think, you know, organically what happened over time, just from following my passion, my like, actual passion is that I was able to do all these things. So now I have a private practice. And I'm seeing patients, and I'm writing books. And I have a column in Psychology Today called pain explained where I do a lot of science writing about pain, and I'm teaching pain education at Dartmouth, and at UCSF, which I deeply, deeply love because I get to connect with physicians and other health care providers. And, you know, it's just sort of the it is sort of naturally and organically, exactly what I feel like I was called to do you put it out, you put it out into the universe, and it happened. Yeah, I mean, but not without a lot of trial and tribulation. But I think I would just tell my younger self to trust your gut and trust your instinct and you you actually are on the right path. If you're doing something that you love, you are on the right path, even if you don't know
52:09
- Excellent advice. Well, Rachel, thank you so much for coming on the podcast and chatting today. I really appreciate it and I appreciate you. So thank you so much. Thank you for having me. Absolutely. And everyone. Thank you so much for listening, have a great couple of days and stay healthy, wealthy and smart.
In this episode, CEO and Founder of The Bold Leadership Revolution, Tara Newman, talks about creating a better relationship with money.
Today, Tara talks about Profit First, her EMS Framework, the common blocks that women face, and helping women feel more comfortable talking and thinking about money. How do you raise your rates? How do we shift our energy without losing money?
Hear about startup burnout, improving your relationship with money, and get Tara’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- Profit First helps women make and keep more money.
- “I’m really passionate about teaching women to change the way they think, and even talk, about sales.”
-
The EMS Framework:
-
Energy. What is the energy in which you’re approaching sales?
- Mindset. What is your beliefs and attitudes around sales?
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Strategy. This is your sales process, and how you come at it with your energy and mindset.
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“When we feel good, good things happen.”
- “Shifting your energy and feeling good does not actually have to cost a dime.”
- “Selling is about empathy. Women are empathetic. Women are fantastic listeners. They ask great questions. These are all the things that being a good salesperson encompasses.”
- “The secret to sales is to keep going.”
- “It’s okay to be uncomfortable. It’s okay just to listen.”
- “Women think that they need to be perfect in order to make money.”
- “I hear from a lot of women that they don’t feel safe with money. We were never taught how to make it, manage it, keep it, and use it for growth reasons.”
- “There is nothing more frustrating than wanting to do good work in the world, and not having anybody to do that work with or for.”
- “Raising your rates is actually easy. Can you communicate the value and not the amount?”
- “Don’t take yourself so seriously. Be weird. Be yourself. That’s what people want. People buy from people.”
More about Tara Newman
Through her podcast, The Bold Leadership Revolution, as well as her association, The Bold Profit Academy, Tara Newman is the Leader of Leaders. She supports leaders as they embrace their ambition and leave the grind behind. Using decades of entrepreneurial experience and a Master’s in Organizational Psycholgy, Tara is uniquely qualified to teach leaders to run businesses without sacrificing their health, relationships, or integrity by establishing behaviours, habits, and rituals aligned with their vision of success.
Suggested Keywords
Sales, Leadership, Money, Income, Lessons, EMS, Energy, Mindset, Strategy, Profit First, Responsibility, Relationship, Communication, Expectations, Healthy, Wealthy, Smart
Revenue Goal Calculator: Profit First Revenue Goal Calculator
To learn more, follow Tara at:
Website: https://theboldleadershiprevolution.com
Facebook: The Bold Leadership Revolution
Instagram: @thetaranewman
LinkedIn: Tara Newman
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full transcript here:
Speaker 1 (00:02):
Hey, Tara, welcome to the podcast. I am happy to have you on.
Speaker 2 (00:05):
Thanks for having me, Karen. I'm excited to be here
Speaker 1 (00:08):
And I will say right when I got on the call. So you can't see this everyone because it's a podcast, but we both have the same rode podcaster microphone. So it's like, this is destiny, but I have a question
Speaker 2 (00:23):
Because I think I know why we have the same ones by any chance. Did Jason help you set up your podcasting stuff or did you ask him for it?
Speaker 1 (00:32):
You know, and we're talking about Jason van Orden, did he? No, no. I just did a lot of research and I went to be my gosh.
Speaker 2 (00:40):
He is like the King of podcast equipment. Yeah. So see, maybe he helped you. I know, I think I got my, this suggestion from him.
Speaker 1 (00:48):
Yeah. I think I just looked around, I went to BNH and I asked them like, this is what I'm doing. BNH photo is a big store here in New York city. And I said, Oh, I'm debating between like, what's the other one that everyone uses the Yeti. Yeah. The Yeti and the route. And they were like, no, you want the rode podcaster? And I was like, I'll spend the money. I'll do it. I'm going to do it. So so yes, when we came on, I was like, Oh my gosh. And then of course we have all these people in common as well. I guess just a New York thing. I don't know. I know, but you sound less new Yorker than me. Well, I'm originally from Pennsylvania, so that explains it. That could explain it. But I was telling Tara when Tara, when we got on that, I saw her speak at Tricia Brooks speaker salon a couple of years ago, year and a half ago. And I thought to myself, Ooh, I like her mental note, like reach out to her for the podcast. And then, you know, 2020 came and, well, we all know what happened there that we do. We all know what happened there. So I feel like I already know you, but now it's a chance for the listeners to get to know you. So let's get into it before we start. Can you give the listeners just a little bit more about you about kind of why you do what you do?
Speaker 2 (02:13):
Oh yeah, sure. That's like a, a loaded question. I feel like I could talk about that forever, but I really teach female business owners how to increase their sales so they can have more cashflow and they can have more profit in a way that's simple and without as much stress, because I know that, you know, when I'm working with women business owners, they're usually really amazing at what they do and they're experts and they love it. And they're passionate about it, but they're not as passionate about running a business and I'm actually passionate about the running the business part and the sales part. So it winds up being like a fantastic
Speaker 1 (02:55):
Partnership. And I will also add that you're also profit first consultant now in my business group that I ran with physical therapists. That was the first book. I said, you have to read this book. Right. And so now this is not a profit first based podcast or anything like that. And we're going to go into a little bit more, but what, what was that like to become a consultant from profit first? Did you read the book and it changed your business? How did that come about?
Speaker 2 (03:26):
So I actually read the book in 2014 when it first came out before, like right before I started my business, but I wasn't, it's not an easy book to read to be honest. And I think like when I read it, I didn't really read it. Like I dabbled, I think my husband read it. And, and so I didn't actually fully read the book until after I was certified, but I had implemented profit first ish in my business in 2006 teen. And it really changed everything. It made things so much easier. I used to have plenty of revenue coming in, but the cash wasn't there, like the cashflow was off. So I get really stuck. And I remember being in a mastermind and being in my hot seat and just being like, I have no money. So that's really why I love profit first is because it really helps women keep, make and keep more money. And I think that we don't think about that when we start out, we think about like, we have this great idea. We love what we do. And it's like gangbusters out the door and then it's like, Oh wait, like there's this money component.
Speaker 1 (04:38):
Absolutely. And especially with women, it seems like and I, I know I'm this way. I hear this from people it's Oh, well, it's, it's the charging part. It's how do you bring up to people? What your, what your fees are and, Oh, I feel weird about it. And that the money issue, especially with women can be really sticky. I'm sure you found that. That's why you do what you do.
Speaker 2 (05:06):
It is really sticky. And you know, we weren't, a lot of us weren't raised with the language for money, especially for me, I'm a gen X-er, I'm 44 years old. My mom stayed home most of the time. She didn't go to work outside the home until later. And, you know, I always say like, women, women come to me and they're meeting me like 15 years into my journey leading them. And so they don't realize that I started exactly where they started. You know, even when I first started my business, that was the first time I was really responsible for my own money. I always tell people, I'm like, I'm so embarrassed. But like, even from before my husband and I were married, I just used to hand him my paycheck and be like, just pay the bills and deal with it. So that was like a really rude awakening when I started my business and my own. And that's really why I've become so passionate, not just about profit, but about helping women sell.
Speaker 1 (06:04):
Yeah. And, and let's get into that because you have created a framework inside the bold profit Academy, which is part one of the offerings that you have to help women and their relationship with money. And it's called the EMS framework. So we know it's not emergency medical services. I Googled that. It's not it. So what is the EMS framework?
Speaker 2 (06:31):
I always joke around though and say it's equally important. So the Amis framework, I'm really passionate about teaching women to change the way they think and even talk about sales, right? The way we have absorbed sales and the framing and the lens through which we look at sales is, is actually not really in alignment for a lot of women. Right? And they, you mentioned some of the challenges that they have, like asking for their rate or understanding their value or not having the confidence to have those conversations, not knowing how to have those conversations. They've never been taught. And if you were anything actually like me and my husband, when we first started our first business, we didn't even realize we have to sell things. And what happened was, is we went out of business. Well, I guess we might make sense. And we went bankrupt.
Speaker 2 (07:30):
Right, right. And we didn't even realize we needed to sell. So ever since then we have made it kind of really a part of our mission is to help people learn from the lessons that we learned. So I've created the EMS framework and it stands for energy mindset and strategy in that order. So what is the energy in which you're approaching sales? Is it desperation? Is it fear? Is it, you know, tense and gripping what's happening with your energy and how can we get you to shift that energy before you even do anything else? And then it's like, what is your mindset around sales? Is it that you don't believe you can sell? Maybe you don't believe you have the personality of a salesperson. Maybe you don't believe that, you know, how any of those things, what are your beliefs and your attitudes is in the mindset piece. And then in the strategy piece, that's your actual sales process. And honestly, any process will work. They're like the same seven steps, all that jazz, but it's how you come at it from your energy and your mindset that makes that the strategic action that you're going to take in your sales process. So much more powerful and potent.
Speaker 1 (08:47):
And what are some common things that you're coaching your clients through? Let's start with energy, right? What are some common energy blocks that women have and how do you help them get over it?
Speaker 2 (09:03):
So I think it's one, and I wouldn't say it's necessarily a block. I think it's our conditioning. Do you believe you deserve to feel good as a woman? Like, do you like, do women have this belief that they should,
Speaker 1 (09:15):
And I have to think about it. So I saw you, right.
Speaker 2 (09:21):
Because when we feel good, good things happen. And when we feel good, we're more confident when we feel good, we have a better self concept. You know, Brian, Tracy, he's a sales you know, well-known sales trainer. And he just says like, can you just say in the mirror, I like myself, but that's so hard for people to do, especially women to stand there and be like, I actually liked myself. Right. But when you can do that with your self concept and how you see yourself in the energy and what you bring to things that changes everything.
Speaker 1 (09:53):
Absolutely. And it's, isn't it sad that I had to think about that. I'm like, yeah, I think I deserve good stuff, but it shouldn't be, I really struggle with it
Speaker 2 (10:03):
That w they struggle with like, feeling joy and pleasure and enjoyment and just good. Right. And it's not fake good. It's not coping in wishing good. It's like, and it's not even like, what's your morning routine, but everyday when you wake up, what are you doing for your energy?
Speaker 1 (10:26):
Is this a question? No, I'm just [inaudible] Oh, no. What am I doing? Well, what, one thing I do that actually does help with my energy is I get up in the morning and I make my bed first thing. And that actually helps with my energy
Speaker 2 (10:44):
A hundred percent. Right. And I think you bring up such a great point, because when I talk about this in the, in the framework, what I want women to hear is it doesn't have to cost to me shifting your energy and feeling good does not actually have to cost a dime. It doesn't have to take a long period of time. You know, you can do it at any point during the day, you know, depending on what you're feeling and where you're at. And so if you, if everyone can just wake up in the morning and think to themselves, you know, what am I doing to care for my energy? What am I doing to feel good today?
Speaker 1 (11:20):
And, and that's a big, that's a very powerful shift, especially in these times when everything there's like tension on top of tension on top of tension. And you know, a lot of people that listen to this podcast are physical therapists. There are health and wellness professionals, and it's, it's stressful, you know? And so being able to do one thing that doesn't cost any more money, it may cost you a tiny bit of time. Not a lot. It takes me two minutes to make my bed in the morning, but I feel like, all right, I've accomplished something. This is good.
Speaker 2 (11:56):
And
Speaker 1 (11:59):
When it comes to, so let's say, you've, you, you are working on your energy. And that obviously flows right into the mindset part of things. Right. And oftentimes, you know, you hear a lot of women say, Oh, I don't want to like sell things. Cause it just feels like icky. I don't want to be like that used car salesman, quote unquote. And that is a mindset issue, right?
Speaker 2 (12:24):
Yeah. I mean, those are your beliefs that you have around, around selling. And so what I like to do is I like to reframe things. So for example, I'll hear somebody say, Oh, I need to create this opt-in so I can lore people in yeah. Loring people. And these are human beings, right? Like you're welcoming people and you're inviting them in, you're sharing something with them that can help them. And the funny thing is, is like women, I think are so naturally gifted salespeople. They just do all the things that great salespeople do it. We just haven't been presented that like, when you think of, of amazing salespeople, I just mentioned Brian, Tracy, right? Like he's a dude in there. There are really great, amazing women salespeople, but there are fewer. And the ones that maybe we think of right off the bat, or like the used car salesman, I hate going a Bob's to buy a couch. No, like that just doesn't work for me. But I think too, like thinking about when you've been, when you've had somebody sell something to you and it's felt really good to kind of shift that perception and to reframe that is really helpful as well. So not looking for the reasons to believe selling is icky, slimy, sleazy, smarmy, whatever your words are for it. And, and finding the examples of it being done really well.
Speaker 1 (13:50):
And do you have examples of people doing it like women in particular who are doing it very well?
Speaker 2 (14:00):
So I can share with you the reason why I think women will sell Stu sells really well. So it's about selling is about empathy and that completely gets missed, especially in the online business space, or like as soon as you like flip open an app and there are all these internet marketers swarming about or anything like that, you, you know, you see it in the health, the health and wellness field, it's, it's gross. It's, flat-out gross. The way that people, and I think they just particularly happen to prey on people's pain, specifically women. So we tend to see it as not feeling good. But women are empathetic. Women are fantastic listeners. They ask great questions. These are all the things that being a good salesperson in campuses. Yeah. It's not so
Speaker 1 (14:52):
Much the sort of vomit all over the person. This is what I do, and this is what I can offer. But instead, it's you doing a little less talking and doing a little more listening.
Speaker 2 (15:05):
Exactly. Exactly. So from my perspective, when we have women in the bold profit Academy and we're teaching them how to sell, we're not teaching them how to do anything different than they're already doing. We're teaching them to leverage the things that already come natural to them. And they experience success so much more quickly because we're not actually asking them to change their behavior.
Speaker 1 (15:30):
Right. You're just, you're kind of putting this obviously into a framework, but almost into a, I don't want to say a script, but into an outline, is that the right or no
Speaker 2 (15:46):
Going to correct you slightly. So the way we do things in the bull profit Academy is through frameworks. And the reason why we pick frameworks is because it gives you a guideline and then you can take that and adopt that to itself. So I'm saying to you, energy is important. You, yoga might be it for you or like throwing around heavy weights might be it for you. Or, you know, I love my Peloton, but someone else might do something else. Right. Someone might not choose to do anything physical, you know? So because I love Peloton, I take Tuneday's classes and she always says she has, I'm giving the class of classes, the recipe, and then you season to taste. And so that's why we do frameworks, because like I said, in the beginning, women business owners, any business owner goes into business because they love what they do. Right. And they're passionate about being the expert that they are. And sometimes the business piece doesn't excite them as much. So we give them a lot of frameworks and templates for them to customize in their business to do that heavy lifting
Speaker 1 (16:50):
Yeah. Template. That's the word I was searching for. It was not coming into my head template. Listen, and I will tell you the people who listen to this podcast, we love that kind of stuff. We love that. Having a little structure around things, you know, we're, we're a little more kind of type a like, let, give me some structure and I'll run with it. And so how has this EMS framework, how does it impact daily sales habits for small business owners for these female entrepreneurs?
Speaker 2 (17:22):
Okay. So there's your secret about sales? I'm not one for telling secrets, but there's a secret. The secret to sales is to keep going. So the whole point of the EMS framework is to build resiliency because if you're taking care of your energy and you're looking at your mindset before you take the strategic action, that's resiliency. So when you wake up in the morning and tired and you think, what can I do for my energy to get me to feel good? Right? You're not just rushing into your strategic tasks, feeling like hell and then burning yourself out or, or feeling like poop, right? Like you're, you're actually feeling, you're always feeling good and you're always able to move forward. You're always fueled up and really taking care of yourself so you can keep going. And that consistency is what brings in what brings in the sales and fills your pipeline.
Speaker 1 (18:22):
And I think you hit on something really important and it's that burnout. And I hear that a lot, especially from women who are just starting their business. They're like, I don't, I feel like I'm already burned out and I haven't even started yet. Right. I haven't even gotten out there. I haven't done the sales yet. I haven't. And I'm already burnt out. So how do you coach those women? What do you,
Speaker 2 (18:46):
I'm sure they come to you, but that I just actually posted on Instagram. I want to be, I'm going to host be hosting a free conversation around women and business and what I'm calling a global crisis of fatigue among women. The number one reason why women come to me is fatigue, tired, feeling like poo, whatever it is, right? Because we have been conditioned to jump through every hoop imaginable for our success. Women's sex women and success. It hasn't typically come easy. We're the first ones to raise our hands were the first ones to volunteer. We are the first, you know, we do a tremendous amount of unpaid labor throughout our, throughout our lives. And we're exhausted. And then we get into our business and we think that we don't know anything. We think we're doing it wrong. We think that you know, we should be doing it differently.
Speaker 2 (19:55):
The marketing messages start to come in preying on the fact that women want financial freedom, but have the things like I'm not good enough. I don't see my value. I'm not con right. Like if you, if you really think it's insidious and it's gross. And so what happens is, is there's more hoops. Well, now I need to go take this training and now I need to go take this course. And now I need to go do more. And if it's not happening fast enough, I must not be doing enough. And if it's not right, all the time over and over and over again. And none of that is true.
Speaker 1 (20:28):
And I have thought that all the time, I still think that all the time, Oh, maybe I should take this course, or maybe I should do this, or maybe I should. And yeah, it's, it is. And it is gross, but it is, it's hard to get that out of your head, because like you said, we've been conditioned you and, and you'll find this really interesting as a fellow podcaster. Talking about that sort of conditioning of how we, we just don't think we're good enough. A, a, a physical therapist or a physio from, from Europe said, how come, how come? I don't see a lot of women as guests on podcasts. I don't understand if we're in a profession that's 60, some percent women. How come all the podcasts are men? How come all the podcasts are hosted by men? Where are all the women?
Speaker 1 (21:23):
And, and and so a pod, a male podcaster, I guess, sent she's like, well, we asked 30 women, 20 of them said no, and five never got back to us. And, and so I think to myself, this is a tough nut to crack. Is it exactly what you said? I don't know anything. Is it all, this is it. They don't have time because they're raising kids, they have to do this. They have to work. And then I brought up, well, maybe it's a way they were asked because I will ask people to come on and I have had women sad, and I don't know what I would talk about. And I said, well, I wouldn't ask you to come on the podcast. If I didn't think you had something to talk about. So I coached them through and we work on a podcast together. Right. And, and so, I don't know. What are your thoughts on this? I mean, you're a podcaster.
Speaker 2 (22:11):
So I think, I think that there's, there's a lot of, there's a lot of things that could be at play here. However, what I do know for sure is women who are experts, don't see themselves as experts, right? Women don't see their value, and that's why they struggle to make sales present themselves. And this is whether you're in your own business or whether you're working as a professional in somebody else's business. Right. And so I know that they struggled to see their value and they struggled to see their con like that they're good enough for that contribution. I, myself, when I was first starting out in my business, I turned down oppor opportunities that I was referred for, where people were like, no tower, you need to go and do this consulting gig. And so I do some corporate consulting as well. And I was like, Oh, that company's too big. Or the topic they're asking, I don't feel confident enough on. And you know, I think that's part of, what's keeping women in a, in a financial bracket. That's, that's not sufficient.
Speaker 1 (23:15):
And what do we, what do we do? What do we do? That's the big question, right? What's your best advice on that? What, like, what do you tell your ladies?
Speaker 2 (23:27):
So I think what's important about this is that I started a couple of years ago in the mastermind that I run, where we had a quarterly money date that we just got together and we talked about money and we do this in the bull profit Academy as well. And it's okay to be uncomfortable. It's okay. Just to listen, I have had women sit on these calls, looking like they were going to vomit. That's how uncomfortable they were. But I think you have to have these conversations with the right people who understand all that's there around money. And that it's actually not about your mindset, because that's what people get told that this is, Oh, this is your money mindset. You're in scarcity. Yeah. That's why. Yeah. Right. No, that's a marketing message. I mean, yes. Women feel scarcity, but you know, I think that there's a lot to unpack around how we think about money from a generational standpoint, from a societal standpoint, from a racial standpoint, like there are so many intersections when it comes to money, you know, you know, my dad, my dad, my dad's a business owner too.
Speaker 2 (24:47):
And he laughs at me sometimes when I start to get a little tight fisted, because he's like, you're just being a refugee Tara. This is like the refugee in our family. Like, cause my grandmother fled Poland and it like in 1920 and he's like, you're not in the shuttle anymore, Tara, like you can, you know, and I'm like, that's right. Like they do. I, I, you know, we, we feel that way and it's not always ours that we're carrying, like our parents have passed down messages or grandparents have passed down messages, society. We don't have the language for money. We feel shame around it so much shame around money. Women think that they need to be perfect in order to make money. They think they have to have the perfect family to be successful. They think they have the perfect marriage. They think. I mean they, the stories. Right. And I think that if you can find a safe environment to talk about that so much more and get that support as possible.
Speaker 1 (25:42):
Yeah. I think that's wonderful, wonderful advice for, for people out there and it doesn't have to be formal. I mean, you can have like a group of, of girlfriends or fellow entrepreneurs that you've, that you trust and that you feel, you can talk about these issues with, because it is hard and I'm gen X as well. And it's the same thing. My mom, wasn't working for most of my childhood and then went back to work a little bit later. And, and it is, there is this, Oh, I don't know if I deserve to make that much money or I don't know, Oh, this seems expensive. Or if I run things even by my parents or something like, Ooh, that seems like a lot, Oh, I, how could you charge so much? How could, and so those messages get stuck in the brain, you know? So it, it does take a lot of work to get that unstuck.
Speaker 2 (26:36):
I will also say, this is where profit first comes in really handy because it gives you language for money. And it gives you a system for money that if you just do the steps and you just do the system, it takes a lot of I find any system in any structure calms. My nervous system makes like literally my nervous system calms down. And so having that structure for my money calms my nervous system way down and allows me to approach my money from a much different perspective.
Speaker 1 (27:10):
Yeah. We, in the PT world, we would call that a SIM, which stands for safety in me. So throughout your day, you have Sims, which are safeties in me or dims, which are dangers in me and from a pain science standpoint it is hypothesized that the more dims you have during your day then Sims, you may feel more pain, especially if you're a chronic pain suffer. So we try and have those have more Sims introduced into, into one's life to outpace the dims. That's actually really good.
Speaker 2 (27:40):
Interesting, because I hear from a lot of women that they feel, they don't feel safe with money. They don't feel responsible with money. We were never taught how to make it, manage it, keep it, and use it to for growth reasons. Like those were things that were not, that were not taught to us.
Speaker 1 (27:59):
Yeah. And I, I will say like using profit first using that system, I started using that a couple of years ago and I was like, Oh, I do have money. Oh, I see how it works. Oh, when it comes to paying my taxes, I'm not stressed out. Like I turned my quarterly taxes up, it's right there and I just pay it. And it's so like, I feel like so light and I do have a history of chronic neck pain. And, and I will say, this is for me a big, it's like a super SIM for me, because I don't feel that anxiety and stress and around tax time, because I know it's there, I've already done it. It's true. And, and it just makes such a huge difference, but you're right. There is that conversation needs to be had for women around their safety, with money and with sales and with, with confidence around all of that. It's hard. And the thing that's so
Speaker 2 (29:03):
Interesting about women too, is that they do such a great job suffering in silence. I'm sure you see this.
Speaker 1 (29:09):
Yeah, yeah. Right. Yeah. Right.
Speaker 2 (29:14):
Bring in silence and not asking for help. You know, not wanting to receive support. I know a lot of women that I work with feel like they need to know it all or they need to get it all right.
Speaker 1 (29:27):
Yeah. No, you hit it. You hit the nail on the head before when you said it has to be perfect before I do something. And that was me for years and years, if I'm going to put a program out, it has to be perfect. I have to have, it's all planned out, needs to be perfect. And it doesn't not at all. And it doesn't. And just having, knowing that was very freeing.
Speaker 2 (29:50):
Yeah. I watch I watch women put a lot of obstacles in their way and, and I know I get that. We do that for self protection. Yeah. To feel safe, to, you know, to, to not fail to, you know, not look silly or foolish or whatever our stuff is. And at the same time we really need to get on with that. Yeah. And we need to find a way to be courageous and brave now more than ever
Speaker 1 (30:25):
Agreed. Agreed. It's just, yeah. And what would you say to people who are like, Oh, it's so daunting. I'm just not even going to bother.
Speaker 3 (30:33):
Yeah.
Speaker 2 (30:36):
Well, I mean, we can have a conversation around what's that costing you [inaudible], you know, and, you know, peel back the layers to that because I can guarantee you that, you know, that's affecting you in ways beyond which you're even able to conceptualize because you're, you're shutting it down and you're closed off. I mean, ultimately people have to be willing to do this and which is why, you know, around the work that I do, it's really important to me to always reiterate to people. It's okay. To be scared. It's okay. If a spreadsheet feels intimidating it's it's okay, like, please don't overthink this, please. Don't overcomplicate this. I am giving this to you the way it is so that all you have to do. I do, we do a lot, like a lot of it in the bowl profit Academy, we do a lot of calculators that like just takes all of the, all of that stuff out of it. Right? Like that charge that, all that charge out of it. If I could just remove all of the barriers and all of the obstacles, I will do that.
Speaker 1 (31:50):
Yeah. And that's what I think that's what women need, you know, it's what we need to feel good is to say, how can you take away using the analogy? So before, can you take away some of those hoops?
Speaker 2 (32:04):
Yep. Yeah. Don't don't you dare go into your money without checking on your energy first and your mindset. Do your EMS before you look at your money.
Speaker 1 (32:15):
Yeah. And that's, that is good advice because we we've all gone into our bank account when I did it the other day, which has happened. What's just happened here. And, and whether that be good or bad. Right. but, but you're right. You have to use that energy that in order to, to get into the sales process, to make money, to help more people, right. Like you said, women want to get into business so they can help people. Well, guess what, if you don't have a good framework what's going to happen.
Speaker 2 (32:53):
There is nothing more frustrating than wanting to do good work in the world and not having anybody to do that. Good work with her for I have been there. Yeah.
Speaker 1 (33:06):
And it's an, and then that can lead to this sort of demoralizing mindset. The, I failed. I can't do it well. Oh, well, I was, this is, this is, I'm done.
Speaker 2 (33:17):
Well, here's where women, here's where women go. I must be charging too much. Yes. So I'm just going to lower my prices. But the reality is, is we just need to up our skillset.
Speaker 1 (33:31):
Yeah. And, and I I'm guilty of that. I've certainly done that in the past. I'm like, Oh, I'll just, Oh, well maybe I'll just lower the rate. And that will get more people to come in. And it doesn't, it doesn't
Speaker 2 (33:45):
No, because then you're looking at perceived value of what you're selling. Right. People will be like, why is she, so why is she so cheap? Right.
Speaker 1 (33:54):
Yeah, absolutely. Absolutely
Speaker 2 (33:56):
Not know what she's doing. She must not be confident. That's
Speaker 1 (34:00):
So true. And, and I try, and you know, a lot of physical therapists now are, are sort of using an out of network model or a cash based model where the person pays you up front. And, and it is hard for women to raise their rates. Men are like, after six months, I raised my rate by $50. Oh, I raised it again. No problem. No problem. Women are like, so how do you, what do you say to someone who's like, I can't raise my rates.
Speaker 2 (34:29):
All right. So there's like the practical piece complex. I mean, it isn't, it's not, so I think there's a couple of things at play. I think if you think that you can't raise your rates, raising your rates is actually easy. You change the number, you put it on your, your chart or your website, right. I mean like the actual act of raising your rates is easy. Maybe we need to do some talking around like how much should you raise them to and whatever. But the reality is is can you communicate the value and, and not the amount, it's not about the amount, it's about the value. And it's about understanding how to talk to people, have a sales conversation and overcome whatever concerns they have around that. So it's, it's not actually a price issue. It's again, it's are you comfortable with selling issue? Yeah.
Speaker 1 (35:27):
Yeah. And that's like you said, where the listening and the empathy and stuff, that women are so good at any way that they're probably doing naturally, they just don't know it. They just need a framework. They just need a little bit of guidance.
Speaker 2 (35:38):
Think about someone who, who, or something you've just bought recently. And like, you just couldn't wait to buy it or you couldn't wait to give them your money. Right. Like why, what happened? What was that conversation like? And inspect that because someone is, is like excited and can't wait to give you their money, you know? Gosh, if somebody's back is bothering them. Or I had sciatica last year, that was like my worst hell ever. So, you know, I would have paid millions of dollars for someone to make that go away. It wouldn't have even mattered. I wouldn't even cared if you were like, I can help. You'll be like, awesome.
Speaker 1 (36:13):
Yeah. And, and I hear that so many times over and over again from people who are not physical therapist or not health and wellness professionals. And I think it's, I love that you said that because I think it will give the people a little more confidence.
Speaker 2 (36:30):
Yeah. I mean, if you're, if a lot of your audiences like physical therapists and chiropractors, I will tell you that, like I had, I've worked with a couple of chiropractors and they're like, I went to the chiropractor convention, I'm going to be facetious and silly. I went to the chiropractor convention and I came out with this 4,000 page manual on how to run my back office and my front office and all this stuff. And I'm like, great. So what are you going to do to actually stand out? Because the 5,000 other people that went with you got the same 4,000 page manual. And so I find a lot with health practitioners that I work with, they really it's beneficial to get outside of that health practitioner loop and, and, and look to find strategies from other industries talk to people who are outside that industry.
Speaker 1 (37:23):
Yeah. Yeah. Great advice. I
Speaker 2 (37:25):
Mean, that's with any industry, but I just specifically know sometimes that, you know, or, or in health industry too, you, you tend to have a lot of regulations and quote unquote rules. Right. So you'd get very stuck in like, well, the regulation, the regulation, the regulation. And so I sometimes come in and I'm like,
Speaker 4 (37:47):
Is that really the regulation?
Speaker 1 (37:54):
But yeah, it is that, that is true. There are some perimeters from which we have to work around, but you can still work around them and be successful and, and have a better relationship with money, which is all, you know, what we're talking about here today is just to how to have a better relationship with money and how to not be afraid of it and how to move forward with your business, knowing that it's, it's part of business. Yup. Period. When we take it personally, but it's business, it's business. Yeah. It's business. And now before we wrap up, is there anything that maybe I over or that we didn't cover that you're like, Oh, I really want to, I really want the listeners to know this.
Speaker 2 (38:43):
I think we really we really covered a lot. Actually. We talk a lot, we talked a lot about money and sales, which is so exciting to me cause I can talk about that forever and ever and days.
Speaker 1 (38:56):
Well, speaking of which, where can people find out more about you to learn about when you're, when you have events and learn about your programs and follow you on social media and all that fun stuff.
Speaker 2 (39:08):
Okay. So the first thing that I want everybody to do is I have a resource for your crew. So if they go to the bold leadership revolution.com forward slash resources, I have a revenue goal calculator that actually you plug in your personal information, it tells you based on how much you need to make to cover your expenses. It tells you how much revenue you need in your business. And it'll plot it out with profit first. It is nifty
Speaker 1 (39:39):
Amazing. And we'll have that link in the show notes.
Speaker 2 (39:44):
Yup. I like to hang out on Instagram. So I'm at the Tara Newman and I have a podcast, the bold money revolution.
Speaker 1 (39:51):
Awesome. So Tara, last question, knowing where you are now in life and in career, what advice would you give to your younger self?
Speaker 2 (40:03):
Hmm. Don't take yourself so seriously. I'm a serious person. Like I could be super serious. And I think like if I had to do it all over again, just like be weird, you know, be yourself. That's what people want is people buy from people, right? Like you're humans are out there and they want to work with you and they want to know you in all your weirdness and all the things like just be you it's, it's really that simple.
Speaker 1 (40:34):
Yeah. And I remember having this conversation with someone else on the podcast and said, you know, you want to be the Flamingo in a sea of penguins
Speaker 2 (40:45):
For sure.
Speaker 1 (40:46):
Because there's like you said, there's someone out there who's looking for you for you. And if you're like everyone else they're going to miss you.
Speaker 2 (40:54):
They, yes, there are people who are out there. And I think here's the thing when you beat, when you're more, you, you S like other people feel seen. And when you tell your story and you can connect with people, like just super quick, I just had a recent ADHD diagnosis at 44. And I, when I was like, Oh, I think I need to get an evaluation done. I went and we went to listen to the whole bunch of podcasts and I just typed in ADHD. And there were all these women podcasters with ADHD, and I would listen him. And I would cry because I didn't know how to, I was so normalizing what was not normal, but I lived with it my whole life. And I didn't know. And them sharing their story helped me see, like, what was normal, what wasn't normal, what I needed to talk to my doctor about places where I could be releasing guilt that I felt about things. And so I think it's just so important.
Speaker 1 (41:59):
Yeah. And thank you for sharing that. That's so, so powerful for for people to know that there are others out there going through the same thing and that yes, you're seen in your herd. And I think that's a great way to end the podcast. So thank you so much, Tara, for coming on, and I really appreciate it. And I can tell you that all the listeners do too.
Speaker 2 (42:21):
Thank you so much for having me
Speaker 1 (42:23):
And everyone. Thanks so much for listening in today. Have a great week and stay healthy, wealthy and smart.
In this episode, Physical Therapist in Detroit, Ted DeChane, talks about his experience living with Long Covid.
Today, Ted talks about his Long Covid timeline (including attempts to return to baseline, his relapses, and his work), the Long Covid Physio group, and the mental aspect of managing Long Covid. How has Ted adapted his life and work around Long Covid? What is the most common question people ask him about Long Covid?
Hear about the importance of peer support and shared experience, the role of Physio in managing Long Covid, and how cognitive and emotional fatigue can set off Long Covid, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Long Covid in itself is not caused by anxiety, depression, and those things, but they certainly do exist.”
- “Finding the things that help you get through the day is really important.”
- “If you don’t allow yourself that pacing, that rest, you’re going to be forced into it.”
- “It’s so much more than just the physical aspect of having Covid. Emotional and cognitive overload can cause these physical symptoms as well.”
- “We [physios] can play a huge role in the Long Covid epidemic.”
- “Sometimes these symptoms can come days later.”
- “Helping them [patients] log what’s triggering their relapses is helpful.”
- “If youre interacting with people with Long Covid, just have a little sensitivity around some of these questions. They can be triggering, and they can be stressful, and can be something that can increase symptoms of Long Covid.”
- “10% of people who are diagnosed with Covid may have Long Covid symptoms.”
- “Don’t be so rigid in your box of knowledge. What you learn in PT school is great, but there’s so much more out there. Be open to things you haven’t heard of or things that don’t fit what you’ve heard.”
- “It’s okay to step outside your box and look at something from a different lens. Even if it doesn’t quite make sense yet, be open and willing to learn about something a little different.”
More about Ted DeChane
Ted DeChane is a physical therapist in the Detroit area specializing in pediatric therapy. He covers multiple settings including school-based, outpatient, and acute care. Ted became ill with COVID-19 in March of 2020, and continues to experience persistent symptoms.
As part of the Long Covid Physio group, he has contributed to podcasts, articles, and peer outreach.
Suggested Keywords
Covid, Long Covid, Physical Therapy, Physiotherapy, Recovery, Mental Health, Support, Fatigue, Symptoms, Adaptation, Relapses, Healthy, Wealthy, Smart,
Resources:
Ted - “Living and Working with COVID.”
Uncharted: Patient Experience With Long COVID
Round Table Talks: Round Table Talks
To learn more, follow Ted at:
Website: https://longcovid.physio
https://teddechane.wixsite.com
Twitter: @TedDeChaneDPT
@LongCOVIDPhysio
Instagram: @longcovid.physio
LinkedIn: Ted DeChane
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full transcript here:
00:02
Hey, Ted, welcome to the podcast. I am happy to have you on this month as we're talking all about long COVID. So welcome.
00:10
Yeah, thank you for having excited to be able to talk about it. Okay, so
00:15
let's start out with the basic question. What is your interest in long COVID?
00:22
Yeah, unfortunately, it's kind of been thrust upon me, it wasn't something I chose to be a part of. I became ill with COVID symptoms in March of 2020. right at the beginning of the pandemic, I work in an acute care hospital in the Detroit area, which was a early hot spot, so hard to say where how I contracted it. But regardless, I did, and I had the pretty classic textbook COVID-19, acute phase, cough, fever fatigue, lasted about probably two to three weeks, that initial acute phase, and I had recovered mostly so I thought, went back to work back to exercising back to running, living, all those things and just couldn't, couldn't quite get back to where I wanted to be and was pre illness. I had just been suffering from fatigue, and since some heart rate issues, inability to tolerate exercise, and it was beyond the kind of normal deconditioning. You know, I've been in and out of running for years. So I knew that, you know, when you first get back into it, it's not always fun or pleasant. But it wasn't that normal, fun or not fun or not pleasant feeling it was this, just complete debilitation, you know, laying on the couch in a dark room, couldn't even tolerate sitting up kind of thing. And that's when I initially knew that something was wrong and started reaching out to healthcare professionals. My own health care professionals couldn't really give me an answer. It was unheard of at that point, that early on. But I connected through Twitter of all places with some other people who were experiencing nearly identical thing that I was. And that's when we kind of realized that this was a bigger problem than it had seemed to be initially. So that's kind of where we, especially a group of physical therapists got together and kind of began bouncing ideas and symptoms and trial and error off of each other and realized what was working, what wasn't working. And it was through that, that we kind of became this long COVID physio group to try to help each other initially and then realized that we needed to start helping others as well. So that's kind of how I got involved in the long COVID. process.
02:50
And it must have been quite scary in the beginning, because like you said, the doctors didn't know no one knows. So very early on. Do you remember when that diagnosis of long COVID symptoms or you know, being diagnosed with lung COVID? When When did that happen? Like what was the timeline on that?
03:14
Yeah, it's definitely a fuzzy gray area in the beginning, you know, I was sick in March, God, quote, unquote, better April, May. And then June is end of May, early June, is when I really began trying to pick up the running, I was like, Okay, I have to get going. You know, it's time I've been down for a month and a half now. And that's kind of when my gears started turning that it wasn't right. It wasn't until probably October or November that for me the phrase long COVID really hit home and, and I kind of gathered that that's what was going on. So it, it took a long time for me to realize for others to realize that this wasn't right. It's not, you know, expected progression of what we thought was supposed to happen.
04:03
Yeah. And I think Daria echoed a lot of what you just said, in that she was like, I just wanted to get back to running. I'm a PT, so I'm just going to use graded exercise. And that did not work.
04:15
Yeah, it's, it was really kind of a mindset shift. When you when you really get down to it, you know, we as pts we know that we need to go or we think we need to go I should should correct myself. You know, we thought that's what we had to do. And we tried it and we we did not it didn't work. So yeah, that really clued me especially in that, you know, this wasn't right, you know, as pts where we're supposed to be the experts at monitoring Response to Intervention so that I just, you know, it's hard. It's easy to do in when you're monitoring a patient's response to intervention, but when you're kind of monitoring your own, it really was another hurdle to cross to accept that. You know, I Can't do these things right now. So
05:02
and you know, dari and I also talked about that mental aspect aspect of it, and how, gosh, so challenging? So what what have you done around your mental health and the mental aspect of living with long COVID that maybe you can give advice to others?
05:20
Yeah, that's a really important part of it is the mental health aspect. You know, we always stress that there is can be a lot of anxiety, depression, fear over a long coat COVID in general, but especially long COVID diagnosis. But we also want to emphasize that that is usually a secondary issue, you know, you know, long COVID in itself is not caused by anxiety, depression, those things, but they certainly do exist. And it's, it would be remiss to, to not mention them. For me, personally, you know, there was a long time where you kind of get that dark cloud over you, and you think, am I ever going to get better, and I still have those days, to be quite honest. But, you know, I think just focusing, and thinking about the positives, and the gains that I have made, personally, has really helped me. You know, I, I see it a lot on my Twitter and my Facebook history timeline coming up, especially this time, on my runs that I did, and all my failed runs that I did, and you know, even not going to work some days not getting off the couch some days, and those days are less than less than less now. So really looking back where I was, and where I am now is, it's been really important for me, to see that there is progress being made. It's it's not linear, it's not quick, but it's there. So that has helped me personally kind of get through that. But in addition, the peer support has been really instrumental, um, that we've created kind of through long COVID physio, there's a whole group of us who kind of have a very similar mindset, a very similar training, and a very similar experience. So we can all kind of commiserate and, and vent when we need to, but also pick each other up when we need to share resources, those kind of things. So finding that group has really been helpful.
07:09
Excellent. Yeah, finding that having someone who's gone through what you've gone through, or is currently going through, that peer support can be so so helpful. And we'll have a link to long COVID physio in the show notes for this episode for anyone who wants to learn more about what you guys are doing, and maybe they need the support themselves. So we'll have a link to that. And now you said something. Just before about some days, you can go to work, you can't get off the couch. So let's talk about how one can adapt to living with long COVID because we got to do things, right. I mean, most of us have to work or most of us have to do things around the home or with family and friends, etc. So can you talk about adapting all of that while living with long COVID?
08:04
Yeah, initially, that was really tough thing for me to do. And even still, it is a very tough thing to do, especially as pts, we have a very active physical job. Regardless of what setting you work in acute outpatient, you know, I'm in pediatrics, as well as acute care. So there's a lot of up and down moving, running, note taking cognitive, mental, emotional exertion that's going on, and all those things can trigger these long COVID crashes, relapses, post exertional malaise, whatever your name of choice is. So finding the things that help you get through the day is really important. Some of the things that a lot of us have found helpful. pacing is a big one. So you really have to look at your day, how can you chunk it up and kind of take things minute by minute, which is, again, hard to do when there's productivity demands and billing demands, and maybe you're a clinic owner, and you're, you know, relying on that income. So that is a really hard thing to do. But it's so important. And I always say that if you don't allow yourself that pacing, that rest, you're going to be forced into it. So it's better to do your best to plan around it rather than let the kind of disease process do it dictate it for you. So, you know, if I think I'm going to push through this week, and I'm, you know, going to make my productivity while the next week, I might have to take two days off work and then I'm not helping anyone. So, you know, really accepting the fact that you do have to listen to your body and rest when you need to and, and make the accommodations at work, whether it's building in an extra break, or maybe you need to do your charting in a dark room. You know, maybe there's a half hour in the day where you can just lie down on a mat table in a treatment room and have you know, 1520 minutes You know, no stimulation, it's really about finding those things in your day that make make it easier. So you can last, you know, through a day through a week through, you know, a month kind of thing?
10:14
And how would you suggest someone have this conversation with their supervisor, Boss owner of the clinic they work at, because you obviously have to have cooperation with the people that you work for. Now, if you're your own boss, I guess that's a different story, you can probably, you know, kind of set your schedule accordingly, maybe, but what advice do you have for people who maybe have to have these difficult conversations with their employers?
10:42
Yeah, it's, it's a really tough place to be in for the employee, and also the employer, you know, they have a budget to make to, I get why they, you know, set these demands, but at the end of the day, you really just have to be open and honest with them, and your co workers about what's going on, what your needs are, how you how you need the accommodations, you know, that's a struggle a lot of people are having, especially in the US, we don't have a lot of options, as far as you know, paid time off. You know, in the UK, there's, there's union representation, which we don't have in the US, generally speaking as a profession. So it's really important that you can connect with your boss and explain the importance of the, the needs for accommodation. You know, we do know of a few people who have been successful kind of navigating the, you know, short term, Long Term Disability here in the US under like a chronic fatigue type diagnosis. So that may be a route you have to take, if you're finding trouble getting these accommodations, obviously, try to find a, you know, physician who is supportive of your long COVID and the needs for the documentation that you might need for that. You know, but I, I'm fortunate enough that I have, you know, administration who has supported me, and I think that's do a lot in part A to them, thankfully, but also, you know, just to the open and honest dialogue that you have with them, and explaining the needs and how putting in these needs now can save you some time later. You know, so that it's beneficial to everybody.
12:26
Got it? Yeah, great advice. So just being open and honest with your communication with your supervisor, employer, etc, would be your best advice to people who maybe are living with long COVID and don't know how they're going to get through the week.
12:41
Yeah, you know, hopefully, that route works, obviously, there's going to be places where that isn't going to work, where you might need to escalate. In addition, you know, finding co workers who are supportive, you know, maybe you have a close coworker that you can confide in and kind of help you through the process. You know, I kind of had a funny story when I was kind of navigating my own long COVID process. I had a co worker who texted me and she said, Are you feeling okay, today? And I said, Actually, no, you know, how did you know because I thought I was holding it together. And she's like, Well, I can tell whenever you're not feeling well, because your voice gets deeper. And I just thought, Oh, that's really cool that she was able to notice that, because I didn't even notice that. So, so finding a co worker who you can lean on, and maybe they can, you know, help you through things, if you have a difficult patient you need help with or you say, Hey, I have to take the afternoon off, can you help cover some of these patients? So it's not, you know, such a burden on the clinic, kind of thing, just building those relationships, and being open and honest about it.
13:41
Yeah, makes perfect sense. And you sort of touched on something that I want to highlight. And that is when people think of long COVID and they think of pacing, they think of the physical pacing. Right. So moving your body pacing, but you also touched upon and I would love for you to go into a little bit more the cognitive and emotional fatigue that can also set off long COVID So could you explain that for the listeners?
14:11
Yeah, that's a really difficult piece to manage, because it's not as black and white as some of the physical things that happen. But a lot of us, including myself have noticed that with increased cognitive load, you know, we have the same physical symptoms that we would if we were to run a mile you know, just maybe we had a really hard case we needed to critically think through or or, you know, in my case, I was doing a lot of spreadsheets over the summer we were doing some budgeting things and normally that would not have been a problem for me but I just and this was before I even realized what was going on. You know, I was having struggling with these spreadsheets and and that kind of would set me back and and I would have to shut the computer off and and take a step back in a day off and Um, so those things we don't really realize are adding to the stress of our mind and our body. You know, the documentation and screen time, if you're doing a lot of notes on your computer, or you're doing virtual sessions kind of thing that can really fatigue your body and give you a lot of the same symptoms as physical would. Are you muted there, Karen?
15:25
Yep, sorry, I was just saying kind of unbelievable, right? Because it's like, it's so much more than just the physical aspect of having COVID. It's, you know, people talk about brain fog. And they, they talk about fatigue, but knowing that just emotional and cognitive overload can cause these physical symptoms as well. And I think that's something that a lot of people are not aware of.
16:04
Yeah, and I think a lot of people have set themselves back thinking they're doing a great job pacing and not realizing that they're still carrying the emotional load of their patients, or maybe there's something going on at home a relationship issue, you know, family stress, things like that can can add to your total body fatigue, and that's. So when you look at your, your work day or your home day, you also have to include that piece too. So like, for me, one thing that I found difficult was bouncing back between patient care and documentation, just the back and forth was like a lot for me to get my brain switched into like documentation mode, and then back to patient mode. So, you know, for me, what I found helpful is actually kind of, you know, doing a few patients in a row, and then then going and doing a couple notes at a time, rather than where I would normally do you know, a patient, a note, a patient a note. So everyone's different, that might not work for somebody. So it's really finding that balance of how you can navigate doing your job, but also not being a detriment to your own health.
17:15
Yeah, so it sounds like a little bit of trial and error until you kind of find that sweet spot.
17:21
Exactly. And that's kind of what we tried to learn from each other in this peer support group is, hey, what worked for you? Because I might like to try that. So
17:30
make sense. Now, let's talk about the physios role when it comes to long COVID. So where do we fit into this recovery in this puzzle?
17:41
Yeah, I think we can play a huge role in in the long COVID. epidemic, if you want to call it that, because that's what it will become if it isn't already. I am fortunate enough to not have to be treating these patients right now, especially in pediatrics, there is cases of lung COVID. In kids, it's not as prevalent. Unfortunately, I've not had to deal with that. But as physios, we are spending a lot of time with patients, more so than most, any other health care provider, you know, we have the knowledge of pacing and, and monitoring, medical status. And I think we need to use that. So being a part of the pacing process for patients I think would be good because that is a cognitive tool for someone to sit down and plan out their day. So if you can kind of help them be there to guide their day, just as you would a patient who has, you know, hip replacement or cardiac surgery, you would you would be the person to help plan their day out to make them the most efficient. So that's something you could also as a PT, and do for a long COVID patient being the one to help them through that. But But in addition, you know, as I kind of mentioned in my intro, that response to intervention is so important and what sets us apart from other providers is that we we can pay attention to what's going on. You know, and make sure that our treatment isn't a thing that's doing harm and causing the post exertional malaise or symptom exacerbation. And it's really important to look through that through a lens of not immediate either sometimes these symptoms can come days or later. So think of it more like delayed onset muscle soreness, you know, you might do a treatment on Monday, they may be fine Tuesday and Wednesday and then Thursday, all the sudden they flare up. Well, it could have been your treatment on Monday that caused that. So it's important to recognize and do a look back at each session, you know what happened kind of thing to kind of help help the patient progress because if they're going into these crashes, they're not progressing. They're regressing so it's important to progress rather than regress.
19:55
Yeah, so it sounds like it's a lot of on the physios part, certainly education. to the patient. And and I really love how you said you can help them set up their, their pacing schedules, you know, you can be the person, you You said you have the long COVID group to bounce ideas off of, well, you can be this person to help them bounce ideas off of right?
20:16
Yeah, exactly. They might not have a peer support group that they found, you know, or they might be overwhelming for them to go to a peer support group. So for you to be the patient, or the person to say, hey, let's sit down and say, Okay, so the shower is an issue for you. Well, how can we fix that maybe you need to sit down when you shower, maybe you need to shower in the evening, something like that, you know, trialing and airing with them. And you're helping them log what's what's causing and triggering their relapses is super helpful.
20:48
Yeah, I think that is great advice for any physio, who is going to be working with anyone with long COVID to kind of know that it's more than just giving exercise way more.
21:00
Yeah, absolutely. You know, you we have a huge role as far as physical therapists and it goes beyond exercise. You know, that is an important piece of, of our profession, obviously. But there's so much more that we can do and, and step outside of our, you know, musculoskeletal box and kind of really help these patients at the end of the day.
21:21
Yeah, I think that's great. Thanks for sharing that. And now I have a question. What is the most common question people ask you about living with long COVID? Because I'm sure you get questions, even if it's family, friends, if you divulge to your patients, hey, I'm living with long COVID what's what's like the main question you get from people?
21:43
Yeah, there's a lot of questions. You know, the biggest thing could be it could be questions, that's okay. Yeah. Well, the a lot of people always ask about, did you have the vaccine? Did that help you? And my answer is no, that's a big question. A lot of people did find relief from the vaccine I personally didn't. But then a lot of a lot of the times the question I just get is, how are you? And that's a really tough one. Because you never know that they want, you know, I'm fine. How are you? Or do they want the Well, today, I have to lay on the couch for an hour in the darkness. And so that that is a tough question to navigate. It's just the How are you? So if you are asking that question of long COVID of, you know, patient, someone who's living with long COVID, you know, be prepared for a full answer. You're actually intending that. So, because it can be loaded?
22:35
Yeah, absolutely. Yeah. I don't even think about that. How are you? Well, yeah, really want to know, or do you want me to write? Exactly, yeah, yeah, yeah. Yeah. I think that's a great advice for people to what's what's it a question that you wish people would ask you? Or maybe how to phrase that? How are you questions? You know, what I mean?
23:00
Yeah. You know, I don't mind that. How are you question? As long as it's coming with, you know, good intent, and, and all that. So, you know, I think it's okay to ask, but also know that maybe that can be a stressful question for for someone. So, you know, maybe, maybe instead saying, you know, is, you know, how, how are you feeling today? Is there something I can help you with kind of thing, you know, putting a more kind of purposeful spin on it rather than, you know, just kind of, for your own personal curiosity. So,
23:35
yeah, I love it. I love that. How can I help question? I asked that a lot. And it's Yeah. So nice for someone to hear that. Especially. I think people living with long COVID many of you don't look sick. You look fine. I'm sure people have said that to you. Countless times. And it drives me crazy. That's a tough thing to hear. Yeah, you look fine. It's one of those invisible diseases, and it's invisible diagnoses. And I think that can be very stressful. Yeah, you know, you do hear that. Oh, you look good today. Well,
24:15
I did a good job then. Cuz? Because I don't feel good. A lot of days. So yeah. You know, and I get where people are coming from, but it is, it is kind of just something that is a hard thing to hear. Yeah,
24:27
yeah. Yeah. So I think for people, if you're interacting with people with long COVID just have a little sensitivity around some of these questions, you know, because they can be triggering, and I think that they can be stressful and as we just spoke about stress can be something that can increase symptoms of long COVID. So we want to try to minimize that throughout the day, right? Hmm, yeah. Well, Ted, I have to tell you, this is great. I'm so looking forward to Our roundtable discussion at the end of the month with you and Daria and Darren, and maybe a surprise guest in there as well, time will tell. Because I just think, as we discussed before went on the air, it's timely, it's important. If the, if they're modeling out 10% of people who are diagnosed with COVID may have long COVID symptoms, it's a lot of people. And so if you're a physio, odds are you may be seeing someone come into your clinic with long COVID.
25:35
Yeah, and even that 10% number could be conservative. So it's, it's hard to say there are a lot of a lot of people out there and a lot of people who still haven't heard of long COVID, especially outside of the medical community, I've run across a few people who have kind of talked to me. And as they start to tell their story, I kind of have that little thought in the back of my mind that, you know, this was me 15 months ago, I can hear some of the things they're saying in myself. So
26:02
yeah, yeah, well, hopefully things like this will help get the word out to more and more people. So thank you so much for your honesty, and for sharing your own story here on the podcast now, where can people find you if they have some questions?
26:17
Sure. Yeah. So my main social media is my Twitter. It's at TED Duchaine, DPT. And then we also have just started long COVID we have our peer support long COVID physio group, but we also just started a page for people who aren't living with long COVID just for information. So that's on Instagram at lone COVID physio, and also on Facebook and Twitter at the same handle. So
26:45
Excellent. Well, thank you so much. And we'll have links to all of those at podcast out healthy, wealthy, smart, calm under this episode. And last question, knowing where you are now in your life and career. What advice would you give to your younger self? Let's say fresh out of PT school?
27:03
Sure, yeah. I would say don't be, don't be so rigid and you're in your box of knowledge, what you learn in PT school is great, but there's so much more out there be open to things that you haven't heard of, or things that don't fit what you've heard. You know, I can honestly say that have had I not been living with long COVID I would have had that little squint in my eye that a lot of pts probably have right about now listening to this. And, and that's totally normal, but it's okay to step outside your box and, and look at something from a different lens, even if it doesn't quite make sense yet. Be open and willing to learn about something a little different.
27:46
I think that is great advice. Thank you so much for that. And thank you for coming on today. It was pleasure. Yeah, thank you, and everyone. Thanks so much for listening. Be sure to catch us for our roundtable talk, and have a great couple of days and stay healthy, wealthy and smart.
In this episode, Physical Therapist at Pro-Activity, Dr. Daria Oller, talks about living with Long Covid.
Today, Daria talks about the signs, symptoms, and causes of Long Covid, how to implement #StopRestPace, and how wearables can help guide your decisions. What are the considerations for athletes wanting to return to sport post-Covid-19 infection?
Hear about the role of social media when it comes to Covid, the many mental health aspects of Covid, and get Daria’s advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Long Covid comes after an acute Covid-19 infection. The current definition is ‘prolonged symptoms after 4 weeks.’”
- “It’s multisystemic… Two people don’t present the same.”
- “We’re not in a lab. We can’t control for every possible thing. Just tweak one little thing and see what happens.”
- “Our energy is very finite.”
- “Learn how to pull back, do what’s really essential first, and find opportunities to rest when you can.”
- “Work with where you are that day.”
- “With any athlete who has had a Covid infection, you just need to be aware and monitoring for possible red flags… The fact that they’re able to keep going doesn’t necessarily mean that it’s safe.”
- “There are people who are committing suicide from Long Covid.”
- “There are lots of great peer support groups. Even if you’re not getting professional help, you at least have other people you can relate to.”
- “Looking for those little wins and victories, even if they’re small, even if they don’t seem like much, it helps.”
- “Do not try to push through symptoms… Stopping, resting, and pacing makes a really big difference.”
- “You don’t have to push so hard all the time. Things will be there. You know yourself, you know what you’re capable of doing, but resting is as important as pushing hard.”
More about Daria Oller
Daria Oller is a physical therapist at Pro-Activity in Lebanon, New Jersey in both an outpatient clinic and on-site with employer clients. She specializes in working with dancers and athletes and in prevention and health promotion. She is also an athletic trainer, having worked in clinical, research, and education settings.
She served as the PI for a study describing the injury and illness experience of youth campers at university-sponsored summer sport camp program.
Daria contracted COVID-19 in March 2020. It continues to affect her daily life, including her ability to participate in and pursue her passions for dance and running. She is one of the founding members of Long COVID Physio, and has been sharing her lived experience on social media.
Suggested Keywords
Covid, Physiotherapy, Recovery, Long Covid, Healthy, Wealthy, Smart, Symptoms, Relief, Pacing, Resting, Support, Energy, Mental Health, Sport,
To learn more, follow Daria at:
Website: https://www.pro-activity.com
https://longcovid.physio
Facebook: @LongCOVIDPhysio
Daria Oller
Instagram: @ontapphysio
@proactivityus
@longcovid.physio
Twitter: @ontapphysio2
@LongCovidPhysio
LinkedIn: Daria Oller
YouTube: Long Covid Physio
Twitter Accounts to Follow for more info on Long Covid:
@OT\_Skiff @ahandvanish @PTOT4MECFS @PhysiosForME @ManeeshJuneja @itsbodypolitic @patientled @LongCovidPapers @AlyssaaErinn @ItsAngInLA @BreathewellPT @sunsopeningband @PutrinoLab @4Workwell @AHPLeader @SimonDecary @fi\_lowenstein @MichelleBull4 @elisaperego78 @respphysio @Dr2NisreenAlwan @Dysautonomia @LongCovidKids Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full transcript here:
Speaker 1 (00:03):
Hey Daria. Welcome to the podcast. Happy to have you on this month, where we are talking all about long COVID symptoms and rehabilitation. So welcome.
Speaker 2 (00:13):
Thank you for having me.
Speaker 1 (00:15):
And now what's your interest in long. COVID let the, let the listeners know if they don't follow you on
Speaker 2 (00:21):
Twitter. It's a very public about this. I got sick with COVID last year in middle of March, 2020, and the symptoms never went away. And early on, we were told people recover in two weeks and after two weeks, I said, I'm not better yet. And I was young and healthy. I'm a distance runner, I'm a dancer, pretty fit, and I just wasn't getting better. And I didn't know anything about post viral illnesses at all. So being the good PT that I am, I just pushed exercise and pushed and pushed because that's what we do. And it made everything a lot worse. And then through Twitter some of the PTs who specialize in myalgic encephalomyelitis and chronic fatigue syndrome reached out to me when they saw my tweets and said, this is bad. You need to stop. We're gonna help you. So then it just snowballed from there.
Speaker 2 (01:07):
I started learning about chronic fatigue and the similarities that were coming up with long COVID. And so besides that, like just personally affects me, cause it really drastically effected my life and thinking if I wasn't aware of this and I'd been a clinician for 15 years, like how many other people don't know about this? Because it seemed like just as all the PTs with long COVID started finding each other. So many of us had no idea, and this is across all different specialties and settings, different ages. And we just didn't know, unless you somehow happened to wind up in the chronic, the peak space already. We had no idea and it seems really easy not only to make mistakes with ourselves, which many of us who got sick in the first wave did, but to then make mistakes for patients because you're going to do great at exercise. That's what we do. You're going to encourage patients to push a little bit, to push through all the symptoms and it's really dangerous. So I want to make sure, you know, that people are learning, that we're educating our colleagues and even they're trying to reach out to patients to and teach them how to advocate for themselves, teach them some of the basic information that's out. So yeah. So in addition to just affecting me personally, I've seen professionally how important it is to help educate and advocate.
Speaker 1 (02:10):
And can you, Darren and I spoke about this last week, but I feel like we can never say it enough. Can you define what is long COVID and what are some common signs and symptoms?
Speaker 2 (02:26):
Yes. So long COVID comes after an acute COVID-19 infection. So it basically, you don't clear the symptoms. You continue to have symptoms and they can change what the acute symptoms are in those first couple of weeks can be drastically different. What happens weeks and even months later, people are reporting new symptoms. So right now the current definition definition is prolonged symptoms. After four weeks, there are people who have it just for a couple of months. Many of us are on month, 15 month, 16, and some of the common signs and symptoms. Some like for me, example, seem to have carried over from the acute having shortness of breath, chest tightness, chest pain, all different kinds of chest pain. Dysautonomia is really common now. So we're seeing people who have really funky things happening with their heart rate, with their blood pressure, heat and tolerance, just a really poor tolerance to exercise.
Speaker 2 (03:14):
And so taking a term from chronic fatigue syndrome, there's post exertion mollies, or we've been saying post exertional symptom exacerbation. So whenever you can do not only exertion like exercise, heavy exercise, but just general physical exertion, you know, walking to the corner could have cognitive exertion, like going to work or emotional exertion that can set off a whole cascade and worsened symptoms. And that can range from just get small exacerbation to people, get fevers for me personally, like I can't get up off the couch. I can't speak really well. And it's multi-systemic so it's really interesting because two people don't present the same. Some people can have more neurological, some could be more cardio, some could be more cognitive respiratory. There can be a whole mix. We're seeing people who have mass cell activation syndrome and you're seeing allergic type things and rashes and changes in food tolerance and GI disturbances. It is really, really across the board. So there's no one set. This is what long COVID looks like. But if there are symptoms that are just continuing for weeks to months after the acute infection, terrible, terrible.
Speaker 1 (04:18):
And let's talk about from, so your physical therapist, athletic trainer, let's talk about the, some of the treatment parameters around people living with long COVID. So you had said, when you talked about why you're interested in long COVID it's because you are someone living with that and you said, I'm just going to exercise. I'm going to go harder. I'm going to put in a graded exercise program and that's going to get me all better because that's what we do. So tell me now, what should therapists or trainers be trying to implement into your patients or, or even you, if you are
Speaker 2 (04:57):
Someone living with them? Yeah. So it's, it can be such a different approach. I'll start with, there are some people that starting with the light exercise program can be appropriate, but there are things that you really need to monitor for. And nobody's like red flags. So looking at somebody has its own an again, seeing their heart rate blood pressure changes, just poor tolerance to even just moving from supine, to sitting upright, to standing poor tolerance to the heat, that trying to get that under control first so that it could be just working on breathing in their sessions, working in diaphragmatic, breathing, trying to get out of that, like very accessory breathing pattern because many of us hyperventilate and just don't even realize that we had adapted that pattern. I look at this tooth, I have one patient right now with it. I'm teaching people how to manage their symptoms, that these things are going to happen.
Speaker 2 (05:45):
And it tends to be very unpredictable and episodic. And that's, what's really frustrating. It's not that, oh, I just let me not do this. And then I'll be okay if I avoid this. Cause you could do something one day and be fine. And the next day it sets off a horrible crash. So teaching patients how to start recognizing those signs and symptoms and sort of like you can sort of tell sometimes and things are starting to go in a bad direction and what do you need to do if you're home, teaching them how to lie down, go through the diaphragmatic breathing. I've been sitting with my patient going through her day and like, where are there opportunities to rest? So this is very different than here's your theoretics program. It's where can you rest in your day? Where are, what are the things you absolutely need to do?
Speaker 2 (06:21):
Like eat, prepare food, order food, something like that. What are the things that, you know, are good you'd like to do with maybe aren't, you know, priority. And one of the stuff that like just don't even, it's not worth exertion that can set stuff off. So that's a really big part for me with the sessions is teaching people sorta how to figure out how to live with it. It's not a set plan. Like this is what you do, but here. So here's your life. Like I explained to my patient today, like we're not in a lab, we can't control for every possible thing and just tweak one little thing and see what happens. So here's your life? What do you need to do? And then how can we best set up to get you like that you're able to function that you were able to within reason control the symptoms. Like as an example, you know, right now it is incredibly hot in New Jersey, New York city. So we know that that can trigger symptoms. All right. So maybe we figure out if you have to have food shopping going early in the day, not going at noon when it's going to be really hot out. So there's not necessarily something set, but I look at it as helping people figure out how to live their lives right now while managing the symptoms.
Speaker 1 (07:19):
And that kind of takes me to the concept of pacing, which I think maybe a lot of people don't quite understand. So can you talk about what pacing is and how that differs from a graded exercise program?
Speaker 2 (07:31):
Yes. Hazing is so difficult. It sounds easy and it's not. So, and this is pacing, like say I'm a distance runner. So I understand how to pace, you know, over running, but to pace in your life is so challenging. So it might mean breaking something up. Pts will understand this. Some, some of us can sit at a computer for a few hours just to go through those notes, get them done. I can't anymore. So it's like maybe set a little chunk of time and then maybe you need to rest. Maybe you just need to get up and take a break. It might be cleaning your house that you can't do it all in one shot that you need to maybe do some in the morning and some at night, some today, some tomorrow is I look at it as like finding opportunities to slow down and opportunities to rest and something I've noticed as the world doesn't really set up for that.
Speaker 2 (08:14):
It is really, really challenging. You do your best and there are certain things, you know, you won't necessarily be able to pace with, but when you can just trying to spread it out because our energy is very finite and this is like literally at the cellular level, the energy is just not there. So you can't necessarily push through it. You could try, but that's going to affect you tomorrow. And then you'll be at a deficit for the next day and the next day. So it's learning how to pull back. Do what's really essential first, like really prioritize and finding opportunities to rest when you can,
Speaker 1 (08:48):
Yeah. Much, much different than a graded approach to activity or a graded approach to exercise is every time you do something, you increase it a lot, a little
Speaker 2 (08:57):
Bit more. And that's, what's interesting too, because yeah, that's just, that's what we do, but because symptoms can be unpredictable just because like, I'll use an example just because I could pick up five pounds one day doesn't mean I could do five or six pounds the next day. It might be the next day one pound. So it's really, really hard. You have to really listen to the patient and just go off of how they are feeling that day and let them know too that they're not doing worse because they can't do the same amount of whatever it is that they could do the day before. I mean, that's a hard thing. You look at it. You're like, but I just did this two days ago. Why can't I do the, why am I so tired today? It's so complicated. So yeah, it's trying to avoid that a little bit more the next day, a little bit more, a little bit more and just work with where you are that day, wherever your symptoms are at let's work from there,
Speaker 1 (09:41):
It's a much different mindset than what we're used to. And now, as, as we talk about that, I think that there's something important that we have to mention and that's athletes living with long COVID. So with athletes, we have to get them ready to get back onto the field, which means they have to be able to do a little bit more, a little bit more, a little bit more because they need to be able to compete. They need to be able to perform. So what are some specific considerations for athletes returning to sport post COVID infection or athletes with long COVID?
Speaker 2 (10:19):
Yeah. I look at this as with any athlete who has had a COVID infection and you just need to be aware and just be monitoring for possible little red flags that they might be going along COVID direction, because for anybody it's not always immediate, there are people who are doing okay in a couple months later, I had a flare up and we know with athletes in general. And I say this as one we push, you know, there are athletes who have plead while they have broken bones and concussions and all kinds of things. So the fact that they're able to keep going doesn't necessarily mean that it's safe. And an example for me, like I ran 10 and a half miles, two months after I got sick, which is insane, but I pushed and I did it. And then you could look at my heart rate and see why it was bad.
Speaker 2 (10:58):
So you're monitoring for, especially that post exertion L symptom exacerbation, if after they're working out, they're doing their practice, even watching film the cognitive demand for that, if it's a sport that has filmed, are they crashing? Not just the normal you know, you're a little fatigued or maybe have some dorms or something like that, but they're just completely done. It's really important to educate them and let them know because they might just think that it's just deconditioning. You need to get back in shape really important to monitor their heart rates too, because then they're going to push, especially getting back now after, after not being able to play sports from the pandemic, everyone's gonna be excited and have big adrenaline rushes and be able to push. And it's great to be able to look at some vital signs, to look at their heart rate, look at their blood pressure and see what it's doing, because they might not always be aware of what's going on to report it, but we know what you could look at as something objective like a heart rate and see, this is not the normal response from like what we would expect.
Speaker 2 (11:50):
So I know in the literature there's been some emphasis on clearing them for cardiac conditions, obviously super important. We see myocarditis and all kinds of things that is very important, but we're seeing many people in general on COVID whose basic lab work imaging is negative. But that doesn't mean that they're necessarily. Okay. So it was looking for the dysautonomia, particularly with sport, looking for the post exertional symptoms, symptom leaves after their playing, after their conditioning, again, after even cognitive exertion to see how they're doing monitoring for months, you know, don't assume because they were okay in the beginning because they're able to push through a couple of things that they're okay. Cause athletes will push through some pretty dangerous things to play.
Speaker 1 (12:27):
And can you just for the audience give a specific definition to the post-exercise malaise or post-exercise symptom exacerbation. Cause I really want people to understand that it's not just like, I'm a little tired and I just need to rest. So can you explain what that means?
Speaker 2 (12:47):
Yeah, it is. That looks like yes, it is actually physiologic reaction. So people will report an increase of flare up, increase in severity of their symptoms and you will actually see like physical, sick symptoms, like a fever is I think a really great example because no matter how hard you push exercising, a fever is not normally you know, response to that. And it is, it is so hard to explain when she experienced it, how crippling the fatigue is. It is something you cannot push through. Like you cannot get up. It sounds like I'm exaggerating, but I'm not. And I was talking to PT, Todd Davenport about this. And he, with his work in chronic fatigue was saying like, it's literally two energy demanding to talk like the amount of energy it takes for what we're doing right now is not there. So, and again, it can vary too.
Speaker 2 (13:38):
There are crashes. That's what I've kind of called them. Some other people too, that can be a little minor is not the right word, but not as severe. And some that are, people are literally bedbound and are unable to get up and it can vary to where the post exertional symptom exacerbation, those crashes can last for a few hours. They can last for days, weeks. Some of us, it takes us months to be able to bounce back from one. And even that, we're just trying to get back to that baseline of where we were when the crash happened. Not like a true, like pre-illness baseline. Got it. Yep.
Speaker 1 (14:10):
Thank you for that because I think it's really important to make that distinction for the listeners. Now let's talk about let's talk about the rule of social media when it comes to long COVID or COVID in general. I mean, we all know that social media is full of misinformation. As a matter of fact, I was reading an article where they said the long COVID misinformation, 80 or 80, some percent of the long COVID misinformation and misinformation on vaccine surrounding lung COVID was coming from 12 accounts.
Speaker 3 (14:46):
Can you imagine
Speaker 1 (14:47):
They just happen to have like a really, really strong presence and a really large following on social media. So what is the role of social media with long
Speaker 2 (14:56):
COVID? This has been fascinating. So we all people with on COVID found each other on social media pretty early. This part I didn't find initially, but body politic, they found each other really early in starting this whole launch. The patient led is another group too, but so this patient led movements. So people just coming together and saying, we're not better. We don't necessarily know what this is, but this isn't right. This isn't the two week recovery that we're hearing about. And at the same time people with chronic fatigue were jumping and they had been sounding alarms from the start of the pandemic. We didn't know about it. Cause you know, we weren't in that space. And then, so it's the people with lung COVID who named it. We gave it a name when we, you know, we weren't being heard initially because things, you know, being New York city, things were so severe that the focus was on the acute.
Speaker 2 (15:40):
We severely sick hospitalized people. So we on our own kind of came together and gave it a name and have gone from there. So that's social media has allowed for peer support groups and we have long COVID physio specifically for PTs, PTs, other allied health care professionals with it. I'm in a group for endurance athletes with long COVID. I'm sure there's plenty of other like specific groups where you can relate to each other because when you try to explain this to people who don't have it, they look at you like you're crazy because it just sounds so ridiculous. It doesn't sound like it's real, especially for those of us who were young and healthy and fit, you know, prior to COVID and then it's allowed us to get information out really fast where, you know, it takes a while to publish. It takes a while to do a study, but all of us, you know, we've been our little ends of one, like I'm going to report what I'm going through.
Speaker 2 (16:23):
You know, PT, Twitter was great. Encouraging me from the beginning, just report where you have. Cause that's, you know, that's one example we'll learn from. So we've been able to get that information out and papers have gone out very quickly. We have had some amazing webinars and just things that are, people are just producing so quickly and on their own, sometimes it was faster than having to go through a whole, you know, association and, you know, with the journal and everything. So that's been amazing and we find each other and I know which are the accounts that are going to put out like the peer reviewed articles when they're there. I know, which are the accounts that are going to have the great webinars and all the free things that are available on YouTube to watch. I know which are the counselors patient share and their stories. So you kind of find to what fits with, with what you need to know and whether you're at the, just the patient level or you're a clinician who needs information
Speaker 1 (17:08):
And can you, what are some of the accounts or, or if you want, you can send them to me and people listening can just that way you don't have to rattle through land accounts that no, one's not going to re no, one's going to remember anyway. So if you can send me some of the accounts of individuals and groups that people, if they're listening have long COVID, they know who to follow on where to get accurate information
Speaker 2 (17:32):
From. Yeah. Yeah. That's a great point that accurate that's been for better or for worse having clinicians and researchers with long COVID gives you people who know what they're talking about that you can follow them and I'll add for what you said. Cause I went, oh no, because one of the things that happens with long COVID is brain fog which is a broad term. And it sounds like not much, but the symptoms, the cognitive symptoms really, really range. And you'll see some of us just kind of get stuck finding words or trying to remember something, or I can picture people's Twitter profile photos. Couldn't tell you what the handle is on the list. Like actually see it, that's been a really challenging thing. I've been trying to kind of figure out how to work so I can send you yeah. Cause that's great. It is, it is so great to have other people to follow who are in the same boat or what we're calling, you know, allies, people who are sharing, they might not have it, but they're in a clinical space or research based to help.
Speaker 1 (18:21):
Yeah. Fabulous. Yes. So for all of you listening, Daria will send them to me. You can go to podcast dot healthy, wealthy, smart.com click on this episode and then you will click on whichever of those links you would like to follow. That would be much easier. Okay. So now let's talk about just this'll be well, we'll sort of finish up our conversation on a light note. Let's talk about the mental health considerations of those
Speaker 2 (18:50):
Living with Ms. Oh yeah. This is a whole big topic. So I'll start with it was pretty early on from when I had symptoms that somebody had first mentioned anxiety in me kind of implying that might be what the cause of my symptoms were. And I just say for me personally, I'm not an anxious person at all. So on one end, we're, you know, we're trying to say that it is virus driven. People can have mental health aspects a lot to get into, but that's not the root cause. So it's really important to tease out because people are told and I'm learning all about this from other people, chronic illness going in that direction and say, no, but psychological interventions can help, but that is not the underlying cause. But that alone, when people are telling you you're anxious, you're depressed when that's not what's driving.
Speaker 2 (19:34):
It is really frustrating. But because of all these symptoms, having this new chronic illness during a pandemic that has been politicized with false information is really hard because you'll talk to people who don't believe in the science of what this is, and they don't know that you have long content and you're just so that's really, really difficult. And it changes your life. You know, it's a complete change in your identity for all of us, particularly who are really active, whether it's exercise or as PTs, if physically demanding jobs. And you have to like figure out who you are now, if you can't do all the things you used to be able to do, you know, who are you? And then say for me, like running and dancing, that was my stress relief. That's my outlet. That's how I express myself, particularly with dancing. And now, you know, I'm not able to do that.
Speaker 2 (20:23):
Like I was before and it takes a toll and you're trying to find, well, what can I do then? What, what am I able to do to try to help cope with these symptoms is it is so frustrating. You are trying to figure out how to live with symptoms that are unpredictable and episodic. And like I mentioned before, you know, the world isn't adapting to what's going on in the world, just going on, like it was before the pandemic. So having the peer support has really, really invaluable to have other people to talk to that, understand it. And you can not only explain the symptoms, but you can be going through the symptoms and you know, they understand when you forget your word, when you stumble, when you're just too tired to sit up. So you're on a zoom, lying down. There's so many things like that.
Speaker 2 (21:06):
When you have people that to just, just to vent to or who, you know, they just understand what you're going through. That's been really big because the first for me, the first few months, I didn't know anybody else with it. And I obviously, there's plenty of great PTs who I was talking to, trying to help and my friends. But when you have people to talk to who understand that makes such a difference. It's just like, there's weight off of your shoulders. And like, oh, you understand you get it. I've met people. When we work with employer clients for my job who have long COVID and they start to explain the symptoms to me and I could see them kind of hesitating when they say that, it's like, no, no, I understand. I understand that you get really sweaty all the time. You're not crazy.
Speaker 2 (21:41):
That's a real symptom. That is a thing we can talk about that because this is something I didn't appreciate earlier. I work in orthopedics and it is, you know, there, there is a mental health aspect to it, but this is a whole other world there wasn't aware of. Yeah. As a PT, it's making sure you're listening to the patients that you're validating their experience and not say maybe if you're not familiar with this thing, well, that's weird. You know, that, that can't be right, that you're really listening to them. And that when you're, as you're listening, if you're hearing some of those red flags that maybe as a results of long COVID, or maybe they had anxiety and depression already, and this is exacerbating, it know that you're listening, you're ready to provide resources. If that's appropriate. And then now we're even taking a sad turn, but there are people who are committing suicide from long COVID.
Speaker 2 (22:26):
There was just a big case in the news because the woman was a writer. There's somebody who owned a chain of restaurants, it was pretty famous that had committed suicide. And there's more that are in the news, but that's really big too. And it's something that, again, I didn't necessarily appreciate until I was going through not only chronic symptoms in general, but symptoms where there's not a cure or treatment necessarily. So it's a whole new, a whole new world to learn about this. So as a PT, it's just really listening to the patients and under trying to, you know, understand, be open to what they're going through. That it's not just physical symptoms, but it's going to affect their entire being.
Speaker 1 (23:02):
Yeah. And you know, in Darren and I were talking about this, I said, you know, it reminds me or it makes me think of people with a headache, chronic headaches, migraines, maybe neck pain, back pain, where, you know, you're not walking with an assistive device. You don't have a limp. You're, you know, you don't have the symptoms of someone who's quote unquote sick. So it's one of those sort of silent silent diseases, if you will, or, or silent symptoms for a lot of people. And to have to explain to people why you can't meet them for dinner or why you kept it, it can just be, so how do you deal with that? Oh,
Speaker 2 (23:49):
This has taken a long time because I'm someone where you can look at me and assume I'm high functioning. Cause I go to work every day, you know, I, to a degree, kept up with dancing. But I'll explain to people and they're not getting it that they don't see what it takes for me to be able to do those things. The resting that I have to do, as soon as I get home from work or dance or something draining, I lie down I'm supine. That is like, if, as long as my schedule lets me do that, that's the first thing I do when I walk in the door. If I have to dry for a while, if I can I sit down when I get done or lie down even better. So there's a lot of strategies like that, that go on that you wouldn't see unless you're next to me.
Speaker 2 (24:24):
So I'll tell people about that. You know, I might look okay, but there are symptoms that are going on and I'll explain to a particular thing because I dance, you know, and the show must go on. I'm accustomed to ignoring symptoms and smiling and getting out on stage and spurt, you know, pretend everything's okay. So that's something that I've learned. It's not the greatest treat to have with long COVID because again, people, it just looks like, you know, we're okay. But it's, it's explaining, you know, what it takes to be able to just do basic things like food shopping. And what advice do you have for
Speaker 1 (24:56):
For people living with long COVID when it comes to their mental health? I think the advice that you just gave for therapists to really listen to your patients, not only listen, believe them. But what advice do you have for people living with long COVID? If they are kind of suffering their mental health is suffering.
Speaker 2 (25:17):
Yeah. A big thing is like, we've already talked about social media. If you can find, there are lots of great peer support groups. There are just general long COVID groups on Facebook. And then, you know, there's specific ones targeting you know, very specific populations. So at least even if it's not, you're not, you're not getting professional help you at least have other people you can relate to because I know that with long COVID clinics that are, that are starting on their wait lists. So trying to go through that referral system, you know, to try to get to somebody to help can be a little challenging. And I know for me and other people it's been having to just kind of accept that this is a thing going on and that it's, you can't push through it. You can't just kind of wish it away.
Speaker 2 (25:59):
You can't ignore it, it's there and you can, you can try to ignore it, but it won't let you, you're not going to get very far. And is this so much easier, seven number, just trying to accept the, how uncertain it is and just being able to kind of roll with it and know, you know, you might plan, have plans for a certain day and you wake up and say, Nope, that's not today. That's not going to happen. You know, I wanted to go to the pride parade on Sunday in the city and it was 90, whatever degrees, obviously very crowded. A lot of stimuluses Nope, this is, this is not a good idea. It would have been great to do, but not safe. So it's being able to, you know, recognize your limitations and something. I can't remember who told me this, but it's not only acknowledging the things you can't do because that is important to recognize certain things that are not right now, but something you did do that day.
Speaker 2 (26:45):
Like maybe I wasn't able to go food shopping, cause it was too much, but I didn't crash. I got through the day without a crash. So that's a positive thing. And it's hard again because it's not always in our control, but I that's something I've been trying to do as frustrated as I get, because there's so many things I can't do right now or I could, but I shouldn't because I've learned the things I shouldn't do. Just also recognizing there are still things that are not control maybe even on the worst day and you're not able to really get up and do much look at your heart rate and say, Hey, but I was able to keep my heart rate at a fairly low level because I understood that I was supposed to stay in bed. So looking for those little wins and victories, even if they're small and if they don't seem like much, if you're accustomed to doing a lot, it helps. It gives you just like a little bit incentive. So you can kind of look at the big picture and see that if you aren't making progress.
Speaker 1 (27:30):
Yeah. That's such great advice. And you know, Louis Giffords called that, looking for the pink flags. So looking for those, you know, cause we got red flags, yellow flags looking for those pink flags, which are those, those exactly what you just said those times where you're like, you know, I still have back pain, but Hey, I was able to sit through a movie, right. Or, oh, I was, I wasn't able to get out, but I was able to, to do some stretching. Right? So it's like, these are, you're really looking for those pink flags, those things that give hope that give a sense of accomplishment, however, small or big it might be. So I think that's really important.
Speaker 2 (28:14):
So now, so it's helpful two, because you don't know from day to day, what's going to happen. Which is just makes it so hard. That is the really frustrating part. And like you really have no idea. I can't remember. There's so many things that I've read. I always forget who, where I read what, but there was a physician who said with long COVID, it's like putting your hand in a bag of symptoms and pulling them out and say, this is me today, which is very accurate. That is a hundred percent accurate. So yeah, when you can say, all right, well today didn't turn out as planned, but I did something or at least, you know, things didn't get worse. Sometimes literally the accomplishment is that things didn't get worse and we're able to sort of manage it. It just really changes your perspective on how you look at things. But it's knowing that we don't know what's going to happen. We don't have a predictable, rough timeline on what to expect. We don't know that, oh, if you're in this age range, you're more likely to have this. Or if you were healthier, you're because we're seeing people who had no comorbidities I'm like, you know, with the severe acute infections. So just looking for those little wins can make a difference. Yeah.
Speaker 1 (29:16):
And, and living with that uncertainty certainly not easy. But if you have support groups, you have friends, family, peers, professional help. I'm sure that all of those things can help you kind of manage your life and manage where you are at this moment.
Speaker 2 (29:37):
Yes. I was explaining to my patients today that I, because she was, she was explaining friends who aren't understanding it and if it's going to happen and this, as soon as you have to, I think of the Mr. Rogers quote about finding the helpers. And in that case, you know, I had a friend who visited that hadn't seen our literally two years, but I knew she would understand. And there was a couple hours, one day I just had to lay down and I knew that would be a non-issue for her. She'd either take a nap or find something else to do. So I was looking for that, like knowing who the people are in your life that they'll understand. If you have to cancel last minute, that's fine. If you need to sit down last minute or, you know, slow down, you can do it, but that they will understand. And that's not going to be everybody not everybody's going to get it, which is fine. It's frustrating. But you know, it is what it is. But looking for those helpers who even if they can't directly help you, you know, cause they're not in healthcare, they at least will understand. They at least will listen to you. And they'll at least say, no, that's fine. This is who you are today. So we'll work with that.
Speaker 1 (30:31):
Yeah. That's so great. I think that does sound something like very Mr. Rogers E write something he would say. So now what would you really like for the listeners to kind of take away from
Speaker 2 (30:45):
This episode? A couple of things is the one is with anyone with long COVID, whether are living with it, or you have patients with it to not try to push through symptoms. I cannot stress that enough. You can use me as the example of why you should not push through symptoms. I have tons of data available from my garment and heart and crazy heart rate things. And it is just not something you can push through and it's not a failure on somebody's part. It's not that they're not trying hard enough. It's not that you're not strong enough. It's just physiologically. This is where you are right now and really doing your best to embrace. It's hashtag stop, rest pace, which is from the chronic fatigue community to really, really try to do that while there's, you know, like I said, there's no set treatment or cure.
Speaker 2 (31:31):
We know that that that helps it. Doesn't magically fix everything and everybody's different with how you implement it in your life. But the stopping resting and pacing makes a really, really big difference. And like as a PT, you just need to be open to the paradigm shift. It is so different than what we are taught from, you know, my mindset like so many people's it was, I gotta move. My dad's a respiratory therapist. He's retired now. But when I got sick last year in March, he said, knowing me, you know, you need to wait two weeks until you don't have symptoms before you start running is like, that's crazy. No, I got to move. And here's all the reasons why I can't be sedentary. Here's all the health reasons. And now I've had to like shift that in my brain a lot and say, okay, I know there's risks with bone health and cardiac disease and all these things, but the priority right now is trying to get the symptoms under control and really trying to prevent crashes as much as possible. So just being open to that, and yes, there are concerns about being sedentary, but right now preventing the crashes, supersedes that.
Speaker 1 (32:23):
Got it. Excellent advice. Now, where can people find you on social media,
Speaker 2 (32:28):
On Twitter? I'm on Twitter often. And I would say you can tell when I'm lying down resting, cause that's when I'm tweeting. Well, good to know it's at on tap physio two, number two, that is the best place to reach me on Instagram. I'm ONTAP physio. Excellent. It's on Twitter often. Yeah. Yes
Speaker 1 (32:45):
You are. And you get spread a lot of really, really good advice and, and we all appreciate your being there and being a voice of truth for people living with lung COVID and for clinicians who want to learn more. So we all thank you for that. Now last question I ask everybody this, where what advice not, where, what advice would you give to your younger self knowing where you are now in your life and
Speaker 2 (33:15):
In your career? I'm laughing because to not push so hard, which is crazy as a physical therapist or someone in healthcare in general, but to not push so hard. You know, I learned at my very type a all girls high school to push, like we just push you work as hard as you can. You grind got that in undergrad. And I was at the other training student, obviously I was in PT school and after that, and it has been to my detriment now that we're, you know, we look at that drive that that's such a great thing to have and look how resilient you are, look how antifragile you are looking all these great things, but we're seeing with not just lung COVID, but other post viral illnesses that can actually really harm you life in general. Yes. Yeah. And we get accustomed to not sleeping and illustrating caffeine and all that. So it sounds crazy to be saying to myself, knowing how I am, but it's to learn, like you don't have to push so hard all the time that things will be there. You know, you, you know yourself, you know what you're capable of doing, but resting actually resting, not doing things just resting is really, is as important as pushing hard and pushing hard can lead to all kinds of fun trouble.
Speaker 1 (34:30):
Absolutely. I think that is great advice. And one that I think any, certainly any PT should, should take and should live by. So thank you for that. And thank you for your honesty and being so candid during this conversation, because I think it will help a lot of people. So thank you so much for coming
Speaker 2 (34:48):
On. Well, thank you for having, like I said, finding the helpers, you are one helping to get all the information out to people on your, you have such an incredible platform where it's so important that we're reaching people wherever they are, and podcasts are definitely a way to do it. So thank you.
Speaker 1 (35:03):
I am happy to do it and I am learning more and more myself throughout this whole month. So thank you again and everyone. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode the chair of Long Covid Physio, Darren Brown discusses the World Physiotherapy briefing paper on safe rehabilitation approaches for people living with Long COVID.
Today Darren talk about the Key messages for Safe rehabilitation from the briefing paper:
" • Post-Exertional Symptom Exacerbation: before recommending physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, individuals should be screened for post-exertional symptom exacerbation through careful monitoring of signs and symptoms both during and in the days following increased physical activity, with continued monitoring in response to any physical activity interventions.
• Cardiac Impairment: exclude cardiac impairment before using physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, with continued monitoring for potential delayed development of cardiac dysfunction when physical activity interventions are commenced.
• Exertional Oxygen Desaturation: exclude exertional oxygen desaturation before using physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, with continued monitoring for signs of reduced oxygen saturation in response to physical activity interventions.
• Autonomic Dysfunction and Orthostatic Intolerances: Before recommending physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, individuals should be screened for autonomic nervous system dysfunction, with continued monitoring for signs and symptoms of orthostatic intolerance in response to physical activity interventions."
More about Darren:
Darren Brown is a cis-gendered (pronouns he/him), gay, white man, of English and Irish heritage, living in London, UK. He is a clinical and academic Physiotherapist specialising in HIV, disability and rehabilitation. Darren leads the HIV rehabilitation service at Chelsea and Westminster Hospital NHS Foundation Trust; Europe's Largest HIV centre. He is the Vice-Chair of Rehabilitation in HIV Association(RHIVA), HIV/AIDS coordinator of World Physiotherapy subgroup IPT-HOPE, and steering committee member of Canada International HIV Rehabilitation Research Collaborative (CIHRRC). Darren was awarded an NIHR funded Masters of Clinical Research (MRes) in 2019 and continues to conduct both quantitative and qualitative research about disability and rehabilitation among people living with HIV in the U and internationally. Darren contributes to national and international programmes focusing on disability inclusion across all responses to HIV. Darren contracted COVID-19 in March 2020 and continues to live with Long COVID. He is a patient advocate for Long COVID healthcare and research, calling for the greater involvement and meaningful engagement of people living with Long COVID in all responses to COVID-19. Darren founded Long COVID Physio in November 2020, an international peer support, education and advocacy group of physiotherapists living with Long COVID. Darren is an invited expert contributing to World Health Organization Guideline Development Group on COVID-19.
Suggested Keywords:
Covid, Physiotherapy, Recovery, Long Covid, Healthy, Wealthy, Smart, Symptoms, Relief, Pacing, Resting, Support, Energy, Mental Health, Sport
To learn more follow Darren at:
https://www.hiv.physio/
https://longcovid.physio/
Long Covid Briefing Paper
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Read the full transcript here:
Speaker 1 (00:02):
Hey, Darren, welcome to the podcast. I'm thrilled to have you on today. Thanks so much.
Speaker 2 (00:07):
Hello. And thank you for having me. My
Speaker 1 (00:09):
Pleasure. So this month we are talking all about long COVID. So people living with the long COVID symptoms and also what long COVID is at least what we know now, what we know at this present time. But before we get into all of that, and before we talk about the the world physio therapy briefing paper nine, which we will have a link to in the podcast notes I would love for you to let the listeners know a little bit more about you and why you are part of that paper and, and part of this world.
Speaker 2 (00:48):
Yeah. So thank you very much for having me today. So my name is Darren brown. I'm a, cis-gendered gay white man. I've mixed English and Irish heritage. I live in London in the UK. Hence my accent for anyone that's not where I am. I am both a clinical and an academic physiotherapist, and my background is in the area of HIV, disability, and rehabilitation, so specialized in that for a decade. So I'm kind of used to the chronic implications of viral diseases. And I also happen to be a person living with long COVID. So I contracted a coronavirus acutely in March, 2020. So as I sit here today, I'm of my 15th month after acute coronavirus and I am currently sitting here today in a really stable, good place with my long COVID I predominantly symptom free.
Speaker 2 (01:45):
However, it's been a 15 month journey and it's been a very episodic and up and down journey which I'll be very happy to summarize for you if you thought that was useful. So I, as I said, I contracted coronavirus last year. I went back to work pretty quickly actually, and I ended up working full time for six months, switched, included being redeployed to various sectors, including intensive care in response to the pandemic. Had some ongoing symptoms, but in September last year I crashed. And I ended up being off work for two months and the crash lasted for about six months where at my most disabled I was bed bound and flat bound and walking with a walking stick. And my symptoms were multi-dimensional episodic and unpredictable in their nature with profound exhaustion, fatigue, brain fog I've had some respiratory symptoms.
Speaker 2 (02:37):
I've had cardiovascular symptoms. I've had urological symptoms are neurological symptoms and I'm under all of those physicians for investigation still. I then had my vaccination, my first dose in January. I got better. I returned back to work. And then I was getting so much better. I started to do a bit more and unfortunately I had second crash. But then I had my second vaccination felt a bit better. And I've been continuing that journey since. So yeah it's been a very episodic journey but I'm also a co-founder of a group called long COVID physio. So long COVID physio was born out of the need for peer support amongst physiotherapists, living with long COVID, both in the UK and the United States, but now it's evolved, it's now a global peer support group that also provides education in the context of a long COVID disability and rehabilitation. And also acts as an on an advocacy level which kind of brings us round to where the briefing paper came in really. Because it was born out of a need for education and advocacy led by people living with long COVID.
Speaker 1 (03:54):
And you know, I think we spoke about this before we started recording, but your background working with HIV that has multi-system whole systemic bodily implications, you said, well, with these, the code, the symptoms of long COVID, you weren't, it wasn't like out of the blue, it wasn't a huge surprise for you, but is it safe to say it was a huge surprise to a lot of other people in healthcare and out?
Speaker 2 (04:26):
So in the context of HIV, we know that HIV can be controlled with medicines antiretroviral therapy. And when a person is undetectable, meaning you can't detect the virus in the blood because the medicines are working that well, people are on transmittable, meaning you can't pass it on. And when people are undetectable and they've been taking the medicines, people can live a normal life expectancy. But what we know with that is that people are growing older with HIV and the developing other complications and people living with well controlled HIV, still experience issues, including episodic disability. So when this pandemic came out, there was quite a few of us at work in the world of HIV, disability, and rehab that were kind of anticipating well, if people recover, there may be a risk that people will develop long-term consequences. So it wasn't surprising. I think what was surprising was that I was one of them and actually how severe the disability was.
Speaker 2 (05:19):
There are other groups of people that also were anticipating a post viral manifestation, particularly groups of people living with Emmy or my LJ can. And my lightest also known as chronic fatigue syndrome. And other people that have been living with post viral complications probably were anticipating there was going to be some form of complications after acute Corona virus. But I think mostly the world has been caught off guard by this. And maybe it hasn't been prepared for the critical mass of people globally that are going to be living with ongoing consequences after acute coronavirus, which is now commonly referred to as long COVID.
Speaker 1 (06:00):
Yes. And so now I think that leads us right into the briefing paper. So like I said, there'll be a link to this in the podcast notes, but when you look at this briefing paper, there are a lot of contributors to this. So before we get into the meat of the paper, can you give can you explain how you got all of these people together in order to write this paper?
Speaker 2 (06:22):
Yeah. So this brief briefing paper was specifically brought together communities of people from different experiences. So the idea started with myself and a few other people that had expressed some concerns that maybe there was lacking guidance and policies and standards around the utilization of physical activity, witching of all types, including exercise and sports in the rehabilitation of people who may have been recovering from coronavirus or living with long COVID. And so initial conversations were between some people that had already connected pretty much through social media. And when we got the kind of green light with world physiotherapy, that this might be something that we could work towards. We started to snowball our collective groups. It, this, this briefing paper is brought together over 50 different people from different geographical regions in the world, so that all of the five corners of the global four, four corners, but, you know, five weld, physiotherapy regions have been represented here.
Speaker 2 (07:29):
So we've got people from Europe, north America, south America. We've got people from Africa, Asia, and Asia specific. So we, we have huge diversity, not only in where people are from, but also in that backgrounds. We've got people living with long COVID. We've got physiotherapists, we've got physicians, doctors that specialize in a range of different things, including physical and medical rehabilitation. Also known as physiatrists. We've got occupational therapists, psychologists. We've got people living with M E the list goes on and we've got such diversity because what was needed was a consensus here. What was needed was a diversity of thought experience, both lived clinical and academic, but also geographical to come together to say non COVID is not just affecting one place in the world. And this experience is not singular to two groups of people or people in certain locations. This is actually a unifying global issue and the long-term consequences after acute coronavirus and affect people around the world. And that's why it was so important that we have that diversity, if the people that were contributing, but also diversity of experiences and thoughts, because not everybody comes from the same background with the same beliefs about all of this. And so we needed to bring that consensus together. And that's how we was able to develop the paper, though. It was not only recommending caution, but was also what can be done and also where rehabilitation is successful.
Speaker 1 (09:00):
Yeah. And I think, you know, for a whole systemic disease, that COVID is, and it being global, it is important to have a whole systemic group of people working on this. So I just wanted the listeners to know it's not only physical therapists or it's not only physicians, if this was a real collaborative world effort. So that being said, let's talk about what some of those key messages are, especially when it comes to safe rehabilitation of people with long COVID. So I'll hand it over to you.
Speaker 2 (09:33):
Yeah. So the, the way the briefing paper was written was to introduce T considerations when rehabilitation specific to physical activity in all of its forms. As I said, including exercise and sports, when those key considerations need to be taken from a safety perspective before we prescribe exercise and physical activity. And I purposeful in my terminology there because we are health professionals that do prescribe our interventions. And so therefore we do need to have safety at the core of what we do. We know that there is currently not enough evidence or any evidence on the safety and effectiveness of physical activity and exercises and intervention for people living with long COVID, but there's loads of indirect evidence. And there's also enough evidence in long COVID to give us the signals and clues as to which direction we could be traveling in. And so there was four key messages that came out in this.
Speaker 2 (10:31):
So the first was before recommending physical activity, as a rehabilitation intervention for people living with non COVID individuals should be screened for post exertional symptom exacerbation. Now, this is a term that's called different things. So post exertional symptom exacerbation is something that I quite like, but it's also used by other groups sometimes more commonly known as post exertional malaise, but can also be known as post exertional neuro immune exhaustion, basically, in a nutshell, when you exert yourself, whether that be physical, cognitive or social exertion, your symptoms get worse. So obviously before you get people to exercise, it would be quite useful to know whether they've got that because you can't exercise your way out of a symptom, which is made worse by exemption
Speaker 1 (11:21):
And, and from a physical therapy. Cause we're both physios from that physiotherapy perspective, how do we screen for that? Is it a simple questionnaire?
Speaker 2 (11:33):
So this is where the briefing papers really quite useful because obviously that's the first key message. And the way the briefing paper is designed is that you have the key message and the rationale for that key message. So if anyone's now going, why they brought that key message out in the briefing paper, there is an evidence based rationale for that. And then off the back of that, there's an action. So each key message has an action point where clinicians and also communities of people living with an effected by long COVID can utilize these action points. So as you rightly said, there are ways of screening for post exertion or symptom exacerbation. Now, one of the best ways of doing that is actually a narrative approach, which is having a effective communication between clinician and the person accessing the clinicians care. So one of the nice things about this briefing paper is it's also included the whole context of person centered rehabilitation and the therapeutic Alliance or relationship and how that's going to be an integral part of ensuring that safe rehabilitation is provided. Because if you can use a narrative approach to hear that people are experiencing this symptom, then it's a really good starting point. There are other tools though.
Speaker 1 (12:47):
So are you saying that we actually have to make the time in our evaluation to speak with our, the person in front of us to really get to know them and to ask more narrative questions, motivational interviewing, not just yes and no, and typing into a computer
Speaker 2 (13:06):
Now that's that's yes, that's leading, right? So, but you know, the average person probably listening to this, he's probably going, of course, I listened to my patients. Of course I communicate with my patients, but, but, but I think what it is, it's about providing space for people to feel safe, to provide the information that they can engage in. So if person centered care is going to be a key pillar of rehabilitation, we must make sure that our patients feel safe to open the engage in rehabilitation with meaningful connections that are established with the clinicians knowledge, but also the patient's belief and knowledge of their own lived experience. And I think this isn't new to many people, but I think it's a really vital skill that we can harness in terms of delivering safe rehabilitation.
Speaker 1 (13:56):
Yeah. And everyone deserves to be heard and acknowledged and seen and given the space to do that. So as physiotherapists, we should obviously be doing this with every patient. But when you're seeing patients who are living with long COVID, I think it behooves you to give them some extra space because I'm sure they have experienced people, not believing them. Like you said, just exercise your way out of it. You'll be fine. And because a lot of people with long COVID, unless you maybe are walking with an assistive device, they may come in and look, okay. Yeah.
Speaker 2 (14:40):
Th that's that's the key point, isn't it, you know, a long COVID could be classified for many people as an invisible disability. And certainly it's something that's experienced as, as not only, but also episodic in its nature and also unpredictable. So someone may look okay, one moment, but not another. And this is something that I've talked about from the lived experience of having the symptom of post exertional symptom exacerbation, which is that it's, it's wholly invisible to the majority of people because when I'm out and about, and I'm doing okay, people see that I'm doing okay, well, they don't see as the repercussions of that a day or two later where I'm laid up in bed because no, one's around me when I'm laid up in bed and no one can see that. So it is truly an invisible symptom and that's where people need to feel safe to talk about that.
Speaker 2 (15:26):
Because a lot of people may not understand it themselves and may be very confused by this because my experience was, I was totally confused as to what was going on with my body, when this was going on. And I was very lucky that people were able to guide me through what the symptom was and to understand it better. Yeah. And you're in the biz. So just people who aren't. Right. Yeah. I have a head, I have a level of health literacy that is probably different to the general population. And I didn't have a Scooby-Doo what was going on with my body. I thought I was doing the right things to try and rehabilitate myself by gradually increasing my activities. What I thought was dependent on my symptoms, but I had zero clue what was symptoms were doing because they were all over the show, but there are some tools to screen for this as well.
Speaker 2 (16:14):
And that's within the briefing paper. So there is a range of different questionnaires. And actually specifically within the, the, the briefing paper, there is a a box which actually has these 10 items that you can use. And it tells you how to score it, how it links it to the evidence-based research, which comes from Emmy and CFS. Hasn't been validated in long COVID, I'm sure that work will happen, but it's a tool that could be useful. There has been some research already that's come out of Calgary in Canada, which has used this tool specifically along COVID. And actually that was published as a pre-print literally the day after this was published. So it's not included in the briefing paper and that's a sign of how fast this research is moving, but a very high percentage of people are scoring as the threshold for experiencing post exertional symptom exacerbation when living with long COVID.
Speaker 2 (17:07):
So it's there, it's prevalent. It's an important consideration because what we know is that a graded exercise therapy program, which is incrementally increasing the amount of activity you do, irrespective of your symptoms has been shown to cause harm in other populations of people, particularly MEFs that experience post exertional malaise, and at our heart of what we do rehabilitation should be there to support people. It should be nourishing. It should be improving functioning, and it should not be causing harm. And that's where that narrative approach is useful because when we provide interventions, we need to provide the safe spaces for people to tell us that it might not be working and not allow people to feel that it's their fault that it's not working because they've got this symptom.
Speaker 1 (17:57):
Yeah. So, so, so important. We don't want to place the blame on someone for something which they have no control over. Right. And, and I think as, as physiotherapists, we have to check our biases. We have to understand that when this person comes in, I mean, we all have biases. We were, that's how we are, you know, maybe not as a four year old child, but certainly as you grow up, you acquire these biases and you have to know as the practitioner to be able to recognize that bias and push it aside, right.
Speaker 2 (18:36):
That's such an important point about implicit bias as well and unconscious bias. Because I think actually wholly as a profession physiotherapy has an unconscious bias, which is that the mantra exercise is medicine is within our bones. And I think as a profession, it's quite hard to hear that exercise can't cure everything
Speaker 1 (18:58):
Well. And, but I think you kind of said this earlier is exercise is prescribed. So we need to prescribe it just like you would prescribe a medication by dose. Right. So, and sometimes guess what that dose is zero, right? Sometimes it's zero, you're prescribing it. So again, it's that exercise is medicine. Yes, it's a thing. But you have to know enough about the person in front of you to know how to prescribe it. Exactly.
Speaker 2 (19:29):
And that's where physio therapists are. So ideally placed to take on board these messages, there's key message of screening for post exertional symptom exacerbation, because we all are good at prescribing physical activity and exercise interventions that are based within a rehabilitation model. And we are also good at knowing when not to prescribe. And I think that if we're given the tools to be able to identify the symptom, recognize that there might be an adapted approach that's needed that works with individuals and potentially takes a stop rest and pace approach because pacing is not easy to do. I'll say that from lived experience you know, there's, there's so much that can be done beyond the scope of just prescribing physical activity and exercise interventions. And I think that physiotherapists are so ideally placed to be working along those lines and working with our multidisciplinary team colleagues. And this is where the big shout out to the OTs go because pacing is their bread and butter.
Speaker 1 (20:28):
Yeah. Yeah. For sure. Absolutely. Okay. So we've got one key message is screening.
Speaker 3 (20:38):
Cause there were four, right? So what's number two, we
Speaker 2 (20:42):
Went on a topic, but it's important.
Speaker 4 (20:47):
[Inaudible]
Speaker 1 (20:47):
The most important part is to be able to screen and know the person in front of you. Yeah,
Speaker 2 (20:53):
Yeah, absolutely. So the second is about cardiac impairment. So what we know is that before we prescribe physical activity, interventions, including exercise or sport, we need to exclude cardiac impairments. Now there is enough evidence to demonstrate that's people that have had coronavirus and people that are living with the long-term consequences are long COVID can have cardiac impairment. And that can include things like pericarditis, myocarditis, even at mild levels. Now we know the opposite. There's a favoring for excluding exercise interventions for people that do have perio myocarditis for the safety implications. So reducing morbidity and mortality. Now, obviously this is a safety message. We don't have enough evidence yet to say what the true prevalence of cardiac impairment is amongst people living with long COVID what the safety implications are. But this key message is we must make sure that we are conscious of this because the evidence is indicating there's a risk and we need to be mindful of that risk.
Speaker 1 (21:58):
Right? So as a physiotherapist, if someone is coming to us with long COVID, who has not seen a physician has not seen a cardiologist has not had a cardiac workup, it would behoove us to say, Hey, listen I think your next stop should be, let's get you to a cardiologist to evaluate your cardiac function,
Speaker 2 (22:18):
But depending on symptoms, certainly. So, you know, people are having it disproportionate tachycardias on exertion. They are having strange cardiac symptoms, including changes to heart rate and blood pressure. They have chest pain, they have desaturations, you know, the classic cardiac symptoms that you'd expect. You're not going to try and push them through an exercise program. You're going to encourage them to see a physician first. And I think that there is going to be many people living with lung COVID that might not be going through specialist services for people designed for people living with non COVID. And there may be many that come through the doors of physical therapists and physiotherapists around the world first. And so this message is there because we need to make sure that we are aware that there is a risk.
Speaker 1 (23:06):
Perfect. Okay. What's number three. So
Speaker 2 (23:09):
We know that third one is around excluding exertional oxygen desaturation. So what we know is that COVID-19 can cause interstitial pneumonias. And so we have seen this in other diseases. So, you know, it can be things like pneumocystis, pneumonia, or PCPs. You see it in things like interstitial lung disease or idiopathic lung fibrosis with these they can cause these saturations on exertion basically, and as the most safest thing, you want to make sure that your patient is not hypoxic when you try to exert them. So it's a simple thing, but what we know is that this is often something that may have happened to people during acute COVID, but it doesn't mean that they can't have it ongoing. And we are seeing people that are having pulmonary impairments and sometimes these pulmonary impairments can manifest slightly later on as well. So it's just to be mindful of this.
Speaker 2 (24:04):
So the world health organization does recommend, you know, the pulse oximetry is used to measure that's and certainly in terms of long COVID services. So I'm based in England. So the long COVID services that are here do often utilize functional performance measures to determine if someone is exertion de-saturated and they might use something like a sit to stand test or a 40 step test to see if somebody is exertional desaturation, or having disproportionate successional tachycardias as well. But that needs to be finely balanced with point number one about posted exertional symptom exacerbation. Because obviously you don't want to put somebody through a test to determine if their exertion de-saturated, if it's going to cause them to end up in bed for a bit.
Speaker 1 (24:49):
Yeah, absolutely. Again, why point number one was so important. Let's go on to point number four.
Speaker 2 (24:56):
So point number four is about autonomic dysfunction and orthostatic intolerances. So many physiotherapists might not be aware of some of these conditions. So for example, there's something called pots or postural orthostatic tachycardia syndrome which is where people change posture. They go from lying to upright there, their heart rates go really, really high. And with that, they can have symptoms of presyncope or even syncope. And also other orthostatic intolerance is exists where people can have really significant drops in their blood pressure again, causing issues with precinct pain syncope. So these dysautonomia is, are actually being seen to be quite prevalent in many people post virally, potentially. When they're living with long COVID, I said potentially there, because we don't really know what's going on with long COVID. So so we are seeing there's a higher amount of that and the American autonomic association has already published some guidance on that specific to long COVID.
Speaker 2 (26:00):
So the key message with this is if you've got somebody who, when they change position may have a disproportionate dropping their blood pressure or a disproportionate increase in their heart rate, you probably don't want to be getting them doing a downward facing dog or sitting on an upright bike because the likelihood is they could find, or they could have a heart rate of 220. So we need to think about that. Now there are lots of existing research prior to even COVID existing about dysautonomia is including pots and there was all these protocols that existed. And actually some of the work that's come out of Mount Sinai in New York has been looking at adapting those protocols to develop something called autonomic conditioning therapy which that developed in the context of long COVID. But it's really important that we're aware of this because if we're going to be looking at whether a physical activity intervention, including exercise or sports is going to be safe and effective for our individuals sat in front of us in the absence of evidence, guidance, and policies and standards. We need to be aware that these things are happening and people are having strange symptoms including changes to their blood pressure and heart rates with changes in postures. And the, the briefing paper is really clear on what it is what can cause it, how to measure it and what to do if it's there.
Speaker 1 (27:26):
And so we've got those four key messages. We're not going to dissect every bit of this briefing paper, because that would be a whole weekend course, I think, but for people that are listening, what, you know, as being one of the authors of this paper contributors to this paper, what, what is that, that group's hope for people upon reading this paper?
Speaker 2 (27:53):
So I don't know that I can speak for everybody that was contributing to this, but I would imagine that the majority of people have the same opinion as me. It's the lead author of this which is that we hope that this supports firstly, communities of people living with an effected by long COVID when they are accessing care, which is they have a resource that they can take with them to their health care providers and have these open conversations and dialogues about what may or may not be right for me. I also think that collectively, we all really hope that this is going to support clinicians that are going to be providing care for people living with and affected by non COVID. Because we know that at the moment, a lot of people are looking for information and there's, there's a lot of information that's either direct or indirect, and sometimes it can be difficult to see the wood for the trees when there's that much information.
Speaker 2 (28:48):
And so we're really hoping that this has consolidated over 180 citations into one document and every single citation has got a PDF link. So you can access that literature yourself. You can do your own research around it, should you want to, but we're hoping thirdly, that this will be a starting point. We're hoping this is going to be a starting point for hopefully international collaborations to work on these messages, to develop guidelines, standards, and policies around that as the evidence continues to emerge, but also to guide the research agendas, because obviously there are going to be some people where exercise will work for them, but we need to know who they are. And we need to make sure that whilst we're doing that research, that we have the safety messages at the heart of delivering that research too. So this crosses communities, clinical practice policy and also research.
Speaker 2 (29:46):
So I think the hope is that this has wide reaching impact. Obviously we need to see how that is, but this isn't the end of the journey. This is going to have further interest iterations. This is a live document. This will be updated as more research comes out, but we hope as well that people will work with us as things move forward and looking at international collaborations because we know that it's interprofessional, but also multi-sectorial collaborations that meaningfully engage and increasingly include people living with an effected by the health condition that leads to much more positive responses in all of the responses to that health condition.
Speaker 1 (30:25):
Yeah. And, and last thing I'll, I'll touch on here. And that's, I think what you were getting at at that last little bit is really looking at the social determinants of health and of the people who are affected by long COVID. I know I can say here in the United States that we know that African-Americans and Hispanics within the United States much more effected by COVID than other other folks. And so can, might, might this also be with this international collaboration across a lot of different professions, a way to really look at our social determinants of health and what can we do as healthcare providers and researchers, and so on down the line to make sense of this and to to address this, even in, in a small way, I know it's opening a whole can
Speaker 3 (31:25):
Of worms, but you know what I'm saying? Yeah, I
Speaker 2 (31:28):
Do. And I think it's, it's a can of worms I'm prepared to go into. So so yes, we know that in different parts of the world obviously the people that are affected more by acute Corona virus has been disproportionately people of different ethnic groups. So for example, here in the UK, we are seeing it more amongst black, Asian, and minority ethnicity groups. And we're also seeing it amongst different populations of people in terms of employments, but also in terms of socioeconomic status. So we know that health workers and teachers are more likely and people that drive buses, people from black, Asian, and minority ethnicity groups and people that live in deprived areas in the UK. But what's really interesting is we're not seeing that same demographic appear in terms of who's presenting in terms of the demographics of people that we are collecting data on in terms of long COVID.
Speaker 2 (32:16):
So what we're seeing in the UK so with the office for national city plastics, which is probably the most representative and largest epidemiological studies on long COVID to date globally, it's actually disproportionately young white women that are have relatively different social economic. So I think the aims of maybe an unintended aim, but hopefully a positive unintended outcome is that if more people are aware of some of these key indications of awareness, maybe some greater awareness of lung, COVID the people that are probably more likely to get COVID are probably going to also be more likely to get long COVID, but we're not seeing that come out in the data or the people presenting to those services. So we need to think about health inequalities in terms of the candidacy of people to access these services, how permeable are they to access?
Speaker 2 (33:19):
How, how is the adjudication between the individual and the health care providers to be referred to that? What's the individual's candidacy to raise their voice, to say I deserve to access these services. And at the moment we know that structural racism exists, health inequalities exist, and people that experience structural racism often experience healthcare incredibly different to other groups such as white people. And so it's probably likely that many of these people may also be living with long COVID and not presenting to health services and not being counted. And this is a particular issue globally, which is that we're still not effectively counting on COVID. And so we don't know the proportionality of people affected by it and the need globally. So if this briefing paper has any way in contributing to more clinicians, more people being aware of some of the signs and symptoms of lung COVID and particularly those key recommendations in terms of safety, if they can say, well, maybe you do have long COVID. It might be a way of identifying people that are more at risk, but also are more vulnerable to not accessing services.
Speaker 1 (34:21):
Yeah. Perfectly said, I am in awe of your of your ability to succinctly and efficiently get big ideas across that allows people to understand better. So thank you very much for that. That was wonderful. Now, before we sign off here, where can people find you? They have questions. They want to know what's up. I love
Speaker 2 (34:44):
A bit of Twitter, so I'm on Twitter, I'm at Darren brown. Also we've got our long COVID physio group at long COVID physio on Twitter. We've also got a website long covid.physio. So they're probably the best way he's very responsible on Twitter. So yeah, I won't give out my email address, no need,
Speaker 1 (35:02):
No need to, no need to get that personal. But I do have one personal question before. So knowing where you are now in your life and career, what advice would you give to your younger self? Oh
Speaker 2 (35:13):
My God. So you warned me about this earlier, didn't you and I get to repeat what I said earlier. I was like, oh my God, this is like, RuPaul's drag race. Isn't it. There's going to be a picture of a five-year old Darren big helicopter. What would you say to baby Darren? Do you know what I would actually say? Whether I was on RuPaul's drag race or dot is the diversities of people bring out the strengths in others and I'm a man, and I know that Mo and I'm now a person living with an episodic disability. Those things have made me a better person and enabled me to have conversations with my patients and the people that come and access my care in a completely different way that because of the lens that I've seen society and life. So if I was seeing myself as a younger Damron, I would have said, be proud of who you are, be accepting of who you are and know that your diversity, your differences, your quirks, your geekiness, your diff, your things that make you unique are going to truly make you unique when you're older and give you advantages in terms of how you navigate life, society and your job.
Speaker 1 (36:23):
I love it. Thank you so much. That was so perfect. What a great way to end this podcast, Darren, thank you so much for coming on. Thank you for your time. I really appreciate it. Thank you for having me and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Founder and CEO of Rehab 2 Perform, Dr. Josh Funk, talks about his experience with the business side of physical therapy.
Today, Josh talks about how he created his business culture for employees and patients, his community outreach, and how he assembles his teams. How has Josh grown his business so quickly?
Hear about the importance of a balanced dashboard and being mindful, and get Josh’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “If I think of somebody who has more autonomy, I think of somebody who’s automatically going to be more engaged.”
- “The first thing that you need to start with is admitting that you don’t have all the answers.”
- “We move fast, we break sh*t, we fix it, we move on.”
- “A lot of it [growth] starts with continual self-analysis.”
- “Me working in my business was the single biggest blockade for us moving forward.”
- “We’ve put equal investment on people, we’ve put equal investment into our local communities, and we’ve put equal investment into the company as a whole, and as long as we continue to feed those three different areas, and maintain lines of communication, I think we’re going to continue to be successful.”
- “A conscious capitalist is somebody that’s mindful of all stakeholders.”
- “I view the 35-50 year old female in the community as being probably the single most influential person in your local community.”
- “When I think of marketing, I always think of market relationships.”
- “When you start your company based on core values, you have people that are culture champions.”
- “Your balanced dashboard is most likely going to lead you to better decision-making and getting a better gage for what is actually going on behind-the-scenes in your business.”
- “Much of healthcare practices from a business standpoint are extremely dated, and you are better off spending time studying businesses in other industries for inspiration.”
- “Continue being open for inspiration in a wide variety of places. You’d be surprised, if you had an open mind, what you might be able to see in something that, maybe at one point in your life, you completely ignored.”
More about Josh Funk
Dr. Josh Funk was born and raised in Montgomery County, MD and attended Poolesville High School. Josh went on to play Division 1 lacrosse and earn a B.S. degree from The Ohio State University before earning his Doctor of Physical Therapy (DPT) degree from the University of Maryland-Baltimore. It was a little over 3 years after graduating from Maryland, that Rehab 2 Perform was founded in late 2014.
In addition to his physical therapy expertise, Dr. Funk has been equally, if not more committed to the growth of his role as CEO of Rehab 2 Perform. He has made sure that his personal development is not just reserved for the clinical side of things, but also to ensuring that Rehab 2 Perform is one of the most well-run and well-known health care companies in the area. Dr. Funk has immersed himself in business programs and community initiatives over the past few years in his efforts to ensure that the team and clients of Rehab 2 Perform are receiving everything they need to be at their best. It is his goal to push Rehab 2 Perform to the forefront of the community through innovation, progressive business operations, strategic growth and clinical excellence.
A lifelong athlete, Josh became interested in becoming a physical therapist when going through PT as a D1 lacrosse player at Ohio State. After avoiding shoulder surgery for a torn labrum and rotator cuff, Josh has been entrenched in the world of physical therapy and sports performance. Over the years, he has continually developed his knowledge base and expertise as a physical therapist through continuing education courses and working with athletes of all ages. A Montgomery County resident, Josh is heavily involved in all areas of the community throughout the region.
Suggested Keywords
Rehab, Physical Therapy, Physiotherapy, Autonomy, Community, Business, Metrics, Performance, Processes, Teams, Decision-Making, Healthy, Wealthy, Smart,
Round Table Talks: Round Table Talks
To learn more, follow Josh at:
Website: https://rehab2perform.com
Email: drfunk@rehab2perform.com
Facebook: Dr Josh Funk
Rehab 2 Perform
Instagram: @drjoshfunk
@Rehab2Perform
@R2Pacademy
Twitter: @drjoshfunk
@Rehab2Perform
LinkedIn: https://www.linkedin.com/in/joshfunk
YouTube: Rehab 2 Perform
Round Table Talk: BizPT
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Read the Transcript Here:
00:02
Hey, Josh, welcome to the podcast. I'm so excited to have you on today. Karen, thanks for having me. I'm just a big fan of everything you have going on and just everything you're doing for people in the profession.
00:13
Ah, thanks. That's nice to hear. And today, well, actually, this whole month, we are talking about the business side of physical therapy. And so I wanted to have you on because from what I can tell, not that I'm knee deep into your business, but from what I can tell on social media and your website is man, you are really growing, you have a budding business, it's an interesting business, it looks like your customer service is top notch. And people genuinely like your business. And they like you. So let's talk about the growth of your business and how you're able to do this in I would say a relatively short amount of time. So I'll just throw it over to you to just talk about your your business, why do you talk about your business first, so the listeners know who you are, what you do where you are, and then we'll get into how you've grown so quickly. Absolutely. So
01:09
for the listeners out there, I am the owner of rehab to perform. It's a fitness focused physical therapy company, offering, obviously physical therapy, sports rehabilitation services, concussion rehab. And then we have a couple different wellness offerings, including a golf program, golf fitness program, and our two p plus, which is kind of a discharge program, that people utilize an app receive home workouts and are able to communicate with their PT after more formalized discharge. But you know, you alluded a little bit to the growth that we've had, over the years been very fortunate past couple of years, including even during a challenging year, last year, just to continue to be able to move forward, I would if I had to break up, the time that the business has been in existence, I would say you have the first three years, and then you have the last kind of three and a half, almost four years, first three years, really just trying to figure things out, put the pieces together, do everything you can honestly to get out of debt have that minimum viable product. And when I was thinking about that minimum viable product, viable product, a lot of it surrounded creating an environment where PT was not a grudge purchase. So how do you create healthcare and physical therapy that is not a grudge purchase, it's something that has very, very minimal friction, people easily interact with it from a from a, you know, front desk customer service standpoint. And then when they actually experienced the clinical side, it is something that speaks to them, it is something that is enjoyable. And that goes for everything from just the processes and the kind of people that you have, as well as the deliverables. So, you know, these past three and a half years, we've been fortunate to, you know, heading honestly into opening our sixth location this fall. And we're very, very close to opening our seventh location. In early q1, we are based out of the DMV, and for anybody's unfamiliar with that, that is DC, Maryland and Virginia.
03:16
Awesome. I mean, it's just, it's pretty amazing. And you you hit on something that I want to talk about really quick before we go into the how you grew. But that's creating a culture that's not a grudge purchase. So let's talk about how you created your business culture, because I think this is something that is often overlooked, especially in in a lot of businesses. But how did you create that culture for your employees and for your patients?
03:52
I think if I start with the employees, I think a big part of what at least has influenced me was being in situations in which I perceived there to be too much rigidity, in terms of the how, and there was not enough autonomy given to people to just execute. Everybody executes things slightly different. And much like I would say, a good clinical framework. But if you have a very, very good cultural framework for your company, people kind of bounce back and forth between the guardrails so to speak, but you don't have this rigid playbook. Were rigid rules that are in place. There's a little bit of flexibility, adaptability, and at the end of the day, it is a shared way of doing things. It's a collective and it is not a top down style of leadership. It is more of this, what I'll call like circular leadership. So people are more familiar with, you know, an organizational chart. That's more formal, obviously, if somebody's at the top and it kind of trickles down and always whether or not it was you know, Anything from a student internship program to a specific program that I mentioned earlier, or somebody who's taking a role just on a project, or somebody who's in charge of a specific location, there is a certain a certain amount of autonomy that they are able to have. And I think that that ownership that is created really allows people to, I think, engage more when I think of somebody who has more autonomy, I think of somebody who's automatically going to be more engaged. And then if I think that I take it to the consumer, the customer, and I always like to call them clients, because at the end of the day, especially in a place like Maryland, you know, they have a choice. Direct Access is something that we have almost, you know, a, I would say, the most liberal version of it. In the United States, we have more than probably 75% to 80%, I can say definitively on a regular basis of people who come to us without having a physician tell them to come to us. So that being said, the only way that that happened was creating an environment that was enjoyable, I wanted to create chairs, a barber shop in your local bar, and deliver PT, so the more that you can make it, something that resonated with them. And for me, I always thought of a gym environment, it was very, very enjoyable, people liked being at the gym, you rarely wanted to, you know, potentially leave as well. So when you walk in, you know, it's it's open, it's friendly, there's quotes, there's gym equipment, there's a certain way of greeting people, people are going to greet you that aren't even necessarily your PT, the manner in which you're communicated to is going to be, you know, there's there's a certain amount of intent and thoughtfulness behind it. What you're going to be provided during that session is going to be something that ideally you leave with, and you go, this is personalized, individualized, and it resonated with me. So I was thought about trying to create an environment where somebody went, Oh, man, I got something small going on, I'm just going to go right into rehab to perform because I love going there, I get to go there, instead of I have to go there and that small change. And we can go down to all of the many pitfalls of your local pops, physician place that's sterile, right? It's boring, you have something that looks cookie cutter, you are doing the same thing, almost every single session, there's a lack of connectivity, right? There's not even music at some of the places in there. Everybody's wearing the same exact thing every single day, right. And we can go down that rabbit hole that people went down recently on Twitter surrounding professionalism. But I think overall just you create an environment that if I take it back to the top, you create an environment that has been shaped by so many people that have been a part of our company, too. I might be the CEO at this point. But I'm just a really good listener, just listen to people. And we make changes based on what the group wants. I'm not sitting here. And just telling everybody that I have all the answers, there was no different than advice that I gave to a young clinician the other day where he was like, Where's the first place I need to start, I was like, the first thing that you need to start with is admitting that you don't have all the answers. And the sooner you get somebody that's a cultural fit that comes in your place. And they show you a new way of doing things, the better off you'll be. But too often I think people get in a situation where they can't let go. And they can't allow other people or they think they found the special sauce. And I sit here today with a team of about 35 people. And I will tell you that I will listen to the new new front desk person that we just hired because she has new perspective and a new way of viewing things. And she can add value. And we never get to a point where ideally we're that we're that fixed project, fixed product. And then it has been that collaboration over the years that led us to both have an environment that people enjoy working in an environment that people enjoy interacting with the professional physical therapy.
09:08
Excellent. And this is gonna sound really familiar to you. But it sounds to me like your operations and processes. So if I say that to Josh, Josh and I both took while I'm still in it, he has taken the Goldman Sachs 10,000 Small Business program, we were talking about operations and processes, which is one of the modules before we came on. And the thing that resonated with me with what you just said is you you give people the process or the sub process, let's say and the details are up to them. So you're giving them autonomy. And to me that leads to innovation, it leads to better care leads to better efficiency, because you're allowing people to make the process there. own while still getting the work done, right?
10:04
Yes. And I would say that that makes me think of the number one question that we ask when something gets done wrong is not a people person, it is a proper process problem first and foremost. And we go to that person and say, hey, how can we make sure that this does not get done wrong? Again, okay, we did not provide you with enough support, we did not provide you enough clarity, we did not provide you enough, whatever. But I am asking that person who may have automatically get on the defensive because they got something wrong, quote, unquote. And instead, they're becoming a part of making sure that process is easier, it takes less steps, there's more clarity, whatever. And then there's ownership. And then they automatically feel like oh, my God, okay, now, instead of me getting yelled at, I'm in an environment where when screw ups happen, we just, we just work on it make it better, like, then they show up to work every day, you never really worried about screwing up. Because what do I tell people all the time, we move fast, we break shit, we fix it, we move on, okay. And at the end of the day, we are we're trying to move relatively quickly. We're trying to be agile, we're trying to make sure that we're doing everything we can to kind of get out in front of, you know, really the, you know, the profession in healthcare as a whole and ideally, continue to show other people that, you know, there's a different way of doing things, a different way of doing things.
11:30
Yeah, I love it. And, and that is something that I didn't really think of before until literally today. Just before we went on the air is all these like operations and processes, which I always thought were so rigid, right. But if you give people the autonomy and innovation, I can only imagine that helps you grow faster and smarter. So let's talk about your growth. How did this happen? I think we can confidently say operations and processes are a big part, what else helped you to grow your practice, because I think there are some listeners out there who might be at the stage, like I'm going to grow my practice, but I have no idea what I'm doing.
12:16
I think, you know, a lot of it starts with just continual self analysis. And I think that I finally got to a point where I recognized that me working in my business was the single biggest blockade to us moving forward. And I think part of that also was me recognizing that I, I have a little bit of a unique skill set. And that's not to say that my skill set is more important. But then from a collective standpoint, my brain works a lot more in branding, sales, and marketing. And I needed to be spending more time in that area. So let's say about three years ago, I finally stepped back. And I put myself in a position where I was spending more time than ever, on the ins and outs of the brand of our company, the brand of the profession within our company, our sales and marketing strategies, and then to be quite honest, doing a better job of making sure that we had more of a predictable rollout when opening up a new office. So at this point, you know, we have, I hate to go back to processes again, but we have a very clearly defined rollout. And it starts about six months out. And every 30 days, you're doing X, Y and Z. And there are you know, at this point it I hate to say it, but you're almost following a playbook. And much like I referenced earlier, it's not necessarily rigid. But we know that at least if we're doing these things here, and at least 90% of that we're going to put ourselves in a good place to be successful. But I think you know, the biggest thing was recognizing that I had what it took. And it was after the Goldman Sachs 10,000 small businesses program to actually operate a business because before that program, I was solely a PT, who had hired myself to deliver good PT, I wasn't necessarily doing everything that I needed to to support the team. And to put us in a position where growth was naturally happening. Now if I get back to why we're growing now, I think we've put equal investment on people, we put equal investment into our local communities, and we put equal investment into the company as a whole. And as long as we continue to feed those three different areas, maintain lines of communication. I think we're going to continue to be successful when we go in and we just opened up a new location last Monday. And I think we're going to just put ourselves in a good spot and that kind of goes to just some found Thanks for me, I know that a lot of people hear the word capitalism. And I think they there's enough stories out there and examples of, of what I would consider more of the poor version of capitalism, that crony capitalism, one that maybe is a little bit more focused on, you know, your, your, your money, right, you're just focused on bottom line. And that's pretty much it. But I think of a cop of capitalism, I always want to think about being a conscious capitalist. And a conscious capitalist is somebody that is mindful of all stakeholders, all stakeholders, being the people on your team, they all matter, the small people, the big people, whatever you want to, you know, do people that people have been with you forever, that people that are new, right, you have to make sure that you're placing value in those people. And then for us, we have five different community hubs, so to speak, that we have initiatives under just to make sure that we're making connections, we're involved or engaged, we have a pulse on the community. And then we're finding ways to meet people where they're at outside of our four walls, ideally, deliver value even without asking for anything in return. So that that conscious capitalism piece, that's one of my favorite books, I think that's always been something that's kind of been near and dear to my heart. And in putting something out there from a business product standpoint that people could look at and say, you know, what, that's a that's a big, it's a business of the future, just in terms of how it's run.
16:18
So let's talk about that foray into the community. Because that is important. So if you are setting up shop in a community, what advice do you have for budding entrepreneurs and therapists who maybe have been in practice for 10 or 15 years, but maybe they sort of stalled? You know, because that can happen? Right? So what are some examples of your community outreach or outreach? Excuse me, or how you insert rehab to perform in the community?
16:52
Yeah, I mean, I think a big part of it centers around our avatars and our avatars being like our ideal consumer, right? Who is your target audience who interacts with your business the most at the location in which you have right now or locations, and you build out the community touchpoints that that person has. So I'll be quite candid, I don't think anybody will be surprised. But I view the 35 to 50 year old female in the community as probably being the single most influential person in your local community, probably you can stretch at 35 to 55. She is in a family where she is literally dictating the decisions for the head of household, the kids, the grandparents, the in laws, etc, there is nobody who is more influential in terms of what people are doing in the family, and where they're going. So if you just appreciate that as a whole, then you start to look at a little bit more of trends. And some of the metrics surrounding where that type of demographic is interacting. And for us, we also build this into our five hubs. So, you know, from a medical standpoint, fitness standpoint, business, youth, sports, and schools, what is that particular target demographic doing? Where are they interacting? Where are they going, and then you start to have a little bit better idea of where you potentially need to develop your connectivity, but initiatives under those five umbrellas after first and foremost, creating that lead avatar is something I recommend to everybody. We do have other avatars, I would say for us, it's a competitive athlete, college athlete, high school athlete, you know, your your clubs, use sport athlete. So, you know, who are the influencers in that community, who are the influencers, providing guidance to that individual is everything from skills coaches, to strengthen conditioning coaches, to the actual sport coach, to the club director to the athletic director, and you start to build out these chains of almost influence that that these people are connected to, and you have a better idea of who you need to have that market relationship with. And when I think of marketing, I was thinking of market relationships, right? It's not necessarily creating a piece of content to put in front of somebody, it's not necessarily you know, sending somebody something and give him a hard sell. Sometimes it's just the Hey, I saw your work I'm connected with so and so they just came into the office, you know, I keep hearing more and more and I'm at least curious at this point. Can we go grab coffee or if we got on a phone call? I'd love to learn more. And the more that you're genuinely curious about people, and you're invested in learning about them, and and actually taking the time to show that you're, you're genuinely interested in in that particular relationship. I think the easier that these relationships come about their authentic people can feel them and it becomes a lot easier for you to get into what the most important is part is who you are, what you do, and, and how you solve people's problems. So once you have those three things communicated, and I should say, once you have that authentic relationship, it's much easier to clearly communicate that those three things you bring to the table once again, name, what it is that you do, and how you solve people's problems. So that's kind of a little bit of the behind the scenes just in terms of, you know, my thought process. When we go to new location, you know, we have our initiatives, you have a pretty good idea of what works, obviously, there's some uniqueness to each area. But we're starting to develop those relationships, probably a relatively early time period. I mentioned before, we have a six month clock that we function off of. And really, you're just trying to find a way to almost solve their problems before they even necessarily need to send somebody into your office.
20:55
Yeah, amazing. I love everything about what you just said. And I really hope it gives people listening who are maybe thinking of starting their own practice or expanding like this is work. Yes, right. It's not like I'm gonna open up a practice, just because I feel like it is like you have to do this is done before you open your doors, you need to know who your avatars are your ideal clients, your ideal customers, whatever you want to call them, and you have to build them out. And there's more than one. And for every single one of those, there is a separate marketing plan. There is a separate communication plan for each and every one of those avatars, you do not use the same marketing plan for Well, the 35 to 50 year old woman who Yes, the women are the users and the decision makers. We all know that they run the show. There's no secret anybody out there says no, you're sorry, sorry, wrong. But you know, you're going to market and communicate with them differently than maybe the local college athlete.
22:06
Yes, right. 100%. They have different needs, different interests, different places that they're frequently interacting in the community. 100%
22:15
I love I love everything you just said. I think that is just a wealth of advice for anyone listening to this podcast, who I can't wait to we do our roundtable next week. Awesome. Or I shouldn't say next week. We're recording this a little earlier. Tomorrow, tomorrow. All right. So now everybody, the jig is up. It's not live. But yeah, no, I love that. All right. And then last thing about growth and movement within a business is really assembling a good team. Yes. So talk to me about how you assemble your team or teams within your business.
22:56
Here's the part that I'll be at least honest about the early part of the business and say some of it was just damn good luck. The first person that I had a part of my team probably could not have been more of a culture fit than if maybe he was a part of my own family. So we went to PT school together. We didn't grow up very far at all. From a high school standpoint. family values were all very, very similar. We had very similar outlooks on the world similar ideas when it comes to came to leadership. And when you asked us in general, what your principles and values were, that governs your life, they were very, very similar. So I was fortunate to actually and I'll probably get a couple chuckles here, I convinced him to quit his job. Right after his wife had delivered their first child, I think that their first child was four at the time. And I gave him three months of paper checks. And I said, hey, there's enough money here for you to quit your job and give it a go. But nonetheless, he helped me kind of shaped the culture of the company. Our next hire was a female was more compliance oriented, somebody that we definitely, definitely needed. And then the fourth person, some people might be familiar with Dr. Jared Boyd. He's now an NBA PT for the Memphis Grizzlies. And his commitment to I'd say, research, and the clinical side of things was kind of what Zack and I needed. And what we needed was contrast. So we overlapped on a lot. And we were able to find contrast in terms of areas in which we didn't have a natural affinity to we're really have that much interest in diving into and then moving forward. We hired people predominantly off of, once again, a collective decision making process. It was, Hey, is everybody comfortable with hiring this person? There was no one person in charge of the hiring process. And a lot of what we did was make sure that there are multiple touch points for that person to interact with our business. So whether it was an early exploratory phone interview, that then would follow into a formal phone interview, obviously, that things like a background check references, etc. And then you would actually have them come into the office and spend some time Hey, Shadow, people spend time with the front desk. And you start to get multiple touch points where every single person at the office had at least interacted with them enough to go Yes, or we've had more than our fair share of knows where somebody's got a wrong vibe, or something was said or something was picked up on. But making sure that you know, hires especially at this stage of the game, where we do have five locations, me hiring for a location, and me being the sole decision maker is silly, I do not work at an office with these, right, these people for 30 to 40 hours, I'm spending a much smaller block of time. So at the end of the day, the people that need to have the most influence are the people that actually are the leaders at that office that are at that office every single day that to be quite honest, probably have more control over what's going on in the culture and in the environment at that particular office than I do. So I once again, I think it goes a little bit more to like your decentralized leadership style. And your you have more of this flattened approach to leadership where a lot of people are involved. But if we talk about just central pieces to team, what are your values? What are your principles, those have to be the early conversational points, that that drive the conversation about whether or not this person is a fit, we have our core values literally on the wall, every single office is transparent, so much even that the clients can see them. You know, so when when you start your company based on core values and principles, everything from I mean, a couple like just basic things, obviously, you know, education, empowerment community, for us to be talking about principles on offense at all times, right? solutions instead of problems. Or we say thumb first, instead of pointing a finger, right? What can you do to potentially change something than then pointing a finger in another direction. So I think when the foundation of the company is just so grounded in in those core principles and values, you have people that are culture champions, and at the end of the day, people understand that, that the sole reason why we've been able to do that we've been what we've been able to do is attracting people for the right reasons. It's not people that necessarily are championing solely their GPA or their clinical knowledge and expertise and kind of beating their chests about how smart they are. It's first and foremost, foremost, like, how does this person align with us on a foundational level, we know that at the end of the day, that person will become the best version of themselves within the company, because they value with the rest of the collective value. So I know when a bunch of different directions there, but I think, yeah, I mean, we've been very just purposeful. And there's been a lot of evolution, I'd say there over the years and knock on wood. And I never like to honestly say this without just just being aware that it's not just me, it's our whole team. But we have only had three pts in almost seven years decide to leave the company, one was for the MBA, one was for home health, because she wanted to spend more time with their kids and another one would took a military job. So we've not had a single person yet that's had a parallel move to somewhere else in the local community. They've either completely moved in are on a base somewhere or in a professional sports organization, or in home health, spending more time, you know, raising their family things that we can't compete with as a company.
28:55
Right, amazing. And, and I really like that your approach to hiring, I guess it's the hiring funnel. You know, we talk about sales funnels and marketing funnels, you have a hiring funnel, where it starts with some exploratory calls to more formal, and then you keep going down. So you may have 100 exploratory calls. But as you funnel down into how many ideal candidates are for the job, maybe it's two. Yep. Right. 100%. So I think it's a nice visual for people to see that.
29:27
I am involved in exploratory. And that's literally about it. At this point, I will get resumes and stuff will catch my eye or somebody will connect with me on social media. And there'll be something that I'm at least like, hey, let's explore this. And I'm often handling an exploratory call on looping in people, most likely the site directors at potential offices that could hire this person. And then they actually start to incorporate the other members of their team for calls as well. So it really becomes a point where this person goes, Oh my gosh, I could be a part of this team. I bet make an impression, or different times or five different times because all of these people are important. And if any one single person says no, then we move in a different direction. And that has happened before.
30:10
Hmm. Amazing. I love it. Okay, so we touched upon your company culture, we touched upon your avatars, your team, how you've been growing? I mean, we can go on and on and on? Or is there any other major point that you wanted to hit about the growth of your company that we didn't touch upon that you're like, Man, this is super important. I really want people to know this. I think a balanced
30:39
dashboard is very, very important. And I think that in a world where people do focus a lot on productivity and utilization, right units, or how many slots you have filled, and I'm not here to say that that's not important, because at the end of the day, you need to have a business that is delivering a service for a certain amount of time, and having an individual which you're providing a salary benefits, etc, PTO, whatever, some some benefit, that certain things are also, you know, reciprocated. So it's not to d value those but to paint a better picture of business health and metrics that would support at least for us, when I think of smart growth, it's like, Alright, how do I know that we're just not adding locations, and the quality is rapidly diminishing? Okay, that stuff over there good. We get people in the doors, okay, yes, in terms of just keeping the lights on, we need to be able to have a certain amount of billable units. And if we hire somebody, they need to have a certain amount of slots allocated. Beyond that, what else is meaningful for us to continually be looking at. So net promoter score and churn rate are two big metrics that I'd say we've looked at more and more, especially over the past two years, for people are unfamiliar with Net Promoter Score, it's considered a gold standard with regards to brand loyalty, and the creating the kind of word of mouth referral generating, I think all of us are looking for. So I say this, once again, just to provide perspective, but we add locations, we have to make sure that the company stays above 90, which is considered world class. And when we don't, or something pops up, or somebody is saved below 90 for a given quarter. You know, there's certain just conversations that are had, in addition to the fact that when we have a seven or eight, or a six or below, there are certain things that are happening internally to make sure that we're being mindful that somebody is either potentially a little bit passive on what we have to offer. And they've communicated that or they potentially might be somebody who's going to drop off. And then when you think about churn rate, just think about somebody interacting with your business and having a negative experience and not even really giving it a chance for you to work with them. To get towards ideal outcomes. At the end of the day, we're trying to drive outcomes. So when you get somebody in, and you've put time and energy behind communicating what it is, who you are, what you do, and how you solve their problems, and they get so turned off after a visit two visits or three visits, that they've gone somewhere else, or they just altogether potentially left the profession. That's not necessarily a positive thing. There is metrics out there to support that, say, if they get to four visits, they are X amount more likely to actually go through a plan of care and be able to see some of those ideal outcomes that I think all business owners would think that their business can, can provide. And then, you know, outside of that, I mean, obviously online reputation, being mindful of Facebook reviews, Google reviews, those are some some big ones for us. And then not to completely discredit your functional outcome measures, right. And then there are certain things in web PT we have afforded where you're able to track pain from IE to DC are able to track satisfaction goals met, in addition to some of your outcomes measures that are a little bit more formal. And yeah, the insurance companies telling you to do them, but doesn't mean you should automatically dismiss them. Right? There's, there's often some tangible and objective data out there that a lot of other people are valuing. So take it with a grain of salt, you're not putting much like your evaluation, right and your return to sport testing, because that's the world we live in where everybody likes to argue about that all the time. You're not putting any more value on any one given thing, the more that you have this aggregation of data, the better off you're able to look at that and maybe potentially come up with certain trends or or certain things that in terms of painting this more broad picture better define your your business health So figure out your balance dashboard, your balance dashboard can be applied to a lot of different things obviously could go behind the scenes with regards to finances and stuff like that, but all other conversation 100% but you know, your your balanced dashboard is most likely going to lead you to better decision making. And giving you a better gauge for what actually is going on behind the scenes in your business. And it really, it's, it's, and I always look at that, and I go, Well, this is telling us whether or not a process actually works. And if I'm not getting what I want to hear, we need to go back to process,
35:14
I was just you took it took the words out of my mouth, I was gonna say having that balanced dashboard allows you to make better shared decision making 100 better, better shared, better shared decisions. Yes, just like just like we would do with a return to sport after an ACL. It's a shared decision making between the therapists, the coach, the parent, the the patient, whoever it is, everybody's got some input. So when you look at a good balanced dashboard, and just for people who aren't familiar when we're talking about what a dashboard is, it's where you have, what metrics you're using to evaluate your business. And those metrics can be your net promoter score, it could be your net profit, it can be patient satisfaction, it can be whatever it is for your business you want to have on that dashboard. And it's different for everyone and should be, right, yes.
36:13
and dare I say after 10k, SD, my dashboard looks a lot more like an Excel spreadsheet at this point. And I know you can relate.
36:20
I can't go into Excel spreadsheets right now. But yeah, so just so people know, like your dashboard is anything that you're using to measure something, a process in your business. So it can be a whole boatload of different things. But just like we do with patients to look at that dashboard, and be able to to look at it with your team employees, whomever, and be able to make informed shared decisions on how you're going to move that business forward. how you're going to make changes in your process, like you said earlier. So perfect. Perfect. All right. Now, last question are actually no, where can people find you? Let's talk about that first.
37:03
For sure. Instagram and Twitter is probably where I interact with the most I try to keep Facebook honestly just a community connection. So if you friend me on Facebook, don't take it the wrong way. I just try to keep the PT side of things off of Facebook. But from a professional connectivity standpoint, at Dr. Josh funk on Twitter, and Instagram, my email is also Dr. Funk at rehab to perform calm. If you really want to get a hold of me, DM me on social media, get my phone number, text me your availability, that's the best way to get things done. Email right now is very chaotic. We just opened up a new location. I'm also getting married in about three weeks. So my life is not necessarily all that organized. And just because there's a lot of moving parts right now. So email, not the best place. But I'm very happy to interact, always happy to make time for a call, especially when I'm driving sometimes I like to just honestly plan out a call for when I'm driving between locations or something like that.
38:00
Excellent. Well, thank you so much for giving people all that info. And last question, knowing where you are now in your life and in your career. What advice would you give to your younger self, let's say a young grad out of PT school,
38:13
I think I would have focused more on expanding my horizons outside of healthcare and physical therapy sooner. I think the more that I started to look at what was going on in other industries, other professions. It made me better at PT and especially made me better at running a business, I can safely say that much of healthcare practices from a business standpoint are extremely dated, and that you are better off spending time studying businesses and other industries for inspiration. It's not to say that there's not some people that are doing amazing work in our profession and healthcare as a as a whole. But I would say the collective is still I almost at this point. I wonder if it's decades behind, just with regards to just how they're operating. So continuing being open for inspiration in a wide variety of from places, you'd be surprised if you just had an open mind. What you might be able to see in something that maybe at one point your life you may be just glanced past or completely ignored.
39:16
Love it. Excellent advice. Josh, thank you so much for coming on. And again for the listeners tomorrow at 730. Yeah, right. No eight. Oh my gosh, where's my head tomorrow? The 27th at 8pm we're going to have our roundtable with Josh, Eric mellow Michelle Callie and shantay Cofield. So if you haven't signed up yet, definitely sign up because we're gonna be talking like this but probably more in depth and we need your questions. This is a this is your chance to ask people like Josh and Shantae and Erica and, Michelle, any question you want to have these four people together on one sort Stage, it's not going to happen anywhere else. So now's your chance, ask those questions. You ask those burning questions to four amazingly successful entrepreneurs in the physical therapy space. So I encourage you all to sign up. You could do that at podcast at healthy, wealthy, smart, calm, click on the tab that says round table talks. So Josh, thanks so much. And again, looking forward to tomorrow. So thanks.
In this episode, CEO of Performance Physical Therapy, Michelle Collie, talks about the business of physical therapy.
Today, Michelle talks about the lack of business knowledge of physical therapy graduates, the belief that marketing and sales are bad, and the importance of encouraging entrepreneurship. How do we change the public’s understanding of our roles in health care teams?
Hear about the challenges Michelle has faced, how she maintains her company culture, and get some great advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “I do think that it’s our responsibility for the well-being of our profession that we do include some basic business information.”
- “People don’t know what we do. We don’t do a good job of explaining the value.”
- “Any way we can support small businesses is going to be helpful for the future of our profession.”
- “You definitely have to work on yourself a lot, and be very mindful of what you need as a person if you want to be a leader in an organisation.”
- “How you act at a holiday party or social event, is going to have a big impact on what your organisation is like.”
- “Get comfortable with the word ‘money’. It’s not a bad word. Just think of money as one of the things that helps us be able to evolve as a profession and serve more people in our communities.”
- “Be curious about learning more about business.”
- “Believe in yourself earlier, and address the fears that you have of your lack of knowledge and your inability to do things. Make your mistakes earlier.”
More about Michelle Collie
[caption id="attachment_9677" align="alignleft" width="150"] headshot of Michelle Collie[/caption]
Michelle Collie PT, DPT, MS is the CEO of Performance Physical Therapy, a privately held practice with clinics in Rhode Island and Massachusetts.
Celebrating 21 years since it was founded, Performance employs over 230 people, with ongoing growth plans, including 2 new clinics opening this month. Performance PT has celebrated many accolades including being the recipient of the APTA-PPS Jane L. Snyder Practice of the Year, and 7 times, Rhode Island best places to work award.
Michelle currently serves as the president of the RI chapter of the APTA and chair of the PPS PR and Marketing Committee. She was a member of the PPS Covid Advisory board and is a two- time recipient of the PPS board service award.
Michelle is a board certified orthopedic clinical specialist.
Suggested Keywords
Well-being, Knowledge, Business, Physiotherapy, Culture, Marketing, Sales, Money, Entrepreneurship, Leadership, Healthy, Wealthy, Smart, APTA, PPS, Therapy,
Recommended Resources
August 20th Graham Sessions: https://ppsapta.org/events/graham-sessions
Marketing Resources: https://ppsapta.org/practice-management/marketing-resources.cfm
To learn more, follow Michelle at:
Website: https://performanceptri.com
Facebook: Performance Physical Therapy
Instagram: @performanceptri
Twitter: @performanceptri
LinkedIn: Performance Physical Therapy RI
YouTube: Performance Physical Therapy
BizPT Round Table Talk
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Read the Full Transcript Here:
Speaker 1 (00:03):
Hey, Michelle. Welcome back to the podcast. I am so happy to have you here for this month, where we are talking all about the business of physical therapy. So welcome.
Speaker 2 (00:13):
Thank you, Karen. It's great to be here.
Speaker 1 (00:15):
And I mean, you and I have talked business in the past, like I said, in your intro, you have several offices within your business and you've really grown your business into a really great place to work. And I think that that's so important. It seems like your employees are happy. You're happy, and that is not an easy thing to do these days. So kudos to you for that. And that's one of the reasons why I wanted you to come and be part of this discussion this month, because you are a physical therapist with multiple locations. You're not just a solo preneur, right? So how many people before you go on, how many people do you employ, just so that people can get an idea of, you know, the, the breadth and width of your practice.
Speaker 2 (01:04):
We currently have approximately 230 employees. Now we've got openings case. Anyone's looking for a job, but as I know, everyone else is looking for employees as well. This is a common problem throughout the nation at the moment, but yes, 230, but still growing.
Speaker 1 (01:21):
Yeah. Which is amazing. I mean, that's, so I always think about that as they're in, like you're helping 230 people grow their wealth, improve their families, keep their lives going. I mean, it's a big deal. It's a lot of responsibility.
Speaker 2 (01:37):
It's a great point. And I kind of guess I love that opportunity to do that because people often say to me, oh, do you miss treating patients? And I am like, well, I do. But now I feel like I get to somehow have a larger impact on a whole lot more people. And I, yes, I love to treat patients. I love the care that we provide as physical therapists, but I do love knowing that I'm helping to provide a place for an employment for lots of people to work. And I especially felt that through COVID and the way that we were actually able to keep all of our stuff on, we did have to furlough for some of our administrative staff, but then ultimately we're able to bring everyone back. And and that was something that helped me get through the pandemic actually, knowing that I was able to have a positive impact on the fiscal sanity of all, for lack of a better term for many of the people in our community.
Speaker 1 (02:32):
Yeah. Which is amazing. And now, you know, this month we're talking all about business, you have a growing thriving business. So how much of the business of this business knowledge did you get when you graduated as a physical therapist? How much did you learn in PT school? Well,
Speaker 2 (02:48):
Probably about the same amount that every PT that's graduating these days you know, and to be fully transparent and clear, I took over performance. I actually purchased from the original founder. I was a clinic director there. It was a smaller practice with 16 employees and I was very pregnant, eight months pregnant. So I thought I was invincible. And through a seller finance note and an SBA loan, I somehow ended up with this practice and a lot of debt. And the first day that I officially owned it, which was I think three weeks before I had my first son, I walked into the office manager and said to them, don't tell anyone this, but people keep talking about financial statements, but I don't really know what they're talking about. So I prided myself on being a good PC and really loved that the value of physical therapy and what it provided to our community and patients. But when it came to actual business knowledge, especially those off to do with the financial management of an organization, and even thinking about things such as marketing and human resources, I would say I was completely ignorant and didn't have one scrap of knowledge.
Speaker 1 (04:04):
Right. And so this is obviously a huge deal challenge for our profession, right. So what can we do should, should these topics be included in school?
Speaker 2 (04:16):
I mean, I, of course I'm a proponent of it for a number of reasons. And I do, and I really respect those folks had in academia and I bought them, challenged them. You know, why don't you include some more business information and the curriculum. And the response is usually I revolve around time. We don't have enough time. And the other one is, is that always students don't want to learn that they want to learn physical therapy things. However, I do think that it's Sarah, truly a responsibility for the wellbeing of our profession, that we do include some basic business information. And that's not just because some people will want to go and start a business or be part of the business. So yeah, it will help those folks. But I do think for, let's say the staff PT, if a staff PT has a little bit more understanding of, let's say what marketing is, then they suddenly are better at advocating and speaking to their patients about the value of what we do.
Speaker 2 (05:17):
If someone is able to understand some of the communication skills that align with marketing and even sales, then we will suddenly see word of mouth referrals go up. When someone understands financial management a little bit more, they have a better understanding of how to code, how to negotiate your salary, the meaning of different kinds of salaries and what they mean in the longterm. So I think having some basic business information seats up every individual, no matter what setting they're working in to be a better manager and better, better more knowledgeable for the career and the longterm. We hear so often PTs talking about burnout. We hear them talking about lack of reimbursement and not getting paid enough and obviously student loans. But I think with empowering our graduate San UPTs with some bitter understanding of business and how it works, it actually gives them some foundational knowledge. So they actually can do something and make a difference rather than just this overall overwhelming complaints we hear, oh, we're not paid enough. Reimbursement keeps going down. Student loans are too high. We have at least problems with their proficient, but we need to empower our next generation to have some business knowledge. So they can ultimately help do something about this crisis that we're headed into.
Speaker 1 (06:44):
Yeah. And, and I think even being able to make a financial statement for yourself, it doesn't have to be a business. You don't have to own a business, but you should know, well, how much money are you bringing in? What are your costs after that money comes in? What are your debts and your liabilities? And you can look at that and, and make a budget. It may help you be able to better budget yourself to be able to pay off those student loans or, you know, do the things that you want to do. I mean, I find, I found that learning all of that has just been so eyeopening for me.
Speaker 2 (07:19):
Yeah. I couldn't agree more. And especially these days, we, you see different compensation packages coming out, different kinds of variable salaries. Oh, you know, if you work per diem versus full time, or maybe I do wanna, you know, have a side hustle, but understanding the long-term financial implications of those decisions can be really important and again, and how you to make the decisions that are best for your career. So you can actually work in the seating and provide the kind of care that you truly want to, and being out of balance out the money side of it and in the clinical side of it. Yeah.
Speaker 1 (07:55):
I couldn't agree more, I think, and I, you know, I do hope that at the very least when it comes to teaching business courses, I mean, at least help therapists understand the financial aspects of a business, whether that be a hospital, a skilled nursing facility, an inpatient facility and outpatient facility. I just think understanding that will give them a better idea. Like you said, of salaries negotiations, how much are you getting paid? Whether it be per code per patient, like you said before, you started a little, a little tweak and what you code and how much you code can compound exponentially.
Speaker 2 (08:35):
Exactly, exactly. Very small changes in your coding changes of business. But I also think speaking to that, having a knowledge of the kinds of employers that are out there, and that's a side of businesses as well, understanding the difference between for profit nonprofit, understanding the difference about PE and corporate owned and public on versus privately owned. There is not one that is better than the other at all. There a great PTs who are in corporate practices. There's also crappy PTs and corporate practices, same thing for private practice. It's all over the place. However, if individual PTs have a basic understanding of the, those different businesses and how they're set up, it gives them a more well-rounded approach to being part of that team, no matter who they decide to work for, or at least they want to go out in the business on their own.
Speaker 1 (09:30):
And, and I don't know if you have the answer to this, but do you have, can you think of off the top of your head, any resources that may be practicing PTs or new graduates can utilize to help them understand? Let's say to be more financially fluent in the physical therapy world. So let's say you didn't get it in school, which odds are you probably didn't. Where do you have any resources that people can learn more? Well,
Speaker 2 (09:57):
The one that's out there, which we don't actually do, I don't think a good enough job of messaging and marketing and here's, I can do that right now, but obviously the private practice section or, you know, and maybe it should be called the business section because it does have all the resources there for, for business. And again, that doesn't matter if you're a pediatric or orthopedic or in a hospital or in home care, the business of PT is everywhere. And I think the private practice section has tremendous amounts of resources for that they have, for instance, a whole series called finance 1 0 1, which is multiple videos, just on finance marketing 1 0 1. So educational opportunities, webinars, all of those, there's a huge amount of resources through the private practice section, their annual conference, and many, many people who work in all kinds of different settings come to get a through that chapter of the AP TA. So I would say for anyone with any business interests, it is a very non-threatening welcoming chapter for peoples that people at all different times in their career and all different kinds of practices to come to.
Speaker 1 (11:09):
Yeah. Excellent. All right. Thank you for that. So now you've said it a couple of times marketing and sales, and I know you're on the marketing committee, so we are going to dive into that. So what about the belief that marketing and sales is bad? Like it's icky. It's like people should know what we do. Why do we have to go out and market ourselves and be like, quote unquote used salesman, used car salesman, not use salesman.
Speaker 2 (11:38):
So incredible. I tried to flip it and say that to me, marketing and sales, we should call it advocacy because what it is is actually advocating for who we are and what we do. I was speaking to a student the other day, actually. And I love speaking to students because it's really interesting to hear when and how they learn their sort of opinions and biases. And this student was telling me about their clinical affiliation and that he couldn't understand why all doctors weren't telling their patients about direct access and we have direct access, but doctors don't tell their patients. And I see this, I say to the student, I see, did you, did you, does your mother know what [inaudible] is? And he goes, no, I had to explain it. And I see it. So let's first of all, stop using this word direct access because no one understands what it is we like to use it.
Speaker 2 (12:36):
But first of all, we have to be able to communicate and let people know. And then I said, do you think that the average doctor healthcare professional knows that you could see us without a referral? I don't know that because we never tell them how are they supposed to know that? So I think what it is is when we're marketing is really about advocating or educating people don't know who we are and what we do Magento here's my random guests is that 40% of PTs. And I just made that number up. But I asked a lot of people, 40% of PTs got into the field of PT because they were injured as teenagers. And they learned about the field and I was one of them. And I, I would love to know what percentage of PTs out there had ACL tears, because there is every second PTI made is like, yeah, I told my ACL when I was like 15 and I fell in love with my PTs.
Speaker 2 (13:28):
And I realized what a difference it made to my life. And then I decided I want to be a PT. Like, why do we have to be, you know, we experienced it. That's how we found out about it. But yet we don't want to tell other people about it. We think it's icky for some reason. So I just always try and push people. People don't know what we do. We don't do a good job of explaining the value. People have biases and think, oh, you just helped someone after they've had a stroke to walk things like that. But I think it's time that we don't just say, yes, we take care of all different kinds of people. Get them back to their life and doing what they want to love. We actually have to take it a step further and say, no, no, we're actually a major solution. When it comes to the issues with MSK, MSK ailments are a huge problem in our society. And we have the ability to keep people moving so we can decrease those downstream costs, such as knee replacements, hip replacements, chronic illnesses, your diabetes, your obesity, your hypertension. So the value in Walt we can do and create is way, way more than even what we message on a day-to-day basis at this stage. And we have to do a bit, your job of it.
Speaker 1 (14:40):
How do we do a better job? That's the question, the million dollar question, great.
Speaker 2 (14:46):
How do we do a better job? You know, I've worked at PPS and we've tried to pull PR committees and PR companies to help us with it. But I think at the end of the day, what we've found most useful is is doing grassroots advocacy work, ensuring that every student comes out and understands how to describe and how to talk about and the meaning of it. Yeah. Yeah.
Speaker 1 (15:14):
And, and I, like, I always tell people, if you want people to know what you do, what we do as physical therapists and you have to put yourself out there to do it. So it's not just talking to each other within the profession. We know what we do. You know, I always encourage people like you know, pitch yourself to your local newspaper, get a column, right. Like I said, this too, like in my PPS talk that was online last year. I went step-by-step and taught people how to do that. And then a couple of weeks later, I got an email from a woman who watched it and she said, I, I, I was able to get a column with my local newspaper
Speaker 2 (15:59):
Colson. Exactly. You put yourself out there and don't think I just have to be a PT in the clinics. I like you do a podcast. Mine's very different. My podcasts I do with different healthcare providers in our community, including PTs. And we discuss things such as how to stop running or picking your right running shoes, or what do you do if you've got back pain or how did you manage through COVID, but putting out information so that people in the community see, you see you as experts in movement and health and wellbeing and not just the clinician that your primary care doc seems to you once they don't know what to do with you because of your ongoing back pain. We're a whole lot more.
Speaker 1 (16:44):
Yeah. Yeah. And I think physical therapists in general, this is just my opinion, but they really need to get off the sidelines and start taking control because a lot of this, like, is it up to the AP TA to do all of this? No. You know, as an individual physical therapist, you have to put yourself out there as well.
Speaker 2 (17:03):
You really do. And I, I do get a little frustrated when I see people on social media bashing the, a PTA about all the things that a PTA should be doing. I think what we've seen in the year, we've seen changes in our profession such as, Hey, we're all now doctors, a PT thinking that this label would suddenly change how the public and how healthcare providers perceived us a new title, a new label, or a fancy ed doesn't change who we are. It's how we behave. So we have to behave like professionals. We have to stop being on the sidelines and actually get in and play the game. When it comes to health care, sit at the right board tables, be confident and comfortable calling out local docs, countable care organizations, insurers, and letting them know the role and the value that we provide.
Speaker 1 (17:57):
Yeah. Perfect. Couldn't have said it better. Excellent. Now, you know, this whole month is all about small business or not small business, but about businesses, entrepreneurship. And, you know, in speaking, before we went on the air, we were saying how important small businesses and entrepreneurship is to I think bringing back this country after hopefully as COVID starts to recede. So can you talk a little bit more about that?
Speaker 2 (18:27):
Yeah. I mean, you see it in every industry, that's entrepreneurship, these are where the new ideas, the crazy ideas and small businesses have the opportunity, the luxury to be savvy and make quick changes in what they do. COVID sore that, I mean, who were the first folks to suddenly provide telehealth services? It wasn't the big corporate or hospital run facilities. It was the savvy small businesses who were able to flip their operations overnight and suddenly implement telehealth. And of course that led the way for everyone else being able to follow. So I think COVID helped to prove it and show that that is the way that the world works. Entrepreneurship, small businesses seems to drive innovation. I think now in the world of physical therapy, we are seeing major challenges with reimbursement and payment. I personally, and a big fan of my moving towards value-based payment.
Speaker 2 (19:24):
I really despise the whole, you know, the more you do, the more you get paid, I would much rather the, we are paid to keep or get our patients healthy and have good outcomes and just find the journey to get there. But I think it's small businesses that had the opportunity to, to take on risk and try different ways, whether it's with employers or whether it's with healthcare insurance, healthcare insurance companies like go to these different organizations and pitch, then pitch different ideas. Now you're going to get turned down probably 90% of the time. That's okay. But then you're going to find little pilots and you're going to find opportunities. And even when I look around the country, now I hear from colleagues and peers who are like, oh, I'm in this kind of financial model where we're doing health screenings and we're just taking care of the lives. And someone else says, oh, we've got a subscription paced program to keep people moving. So there's different pilots going on. And it's small business that has the ability to be innovative and do those that then we can ultimately model after. So I think any way we can small support small businesses is going to be helpful for the future of their proficiency.
Speaker 1 (20:39):
Yeah. And I love that. You said they could be more innovative and nimble and, and that's true. That's true. Most entrepreneurs because they don't have to go through a million different boards and get approval from XYZ. They could say, well, this is what I'm seeing in the market. This is what our clients want. So let's try it.
Speaker 2 (20:59):
Exactly, exactly. And you can do it at a clinic level. You can do it at company level. You can do it with, oh, let's try this program at this clinic and see if it works. And yeah, you can be very savvy and very timing and get these things done quickly. It's small business might not have all the resources and may not have whether that's financial or brains like people power, but usually entrepreneurs are pretty savvy about finding solutions to some of those challenges and problems. And that's where the likes of PPS and a PTA can be really helpful because it's pretty easy to find other people with that business or entrepreneurial ship desires that can come together and help each other. Yeah,
Speaker 1 (21:41):
I agree. And now, you know, as we're talking about business and you have a thriving business at this point, but what were the challenges of your business and a view as an entrepreneur now, I think you mentioned one of them earlier being, having no idea what financial statements were, I'd say that's a challenge. But for people listening for who might be maybe wanting to dip their feet into the entrepreneurial pond, so to speak, what are some challenges that came up for you and what did you do to overcome them?
Speaker 2 (22:21):
As you said, that I started writing out a list of challenges because I've made a lot of mistakes. I've had many challenges. I heard an interesting quote. I read an interesting quote today, actually. If I could have my time again, what would I make? All the mistakes, same mistakes. Yeah, I would, I would've just done them a lot sooner. So I could've got the mistakes out of the way earlier, but I think some of the challenges, a lot of the challenges were with delegation and leading things go, it's very hard to step away from patient care when that's something that you're very comfortable with and you think you're good at so managing time and I hear that coming up a lot with business owners, how much, you know, should I treat patients or not, not, there's no right answer there. You know, it depends what makes you happy.
Speaker 2 (23:06):
And it depends what you enjoy doing. So delegation was a big pot. Someone else told me the other day, I liked this quote as well. You know, you're delegating enough. If you want to have a growing business that if three times a day, you cringe now you cringe because you had given something, a project or a task or something to do at work to someone else so that they have the opportunity to grow and evolve. But you cringe because you look at them doing it and thinking, oh, I could do it a little bit faster. I could do it a little bit better, or I might do it a different way, but that's okay. And you have to get to that stage of going like, you know, you could call it 80 20 rule, but that rule of going like it's, it's actually a gift to be out on power and allow other people to grow and evolve.
Speaker 2 (23:53):
So learning how to manage that can be had the culture things interesting. When you've got a very small practice, the culture just happens automatically and you have this amazing culture as a practice grows and evolves. You have to become much more disciplined and diligent about how to actually execute on maintaining and having a great culture. So something you have to be aware of putting the systems in place as you grow and evolve, the more systems you have in the place in place, the smoother things can run. And it creates actually a structure, a structure that actually allows innovation and allows people to be creative, but they've got the walls and the guidelines of how to do that in a safe way. So I don't know, those are the key things that came to mind for me. You know, it really comes back to managing your time, how you delegate, how you let go of things.
Speaker 2 (24:47):
You got to keep becoming more and more humble that every year I realized how much I don't know. And it just seems to be almost, it's like my list of things I don't know, actually is increasing. So I'm not sure if I'm just getting older and losing my memory, or if I'm just becoming more aware of how clueless I am, but I guess I'm comfortable owning that at the stage. So I think, and being comfortable with who you are and your own skin, you definitely have to work on yourself a lot, take care of yourself a lot and and be very mindful of what you need as a person, if you want to be a leader in an organization.
Speaker 1 (25:20):
And what is your advice to maintain culture as your company grows? Because that's like you said, I'm really glad you brought that up because people join your company because of the culture. And if you grow and you let it go, or something happens, then people are going to leave. So how did, how did you do that? How did, what is your company culture and how did you maintain it?
Speaker 2 (25:44):
I liked the question. What is your company culture? Because I mean, I think of our culture is a very much like work hard, play hard, definitely a lot of fundraising up a lot of philanthropy, a lot of giving back to the community. Now, maybe what would happen 15 years ago, it would have been like, Hey, let's all dress down this month for this great organization and get together and do a 5k for them. And they will go out to her via what's. The net would stay the same for a great culture and getting to know people as individuals now, as with a larger organization, we have to be much more diligent about or more mindful about hearing from all of our people who should we dress down for and choose carefully based on the feedback and then communicated appropriately, have some PR involved the social media, making sure everything's much more streamlined.
Speaker 2 (26:38):
So all of the good happens, but it just takes a lot more work. It just doesn't happen quite so easily. So you just have to put the work into it determining what kind of feel you want it, social events, what kind of behavior expect again, you know, speaking your late leadership, how you act at a holiday party or at a social event is going to have a big impact on what your organization is like. And if you want to dress up like a pirate and dance around, which is what I do then yeah. You're going to create a different kind of culture to someone who's going to come across in a different way. So you just gotta be really mindful that as you grow, people are watching you and how you behave and that's going to drive it a lot of the culture.
Speaker 1 (27:20):
Yeah. I think that's thanks for elaborating on that because I feel like that's a piece of the entrepreneurial pie that often doesn't get addressed.
Speaker 2 (27:30):
I agree. I think especially if you have a smaller company as that grows, you think you can, it's easy to forget about culture because it almost seems fun and that is fun. And it almost seems like, is it silly that we're talking about what events or what we're going to do to build culture, what team building things, but it's really, really important because your people are everything. And if we're, I always just say to my stuff, sometimes people say to me, what do you actually do? And I'm like, really my job is to keep you all happy. That's really all it comes down to because when you're happy, you'll give good care. If you're miserable, the care you give sucks. If you're happy, you give good care. And if you happy you'll stay. So my job is to keep everyone here simply saying
Speaker 1 (28:16):
You're the C H O chief happiness officer officer. Exactly. Pretty much. Yeah. Well, that's a great title. Actually. You should put that on your cards. Bring that up to PPS. Ask how, asked how many businesses in PPS have a chief happiness officer. Yeah. And see, see what we can see what shakes out on that one. But yeah, I, thanks for elaborating on that. I just really wanted the listeners to understand that your business is more than dollars and cents
Speaker 2 (28:48):
Completely, completely. And if it was just business dollars and saints, it would be kind of boring. I do think it's wonderful. Seeing the PTs, who own practices, they do it with no matter what the size you do. It, we all love people and making people happy and better. And whether you're their employer or their physical therapist, it's not that much different.
Speaker 1 (29:09):
Right. Absolutely. And now before we wrap things up, what are the key takeaways you want the listeners to come away with with R D from our discussion today?
Speaker 2 (29:19):
I would say that get comfortable with the word money. I know I'm going to go straight to business. It's not a bad word. It's not a bad word. And as PTs, we don't like talking about it. Oh, I don't want to talk about my salary or I don't want to do this, or I think I should get paid more, but I don't really want to understand it. Like, it's just, just think of money is just one of the things that helps us actually actually be able to evolve as a profession and serve more people in our communities. I don't know if that came across very professionally or not, but I do think people should be comfortable with it. Be proud of what you do. And when someone at the local bub you're a barbecue, or when you're grilling with friends, complaints to you about your back, their back pain, help them and tell them what you do and make sure they get the care they need. And don't sit back and, and let them have to try to figure it out on their own. And and just be curious about learning more about business. It's not scary and it will help. The more you understand, you'll have more control over the decisions you make. And I actually think you become a better clinician because you're more mindful of the value of the services that you're providing.
Speaker 1 (30:32):
Excellent. And where can people find you if they want to get in touch? Do they have questions? They want to learn more about your business?
Speaker 2 (30:39):
Pretty easy to find live up in little road, mighty Rhode Island. We like to call it. So email's the easiest way. You've I, and through my practice, performance PT, R i.com. You'll find me on Facebook and on Twitter as well. I'm not as savvy on social media, some of you, but I love getting emails from people and helping other PT students, practice owners, different kinds of business owners out there.
Speaker 1 (31:06):
Great. And we'll have the link to your website at our website at podcast at healthy, wealthy, smart.com in the show notes for this show. So people can one click and get straight to your website to see what your business is all about. And if they have any questions, like Michelle said, highly encourage you reaching out to her and emailing her to ask questions. That's what we are here for. And Michelle before. Last question is knowing where you are now in your life and career. What advice would you give yourself as a new grad?
Speaker 2 (31:39):
Well, that's a good question. What advice would I give myself as a new grad who as a new grad, I would just as a new grad, I would say, believe in yourself earlier and address the fears that you have of your lack of knowledge and your inability to do things. So, yeah. Maybe make your mistakes earlier. Michelle is what I want to say.
Speaker 1 (32:06):
Excellent advice. Well, thank you so much for coming on for our month of business. And of course, we'll see you in a couple of weeks at our business round table, which will be on the 27th of July. Think at 8:00 PM Eastern standard time where it will be you and Eric and mellow and Josh funk and Shantay Cofield AKA the movement. Maestro people probably know her better with her Twitter, with her Instagram handle than her actual name. But I'm really looking forward to that. I think we'll a really robust conversation because we've got just like PPS, we've got those four different personas, totally nailed down. We've got your solo preneur, we've got your more traditional PT practice, which is Michelle's. We've got a newer grad with an, a growing practice in Josh and we've got a non traditional PT. So working as a physical therapist, but not with patients in Shantay. So and that was total coincidence. I didn't even know that when I plan this out. Perfect. So I'm really looking forward to it.
Speaker 2 (33:15):
So, and I just think it's really cool when you get these different kinds of business owners who are PTs and all different kinds of businesses. It's awesome. Yeah.
Speaker 1 (33:24):
Yeah. We'll have a nice, a nice step meeting of the minds. So everybody definitely sign up for that. And the link for that is also in the show notes for our round table. So Michelle, thank you so much for coming on and I hope to see you hope to see you soon. I hope to see you too.
Speaker 2 (33:41):
Karen. Thank you so much. Of
Speaker 1 (33:43):
Course. And everyone, thanks for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Co-Founder and CCO of WebPT, Heidi Jannenga, talks about the trends that were revealed in the State of Rehab Therapy Report done by WebPT.
Today, Heidi gives an overview of the Rehab Therapy Report, and she talks about how technology has benefitted the industry, business continuity and growth, and the reality of burnout. How has the pandemic impacted business revenue, budget, and employment.
Hear about the lack of diversity in the industry, the disparities in advocacy and associations, and the tech adoption boom of 2020, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- Survey results show that 77.4% of rehab professionals identify as white, 6% as Asian, 5.5% as Hispanic/Latino, 2.8% as Black/African American, and smaller percentages as American Indian, Alaskan Native, Native Hawaiian, and other Pacific Islander.
- “There are huge gaps in terms of not reflecting who our patients really are in every area of the nation.”
- “40% of the [women] respondents said that they now hold C-Level executive positions. That’s a 10% improvement.”
- “Almost every clinic leader I talk to today are at pre-Covid numbers, and most of them are above pre-Covid numbers.”
- 50% of therapists, and 42% of therapy assistants reported feeling more burntout now than they did prior to the pandemic.
- “60% of rehab professionals said that they didn’t participate in any of the numerous advocacy efforts from last year.”
- “Even if you disagree with some of the decisions or directions of APTA, that’s all the more reason to be involved.”
- “It takes a lot of vulnerability and confidence to say ‘I don’t know.’”
- “As a leader, you shouldn’t have all the answers. You become a crutch to those that work with you if you’re the only one who has all the answers.”
More about Heidi Jannenga
Dr. Heidi Jannenga is a physical therapist and the co-founder and Chief Clinical Officer of WebPT, an eight-time Inc. 5000 honoree, and the leading software solution for physical, occupational, and speech therapists.
As a member of the board and senior management team, Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for rehab therapists, women leaders, and entrepreneurs on a national and international scale.
Heidi has guided WebPT through several milestones, including three funding rounds: an angel round with Canal Partners, a venture capital round with Battery Ventures, and a private equity round with Warburg Pincus; five acquisitions; and numerous national corporate and industry awards.
In 2017, Heidi was honored by Health Data Management as one of the most powerful women in IT, and she was a finalist for EY’s Entrepreneur of the Year. In 2018, she was named the Ed Denison Business Leader of the Year at the Arizona Technology Council’s Governor’s Celebration of Innovation. She also is a proud member of the YPO Scottsdale Chapter and Charter 100 as well as an investor with Golden Seeds, which focuses on women-founded or led organizations. Her latest venture is called Rizing Tide, which is a foundation dedicated to fostering diversity and inclusiveness in the physical therapy workforce.
Heidi is a mother to her 9-year-old daughter Ava, and she enjoys traveling, hiking, mountain biking, and practicing yoga in her spare time.
Suggested Keywords
Covid, Survey, APTA, Rehab Therapy, Report, Data, WebPT, Diversity, Physiotherapy, Advocacy, Technology, Burnout, Business, Healthy, Wealthy, Smart,
Recommended Resources
The State of Rehab Therapy 2021: https://www.webpt.com/downloads/state-of-rehab-therapy-2021
The State of Rehab Therapy Webinar: https://www.webpt.com/webinars/the-state-of-rehab-therapy-in-2021
To learn more, follow Heidi at:
Website: https://www.webpt.com
Instagram: @heidi_jannenga
Twitter: @HeidiJannenga
LinkedIn: Heidi Jannenga
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here:
Speaker 1 (00:03):
Hey, Heidi, welcome to the show podcast. I'm so excited to have you on today.
Speaker 2 (00:08):
Thanks Karen. So excited myself to be here. So thanks for the invite. I really appreciate it. Of course.
Speaker 1 (00:14):
And today we're going to talk all about the key trends that were revealed in the state of rehab therapy report powered by web PT. But before we get to those trends, can you tell the listeners how all of this information was compiled?
Speaker 2 (00:32):
Sure. So we actually started conducting this industry-wide survey of the rehab therapy industry and what we consider rehab therapy is PT, OT, and speech back in 2017 that was the first time we released the state of rehab therapy report. And essentially we were trying, we had a lot of questions about the industry that we just honestly couldn't find the answers. And so we decided, well, we're just going to put out a survey to ask the questions we want answered topics ranged from business financials, operational structure, patient volumes, job satisfaction, technology trends, demographics, like we just really wanted to dive into sort of slice and dice the industry a little bit more as far as data goes. And we took a little bit of a pause in 2020, obviously due to COVID. But we did actually launch the survey at the end of the year. And so that's what we're talking about now. As far as the results go and we collected, I think over 6,700 responses, the majority of, of whom treat patients directly. So either as therapist or assistance, and 60% of them were from outpatient private practice. So the other 40% were from other therapists who work in other areas of the industry. So we feel like the findings really you know, give a good sort of breakdown of what's going on in the profession as a whole.
Speaker 1 (02:10):
Let's just dive in, then let's talk about some of those trends. So I will just kind of throw it over to you and we'll go through the major trends that you found. So let's, let's start.
Speaker 2 (02:22):
Yeah, let's just kick it off with something that's top of mind. I know for a lot of businesses and not just in the PT world, based on some of the occurrences within 2020, and that's really focusing on diversity. I think we've talked about it a lot that we, we all sort of know that there's this issue of lack of diversity within our profession as a whole. We're pretty much racially, very homogeneous. Our survey results showed that 77.4% of rehab professionals identify as white. Our results showed 6% identify as Asian five and a half to identify as Hispanic or Latino 2.8% identify as black or African-American. And then smaller percentages of the American Indian or Alaska native and native Hawaiian and other Pacific Islander. And so if you sort of then contrast that right with the overall society of, of the U S I mean, there's just huge gaps in terms of not reflecting who our patients really are and in every area of the nation.
Speaker 2 (03:42):
So, you know, we, we asked a little bit of why some of the factors that are leading to that, and, and I, I think that, you know, we can sort of hypothesize a lot on, you know, the flood student recruitment. Like we're just not getting them in. We're not, for whatever reason. They don't know how cool it is to be a physical therapist. They're not attracted to it. So the recruitment is kind of broken. And so from there you just have a limited hiring pool. And so of course, you know, I think what a lot of people are sort of now attacking also is just, do we have some unconscious bias, like, do we need more training of our, our teams and recruiting processes within our own organizations to sort of eliminate and hopefully put a little more attention on trying to, to become more diverse in our employee base.
Speaker 1 (04:33):
Yeah. And you know, like you said, that this is not unexpected to continue to show this lack of diversity and, and yeah. Where, where does this start? Does this start with recruiting teenagers out of high school, into undergrad and then recruiting from undergrad into grad school? Is it exposing more you know, people of color just to the profession in general? You know, there are some people doing great job with that, like Jasmine tools in Southern New Jersey. I don't know if you know Jasmine, but she created a girl scout badge, a physical therapy girl scout badge. And she works mainly with girl scout troops in inner cities in Philadelphia. So you've got all these young girls who now know what physical therapy is because they're getting their physical therapy badge.
Speaker 2 (05:25):
That's awesome. I love that. Yeah. And we need more of that obviously happening at an earlier age to just, I mean, we've talked a lot about it. I knew you've talked about it on this podcast about sort of the brand problem of actually attracting patients in, but that also is reflected in attracting amazing people of all, you know races, color, everything like, you know, into our profession as a whole. Now I will say Karen, that we did see something positive you know, we, you and I have talked a lot about sort of the misrepresentation of women in leadership within our profession. And we did see a pretty good uptick. We we've also always talked about it in terms of you know, 70% of therapists are women and yet only 30% of them hold any kind of leadership position whether it's clinic, director or above manager. But we did see that number go up from where it was. And so 40% of the respondents said that they now hold a C level executive positions, which I thought was mean that's a 10% improvement. So huge. That was awesome to see.
Speaker 1 (06:45):
Yeah. I love hearing that. That's a huge, that's a huge jump. 10%. Excellent. Well, that's a, that's definitely a positive. Okay. So let's go to another trend that came out of this report and it has to do with technology. So can you expand on that?
Speaker 2 (07:04):
Yeah. So I'm sure that a lot of your listeners can relate. Telehealth was an explosion that had to happen during COVID. We were all stuck at home and people were in the midst of rehab, some hurt themselves doing, you know, working out at home using their, their Peloton or whatever it was, and they still needed therapy. It wasn't like people stopped needing PT, right. Or rehab therapy. And so tele-health exploded. So the use of, of platform tele-health technology platforms spiked significantly over the last year, although we saw about 75% of clinics that actually implemented tele-health during this time, we've now seen that number completely plummet down to two pretty low numbers. So people are going back to status quo. Now that most cities and states are, have opened back up. So it's going to be interesting to see how this trend continues.
Speaker 2 (08:14):
I do a whole tangent, we could do a whole nother podcast, I'm sure on how do you, how can we put, how can tell a health be you lies a, from a patient experience perspective, but also from a reimbursement payment perspective, like how do we make sure that is there, is there a hybrid potential in the future to, in, in my assessment, reach more people like we, you know, we always talk about the 90% problem, right? If 90% of patients who have a diagnosis that could be beneficial in rehab therapy, aren't getting to us. So how do we expand that opportunity? Tele-Health has it, has it, has the potential to be a of that? Yeah. I experienced
Speaker 1 (08:57):
That over. COVID that exact thing now I still am. I am still using tele-health because I'm in New York city as a lot of people know, and there are still people who are like, not, not just not comfortable, you know? Right. So I'm still using it. But what I found was that, so I have a cash based practice. And so some people were like, Ooh, it's a little pricey. Do you have a way around this? And I said, well, why don't we do one session in person? And then we can move to tele-health and maybe do half hour sessions on tele-health, which will be less expensive. Right. And it was a great mix. I do that. I did that a lot with kids. I mean, you can't keep a kid's attention for more than a half an hour in person or on telehealth and teenager, forget it. Right. So I found, oh, this is a perfect use of tele-health. So it's, it's still allows me to create the revenue I need for my business. And it's certainly a less expensive option. And I would argue a very very convenient and, and maybe just the perfect option for that subset of people.
Speaker 2 (10:04):
Yeah. I agree. I'm, I'm very much in favor of understanding the patient experience and the flexibility that telehealth can allow patients. Right. I think that there's just a lot of discussion right now on how do we get paid for that? Right. And whether or not does it tele-health is, should we be paid the same amount as an in-person in-person visit versus a tele-health visit? And I think it's still up in the air. Like, I, I, I fully can see it from both sides. Right. but to your point, the expense side of what your, your cost as a individual business owner on tele-health is significantly less. Right. And you could, the volume of people that you can kind of stack up to be able to see is significantly more. Right. And so, I guess also the, there's still a lot to be known about the outcome, right.
Speaker 2 (11:03):
Is it truly beneficial for the patient experience? Because, you know, there's, there's data now coming out that telehealth is actually expanding the utilization of care of in-person. So people aren't getting Nessus it's, it's increasing the number of visits in a episode of care because it's not taking the place of in-person it's adding to in person. Right. So we still need to understand and pull the data 2020 to understand how it fully impacted. Cause you know, insurances are always leery about adding more visits and paying out a little bit more for treatment, but if the outcomes are better, that to me always speaks volumes as
Speaker 1 (11:48):
Well. Yeah, absolutely. Now, was there any other technology aside from tele-health that reported being used more like, were there any apps or any, you know, other types of, of tech or was tele-health really the, the main thing?
Speaker 2 (12:04):
Well, telehealth was the big one. But I think there were a lot more folks that decided to ramp up their direct access marketing efforts. So I thought that was really interesting, like in order to, to keep in contact with your patients, right. And also keep some volume coming in. Again, we, it, it sort of pushed people in areas that they knew they should be doing, but now had the opportunity to do during this sort of time. You know, we, we were talking a lot about it at web PT. This is the time to work on your business when maybe you can't work in your business. Right. And so we saw, you know, marketing significantly ramp up for a lot of clinics, whether it was, you know, working on their website to their digital marketing strategy things like that.
Speaker 2 (12:59):
And then figuring out some different ways to offer more non-traditional services, whether that's, you know, like you cash-based services, ride share you know, nutritional counseling, like additives sort of things to their repertoire of services that they could add add on additionally to the clinic, which, you know, all great things. So I think it's just expanding the opportunity for more revenue streams through the use of technology mainly via their site or zoom or, you know, other things where they can have a larger audience all at one time versus having to only have a few that you had to physically come into the practice. So that's really cool to see.
Speaker 1 (13:49):
Yeah. I think it COVID sort of forced people to think outside the box. So instead of just sticking with, well, it's been working and then all of a sudden, wait a second, this literally can't work at the moment. So what do we have to do? So it may be, it, it sparks some more creative thinking from people. Absolutely. Yeah. That's a good thing.
Speaker 2 (14:10):
That's a good thing right. Out of your, out of your proverbial
Speaker 1 (14:14):
Box. Yeah. Yeah. And, and oftentimes you'll have business growth from that, which leads us to our next point. Let's talk about what a great segue let's talk about. Business continuity and growth, which when I read this, I was like a little boy. So go ahead. Let's talk about that.
Speaker 2 (14:35):
Okay. Well, as you can imagine, it was a bit of a mixed bag, right? I mean, there were quite a few unfortunate closed doors that happened at practices. It was also a huge opportunity for some of our larger organizations, enterprise organizations in the profession to continue with their consolidation and bringing more clinics into the fold. But we did find, you know, we, we've been doing a lot of education over the years on the business side and really have talks about how important it is to have that rainy day fund of, you know, at least three months of expenses. Now we all know that COVID happened longer than that. We've been under this COVID umbrella for longer than that, but truly having to close your doors probably did not have to happen for more than 90 days, depending on what state you were in, but essential, we were essential workers.
Speaker 2 (15:32):
Right. So, you know, the bright side of that was that I think 38% of leaders that took the survey said they did have that. So 40% of respondents said, yep, we had what we needed to do. We hunker down, we did some of that. There's other things that we could outside of the box during that time. Right. and we survived. Right. And so that, to me, it was just really heartwarming to see, like you hear horror stories and other industries, restaurant, and other things where man, they just suffered big time. Right. And so it was good to see that from the private practice sector there were still significant amount of businesses that were remained viable during this time found ways to continue on with some other revenue streams. And as a matter of fact, 34% of our clinic leaders said they were already starting to open more practices and locations within the next five years.
Speaker 2 (16:37):
So they're not, you know, struggling right now. And as you know even though our visits completely plummeted for a few months, like they quickly ramped back up and almost every clinic leader that I talked to today are at cope pre COVID numbers. And most of them are above COVID numbers. They can't keep up with the volume right now for the most part, so good problems to have. I'm just excited that, you know, again, we we were at the forefront of, of essential workers helping people in need, whether it was specifically in orthopedic you know, rehab, but also there's so many great stories of how clinics, you know, were out there helping folks. And now we have the post COVID long haulers that we're now getting into our practices. So the value of PT did not dwindle during this time, which is, which is great to see. Yeah,
Speaker 1 (17:38):
Absolutely. And now, as we talk about these clinics ramping up and more patients coming in and more work for the PTs, well, oftentimes you can kind of see where I'm going here that can lead to burnout. So talk about the, the topic of burnout that you found within this report.
Speaker 2 (17:59):
Well, this was a problem pre COVID, so it's not even anything super new. We we've continued to report on this. It can, you know, the, the slope is on the RA is going in the wrong direction. Based on our, our, our survey 50% of therapist and 42% of therapy assistants reported feeling more burned out now than they did prior to the pandemic. Most of them cited reasons for that burnout or fear of contracting COVID and just reminder, you know, this survey was taken at early this year, end of last year. So we were still sort of in the thick of things changes in their work hours and sort of change in the whole overall clinic morale.
Speaker 2 (18:51):
We're all experiencing some, you know, mental health sort of pieces fall out great word fallout from all of this. Right. And so, as you can imagine, that was reflected in the survey. So, you know, at the, at the same time, even though they reported this, this burnout most of them have said that they obviously still love our industry. They don't have any necessarily thoughts of, of potentially leaving. Although we do, we are seeing some, a little bit of that. I think just like every other industry, when you couldn't work, people picked up their heads and said, Hmm, what else is out there? And we are seeing, you know, a few, a few more percentages of people looking outside of clinical care, which I I'm, I don't think is necessarily a bad thing to, to continue, you know, projecting a, an awesome brand for PT professionals. But outside or doing things now in nonclinical care nonclinical work.
Speaker 1 (20:00):
Yeah. And I've definitely seen a lot. I've seen that sort of trend as well as moving away from patient care and going into nonclinical roles, which, like you said, there's nothing wrong with that. You have to do what feels good for you. What, what advice would you give to a PT who is maybe they are one of those 50% who are feeling burnout or feeling like we hope it's not feeling apathetic towards the profession and their patients, but that is part of, of the burnout feeling burned out. Is that real, like apathy for just doing the job? So what advice would you have?
Speaker 2 (20:48):
Yeah. You know, most of the time and I'll speak to myself and when I feel burned out, I have to get back to the root of passionate around why I'm doing it. Why, why do I love, why, why did I get into this in the first place? What is my purpose sort of in being a PT and you know, and figure out, you know, what's causing, what are the root causes of, of, of these feelings of burnout? Is it the current position I'm in? Do I just not like who I'm working for? Do my values, not line up with my employer. Like some of these things like people, you just, you still feel so lucky to have a job sometimes during time. And then, and then now that, you know, things are kind of opening back up. I think a lot of people are coming out of COVID experiencing like, holy crap.
Speaker 2 (21:38):
Like, what am I doing with my life? They they've lost their family members. They've lost friends. Like it's, it's kind of this wake up call for a lot of people to say, holy crap, what am I doing with my life? Like, is this really what I want to do and love to do? And so you see a lot of people struggling with that and maybe not perhaps loving what, where they are and what they're doing. And so they're kind of in this burnout phase and I, again, this was taken in like December, January, right? You've been hunkered down for a whole year with not a positive end in sight, even at that point. Right. I mean, it's starting to come out of it. So things were kind of doom and gloom in the country. We're just transitioning out of, you know, a present presidential race.
Speaker 2 (22:27):
There was a lot of change and a lot of turmoil going on in the, in the country at that point in time. So I think that's also reflected here, Karen. I would say this is probably similar to what you might ask any average American during this time. Right. So I would just take that into consideration as we look at these numbers, but you know, one of the things we didn't talk about here with regard to demographics is also just the, the student debt that is still a, such a huge problem in our profession. And it's just, it's not getting any better necessarily. And so again, compounding your student debt on top of, oh my gosh, do I really love my job? Like, there's an COVID and everything else, like, there's just you just, you feel kind of in despair. Right. And so I think that's, what's really reflected here again. What would I tell people I'm like, again, go back to the roots. Like what, what do you, why do you love what you do? Or why, why do, what did you get into this profession to do and find a path to be able to make that happen?
Speaker 1 (23:40):
Yeah. It's like you said, it's sort of stress upon stress upon stress with uncertainty. Yes. And that's really difficult for people, especially when you have a boatload of student loans and wait, no, one's hiring now. Right. When this was taken, when the survey was taken, we weren't at those pre COVID levels yet because the vaccine hadn't been widespread yet. And so yeah, I can understand why a lot of people felt burnout and, and quite honestly, I agree with you, I would say 50% plus of Americans felt burned out at that time as well.
Speaker 2 (24:20):
Yeah. And, and going back to some of the COVID impacts, like when the survey was taken, you know, our survey results showed that a lot of clinics were in that uncertainty phase of not exactly knowing when they were going to actually meet or exceed or even get close to their budget that they had projected for 20, 21. Right. And so there were cutbacks being made perhaps, you know raises were on hold. Right. There's just a lot of factors as an employee or as a therapist that you're kind of like that uncertainty really does not make you feel good. Right. So I think all of that is reflected. I mean, there's so many facets that that can be reflected in that burnout number, especially after the year we just had.
Speaker 1 (25:07):
Yeah. Yeah. It's not just one thing. It's a lot. Yeah. It's a lot. Okay. Is there, what were, are there any other sort of major trends from the report that we didn't hit on yet that you want to make sure the listeners get?
Speaker 2 (25:22):
Well, you know, I'm a huge advocate on advocacy as you are. And you know, we always kind of want to know, like where, and how are people doing advocacy? How do they get involved with the profession? How did they get involved to, to stand up for where the profession and no, no difference in, in years past, you know, the, unfortunately the PTA and the OTA and even ashes to some point, Ashleigh actually has done a fabulous job as far as galvanizing their SLP base. But AP TA and, and almost 50% of those responded to our, our survey said that they were either not members or had no intention of being members. Cause they didn't feel like it added value for the cost of, of being a member. And so, you know, from an advocacy perspective I, it was also a dismal number to sit to show that 60% of rehab professionals said that they didn't participate in any of the numerous advocacy efforts from last year,
Speaker 3 (26:43):
Which was
Speaker 2 (26:45):
Again to my heart. I will say though, that that is a significantly yeah. Lower number, which is still sad because we did rally a lot of people last year around the 9% cuts and all of that. I think more people than ever, I guess, if you look at the, you know, the positive side of this, more people than ever did get involved whether it was, you know, to provide tele-health to have an avenue for more for revenue, the 9% cuts, you know, all of those things definitely rallied folks to become more involved, but we still have, you know, to your words earlier, some apathetic PTs that just don't understand, maybe it's just don't even understand how advocacy works. They don't feel like they have time. It doesn't make a difference, like all the excuses that people want to give. So it's always a point of contention for me, whether it's, you know, if you want to be a member, I believe everybody should be a member of the PTA.
Speaker 2 (27:45):
It's your association. They represent all everyone in, in the profession as a whole. I know they struggle because it's just, there's so many opportunities for PT and, and specializations within our profession that everybody wants to raise their hand and say, you need to represent me. But at the end of the day, we're all physical therapists and that's what we need to, I feel like we must come back to and so, and also with the PT pack, you know, and, and having been a previous trustee, I know how hard it is to in the small, small percentages of people that do contribute to this hugely important effort of how advocacy has to be done in meetings and people knowing who you are as an association and as a group, and why it's so important to, to not have cuts to our profession. Right. I mean, they are just ignorant to, to essentially what we do on a regular basis and how much we get paid for it, or lack thereof.
Speaker 1 (28:56):
Yeah. And, and what I would say to people listening, even if you disagree with some of the decisions or directions of a PTA, that's all the more reason to be involved so that your vote, your voice can be heard. And, and maybe you can change some of those things that you don't like. I mean, I understand it's a slow ship to steer. It's a big organization. Like, you know, it's not like a nimble small private practice owner who can change things on a dime, you know, but it is a big ship to steer, but the more and more people, especially younger therapists that can get involved and have their voices heard. I think that there's a good to make a difference
Speaker 2 (29:43):
For sure. And I, I think just understanding how you can get involved, whether it's, there's lots of ways to be involved, even if it's financial for now, or maybe a kind of, maybe it's just time, like there's lots of different ways to, to add your voice and your voice does matter. And I think that more than ever is important to, for people to understand. I think we had the most it's not just even therapist's voices, but patient voices. We had the most number of patients that was something we, we rallied so well with this year is to get the patient voice heard with regards to the 9% cut, especially on the Medicare side. And so I think that was pretty impressive and made a huge, huge impact with the legislators, with regard to the effect and why we've had some significant progress in, in mitigating those cuts.
Speaker 1 (30:40):
Yeah. And oftentimes, like you can be involved in like the easiest way possible by just like going onto a website and putting in your zip code, finding the people and pressing a button and it sends it up. Like to me, it sends it off to like Chuck Schumer and, and Kiersten Gillibrand. And I don't know. Yeah.
Speaker 2 (31:01):
It's so easy. Even if you don't know who your legislators are, the apt [inaudible] like, there's so many sites now that are help making this so much easier to become involved to, to, to lend your voice right. In a way that is super impactful and only takes a couple minutes. Yeah.
Speaker 1 (31:24):
If that, and you don't have to be a member to do that yes. Nor do your parents or your friends tune in seconds and it's free. And if you have a smartphone, it literally takes two seconds and a LA it's all pre-written. So, yeah, I agree. I think positive advocacy efforts are so needed and like you said, they, they make a difference, you know? So, okay. I think we talked about a lot. We talked about diversity technology, COVID advocacy business growth. Anything else that really jumps out at you from this report?
Speaker 2 (32:09):
No. I think those are the big highlights. You know, we look forward to, to now be able to compare this is a a great sort of slice in time, immediately post kind of post COVID bef just immediately prior to the, you know, getting back to quote unquote normal as far as visit numbers and things like that. So we definitely look forward to doing this again next year. So I, your listeners to participate in the future again, to get your voice heard and to, to really be able to reflect more of what's going on in the industry.
Speaker 1 (32:53):
Yeah. I think it's great. And where can people find this report if they wanted to read the whole thing?
Speaker 2 (33:00):
Yeah. If you go to web pt.com/state of rehab therapy or if you just go to our blog page you'll find it and it's a free to download. It's actually a 60 page report full of graphics. And like, if you're a data nerd, like dive in, because they're there, we have sliced and diced it and made this beautiful. Our team is just awesome. And did a lot of work to, to make this digestible from anyone, even if you're not a data nerd to bring out the highlights. And then also Karen, we're going to be doing a webinar coming up in just a couple of weeks. So you'll find that on our website as well. You can sign up for the webinar. We'll, we'll go in much deeper depth as far as the details of, of more of these topics that you and I have talked about today.
Speaker 1 (33:57):
Excellent. Excellent. And they can, all that can be found on the web PT website. Yep. Perfect. And where can people find you on social media, things like that if they want to follow you or get in touch or ask you questions? Yeah,
Speaker 2 (34:12):
I'm on LinkedIn. I'm also on Instagram at hydrogen Nanga. So it's J a N N E N GA. And yeah, happy to engage on social, do it quite a bit, especially on via LinkedIn. So love to connect with any of your listeners.
Speaker 1 (34:31):
Excellent. And then finally, last question. What advice knowing where you are now in your life and career, what advice would you give to your younger self? Maybe you're that PT right out of PT school.
Speaker 2 (34:47):
Yeah. it's a great question, man. I have to reflect back quite a few years when I was a young TT now. But I think that the biggest piece of advice I would give is really around not thinking that you have to have all the answers. So I had a hard time when I first came out of the, I felt like, okay, I'm a, I'm a physical therapist. Now I'm in front of my patient. That credibility of any question they have are going to ask me, I have to know the answer. And that's not always, that's not true, actually the, the ability to say, I'm not sure that gets, let me get back to you and truly providing research, great response versus an off the cuff, maybe not perfect response. I think sometimes it can be so much more valuable in your overall long-term credibility with that, that particular patient or other therapist or leader.
Speaker 2 (35:59):
It takes a lot of vulnerability to say, I don't know. And a lot of confidence to say, I don't know, but I wish I would have been able to do that maybe a little bit more on the beginning and not felt the pressure of having to feel like I needed to know all the answers because Lord knows, I didn't know all the answers back in the day. I still don't know them today. Right. And you know, one of the other interesting things, just from a, as my growth, as a leader in this same sort of vein is what I've learned over time is that as a leader, you shouldn't have all the answers, right? It's my people come to me now and they've learned over time, like you become a crutch to those that work with you or for you. If you're the only one who has all the answers, right. Versus putting it back on to them to say, well, what do you think? Like, what do you think the answer is? Coming to me with solutions, not just a problem. And so to me, that's training and bringing in new leaders. I learned that from, from a leader who was a mentor to me quite a few years ago. And so that's another sort of way that now I've shifted that same response from a leadership perspective.
Speaker 1 (37:24):
Oh my gosh. I could talk all day on this from a leadership perspective who may have to do another podcast on it. So I think people would love it. Well this was Heidi, this was great. Thank you so much such good, good information for anyone in any of the rehab therapies, PT, OT speech to download this report, dive in and, and use this report for your own business or your own practice, you know, that's what these reports are for, right. To kind of not just look at it and say, oh, that was cool report, but to actually use the report and use it to be a guide maybe to your business or to your practice. Yes.
Speaker 2 (38:04):
Yeah. That's exactly right. Like how, how in your business decision trends that you're seeing in industry that you can validate some of your decision-making on is exactly why we've, we've put this out there to the public with no cost to you. Like it's, it's really just to, to benefit and give back to this industry that we love so much and want to see flourish. So Karen, thank you so much for having me. I really appreciate the opportunity. Congratulations on all your, can't say enough, how awesome you are with your advocacy and as an influencer and, and true thought leader in our industry. So thanks for everything you're doing with this podcast and, and, and all of your other ventures. It's, it's awesome to watch you and see how much of an impact you've been able to have in our profession.
Speaker 1 (38:57):
Thank you. That's so nice making me blush aside from the large scratch for my cat on my cheek, where it's already red. Thank you so much. I really appreciate that. And everyone, thank you so much for listening to this episode, go download the report today. We'll have all the links to it at the podcast at podcast on healthy, wealthy, smart.com under this episode. Thanks for tuning in, have a great couple of days and stay healthy, wealthy, and smart.
In this episode, Owner and Founder of Velocity Physiotherapy, Erica Meloe, talks about the business of physical therapy.
Today, Erica talks about her previous career, how to foster motivation and commitment in patients, and addressing company culture. What does it mean to be out-of-network?
Hear about the biggest lessons Erica has learned in her career, the importance of mentorship, and get some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Being an entrepreneur, you need to be able to know what your strengths are, and really work with those strengths.”
- “I learned over the years to delegate out what I don’t like to do or what’s not in my strengths.”
- “Practice makes permanent. It does not make perfect.”
- “If you put a computer between you and your patient, you decrease the outcome by 50%.”
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Some important definitions
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Co-pay. This is a fixed amount that’s generally used for an in-network model.
- Co-insurance. This is based on a percentage of the bill.
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Balance-billing. This is balancing the bill up to what you typically charge.
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“Lately, a lot of plans are being reimbursed as a percentage of Medicare.”
- “A lot of being an entrepreneur is mindset.”
- “Why reinvent the wheel when someone else has done that?”
- “Be unapologetically yourself.”
- “We need to find joy in our life, and whatever that is, we need to do more of that.”
More about Erica Meloe
Erica Meloe is a board certified physiotherapist in private practice in NYC. After a decade solving financial puzzles on Wall Street, Erica took her MBA and her problem solving skills into the clinic. She specializes in treating patients with unsolved pain and her mission is to raise awareness of the physical therapy profession to a level like no other.
Erica is co-host of the podcast “Tough To Treat. A physiotherapist’s guide to managing those complex patients.” She is also a thought leader in the profession and helps her patients as well as her colleagues empower themselves to lead and live with purpose.
Erica’s book “Why Do I Hurt? Discover the Surprising Connections That Cause Physical Pain and What To Do About Them” was released in June of 2018. She has also been featured in Forbes, BBC, Women’s Day, Better Homes and Gardens, Muscle and Fitness Hers and Health Magazine.
Erica is also fluent in Spanish and loves traveling!
Suggested Keywords
Physiotherapy, Therapy, Health, Motivation, Commitment, Consistency, Practice, Entrepreneurship, Culture, Mentorship, Business, Mindset, Healthy, Wealthy, Smart
To learn more, follow Erica at:
Website: https://ericameloe.com
https://toughtotreat.com
https://www.velocityphysiony.com
Facebook: Erica Meloe PT
Velocity Physio NYC
Tough To Treat (Podcast)
Twitter: @EricaMeloe
@VelocityPTNYC
Instagram: @toughtotreatpodcast
Pinterest: @emeloe
LinkedIn: Erica Meloe
Velocity Physio
YouTube: Tough To Treat
Business Round Table on July 27, 2021 at 8:00 PM EST
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript Here:
Speaker 1 (00:04):
Hey, Erica. Welcome back to the podcast. It is always a pleasure to have you on, so thank you for coming back.
Speaker 2 (00:11):
Thanks. Thank you Karen, for asking me, I can't believe it it's been, I remember our first podcast was probably 10 or 11 yeah. Years ago.
Speaker 1 (00:19):
So yes. So long ago, like way way, the beginning of healthy,
Speaker 3 (00:23):
Wealthy and smart. You were
Speaker 2 (00:27):
On the second street. I was just, so I remember taking a car going up in the elevator and sitting there in the office. Oh my God. Yes. It's a pleasure to be back on again. Thank you so long
Speaker 1 (00:37):
Ago. Gosh. Yeah, that was a long time. It was like 10 years ago. And now this month we are talking all about the business of physical therapy. So I thought who else to have on who better to have on than you, who is a successful physical therapy entrepreneur business owner here in New York city. So before we get into your, what your business structure is like and how you run your business, I would love for you to remind the listeners a little bit of your background. So just so people know, Erica had a career before she became a physical therapist. So talk about that and how that career prepared you for your role as an entrepreneur.
Speaker 2 (01:24):
Yeah, that's a great question. I, it's funny, I've gotten much more involved during this time being at home a bit more during COVID with the whole wall street and and, and the whole, the financial markets, cause I've had more time to look at it, but I graduated just in brief. I have an MBA from stern school of business at the NYU stern school. And after graduation, I ended up working for an investment bank, a global investment bank and international foreign owned bank, literally starting in Karen, when I tell you and I'm dating myself, but I started like just before the market crashed. Okay. Like the 87 crash,
Speaker 3 (02:05):
I was going to say, you have to, you have to be more specific. There's been a few. So,
Speaker 2 (02:12):
So that was, and I started off in research and, and that was all great, but I ended up going on to a trading floor and it's, it's a, you know, like a huge trading floor with a lot of seats and it's an open, open area and mostly selling and trading international bonds, futures and options. And I, I really, I loved it. I loved, I really enjoyed working on wall street and I think that it was a different time back then, way different than it is now. And, you know, somebody asked me recently, why did you leave? And I was like, I didn't want to retire on a trading floor, which was the truth. You think God. Right. But I, I, I often think about why did I like it so much and how can I take that, that part of the business into anything else that I do.
Speaker 2 (02:58):
Right. And I liked it for many reasons. And one of it was, I was part of a team, you know, and I think the team of people, you know, we talk about collaborating in our, in our, in our world. I do very well with people, with a team, people who are team players. And I think for me, that's why I think in physical therapy land, I've been, you know, in the profession going on. Yeah. Committee's trying to run for different positions because I like being part of that team. It's just an, and we all have a lot in common too, I think as well. So it, and that's, you know, I got to talk to people on the phone a lot. I was, it was very much, it was back in the old days where we actually had to pick up the phone and call people and not, and it wasn't all computers.
Speaker 2 (03:42):
So that's the point. I think for me, I enjoyed the most and, and also figuring things out and problem solving. And as an entrepreneur, I mean, we have to figure things out all day long. Right. I think for me, it's, it was being a team player was definitely the main thing why I miss it. But I also liked the, the fast pace and, and, you know, yes, we're in New York, we all liked the fast paced and certainly not as fast as it used to be. That's for sure. But I enjoyed making those quick decisions and, and, and talking to clients and analyzing with them to solve their problems. So it's similar to physical therapy, right? I mean, we deal, we see patients, we try to, we talk to them, we try to figure out, you know, what, what's going on, what's going wrong with them or what their problem is.
Speaker 2 (04:33):
And, you know, I did recently a a paper for I'm doing part-time some courses and I did something on the therapeutic Alliance and the therapeutic Alliance, the quality that is the most important is really being, being a good listener and like listening to your patients, listening to your clients. So that's how I'm when I was on wall street. I, I really, this is when we had great expense accounts. Peter I've waited, you know, I flew to Mexico city for, for lunch one day with, for the central bank and came back. I exploited, I mean, that's the life I loved and I, to this day, I do miss it. I'll be, be honest, you know? And I, I was able to fly. I didn't, I didn't, I only covered a few international clients was mostly of domestic, but it was establishing those relationships, maintaining those contacts.
Speaker 2 (05:25):
I know you talk about like the concierge I read your article actually in an impact magazine. It was excellent. And it's about, you know, it's that extra service it's that, it's that developing that relationship. It's going that for mile. And, you know, I was one of the top sellers on the desk. And when I left people, some of my top clients were like, we liked you, or, you know, the, what if they use the word like, but they were like, you never shoved anything down our throats. I never shoved the deal down their throat. I never shoved anything down their throats. It was a, and I think that's, what's, I've taken a lot from that, you know, in a nutshell that, that whole experience, you know,
Speaker 1 (06:05):
And as an entrepreneur, where, where does that sort of plug in? Where does that fit? How did that help you grow your practice? Because you have a thriving practice in New York city. It doesn't happen overnight.
Speaker 2 (06:20):
Oh no. Oh no, no, no, no. And to be honest with you, I think as entrepreneurs, we are lucky in the sense that, you know, since we don't work for somebody, we work for ourselves, right. We have a little bit more leeway to discover things about ourself and what we want to do to grow the business. Right. and I think that what has from taking from the wall street experience the ability to that, what's the word I want to use. It's almost like being an entrepreneur. You need to be able to know what your strengths are and really work with those strengths. So when I first started out, I knew that my strength was I did the strength finders 2.0, you know, everybody should do that. It's, you know, and I'm like a learner achiever. You have to be a connector. I swear you have to be a connector.
Speaker 2 (07:14):
Right. You must, right. I'm a learner achiever like maximizer input and responsibility for those of you who have done that. So for me, the way I work best is when I play to my strengths. And I learned over the years to delegate out what I don't like to do, or what's not in my strength. Like, I it's just, why would you, do you, you know, we have the ability to do that. So playing to your strengths is that one of the first things I learned early on, because, you know, people say, oh, you can be a generalist physical therapist. You can treat everything, but what makes you different from the person down the street? Right. And for me, it's like, and I'm still, I still hone this to this day. This is all a work in progress. But you know, it's the problem solving. I love to figure stuff out.
Speaker 2 (08:06):
That's just basic. I love to figure stuff. I look to look at a trade when I was on wall street to figure it out, how can you make money? How can I make you money? Because if you make money, I make money. Right. And you know, if you feel better, if I can make the patient feel better, I do make more money. Cause they'll refer their friends and family. So it's very similar mindset. I think that was the hope. That was the answer you wanted, but it's, for me, it was really honing on, on what I did best. And then more recently, Karen, I looked at patients who I really like to treat. And what was the common thread, right. Wow.
Speaker 1 (08:45):
You knew what was it? What was the common thread?
Speaker 2 (08:49):
The, honestly it was being motivated and coming in consistently and being committed to going the full pro the full, raw, the full round. Don't come for two visits and don't come back. You want to, you're, you're literally, you are committed to having someone look at your entire body from the brain to the foot and looking at the connections in the body and be willing to commit some time to getting yourself better. That was the commonality,
Speaker 1 (09:15):
But, and they were athletic. But here I have, I have something to say about that. So was that the common thread they innately had or was that something that you helped to foster in them when you first see them, those first one or two visits?
Speaker 2 (09:34):
Yes. I helped to foster that. How
Speaker 1 (09:37):
Do you do that? How do you do that? How do you help to foster that? So,
Speaker 2 (09:41):
So when people phone initially, I'll backtrack a second. When people like this recently I had someone come in to sit, you know, she said, I'm seeing a well-known therapist in New York, blah, blah, blah, et cetera. What makes you different? And I was like, this is what makes me different. And I start off and I say, everybody says, they treat the whole body. You know, it's everybody treats differently. But what I do is I look at the connections in the body of the relationships of the regions, of the body, to each other. And I don't just treat your symptom. I look at your impairment and I look at their relationship with the head to the PIP, the need of the foot. And I tell them a story. I say, I have a patient recently. She had a pet issue in her pelvis, low back pain.
Speaker 2 (10:18):
And her driver was her foot. And I explain a little bit about why I do that. And I do that with patients when they first come in, this is what I say. I say, look, I don't want say, look, I basically tell them it's w I try. I listened for quite a bit. And then I basically tell them that it's, this is a relationship. And we're trying to change your movement patterns. If learning is very important, and I need to know how you learn best practice makes permanent. It does not make perfect. So you need to be able to come in and I'll say this to them. I need you to come in consistently at the beginning, once a week, I generally don't treat twice or three times and they start a surgical. But I'll treat for the hour. And I'll say, you know, minimally once a week for, let's say three weeks, I need to front load the visits because I'm trying to change strategies and trying to train your change, your brain.
Speaker 2 (11:11):
And I need to do that with a lot of input at the beginning of the treatments of the treatments. And if you want to space those out after I'm fine with that. And if patients can't do that, I basically say for whatever reason, if it's financial or Trey or vacation, I tell them that that's okay, but you won't get the same results. It will take longer. And the people who come in at the beginning, who front-load them get results quicker, and those are the people. And I looked at that list and that very true. They were coming in consistently and front-loaded, but I tell them that, but you know, it's based on the assessment and if I can give them, like, I don't want to say a wow, but if I, if they get what I'm trying to say, I can make a change in the first visit.
Speaker 2 (11:55):
Then they are more convinced of coming in more frequently. And I think because I do a lot of listening and I ask questions that not many people ask. I mean, we're similar. You and I, but I think that they don't get a lot of that outside of, of medicine, traditional medicine. And I think that when I explained to them, I'm trying to change your movement pattern. I'm trying to change your strategy. You're, I'm trying to work with you. You know, I'm trying to change how you move about your nervous system, your neuromuscular recruitment, things like that. And I, I, I work with them. I'll have the move and I can see I can. And I take P ever since COVID started, I've been with that Darla health. I've been taking more pictures in the office because I can really, I mark them up on my apple preview. And I'm seeing things that I never saw in the clinic before. And then when I show them this, they're like, oh my gosh. Wow. And I think their brain starts to change immediately when they in the first visit. And I think that that's important to get that buy-in at the beginning a little bit to help them come more consistently.
Speaker 1 (13:00):
Yeah, absolutely. If you don't have buy-in in the beginning, then they're not gonna, they're not going to be that patient who you said this common thread is they're motivated and committed. But I think that yes, if people are coming to see if they're seeking out a physical therapist, they're somewhat motivated, maybe committed, but it's, you who's educating them and listening and going that extra mile, making them feel comfortable, making them feel heard. And that's why you have motivated and committed patients. Correct. So it's a combination of the patient and what you do. So don't say, oh, it's just these motivated people.
Speaker 3 (13:43):
Good point [inaudible] I
Speaker 2 (13:47):
Know. And it's so funny because the, the, because we spend so much time listening, that is the form of communication, the best therapist or the best communicators. I mean, when I was doing this paper for therapeutic Alliance, you look at the, there's a like different pieces of the puzzle, listening and communication where like 70% of the outcome. I mean, maxi, Missy acts, she's a researcher at a McMaster, right? She says, you know, you walk into a treatment room, I'd say for somebody who's, you're, you're the fifth person you walk in there, hypervigilance, you know, distracted, you've exerted a no cebo effect on your patient before you even sat down. And they're not coming back after that. Right. So it's so important. And to, to know that, and I think that that'll help them make, make changes. You, if you go in there, you can be the best therapist ever and, and try to get them to be more motivated and committed. But if you're distracted, that doesn't work.
Speaker 1 (14:43):
Yeah. I mean, just put yourself in their shoes. That's all you need is, is like just a smidge of empathy, you know? Cause we all, you don't have to be like an empath. You just need a smidge because like, we all know what it's like, like when you go to the doctor and, and you're trying to like spill your guts to them. And they're like on their commute computer. Aha. And you're like, well, nevermind. I don't feel like telling you anything.
Speaker 2 (15:10):
I know. I know. And you literally, if you put a computer between you and your patient, you've decreased the outcome by 50%. Wow. That was an interesting statistic I found. And so now people are looking at me and this is extra work for me. And it's something I'm working through, but I literally barely write in the first part of the interview. I'm just listening to them and looking them in the eye. And I'm like, I'm trying to remember, and I have a good memory, but I'll write a few things down, but I'm listening to them. And I'm just passive, to be honest, if they don't give, I don't get what I want. I will ask other questions. But I think that that writing that paper on the therapeutic Alliance, even as an entrepreneur, because yes, we have the, we have the ability to make it, make our own schedule.
Speaker 2 (15:54):
Right. Have the freedom to do that. We have the, we have the freedom to tell people we don't want to see them. You know, I literally someone said to me recently, I don't know what you think about this is that you should have an application process to have them become your patient. I was like, Ooh, that's interesting. I'm not sure I'm there yet, but that's an interesting concept. You know, how business coaches do that a lot, you can apply for the program, right? I'm not sure I'm there yet. I can, you know, I can talk to somebody on the phone and get an idea of who, if they're right for me or if they're not, I'll say maybe there's somebody else, but I don't like, like a formal application process to do that.
Speaker 1 (16:32):
Qualifying people. I mean, I guess you can, but I, I mean, I think that you're doing that in that first visit by saying, you know, I, I really want you to be committed to this process. Is that something you think you can do? Yes. Right. how do you learn best? Because I want to make sure that my teaching style matches your learning style depending on who you are and how you do things. And, you know, what's interesting is you know, there's StrengthFinders, there's all these different things. In the Goldman Sachs class that I'm taking now, we used one called people styles at work, by Bolton, Bolton and Bolton second edition. And it basically it's 18 questions and it splits you up into four different kinds of learning styles or leader, sorry, leadership styles. But you can use that even with your clients and with, if you're an entrepreneur, let's say you have multiple people working for you.
Speaker 1 (17:31):
You can have them take these take this test or quiz if you will. And if someone is more analytical, maybe you want them doing this kind of work. If someone is more, there's four different kinds, there's analytical, which I think you are which would be less assertive. But some of these, I, I don't agree with that. I mean, it's, they're not all perfect, but less responsive to others, task oriented, precise, and attentive to detail, prefers to work with procedures and symptoms motivated by the right way to do things I, and, you know, we sort of fall into things that might be a little analytical, a little expressive, but there's our analytical, your exp you could be an expressive and amiable or a driver.
Speaker 1 (18:22):
And it's, it was very interesting to look at that, even from a client standpoint. So as you're talking, you can kind of guess like what the, what maybe your client is and how you can. So if they're more analytical, maybe you're going to want to hit them with your facts, your figures, your numbers. If they're more expressive, maybe you're going to want to hit them with the things that sort of tug at the heartstrings. If you're more amiable, if you think they're more amiable, then you're gonna maybe want to challenge them a little bit. So they're not always just yessing you all the time. You know what I mean? Yeah,
Speaker 2 (18:58):
Yeah, yeah, absolutely. That's, that's a great that's a, that's a great tool. I have to look into that. It's funny because I sent out some questionnaires ahead of time as well. I do the CSI questionnaire and the DAS questionnaire, and I get a good idea of, of just what their personalities are by looking at those. And some people I see them and I look at them, their questionnaires and they're like completely different people, you know, honestly. Right. But that gives me an idea of just their, just their overall persona. And then I explained to them, you know, I explain how I assess and I just say, and they're like, well, why are, you know, why are your hands in my armpits type thing? And I'll cause I'm well on the thorax, the head had the feet and I'll say, well, I'm, I explained the rules of the game.
Speaker 2 (19:39):
I said, I'm just gonna explain the rules of the game. Cause we don't know the rules we can't play and they all laugh and it's fun, you know? Cause I think it's just a way to make people feel at home. And I think it's funny because when I weirs ago and when I was working for other people as like a staff PT, yes, I'm older now, but I, I feel that as an entrepreneur, you can, you can express yourself differently and you have more freedom than if you were to be with, you know, sort of in the confines of a culture, like a corporate culture, like on wall street. For me, I wasn't confined in the sense because it was all about getting the deal done, making the money is pretty driven by money, right. So there were kind of no limits at that point back then.
Speaker 2 (20:18):
So you did what you felt, whatever you, whatever you do, you get the deal done. And we didn't really have, it was just, we had limits obviously, but it was very different. We weren't reigned in so much, you know, and then we were able to sort of be ourselves a little bit. And I, I always believe that things happen for a reason. I believe that I was meant to cover central banks are meant, I was meant to cover other banks at other different hedge funds because of the analytical style that these people have. You know, I think, you know, people say you find patients, I think patients find us, you know?
Speaker 1 (20:54):
Absolutely. Yeah, absolutely. And that's where, you know, your website, your wording, your copy, all of that can reflect that. And you hit on something that I want to touch on quickly too. And that's company culture. So how did you, and you have a partner and he gal, how did you guys address your company culture, the culture of your clinic, where you sort of very what's the word I'm looking for?
Speaker 2 (21:31):
Like, did we have like something
Speaker 1 (21:33):
Like, was it purposeful, did you sort of purposefully, like this is going to be our culture, this is, these are our values and what we want to reflect on our business. Yeah.
Speaker 2 (21:45):
I mean, we didn't do that formally. But we certainly, if it evolves over time, because it naturally the types of patients that would, that would come into the office would be those ones who sort of have been elsewhere or have, you know, really wants I don't even want to say hands on approach anymore, but more of a, of a, of a whole person approach and that it naturally evolved that way. And that sort of like when we did at one point when we were gosh, I think this was when we first started, we actually had to go up to Columbia university to speak to the student center up there. And, you know, we did a little PowerPoint and in that PowerPoint, it was, we talked about, you know, why the, you know, the hip is related to the foot. And, and so it evolved over time that, that whole, that whole culture and, and, and we were out of network from the get-go all right, because we knew that in order to treat this way and certainly New York rents, you know, you know, they're changed now, but back then, it was you, you could not at least in New York state, cause we're like, like the lowest reimbursed state in the country, right.
Speaker 2 (22:55):
I mean, you cannot maintain a business in New York city on an network network, unless you see, you know, five patients an hour, which is unacceptable to me. So that is not the way I'm I treat. And even, you know, it's funny when I graduated PT school, I called up a lot of places that I was going to interview at and see how many patients they saw an hour. And if it was four, I didn't go for the interview. And I had, I was lucky I had a career change. I had some savings, so I could be a little bit choosy, but I, I, it's very stressful working in that kind of an environment.
Speaker 1 (23:25):
Yeah, absolutely. So let's talk about the structure of your business. So you said you've been out of network from the beginning. So what does that mean? Can you explain to the listeners what that means?
Speaker 2 (23:34):
Yeah, so we don't contract. So basically we don't contract with an insurance company. So we have, we take Medicare. We are what we call par for Medicare. So that's con that's a contracted in New York city rate. And, but other than Medicare, we are out of network, which means that if your client has out of network benefits, we can do one of two things. You either build the insurance company directly. We charge them the co-insurance and then we get paid. So we get paid or the patient pays us directly. And then they submit the claim themselves, or we can submit the claim for them. So the majority of patients now have no out of network benefits. So what we end up doing is just billing the patient directly. And there are some insurances that we don't take it all. And so even out of network, so what we'll do is we'll just, the patient will pay us directly and then they'll submit on their own. We just give them a receipt, but out of network. So long-time patients of ours. We will bill the insurance company for them and wait for the insurance company to pay them, pay us, excuse me. And we'll charge them the co-insurance and that's gotten much less lately.
Speaker 1 (24:51):
Yeah. And can you explain what a co-insurance is?
Speaker 2 (24:55):
Yeah. So there's the co-pay and the co-insurance, the co-pay is a fixed amount. That's generally used for an in network model. So you have a 60 per dollar copay when you see a specialist. So co-insurance is based on a percentage. So for example, I work for, you know, large company, a here in New York, I have Cigna, my benefits are 70%, 30% Cigna will pay 70% of what's reasonable and customer in 30% is the co-insurance that 30% of the co the co-insurance is based on what you bill out of network. So you bill $400, the co-insurance can be 120 bucks, or it could be lower. We generally drop it lower. Okay. But we're because we're not contracted with, with any insurance companies. So a lot of people lot of lately, a lot of insurance companies have been sending patients letters like you, just so you know, you're seeing an out of network, I'm using this in air quotes, out of network, physical therapist, just so you know, they can balance bill you. So they're doing a lot of these sort of nefarious practices to get the patients saying, well, I don't know if I want to do an out of network practice, and they've been doing this for a while now, but in my patients know better. But recently someone brought in a piece of paper and it was not, was not a bill. It was just a statement of fact we've received charges, you're out of network, just, just FYI. They may balance bill you, which is, you know, they never did that before.
Speaker 1 (26:21):
Yeah. And balanced billing is
Speaker 2 (26:24):
They're going to build. So I'll use a simple example. Let's say $300. We charge, for example, let's say that's the number the patient's covered at 70%. Assuming. So let's say that it's, that would be two 10. That's usually not what they pay. Let's say they pay one 50. The co-insurance we charge was 50 bucks. That's $200. We can bill them to a hundred. That's a balanced bill means you balance you balance bill up to what you've charged.
Speaker 1 (26:48):
Got it. Got it. Yep. Just so people understand what all the well, because we're throwing out a lot of terms here. I want to make sure people understand, because this is all about the business of physical therapy, right. This whole month. So this is, this is literally the business, right.
Speaker 2 (27:04):
And I will, and I will. Yes. And I will tell you lately, a lot of plans just for anybody who's wants to do an out of network and bill and accept what they pay. A lot of plans are being, being reimbursed as a percentage of Medicare, which as we know is not great. So more often than not, you do not know that upfront. Sometimes they'll tell you, we do mostly electronic right now. And they won't, if there's nothing on the site that says patient is reimbursed at a certain rate, so you'll get paid. And then you realize, oh no, this is not enough. And so, you know, and that happens a lot of times after the fact. And so we have to, we have to you know, make the different part of the difference up in the co-insurance. So it has to, it's just, we have to, because of the, you need, we deserve caring.
Speaker 2 (27:51):
We deserve to get paid. This is what I say every night or every morning I write in my journal, my work is of high value and worthy of massive compensation because it is yes, we deserve to get paid. And and patients accept that now a lot more than they used to, a lot of patients now do not have out of network benefits at all. So they just pay and that's that, and that also comes down to your ideal client, right? Who, you know, you want, do you want somebody who's just going to like, you know, ask you to drop your rate or cause they, they will do that. They will ask you to drop your rate. And I generally don't do that anymore. You know, it's a special situation of course, but because those people are not sort of going to stick around, right?
Speaker 2 (28:36):
You want a lot of people who have no problem paying and it, depending on what your rates are, they will stick around and they will have no questions asked. And that, you know, as, as an entrepreneur, you will hone that ideal customer avatar over time. But speaking from experience, it is very frustrating when you, you, you treat an hour an hour and 15 minutes sometimes with people in any insurance company, out of network reimburses you at a percentage of Medicare, that's a joke. So you and I would get angry over it. And so at a certain point, you know, I, you know, a lot of I'm happy that we don't have out of network benefits a lot of the times, because it will save me that frustration and anger and the patient can just get reimbursed themselves, you know, pay me directly. But once again, as a new PA, if, if we have people who are just starting out or they're five years in the business and they want to start their practice, they may have to do that. And you're going to learn over time that the reimbursement changes from between insurance companies in between dates of service. I mean their insurance companies who we bill out of network will pay different rates for the same codes. It's just ridiculous. It's ridiculousness. And, you know, we have a small practice, someone who has a large practice like that, who's getting hurt like that. You need to almost hire us, hire like an advocate or somebody who can negotiate for you, you know, because that that's, that's a full-time job.
Speaker 1 (29:57):
Yeah, absolutely. And, and I think that it was really important to go through all of that, because that can be really confusing, especially for a new physical therapy entrepreneurs who want to start their own practice, who are on the fence. Should I take insurance? Should I not take insurance? I always tell people, call insurance companies and find out what they reimburse in your area. Yeah. Because it may be worth it to take an insurance, take one insurance and not take the others because there are insurance companies that may reimburse 120, 150 a visit. Hey, that's not bad.
Speaker 2 (30:33):
I will tell you there's a couple of patients. And if it's planned dependent, because there's far and few between, like I can count on one hand, the amount of patients I have who have like the platinum insurance plan. Right. And you will get paid more than your direct rate, which that number is dwindling. I've had people therapist asked me recently, should I? Because of COVID because of the financial stresses people are under, should they start billing out of network for their patients? And I basically tell them what I just told you. It's, it's, it's a great service you can offer. But if you don't have an assistant, you will be on the phone way too much than you want to be on the phone. Okay. so it just misses out your priorities. Yeah. Yeah.
Speaker 1 (31:16):
And actually my next, that was going to be my next question for you is if let's say a, a budding physical therapy entrepreneur comes to you and says, gosh, what, what was one of the biggest lessons you learned when in the course of either starting or now continuing to run your business? What would that be? Hmm. I think
Speaker 2 (31:47):
With regards to, I would say being willing, being open and being open to collaboration, being open to like expecting the patient to do the right thing. Because a lot of times we can say, oh, their patients never got going to pay. They're not going to do this. They're not going to do that. And I think that a lot of about being an entrepreneur, and this is one of the biggest lessons is, is your mindset. It's the vibration that you have. And it may sound woo woo. But trust me, it works. You know, 80% of this is mindset. 20% is execution. You know, you can sign up with an insurance company, you can do the billing, you can put the codes and you can do the evil, right. It's about minds. If you expect people not to pay you, or if you expect people to, you know, B B be difficult with, with regards to where, if you expect with insurance, we expect to have a difficult time.
Speaker 2 (32:44):
You will have a difficult time. And a lot of it is mindset. That's the biggest lesson I think because the technical stuff can be, can be taught, you know? And when I first started out opening the practice, I was looking for a mentor in our profession and, you know, Karen, I still, I couldn't find one. And it was very frustrating because I was I was, you know, did have an MBA, but the school of entrepreneurship didn't was not open at stern. And when I was there, right. So I was coming from a corporate culture, transitioning to an entrepreneur, an easy transition in terms of mindset, but not an easy one in terms of logistics of, you know, what does it take to be an entrepreneur versus working for a corporation or corporate it's very different. You have to really advocate for yourself.
Speaker 2 (33:32):
You have to know who you have to know who you are treating. Your marketing is huge. You have to really learn a lot about that even before way before you even, I mean, I w I wouldn't say learn that before you start your business, because most people, if we did that, we would still not have a business. You know, I would just start and go and you'll learn, you know, but, but the mentorship is huge. I think because why reinvent the wheel when someone else has done that? So talking about the 80% strategy, why, why reinvent the wheel, find somebody in our profession who can mentor you, right. That can help you do that. And the 20, the mindset is stuff is, is, is you, you can learn with mentors or finding somebody outside of our field to help you with that. But that's, that is important.
Speaker 2 (34:17):
And I believe that the, the, I know we've got a lot of business groups out in our field right now who charge very large sums of money to, to, you know, to up to, you know, and they're great programs, but I will throw out an option. You know, there are a lot of great physical therapists out here, you know, who have business backgrounds, who are entrepreneurs, who have successful businesses like you and me, we, we could all easily help out people, you know from a mentor program. And, you know, we need to grow the profession. We need to grow our physical therapists. And I think it's important that we give back and, and it being, and, and learning one of the main things I've learned as side's, the mindset is learning to be a mentor and learning the importance of mentorship. Because I didn't have one when I first came on and I still don't have one yet. I'm still looking, but, you know, that's why I have a team and collaborate with people like yourself, you know, cause we learn. But I do think that people should like you and I are like on the front lines, so to speak, right. We're, we're, we're, we're seeing patients, we're, we're actually doing it, we're running a business. And I do think that is important when people look for programs out there. Right. Because I think it's, it's, you know, we've done all the hard work. Why reinvent the wheel? Yeah,
Speaker 1 (35:41):
Absolutely. I couldn't agree more. And I think that's great advice for any upcoming entrepreneur in the physical therapy space. And before we jump off, where can people find you, if they want to ask you questions, if they want to know how you do things, where's the best places for people to reach
Speaker 2 (36:00):
You? A couple of things, we have a podcast with the wonderful Susan Clinton and myself it's called tough to treat. Yes. we've got our a hundred, our hundredth episode was last week kind of
Speaker 5 (36:11):
Crazy. Right. I was so proud my God.
Speaker 2 (36:14):
So there's our website, tough to treat.com and I've got a bunch of website, our business, the website, but I'll give you like the way to reach me is all my handles on social media are at Erica mellow. And my email is erica@ericamellow.com.
Speaker 1 (36:31):
Perfect. And your website, Eric
Speaker 3 (36:33):
And mellow.com. Yes, yes, yes.
Speaker 2 (36:37):
Yeah, no, I'm thinking more philosophy. Physio. One is being redone right now. So that Erica mellow.com is a,
Speaker 1 (36:42):
It's a good one. Perfect. And we'll have the links to all of that at podcast dot healthy, wealthy, smart.com and the notes for this site for this podcast. And I know that you've answered this question before, but I'll ask it again because you know, more advice from you is not a bad thing. And that's, what advice would you give to your younger self? Maybe like fresh, forget, forget you your first job out on wall street, or even your MBA. How about like fresh out of undergrad?
Speaker 2 (37:18):
That's a good question. And you asked this of everybody, right? I, I know this, I know you do. I think that, and, and I'm saying this now because I've experienced so much throughout the life, I've lost loved ones and things like that, but be unapologetically yourself. You know,
Speaker 1 (37:39):
I know don't we waste too much time being somebody else. Yep.
Speaker 2 (37:44):
Yep. It's at it is. Yes, we have. We do. And I think that if we are Susan always calls me my podcast. CO's a confronter, I'm like, I'm not really a confront her, but I do, you know, have opinions. And I think that we that's the advice just, you know, open your mouth basically and be up, be yourself.
Speaker 1 (38:09):
Excellent advice. Because like, like you said, we waste so much time trying to be somebody else and trying to conform to what people think we should be instead of just being who we are.
Speaker 2 (38:19):
Yes. And I, and I think that if I were to give an like other advice, because there's so much burnout in our profession now is that, you know, we need to find joy in our life and whatever that is, it varies for everybody need to do more of that. And this is a practice that I've done. So I recently went to a polo match gesture day. And so I have every year I have a thing called magical moments. And if I have a magical moment like that, I write it down. So it can be like, you know, spinning at soul cycle and Hudson yards during a pandemic, you know, or, or, you know, going to the, met with my niece or going to a polo match or Disney when I, and so at the end of each year or new year's Eve, I'll look at that. And I'm like, oh, I actually did have a nice year because I think we don't write those things down, you know? And I, and I think that's good for, for, for us to do.
Speaker 1 (39:10):
I love that. I love it yet. Another great piece of advice. Well, thank you so much for coming on the podcast and we will see you again at the end of the month on Tuesday, the 27th of July for our business of physical therapy round table talks, I'm really excited. And for all the people listening, you can find that out in the show notes as well, how to get more information on that round table. So I'm looking forward to that. So thank you so much, Erica, for coming on
Speaker 2 (39:45):
Again. You're welcome, Karen. Thank you. And, and to all
Speaker 1 (39:48):
Of you guys listening, thanks so much, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Co-Owners of Kornetti & Krafft Health Care Solutions, Dee Kornetti and Cindy Krafft, talk about all things maintenance therapy and care.
Today, they talk about maintenance therapy in the home, diversifying revenue, and they bust a few maintenance therapy myths. How can maintenance patients have a goal statement if they’re never going to get better?
Hear about home-based therapy, teaching patients to self-manage, Medicare part B, and their book The Guide to Delivery of Home-Based Maintenance Therapy, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “It’s never been that if you don’t improve, then services aren’t covered.”
- “Rehab potential is the responsiveness to care.”
- “The myth of coverage has some roots in the denial issue.”
- “If there’s room for improvement, a restorative or improvement course of care is what your skills would be indispensable for. That’s what would make your care medically necessary under the Medicare benefit.”
- “If someone else can do it just as well as I can then this is no longer considered skill.”
- “We are helping patients be accountable for their chronic disease management.”
- “There are times that we are indispensable to help people improve and recover function back to a prior level or maybe beyond, and then there’s times we are needed to preserve and stabilise their exiting function so that their quality of life can continue on in the fashion that it currently is.”
- “Be a bit more open-minded with how physical therapy really works in reality. Don’t assume that what your path at the moment is THE path and can’t vary and can’t change. There are many other ways you can utilise your skill to benefit those around you.”
- “Don’t be afraid to ask questions, and don’t think you have to know it all.”
- “If you’ve got a great idea, or you have something that is a passion, and you’ve got that intersection of your passion and your skill set, go for it. Start to explore that. The possibilities are endless.”
More about Dee Kornetti
Dee, a physical therapist for 35 years, is a past administrator and co-owner of a Medicare-certified home health agency. Dee now provides training and education to home health industry providers as Owner/Founder of a consulting business, Kornetti & Krafft Health Care Solutions, with her business partners Cindy Krafft and Sherry Teague.
Dee is nationally recognized as a speaker in the areas of home care, standardized tests and measures in the field of physical therapy, therapy training and staff development, including OASIS, coding, and documentation, in the home health arena. Dee is the current President of the American Physical Therapy Association’s Home Health Section and serves on the APTA’s national Post-Acute Work Group.
She serves as the President of the Association of Homecare Coding and Compliance, and a member of the Association of Home Care Coders Advisory Board and Panel of Experts. She has served as a content expert for standard setting for Decision Health’s Board of Medical Specialty Coding (BSMC) home care coding (HCS-D) and OASIS (HCS-O) credentialed exams. She holds current credentials in Home Health Coding (HCS-D) and Compliance (HCS-C) from this trade association. Dee is also on Medbridge’s Advisory Board for development of educational content on its home health platform, and has authored several courses related to OASIS, Conditions of Participation (CoPs) and therapy.
Dee is a published researcher. on the Berg Balance Scale, and has co-authored APTA’s Home Health Section resources related to OASIS, goal writing and defensible documentation for the practicing therapist. Dee has contributed chapter updates to the Handbook of Home Health Care Administration 6th edition, and co-authored a book, The Post-Acute Care Guide to Maintenance Therapy published in 2015, along with an update in 2020 titled, The Guide to Delivery of Home-Based Maintenance Therapy that includes a companion electronic workbook.
Dee received her B.S. in Physical Therapy from Boston University’s Sargent College of Allied Health Professions, and her M.A. from Rider University in Lawrenceville, NJ. Her clinical focus has been in the area of gerontology and neurological disease rehabilitation.
More about Cindy Krafft
Cindy Krafft PT, MS, HCS-O is an owner of Kornetti & Krafft Health Care Solutions based in Florida. She brings more than 25 years of home health expertise that ranges from direct patient care to operational / management issues as well as a passion for understanding regulations.
For the past 15 years, Cindy has been a nationally recognized educator in the areas of documentation, regulation, therapy utilization and OASIS. She has and currently serves on multiple Technical Expert Panels with CMS Contractors working on clinical and payment reforms and bundled payment care initiatives.
Cindy is an active member of the National Association of Home Care and Hospice (NAHC) and currently serves on multiple committees. She has written 3 books – The How-to Guide to Therapy Documentation, An Interdisciplinary Approach to Home Care and the Handbook to Home Health Therapy Documentation – and co-authored her fourth, The Post-Acute Care Guide to Maintenance Therapy with her business partner Diana Kornetti PT, MA, HCS-D.
Suggested Keywords
Maintenance, Therapy, PT, Physiotherapy, Improvement, Assessment, Goals, Home Care, Rehabilitation, Accountability, Medicare, Myths, Health, Healthcare, Sustainability,
Book Discount Code (10% OFF): KK2021
The Guide to Delivery of Home-Based Maintenance Therapy
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Website: https://www.valuebeyondthevisit.com
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@KornettiKrafft
LinkedIn: Kornetti Krafft HealthCare Solutions
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Read the Full Transcript Here:
Speaker 1 (00:01):
Hi, D N Cindy. Welcome to the podcast. I'm happy to have you guys on. Welcome. Welcome. Thanks for having us happy to be here. Glad to be here. Excellent. So today we are going to be talking about maintenance therapy. So when a lot of physical therapists think about maintenance therapy, they often think that, well, this is something that's not reimbursed. This is something that maybe the patient doesn't quote unquote need. So today we're going to talk about what it is, some of the myths and a lot of other stuff surrounding maintenance care. So my first question is, can you define what maintenance care is or maintenance therapy?
Speaker 2 (00:47):
Okay. Karen, this is Cindy. I'll take that one. I think, you know, just as you were saying, the word maintenance, I'm sure at least one listener twitched, a little, the eye Twitch, the uncomfortable many times when you say the word maintenance, it looks like, you know, people react like you swore in church to like, oh, I don't do that. Or I, you know, somebody does that and get in trouble. And, and I think even the word has become a barrier. So Dee and I have tried to reframe the conversation by getting to the heart of what it is by referring to it as stabilization of function. So putting aside that baggage and the history of the word, the approach to care is saying I'm utilizing all the wonderful things I know as a therapist, my ability to assess and all of those great things and develop a care plan. But the end result that I'm going for is a stabilization or preservation of their functional level or slowing of decline. I think maintain can get people tied up in knots and miss the point or think that we have to do all kinds of different things, which we'll talk about in a moment with the myths. But I really think it helps to, to approach it as we're talking about stabilizing someone's function.
Speaker 1 (01:58):
That makes a lot more sense. And I really like that word. And you're right. I feel like maintenance care does kind of give people that, oh, I don't know if that's quite my lane, but when you say stabilization of function, preservation, decreased speed of decline. I think physical therapists are like, yeah, of course that's what we do. We'll think about it. We, we, we treat patients that have these chronic diseases right there. We don't share them. They go to doctors, numerous doctors, you know, cardiologists primary care, right. With their, with our heart conditions, they see nursing, right. They see all kinds of disciplines and all kinds of professionals. But they're never getting cured. They're it's management of their symptoms, right? So, so it's to like Cindy said, we are, we're going to preserve function. We're going to, you know, optimize their ability.
Speaker 1 (02:50):
We're gonna re hopefully use our skills, knowledge, and ability to reduce their demand or their requirement, higher cost centers of care. What happens when you have poorly managed symptoms of chronic disease, like COPD or CHF or diabetes, these people use urgent, emergent care. These people go in the hospital. This is extremely costly to our, to our medical system. And it's, it's not sustainable as an aging pie, you know, as we age as the population. And so this idea that there's things we can do to have people function optimally, no matter what phase or stage of this chronic condition they're in too, so that they're not as dependent or on higher cost centers of care, or they don't realize the kind of sequella, you know, think about a diabetic with poorly managed blood sugar, you know, that starts to develop retinopathy Neff, prophecy, peripheral neuropathy, right? All these other problems that happen. You know, that's all very manageable. If we can get an early and often and preserve an optimized, I even say optimize function. So we're not improving people necessarily because sometimes they haven't already experienced a decline. A lot of times we're just going in there to share what we know so that they can be accountable and manage these chronic diseases themselves. Yeah. That makes so much
Speaker 2 (04:16):
Karen. I would add to that, you know, for your listeners, cause some folks, you know, D and I have been talking about this for years. Some folks have a difficult time with this conversation, not just the word, but the concept. It sounds good. It sounds valuable. But I think we have to take a moment and acknowledge how deeply as therapists. We have defined ourselves by that word improvement. You can see it in our documentation. If you're going to get physical therapy, you're going to walk five feet more or 10 feet more, every time I get near you because that's, that's what I have to do. And that if I'm not improving you, we've all been told that if, you know, after a certain number of visits or certain number of treatments, if you don't see improvement, you're obligated to discharge people. When you start finding out that, that isn't really true and it hasn't really ever been true.
Speaker 2 (05:06):
I think we've got to give ourselves a little bit of grace here and realize that this can be quite the seismic shift internally about how we value ourselves as therapist, how we define ourselves and how we're defining ourselves to our patient populations. I think to the patients, to the potential patients, to our other members of the interdisciplinary team, we've done such a bang up job, talking about improvement, that when they don't feel that they're going to improve as, as the beneficiary or other members of the team say, well, that's patient, isn't going to get better. They don't even refer them to us. They don't even come to us because we've created this wall of you have to be able to get better, or you can't come to physical therapy.
Speaker 1 (05:47):
Yeah. Oh, I'm sorry. I was going to say, Cindy, what's your favorite line? When you talk about how we are addicted, like we, we are ingrained with improvement. What is your favorite line to say?
Speaker 2 (05:57):
Oh, well, I created a little, self-assessment like you answer these questions to get these points about how addicted are you. Because it, I feel very comfortable using that word because this challenge is a lot of those core beliefs. And we have identified ourselves by this. So tightly that it's like, okay, we, we have to step outside of our comfort zone a bit. And then as we see therapists start to do that, then we get the questions. Then we get the, okay. I kind of understand it, but what about this? And what about that? And what about this other thing? And that's when the myths all start to bubble up to the surface with where did that even come from?
Speaker 1 (06:40):
Yeah. So let's talk about some of those myths and see if we can bust them. So I will, I'll take, I'll throw it over to you guys. Either one of you can start, but let's talk about a couple of myths of maintenance therapy for me. One big one is, well, it's not covered.
Speaker 3 (06:58):
It's not covered by insurance.
Speaker 1 (07:00):
I'll take that one. This is thing. Yeah. Well you know, maintenance has been part of the Medicare benefit under any Medicare beneficiary part a or part B, since you can find it in the Medicare benefit policy manual, as far back as the, as the 1980s. So it's been around forever. This is not new, that Jimmo V Sebelius case that was brought forward. Just kinda shine the light on it, but it's never been that if you don't improve and services aren't covered or you don't have no, this idea that rehab potential is the ability to improve no rehab potential that we all typically document at some point is the responsiveness to care, right? That's what rehab potential is. Whether the care is going to allow you to improve from where you are at the baseline of assessment or to maintain or stabilize your function from where you are now without any unforeseen event in the next three, six, nine, 12 months, two years, are you going to be able to manage this condition and not decline, right?
Speaker 1 (08:13):
Or if you're in a progressive type of disease process, are you functioning optimally? And are we slowing that deterioration or decline? That is a normal part of the condition. So Cindy, I can pop a punch it over to you. And since we talk about it being paid, I think we busted that Karen. Right? We busted that pretty good. Okay. So, so other payers, I don't know, but anybody that is a Medicare provider, so under part a or part B, it, it is part of the benefit. Okay. So Cindy, talk to me about what are the type of conditions that are covered by maintenance as if the diagnosis determines it? What do we know about that?
Speaker 2 (09:00):
Well, very often what we hear is, okay, I understand maintenance therapy. I know what it's for. It's for people who have progressive neurological conditions. So it would make sense for Parkinson's. It makes sense for Ms. It makes sense for ALS. So it must be those three patient populations that are maintenance. Okay. We got to step back for a minute. There are patients with those three conditions that benefit and have the ability to improve with therapy. So it's not Parkinson's is synonymous with maintenance. And there's nothing in the coverage criteria that is diagnosis specific. Diagnosis is only one piece of the conversation. It is where are they functionally? What are the, what is the impact of this diagnosis and their resorted comorbidities on their functional ability? And what does a therapist know? What does that skill that you bring to the table that is unique to that discipline that is indispensable to this patient?
Speaker 2 (09:56):
But I think the myth of coverage has some roots in the denial issue. We, we can't go past this point without acknowledging that therapists have seen denials for providing maintenance therapy, that you did not show improvement in wham. They took away payment for part of this care, which is what drove the Jim versus civilians conversation that led to the court settlement with CMS to basically say, you know, Hey, we've looked at this benefit. It doesn't say you have to improve to get services. And, and we're, we're good friends with Judah Stein who was the lead attorney in that case, and still has the ability to call CMS back on the carpet and the legal sense about how that settlement has played out since, because CMS basically approached it with a oops, you're right. It doesn't say that shame on us, but it's like, wait a second.
Speaker 2 (10:48):
You've been denying coverage of services for a long time. And so it's very hard to say, yes, it's in there. And we understand it's in there. And D and I've explained the fundamental pieces of that, but there's still that I got denied, or I know somebody who got denied this can't possibly be true and it's unfortunate. And my personal opinion is I have a really hard time with CMS, just kind of Oop, seeing it versus, you know, ownership. And we saw a subsequent event to the initial Jimmo case that compelled CMS to put on their resources, particularly on their website, where they had to quote disavowal the improvement standard. So not just say oopsies, but say you have to flat out say that does not exist. And if beneficiaries qualify for these services, they absolutely should get them.
Speaker 1 (11:36):
Yeah. The, the, the woopsies sees that my bad defense never, ever seems to go over well, does it? No, no, no. Okay. So we talked about, is it covered? We talked about diagnoses covered. What other big myths are there surrounding maintenance therapy? All right. I
Speaker 2 (11:59):
Got one for you. D I got, you know, where I'm going. We very often hear they say, okay, so if it's not about their diagnosis, I need to assess the patient. Right. Figure this out. So now looking at what I typically do in an assessment, oh, test and measures. Well, those must not apply. Then I wouldn't be using tests and measures on a maintenance patient. And we would say, well, why not? Well, why would I measure something if I measure it again later? And it's the same, then why did I measure it to begin with? So any thoughts on those tests and measures in the maintenance patient D
Speaker 1 (12:32):
Yeah. Well, and, and I'm going to tie it to goal statements too, from there, right? So, so this idea, why do we take objective measurements of patients to establish a baseline, right? And we need to do that regard, you know, based on the presentation of the patient, regardless of their diagnoses and comorbidities, because we want to see if they're functioning at, or near where we would expect them think of a class three heart failure patient, are they functioning where you would expect, you know, a class three heart failure patient to function, or are they functioning like end stage, right. Class four, are they functioning below where you would expect them to function? And so obviously if there's room for improvement, a restorative or an improvement course of care is what your skills would be indispensable for. That's what would make your care medically necessary under the Medicare benefit part a part B that's what it would do so that the tests and measures, establish that baseline.
Speaker 1 (13:30):
And you compare, this is how the patient's functioning. This is how we'd expect them to function. Now, when you get a patient who is functioning at, or near where you would expect them to function with, with their PR their presentation, the question you have to ask yourself, as you don't just jump right to maintenance, right? You can't just say, okay, this a maintenance patient. They need me. Yeah. Basket. What do they need me for? You know, is there something I can teach them, train them, provide them so that they continue to stay, be stabilized, maintain, be accountable for their care over longer period of time. Right? And if the answer is yes, then you absolutely should pick them up on, on, on a maintenance course of care, because there's some sort of skills, your knowledge, your expertise, that which makes you, you, what I like to call the magic, that is me as a PT, right.
Speaker 1 (14:21):
And we've all had those magic. That is me moments. When you ever, whenever you walk or, or you, you readjust a, an assisted device to properly fit a patient and people look at you like, oh my gosh, why didn't we think of that? And it's just like, because you're not the magic. That is me. I mean, I, and we take it for granted. So the idea is that tests and measures absolutely help you establish a baseline and determine if there's room for improvement or they're functioning at, or near where you would expect them to function based on the severity, the course, the interplay of these disease processes. And then that helps you pick which course of care restorative or improvement, stabilization, or maintenance. And then you have to say, this is what my skills are going to be medically necessary for. So, so I'm going to tie that now to the next thing that comes, because if we get people this far down the myth-busting trail, Karen, the next thing they say is, well, how am I going to write a goal for that? I mean, if I'm not going to write something to improve, I mean, our, our documentation is called progress notes. I mean, you want to see how addicted we are. That's Cindy's line, right? We write on progress notes you know, Cindy, talk to us about goal statements. How can, how can maintenance patients actually have a goal statement if they're never going to get better?
Speaker 2 (15:43):
Well, I think, you know, we talked, we talked about coverage criteria, and then the documentation piece goes with that because I can't, and I'm going to kind of work backwards because what we'll see at times is therapists kind of go, okay, I understand it. And then you go to the goal statements and every one of them says, maintain this to maintain that I'm maintaining strength to maintain ADL's. And it's kind of like, okay, let's, let's take maintenance out of it for a minute. That that doesn't measure anything. What ADL's are you talking about? You didn't give any sort of quantifiable way to say what you're trying to maintain. So the goal solution is not to stick the word maintain in there as many times as humanly possible. It's still looking at it as we should be looking at it is what is that quantifiable element?
Speaker 2 (16:29):
How am I measuring something so that I can demonstrate whether or not we've improved it or stabilized it or slow the decline. And then the end piece is how was this functionally relevant to the patient? So I think what happens at times when D and I work with agencies about writing goal statements for maintenance, the by-product is actually their goal writing overall gets better. Because I think we've lost focus. We think, oh my gosh, I have to have an HCP goal, right? Because that's another addiction, you know, patient will have, you know, visual be independent with Hep. Well, it doesn't say what it's for. Why do you tend for them to do it forever? We don't know, but you have to have that goal. Then you have to have a strength goal. So, oh gosh, this has maintenance. I'm going to put, you know, increase a quarter grade. And yes, Karen, I have seen that documentation, the plan to increase one quarter grade, it's like, can you just go to maintenance and stop trying to improve in minuscule, teeny tiny amounts?
Speaker 1 (17:27):
How, how is that measured? I
Speaker 2 (17:30):
Have no idea. I thought half a grade was bad, but then we get into quarter grades. We see assessments that contain the terminology of severely poor. I thought poor was like the basement. I didn't know there was a tunnel under the basement. So this goal writing is really a good place to say, am I focusing in on, what am I quantifying? Why is this functionally relevant to this individual? Then we're setting the stage as to why therapy is in fact necessary for this person. I think the, I will maintain this to maintain that. Doesn't really speak to that. And then we'll go see, I got a denial. That means this whole thing is, is self fulfilling prophecy. They don't pay for maintenance. I will never do this again. And it's like, yeah, but did you really cover what you needed to cover and speak to why the therapy was important and why they needed to have it now? Yeah. Oh God,
Speaker 1 (18:24):
No. I was going to say, that's great. Thank you for that.
Speaker 2 (18:29):
But I think the extension of that, and I guess my way to push the ball back to D here as it were, is okay. So I've assessed them. I did my test and measures that wrote some goals. Now the issue becomes, I got to establish a care plan. So how often am I going to see them? And this is where at times, you know, when we had the ability to see folks in person, I swear people's heads are going to start spinning around in confusion because we start talking about things like you don't necessarily see these folks every week. You may see them once a month. And then D what about PRN visits? Can, can therapy use visit frequency? I mean, don't, we have to go or see them or interact with them at least once a week or else this won't be paid for.
Speaker 1 (19:14):
So talking about service utilization, you know, it's my answer is it depends. What does the, what does the beneficiary, what does the patient need, right? And so do I have to go three times a week for them to stabilize function? Do I have to go once every three weeks? What does it take? What is it that I'm doing that is indispensable for them that only can be provided by a therapist? You know, they can't go to the local you know, green, orange theory and have somebody work out with them in the gym and get the same benefit. What, why, why do you know, why does it have to be me? And so we, so we have to have an understanding of what's it going to take? How often do I have to go? And so when Cindy's talking about PRN visits, that's like a big no-no in home care for therapists, right?
Speaker 1 (20:04):
Under the Medicare part, a benefit in reality, it's not nurses do it all the time. You know, when they have to adjust Coumadin levels, right? For, or blood thinners, when they have to, if people still even on Coumadin, when they have to do sliding scale insulin adjustments, when they have to run labs, when they update or they're changing wound care orders, they write PRN visits all the time, but supposedly therapists can't do that. Well, that's not true because think about it. I think in, when I'm making this care plan, I'm not writing everybody for three weeks for I'm writing this person in five times a week, because they just got out of the hospital for an elective surgery. And I'm going to go every day, because if they went to an ER for SNIF, rather than home, they'd probably get daily therapy. Right. Okay. And this person was referred from maybe from their physician.
Speaker 1 (20:54):
And, and we're in the second episode of care, if you will, the second certification period. And there were still as ensuring that they are being, that they're stabilizing function. They're still teaching training oversight, checking, following up on 30 day reassessments to confirm that our interventions are actually working well, if I'm waiting on a piece of equipment, maybe that I decided, okay, we're going to get them a splint or something to meet, or we're going to get them this, this device. And we have to go through all the machinations with DME. I could write that I'm going to go out one time a week for four weeks. But what if that device doesn't come in for two weeks, what am I going to do? Just go, yada, yada yada. And the second week of that 30 day period, or do I just write like a PRN visit that says, you know, when the device comes, if it's not a, you know, when I would normally go out, if it's not going to be there, when I'm planning to go out, I'm not going to let it sit in my office or the back of my, you know, the boot of my car for another week.
Speaker 1 (21:52):
Or I'm not going to write an add on order. I'm going to have this PRN, but well, it's come in. I wasn't planning on seeing you for a week. I'll bring it out there, fit, adjust it, set it up, teach you how to put it on Don and doff it, you know, check your skin, how to wear it, everything you need to do. It's the same thing. Think about when you think about Karen, when you tell your patients, oh, Hey, if you have a problem with this exercise program, give me a call. How many calls do you get? I don't get that many calls. And then I go back out there and they're doing like rhythmic gymnastics with the Sarah band. And I'm like, that's not what we taught you. Right. That's not the correct exercise. So, so this is a way this, this kind of go out as often as you need to, and not one visit more is appropriate, not just for maintenance, right?
Speaker 1 (22:37):
So, so writing, writing utilization is really hard for people to understand, because they're used to seeing their patients every week and that doesn't sometimes have to happen. How long do you have to wait to see if the exercise program was efficacious two weeks, three weeks, four weeks, how long, you know, you've got to base it on what, you know, what the evidence shows us? What, what, what our, you know, our, our scientific literature says that's important. So, so I have one more myth to kind of finally push the ball back to Cindy since utilization depends. So now we've got people test to measure some kind of goals that aren't just written, maintain. We have utilization. That seems to be very beneficiary specific, Cindy now, cause they're on maintenance. I got to see them for the rest of their life, right?
Speaker 2 (23:29):
Yeah. That that's, that's very common and, and it kind of splits into different ways. Karen, sometimes it's the, I made a lifelong commitment because they could decline at any point in time. So by that standard, this is forever or there's the gleeful hot maintenance, a great way to go for patients that don't want to be discharged. So as opposed to them crying, when I talk about discharge or the daughter runs back to the doctor and keeps getting orders, I'll just put them on maintenance and then everybody's happy. Okay. You can't do either one of those things you still are accountable to skilled, reasonable, unnecessary. So the benefit is clear. You can't just keep going or having them come to see you at the clinic, just because you're nice. This does need to require the skills of a therapist. We're still accountable to all of those criteria.
Speaker 2 (24:19):
And as di said earlier, if there's nothing left to teach, train, or do I can't just do it because you either don't want to, unless I stand here or the caregiver doesn't want to have someone else can do it just as well as I can, that this is no longer considered skilled. And that's what drives the decision to discharge as well is when I have taught you what I, everything that I can the program I've given you is effective. It is in fact stabilizing function. There are no more adjustments to make. There are no things that need to be changed, then you really don't need me anymore. And that's where I think that it comes back to again, how are we finding our value that I think we've gotten very used to. They come to see us X number of times per week for this number of weeks in a row.
Speaker 2 (25:07):
Then we say, okay, you're done. The order is done. If anything goes wrong, then come back again. Where maintenance really makes us think about a term we use very often is how are we dosing ourselves? So thinking about ourselves, like a medication, when do they actually need that encounter with a therapist? And when we've reached a point where you don't need it, there's nothing I'm doing that is uniquely therapy, then we need to stop. But I think the hard part in that, Karen is some of our skill and touched on one, oh, I had just a piece of equipment in the family looks amazed because that is a skill. You, you know how to do that because of your training. I think sometimes the decision to discharge, we jumped the gun too fast, whether it's a maintenance approach to care or restorative by this. Oh yeah.
Speaker 2 (25:53):
They got it. They understand it. I don't really, you know, they're just doing the same thing, but are you still contributing something? Are you still making any sort of adjustments? Are you convinced? Because on the restorative side, I've never understood these, you know, lofty strength and improvement goals for a two week care plan that suddenly, you know, the, the they've gained a whole muscle grade in two weeks. I don't know what literature I missed, but this, this, this will be great because I'm going to go join a gym for two weeks when it's safe for me to do so. And then I will be fixed in two weeks. It's all done. So I think it, again, challenges us to think about, have we done everything that we can, are we confident as do? You've said more than once. I mean, we've taken care of mitigating concerns.
Speaker 2 (26:37):
I mean, if they may have a completely unexpected stroke next week, I'm not expected to be telepathic, but I have looked at your condition, given you the tools and resources. And in fact, whether there is nothing left for me to adjust to do, I am going to discharge. So there is active discharge, planning and maintenance care. We are, we are not saying because of this decline risk, then I'm here forever. And we also have to be careful because a lot of beneficiary advocacy groups have done a great job, educating our patients about this, who will then come at us with the resource. You can't discharge grandma because I've got this GMO thing. And it says, you have to, that's where I think some therapists have gotten caught and been like, oh, okay. That looks like an official document. I'm going to keep having you come to the clinic. I'm going to keep seeing you in the home. And it's like, wait a minute. That's why you have to know what the rules really are because yes, beneficiaries should be educated, but they don't necessarily understand the coverage criteria very well, just because they want this to continue. Doesn't mean it's automatic because of that, Jim. Okay.
Speaker 1 (27:43):
Yeah. And I think that that is where your judgment as a physical therapist and as the authority figure in that situation, you really have to come down from on that and, and be able to explain exactly why you're making that decision instead of just being like, oh, okay. I guess I'll just keep seeing the men, even though it's at this point, not medically necessary. So what, what advice do you have for the physical therapist who might be in that situation? How do they then speak to the caregiver, the patient, et cetera. So that's, that's happened to me cause I've been providing maintenance therapy. When I had my Medicare certified agency in central Florida, way back 2008, 2009, been doing it a long time because we get tired of people. We get them better and then they'd go off and then they decline and then they come back on.
Speaker 1 (28:41):
I'm like, we're missing something. We have to be able to monitor these people. I watched nurses do it all the time with the monthly catheter changes, right? Because most people are not good at self cathing and preventing infection and doing it accurately. So they'd end up in the hospital, you know, with some sort of puncture or something or an infection. So, you know, monthly catheter changes can happen for years and years with nurses. So what were we missing here? Here is the bottom line for clinicians. I, when I have taught and trained everything and my skills are no longer necessary. You ask yourself, is there somebody that could oversee that could carry this out with you? Because it really just requires sometimes the assistance of another person or a cheerleader or somebody to motivate you or supervise you. What we have a lot of patients that might have cognitive and limitations.
Speaker 1 (29:31):
And even if that person isn't available, just imagine, just ask yourself the question. If that person holographically appeared in the room, right, and said, teach me train. And they were capable. Would you give it to them? And if the answer is yes, then you should no longer be going anymore. So what I tell patients is I will say to them, I understand that you want me to come, but as a licensed physical therapist, I have a fiduciary responsibility to the payer and the payer has requirements. And one of them is medical necessity. And at this point you need to do this, but you don't need me as a physical therapist to do this. So I can teach and train you, your spouse, your family member, a paid caregiver, or you can pay me to come, right. But I cannot bill your insurance for this because I would be in essence, fraudulently saying, it's still required.
Speaker 1 (30:27):
My skills, knowledge and ability when I'm telling you it doesn't, it just requires another pair of hands or somebody that could be shown a lay person, how to do this. And so they're like, oh, well you calm. And then I'll tell them, this is what it costs to privately to pay for a physical therapist. And some people take me up on it. And some people say, oh no, I'll get my grandson to come over. Can you show him how to do it? And I'm like, that's great. So, so I think we have to, like Cindy was saying, we have to understand the regs. We have to understand this. Doesn't go on forever. We have to understand that when we are going to sign our name with our credentials, so hard earned right through through education and practice that we are basically signing an affidavit. If you will.
Speaker 1 (31:13):
That says, I attest that this meets the requirement of this third-party payer. If Benny therapists stopped, many clinicians heck stopped and thought about that. They might not provide some of the services that they're told they have to provide or do the things they have to do, but it's really comes down to our license. So when I sign that and say, this is medically necessary, I I'm going to make sure that I show that my skills and my contribution to that visit is a billable visit. If I no longer have needed for that, then I can teach and train someone else, or I can discharge them from the third-party payer and they can pay me privately. They could, it can be a cash based service. And that has happened.
Speaker 3 (31:56):
Yeah. Yeah. That
Speaker 1 (31:57):
Makes so much sense, guys. This was so good. I just know that therapists are going to have a much better idea of what stabilization care is versus maintenance care. We won't use that term anymore. Maybe we can, we can change that preservation of function, care stabilization of function, carrot just, it sounds it's. I think it sounds better for the therapist and quite honestly, like more humane, more human for the person that we're caring for. Instead of just maintaining someone, you know, we're preserving their function, we're their ability to do the things that they want to do. Just sounds so much more, I don't know, human than maintenance care. It sounds so cold and sterile. I don't know. Maybe it's just me. No, I think, you know, for me, when you say that, it makes me think that we are helping patients be accountable for their chronic disease management.
Speaker 1 (33:01):
Right. We are teaching them what we know and how important it is for people with aerobic impairments that they have to maintain that lung capacity you know, within the confines or the constraints of that disease process so that they can continue to do their self care, which is metabolically demanding. Right. So, so it, it really, it really shifts responsibility. I think maintenance is a very passive sort of thing that, you know, we're, we're maintaining range. You know, I, I think you know, people that were doing stuff to versus where we're in we're we're arming people with the ability to manage and be accountable for their chronic disease and to, and to function optimally within the constraints of those, that disease or those diseases through a stabilization or preservation of function. Yeah.
Speaker 2 (33:55):
And I think it's important to, to just kind of circle back a minute that we don't want the visual now to always be maintenance patients or stabilization patients are very debilitated, have to have a caregiver, very ill individuals. These, we can teach these types of programs to the patients themselves, for them to self manage. I think sometimes, you know, okay, I'll give it up. It's not Parkinson's ALS and Ms. I got that point, but these must be like really sick, bad off people. They might be, but they might not be, they might be the heart failure patient that's functioning pretty well right now, but has a history of pushing themselves too hard. So the now kicks in the fluid overload. It ends up back in the hospital because they're overdoing. How do you better task plan? How do you help someone understand when their disease process gives them good days and bad days?
Speaker 2 (34:45):
What, what do we want them to do on a good day? What do we want them to do on a bad day? Because we know many of our folks that are receiving therapy. Cause they basically think that we're gym instructors, we're gonna, you know, show up for the treatment, wearing spandex and tell them to drop and give us 20 anyway. So we're trying to get past that, but on a bad day, too many of our patients, regardless of diagnosis, sit and wait until they feel better, maybe, you know, with a recent orthopedic surgery, a little bit arrest, okay. We encourage some rest. That's not a problem. And some of these chronic diseases, you're one day turns to two days, turns to a week, you haven't done much of anything and now you've compounded the problem. So I think you're right. It does feel like we're utilizing our skills in a more person focused way meeting them where they are.
Speaker 2 (35:34):
But I think, you know, very often just briefly we'll get the, well, what are the treatment interventions for maintenance you didn't in this whole conversation, give us any treatment strategies because it's not about the treatment. It's not about the assessment. We do what we do. We have the tools in the toolbox, but what, what are we trying to get to? What is the end vision for this individual? And then I'm going to utilize what I know how to do best in that context. I just think for a lot of us, we felt that door was never open. That you were not supposed to do that. That if you could not show significant improvement that you had to discharge and Dee and I have seen therapists, when you see the wheels turning, I've said a couple of times we need to develop like a stages of grief equivalent for the discussion of maintenance, because we'll have people get mad.
Speaker 2 (36:21):
Like I can't believe nobody told me this. And then you'll see guilt, you know, oh my gosh, I've had patients and I discharged them. I thought I was doing the right thing. I'm a horrible therapist. What am I going to do now? And it's like, okay, let's just start looking at the information and change what we do going forward and not go backward and be all upset and think we're horrible or mad about who lied to me. It didn't tell me about this before, but we do need to start making a difference. Cause D and I heard far too often, you know what? That was interesting ladies, but we don't do that here in this clinic. We're not going to do maintenance therapy. And it's like, wow, you just get to unilaterally, decide you're out. If you want to be out, that's fine. But then you want to direct them to a clinic that does do it because if they need it and they qualify for it, then find them a provider who will, but this kind of, oh, I never heard of it. I'm not participating thing is, is very frustrating in the current environment.
Speaker 1 (37:14):
It's, it's not correct. I mean, we have to understand beneficiaries have paid into this benefit. They are entitled to it. And if their presentation is such, that stabilization of function is the appropriate course of care. They are entitled to it. It is part of their benefit package. You don't have a right to say, oh, we'll take you on care. But you know, you're not going to get that. That that's that's you, you can't do that. I mean, you either provide the care that is within the insurance. Right? I mean, think about it. If you went to Jiffy lube for your 32 point checkup and they charged you 90, 95 and, and you only got 10 of them because that, oh, we don't do those other 22. Would you be paying for, I wouldn't as like, listen, I'm entitled to this. This is what I'm appropriate for.
Speaker 1 (38:07):
It's part of my benefit. Maybe you don't do it, but you can't determine that I don't get it if it's part of my benefit package. So it really comes back to the beneficiary. If they're entitled to it, we, as professionals are not ones to say, we can recommend and say, I don't think that's the appropriate course of care. But to literally say, we're, you're not getting that component of your benefit. I don't think that would go over very well. Do you care? Do you not? No, not at all. Not at all. Especially with, you know, like you said, people have been paying into this, their whole working lives. If it is part of the benefit you should offer it. For sure. And if you're a physical therapist who says, I don't know how to do that, well, you better get educated and learn how to do it.
Speaker 1 (38:56):
Exactly. The things that I am not the most gifted at as a therapist. So I'm not just going to start dabbling in dry needling. Okay. That's that's not my area. Oh yeah. Just give me some, you know, go into the pin cushion and let me start working on you. It's a skill set and it's something that you have to understand the rules and regs. You have to understand what the payer source requirement is, but we as clinicians don't need any other evaluation skills. We don't need any other tests and measures. We don't need special interventions. What we need to understand is that there are times that we are indispensable to help people improve and recover function back to a prior level or maybe beyond. And then there's times we are, we are needed. We are indispensable to preserve and stabilize their existing function so that their quality of life can continue on in the fashion that it currently is perfect. I was going to say, do you want to button it up? But I feel like that did it, but now listen, before we wrap things up, let's talk about the book, the guide to the two delivery of home-based maintenance therapy. So talk about the book, where can people find it? And what will they get out of the book? If people go and purchase this book, what are they getting?
Speaker 1 (40:16):
Well, they're going to get DNA, Cindy. That's what I'm going to start with. They're going to get us, they're going to get us. They're going to get an updated version. I think it's the only book. And actually it's our second edition and really focused on community-based care part a and part B for Medicare, right? Whether it's part B in a clinic or part B in the patient's home. And we really focus on the rules and the regs. And we and, and literally walk you through common case scenarios. We try to myth bust, and we try to give you a how to like how to start to think about this, because I think theoretically or conceptually when, Cindy and I talk about this and we've been talking about this for eight or nine years now. And teaching on this, people don't disagree with this. They fundamentally understand, they just don't know how to operationalize it. They don't know how to, if they see it. Okay. Well, I understand what you're saying. I understand. I, I agree with you. That would be, I could see where that would happen, but then how do I do these things we've talked about? So Cindy, what does this second edition really afford them? This time around that, you know, it was kind of like a value.
Speaker 2 (41:30):
Well, I think part of it came from, we were folks, as you just said, understand the concept, but then struggling to say, I got chew on this for awhile. This is really going to change my core, that I am not just defining myself by improvement. I got to work through some stuff and figure out how to do that. And so our first edition started out. We have a consistent scenario throughout to really talk about assessment and goal writing and detail and all of those pieces. But then as we looked at the second edition, we said that that's a good place to go. You got a nice, consistent scenario. It builds throughout the entire book. So you have opportunity to do that. But then this time around you know, I think you got the sense. I tend to be more in the regulatory nitpicky, wheelhouse, and D tends to go toward the operationalization side.
Speaker 2 (42:18):
And so she brought up, why don't we put a workbook with it? Why don't we add to that idea of a consistent scenario and say, what are some additional knowledge application activities? How do you comment that same thing about assessment or goal writing a little bit differently than one scenario to really get the juices flowing about how to do this. Now, the challenge is, is there a right answer? Like, do I just go to the answer key? And there was only one way that could have been done while listening to this conversation. There was quite a few, it depends. How often would I go? What would I focus on? So the answers give you some context, some suggestions, some validation, but it was not meant to be, there's only one way to do this. And in a scenario, you know, five sentences long, you better figure out exactly what you would do all the way through this only one path, but it's really to help kind of put those guard rails on and say, well, did you think about this?
Speaker 2 (43:14):
Or what about that element to, to be able to say, okay, I am understanding this. So I could use that as an individual to go through that process, or I could use it in an organization and do it as a group activity, but to really help people continue to process what sounds like. Yeah, I got it. But now I have a patient in front of me and, and I'm still stuck. Old habits die hard. I still struggle with the goal. I still think I can fix this. I, I still feel that voice in my head. That's telling me if they're not getting better, you're not supposed to be here. So people need that opportunity. So we wanted to provide that in a tangible way that, you know, doesn't really lend itself to an educational event unless the thing was days and days long, and people camped out with us, which nobody wants to do. But gives them that opportunity to come to step away, think about and come back to it at their own pace.
Speaker 1 (44:07):
Awesome. And just so everyone, all the listeners out there the book, the guide to delivery of home-based maintenance therapy, it's on the Kornetti and craft website, but we will have a link that takes you directly to the book and, and listeners. If you use the coupon code KK 2021, you'll save percent on your purchase. We will have all of that at the show notes at podcasts on healthy, wealthy, smart.com under this episodes, you don't have to remember it. You don't have to send everybody DMS and things like that. Just go to podcast at healthy, wealthy, smart.com click on this episode, it'll be under the resource section in the show notes. So we will make it very, very easy. That's all you got to do is one click, and it'll take you right there. So now before we wrap things up, the question I ask everyone on the podcast is knowing where you are now in your life and in your career. What advice would you give to your younger self?
Speaker 2 (45:19):
Come on Cindy? I would say, well, I, I would say to my younger self to be a bit more open-minded with how physical therapy really works in reality. I think career-wise would come out. I came out very, this is what I'm going to do. And, and briefly my goal is I'm going to work in a traumatic brain injury unit. I loved working with that population as a student, I'm going to be a famous therapist in a big old rehab facility. And now I'm going on nearly 30 years in home health and have never actually worked in a, in a fancy schmancy rehab clinic. I started this kind of on the side, fell in love with it and never went back. I tell, I tell students all the time, don't assume that what your path is at the moment is the path and can't vary and can't change whether you go into teaching, whether you go into other avenues there's a lot more possibilities and it took me a little while to process that piece to say there, there are many other ways you can utilize your skill to benefit those around you.
Speaker 1 (46:28):
Excellent. D I would say to my younger self I may not come across that way now 30 going into my 36 years a PT, but I would say don't be afraid to ask questions and don't think you have to know it. All right. So I, I think that I kind of stayed in my box a little bit more and got really, really good at what I did. Some of that time, Cindy was in a traumatic brain injury a locked unit and I got very good at what I did, but I had a lot of questions about, but what if, but why not? Right. And I think sometimes I kind of just that maybe I shouldn't ask that question. I was a little bit too con you know, self-conscious about it. And so I, I think the idea is ask those questions, be fearless.
Speaker 1 (47:18):
And, and instead of asking, why would I do that? You know, look around. Why not? You know, I'm a big, why not, if you've got a great idea, you have something that is like a passion, and you've got that intersection of your passion and your skillset go for it. Right. A good friend of Cindy and mine Dr. Tanya Miller started event camp for kids. Like when she was like a new grad PT. It's like in it's what, 27th year. And she's written grants for it. And, you know, they take these kids on ventilators out in kayak. I mean, you can do it, you can do it. So be fearless and don't be afraid to ask questions. Don't don't, don't think, oh, well, I don't know as much as Karen Litzy or I don't know as much as Cindy craft, you know, start to explore that the possibilities are endless. That's what I would have told myself when I was younger, fabulous advice from both of you. And I couldn't agree more. Thank you so much for coming on for sharing all of this great information and your book, and it's just sounds great. So thank you so much, Dee, and thank you so much, Cindy, for coming in. Thanks for having us, Karen. It's always nice talking to you. Pleasure. We had a great time. Excellent. All right. And everyone who's listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Circus Medicine Specialist, Emily Scherb, talks about all things circus.
Today, Emily talks about recreational circus, how physical therapy comes into play, common circus injuries, and the things physical therapists should be aware of. How is “circus” defined?
Hear about important lingo, one of Emily’s favourite circus stories, and get some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways • “Circus is everything that can happen in a performance environment that would be defined as ‘circus.’”
• “Ask questions. It’s okay to not know. With these artists, they’re expecting you to not know.”
• “Figuring out the demands of the sport can be really challenging if you don’t speak the language.”
• “Every circus artist has a video of them training on their phone.”
• “Use the knowledge you have, and then seek more information.”
• “Circus really is for everyone.”
• “Be brave enough and take the time to listen more. It really does take bravery to admit you don’t know everything.”
More about Emily Scherb Dr. Emily Scherb is a physical therapist specializing in circus and performing arts medicine. Through her 30 years of training and working in the circus arts she has gained deep insight on how circus bodies work in the air and on the ground. Emily now teaches workshops for circus artists, instructors, and healthcare providers with the mission of improving health and safety in circus training and performance. Her bestselling book Applied Anatomy of Aerial Arts was published in 2018.
Suggested Keywords Circus, Physiotherapy, Medicine, Artists, Safety, Injuries, Lingo, Performance, Healthy, Wealthy, Smart, Healthcare, Training, Fitness,
Get 80% OFF Emily’s Course: Learning The Ropes Course
12 Weeks of Circus-Based Knowledge and Content: Circus Fusion
Circus Vocabulary List: Circus Vocabulary
Get Emily’s Book: Applied Anatomy of Aerial Arts
To learn more, contact Emily at: Email: Emily@thecircusdoc.com Website: https://www.thecircusdoc.com Facebook: The Circus Doc
Instagram: @thecircusdoc Twitter: @thecircusdoc LinkedIn: Emily Scherb
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Read the Full Transcript Here:
Hi, Emily. Welcome to the podcast. I'm happy to have you here.
Speaker 2 (00:06):
Hi, thank you so much for having me. It's really exciting to get, to spend some time talking about circus with you.
Speaker 1 (00:11):
Yes, and I'm excited because as we were talking before we went on the air it was, it sort of changed my outlook on what circus is and what circus quote unquote performers are. So we're going to get into all of that, which I think the audience will really love. But before we do that, can you talk a little bit about your journey into this niche, into working with circus performers or circus athletes?
Speaker 2 (00:40):
Absolutely. I started off as a kid who loved gymnastics love to flip and fly and just be in my body and move through space. And I stumbled on circus as a hobby at a summer camp when I was a kid. So I started doing circus and I was really young and realized that I loved to perform way more than I love to compete. So the competition aspect Gnostics was fun for me, but I really just liked being out there in front of the judges and smiling and doing my thing. And I realized I could do that with circus. And it was a really collaborative collaborative environment and very challenging and very similar ways. And so I started circus as a kid went through high school, continuing to expand my knowledge about spickets and my own body. When I could, there was not a lot of resources for learning circus at the time.
Speaker 2 (01:27):
And after high school, I moved out to the West coast and joined some aerial dance companies to continue to pursue professionally knowing I'd go back to school eventually. And I did. So I went, I went to undergrad every summer, either working at a summer camp teaching circus, cause that was a popular place for circus schools to be, or wherever I could get a job teaching circus doing circus during the summers after college, once again, much, much to my parents' chagrin. I took more time off to go back and do more circus. And I moved to New York to your neck of the woods, spent some time there working with a dance company called strep and with trapeze school, New York while I was there and teaching circus, doing circus and professionally using my body through space as a performing artist before going back to grad school. And then even in grad school, I may have taken residencies and done my clinical rotations where there were circus schools. So captain was part of my life for sure.
Speaker 1 (02:29):
That's amazing. And now before we go on, can you define what circus is? So you're teaching circus and people think, wait, circus is, I thought circus was a show or an event. So I'm a little confused. So can you define what that is?
Speaker 2 (02:47):
Really great question. When I say circus, it's also going to be slightly different than when someone else says circus circus is everything that can happen in a performance environment that would be defined as circus, which is debatable even in the circus community. So circus is acrobatics. It's aerial artists, it's juggling, it's clowning, it's acting, it's dancing, it's communicating through movement, it's performing arts and what qualifies a circus is kind of the definition of the individual company members that are involved in the, in the creation. When I say I'm teaching circus for me, I'm primarily teaching aerial arts, I'm teaching flying trapeze or I'm teaching aerial silks. It's like that fabric that hangs down or I'm teaching a static trapeze or rope or web there's lots of different apparatus and lots of different challenges for the body. I just prefer my challenges to be off the ground and in the air. So when I say teaching circus, I personally mean Ariel. Generally I have taught tumbling as well. But circus is a huge, huge arena for challenges to the body and performance challenges in space.
Speaker 1 (04:09):
Awesome. And now when, when we're talking circus and when people think of circus, they might think of Ringling brothers, Cirque de Solei, these, you know, grand extravagant performance artists. But I know what you want to talk about is the growth of what we would call recreational circus, recreational circus athletes, let's say. So I want you to talk a little bit more about that. I'm just going to throw the mic over to you to let the listeners know what the heck is that and where does a physical therapist come into play?
Speaker 2 (04:47):
Absolutely. so circus in the U S has grown exponentially in the last 15 or so years. We went from having maybe 10 schools for all levels. But like I said, I started a summer camp. That was an opportunity. A couple of the universities around the country have had circus schools. So like Florida state university has one. There's some youth circuses in, in like circus Ventas in Minneapolis, Minnesota when actually youth circus out here in Washington where I am, those have been around for a really long time, but then there's this phenomena of circus rapid rapid growth in this last 10 years. We've gone from those 10 or so schools to having over 800 schools in the U S that I know about, and that's counting circus schools. That's not including aerial yoga. And that's not including pole-dancing studios that might have an apparatus or gymnastics gym that might have an apparatus or two in their space.
Speaker 2 (05:46):
So circus has not only grown for recreational use of it's not only grown for recreational artists across the country to, to try to do after work or on the weekends. It's also growing in these other niches and, and kind of just keeps expanding. So there's things that we can all do after work or on the weekends to keep our bodies healthy. This can be our, you know, our soccer game instead of soccer game, I'm going to go take a class and I'm going to stay fit and stay strong and build my community through the circus world. The other thing that's really happening in, in an interesting way in circus is the development of what's called social circus, which is using social using, just using,
Speaker 3 (06:35):
There we go
Speaker 2 (06:38):
Social circus, which is using circus to do outreach and community building through specific groups often involving a social worker or using trainings that have a lot of which have been developed by search delay through a program, they call sick demo to do outreach in schools and in different settings that make people grow and increase physical literacy to also increase health literacy. There's a urban youth circus in St. Louis called circus harmony. That's been around for decades. I should know when, but it's been around for decades and they have youth classes and they also have these youth performers performing every weekend at a, at a museum. And they perform every weekend. They have the social responsibility of showing up, getting their work done. They, they really have that community building element. There's also been studies all over the world, but the one I'm thinking of in Canada in the fiscal education system that uses circus is as PE class to have an equal growth of both boys and girls.
Speaker 2 (07:47):
And they find that that does not have a gender differentiation. Everyone has an increase in physical literacy in those, in those groups. So it's a great way of reaching out that way. Here in Seattle, we have a women's group, a women's circus group. That's run by a social worker here which is a really great resource for, for these women. We also have a boys and girls club group that comes in and we have on the other side of things on the more medical side of things, we have circus it's been adopted for anyone to participate. There are juggling tools that don't actually involve throwing and catching. They involve rolling in gliding so that they can be a little more accessible. We can take our aerial apparatuses and lower them down to the ground. So we can use it like the aerial silks, more like a sling or a hammock where you can tie the bottom together.
Speaker 2 (08:36):
And you can use that for compression. You don't need to have quite as much balance or grip strength. So we've been able to do work with kids with cerebral palsy and had great work with them on the trampoline, kind of getting some, some input with them there and then taking them to the air and they get to do things that are cooler than their friends. They have to go back into and tell stories. And on the other side of that, we have adults with Parkinson's and we have a Parkinson circus group and using the novel learning novel movement, learning of circus with Parkinson's to make improvements and give them more comfort moving in their bodies as well. So circus has just really expanded into the recreational world and into every aspect of movement, which has been incredible boon to, to see, and, and to be on the sideline of, as a physical therapist, my personal interests tend to be more on the orthopedic side, but if there's someone out there who really loves working with pediatrics, and you want to get involved with circus, how cool, you know, someone, someone comes in your door and they have difficulty with dorsiflexion, but what if the goal is to hook their foot on something instead of just trying to make their ankle move, you know, and it gives different goals and different levels of excitement for all sorts of artists of all ages and abilities.
Speaker 1 (09:53):
I mean, this is so much more than I was thinking. I was literally thinking that what you do within circus medicine is just working with like Cirque de Solei or professional. Like I had no idea, the large umbrella that is sort of circus and that is circus performing and yeah, so much more fun,
Speaker 2 (10:19):
So fun and so cool. And it's incredible because all these schools have popped up that most of us can within a couple mile radius find a circus school to take a class in on the weekends if we want, or are likely to, as healthcare practitioners have a client will walk in the door, who's taken a class and wants to get back to doing it as their physical activity.
Speaker 1 (10:39):
Okay. Well, let, now let's talk about that. So, because let's say you're a physical therapist and maybe this is not your specialty, but like you said, if there's this huge rise in recreational circus, we may be seeing people who are coming in for an injury that maybe they got well doing circus. So let's talk about what are some, and if there are common injuries that one may see understanding to all the listeners understanding, like we said, this is a huge umbrella, so we're not going to go over every single injury, but let's talk about some common ones that maybe the everyday PT might see from one of their recreational circus athletes.
Speaker 2 (11:23):
Probably the most common one that I see in my practice is chronic overuse of the shoulder. And when I say overuse, I mean under preparedness for the activity that they're undertaking and that's because most of us live our day-to-day life, especially right now in front of our computers, typing away with their arms in front of us and reaching out to our laptops. And then when we go into the circus world and we're all of a sudden asked to bring our arms all the way up, overhead stabilize our entire body weight, without relationship to the ground, or only in relationship to the ground, if our legs are over our heads and we're in a handstand, our shoulders just aren't necessarily prepared for that level of load. And so there's definitely a pattern of different shoulder problems that crop up. So there's, there's a lot of chronic shoulder pain.
Speaker 2 (12:13):
And some of my job is also go into the circus schools and educate these artists that, that chronic shoulder pain is not normal and that they can get rid of it. So that's also a huge, huge thing is there's a, a saying in circus that is pretty pervasive, which is circus hurts and circus does hurt in that you're pushing your body in new ways. You may be having pressure against an apparatus. Maybe you get a bruise and that's okay, but circus shouldn't hurt like an injury hurt like deepen the joint hurts. So that's one of those things I try to get out there and, and explain to people there's of course, more acute injuries both of the shoulder and the rest of the body, but that, that's one of the biggest ones, especially in my aerialists and a little bit in my hand balancers.
Speaker 2 (13:01):
And even my recreational contortionists, that is a thing we have recreational contortionists now, which is incredible. The other really big injury is hamstring strains, proximal, hamstring strains are a huge one. I can. Same thing. Yeah. So we're getting to end range possibly with dynamic motion. So maybe if there are tumbling and working in the ground and they go to do a Cartwheel for the first time as an adult, or the first time in a very long time as an adult, and you're kicking your leg approaching end range rapidly without necessarily the preparation, strength and control at that end range. So that's, that's another one that's really common. And then, Oh, go ahead. Oh, say one of the, the third, probably most common injuries are ankle sprains, either from landings or falling off mats. So often protective equipment can also be in an interesting challenge as well.
Speaker 1 (13:55):
Oh yeah. That makes a lot of sense. I was a gymnast for many years when I was younger and I always had an ankle sprain. So I would feel like I remember being on crutches at least once a year, once every other year from an ankle sprain. So I can definitely see that now let's say you're a physical therapist like me or others who do not don't have like this vast knowledge on circus and what is involved. And someone's coming in to see me with chronic shoulder pain. I don't expect you to go through a whole eval here, but what are some things, maybe some questions we want to ask some things that we should be aware of and then maybe even some resources you can send us to, to look at, Hey, what are these people doing?
Speaker 2 (14:45):
Yeah. So great question, because I think it really will be a challenge that we will face soon. I hoping circus keeps growing beyond the pandemic. And as, as circus schools keep keep expanding. And I hope that you will get to see eventually a circus status walk into your clinic. So the first thing is, ask questions, ask questions, ask a lot of questions. It is okay to not know with these artists, they're expecting you to not know. They, they probably learned relatively recently, all the things that they're learning about circus. So ask questions, ask them what their discipline or their apparatus is. Ask them if they're an aerialist or a ground Acrobat. Are they doing handstands on the ground? Are they doing handstands on another person holding them up? Are they hanging from a bar or a horizontal apparatus grabbing kind of like with normal shoulder flection or are they holding a vertical apparatus?
Speaker 2 (15:43):
Like those aerial silks where they might be grabbing one hand up stacked on top of each other. Let's just give you, gives you an idea of what kind of shoulder range of motion they're going to need. And what they need to do with their body is also asking what level they are. Because as recreational circus grows, circus artists people are defining themselves as circus artists in different ways. So the recreational artists may still say, I'm a circus artist. And so might your professional. And so really diving down, what does their training look like and who are they? And then specifically to the shoulder, I just want to reassure everyone that circuit shoulders aren't that different. They are just functioning at, at end range. So you just need to make sure that all the things you normally look at are working and are working at and range. So if they need to get into field reflection, making sure those last 10 to 15 degrees, if their mechanics look perfect and I do a lot off the ground sorry, I do a lot on the ground without them being in the air. And you can learn a lot just by watching their movement through everyday activities. Even if they're not having pain with those, they may only have pain with their circus activity, but there's still things you can see with your professional life that really can be helpful.
Speaker 1 (16:57):
Awesome. And then obviously when you ask those questions, you look at that end range being so important, and then you get into the treatment. And again, this is where, you know, as a physical therapist, you're looking at, what are the demands of the sport? What does this person have to do? And how can you create a plan around that? Is that about right?
Speaker 2 (17:17):
Yeah. And so figuring out the demand to the sport can be really challenging if you don't speak the language or you don't know what the apparatus, the discipline is that they're doing. And here's the cool thing. Every single circus artist has a video of them training on their phone.
Speaker 1 (17:31):
Oh, that's so smart. Of course. Right?
Speaker 2 (17:33):
So everyone's like setting their phone up in the corner and watching themselves trained. If they have a move that's painful, they usually have a video of that too. If you didn't ask them in advance to take one, if you have that opportunity, that's fantastic. And if not, just ask them, Hey, you have a video of you doing that and you can get a general idea of what they're doing. If you, and, and that's interacting with your patient as well, in a way that's kind of building that trust trust with them, that that level of interest, if you have advanced knowledge and you kind of know what's going on, Google it, it's amazing. There's so many beautiful performers out there and you can Google almost any apparatus and see how they interact and what they need to do. Again, it's going to depend on their level, but it gives you an idea or even better. If you do have access to a circus school, taking a class, if you have the have the ability to do it, or just go out and observe and see kind of what's going on with their bodies it can be really fun and educational and the, both the students and the coaches usually love it. They love knowing that healthcare providers are interested and want to get involved with their bodies and help them perform better.
Speaker 1 (18:41):
Awesome. That's all great tips and great advice because I just don't want PTs to walk away from our conversation and be like, well, that was really cool, but what am I supposed to do? Well now, you know what to do.
Speaker 2 (18:53):
Absolutely. Yeah, yeah. There's plenty of resources out there. There's not plenty of resources out there. There are, there are resources out there to seek knowledge in how to work specifically with circus artists, but there's so much you can do with the knowledge that you already have. And that's the real key is use the knowledge you have and then seek more information. The artists are great resource themselves, and they really want to get the most out of the treatment and that interaction. I have learned so much from my artists. I give them an exercise, they come back making it three times more relevant, and I've taught me so much over the years, which is just absolutely incredible.
Speaker 1 (19:35):
Yeah. That's pretty amazing. And is there like lingo or jargon that if you're going to be working with this population that you should really know,
Speaker 2 (19:46):
There is some lingo, some jargon I can happily get you a link to a vocabulary list that I have. And I'll, I'll get that over to you. So that there's a little bit of a little bit of lingo that, that helps. There's some things that just having a few words mean so much to these artists to just feel welcome. So taking the time to look over and things like that is great. Some of the lingo you should know is Ariel is anything off the ground. A bass or a Porter is a person who throws someone else or move somebody off. And they place them in space, either from the ground or from hanging the flyer is the person who's being manipulated. Right. And then some other things that are really helpful, kind of coming from the domestics world, the idea of opening or closing a joint is kind of a similar to flection or extension opening in the shoulder cases.
Speaker 2 (20:47):
And closing would be extension hips. Closing the joint would be fluxion opening extension. So like when they're artists are saying things like that inversions are hand balancers are doing inversions when they are turning upside down. Our air lists are inverting when they turn upside down as well, but they're hanging from their hands. So that's another really common place that there's pain is as we're changing through all those planes of motion. That's another really helpful term to note as well. And then that, that vocab sheet just has some of the common ones on it. Of course the circus being so broad, it doesn't cover everything, but it gives it a good starting point, at least a starting point for us.
Speaker 1 (21:29):
Yeah, absolutely. And, and I'll have that in the show notes at on the website under this episode so that people can, can click and download that. And, you know, as you're saying all of this, gosh, it does sound a lot like the competitive cheerleaders, the flyers, the base. So, you know, learning about the rehab, learning about rehab within the circus space can really translate out to a lot of other areas of, of athletics, I suppose,
Speaker 2 (22:03):
And the other way around. So if you are working with St gymnast or park core artists or climbers or cheerleaders there's, there's so much inter relatedness of the movement, other, so there's so many connections in, in how there's so many connections and how these artists move to other things, because circus is so broad, it comes from a tumbling background, it comes from a climbing background. It comes from all these things that have been pulled into what is now currently circus either in a contemporary or a more traditional sense.
Speaker 1 (22:38):
Yes, yes. I think that's great. And, and for me, this cleared up a whole heck of a lot because I had no, I mean, I had an idea of maybe what a physical therapist can do, but boy, it's so much more, it's just so much more, so it was great. So much more than I thought. Like, I, would've never thought of working with children's cerebral palsy or adults with Parkinson's or the recreational, the growth of recreational circus didn't even come into my head and I'm in New York city. I see that trapeze on the Hudson, you know, like I know it exists and I know it's not professionals using it. Know, we all saw that sex in the city episode when Sarah Jessica Parker was flying on that trap piece. Right.
Speaker 2 (23:27):
Absolutely. I was happy to be involved with that school at the time. And it was a blast to be there.
Speaker 1 (23:33):
Yeah. Oh, I bet it was. Yeah, I bet. So I, so when people, when therapists say, Oh, I'll probably never see anyone that works in the circus, ah, you don't have to be a professional. So you might,
Speaker 2 (23:48):
I don't have to be a professional and those recreational artists need help. And if I have a moment to tell a story, I would love to, one of my favorite stories is I had the pleasure of talking to someone, not a patient actually. She's 72 year old woman. And she was telling me her story, which is she went golfing and she hurt her shoulder, playing golf for club into the ground, hurt her shoulder. And she was fine doing everything she does except for pole dancing because she was also a recreational pole dancer. And so she went to go see her doctor. And she said, doctor, my shoulder hurts my pole dance, but I'm fine. Otherwise I heard it playing golf. And he said, well, you shouldn't pull down. That's dangerous stick to golf. And it's like, it's just so interesting. Our preconceived notions of what our normal activities for our body. She's 72, she's spinning in space. She's holding her body weight up. She's doing proprioceptive training, strength, training full body movement, mobility work. How much better could it be than that? And, but golf is the normal activity. So the more we normalize recreational circus and make it more part of our practice, the more helpful we can be to keep our patients healthy and active in doing the things they love.
Speaker 1 (25:01):
Amazing. And now I have to tell you, after watching the super bowl halftime show, not this year, but last year with Jayla and Shakira, I was like, okay, I think I, I need to do some pole dancing here because, Oh my gosh, like J lo is out of this world, you know,
Speaker 2 (25:20):
It's an amazing fitness tool. It really is. Yeah. It's on so many aspects.
Speaker 1 (25:25):
Yeah. Oh, and I never thought of that as being in circus again, under that circus umbrella, but of course it is. It's just your apparatus is the pole versus the silks.
Speaker 2 (25:35):
Exactly. Exactly. And again, it'll depend on the person and how they want to define circus because it keeps changing. But there are many circuses now that do include pole and there's even something called swinging pole or hanging pole that moves in space instead of just staying.
Speaker 1 (25:50):
Oh my gosh. No, thank you. Oh my gosh. That's crazy. Well, is there anything, do we gloss over things? Is there anything that we didn't hit that you're like, Ooh, I really want the listeners to take home this.
Speaker 2 (26:06):
I just really want the listeners to understand that circus really is for everyone that you can go take a class right now and that you might have a client in your waiting room at any moment that has at least some experience with it. And being able to speak that language or having a little understanding of what they do can really go a long way.
Speaker 1 (26:23):
Excellent. I love it. Now, where can people find you? Where what's your website? Where are you on social media? If they have questions, they just want to say, wow, this was awesome. Where can they find you?
Speaker 2 (26:34):
They can find me on social media at the circus doc on Instagram, on Facebook, on Twitter. I'm on most of the things I was going to say, all the things that I'm on Tik TOK yet. But I am out there on at the circus doc and my website is the circus doc.com. And through there you can find the courses I teach and lots of information lists of physical therapists that like to work with circus artists and other resources to help improve your knowledge about circus bodies.
Speaker 1 (27:04):
Amazing. Well, thank you so much. And before we sign off, I have one last question and that's knowing where you are now in your life and your career. What advice would you give to your younger self let's say right out of, right out of PT school?
Speaker 2 (27:18):
I think the biggest thing is taking the time to you. The biggest thing is to be brave enough to take the time to listen more. I think it really does take bravery to admit you don't know everything and to do more listening and do more and better question asking both of my patients and of mentors and of just the resources around me. I think in the last couple of years, I've just done such a better job of connecting with humans like yourself and, and taking the time to ask questions because you just never know what you're going to learn and where you can help each other on this great journey that we're not in competition and having the bravery to collaborate.
Speaker 1 (27:58):
Amazing. What great advice, Emily, thank you so much for coming on. This was great. I'm like so excited because I feel I learned now and like, I was like, I want to go take a class. So next time I'm in New York, we'll go together. Perfect deal. I will hold you to that. Thank you so much for coming on.
Speaker 2 (28:15):
Thank you so much, guys. This was a bunch of fun,
Speaker 1 (28:17):
Everyone. Thanks so much for listening. Have a great week and stay healthy, wealthy and smart.
In this episode, author of The Full Spirit Workout, Kate Eckman, talks about achieving success and fulfillment.
Today, Kate talks about the 5 P’s of Confidence, the story behind the Full Spirit Workout, and how we can find personal fulfillment and success. How can we boost our mental metabolism? How can we achieve our goals?
Hear about coaching programs, how to handle perfectionism-itis, and get some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Coaching isn’t consulting. It’s not therapy. It’s not problem-solving.”
- “Remember to stay in your own lane, think about the impact that you want to make, and the work that you’re here to do.”
- “So many people see the end result and they just want that, but what they dont see is all the work that we have put into it.”
-
The Five P’s of Confidence (and 2 Bonus P’s):
-
Presence. Being fully present where you are, in the moment. But also, showing up like you mean it.
- Patience. “Hold on loosely.” Put in your work, take those action steps, and then take your hands off the wheel, gently lean into trust, detaching from those outcomes, release expectations, and trust in the process.
- Purpose. This is your ‘why’. It’s important to have a strong ‘why’ that will keep you going, even when it doesn’t feel like anything is working out for you.
- Preparation. Build habits that lead to better behaviours that lead to better results.
- Practice. Your talent warrants investment.
- Pause. Take a moment of mindfulness.
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Person. Be a person. Lean into not only the person you present to the world, but the messy person behind-the-scenes.
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“We don’t often give ourself the grace to expand our inner selves.”
- “You can do whatever you decide is important enough.”
- “Everyone is struggling with something.”
- “Even if you don’t tell someone else, tell yourself the truth.”
- “It’s all happening. Keep going. Keep trusting. You’re doing a great job. I’m so proud of you. Just go relax and have some fun. You’re doing great.”
More about Kate Eckman
Kate Eckman empowers high-achieving individuals to actualize their full potential. She leverages her experience as a well-known communications, performance and mindfulness expert; accomplished entrepreneur; and former elite athlete to equip leaders with the tools, methodology, and energetic boost they need to compete and win at the game of life.
With a results-driven approach rooted in neuroscience, positive psychology, and whole-person coaching techniques, Kate helps her clients succeed in and out of the boardroom and on and off the field. She guides them to identify who they are beneath their titles and labels, clarity their priorities and values, and then co-create a game plan to get them from where they are now to where they most want to be … adding in some fun and humor along the way.
Kate incorporates a mind-body-spirit approach into her coaching engagements, recognizing that when we take care of our inner world, our outer world takes care of itself. Clients report that working with Kate leads to greater focus, energy and presence; increased performance and resilience; more meaningful relationships and newfound confidence; and greater overall well-being and fulfillment.
As someone who is known to thousands as a broadcast journalist and an international TV personality, Kate understands the pressures and demands to be always “on,” perform at a high level and be an exceptional team player. She brings that high-level presence, professionalism, and infectious enthusiasm to each coaching engagement.
Kate recently led and organized the team behind the launch of QVC’s first and only proprietary beauty brand, which made more than four million dollars in sales the first day alone. Known for her incomparable salesmanship, she helps global beauty brands shape their vision, strategy and innovation to inspire the achievement of breakthrough results.
Kate earned her B.A. in communications from Penn State University, where she was an Academic All-American swimmer. She received her master’s degree in broadcast journalism from Northwestern University’s Medill School of Journalism. She graduated at the highest level from Columbia University’s executive and organizational coaching program. Kate is also a certified International Coaching Federation coach (ACC) and a licensed NBI consultant.
Kate is the author of, The Full Spirit Workout: A 10-Step System to Shed Your Self-Doubt, Strengthen Your Spiritual Core, and Create a Fun & Fulfilling Life, which helps readers excel at the game of life with research-backed strategies (New World Library, April 27th, 2021).
Passionate about mindfulness practices for both brain and body health, Kate is a meditation teacher and course creator for Insight Timer, the world’s number-one ranked free meditation app.
Suggested Keywords
Coaching, Spiritual, Perfectionism, Mental Health, Workout, Community, Confidence, Goals, Support, Presence, Patience, Purpose, Preparation, Practice, Pause, Person, Health, Truth, Fulfilment, Success, Impact,
Pre-order the book for FREE gifts: https://www.thefullspiritworkout.com
To learn more, follow Kate at:
Website: https://www.kateeckman.tv
Facebook: Kate Eckman
Instagram: @kateeckman
Twitter: @kateeckman
Pinterest: @kateeckman
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Read the full transcript here:
Speaker 1 (00:01):
Hi, Kate, welcome to the podcast. I'm really excited to have you here. Thank
Speaker 2 (00:06):
You so much for having me. It's my joy to be here. And now,
Speaker 1 (00:08):
As I said, in your bio, you are the author of the full spirit workout. And we will talk about the book in a little bit, but what I'd love to talk about first? Well, a couple of things. So one I, one thing I'm actually quite curious about, I noticed on your website that one of the coaching programs you went through was the Columbia three CP program. And I know a lot of listeners are always wondering what, what is a coaching program? How can I get into that? So can you talk just briefly about that before we get going? Just so listeners have a better idea of where you're coming from? Sure.
Speaker 2 (00:48):
So it was a very, very rigorous intense program. It was about a year, a little over a year, and it was, it was deeper and harder than master's degrees. And I had colleagues who went to Columbia business school. They said it was harder than that. I mean, it was really intense and hardcore, but it was such thorough training. And we learned whole person coaching techniques and neuroscience and positive psychology. And it was just so much peer coaching and, and really going through a really detailed process and going through the guiding principles of coaching and going through just so many programs and processes that they had developed. And that main man named Terry [inaudible], who started the program, who is a genius. So I was just working alongside so many top notch people and minds, and the faculty was incredible and, you know, coaching right now is I feel like everyone in their mother is calling themselves a coach.
Speaker 2 (01:48):
And it, it, it kind of disheartens me a bit because it is a serious role where you're holding someone's well-being and in your hands. And it needs to be, I think, a bit more regulated and taken a bit more seriously. And that's why I chose this program. And I wanted to have this knowledge and, and taking the profession very seriously and not to sound like a total nerd, but I also loved that they required us to write a massive research paper that was almost like writing a thesis and, and really dive into the art and the practice of coaching. That's
Speaker 1 (02:19):
Amazing. I have to, I didn't think that it was going to be that rigorous year because oftentimes I hear, you know, kind of coaching programs might be a couple of months, three or four months. So that is much, much more than I thought. It sounds incredible.
Speaker 2 (02:33):
It was, was probably the best investment I've ever done. And I, I have gotten another graduate degree at Northwestern years ago and journalism, and I was about to say, I love that program. I liked it. It was it, that was another superintendent. Was it a year intensive program that I took an accelerated program and nearly killed me. It was, it was so much work. So between undergrad and grad and then this program, the Columbia was I think my favorite and just rewarding and just to be able to help people and an impactful way. And so much of it is, is, is underneath the surface level though, you know, it's listening to what people aren't saying and, and really reading and feeling body language and just opening up this space and container for people to come to their own conclusions. I think that's another misconception about coaching, coaching.
Speaker 2 (03:22):
Isn't consulting. It's not therapy, it's not problem solving. You know, when I first got into coaching, that's what I thought it was like, if you were my client and you came to me for example, and said, I want to make more money. I thought it was my job to come up with this business plan or to come up with the solutions. But really it's, we're focusing on the client's agenda and you have all the answers. It's my job to ask the questions that will make you reflect so deeply questions. You've never been asked before to take you into the depths of yourself where you actually have the answers. And of course, I can say some things I can ask for permission to add here and there, but really it's about bringing out your own wisdom. That is way more powerful than anything I could say to you or tell you to do. Does that mean makes sense?
Speaker 1 (04:08):
Yes, absolutely. And, and I thank you for that because I agree the word coaches all over the place these days. And I think that was a really succinct way of saying, Hey, this is what coaching is, and this is how I learned how to be a good coach. And I think that that makes a big difference.
Speaker 2 (04:29):
And it, it really is a partnership. I like to say, I'm your thought partner and, and we are co-creating together. And it does become about that, that container. So, you know, I, everyone who's in the field obviously wants to help someone. I just invite and encourage people, whatever your field is. And you know this from your profession too. I think this, I come from a family of doctors. So I come from a family where you go to school for years and years and years, and you have to have the medical school and the fellowship and the residency and all the things before you can, no one can just call themselves a doctor on Instagram, you know, or a physician. And so I see, I see I've seen what my brother has gone through, for example. So I think I wanted to, I want it to be there and, and, and have longevity and just the type of people that I wanted to coach who quite frankly, are not going to put up with any nonsense, know the high achievers are professional athletes.
Speaker 2 (05:23):
They expect you to come in and be on top of your game. And that takes training. And that takes research. And that takes working on, on yourself. And then as I like to say, you have to fine tune your instrument before you can play it for the world. And there's no escaping that. And you know, when you're in the midst of the hard work and you're paying a lot of money to work really hard, and you see people around you who have no credentials and are making 50 K whatever on Instagram to sell something, that's when you have to just remember to stay in your own lane, think about the impact that you want to make and the work that you're here to do, because it wouldn't be tempting. I can see why people like I would never go back to school or I would never pay money or do some intensive program. That's too much work, but I just, I just have to ask what kind of impact do you want to make? And I can even feel some eyes rolling or, you know, a lot of people, I think don't want to hear what I'm saying, but for me, this is, was the right decision.
Speaker 1 (06:21):
Yeah. Well, I think I can say with confidence that I feel like my audience does want to hear what you're saying, because you know, as physical therapists who go to school for seven years,
Speaker 2 (06:31):
You know, my mom's a PT, so I
Speaker 3 (06:33):
Love you already. Yes. Yeah.
Speaker 2 (06:36):
So I, I, I, okay, so your audience gets it because I, you do a lot of the Instagram crowd. They, and I'm not saying that that's your audience, but they kind of think I see it, that culture thinks the opposite. And it is kind of frustrating because same with writing a book, for example, I think so many people see the end result, whatever it is, and they just want that. But what they don't see is all the work that we have put into it. And this, this reminds me of even a story that just came to mind that comes to me often, which is interesting because it literally happened 20 years ago. But in 2001 country singer Shelby, Lynne won best new artist. And when she accepted her award, this is the only acceptance speech I have ever remembered at the Grammys ever 20 years ago. And she was gracious. And she said, thank you. But also kind of mocked the award and said, best new artist. It only took me 13 years and six albums to get here. I just thought, yeah, because people think you just show up and no, you have to put in the work. And I don't know why people aren't wanting to hear this or understand this. And so all everyone listening who has been through your seven year program, I honor you, and you will have a much greater impact and you will have the longevity. And, and if I was your patient, I would feel so held in your care. So thank you.
Speaker 1 (08:05):
Yeah. Yeah. That's great. And you know, I, as I mentioned, I said, I could say with good confidence that my audience would agree with you and that this is a nice segue to talk about. One of the things that that you coach and that's confidence. So what are the five PS, the letter P just for people know of confidence?
Speaker 2 (08:28):
Sure. So it's presence, patience, purpose, preparation, and practice, because I love you and your audience. I'll give you two bonus piece. And that is pause and person as in be a person, and I'm happy to quickly go through them. And it's something that we can all discuss later, even offline or online somewhere, but presence. So presence obviously is being fully present where you are with whomever you're with, even if it's just yourself. So the phones and the TV and all of it is off. And you are just there in the moment, focusing on your breath, focusing on the task at hand right now, I am locked into you. Nothing else. There's a million other things that could be going on, but being present. And then with that comes, bringing your presence. So showing up like, you mean it. So many people tell me, oh, I'm not getting a school.
Speaker 2 (09:25):
This isn't happening. And I'm like, I don't think that you care, you're showing up. Like you don't care. So I think bringing that energy, bringing that enthusiasm to everyone, you meet and to everything that you do, patients, oh man, I think of that 38 special song that says, hold on loosely. So I think sometimes we're all guilty of gripping. So tightly to our goals, we want this relationship. We want this job. We want this money. And when we grip so tight, we actually repel it. So putting in your work, taking those action steps and then taking your hands off the wheel and gently leaning into trust and detaching from those outcomes, releasing expectations and Shelby Lynn, the story I just told what a perfect example of patience, right? And trusting in the process and confidence stems from the words to trust, to do something with trust, which is great because you can build on that.
Speaker 2 (10:18):
And it's something that comes from within purpose is your why. So it's so important to have a strong why that will keep you going. Even when it's hard, when you want to throw in the towel, when it doesn't feel like anything is working out for you, that's what this book. I had a really strong why. My two friends who are no longer with us and they kept me going when it was really challenging. And I think a lot of people, this is where they get tripped up because I'll ask them, well, why do you want to do this? And they often don't have a good answer. Or the answer is impressing other people or just money is the only goal. Things like that. It's like the people who say, well, I want to be a parent because when I post pictures of my kids on Instagram, I'll get more likes.
Speaker 2 (11:01):
Ooh, probably going to hate parenthood. And your kid's probably not going to go over well. Yeah, yeah. Not a good reason to be a parent. Yeah. So I, I, yeah. And, and if you are a parent, you are my personal hero. I don't know how parents get anything done. I, I bow down to them every day. Preparation of course is about, you know, building habits that lead to better behaviors that lead to better results. So that boosts your confidence when you're prepared and practice, there's this misconception that we don't have to put in that much work. It's like what I was saying about school and the credentials. And I think of Tom Brady, because we're the same age. We're both big 10 athletes. He's still winning super bowls. And my knees hurt when I go to Pilates. So Tom Brady are an inspiration, but Tom Brady is the best because he practices harder than anyone.
Speaker 2 (11:52):
You know, people think, oh, well, if you need that much work, you must be the worst. No, you, you P he practices that much. Cause he's the best, not the worst and your talent merits investment. So practice pause is really what the, this inner fitness program is about. It's, it's taking that moment before you respond to the upsetting email, before you tell the jerk what a jerk they are. It's taking that moment of mindfulness and thinking, okay, I'm really upset, but I'm willing not to be. And who do I want to be instead? So it is about non-reactivity again, I got to practice this a lot. And, and the last one is, is, I mean, they're all my favorites, but this one makes me laugh, be a person. My speaking coach, Eduardo, plusser always says this to me because I'm someone who has struggled with perfectionism and performance and obsession with performance.
Speaker 2 (12:39):
And he always says, just be a freaking person. And this is really about our humanity and just leaning into not just the person we present to the world who has put together, but that really messy person behind the scenes, just trying to keep it all together. He or she is awesome to let let's embrace that and just be a person. Cause that's where that's, what's really beautiful about us, right? Our humanity, and just being willing to show up, even when it's hard. And, and that's, that's another, a key building block of confidence is, is our willingness to show up and not be great first or ever that's to be in dance class, never going to be a great dancer, but you show up, I build confidence because I dare to put myself out there and not be good and a room full of dancers and feel like a complete, but it's fun. And, and it's, it's that one activity I can do where I it's such a rebellion against my inner perfectionist. Cause there's, there's never going to be a perfect performance dance class. It's, I'm just there to show up and, and, and move around and, and release some energy.
Speaker 1 (13:40):
Absolutely. You're speaking my language. Totally. I, cause I took, when I was at Equinox, I always took this dance class. It was like six 30 in the evenings. And it was with this guy, Johnny, and some days it would be like jazz hands. Some days it was hip hop. So I'm not a dancer, but I would show up and I would have the best time. And I mean, there are women in there who were clearly dancers in their early years. I mean, they're like in their sixties and seventies and they're splitting and high kicking and doing all this stuff. And I'm like, I can't even touch my toes when I'm sitting. And these women have like, their, their stomachs are on the ground, you know, but it's true. You go out there, you put yourself out there. And the more I did it, the more confident I was as a dancer, not that I'm a good dancer, but I was confident in what I was doing because I practiced. And the more I did it, the more, and I also think the more I really enjoyed it.
Speaker 2 (14:34):
Yeah. And, and those moments, then we become a dancer and I had this woman in class who was a gorgeous dancer and I had to perform in front of these people. Let me restate that. I got to be a person in front of these people. And they, they wrote the one woman wrote me a note after class. And she said, you are a dancer. And I thought, yeah, I am. Cause I'm here dancing. It's not about being ushered J lo or you know, whomever it's I'm yeah. I'm here dancing and I'm a dancer.
Speaker 1 (15:04):
Yeah. That's great. And you know, and it brings me to that concept of perfectionism and performance, which a lot of high achievers have they have perfectionism itis or performance itis. I don't know that those are words, but you know what I'm talking about. So what do you say to those high achievers where it's all about high performance and perfection? Yeah. I first
Speaker 2 (15:32):
Would want to work with people like I had to do with myself and just ask, where does this come from? Where does this thought process come, where you even think you have to perform or achieve at this high level to even be worthy or valuable or loved. And it really is about feeling safe in the world and not feeling so alone. And that's the story I tell in the book about being the four year old at the swim club and being in swim lessons that I didn't really like and overhearing my instructor, tell my mom that I'm not a very good swimmer and how heartbreaking it is for me as an adult to think of my sweet little innocent. Four-Year-Old thinking like, oh gosh, I, I love my mom and dad. I want them to be proud of me. I don't want them to have a daughter who's a bad swimmer, especially since they're so athletic and then going on to break every record at that swim club, because my mentality was I have to perform at a really high level to be safe and not just when the love of mom and dad, but I guess I need to impress strangers.
Speaker 2 (16:34):
So they say nice things about me and I can feel worthy. And, and then people will love me because I'm good at something. And they can be wowed by my quote unquote performance and what a trap that is. So I think it is about taking ourselves back to where we even come up with this mentality. But I think when we are in that place of obsession, it's like I said, you have to go back to being a person, but you have to also go back to why do I even, why am I even doing this? And, and I think when you are more clear, even I have a client who's extremely wealthy, extremely high achieving, and he's coming to that point in his life. He's about to turn 50 where he thinks, what does all of this even mean? What is my cause? He had a health scare and what if I pass away, what is my legacy that I made a bunch of money?
Speaker 2 (17:22):
And, and so he's starting to think of what impact he wants to make, or, you know, like many of us, we experience external success, but then we feel unfulfilled on the inside or insecure full of self doubt, full of anxiety. And so I think it's just coming back to what, what really matters to us and who are we underneath all of the titles and the labels and the achievements and the accolades and awards, all of that stuff, and really clear on that. And then your desire to be perfectionistic or to always have to perform at a high level goes away because you know who you are without all this stuff. And then spoiler alerts, you actually end up achieving more and less time and attracting the people, experiences relationships, because you've become the person who just gets to have that or gets to be that rather than striving and forcing and controlling. Does that make sense?
Speaker 1 (18:19):
It does. Yeah, absolutely. And it has me going back in my head, like, is that why I did that? Is that why I did this? Was it for, you know, to have your parents feel proud of you or to have people tell you, wow, that was so good. Or for, yeah. I need to do a lot of inner work thinking about this right now,
Speaker 2 (18:43):
But what a great practice that I invite you and everyone listening to do is go back and think of that limiting thought or think of, wow, I am so anxious and it's because I feel like I have to impress people or earn someone's approval and try to go back. And it's always in childhood something. And it's something that we don't even think of. I hadn't thought of that swim club moment until I was doing heavy thought around this book when I was writing it and doing a lot of meditation and reflection, and that story came I'm like, where did this come from? This obsession and how crazy right. And that we hold onto, and then also inviting everyone to, instead of the criticisms or the society that tells us how we don't add up ever, especially as women. So really think of the compliments or think about your strengths and, and, and making that the root of your core belief system instead of all that other crap. Yeah.
Speaker 1 (19:36):
Oh, it's so good. And now let's talk a little bit more about the book. So the full spirit workout. So what is, what was your why for writing the book, talking about purpose, right? So let's tie it together. What is your why?
Speaker 2 (19:52):
Oh, you're so good. My, why is salmon Roth? There are two dear friends. They were both two of the loves of my life and they both decided to leave us. They both took their own lives almost a year to the day of one another. So I lost both of them in one year. And this project, I call it a divine assignment. It's the most challenging life assignment I've ever had, certainly the most rewarding, but I did it for them. And for everyone who has felt like them in a place of hopelessness or despair who didn't have the tools who didn't feel confident or secure or safe to reach out for help, who thought they had to do it all on their own or hold it all in. And the, the name of being a man or looking cool to the outside or not wanting to show their dark side for lack of better term, and also wanting it to be a celebration of life for everyone.
Speaker 2 (20:47):
And, you know, I talk about society and, and it's really sick right now. And it bombards us with all these messages about how we aren't enough and it doesn't give us the tools to, to be healthy and happy. It's just, it's the constant negative. And so, you know, I was a competitive swimmer for 17 years and knew how hard I had to train my physical muscles to compete at a high level. And after losing them and finding myself at the Dwayne Reed on eighth avenue and 34th street contemplating taking a bottle of pills, I knew that my life depended on answering this wake up call and shifting the way that I was choosing to live my life. Like everybody, I will say everybody is guilty of placing their worth outside of themselves. Some may not even realize it, but that's why they have the emptiness feeling on the inside at times.
Speaker 2 (21:38):
And I really just dove into so much studying and research and spiritual tools and practices and, and, and went back to school and just really wanted to put a program together for everybody. You know, someone said, who is this book for? And I said, everyone who can read, because we all need these practices, just like, we all need to exercise our physical bodies to stay healthy and fit and strong. And it's not about looking hot in a bikini. It's about being able to navigate the world and do everything that you, you want to do and can do whether it's travel or get out of bed. This isn't about a six pack abs, but this, my program will give you a six pack spirit, and that will lead to health on every level. So I just encourage everyone, even if it's five minutes a day to do some of these practices, I wrote this book and a fun is in the subtitle.
Speaker 2 (22:27):
So this is fun. It's, it's a workout you're going to actually want to do and return to. And, and I return to these practices daily because it's just like exercise or sleep or eating. It's, it's part of our health that we need to tune into every day and, and give ourselves this gift. And if I've learned anything this past year, my wellbeing comes first, no matter what, I'm not willing to go to a dark place. Again, I, I'm not, I'm not doing it. And I, I just, I see so much struggle around me. I it's been such a challenging year for everyone. That life was challenging way before COVID and then everything else we dealt with, especially in this country this past year, it has just been trauma and chaos after trauma and chaos. And so this is really within these pages, just such a place to be in self discovery and be in self-growth and really get acquainted with yourself again and feel really good. And it's all there for you. So let's go, I'll just do it.
Speaker 1 (23:28):
Yeah. And I loved it. The thing that I really picked up on, you said, you know, you want to be able to like you work and you exercise and you move to help kind of expand your world. Right. I mean, as physical therapist, I mean, I have patients who are in pain, osteoarthritis of their knees, so they can't walk. They can't, they can't do the things they want to do. And they, and, and she said to me, just today, she's like years ago, my world was, I could do anything. Now it's just narrowed so much because I don't have the physical capacity to do the things that I used to do. And, you know, you hear that. And it's, it's so upsetting to hear, you know, and she has some other systemic issues going on as well. But so when you just said, you know, you want to kind of work on your inner spirit and your inner self, just like you would your, your health on the outside. Because again, you don't want to narrow your, your mind and your spirit, like you would, if you didn't exercise and move on the outside. That just so
Speaker 2 (24:37):
Brilliant what you just said. Yeah.
Speaker 1 (24:40):
It just really, when you said that, I said, oh gosh. And we see it all the time. And people from a physical standpoint, and we don't often give ourselves the grace to, to expand our inner selves as well. So I,
Speaker 2 (24:54):
I love it. That's such a great analogy. And that's why I did, because there is such an obsession with the physical and this world, right? What we physically look like face hair, skin, body, all of that. And the obsession with, with working out where it goes too far, the other direction where it becomes unhealthy and that's the whole diet culture and all of it, but that's such a perfect example. And people see that like, oh, I break my leg. I can't do X, Y, and Z, but so many people are injured on the inside because, or they're there, you have the spiritual flag, the emotional flag from just not working out are inside. And it's the same. It has the same limiting effect. And so when, when you do get fit and strong and resilient and optimistic on the inside, really the world is yours.
Speaker 2 (25:37):
And you, you, like I said, you attract the opportunities, experiences. You become the person who can actually attract and achieve your cherish goals and live the life you say you want to live. And I think a lot of us have forgotten that we have access to this and that we are powerful. And so I'm just gently reminding everybody to tune back into that and to live from that place so that you don't feel limited. So you don't feel like you have a broken leg or like, oh my gosh, I can't physically even exercise. I feel miserable. We're doing that to ourselves, with our minds and with our hearts and our spirits. We just, we don't even realize it. Yeah.
Speaker 1 (26:15):
And you know, I was going to just ask you what is the book's core message, but I think you just said it, is there anything you'd like to add?
Speaker 2 (26:22):
I mean, I, it is, I, I get very, almost like dramatic and passionate about it. Just reminding people who they are and, and being comfortable with who you are right now in this moment exactly where you are and reminding yourself of, of your strength and your inherent worth, and that you can do whatever you decide is important. I think people think, oh, this is just as good as it gets, or I can't have that. Or even had some woman say to me, well, you're beautiful. You can get anything you want. And I think, wow, are we still doing that to each other where we're, we're judging or policing or thinking that it's about what we look like? Or you can do everything because you have a nice house and, and diminishing each other and, and everyone is struggling with something. And, and I wish people would, would talk about it more and tell the truth.
Speaker 2 (27:09):
And even if you don't tell someone else to tell yourself the truth and sit, I call it my sit and stare time where it's, non-negotiable at least five minutes a day. And I sit and stare out the window or stare ahead. And I talk to myself like I would a small child and say, how are you doing, what do you need? What's working. And it has saved me so many times. And, you know, I can hear some people saying, well, it must be nicer. I don't have time to do that. Just like people say about meditation. And I say, I don't have time to be angry. I don't have time to treat people badly because I'm exhausted and overwhelmed. And at the end of my rope, I don't have time to be miserable. I don't have time to be sick. I don't have time to be rushed to the hospital and pay some crazy bill or whatever, you know? So I think it's just asking yourself, what do you really want? And who are you? And, and be willing to show up and just keep going and take little baby steps here and know that you're going to get stronger and stronger. And then you will crave this. You'll crave the sit and stare. You'll crave these journaling exercises and this time to really get to the core of what's happening inside of you.
Speaker 1 (28:25):
Excellent. I love it. Thank you so much. So again, everyone, the book is the full spirit workout. And now Kate, where can people find, you find the book, et cetera, et cetera. So
Speaker 2 (28:38):
You can find the book@thefullspiritworkout.com. And that will also link to my website, which is Kate ekman.tv, E C K M a N and Quebec men, everywhere on social. I'd love to connect with you. I love meeting people who are ready to kind of take on this journey and have fun with it. And we can all support one another. I really believe in community and collaboration over competition. And we're all in this together. So let's go,
Speaker 3 (29:03):
As you said, let's do it. Let's just do it. Yeah. Excellent. I love
Speaker 1 (29:07):
It. Thank you so much. One last question that I ask everyone, and that's knowing where you are now in your life and in your career. What advice would you give to your younger self?
Speaker 2 (29:17):
Ooh, hold on baby. It's it's all coming. It's all happening. Keep going, keep trusting. You're doing a great job. I'm so proud of you. Just go relax and have some fun. You're doing great.
Speaker 1 (29:32):
I love it. I love how you said. I'm so proud of you. That's so nice. Such a good exercise to do. I love it. Kate, thank you so much for coming on for your book and sharing all this great advice. And I just thank you very much. Thank
Speaker 2 (29:47):
You. You're the best. I appreciate you having me
Speaker 1 (29:49):
Pleasure and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Optimal Self Coach, Jeremy Herider, talks about how he discovered, and strives toward, the Optimal Self.
Today, Jeremy talks about “the Art of Becoming the Best Version of You”, why it’s important to you but more important to those who look up to you, and why we should prioritise #GenerationalHabits over #GenerationalWealth.
Hear about the moment he started re-evaluating his identity, his three most important values, and his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “If I’m going to have success in any endeavour, it’s going to come from what happens when no one’s watching.”
- “Don’t get your identity caught up in things that are out of your control.”
- “Integrity is do what you say you’re going to do. Character is ‘be who say you are.’”
- “You can be what you want to be but, at the same time, not at the expense of someone else.”
- “If you’re lacking motivation today, normally it’s not lacking motivation, it’s lacking clarity. When you get clear on something, motivation jumps out of you.”
- “You either give that thing 100% of you, or dont, because 99% wont work.”
- “You’re leaving something behind whether you like it or not.”
- “Stay the course. It’s going to take work. Don’t be afraid of the work.”
More about Jeremy Herider
Meet Jeremy Herider, life coach, business consultant, professional athlete, podcaster… the list goes on. How can one person even have so many titles? That’s just what you get when you’re living as your Optimal Self. As a pioneer in two professional sports, Jeremy has spent a lifetime building the elite habits necessary to thrive not only in pro sports, but in every other venture that he’s been a part of.
Originally from Lancaster, California, Jeremy found his strength as an athlete from an early age. He was a three-sport letterman in high school and an MVP in baseball. He graduated from Gonzaga University where he was an All-Pac10 Infielder. His pro baseball career took off not long after.
But his drive didn’t stop there and neither did his list of accomplishments.
Jeremy was the first contracted player with the Diamondbacks to get a hit in the history of the organization. He was later drafted by the LA Reign, officially making him a two-sport professional athlete. More recently, Jeremy has been named a CrossFit Champion, taking home 1st Place for the Deadlift/Box Jump event. Of course, now Jeremy has shifted his focus once again as a productivity consultant for Fortune 500 companies, private business coach, and motivational speaker.
Jeremy’s Optimal Self Coaching program and podcast boil down this lifetime of achievement into tangible, attainable habits that anyone can adopt for success. No success story, including Jeremy’s, happens by accident. Begin yours with Optimal Self.
Suggested Keywords
Motivation, Identity, Improvement, Habits, Wealth, Health, Smart, Success, Achievement, Integrity, Character, Generational Habits, Priorities, Clarity, Empathy, Empowerment, Choices,
To learn more, follow Jeremy at:
Website: https://www.optimalself.today
Facebook: @OptimalSelf1
Instagram: @optimal_self
YouTube: Optimal Self
TikTok: @optimalself
Optimal Self: Optimal Self linktree
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript:
Speaker 1 (00:01):
Hey, Jeremy, welcome to the podcast. So happy to have you on today. Well,
Speaker 2 (00:05):
Thank you. It's so happy to be here. I know
Speaker 1 (00:08):
A fellow podcast host, we'll get into your podcast later on in the, in the episode, but I always love to have a fellow podcast host on for a number of reasons. Number one, being good sound.
Speaker 2 (00:21):
That's so important. That's so true.
Speaker 1 (00:24):
So important. All right. Now, before we get into the meat of the interview, what I'd love for you to share with the listeners is how your background of being a professional athlete baseball, CrossFit I can Zaga, right? Almost they almost did it. Oh my gosh. Are you just dying?
Speaker 2 (00:53):
Was except for that game, we didn't really almost get it. We really got crushed by Baylor. So hats off to Baylor. They, they, they did not miss a beat and they crushed us about halftime. I was, I was already turning the channel a little
Speaker 1 (01:06):
Defeated, but close. Yeah, absolutely. Absolutely. Okay. So enough NCAA talk. So let's talk about how your life as a professional athlete kind of shaped your views on your life now and kind of what you're doing now.
Speaker 2 (01:25):
But I love that question cause it can, it's, it's so many different things in, in regards to, you know, you see what most people see is the end result, right? Is, is you running on a field? In my case, it was baseball. They, they see the end result. They see you on a field with the stadiums packed and the lights are on, you know, and, and, and it's, it's incredible, right? Cause we all watch it. If those of you that are out there that are, that are sports fans, you know, it's just, but we get to see the end result. What we don't see is the work and we don't see the behind the scenes. We don't see it. So as far as is shaping me today is it's still the same way. What I mean by that is this, is that what I, what I loved about athletics was truly not the game.
Speaker 2 (02:14):
Although the game is the icing on the cake. I enjoyed practice. I, I love getting up and going to practice. My mom tells a story, you know, cause you know, with my girls, I have two girls in, you know, mine were like, they didn't want to go to practice. They were like dad, really again. And my mom tells the story that she's like, no, you'd get done with school and you'd walk in the door and already being your uniform ready to go. And you're like, no, I know you got like two hours and I'm like, no, no, no, let's, let's go now just drop me off. She said, you know, she'd be pulling up and I'd be, the door would be open before the car was even stopped and I'm running. So it's, that's kind of the thing that's been ingrained in me since a kid.
Speaker 2 (02:57):
And, and so I enjoy that work and, and moving into your adult life. And when that, you know, when that side of my life ended moving into other aspects, which now I'm in a real estate and in starting optimal self and doing what we do now, you know, I just love the work it's so it's, it shaped me the same way. Is that what I know to be true? Is that the true success that actually people see? Cause a lot of times, you know, people see that success and I, let me be clear. I didn't, I didn't reach my goal. My goal was to be a 20 year major leaguer and a hall of Famer. And you know what I mean? And, and be, you know, Canton, Ohio and be putting on that hall of fame jacket and giving a speech and B I was nowhere near that.
Speaker 2 (03:43):
I didn't get close to that. You know? So my w but when most people see the accolades and they go, oh, wow, you've done this. They, they think of success, right? So again, that is kind of the outsider looking in, but what they, what they never see is, is the work that's put in and that's what you have to love. And, and that happens today is whatever people think is fine. They what they see and what we see of others, that little tip of the iceberg, that's, it's poking out, right? You always see these memes and these things on the internet. It's, what's underneath that water. Well, what I learned is if I'm going to be successful or have success in any endeavor in my adult life, it's going to come from what happens when no one's watching it. What happens when they're not looking with those, those sessions in those days, in those moments. And so that's, that's probably what I learned the most. And it's, it's what I've brought into my adult life from, you know, into these other businesses, from being an athlete.
Speaker 1 (04:44):
Yeah. And that makes perfect sense. And, you know, I liked practicing too. I like the games. I like the practice. I like the teammates, the camaraderie, that feeling of being on a team is always so great. And that teaches you a lot as well. Just being part of a team and being responsible to someone else for someone else and, and being held accountable as well. Yeah, definitely.
Speaker 2 (05:07):
I, yeah, you're, you're spot on. Which is interesting because going from, you know, being a baseball player again with 25 guys on the team, nine guys on the field at a time, right. Is, is you are, you're, you're a hundred percent responsible for, for everybody around you. And, but here's what I'll say. And it kind of goes into optimal self as well. Cause it's the optimal self is the art of becoming the best version of you is that one of the things that I think I failed at in those days was not is, is focusing on, on wanting to be the best at my position or in that league or whatever. And what I should have been doing, what I've learned over time is just truly be the best version of me. Like that guy is still, could be the best, but, but if I'm just stopping and always, then I lose sight of just truly who I am and what I can do.
Speaker 2 (06:03):
And so, and what you're saying is, is very true because going from baseball to where I was accountable to all those guys and coaches and, and, and, and the team, and then when I got into CrossFit and you're all by yourself, you're all by your lonesome, in that a lot of lonely nights at the gym, lonely mornings at the gym training, because nobody has that same goal, right. To, to be a champion or to want those things that a lot of guys would come to the gym and train with me, but I would have to literally put a different guy in at each time, like, oh, we're running, I'll get the good guy, the guy that likes to run, oh, we're lifting the B find the guy that likes to lift. Oh, we're, you know, and so you put, you, you put in all the different people. Cause there was nobody that was just going to be like, yeah, Jeremy, I can't wait to get up at 6:00 AM with, you know, Jeremy, I can't wait to be there until nine o'clock at night with you. So again, I, I, I love what you're saying. Cause that's true. And the truth of life is you do have to have some accountability and the team would definitely show that. So yeah.
Speaker 1 (07:03):
You're spot on. Yeah. And now you mentioned sort of the art of becoming the best version of you. So mentioned it a little bit. Nice segue into why is that important to you?
Speaker 2 (07:16):
So it goes back to that same timeframe is when, when baseball ended and for most people in, in an athletic endeavor, it doesn't end on your terms. Very often, there are very few people that, that get that right. They get to
Speaker 1 (07:32):
Be Derek Jeter,
Speaker 2 (07:36):
Jeter, Tom Brady's like very viewed people are, are those, those people, right? That get to win the world championships, get to be the MVPs and then get to say CNR when they, when they choose. So, you know, most are on, on, on my side where they, they tell you to you're you come to the stadium and the uniform is not in the locker room anymore. We're not renewing your contract. And thanks for your service. It's no. So, but I mean, that app is everybody. It's, it's nothing, but what I learned and I went through a time and I'll be honest. I didn't know it was this right. Is that I was in a form of depression if you will. Is that because I didn't have an identity, my identity was attached to a hundred percent to baseball. Like I was a baseball player and I knew I was in trouble.
Speaker 2 (08:28):
It wasn't that the game was over. I was okay with that. Honestly, like I knew that there was more things I had, you know, two little, little girls in those days, they were tiny, right? Like dad got to be around and we got to go to the park and I got to, I get to do stuff that I, that I hadn't been able to do really. So that was wonderful. But what I was, what I failed to, to start to understand was how my identity, how I had attached myself to being a baseball player. And I was in the store one day and I ran into a gentleman that, that knew me. And he was like, yeah, Hey Jeremy. And all his Isley comes over and he's like, how are you? And I say, great, man, how are you? One of those guys that you see their face, you know, but you don't remember their name.
Speaker 2 (09:09):
Right. And he's like, can you stay here for a second? I want my son. So he calls over. Then here comes his little dude rolling up seven or eight years old. And he goes, Hey, you know, Mason, this is Jeremy, this is the baseball player I was telling you about. And I hadn't played baseball in a few years. Like I hadn't got a paycheck or been on a baseball field in a few years. And it crushed me inside. It was that moment that I realized like, oh shoot, something's wrong. And so I talked to him and we talked baseball and you know, gave him some pointers and you know, you can do this kind of thing. Right. I was the little guy and, you know, we, he was like, he's so small. And I was like, you know, so it was, I, I didn't grow till after.
Speaker 2 (09:53):
Yeah. And we talked a few stories, but when I left there that day, I knew, I was like, okay, I got it. I gotta get this together. Because that, that it shouldn't feel that way. Right. And I knew at that moment that, because he called me a baseball player and I knew I was not a baseball player anymore. Right. Or in the side of being a physical, getting on the field, practicing, playing, getting a paycheck from the Mino, a major league organization. So that's when I knew, I was like, okay, we got it. We got to work on some stuff. We gotta figure some stuff out. Cause th and again, now it becomes getting away from putting my identity to anything more than just being me. And who is that guy? How does he show up in the world? How does, what is the, what are those fulfilling things that happened that I can do on a daily basis that beat me up.
Speaker 2 (10:45):
They, they get me excited. So that, and again, when somebody says, Hey, you're not a baseball player. Cause I almost stopped them. Like I almost had to say, Hey, no, I'm not what to mean. It was just like, oh my goodness. And here's this little boy, you know, and you know, try to keep it together on the outside because on the inside I was just dying. But I hope people, what I hope people get out of that is understanding that don't get your identity caught up in things that are out of your control. It was out of my control of being a baseball player. Somebody had to give me a chance. Somebody had to say, yeah, this is this guy's good enough. Here's a contract. We'll take a chance on you. Somebody has to say, Hey, here's a scholarship. We'd love for you to come to play at our university. It's it's, it's not totally in your hands. The practice, the work, the time, the energy, the effort, the desire. Yeah. That's stuff that I can control. That's the stuff I got to work on, but not tying my identity to the actual act. Right. It's what I do. It's not who I am. And that was a big turning point for me.
Speaker 1 (11:48):
And what advice do you have for someone who maybe is at this crossroads of, you know, maybe they lost their job. Maybe they are came out of a relationship, a long-term relationship where that was part of their identity. So what advice do you have for someone or maybe an exercise or something that you did that helped you pivot that at that moment? Love
Speaker 2 (12:13):
It. That's such a great question. Perfect. So, you know, there's a lot of different ways to look at this and what I, what I go back to is, is the clarity piece in the sense that, who am I? And so then it becomes, start answering that question of what do I stand for? What's important to me. Right? And you know, there's so many different catch words and I'm just going to give you mine for people. So when I sat down and said, okay, what, what matters? Well, what matters the most to me is, is integrity. And so that is a pillar of my life. One is integrity. And what integrity means to me is simple. It's do what you say you're going to do. If you're going to meet me here at five 30 Pacific standard time, then I'm going to be there and I'm going to be ready and I'm going to be prepared.
Speaker 2 (13:01):
So, so integrity, just, just living that way. And then the second thing is, is character. And a lot of people associate those two things together, but here's the difference, integrity being, do what you say you're going to do. Well, character is be who you say you are. If you're a dad, then be the dad, right? If you're that, that worker. And I think that character shows up in many ways, especially for people. Like what you're saying right now is, you know, if you, if you had that breakup and it's going tough because, oh my gosh, now who am I without that partner? Or a job or whatever is understanding first, we got to dig inside ourselves. And so, okay. Who, who do you want to be? How do you want to show up in the world? Well, for me, character means be who you say, you're going to be, if you say, you're going to be that, then you be that every step of the way, and that type of clarity will, will, will actually help you make all the decisions in your life.
Speaker 2 (13:55):
And so, and the third one is empathy for me. So I'll just give you my three integrity, character and empathy. And so I've built it around their empathy. Again, to me was I grew up with women. My mom was a single mom, right? Since she only had sisters, right. Nana and Papa pop was there too. But, but my, my grandparents but, but it was a lot of Nana, right? I was, I was, I was the first born. My mom was 16 when I was born. And so that was not something, you know, no, I don't think there's any 16 year olds in the world that are truly ready to be a parent, right. Or a mother at that at that matter. And so would that being said, right? Like I've been around women that I hear, I get these. And I get blessed with two little girls.
Speaker 2 (14:36):
And my job for them was to empower them, to know that they can be and do anything they want in this world that, that the gender was not. And so I say this in this regard is that empathy means I need to put myself there. I need to listen to them. I don't have to agree. Right. Even if it was, you know, you can go down, whatever. I don't have to agree with you. We don't have to believe the same things, but it means a lot. If I can, if I can listen in and at least try to understand your point or your view on something, it doesn't mean I have to agree, but it does make it a lot easier. And if that, if that's reciprocal, man, how powerful that can be. So I've always wanted those girls to, to understand that. And to know that yes, you can be what you want to be, but at the same time, not at the expense of someone else, you don't have to put somebody else down for you to be for you to be great.
Speaker 2 (15:26):
You don't, you can just be great. It's okay. You can be unapologetically. Great. And, and the thing is, is, I mean, as we grow, so to go back to kind of summarize. So in what you asked was how could somebody would just start with yourself, start with who you are. What, what are those words that you have? And I mean, there's so many different things out there. I mean, I'd love to, free to use ours. We have, when you could sign in and get in, put your email address, we send it to you for free. It's an identity creator. It has steps in it and all that kind of stuff. But even so again, it's free, but if you don't want ours, you can, I can Google. There's so many great things out there that can help people. You know, I'm not, I'm not the one to say, this is the only way there's not, there's so many different ways, but I know this.
Speaker 2 (16:16):
If you're lacking motivation today, it's not, normally it's not lacking motivation, lacking clarity, because when you get clear on something, motivation, jumps off out of you, it will jump out of your skin. Right. And most people can identify with that when they go, oh yeah. When I knew right where I wanted to, where I was going, man, did I take them steps to get there? Right. So, so I think taking it back in that sense for me was all right, who am I? You're not a baseball player anymore. Who are you? What do you want to stand for? How do you want to show up in the world? And let's go be that guy. And again, it also allows you to make incredible choices because the moment you have that clarity, it's like, wait, does, is, is this who I am? Nope. Okay. That doesn't go in my mouth.
Speaker 2 (17:07):
Okay. That's not what I do. Okay. That's not what I, I choose to. You know what I mean? Like you can literally go from every single piece of how you move, what you eat, the people you hang around, you can start to see. And what's really crazy. Karen is this is that you start to implement those things in your life. You start to be it not no other way. Not words on a page, not just talking about it. Yeah. You actually start living it. You start to see the people around, you change all of a sudden other, your, your whole, your identity starts to attract that when you're being that. And it's an amazing with, without even, without even purposely doing it, because what you radiate, what people hear, what people see when, when they say, because again, I'll go back to my life. Like those guys that I was hanging out with, even at the end, right?
Speaker 2 (17:58):
Like it was nothing to go to Monday night football and have, you know, eight or 10 beers on a Monday night and drink a bunch and eat a bunch of wings. It sounds fun. And it's great. But I can tell you this, the moment that, that I, that switch started to happen for me. And I started to pay attention to it. Those weren't the choices that I made anymore because they weren't serving the life that I wanted to live and where I wanted to go. And, and it, and again, it makes things a lot easier for yourself. Cause it's, I call it a hundred or nothing. You either give that thing 100% of you, or don't because 99% won't work because there's always that 1% time that somebody something's going to crack when you leave a crack open, that crack will get used and it will get destroyed and it will be, and it will get bigger. So the more you can give to exactly what you say you are going to give, when you give that a hundred man hundreds easier than 98 or 99, because 98, 99, you haven't really made a full decision yet. And you know, this decision is the, is the key to all of it. Cause the moment you do make that decision, man, how the, how the universe will conspire with you to make it happen.
Speaker 1 (19:08):
Yeah, absolutely. So it sounds like I'm just going to recap quickly that when you're at that sort of crossroads of, of your identity, of, of who you are as a person, you really want to try and get clear on your values, write it down, write down the value, why it's important to you and really like dig deep, you know, it's might be uncomfortable. It might
Speaker 2 (19:34):
Be uncomfortable making that. You're, you're
Speaker 1 (19:37):
Really asking yourself the tough questions. And if you don't like doing this on your own, like you said, there are tools out there. You have a tool, there are tools out there, ask your friends, ask your family. If you have good relationships with said people if not, you can hire someone and they'll help you. But really getting deep and asking those questions. It's the same thing that you would do if you're an entrepreneur and you're trying to figure out your vision of your business, you know, you just want to figure out that vision of yourself as well, and it'll probably help your business. That's a whole, that's a whole other conversation. We'll be here for hours. Now I love when you were kind of talking about what people can do when they're at that crossroads, and you talked about your mom and your grandparents and your children and, and you know, we're talking about generations of a family, right? And so a question I have for you is why generational habits should be taught versus generational wealth. And if you can even explain what you mean by generational wealth, do you mean wealth of money, knowledge, X, et cetera, et cetera. So I'll hand it over to you.
Speaker 2 (20:56):
Yeah. So that's, again, what we see in, in, in at least in our country for sure is, you know, we, you know, that there are families that have, you know, through industrial age, in, in, in all the different times that have handed down, then let's talk w in this case, we're talking money, right. Wealth, right? Whether it be real estate, whether it be, you know, the buildings and things like that, whether it be business, the railroads or the steel or, or whatever that is. And what's, what's, what's incredible is that the majority over time gets, it ends up failing by the third, by the second generation or the third generation. And the reason we say that is the person who built it. They might be handing over the wealth side of things, but they haven't handed over the habits that it took for them to get there.
Speaker 2 (21:50):
And so when you start to get second and third generation away from the actual being that that created it, it starts to dissipate. And so they don't have those same habits, that work habit, that work ethic, that, that mindset that they, that this was built under. So when we talk at optimal self, when we talk about it, we talk about leaving that generation. We start talking about generational habits. And the reason we say that is this is that you're leaving something behind whether you like it or not. You're leaving a legacy, whatever the term is you want to use, you're leaving that now, right now, somewhere, somehow you, because you have interaction with people, whether you have children or not children, you have interaction with people. You're, you're either at a job. Your, you know, if you're in school, right, they're going to know you, somebody, some they're going to be able to describe you and what are they going to describe?
Speaker 2 (22:45):
What are you leaving behind? So what, what we talk about is, and this goes back to what we started this with, is that the only way I can help and I, and I use my family, I use because that's the direct connect, right? My girls, the only way I can help them is by me being a better me. Because again, how many of you out there right now are telling your kids to go make their bed? And they walk by your room and your bed's not made, what are we really telling them? Right? What are we really teaching them? And so when I talk about generational habits, I'm talking about, listen, be the person, right? You've, you've heard Gandhi. You've heard it for years of, of all kinds of Nelson, Amanda, about we have to be the change. Well, well, truly, all you have to do is you can be the best version of you and you will inspire others to do the same.
Speaker 2 (23:35):
What are the habits that you want those children or the people around you to have? What do you want them to learn from you? And if you, if we can at least frame it up that way, then the chances of us living to our own standard are much better. Because sometimes that's what it takes. You know? I mean, our world today is built around social media. Let's be clear, right? It is whatever your view is on it. I don't want to go into my own view because it's really doesn't matter. But there is a bit of it that is corrupting all of us in, in ways myself included. And that's what kind of spins us away from it. So let's get back to saying if, if, because you, we do, I like to tell people I don't care what you think, but I do. Of course I do.
Speaker 2 (24:20):
Like, and I don't mean that I'm going to do something different because of it. If you don't, if I, if I'm living to the best version and you don't like that, then let's have a conversation. Cause, cause I, I, for sure don't want it to hurt somebody, right? That that's, that's not the case, but with generational habits, if we can leave, if we can start to create and be the difference in our own households, that's how we start to create better environments at all times. So we put our kids in better environments. We choose better environments because those environments are, are more conducive to what our habits are. So yeah, we talk about generational wealth as well, because there's nothing greater than that. I mean, if, if my girls can have more than I had, how incredible would that be? That's that's and their kids' kids, right?
Speaker 2 (25:09):
Like, let's talk, let's, let's make it. But at the same time, what I have to be able to help them and what they need to be able to see from me. Not just words on the page or words out of my mouth, but what they need to be able to see from me is how I live. How do I personally get up every day? What is important? What, you know, my hydration, how we eat, the things that we do, the things that we consume, right? Consumption what, not just what we eat, but what we hear, what we watch, what we say, because those words are very powerful. Every word that we, we say, we say to ourselves, you're your cells are eavesdropping that they're paying attention. That subconscious is paying deep attention to that. So again, generational habits or what are you leaving behind? What habits in art.
Speaker 2 (26:01):
And again, because you asked that question and you're like, oh man, as I've done it for myself, I'm like, oh my God, I do do not want my kids. When the kids are a little, this is this is some of you out there that our parents can remember the time that you said something, maybe to you, your wife or your husband or whatever, and your kid repeats it. And you're like, oh, you don't even realize it. Right. We're like, oh my goodness. So again, thinking along those lines, just even if you don't have kids, is what are the words that I'm saying, how am I being and can I help? So can I show people better habits that can, that can inspire them to do the same?
Speaker 1 (26:43):
I love it. That makes so much sense. And, and we'll hopefully be able to instill confidence and allow those next generations to keep building on whatever it is. You're leaving from a wealth, even from a wealth standpoint, from a health standpoint. It's, it's just a great, great way to look at that. Handing down of one generation to the next. I love it. I love it. Okay. So before we start to wrap things up here, where can people find you? How can they get in touch with you? Great.
Speaker 2 (27:19):
So we are on all the social media platforms, Instagram, Facebook optimal self Facebook is optimal. Self one. Igg is optimal underscore self as well. But our, our webpage is optimal self.today, optimal self.today. And on there our, we do have some courses everything up there that we're even showing, right, right now is, is free. So we can, you can jump in we'll, we'll get you in. We have a private Facebook group that we, we put a ton of stuff in that you can actually, you know, it's getting, it's getting pretty good. There's a lot of really cool people in there doing some really cool things. Because again, it's not about us. It's not about me. It's about building a community of like-minded people that want to pull for each other root for each other. You know what I mean? Like environment matters. And so we're trying to build an environment that, that, that people are, are, are trusting of. But they're also contributing back to, because man, to see some of the things that these people are doing just using some of the principles of optimal self is pretty amazing. So we'd love to have everybody. So if you're interested, please optimal self that today. We'll get you there.
Speaker 1 (28:30):
Awesome. Thank you so much. And who can want a little more encouragement and support in their life. And now before we end last question that I ask everyone is knowing where you are now in your life and in your career. What advice would you give to your younger self?
Speaker 2 (28:48):
Man, so much. No, I think that I, I think for myself is the thing that when you, when you ask that the, the, the very first words that came to my head is stay the course and what that means, what I mean by that is a lot of times we, we believe something. We want something we're afraid to talk about it. And I will say this as an athlete. You know, when I was very little, yes, my, the, you asked me what I was doing. And I was like, I'm going to be a baseball player. Like, that's what I was doing, you know? And I wasn't the best. Let's just be very clear. I wasn't your all-star game guy. I wasn't the kid hitting home runs as a kid who was getting tired. I was opposite. I didn't make all star teams. I didn't have all that stuff.
Speaker 2 (29:40):
And so, you know, it was, it was a turning point. I'll share this really quick because I think it'll help people out. There is I was 13 years old and my best friend's dad was our coach. My best friend was the best player, if not in the league, definitely on our team. And we grew up together. He's still one of my best friends to this day. And he was, it was a bigger kid growing up. You probably, you guys probably remember this. I was not that kid. I was the little munchkin kid, you know, you just hit over at second base or, you know so, and at 13 we won the championship in our league and it was probably the best year I ever had as a, as, as a baseball player at that young age, I thought for sure, man, this is the year I'm going to make the all-star team, right.
Speaker 2 (30:23):
This is the year and I didn't make it. And our team had won. So we had this, you know, the, the, the, the pizza party after. And, and so I went up to coach who was also, you know, I'd been on vacation with him because I was, you know, got to, you know, he's, his son was my best friend. And I said, you know, he's like, what's the matter? What do you want? And I said how come I didn't make the all-star team? And he looked me dead in the face. Can I can tell you this? I, I can tell you to this day, which is not even know how many 40, 30 years later he, and I said, and he, I could tell you what he was wearing. I could tell you what he smelled. Like, I could tell you everything about it.
Speaker 2 (31:02):
Every I could tell you what I was wearing. And he said, because you weren't good enough now don't get me wrong. The crushes, any 13 year old boy or girl, probably. But that 13 year old boy in me was crushed. He was, he still is to this day, but I'll tell you this. And I went to the side, you know, and got away from where everybody was. I went up to the lady, the pizza counter, and I asked her if I could use the phone, if she'd call my mom, because her mom wasn't there, she could dial the number for me. I asked her to come get me. She's like, what are you doing? I said, mom, please come get me, please come get me, please, please, please, please swish. She's like, find them on my lap. I didn't even wait. I just went out and sat on the curb, waited for her.
Speaker 2 (31:39):
She pulled up and she's like, what is going on? And as soon as I got in the car, man, tears just pouring out and she's like, what is going on? I'm like, just go, please. She's like, I'm not leaving, moving this car until you tell me what's going on. So I told her, right. I said, I wasn't good enough. And she was like, ready? Any mom? Right? Like, and here's the thing. She, you know, I said, please, don't go in there. I mean, bears don't please, please, please. Well, what do you want? What do you want Jeremy? And I said, can we go to big five? I don't even know big five as a place anymore, but in California was at sporting goods store. And I said, please take me there. And she said, what do you want? And I walked in, I showed her.
Speaker 2 (32:18):
I said, can we please buy me a tea? I'll never forget. It was their big yellow sign, $19 and 99 cents. And that tea is still with me today. That was my 13 year old year. And that tea, I went in the backyard and I hit minimum a hundred balls off that tee every single day. No one's watching. I didn't have many balls to start and I'd tear them up. I started using tennis balls or racquetballs and anything I could find to hit off and a hundred swings. I would not. Everyday when I got home, I'd go out and do a hundred swings or now, or I wouldn't let myself do anything else. Right. All the way through, by the time I was 18 years old, I was, I was in all league player. I was the MVP of our team. I got a scholarship and the rest is kind of history.
Speaker 2 (33:02):
But that, that, that T stays with me as a symbol is because that it wasn't that he was saying, I want people because most people, even when they hear this, they go, what we should have knocked that guy. And what is it? You know, where's he at today? And I'm like, it was the greatest thing that ever happened. And here's why is because he was honest with me. He wasn't saying I wasn't good enough ever. I wasn't good enough in that moment. So again, there was 12, 15 teams in that league. There's, you know, whatever, 15, 16 kids on everything. There's 80 to a hundred kids in that league. It's not like I'm the only kid that didn't make it there. 15 kids and made that all star team. If I was the 16th best kid that year, then I wasn't good enough. Right. But it's not that I'm not good enough forever.
Speaker 2 (33:47):
It depends on how I, how, how you look at it. But I knew this, no one was ever going to say that to me because I, because of lack of effort, you, weren't going to tell me that because I didn't work hard because I'm not, I'm telling you, I'm still not best of that in my, you know, I wasn't the best player of all time now, but I maximized my ability. I will say that like that, that's something that I want people to understand, but I want what I wanted them to see is there's somebody out there right now that has probably been told they're not good enough. They're not, they're not pretty, they're not smart. You're the dumb sister. You're the dumb brother. You're this, whatever, right. It happens to all of us. There's so many people out there that did that lives with us forever.
Speaker 2 (34:26):
And I'm here to tell you it lives with me today, but it lives with me in a way that he told me that, because in that moment I wasn't good enough. And I needed to prepare. I needed to get better. That was in my control. That's the thing that was in my control because I didn't make it at 14. I didn't make it a 15. I didn't make it to say let's be clear. Right. And, and I, and you probably heard this, I think it was a bill gates and say, we underestimate, you know, we, we overestimate what we can do in a year. And we underestimate what we can do in five. And again, and when I look back at those years, I think, oh my gosh, because if I would have expected after that, you know, to go out side and hit a hundred balls and then leave and go make the next all-star team.
Speaker 2 (35:07):
Cause I did it once I would have been, it would be a full, everybody would be like, yeah, you're crazy. Right? It's the same person that goes, oh, I went to the gym once. Like, no, it's not, that's not going to work. Oh, I had us salad. No, that's not going to work. This is about consistency. This is about finding your thing and doing consistency over time will create those results. But, but that story in that, that T is a symbol for me to remember like, Hey, starting a podcast, starting this. You're not good enough. You're not, you have to get better. And that takes the work are you with? And if you're willing to do the work, man, you get to be on cool podcasts like this with Karen. And that's that's, that's what ultimately happens. Right? You get the, you get the plug along and, and cool things happen. So I would just tell myself to understand that, listen, it's going to take work. Don't be afraid of the work. Don't be afraid of putting in the extra hours. Don't be afraid of getting up early. Don't just, just keep going, man, stay the course. Don't be afraid of the work. Cause if you do that, anything's possible.
Speaker 1 (36:18):
Oh, you went on mute. You're on mute. I was saying excellent advice for anyone and certainly great advice for any youngster out there trying to get better at things I want to get better at. So thank you so much for that advice. Thank you. And thank you so much for coming on today and sharing all this good stuff. We will have all the links to all of your stuff at podcast dot healthy, wealthy, smart.com. One click will take you to social media. We'll take you to the website, everything, to all the free stuff you mentioned. So we will have all of that over at the podcast website. So Jeremy, thank you so much for coming on today and giving us up, giving up some of your time.
Speaker 2 (37:07):
Thank you. Thank you so much for having me. I really, really appreciate it. I really enjoyed it. So looking forward to the next time.
Speaker 1 (37:14):
Pleasure, pleasure, and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Financial Advisors at Certified Financial Services, LLC, Erin Hoffman and Jill Van Nostrand, talk about physical therapists’ financial wellness.
Today, Erin and Jill talk about prioritising financial wellness, the different types of disability policies and insurance, managing student loans, and saving for retirement. Is it recommended to get a business disability policy? How can you maximise your financial wellness?
Hear about a few forgiveness programs, asset location strategies, and the difference between an IRA and a Roth IRA, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Our health and physical wellness goes hand in hand with our financial wellness.”
- “There’s a huge difference between the language of a group policy versus an individual policies.”
- “When we’re talking about disability, we’re talking about protecting the source of where all of that comes from, which is our income and our ability to produce income and revenue.”
- “We don’t want to leave ourselves open to situations that would erode everything that we’re working to build.”
- “Student loans are probably the biggest threat to our retirement.”
- “Retirement is something that is never too soon to start.”
- “We want to make sure we have ways of saving that are going to give us liquidity during our working years.”
-
The Top Three Tips:
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Protection and disability insurance.
- Managing student loans.
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Understanding your retirement.
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“Start saving sooner than you think.”
- “Go for it. Achieve what you want to achieve.”
More about Erin Hoffman
Erin Hoffman is a Financial Advisor at Certified Financial Services, LLC (CFS), a wealth management firm headquartered in Paramus, NJ, providing individuals, families, and businesses with financial protection and wealth accumulation strategies.
She specializes in working with women business owners, and Physical Therapists, as well as other Healthcare Professionals. She understands that as a Healthcare professional, you specialize in the movement of the body. Once she started working with her aunt and best friend, who were PTs, she started partnering with countless others who wanted to focus on the movement in their financial world. She has been successful in assisting with sticking points in their finances, leading them to a place of greater range of motion in their financial world. She also hosts monthly educational classes for Healthcare Professionals on various topics- from financial, to legal, to even marketing.
More about Jill Van Nostrand
Jill specializes in helping PTs, dentists, and others in the medical fields grow and protect their wealth by focusing on key areas of importance in their finances. Jill built an impressive career as a musician and college professor, but it wasn’t until her career as a real estate investor that she grew aware that a leading cause of a person’s stress derives from financial worries. As she was intrigued by that relationship, Jill decided to bring together her interest in financial wellness with her desire to help others.
Jill’s mission of educating clients and guiding them towards stress relief and financial balance is drawn from her own family experience. She wants to provide families, individuals, and practice owners with the knowledge to help them protect and grow their assets and, in turn, enjoy life more.
Jill enjoys spending time with her husband, Gary, and son, John, in the North Jersey lake region or hiking in Vermont. She serves on the Economic Development Commission in her town of West Milford, NJ.
Suggested Keywords
Physiotherapy, PT, Healthcare, Finances, Wellness, Policies, Insurance, Loans, Disability Policies, CFS, Retirement, IRA, Savings, Strategies,
To learn more, follow Erin and Jill at:
Website: https://www.cfsllc.com
Facebook: Erin Hoffman
Jill Van Nostrand
LinkedIn: Erin Hoffman
Jill Van Nostrand
Mama Bear PT: https://www.mamabearpt.com
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Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript Here:
Speaker 1 (00:01):
Hi, Jill and Erin. Welcome to the podcast. I am happy to have you on
Speaker 2 (00:06):
Hi, Karen. It's so great to be here. Thank you for having us today.
Speaker 1 (00:10):
Sure. And now today we are going to talk about wellness, financial wellness for physical therapists. So like I said, in the intro, you guys love working with physical therapists. You specialize in this. My audience happens to be a lot of physical therapists, so this is just a perfect match. And today we're going to talk about kind of the top three things physical therapists need to think about and implement for financial wellness. So guys, I'm going to turn it over to you, um, to start it out. What is your first tip?
Speaker 2 (00:50):
Awesome. I'm so glad that we're here today. Karen, because as you're saying, right, our health and our physical wellness goes hand in hand with our financial wellness. And a lot of times there's a disconnect, but that's why Jill and I love working with PTs and it's really close to home for both of us. My aunt's a PT and we have a few friends who have come out as doctorates. Uh, and just a quick recap for Jill and I. We are financial advisors at certified financial services, and we love partnering with PTs who really want to focus on the movement in their financial world and achieve that financial wellness. Uh, so the first thing that we always kind of start right off the bat with them is protection, right? That's, that's the first thing. That's the most important thing also, because if we think about, you know, you've worked so hard to get your degree to get into the clinic that you're in or that you're starting, but we really want to make sure that we have a secured, satisfied lifestyle. If we think about what could happen, if, if we weren't able to go to work the next day, right? If we became too sick or injured, that would prevent us from a bring home a paycheck, uh, and without a paycheck, how long could we pay for our rent utilities, buy groceries, make those student loan payments that are so fun. Right? So disability insurance is first and foremost. One of the most important things that we'll talk about with our PTs,
Speaker 3 (02:25):
That's it that's really well said. Yeah. Thank you, Karen. I think it's really well said, Erin, when we start with protection first, we're protecting our most important asset, which is our ability to produce income, right. To produce cashflow. So that really should be number one in our priorities. And it's really important to think about what our priorities should be. Not everything can come in first for that number one position in terms of things that we need to accomplish for our financial wellness. And that is definitely a number one for us. And there are different kinds of insurance out there. There's individual. There's also disability insurance that covers the daily running expenses of a brick and mortar business, for example, or a practice for example. And there's also disability insurance that covers our contributions to our qualified retirement accounts. So there are a lot of different options out there. Some of which are very new and a lot of people are not aware of them. So we make our clients aware of them and, and get out as much education as we can.
Speaker 1 (03:29):
So now let's talk about, cause everyone, um, let's talk about a couple of those different types because a lot of times I see on social media, we talked about this before, um, especially newer grads or even those out for a while will say, well, I get disability to the company I work with. So do I really have to have my own as well?
Speaker 2 (03:53):
Go ahead. It's a good point. Karen and Jill and I get asked this question all the time, and I think one of the most important words that comes to mind when thinking about having your own individual policy is I it's yours, but it's also portable. You might not be at that clinic with that same employer for your whole entire life. So if you have your own individual policy, that's yours, it doesn't go away. Whether you, you know, have clinics, uh, what have you and Jill and I also spend a lot of time reading through the language of a disability policy with, with our PTs. And it's so important. They might, your employer might not have certain riders that an individual policy would have that could be in your benefit. Uh, and it might not be through a carrier that favors PTs or other healthcare professionals that Jill and I work closely with. So I think those are, those are some of the big, uh, advantages to having your individual policy. And also that you're ensuring your own insureability right. Your, your age, your health, uh, at today's point in time.
Speaker 3 (05:00):
Yeah, definitely. I, and that, that is so true, Aaron, that there's a huge difference between the language of a group policy versus an individual policy. And the individual policies tend to be much more favorable to the insured in terms of what qualifies as a disability, or even in some cases, a partial disability. So when we have an individual policy, we can design that to fit someone's exact needs and their exact situation. And in a group policy, you're just not going to get that kind of customization. Um, it's great to have, but we, we look at it as like an add-on benefit. It's much, much better to have an individual policy and there, and there's another point which comes down to taxation of the benefit if we are actually making a claim and we're getting that benefit, if it's an individual policy that we are paying for, we get that benefit, tax-free income tax free. And if it's a group policy that our paying any part of four, then that benefit's going to be completely income taxable. So there's a big difference in the actual benefits and the language between a group policy and an individual policy. Excellent point.
Speaker 1 (06:12):
Yeah. I had no idea what a great point. Um, and now let's talk about quickly the difference between an individual policy and a sort of business policy. So if you're a business owner, can you, or should you just continue, so continue with your individual policy or is it recommended that you get a business policy, which are usually more expensive?
Speaker 3 (06:40):
Yup. So for an, for an individual to protect their income, we definitely recommend that whether that is a business owner or someone who is a W2 employee of a business, whatever it might be, it's really, really important to have that we do recommend it. And then business overhead insurance is something that can be added on to a, sometimes to an individual policy can be a separate policy and that would cover the day-to-day runnings of the business of the practice. So they're usually two separate policies that people would have. So the one would protect the income and then the one would protect those day-to-day expenses of running the practice. So it's really important to have both, if you are a practice owner
Speaker 1 (07:24):
And would this be, so let's say you are a practice owner and you have what you think is a business, uh, disability plan. Should you specifically ask for business, overhead insurance is, or is, does, is that considered part of it?
Speaker 3 (07:42):
It is a separate policy business, overhead protection. That should be a separate policy. Um, aside from your business insurance, like your business liability insurance, whatever that might be, um, or any kind of property insurance that a property owner would have. So those are all different kinds of policies. They're all super important to have, of course. And when we're talking about disability, we're really talking about protecting the source of where all of that comes from, which is our income and our ability to produce income and revenue. So super important.
Speaker 1 (08:17):
Got it, got it. Well, that is a great tip for people and it's making me think too. I have that. I have to, every time I do a podcast with, with, uh, folks like you, it gets me like, wait, do I have that? Do I? Okay. Yeah. Mental note check to see if I have business overhead insurance, which I don't think I do. That's going to be something I'm going to call about. And now when you're working with your clients and they say, oh, but it's so much more expensive. Can't I just stick with my individual policy.
Speaker 4 (08:50):
Well,
Speaker 2 (08:50):
We always bring up the point of, well, think about the expense, if you did not have this coverage in place. Right. And specifically with the business overhead expense, as Jill had, had talked about, that covers the everyday. So the rent and utilities. How about if you have employees, their wages, how, how is that going to be covered? Right. You know, even loans, voluntold they're covered under having this business expense policy, you can get, you know, additional, you know, health coverage covered as well. So these different plans kind of cover different things and we kind of help PTs and business owners navigate. What's the best strategies for them.
Speaker 1 (09:34):
Awesome. Okay. Before we move on to tip two, is there anything we'd glossed over on disability, insurance and protection that you want to add onto before we move on? I would just say, oh, sorry, go ahead there. No, go ahead, Jill.
Speaker 3 (09:49):
I would just say that it really is one of the most important things that we can do for ourselves financially. Uh, in terms of growing our wealth, we also need to protect our wealth. We don't want to leave ourselves open to, uh, situations that would erode everything that we're working to build. So, you know, just something to leave people with on that. Yeah.
Speaker 1 (10:10):
Very, very good point. You work so hard. You don't want an injury to take it all away from you, right. Okay. That makes perfect sense. All right, let's go on to tip number two.
Speaker 3 (10:21):
Okay. Two is management of the student loans. If a PT has student loans, managing them is a major priority. We believe in terms of financial wellness. It's not something that we can, that we can ignore, uh, that needs to be addressed as soon as possible so that we can get, we can help our PTs get on a plan and get them into a situation where they're going to have a comfortable monthly payment. They're going to have, uh, the POS, first of all, the POS first things we do is look at, is it possible for them to get into a forgiveness program? There are a few different programs today. Uh, we work with an expert in the student loan field. She's helped many, many of our clients, and we work hand in hand with her to help our clients. And first of all, we see if we can get them into a forgiveness program.
Speaker 3 (11:12):
That's number one. And number two, if a forgiveness program isn't impossible, then we're looking into management. How can we get that payment to a reasonable amount that is not going to prevent everything else in life that all of us want to have from happening and to make sure that we can still fulfill our dreams and reach our goals. So if we are, uh, if we have a PT who, for example, is working really hard to get those loans down, we're also gonna talk about, let's start some savings, right? Because we can't get those years back. And it's all about management and for saving and servicing our loans at the same time, then that's going to give us the optimal results. Aaron,
Speaker 2 (12:00):
It brings up a really good point. And a lot of times, you know, student loans might be one of our biggest expenses in our world. So we have to kind of help find that balance between where are we saving, how much are we saving and still paying down, servicing that debt. So that's kind of where Jill and I come in and find that, that happy balance, because we have to be saving and have some kind of bucket, right? God forbid, while we're still servicing the debt and we'll get into the retirement more. But student loans are probably the biggest threat to, to our retirement. Um, you know, we'll get more into that, but it's important to be balanced in both.
Speaker 3 (12:40):
Yup, absolutely. And I think from the perspective of a student today, who's graduating, let's say they're coming out with a couple of hundred thousand of student loans that may seem almost insurmountable. And what we do with our clients is help them and help PTs to, uh, be able to fit that into the budget and still have everything else going on that they want to have in their lives. So it's, it's about building that career that you love, PTs love their careers. They want to be in that career. They, they want to work with their patients. It's a wonderful career and they should be able to love it and enjoy it and not have that be something that's going to be an anchor and weigh them down. And that's what we do with our PTs, helping them with that.
Speaker 1 (13:30):
And let me ask you a question. You had mentioned forgiveness programs. Could you give some examples of some forgiveness programs that, uh, physical therapists and maybe other healthcare professionals can take advantage of if they qualify? Sorry. Sure. We have a few that's okay. Is it okay now? Yeah. Yeah. My internet connection was a little unstable, but it's back.
Speaker 3 (14:04):
Okay. All right. Awesome. Should I just pick it up there? Okay. Is it, is it not good again? I can hear you, Aaron. Are you okay? Yes. Okay. All right. Okay. We're good. Yep.
Speaker 1 (14:20):
Okay. Yeah. So you can just pick it up from there. So, um, what forgiveness programs can physical therapists or their healthcare professionals take advantage of?
Speaker 3 (14:30):
Absolutely. So there are a few different programs today. The first one that I think most people are the most familiar with would be the public service loan forgiveness. So that's for people who work in the public sector or they work at a five oh one C3 non-profit, uh, company, which allows you after 10 years, assuming that the balances have not been paid off to receive forgiveness. There's another program, which also a lot of people are familiar with income based repayment, uh, that has some different things that we need to qualify for in order to be part of that program. But it's actually a lot more, a lot easier and a lot more possible than a lot of people think it's definitely worth looking into. And that program allows for forgiveness of the loans after 25 years of on-time payments. And then there's another program which is fairly new.
Speaker 3 (15:27):
That's called the pay as you earn program. It has very specific rules and dates about when the loans were dispersed and w we can definitely help go through those and work through them and see if our, see if PTs would qualify for any of those programs. We find that many people do qualify for forgiveness programs. They're not always aware that they can, or they think, you know, they have to work at a specific kind of a hospital or something like that, but, but there are a lot of options out there and it can, it can save hundreds of thousands of dollars. Literally. This is the amount of money that we're talking about here that people have saved by taking the time to talk to a professional who knows the ins and outs of this, this part of the field. So it's really, really important to take a look at this.
Speaker 1 (16:22):
Excellent. So we've talked about protection, having the right disability coverage, managing student loans, and you alluded to within the managing of student loans that we also need to save for our retirement. So let's talk about retirement because I think it can be confusing and overwhelming and daunting if you have, if, if you're just not sure what you can do. So what are our options for retirement? Yes. Great.
Speaker 2 (16:52):
And you bring up a good point when people hear retirement, Karen, right. They kind of want to run for the Hills. It can be very overwhelming, Joe. And I try to make it as, you know, as an in line to your goals and help walk you through it as much as we can. And that's, there's a lot of different options for, especially for business owners. There's something called a SEP IRA that a business owner can have. Uh, we walked through a lot of different options that a lot of people might not know about or even available to them. And Jill and I talk a lot about saving into different buckets of money. So not put putting all of our retirement savings into one specific bucket or vehicle, if you will, and really having a strong plan, that's diversified across a lot of different buckets. Jill, I'm sure you can, you can add more to the bucket. We can go on and on about those. Oh, thank
Speaker 3 (17:52):
You, Aaron. Aaron knows I can go on and on about this. So retirement is something that is never too soon to start it. It's just never too soon. If we start saving for retirement in our twenties, we can, we can literally save half or a third of what we would need to save. If we start in our thirties and then help us, if we start in our forties, it's something that we need to start as soon as possible. And what Erin, when you were saying is so true, it's not just about our asset allocation. It's about asset location. What are the different accounts that we're able to take advantage of to save money in? So that we're both saving now on say for example, on taxes, but also in the future. So we're, so we're not creating a lot of tax liability for ourselves in the future.
Speaker 3 (18:43):
We want to make sure that we have assets that we can turn into income in the future because while net worth is really good to talk about, it's important, really what we need to be able to do with our assets and with our net worth is in your retirement to turn that into reliable and guaranteed income sources, because that is really, what's going to set us up for wellness now in the midterm and in the future and retirement accounts, we have our qualified accounts like our 401ks and our IRAs and our Roth IRAs. And then we also have other options that have tax advantages that we also talk about. We also want to make sure that we have liquidity during our lives so that we're saving in ways that are going to, so we're going to be able to access some of our savings if we need it while we're in our working years. And then when we get into, uh, finishing up our accumulation period and getting into retirement, which is our distribution phase, that we have created ways for ourselves, uh, to both have that guaranteed and reliable income, and also been as tax efficient as possible all along. So we can continue that tax efficiency in the retirement years as well.
Speaker 1 (20:02):
And so you had mentioned 401ks, IRAs, Roth IRAs. Um, quick question. And I think I know the answer to this, but I don't know when you're, uh, w working for a company, you can have a 401k. I don't even know if companies are matching anymore. I don't know if that's a thing anymore, but if a company is going to match, do you, let's say a company matches at 7%, I'm just pulling a number out. Right. Do you suggest that as the employee, you put 7% in and have that match, or do you suggest as an employee, you put as much as you can and they'll kick in an extra 7%. Does that make sense? I think
Speaker 3 (20:47):
In general, I'm sorry. Go ahead. I said, does that make sense? Yeah, that, that does make sense. Yeah. I think it does depend on an individual's particular situation, but if we, it, and believe me, if an employer is so generous today that they do a 7% match, of course, we generally would recommend that people get the match if they can. Um, some employers don't match today. Most common we've seen is around 3% if they do match, but, uh, if they, if they do match and we can be putting enough in there to get the match, that's a great idea to get that because that's like additional income for us from the employers. So that's great to get. And then there, there are some other ways that we can also save in addition to the 401k, because we, one of the, one of the things about those qualified retirement accounts, as you know, Karen, is that they, we do have to wait until we're 59 and a half to access that money without penalties or paying income tax on that.
Speaker 3 (21:49):
Uh, we do have to, unless there are specific situations along the way, of course. Uh, so we do want to make sure that we have ways of savings that are going to give us liquidity during our working years, during our accumulation years. So there are other types of accounts that we can take advantage of as well and save in those as well. So, as you were saying, Erin, we have those different buckets of money that are in different types of accounts that have different rules as to how they work, how they are taxed. And th that's going to be the most beneficial for us in the long run. It's not just allocation, but asset location. Mm
Speaker 2 (22:28):
That's. You bring up a really good point, Joe, with location, right. Is almost even more important than the amount we have. Uh, and this is one of the biggest problems. I think that Jill and I see with clients is a lot of clients have, you know, a retirement plan they've been saving, but what's their distribution plan. They want over time and where is money coming from? And where's the best place to be starting to pull it from and in what order? So we're walking through all of those strategies, uh, with, with our clients and ultimately how to have the highest possible cashflow with lowest taxes and, and leave a legacy if we decide to. So those are all really important things that we'll, we'll kind of walk through.
Speaker 1 (23:13):
And can you give an example, maybe one example of where you can kind of what, where you can park your money bucket. That's not the 401k, the IRA, the Roth IRA, the step, you know, I think everyone kind of has, um, an idea of what those are, but what else is there?
Speaker 3 (23:41):
Absolutely. So I think it depends also Karen, the purpose for our savings for that particular savings and also our timeline. So when we're thinking about, okay, is, is this money that we're saving, that we want to be able to access, let's say in 10 years, and we want to invest it in the meantime, it's not something that we need right away, because if we're thinking about an emergency fund money like that, we usually recommend that people put that into a savings account, just a regular savings account that they can get to very easily. But if this is going to be invested money, then we can always do a brokerage account, which is going to enable us to access that at any time, we're not going to have any penalties or fees associated with it. If we have gains and we take some of those gains, then we're only going to ever have capital gains tax, as long as we've held those, those, uh, investments for a year in a day. So that's something that I think could be very beneficial to people as an accompaniment, to the qualified plans and, uh, you know, a great something great to have in the overall design of the financial plan.
Speaker 1 (24:50):
Yeah. That makes a lot of sense. Thank you for that. Um, and then I think one more thing on the IRA versus the Roth IRA, can you differentiate those two so that people know what's a Roth IRA what's qualifies for, how do you qualify for a Roth IRA, a regular IRA?
Speaker 3 (25:11):
Sure. So there, there are a couple of differences between a Roth and actually a 401k can have a Roth option as well. Not all employers offer that, but some do so between a Roth IRA and a traditional IRA, the main difference is how money is tax going into the account and then how money is taxed or not taxed, it's coming out of the account. And the difference is with a traditional IRA, we are putting in pre-tax dollars. We are not paying tax on the money that we put in right now. And we can also take that off of our income. So we get slightly reduced income tax, and then we have that money growing tax deferred. And then when we go to use it from 59 and a half on, uh, we are taking that money out and we're paying income tax on it. So with a Roth option, kind of doing the opposite kind of thing, and the rods does have income limits in terms of being able to contribute to a Roth account, uh, both for individuals.
Speaker 3 (26:12):
And, uh, so going forward, when we think about a Roth, we're going to be setting ourselves up with tax-free income in the future. As long as our money has been in the Roth account for at least five years, when we take it out after 59 and a half, we're going to get it. Tax-free, it's growing tax free all along and what, but when we put it in, we're putting in after tax dollars. So we paid income tax on our dollars that we put into a Roth, it grows tax-free and then we take in retirement income tax free, as long as we have that five-year period.
Speaker 1 (26:49):
Got it. Thank you. Great. Cause I know, uh, oftentimes people, um, can get confused on that. So I just wanted to kind of bring a little clarity around those different kinds of IRAs and things like that. And, and, you know, physical as a physical therapist, like this is not what we went to school for. So we depend on people like you, um, to walk us through and figure out where, where, where can I put money in now? So that at 59 and a half, I'm taking it out with the greatest benefit I can. And you're not like getting hit with like, oh my gosh. Or if you want to save for a house, maybe you don't want to have that in, uh, obviously in like a, your 401k, because if you pull that out early, you get a big penalty.
Speaker 2 (27:35):
Absolutely. And that's what we spend a lot of time, you know, collecting goals and walking through personal business goals, because that really determines where we're saving and how timeline wise. We want to access that money and we'll review it at least twice a year with, with clients. Um, and because that plan is always changing. Right?
Speaker 1 (27:57):
Yeah. And I think, you know, I think this gives this talk, gives, uh, the listeners number one, a lot to think about, to look into maybe what they already have in their retirement, what they already have in disability, how they're managing their student loans and perhaps they can take to their financial advisors, or maybe they want to come and talk to you guys to see how can we maximize our financial wellness. I mean, how can we make sure that we're not wasting money and that in the end we can get back the most money. Right. That's kind of the deal. Exactly. Yeah. So now, all right. Is there anything, um, so I just to, I'm going to recap the top three tips are protection and disability insurance, managing your student loans and understanding your retirement and where all of your, all the buckets that your money is going in. And to make sure that it's not all in one.
Speaker 2 (28:59):
Yes. Okay. You summed it up very well. Karen, I think ultimately to even break it down even more Jill and I are just here to kind of help people understand how to organize and what to prioritize. And we're here to help kind of navigate all of that because it can be very overwhelming and we are here to, to help navigate through that. All
Speaker 1 (29:20):
Right. Awesome. And now, where can people find you? Where can people find you, uh, websites, social media, all that fun stuff.
Speaker 2 (29:32):
Yep. So Jill and I are both on, on LinkedIn. Uh, you can find us on our website. We are on, uh, CFS, llc.com. We each have our own, uh, aims under there. And can you start us on LinkedIn?
Speaker 1 (29:48):
Perfect. And we'll also have just so people listening will have all the links at the show notes at podcasts at healthy, wealthy, smart.com. Um, so you can just go on there and one click will take you to Jill and to Aaron, to their LinkedIn and to their website. So excellent. Now we're going to finish up, I've got one last question for both of you. It's I ask everyone the same question and it's knowing where you are now in your life and your career. What advice would you give to your younger self
Speaker 2 (30:21):
Start saving sooner than you think? Even if it's, even if it, we always Jill and I always say we laugh at the start somewhere, right. Even if it's 10 bucks a week, you know, just start somewhere. And that will, that will grow over time. Absolutely spoken.
Speaker 1 (30:37):
Like it's spoken like a true financial advisor.
Speaker 2 (30:41):
Go ahead, Jess. How about you, Jill, I'll
Speaker 3 (30:44):
Give a nonfinancial nonfinancial related advice because I think that was perfect advice. Aaron, the sooner you start the better, um, I would also say to my younger self, um, just go for my dreams and my goals even more than I did. I think for young people today, just, just go for it, just achieve what you are, what you want to achieve with what's deep inside you. You want to bring good into the world. Just go ahead and do it.
Speaker 1 (31:12):
Excellent advice from both of you ladies. Thank you so much. And I also want to give a shout out to Helene, um, cause she sort of put us together and um, she, uh, is the creator of mama bear, uh, physical therapies.
Speaker 2 (31:29):
Yeah. So we'll
Speaker 1 (31:30):
Have a link to Helene's, uh, business in the show notes as well, because I love, um, I love to show sort of the web of how we're all connected, you know? So it's just shout out to her. Yeah. And to her business and we're all very excited. I think the three of us are collectively very excited for her.
Speaker 2 (31:50):
We're so proud of her. She's awesome. Agreed.
Speaker 1 (31:54):
All right. Well ladies, thank you so much for coming on and everyone thank you so much for tuning in and for listening. Have a great week and stay healthy, wealthy and smart.
In this episode, TEDx Speaker, Mentor, and Certified Feng Shui Practitioner, Kate MacKinnon, talks about getting on to TEDx stages.
Today, Kate talks about overcoming roadblocks in the application process, how to prepare your presentation for the event, and how she decided on the topic of her TEDx talk. What does it feel like to share an idea worth spreading?
Hear about her own experience getting on to the TEDx stage, being mistaken for Kate McKinnon, and get Kate’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “It’s not an outside thing. It’s an inside thing.”
- “We’re in a society that values youth, youthful looks, the up-and-comers, etc.”
- “Age is just a number. But I know so many women feel like they’re not heard, especially if they’re over a certain age.”
- “We get better as we age. That’s the thing that we really need to get.”
- “There are a lot of TEDx talks out there. You want to vet them. You want to find out about who’s producing them.”
- “Don’t bother the TEDx producers. They’re not the ones to ask these questions of.”
- “Reach out to past TEDx speakers.”
- “Ultimately, you dont want to just be practicing in front of your cat. You’re going to want to practice in front of other people.”
- “Don’t get too overwhelmed by it. You can learn.”
- “If you want to get better at tennis, you hire a tennis coach. If you want to get better at speaking, you hire a coach that can teach you how to be a good public speaker.”
- “If there’s one person out there that I can touch and make a difference, there’s that ripple effect.”
- “You have everything you need to be successful right now. The only difference between me and you is experience.”
More about Kate MacKinnon
Kate MacKinnon, Feng Shui Expert, TEDx Speaker, and Mentor, is a Certified Feng Shui Practitioner, consulting for businesses and individuals for over 20 years, both locally and globally. Before becoming a Feng Shui Expert, Kate had a management technology consulting company and was Vice President for JPMorgan Chase & Co.
She taught the first online Feng Shui course for the Institute for Integrative Nutrition and a workshop for the Hospital for Special Surgery and Global Real Estate Women’s Group at JPMorgan Chase. Kate has also written articles on Feng Shui and been a guest and interviewed by thought leaders on Speaking, Life Transitions, and Women Empowerment.
Kate’s mission is to use Feng Shui’s power to illuminate and inspire women to step into their power and greatness and live a life of Beauty, Grace, Dignity, and Abundance, and make a difference in the world. You can find her inspiring talk on Women, Aging, and Visibility on TED.com.
Kate’s TED Talk: Women, Aging, and Visibility
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Suggested Keywords
TEDx, TED Talk, Speaking, Public Speaking, Feng Shui, Women, Age, Aging, Visibility, Talking, Influence, Learning, Healthy, Wealthy, Smart, Inspiration, Motivation,
To learn more, follow Kate at:
Website: https://kate-mackinnon.com
Facebook: Kate MacKinnon
Instagram: @fengshuikate
Twitter: @fengshuikate
LinkedIn: Kate MacKinnon
Subscribe to Healthy, Wealthy & Smart:
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Read the Full transcript here:
Speaker 1 (00:01):
Hi, Kate, welcome to the podcast. I am happy to have you on. Thank you,
Speaker 2 (00:07):
Karen. I'm so excited to be on with you.
Speaker 1 (00:09):
And just so the listeners know, as you probably heard in the intro said, my guest today is Kate McKinnon, which it is. And so how often are you getting mistaken for the famous comedian, Kate McKinnon also in the New York area?
Speaker 2 (00:26):
No, all the time. I just a quick funny story, because the first time it happened to me when she was just becoming popular was I made a dinner reservation at the Odeon. And when I showed up, somebody said, are you Kate McKinnon? And I said, yes, the star, Kate McKinnon. I said, yes. And then he realized I was not her. And I said, well, I am, am I
Speaker 1 (00:49):
That's great.
Speaker 2 (00:50):
It's funny. And then my husband said, I'm going to start making dinner reservations,
Speaker 1 (00:55):
But that, but the thing is, she actually
Speaker 2 (00:56):
Spells her name. M C K I N N O N. And I spelled M a C K I N. So she's ruined the spelling, my name, but that's okay. I'm delighted to be the Kate McKinnon not the comedian.
Speaker 1 (01:09):
Absolutely. And, and, you know, you can probably get a table anywhere. Oh yeah. Oh yeah, absolutely. And when you show up, you're not lying. I think it's great. And now, but you are a star because you were on the TEDx stage and this month we are talking all about Ted X talks and how to get onto that stage. So, like I said, in the, in your bio that you were on TEDx Farmingdale stage in 2020. So talk about your experience. What was it like?
Speaker 2 (01:44):
My God, can I tell you a little history to it? I mean, it's, it's an amazing experience. It really is because I I've been wanting to do TEDx for a while, but to be honest, who I was not born a speaker and we met, we actually met with Tricia, Brooke at her speaker salon in 2018, the spring, I think it was 2018. And that was the first time I'd ever spoken on a stage in my life. And honestly, it was one of the most terrifying things I've ever done. I thought it was going to die. And it was the first time I'd done a talk that was even remotely like a TEDx. And what I did love was the power of being able to get up and be an authentic speaker and have a message that resonated for people on. And I just want to share that quick story because I S I talked about my two greatest losses being my two greatest gifts, and I lost my, I lost my hearing in my left ear at one and a half for meningitis.
Speaker 2 (02:39):
And then I lost my mother at four, and I talk about that and I couldn't even put it on line for a long time, but I finally did. I went to Spain. I was in a, at a Tapper's party in the mountains of Spain, and somebody came up to me and they said, I heard your talk. I'm deaf too. And they wanted to talk to me about it. And what I learned then was it doesn't really matter. You could speak to a hundred, you could speak to a million people, but we're really, we're really trying to get to that person that, that touches. And if it's only one we've made a difference in somebody's life. And so that just gave me the bug. And so I then did Trisha did another speaker salon in the spring of 2019, and then it wasn't. And so I did another talk.
Speaker 2 (03:25):
And then finally the third talk in the fall of 2019, I I was going to do at the speaker salon to talk about my business functions way, but Trisha had this masterclass on doing a TEDx talk. So I took it, and it was during that, where we went through the process of how do you actually create an application? So it starts with the whole process of, of an idea worth spreading. It's not like having an issue or a problem. It's like, you're creating an idea that's worth spreading. And, you know, we go through a whole exercise and she gives us questions that we answered to just kind of dig deeper to those things that are important to us, that we feel like we want to talk about. And in the process of going through the class we I dunno at one point I somehow got talking about women and how mentoring women and the importance of me, of women.
Speaker 2 (04:18):
And, you know, there were, there was sort of this topic around there. And somehow it got shaped where it was about me turning, you know, at that point it was, I was 62, I think, 62 or 63. And somehow it got shaped around what it means to be a woman aging in this society. Oh, and I know that was really the key. We were doing it with a TEDx in mind. So there was a TEDx on women. And so the topic became of that. I'm sorry. That's right. That's like talking about that and sort of digging deeper into that. And that just really resonated. And so there's that the idea where it's spreading, which ended up being for me that society deems women invisible after a certain age, and this is something we can change now and forever. So our younger sisters never feel they're like go out, which still makes good silica gives me chills.
Speaker 2 (05:12):
I mean, it just really still came so deep from with me. And then the next question is when you're doing the application, why are you the person to give this talk? And I was like, I don't know. And Trisha was really funny. She goes, can I answer that question for the church? He goes, because you've been doing this your entire life. So that, that it wasn't just like an intellectual thing. It was a thing that had been important to me for a long time, but I didn't really know it, but once these ideas come up and they come out, they sort of take on a life of their own. They really do. And so in that, that speaker salon, I had a chance to actually work on my talk in a workshop environment. So as you know, with the speaker salon, we have other speakers.
Speaker 2 (05:57):
So you get up on stage and you get to practice and get to write you get feedback and stuff like that. And it just, I could see from my fellow speakers that it was really resonating with them. So that was really powerful. Like I felt like there's something here that I really have to talk about. And so that idea then grew and grew and grew. And actually I had an opportunity to present it that, for that particular TEDx women's talk and I went there and the environment wasn't there, wasn't right. For me, I felt totally out of alignment. I didn't get support. It was like, I'd been with Trisha. We were so well taken care of. And, you know, you just show up, dressed up, made up, get on stage, you tech is taken care of. And it just wasn't that kind of event.
Speaker 2 (06:43):
And I felt like my talk deserved an event to really showcase it. So I actually had the talk a year before. So in December of 2019, it was ready to go. And that was really hard to walk away from. But by the time I did it for TEDx farming tale, it was just, it was in me, it was part of me. I probably can still do it with a little practice. It just came from me. So to me, that's a really powerful thing to say about doing TEDx talks. It's, it's an idea, but it's like, you end up, it's like, it comes out of you, you speak it. And then as you're speaking, you learn to embody it. Like, it's, it's a really interesting, like you talk it, but then it becomes part of you. So when you're actually presenting it for me, it was a full body experience.
Speaker 2 (07:30):
That's amazing. It just felt like it came from me. Yeah. Yeah. And it's so good. And, and don't worry everyone. We've got the link to it in the, in the show notes here. So you'll be able to watch her talk. But I love, I just want to circle back to something that you said when you were filling up the application, why should you be the one to do this? And you said, I don't know, had Trisha take that one. She does not like the, I don't know. She does it well that well, and that's, what's so funny because she goes, she goes, well, I do. And so she knows me. She knows me well enough to say that, but it was, it was funny. She was like right on it. She was right on it. And and I think a lot of people might hit that, that roadblock in the application process. I don't know why should I do this? Like, you know, those, that imposter syndrome creeps in and why shouldn't you be the person to give this talk? That's a really hard question to answer. So what advice do you have for people if they're filling out an application and they get stuck, they hit a roadblock.
Speaker 3 (08:39):
Yeah.
Speaker 2 (08:41):
Yeah. You know, I I'll tell you something. I I'm an, a big believer I get, I always get help. I, you know, I have a community of people that I can ask things and run things by. And I think it's really important for something like this, because you want to get a sense that does it land, does it resonate or like people even knowing what you're talking about? Do you know what I mean? I just, that, that has been my experience that I think it's really been important for me to be able to run it past people. And, and in this case because I was in that masterclass setting, the other thing I was going to say was really, there was an interesting part of that because as I was working on the idea and that's part of it, it's like, sort of, it's like, we're responding, but we're working on the idea that somebody said to me, I got up and I don't quite remember how I said it, but at one point, one of the women said to me somewhere we both know, she said to me, why would I like, you know, cause I looked pretty good for my age.
Speaker 2 (09:41):
Right? Like I'll say, yeah, I look. And so a lot of people don't realize how old I am and it's just, it just sort of, you know, I always say to my father, he looked, he looked young until he turned 70. So I have a few more years. And so she said, why would women, why would women believe or trust you if they, you look like you do? And I said, but it's not an outside thing. It's an inside thing. But that question was so important, right. To get that kind of response. And I think, you know, that's, the other thing is like, you know, for me, you know, of course since I've done it, but like even doing it where it resonates for men, like there was something about it. It was, it was more than just being a woman, even though the conversation was about being a woman.
Speaker 2 (10:23):
And I got that from testing it out. Right. And talking about it as I was writing it that it needed to resonate beyond like, yeah, why would I listen to her? Cause she looks great. What does she really know about? So my story tells how I know deeply about what that experience is. And I think that's that, that one question stayed with me the whole time. It's like, it's gotta be beyond like, just looking at me and saying, Oh yeah, like, you know cause that's not really what it's about our inside light. And it's interesting since I've done the talk and lots of people have talked me about it. Men, women, men have talked about how it's affected them. Men have talked to me about how they want their wives to listen and, you know, gay men have talked to me. I mean, like it's really kind of across the board.
Speaker 2 (11:13):
But there was Oh one woman. I was somewhere and she came up to me and she was you know, like a 32 year old Afro-American woman. And she goes, identify. She goes, I've been feeling that she said, not only because you know of my race, but also because as a woman that I feel like I don't get taken seriously and I'm invisible. And I thought, wow. And I said to her, this is why I'm doing the talk because I like it so that you, you women, your age never had this experience ever. And you know, we're in a society that values youth that values youthful looks that values, you know, the
Speaker 1 (11:54):
Up and comers, the Anji news, the et cetera, et cetera. Right. And so, you know, when you, it's, it's surprising to hear someone in their thirties say that, but I, I mean, I'm in my forties and I know I feel that way. Yeah. You know, and, and that's why listening to your talk is actually quite healing because you're like, Oh, well, wait a second. I'm not the only person that feels this way or wait a second. It doesn't, that doesn't matter. It matters. What would I, like you said, the light that I have on the inside and how is that B how am I sharing that is kind of like what I got out of it. So I found it to be like, really affirming that like, Hey, and I know this is so cliche age is just a number. But it is, but I get, I know so many women feel that way. So many women feel like they're not heard especially if they're over a certain age, they're passed over if they're over a certain age. And so I think that's why the talk resonates so much.
Speaker 2 (13:05):
Yeah. Yeah. Well, it's, it's also interesting, you know, it's like the, you know what they say, like, you know, you see your, you see a yellow VW car, you know, Volkswagen car, and then, then you only see them, right? Like, it's like once I started writing about this talk and then reading books and it just happened, right. Like it seemed, but it was very synchronistic. How many in the books, like women over 50 writing stories about when they turn 50, when you know people in you know, broadcasting, people consulting people, you know, high-level executive women. It was really it. I suddenly saw it everywhere. I said, wow, I didn't even realize that this is just in the water of the conversation. Like we don't even know it's existing. So when I started talking about it, it's been out there, but I think people heard it in a new way.
Speaker 2 (14:00):
And my conversation, I actually just had this happen the other day, a woman I haven't and a beautiful, beautiful young woman who I haven't seen for years. I met her at a workshop up in Syracuse. I met her mom and she's been, you know, we've been sort of tracking each other on social media all these years. And then she reached out to me because she wanted to do an interview on funkshway. And she told me, she'd heard my talk. And she said, and she started quoting it. But the thing that she said that really struck me is what I had said, but she really mirrored back was that we get better as we age. That's the thing. And that's the thing that we really need to get. And so my talk is looking at the hero, not looking at the women behind me, but looking at the women who are out there, I start with an Amash, if you will, to, you know, by time I did it.
Speaker 2 (14:52):
And, and Farmingdale, Ruth, Ruth Bader Ginsburg was the first woman. I mentioned queen Elizabeth, Jane Fonda, Lily, Tommy, Tommy, like they're in their eighties and nineties and they are living full out lives. That's the message. We, we don't need to stop at our fifties. And if we're turning our light on and we're excited about what we're doing and we're out there, you know we were alive and that is what people see. That's the beauty. I mean, to me, that's really the beauty. It's like, we're living, we're living our life. And I, you know, I talk about Jane Fonda. She had a movie you know, five at Jane Fonda in five acts.
Speaker 1 (15:33):
Like she's still out there. Like she continues.
Speaker 2 (15:36):
I used to be out there. And she's now, you know, climate change and, you know, getting arrested for protesting and stuff like that. I love her. I love her. Right. That's, that's what I want. That's where I want to be looking. That's what I want to be looking at. Yeah.
Speaker 1 (15:52):
And it reminds me too, of like Joan Rivers, who was at her prime when she was 81, she had four TV shows a best-selling line on QVC all over the place. I mean, this is a woman who didn't stop, talk about always looking forward. Right, right. Definitely one of those women. So obviously your TEDx talk was a talk and an idea worth spreading touch people's lives a hundred percent. What do you have any other tricks or tips for the listeners about applying for your talk? And then, so you gave one have people around you to bounce ideas off of, I want to circle back because I want to know if you have any others and then we'll talk about the prep, the preparation. So any other tips or tricks? I, I,
Speaker 2 (16:48):
I would say so. I, I honestly I'm not here to promote anybody, but I would say it helped to have a coach. It really helped to have somebody knowledgeable because I'll tell you what I did learn from her is you kind of, you want to vet, there are a lot of TEDx talks out there and you want to vet them. You want to find one that is going to be, you know, preferably find out about who's producing it cause they're independent and they have guidelines and they should be following them. But sometimes a first time producer may or may not be prepared, right. Fully prepare to really give the, the, the kind of support you need. And that was my experience. It was just, I was, I was spoiled by the kind of sport I've been getting, but I saw that I needed to not worry about anything other than getting myself on stage and speaking and letting everything else be taken care of.
Speaker 2 (17:42):
So you want to vet and and that's, again, through a coach, I have somebody who who's experienced, she's placed other TEDx she's up place, but helped other people get on the TEDx stage. So that, that, that certainly for me was true. And you know, now it really getting out and you can, I, now we have club, you know, clubhouse people, you know, clubhouse event with people talking about TEDx and, you know, being able to do that 90 minute pitch and stuff like that. And people talking about is this topic. And, you know, for me, it was gathering information about it sort of understanding really what it was, watching them, watching them learning, you know, seeing what worked, what didn't work. And you know, certainly that's a big part of it. And if you know people, I had somebody reach out to me on LinkedIn cause she was going to do TEDx.
Speaker 2 (18:34):
So she wants to just talk to me to find out more about it. I think it's, it's one of those things where you, there are ways you can find people to find out. One of the things that, you know, Trisha will recommend, like don't bother the TEDx producers, right. If you're like an apply, you're going to apply, they're not the ones to ask these questions. They're really not. They're like, so you need to find that information elsewhere, but there's enough. There's like, Oh, and then that's it. Chris Anderson who started ted.com, it's also, he has a good book out on that. There's a number of books on it. I mean, it really kind of guides to help you think the process through, think about what you're really talking about. What's the difference between a TEDx talk and doing a key note for instance, or, you know, a lot of people. Yeah. I, I did you know, I worked in corporate America for a long time and I did a lot of debt, you know PowerPoint presentations, it's not the same, right. Like really kind of begin to understand really what it is that distinguishes it from other kinds of talks. So those are some of my thoughts just off the top of my head. That's amazing. I love, I would never thought
Speaker 1 (19:44):
Reach out to pass TEDx speakers. That's such a great tip. Such a great tip. All right. So let's talk about preparing for at the talk. So you just don't say, Oh, practice it a couple of times and wallah I'm up on stage. So talk about your preparation. Yes.
Speaker 2 (20:04):
So when I, and I, and again, I had a little bit of a jumpstart because I was in and working on another talk and then I ended up practicing my talk and the speaker salon. But
Speaker 1 (20:17):
It it's it takes
Speaker 2 (20:19):
Time. I, you know, I think there maybe some, somebody who's a better speaker than I am, but like if you were to apply and it was three weeks from now, and by the way, P TEDx neuro doesn't work that way apply. And then it's several months out, but you really need time to write the talk if you haven't written it to practice it memorization as a whole process, by the way, this is one of the things about getting older. I was afraid I was not going to be able to memorize a talk longer than three minutes. And my talk was I think, nine minutes and I've done 18 minutes, but learning the technique of memorization because they are a memorized talk and, and you don't necessarily have a teleprompter as a whole process of like, how do you memorize? So you've written the talk now you Steve to memorize it.
Speaker 2 (21:09):
And so that's a really important part. And part of the memorization, again, I've, I've had a lot of coaching from Tricia where you know, ways of memorizing, how to break the script down, sort of, you know, learning a little bit at a time, learning a little bit of time and then starting to put it all together. But part of that practicing is, you know, for me practicing at least three times a day, at least three times a day. And ultimately you don't want to just be practicing in front of your cat. You're going to want to practice in front of other people. But part of that practice was I'd go out walking and I'd practice the talk I'd be driving. I practice the talk. I mean, really I have to, for me, I had to get to the point where it was.
Speaker 2 (21:52):
So it wasn't just up in my head. It kind of has, I don't know how to describe this, had to drop from my head into my body. Right. And also part of that was to choreograph it. So, you know, like sometimes people have a way of rocking and, you know, they walk around the stage. You have a little, as far as I know for TEDx, there's you have your red circle, which can be a small rug or big rug, but I think you're not supposed to go off the rug. I've seen some Ted dot coms where they do it's a different staging, but the idea is you kind of are in a small space. So you have to practice being able to really stand fairly still, or like move a little bit. But when you're moving, not just because you're rocking, but we actually, I actually choreographed what I was doing and I do it like a performance to be honest with you.
Speaker 2 (22:40):
And so I got helped with that performance and I got had, you know, somebody I trusted and, and, you know, ultimately Tricia, you know, have somebody see me perform, tell me how to move. You know, maybe I should say it this way. And so it was for me, it was, I had the opportunity to prepare my TEDx talk over three months for the one the one in December of 2019. Then I actually performed it again for speakers who day or another Patricia Ray, after the pandemic. And I had to learn how to do it into a video, looking at myself, that's a whole other technique. And then finally, actually on a stage for a TEDx Farmingdale, which was not, it was live stream, but it was, I did not have a lot live audience. And so each thing each time was something different.
Speaker 2 (23:34):
So there's a preparation for what you think it's going to be. And then you show up and you have the experience. So it's, it's practice, practice, practice, practicing in front of people. And the other thing we learned is, you know, and then if you're going to practice in front of people two weeks before the talk, don't ask them, you know, you can say, I want to practice. But don't ask, don't have them like start ripping your talk apart, like a certain point. You have to have a few trusted people where they're going to give you good feedback, but it's not about redoing. The talk is a certain point. That's the talk, right. It's very interesting. It's a very it's a, it's a lengthy process. I hope, I hope that answers it. It's like you know,
Speaker 1 (24:18):
Oh yes, absolutely. Absolutely. And I just, I, I love that you're giving the list,
Speaker 2 (24:25):
The insight into these things
Speaker 1 (24:30):
Talks like, Hey, like this takes time, this is months of preparation. This is months of memorization. There are techniques to it. You know, you can memorize one sentence and memorize a sentence, add another sentence at another, till you have a paragraph, right. It's not like you're just going up there trying to memorize a nine minute talk right off the bat, because that's so daunting. And I, I want the listeners to know that you do have time before these talks that it's not like you apply. And they say, okay, see, in
Speaker 2 (25:01):
A week, right.
Speaker 1 (25:04):
Yeah, no, they want to make sure you're ready to, yeah.
Speaker 2 (25:07):
Thanks about the application I forgot to say is very often they ask for video. And so you do like a one to two minute video of yourself. Partly because they want to see who you are, how you speak at a sense. So it's not like if they select your, you just sort of seeing your application and that's it. And so that's always interesting because you know, that was in writing a piece of my talk, not, it was a way of giving, giving the essence of my talk. Actually what I did was I wrote something that was the essence of the talk without like doing the talk. Right. But giving them an opportunity to see me on camera, to get a sense of how I am as a speaker is really important. And that is always a challenge, right? Like I still, I've been doing this for a while and I say this so people understand, like, you know, have, have a little hope because if I can do it, honestly, if I can do it, other people can do it because it, it was an area that I wanted to do, but it was a challenge for me.
Speaker 2 (26:07):
And I had to learn to do everything, everything, it was always learning something new, something new. And again, I could say at my age, you know, it was tough, but that's not really what it was just, I hadn't learned how to do it before. Right.
Speaker 1 (26:19):
Yeah. Don't, don't, don't get too overwhelmed by it because you can learn,
Speaker 2 (26:24):
You can learn and that's really the point you really can learn. But I, you know, I, I say this with all all respect to anyone who wants to try this, if there's a way that they can find, you know, if you, they can find someone to help them with this. For me I'm one of those people, I've done many things in my life. I like to have somebody help guide me because it does seem so daunting. And so the other way, it just feels like, okay, I'm shooting in the dark. I'm not sure because you may never hear from the people that you've applied to. Right. So you have no idea why they didn't accept you. And so it's helpful to get some feedback and guidance from somebody who, who has some experience or expertise in this area.
Speaker 1 (27:11):
Yeah, absolutely. I couldn't agree more. I mean, we have coaches, like if you want to get better at tennis, you hire a tennis coach. If you want to get better at golfing, you hire a golf coach, you know, it's the same thing you want to get better at speaking, you hire a coach that can teach you how to be a good public speaker, which is why I joined the speaker salon way back when, why you did and, and here we are. Right. Right. Exactly. Exactly. Yeah. I think that's great advice. Now, is there anything that we glossed over or any other points that you want to make about your experience on the TEDx
Speaker 2 (27:50):
Stage? Yeah, I just it it's I have to say if someone really wants to do it, I think that's half the battle. You really want to do it. You really, really there's something for me. It wasn't just like I did it halfway and said, Oh, this is too hard. There was something in me that felt like I had something I needed to say that, that, that, and that really is, it's something, it became something bigger than me. It wasn't just getting up and doing a talk. It had to be something for me to keep going, had to be something bigger that I felt like there was an important message that I needed to say. And I think that's part of it that that is part of what had me do it. And then go to a stage and say, this, this just wasn't the environment, like from a functional perspective, let alone, like, just that, for me, wasn't an alignment with what my talk was about.
Speaker 2 (28:53):
And I would rather not do it just to say I did it. I th there was a, there was a challenge in that for me, but ultimately I said, it wasn't about saying it just to say it and get it done. This was an important message. And I wanted to be on the stage that I can convey it to where I felt like it could get out. And so that desire that there's a bigger message and that desire for me if like that person in Spain, if there's one person out there that I can touch and make a difference, there's that ripple effect. So it's, it's, it's something that's bigger than us ultimately. And I think that's the important thing. And even like, starting with, you know, that, I don't know why am I the one to say it? Like we don't even know sometimes, but the more I worked on it, the more I realized it was something that had been for me to say for a long time, I just didn't know it.
Speaker 2 (29:45):
And so it grew and I grew, and there was something so beautiful for me when I finally got on that stage. I really, it really was, I was prepared. I was more than prepared, made up, dressed up a beautiful stage, great support. And and I, I have to say there was one moment where I was moved by my talk. Right. That's the other thing, you know, if you have emotion, but when you're doing your talk, you don't want other people to take care of you. Like they'll just fall apart on the stage. It's really like, you want them to have the experience. It's like, you're giving them a gift and you want them to have the experience. But there was a moment my husband even saw it where my eyes started watering up. I was so moved by what I was saying. It's like, every time I said it, it was new to me.
Speaker 2 (30:37):
It was new to me. That's the kind of talk. I think that we're looking for something that is so deeply important and satisfying and feel like I am the one to say the talk that, that, that is the thing that kept me going with all the challenges and all the new things to say I wanted to get there. And when I did it and walked off the circle is one of the most satisfying things. I, it really is a peak experience in my life. I've had a few of them. It's really, it's it probably at this point in my life feels like my greatest achievement, to be honest with you so strongly about it.
Speaker 1 (31:15):
Oh, that's so wonderful. Thank you for sharing that. And now Kate, where can people find you? Like I said, we will have the talk in the show notes for the, for this episode, but where can people find you if they want to do a Ted talk and they want to reach out to you for some advice and just where people can find you on on the regular, regular.
Speaker 2 (31:38):
Okay. I would say probably my, I am on LinkedIn, Kate McKinnon, spelled M a C K I N N O N. That's probably, you know, that's certainly a good place to reach out to me. I'm on Instagram. Funkshway K at funkshway Kate and Facebook I'm Kate McKinnon. But I also have a website at kate-mckinnon.com, M a C K I N, and r.com. M-Sci K I N N O N, that cog and you know, a place where you can send me an email that way as well. Also, I I'm reachable and you know, all of those are, you know, I check everything, so please feel free. I would be happy to, you know, people really want to talk with me about it, be my honor and pleasure. Really. That's awesome.
Speaker 1 (32:30):
Awesome. Thank you so much. And last question, knowing where you are now in your life and in your career, what would you give to
Speaker 2 (32:40):
Your younger self? Oh, I love this question. I, I would say, and I've said this to young women before, who kind of remind me of my younger self. Like I have an assistant working for me. It was like 23 years old. And I've had women like in their 1819 that I would say you have everything you need to be successful right now. The only difference between me and you is experience. I love it. That's great advice. Yeah. Excellent advice. Thank you so much, Kate. This was a great talk. And I think the listeners now have a better idea of what it takes to get on that TEDx stage. And we will regroup with you and Kaia and Trisha for the TEDx round table, which I'm really excited about. So thank you so much. Thank you, Karen. Thanks you so much for asking me to be on it's my honor, and privilege, and you know, to be able to talk about this, obviously I get really excited, but I, I really love sharing with people and I really hope that people really look to themselves to see where they might actually have that message that they want to do this.
Speaker 2 (33:57):
That would just mean the world to me. So, and I look forward to seeing you with Kaia and Tricia at the round table. Yes, I'm definitely looking forward to that one and everyone thanks so much for tuning in and listening. Have a great couple of days and stay healthy while at the, in smart.
In this episode, Creator of The Magnetic Soul-Work Success System, Keiya Rayne, talks about her process from no talk to TEDx talk.
Today, Keiya talks about leveraging the power of energy to land a TEDx talk, how to set yourself up for success, and how to achieve a calmness and confidence in the Red Circle. How did Keiya go from having no talk to stepping onto a TEDx stage?
Hear about the secret sauce to creating, developing, and delivering an Influencial talk, find out how the TEDx talk has changed Keiya, and get her advice for her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “We have all these different experiences of our lives, and when we bring them together it makes the essence of our lives, and it gives us a message that we can impart to others and help them improve their lives.”
- “The secret sauce is hiring a mentor.”
- “When you’re giving a TEDx talk, you want to appeal to a lot of people.”
- “When you have an idea that’s worth spreading, then it’s universal.”
- “The human energy is so powerful.”
- Keiya’s 1-minute energy reset tool:
“Pivot, pause, smile.”
- “The most important thing is to make the decision and have the intention to do so.”
- “A lot of times we’re so focused on doing. I want to introduce the idea of the beingness - the energy of lightness about what you desire.”
- “People buy from you based on how you make them feel.”
- “A lot of times we’re afraid to even take that step. Set the intention to do that, apply, and go for it. If you have that desire, then the universe wants you to have it.”
- “Nothing is ever going to replace rehearsing.”
- “When you feel comfortable and confident, and you’ve embodied your talk, then you’re free.”
- “Be still, and trust that everything is going to be okay.”
More about Keiya Rayne
Influential TEDx Speaker, Keiya K. Rayne, is a Clarity Coach, Relationship Expert, Intuitive Healer, and the Creator of The Magnetic Soul-work Success System.
Described by one of her clients as Yoda, but only cuter, for more than 15 years, she’s helped her clients master their mindset and attraction energy, so they're able to achieve a higher level of success in the areas of Love, Business, and Purpose with unexpected ease.
Keiya’s been featured in the documentary, The Big Talk Over Dinner: Race and immigration, The Big Talk, Follow me Friday, Courage Up podcasts, as well as various online magazines publications.
She’s a recipient of The White House President’s Volunteer Service Award for her humanitarian work domestically and globally.
Suggested Keywords
TEDx, TED Talk, Speaking, Public Speaking, Talking, Experience, Energy, Determination, Confidence, Preparation, Pivot, Pause, Smile,
Keiya’s TEDx talk: Being Taught to Form a Line is the Greatest Gift We Can Ever Receive
To learn more, follow Keiya at:
Website: https://www.keiyakrayne.com
Facebook: Keiya Rayne
Instagram: @keiyakrayne
Twitter: @keiyakrayne
LinkedIn: Keiya Rayne
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript:
Speaker 1 (00:01):
Hey Caio, welcome to the podcast. I'm so excited to have you on, and it's so great to see you.
Speaker 2 (00:08):
Likewise, it's a pleasure to be here. It's like, you know, a family reunion side rail to be here
Speaker 1 (00:14):
This whole month. We're talking about how to get on a TEDx stage. And I was part of the speaker salon, which is by Tricia, Brooke, who is also a guest this month. And I met you and I met Kate and we're all getting together to talk about how to get on a TEDx stage and really just how to do a talk. Right? Yeah. So let's start. My first question is how did you go from having no talk to getting on the TEDx stage? I think
Speaker 2 (00:45):
Everybody wants to know. Yes, yes. That is, you know, it's a very fascinating story. I actually met Tricia Brooke at an event. And when I met her, there was something that was just in her energy that drew me to her and I just really fell in love with her. And of course she mentioned, she was, of course speaking about speaking. And I just casually mentioned to her, I'm like, you know, I'm going to get on your stage now. I did not really have an interest of getting on her stage. I, you know, I knew, you know, in my life like getting on a stage at some point in my life was going to happen. You know, I just, I just knew that, but at that particular time, I was really just kind of like, yeah, you know, that sounds good. Well, of course, two weeks later, I get this email from Trisha saying, Hey, I'm launching this week or salon and that's what happened. And so I did speak her salon and it was through the speaker salon. Now, when I arrived on the speaker salon, I had no talk whatsoever. And, you know, with Trisha, she really creates a safe space for you to just get up and share from your heart, from your soul. And I got up and whatever she was able to pull out of me you know, most people were like, wow. And so
Speaker 1 (02:12):
I can, yes, that is true. I will, I will agree with that.
Speaker 2 (02:17):
Right. And that's right, you were there. And and that was the making of my TEDx talk. And then later on I did another speaker salon and that was where one of the TEDx producers was in the audience. And that's how I landed my TEDx talk.
Speaker 1 (02:36):
Yes. And now let's talk about, so do you have, did you have a specific process by which you had your idea, you then took that idea and formulated your talk?
Speaker 2 (02:53):
Well, you know, thankfully the idea from my talk came from the speaker salon. And so for me, what was great about that was that I already had something. And so I was able to really just, and it's interesting because my TEDx talk had pieces of my speaker salon talk, and there's something that I will share later, but there's a little, the secret sauce that was, you know, really working with someone to help you do that. But it was really, you know, receiving the support, I believe from Tricia in working with that talk and being able to take it, it's fascinating because, you know, we was able to take all these different experiences that I've had and was able to bring them into this talk. And a lot of times, you know, we may think of ourselves like, well, you know, I don't really have a talk and not realizing that, you know, we have all these different experiences of our lives and when we bring them together and really makes the essence of our lives, and it really gives us something that we can a message that we can impart to others and, and, and help them improve their lives, inspire them in some way.
Speaker 2 (04:17):
So you don't have to reinvent the wheel to find these talks. You can look at your life experience, look at within yourself and say, Hey, wait, this happened to me and it might help someone else is abstinence kind of what I got. Yeah, exactly. Exactly. And just keep in mind though, you know, TEDx talk is a very different type of talk, so it's not like it's a keynote talk or write it. It's a very specific type of talk, which I'm sure, you know, Trisha will elaborate on that a lot more, but either way, right. There were still all these different pieces that came together to create that top. Yeah. Right. And now you alluded to this before, but the secret sauce to creating, developing and delivering this impactful TEDx talk, what is that secret sauce? You know, it's, it's, it's, it's a V it's, it's simple, but it's not.
Speaker 2 (05:13):
And I'm going to tell you, the secret sauce is hiring a mentor and they'll just, you know, just hire Patricia, Brooke, because I, I just believe, and she doesn't even know what I'm saying this, but I really believe she she's just the best. I mean, she knows this inside and out, but she is, you know, she has a hearing and I, and this is something that she's really masterful at helping other people share their story. And so when you're able to find that type of person who can really help you in all these pieces, right. And then, you know, because like I said again, right. Tedx talk is, is is, you know, we suspend the islands and they may say it in America too. Like, you know, a horse of a different color, you know? So when you're getting on, when you're dealing with the red circle, right.
Speaker 2 (06:07):
You, you really need to know if that's right. If you want it to be impactful right. And influential, then you want to get someone who knows how to make that happen for you. Yeah. And I should also say, I'm glad that you kind of said, it's, it's different than a keynote talk. Right. Because when you're at a keynote talk and you're at a conference or something like that, you're really directing that talk to a specific group of people. Right. So you really have narrowed down in each down to maybe what is probably your ideal audience, but when you're giving a TEDx talk, you want to appeal to a lot of people. Was that difficult?
Speaker 2 (06:50):
It wasn't. And I'm going to tell you why. I didn't think it was difficult. I think it was because of the message, right. The idea worth spreading. And so when you have an idea that's worth spreading, then it's universal. Yeah. That's very true. Hey, wait a second. What was your TEDx talk about? We didn't even mention that yet. I mean, we'll mention it to get at the end, but what was, what was your TEDx talk about? Give us the cliff notes and then of course we'll have a link to it in the podcast. Exactly. Exactly. Well, it, it's how being taught to form a line is the greatest gift you can ever receive. And so all I'm going to say about that is, you know, we all learn how to form, you know, like what we were like in grade school, learn how to form a line and not realizing the impact that something as simple as that has had, have had on our lives, as well as, you know, other people around the world who really don't know how to form lines.
Speaker 2 (07:54):
Right. And through my humanitarian work, you know, I did humanitarian work for many, many years traveling around the world. And that was a big thing. Just getting people to form a line. And so that's kind of, you know, a little, I don't want to give it all away. No, no, no. Don't give it all the way we want people to go and watch it and listen to your words. Yeah. So now let's take us to that moment of when it was your turn to give your talk, you have to go into the quote unquote red circle. So how do you set yourself up energetically for success? How do you stay calm? Cause I feel like if I was wearing my Garmin watch, my heart rate would be like 106. Like it would be off the charts. I would be so nervous. So how do you do this?
Speaker 2 (08:42):
Well, you know, the thing is, you know, the nerves are there, but energetically, you know, I started setting myself up and which is something I do every day. Right. So it is a, it is a non-negotiable practice for me to really set myself up energetically every day. And that is, you know, through meditation, through journaling, through you know, getting quiet and doing all those things that will enable me to really get into a calm state and, you know, the more you practice it right in, and you're in, you know, that right? So the more that, you know, so that is something that I've practiced for so long. And so that when it was time for me to get on the stage, I had that to reach back to. And so I, I really was able to kind of channel right. Being calm because it was, it was something that practice because when you're ready to go on that stage, it's just, I mean, you know, everything is happening.
Speaker 2 (09:44):
You're what am I going to remember my lines? And, and it wasn't the time for that. And, and just to get in the zone, but when you set yourself up for that, right, you, you are really working on your vibration on, on, on your nervous system and calming yourself down, you know, then that makes that that's a game changer, because that was one of the things that I heard quite a bit was you looked so calm when you gave your talk, you know, it was like, you just, you were just walking, like you were floating. It is like, Hey, you don't know how much, you know, right. It was all that meditation and breathing exercise that I did.
Speaker 1 (10:23):
I think that's a really great point for people to understand is that you're still nervous, but you had some tools to help mitigate that a little bit. Now, would you recommend, let's say someone they want to get on a TEDx stage and let's say they're accepted. We'll just throw that out there. Is this something that you would recommend someone to do in preparation for that or just something to do just because you're a human being
Speaker 2 (10:49):
Living in this world? Well, both, I think just, you know, just as a human being, living in this world, right. We have so much to deal with and I'm really, really big on, you know, mastering your energy and understanding, you know, the human and the human energy is so powerful. And I think it's one of those things that we as humans don't really give a lot of attention to, you know, like we just don't realize the power of, of our energy and, and of our vibration and how, when we learn to manage that, and we can also use, we can also learn to leverage that as well. So it's, you know, when you learn how to do the two, wow. Yeah. It really, it, it, it puts you in the center and it really assist you in every area of your life.
Speaker 1 (11:43):
And do you have for the listeners, if they're curious, like, what the heck is she talking about? How can I do that? Do you have like a quick example of how someone do that, or even where they can find out more information about how to do that?
Speaker 2 (11:58):
Well, you know, it's, that's a great question. And one of the things that I was going to that I'm offering the listeners is what I call a one minute energy reset tool. Right. And what that is. Right. And it's, it's a one minute tool that we can use to always bring ourselves back to the moment. And it's called pivot, pause, smile. Right. Very, very simple. But it's very powerful. Right. And so as, even as you're going through your day and you're like stressed out, and if we just think to pause and you think, okay, I'm going to pivot my energy in this moment. I'm just going to put a smile on my face. Right. In that moment, you can change it. But as well, there are tons of, you know, whether it be method, meditation, breathing exercises, there's quite a bit, but I think the most important thing, right. Because you can find it if you want, it is to make the decision and have the intention to do so. Yeah. And this
Speaker 1 (13:04):
Is the kind of stuff that I know you probably work with with your clients on the regular, right.
Speaker 2 (13:10):
Oh, 100% because it's not negotiable.
Speaker 1 (13:15):
Yeah. And, and now let's talk about, so we talked about how to kind of set yourself up for when you get into that red circle, but what about landing a Ted talk? I mean, that's stressful as well. Right. So can you walk us through your process of how you, like, how did you choose which one, how did you foster your energy toward landing that go ahead. Okay. So
Speaker 2 (13:49):
In my case, I was actually, you know, because I was, I was kind of recruited if you will. Right. It was like, I was auditioning without realizing I was auditioning for a TEDx talk. And, you know, at the end of Tisha speaker salon, she has people come in various influencers and producers come in. And so in that sense, I was fortunate that sort of the introduction was already made for me because he saw me and it was like, Hmm, I wanna meet her. However, I still needed to apply. And so this is, I feel like it's my secret sauce, right? W in, in terms of applying. So I actually want to go back to when I was giving my talk. Now I knew there were going to be produces influences in the audience. And so I actually had set myself up and a genetically from then to attract and land buy talk.
Speaker 2 (15:02):
It's really, really important. Right. And so would, that would look like was, again, in my morning practice eyes, you know, set the intention one that, Hey, wouldn't it be great to be chosen by one of the influences or one of the produces. So that was an intention that was already set, right? So there's, there's that energetic piece there sending myself up. This was even when I got on stage to do speaker salon, and again, just having the, what I call the universal law of detachment. And so I wasn't attached to whether I got chosen or not. It was just really important for me to, to give an impactful and inspirational and transformation, transformative talk, but I just want to plant the seed right. That it started. So the, the energy, the energy of everything that you do starts from the very beginning.
Speaker 2 (16:11):
And so I will tell you, I wasn't surprised by the fact that I was chosen in a way, because I had sort of said that intention, and there was an energy, right. That I was putting out there for that. And not to say that other people weren't doing it right. Because it's, everybody's like, they're putting out, I want to give a talk. Right. But there's something about when you understand and which I spoke about before, when you understand how to leverage energy and you really get to understand the power of attraction that we have to attract what we desire into our lives. Right. And so with all of that, all of that, knowing if you will, which is what my speaker salon talk was about, I think created that vibration within me. Right. So that whoever was in the audience, it made it possible. Right. For kind of, for them to define me. Does that, does that make sense?
Speaker 1 (17:19):
Yes. And I, I really love that. What was it? The universal law of detachment. Yes. I really I'm. I don't think I've ever heard that before, but I really like it because if you go, it, it sounds to me and correct me if I'm wrong, but you went into this talk with that sort of love detachment. So it wasn't like your whole being was, was predicated on this talk. Right. Is that right? That's exactly correct. Exactly.
Speaker 2 (17:50):
Correct. And it's also when you learn how to use universal laws and university and just energy. Right. And so these laws are set up to, to support us and we don't know about them. And so would that combination, right? That, that was sort of the, like the, the game, if you will. Right. I was playing, that was w that enabled me to create that sense of lightness. Right. And, and so, and I say that because now let's think about the person who's now applying. Right. So I, I still had to apply, but I was kind of like in, because he saw me. So let's say for the person that you know, is not in front of a producer, and now they're applying to a TEDx talk. And what I want to, what I'd love to invite that person to do is because everything is energy.
Speaker 2 (18:47):
And so even when you were filling out that application, if you're filling out that application with the energy of desperation, Oh my God, I really want to give this talk. And, and, and, but there's so many other, all of that, right. You're, you're going there is just like, you're going to block yourself from attracting that talk. Now I'll tell you something. I heard I was listening to two women speak about applying for TEDx talks and, and both women had already given TEDx talks. And so they were speaking of applying for other TEDx talks. And as I listened to both of them, I can hear the level of, sort of the level of, of stress and frustration in, in, in, in, in all that it takes right. To apply for the TEDx talk and right away, I was like, wow, just, just that alone, just that energy that you even, you know, coming to it from where you're coming from with it will impede the process.
Speaker 1 (20:02):
Yeah. That makes a lot of sense. And, and I think, I just want to make a clarification when you're talking about that universal law of detachment, it doesn't mean that you're filling it out and saying, Oh, whatever, if I get it, I don't really care. Is that right? Cause that was kind of coming, especially as you were speaking just now I was thinking, wait a second. That doesn't mean that you're like blahzay and like, whatever.
Speaker 2 (20:27):
Right. Not at all, not at all, not at all. It's, you know, it's, it's, it's kind of, you do your part and then you release it.
Speaker 1 (20:36):
That makes sense. Yeah. So you're still doing your part with the best intentions with all your, with your energy and your, this is the ASM. Yeah, exactly. Exactly. And, and I bring, and I
Speaker 2 (20:48):
Bring, you know, and I bring, I keep going. I, you know, I go back to the energy piece a lot because, you know, again, for the, let's say for the person who's applying for that top, right. W w w a lot of times we're so focused on doing yes, yes. Right. And so, and we do that with everything. Like, I want something I'm going to go after, what do I have to do to get it?
Speaker 1 (21:09):
We often say that in an email, what do I have to do? What, what are the next steps? What I have to do next? What do I, yeah, totally,
Speaker 2 (21:16):
Exactly. Right. And so I want to really introduce the idea of the beingness of that energy of lightness, about what you desire and what you want, be it a TEDx talk or anything else, because it's that sort of, that energy of likeness that, you know, I feel makes, makes you more of a magnet to that. And so you're not impeding it with your okay, I got to do. And, but also as well is that you're leveraging, right. You're leveraging energy in a way, instead of just, you know, all of the, like, what do I got to do? And you're trying to make this happen. Right. It's like, you kind of like, okay, because then the right person will be put in your path, your application, you know, the person that is reading your application that is watching your video. Right. They are going to feel you, they can feel right. So everything is, and so that's why it's so important to bring in, I feel the energetic piece. Yeah.
Speaker 1 (22:30):
And thank you for that. I think that's great advice for anyone out there that wants to with the, with the aspirations and the hopes of getting on a Ted ex or maybe even a Ted stage. Yes. At some point that will come, these live events will come back. I know it. And, and what has changed for you since you did your TEDx talk?
Speaker 2 (22:57):
Oh my God. So much, so much, so much in terms of, you know, I will say even my, my level, just my level of confidence that in and of itself, I think my, you know, the income, my clients, just my entire, just everywhere in, in all aspects of my life has really gone to a completely different level, you know, since doing the TEDx and more importantly, just me as a person. Right. I have evolved and grown since then. Yeah.
Speaker 1 (23:30):
Yeah. Cause oftentimes people, you know, if you're an entrepreneur, you have your own business, you may, part of going onto the TEDx stage is yes. Of course, to get your message out, but also like, will this help my business?
Speaker 2 (23:43):
Absolutely. Yeah. And it sounds
Speaker 1 (23:46):
Like people have found you, people have started to want to work with you, which is amazing. Absolutely. Absolutely. And, and that, that's, what's great about, I think just taking the stage in general, really, because people have an opportunity to to hear you. Right. And so as an entrepreneur, it makes it a little easier, right. In terms of you don't need to go looking for people because they've heard you, they've seen you and it, it kind of gives them an insight into who you are. They get to feel you, they get to connect with you. And you know, when people buy from you based on how you make them feel. Absolutely. Absolutely. I love it. Now. Is there anything during this talk, did we, did I gloss over anything? Did we miss anything? And if we did, let me know if we didn't, what's your best advice for someone wanting to get on a TEDx stage,
Speaker 1 (24:45):
You know, hire Tricia, Brooke. I could second that yes. You know what, we're not, we're not paid to do that. No, we're not right. I'm just going to keep it real, you know what I'm saying? Like, and, and I say that, and I'm gonna tell you why I say that. Right. and also you, right. First of all, if you have the, the, the desire and the intention to do so, go for it. Like just, you know, I think that's the most important, I think a lot of times we're afraid to even take that step. And sometimes someone might think, Hey, you know, a TEDx it's too big. Cause a lot of people will look at that TEDx talk or tend to be like, Oh my God. Right. Like I could never do that. Right. And so, you know, besides hiring Tricia had, you know, said that intention to do that apply and go for it because if you have that desire, then that the universe wants you to have it.
Speaker 1 (25:44):
Yeah. And, and, you know, working with Trisha or with any other coach, I think just really, really important. I remember during our speaker salon, like I remember people going up and speaking and I was sitting there thinking, I thought this was supposed to be for like, non-professional speakers. Why is everyone like a professional already? And I got up and I was like shrinking in my chair, like, Oh, this is amazing. This is not good. This is amazing. But having Trisha there, cause I remember my idea of doing my talk about my experience with pain. And I was speaking about it in the third person. And I remember a Trisha like, like I was, you know, just maybe a couple of minutes in and she was like that was really good. But let me ask you a question. Is this about you? And I was like, yeah, it's just like, why, why are you talking in the third person? And it's those and that,
Speaker 2 (26:44):
It's those simple things that we would never be aware of and never. And the other thing I want to say about that too, was that, you know, when I, when I was done with my talk, I was able to, with my TEDx talk, I was able to go into the audience and sit and you know, support and watch the other speakers as well. And there was there was a difference, it was a clear distinction and difference, right. Between the people that, you know, had, I'm able to Tricia speakers in particular because there was, I think two of them that went after me. Right. and the other speakers. And so it, it really
Speaker 2 (27:29):
Separates you. Yeah. And I would think, and this is, this will be the lab. Maybe we could talk forever, but I think practice, practice, practice. How much did you practice? Let's not gloss over this. Yes, that's right. That's right. Thank you so much. Because when you said was there something that we forgot that was it because in my mind I was like, I, I gotta remember that. So yes. Well all we got all the energy, right. You're, you're centered. You're, you know, you're you're you got your energy together. Nothing. And I mean, add absolutely nothing is going to replace
Speaker 3 (28:19):
Rehearsing. Yes.
Speaker 2 (28:20):
Memorizing. And so what gave me that confidence also, right. To be calm was the fact that I knew that talk inside and out and, you know, and, and, you know, Tricia taught us also how to memorize. And so that for me was, was really the key because then, you know, when you feel comfortable and confident and you've embodied your talk, then you free. So thank you for bringing that up because I really wanted to like, make sure that we said, Oh yeah, I can just use my energy. And then yes. Yes. And just to give the listeners some insight how, if you could even remember how many hours do you think you rehearsed? Cause it's not like five hours. It's not like you just did it a couple of times. No, no, no, man. You know, it's, it's kinda 24 seven almost really like I'm, I'm serious.
Speaker 2 (29:31):
Like I, you know, in the beginning, you know, and I think we kind of, I give myself like a little bit of a leeway, like kind of in the beginning I was like, okay, let me, you rehearse. I think for the last, and I didn't have a whole lot of time. I had, how much time did you have since, since you knew you were going to get the talk till the day you gave it. Exactly. And it was unusual, right. Because usually people can have, I think like up to six months, I think I found out, I think speaker salon was like July 20th and September 7th. Oh boy. Yeah. Okay. Right. I think it was either June, June, or July. And so I had very little time because I think I was the last person that came on board. Okay. Right. But, but I think we all, we all found out at the same time, but but I mean, because I didn't apply, so I didn't even kind of, I hadn't applied yet.
Speaker 2 (30:26):
So I kind of didn't even know that I would even be chosen. So it was a very, a very short period of time, which meant rehearsing, rehearsing, memorizing. Like I ate, slept, drank that talk so that I can embody it. So I didn't have to deal with the nerves. Right, right. Excellent. Well, this was great. Now Kaia, where can people find you on social media website, et cetera, et cetera. Awesome. Awesome. Thank you. Yes. People can find me@caiorain.com. Kaia K rain. Actually, I'm going to spell it for you even. I know you're going to have the link. It's K E I Y a K R a Y N e.com. And you can also find me on Instagram and if I'm making it easy for you, everything is Kaia K rain, Instagram, LinkedIn, all those good places. Excellent. Well, thank you so much. And I, Oh, I almost forgot. I have one last question. Knowing where, and I ask everyone this, but knowing where you are now in your life and in your career, what advice would you give to your younger self? Wow, that is, I love, love, love, love, love this question.
Speaker 4 (31:46):
Yeah.
Speaker 2 (31:48):
Be still and trust that everything is going to be okay. Fabulous advice. You know, because when I look back and if we all look back at our lives and we look at all the things that we stressed out about and we worried about it and we made ourselves crazy about like every little thing. If you real, if you knew that if I can just have a sense of trust and just chill, I was going to say, chill the hell out. Right. Things are going to work out. So that's, that would be my advice. Excellent advice. And I thank you again. And of course everyone, we will have links to everything Kaia, including her TEDx talk in the notes at podcast
Speaker 1 (32:40):
Dot healthy, wealthy, smart.com. Thank you so much for coming on this one.
Speaker 2 (32:44):
Wonderful. Thank you. Oh, this was great. Thank you so much for having me. It was fantastic.
Speaker 1 (32:50):
And I'll tell you listeners, thank you so much for listening. Have a great week and stay healthy, wealthy and smart.
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Tricia Brouk to talk about how to land a TEDx Talk. Tricia is an international award-winning director, author, speaking coach, and podcast coach.
In this episode, we discuss:
- What is a TED talk?
- How do you get chosen?
- Why do you need to vet organizers?
- What makes an exceptional TED talk?
- How do you prepare?
Resources:
Round Table Talks
Tricia's Website: Tricia Brouk
www.TheBigTalkAcademy.com
www.speakersalonapplication.com
Tricia's Social Media:
YouTube
Podcast
More About Tricia:
Tricia Brouk is an international award-winning director. She has worked in theater, film, and television for three decades. Her work includes the writing of two musicals, both produced in New York City, a one-woman show, and four documentaries, two eligible for Academy of Motion Picture Arts and Sciences nominations. She had an extensive career as a dancer performing all over the world. In addition to her work in the entertainment industry, Tricia applies her expertise to the art of public speaking. Tricia founded The Big Talk Academy where she certifies speakers in the art of public speaking. She was the executive producer of Speakers Who Dare and TEDxLincolnSquare and now The Big Talk Live. She has shepherded more than fifty speakers onto more than fifteen TEDx stages in under three years. She is currently being featured in a new documentary called Big Stages, which highlights the transformation of her speakers. Tricia’s commitment and devotion to inclusion is a priority as all of her shows, events, and communities are diverse. She curates and hosts the Speaker Salon in NYC, The Big Talk, an award-winning podcast on iTunes and YouTube. She directed and produced The Big Talk Over Dinner: Race and Immigration that premiered at the Be Your Best Self Expo in 2020. She was awarded Top Director of 2019 by the International Association of Top Professional and is relentless about her vision of amplifying voices all over the world. Her book, The Influential Voice: Saying What You Mean For Lasting Legacy was #1 New Release on Amazon in December 2020. Tricia lives in New York City with her husband, Joe Ricci, and their two cats, Lola and Bella. Their building faces the Alvin Ailey Dance Theater where she gets to watch young dancers realize their dreams every single day.
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Read the full transcript here:
Speaker 1 (00:01):
Hi, Tricia. Welcome back to the podcast. Third time. Third time on I'm so excited to have you here.
Speaker 2 (00:08):
I am so excited to be birth. Third time, Karen, it's always awesome to talk with you.
Speaker 1 (00:14):
Agreed, agreed. Awesome to talk to you. Not to me. Now this month we're talking all about TEDx talks, how to get on that stage. We've spoken to, we're going to speak to a couple of TEDx speakers, which I'm really excited about and you help prepare speakers for the TEDx stage. So we've got a lot to talk about. My number one question is what is a Ted talk?
Speaker 2 (00:43):
This is such a great question. And for anybody out there who really wants to dig deep and go into the world of Ted Chris Anderson's book, the official guide to public speaking, Ted talks, the official guide to public speaking is really the place that you need to go. A Ted doc is an 18 minute or less talk. And Chris Anderson actually says, 12 is the new 18. It is a gift, not an anus. It is an idea, not an issue. And you want the audience to adopt your idea as their own. At the end of this talk, a Ted talk is an idea worth spreading, and it is really meant to get the audience to think differently. And there's very specific format and outline when it comes to what a Ted talk is. And I highly recommend you dig deeper with Chris Anderson's book.
Speaker 1 (01:37):
Yeah. And for those who are watching here, it is. I just happened to have it coincidentally right on my bookshelf next to me. So this is the book. Great. And, and because I do want to differentiate that a Ted talks, not a keynote talk,
Speaker 2 (01:54):
Right? A Ted talk is 18 minutes or less, and it's really all about getting the audience to think differently. A keynote is 45 to 60 minutes long, and the keynote is going to start out by you telling the audience why you're the credible expert to talk about this idea. You're going to share with us what you're going to cover. Then you're going to cover it. Then you're going to summarize what you covered. And then there's a very clear call to action, which is buy my book, sign up for my program, donate to a worthy cause. And when you're thinking about that in relationship to a Ted talk, it is so different because literally you can open a Ted style, talk with music. This is how I see the world though, through Spiaggia trickle lens, you can open with music with video, with compelling slides. And it's really about taking the audience on a journey from where you start. What is the idea worth spreading that you want the audience to think about, taking them on a personal journey, your personal story, or someone else's personal story, and then wrapping up so that they think differently and potentially walk out of that theater, adopting idea, adopting your way of thinking as their own and maybe even behaving differently in the world.
Speaker 1 (03:06):
Yeah. And I, a great example of that is a Ted talk from Ted X, Lincoln square that you produced on forgiveness. You know, the one, I mean, right.
Speaker 2 (03:18):
I do Sarah Montana, one of the most compelling speakers I've ever had on my stage, she applied to TEDx Lincoln square with a talk about forgiveness. The idea was about forgiveness and how do we teach people to forgive? We all know forgiveness is important. It's good for our health. It's really important, but nobody teaches you how to do it. So in her application, the written application, she submitted her talk about forgiveness with a personal story that her mother and brother were murdered on Christmas Eve. And I thought, how in the world is this woman going to be able to share an idea worth spreading from the stage where I don't feel bad, the audience doesn't feel bad. We are not just sad hearing her talk about this horrible tragedy in her life. So I gave myself the challenge Garren, I thought, okay, I'm going to challenge myself and ask her to submit a video because I could not imagine how this story could be shared in a way that was an idea we're spreading.
Speaker 2 (04:22):
That would get me to think differently. All I could focus on was the trauma. So she submitted this incredible video and what was wonderful about this, and this is really an important takeaway here. She was healed from the trauma. She did not share a vulnerable story before she was ready. And she was able to tell us the story. So she set up context and then take us on the journey of her journey of forgiveness and how she ended up forgiving so that we could potentially put into motion, her practices of forgiveness into our own lives. And that is an incredible example of someone who is sharing a powerful idea, worth spreading, also giving context and her personal journey so that we can observe as the audience member not feel bad, but observe and adopt this idea as our own.
Speaker 1 (05:19):
Yeah, I, it was such a powerful story. We'll have a link to it in the show notes. It was just so wonderful. And that actually leads perfectly into my next question is how does one get chosen? So you gave us a little bit of the backstory of how she was chosen, but for the listeners who are thinking, Oh, I really want to do a TEDx talk or a Ted talk one day, how does that happen?
Speaker 2 (05:41):
This is really great. You have a million search engines looking for Ted talks all the time. The best thing to do is start with cities, TEDx, Philadelphia, TEDx, New York, TEDx, Dallas, TEDx St. Louis TEDx, all cities. It doesn't have to be where you live, but there will be amazing Ted X events in major cities, TEDx, Los Angeles. That's where you want to start, because the reason you want to start there is that they will have been around for a while and they will know what they're doing. And we'll get into that leader of the next step is universities, TEDx, university of Nevada TEDx case Western reserve, university TEDx rush, you universities put on TEDx events all the time. And the other reason that's a great place to start is because they will have the support of the school. They will have the support of the, of the university.
Speaker 2 (06:38):
Tedx UCLA is an Epic event. It's really hard to get into that one. And it's wonderful. And that's because they've been around for awhile, they know what they're doing. So cities, universities, and then you can actually go to ted.com and they have a map of all the TEDx events in the world. So if you want to speak in Ghana, if you want to speak in the UK, if you want to speak in New Zealand, you can search the map and it will identify where those TEDx events are happening. And then you just get in touch with the organizer. So the next thing you want to do is subscribe to all of the TEDx events that you can get on their mailing list so that you are notified when the applications open applications are rolling for many events, meaning you can apply all year and many have a specific window. So you want to make sure that you don't miss that six, eight week window where their applications are open. And this happened to one of my clients. She lives in Chicago. I gave her the application information. We worked on her application for months, months so that it would be right. She knew the deadline and she missed the deadline
Speaker 1 (07:55):
For heartbreaking. It was
Speaker 2 (07:57):
So heartbreaking. There was a little bit of is this self sabotaging thing happening right now. So just know that they do close. So make sure that you understand if you're notified, get those dates on your calendar, create a spreadsheet for yourself. Because if you believe you're going to apply to one event and land that event, you're a unicorn. I
Speaker 1 (08:18):
Have had unicorns. Trust
Speaker 2 (08:21):
Me. I haven't had unicorns. I currently have a unicorn, Dr. Kristin Donnelley, we just started working together and her first application was accepted. So she's going to be speaking itself, Lake Tahoe in may, which is super exciting. It does happen. However, she'd got my support. So if you are working on applications, apply to as many as possible. And if you are chosen for more than one, guess what you can do more than one, or you can determine which one you actually prefer. And you can take that stage. So making sure that you start with cities, moved universities, go to ted.com and search that way. Google is not your friend here. There's a million million, million ways that you can go around that and find the actual events that you want to speak out. And
Speaker 1 (09:07):
Let's say, I, there are three TEDx events that I want to speak at. Can I submit the same talk to all three? Or should I have a different talk for each one?
Speaker 2 (09:18):
Submit the same idea. We're spreading to as many applications as possible. And when, and if you're chosen for more than one, you can determine with the organizer. When you want to switch your idea, most organizers, 99.9% organizers are not going to let you do the same talk at multiple stages. You can absolutely speak at multiple stages, but you want to speak with the organizer about, Hey, I just accepted TEDx South Lake Tahoe, and I'm talking about tolerance. Can I talk about empathy at your event? It's similar, but I want to talk about something different and you can have that conversation with the organizer.
Speaker 1 (09:56):
And when it comes to the applications themselves, is there, are there any tips or tricks or to make yourself stand out?
Speaker 2 (10:08):
Yes. Very, very important that you do not pitch your business. This is not about how to get sales. This is about an idea worth spreading. So if you have a business where you are connecting rescue animals, to people who need support and that's your business, that is not your idea. We're spreading. You have to dig deeper and find a reason to talk about why animals can serve us in humanity. The other thing is, if they're asking you a little bit about yourself, go, go above and beyond. Don't cut and paste your bio. Tell us who you are. Tell us that you love cooking. Tell us that you absolutely that you've been married. And then you have two cats or personal things. The reason that is going to make you stand out is because nobody else is doing it. I coach all of my speakers to incorporate who they are in that question.
Speaker 2 (11:05):
Tell us more about who you are. And that is because you want to be a human being. When producers are choosing their speakers, it starts with the idea worth spreading, and then it moves into do I want to work with this person for nine months? And if you are high maintenance or lazy by cutting and pasting a bio into the application, we take cues. We are looking for who you are in those applications, which means if I say, I want one line for your idea worth spreading, and you write three, you can't read directions. You're not going to follow the rules, which means you're going to be difficult to work with once I book you. So I'm not going to, I'm not going to choose you. If you submit a video. And I say, I want a two minute video and it's two minutes and three seconds. You just disqualified yourself because I have hundreds of other people who are actually following the rules. So it's really important when you apply to these events that you answer the questions they're asking, you do not pitch your business and do not cut and paste a bio because that tells us you're lazy or somebody else supplied for you. Not you.
Speaker 1 (12:15):
Ah, I love the rule following thing. I'm a rule follower, but it, you know, I think that's great for the listeners here because that's how specific TEDx talks are because hundreds of people are applying. So like you said, if I say one sentence, you give me three. They're not even, they're not, you're not going beyond that. It's a next
Speaker 2 (12:38):
That's right. That's how I do all of my operations. It, we don't have, but not brutal, but smart, efficient, efficient. Yeah. We don't have time to handhold. We want to work with speakers who we know are going to show up prepared. And if we say you have eight minutes that they're going to actually deliver eight minutes. Because ultimately, if you are working with an exceptional TEDx producer who knows how to produce a show, they are putting on a show. There is a journey here. There is an arc and a through-line to that performance, to that show, to that event, which means you're going to put you in specific orders as speakers so that the audience goes on a journey. And I say specifically, a good TEDx producer. And that's something that is really, really important to remember. Not all Ted TEDx events are created equally. Not all TEDx events are going to give you the support that you need. So it's really important that you understand that as well, when you're looking for events
Speaker 1 (13:41):
And how can you pick that out? Like if you're like a newbie to the TEDx world, this is your first time applying, how do you, how do you know who's good and who's not good.
Speaker 2 (13:53):
First thing you want to do is go to the YouTube channel and watch the videos from past events. If the sound is bad, if the set is wonky, if the lighting is terrible, you can't trust that event's going to be improved. If you decide you do want to speak, there, have a conversation with the organizer, making sure that they have the proper audio and video. That's the first place you want to start. The next thing you want to do is get in touch with people who have spoken at those events. And this is the thing that people are afraid of, or have not been given permission to do. Karen, it's reached out to other speakers who had the experience. They will tell you the truth. They, if it's a good event, they will tell you it's a good event. And they may even put you in touch with some of the organizers, some of the, the the volunteers, so that you can talk with them about the process.
Speaker 2 (14:45):
So make contact, reach out, ask all the questions you want to ask. Were the organizers micromanaging your script. If they were think about that, did they take your voice out of your talk and make it their voice? If they did, you need to think about that. You need to create boundaries immediately, which means I'm so excited that I'm going to be speaking at your event. I am very, very competent in terms of writing my script. I will absolutely take your feedback, but the final script is mine. Not yours, set boundaries right away. People are afraid to actually tell organizers what they want. And that's something that I want to invite you and all of you to give permission so that you take back the control. It's your talk. Now let's be real. You do not own that. Talk. Once you take a Ted stage, head owns it. It is forever there's you cannot do it anywhere else. So be, be mindful, your image and your script will belong to Ted for the rest of eternity, which is also why you do not want a bad video to end up on YouTube for the rest of your life, because you have zero control over it. You cannot take it down. So really important that you vet organizers and that you're clear on how they work, what the process is. And if it's something that you are willing to champion or risk. Yeah, I would be safe.
Speaker 1 (16:15):
So nervous to say that to a Ted organizer. I mean, just because that's my personality, as you know, I would be like, Oh, well, you know, I mean, this is, this is what I want to do. And if it's okay with you, I'd like to do it this way. So to be able to set those boundaries, but not be dismissive of them. Yeah.
Speaker 2 (16:37):
Right. Their event, you want to honor, it's their event and Bay. They are the producer of this particular TEDx event. And you can absolutely respect all of that. And I encourage you to take that very seriously. They're in charge and reminding them that it's your idea worth spreading. They chose you for a reason and they need to allow you to be your amazing self and not try to infuse you with something else in that moment.
Speaker 1 (17:06):
Yeah. And, and that makes perfect sense. And you just have to keep your, have your confidence in yourself
Speaker 2 (17:12):
And in what you're doing. Absolutely. And I've had speakers who are extremely seasoned that I've worked with, who have come back to me because the TEDx events will, will provide you with a speaker coach for free. And I've had clients come back to me and say, the speaker coach thinks we need to do it this way. And they want to take this out of our script. And I'm really freaking out right now. It's two weeks before the event and all these nerves. And like all this panic, my talk is terrible. All that happens until you say, thank you so much for your feedback. I really, really appreciate it. And I'm going to do the talk I've written and they all say, no problem, no problem. They all say no problem.
Speaker 1 (17:53):
Excellent. Well, that is great advice for, for those folks out there, like me who are like, Oh, I don't, you know, want to offend anyone. And so that is really, really good to know. And the other thing that you said earlier that I just want to circle back on is when you're vetting these TEDx producers, you said that this might be someone you're working with for nine months. What can you explain that
Speaker 2 (18:20):
If you are going to work with a TEDx producer or say yes to an event, it needs to be yes. To an event that is not two weeks from the day you're accepted my event applications, whether it was TEDx Lincoln square or speakers who dare applications opened up in September, I made the decision in December and then the event was in March. So January, February, there was three months of speakers preparing. Now. They were also submitting in September. So September, October, November, December, January, February, that's eight months where I was spending time with these speakers, watching their videos, reading their applications. So you will want to have at least three months no less to prepare for your event. If you're being asked to speak in an event that happens in less than four weeks, I would gracefully decline because you are not going to have enough time to write a powerful talk and memorize it so that you can be your best self on that stage. And trust me, it has happened many organizers. This is really important. The one question Ted X does not ask on the application to become a licensed holder and organizer is, do you know how to produce an event?
Speaker 2 (19:52):
Anyone can get a TEDx license if they go through the process and they're granted a license, not everyone knows how to produce an event. And that is why vetting is important. And it's also important for you to know that this is an opportunity for you to share a very important message that you care deeply about in order to serve in order to reach people. The Ted brand is a massive platform. You have an opportunity to end up on ted.com and reach millions of people, which is why you want to set yourself up for absolute success and have a runway so that you can write an amazing talk, get the coaching you need, and then perform it beautifully. And that leads
Speaker 1 (20:39):
Perfectly into my next question. You answered it a little bit just then, but what makes an exceptional Ted talk?
Speaker 2 (20:48):
If the talk is really truly an idea worth spreading, that's the audience to think differently. And if you are activating from the stage, which means, you know how to deliver this content in a way that is how is MADEC in control in command while also sharing the idea worth spreading. And it doesn't mean teaching. It means sharing the idea worth spreading gifting, this idea, making sure that it's not an issue. And it's truly an idea. For example, teachers in public schools do not get enough support financially. We all know that to be true. It is an issue. If we reframe that as teachers are the GPS of our children's future, that is an idea. So really be clear that you are sharing an idea worth spreading, that you were in command of the material that you care about it, and that you are gifting this material to the audience so that they adopted as their own.
Speaker 1 (21:56):
And that was a great example, just switching the, the framework of the title makes all the difference. And, and I like that. It's, it's an idea, not an issue, an idea worth spreading, not an issue that we all kind of know, or maybe take for granted or something, right? Yeah. And that makes a big difference. Okay. How do you prepare for a Ted talk or a TEDx talk? It seems so daunting.
Speaker 2 (22:25):
It's the same preparation. If you are a speaker for any kind of stage, you are about to take, you begin with the writing process. You write and you rewrite and you write and you rewrite and you edit and you kill your darlings and you end up hating your talk and you think it's terrible. And you get past that part of the process. And now you have your, your final talk, your script. Then you begin to memorize. There is nothing sexy about memorization. It is boring. It is wrote. It is hard work. It's bicep girls it's plays. It is over and over and over start with the first sentence, move to the second, finish that paragraph. If you cannot prevent yourself from glancing down at the script, you are not memorized in that first paragraph. Do not do not cheat yourself. You want to make sure that first paragraph is memorized before you move on to the next, once you have the next paragraph, go back to the burst and tie those two together with the transition.
Speaker 2 (23:27):
So the last sentence of the first paragraph with the first sentence of the second paragraph, connect those dots. Once you have that and you are in complete control of those two paragraphs, then move on once you've done that through the whole talk, start in the middle and go to the end. Then mistake speakers make again. And again is they have the first half memorized cause they keep starting at the beginning and then they get on stage and nerves happen and they can't remember the second half. Once you have it all memorized, go back to the middle and work on the middle to the end. Once you are truly memorized and you can also record yourself doing the talk and listen to it in the car and listen to it on the treadmill, listen to it outside. When you're walking, when we're listening to songs, we memorize them because we're doing it while we're doing something else. Same thing applies here. Listen to yourself, give the talk over and over and over and over once you're memorized and really memorized, then do what I call an Italian run through. And this is from the world of theater, fast as possible, no emotion at all. You just want to give the talk as fast as possible. So your synapses are firing and you know that, you know the words, the moment you don't know the words, that's the section you're not memorized.
Speaker 1 (24:35):
Yes. And I remember doing this in the speaker salon, and I will say everyone, all you people listening that what Tricia just said, how to prepare, how to memorize. It works. Like, don't think your way is better. It's probably not. This is what works. Trust me. I did this when I had to give a keynote talk a couple of years ago. And the other thing that you cannot just glance over is the writing process. Because Trisha, remember when I first came out and gave my talk and Trisha is so wonderful because she'll say, Oh, you know, I really thought this was very strong, but Mike, you think about, and then she'll give her feedback and it's such a gentle way to give feedback. And you can, you can expand on that in a second. But I remember giving my talk and you were like, is this about you?
Speaker 1 (25:30):
And I said, well, yeah, it is. And you were like, why are you doing it in the third person? So I have this clever talk. It was, I mean, it was all written out. I was ready to go. I was prepared. And like Trisha said, you're gonna edit, edit, edit. You're going to feel uncomfortable with it. And then you're going to do it. And that's exactly what happened. And it was all the better for it. So the other thing I would say is get feed back from a coach from a trusted person, because when you're in it, it's hard to see out of it.
Speaker 2 (25:58):
And we are not comfortable being vulnerable right away. We often need permission. We often need to have a safe place to become vulnerable. And that's what I witnessed with you. Karen, as you walked up on stage, super confident sharing the story, it was very compelling story and zero vulnerability. And the moment you told us it was about you and that it was about your chronic pain. We all leaned in and could not take our eyes off of you. It was the most powerful transformation. One of the most powerful transformations I've seen. And I've seen a lot when you're talking about feedback and this is really, I'm great. I'm really grateful that you brought this up. Karen feedback is paramount. And you also need to know when you're asking for feedback and from you. Many of my speakers in the past have asked for feedback one or two weeks before their Ted talk and we're not specific.
Speaker 2 (26:58):
And all of a sudden they're getting feedback from random people. I think you should change the beginning. I don't really like what you're doing with the choreography and the blocking is not good. And all of a sudden they have absolutely no confidence. And that's because they weren't specific in asking for feedback three months before the event ask for feedback from somebody you trust a coach, whomever, because you have time to make those adjustments two weeks or one week before your event. Let's say two weeks. I'd like to know if there's anything about this specific talk that you love week before. You're a warm body. I don't want you to say anything afterwards, except thank you for giving this talk. Right? So get really specific when you're asking for feedback so that you don't derail yourself a week or two before, you're about to deliver a talk that you have memorized and no longer have time to make adjustments.
Speaker 2 (27:57):
Yeah. And that is great advice. And it reminds me of advice that jazz, who we both know, lovely, lovely, jazz set on this podcast. She said, you know, cause we were talking about asking for feedback from people and she's like, you wouldn't leave your apartment to go get a cup of coffee and ask every person you passed on the street. What kind of coffee you should get? Because you're going to get a different answer. And it's just crazy-making. It is crazy-making and nobody needs crazy-making two weeks before they're set to give a Ted talk. No, that's the visualization making needs to be happening. You need to be visualizing what it looks like to walk out onto that stage. You need to be visualizing what it looks and feels like to be delivering perfect mandating, powerful idea, worth spreading. You need to be visualizing what it's going to feel like when they applaud and when they rise to their feet and give you a standing ovation, you need to be visualizing what it means to walk into an out of that red circle.
Speaker 2 (29:01):
And this is part of the deep preparation work that I do with my TEDx speakers and with my community and clients is it is a big deal to walk out onto that stage and deliver your powerful message. You can change and save lives by speaking, whether it's in the red circle or not. So taking the role of speaker seriously and understanding the magnitude of your responsibility requires you to go above and beyond. It's not just about memorizing and talk and going and doing performance. Think about how powerful it is when that person is going to be watching your video. And they're going to think differently. They're going to potentially behave in their lives and that ripple effect can reach every other person in their life. So it is a very big responsibility when you are speaking from any stage. So give yourself permission, set yourself up for success by going through the process.
Speaker 2 (29:58):
And that's why I say nine months, because you really want to give yourself enough time to identify that idea, cultivate that talk, frat that beautiful, powerful talk, memorize it in a way that is so solid. You, if the chandelier falls on your head, you could absolutely continue and then give yourself the success set up by visualizing, by knowing what you're going to eat. And at what time you're going to eat it before you take that stage so that your body is not using energy to digest, but it's using energy to support you as a performer. This is about being an athlete and any and everything that you can do. You want to shoot that ball into the, into that hoop over and over again so that your muscle memory is ready to go. It is game on and Kyrene did this so beautifully. We worked like an athlete, works repetition over and over mindset. Self-Sabotage we did every possible trick and, and practice in order to have her walk out onto that stage and own it. She got a standing ovation.
Speaker 1 (31:06):
Yeah, she's amazing. It was an amazing talk. And again, we'll have that in the show notes here as well. Well, you know, I was going to ask you, would you like to sort of wrap things up, but you already did it. That was a perfect way. Now, before we before we end the podcast where can people find you? And if you don't mind, can you talk about your new book?
Speaker 2 (31:28):
Oh my goodness. I would love to talk about my new book. I'm a new author and it is so exciting. It's all the influential voice saying what you mean for lasting legacy. And it is on presale now@theinfluentialvoicebook.com. And you can find me at Tricia, brooke.com. I'm on Instagram, LinkedIn, and the influential voice is really a book about how to be a good human being while also teaching you to effectively communicate on stage and off. And I wrote it in June of 2020 instead of going to Mexico for 10 days with my husband, because we were all quarantining inside. I decided to use that time to write a book about how to teach people, to communicate with dignity, respect, curiosity, and love. And it is my hope that it will teach people that their voice matters and how to use their voice for good in the world.
Speaker 1 (32:25):
Amazing. And what a great use of time during quarantine. Geez. I feel like I just like rearranged my apartment. You wrote a whole book. That's amazing. Amazing. Yeah. And so we'll have links to that as well. Now, Trisha, before we leave I've asked you this question a couple of times already, but you're going to get it again. At what advice would you give to your younger self knowing where you are in your life,
Speaker 2 (32:51):
In your career? You can not imagine what is waiting for you. So keep taking those forward steps, excellent
Speaker 1 (32:59):
And advice. And Tricia, thanks so much. This was fabulous. I think everyone here will be inspired. They will start looking up those TEDx stages and, and again, get your book, get Chris Anderson's book, Ted talks. I think there are two great resources to sort of set you up for success in your speaking career, regardless of you get on a Ted stage or not. So thank you so much for coming on. Thank you, Karen and everyone. Thanks so much for listening. Have a great week and stay healthy, wealthy and smart.
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Jonas Sokolof, DO, a physician specializing in physical medicine and rehabilitation at NYU Langone’s Rusk Rehabilitation to talk about the importance of exercise therapy in cancer care.
In this episode we discuss:
- What is Oncological Physiatry
- Use of exercise in improving function and quality of life
- Lifestyle Medicine in Oncology
- Dr. Sokolof's baseball diamond analogy for rehab
- The importance of collaboration in the treatment of patients live with and through cancer
- Common side effects from cancer treatments
- And more!
Resources from this episode:
Round Table Talk: Cancer Rehab and Survivorship
More info on Dr. Sokolof
NYU Langone Oncology Rehabilitation Summit: Optimizing Rehabilitation Outcomes Through Exercise
More About Dr. Sokolof:
I am a physician specializing in physical medicine and rehabilitation at NYU Langone’s Rusk Rehabilitation. After completing my residency training at Harvard Medical School, I subspecialized in musculoskeletal/sports medicine and interventional spine care. During this time, I acquired additional skills in the nonoperative treatment of various musculoskeletal conditions, including arthritis, lower back and neck pain, coccygodynia, neuropathy, dystonia, and tendinitis.
As a physiatrist, my goal is to help my patients regain function through various nonoperative treatments, including rehabilitation, injections for spine and joint pain, and medication. Whenever possible, I try to avoid prescribing medications for long-term use and prefer a more holistic approach to patient care.
For instance, I have expertise in osteopathic manipulative medicine treatment (OMT), also known as manual medicine. OMT is “hands-on care”; I use my hands to diagnose, treat, and prevent illness or injury, through stretching, applying gentle pressure, and using resistance. I often find this modality useful as a supplement to other treatments. If needed, I can also provide people with image-guided injections for the spine and peripheral joints. Additionally, I perform electrodiagnostic testing to diagnose and guide treatment of various neuromuscular disorders.
A major focus of mine is the rehabilitation needs of cancer patients and survivors. My goal is to help individuals, from diagnosis to cure, improve overall function and quality of life. I have expertise in diagnosing and treating a variety of cancer treatment–related side effects, such as chemotherapy-induced peripheral neuropathy, radiation fibrosis, lymphedema, and post-mastectomy pain syndrome. As the need for physical rehabilitation grows in the field of oncology, I find it exciting and rewarding to help restore function in anyone who has experienced cancer. I’m also certified in sports medicine, so I’m experienced in treating sports-related injuries in cancer survivors and helping them return to sports and exercise routines.
I am passionate about lifestyle medicine, an evolving field that focuses on lifestyle interventions, such as diet, exercise, stress reduction, and smoking cessation, to treat and prevent various chronic conditions and improve function. In my research, I explore lifestyle interventions to improve the lives of people who have had cancer. I also speak at the local and national level about rehabilitation programs for people with cancer. I am a co-chair of the lifestyle medicine counsel for the American Congress of Rehabilitation Medicine and a co-chair of the medical fitness working group for the American College of Lifestyle Medicine. Additionally, I sit on the executive committee for the American College of Sports Medicine’s Task Force on Exercise Oncology.
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Read the full transcript here:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everyone.
Speaker 2 (00:36):
Welcome back to the podcast. I am your host, Karen Litzy and this month, which is the month of April, 2021. We have focused our attention on cancer, survivorship, and oncological rehabilitation. To that end. I am thrilled to announce that on May 11th at 8:00 PM Eastern standard time, this is a Tuesday evening. We will have our round table talk focused on that subject. Oncological rehabbing cancer survivorship. All of the guests from this month will be on that round table talk. So that includes Kristin Carol Jillian Schmidt, Dr. Lisa van Hoose, and our guest today, Dr. Jonas Sokoloff. This is your chance to ask these four amazing experts, any question you want. And I know being a physical therapist going to conferences, I always want to try and get the person's attention to ask them a question. Sometimes you never get the chance. This is your chance. So if you have questions on oncological rehab on cancer survivorship, whether you're a physiotherapist, a healthcare professional fitness, professional, learning more about how to treat this population is imperative because a hundred percent of us are probably going to see someone who has cancer, who has lived through cancer in their lifetime.
Speaker 2 (01:55):
So how do you sign up? Go to podcast dot healthy, wealthy, smart.com click on the link that says round table talks, and you can sign up right there. And again, it's going to be Tuesday, May 11th, 8:00 PM, Eastern standard time. Now onto today's episode, like I said, today's guest is Dr. Jonas Sokoloff. He is a physician specializing in physical medicine and rehabilitation at NYU Langone Rusk rehabilitation. After completing his residency training at Harvard medical school, he sub-specialized in musculoskeletal sports medicine and interventional spine care as a physiatrist. His goal is to help his patients regain function through various non-operative treatments. And he also has expertise in osteopathic manipulative medicine treatment. Also known as manual medicine it's hands-on care. So he does use his hands to diagnose, treat and prevent injury or illness through stretching, applying gentle pressure and using resistance. A major focus of his is the rehabilitation needs of cancer and survivors is goals to help individuals from diagnosis to cure, improve overall function and quality of life.
Speaker 2 (03:06):
He has expertise in diagnosing and treating a variety of cancer treatment related side effects, such as chemotherapy induced, peripheral neuropathy, radiation, fibrosis, lymphedema, and post-mastectomy pain syndrome. As the need for physical rehab grows in the field of oncology, he finds it exciting and rewarding to help restore function in anyone who has experienced cancer is also sort of certified in sports medicine. So he's experienced in treating sports related injuries in cancer survivors and helping them to return to sport exercise and routines. And he is also passionate about lifestyle medicine as am I and ever evolving field that focuses on lifestyle intervention, such as diet, exercise, stress reduction, and smoking cessation to treat and prevent various chronic conditions and improve function. And we talk about that in the podcast today. What else do we talk about? Well, we talk about exactly what a physiatrist is and how they work in the field of oncology.
Speaker 2 (04:06):
We talk about some common side effects that people may experience from cancer related treatments. We also talk about the, his baseball analogy on rehabilitation and getting people back to their sport or back to life, which I love because I'm a softball player. So I had anything with a baseball analogy I'm all in. And he also talks about the importance of lifestyle medicine and why that's important, especially with cancer patients. And he lets us know exactly why that's so important. So a huge thank you to Dr. Socolow for coming on the podcast. And everyone don't forget to sign up for our round table on May 11th, by going to podcast at healthy, wealthy, smart.com and clicking on the round table tab. Enjoy everyone.
Speaker 3 (04:59):
Hi, Dr. Sokoloff welcome to the podcast. I'm happy to have you here this month, where we're talking all about cancer survivorship. So thank you so much for coming on. Oh, thank you very much for having me. It's really great to be with you. Yeah, this is really exciting. I'm definitely familiar listening to your podcast or floor gray while you're doing and you guys, my pleasure. Awesome. Well, thank you so much for that. And like I said, in your bio, you're a physiatrist and you're here at NYU. And we'll talk about that a little bit later, cause you guys have an oncology summit coming up and we'll talk about how people can sign up for that, but they have to listen to the whole, they have to listen to this whole podcast to get all the goods. So before we get into the meat of the discussion today, can you tell the listeners what oncological physiatry is? So uncle logical desires, you, maybe I should start by what is desire?
Speaker 4 (05:58):
You know, there's, I'm sure most of your listeners are well aware of what the field of desire tree is all about, but there may be a few that aren't so desire tree also known as physical medicine rehabilitation is a sub-specialty of medicine that involves essentially working with patients to enhance quality of life and physical function for patients that may be suffering from whether it's a an illness or an injury traumatic brain injury, spinal cord injury, or musculoskeletal injury. And it's a, it's a very multi-disciplinary field that overlaps a lot with orthopedics neurology, internal medicine rheumatology sports medicine, and, you know, several others. So you kind of have to know a little bit of everything, but basically the main goal of [inaudible] is to enhance quality of life and physical function. Now in oncological, physiatry is, is sub specialty.
Speaker 4 (06:57):
So we are experts in neuromuscular and musculoskeletal and other functional impairments that directly affect you know, people living with the beyond cancer, whether it's from the actual cancer itself or from the treatment of cancer. So surgery, radiation, systemic therapies, chemotherapies, immunotherapies, targeted therapies, et cetera. So in a nutshell, that's, that's, that's essentially what the field is about and what drew you to this subspecialty. So I am a sports medicine trained physiatrist. I did three years of a physical medicine rehabilitation residency. Before that you have to do a, a year of a general internship. And then I went on to do a three-year residency in PMNR. And then after that I did another year long fellowship and what's called spine and sports care or spine and sports medicine. So I received training in sports medicine care. So sort of like non-surgical orthopedics, interventional spine psychiatry, injections under fluoroscopy and under ultrasound.
Speaker 4 (07:59):
And, you know, I thought I was going to, you know, treat, you know, weekend warriors and, you know, athletes and, you know, yoga moms and so forth. And you know, essentially non-surgical orthopedics. But for me, I learned kind of early on in my fellowship year that, you know, I, I tend to kinda get bored doing the same thing, you know, over, over and over. And I, I really liked the variety and really like the challenge. And there was an opportunity to major cancer center in New York where they were looking to hire another physiatrist. They already had two physiatrists and they were looking at another physiatrist who actually had more of a sports medicine, interventional background. And I ended up applying for the position and it was, I was so impressed with the institution, but more importantly, I was, I was really impressed with this opportunity to really make a big impact in the field of oncology and really help like enhance the quality of life for people living with and beyond cancer.
Speaker 4 (09:03):
I just felt for me, that was more meaningful because there's such a huge need. Unfortunately, people who have the disease of cancer and go through treatment through the whole continuum, they have a lot, a lot of problems with, you know, getting back to the way, the level of functioning and quality of life that they had prior to their diagnosis. There's just a tremendous need, but we've gotten so much better at treating a variety of different types of cancers keeping people alive longer. Unfortunately a lot of these treatments do have a lot of sequelae that, you know, the oncology field, it's just not, they're just not well equipped to deal with these issues. And that's where we really shine as rehabilitation professionals because we are the experts in physical function and quality of life, and we really can make a difference. And I liked that feeling of really being able to make a big difference in the lives of these people.
Speaker 3 (09:59):
And you had mentioned in there that a couple of things that stood out to me, one that there are more people living after and beyond cancer than before, because of I'm assuming better treatments, better detection. Correct. And you also mentioned that there are side effects from some of these treatments and interventions. And I think oftentimes people think physical therapists alike think, Oh, someone had cancer, they survived it, they must be fine. So what do you see as the most common side effects and where can rehabilitation physical rehabilitation make a difference with those side effects?
Speaker 4 (10:44):
I would say probably amongst the most common side effects that I see, for example. So I see a lot of breast cancer patients and survivors in my practice and a lot of head and neck cancer survivors, a lot of prostate survivors. I'd say, you know, sequentially after surgery, for example, after mastectomy, or even in breast conservation, surgery, lumpectomy, and so forth. Whereas like you're, you're right. Patients, essentially in many, in many cases they're diagnosed early. They are, you know, very high success rate. The achieved cure is very often, but unfortunately a lot of these people, these individuals are left with a lot of pain and dysfunction, everybody heals at their own pace or rate. So their ICL, I see a great deal of patients who, whereas it it's expected that they're going to sail through their, their treatments. And men, many instances, they have achieved the events they have achieved you know, complete remission, but yet in some way, they're, they're left kind of broken and they're not able to get back to their baseline level of functioning.
Speaker 4 (11:50):
They have, they may have prolonged pain that lasts longer than what would be expected. They may have more scar tissue. And there's there. These factors may be, are usually multifactorial lifestyle factors come into play. Underlying premorbid conditions come into play you know, whole host of factors. And in many instances they are not, they don't recover as fast and they need a lot of help. So I'd say the biggest, you know, impact. I think the, in my practice, I would say in our breast cancer patients, we see a lot of patients with post-mastectomy pain syndrome pain that lingers way past the recovery period with scar tissue that often results in shoulder dysfunction adhesive capsulitis rotator, cuff dysfunction and impingement, bicipital tendonitis, various other factors that really adversely affect people's abilities to get back to like their life. That's one example that comes to mind, radiation fibrosis.
Speaker 4 (12:55):
So, you know, chemotherapy, radiation being the cornerstone of treatment for head and neck cancers, a great deal of morbidity there, you know a lot of scar tissue that forms after radiation, that impairs neck range of motion, ability to open your mouth trismus swelling, lymphedema in the head and neck population. Nobody, nobody knows how to handle these types of issues, but as rehabilitation professionals are really well equipped in you know, are able to really make a big impact in the lives of these folks. So I'd say those, those two populations really stand out to me and they are, they do make up a majority of my practice.
Speaker 3 (13:37):
And one thing that rehabilitation professionals are really proficient as in is exercise. So how can exercise help with these patients to improve their function and quality of life?
Speaker 4 (13:49):
Right? So we do have very robust data in the form of randomized controlled trials that exercise both aerobic training and resistance chaining can actually help improve several different cancer-related health outcomes. And that includes overall physical functioning lymphedema, anxiety, depression, overall, quality of life and wellbeing. And this comes from, you know, a tremendous amount of rigorous, you know well-designed clinical trials. So we do have, we now have really great evidence supporting this. We actually know that it, that it can be used as medicine, and we all know, I'm sure your listeners are well aware that exercise is medicine and really in oncology, this is actually even more apparent.
Speaker 3 (14:39):
And when we think about these patients living with and living beyond and through cancer, one of the things at least that I've seen with a lot of my patients that I have seen is that fatigue is an issue. And so when we're thinking about exercise, so as physical therapists, you're sending your patients to us, fatigue is a big issue. Do we center our treatment approach around a graded approach to exercise or to a paced approach to exercise? Or is it one of those answers that it depends.
Speaker 4 (15:11):
So it's all it's should be a personalized approach, right? It's really not a one size fits all. And that's why, again, it helps to be, you know, it helps for a patient to work with a highly skilled trained rehabilitation professional so that they can really hone in, do a full comprehensive assessment and really understand, you know, what exactly that particularly low patients struggling with with the impairments may lie what their history has been and order to come up with a real, you know, comprehensive, structured, personalized program. Oftentimes we use in rehabilitation, we're using a therapeutic exercise program. So for example, patient has, let's say rotator cuff dysfunction, right? They have imbalance of their scapular scapular stabilizing muscles, right? And they may have altered glenohumeral mechanics that are promoting this condition of impingement, let's say of the supraspinatus tendon and that leads to pain, loss of range of motion.
Speaker 4 (16:14):
And then that then progresses to let's say, adhesive capsulitis or frozen shoulder, for example. So we would, we would construct a therapeutic exercise program specifically honing in on that specific dysfunction, right. The shoulder. But we can also use, you may say generic exercise. We could use aerobic training and strength and conditioning on top of the therapeutic program, all from a personalized standpoint for what meets the needs of that specific patient in conjunction with a therapeutic exercise program. And that's where I think really where the field is headed is really being able to the goal should not just be, to get the patient out of pain, would get them back to, you know, being able to do some of their life specific activities, but also getting them to an exercise program that should be one of the main goals of ecological rehabilitation program.
Speaker 3 (17:10):
And I think that's great advice for all the physical therapists and physiotherapists out there listening is that when these patients are coming to you, like we'll take the example of shoulder pain post-mastectomy or post some sort of treatment that we don't want to just focus on. Let's just do exercises and rehab around the shoulder, but let's take it broader and try and make this into like a lifestyle change for the patient.
Speaker 4 (17:40):
Exactly, exactly. There's a there is a diagram that I often use on a lot of my talks when I lecture on this subject. And it's
Speaker 5 (17:50):
The baseball diamond approach to rehabilitation is a approach that is utilized in sports medicine. It was it was passed on to me by some folks some physiatrists at the Mayo clinic. It's very simple way to think about it, but essentially your goal is to get, get to home plate, get back to return, to play, you know, so to speak or return to life, do advance through all the bases to get the first space you have to restore range of motion from first base to second base. And you have to start to work on strength from second base, third base. Now you're starting to work on the neuromuscular kinetic chain on the pitcher's mound. You really want to put an exercise program that they should be able to be able to do for the rest of their lives. Because what it's going to do is actually going to, it's going to improve survival.
Speaker 5 (18:32):
It's going to improve cancer related you know health outcomes. Okay. So it's gonna help them to improve. It's going to help to improve anxiety, fatigue, physical functioning. And this is another thing that I really love about the field of oncological rehabilitation, because not only are we helping to restore quality of life and overall physical function, but we actually have the opportunity to make an impact on the disease itself. We actually can, as rehabilitation professionals can actually change the course of the disease by getting our patients back to a safe and effective exercise program. So it really needs to be incorporated into rehabilitation. It really should be all part of what we're doing as rehab professionals.
Speaker 3 (19:14):
I really liked that baseball diamond analogy. And, and oftentimes when we think of that return to play, I know the first thing that comes to my mind is as an athlete. So you're getting them back to their sport, whether whatever that sport may be, but you're absolutely right, that that same framework can be used for all of our patients. They have to get back to, it may not be back to the soccer pitch or the baseball field, but they are getting back to returning to play, which is their life
Speaker 5 (19:49):
That's correct. And even back to their familial roles, there's societal roles, there are vocational roles really getting them back to the things that they want to be doing, the things that they need to be doing to live out the rest of their life.
Speaker 3 (20:06):
Yeah. I love that baseball diamond going to be using it all the time. I love it. Especially as a former softball player and a former pitcher, I can definitely relate to that. Now we've been saying this word a couple of times throughout the interview, and that is lifestyle. So there is this lifestyle medicine, branch of medicine. So how does that fit into the oncology patient in the world of oncology?
Speaker 5 (20:34):
So two thirds of the world's cancers, according to the world health organization can actually directly be linked to lifestyle, right? So smoking alcohol dietary intake lack of physical activity, increased stress levels and so forth. So we have as rehabilitation professionals, the opportunity to intervene to provide lifestyle interventions and again, help restore physical function, but also have a major impact on the, the course of the disease itself. So I believe that lifestyle medicine actually should be, is a very important aspect of what we offer in rehabilitative care, especially in on-call oncological rehab. So I try to incorporate it into my practice counseling patients and educating patients on proper nutrition, certainly exercise. We do a lot of cancer counseling and exercise. We offer stress reduction techniques. Certainly when, when patients are smoking we, you know, get them as soon as we can plugged in with smoking cessation programs and so forth and so on. So because there is such a direct relationships to lifestyle and cancer it, it has to be a key component of the rehab plan as well.
Speaker 3 (21:51):
Yeah. And that, that is all in our lane.
Speaker 5 (21:54):
Exactly, exactly. Yeah, I mean, you know, the F really up until, you know, recently the thought process, you know, cancer essentially had a very strong genetic component. But right. The it's the way the, the environment or lifestyle is affecting those genes, which we know that, that poor lifestyle can actually turn on a lot of those oncagenes and promote you know, promote cancer growth. So yeah.
Speaker 3 (22:26):
Yeah. And so what is it coming from you from your position as a physiatrist? What are some things that you really want physical therapists to know when it comes to treating patients that have, or have lived through cancer,
Speaker 5 (22:43):
Physical therapists that it's, it's safe to put these folks through an exercise program it's safe to put them on a resistance training program as long as it's, you know supervise and as long as, you know, if you're working with a physical medicine rehabilitation physician or a physiatrist, it's really great to partner up so that you can learn, you know, what would be a safe way to approach, for example, a patient with metastatic disease in the spine or metastatic disease somewhere else. You know, in the, in the skeleton, for example, cause I think a lot of therapists may be apprehensive. They don't want to, you know, cause a fracture, for example, they may not want to injure a patient and they're not sure what would be safe. Just know that it is safe when it's done, you know, under the supervision of someone who's as skilled, as trained as yourself, but also helpful if you have members of your oncology community that you can communicate with and determine you know, what would be the great, the best plan for that patient and what would be the safest plan?
Speaker 5 (23:57):
I mean, therapists were, we, we were in constant communication about the patients programs in our, in our at our site as to what, how you can progress them through an exercise program safely based on, you know, review of imaging and based how, and then how they present clinically. So yeah, I mean, I, I would, I would just say, I think, you know, a lot of these patients can tolerate probably a little bit more than what's been previously done in the past.
Speaker 3 (24:29):
Awesome. Well, thanks so much for that. And hopefully all the physical therapists and physios and even other healthcare professionals listening or taking notes on all of this, cause this was great. Let's talk about the NYU Rusk rehab. They have an oncology summit coming up. Is it in October,
Speaker 5 (24:49):
October 1st, it's going to be
Speaker 3 (24:51):
Featuring our very own Nicole Stout as a keynote. We love her here. Love her, love her so much. So go ahead and talk a little bit more about that.
Speaker 5 (25:00):
So we are having our first you know, annual uncle logical rehabilitation summit Ruskin suit, NYU school of medicine on it's gonna be October 1st, it's going to be a hundred percent virtual. Eventually as we come out of the pandemic, we will hopefully transition to an in-person program. But this year we're going to starting off as virtual. And the theme of this year's symposium is going to be exercise oncology. So we are going to have oncologists lecturing, certainly physical therapists, speech therapists, occupational therapists Dr. Katie Schmidts, the CSM round table leader in luminary in the field of exercise oncology as well as Nicole Stout, excited to have them are two keynote speakers are really looking forward to providing a robust program for anyone interested in how to implement exercise into a rehabilitative care plan for oncology patients.
Speaker 3 (25:58):
Yeah. And it's like total coincidence. I got the email for that. Like a couple of days ago, I was like, Oh, this is perfect because here we are doing this interview. So this worked out very, very well. And now where can people find you, if they want to ask you questions, they want to connect with you? Where can they find you?
Speaker 5 (26:17):
My email probably is the best. I'll definitely find putting it out there. It's my first and last name, so that's Jonas, J O N a S dot SoCal off that's S like Sam. Okay. O L like Larry off, likeFrank@nyulango.org, one word, NYU llangollen.org.
Speaker 3 (26:37):
Perfect. And we will have all of this links to sign up for the summit and your email in the show notes for this episode at podcast at healthy, wealthy, smart.com. And last question that I ask everyone, is that knowing where you are now in your life and in your career, what advice would you give to yourself as let's say, fresh out of medical school?
Speaker 5 (27:05):
What would the advice would I give myself fresh out of medical school? I would say, you know, I would say, probably go with your gut. Right. You know, there's a lot of pressure. I think when you're, when you're going through medical training and medical school you know, pulling in different directions on planning your career you have a lot of different factors, financial and I think, you know, I always had wanted to, into going to have a medical career that was going to make a big impact. I think I got a little bit sidetracked along the way, and I, I kinda may have been chasing a different dream, but then when I finally realized what I think what I was meant to be doing, it really kind of brought me back in line on my path. So I'd say, you know, just really follow your gut, you know, pursue your dreams. You know, really go with what you feel is right deep down in your heart, and now you really can't go wrong. So
Speaker 3 (28:06):
I love it. Great advice. And, and frequently heard advice here on this podcast. So it must be a good one. So, Dr. Sokoloff thank you so much for coming on today and look forward to seeing you at our round table discussion in a couple of weeks. So thank you for that as well. So thank you. Thank you. Thank you.
Speaker 5 (28:26):
Thank you. I'll look forward to the round table.
Speaker 3 (28:28):
Yeah. As in everyone for listening everyone out there listening. Thanks so much. Have a great couple of days and stay healthy.
Speaker 1 (28:34):
Be wealthy and smart. Thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
In this episode, Associate Professor and Program Director in the Physical Therapy Department at the University of Louisiana Monroe, Dr. Lisa VanHoose, talks about the provider role in cancer survivorship.
Today, Lisa talks about implicit provider bias, survivorship as a concept, social determinants and healthcare access, and provider trust. How can physical therapists help lessen the overload? How do you determine whether or not you’re a trustworthy provider?
Hear about the effects of cancer on co-survivors, get some advice for screening when working with cancer survivors, and learn about the disease burden on marginalised communities, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- The definition of cancer survivor: “You become a survivor from the time of diagnosing.”
- “When we talk about survivorship, it really is a conversation about how well are you able to live your life.”
- “Cancer and its treatment is one of the top causes of bankruptcy in the US.”
- “Cancer and Alzheimer’s Disease are two chronic diseases where we’re seeing the caregivers die earlier than the survivor because of the caregiver burden.”
- “Medical access accounts for about 20% of someone’s health outcomes.”
- “Cancer survivors who have unmet social determinants of health are more likely to miss appointments.”
- “If you want to know if you’re a trustworthy provider, you should probably ask.”
- “You can condition yourself to have less bias, but you have to actively do it.”
- “100% of physical therapists are going to see someone who had cancer or has cancer.”
- “Everyone needs to be doing a self-assessment of where they’re at in regards to their own biases.”
- “African American women were dying at rates 3 to 4 times higher than those of their Caucasian peers.”
- “That difference in healthcare is avoidable if we would just stop and be intentional about the care and the way in which we deliver care to each other.”
- “We’re one decision away from someone having a different type of cancer survivorship journey.”
- “Although we know cancer survivors are recording these side-effects to cancer and its treatment, only about 20-30% get referred to a provider to address them.”
- “In our quest to provide care for others, we forget to refresh and replenish ourselves.”
More about Lisa VanHoose
Dr. Lisa VanHoose is an Associate Professor and Program Director in the Physical Therapy Department at the University of Louisiana Monroe. Dr. VanHoose received her PhD in Rehabilitation Science and MPH from the University of Kansas Medical Center. She completed fellowships at the University of Arkansas Medical Sciences Donald W. Reynolds Institute on Aging and the National Institute of Heart, Lung, and Blood Institute PRIDE Summer Institute with an emphasis in Cardiovascular Genetic Epidemiology. Her Bachelor of Science in Health Science and Master of Science in Physical Therapy were completed at the University of Central Arkansas. Dr. VanHoose has practiced oncologic physical therapy since 1996. She is a Board-Certified Clinical Specialist in Oncologic Physical Therapy. As a NIH, PCORI, and industry funded researcher, Dr. VanHoose investigates socioecological models of cancer related side effects with an emphasis on minority and rural cancer survivorship. She has been an advocate for movement of all persons, including the elimination of social policies and practices that are barriers to movement friendly environments. Dr. VanHoose served as the 2012-2016 President of the Academy of Oncologic Physical Therapy of the American Physical Therapy Association. She currently provides oncology rehabilitation services through the Ujima Institute, PLLC, as the owner and service provider.
Suggested Keywords
Physiotherapy, Research, PT, Health, Therapy, Healthcare, Cancer, Oncology, Survivorship, Rehabilitation, Mental Health, Providers, Biases, Movement, Wellness,
To learn more, follow Lisa at:
Website: https://www.ujimainstitute.com
ULM - Lisa VanHoose
Facebook: Ujima Institute
Instagram: @ujima_institute
Twitter: @LisaVanHoosePT
@UjimaInstitute
LinkedIn: Lisa VanHoose
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Transcript:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy.
Speaker 2 (00:35):
Hey everybody. Welcome back to the podcast. This month is all about cancer survivorship. So if you missed the episode two weeks ago with Christine Carol and Jillian's Schmidt, make sure you go back and listen to that episode. Lots of great information, especially for providers on how to treat people with cancer currently, or cancer survivors. Now today's episode is brought to you by net health and tomorrow, which is Tuesday, April 20th, net health has a three-part mini webinars series bet with best-selling author, Stacy Fitzsimmons and Kelly Castillo of net health. They'll be talking about the three T's of creating revenue ownership beyond just billing beyond just the billing department, training tools and transparency. Stacy and Kelly have over 25 years of combined experience helping private practices give the best possible care while increasing their revenue head over to net health.com/litzy. To sign up as a bonus. If you put Litzy in the comment section and show up, they've arranged for net health to buy lunch for your office.
Speaker 2 (01:44):
Once again, that's net health.com forward slash L I T Z Y. So head over and sign up now and moving on to today's episode again, following in our theme of the month, which is cancer survivorship. I'm thrilled to have on the program, Dr. Lisa van hus. She is an assistant professor and program director in the physical therapy department at the university of Louisiana Monroe, Dr. Van who's received her PhD in rehab science and MPH from the university of Kansas medical center. She completed fellowships at the university of Arkansas medical sciences, Donald W. Reynolds Institute on aging and the national Institute of heart lung and blood Institute pride summer Institute with an emphasis in cardiovascular, genetic epidemiology, her bachelor of science in health science and master of science and physical therapy were completed at the university of central Arkansas, Dr. Van, who says practiced oncologic physical therapy since 1996.
Speaker 2 (02:40):
She is a board certified clinical specialist in oncologic physical therapy as an NIH, P C O R I and industry funded researcher, Dr. Van who's investigate socioecological models of cancer related side effects with an emphasis on minority and rural cancer survivorship. She has been an advocate for movement of all persons, including the elimination of social policies and practices that are barriers to movement friendly environments. She served as a 2012 to 2016, president of the Academy of oncologic physical therapy of the APGA. She currently provides oncology rehab services through the Ujima Institute PLLC as the owner and service provider. So on today's episode, what do we talk about? Well, it's all about the provider. So in today's episode, Lisa talks about implicit provider bias, survivorship as a concept social determinants of, and the healthcare and healthcare access and provider trust. So how can physical therapists help lessen the overload? How do you determine whether or not you're a trustworthy provider we'll hear about effects of cancer on coast survivors, get some advice for screening when working with cancer survivors and learn about the disease burden on marginalized communities. So there's lots to dive in. This is a long episode but it is well worth it. I highly encourage you to listen to the very end because everything is so good and you will get so much information from Dr. Van who, so I want to thank her and thank net health and thank you for listening.
Speaker 3 (04:20):
Hey, Lisa, welcome to the podcast. I am very happy and honored to have you on, so thank you. Thank you. Hi, everyone. Super excited to be with you today. And now all this month, we are talking about cancer survivorship. This is your research. This is your wheelhouse. This is what you teach. So let's get to it. What we're going to talk about today is provider bias in that lens of cancer survivorship. So can you tell us how that works and what that is? Yes. So I think most of us are now familiar with the term implicit bias because of all the things going on in the social environment, right? So implicit bias is basically those preferences, attitudes, stereotypes that we might have towards a person or towards a specific group of people. And so when you talk about provider bias, it's that implicit bias, but it's something that is hailed by a provider that might then potentially impact have a interact with that patient or client, and even the decision-making process for that client and the research to just that it, a lot of times occurs either subconsciously or unconsciously. And so we're not even realizing how we might be negatively impacting somebody's care. And how can that provider bias affect outcomes affect treatment and affect the survivorship of these cancer
Speaker 4 (05:58):
Or patients with cancer. I don't want to say cancer patients. I want to say patients, people with cancer almost, almost, almost set it wrong.
Speaker 3 (06:09):
No worries. So when you think about provider bias so the research should just that most of us have a bias towards people that are a bigger body size or what we call obese, right? And so if you were a PT, a nurse, a physician, and you were talking with someone that is of a larger size, and they're trying to articulate to you that maybe their knees hurt, or maybe they've got, you know, some type of discomfort provider bias might make you minimize their complaint. It might make you not do a full assessment because you're like, ah, it's just related to their weight. Or you might just go, well, you know, it's part of their lived experience because they chose to be fat. And so there are things that instead of us doing the standard care, we actually will deviate from it because of our bias.
Speaker 3 (07:04):
And so where we see that happen, where that has an influence on cancer survivorship is we know that every cancer survivor will have at least one physical impairment and most of the time it's fatigue, but let's say that cancer survivors, someone who identifies as as a sexual orientation, that's not heterosexual. And you as a provider, you may believe that, you know, there's a moral or religious issue with that. So then when that person's talking to you about their fatigue, as it relates to maybe their sexual activity, or maybe just how it relates to their everyday life, you may decide consciously or unconsciously to not listen. Or you may decide that, you know what, that that's, God's answer to, you know, their, their lifestyle choice. So, sorry, y'all just, somebody is having a healthcare emergency right now.
Speaker 4 (08:06):
That's okay. Normally it's on my end because I'm right on Broadway. So there's always a siren going off. The listeners are used to it, please continue.
Speaker 3 (08:14):
So I think when we think about, you know, someone's care, we're all talking about, you know, high quality care and standardized care and trying to minimize variations. But a lot of the variations we see are related to our biases.
Speaker 4 (08:29):
And so let's talk for a minute about, so we know outcomes may be different because of this provider bias. And, you know, we are talking about cancer survivorship, but there's a difference between you're alive. You lived, you survived and the concept of survivor ship. So can you talk a little bit about that and how again, where that bias may play a role?
Speaker 3 (09:01):
Yes. So the new definition for cancer survivor is that you become a survivor from the time of diagnosis. And so often we think of that as binary, right? Are you alive or not alive? When we talk about cancer survivorship, it really is this conversation about how well are you able to live your life? Right? So regardless of the cancer diagnosis are, do you have the resources that you need to live the life that you choose at the best level that you so choose? And so when we talk about survivorship, now we want to know about all of your physical wellness. We want to know about your emotional wellness. We even talk about financial wellness because one of the side effects to cancer is financial toxicity cancer and his treatment is one of the number one causes of bankruptcy in the United States. So survivorship is really about how well are you able to live your life?
Speaker 4 (10:05):
And I would also have to assume that within that survivorship is the environment in which you're surviving. So can you talk a little bit about that as well?
Speaker 3 (10:14):
Beautifully stated. So the hot topic everywhere right now is social determinants of health. And I think that is also just as true for cancer survivors. And I also want to say their caregivers because when we talk about cancer survivorship, we want to also talk about the coast survivors, right? So a lot of times we'll focus in on the cancer survivor. But the work that we did in Arkansas, a couple of years back, we went throughout the state talking with cancer survivors and caregivers. And the thing that cancer survivors told us over and over again, was I'm more concerned about my loved one. I'm more concerned about my coast survivor because everyone's focused on me as a person with cancer, but no one is thinking about the lived experience of my of my caregiver. And I was at a conference once and they were talking about how that cancer and Alzheimer's diseases, Alzheimer's disease are two chronic diseases where we're actually seeing the caregivers die earlier than the actual survivor, right. Because of the caregiver burden. And so that's a trend that people are watching in the data. So, yeah.
Speaker 4 (11:29):
Yeah. So it's, it's more of, it's more than just the patient, it's the caregiver and it can also be their community. Do they have access to their treatments? Do they have access to the things they need to help them survive and survive? Well, if you're living perhaps in an area that you don't have access to a lot, these things might
Speaker 3 (11:54):
That also be something that can cause a bias in the provider, almost definitely. So I think you have to think about all of the social determinants of health. So in the, the literature suggests that the medical access, like the healthcare access, a counselor, about 20% of someone's health outcomes. Now we do know that your ability to get to a provider of choice is important. And we also know that people typically don't want to travel more than a 20 minute drive to get to care, but there are some areas where people are driving hours. I remember when I was in Kansas practicing, I had clients that would drive three to four hours one way to see me. And so when you think about cancer survivorship, and we know one of the number one complaints is fatigue. If you're driving three to four hours to get to therapy, then the expectation is you're going to work with a therapist for an hour, hour and a half.
Speaker 3 (12:58):
It's just not a realistic journey. So we have to figure out a way to improve access. Most definitely. We also have to think about the fact that, that it's not just can someone access care, but can they access high quality care? So there is a time and a place for generalists. I totally love my generalist, right. Shout out to you. But then there also Toms for specialists. And so there are certain geographical areas where it would be really difficult to find a specialist in cancer, be it an oncologist, be it a PTB in an OT, be it a dentist. So we have to think about those issues when we talk about healthcare access. But then you talk about the 80% and the 80% are going to be the things like what is the environment that that person with cancer has to live in.
Speaker 3 (13:50):
So like I'm here in Louisiana and Louisiana has a stretch of highway that's known as the cancer corridor, right? Because we have hundreds of production, meals and industries that have a lot of waste products. And so because of that, we see this uptake in cancer prevalence, we see a different survivorship experience for those cancer survivors because they're constantly exposed to these environmental exposures. So I think, you know, that's one thing when you think about cancer, survivorship is what is the environment in which they're living right now? We're talking to everybody about, you know, physical activity, the, the APA has just launched a physical activity campaign, but then you have to think about, okay, what, what is their green space availability? Is it safe for them to be out and walking, right? Then you have to think about how are they going to fuel that movement. So are they close to grocery stores, right? Or, you know, community gardens. So I think when we think about cancer, survivorship, healthcare is one piece, but then we also have to think about all those other determinants of health as well.
Speaker 4 (15:02):
And it's does it not seem overwhelming? I mean, gosh, to me it sounds, seems so overwhelming. So how can as providers, let's say, as physical therapists, healthcare providers, what can we do to help lessen that? What that
Speaker 3 (15:19):
Overload? Yeah. So I think if we, number one, just all can agree that we have some level of implicit bias because we're all animals. So therefore we are slightly tribal in animalistic, which means that you're naturally going to have a preference towards people who look like you or people who act like you or think like you, so you have to engineer the system to combat that. And the best way to do that is with screening tools, right? So could you introduce a screening tool that asks that client about their cultural beliefs and their lived experience? Right. so then that way you can incorporate that into their care because I was pulling up some articles that looked at the lived experience of black or African-American and Hispanic or Latino X cancer survivors. And one of the things that they talk about is the fact that their provider, who is often, you know, someone who identifies as white, doesn't really ask them about their life.
Speaker 3 (16:27):
They might give them instructions, but doesn't ask them about the context right. In which they're supposed to implement this. And they're like, that's part of the reason why I don't follow those instructions and then they get dinged for noncompliance, right. Or, or non-adherence, and they're like, that person never asked me anything about me. So could you potentially introduce that as a screen in regards to kind of getting some information about their cultural values and beliefs, and then introduce a social determinant of health screen. So then you can find out kind of what their needs are because one of the articles I pulled up was talking about how that cancer survivors who have unmet social determinants of health are more likely to miss appointments. And so how often do we all get frustrated at that patient? That's a no show. Well, have you asked them about what's going on in their life and then help to align them or connect them with some community resources, because that might be the root of a no-show right. So I would say start off with some screening.
Speaker 4 (17:37):
Yeah, that's great. And you know, we had a conversation last night on clubhouse with a group of physical therapists and it was about the female athlete, but one of things that
Speaker 2 (17:50):
Was very clear is, are we asking the right questions? And I think that completely aligns with what you just said. So what is your food security? Like, what is your home security like, right. Do you have children? And this is another one, do you have pets? But if you have, what is your responsibility in your home life? If you have a dog, if you live alone or do you have to walk this dog? We just talked about fatigue being one of the major aspects. So what if they have to walk their dog three times a day and they have physical therapy that day? Well, which one do you think is not going to happen?
Speaker 3 (18:28):
Exactly great points. You know,
Speaker 2 (18:31):
These are all great questions to ask. So it's, we're asking questions, but are we asking the right questions? And I think that was a solid point that you just made.
Speaker 3 (18:41):
I love that. Are you asking the right questions and then are you living?
Speaker 2 (18:47):
Hmm, well, even more important because like you just said, implicit bias can make us our brains be like, blah, blah, blah, blah, blah, blah, blah. Oh, were you saying something or, or, you know,
Speaker 3 (19:01):
Often someone will say something, someone will tell us what they value and then, because we don't value that we'll minimize it and that might've actually been the secret sauce to them being able to achieve their healthcare goals.
Speaker 2 (19:15):
Yeah. Yeah. Another and again, gosh, another great question that was brought up yesterday is, well, what kind of successes are you having right now? And then, like you said, that might be it, that might be the secret sauce. So if we're not tuned in, are we going to miss it?
Speaker 3 (19:33):
Great points. And then I think often as providers, we tend to ask all the questions about the negatives. And especially when you add in your provider bias your implicit bias, because we've been conditioned to think so many negative things about different subgroups. So we automatically start asking them all these questions about all of these negative things that we think should be occurring in their life. So I love this concept of saying, well, what's going well, right? What are the successes? Because then it also changes the dynamic of the relationship, because then that helps you to understand what are the things that you could leverage. Right. And expand. So I, I really think, you know, the other hat I wear y'all is I'm an educator. And so when we talk about culturally responsive pedagogy, one of the core elements is are you coming into that exchange with the student from a positive lens?
Speaker 3 (20:36):
And I think we also have to think about that as a provider. Because anytime you interact with a human, it's an exchange of energy, and if the energy I'm putting to you as negative, that's going to impact you. So I think always kind of, you know, asking, you know, what's going on. Well also thinking the best of the person that's sitting in front of you. That's one thing that I've learned from the patients that I've been able to serve is they're like, there are some days that I just have to borrow the positivity from my providers. Right. And I think we have to recognize that that some days we are, we are that, that shining star, that good vibe for another human, but that requires us to actually believe in that other human and in their experience. So you got to see that human in front of you perfectly said, of course. And that leads me to the next topic. Is, is, are you a trustworthy provider? And how do you determine that? Because is, is trust normally determined by the person in front of you? They feel you're a trustworthy provider. If you feel you, are, are you biased towards yourself? Like, yeah, I'm awesome. Right. So can you expand on that? And on that note, we'll take a quick break to hear from our sponsor and be right back
Speaker 2 (22:03):
Tomorrow, April 20th, as part of net health, three part webinars series bestselling author, Stacy Fitzsimmons, and Kelly Casio of net health. We'll be talking about the three T's of creating revenue ownership beyond just the billing department, training tools and transparency, head over to net health.com/lindsey to sign up as a bonus. If you put Lindsey in the comment section in the registration page, sign up and show up net help, we'll buy lunch for your office. Once again, that's net health.com forward slash L I T Z Y. Sign up today.
Speaker 3 (22:39):
Oh, that's a good one. So there are two dynamics that occur in the therapeutic Alliance. There is the trust that the patient or the client, or maybe their caregiving unit, the stove's on us as providers, right? So that's the gift. And I think often as providers, we feel like we're entitled to trust and you're not, it's no different than any other relationship. It is something that someone is gifting to you, if they're dressed. And then for us as providers, we have to prove to be trustworthy and trustworthy is reliable and honest, right. And authentic. And so how do you know if you're trustworthy is that patient or client is actually the judge of that. It's not you. And so the definition of trustworthy may slightly vary for different patients, right. Because they are actually the judge and the jury in that. So if you want to know if you're a trustworthy provider you should ask, or maybe it should be part of your customer satisfaction survey, but I think, you know, when you think about provider bias or even implicit bias most of us can sense when the person that we're interacting with is not being authentic.
Speaker 3 (24:03):
Right? And so your bias thing can impact your ability to be, to be perceived as trustworthy as a provider or even just as a human. And so that's why it's really important for us to do the self work, to really kind of sit with ourselves, know what our triggers are. So, you know, who is it that we have these really negative perceptions of, or thoughts about, and then really questioning that. So Eckhart totally talks a lot about watching your mind. And so my challenge to providers is even in that interaction with the client or the patient in front of you, you know, always kind of paying attention to what are the voices in your head saying, you know, as you're doing that interview, listening to that client what, what is really S what else is going on? You know, like when that patient says, you know, no, I've not been able to, you know, take my blood pressure medicine, are you like, yeah, it's probably because, you know, you're doing X, Y, and Z with your money, or, you know, you're always telling a lie, but could you say to yourself, is that true?
Speaker 3 (25:12):
Cause Bernay Brown talks a lot about asking yourself is that the story is, you know, what's the story I'm telling myself. So could you really question that and then push back on, push back on that a little bit, cause you can condition yourself to have less bias, but you have to actively do it
Speaker 4 (25:32):
And it takes work and it can be uncomfortable. Yeah.
Speaker 3 (25:35):
It takes a lot of work, takes a lot of work. Because it's easier just to believe your own little echo chamber that you've created.
Speaker 4 (25:44):
My next question is what is your advice to providers when it comes to dealing with cancer survivors? Because as I spoke about in another podcast with Kristin is a hundred percent of physical therapists are going to see someone who had cancer or has cancer, the numbers are there. So what is your advice to providers when working with this population and kind of checking themselves? Quote unquote,
Speaker 3 (26:15):
Great question. So I'm, I'm going to say, first of all, we're going to go with your statement of ask the questions. Because I have actually seen therapists, physicians care for a client and never know that they had cancer because we didn't do a complete history. Right. and so you, you want to ask people that because the data says that one in two men will have cancer in their lifetime, one in three women. So just like you said, the odds are, is that you're going to care for someone that has had cancer or currently has cancer. So ask the question, number two is ask some details about it. So now the standard is, is most cancer survivors will have, what's known as a cancer survivorship plan that outlines the details of their tumor and also the treatment of it. And that's really beneficial to you as a provider because it'll help you be able to explain maybe some of the symptoms that they're reporting and also potentially anticipate some of the symptoms that they might have in the future.
Speaker 3 (27:23):
And there are things you could do to prevent that so that they have a better survivorship journey. Then number three, just listen and listen with a beginner's eye and beginner ears. Right? So be really curious about what that person is saying. Everything doesn't have to be judged because I always remind people, there are 8 billion people on the planet, so there are 8 billion ways of doing this thing. There's no rights or wrongs. And then the fourth thing is a screen, right? Because I have to recognize as a provider that I'm going to ask the questions, I'm going to do the things that are often comfortable for me because you get in this routine. And then, because this is a human sitting in front of me and everyone is diverse. I have to have some screening so that I don't miss anything. Right. Because often my pattern is based on what I like and the things that I do with the community that I'm, you know, most accustomed to.
Speaker 3 (28:28):
And so when I'm treating someone that might be different from me and everybody's different from me, then it's always good to have a screen that way you make sure you're not missing anything. And then I would say the last thing is ask that person what is important to them because often as providers will create a whole plan of care and never really asked people to rank or prioritize, what's really important to them. We often make judgements for people and that's not our jobs as providers, we're, we're part of their team. So those would be the things that I would say to remind people love. And then, you know, I think everyone needs to kind of be doing a self assessment of where they're at in regards to their own biases. And then just getting curious about it, be okay with talking with someone who doesn't think like you or who doesn't look like you.
Speaker 4 (29:23):
Yeah. Every point. Excellent. And hopefully people were taking notes on that. And now Lisa, where can people find you if they want to learn more about you and what you're up to and what you're doing.
Speaker 3 (29:35):
Awesome. so you can typically find me at the university of Louisiana Monroe. So I am the associate I'm associate professor and program director of the physical therapy program there. Or you can find me through Jima Institute. So the Ujima Institute is a grassroots organization that we started to primarily look at ways in which we could collectively come together to address the health and wellness of black communities. Because one of the things we didn't even talk about was health disparities as it relates to minority or marginalized communities. So when you think about black and Brown cancer survivors, when you think about cancer survivors from LGBTQ communities their disease burden is significantly different than the majority group. And even things like just their mortality rates are significantly different. That was some of the work that we did early on in Kansas city where we found that, you know, African-American women were dying at rates three to four times higher than those of their more of Caucasian peers. So yeah. Of white peers.
Speaker 4 (30:47):
And is that because of lack of access, was it because of lack of belief that they were ill or what, what did you, what did your findings
Speaker 3 (30:59):
So some of it was an access issue. So when you think about where the mammography centers located also the quality of the equipment at different sister centers varies as well. I think people often don't think about that. Then also the providers. So there's often a difference in which providers are available to which subgroups then also, and this is one thing that even, I think PTs and healthcare providers should think about in general is our typical office hours, right? So we tend to do eight to five. Well, if I'm a second or third shift worker that might not work for me, or if I work in an industry where I do a 12 hour shift that may not work for me. And those are often jobs that black and Brown community members are holding down. And so the very nature of how we deliver care often introduces some inequities. And I love that Def to my favorite definition of inequities talks about how they are avoidable, right? So that difference in healthcare is actually avoidable. If we would just stop and be intentional about the care and the way in which we deliver care to each other.
Speaker 4 (32:18):
Mm gosh, it's so multifactorial. But changeable
Speaker 3 (32:25):
Very changeable. I often say we're just one decision away. We're one decision away from someone having a different type of cancer survivorship journey because for your audience, fatigue is the thing that we often talk about, but the other things are like pain. Most cancer survivors are also experiencing a high level of anxiety. And in the United States, we're actually going the opposite direction in regards to our mental health resources, right. And cancer survivors need that support. Other things that bother them are things like neuropathy and even like itching. Like I cannot tell you how many cancer survivors are like, can you just make the itching stop? And people are like, well, who is it that big of a deal, but if I have a job and if my job is customer service and my receptionist is scratching, I'm like that impacts employment. So I'm like all of these things are, are part of the cancer journey where there are things we could do to prevent that or to attenuate it, even things like weight management, there are so many parts of this cancer sequella that we could adjust address early on. The other thing that has always been really interesting to me in the data is although we know cancer survivors are reporting these side effects to cancer and it's treatment only about 20 to 30% of them actually get referred to a provider to address them. So there are a lot of people live in a life that has less quality that really, that doesn't have to be right. And to me, that's not kind that is not con no.
Speaker 4 (34:14):
So you survived then what?
Speaker 3 (34:19):
Yes. Yeah. So, yeah. Yeah. So, and especially when we know that there are clinicians and providers out there that could be helping.
Speaker 4 (34:30):
Absolutely. And you know, I think don't you think that this is such an opportunity for the world of physical therapy? You know, we can be a conduit to other providers. Yeah. So, so if they, the cancer survivor is only spending 10 minutes with the doctor, but Hey, maybe they are coming to us maybe. Well, now it's like an automatic PT referral at the time of diagnosis. At least that's what the guidelines say. Am I correct in that
Speaker 3 (34:59):
Is the preferred guidelines. So that's kind of the pre rehab standards, right? That you get that diagnosis, you get a PT a Val, so we can get some baseline data.
Speaker 4 (35:10):
Right, right. Exactly. So might we also be the person to have the time to listen? And like I said, be that conduit and that super connector to people they need. So something to think about for the PT profession, you know, it's a huge opportunity for us to expand our reach, to be helpful and to make a difference in people's lives. And that's what we're supposed to be doing anyway. I totally agree. Because early
Speaker 3 (35:38):
On in my career I went through patient navigation certification and I remember people going, why would a PTB here? But it's a great place for us to be as a, as a rehab professional and especially as movement specialists, right? Because movement is the key to life. And so if I can help a cancer survivor, figure out the resources, they need to be able to keep their movement and function. That's a game changer in regards to health and wellness, even cancer outcomes. Some of the data even suggest in regards to mortality recurrence rate. So PT might, you know, often we talk about nurse navigation, but actually having a PTs, a navigator is not a bad idea.
Speaker 4 (36:28):
Absolutely. Well, I have to say, I thoroughly enjoyed this conversation, Lisa, and as always, and last question is knowing where you are now in your life and in your career, what advice would you give to your younger self, maybe that fresh face gal right out of PT school.
Speaker 3 (36:47):
Yeah. If I could talk to her, I would tell her to put herself first. Cause I think there is a reason why that the triple aim moved to the quadruped blame, right? To include burnout of providers because often in our quest to provide care for others, we forget that we need to refresh and replenish cash sales have. That is really, really important. We take better care of the equipment in our clinics and our hospitals that we do of our providers.
Speaker 4 (37:20):
And if it's, if we can't take care of ourselves, we are the most important piece of equipment.
Speaker 3 (37:26):
Yes we are. So we are the most important piece of equipment as it. If you wanted to talk about resources and I think also in regards to, when we think about our patient you know, client interactions, cause I often ask therapists nowadays, are you causing harm to the client that you're serving because of who you are. And maybe that's because you've not done yourself care, maybe it's due to your provider bias. Maybe it's due to, you need to re upskill in regards to your clinical skills. But I think it's always good for us to ask ourselves, are we doing somebody harm and why?
Speaker 4 (38:04):
Excellent. And on that we will end. So I will thank you so much for coming on, Lisa. Thank you.
Speaker 3 (38:10):
Thank you so much for having me. It's always a blessing to be in your space.
Speaker 4 (38:15):
Thank you so much mutual mutual and everyone. Thank you so much for listening. Have a great week and stay healthy. Well, the in smart, a huge thing.
Speaker 2 (38:23):
Thank you to Dr. Lisa van who's. And of course, to our sponsor for today's episode net health, again, sign up for their webinar, which is out tomorrow, April 20th, as part of their three-part mini webinars series, bestselling author, Stacy Fitzsimmons and Kelly Casio of net health. We'll be talking about the three T's of creating revenue ownership beyond just the billing department, training tools and transparency, head over to net health.com/lessee to sign up. And remember if you put Litzy in the registration page, sign up and show up net health. We'll buy lunch for your office once again. That's net health.com forward slash L I T.
Speaker 1 (38:59):
Why thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
In this episode, Net Health's Daniel Folsom talks about how to use Google ads and how to boost your SEO to drive more potential clients to your business.
In this episode we discuss:
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How to use online directories to boost your SEO
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The importance of online reviews
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The ins and outs of running a Google Ad
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Are Facebook ads worth it?
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How to prepare to run an ad on either Google or facebook
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and much more!
More about Daniel:
My Name is Daniel Folsom the account executive for the Digital Marketing Group at Net Health. I have 20+ years’ experience in the healthcare world through sales and practice development. I live in the beautiful state of Georgia and have two kids (four-legged) Jon Jon and Oliver. I have a passion for helping private practices find ways to grow their brand and sustain a healthy level of consistent revenue through patient engagement.
Resources:
Rehab Therapy Outpatient Services 101: How to Expand into the Home or Assisted Living Facility.
Free Market Scan
Daniel's LinkedIn
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
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Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Transcript:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy.
Speaker 2 (00:35):
Hey everybody. Welcome back to the podcast. I'm your host. Karen Lindsay and today's episode is brought to you by net health. So net health has a great new webinar coming up tomorrow, April 13th at 2:00 PM. Eastern standard time with Ellen Strunk. She is a physical therapist, owner of rehab resources and consulting, and his net health guest panelists discussing rehab therapy, outpatient services. One-On-One how to expand into the home or assisted living facility. Ellen lectures nationally on the topics of pharmacology for rehab professionals, exercise and wellness for older adults, coding billing, documentation for therapy services, and the importance of functional outcomes to value based payment, head over to net health.com/litzy to sign up as a bonus. When you sign up for the webinar type, Litzy in the comments section of the registration show up to the webinar and net house. We'll buy lunch for your office. Once again, that's net health.com forward slash L I T Z Y.
Speaker 2 (01:32):
To sign up now on today's podcast, we are talking all about S E O for people who aren't familiar. That means search engine optimization. And my guest is Daniel Folsom. He is an account executive for the digital marketing group at net health. He has 20 plus years experience in the healthcare world through sales and practical development. He lives in the beautiful state of Georgia has two kids, four legged, John, John, and Oliver. And he has a passion for helping private practices, find ways to grow their brand and sustain a healthy level of consistent revenue through patient engagement, which is something we all want if we own our own practice. So today we talk about digital marketing. We talk about search engine optimization. What it is, is it dead? Is it alive? How can you make your website more SEO friendly? We talk about Google and Facebook ads and are they really worth the cost?
Speaker 2 (02:30):
And guys, this is a deep dive. This is really talking about Google ads and definitely Google ads more than Facebook ads. But boy did I learn a lot and Daniel is very generous. He is offering a free market scan, covering all online directories, which there's like, guys are so many. I had no idea all these online directories that will make a difference in where your podcast is ranked on Google. And so what the folks at net health are, is a free market scan, covering all those online directories to see if you're in there or not tedious work folks. You don't want to do this yourself. So Daniel talks about how you can get that free scan in today's podcast. So everyone enjoy,
Speaker 3 (03:16):
Hey Daniel, welcome to the podcast. I'm happy to have you on the show this week. Thank you very much. Happy to be here. Great. And today we're talking about, I think something that can affect every single physical therapist that has a website, every company, every individual therapist, and that is looking at SEO or search engine engine optimization. And we're also gonna touch on online ads, Facebook ads, Google ads, things like that, but let's start out with SEO. So here's the question is the title of the episode is SEO dead. Absolutely not. That's the biggest question that we have to answer today, right? How are you found online when you're found, what does that online reputation look like for your Google ads? So when I find you, what does it look like? Funny, kind of a funny story. I was working with a physical therapist group last week and we've looked at their Google listing and they actually had a picture of chilies.
Speaker 3 (04:22):
So what happens is, and I thought, well, Hey, if you're cracking backs in ribs, I think I want to make an appointment, right? That would be a win-win yet what Google does. If we don't actually create that directory and clean it up is they take the Google earth pictures that attached to your address and they put those images on. So if you haven't looked at it, definitely take a peek at that Google listing anyway, yes. With our SEO, try to get back to that. We want to know what you look like across these search directories. Can people find you with your address and they call you from your phone number. If they look at these directories, are these directories actually clean with reviews? Are you getting good reviews? Are you responding to the negative reviews? So all of this goes into making up that SEO.
Speaker 3 (05:12):
You know, I always say, if people ask me, you know, when, when should we start SEO? And, and as I mentioned, you should have started 20 years ago. And when you say looking at all these different directories how many directories are there? And can you give some examples? Because I just think, well, Google, what are the other directories? So there are 72 plus directories. And when we talk about directory management, we talk about 72 different directories. The reason we talk about 72 is those are what massage, Google analytics to make Google happy. So Google actually sends these small bots out across all of these different directories to make sure they're consistent across internet. And that affects your Google analytics. Of course. So these bots also work in tandem with Google because they want to be the next game on the net. They want to be the next big game on the street, right? So they're sending bots out to find information. So when we run what we call a business scan here at net help, we are running that business scan to look at how accurate all of these directories look for you. You will find if you've had a practice purchase, if you have gone by a different name, if you've moved locations, a lot of these directories are going to be out of line. So if anyone's using those, they're either going to go to the wrong address. They're going to see the wrong name so forth.
Speaker 4 (06:37):
And what, so aside from Google, what are some of these directories? Is that like Yelp or is it, is that one or no,
Speaker 3 (06:46):
We, we have Yelp, we have yellow pages. We have Google business, we have Facebook and using a service, you know, a service we'll actually go in and create those directories so that they're all consistent. More importantly, they go in after that and lock those directories for you, which means they can never be changed or modified unless we go in and actually change your modified those directories for you. You know, some of the other search directories, we talk about Yahoo four square city search MapQuest, local database, a few more just to add on.
Speaker 4 (07:21):
Yeah, that's a lot. Okay. So what you guys do is you scan all of these directories to make sure that it lines up with what your, what and where your business is, and then absolutely. And then you make it so that people can't hack into it, or can people still hack into it and kind of screw that up. Or
Speaker 3 (07:45):
Nope. Once these directories are locked, we actually claimed the directories. We clean up that directory management and cleaning up that directory management. We're going to make sure that we've got consistent pictures of the practice. We've got pictures of the team, maybe of the owner with a nice blurb there. So all of these directories are going to look consistent. And of course the goal here is to create a beautiful story, right? So if I search physical therapy near me, I go to your Google ad, your Google ads, beautiful with pictures and reviews and things that click on your website. It then translates the story over to your website. So it's a nice flow from the original organic search all the way to your website.
Speaker 4 (08:26):
When, what else goes into SEO, because I know people talk about SEO and we always just think, Oh, it's just maybe cleaning up these directories, but I know that what's on your website and maybe the backend of your website also counts for SEO. So can you talk a little bit about that?
Speaker 3 (08:49):
Sure. So when we talk about your website, we want to talk about keywords that drive to your website. So in using a vendor for your website, you want to make sure that you keep those keywords accurate and you also keep them fresh. For example, when microneedle and came out, we wanted to make sure that we added any of the search words for microneedling in, into those keywords to drive traffic. So we look at the meta tags, we look at the data tags, we look at the backend of what that website is there for, because again, that organic search with Google is the happiest that Google analytics, that it makes it the happiest there. So that's what we're really doing when we drive that traffic with those back keywords. You know, I think a lot of people too, when we talk about websites, miss the opportunity to blog and blogging is huge in having searchable content. You know, let's say you just came back from a wonderful conference and you learned all these cool new techniques or, or services that you can offer going in and creating a blog about that makes it searchable content. Again, we're driving that organic traffic directly over to your website.
Speaker 4 (10:06):
And if you can drive more organic traffic, does that bump you up in the Google search? Because everybody's like, Oh, you want to be on the first page of Google.
Speaker 3 (10:15):
Right. Right, right. Where do you hide a dead body, the second page of Google.
Speaker 4 (10:20):
Right. So how do we, how do we, so obviously adding a blog, making tree of these keywords, making sure all of these directories are up-to-date and locked in. Is there any other tips or tricks that can bump you up in the Google in the eyes of Google without having to pay for it? Cause we'll get into ads in a little,
Speaker 3 (10:42):
Right. You know, that Karen is a beautiful equation that deals with how old is your domain? Are you garnering reviews? Are your directories established and consistent? So there is a really long equation that goes into making that very, very happy. Of course, you know, running ads can potentially puts you on the first page. And when we talk about ads, we'll talk about what that looks like. But putting you on the first page, it's just a lot of consistency and it's a lot of work to check the right boxes as far as what SEO means and what makes Google happy for you. Okay.
Speaker 4 (11:20):
Right. So doing all these things that we just discussed, obviously very helpful. Right, right, right. And the more you update your website, does that help to boost it up?
Speaker 3 (11:32):
Absolutely pleased fresh content every month, whether it's an e-book, whether it's a newsletter, whether it's a blog post, whether you're just changing staff names, we want to keep that website fresh. You know, part of what we, we pride ourselves on at net health is every month and account manager is actually going to go with the customer. We're going to make sure that we're pushing out those blogs. We're pushing out those eBooks. We actually set up cadences for the month ahead of us just to make sure that we're tackling maybe seasonal issues as well. So let's say it's winter time, everybody's slipping and falling. How are we addressing that type of searchable content as well, pulling that organic traffic over to your site.
Speaker 4 (12:17):
So now let's move on to ads, right? So you've got Google ads, Facebook ads. The big question everyone wants to know is where can I get the most bang for my buck,
Speaker 3 (12:30):
Bang for your buck. Here's what we need to do everybody. Before we dive into ads, we need to make sure running an ad for you even makes sense. If you just take money and put it into a pay-per-click ad, it's probably not going to work. You know, one of the things that we do at net health with our customers is we do a forecasting call. That forecasting call looks at your geographic area, longitude latitude within 30 miles, because that's generally the driving distance. People are going to come to see your location. And then we type in keywords. I want to see if enough people are searching for those keywords. You know, you could put $2,000 into an ad, but if you have 20 people searching for the keywords that are relative to your services, it's probably not going to be a good return on your investment.
Speaker 3 (13:17):
So with that forecasting call, we look at those keywords and we also see how much they cost. You know, as we kind of spoke about earlier, those keywords could literally drive your ad budget way out of socket. I've seen people who have run ads in the past that it did make sense to run ads, but they had an ad budget of $400. When we look at that ad budget, we have to tie it into what does a conversion look like? And a conversion is when someone searches for your words goes over to your ad, clicks on that ad and fills it out. So that's somebody that converts over. Now we call that a lead. So this is someone that has engaged. They're looking for your services, they're in your target area, they're searching for your keywords. And they said, Hey, we are looking for you.
Speaker 3 (14:12):
Now, the other thing when we run these ads to care is which is very, very important is we need a really good call to action. And what does that call to action mean? You know, I think for everyone, this can be unique to the practice, with their call to action. It's something that's going to engage them to take the next step. You know, I have some people who use eBooks and toolkits and things that, you know, fill this out and get the free toolkit or ebook. We generally find that people generally just want the ebook. They really don't want an appointment. So when we really look at a conversion here, we really want to something unique. You know, the cool part of forecasting is we can actually look at what other ads are running, what their calls to action are. So we can really kind of create a unique structure to walk that practice through having an amazing call to action and filling out the form to have that conversion into the lead. I have to say some of the more successful physical therapy practices that are using any type of ads right now, last month, we had someone who ran a targeted ad that gave away a free 30 minute back massage. He had well over 50 participants fill out his lead form, which was huge. I didn't always, I mean, I didn't know that many people needed they're bankrupt, but obviously they do.
Speaker 4 (15:36):
Right. And what other call to actions have you seen that have been really successful? Like I know a lot of people will say, you know, a free, you know, 20 or 30 minutes call or, or screen or something like that. But what, what else have you seen that has really worked?
Speaker 3 (15:59):
Usually you want to tie it to something within your services that keeps the person engaged or will engage them. For example a physical therapist was really focused on their, their dry needling and they actually did this hot patch. It was almost a massage machine as well. So after the dry needling, you literally sat on this like hyperbaric type chamber chair and got this warm back massage. That was a part of it as well. Now that was after the third visit. So of course at that point they've got the patient engaged with it. Again, we usually find toolkits eBooks and things really aren't that effective, but something tangible that the patient can actually use or have you know, we've even had people tie them around Starbucks gift card with, we all have our Starbucks.
Speaker 4 (16:56):
Right, right, right. So really taking some Liberty here to be quite creative, correct? Correct. Okay. And you had mentioned something in talking about the ads about the price of keywords. Can you talk about that a little bit more? Because I know it's definitely something I don't understand. I'm sure it's a lot something, a lot of the listeners don't understand. So go ahead.
Speaker 3 (17:20):
Sure. So when we, when we look at the forecast, we actually look at the keywords of course, for the services that are offered there at the practice, those keywords, and what Google will tell us is, is what people were paying for those keywords. So the funny part about keywords is in certain areas, some lawyers may be bidding on those keywords as well. So we generally want to keep the costs, the cost per click below $3. If it's above dollars, we really want to see if it makes sense for our practice with their budget. And of course, what outcome they're looking for. Does it really make sense for you to run these ads? Sometimes it does. Sometimes we can have a great return conversion level. Other times we may want to look at some other keywords and other prices just to make sure that, you know, again, this is going to be affordable for the practice and we're going to bring the number of conversions that they need to make this profit.
Speaker 4 (18:17):
And so for example a keyword like low back pain might be worth, I'm just going to make this up here for $4. Whereas shoulder pain might be worth $3. Like, is that how that works?
Speaker 3 (18:33):
You got it. Yep. Yep. The biggest trend difference that you see right now is physical therapy. Of course, near me. Where, of course that's an extremely popular keyword search. I've seen it cost 58 cents in certain areas. Right now in Seattle, it's $58 for late work.
Speaker 4 (18:56):
Okay. So if you're running a Google ad and you have back pain in your ad, it costs $58 per day,
Speaker 3 (19:06):
$58 for someone to search for that in your area, click on your ad, just click on your ad.
Speaker 4 (19:15):
Wait. So if five people click on your ad in one day, it costs you like $300.
Speaker 3 (19:24):
Correct. Do you see what ads can fail for people who aren't doing proper form?
Speaker 4 (19:28):
I see. Yes I do. Now. Okay. Now this is making much more sense, much more sense. So you really want to know how much those keywords cost to see, like, if it's worth it or can you put in a different keyword and still get that demographic and okay.
Speaker 3 (19:47):
Absolutely. So some of the things and part of the service of net health that we provide is we provide weekly checks. So we actually go in and you can bid on words every week. So some of those higher dollar words for our customers, there's no guarantee that you're going to win, but if you're paying $10 for physical therapy near me and you bid three 50 on it, you win the bid. Guess what? For the week you actually get $3 and 50 cents. You save $7 for every click for that. We also go into the ad. We look at stale keywords. So if all of the keywords that we have, and you can have up to 50 plus keywords here that we're talking about in a plan we look at what words really are stale. We want to pull those words out because they're just kinda sitting there doing nothing in our, in our campaign.
Speaker 3 (20:34):
And then we want to put in those active words. So we want to look at what new words may have come up within the week. Also Google gives us a ad score. So if your ad is not running at a hundred percent, we want to make sure that it is running at a hundred percent. So we look at what Google tells us of why it isn't. And we go in and repair that for you. We also, every two weeks make sure that we have a call with our clients just to make sure the ads are running correctly. We're making sure that they understand the keywords because as you can envision, we're bringing the horse to water. It's up to them to teach them how to have that horse drink the water. So we really have to do a lot of sales training on, on what that conversion looks like. You know a few weeks ago we had our podcast on purpose, the profit, and you know, the big comp topic of conversation was, you know, how well trained is your, your front desk staff and answering the phone. So, you know, I really depend a lot on that when we talk about these, these ads, because of course these are hot leads, ready to schedule an appointment. What does that look like when they're actually called for that follow-up
Speaker 4 (21:45):
And where are these Google ads showing up? So are these the things like if I go onto a website and I see a banner ad or something, is that a Google ad? Or is it only like when you go into Google and you type in physical therapy near me and you see those ones above the fold, the T ad, is that the only place? Right?
Speaker 3 (22:08):
So, so, so it can be a banner ad. It can be the ladder, as you mentioned, that says, ad generally it's the ladder that says add there, it pushes it to the top, you know? And I think a lot of people get really confused with that because they think, Oh, if I run an ad, I'm going to be at the top of Google. What they don't understand is Google only a lot certain ad spaces on each page, you can have two to three at the top. You can have two to three at the bottom. And that is all based upon the number of people that you actually have in that search criteria. So you could easily pour $2,000 into an ad and be on the top of page two, which again, who's going to look for you there. So one of the things that we really dive into when we run these ads is where are you going to be on that page placement? And where are we going to be able to put you? Because of course it's very important.
Speaker 4 (22:58):
And in these ads, I mean, are, is, are there photos, are there videos or is it just texts? There is
Speaker 3 (23:07):
Absolutely. So when we talk about the Google ad, it actually is, it looks like a landing page. So when I click on physical therapy near me and I see Karen physical therapy, I'm going to click on that. It's going to take you to the landing page. Now that landing page again, as we go back to create this beautiful digital marketing story should look just like your website, which should look like your Google directory, which creates this beautiful flow over. Now, that landing page is going to have graphics on it. It could have videos on it. Of course this is where we were going to have your call to generally we ask for name, email address, phone number, and maybe some other information that you want to gather. For example, you know, tell us how we can help you. You know, when would you like to be contacted?
Speaker 3 (24:00):
Those types of things are important on there as well. The beautiful part of filling out that ad for us is that it actually goes into a lead database. So from that lead database, we can actually nurture that lead for our customers, with eBooks, with personal letters. I love the nurture campaigns to be very personal. You know, let's get to know who the physical therapist are there. Let's get to know who the front desk staff is. So let's send out some really good tailored, personal messages, say, Hey, thanks for clicking on our ad. We'd love to help you. This is Megan she's at the front desk. She can help with that. This is Dr. Smith. He's going to be able to help with it really puts the face and the name together, which creates again that beautiful story and a lot of familiar nurse with the ad. Yeah. Okay. All right. Well, this is so much more robust than I had originally thought. This is great. Now let's talk about Facebook ads because with this, I would think, well, if your ideal, customer's not on Facebook, obviously you're not going to be running a Facebook ad. So how effective are these Facebook ads?
Speaker 2 (25:12):
And on that note, we'll take a quick break and be right back, be sure to sign up for net health next webinar, which will be Tuesday, April 13th at 2:00 PM, entitled rehab therapy, outpatient services, one Oh one. How to expand into the home or assisted living facility. Their guest panelists will be Ellen Strunk, owner of rehab resources and consulting head over to net health.com/glitzy to sign up as a bonus. When you sign up for the webinar type Lindsay in the comment section or the registration show up with a webinar and net health, we'll buy lunch for your office. Once again, that's net health.com forward slash L I T Z Y
Speaker 3 (25:54):
Facebook ads can be really effective. You know, where we win with Facebook ads is target marketing. So with our ads that we're running they're actually going to be slow creep ads. So they're not kind of those, those strange ads over on the right that nobody hardly ever looks at. These are actually in the feed. So as you're looking at Sonia's wedding photo and Katie's baby picture, you're actually going to see the ad. Now, when we talk target marketing for Facebook, we're really talking about who you want to attract as your patient. So if you're looking to grow your 30 to 45 year old demographics within a certain zip code with Facebook, we can really, really target out who sees that ad to make sure that we're achieving your key goals are to grow the market within that targeted area.
Speaker 4 (26:49):
So yeah, you can really get like drill down to really your ideal patients.
Speaker 3 (26:59):
Absolutely, absolutely. You know, the good part about running Facebook ads is it's fairly inexpensive. I will say the rate, the return on Facebook ads, isn't near what it would be running Google ads. Big only because you've got to think with Google, we have 200,000 people searching for physical therapy near me with Facebook. We've taken that and we've really targeted down to kind of a small pocket of people that are going to be looking for that ad. Again, the Facebook ad is going to be like the Google ad. It's going to be beautiful pictures. It's going to be a nice call to action. It's going to be something that's going to engage them and want them to click on that ad to fill out that call to action form.
Speaker 4 (27:41):
Got it. And what are some big no-nos if you have big no-nos for, for Google ads or big no-nos for Facebook ads?
Speaker 3 (27:51):
You know, I think some of the big no-nos are over promising and under delivering on your ad. You know, when we talk about these ads, we really want to make sure that they don't go stale. So that's another big no-no that people don't really understand. So, and when we talk about an ad going stale, we actually talking about keeping some of those higher dollar keywords that aren't really searchable right now and taking them out if people really aren't looking for them, because as you pointed out in the example, if you've got a $58 per click and you've got 30 people or three people clicking on it, it's a stale keyword. It's still taking a lot of money from your ad dollars. So we really got, I think that's the biggest no-no here. And a lot of that is just us making sure that we're doing that for the customer.
Speaker 4 (28:43):
And what about Facebook ads? Any big no-nos there?
Speaker 3 (28:47):
You know, I think with Facebook ads, again, you just want to keep them simple. I think in this philosophy of life kiss, keep it simple. You know, with Facebook ads, a lot of our customers really want to get involved, almost tell a complete story in that Facebook ad. And you really, really want to use that ad as if I'm looking at this for two to three seconds, what am I going to get out of it? So I think a lot of people over-complicate their Facebook ads. And of course you lose your audience at that point, they should be able to in literally two seconds, scroll your ad, see your good call to action, who you are, what you're trying to accomplish and send that right over again, all of the aesthetics for either Google or Facebook should match your website. It should match your landing page. It should be that beautiful story that just carries over.
Speaker 4 (29:38):
Got it, got it. Well, this has been very, very informative and super helpful. Is there anything that we missed, anything that was on your list of, of talking points that we,
Speaker 3 (29:53):
I don't think so. You know, I think some of the things too, when people are looking at ads that I just wanted to mention here, because this is the biggest oversight I think is when we talk about running those Google ads, we talk about, of course, how much your cost per click is, how many conversions you're going to have a big number that people really overlook is what we call the impression. And the impression is people who actually went to your ad, but never filled out the ad form. And I think a lot of customers and, and, and practices overlook this number, but it's super important because this is part of your paid ads. That's pushing your brand. I've seen where I've been able to give for example, 10 leads, 10 plus leads to a particular practice, but they had 32,000 impressions. So if you could imagine 32,000 impressions of just looking at your ad or just looking at that Google directory that displays your ad, that's a huge number. So I think that's the biggest thing I just kind of wanted to touch on. When we look at running these ads, let's look at the impressions as well, because again, that's promoting your brand,
Speaker 4 (31:07):
Right? And like the way I look at it, and this may be completely wrong. Now that you said those well, 32,000 people looked at it, but only 10 people clicked. So do I have to change something? Is something not landing correctly? How do you, how do you interpret that?
Speaker 3 (31:25):
So we definitely want to, we, that's a great observation. So we definitely want to look generally their extra call to action. Was your call to action, not engaging enough. Was it not? I guess salesy that's, you know, I hate that word, but was it, was it not catchy enough that people were like, wait a minute, this is actually something that I want to look into.
Speaker 4 (31:50):
Got it. Okay. That makes sense. That makes sense. Cause I would think, Oh, why am I running these Google ads?
Speaker 3 (31:56):
Yeah. And of course we don't want to give up. Right, right. Yet the good thing is of course of the people that click on that ad, we then get to look at what that return on investment is. So of course, in physical therapy, you know, we look at, if we add five patients with 10 visits per patient, you've definitely reaped what you've paid for your ad service plus. So we definitely look at what that conversion rate is for you as well.
Speaker 4 (32:27):
What is this ad bringing back to us? So again, you're looking at how much you spent on the ad, how many people came in for initial eval and how many of those followed with their plan of care, whatever that plan of care may be. If it's, if you average six visits per patient, you know how much each visit costs, you can multiply that by however many patients you got from the ad. And if it made you profit great. If it didn't, I think you have to do some rejiggering there.
Speaker 3 (33:00):
Yep. Yep. We definitely need to either run a different campaign. We need to look at what, I guess why the wheel didn't spin properly here. One of the beautiful things of net health is that we tie certain KPIs. And if, if anyone isn't familiar key performance indicators to our ad module. So for example, Karen, if I told you, I'm going to bring you 10 patients every month and I don't meet that criteria for you, you're actually able to stop running ads with us. So we really put our feet to the fire to make sure that we're doing the right job. We're also doing what we said we were going to do in making sure that you're getting that return on investment for what you're giving us. Cause it's expensive, you know, act, I mean, add packages right now started a thousand dollars. So it's a lot of money. That's a lot of money. Are you getting that back?
Speaker 4 (33:53):
Absolutely. And that makes perfect sense. And now before we wrap things up, I have another question in a second, but I want people to find out where they can get more information on what you do, how they can get on board. So what is your call to action?
Speaker 3 (34:12):
Sure. So we're offering for anyone that's interested what we call that free business scan. So I'm going to go in for the practice. I'm going to run that free business scan. That's going to look at all of those search directories that we talked about earlier. I'm also going to look at, in that business scan, it shows how that practice compares to their competition. When we talk about reviews. So I'm offering a free business scan for anyone that is interested. I'd love to dive into that. Of course after that, I would definitely email that over. I would also love to offer a free forecasting call for any practices interested in running ads. Let's look at it, let's see if it even makes sense for you to run ads. I have to tell you, last month we walked away from three different practices where it just didn't make sense for us to run ads. So want to make sure that it's a good fit for both of us,
Speaker 4 (35:03):
Right? Well, that is awesome. And where can people get all of this? How can they yeah.
Speaker 3 (35:09):
Www.Net health.com and click on the digital marketing page. Perfect.
Speaker 4 (35:16):
Perfect. Well, that's great. I mean, yeah. Sign me up free. I would love that. So now last question is something that I ask everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self?
Speaker 3 (35:34):
Oh, you know, Karen, that's such a good
Speaker 4 (35:38):
Question. I think it would just be slow down. Enjoy the martinis, enjoy the dog. Walks spend more time with your mom and dad. It's just literally just stopped going. And fifth years shifted down to second and learn how to live on cruise control for just a little while and be calm. Lovely advice. Thank you so, so much for coming on and talking to us about SEO and ads and for all of you PT entrepreneurs out there, head over to www.net health.com. Click on the marketing, digital marketing, digital marketing tab and get this free business scan free forecasting calling me. And that's huge for people to see, Hey, should I be, should I be running ads? Or if you are running ads, EEGs, are they working? Yikes. Well, Daniel, thank you so much. This was great. I really appreciate it. Thank you and everyone. Thanks so much for listening. Have a great week and stay healthy, wealthy and smart.
Speaker 2 (36:43):
Thanks to Daniel. And of course, things to net health for sponsoring today's episode again tomorrow, Tuesday, April 13th, 2:00 PM. Eastern standard time. Sign up for rehab therapy, outpatient services one Oh one. How to expand into home or assisted living facility with Ellen Strunk. And in order to do that head over to net health.com/lindsey to sign up type in Lindsay in the comment section net health, we'll buy lunch for your office once again. That's net health.com forward slash L I T Z Y. Sign up now.
Speaker 1 (37:16):
Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
In this episode, Associate Professor in the Doctoral Program of Physical Therapy at Rutgers, Dr. Ellen Anderson, talks to Dr. Stephanie Weyrauch about burnout in physical therapy.
Today, Ellen talks about her dissertation on burnout, the distinction between normal stress and burnout, and how these markers of burnout fit into the anecdotal accounts of burnout seen in blogs and magazines. Why is data so limited on burnout in physical therapy? Which settings within physical therapy experience the highest rate of burnout?
Hear about the many factors impacting the number of therapists affected by burnout, how Covid-19 has affected recent graduates and students, and the causes of burnout, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “When people work with people who are in crisis, there are a lot of demands placed on them - very different than in other kinds of work, for example.”
-
There are 3 categories in burnout:
-
Emotional exhaustion.
- Depersonalisation.
-
Personal Accomplishment.
-
“When we think about just being stressed out, it’s hard to know what that means because everyone’s stressors are different.”
- “If a physical therapist has high perceived stress, that’s correlated with emotional exhaustion, which is a part of burnout, but not the full definition of burnout.”
-
Researchers have suggested that there’s 2 ways to look at burnout:
-
The Personal Approach. Make the person resilient, and they will be able to handle any kind of environment.
-
The Work Environment. Make a nurturing environment that’s conducive to good work, and supporting people who are in crisis, then you’re supporting the workers and you’ll have less burnout.
-
“Younger physicians have higher rates of burnout than do older practitioners.”
- “When people in healthcare feel as though they don’t have control of the situation, or they cannot contribute to good patient care, effectiveness, and efficiencies, that the burnout rates are higher.”
- “There needs to be an understanding on how stressful and difficult it is to work with people who are at risk and people who are in crisis.”
- “We need to be thinking about ways in which physical therapists can have some participation in systems that supports everyone in that work environment.”
- “One of the things that’s very detrimental when people share thoughts and ideas, is that the first response they get is ‘we cant’ or ‘no’ without any kind of real honest investigation into the suggestion or recommendation.”
- “Breathing practices and meditation are two strategies which help people be able to manage their stress effectively. The idea is that you practice those things so that when you need it, you can use it.”
More about Stephanie Weyrauch
Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government.
Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery.
Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.
More about Ellen Anderson
[caption id="attachment_9555" align="alignleft" width="150"] Rutgers School of Health Professions in Newark. 11/7/16 Photo by John OBoyle[/caption]
Ellen Zambo Anderson, PT, PhD is an Associate Professor in the Doctoral Program of Physical Therapy at Rutgers, The State University of New Jersey where her primary teaching responsibilities are in Therapeutic Exercise, Development Across the Lifespan and Clinical Inquiry. Dr. Anderson, a Board Certified Geriatric Clinical Specialist, earned a BS in Physical Therapy from West Virginia University, an MA in Motor Learning and Control from Columbia University and a PhD in Health Sciences from Rutgers University. She is the Assistant Director of the Rutgers Community Participatory Physical Therapy Clinic, a student-run, pro-bono clinic in Newark, NJ, and serves as the Special Olympics Global Advisor for Young Athletes.
Dr. Anderson is the co-author of the textbook, Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach and has spoken internationally on physical activity, mental health, and complementary health practices. She is also co-owner of YogiAnatomy, a company that provides continuing education for rehabilitation professions on topics related to complementary approaches for managing well-being, health and function.
Suggested Keywords
Physiotherapy, Research, PT, Health, Therapy, Healthcare, Education, Training, Stress, Burnout, Wellbeing, Mental Health, Stressors, Support, Covid-19, Exhaustion, Depersonalisation, Accomplishment, Environment,
To learn more, follow Ellen and Stephanie at:
Website: https://stephaniesandvickweyrauch.academia.edu
https://ptsmc.com/stephanie-weyrauch
https://www.yogianatomy.com
Facebook: Stephanie Sandvick Weyrauch
Instagram: @thesteph21
Twitter: @thesteph21
LinkedIn: Stephanie Weyrauch
YogiAnatomy
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Read the Full Transcript:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everybody.
Speaker 2 (00:37):
Welcome back to the podcast. I am your host, Karen Litzy and today's episode. We have our good friend of the podcast back, Dr. Stephanie Y rock, and she is interviewing Dr. Ellen Anderson all about burnout in the physical therapy profession. I'm not going to go into Dr. Anderson's bio because Stephanie reads that in the beginning of the podcast. We don't need to double up on that, but what you're about to hear, I'll give you some highlights is they talk about the three categories of burnout and does the research definition of burnout jive with the anecdotal accounts of burnout that we see on blogs and podcasts and things like that. They also talk about the difference between stress and burnout or perceived stress and burnout. The main causes of burnout in physical therapy, how COVID is affecting burnout. And Dr. Anderson talks about some things that perhaps you can do as an individual to help with your perceived stress.
Speaker 2 (01:41):
And she hypothesizes on some things that perhaps some businesses, some physical therapy businesses can do to help their employees with stress and burnout. So thanks to doctors why rock and Anderson and everyone enjoy today's episode. Hello everyone, and welcome to the healthy, wealthy and smart podcast. I'm your guest host today, Dr. Stephanie, why rock and, or once again, going to partner with the American physical therapy association, private practice section to discuss a topic that has been in the forefront in healthcare and that's burnout. This is an especially relevant topic. I think as COVID-19 pandemic continues to rage on, and I've actually been asked to write an article for PPS impact magazine on this. And so when I went to do some research on this topic, I of course found a lot of blog posts and opinion articles by physical therapists throughout the profession on this topic, but was really surprised to find that there's really not a lot of research in physical therapy on burnout.
Speaker 2 (02:50):
And I was surprised by that because it's so frequently discussed in our profession. So eventually my literature review led me to our guest today, Dr. Ellen Anderson. So Dr. Ellen Zombot Anderson is an associate professor in the doctoral program of physical therapy at Rutgers university in New Jersey where her primary teaching responsibilities are in therapeutic exercise development across the lifespan and clinical inquiry. Dr. Anderson is a board certified geriatric clinical specialist and earned a BS in physical therapy from West Virginia university, an ma in motor learning and control from Columbia university and a PhD in health sciences from Rutgers university. She is the assistant director of the Rutgers community participatory physical therapy clinic, which is a student run pro bono clinic in Newark, New Jersey, and serves as the special Olympics global advisor for young athletes. She's the coauthor of the textbook complimentary therapies for physical therapy, a clinical decision-making approach, and has spoken internationally on physical activity, mental health and complimentary health practices. She's co-owner of yoga, Yogi anatomy, a company that provides continuing education for rehabilitation professions on topics related to complimentary approaches for managing wellbeing, health, and function. So thank you so much Dr. Anderson for joining us today on our podcast. And again, I read your dissertation and I've, I found it really interesting that you decided to tackle burnout for your PhD dissertation. So maybe summarize your dissertation a little bit, tell our listeners a little bit about yourself and how you became interested in this area of research.
Speaker 3 (04:38):
Okay, great. Yes. It's a pleasure to be with you, Stephanie. Thank you very much. Initially I became very interested in complimentary therapies and through the work that I do with my colleague, Judy Deutsche, where we published a textbook in that area, I was interested in the application, the safety and the efficacy of complimentary therapies for patient populations. And that got me to realize, or helped me realize that there is a fair amount of data that suggests these complementary therapies can be useful for our patients, particularly in the areas of mood reduction of stress, as well as reduction of pain. And so that got me thinking about using approaches such as Reiki or yoga, meditation, breathing practices for self care as well as patient care from that point. However it was determined that we really didn't know what stress was in physical therapists or what burnout is in physical therapist, because as you've identified, a lot of people are talking about it, but there hasn't been a lot of research in that area.
Speaker 3 (05:57):
And so I started to embark on trying to get a handle on what is the stress and burnout in physical therapists. My focus took me to burn out. And the reason for that is because burnout was defined by fruit and burger back in 1975. And it was based on his observations in working with healthcare providers. And what he observed is that when people work with people who are in crisis, there are a lot of demands placed on them, very different than in other kinds of work, for example. And he began to categorize some behaviors that he saw in people who were becoming more and more stressed. And then it was Nass latch who developed the mass latch burnout inventory. And so what mass latch did was kind of support the observations of fruit and Berg by saying there are three categories that we need to look at in this thing called burnout, that there's emotional exhaustion, there's depersonalization and there's personal accomplishment.
Speaker 3 (07:16):
And so when we think about just being stressed out, it's hard to know what that means because everyone's stressors are different. So what stresses you out is different than what stresses me out, you know, when you kind of come to your work with a certain constitution about what keeps you even keel and what are your triggers? The burnout goes a little bit further because it's not just emotional responses. And in this case, emotional exhaustion is that sort of physical, mental exhaustion that many people might be feeling. That's just one part of burnout. So the next part of burnout is this deep personalization. And what that means is that you kind of begin to separate yourself out from your patients. And there's this phenomenon of, of I'm sick of thinking that the patient is to blame for their problems. You know, so they brought it on themselves and some psychologists and researchers suggest that perhaps this deep personalization is really kind of a protective mechanism because you're dealing with people in crisis all the time. And then you have the personal accomplishment and that's where you feel like your, a rat in a, in a maze or in a wheel. And you just keep going round and around and you ask yourself, finally, what am I doing this for? Am I really making a difference? So the, the, the curiosity for me is, was understanding the D the difference between just job stress and burnout, and that physical therapist in fact, would fall into a category of people working with people who are in crisis most of the time.
Speaker 2 (09:28):
I think that that's really interesting that, you know, we have a defined a true research definition of burnout. I'm wondering what your opinion is on how this definition fits with these anecdotal accounts of burnout that we're seeing in some of these blog posts that people post or that TA magazine has been posting about regularly.
Speaker 3 (09:50):
It doesn't really jive a very well, to be honest with you. So when, when I see comments about burnout, I just say to myself, well, people are stressed out and, and we should honor and respect the fact that people are very stressed out. That burnout technically from a research standpoint has a different definition. And what I found through my research is I did study and survey physical therapists, both using the mass latch burnout inventory, which has the three part, but I also included the perceived stress scale. And so the perceived stress scale, I think, is a very valuable tool because as I mentioned, previously, stressors for you are different than stressors for me. And the perceived stress scale has been used in thousands of studies. And it's looked to be sort of a gold standard if you will, to get a finger on the pulse of people's stress, because it is about perception of your stress.
Speaker 3 (11:04):
And, and so what I found in my, in my dissertation was that all, although physical therapist had better perceived stress scores than the national sample that I compared it to, there was a relationship between a high perceived stress score and burnout especially in the category of the emotional exhaustion piece. And so what we, what we saw was that if therapist had high emotional exhaustion, they were seven, seven times more likely to actually have burnout. So let me tell you what burnout is. According to those three parts is if you do the burnout scale, and you're very high where you're high in emotional exhaustion and you're high in deep personalization, and then you have low professional accomplishment, you fall into the category of burnout. And so what I found was that 29% of PTs are high in emotional exhaustion, and that is consistent with what people are talking about in the blogs related to being stressed.
Speaker 3 (12:27):
Okay. The other thing that I want to know is that in a lot of studies that are being done with physicians and nurses with burnout, sometimes the headline is 50% of physicians have burnout. And what they did was that they used the burnout scale, but they focus their, their headline on the fact that it was emotional exhaustion. And so there was recently a systematic review that looked at just that is the reporting of burnout and how it's a little bit of a mixed bag now where it traditionally had been the high score in exhaustion depersonalization on a low score in professional accomplishment. But now people are reporting even just on the emotional exhaustion. So when we think about PTs and what I found was that 29% had emotional exhaustion and then 12% had actual burnout. And so that's, that's really a concern because we're talking that we have a vulnerable PT workforce out there when it comes to stress and when it comes to burnout.
Speaker 2 (13:56):
So if somebody has, if a physical therapist has high perceived stress, that's correlated with this emotional exhaustion, which is a part of burnout, but not the full definition of burnout.
Speaker 3 (14:09):
You got it, it's perfectly stated.
Speaker 2 (14:11):
So do you think that we, that our research needs to maybe reassess the definition of burnout? Or do you think that people, that we just need to get the word out there about what burnout actually is and educate people that, you know, you're not quite burned out yet? You're, you're emotionally exhausted. Here are the steps that you can take to decrease this high emotional exhaustion to prevent burnout, or what, what's your kind of opinion on that?
Speaker 3 (14:39):
Well, it would be a wonderful thing if it was so simple. But the reason why it's not simple is because people have looked at well, what comes first is an emotional exhaustion, and that leads to depersonalization followed by lower professional accomplishment. And the answer is not clear. So there are different models that have been proposed and tested to show that it can be multi-directional. And so it's not easy to say that if we manage stress, as we know stress, the perceived stress that we will have made a dramatic effect on burnout, because if depersonalization is what drives emotional exhaustion or low self-efficacy kind of low personal accomplishment, low self-esteem that type of thing in your workplace, if that drives burnout, then managing stress may not have as dramatic effect on those areas. So I, I think it's, I think it is behooves us to think about the complexities of stress and that mirrors the complexities of burnout.
Speaker 3 (16:04):
But I think that the first step is to be thinking about what are those stressors in the workplace because researchers have suggested that there's two ways to look at burnout, and that is the personal approach, so that you're more resilient to that stress, to that emotional exhaustion. And then the other area of focus should be on the work environment and the, the experiences that a person has at work. So we see that there's both sort of schools of thought that you, you make a person resilient and they will be able to handle any kind of environment. And then the, and then the counter is that if you make a nurturing, caring environment, that's conducive to good work and supporting people who are in crisis, then by that you were supporting the workers and you'll have less burnout.
Speaker 2 (17:14):
I think that those are some very interesting points. You know, this is obviously a very popular topic in our profession. Why do you think there's then we had, we've talked about that. There's not a lot of data for this. And just so our listeners know, like there's maybe a few studies, including Al including Dr. Anderson's recent dissertation, which was published in 2014, there's a couple of articles that have been published since then, but most of the research has been, was done in like the eighties and the nineties. So it's like over 20 years old. Right. So why do you think that data regarding burnout is so limited in our profession? And is there really any research going on in this area right now in our profession today?
Speaker 3 (18:00):
Yeah, I I've thought about that quite a bit, and I'm not sure why there hasn't been much, much research in the area. You can imagine that when I was working on my dissertation, I was shocked that there wasn't anything that was substantial. Everything was very old, as you had mentioned. And it was done in very discrete populations. So one was in rehab inpatient facilities in Massachusetts. Another wasn't a head injury unit in the Pacific Northwest. So very specific, nothing quite as broad as a national sample. Why, I don't know. I, in general, though, the efforts in looking at burnout has been focused on nursing and in physicians and MDs. And the only thing that I could come up with is there's a difference in the way we think and do things if you're medicine versus when you're rehabilitation. And I think that in comparing some of my findings in, especially in the areas of deep personalization and personal accomplishment, is that PTs typically were scoring much lower than nurses and physicians in those two categories.
Speaker 3 (19:24):
And I speculate that perhaps it's because of the kind of relationships that we have with our patients, that because we spend more time with our patients, we get to know our patients, families, and a lot of instances that it's very hard for us to depersonalize when you really spend a lot of time with someone. And that may also contribute to the fact that PTs score better than people in medicine, in the area of personal accomplishment, because although things may be crazy in your, in your practice setting, the fact that you can see a difference in the individual clients and patients that you see may in fact be reinforcing for that personal accomplishment.
Speaker 2 (20:16):
So is your belief then based off of what you found in your research, that kind of the difference between say physical therapists and nurses and physicians, which are more studied than what our profession is that we have better really, you know, longer lasting relationships with our patients and get because of that, we get a lot more accomplishment. Whereas physicians and nurses are more short term relationships with their patients. And so kind of those better scores and deep personalization and in personal accomplishment kind of help us save us from being burnt out. Like maybe our physician and nursing colleagues is that a,
Speaker 3 (20:57):
That is my hypothesis, but I haven't tested it. But that in looking at some of the publications in physicians of, of all different practice settings they are scoring typically higher, interestingly, except for those in mental health fields. So that may be a situation, two fold. Number one, is that a person working in mental health may actually have more skills to deal with their own stress and burdens. But they also may be spending more time with their patients because of the kind of therapeutic relationship that would occur in, in mental health.
Speaker 2 (21:44):
I think that your hypothesis is a very logical one, because if you think about, so if we, if we look at those studies from 20 years ago, obviously our profession has changed a lot. I mean, healthcare in general is just always changing. So, you know, right now student loan is at an all student loan debt is at an all time high wages for physical therapists are basically the same as what they were in the nineties. And the two thousands, we continue to experience decreases in payment. We have rising productivity expectations in order to maintain that bottom line. And so a lot of these factors are kind of cutting into our ability to form these relationships, so to maintain those good scores and depersonalization, and to have that personal accomplishment. But I'm interested in potentially knowing your opinion on how you think these factors have impacted the number of physical therapists affected by burnout.
Speaker 3 (22:43):
Yeah, I think that it has one of the, one of the findings that I observed in my research and that others have observed in medical populations is that younger therapists, younger physicians have higher rates of burnout than do older practitioners. And it's speculated that it's because the more seasoned therapist or physician has learned how to manage, right. They've learned how to manage sort of the, the game, if you will. They've also learned strategies for self preservation. So that gets us into that twofold area again, right. The personal, you know, wellbeing, and then the institution as something separate, I think it be worth it to take a look now, even compared to five years ago, with all the things that you've described, they were occurring five years ago when I did my dissertation, but then along comes higher expectations for productivity.
Speaker 3 (24:01):
And now, you know, let's throw in a worldwide pandemic onto that. Right. And so I think that what we've, what we'll, what we will see is that institutional changes that people may not have been able to keep up with because it's happened so rapidly over time, or it's sorry, that's weird. It's happened so rapidly within a short period of time that I think it would be worth looking into what changes have occurred in perceived stress or burnout. Within the past couple of years in physical therapy, because I would predict that those numbers would be greater than they were back in 2014.
Speaker 2 (24:51):
Well, I mean, that leads me beautifully to my next question is how do you think COVID-19 has contributed to burnout in physical therapy amongst physical therapists?
Speaker 3 (25:01):
Right. So when, so, although I didn't ask the question in my survey about what's causing you to be burned out or, you know, identify things that are stressors in your life. What I know, what I know from the literature is that when people in healthcare feel as though they don't have control of the situation, or they cannot contribute to good patient care effectiveness and efficiencies that the burnout rates are higher. So there is something to be said about this time in COVID where in our physical therapy world, we went from non essential to essential. We went from, you know, not doing rehab to doing nursing care. I colleagues of mine who were sent to the Mork colleagues of mine who worked security desks because in order for them to keep their job, they needed to say I would do assigned duties. So if we know that having little say about your work environment, little, say about how much time you spend with patients or what your responsibilities are, or what responsibilities you can delegate to other people, we know that that's contributing to burnout then hello, because that's exactly what happened to the physical therapy profession during COVID.
Speaker 2 (26:39):
So you teach at Rutgers what types of what types of instances of burnout or stress have you experienced amongst your students who are now like fresh into our profession and the students that are maybe still in PT school? How have they reacted to this COVID-19 pandemic in relationship to burnout or perceived stress?
Speaker 3 (27:04):
Right. So I think that we, we probably have cooked two cohort of students, the ones that graduated in 2020, who did a big sigh of relief because, because of in our program, the amount of weeks and hours they had got in for clinical experiences was complete by the time that they started to be pulled out of their clinical rotations. So all of our students were able to reach a level of competency and entry level so that everyone graduated in 2020. So they were like, just so relieved the group that is scheduled to graduate in 2021 have been dealing with the stresses, the traumas that come with changing responsibilities and different expectations because of COVID. But I think that by and large, they've had excellent clinical instructors, so kudos to the physical therapy profession and that they have been able to take the challenges in stride in part, because of the support from the institutions and their clinical instructors.
Speaker 3 (28:30):
I think that the students that are engaged in academic work, their stressors come from the fact that they know that they are in a program that's delivering information very different than the previous year and their hands-on experience has been truncated. And, and that, despite the efforts of the faculty to give them all the experiences that they normally would have in person that we are limited by the COVID restrictions of our university. So what we've, what we've attempted to do is to speak about the virtues of tele-health. We have some testing opportunities for students to engage in tele-health and improve their skills with communication and observation. Also giving directions watching movement from like you and I are right now from across the screen. And I do think that that is something that many therapists are learning. There's many courses and, and many workshops that you can do for best practices in doing telemedicine. So I think some of our students will be better equipped coming out because they have had some work in that area.
Speaker 2 (30:09):
So we've talked a lot about some of the different stressors that potentially could lead to burnout, but do you think are the main causes of burnout amongst physical therapists?
Speaker 3 (30:19):
Yeah, I think number one, I think autonomy is, and, you know, we got out from under the physician prescription. But if you think about autonomy from many practices in which the productivity demands is so high that you feel as though you've lost some sense of autonomy, and that comes from not being able to perhaps schedule your patients based on their needs. So, you know, if 30 minutes session versus 45 versus an hour so that contributes to a decrease in, in autonomy, which we know is that, which is a stressor when it comes to burnout. The other thing that is a big factor is redundancy. And it can be primarily in documentation where, you know, we've all experienced that you fill out one form, then you fill out another, then you have to do this chart and so on and so forth.
Speaker 3 (31:20):
You have this information in four or five different places, and that contributes to burnout because what happens is you feel as though you've imparted your professional opinion and you've made your professional observations, and that should be good enough. And you know what, Stephanie, it probably should be good enough. The fact that we have to, you know, regurgitate it in three different ways for different purposes is, you know, sucking the life out of people. All right. So the other thing that happens is that acknowledgement of credentials and continuing education and bettering yourself when that is not honored and respected by an employer or by a setting that contributes to burnout. And so in the physician world, they talk about having their board certifications. And we could also think about that in physical therapy as well. So even if you've got staff that have qualified or are now OCS is, or sports, clinical specialists is they need time to maintain that expertise.
Speaker 3 (32:35):
They need to do continuing education. They need to see the right patient caseload. They need time to do some outcome measures so that they can maintain that level, that high level of expertise, and that needs to be respected and time needs to be given to those professionals. Otherwise you can see an erosion of professional accomplishment. So it, it's not from my, my work, but from the readings that I've done in other professions, you know, predominantly medicine and nursing, these are the institutional things that contribute to burnout. And I can see that how that can they can have a big role in physical therapy as well.
Speaker 2 (33:23):
So I recently did a very unreliable and bias social media study pool on this topic asking you know, what, which physical therapy setting is burnout most prevalent. And I had 147, a sample size of 147 on, and I was kind of surprised by the results, but here were the results. 48% said private practice, 23% said, hospitals, 24% said skilled nursing facilities, and 5% said home health agencies. Do you think based on kind of what your research showed and based off of what you've read and potentially what your alumni have said, do you think that there is a higher rate of burnout amongst physical therapists in certain settings? And if so, what settings do you hypothesize put people most at risk for burnout and how can leaders within those settings decrease the rate of burnout amongst their employees?
Speaker 3 (34:25):
Okay. So I don't have to hypothesize because I actually have the data that was not part of my dissertation. So I will share that with you now. All right. So the winner in the burnout rate is skilled nursing facilities at 24%. Okay. followed by home a home care at 14% closely followed by the hospital outpatient department at 13% and private outpatient at 12%. So 12, 13, 14%, you know, sort of in the ballpark, but the standard, our skilled nursing facilities. And in, in a statistical analysis that I even still don't remember or can explain the one that stands out is truly statistically significant difference are those people who practice in skilled nursing facilities. And I mean, I would have to say that that number is probably in a higher, I mean, look what our colleagues in skilled nursing facilities had to deal with with COVID.
Speaker 3 (35:39):
You know, people were not being able to have visitation by family members, right. Trainings for going home sometimes were done via zoom sometimes in person for maybe five minutes. But think about that, think about all of the subacute rehab, people who didn't have family support when they're, you know, they're following surgery. They've never been in that kind of situation before, and they had to do that totally alone. And the demands that were placed on the rehabilitation staff and the nursing staff to keep moving forward with subacute care, nevermind all of those residents in long-term care that needed attention. So it, it back several years ago, it was still ranking pretty high as a stressful burnout written place to be long-term care. And I think it's still gonna sort of be at that level if not higher, what can they do?
Speaker 3 (36:50):
I still, I still have to go back to having compassionate supervisory support that there needs to be an understanding on how stressful and difficult it is to work with people who are at risk and people who are in crisis. And with that compassionate understanding supervisor comes a system that optimizes the physical therapist clinical decision-making professional opinion and allows therapists to continue to impact people's lives as positively as we do and not be burdened or, you know block or have a blockade set up through unreasonable demands and expectations. I think that the other the other idea that I didn't speak about earlier also is this sense of fairness and justice, and that comes from also the supervisor and, and the institution, and that it appears that when there's good transparency by knowing what everyone's case load is by knowing what the expectations are and that everyone is contributing to a a great unit or a great facility and that there's rewards and acknowledgements.
Speaker 3 (38:37):
And sometimes it doesn't have to be an actual bonus or reward. Those are nice, but sometimes it's just the acknowledgement. And at the same time that there shouldn't be any kind of punitive action on people who are not able to accomplish the same benchmarks. So I'll give you an example of something that happens in medicine quite a bit is that physicians who work in clinics are, have their appointments, you know, done by a scheduler, and they will have an income based on bonus based on how many people that they see. But what happens is when people cancel, they don't see anyone and there's no one there to fill in that spot. So physicians are, who are in that situation, feel like I'm not pulling my weight, but it's no fault of my own. And now I'm also being penalized because I don't have that slots filled. So I can't generate a ticket if you will, in order for a charge to go in, and yet it's by no fault of their own. And so we need to be thinking about ways in which physical therapists can have some participation in systems that supports everyone in that work environment.
Speaker 2 (40:17):
Do you have any advice on any of those systems or any thoughts behind developing those systems?
Speaker 3 (40:24):
I don't actually, I think that those are for, for different minds than mine right now. And I bet that there's plenty of people in the private practice section who have looked into different types of systems that include participatory type management strategies.
Speaker 2 (40:48):
I think you're probably correct on that statement, Dr. Anderson and, you know, most physical therapy facilities, including private practice, we're moving towards using data to make decisions. So how, what advice would you give to private practice owners? How can they use data to measure burnout amongst their employees?
Speaker 3 (41:09):
Yeah, I mean, I think, I think one of the the easiest tools to use is actually the perceived stress scale. It's by Cohen, it's free, you know, there's plenty of places where you can find it online and know how to score it. And one of the reasons why I, this is because I've done the perceived stress scale with groups of therapists who take continuing education courses with my partner and me and they are often surprised at what their score is. So some who thought they would score really high on this perceived stress scale, realize that no, they really didn't. And those who thought, you know, they were getting along pretty okay. When they went through those questions, they're like, Oh, I didn't think I would score that high. And so it, it leads to a conversation about that personal side, right? So what are you think that your stress, but your perceived stress scale kind of comes out a little bit low.
Speaker 3 (42:22):
So what are you doing in your life? How do you approach your day? What are the things that you do to manage your health and wellbeing? And I think that facilities that make that part of the culture will do really well with being able to use some of that information from the perceived stress scale, not where they're collecting the data, but they're increasing the awareness of their employees and the people that work together. And it opens up the opportunity to have a conversation about the stressors at work, the stressors at home, and how people can support each other and how people are coping with their stressors.
Speaker 2 (43:09):
What advice or solutions do you have for private practice owners or any, or organizational leadership on managing burnout amongst their employees once they kind of figure out some of the data points that you mentioned previously?
Speaker 3 (43:23):
Yeah, I, I think that one of the things that has come out in some of the literature is the fact that when you're working with highly intelligent people. And so remember that burnout came from people who were working in healthcare, right? They, they are licensed healthcare providers. They often have advanced degrees. They often have specialties. One of the keys is to give people a voice regularly. And then what is also been found is that when people are given a voice and suggestions are made for changing in the environment or something that could help greater efficiency, that the response from the administration is that I will look into that and then come back with information to either support that idea or to say at this time, and in this situation, that idea won't work. And here are the reasons why, but one of the things that's very detrimental is when people share thoughts and ideas, is that the first response they get is we can't, or no, without any kind of real honest investigation into the suggestion or recommendation. And so I think that that's a very sound place to start and trying to have a clinic or a facility that is going to be resilient against all of these forces that are going on in healthcare and have a happy and healthier staff.
Speaker 2 (45:23):
What about employees? What type of advice do you have for employees who are maybe close to, or are experiencing burnout?
Speaker 3 (45:32):
Yeah. institutional change takes a very long time, and sometimes it can be really frustrating, particularly if you don't have those empathic caring supervisors who are going to sort of beat the drum for you. And so you have the chance to turn to yourself. And what we know from some work site studies that have focused on healthcare providers is that breathing practices and meditation are two strategies, which help people be able to manage their stress effectively. And the idea is that you practice those things so that when you need it, you can use it. So, you know, you could always think, well, like when I get really anxious or whatever, I just stop and I take some deep breaths. Oh, okay. That's great. But when do you, do you always have an opportunity to like, just stop, pause and like take your deep breaths? No, you, you have to anticipate that this is happening and you have to be really good at pulling that up very quickly. And that comes from a regular practice. And I think that in general, we know those practices are really good for managing the balance of the sympathetic and parasympathetic nervous system. We know that those practices help increase heart rate variability, decreased blood pressure, decreased heart rate. And so it's not, those are strategies that are not just great for managing stress, but they're also great for managing your overall health.
Speaker 2 (47:27):
Well, Dr. Anderson, this been a great conversation. I know that I have learned a lot and I'm really looking forward to using some of this information to write my article. One last question that I want to ask you, that we ask everybody on this podcast is knowing where you are now in your life and in your career. What advice would you give to your younger self?
Speaker 3 (47:53):
Huh. I think, I think to my younger self, well, Hmm. Okay. There's two, there's two sides to this sword. One is that if I wanted to be more accomplished, I would say in my career I would have focused earlier on, on a line of inquiry or a line of research. However, not having done that. I can't say that I have a lot of regrets and I have dabbled in a lot of things so that you, you saw from my bio, that I have a lot of different interests and I don't do anything with a half effort. So, you know, a lot of research went into the book. A lot of research went into my being the advisor for young athletes for special Olympics. You know, there's, there's, I haven't really ever fallen into anything. I feel as though I've put a lot of effort into that and, and all of those parts of who I am. I enjoy immensely and I wouldn't want to give anything up. So my advice is if I had a clear career trajectory, I should have focused more on one area. But I don't know if that was really me to begin with.
Speaker 2 (49:34):
Yeah, don't we all want to have one area that we want to focus on and have a very clear trajectory. I think of 2020 has taught me anything. It is, that is not something that's going to happen most of the time. Well, I want to thank you so much, Dr. Anderson for joining us today on the podcast, and thank you so much for your time. Thank you to our, thank you to our listeners for listening to another episode of healthy, wealthy, and smart, and hopefully you will stay healthy, wealthy, and smart.
Speaker 1 (50:10):
Thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
In this episode, Co-Founders of Survivorship Solutions, Jillian Schmitt and Kristin Carroll, talk about Cancer Survivorship and the need for Caner Rehab Education.
Today, Jillian and Kristin talk about the prevalence of cancer, the importance of competency in cancer rehabilitation for all rehab clinicians, and compiling educational courses from leaders in the field.
When should cancer rehabilitation start? Jillian and Kristin tell us that learning is not enough, hear about the value of mentorship, and Jillian and Kristin’s community of clinicians, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Cancer is not just one type of cancer. Cancer is not just what you’re seeing on the outside, there are physical changes on the inside as well.”
- “One thing that physical therapists have to keep in mind is that 100% of physical therapists, at some point in their physical therapy career, will see someone with cancer.”
- “If you want to stay on the bus, get competent and elevate your skillset to everything, not just cancer rehabilitation, but add that as another skill in your pocket.”
- “If you are a clinician or a therapist, it really is your ethical responsibility to take care of every patient that comes through the door, regardless of what their past medical history is. If you are not confident and competent in taking care of oncology patients, get that way. There’s a solution for you. Educate yourself, feel comfortable, feel confident, take care of your patient the way you should.”
- “For administrators and leadership teams, you really want to know that your team can take care of this population. If you do not have something in place that is ensuring that your clinicians and rehabilitation teams are really competent at taking care of these patients, you need to get that way, and you need to get that way pretty quick because the regulations and requirements from the very top levels are requiring that you do that.”
- “If your oncologist is not talking to you about function and what’s happening to you during your cancer journey and how that is going to be mitigated, or how you’re going to have a rehabilitation therapist of some sort as part of your team, ask for it. It needs to have this bottom-up push as well.”
- “Think big, be brave, and just go for it.”
- “Keep being a sponge. Keep learning. Don’t be afraid to try new things. When you’re starting to get burned out, try something else. Keep learning and keep growing, and eventually you’re going to find something that just wows you and really makes you change not only your career, but your personal growth as well.”
More about Kristin
Kristin has been in clinical care and leadership roles within the Boston and Hartford healthcare systems for over 30 years. For over a decade she has focused on elevating her oncology specific practice with Klose coursework in lymphedema, oncology and breast cancer rehabilitation specialty courses through Julia Osborne and the American Physical Therapy Association (APTA); Academy of Oncologic Physical Therapy, and earned completion certificates in Chemotherapy/ Biotherapy Agents and Radiation Therapy from the Oncology Nursing Society. She is planning to sit for the 2021 Oncologic Certified Specialist Examination.
Kristin has been a mentor, clinical coordinator, and educator at both the system and collegiate level. She continues to serve as an educator through her role as an instructor within Survivorship Solutions ’clinical education course: Core Competencies in Interdisciplinary Cancer Rehabilitation, contributing to guest podcasts on Breast Friends Cancer Support Radio, Mama Bear Cancer Support Radio Talk Show, and The OncoPT Podcast, contributing to Alene Nitzky’ s book “Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care”, and as invited speaker at the International Breast Cancer and Wellness Summit, and the American Congress of Rehabilitation Medicine National Conference 2020.
She actively supports and is involved in the oncology community as a member of the American Congress of Rehabilitation Medicine Integrative Cancer Rehabilitation Task Force, Connecticut Lymphedema Consortium, local and national chapters of the American Physical Therapy Association (APTA); APTA Academy of Oncologic Physical Therapy, Hospice and Palliative Care Special Interest Group, and serves on the board of the APTA Connecticut Oncology Special Interest Group as Program Coordinator.
Kristin received her Bachelor of Science in Physical Therapy from Northeastern University.
More About Jillian:
Jillian is a licensed physical therapist with over 20 years of experience in patient care, clinic development, management, and consulting within the fields of oncology, orthopedics, pediatrics, ergonomics, and corporate health. She studied biochemistry and business management at the University of Texas at Austin, and received a Bachelor of Science degree in Healthcare Sciences and a Master's degree in Physical Therapy from the University of Texas Medical Branch in 2001.
Much of Jillian's early career focused on orthopedic and pediatric physical therapy intervention, specializing in complex, limb-salvage rehabilitation programs, spinal dysfunction, and sports medicine. Later, she turned her attention to program development, clinic start-ups, and management within the corporate healthcare industry. For the past six years, she has consulted in the implementation and optimization of survivorship services and cancer rehabilitation programs within national healthcare organizations.
Jillian maintains professional licensure in physical therapy and participates in continuing education programs and certifications within oncology and other specialties. She serves as a contributing and presenting team member for the American Congress of Rehabilitative Medicine (ACRM)'s Integrative Cancer Rehab Taskforce and is a member of both the Education Section and Oncology Section of the American Physical Therapy Association (APTA). She also participates as a member of the Hospice and Palliative Care Special Interest Group (SIG).
Jillian regularly contributes to podcasts, journals, and other professional publications related to oncology, healthcare, and business, and she participates and contributes regularly within the entrepreneur and small-business community of the Chicago-land area, including SCORE mentorship and women-led business groups.
In 2016, Kristin and Jillian founded Survivorship Solutions, LLC., an education and consultancy firm dedicated to supporting clinicians and healthcare organizations in implementing high-quality cancer rehabilitation and survivorship services.
The company collaborates with national and global experts in oncology, survivorship, and rehabilitation to grow team safety and competencies in oncology knowledge and evidence-based care.
Suggested Keywords
Physiotherapy, Learning, Cancer, Research, PT, Health, Therapy, Oncology, Survivorship, Healthcare, Education, Training,
Recommended viewing
https://vimeo.com/485402119
https://survivorshipsolutions.com/p/core-competencies-in-interdisciplinary-cancer-rehabilitation-2-0
To learn more, follow Jillian and Kristin at:
Website: https://survivorshipsolutions.com
Vimeo: https://vimeo.com/survivorshipsolutions
Facebook: Survivorship Solutions
Instagram: @survivorshipsolutions
Twitter: @survivorshipsol
@KCarrollPT
@JSchmittPT
LinkedIn: Kristin Carroll
Jillian Schmitt
Survivorship Solutions LLC
NetHealth Webinar:
Rehab Therapy Outpatient Services 101: How to Expand into the Home or Assisted Living Facility.
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Read the Full Transcript:
Speaker 1 (00:00):
Hey, Kristin and Jillian, welcome to the podcast. I'm so happy to have you guys on
Speaker 2 (00:07):
Or happy to be here.
Speaker 3 (00:09):
Thank you so much for having us on today.
Speaker 1 (00:11):
So today we're going to talk about cancer, survivorship. This is something that I've spoken to, one of your colleagues, Dr. Nicole Stout with, but before we get talking about that, what I would love to know is how the two of you came together to create survivorship solutions, the how, and the why behind it.
Speaker 2 (00:31):
So, Kristen and I knew each other before we started the company together for a couple of years, we, we previously worked for another organization and had similar roles and that was to implement cancer rehabilitation, service lines within healthcare systems. And Kristen and I really connected during that time. And we really enjoyed working with each other. We valued a lot of the same things. And so once we left that situation or once that situation of our, our, you know, once that's working together no longer happened for that particular company, we decided that we were great together and that we would we needed to continue the work. And so we started survivorship solutions together
Speaker 3 (01:21):
And Julia and I are both physical therapists and I have a special, I've been working with oncology patients for over 12 years. And even though we're both PTs, we both kind of had different soap boxes and what we were so passionate about. And Jillian has a love and just a savvy for business and growth. And you know, I just love to educate and things like that. So together, you know, just our, our strengths and our passions just forged us forward to create this, this company to, to continue to help healthcare organizations, but also individual commissions that, that really just needed to get more information on how to take care of people with cancer.
Speaker 1 (01:59):
Yeah. And that was my next question is where, where was the gap that, what was the gap that you guys saw that you were like, Hey, if we can put our heads together and create this, we're really going to help fill that gap?
Speaker 2 (02:11):
Right. Well, you know, for me personally, it was I was not a cancer rehabilitation therapist for most of my, my clinical career. I was in orthopedics and I th the opportunity to begin working in cancer rehabilitation actually came about it was pretty unexpected. I received a phone call from a very good friend of mine and also therapists I would school with. And I've been in practice for 15 years and she said, you know, I think that this would be a really good opportunity for you, you know, you, you've married sort of this business. And I, because I had opened clinics and I had done a lot of the, the business part of it. And but I really loved clinical practice. And I also had a very personal situation occurring in my life, or one of my loved ones was experiencing the cancer journey and really having a lot of issues and a lot of problems that I was really familiar with. But I, you know, like weakness and numbness and things like the things that physical symptoms, but I was just kind of watching through this lens and like, all right, well, that's like what I do every day, but why isn't somebody helping him? So it was all these three things that kind of came together and took me out of my orthopedic world pretty quickly and thrust me into the cancer rehabilitation world, which I had thought, I mean, admittedly been very naive of until that happened.
Speaker 3 (03:43):
Yeah. And I was working in an outpatient center and had surgeons come to ask if I would become competent to learn how to take care of breast cancer patients. Cause they were breast cancer surgeons. So I went to Olympia DEMA course and I learned all about lymphedema. And then I came back and I saw a breast cancer patient and I was all excited to use my new education that I just learned and she didn't have lymphedema, but I was like, Oh my God, what do I do with her? I mean, I learned all about lymphedema isn't that cancer rehab isn't. And so Julie and I learned quickly that in order to really become competent, to take care of people with cancer, you have to travel around the country at your conferences and online and, and do all sorts of things to get there. But a lot of it was just disease specific, like just breast cancer. So how do you learn how to take care of everybody that has all different kinds of cancers and all the different problems? So we felt that it really was our ethical responsibility as we were working with healthcare organizations to make sure that if we were going to implement a program, we had to make sure the team really was confident and competent to do that. So how we created education to go along with that implementation.
Speaker 1 (04:54):
Yeah. Excellent. And, and I will say that people who, like, I know people who've been diagnosed with cancer and as of yet only like two of them have gone to physical therapy. One of which was because I said, you have to go to physical therapy, she had a double mastectomy. And I said, tell your doctor that you want to go to PT afterwards. And she was like, but the doctor gave me this list of exercises. And I said, no, no, no, no, no. Tell your doctor, you want to go to see a physical therapist after this and, and sh afterwards she was like, yeah, I I definitely needed a PT. And so I think the issue here, and we'll get into that, we'll get into this conversation in a little bit, but you know, the issue here is that cancer is not just one type of cancer. Cancer is not just a, what you're seeing on the outside, but there are physical changes on the inside as well. And that's where being a knowledgeable physical therapist on, on the rehab of people diagnosed with cancer is so important, but let's talk about cancer in particular. So cancer itself can affect anyone true or false. That's absolutely right. Yeah, definitely. And so let's talk a little bit about the, this sort of prevalence of cancer and what that means for us right now,
Speaker 3 (06:31):
Almost 17 million cancer survivors in the country. And so that is all different ages, you know, doesn't matter which sex, all different kinds of cancers, definitely cancer is not discriminant. And so you talk about the gap in care. And Andrew Chevelle is, is kind of huge in our cancer rehab world and does research. And you know, she talks about the 83% of general cancer survivors have problems that really require rehabilitation and take it to the other end where women sorry, excuse me, general cancer metastatic or stage four, they have up to 92% of problems. So obviously somebody that has a chronic cancer condition is going to have more and more problems because they are receiving more and more treatments. And so the percentage of people that actually get rehabilitation is only about 30% according to, to her study. So that's, you know, that's a huge gap in care wizards.
Speaker 3 (07:25):
It's 83% of general cancer survivors or the 92% of our metastatic breast cancer patients. That's a huge gap with 30%. So when we're looking at that, if you're young and you're diagnosed with cancer and you have treatment, you're going to grow up to have perhaps problems, you know, as you get older. And so, you know, these people are inside our clinics already. And sometimes it's a little tiny past medical history. That's checked, you know, on their, on their form and we see cancer, but yet we're a little bit afraid sometimes to ask a little bit about what that is. And, and even I do that when I'm in a private room with my cancer patients that I'm treating them, I have no problem talking about what they went through, but on an open clinic. And I see that little word cancer, sometimes I, I will say, Oh, well, you had cancer. What kind did you have? And you know, but we really have to have these conversations. What kind of cancer did you have? What kind of treatment did you have because it really can impact the treatment that you are providing your patient, whether they're a pediatric patient, you know, an inpatient and outpatient adult really doesn't matter what the setting is. It really could depend on what your care plan is going to be.
Speaker 1 (08:41):
And Karen, you, you had mentioned that you said you asked, can anybody get cancer and can this affect everybody? And absolutely. And I think what's, what's really interesting is that healthcare professionals, you, myself
Speaker 2 (08:56):
Included, we don't necessarily automatically think about like the, the functional consequences of having cancer, even though we see it. We're so we have this new normal instilled in us that we sort of expect cancer patients to not have normal function or not be doing well. And it just really to be part of what the expectation is once you get that diagnosis. And even me, even somebody that has worked in therapy for a long time and having a person very close to me, experiencing physical symptoms, I still, it was almost like a, it was just sort of like an out of, Oh, you know, like I didn't really make sense to me why he wasn't getting it, but it wasn't sort of this, well, this is a person that needs to have therapy. That connection wasn't, wasn't quite there yet. And I think that that's true for a lot of clinicians.
Speaker 2 (09:49):
They say, well, we, we don't see cancer patients, but but w w what Christina likes to say, well, yes, you actually, you have, and you do you see them probably every day on your schedule, there's such a high percentage of people that cancer at this point, that if you're seeing any population in ortho population or a neuro population or whatever in your clinic, you have seen patients that have either current or a previous diagnosis of cancer. And so you are, these patients are coming into our clinics already, and people are just not really making that connection.
Speaker 1 (10:23):
Yeah. I remember when I spoke to Nicole, she said, one thing that all physical therapists have to keep in mind is a hundred percent of physical therapists in, at some point in their physical therapy career will see someone with
Speaker 2 (10:36):
Absolutely, absolutely. Probably this week. Yeah. And like, you know, it's, it's not, it's not when, or, or it's, I mean, like it's very, very soon because patients also don't necessarily think about the fact that they have a cancer diagnosis and it's something that they really need to kind of put, put front and center when they are going to rehab. So maybe they've had a knee replacement or they've had some other traditional rehabilitation problem, like a BA like back pain or whatever they go to PT for. And they had that pesky, you know, cancer diagnosis 10 years ago that colorectal cancer, but they, they got it and they got the third, but so they don't really, but you know what, those things that happened 10 years ago with that diagnosis and the medications that that patient had and the treatments that that patient had are actually going to impact the way that they heal in, in physical therapy. And so I think the patient doesn't understand the significance of it. And then the clinician doesn't really understand the significance of it. And it makes a huge impact in how well that patient is gonna, you know, do and how, and in the course of their therapy, it really should kind of direct the course of their therapy and and predict how well they're going to be able to, you know, certain, certain things that should be in therapy and certain things that should really not be done in therapy should be based on that.
Speaker 1 (11:57):
And something that as you're saying, all of this, that kind of struck me is that in physical therapy, you know, we are expected to have the competency to treat people with a total knee replacement, low back pain post-stroke Ms. But you guys have traveled around the country. You've spoken to many physical therapists, is that clinical competency in cancer rehab there amongst the physical therapy profession. And this is a silly question, but is it essential?
Speaker 3 (12:35):
I do. I think it was definitely not there. I mean, there are therapists that are very skilled at providing lymphedema treatments, and there are therapists that are very skilled in targeting certain kinds of breast cancer. But I think one of the things that we think, what I think about is that the things that people going through cancer treatment, it's kind of like an anticipated decline, right? Like we kind of know that they're going to feel like crap when they're going through chemotherapy. And I think that maybe, and I had this assumption that once their chemotherapy is over, they're going to be fine. And I think a lot of the providers think that as well, we kind of know that they're not going to do well during treatment, but I don't think that a lot of people know is that they don't do well even after treatment and that six months and years later, they have these effects.
Speaker 3 (13:24):
And because there are one in eight women that get breast cancer, and there are so many men that get prostate and other lung cancers are, are breast cancer women, and are prostate men have to take medications sometimes for five and 10 years, that affects their musculoskeletal system that affects every ortho therapist. If they're treating these people that are in their clinics. So there may be a general awareness, but I think there is kind of pick and choose, like you make it a lung cancer patients that you're treating for weakness. You don't have to treat weakness, you don't to treat balance issues, but you may not really understand what the chemo regimen did to the patient, why they're having those. So I think explain the why around it helps to decrease the fear that some therapists have of treating, because I sure was afraid when I saw my frail bald patients walking in, I was really afraid I was going to hurt them. And I didn't feel safe to take care of them because I had one month of DEMA course, and I wasn't. So we kind of wing it, right. Because there's not really many resources out there. Right, right.
Speaker 2 (14:36):
Back into my schoolwork and looked and to see what oncology criteria like curriculum that we had gone through when I was a student. And yeah, I mean, it was so minimal. It was less than a week was one core, like within one class that wasn't oncology focused. It was, I mean, the amount of information that clinicians were getting in school and professional programs was very, very minimal. And of course that's more than 20 years ago when I was in school. But even now even now I would say that there was a huge percentage of of clinicians that take our course who are new grads. They just got out of school. So we know, and we've communicated with them. Talk to them. This is not in their curriculum. They are not learning this in school. Otherwise they would not be seeking out some of this information that they know is really important anyway. And that's physical therapists, occupational therapists, anybody that's in allied health or are seeing patients really needs that they need to have this foundational, basic knowledge that makes them safe and makes them competent to care for these patients. And so it is a little, I I'm sure the education, maybe at some point we'll catch up, but it hasn't yet.
Speaker 1 (15:56):
Yeah. And, and I'm sure it also depends on what's on the MPTE, but that's a whole other thing and let's, we won't get into that, but we know that certainly exists when it comes to educational curriculum in schools. Yes. At any rate I digress. Let's talk about, let's talk about when should rehab physical therapy, occupational therapy start. So someone is diagnosed with cancer. When do they start their rehab?
Speaker 3 (16:27):
The rehabilitation starts at diagnosis and that's when the American cancer society. And so many of our, our industry regulators recommend that it started and it start from diagnosis all the way from end of life or end of care. And, you know, we compare this to kind of our other service lines, but, you know, somebody is having a knee replacement they're coming in for prehab, right. They're coming in for education, they're coming in for strengthening before they do that. And it's, it's no different for a patient with cancer. They need to be armed with what they are going to go through. Not only the education to help decrease their fear, but also the problems that they are going to incur, understanding that we have the skillset and the tools to be able to support them throughout that journey. And I think the other thing that rehab teams don't realize is that general clinicians that don't have specialties really can treat the scope of most of the impairments that people have. Just like we all can you know, balance and numbness and tingling and strength issues and fatigue, and just, you know, the list goes on and on, but if you have a pelvic health issue or if you have lymphedema, then we triaged to our, to our specialists
Speaker 2 (17:35):
And, and best practice really dictates that when you're going to begin any type of a treatment or any type of incur, any type of or undergo any type of surgery or anything like that, it's really to establish a baseline. And in cancer, there's really, it's, it's very important to establish a baseline because we know pretty, pretty well that cancer treatments are going to cause problems. They're going to exacerbate existing problems. And so if we can add diagnosis, capture what that baseline is for that patient and monitor and survey that patient and make sure that that patient is not there, that their existing, their preconditions or existing deficits or impairments are not getting worse or that new ones are not popping up. That really is best practice because we know that if we can see something pop up, you know, and catch it immediately, it's going to be a lot easier to take care of and to recover from or to prevent even then, if it's something that we don't, you know, that we don't look for until after treatment is over, maybe, you know, the patient is having a lot of functional problems that are really obvious.
Speaker 2 (18:50):
If you just wait until then it's going to be a lot harder to intervene and it's going to, I mean, and this is it's gonna be a lot more expensive. I mean, something that may take just an education and maybe one visit and rehabilitation from the very onset and the very beginning even something, you know, just as you're going to have this, you're going to have a lumpectomy you're going to guard you. You know, let's make sure that when this happens, you're going to continue to do range of motion within a certain, you know, limitation, but that the patient knows that that can later prevent like three months of a frozen shoulder. Right? I mean, like we know that this, these things happen all the time and it's easy to just kind of get in there from the beginning. So best practice is, is at the very beginning at diagnosis, patients should definitely be at least screened for impairments and informed that rehabilitation is part of their medical care. They should expect it, their patient should walk in knowing that rehabilitation is part of their medical team. Yeah, absolutely.
Speaker 3 (19:52):
And this is, and this is something that Nicole Stout talks a lot about in her research has called the process perspective surveillance model. And that is, you know, screening patients before each intervention. So we know kind of what we call each medical touch point. So whether they're having surgery or chemotherapy or radiation really being screened before each of those interventions. So like Jillian said, we can kind of pick up on those impairments when they're acute in nature, that's really important.
Speaker 1 (20:19):
And so let's talk about cancer rehabilitation education. I think we've already established that physical therapists do not get an adequate amount of cancer rehabilitation education in school, and you may not get it on the job either, depending on where you work. So couple that with millions and millions of people getting diagnosed with cancer every year rehab should start at the point of diagnosis. So let's talk about the education around it, because if that is the case, and now it is recommended rehab start at the time of diagnosis. And there are tons of PTs in this country and not many know how to deal with this. How do we educate physical therapists in a robust manner so they can help with these patients?
Speaker 2 (21:15):
Well, I think that things are kind of catching up here. It's been established that cancer rehabilitation is important and it needs to be part of cancer patients cancer care. And we have national regulatory agencies and different sort of top level drivers that are encouraging and really requiring organizations to provide cancer rehabilitation. So we have a lot of these companies that are starting to recognize, all right, are people that are in house already need to be doing this. And then from the clinician's perspective. And, and I can say this as a, as a physical therapist, if, if my boss had come to me in my outpatient clinic and said, okay, we're going to have a bunch of oncology patients come in the doors now. Because there's these guidelines and we're going to see this influx of patients and you guys are gonna be treating these patients.
Speaker 2 (22:15):
I would have been like, okay, like I would have been really nervous about it. And so we, we still sort of were getting that response as organizations are starting to implement some of these policies that are requiring that their organizations provide these services. So we're also getting this sort of searching from these clinicians, like, all right, I'm going to see cancer patients. And when I go online, I see like a billion, different CU courses for different types of, I mean, I can be different specialists in this or a specialist in that, or I can take this or I can take that. What I really want to know is how can I be safe to see these patients coming through the door. I don't, but maybe cancer is not there. And you know, what, what they're interested in, they don't want to specialize in it.
Speaker 2 (23:03):
That's fine. And so they don't want to spend thousands of dollars on specialties and weekends, but they do want to be safe and they want to know. And so Chris and I kind of came at it from that perspective, like, all right, we're gonna, we're gonna say, we're going to get more referrals in your clinics because of these guidelines, because it's the right thing to do because research says that cancer patients need it. But what's really important to us is that your clinicians feel competent. They feel safe. How can we create the education that your, your clinicians are gonna feel like they can have anybody land on their schedule and that's going to be fine because that's going to make them feel comfortable. And what that's going to do is going to make their bosses feel comfortable there. The leadership is going to know that their entire Rhea team has a competency and anybody can kind of come through there and that their service is going to be very similar from facility and location location.
Speaker 2 (23:48):
So we, that's kind of where we started with. We weren't, we didn't, we didn't want to make a course that was going to make somebody a specialist. Those are out there and they're awesome. And we work with all those people that make those courses. So we know they're awesome. We wanted to create something that was respectful of somebody's time and their money, and, and really want to just pull the most excellent parts of all those specialties into one spot so that a therapist could go through it and be pretty confident in their leadership can be pretty confident that they were that they were gonna be able to take care of these patients as they come through the doors.
Speaker 3 (24:23):
Yeah, Kristen, and then I, I was live and then I was living in the cancer rehabilitation world. So I knew a lot of the experts and the leaders in the field from just attending their courses and conferences like Nicole, Nicole Stout, and Julia Osborne. And, you know, just all of these amazing people that really aligned with the same mission and vision that Jillian and I both had to spread this education. And, but what was missing was a comprehensive online platform. And, you know, I I'm sitting for the specialty exam in February, but I'm an expert in certain things, but I certainly not the expert on everything. And so Joanie and I said, you know, when we're learning, we want to learn from our role models, right? Our peers and our colleagues who respect in the field. So we went out and we asked them, you know, will you help us create this education?
Speaker 3 (25:18):
And they all said, absolutely it's really important. And why it's important is because we have to get it in the hands of people quickly. I, it took me 12 years to kind of get all this information. We don't have that kind of time because we have almost 17 million people that need this care right now. And these patients are in the clinics and, and they need it. You know, they're, they're just people that want to do marathons and, you know, raise their children and go to school and do all the things that everybody else does. So how do we get it into the hands of people? So we went out and they created this, this education, and then we went and got it approved recently for continuing education credits. So it really is an amazing compilation of education that spreads a blanket over all different kinds of cancer, disease types and all the impairments. But it isn't just for somebody that wants to be competent and confident. Cause I went through it myself and I learned a lot of information and I've been doing this for over 12 years. So it really is also for clinicians that are interested in cancer rehabilitation that work in cancer rehabilitation, but are also experts because they will learn about a lot of things that there are no courses for like pharmacology. There are no courses for pharmacology, right. They're out there right now for to learn from
Speaker 2 (26:39):
It's really for the whole team. Yeah. And so when, so let's
Speaker 1 (26:44):
As a physical therapist I go through, through this chorus, I'm confident, I'm competent. And is it like, okay, thanks. I guess I'm, I'm, I'm good now. I don't need anything else. So what happens after this sort of ed, you have this experience with you guys and you're, you know, relatively confident and competent is, is that where the learning ends?
Speaker 2 (27:12):
No, I, I, I really love that you asked that question actually, because this is what I, this is my soap box. You know, we all, all of our presenters for our course, they all have their soap boxes. They're all specialists about what they think is the most important. That's why our education is awesome. We, you know, we went to the specialist, we said, give us 30 minutes, you know, or, or whatever that you think is the most important part of your specialty that you think all general people should know, and then they bring it in and that's, what's in the core. So you kind of get the best of everything and what the specialist actually think the general therapists really need to know about certain things. But we did recognize absolutely that once you have, this is acumen or you, this information about, you know, cancer rehabilitation and you have got to be able to communicate with others that have the same information that, that are there in the same world.
Speaker 2 (28:02):
Because even though there are going to be a lot of patients that are starting to come in in the future right now, it's a little bit of a small world. It's kind of a, a small world in regards to who is in cancer rehabilitation. And we know this because we go to the conferences and we see the people that come to the different lectures and the presenters. And we know that this is kind of a small world because we see that a lot of the same people over and over again. And, and so the education is really important, obviously for Kristin and I, we have it updated constantly by the presenters. Each one of them is responsible for their segment so that we know if legislation changes, if there's evidence that comes out, something happens where their presentation or their part of our education needs to be updated.
Speaker 2 (28:42):
That's going to happen in pretty, pretty much in real time. But how do we answer our students' questions later? How do we grow their interest or their confidence beyond just an online course and the way that Chris and I have been doing that, as you know, we've worked with clients and we've sort of built this community within our own clients, that they reach out to each other all the time and communicate in that way. They know they've got other people that are doing the same thing, implementing the same types of interventions or screenings or things like education. And so they can connect with each other. And that's great for those clients. But we've really recognized that there is there is a need for a community where people could really discuss their patients, discuss their experiences, discuss their education and grow from there.
Speaker 2 (29:32):
And so that's actually something that we're working on right now really hard. And we, we already, you know, it's rolled out for our clients right now. So it's just a matter of being able to make it more of a public forum where people can, they they've got this, they've had the education. So they kind of were speaking the same language, at least at a bare minimum. And then they can discuss and communicate. And what's nice about it is that we've got all of our partners who have created our course, like Nicole Stout and Mary Lou Valentino. And some of these others who are very reputable, well-known that created part of our course for us. And they're all in there like, heck yeah, we're going to be part of this conversation. We want to be part of this community. And so our vision of course, is that we can have discussion groups and different opportunities where people can get their questions answered about either about the education or applying that application, that education to real life scenarios. How can they get that feedback and that comradery that they're going to need to feel even more confident in this industry. That's why we have, that's why we have great relationships is that they all want to do this. They all know this community is important and it's not a big ask. It's not like, Hey, can you talk to a bunch of therapists that really think this is important? They're I mean, they're, they're all in it. They're all in. So
Speaker 3 (30:51):
Being an Island is, is kind of scary. And like you said, you take that education and then you go back into your clinic or your place. And for people that are working in rural communities, they may be the only person that is taking this education. And we're all really busy people in our work lives and our home lives. And I think one of the hardest things for me as a clinician and a business owner is what do I need to know right now? You know, there's so much research that comes out. And so that's how we also wanted to support with, with workshops. And you know, what is the need to know research that you need to know that's coming out today? You know, you can't afford to fly all over the country and go to all these conferences. Well, guess what, we've tidbit from all the conferences that now that's out there, that's pertinent to you so that you understand what's going on out there in the world without having to do that.
Speaker 3 (31:43):
And so it's you know, it has meant so much to Gillian and I to work with all of the partners that we have. All of the organizations that we work with are so passionate. We've met clinicians that are passionate. I've never met anyone that has not been exposed to cancer in some way, whether it's personally a friend, family, somebody, so everyone is connected by it. Nobody doesn't want to take care of somebody that's going through this. So it's really, how do we all kind of work together to support each other? That if you have questions kind of there in a non-threatening way. Certainly, you know, when Julia and I first met Nicole Stout, we were, you know, at, at, in section meeting and she was standing over there and, and, you know, Julie was like, I'm going to go over there and meet her. I'm like, no, no, it's Nicole Stone. You know? And I was so intimidated by her and because she was a big wig. Well, yeah, but when you meet her, you go, you meet her and you learn that she has the same passion and mission and commitment to people that you do. And, and she's so accepting and welcoming that, that really went away. And I felt like we had to really offer that to everybody else so that they could acknowledge that these people are, are very willing and receptive to helping.
Speaker 1 (32:58):
Yeah. Yeah. She's fabulous. Plus, I mean the shoe collection, I mean, I mean, can we just be envious of her shoe collection? And so, but yeah, she's, she's fabulous and what she does for the, for the physical therapy world oncology in particular. But I think the PT world as a whole is, is huge. As a student, she might, people might be intimidated by, by that. I mean, we were, but I think that that's what we're trying to do is as we're breaking down those, those barriers for our students, and we're saying, Hey, look, you know what your course is awesome as taught by an awesome person. And here's an awesome person that you can ask that question too. Yeah. Yeah. What a wonderful opportunity to give to your students to, to have to have those collaborations and those relationships, which in, in my, in my eyes, relationships are everything they're key. And, and that's the thing for me that keeps pushing this profession forward. As we wrap things up, I'm going to ask each of you. So what would be your big takeaway that you want the listeners to come away with from the talk today?
Speaker 3 (34:09):
I think one of the biggest things that I learned was actually back at CSM. And somebody said that as physical therapists, we are medical coordinators of care and is our ethical responsibility to really be able to take care of everybody that comes into our care. And he said, you know, what, if you're not competent to treat everybody get off the bus because you're bringing our profession down. You know, we have autonomy. Now we can have people coming into our clinics without physician referrals. So we have to know this many, many PTs can order x-rays and things like that. So my take home message is if you want to stay on the bus, get competent and elevate your skillset to everything, not just cancer rehabilitation, but add that as yet another skill in your pocket so that when that patient comes in, you can either treat them or you can triage them. A stroke patient comes into my clinic. I can evaluate them and educate them, but I might triage them somewhere else so that they get more targeted care. So that's, you know, I just want everybody to get on the bus. Yeah.
Speaker 1 (35:20):
Awesome. Jillian. Well I think my takeaway that I would provide it really depends on the audience on who is listening. So if you are a clinician or a therapist like Kristen, it really is
Speaker 2 (35:38):
Your ethical responsibility to take care of every therapy. Every patient that comes through the door, regardless of what their past medical history is you should be able to provide the highest level of care for that patient and as therapists. And we all know you have the heart of a therapist, you want to do the best for your patients. So if you are not confident and competent in taking care of oncology patients, my takeaway to you is get that way. There's a solution for you, educate yourself, feel comfortable, feel confident. You take care of your patients, where you said there's a solution for you. I'm an action girl, but my takeaway for administrators and for leadership teams of your organizations is you really want to know that your team can take care of this population. And when you do something, when you do something and you want to be sure that your team is competent, you put forth these standards and people have to meet these standards.
Speaker 2 (36:31):
And so my, my takeaway for then is that if you do not have something in place that is ensuring that your, your clinicians, that your rehabilitation teams are really competent in taking care of these patients you need to get that way and you need to get that way pretty quick because the regulations and the the requirements that are coming down from the very top levels nationally are requiring that you do that. So it's not just an ethical thing on the clinician side. It really, and, and also this is a new patient population or not, not a new patient population, but this is a patient population that is going to expand. We're going to see a lot more on ecology patients. And so that is an opportunity to reach out to sort of almost a new I don't want to call it a market cause I don't like to call people a market, but it is, it's a new, it's a new market for, for those administrators and most leaders.
Speaker 2 (37:28):
And then the takeaway, of course, if we have patients listening or, or relative caregivers coast survivors is what we call people that are in the lives of, of a person with a diagnosis of cancer. Ask for it. My takeaway is that this is part of your medical care. You should be, if you're not, if you're, if you're on ecologists, your provider is not talking to you about function and what's happening to you during your cancer journey and how that is going to be mitigated or how you're going to have a rehabilitation therapist of support as part of your team. If somebody has not said that to you yet ask for it because it needs to have this bottom up push as well. And it seems so logical when you talk about it. But again, you know, you gotta look, you gotta understand your audience and who are you talking to? What language are you speaking? Yeah.
Speaker 1 (38:16):
Excellent. All right. So before we get to where everyone can find you, I have last question, it's the question I ask everyone. And that is knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad?
Speaker 2 (38:33):
I would tell my younger self or anybody that is kind of starting out in their career and they know they're doing what they love to think big, think big and be brave and just go, just go for it.
Speaker 1 (38:48):
Excellent. Kristen,
Speaker 3 (38:50):
I think that I would tell my younger self to just keep being a sponge, keep learning. Don't be afraid to try new things, you know, when you're starting to get burned out, try something else, which is what I did. I kind of kept jumping around and I found I was passionate about each of those things and just keep learning and keep growing. And eventually you're going to find something that really wows you and really makes you change not only your career, but your, you know, your personal growth as, as well.
Speaker 1 (39:23):
Excellent. Very good advice all around. So now where can people find you? Where can they find the course? What's the name of the course? Give me all the details.
Speaker 2 (39:31):
Great. but you can find us@survivorshipsolutions.com. That's our website and our courses on our homepage. So they can just click, click on the link, they'll see the education and they'll see some of the other, you know, consulting services and things like that that we also provide. But and certainly there's contact page. They can reach out to us. We're happy to, to have conversation with anybody.
Speaker 1 (39:59):
Perfect. And what about social media? Where can people find you follow you, et cetera?
Speaker 3 (40:03):
We are all over social media. We're on LinkedIn. We're on Twitter, on Instagram and I forgetting what's the other one, Facebook both personally and professionally where we're both on there. So maybe you can find us there.
Speaker 1 (40:17):
What are your handles?
Speaker 3 (40:19):
Our business handle is survivorship solutions for LinkedIn and for Twitter. It's survivorship Sol.
Speaker 1 (40:26):
Perfect. Excellent. And we will have the links to all of this at the show notes for this episode at podcast on healthy, wealthy, smart.com. So if you want to get more information on the course, follow them on social media become if you're a physical therapist out there listening, and you want to become competent and safe to treat patients, cancer patients, which we now know, we all will at some point then definitely check them out. So Kristin and Jillian, thank you so much for coming on. I appreciate your time.
Speaker 2 (41:03):
Thanks so much for having us. It's been our pleasure.
Speaker 3 (41:06):
Thanks, Cara. It's been fun. Thanks so much.
Speaker 1 (41:08):
And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Founder of Science PT, Dr. Erik Meira, PT, DPT, talks about his campaign platform as the President-Elect of the American Academy of Sports Physical Therapy, and the many components of this platform.
Today, Erik talks about his roles within the academy over the past 15 years, his formal 5-year strategic plan, creating an executive board separate from the executive committee, and creating a research agenda. What is the overarching vision for the academy?
Who is on the executive committee, and how is the executive board chosen? Erik elaborates on organisational structures and boundaries, and embracing the tenets of Diversity, Equity, and Inclusion, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “If you look at any 1 or 2 year period, it’ll look like things are getting done, but when you look over a longer period of time, you’ll see a lot of what gets published kind of has a circular nature to it.”
- “You have to build the boundaries of your sandbox, and then let the person play in the sandbox.”
- “Not every great presenter is a great leader, and not every great leader is a great presenter.”
- “Not everybody wants to keep progressing and keep pursuing, and somebody stepping back should not be slighted and that should not be seen as a negative.”
- “Somebody turning something down today does not mean that you shouldn’t offer it to them tomorrow.”
- “Nobody can be you better than you. Remember that. And that goes two ways - remember that the person that you’re talking to is also not you. They don’t have a brain that works like you, thinks like you, and sees things like you, and they’re trying to be the best person that they are as well.”
- “We all have different perspectives, and that’s okay.”
More about Erik Meira
Erik Meira is a consultant physical therapist in Portland, Oregon. He is a Board Certified Sports Clinical Specialist and an NSCA Certified Strength and Conditioning Specialist with extensive experience in the management of sports injuries at many different levels. He also created and oversees the PT Podcast Network.
The son of an engineer and a school teacher, he developed a love of science at a young age often running home experiments comparing/contrasting the effectiveness of products such as detergents and preservatives. Before beginning physical therapy school he studied philosophy and psychology while geeking out on chemistry and physics courses. Although he follows medical science professionally, he is a fan of all fields of science, particularly particle physics and astrophysics.
He began his rehab training at the University of Florida where he had the opportunity to be a student athletic trainer with Gator Football. After finishing his physical therapy degree, he moved on to The George Washington University Hospital in Washington, DC where he overhauled the patient education program and became a physical therapy adviser to the GWU Medical School. After moving to Portland, OR he started his own private practice Elite Physical Therapy & Sports Medicine now called Black Diamond Physical Therapy. He also founded and directed the Northwest Society for Sports Medicine, a group of regional sports medicine providers who provided continuing education, professional support, and community outreach in the Pacific Northwest.
Erik is extremely active in the American Academy of Sports Physical Therapy (AASPT), currently serving as the Representative at Large on the Executive Committee. In 2008 he helped initiate, organize, and then chair the Hip Special Interest Group. From 2012-2019, he was the Sports Section Program Chair for Combined Sections Meeting (CSM) for AASPT. He has authored several articles and textbook chapters, and has lectured at conferences around the world sponsored through the National Strength and Conditioning Association, American Physical Therapy Association, and the National Athletic Trainers’ Association, covering topics such as the hip, knee, shoulder, exercise prescription, returning athletes to sport, science application, and ethics in practice. He is a frequent consultant to professional and collegiate sports teams and individual professional athletes.
Suggested Keywords
AACPT, Campaign, Opportunities, Strategy, Learning, Sports, Physiotherapy, Research, PT, Health, Therapy, Architecture, DEI, Diversity, Equity, Inclusion, Problem-Solving,
To learn more, follow Erik at:
Website: https://thesciencept.com
Podcast: https://ptinquest.com
https://ptpodcast.com
Instagram: @erikmeirapt
Twitter: @erikmeira
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript Here:
Speaker 1 (00:01):
Hey, Eric, welcome to the podcast. I am happy to have you on.
Speaker 2 (00:06):
Thank you so much, Karen. It's a, an honor to be here.
Speaker 1 (00:10):
I know it's so nice to see you, even though we're not in person, hopefully one of these one of these years, maybe next year fingers crossed. We'll be able to see each other in person.
Speaker 2 (00:20):
Yep. Fingers crossed for sure. Yeah. I'm looking forward to it. It's I can only do so much zoom. I so much prefer being in person with people to do to do conversations and to do a teaching as well.
Speaker 1 (00:32):
Oh yeah. Teaching is, I mean, what a, it's just a whole different ball game when you're on zoom or whatever platform you're using. So Eric, today, you're on the podcast to talk about your campaign platform. So for people who don't know, Eric is a present elect candidate for the American Academy of sports physical therapy, which is part of the American physical therapy association. Did I get all that right?
Speaker 2 (01:05):
Yes, that's right. We're one of the academies, one of the components of the AP TA.
Speaker 1 (01:09):
Right? So you are here to talk about your campaign platform. So I'm going to hand the mic over to you and I want you to let the listeners know what are the components of your campaign platform?
Speaker 2 (01:24):
Sure. I, I, I really appreciate that. Yeah. So first to clarify, some people have the question, what's the difference between a president and a president elect and for the for the American Academy of sports, physical therapy, the AAS PT our president is elected to serve one term as the president elect. So kind of the president and waiting under the current president for one year, so that the transition is smoother when that happens and then they serve a three-year term after that. And so a little bit of my background is I've, I've been involved in I've been involved with the Academy for, for, you know, well, over a decade, I've been in leadership positions within the Academy continuously for the last 15 years. And so that's everything from just being a member of a, of a committee moving up to, I founded a special interest group.
Speaker 2 (02:17):
I then was the chair of a special interest group moved on to be the, the section programming chair. So I was involved with all of the the academies program at combined sections meeting did that for about six years. And then the last two years I'd been serving on the executive committee as a representative at large. So I have a, I have a huge history with this Academy and a lot of the things that a lot of the changes that have been made over those last 15 years, I've been very involved with and really trying to move things forward. And so one of the reasons I'm running for, for president elect at this point point is to try to kind of complete the mission, so to speak and, and really help set the Academy up for, for the future. We're, we're coming up on 50 years of, of existing as an Academy.
Speaker 2 (03:08):
Or as a component, we used to be a section like most of the other components. And now what I'm looking for is, you know, what's the next 50 years look like, are we set up for, for that future? So the first thing that I'd like to, I actually have five points that I'm highlighting for my campaign. The first one is I would like to create a formal five-year strategic plan that systematically, it gives us something to systematically work towards for our goals over time. And, and so, you know, the Academy has traditionally had strategic planning as a component of what it does, but it has never actually put forward a formal announcement to the members to say in five years, this is where we would like to be as, as a target. And that's something that I think can be really useful for, for a component to have to give a little bit of guidance to.
Speaker 1 (04:05):
And if, if you are elected, how will you go about implementing that?
Speaker 2 (04:10):
Yeah, so a five-year strategic plan. So currently the executive committee does a strategic planning meeting once a year to set basically the agenda for the next year. And so what this would be is actually sitting down and going over where would we want to be in the next five years? And that would be a process of, of actually first, you know, surveying the members, talking to members, trying to get that information of where are we going to go, want to go pitching ideas to the members, to get some feedback from that and then putting it together and setting it forward. And, and again, you'll notice it's a five-year plan. Our terms are only three years. And so that's kind of the point is something that outlives any one executive committee and is something that really is looking to kind of go past that one.
Speaker 2 (04:57):
One of the other points that I'm kind of looking at exploring is creating a separate executive board separate from the executive committee, which is an organizational strategy that a couple of other components have used as well, but it's also very common in associations in general. And so the idea there would be you know, I, I see this in the future as being something that the executive committee would work to create a five-year strategic plan. And then that would be reviewed by an executive board who would then have potentially have voting power to to approve such a plan and, and look at going through implementing the strategy.
Speaker 1 (05:36):
And so can you tell the listeners what, what is made up of the executive committee, who is on that executive committee within the organization, and then how would that executive board be chosen?
Speaker 2 (05:52):
So right now the Academy just has an executive committee and a lot of times within the Academy, they use the term executive board and executive committee interchangeably. And that's not always the case necessarily. So our current executive committee is made up of five elected positions. They are the main elected positions of the Academy. The other elected positions are our nominating committee. And so these are the elected officials. There's five of them and they, they make all, they do all the decision-making for the Academy. And that's, I mean, that's great. You want people who are voted in to be making the decisions you don't want, just, you know, all appointments across the board like that. And so the problem that that sometimes can create is, you know, they get into, they can get into the weeds of dealing with the nuance and the details and all of these things.
Speaker 2 (06:44):
And a lot of times decisions, especially in a large component like ours sometimes they're very nuanced, complex, challenging. They're not easy to kind of educate out on a sound so to speak. And so what an executive board would do first off that would be made up of all of the members of the executive committee would also serve on the board. But then you add additional members that are representative of the rest of the Academy to allow additional conversations that would happen like once a year, for example, of all right, we've been working on a bunch of stuff for the last year. Here's what we're going to bring forward. And again, this would be, this is how it's working towards our five-year plan. This is the, these are the issues. Here's a really tough decision that we're up against that we've had lots of conversations we brought in outside consultants.
Speaker 2 (07:35):
We've, we've had again, conversations after conversations, and now we need to convince the board that this decision is the right decision. And the example here would be well, if that board disagrees, this is where again, these are things that would have to be figured out in designing a board. Would they have the authority to block an executive committee or would it just be, Hey, we're just going to go on down on record that we don't think this is a good idea. And the board, you know, is, is doing this alone. And again, just, just being a little more transparent with that. So those other members, you would want it to, you know, you think of all the different components of a, of an Academy. And, you know, we have, like, we have practice, we have research, we have education within our Academy, we also have early career professionals.
Speaker 2 (08:26):
We also have diversity equity and inclusion as its own part of it. And then we have our SIGs as well. So I could see a representative from, from, you know, all those different committees. So, you know, practice research these could be, the chairs would sit on that and, and there could be a conversation about whether or not those would become elected right now, they're appointed positions and then and DEI and early career professional. So we get all of those voices having a strong voice and then maybe a, an at-large position, which could be a SIG chair, or a couple of SIG chairs could serve in that role there. And, and then, you know, they kind of get that opportunity to be heard, but again, it's still kind of behind closed doors, but it expands that ability to have those conversations out and, and get more advising for an executive committee.
Speaker 1 (09:18):
Got it. And, and because the you've got the, these people on an executive board that are part of these different sections within the Academy, I would then imagine that you can get some more input and feedback from the members. So it sounds like, and you can correct me if I'm wrong. You're trying to allow the members of the Academy have a bigger voice in the decisions made by the, by the executive board.
Speaker 2 (09:43):
Exactly. Cause one of the issues we have is, you know, we have an Academy that's, you know, seven between seven and 8,000 members in any given time during the year, there are definitely fluctuations and all being represented by five people and five people that, you know, yes, they were elected their position and they do know a lot of people within the Academy. They can go talk to those people, but then you have a tendency of just talking to the friends of the executive committee, for example. And so the more, the more kind of diverse voices you can get into the conversation the better. And, and again, if you have an executive board that has a very unified voice, well, that's a very strong position that you would be taking as opposed to a more divisive type position than these would be things that would probably have to have more of a conversation.
Speaker 1 (10:28):
Okay. All right. I like it. Let's move on to, you've got, you said you had a, a couple of things within your plan. So we talked about a five year strategic plan and executive board. What else?
Speaker 2 (10:40):
So the other thing I'd love to see is creating a research agenda and that would be to kind of lay a roadmap for the research needs of our members and explore our ability to drive this research potentially through some Academy funding as well. And so, you know, research and science, that's something that I hold very dear. I it's, it's you know, pretty much everything that I kind of geek out about, you know, in particular. And I hear a lot from, especially our early career researchers, but then other researchers as well, especially the ones that are running smaller labs of of how a lot of times, it's hard to know what is kind of useful information from clinicians or what the true path is to get to what we want to know. And then I hear from the clinicians on the other side, you know, I've been practicing over 20 years and there's a lot of things that I don't feel like we've made much progress much real progress over my career and, and it can get kind of frustrating.
Speaker 2 (11:35):
And, and what I mean by that is if you look at any one, like, like one or two year period, it'll look like things are getting done, but then when you look over a longer period of time, you'll see that a lot of what gets published kind of has a circular nature to it. So they, they're kind of revisiting some of the same questions, not really doing a very thorough job of answering that. And what I mean by that is a lot of times, you know, a group will have, it's like, look, we only have one study that we can do. We're going to try to answer as many questions with this one study as we can. And what ends up happening is it's so diluted that they don't really answer any question really thoroughly for the future. And again, this is looking for where are we going to be 20 years from now with this information?
Speaker 2 (12:20):
I understand that small steps are frustratingly slow, but that's where we actually make a difference long-term. And so creating a research agenda would basically take clinicians X are some of our researchers. And then ideally also methodologist that they're, they're what we call meta scientists. So people who study this study the science of studying information. And so making sure studies are designed appropriately making sure that replication is being set up, making sure that a study isn't biting off more than it can chew. And so in a research agenda can lay out here are the next five steps that we need to see to go towards what we're trying to get done. And then researchers can look at that. It can be published publicly, and they can look at that and say, Oh, I can actually step in right here. And the thinking here is if you have a large Academy kind of endorsing that these are studies we'd like to see done, that should increase the value again from the publishing side where journals would look at it and say, Oh, well, you know, this is a study that was very well executed.
Speaker 2 (13:24):
That answers the question specifically that was asked by an Academy. This is going to be cited in future studies. This is something we'd want to publish. So kind of putting those incentives kind of on both ends of it.
Speaker 1 (13:36):
Got it. So kind of using the Academy as maybe a jumping off point for ideas for future studies, given the input from the members and what they're seeing clinically and what they would like to see, continue on in the research.
Speaker 2 (13:49):
Yeah, exactly. And so part of that too, is, you know as a clinician, you might say, you know what, I would just love to have an answer to this right here. And it may seem really simple to the clinician of, I don't see why that's a hard thing to answer. And that's where the research community can go, come in and say, all right, well, if you want to answer that, you actually have to start with this very simple question way over here that you're not even thinking about. And so we're going to start there and lay the path so that clinicians can also see where are we on this path to see what do we know and how does this actually develop over time? And I think that that's a huge value both for, for the practitioner and for the researcher,
Speaker 1 (14:27):
Right? And, and on the research side. So obviously the clinician side. Great. Cause we're getting some of what we're seeing every day put into the research from the researchers side. It's Hey this is what we're seeing. You get an endorsement from the from the Academy and maybe it will maybe it will allow you to have a greater chance of being published. I don't know. That's not that I'm not phrasing that in the best way. You could probably phrase it better.
Speaker 2 (15:01):
Put it is, I would say that it makes their research more translational. So it's showing that. And, and so, and I think this is something that researchers sometimes struggle with where they're, they're trying to kind of dress up the clinical application side of things to make it more clinically applicable. So it gets that, that, that, that translation, but by doing that, it actually kind of dilutes their, the quality of the study, so to speak because there's certain looking at too many things. And so by getting that opportunity for the research community to say, Hey, it may not look clinically relevant yet, but it's going to be. And so then they're part of that clinical relevance as a package. So instead of one study trying to answer everything, you would have a suite of studies that actually lays your foundation for, for gives you a good foundation for knowledge.
Speaker 2 (15:57):
And, and I'd like to stress. I mean, there are plenty of, of research labs in our profession that are doing this themselves and doing a phenomenal job of that. And this wouldn't necessarily be for them. It's just, we have a lot of questions to answer. And there's a lot of, of again, some of these smaller labs and early career researchers that are looking to jump in and, and, and even some, you know, research clinicians who are like, Oh, I can, I can do a 10 person study that answers this one little, very finely asked question. If it's laid out for me, I can then take that and run with it, or simply just do a replication of it.
Speaker 1 (16:36):
And how does this look practically running through the Academy? How does this happen
Speaker 2 (16:44):
Here would be, you know, somebody would bring it forward an idea, for example, and there would be, you know, we do have a research committee they would start organizing around a couple of research questions and right off the bat. And, you know, I posted this on my blog this idea around a research agenda and I did get some people actually contacted me through my contact form saying, Hey, this sounds really awesome. Are you thinking about, you know, a return to play after ACL? It's like, well, sure. Are you thinking about Achilles repairs? Sure. Again, it's we lay out the agenda and the idea here would be that they would also be living, breathing documents, so to speak that would be revisited every year or every two years. And Hey, where are we? The idea, you know, you lay it all out and then as things get done, you know, you things get checked off the list, so to speak it just gives us a way to have kind of a repository for, for thoroughness that I think is often beyond the scope of a, of a large lab.
Speaker 2 (17:42):
And this is where, you know, even large labs can step in and say, wow, there's a ton of basic science work that got done by lots of little entities. Now we're going to swoop in and we're going to collect 500 subjects and we're going to now do an effectiveness study based off of all of the solid foundation that was laid out for us. So we didn't have to do year after year of sequential studies. We have a base of studies that we can now just move forward.
Speaker 1 (18:11):
Got it, got it. So you're looking at this from the Academy standpoint as being a repository of ideas that early career researchers, clinician researchers, smaller labs can go in and say, Hmm, I think I can, I think I can handle this. I'm going to pull this out and I'm going to see what I can do. I'm going to try and create a study.
Speaker 2 (18:30):
Exactly. And this is also one of, some of our really, you know, big, big names. So to speak. Researchers can look down and go, no, no, no, no, no. That's, that's not how you design that study for something I can use. I would need you to also do this here. And then our research committee and our methodologists might even kick back to them and say, Oh, I understand that what you're actually doing is adding another study in between not necessarily trying to do too much with one study. And so again, this is where it's creating a sounding board that all these people can have these conversations.
Speaker 1 (19:01):
Got it. Okay. All right. I think I understand it now. Thank you. Sorry for asking so many questions.
Speaker 2 (19:07):
No, no, of course. And then ultimately, you know, the name of the game is almost always funding. So if, if we can then set up some, some grants, for example, to say, you know, we want to, we have money set aside to pay for this next step. And then, you know, people can pitch the ideas to us. We can do like a register report process where we would review the study before it was even starting to collect data to say, Oh, this looks beautiful. We're going to, we're going to give you money to complete this.
Speaker 1 (19:35):
Got it. All right. Sounds like a plan. Okay. So what else is on your platform?
Speaker 2 (19:42):
So another thing I'd like to see is creating more structure to our organization. So something that, you know, as I mentioned, we just had the four, you know, executive committee members, and then we've had other we've had committees over the years, as I've said, I've served on a lot of those. But a lot of times what ends up happening is that everything ends up having to go through the executive committee for final approval for every single step. And, and I understand the need for that. I mean, these are the elected officials, these are the ones making the decisions, but when you get to a Academy, as large as ours, it kind of can start to smack a little bit of micromanagement and making it that if you've ever been in a, in an environment where you're feeling micromanaged, it really feels like your hands are tied, your creativity is stifled and you can't really give to the, to the institution if you're in that situation like that.
Speaker 2 (20:33):
And so the way that that gets solved is actually to have better defined roles that people are stepping into. So our, we have a new membership engagement director, Jamie little, who's just absolutely phenomenal. And he's been with us for the last year. And one of the things that he likes to point out is you have to create, you have to build the boundaries of your sandbox and then let the person play in the sandbox. But you, you give them a lane to be in so that they feel confident in what they're doing and feel supported in what they're doing, not just giving them like a very vague instruction and then say, then come back to me and show me what you got. And then I'm going to change everything anyway, but really empower them to say, Hey, here's, here's the goal.
Speaker 2 (21:23):
Here's generally what, you know, what your role is to say, like the chair of the practice committee or the chair of the education committee. And, you know, let's see what you can do. And you know, as long as it's not too far out in left field, we're going to support, support that all the way through. And so since I've been on the executive committee, we've expanded the leadership opportunities for our SIG members. So SIGs used to just have a chair in a, in a vice chair, and now they also have a practice lead and education league, a membership league, and a communication lead, all opportunities for people to step in and take leadership roles and allows us to to let people demonstrate what they can do in the Academy. And I mean, the beauty of it is I, these people, when they step into these roles, I don't know who half of them are. I've never heard of them. And I think that is awesome. That's not me trying to think of somebody to fill this role. That's somebody who stepped up and said, I want to do this role. And of course, some of them are not going to do very well, but a lot of them are really going to demonstrate who they are and what they can do. And it's an opportunity to to let our members really kind of, kind of contribute to the Academy.
Speaker 1 (22:35):
Yeah. And it also sounds like you're developing a bit of like a leadership development pipeline.
Speaker 2 (22:40):
That's exactly right. Yeah. And that's where, you know, and that, that gets to the final. One of my points is and embracing the tenants of diversity, equity and inclusion, and make sure that that applies to all of our members and our future members. And that's going to ultimately make our Academy a better overall. And again, this is the thing that, you know, people get, they get hung up on. And again, diversity equity inclusion typically noted as DEI is kind of the popular initialism that's used now. People get hung up on, Oh, well, that's referring to minorities. Oh, that's referring to gender. It's like that also refers to early young professionals, older professionals people who otherwise don't, you know, quote unquote fit into the to the, the, the club, the cliques, so to speak. And we just want to make sure that we're embracing of all the different voices that are within our Academy and make sure that they, they feel they feel represented and they feel seen.
Speaker 2 (23:45):
And so, you know, you mentioned leadership development. That's definitely one part of it. And a lot of components, a lot of times leadership and, and presentation. So like getting up at a conference and speaking a lot of times they're kind of shoved together as the same thing and not every great presenter is a great leader and not every great leader is a great presenter. So we don't want to fault people for being really strong on one, but not so great on the other. And so we want to create two opportunities for the, the face of our Academy, which is our leadership and our presenters to develop as, as again, as leaders. And then as people who are getting into more of the education side.
Speaker 1 (24:29):
Right. And like you said, they don't have to be the same person that's right. So you can speak on behalf of the Academy, let's say it's at CSM, or maybe even an international conference, something like that as, as a representative. But it doesn't mean that you're the president of the Academy, nor does it mean because you're on the executive board, you get to speak at these different places. It has to be something that is earned, not just given for the position that you're in.
Speaker 2 (24:59):
Yeah. And so that's, that's another definition of diversity is playing to your strengths. So not trying to make one person do everything, but try to find the best person for that job regardless of who they are. And it may be that they're really good at one thing, and they're not so great at other things, instead of trying to shoe horn them into things that, that they're not gonna Excel at, let them really shine where they, where they can shine. And, and again, you know, we're an Academy between seven and 8,000 members. We don't need to have one person doing everything. It's really an opportunity that lots of people can step up and fill different roles. And, and I think that's just, it's just great for all of us.
Speaker 1 (25:37):
Absolutely. And it also makes people feel like they're wanted. Yes. Yeah. And that's important because there's nothing worse than not feeling wanted.
Speaker 2 (25:47):
The other thing too is, you know, I'm a, I'm a big data guy, big analytics guy. And so one of the things that we used DEI in particular for, and this was a little over a year ago when we put together a task force to look at it. And that, that was the mission of the task force was to see what do our demographics, how do our demographics break down along gender and along race race identity. And the simple thing is you can just look at those numbers of the membership and then how do our leaders break down by gender and by racial identity. And then how do our presenters break down in the same way? And so in some respects, we had very, very good matches you know, specifically CSM presenters were pretty well representative specifically in gender, not quite so much when it came to race.
Speaker 2 (26:50):
So we're able to say gender is pretty well addressed from the CSM side. Now that doesn't mean there's, there's not future issues or not some issues still to be solved, but it looked much better for example. But then when we looked at leadership and we looked at some of our other, other events, we had some bigger issues around that specifically. And so, you know, a lot of people will say, Oh, so, you know, are you saying that you know, some of your leaders are racist or massage? Monistic, it's like, no, that's not how this works. What it means is that there's something at play here that is restricting equity and inclusion because of all things being equal, it should balance itself out in that way. And, and, and again, looking at the way CSM programming was selected it was intentionally set up to try to increase the number of submissions in and then trying to go strictly based off of the merit of the submissions and the quality of the speakers and not trying to read into it anymore.
Speaker 2 (27:52):
And it kind of organically started to sort itself out. And so this is where, you know, when we look from leadership, well, if you have an Academy of 7,000 plus people, and you only have five elected positions, a couple of nominating committee, a couple SIG chairs, there's just not a lot of opportunity for people to step up and have a path to leadership. And so that's why we expanded the leadership opportunities within our SIGs. Again, a little more low risks low stakes opportunities for people to step in demonstrate their, their abilities. And then if they want to pursue further, they have an opportunity. And that's the other thing to remember is not everybody wants to keep progressing and keep pursuing. And somebody stepping back and saying, I don't want to do that, is that should not be slighted. And that should not be seen as a negative either.
Speaker 1 (28:40):
You, I was just going to say that, darn it. I was just going to say, then that person can make the decision if they want to continue further, is this for them? Is it not? But it at least gives people the opportunity to make that decision for themselves.
Speaker 2 (28:57):
Yeah. And not only that, when, when talking from a leadership perspective, what leaders have to understand is that somebody turning something down today does not mean that you shouldn't offer it to them tomorrow. And so you may offer somebody an opportunity. They'll say, you know what? I just don't have time for that right now, I'm going to have to pass. And, you know, a lot of times people are advised, you know, never say no, because you never know what it's going to lead to. It's like, okay, well then it's, you're just encouraging people to take on way more than they should be doing. And then you end up with a handful of people doing everything. And so a good, a good developing leader is someone who recognizes, you know, I'm not in a good spot right now to take that on, to do it justice.
Speaker 2 (29:37):
So I'm going to pass for now. But then when another opportunity comes around, you know, bring it back to them and, and keep, keep asking. That's cause a lot of times, you know, especially when we talk you know, women in the workforce in particular, a lot of times they may be, you know, stepping back a little bit with you know, child-rearing and things like that. Which, which honestly, I don't understand why men wouldn't be doing the same thing, but this is where they may not want to be engaged in that way for a year or two, but then they need the opportunity to step back into it. It's not a matter of, Oh, well they just say no to stuff. So we don't ask them anymore. That's not really fair to people.
Speaker 1 (30:17):
No. And that's, I think it's so important is to remember that you have to ask because a lot of people feel like maybe they're not smart enough. They don't know enough people, but boy, they really want to try and get involved, but no one really asked them. Yep. So if you don't ask someone, you may be missing out on some great opportunities that that person can bring to the table. Great ideas. So I'm a huge fan of just asking and then if they say no, then you circle back and you ask again, and if they say, no, you keep circling back and circling back. That's what I did as part of the nominating committee for the private practice section. It was just a lot of circling back, a lot of conversations and sometimes long conversations, you know, because it's not like if someone says, Oh, no, I don't want to. I'm always like, okay, tell me why. Tell me, you know, tell me more, tell me what the barriers are now and what might that look like in a year or two, just so that we have, you know, a good also repository of people who we know want to serve this Academy or the section or component or whatever you want to call them.
Speaker 2 (31:34):
Yeah. And that's where and I like how you, how you put that at the asking the question of, okay, well, you know, can you explain why not now, again, assuming it's not a personal issue. And they may say, you know, I'm, I'm just not really good with this one part of that job. And it might be, Oh, we can get somebody else to do that. You know, that that's not a problem. As a matter of fact, there's another opportunity for another person to step up into a role. And so, you know, hearing them out from that perspective. I remember when I took over as programming chair for CSM, we greatly expanded, you know, we went from, I think it was eight or nine sessions that we offered at CSM. And then I took over and it was like 36. So it was like full, you know, big explosion.
Speaker 2 (32:19):
And it was more, a matter of APA had always offered us that, those number of slots and we just turned them down. We just wanted to do one every, every block and not program against ourselves. And I was like, Hey, if they're going to get us a spot, I'm going to throw people up there. And it was difficult the first year because we didn't have enough submissions to support that, but I wanted to set the precedent. No, no, no, we are going to do this. And so I then had to get on the phone and walk around at conferences and say, Hey, can you submit something on this, this or that? Or why aren't you submitting something on this, this and that. And the most common answer I got back was, Oh, I didn't, I didn't know that, that anybody wanted me to submit something like that. I didn't know that you guys were interested in that. It's like, no, yes, we are definitely interested in that and pleased and trying to lay things out. And then of course stressing that. There's a difference between me asking and me accepting, you know, a lot of times it's just, Hey, give me some missions so that we have something to work with here. And we don't have to accept, you know, necessarily the same speakers over and over, but because of that opportunity to do that.
Speaker 1 (33:24):
Yeah. Amazing. And now, Eric, what would you say when looking at this platform? So we have five-year strategic plan, creating research agendas, expanding organizational structure, creating an executive board and embracing the, and progressing the tenants of DEI. What is sort of the over arching vision in your mind for the Academy?
Speaker 2 (33:49):
So what I'm trying to do is really set things up for and the term that I've been using since I came on as, as representative at large, as well as my big thing is, is architecture. So I'm trying to set up kind of a scaffolding for our members to inhabit and to, and that is set up in such a way that the Academy can move forward into the future with the ability to be adaptable as things are changing, but also to be strong at the same time. And, and that's something that I think having things laid out, you know, I mentioned five-year strategic plan. That's where I would start. And then I would love to see, you know, a 10 what's the 10 year strategic plan. What's the 20 year strategic plan. I mean, that was something that, you know, we just passed a 2020 which, which turned out to be a different year than I think we were anticipating.
Speaker 2 (34:38):
But back in 2000, that was vision 2020. That was the APA made a strategic plan of where we want to be in 20 years. And I think people forget how important strategic planning is. You know, there's a lot of decisions that happen in the course of a year within any organization. And a lot of times there could be three or four perfectly acceptable, you know, courses that could be taken you know, decision courses that can be taken on one of those, you know, big decisions that need to be made, but one of them may support the strategic plan down the road better so that when you're making that next decision, it's going to build off of the previous one, as opposed to just solving the problem that's in front of you. And so making sure again, kind of like that research agenda, making sure that what you're doing today is something that can be built upon tomorrow.
Speaker 2 (35:33):
We're never finished. It's never the end. It's never, we've just solved it. It's how does this set us up for the next thing that we're going to be doing, you know, down the line and, and intentionally laying that out. And, and so some people will ask, well, w w so, so how locked in is this five-year plan? It's like, no, it's, it can be amended as we go. I mean, that's, that's kind of the whole point of it. It's just that we have some sort of a vision going forward with that. And so again, it's more trying to set things up, not for me, not even for the, our, our younger members, but for the members that haven't even joined yet that they have a path through their career, through our Academy, that our Academy supports them every step of that way. And they feel like they're involved as they go through.
Speaker 1 (36:22):
Yeah. And if 2020 taught us anything, it's that amendments are probably needed on any five-year plan. So if it's locked in, it's locked in and it can't be changed, then we're all in a lot of trouble.
Speaker 2 (36:33):
Exactly. Right. Yeah. Everything has to be flexible.
Speaker 1 (36:36):
Yeah. Everything needs some fluidity to it these days. That's for sure. Well, Eric what, what are the things that you want the listeners to take away from this and to think about the possibilities of you being president of the Academy?
Speaker 2 (36:53):
Well, what I would say is you know, I was elected as a representative at large a couple of years ago because I'm, I'm a regular old member. I don't have a PhD. I'm not a, you know, I have not taught in a S you know, as a school or anything like that. Not academic, not a researcher. I owned a private practice for almost 20 years. Just sold it. I work with patients day in and day out. I'm not, again, I'm not conducting research, I'm not doing these things. I do continuing education. I talk to a lot of physical therapists. I do a lot of mentoring across across the country and across the world with other sports physical therapists. I know this world inside and out, and what I'm trying to do is bring forward an entity that supports that.
Speaker 2 (37:50):
Ultimately, it's not that it supports the researchers. It does support the researchers, but that's not the mission. It's not supporting the clinicians either. It does support the clinicians, but that's not the mission it's to support our patients, to make sure that they get the best service possible by supporting our researchers and our clinicians and doing it in such a way that it's integrated in such a way that makes our members feel like they are getting a back and forth conversation with the Academy, which is made up of all the other members. So it's everybody talking across each other. Everybody communicate communicating everybody working together towards some common goals, trying to make their careers, what they want it to be setting it up so they can hand it off to the next generation to make it what they want to be as well.
Speaker 1 (38:40):
Excellent. Sounds wonderful. And now it does, it sounds great. Now, Eric, where can people find you if they have questions or comments or they just want to say hello?
Speaker 2 (38:52):
So probably the easiest way is well, the, the, the most comprehensive one is just going to the website that I run, which is called the science, pt.com, all one word, the science PT, make sure you put the at the beginning. And that's got links to my Twitter account. My, I have an Instagram account although I'm terrible at it. If you want to see an old man hitting something with a rock, that's pretty much what I do on Instagram. But definitely available for the most part on, on Twitter. But there is also a contact form on my website that if you have any questions, you can click on that, right on the homepage. There's a, a button that's, that's a link to my campaign page. And so you can go there and, and everything that we've talked about, I have a blog post and individual blog posts for each point that I highlighted going into more detail.
Speaker 2 (39:41):
And also as I, you know pointed out in this conversation, there are things I don't have answers for. I'm just talking about where I'm thinking of pointing things and then getting information and seeing is this something we can work towards, and maybe it's something we need to revise or change and do differently. But these are just my thinking from what I've seen from all my years of service, things that I think are very doable, very possible within our current means within our current support, within our current structure to really set us up, to grow into the future. And so just that website probably is, is the the most comprehensive spot.
Speaker 1 (40:18):
Perfect. And then before we go, last question, which I didn't tell you about, I probably should have done that. I think you'll be fine. I think you can handle it. So knowing where you are now in your life and your career, what advice would you give yourself as the new grad as that, you know, young, young, professional,
Speaker 2 (40:37):
You know being flexible, being adaptable is, is always the biggest thing be patient for probably the best lesson that I've learned is that nobody can be you better than you. And remember that. And that's, that goes two ways. Remember that the person you're talking to is also not you, they don't have a brain that works like you and thinks like you and sees things like you, and they're trying to be the best person that they are as well. And so the more that we can support each other to both be better at all times, I think is huge. And I think that's something that you can carry in with your patients when you're working with them of being compassionate, to understand that, you know, it might be easy for you to get up every morning and do a 30 minute run, but that might be like torture to the person you're talking to. And it's not their fault. They're not lazy, they're not wired wrong or whatever. It's just the way they, and we have to be supportive of, of that. But then that's also with our colleagues when we're trying to have conversations around things as well, to, to understand that you know, we all have different perspectives and, and that's okay.
Speaker 1 (41:47):
Absolutely. And what wonderful advice. So Eric, thank you so much for coming on and sharing your platform. I'm sure myself and the listeners really appreciate it. So thank you
Speaker 2 (41:58):
So much for having me. I really appreciate it. You're doing a great job with all of this.
Speaker 1 (42:02):
Aw, well, thank you. That's very kind and everyone, thank you so much for listening for tuning in, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Co-Owner of Champion Physical Therapy and Performance, Dr. Mike Reinold, PT, DPT, talks about his platform in the running for President-Elect of the AASPT.
Today, Mike talks about the ‘why’ behind his campaign, what he’s going to focus on as president, and how to make the academy more accessible and inclusive.
What is Mike’s vision for the academy? Hear his thoughts on adding value to the academy members, his plans to provide networking and mentorship opportunities, and his advice for his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “I’m going to judge my success of leading the academy, if in the end of my term, you clearly asked the members ‘why are you a member of the AASPT?’ And they have a very clear and distinct answer.“
- “The most important thing we need to do right now is to re-brainstorm the mission and the vision of the academy to make sure that we’re doing one thing: we’re focused on the goals and objectives of the members.”
- “I’m pretty certain at this point that everything I’ve accomplished in my career is because I specialised. You need to start general, but if there’s something you’re passionate about, every second of down time you have, learn how to be the best at that. Just be absolutely amazing at something.”
More about Mike Reinold
Mike Reinold, PT, DPT, SCS, ATC, CSCS, C-PS is a world renowned and award-winning clinician, researcher, and educator. As a physical therapist, athletic training, and strength and conditioning coach, he specializes in all aspects of sports performance and rehabilitation. Mike is currently the Co-Founder of Champion PT and Performance, in Boston, MA, and Senior Medical Advisor for the Chicago White Sox after years of working at prestigious institutions like the American Sports Medicine Institute, Massachusetts General Hospital, and as Head Athletic Trainer and Physical Therapist for the Boston Red Sox. He has authored dozens of publications, lectured at national conferences, and has an educational website and podcast at MikeReinold.com.
Suggested Keywords
AASPT, Physiotherapy, Research, PT, Health, Therapy, Healthcare, Education, Mentoring, Training, Networking, Sport, Athletics, Election,
To learn more, follow Mike at:
Website: https://mikereinold.com
Facebook: Mike Reinold
Instagram: @mikereinold
Twitter: @mikereinold
YouTube: Mike Reinold
LinkedIn: Mike Reinold
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
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iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript:
Speaker 1 (00:01):
Hey, Mike, welcome to the podcast. Happy to have you on.
Speaker 2 (00:04):
Hey, Karen, how's it going? Thanks again for for having me on your amazing podcast. I F I F I, I remember being on in the past
Speaker 1 (00:13):
So long ago. Yes. It has been a long time, but here we are. We're back.
Speaker 2 (00:18):
That's what happens when we, when we're, we're both veterans we'll, we'll call it. We're both veterans. We, we, we did this in the past, but, but yeah, no, honestly, like big kudos to you for keeping this going and doing such an amazing job with it. Thanks for having
Speaker 1 (00:31):
Any time. And we'll talk about your podcast a little later, but now, you know what it's like to be cranking out episodes on a weekly basis, right.
Speaker 2 (00:39):
And staying up with it, right. It's like, it's a way of life now for us.
Speaker 1 (00:43):
It is, it is. That's why there's like a hashtag podcast life, I think on Instagram or something. It's, it's a thing. It's a thing. So today you're here because you are running for the president elect position for the American Academy of sports, physical therapy. So I wanted to have you on to talk about why you're running and what your platform is and what you hope to do if elected. So let's start with, what is the why behind your running.
Speaker 2 (01:13):
And I love that. That's how you started this off, because that's how I start everything off. Right. If we don't establish our why, right. Like what's the point of even coming out. But a lot of people, they, they, they don't focus on the end. Right. They focus on just doing the day to day. So I love that you started off with a Y so I'll, I'll be honest with you. This is something I've been thinking about probably for the last, I don't know, several years or so. I never felt that it was the right time for me. I've had a lot of my mentors pushing me to, to run in the past and the past elections. And yeah, I mean, trust me, it's really humbling to know that the majority of past presidents of the Academy are all pushing me to run and, and kind of, you know, it's really an honor to be nominated by them, right.
Speaker 2 (02:03):
Like, you know, Mike boy, Kevin Willett, George Davies, Tim Tyler. I mean, it's Melissa gigantic of past presidents that were kind of nudging me to do it, but I was resistant for awhile. And I think that was a good thing because at that point in my career, I don't think I was ready. And I don't think I would've, I would've done the Academy justice for what it needed. Right. So I was kind of resistant for awhile. You know, I, I started a private practice. I have like four jobs, right? Like we all do, right. Like to an extent, you know, I'm flying, you know, to, to work with the white Sox. I, you know, private practice doing all these things with the educational stuff. So for me, it was always like, it wasn't the right time, but things have changed a little bit.
Speaker 2 (02:44):
And I humbly say this now. And I, I really came to this conclusion the last couple of years of my career. I, I really believe I'm on the descent. Right. And don't you think at some point in time, it's, it's all it's about, okay. I am now on the decent portion of my career and I've completely changed my focus on trying to help others succeed. And I can't wait to see the people that I work with surpassing me. Right. Leapfrog me just like we did, like when we were 20 years ago in our career. Right. And that, that kind of point. So I got, so my why right now is that I am completely shifted towards more of a leader right. In a leadership type position with my career. So both educational, both with my, my companies and with the organizations I worked for that, I thought it was a great time to do this so awesome that I've been getting nudged by, you know, such, such amazing people, but I didn't feel it was right until, until now. And I think now I have the time I have the energy, I have a little bit of the head space to now be able to, to focus on this and it's time to give back and it's time to help the next generation. So that's my why.
Speaker 1 (03:56):
Yeah. And that's, I think it's really important for anyone listening. If you are thinking about being of service, whether that be to something, to a section or whatever you want to call them Academy of the AP TA that, you know, you have the head space and the time. Right. Because you just don't want to be saying, yeah, sure, sure. I'll do this. I'll do that. And then guess what, what happens if you get elected and you don't have this space, you don't have the time. Well, that's just not the way to, to enter into, be of service to others. And like you said, you're at that point in your career, at least it sounds like what I got from what you said, that you really want to be of service to others, that you've kind of, you're, you're content, you're happy within your career and probably the time of your life and everything else that you can now do this for others.
Speaker 2 (04:48):
Right. And, and I'm, I'm very eager. Right. I had a lot of good mentors in my career that helped open doors for me, but don't get me wrong. Like we need to be the one stepping through those doors. You have to have the energy and the effort to do that. Right. But for me, it's about opening doors for others. Right. And I saw how much the Academy helped me early in my career, and I really kind of want to do that. Right. And you know, it's funny, Mike Delaney and I were just talking about those. So Mike's running for vice-president right now as well. So I'm myself for president him for vice-president. And we are so similar with our, our beliefs and everything that we have, that we were like, let's team up to try to, to do this. So that way we can really give back and help.
Speaker 2 (05:29):
And we both said this. We said, if, if we don't get elected at this point in time, we actually think that our time, our window will pass. Right. At that point in time, we'll probably be in our fifties. Right. And I am not sure that we would be the right people to lead the Academy at that time, because we want to still be relevant. We still have students. We still work with like clinicians and educate all, all around the country, the world, right. Where we still are in touch with them. I'm not sure if I would be the right leader six years from now or seven years from now, it was probably one of the next election. We would be open if I would be the right leader for that. I, I, I'm not sure. Maybe I would be more out of touch. So Mike and I both said, I think this is our window. If we're going to do it, it's probably now or never.
Speaker 1 (06:14):
Okay. So let's talk about your platform. What do you hope to accomplish as, as president, what are things that you really want to focus on?
Speaker 2 (06:24):
So I, again, I love, I love how you start with the why, and then, and then you talk about, you know, what you want to accomplish. I love that because to me, it's not, it's not about coming up with like a list of things I want to do. What I want to do is I want to flash forward six years or whatever it may be. Right. I hopefully would get reelected if I get elected the first time. Right? So we'll say three years to be conservative maybe, but flash forward. And what I want, what I want to know is I'm going to judge my success of leading the Academy. If in the end of my term, you clearly asked the members, why are you a member of the American Academy of sports, physical therapy? And they have a very clear and distinct answer, right?
Speaker 2 (07:10):
That to me is going to define my success. Because right now, the number one thing I'm hearing from people, both veterans in this field, people in the middle of their career, early career professionals, students, they, they ask, why should I join the Academy? They don't know what they get out of it. Right? And it's, it's one thing to just be a part of a group. But the question always is, what's the value? What am I going to get out of that? So that's how I'm going to judge our success as an executive committee at the end of this, is, is it very clear that we achieve the objective that you know, why? And I think the most important thing we need to do right now is I think we need to rebrand storm the mission and the vision of the Academy to make sure that we're doing one thing we're focused on the goals and objectives of the members.
Speaker 2 (08:00):
It's not about me, right? It's not about my ideas, my initiatives, what I want to get. It's not about me or my legacy to me, it's about what the members get out of it. And I think it's actually pretty simple. I, I looked on the website, I'm just trying to like dig out like the mission statement. Right. And it's very like corporate, right? Very like, like very about like, you know, advocacy and like, you know, making, you know, sports, physical therapy like prominent, right? I actually want to see the mission statement changed the simply the American Academy of sports, physical therapies here to help you specialize in sports, physical therapy, right? You are going to become a specialist now because we're not learning stuff like this in school, we shouldn't be learning stuff like this at school. It was very hard to be, to graduate as a new grad and be a very well-rounded proficient physical therapist.
Speaker 2 (08:44):
Right. But if you want to specialize, if you want the best education to learn everything you need about to become a sports physical therapist, if you want to stay cutting edge, right. If you want opportunities and networking, to be able to become part of this group. And more importantly, if you want mentorship with some of the best people out there, that is why you joined the Academy. And I know right now, a lot of people say that all the time is I'm not sure what the benefit of my membership is, and that's why people drop off. And that's why people don't renew is they're not getting enough out of the Academy. So that's what, that's what I want to achieve. And that's how I am going to grade our executive committee. If, if we do get elected is at the end of this, if it's very clear, have we achieved our mission, that the members know that our whole goal is to help them specialize in sports and to get a job in sports. Right. I think that's what people want in sports. That's a big, big things is an advanced orthopedics. This is sports it's different, right? So that that's, that's kinda, that's kind of what, what we hope to accomplish.
Speaker 1 (09:47):
And how, how would you go about doing that? What changes do you think need to happen to number one, help more people join the section? Cause I know it, it is hard, you know, I'm part of, I'm part of the sports section I joined a couple of years ago. I let my orthopedic one last. So I left the orthopedic and I joined sports. And I'm also involved in the private practice section. And I know it's something that we're always trying to think about in the private practice section is how can we get more people to join? What are we missing here? You know, how can we be more inclusive? So how can the sports section be more inclusive to get those people in, to get them from what it sounds like you're saying, mentorship, education, jobs and just fulfillment within your career. It sounds like
Speaker 2 (10:40):
Here, and this is what I think it is. The past leadership has been amazing. Right? And the stuff that even the current board has done in this last few years is really evolved, right? So there's tarnished take the next step with technology and all these other things. They're doing a really good job with that sort of thing. To me though, I, I really think we need to refresh just the vision a little bit. And I want to reevaluate all of our decisions in all of the things we provide. And just answer that simple question. Does this help you become either become or become a better sports physical therapist. Right. And I think, I think we need to take a step back. Sometimes it's not about what we think is cool or what we think is a list of objectives. It's about how do the memberships actually get value out of the Academy.
Speaker 2 (11:26):
And I think that's, that's the biggest thing we're going to do. So that's a little bit of the vision, but we're going to reevaluate everything, right. There's, you know, one of the big ones is education, right? One of the big ones education and staying current with, with research, right. So recently just in the last year or so the Academy got rid of one of the free benefits of being a member was access to the international journal of sports, physical therapy. And I think that was one of the biggest reasons why a lot of people were members, right. They got, they get access to a free, very well like established journal. Right. So they took that away from the membership a little bit. And again, I just wonder why, I mean, if the reason you join is to, to learn and stay current about being a sport, physical therapist, I don't want to take away benefits.
Speaker 2 (12:11):
Right? Like there's, there's gotta be a way we do that. Right. so I, I, you know, there's, there's, there's a ton of different avenues, right? Like you said, it's hard to go over this and just like a quick like kind of podcast, but I think it's about like networking opportunities. Cause it's all about who, you know, in this world. Right. But for me, it's about education and mentorship, right? We have some amazing clinicians that are part of this Academy that we need to learn from and that we need to go work with. Right. So we have residencies, we have fellowships. Those are great well-established things. Those are large, those are daunting, right? Like, like that's a big commitment, both time and finance for you to go do one of those things. We need to have more accessible opportunities, either online or shorter term, those types of things.
Speaker 2 (12:56):
I think we need to leverage, remember sports, physical therapy. That's where my background comes in. That's all I've done. My whole career is work with pro athletes and stuff. Right. Is how do you get a job in pro sports? How do you get a job in the MLB or the NBA or the NFL? Right. We need to leverage our, our connections. Like I'm friends with people in all these leagues, the PTs and all these leagues. And I've reached out to all of them. And I said, we need to start collaborating more. What if we have joint education sessions? What if we have mentorship opportunities where you come to spring training with me for eight weeks. Right. And who do you think is going to get a job when a physical therapy job opens up now in major league baseball, somebody that's just off the street with a good resume or somebody that's actually done a mentorship program with somebody already established.
Speaker 2 (13:40):
So that's part of the things that I think that's what I bring to the table is these connections and sports. And these are the things I've done. Like I, to me, I feel like I am I'm representative of the membership. I'm a clinician, you know, we treat our butts off. Right, right. And we're still working with people, you know, all the time we published clinical research, right. Impactful clinical research that have great implications that everybody wants to learn from. Right. We teach this to everybody after we publish it. Right. So we're on the trenches. We're working with the pro athletes. We're working with the collegiate athletes. Like I want to give people the opportunities that I've been fortunate to have. And I think that's a big part through networking, mentorship, education. I think those are the three big areas that are really push.
Speaker 1 (14:24):
And I really loved the mentoring aspect or Avenue of that. Especially like you said, maybe some online options and things like that. Obviously during COVID these things have become more and more prevalent, but I think it also does well for members who may be don't have, don't have the finances. They don't have the resources to let's say, even travel to a continuing education moment or even go to CSM. So I think to make things more accessible to all members or to people who want to become a member, right. Cause you may have someone out there is like, I'd really like, want to be part of the sports section. But man, I don't know if I can, like you said, do a residency or fellowship, which can be very expensive and time consuming or maybe they're a later in life PT and they have a family that they have to care for and they can't go off for 12 weeks or something like that. So I think to have those virtual options would be really great. And, and for me, I think it would be something that would really generate some interest in the section.
Speaker 2 (15:38):
Yeah. And that's my wheelhouse. Right. And that's what, that's what we did. I mean, it's funny. Like I stumbled into online education. Like I don't even like 12 years ago now. Right. Remember where the we're the old ones again, Karen. Right. I stumbled into that and have all these online courses now. And I did it for one simple reason. I was unable to travel around and teach. Right. Because I, I was now in getting a new baby. Yeah. Well, no, I was, no, that was before that I was in professional baseball. Right. So meaning like I worked 24 hours a day, seven days a week. I can't take a weekend off and be like, Hey, I know you guys have a game tonight, but I'm going to go teach a course in Louisiana. Right. Like they couldn't do that. So I got in that, but then yes, then you get you, and now you add family on top of that, right?
Speaker 2 (16:23):
Like, yeah, that's a big deal. So, so I started teaching online to kind of scratch that itch for myself, to keep giving back right. And sharing and educating and men that it's amazing how many people around the world you can touch by, by doing it online. And again, we need to catch up with that and just shows again, like, like, you know, the current state of even like the AP team totally. That they don't, they don't even have a way to a good, solid way to be able to offer continuing education credit for people with online courses. It's a mess. It just shows you how, like it's a, we're, we're getting a little outdated. I think we just need to refresh the vision for modern day, you know, this next generation of VCPS and people that want to get further along in their career, we need to meet them where they are.
Speaker 2 (17:06):
And not just assume that like some of the old standards that they've done. Right. And I think that's why bringing some new vision to the board is helpful. Right. I mean, the board has been pretty consistent for a long time. Right. The board has been quite academic for a long time right now. Right. There's not a lot of clinical leaders that are in the trenches, like working with athletes every day. I think there should be both, right. Like, don't get me wrong. I think we need both. We need clinical and academic in there, but I think we need to collaborate on that because I do think there's different perspectives if you know, depending on what you do all day. So I'm pretty excited for those things. Cause I actually think that's going to make a big impact. And, and again, I just think like the benefit of being a member is going to skyrocket. You have all these opportunities.
Speaker 1 (17:51):
Absolutely. I agree. And now before we kind of wrap things up, is there what would you like the listeners to kind of take away from the discussion? What is your main point?
Speaker 2 (18:05):
Yeah. vote for me now. I'm just getting abs. No, in all honesty, I'm like, I, I'm pretty humble about it. Like if, if, if I'm not elected, like I, it's not a big deal to me. I CA I can't wait to continue to continue to contribute to the Academy and help people. Right. For me, it was like, this is the right time to kind of give back and to be able to do that. I think my experience, I think I've done what a lot of people join the Academy to try to also accomplish. I've been there. I've done that. I understand what they're going through. And I'm, I want to get the Academy back to helping exactly, exactly. Achieve your goals. And that's it, it's about the member. It's not about me. It's about the membership. So yeah, and I think that's it.
Speaker 2 (18:47):
And you know, again, just just you know, also throw up Mike Malaney again, as vice-president, because I humbly, I can't do this by myself. Right. We're all busy. Like you're busy, I'm busy, we're all busy, right. This is a team effort. And I think in some fresh vision of people that have this clinical background, like Mike and I, and I've been, I've been big sports PTs our whole career, like adding that to the current board that's already in place, I think is going to be quite a nice dynamic that is going to really help lead this Academy in the future.
Speaker 1 (19:19):
Excellent. And now let's talk a little bit more about you. Where can people find you, your, your podcast website, anything you want to share?
Speaker 2 (19:29):
Awesome. I'm easy to find, right? So I'm just Mike ronald.com. If you want to learn a little bit more about this election and the process with that, you can go to microsoft.com/vote, and there's some info on there that you can, you can get I have a podcast, I have a blog, you know, kind of blot for over 10 years. So there's like a thousand articles on there. So people always ask like, where should I, where should I get started? I'm like, well, you got a lot to catch up on. Right. There's a lot of articles out there, but yeah, no, I'm easy. I'm on social media. Like I just, I really am at the point in my career where I want to help others. So I, you know, we try to hit every, every channel we can to, to have the most impact. So, so yeah, just head to my website, there's a lot to learn on there. And and like I said, Mike reynolds.com/boat, and you get a little bit more info about this election.
Speaker 1 (20:14):
Excellent. And last question. What advice would you give to your younger self knowing where you are now in your life and in your career? What advice would you give yourself as that fresh face? New grad?
Speaker 2 (20:28):
You know, this is, this is actually funny because I, I just wrote this to my, to my newsletter last week. Right. It was kind of funny that I literally, I just wrote this last week and I just wrote like the next one for this weekend, that's going out this weekend. But I, there was one thing I accidentally did in my career that I stumbled into that I, I it's become clear now that that is what we should do. And I said, like, I am pretty certain at this point, everything I've accomplished in my career is because I specialized ready. And in this week's newsletter, I actually talk about like how to, how to arc your career path that way to do that. But like, I remember early in my career, like I got, I got some heat from some other physical therapists that I was too specialized.
Speaker 2 (21:13):
Right. And you were like, no, you need to be generally, like, you're not good with neurologic injuries or something. And I'm like, all right. But like, for me, like getting really good at one thing helped me achieve all the goals that I wanted to get to, to get a job in professional baseball, right. To win a world series, right. To, to open my own clinic, to open my own gym and sports performance center. Right. It was all because I specialize in something. So we need to be general, you need to start general, but if there's some your passionate about say, it's like soccer, football, whatever sport it may be. Right. You just, every second of downtime, you have learn how to be the best at that. Just be absolutely amazing at something. And I think that was the biggest key to my career is overhead athletes and shoulders, like in baseball.
Speaker 2 (21:58):
Like I just, I got super lucky that I engulfed myself in that environment and became a specialist in that. Right. And again, just, that's another thing that the Academy needs to do, and it needs to help people that want to get super specialized in one thing to be able to do that. So I think that would be my biggest thing right now. You know, it keeps evolving as we, as, you know, as we get older, but I think right now is for an early career professional is master the basics, but follow your passion and make sure you are just, you're putting your extra grind and hustle into like, become the best you can at that side. And then it'll grow, you know, grow over time. And then when you're lucky like us, Karen, and you're a little bit older, you, you go to work one day and you're like, gosh, I just have, I have six baseball players today. That's all that's on my schedule. It's like, it's pretty cool. You know, I played catch three times yesterday. Right. Like that's kind of cool. I got, I got paid to play catch. Right. That's kind of cool. So, yeah. So I think that would be my biggest advice really for the early career professionals. That would be good.
Speaker 1 (22:58):
Well, what, great advice. Thank you so much. I don't think I've heard that one yet. And I think that's a great, I think that's great. And hopefully that will help some of our students and younger clinicians as they try and figure out and navigate their career. So thank you so much and thanks for taking the time out and coming on today. I really appreciate it.
Speaker 2 (23:15):
Thanks for having me, Karen. You're the best. This is awesome. And I appreciate it. The LC in the future, I'm sure fingers crossed
Speaker 3 (23:22):
One day. We'll actually be able to see each other in person, right.
Speaker 1 (23:26):
And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, CEO of Julie Wiebe Physical Therapy, Inc., Dr. Julie Wiebe, PT, DPT, talks about running and pregnancy.
Today, Julie talks about running/exercise and pregnancy, creating baselines, the research around female running form, and she busts some pregnancy myths. When can you return to running after pregnancy?
What is Julie’s definition of ‘postpartum women’? She tells us about structuring exercises around their daily exercises and goals, pelvic health education, and she gives some advice to clinicians working with postpartum runners, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Landing mechanics are affected by what’s happening north.”
- “Let’s understand what they looked like beforehand so that we have a better idea of how to help them find their way back.”
- “Just because you had a baby doesn’t mean you should be in pain and weak for the rest of your life.”
- “Listen to what’s happening, but learn to interpret it.”
- “If your 10 minutes is spent running and that’s your goal, you’ll do it. But if I say you’ve got to lay down on the ground and do rehab exercises that make no connection for you, you’re not going to be motivated to do that.”
- “Pelvic health does not mean that you have to be clinically prepared to do internal work. It just means that you’re treating the musculoskeletal of someone who happens to have a pelvis, which, last I checked, is everyone. You don’t have to be certified as a women’s health specialist, but you can get information, read books, watch videos, take courses so that you are competent in treating a woman postpartum that wants to get back to running.”
- “The pelvic floor is not the only gatekeeper that creates pelvic health. It is a component of multiple body systems, and we need to understand that those systems affect the way the pelvic floor acts and behaves. The pelvic floor itself needs to have attention directed at it, but when we talk about just the pelvic floor, it isolates it away from relevance to other areas of care.”
- “Learn to ask questions, and ask questions that make you uncomfortable. You will get more comfortable with it, and understand that what you’re trying to do is open a door of communication.”
- “When you read the conclusion in research, is there any other explanation that could’ve come to that same conclusion based on what you’re seeing?”
- “We need to start broadening our lense, and I think we’re broadening it to look at females as not just little men.”
- “Instead of thinking of learning as this linear thing, include and transcend. Instead of it being a linear line, let it be concentric circles.”
More about Julie Wiebe
Julie Wiebe, PT, DPT has over twenty-four years of clinical experience in Sports Medicine and Pelvic Health, specializing in pelvic/abdominal, pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness and sport after injury and pregnancy, and equip pros to do the same. She has pioneered an integrative approach to promote women’s health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations (ortho/sports medicine, pelvic health, neurology, and pediatrics). A published author, Julie is a sought after speaker to provide continuing education and lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes through telehealth and her clinical practice in Los Angeles, California.
Suggested Keywords
Physiotherapy, Pregnancy, Research, PT, Health, Therapy, Healthcare, Education, Training, Postpartum, Running, Exercise, Pelvic Health, Conversation,
Use the code: LITZY for 20% off the following courses from Dr. Wiebe:
Treating and Training the Female Runner (or Any Female Athlete)
Foundations + Running Bundle A
Foundations + Running Bundle B
Running Rehab Roundtable Live Broadcast
https://www.crowdcast.io/e/runningrehab
To learn more, follow Julie at:
Website: https://www.juliewiebept.com
Instagram: @juliewiebept
Twitter: @JulieWiebePT
YouTube: Julie Wiebe
LinkedIn: Julie Wiebe
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full transcript:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everybody. Welcome back to the podcast. I am your,
Speaker 2 (00:39):
The host, Karen Litzy and today's episode. I'm really excited to round out our month all about running injuries and running rehab with Dr. Julie Wiebe. She has over 24 years of clinical experience in sports medicine and pelvic health specializing in pelvic abdominal pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness in sport, after injury in pregnancy and equip pros to do the same. She has pioneered an integrative approach to promote women's health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations, or at those sports medicine, pelvic health neurology, pediatrics, a published author. Julie is a sought after speaker to provide continuing education lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes to through tele-health and her clinical practice in Los Angeles, California.
Speaker 2 (01:48):
So Julie's amazing. And in this episode, we talk about some myths about running while pregnant and in the postpartum. And of course, the question that everyone always asks Julie is how can we return to run after pregnancy? So Julie answers that question and cause a lot of really helpful hints for practitioners to look for when evaluating postpartum women and those postpartum women, those runners can be anywhere from six weeks to six years, 16 years, 20 years after having a child. And she also encourages clinicians to think critically, to look deeper, to have a framework for evaluation, to try and, and, and get a baseline to ask your patients to film themselves while they're running or exercising so that you can understand what they look like when they're doing what they do. There's a lot of variables to post to running post-pregnancy and Julie really runs through all of them.
Speaker 2 (03:01):
So I want to give a big, huge thanks to Julie for coming on the podcast today and sharing all of this knowledge. And she also has a discount on the course. So she has a course on running a postpartum running. So she has a course for the listeners. So all you have to do is enter the promo code Litzy that's L I T Z Y my last name for 20% off treating and training the female runner. And just to be clear, this is for professionals, not for individuals. So this is for clinicians. So a huge thanks to Julie for that. We'll have all of the information, including links to everything in the podcast at podcast dot healthy, wealthy, smart.com. And tomorrow you can catch Julie live along with Dr. Ellie summers, Dr. Chris Johnson and Tom goom for our live round table discussion. That's tomorrow, March 30th at 2:00 PM Eastern standard time.
Speaker 2 (04:10):
If you can't make it still sign up because you'll still have a chance to get your question answered by the panel, and you will still get to watch the replay any time you want. And listen, this is a deal. It is $25 for four of, in my opinion, some of the best minds when it comes to running injury and rehab. So sign up today. If you're listening to this today, sign up today because you have until probably, I don't know, it starts maybe until like quarter to two tomorrow, which is March 30th to sign up for our live round table discussion. Again, that's with all four guests from this month, Ellie summers, Chris Johnson, Tom goon, and Julie Wiebe. So sign up to day. Hey, Julie, welcome back to the podcast. I think this is like your third visit to help you well, yes, thank you for sharing your platform with me again.
Speaker 2 (05:11):
I appreciate it. Of course. And, and this month, the month of March, we're talking all about running, running injuries, running rehab, and I know something that you're passionate about is caring for the postpartum woman that returned to running after giving birth. And, and we'll also talk a little bit about running while pregnant. Right. So I think that there are, there's a lot to cover. And so we are just going to, we're going to zoom right through this unintended since we're on zoom. But let's start first with running while pregnant. I feel like there's a lot of myths around running while pregnant. I don't know that it's understood very well by many people, including clinicians as well as the pregnant women. So I'm just going to kind of throw it over to you and let you just kind of talk about the, the running pregnant woman.
Speaker 3 (06:14):
Yeah. You know, and I think I think that regarding running and pregnancy, I mean, that's our focus, but really exercise and pregnancy. We still have, we are limited in our understanding of all things. Related to that I think we are started, we have information about things like cardiovascular response or, you know, some of those pieces of the puzzle. But in terms of the musculoskeletal, the neuromuscular, the response of the female host inter like how is that impacting the mom's body systems. Right. and I think that where we are struggling to have a lot of research there in part, because it's hard to find women that are willing to be participate in research. And then there's also a lot of, I, you know, we have to be protective of them. We have to protect them. And so, so it's this, you know, we want to honor that stage of life, but we also need to research it.
Speaker 3 (07:13):
So so I think we are struggling to, to understand all that, but we're starting to get more and more attention on it, which is awesome. As far as pregnant runners go there's only a few studies that I'm aware of that actually look at the pregnant runner and and of those one is a case study and one is on five women. So we have very limited understanding of what exactly goes on, but there were some themes. So I'll just share some themes. One is that in, in both the studies, they were, they were followed, the women were followed throughout the pregnancy changes were seen in all of the women on how they continue to run through the pregnancy meaning. And particularly the one with the five women, they all did something different, which is the variability is what we're seeing now.
Speaker 3 (08:07):
Everybody's bodies individually adapted differently. But the through line for them was there was a loss of pelvic and trunk rotation. So when we think about that pregnant runner, this is the way I've started describing it. The belly covers a ton of joints. Like it goes from the thorax to the pelvis. It it's basically, it takes all of these reciprocating joints and it turns it into a unit joint. Like it's one big joint, it blocks motion. So it reduces pelvic and trunk rotation. And so it limits, and then it forces them to rotate elsewhere. All of these are adaptions to help them continue to move through space appropriate for pregnancy and running. But when they go into the postpartum, they carry it with them. And that was what happened in both of these studies. They found that at six months for the woman who was the case study, and then at six weeks postpartum for the women, the five women in the other study, they held onto these, these some of these variables into the postpartum period and where that's significant is that women are given that okay by their doctor at six to eight weeks.
Speaker 3 (09:19):
This just like, you can just start doing your thing again. But their understanding is I got to just lose weight and get a flat belly. What our understanding needs to be is we need to understand what's changed for them. Biomechanically neuromuscularly emotionally, you know, fatigue, stress, like all of we have to understand all of those pieces and help them restore their interrelationships. Neuromuscularly biomechanically to be more like their baseline in order to prepare them for return to run. Like it's not just, okay, let's get him stronger. It's how do we help them restore that efficiency in their patterns that they lost, but no one realizes they lost it. So six years later, they show up to an orthopedic office and they have some of these running injuries, but how much of it is related to the compensations that they carried into their postpartum. So that's sort of a, an entry point into our conversation.
Speaker 2 (10:17):
Yeah. And that's, that is so interesting. And it makes sense that they would carry that over because our brain has is plastic and it's going to adapt. And our our sense of where we are appropriate susceptive sense is going to adapt to that. And it just doesn't end because the baby's not inside you anymore.
Speaker 3 (10:40):
Correct. And you're pulling it off, like in your mind, like you're still pulling off running, like you're actually running. So it, the understanding of what has changed is not understood globally. And I think like, I mean this, the running study related to the five runners that I mentioned, and that was from 2019. So this is, you know, relatively hot off the presses in terms of clinical understanding. So our job clinically is to help restore reciprocation that's really, and we understand the reciprocation is so important for all sorts of pieces of the puzzle for running. And one of those things is actually reducing ground reaction forces, getting our center of mass over that lead leg. Reciprocation is a huge piece of that. And so understanding just that, if that is all you walk away with today, understanding that you're a female that has a postpartum is postpartum, meaning they have a pregnancy in their history when you're working with them related to it, running injury.
Speaker 3 (11:39):
If it has a ground reaction force components like a knee or anything, you should be looking North of the border, not just foot strength, not just cadence, not like you have to look North and understand, are they actually reciprocating? Where's that reciprocation coming from? Because when you have a unit joint of the lumbar spine in the lower, the only thing that's left is like TL junction and above. So that's where they're reciprocating is way up high at the chest. And if you watch Fumo runner, that's what they're doing. They're punching the sky, it's all up, up, up, up chest high. And it's, that's the pattern that they partially developed during the pregnancy to continue running and pregnancy. There's nothing wrong with that. It co it's an appropriate compensation, but it does. If you don't restore actual reciprocation between the trunk and the pelvis, that's what you're looking for. And if the woman is in gripping her abs, cause she wants to get flat abs again, that's a UDA joint, it's a uniform engagement of the abdomen is what most women hang on to, or try to do while they're running. And that continues to keep their reciprocation high. So it's like understand what's going on North of the border for these women, versus just looking at things like landing mechanics, landing mechanics are affected by what's happening North so
Speaker 2 (12:59):
Well that's so, yeah, that is so interesting. And now I'm going to be, you know, in central park watching all these women to see, okay, are they just running with their, from like the thoracolumbar junction up? And then just having legs move like a cartoon character or are they actually getting excursion and rotation through the trunk?
Speaker 3 (13:19):
Amen. Yeah. And then we're getting into summer, right? I mean, I'm here in California, so we're gonna be able to see people's abdomens. And the thing that I, my cue for my clinician friends is what's going on with the navel. Like if their navel is staying straight, dead, straight, the whole time they're holding their abdomen. So stiffly through their run, that they aren't reciprocated. Like they can't be like, that's an indication that's a quick and dirty clinical sign that you can see that that means the reciprocation is likely coming up higher. And then it'll sort of clue you in and you'll see it. And they're, they're the ones punching high in the sky. They've got ribs flared up, like it's sort of, and that's a lot of our female runners. And it's a lot of our women that have never had children because they're holding their abdomens.
Speaker 3 (14:03):
Cause that's what they think they're supposed to do. And we also have studies that have shown us that stiff abdomen when they had men jump off a height actually increase their ground reaction forces. So it makes sense it's part and parcel, right? Like, you know, we just got to sort of brought in and I think that's my hope when I talk about stuff like this with my ortho and sports medicine, friends and colleagues because that's really, I'm a sports medicine, PT, I'm not a traditional pelvic health PT, but is to broaden our lens and add these ideas into our differential diagnosis. Like we need to start thinking about how these things are affecting. Some of the things we look for in sports medicine. Like we understand to look at how ground reaction forces what's happening, but we don't often this into our thought process. Like how, why is that a typical running pattern for women? It's not just because we have brought her hips and Q angles and, you know, blah, blah, blah, look North, look North with me. There's more going on for these women. And and we have some strategy pieces that we could add into our thought process to help them
Speaker 2 (15:13):
Yeah, amazing coming in hot, right out of the gate pair with a great tip for everyone. So thank you for that. And one one question that I want to ask, just so the listeners really understand when you talk about postpartum women, can you define what that means?
Speaker 3 (15:32):
I'll give you my definition. Sure. It doesn't necessarily mean that it is the definition. But I consider anyone who's ever had a baby. And, and here's what I'll say about that. I think technically it's the first year that might be kind of more of a technical thought process. And that's mainly because I started learning this backwards when my, on my patients who were 35 and 45 and 55 and 65. And they still look like me. This is million years ago. Now when I was at postpartum early postpartum, like the way that I was using my body and it was creating issues for me, they were using their bodies that same way. And they were like, well, they had grandchildren at that point. And so once we start understanding, yes, it's a normal process that women go through, but our job is to understand what they went through and help them find their way back to efficiency and effective use of their structure and their systems and their like I D I was Chris. I love that Chris Johnson talked about their ecosystems, like, you know, like looking at all of those pieces for them and understanding our job is to help them get back to their baseline, their individual baseline. Cause my torso is this, like this with this link legs. Some people have long legs short, let you know, like to understand that. So my, one of my big pushes I hope to achieve at some point is to get baselines, like, let's start getting baselines. I was women. Yeah, go.
Speaker 2 (17:09):
I was just gonna ask that you, you beat me to the punch. I was just going to say, so if someone is coming to me as a woman who is a runner and she had a child would say a year ago or two years ago, even how do I know what her baseline is?
Speaker 3 (17:27):
Correct? Well, what I do is I have them try to bring me film from prior to the injury. So these are for women that haven't had babies or like what they look like running prior to having a baby. And again, so many women have said to me, well, I leaked even before I had a baby when I ran. So then you might find stuff in their running form that might help explain that like Mabel's that go straight ahead? You know, things like that. But it does give us sort of an understanding of, is the running form that we're seeing right now, is that speaking to why they're having the injury, the, whatever it is, or is this the running form they've always had and they used to run without any difficulty. Like, you know what I mean? Like, so for me, that's how I started to create their baseline.
Speaker 3 (18:15):
Even if I can't see what they look like. And a lot of women will, like, when we talk about diastasis, like, you know, something like along those lines, which I might have to define for the audience, but some women will send me pictures of them in a bikini from like their early twenties. They're like, Oh my gosh, you're right. I actually had a line down the middle, but I never gave it any thought because my belly was flat. But now that my belly is not flat, you know? So it's like, that's where we can start to kind of get some comparisons for baselines. But one of my goals is to reach into the medical community, meaning the obstetricians and the midwives and the nurse practitioners. If any of you are out there is to say, let's start creating baseline. You're the first contact for some women they'll come in for a prenatal visit or something like that. Like, let's get some baselines, encourage them to take video. How will they're lifting how they're running? You know, how are they doing these things that they want to get back to afterwards so that they have a library of their own baseline? Like let's understand what they look like beforehand so that we have a better idea of how to help them find their way back.
Speaker 2 (19:18):
Yeah. Yeah. Great answer. Thank you. And so we've talked a little bit about this return to run after pregnancy. And I know you said that is, that's what people want to know from you. How do I go back to running after I had a baby and you know, everybody wants a protocol. If you could do this, then do this and this then do this. Right? Right. So when someone says to you, when can I start running after I had a baby, what is your answer?
Speaker 3 (19:50):
My answer is, and everyone hates it. It depends, but I tell them what it depends on. And so, and that's what it does get a little tricky in a situation like this, because these are some of the variables that I want to know. So my, whenever I get a question like that, my favorite is when I get it from a practitioner, what should I tell my patient who wants to get back to running? And I'm like, okay, well, my, my response to you is I actually wrote a blog like this. Like, and I always get, Hey, quick question. And I'm like, it's not a quick question. It shouldn't be a quick question. You know, did they have a vaginal delivery? Was it traumatic? Did they have forceps? Did they have a Syrian? Was it, you know, did they have bed rest? Were they on bed rest?
Speaker 3 (20:29):
If you're on bed rest, no, you're not gonna start running right out of the gate. You're like, you know, like there's so many variables there was it a complicated pregnancy? Was there, you know, what's been happening to them during the recovery process, have they, you know, are they having postpartum depression? You know, what's the you know, what are all these variables that they're experiencing? Where are they having postpartum depression? Or are they depressed or having baby blues, partly because they've lost their exercise program. Like what, what are all of these variables that we're looking for and what was their athletic capacity before? What is it now? Or what are their goals? Cause I like to make goal specific recommendations. So those are some of like, those are just that's scratching the surface, but I don't want to make it sound like this is an inaccessible population to work with because you don't know what all those things are.
Speaker 3 (21:19):
But what I usually talk to my patients about is I understand their goals and then I break them down and we start preparing for them. So my program for you needs to prepare you for what you want to do. And I need to understand the demands that you're up against. If you want to run, I need to prepare you for impact. I need to prepare you for endurance. I need to prepare you for power and possibly change of direction, depending on what you want to do. Trail runs and jump over rocks and things like that. Like I need to prepare you for what it is you're going to be up against. And part of that preparation is looking at your form, giving you great form twos, helping you build in new form, creating an interval program, getting you impact ready. Like there's, it's not just, I need you to do some curls and tell me stuff and some cables, and now you can run.
Speaker 3 (22:10):
And I think that that's, but that's a typical postpartum recovery program, but it isn't a prep for return to run. I need to teach you to reciprocate. I need you to strengthen into those reciprocal movement patterns. I need you to do single leg work. I need you to do single leg loaded work. I need you to do single leg impact work. You know, I gotta get you practicing some of those pieces. Then I know you're prepared. And if you're leaking or having pain or having an I give you these things we're looking for while we're doing the prep work, we're just not quite ready. We need to modify those things. Keep giving you opportunities to build capacity and strategies for the kind of work you want to do. I'm going to build that back into your system so that you're ready. And if you're, again, if you're symptomatic during all the prep work, we're just not quite ready for the actual events, but let's figure out what still needs to be tweaked and what needs work. You know what I mean? And then like, let's start with elliptical, let's start with hiking. Let's start with things that don't have impact. If we're not, if we're having symptoms with impact, like sort of really parse, what's still creating the problems so that we can troubleshoot that. And then, and then get you back into interval prep, walk, run. You know what I mean? Like it's yeah. So it's yeah. So that's running, that's more running specific.
Speaker 2 (23:27):
Yeah. So if you're not, it's not like, okay, the doctor gave you the all clear at six to eight weeks depending. So I'm just going to give you a walk run program. And that's what you will do. There is a lot more building because like you said you to monitor, you want to give people their program, you want to monitor their, their reaction to it, their symptoms, and then make the necessary adaptations that you need to make and use your clinical judgment. Because we know that there's not a whole lot of research around even returned to run after pregnancy. There's not a lot of research to that, correct?
Speaker 3 (24:05):
Yeah. We're getting, we're starting, we'll give credit where you know, we're trying, but we, yeah, we have a lot of work to do. We need to figure out there's a lot. We need to understand just basics. But, but like some of the things that I, I I'm trying to create like little things, people can remember, like prepare, then participate, monitor, and modify. Like just keep get like put those pieces together for yourself. Cause some people don't have access. That's the other thing, like if anyone out there doesn't have access for whatever reason to the practitioner, like you are, you have a lot of power by knowing what to monitor for knowing it's not normal to have pelvic pressure or leaking or pain while you're running. It's not normal. Like we want you to feel good while you're running and you know, just cause you had a baby, does it mean that you should be in pain and leak for the rest of your life?
Speaker 3 (25:01):
Like that's an incorrect, like I think we did. We say we're going to bust myths. Like that's a myth D please don't buy into it. So yeah, and I think I lost your question in there somehow. Did I? No, no, no, no. Boston my own head. No, not at all, but it is. It's like these, like what else? You know, and then follow the other thing I try to tell people is follow your success. If it seems to be that you're having more symptoms on the flats, but you're okay if you are going uphill, which is not unusual because it sort of helps you have a better running form automatically. Then let's walk the flats, run up the Hill. You don't like listen to what's happening, but learn how to interpret it. I think that's what I'm hoping clinicians can be, is really great interpreters of what's happening with the patient standing in front of them so that they can they can be better guides.
Speaker 3 (25:54):
I mean, that's really ultimately what we're doing. We're guiding people through their process because everyone's process is going to be a little bit different. It should be. And I would love for, I would w I went a hundred percent with lots of over the protocol, charge everybody 10 books now, but it doesn't exist because everyone is different everyone's path through pregnancy is different. That one study we have was so fascinating. All those women did something different to get through the pregnancy running. So, so we, we were just learning, right. We're learning about, about everybody's path through, through all this stuff. So how can we guide them? And I think monitoring modifying, progressing not gradually in a scared way, but in a smart way, like, Oh, we tried that. That was too far. All right. So backing off a little bit. Let's try this. Let's modify, modify, keep adapting. So I don't know. Now I'm going down a whole nother rabbit.
Speaker 2 (26:48):
No, no, no, that's it. This is all, this is all amazing. And I, and I really think the listeners will, we'll definitely come away with, you know, the, the monitor and make it adaptations and watch and listen. And also, like you said you sort of referenced Chris Johnson, sort of talking about the whole ecosystem. So again, I think it's important to when you are sitting down with this patient for the first time, you know, you have all these questions, but then your other questions are, well, how old, how old is your child? Do you have more than one? What are your responsibilities at home? Do you have a nanny? Are you a single mom? Are you working? What are your time constraints? Like, because all of that feeds into what kind of program you can give this person, because they may say, Hey, listen, I have 10 minutes a day to do some exercises. And, and what happens a lot is people think I only have 10 minutes a day. It's never going to work. Right. So how do you get around those with your clients?
Speaker 3 (27:51):
I usually use their exercise program is their fitness program, whatever it is, like rather than ask them to stop. I, and so, I mean, we're talking early postpartum versus someone who's maybe coming back two years later. Right? So you know, I try to integrate, my goals have always been, or my path has always been about building brain strategies, neuromuscular. So then I'm teaching them how to re-establish. Some of the, the, the, so let's talk early postpartum things get kind of funky in terms of how components of the central stability Central's control system operates. I'm working on helping them reconnect and implement it into their function. They have to take care of their kids. If you're lifting your kid, we're going to do it in a way that sort of pulls in the brain's going to use all these components to help them start, to learn, to be reintegrated into your movements, just movement going up the steps.
Speaker 3 (28:50):
Guess what steps is just like running. We're going to actually, if your goal is running, I'm going to make going up and down the steps with your laundry hamper or your baby as your prep for return to run. But we're going to do it super low impact. We're going to think it through. We're going to have to, like, we're going to rebuild that reciprocation through walking up and down the steps. We're going to, you know, match it to your function right now. But if you're two years out and you're, it's a different ball game, I'm going to use your running as your program. I'm going to adapt your running and keep you below your symptom threshold or make it look a whole heck of a lot like running so that you're motivated to do your, if your 10 minutes is spent running and that's your goal, you'll do it.
Speaker 3 (29:32):
Do you know what I mean? But if I say you got to lay down on the ground and do these rehab exercises that make no connection for you, you human, emotional, or your brain to your goal. You're not going to be motivated to do that. So I have always broken down their exercise programs, if they are CrossFitters or going to gym or whatever it is, show me three exercises that you like to do. Yoga, Pilates, whatever it is, what are three things let's implement these ideas and strategies under something that you enjoy, because I know you'll be compliant. And then they know you're listening. That therapeutic Alliance is there, like out of the gate, you want to help them get to their goals,
Speaker 2 (30:11):
Right? So it's, it's like, you can take things they're already doing and modify, adapt it, allow them, give them the tools they need to implement. What will help them in that exercise. And ultimately perhaps help them get back to their running or whatever it might be. Okay.
Speaker 3 (30:31):
Break it down, break it down and then build it back up. That's got it. That's a pretty straightforward way to do it with any athlete. It doesn't have to be running. But you got to know what they're up against. So I, if I am not familiar with something, I just say, show me, I don't know, show me what that is. And I don't know the words, I'm the first one to admit it, but I can't remember what that, can you just show me that and they'll sh and then you can break it down. Like, I think that's, to a lot of people's barriers to working with athletes is they don't feel comfortable with the sport. And then of course we have, you know, members of our community that say things like, well, do you lift, do you even run? I know. And it's like, like, it's really I don't, I don't surf and I will never, my first surfer when I moved to California, you know what I did, I looked at YouTube and I looked at, I watched, I watched videos.
Speaker 3 (31:30):
I looked, I tried to understand what are the physical demands of surfing, but that didn't mean I couldn't help him. You know what I mean? Like, don't get me started. So anyways, so I think that it intimidates because also like, that would mean that men couldn't work with female athletes too. Like, cause you don't have a vagina. Like that's, it's a, it's an illogical argument and it makes me mad. So anyway, surfing is I that's one of the examples that I use because I don't surf and I never will because I'm afraid of sharks. So we w w your job, our specialty physical therapist should be movement analysis. That to me is a pretty basic part of our definition. And I know that you can at least pick out efficiency. Do you know what I mean? Like, you can pick out efficiency and I use video, like crazy.
Speaker 3 (32:19):
Have them bring you videos of them. Weightlifting have them bring you videos of running, and then you can slow it down. Look at it, really carefully. Look at it at home before you stand in front of them, start to break it down, look online. What is a clean and jerk, and then ask them to send you a video of a clean and jerk compared them and start to pick out where it's different. There you go. You know what I mean? Like, I think that we create this barrier for clinicians to be able to participate in this kind of care if we make it unattainable because they don't actually participate in it anyway. Yeah.
Speaker 2 (32:56):
Listen, I could not agree more. I think that's the dumbest dumbest argument against a qualified physical therapist, seeing the person in front of them, because what if you're the only physical therapist for 50 mile radius? What are you supposed to like, sorry, pal. I'm not an Olympic lifter can help you.
Speaker 3 (33:17):
Yeah, it's so stupid. It's so stupid. Well, and it's really the other thing too then is it's also important to sort of highlight and carefully and kindly and respectfully say that's also how pelvic health is understood by so many. Well, it's not, that's not my department, but it's physically inside the woman standing in front of you. It's part of her department. So like, you may be the only practitioner for miles and you are the only person that understands the human body, the way you do as a physical therapist. It behooves you to start understanding some of these processes. When we start to talk about our differential diagnoses for runners is to understand what is happening, what, how might this have affected what I'm seeing clinically? And then it's not, it's not pelvic health, like in this movie way, it's pelvic health as a, it's a, it's a friend to helping you understand what's going on with these patients.
Speaker 3 (34:16):
So, so again, like in the same way that, you know, folks get scooted away from participating with female athletes or athleticism, we don't want to scoot them away from pelvic health because it's scary or UV, or it's not their department. Like we need to open those doors broadly and say, let's, let's skill everybody up. Let's equip everybody, the pelvic health community to understand fitness better, and the fitness community to understand pelvic health better. Like let's everybody come to the middle and not create barriers inside the community to those things. Like, let's appreciate the perspective that we each bring so that we can optimize the care for our patients who don't have resources to go down, you know, and with telemedicine creates new opportunities until unless we can't do it nationally. Right. Can we have a talk about that?
Speaker 2 (35:08):
Yeah. I would love to have a talk about that. Like maybe every, every licensing board across the country, again, it's so stupid because we take a national exam, but we're only licensed in anyway. Yeah. We could have, we could have a round table on that one. But you know, what you said is really important about so for the physical therapist or even other health professionals listening pelvic health, it does not mean that you have to be clinically prepared to do internal work, right? No, not necessary. And it just means that you're treating the musculoskeletal health of someone who happens to have a pelvis, which last I checked is everyone. And so, and so you should, you should be able to do that. You may not ha you don't have to be certified as a women's health specialist, but you can take get information, read books, watch videos, take courses so that you are competent in, let's say for the sake of this month, I'm runners treating a woman postpartum that wants to get back to running.
Speaker 3 (36:25):
Right. And there, and that's, and I think that that's partially, I mean, to just be fair, I think we all learn pelvic health in a very isolated way in PT schools. You know what I mean? So I think that there's been a huge change in the conversation in the pelvic health community over the years. And it's just starting to get out there in, in other ways. So it also behooves those of us. And again, like I find myself always serve in the middle of these worlds. Those of us who communicate it in a way that's relevant to like, let's be communicating in a way that is enticing to learn more. Like, I want those to gain those skills and and understand it in a way that is relevant. And I, and so, yeah, so we have a lot of work to do to the physical therapy educational programming to start to build it into models a little bit differently, so that it's under some of the other side a little differently too. Right. So it's just, we're all we're evolving, but it is true that it has classically been defined that way. Right. Like, right. And so I think so anyway, yeah. So I, I agree with you, there's a lot we can do there. And it's also like, can you at least talk about like, and to have some ability to do that is important, you know, so,
Speaker 2 (37:45):
Yeah. And, and hopefully people like yourself and maybe podcasts like this and other podcasts that are out there will really help clinicians. And non-clinicians, you know, your, your, your gal that, that just had a baby. Who's like, I, I don't know what to do. How, what do I do? Yeah. You know, I just had someone contact me today who is eight months pregnant and she's starting to have a little low back pain. And she said, you know, should I just go to the doctor or should I just go to any PT or what should I do? And and I was like, Oh, I'm so happy that she's reaching out for a physical therapist, you know? But a lot of people just don't even know that that's an option. Right. So,
Speaker 3 (38:32):
Yeah. Cause the messages, while you're pregnant, low back pain, you're pregnant, you know? And, and so it's really, there's a lot of education that needs to happen, but I do think you know, so much of it is around I'm trying to think of a good way to say this, centering the woman as like that, those concerns just because they're common. I hate the common. Not more, it's not, I hate that. I get it, but it's also like, it just always has been, but that doesn't mean that's how it should be, or it has to be moving forward. Like I think we're starting to get more female researchers, myself trying to do that too, to help, you know, we're trying to have females asking questions for females and to the credit of this one particular, he will never know. I should write him a note, but like I had a conversation once with a running researcher.
Speaker 3 (39:28):
And I was like, did you think about the fact that that lady was probably in continent? Like he had just done something at CSM and he goes, that would never have crossed my mind. And I, and he wasn't like a poopoo that couldn't possibly be a variable. He was like, it looks like you need to start doing some research. And it was, it was literally like the last nail in the coffin of me, like meeting that, like I knew I wanted to go that direction, but it was one of those, you know, those really landmarking conversations that just sort of are like, w wait, wait, wait, wait, wait, I'm point. Knowing what I'm doing, like cooking you in the right direction. Yeah. It's to say, you know, this is you, you understand it. And I think that's, you know, again, you know, we talked a little bit about clinical utility and research, like trying to ask the questions that women need to ask, you know, so we need for your eight month pregnant lady, we got to get better information to her and to people that can care for her in her local community.
Speaker 2 (40:25):
Yeah. And, and again, you know, we talked a little bit about this before we went on, but, you know, asking the right questions, asking questions, asking simple questions. Because as, as we've spoken about the research for even simple, for simple questions is not there. So before we went on, Julie was saying, you know, we don't know what the pelvic does when we go to sit to stand, what is it doing when we're walking? We don't, we don't know what's happening in the pelvis and the pelvic floor and, and, and articulations above and below. So how are we supposed to know with certainty what's happened when you're running or when you have impact or jumping? So I think these, like you said, these smaller questions need to be looked at and researched, and then hopefully that body of work can build up to something much more clinically.
Speaker 3 (41:15):
Yeah. We need to sort of, we need to build in the basics and, and, and, and we're working like there are teams working on that, like we have, and we're using computer modeling as a way that this is starting to get there because we can't the issue. And also, I really want to make something super clear before we get moving. This direction is one of the things that I'm trying to be really careful about is not just talking about the pelvic floor, but to talk about pelvic health, because the pelvic floor is not the only gatekeeper that creates pelvic health. And it is a component of multiple body systems. And we need to understand that those systems affect the way the pelvic floor acts and behaves and the pelvic floor itself, you know, needs to be, have attention directed at it. But B because when we talk about just pelvic floor, I think it isolated away from relevance to other areas of care.
Speaker 3 (42:05):
So I just want to be clear on that. So but we don't know what its behavior is. Cause we can't see it. We can't put a, you know, it's just, we are, but we're starting to get new ways to be able to understand it better through a technology advances. So we're getting there, right? Like, so that's been a barrier to understand this better in in the dynamic, in dynamic activity. And we are seeing computer modeling as an option to help us start to understand this a little bit better, but that modeling is usually done on like an N of one. One of my favorite studies is a computer modeling study, but it's with something, I can't remember the title now off the top of my head, but it was something like, you know computer modeling of pelvic, the pelvic floor during an impact activity and an athletic female or something like that, or for female athletes.
Speaker 3 (42:52):
But then it literally says in the methods section that the woman they chose wasn't athletic and I'm like, well, crap. Okay. But I mean, it gives us, it gives us new insight. We'll take it. But I would really like to see it on someone who is an athlete, because, you know, we want to understand all of those variables anyways. So, you know, we're just trying to get there, but we haven't always, we can't visualize the pelvic floor in when we're watching a runner, but we can watch it's relationships. We know it's related to the glutes. We know it's related to the pelvis and the low back and the abdomen and diaphragm, we can watch all those other relationships. And we're really good at that in ortho, in sports medicine. So there's all of these interrelationships that we can watch and understand that a little bit better and differently, but you know, there's elements of what's going on there today. I am grateful to our pelvic health community for their capacity to treat directly.
Speaker 2 (43:49):
Yeah, yeah, absolutely. And now, before we start to wrap things up what I'd like to ask you is for, let's say the clinicians that are listening to us right now what, what is your best advice to those clinicians who are working with, let's say female runners who are postpartum at any point postpartum, whether it be six weeks, six months, six years, what have you,
Speaker 3 (44:22):
Oh let's see. That's kind of a loaded question, but I think it would be to learn to ask questions like that would be my best advice, like, and ask questions that make you a little uncomfortable. You will get more comfortable with it. And understand that what you're trying to do is open a door of communication. Like create a conversation around this with your athletes. Here's what we know, which is not much, but my understanding is after you've had a baby or two, it affects your running form and you can hang on to those changes six weeks, six months, six years, whatever, wherever they are, unless we actually look at them. So I'm wondering how that as part of your medical history is affecting what you're doing, but along with that often comes problems with how you're activating your abdomen. Or you might have a public health consideration like leaking when you're running or painful sex constipation.
Speaker 3 (45:24):
Like there's other problems that women have that are under the public health realm. You know, and so so I'm going to ask you, so have them in your intake form, have them, you know, are you comfortable having a conversation with me about that part of your life and your experience? Cause I'm wondering how it might be affecting what we're seeing here. We understand that there's an interrelationship with learning. The research is limited, but, and if you're not comfortable talking to me, understand that, you know, it is something that I think might be a variable. And so I'm going to actually at least try to incorporate your pelvic floor and your diaphragm and some of those interrelationships into our programming. But I also have someone down the street that you can talk to a few, be more comfortable. I just want to open that door, like open the door to a conversation.
Speaker 3 (46:07):
Like if that, if nothing else, if they aren't comfortable, you also should be skilling up to understand these components. How do you, what should, what do you see in a typical postpartum runner start looking for navels, start looking, going to central park, whatever it is, start to pay attention to these other variables and serve to give fit, give it new. Meaning like I, cause I read a lot of running research and athletics like sports medicine research and the meaning that it's attributed that is attributed to it is often based on what we've understood in men or like a strength based model. Like, well, they're just there post your chain. Isn't strong enough. Well, my question is why, why would every freaking females post your chain the off? Let's put that. Let's start thinking about that. That's the kind of questions I want to ask. Like the why we're seeing that as our common, it's not just structure, it can't just be structured because women aren't all structured the same P S all women do not run it into your tilt.
Speaker 3 (47:08):
Like they don't, what do you mean? Come on. Nobody does the same thing. All of us. Like it can't be. So it's like with what we've put this meaning on it and if you're postpartum or you're pregnant, you're you have an anterior tilt. Well, we have to have research has shown us. That's not true. So it's like, and then I don't know how you can overstride and inter tilt at the same time. Like, we need to really think about that because, but we've always, that's sort of the lens. And so everything gets filtered through it to the point that we exclude, like other, like, instead of thinking, Oh, well, this can't be the explanation. Let's ask other questions. It's this becomes the definition. Does that make, am I making sense? A hundred percent. Yeah. So it's like, how do we start say, okay, that's we didn't get to the bottom of it.
Speaker 3 (47:57):
What other questions can we be asking? And and, and to start to look at women, not just women, men too. So it's, it's like, how can we start to ask our questions a little bit differently? How can we start to and really it's to look for the, why's not, what is, why, why in the world are we finding this with all of our female athletes? Could it be the way that we've trained them to suck their stomachs in all the time, since they were 12 and 10, you know, like how could that possibly affect an entire generation of, of participants, right. Let's start looking at this, you know, so yeah. So I love her. Yeah. I mean, we brought up Eric Miura prior, so we'll throw him a little shout out here, but I wanna, I, I heard him speak at a conference.
Speaker 3 (48:45):
I don't even know time has no meaning now, but and one of the things he said was I, which I love was talking about with research. When you read the conclusion and research, is, is there any other explanation that could have come to that same conclusion based on what you're seeing in the light? And I thought that's so smart because sometimes I'm like, Oh, yay. My biases, my biases, whatever affirmed. And, but I, but so he was referring to that related to the research, but I think one of the things that I keep trying to think through for myself, and I think would be a really wise way for all of us as clinicians to think about it is what are other reasons why they responded to my treatment? What are other reasons that they could be experiencing this problem that has nothing to do with what I've always understood?
Speaker 3 (49:28):
You know what I mean? And I am sharing my bias. Like when I look at a female runner, I'm not like, Oh, that calf looks weak. I'm like, Oh, wow. Look at their central control system. Cause that's, you know, that's my lens. So I, you know, so I want to be open to understanding all of that other stuff, but I already, I already learned all that stuff. And this piece is something that isn't being considered by a lot of permissions. And so, yeah, so again, we need to start just broadening our lens and I think we're broadening it. I hope to look at females as not just little men and the problem we have wider pelvises, estrogen, and Q angles. Like there's other things happening for us that, that are not explained by those things. You know what I mean?
Speaker 2 (50:13):
Absolutely. Yeah. Thank you. This was awesome. Now, where can people find more information about you, more information about your, you have a running a female running course, where can, yes. Where can, where can we find all of that?
Speaker 3 (50:32):
I am at Julie PT and I have discovered that you can misspell my name and still find me. So it's J U L I E w I E B E P t.com. And I have, I do have an online course that was recorded from alive lives online opportunity. So it does have that flair that feel, but it also has the questions, which I love. And, but I also have lots of free resources in terms of blogs, videos. I do a lot of podcasts and have a newsletter to let you know about when opportunities are coming up. Like this one and what's coming up for us this next week to be a part of the round table. But but yeah, and I'm on all the socials
Speaker 2 (51:19):
You're everywhere. Thank you so much. You're all over the place in a good way. Not in a bad way, in a good way. So thanks so much before we sign off, I'll ask you the same question I ask everyone, and I probably asked you at twice or three times already, but we'll ask again, you can keep giving the same answer I want growing and learning. So that's true, but that's true. Yeah. So what advice would you give to your younger self? You know, what I'm going to share?
Speaker 3 (51:49):
It's funny. I was just thinking about this before we got on, but, and this is something that I've learned during the pandemic and and it's from Aaron Nyquist just, but he was referring to the spiritual, but I'm going to relate it to our walkthrough. Learning is instead of thinking of learning as this linear thing that I learned this, and now I know this, so that's stupid. I learned I'm making it on my hand. No one can see me. I forgot it was on a podcast, but instead of it being linear, which is so much of what ends up happening in our rural this dichotomy, Oh, well, biomechanics is stupid pain. Science is everything like, instead of it becoming linear in our thoughts is to think include and transcend. And instead of it being a linear line that it'd be concentric circles. And I was like, Oh my gosh, if I could be a learner like that, always if I had started my thought processes that way, like, wow, that would have been important for me as a person growing, but as a clinician growing to like that, instead of it becoming these battles that we get between these dichotomous, like VMO and like Karen, you remember BIMA, well, remember BMO, but instead of these like dichotomous thought processes, let's see, what can we continue to include?
Speaker 3 (53:05):
And then how do we transcend it doesn't mean that what we used to think was horrible and versus stupid. It's like, how do we keep building on that in concentric circles versus this linear thought process? So, yeah, so that was, that was just on my mind today.
Speaker 2 (53:19):
What wonderful advice it's like, it's like a reverse, it's like a reverse funnel. Yeah. Yeah. It just keeps getting brought. Our perspectives should broaden our questions should really never be answered. Like we should never get to the end of that. Do you know what I mean? And I just, I, anyway, it was a really just as so much has changed and, and it's been a really challenging year for all of us. I thought it was a, and we're headed back to a new transcendent, normal that I hope will bring a lot of changes for all of us. You know, I just, it was, I, I think it's a really important perspective as clinicians to, so I thank you so much for sharing that and thank you for spending the time today and tomorrow. I know, and tomorrow is our round table with you and Ellie and Chris and, and Tom.
Speaker 2 (54:08):
And I was saying like, gosh, to have the four of you on like one stage is like, Holy crap. I can't even believe it. So thank you for that. And so everyone you can find out how to join us all by going to podcast dot healthy, wealthy, smart.com. I mentioned it in the beginning, in the intro as well. So Julie, thank you so much. I appreciate you and appreciate your, your knowledge and your insight. Well, thanks so much for having me again, Karen. I appreciate it. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and stuff.
Speaker 1 (54:38):
Mark, thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Chris Johnson to discuss empowering runners through rehab. He is a Seattle-based physical therapist, performance coach, speaker, and multiple-time Kona Qualifier.
In this episode, we discuss:
- Is resistance training needed for runners?
- Are training errors to blame for running injuries?
- How can clinicians guide the decision-making process around pain and return to running?
- Chris's best advice to be a running injury expert.
- How can the profession of Physical Therapy be thought of as your best friend in healthcare.
- The importance of being present and curious.
Resources:
- Chris's Instagram
- Chris's Facebook
- Chris's Website
- How to Improve Profits AND Profit Margins in Your Practice Webinar from New Health
- Running Round Table Talk
More About Dr. Johnson:
Chris Johnson completed his undergraduate studies at the University of Delaware, where he earned a bachelor of science with distinction while completing a senior thesis in the physical therapy department under Dr. Lynn Snyder-Mackler. Chris was a member of the varsity men’s tennis team, scholar athlete, captain in 2000, and recipient of the Lee J Hyncik award for excellence in athletics and academics. He remained at the University of Delaware to earn a degree in physical therapy while completing an orthopedic/sports graduate fellowship under Dr. Michael J. Axe of First State Orthopedics. Following graduation, he relocated to New York City to work at the Nicholas Institute of Sports Medicine and Athletic Trauma of Lenox Hill Hospital as a physical therapist and researcher. He remained there for the ensuing eight years until 2010 when he opened his own physical therapy and performance facility, Chris Johnson PT, in the Flatiron District of Manhattan. In May 2013, Chris and his wife relocated from New York City to Seattle to pursue a more active, outdoor lifestyle. In addition to being a physical therapist, Chris is a certified triathlon coach (ITCA), three-time All American triathlete, two time Kona Qualifier, and is currently ranked 16th (AG) in the country for long course racing. Chris is also extensively published in the medical literature and has a monthly column on Ironman and an elaborate youtube channel.
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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Read the full transcript here:
Speaker 1 (00:00):
Hey, Chris, welcome back to the podcast. I'm so happy to have you on in our month. All about running and running injury and running rehab. So thank you for carving out the time.
Speaker 2 (00:11):
It's fun to be back it's it's always a pleasure to connect with you. And it just snaps me back to New York city and I still don't know how we never crossed paths when when we were both there, but here we are, and I'm glad we connected and also happy women's history month. You're someone who's sort of spearheading a lot of great stuff in this space. And I think a lot of people, especially women look up to you and that you're a role model. So things that you've accomplished and continue to work on.
Speaker 1 (00:47):
That's very kind. Thank you. And now today we're going to do a basic Q and a with Chris Johnson. So Chris gets tons of flooded with questions and comments and things like that from emails to social media. And so I thought, well, let's see if we can make life a little bit easier, reach a wide audience and get some of these questions and concepts under control for you and out to the public. So let's start with a common question that you get is all is kind of around resistance, training and running. Do you need it? Do you not need it? I know that's a really broad question. So I'll throw it over to you around the the, the concept of resistance training and
Speaker 2 (01:40):
Yeah, and it's a, it's such a great question. I think that everyone's default answer is, you know, basically resistance training is a Holy grail for runners. And I do think it, it has its place, but I think that there are a lot of gaps in the research. And is it something that I prioritize myself as well as in working with the athletes I coach? Absolutely. But I think that anytime you're working with the runner, the primary goal is to get them into a rhythm with their training and to establish consistency of training. And then you can consider to start layering things in this is assuming someone's training and they're healthy. They have no remarkable past medical history. I, I think that, you know, the answer to that question differs especially if we start to get into master level runners who typically have a remarkable past medical history because most of these injuries and conditions go under rehab.
Speaker 2 (02:41):
You and I both know that as clinicians. So I think that a lot of the resistance training may just be cleaning up sloppy rehab that perhaps they didn't get around to addressing things at the tail end of the rehab. So there's a quote that I love, which is, you know, resistance training is really coordination, training under load. So, so yeah, I do think it has its place but it should be there to support our running, into build our capacity to run, but I've seen a lot of people get it wrong and they end up whether it's, if they're racing, they go into races where they're a little bit sluggish or they're carrying some residual fatigue. I've seen people get injured in the weight room if they're not perhaps if they're, you know, younger and more green. So yeah, I, I do think it has its place, but like everything you have to approach that, that runner athlete on an individualized basis and just understand where they're coming from.
Speaker 1 (03:40):
And in your experience, working with runners, what are the biggest barriers to resistance training for runners? Because not everyone has, you know, access to the same equipment and time and everything else. So what, what have you found to be the biggest barriers to resistance training?
Speaker 2 (04:00):
I think a lot of runners are intimidated by it unless they come from perhaps a multi-sport background where they've spent time in a weight room. I think right now with the pandemic, obviously resources and equipment or gyms are not as accessible or gyms opened in New York city right now are on a limited basis.
Speaker 1 (04:22):
They're open on a limited basis. I think you have to make an appointment a certain times and things like that.
Speaker 2 (04:29):
Yeah. And then I think that when people do get to the gym, they may not know what to do, and they may resort to something that they see on social media, some of the time, which might be fine. But I think that with running running has predictable performance demands. So it shouldn't be a mystery in terms of what we're trying to do. We're trying to challenge the calves, quads, lateral hip. And we're also we're not layering this in a ton. We're layering it in maybe twice a week on average. So but yeah, I think a lot of runners lack direction, and that's something that, you know, I try to put out a ton of content online. So people start to see how I'm approaching it. And I'm trying to essentially synthesize the literature and translate it to to just the everyday runner.
Speaker 2 (05:18):
And I think that there's also this element of rhythm and timing with running and that doesn't always get addressed through resistance training. I think perhaps a little bit more since some of Ebony Rio's research, but again, that's really in the rehab sector space talking about tendons, but I think that a lot of the TNT work or the tendon neuroplastic training work just has such salience to resistance training programs as well. So anytime, you know, people work with me, they're, they're going to get accustomed to using a metronome. It's just one more factor variable that I think that we can control for when we're prescribing. I
Speaker 1 (05:58):
Love the metronome. I love it. Love
Speaker 2 (06:01):
It easy. After a while though, I
Speaker 1 (06:03):
Give to everyone, even with my, even with my younger athletes, they get it, you know, and actually with those younger athletes, I'm talking teens, it's using the metronome, although they're like, Oh my God, I have to listen to this again. But it is actually good to give them a little bit of discipline around the, around the movement, around the exercise. But I love, I love the metronome. I have my patients like download the metronome, get used to it when you're exercising. I know it can be a little monotonous, but I think like you, like you said that with the research of Ebony Rio and others, I think it gives people, I don't know, like a, a little bit more discipline around their training.
Speaker 2 (06:49):
Yeah. I use it a lot when, if I'm giving someone calf raises something like a rear foot elevated split squat. If we're basically doing like a three zero three where it's like down on three seconds, up on three seconds without pausing yeah. It helps to maintain this rhythm. And a lot of the times I'll stop the exercise when they break that rhythm. Because it's telling me that, you know, maybe we're starting to reach the upper end of their abilities for that given exercise.
Speaker 1 (07:18):
Right. And we all know that three seconds to one person is very different to another.
Speaker 2 (07:22):
Yeah. Well, and this is what, you know, when Scott Morrison talks about anchoring and I just did that Instagram post on, you know, stop being awake or start to anchor. I'm starting to realize I'm becoming a dissenter. But you know, that's where the metronome comes in. And I've played with this so much. I mean, my, my neighbors probably think I'm crazy because I'm like out front with a metronome going, and I'm doing all these weird exercises. Well, weird to them.
Speaker 1 (07:49):
What sort of things do you implement to get over the barriers? Well, you just answered that. Anything else that you may implement to get over barriers to resistance training for runners? Like, like you said, in that runner who is very intimidated, maybe never used resistance training before.
Speaker 2 (08:06):
Yeah. I mean, I, a lot of the times when patients show up to my house, I mean, I'm working out of my garage. We have a space on our property, you know, when they arrive a lot of times I'm deliberately training. So they see what I'm doing and they see that this is a normal part of my routine. And then they get a lens into my racing background, yada yada. And so I want them to realize that this is something that is normal. And I think in a lot of running circles, and I think this is starting to change that it's not prioritized to the extent that it is. And maybe I'm just getting older because, you know, as a master athlete, it's amazing having dealt with some patellar tendon issues, like my body craves resistance training, where if I don't do it, I start to sort of get reminded. My knee feels so much better after I load it and load it relatively heavy. Now you have to be cognizant for reasons I mentioned before, in terms of like, you're not going to want to do a bunch of heavy squats. If you have a race coming up you can keep your body under load, but you need to be a little bit more calculated with your exercise selection as well as your dosage.
Speaker 1 (09:12):
Yeah. And, and that's where I think working with a coach or therapist or someone who understands understands one resistance training and two race training and how you can kind of blend those together is really important. And now sticking with training, let's talk about training errors. Can we just blame everything on training errors? Is that, is that an okay thing to do now? Or am I, is that not good? And I say, I say that with a wink for those people who are listening.
Speaker 2 (09:40):
Yeah. I mean, I think it's a convenient thing to do, but I think that I'm going to get myself in trouble here. I think it's a little bit lazy too. In, in, I think that having lived in New York city that you realize the life load factor, right. You know, there's different stressors in New York, between loud noises, you know, smelly things, you know, financial stressors in crowded spaces, you know, maybe your sleep has fallen by the wayside. So you may have a training program that's very sensible. And, and then all of a sudden you have something come up. I think to one of my, I'm an athlete who I'm working with right now, and this guy's just been just so tough and durable. And recently things have started to take a turn in a bad way. You know, he, he lost his mom.
Speaker 2 (10:38):
He's been having to contend with that. He's had some other job-related issues and and then he he's come down with the patellar tendinopathy and his training didn't change that much. And we actually dialed it back a little bit and it just shows it sometimes all of these other factors, you know, play such an important role in the overall being or totality of that athlete. So, you know, I, I, I think that we'd be much better off calling them ecosystem EHRs where perhaps there's a disconnect, but I think that we have to be careful, always blaming it on training. And I, I get the point, I think that, you know, from a, from a research standpoint, maybe the reviewers are requiring the authors to, to present it in that manner. But I just think there's a lot more moving parts. And I find myself having worked with a ton of athletes over the course of my career, being an athlete that you have to really be in touch with your ecosystem.
Speaker 2 (11:39):
And I don't know who first came up with that word. I know Greg uses it quite a bit, but I think it's something that, that is great to consider. And anytime I start working with an athlete, I have a conversation and it doesn't end during that initial consultation or phone call, but I'm saying, tell me about your life. What was it like growing up? You know, what, what was your relationship with food? You know, what kind of sports did you play? You know, were you in public school? Did you go to private school? What was college like if you went to college, you know, what's your current situation? Are you single? Are you married? Do you have kids? Are you a single parent? You know, I need to capture all this information and that's just scratching the tip of the iceberg in that conversation's never ending. So I feel like the more I know where people are in life, the easier it becomes to start putting down sensible workouts on paper and make sure when you put them down on paper, they go and pencil nodding.
Speaker 1 (12:34):
Yeah. I love that. Getting deeper into those questions and, you know, we had a conversation a couple of weeks ago with the surrounding a female athlete on clubhouse and Tracy Blake, who is just fabulous. I don't know if you're familiar with Tracy. She's a physical therapist in Canada. She's worked with a lot of professional athletes there, including their Olympic volleyball team. And she was talking about questions to ask. And I think oftentimes this is sort of floated over kind of skimmed over by a lot of PTs because we asked, tell me about, tell me what happened, what happened with your injury? Tell me what happened here, not the questions you just said. Tell me about your life. Are you married? Like Tracy said, you know, a question she always asks is, do you have children? Do you have pets? What, cause that gives you an idea. What are your responsibilities throughout the day? Yeah,
Speaker 2 (13:29):
I always say, you know, look, give me a lens into your situation and let the conversation unfold from there. And I think, you know, whether you're a physical therapist or coach, I think all physical therapists or coaches, whether they realize it or not, you know, you're, you're trying to basically capture that ecosystem. And to, to just have, you know, talk to people about, you know, I just have a candid chat with folks and from there, then we can start pulling levers.
Speaker 1 (13:59):
Right? Cause then you're getting a, really, a more holistic view of this person. And then you can say, okay, they have two small children they're working from home. Their kids are being at school, school, they're at home. They don't have the time to spend two hours a day between training and running and everything else. And how can you make things work for them? Is that about right? Yeah.
Speaker 2 (14:25):
And I think that any, any time a patient or athlete consults us, they're looking at us as an agent of change and the true agent of change is themselves. And it's trying to help them plot out their own course. And maybe you, you know, you're shining a light on the path here and there, or making sure that they don't step into a pothole along the way. But that's something that, you know, I find myself more and more. I have any expectations to, I don't do things to people. I sit there and troubleshoot with them. And, and I think that that's what we, as physical therapists are phenomenal with. And not only do we have the skillset, but a lot of times it most of us have positioned us to have the time to do that. And you can't rush that process. So but yeah, we're, we're not in a system that incentivizes that, you know, you don't get paid to talk to people, you get paid to do things to people. And that's the fundamental problem with, for the reimbursement structure, for people who are in network. I mean, you and I are a little bit spoiled in the sense that when we're providing care, it's just ourselves and the patient, but that's, I think that needs to be the standard or approximate the standard. Yeah.
Speaker 1 (15:41):
And isn't it like amazing when that aha moment comes as you're sort of talking through things like you said, troubleshooting, and the patient goes, Oh, wait a second. I can do blah, blah, blah, blah, blah. Or, Hey, maybe that I didn't even think about that. Maybe that is contributing to XYZ.
Speaker 2 (15:57):
Yeah. And I, that's a lot of motivational interviewing and sometimes, you know, I was talking with a couple of people yesterday. Sometimes people who've already arrived, you know, if we're, if we're discussing surgery, you know, I think our goal is to always try to help people avoid surgery, but sometimes people are just dead set and you say, look, you know, I get the sense that you've really just you've arrived at the fact that you're going to have this surgery. Am I correct in saying that, and you know, if that's what you've elected to move forward with, this is your decision. What questions do you have about the surgery? You know, and, and then you may start getting into a conversation and say, Hey, can I, can I share my experience? You know, this happened to me with my clavicle. I was in Hawaii, we'll be traveling to Argentina to speak.
Speaker 2 (16:44):
My wife was pregnant. We had a little one, I was going to have to do a lot of physical tasks. And I'm like, I just need the surgery. I didn't have it on my right shoulder when I, my clavicle fracture. And I was just dead set. I'm like, I'm in Hawaii, there's a competent doc. This is not a super involved procedure, like a soft tissue procedure of the shoulder hip. And I had this and I could have been kicked myself for doing it in hindsight, but no one would have talked me out of that at the time. So sometimes people have to learn through their mistakes and sometimes that can be a tough pill to swallow, but that, that patient ultimately controls that decision. So sort of bobbing and weaving, but,
Speaker 1 (17:25):
And, you know, you just led perfectly into the next topic I wanted to cover. And another question that you get asked often and that's, and that is surrounding pain and pain and decision-making, so we, you, I feel like you led perfectly right into that. So let's talk about how we as clinicians and practitioners, where our role is when it comes to pain and decision-making for that client or that athlete.
Speaker 2 (17:53):
Yeah. It's it's one of the first things, if not the first thing that I discussed with people I did a book chapter for this it's called clinical care of the runner. Dr. Harris. Who's a physician at university of Washington was the editor. And he asked if I would read a chapter on training principles. And I essentially said, the first thing that we needed to discuss is someone's relationship with pain and what their understanding of it is and how they approach decision-making in around pain. Because if you're running, you're going to be dealing with pain at some point, you know? And and I think people have an inaccurate understanding a lot of the times. So, and I think sometimes we, you know, I'll use an analogy that Mike Stewart or you used which I think is brilliant. You know, sometimes when we're out training and we're driving through a school zone, right?
Speaker 2 (18:48):
School's in session, the lights are blinking, slow down. All right. Sometimes you may be driving through that crosswalk. School's in session lights are blinking and you have a crossing guard. Who's standing in the middle of the stop sign. Maybe that's a case of someone's dealing with the bone stress injury. So you need to really hate that. Other times you may be driving through that school zone. It's a weekend, no blinking lights proceed as is usual. And I think that's a good way to think about training, but you know, you and I both know that if someone has a lower limb tendinopathy, you know, we want to monitor their pain and understand how it's responding as a function of a particular training session, whether that's a run, whether it's a plyometric training session or a heavy, slow resistance, but we don't want to shut that person down in it.
Speaker 2 (19:37):
As much as we in our profession may be, high-fiving each other thinking that we're doing a good job of this. Most of the people that consult me, even people perhaps worked with me in the past for short periods of time. They still, when they experience pain, they assume damage and inflammation. And what do they do? A lot of times they, they they'll resort to taking anti-inflammatories and here we go. I mean, this is a, this is where things go South. So I think it's just important to say, Hey, what sense do you make of this? You know, what do you, what are your reservations? Are you okay working through some pain? And I think from there then the stage is set to proceed. But with a lot of, I've worked with a lot of master athletes and they're, they've had a history of lower limb tendinopathy.
Speaker 2 (20:23):
I know that with my left knee, that, you know, I, I worked through almost a year of pain, but I never stopped training. And I was just sensible in how I was staggering, my workouts to afford appropriate recovery time. And and also just knowing how college and synthesis behaves. So yeah, I think that people have a, a skewed understanding and it's also something very personal, but yeah, if you're working with athletes, it's a critical conversation to have. And I do think that this is where I know Ellie was on talking about bone stress injuries, that if you are remotely concerned about a bone stress injury, and it involves a high risk site, like zero out of 10 pain is the goal. Most other instances, I'm a little bit more cavalier, but if I know, if I see some of the signs that I would associate with the bone stress injury, especially if we haven't had imaging, I'm going to be conservative as hell. Yeah.
Speaker 1 (21:19):
And I think it's important to, to note that understanding the runner and that's where understanding the ecosystem comes in and understanding, especially for bone stress injuries, where those high likelihood of those injuries occurring. So it also like you have to know your stuff as well is what I'm getting at when it comes to runners and, and having that conversation around pain can be uncomfortable for that runner or for that person. Cause you may have to dismantle a lot of long-held beliefs. So how do you go about that with your, your athletes?
Speaker 2 (21:57):
I just asked everyone who who connects with me. I say, can you give me w what, what's your understanding of your situation? You know, and I think runners, a lot of times may not come clean if they're dealing with pain, because if they go to see a healthcare professional, they're going to be concerned that they're going to get shut down work. Perhaps they interpret it as a sign of weakness. If they're out on a group run, they don't want, want to be the one complaining. So I just say, Hey, you know, what's your understanding of your situation? And no one's ever asked him that. And that's when the conversation unfolds. So, and I think the way people respond is going to be different pending the person, the situation. But I think it's remissive anyone who's working with a runner or an athlete if they don't ask that question. I feel like I started to answer your question, but I don't know if I do.
Speaker 1 (22:48):
No, you did. That's exactly what I wanted. That's exactly what I wanted to hear. Cause I want the listeners to get as much of this like great little tidbits of information from you as they can. And you know, all of the questions, the questions to ask the patient that you've given so far, I think are great jumping off points for any therapist, regardless of whether you're working for, with a runner or an athlete. But that question of give me the, let me know, what is your understanding of what's going on? And that opens up a whole lot of doors for you. And then, you know, as the therapist, you have to be well versed in the science behind pain and, and how to talk to people. And, and of course it's a whole other conversation, but you know, I think what you're highlighting here is that you can't wing it.
Speaker 2 (23:36):
No. And I think sometimes, you know, I had a question from a third year DPT student who watched a presentation. I gave at some and they're like, Hey, I feel like I'm starting to ask the right question, but then I don't know how to respond and follow up. And and I think that, you know, you can't rush this process if you're in, if you're a young clinician that you're going to get better at this through reps, through life experience and just through sort of being in the trenches with people. But you know, the other thing I tell folks is I say, look, you're a smart person, you know? And I, you know, when I first acknowledge the fact, I think it's good that you're being proactive and addressing the situation, but left to your own devices. What do you feel like you, you need to do to get on the other side of this and they start to formulate a plan and I do, I don't need to do anything.
Speaker 2 (24:27):
I just need to pose these questions and say like, I think that's pretty sensible, you know? Are you okay if we nudge a little bit and you start to basically prepare them for the fact that this plan has got to be progressive, if we're talking about getting them back to running, because they have to get back to a low-level plyometric activity. And I just love these conversations. And, you know, people ask me, they're like, where you learn motivational interviewing. And I'm like, I lived in New York city for decade. I'm like, I just talk to people and I have no agenda. I'm just curious, you know, it drives my wife crazy. Cause if we're ever out in public this happened yesterday. I went to, I had to get a new watch because my watch crapped out and this guy was checking out some watches and we just got to talk to me. And my wife was looking over at me, like, where are we go?
Speaker 1 (25:12):
Your wife is looking at her watch, like, come on, Chris, get it together
Speaker 2 (25:18):
And things off the shelves.
Speaker 1 (25:21):
But it's true. I think that, you know, asking good questions, motivational interviewing a lot. Yes. There's a lot of books. You can pick any book on motivational interviewing and read it and it will definitely give you some insight, but it's the more you do. It's the more people you talk to and not just your patients, anybody, the more you talk to anybody, it will help you be a better motivational interviewer. And the more that you listen and like really listen and start to formulate it's practice. I guess you start to formulate your follow-up questions in your head as you're listening. And again, it's just practice, practice, practice.
Speaker 2 (25:57):
Yeah. And it's, it's fine. I think that it takes on a slightly different flavor as a function of, you know, what generation the person's coming from too, you know? So but yeah, it's just fun to help troubleshoot with people and to really get them to trust in themselves. Because most of the, the folks that consult me, I mean, they're endurance athletes, namely runners and triathletes these days, and they're going to manage their situation conservatively. Sometimes I feel like they need to be talked off the ledge. If they're going to opt for a more invasive procedure, if that's not really appropriate or perhaps an injectable of some sort. So, but yeah, getting people to trust in their body and and not drag them in for therapy all the time, you know, and I, I have to prepare people for that to say, you know, how do you anticipate this is going to go?
Speaker 2 (26:49):
And they're like, well, maybe I'll see you two to three times a week for six to eight weeks. I'm like, who's footing that bill. No, no, one's good. Yeah. So I say, you know, but this, this requires a lot of work on us on the back end because when I write an email, I mean, email, I wrote to this person yesterday, it was basically like, you know, two pages and cause it, kids dealing with the bone stress injury, the parents don't really understand the implications of it. He's going to be running competitively in college. And, and I think that he was under the notion that he was going to be back to running in four weeks. And I'm like let's talk about more like four months. And I lay this out and I'm like, you know, I know this is probably a little bit, you know, overwhelming, or you weren't expecting to hear this. What are your thoughts on this? You know, to engage him, to just know where he is after I've presented this information and he got the memo. But that's, that's a tricky thing about bone stress injuries is people fall under the, you know, the idea that they're just gonna take a couple of weeks off and plugged back in.
Speaker 1 (27:49):
Yeah. Yeah. And again, that's where you, as a, as a therapist and a coach comes in and helps the decision-making you're ultimately, you're not that runner, you're not that athlete. So you're not the ultimate decision maker, but your job is to give as much information and, and your professional opinion as to their situation as you can.
Speaker 2 (28:14):
Yeah. And I, I think that it traces back to that question is like, what are your expectations or questions around this surgery? I mean, this is a very involved procedure. They're putting you under anesthesia and they're cutting your body open. Never we'll frame it like that, you know, when I'm working with people. But you know, I, I rehabbed all of these people after these very involved, soft tissue procedures of the shoulder when I was in New York, coming from Dr. Nicholas in his staff. And yeah, I'm like, this is going to be six months to a year before you feel like your, your shoulder is like firing on all cylinders.
Speaker 1 (28:47):
Yeah. Yeah. I had, I had a complex soft tissue shoulder repair and it was a year anyway, we can go on and on when it comes to a patient mindset, fear, trepidation, everything else. I think that's for another podcast. But I think you definitely got across the decision-making process on behalf of us as a therapist or coach and how we can influence that process for the patient.
Speaker 2 (29:12):
Yeah. And I think that if patients aren't on board, I mean, if they are around muddy water where there's a sinister situation and they start sort of dilly-dallying, I think that we need to really put our foot down his therapist too and say, look, you know, you've consulted me and here are my recommendations or here's my professional advice. And if you're not going to take it, let's just, let's just part here. And sometimes we don't need to do that a lot, but I think sometimes we drag our feet as clinicians and we need to, we need to put our foot down if we have to protect that person from themselves, because we can't get tangled up in that mess. I can't think of the last time that's happened, but it has happened over the course of my career.
Speaker 1 (29:57):
So those, I mean, those are sticky conversations to have, but for the safety, I mean, our job is to protect that, protect our, our athlete, our patients. So if that is our job, then you have to have those sticky conversations. Yeah. And that's it. All right. So I think that was thank you for that conversation on decision-making and hopefully it sparks plant some seeds in our listeners here. And now we'll go on to two more questions that you usually, that you get the easy ones. You will we'll breeze through these too. These are easy. How do you become a runner running injury expert To how many times do you get that question? How can I do what you do?
Speaker 2 (30:41):
Yeah, I it's, I, I love getting it it's flattering. You know, and, and it's something that it was sort of, I looked back and all, I, there, there were a couple of defining moments in my life. And one was when I was told that I'd never be able to run again. You will never run again. Right. I heard that a couple of times from very world-renowned orthopedists. And I think that's what ultimately put me on a trajectory to do this. And I never ran competitively when I was younger. I probably should have been channeled into a little bit more of a, a running program, but I was always playing sport, different sports, you know, from skateboarding to soccer, to tennis, to baseball, to basketball, to lacrosse, to, you know, rollerblading snowboard, like you name it. I played it. And except football, just because my high school didn't have a football team.
Speaker 2 (31:39):
So I always relied on running to help me in sport. But I feel very fortunate in hindsight that I never started really formal distance running until I moved to New York city around like maybe 24, 25. But I, I think that when I started getting into triathlon is when I started working with a lot more runners. And I think when I started distance running, that was around the same time and it's just a fun bunch to work with. And I think that initially I was overconfident and it got to be frustrating when I'm like, geez, this is a healthy person. Like I would send them out. I'm like, Hey, I think you're doing good. And they would come hobbling home. Or they would call him and be like, Oh, I blew up on that run. And I'm like, why are these people blowing up on these runs?
Speaker 2 (32:25):
Like I thought they were doing a good job. And then it just really forced me to stare at myself in the face and say like, what do I need to be doing to really help these people? And, you know, I started reading a lot of the research. I started spending time around runners. I started speaking a lot with this fellow Bruce Wilke, who was sort of like a savant with running who unfortunately has since passed. But I started to really get a handle on running and not only on running, but just the mindset of runners, how they approach training how they've sort of just been dismissed by the medical community. Because you're like, Oh, here's a runner here comes another crazy runner. And then you start to realize that runner, when someone tells you they're a runner, you don't have other athletes.
Speaker 2 (33:09):
When you meet someone, you know, you could meet someone, you could meet a world-class athlete and they may not come claim that the fact that they play a competitive sport professionally, or they play a professional sport until you talk to them, runners like I'm here, I'm a runner, you know? And so they really stuff, they go through an identity crisis. So you have to look at this from so many different lenses. You have to understand the performance demands of the sport. You have to understand, you know, just running communities. You need to understand that these people's identity revolves around their running. So they become fragile when they're not running. So I just loved the challenge of, you know, addressing all these different factors and and it helps that I, that I'm still training and racing competitively because I sort of go through, I think a lot of the same struggles and challenges that they face so I can speak to them.
Speaker 2 (34:01):
But I think that if people want to go, go in on running as a young clinician, coach running is having a moment go all in, right. We saw an uptick and running with the, you know, with the pandemic. And I think that if you're going to work with runners, you don't want to say like, Oh, I do general outpatient orthopedic, orthopedic rehab. It's like, no, my whole practice revolves around running. You know, people are like, they come to me because they know that, you know unfortunately I've had a pretty rich experience in terms of my, my didactic training. And, you know, when I was getting reps under my belt in New York city. So I feel like now I can look at things through a very global lens when a runner presents and we can troubleshoot most of the time, I'm seeing people for one, maybe two sessions. But I think that that running rehab is challenging in a lot of different ways, but if people have a, an interest go all in,
Speaker 1 (35:02):
I think that's great advice. And I also really liked that. You just mentioned, Hey, I'm not seeing runners three times a week for six to eight weeks. You know, I'm not, this is not how I'm, I'm, I'm building my practice. And I think that's important to let people know, because I think a lot of newer graduates or students might be thinking, Oh, this is going to be great. I'm going to be working with people several times a week for six weeks. And then they're all better. Not so much the case when it comes to running injuries.
Speaker 2 (35:31):
Yeah. And their runners just seem to perpetually get these niggles and aches and pains. But, you know, I, I, I think it's doing a disservice because if you bring someone in, if you say, Hey, look, I need to see a couple of times a week for the next six to eight weeks. You know, someone told me that I'm like, man, I must have something serious going on. So I just say, Hey, look I'm not concerned. Anything sinister is present. I want you to be sensible. You're around muddy water, but carry on. All right. In calling me if you need me. And I think that they're like, wow, I've had people reach out and are, you know, this person told me they were running five to six days a week and their quads were a little bit sore. I'm like, Oh, you're good, man.
Speaker 2 (36:10):
You don't need to see me. You know, I said, and I asked him some, some more involved questions, but I'm like, you don't need to see me. That's a really empowering message, you know, because the person's like, Hey, I'm here ready to pay you. And you're telling me that you don't want to see me. I, one of a guy who's become a good friend of mine. He was dealing with some hip pain. He was in a bicycle accident and he had some films in between x-rays MRR because of a woman who who's pulling out of a parking lot, had collide with him for whatever reason. And you know, and I got a lens, you know, I saw his power profile on his bike. I saw the lifts that he was doing because we were training at the same facility. And he's like, I, I need to come and see you for physical therapy.
Speaker 2 (36:52):
I'm like, no, you don't. I'm like, I'm watching you lift, man. You don't need to come and see for, you know, let's, let's just chat. If we cross paths here and he's become a very good friend, he, he always jokes. He's like, you're the only PT you've told me not to come and see you. He's like all these other people are like trying to get me in and get me on these programs and tell me, I need hip surgery and PRP and yada, yada. So, but you need to know that nothing sinister is going on the flip side of the coin.
Speaker 1 (37:19):
Right. And that's where experience comes in and confidence as a clinician comes in as well. And that takes time. So you're not going to be, so what I'm getting is if you want to be a running injury expert, go all in, read the research, do the things, take the classes and take time. It takes time and leave your ego at the door.
Speaker 2 (37:39):
Yeah. And I think the patterns will become, they'll become pretty straight away in terms of where runners are getting into trouble. You know, where are these injuries are manifesting? And, you know, I, I think that most of it is being disconnected or out of touch with your ecosystem and not laying down programs that sort of reflect your ecosystem and realize that target is always moving. Right?
Speaker 1 (38:03):
Yeah. Yeah. Excellent. Okay. Final question of our interview here. And again, it's, it's an easy one. So, so we talked about this ahead of time. This is an easy one. So, well, how do I even phrase this in looking at the profession of physical therapy, what can we do better to define what we do and kind of stake our claim on what we do as a profession?
Speaker 2 (38:37):
Yeah. I still am organizing my thoughts around this. I went into physical therapy because I thought it put me in the best possible position to help troubleshoot with people through a conservative approach. And I think that the challenge we have is physical therapy is a very tricky thing to define. And I think that where we're ultimately, and this is a quote from Jen Shelton, who was you know, in born to run, she was a young gifted ultra runner at the time. I don't know what she's up to these days, but she's she's a trip in all great ways, but she said physical therapists are your best friends in healthcare. And I think that we're well positioned to be the first line of defense because we're trained across such a broad through such a broad range. So, you know, you may see us working in cardiopulmonary capacity.
Speaker 2 (39:40):
You may see us working in wound care. You may see us working in a neurologic geriatric with geriatric population. You may see us basically with working with pro sports teams you know, pelvic floor. I mean, it's tricky when you have all these moving parts, but I, I don't think that we've defined who we are as a profession, to the extent that we need to. And and I think that's why a lot of other people end up defining us sometimes in good ways sometimes in bad ways. But I think that it's sort of like, you know, I'm in Seattle, I'm going to use a microbrew example. You know, you have run of the mill rehab. And I think some people lump physical therapy ended up, but physical therapy to me is sort of like a microbrew, right. We need to tell people what to think about it.
Speaker 2 (40:34):
We can't let them conjure up their own ideas. We need to really define who we are as a profession. And and I, I don't think we've done that yet. I think that we're, we're getting there, but I don't, I don't think we've done a really good job defining physical therapy. Cause if you ask people, you know, people are like, yeah, I've tried physical therapy and we know the same, the response, it's a heat ultrasound TheraBand. And it's always funny when people connect with me, they're like, this is so different from like what I expect to physical therapy to be. And I'm like, well, what did you expect it to be? And it was generally the response is what I just mentioned. And they're like, you just helped me troubleshoot and in sort of the seamless way. And, and that's what I think we do.
Speaker 2 (41:21):
We triage and troubleshoot. But we look at things through the people who I really respect in life. They're able to look at challenging situations through multiple lenses. And I think that that's how we're trained as physical therapists. And I think that that's why we're in such an incredible position to troubleshoot with people. So I don't know why you've got my gears grinding even more. And I, I, I think about this morning, noon and night is, you know, how do we better define our profession? So we don't let people conjure up their own ideas of what it is, because I think a lot of times if they've had a bad experience, that it becomes very skewed in physical just saying physical therapy doesn't capture it.
Speaker 1 (42:09):
Yeah. I agree with that. And so what can we do as a profession to change that? I agree it needs to be changed. And I agree we need to be the ones out in front talking about what we do and how we do it and why we do it. So when, when you think about that, what sort of ways can we be out in front and take control of the narrative?
Speaker 2 (42:33):
I mean, I think it needs to be orchestrated. And I think that that's, that's a major challenge right now. Because I think that is a profession we're a little bit more fragmented than, than one might think. So I think that we have to have a lot of people come together from different sectors of the field and have have a long, hard staring in the mirror and talk with each other to try and arrive in a definition for what we do. And I think it's a really challenging thing, but I think it's something that is very important, but I think also individuals like yourself where you start to represent the profession. You know, I try to do the same thing. I think that holds a lot of weight too. So I, I think it, you sort of have to take a multi-pronged approach.
Speaker 1 (43:23):
Yeah, yeah. So you have to take that 30,000 foot approach by having a lot of people from different areas come together and give that wide umbrella. But then from a micro position, individuals can also be out there and trying to, to change, to make a change.
Speaker 2 (43:40):
Yeah. And and I, I'm confident that we're going to do that. I don't know. I feel like I'm in my early forties now and I'm starting to become more reflective in life. Right. And and really think about, you know, a lot of things, one of which is a profession and, you know, I just feel like a pig in poop having landed in this profession because I'm such a diehard PT, but I also, like, I feel like the perception of physical therapy needs to change too.
Speaker 1 (44:09):
And, you know, I will say that I do see it changing slowly. I mean, this is a big ship to turn and I'm talking from a societal standpoint. And I say that because I see more and more in mainstream media, whether it be on television, print, blogs, podcasts, et cetera, that journalists are now reaching out to physical therapists. Whereas they would have reached out to a trainer, a chiropractor, a yoga instructor, or something like that when it comes to their articles on everything from training to, I just did an interview yesterday about pillows, you know? So it seems like, well, what, why would they reach out to a PT about pillows? You know, but it's nice that they are reaching out to PTs about things like that. And things about training and things about COVID rehab and, and long haul COVID patients, you know, physical therapists are now being part of that conversation. I'm seeing that more and more from main street, main stream journalists. So I feel like that's a good sign.
Speaker 2 (45:12):
Yeah, for sure.
Speaker 1 (45:14):
A good sign, for sure. And, and also showing that journalists are open to hearing from different groups. So I always say to physical therapists like contact your local newspaper, if you live. And, you know, I'm from a small town in Pennsylvania contact that local newspaper asked to write an article, ask to, you know, be a contributor, get onto your local news stations find, cause that's, that's the way the general public finds out, you know, on social media, there are some people like yourself and others that have great social media followings and are putting out great content designed for the consumer. But a lot of physical therapists on social media, probably myself included do social media posts for other therapists. So it's a little different, right.
Speaker 2 (46:01):
Yeah. And I think that's okay. And I think it's
Speaker 1 (46:03):
Okay. Yeah. But I think we, it could be broader.
Speaker 2 (46:07):
Yeah. I just, I think that when I work with folks and I, I'm not alone here, but when people start getting a lens into my thoughts on a particular situation, if they're like, Hey, I have some calf pain, they call me on the phone. They're like, they may be an athlete. And they're like, Hey, I have some calf pain, but a great example. This guy reached out to me the other day. And he was dealing with what he was told was an Achilles tendinopathy. And he was under the care of a physician and other rehab professional outside of the profession and I'll leave it at that. And when he came to see me, his primary complaint was he was starting to lose coordination in his left, lower extremity on the run. And he started to feel more disjointed on the bike. This isn't an Achilles tendinopathy.
Speaker 2 (46:54):
He may have symptoms that, you know, that are consistent, but that's not what's driving. So, you know, you start to think of, okay, well what could this be? You know, is there something going on maybe like from a differential diagnosis, you're starting to run through like, Hey, is he's telling you this, like okay, is this unilateral? Is that bilateral? You know, is there any loss of sensation, strength, power you know, is this, like if we just start asking a different set of questions, you know, could this be a runner's dystonia? Could it be something like multiple sclerosis, it could be ALS. So you have to, when someone says, Hey, I have this complaint, we're asking in terms of what's running through our mind and the questions we ask, they're very different. So I'm going to start challenging him from different coordination tasks.
Speaker 2 (47:44):
I'm going to take them through lower quarter screen. I'm going to get a lens into his running. You know, I'm going to understand how an Achilles tendinopathy would present if he's not having issues doing calf raises. And he's able to sit there and jump in place. I'm like, you're killing is, is pretty, pretty good, man. You know? So for whatever reason, there's this timing issue in his Achilles is probably seeing a different or an unaccustomed rate of loading that, that he's not withstanding from a timing perspective. So, you know, he's someone that probably ultimately needs to consult a neurologist, right? So why is no one told him that for a year? And they're telling him that he needs to do a more aggressive form of scraping and he's a candidate for a PRP, excuse my language, but that. Right. So this is where our role is just so critical because we sit, we spend an hour with people or at least, you know, a lot, and we, we can sit there and troubleshoot with people and really get them into the right hand. Why is no one ever he's like your assessment makes so much sense to me. And so many examples. Yeah,
Speaker 1 (48:51):
Many, many examples. Well, Chris, this was great. What a good conversation. I think there's a little bit of got a little bit of everything in here, and hopefully we answered a lot of w V a lot of the questions that you get on, on a daily, weekly, monthly basis. So thank you so much now, where can people find you?
Speaker 2 (49:11):
I can't tell you no,
Speaker 1 (49:13):
I'm going off social media now.
Speaker 2 (49:17):
Instagram is good. I'm just at Chris Johnson, the PT, and I'm in the process of revamping my website and that should hopefully be done at some point in the next couple of weeks. And and that's gonna really just, I think, make it easy to understand what some of my offerings are and how to sync up with me. And yeah, for folks, if, if you want to sign up for a crazy newsletter please join my newsletter. It's a little bit of reverence. So I'm preparing it now in, in good ways. So,
Speaker 1 (49:49):
And how can they sign up for your newsletter? That'll be on the website and Chris Johnson, pt.com or Zara and PT.
Speaker 2 (49:56):
Chris Johnson, pc.com. Yeah. Going back to my roots,
Speaker 1 (50:01):
Go keeping it simple. Right? Well, this was wonderful. Last question, knowing where you are now in your life and career, what advice would you give to your younger self now that you're, you're pondering, you're pondering life in your early forties.
Speaker 2 (50:18):
Oh, stop taking yourself so seriously be present with people, equally people, power, power, your phone off, and and be present with people. And for folks who are who are coming to see you understand that a lot of what brings about changes in what helps people are these non-specific effects, you know, during a clinical interactions. So don't feel like you need to have this gnarly didactic knowledge. That's going to come in time by continuing to read the research, spending time around other mentors or clinicians. You respect taking courses from them. But if you can just be present and engage with someone, take a genuine curiosity in their situation, that's going to do wonders and and yeah, take the pressure off yourself.
Speaker 1 (51:07):
Excellent advice. Excellent. And I thank you so much again, Chris, for taking the time out. And we will see you in a couple of days next in a week or so for a round table discussion, which I also think will be phenomenal. So thank you so much.
Speaker 2 (51:22):
Yeah. Thanks again for having me on Karen and keep up the great work. It's fun to, to just sort of follow your, your journey and calling me if I can do anything to support you.
Speaker 1 (51:31):
Thank you so much. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart.
In this episode, we have Tom Goom with us again to join us with our running injuries and running rehab talk this March. Today we will be talking about acknowledging types of persistent pain in our athletes or runners.
He talks about the bigger picture on persistent pain and its other connections, differentiate this persistent pain versus series of acute flare ups, where we should focus the treatment, and navigating injured athletes return to their sport and many more.
Key Takeaways
- we mustn't lose sight of the bigger picture. And actually, I think sometimes we do need to acknowledge that it is more of a persistent pain state, and not necessarily a series of flare ups of acute injury.
- Gritting your teeth and pushing on through isn't always the right answer… we do need to know when we need to back off a little bit.
- Focus on getting you well and ready to race rather than rushing you to get through a particular event when you've got a whole life of running ahead of you.
- Try and see if you can recognize when you are looking at a more persistent pain state and to try and really get to know that person and the bigger picture and what's driving that
Suggested Keywords:
Pain, athletes, running, persistent, bigger picture, acute injury, symptoms.
More about Tom Goom
Tom is physiotherapist and international speaker with a passion for running injury management. He has gained a worldwide audience with his website running-physio.com and has become known as The Running Physio as a result! Tom remains an active clinician committed to providing high quality, evidence-based care.
Social media handles:
Twitter: @tomgoom
Instagram: @running.physio
Website: Running-physio.com
Resources:
Running Injury and Rehab Webinar
NetHealth Webinar
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Read the Full Transcript Here:
Speaker 1 (00:01):
Hey, Tom, welcome back to the podcast. I'm excited to have you on today.
Speaker 2 (00:06):
Thanks for having me back. I really enjoyed it. Last time we took proximal hamstring. Didn't we last time it was a good chat
Speaker 1 (00:13):
We did. And now this time you are part of the month of March and this month we're talking all about running injuries and running rehab. So what we're going to talk about today is persistent pain in these athletes. And I know this is something that you're seeing more and more of. So let's dive in what let's talk about as physical therapists or physiotherapists. Do you feel that we're acknowledging these types of persistent pain in our athletes or in our runners? Or are we just thinking, Oh, well, you know, they have this tendinopathy or this strain and it's just keeps recurring. It's just like a, it gets better and then becomes an acute injury again or this back pain. Oh, same thing. It, it kind of goes away and comes back. So what, what is your opinion on that? Are we acknowledging persistent pain in these athletic populations?
Speaker 2 (01:20):
Yeah, that's a good question. I think maybe we D we do look at it a bit more, like you're saying, we just kind of see it as a sort of repeated acute injury may be large rather than seeing it as a persistent pain problem. And I think that's because in part, when we see people with persistent pain, part of our, of our advice and our management is for them to be active. So if you've got someone to come see seeing you, that is actually already sporty, they're already active that, you know, you kind of think, well, what else needs to be offered here? And I think sometimes we don't really think about the sort of psychosocial practice in sporty or active people, because they're not obviously fear avoidance, especially if they're keeping their sport going. So we, we tend to go down the route. That's perhaps a bit more biomedical isn't now we looked at biomechanics, we look at strength and conditioning and these all can be valuable, but we mustn't lose sight of the bigger picture. I don't actually think sometimes we do need to acknowledge that it is more of a persistent pain state and a, not necessarily a series of flare ups of acute injury.
Speaker 1 (02:24):
How do we differentiate this is persistent pain versus a series of acute flare ups.
Speaker 2 (02:30):
Yeah, I think there's going to be an overlap between those things. We know that people with persistent pain that isn't necessarily stable with change can change quite a lot. People go through periods of quite severe flare ups as well. I think it's about sort of looking at the bigger picture and looking at the connection between things like pain and load. So in, in an acute injury situation with something like tendinopathy, quite often, there is quite a clear load pain relationship. It hurts when I load it. It doesn't hurt when I don't, I'm in a more persistent pain state. We might actually see that that relationship becomes a lot more blurry that the pain may well flare up when load hasn't changed or the pain may remain present. When there isn't a great deal of loading going on. So we start to see a bit of a breakdown of that connection between load and pain. And perhaps you start to see other aspects influencing symptoms, you know, lack of sleep, stress, fear, et cetera. We see other sort of types of behavior creeping in there as well around maybe avoidance coming in. So now they are backing away from their sport. So I think that's something we need to have a lookout for particularly that lack of relationship between load and pain and then exaggerated pain response as well.
Speaker 1 (03:48):
And when we're looking at these more sporty athletic people are runners how do they differentiate from say maybe our non sporty or non-running population?
Speaker 2 (04:01):
I think that there will be some definitely some, you know, some crossover between different people in different groups. And I really would, you know, w I use the term athlete, but I, I have a really broad definition of that. Someone, someone who wants to be regularly sporty and active fits that category for me. So I'm not necessarily necessarily when I say athlete referring to an elite athlete, competing at a high level, this, this can be people that want to be running three or four times a week, that really comes in that category too. But I think they can have, you know, similar concerns to someone that's not sporty around pain and damage, for example. So they might have similar concerns there. They might both have quite high life load which is a term I quite like this, somebody mentioned in one of my courses recently.
Speaker 2 (04:49):
So, you know, this is where you've got lots of stress going on with, with work and family life this kind of Highlife load that plays upon your pain. And they may also both groups have poor recovery. So, you know, athletes may not be brilliant sleepers non-athletes may not be brilliant. Sleep is too, they might not get much downtime much emotional recovery. So there can be quite a lot of of overlap. I think perhaps where they differ is they may have quite different goals. So I think it's, I see Mike might have wanted to go back to running half marathons, marathons, ultra marathons, and beyond potentially. So that might be quite a different goal to non-athletes that want to be more functional with day to day activities or lower level activities, perhaps like walking distances and perhaps something that we do see in athletes.
Speaker 2 (05:38):
That can be different though. Again, we see this in non-athletes too, is they may be a bit more inclined to push through pain. Most of us that have done sports at any level will know that pain is quite often a normal part of sport. And to some degree we do have to work with it. If, if we stopped every time, something we we'd never really, really do sport for very long, but this isn't necessarily always the right approach, gritting your teeth and pushing on through. Isn't always the right answer. And it's not always obvious that that's the case, but sometimes actually we do need to know when we need to back off a little bit. I'm an athletes particularly really highly driven athletes may not be quite so good at recognizing when they need to back off.
Speaker 1 (06:21):
Yeah, that's for sure. Especially if, like you said, they've got this goal of, I want to run a half marathon and marathon or an ultra to be able to, to have to abandon that goal due to pain, persistent pain or injury is, can be very devastating. Right. So how do you, how do you navigate that with your athletes and with your runners, especially with a more persistent pain, how do you navigate that? Very, I would say very sensitive goal or topic with these, with these runners or athletes.
Speaker 2 (06:58):
Yeah. It's not, it's certainly not easy. I think it's it can be challenging. I think wherever possible, we want to try and invite them to review their expectations and goals. So that it's not necessarily us being prescriptive and saying, this isn't realistic, or you're not going to achieve this, but if we can help them have slightly more fluid expectations of themselves and slightly more realistic goals, the ideal world then is that they then come around to the idea that perhaps this marathon they've got on the horizon, if it's not realistic for them, that they can set a different goal with it. And th this is one of the things, again, sometimes with, with higher level athletes, certain personality types is that being, being able to persist is a good skill, a good good thing to have, you know, and you need it when you get to sort of modulating 19 in the marathon and your legs are heavy.
Speaker 2 (07:50):
And, you know, you've got to keep going to hit your target. Tom, you need that in the time. You've got to have that level of persistence. And, and for that to be at least a little bit rigid because you you've got to, if you're going to achieve that goal, you've got to keep going, but to keep going at a certain time. So at times that rigid persistence is useful, but if you apply that all the time when circumstances are changing and your expectations are rigid, it doesn't really work very well. So for example, with the situation's changed, you're now in quite a lot of pain, you're struggling with day-to-day activity. This marathon is, is a lot closer now than, than we would, would like it to be. Ideally we have to try and encourage them to be a bit more fluid there and say, okay, well perhaps what we need to do is change that goal a little bit.
Speaker 2 (08:37):
Let's push it a little bit further down the line, give ourselves a bit more time and helping them see the positives of that decision can help. So you all often say to them, well, you know, if we can, if we can move this, you know, a few months down the line or let's go for a half marathon or a 10 K, it's going to take the pressure off you. You're not going to feel like you're constantly chasing your tail because you're trying to catch up with the training. You're not able to do. You're going to be able to focus on the rehab side of things. You're not going to feel so much pressure, and we can really focus on getting you well and ready to race rather than rushing you to get through a particular event when you've got a whole life of running ahead of you.
Speaker 1 (09:15):
Fair, very fair. And, and I think that's great for clinicians to hear, because I think that wording is very sensitive to the, to your patient and also gives them the goal gives them that aspirational goal that they can eventually get to. So I think that wording was great. Thank you for that. Now here's a tough question. And, and I don't know all the answers to this one, but in your opinion, and in your experience, what do you feel may be driving persistent pain in these runners or athletes?
Speaker 2 (09:53):
Well, we had us, that's a good question. Isn't it? A million dollar question and I would acknowledge I don't, I certainly don't have all the answers with this, and I don't think the research does yet either because it's an area, you know persistent pain in athletes isn't brilliantly well researched. So I think there's a lot that we can, we can learn about this, but there's a few things that would, I think, would spring to mind here. So I think beliefs are important. So and this is, can be beliefs around what the pain means. And then they, you know, what the pain means is if it's, if it's a sign of damage if they think it means they need to stop their exercise altogether, how they feel their body's gonna respond to exercise when they have pain that continuing to run, for example, will that be more harmful for them?
Speaker 2 (10:38):
It can be around beliefs around training too. A lot of people will feel that unless they're pushing themselves a hundred percent in every session it's not worth doing. So that can be quite difficult then for them to pace themselves and modify their training because it kind of all or nothing really. I think one of the things that I'm realizing more and more over the years working with with people and athletes is if they are quite heavily reliant on the sport for their mental wellbeing, then that can have a bigger impact too, because they might be using that, that sport to help them with their mood or anxiety or depression. So if they can't do their sport, it increases the impact of the injury. And I think it increases the fear associated with that because they're losing this coping strategy, they're losing physical fitness, they start to worry about the future.
Speaker 2 (11:27):
And I think maybe that links in with pain science, because it increases the threat that this injury has, and that has the potential then to have a knock on effect in terms of the pain and increasing pain severity and things. And a lot of these things are interlinked. I think training behaviors go hand in hand with that, you know, tending to push yourself hard all the time, boom, or bust, things like that. I think there's also a lot of stuff that we might not necessarily, we see like negative messages from others. So other other athletes, sometimes coaches, health professionals, unfortunately I'm so pumped. Sometimes we can be responsible for that life. I've treated lots of runners. Who've been told that they should never run again, for example, by various different health professionals. So we need to be aware of that. I think Google might have a lot to answer for I don't, I'd love to know. I think you've been Dr. Google doc to goo exactly. I don't, I don't know many situations where someone's been worried about something and put it into Google and felt better.
Speaker 2 (12:31):
What you find is the worst case scenario from it, which does amplify, you know, it does amplify people's worries. And that's actually something as a clinician, I would check in with your patients about what what'd you do when you worried about this? Did you go and Google it? What'd you find when you Google it? How does it make you feel? Because quite often they'll find the worst case scenario and I feel a lot more worried. So we want to discourage them from doing that, come to us. If you've got questions about your care, that's what we're there for really. So there's a lot of things that also impact of the injury, perhaps not being fully addressed. So you know, looking beyond the kind of physical impact of the injury, but the loss of the social side of the sport, the loss of their identity around sport the effects, as we said, it might have on mental health.
Speaker 2 (13:18):
There's lots of other things that go alongside the injury that often don't get talked about. And if they're not addressed, I think they can amplify it as well. And then the final thought I would add to this is perhaps if not had really particularly appropriate rehab it may be, it's been very focused on pain and not really focused on function in maybe that it's not been progressive and it's not really looked to address their rehab needs, lots of stretching and foam rolling and, you know, ice and, but no real kind of planning and progression in that.
Speaker 1 (13:50):
Okay. So that leads me to the next question as clinicians, where should we be focusing our treatments? Good segue there.
Speaker 2 (13:57):
Yeah. I like the connection. You've done this before, I think. Yeah. Yeah. I think, I think he's got to start in the first session with trying to develop an understanding for that person, if we can help them to, to understand their injury. And it takes time to build on that, but really make that part of that first session and give them the opportunity to share their story in that first session and also to air their concerns. You know, I really think we want to make the focus of these treatment sessions on the patient and their needs, not necessarily a kind of a list of things we need to tick off to do in a session because there is actually research showing that quite often, people whose needs aren't really identified we can be quite dismissive as clinicians. So we want to get in there right in the early, early stages and say, you know, what would you really like to, to from, from your treatment?
Speaker 2 (14:52):
What are your concerns? What are you particularly worried about here? What would you really like us to help with? Because we can start with that. I think that helps us form a good, strong connection. We can really help them understand the injury and build on it from there. I think that alongside shared goal setting, I think big PA plan of I'm a big fan of collaborative working you know, so you're working towards their goals. How can we help them achieve those goals together? And again, get a good idea of those in the first sessions. And it is part of the reason I really love working with rhinos is because many of them have a goal. Even if it's just, they want to get back to running 5k, you know, great, brilliant. It's a measurable goal. We can start the planning towards that pretty much from, from session one.
Speaker 2 (15:37):
And then we do want to have some progressive rehab because they're all gonna be psychosocial factors. In many cases, we've talked about, you know, beliefs to address perhaps poor recovery load management to talk about that quite often, there are physical needs as well. So we need to address those if there's a lack of strength or control or range and address them in a progressive way, as opposed to just loads of stretching and rolling, and then we can start to do a graded return to sport when, when they feel like they're physically and psychologically ready to engage in that.
Speaker 1 (16:10):
And what are some, some examples that maybe you can give of the types of diagnoses or the types of patients that you're seeing coming to you with persistent pain, you don't have, we don't have to go into, you know, the specifics of how you treat XYZ, but what are some things that you might be seeing in your patients coming to you with persistent pain?
Speaker 2 (16:36):
So I, I do specialize to some degree in tendinopathy. So we will see a lot of patients with long-standing tendinopathy lots of patients with proximal hamstring tendinopathy, because that's particularly the area I've researched in. But it will say Achilles tendinopathy issues as well. See people with low back pain and hip pain as well, falling into this category people with persistent patellofemoral pain syndrome persistent bone stress injuries, like medial tibial stress syndrome. So it's do see quite a mix. And, and many of those will have been treated first and foremost in quite a kind of biomedical model. I think,
Speaker 1 (17:16):
Yeah, so I think I just wanted to ask, cause I think it's important that clinicians out there hear like, Oh wait, you can have a persistent tendinopathy problem. You know, you can have like, Oh, I, I wasn't aware. I thought, you know, after let's say proximal hamstring after a year of rehabbing, if that kind of comes back, Oh, it's probably just like a muscle strain. It's probably not that tendinopathy again or, or not again, but it continuation of that. Absolutely. Yeah. And
Speaker 2 (17:50):
To give you a clinical example then, because we talked a little bit about how the connection between load and pain can be blurry about how that may, we may see an exaggerated response. So to give you an example of that proximal, hamstring, tendinopathy patient that I've been working with who will not be able to sit for more than maybe 30 seconds because that will really cause a flare up in their symptoms. Now we can see then that's a, that's a really exaggerated pain response. And the average person sits for somewhere around six to seven hours a day. So not to be able to tolerate even 30 seconds of sitting because there's pressure around that that tendon is, is an exaggerated pain response. And that person's pain will fluctuate not necessarily in line with load. So there'll be days where her symptoms are much worse and she doesn't really know why it's not because she's run a long distance or done anything different.
Speaker 2 (18:53):
The fluctuations in activity levels might be small in the range of a few minutes here and there. And yet the pain response is really exaggerated. And again, I talked about sort of beliefs and things go going into, you know, going into this area. And when we talk to this particular person about her beliefs, you can see she's very concerned that sitting damages the tendon and therefore that adds to the threat value associated with the city. She's very fearful of sitting when you ask her to do it, you can see she's really reluctant, but also we need to acknowledge why it really hurts. It's really hard for a long time. So there should be no judgment and our pie, we should be reckless. Yeah. This is really difficult. This is having a huge impact on this person's life. Can't if you can't sit down and even to have a cup of tea or to watch a move at the end of a long day, what should we eat dinner? Like that's big. So I think we have to recognize that as a persistent pain picture and with aspects of tendinopathy in there that we can manage, but just seeing it, like you say, as, Oh, it's just another flare up of the proximal hamstring tendon. We were missing that bigger picture, I'd say.
Speaker 1 (20:01):
Yeah. And that was a great example. Thanks for that. And now, you know, when we talk about running, we talk about athletes. So one thing they all want to do is they want to return to their sport. So can you talk to us a little bit about how we navigate that, how we prepare these people to return to their sport and what that, what that sport may look like?
Speaker 2 (20:24):
Yeah. I think, I think maybe we start, if we can, by seeing if we can reduce irritability a bit where possible. So if we think back to that lady, I was talking about Verrier to boost symptoms at the moment. So if I go straight into a greater return to running, I think that's probably going to be a little bit too much to start with. So in many situations we may we say, okay, let's see what we can do to reduce the symptoms and irritability helping someone understand their pain and that it's not a sign of damage can help helping them work out a list of things that may help to reduce their pain. Maybe particular exercises that help simple things like, you know, using heat or ice if necessary, but trying to give them strategies and work with them. So they've got a little bit of a list of things that can turn that, that pain volume down a little bit, and we're placing them in a bit more control, reducing that threat value.
Speaker 2 (21:17):
And then we can start to work towards that graded return to sport. And again, if we want to plan together because we really want the person to be in the driving seat and us maybe just helping, you know, being a bit of a satnav along the way to keep them on track. So we've had this recently really lovely runner I've been working with who in the first session said to me you know, what she'd like to do is first of all, build some strength then increase her cardio fitness by bringing in a bit of cycling and swimming. Then she wanted to bring in some, some impact and some plyometric exercises before doing a graded return to running. And I thought immediately, brilliant, this is fantastic. This person has a great plan.
Speaker 1 (21:57):
And they find this woman,
Speaker 2 (22:00):
I met wonderful one, and this, this is someone with a lot of experience in sport. Who's also studied a sport of science, so knows the topic really well, but that's a fantastic plan. Let's go with that plan and just help the person with their plan there. So, and we might follow quite a similar plan to that for, for patients. You know, we try and calm things down where we can, we build some strength to try and address some of their physical needs. We bring in some cardiovascular exercise to build some fitness up. We start to introduce impact because it can build impact tolerance, but it also is often a a way of developing some power. So perhaps some plyometric exercise to restore power, which is often neglected in rehab. And then we start to do a graded return to running and that's then where we got to try and work with them around their goals and also work with them around pain. And that can be a bit of a barrier.
Speaker 1 (22:53):
Yeah. And so how much pain is acceptable? How much is too much? Yeah.
Speaker 2 (22:59):
Like our pain scales you know, sort of scoring pain out of 10. And I, I would say there's actually quite a few studies that have done that quite successfully. So I think there's some value in that. But what we've talked about with these pain groups is that the connection between load and pain, isn't very clear and the pain response is exaggerated. So if we're guided purely by pain, we are going to struggle a little bit, I would say with these patients. So I would tend to say that the patient needs to decide what they feel is acceptable, and we provide some, some guidance. And we need to try, and if we can look at longer term trends, then now patients quite understandably might get very focused on day-to-day pain fluctuations, but it's actually more the long-term in pain over the, over the weeks and months that we're a little bit more interested in.
Speaker 2 (23:49):
And we also perhaps need to recognize that there are almost two slightly separate goals here, improving function and improving pain. If you're seeing improvements in function and pain, hasn't changed, that's still a win because you're doing more. In fact, that's quite good when, because you're doing more and your pain doesn't get worse, but patients often won't see that as a win because understandably they may want that pain to go away, but we can often folks first will say, okay, well, let's start with what you feel is a manageable level of exercise. Let's work with it consistently. First of all, and then gradually build as long as you feel the pain is, is an acceptable level. And sometimes what we tend to see then is over time, they're able to do more and more, and then gradually that pain does subside because they're able to do more.
Speaker 2 (24:39):
They're more confident they're starting to get their life back. The threat value of the pain is starting to go down, but that takes quite a long time. So I think quite often, wherever possible, placed the focus a bit more in function and just save the patient a few phone that feel that it's manageable. It's acceptable. This is fine. If it's too much, if it's not manageable, we'll dial it down a little bit, but we want, if we can to stay consistent with exercise, because otherwise we're going to have a lot of beam, bus tear will build you up and stop they'll drop and stop. We want to just see, can we keep you ticking along, even if it's at quite a low level
Speaker 1 (25:13):
And do you have your patients keep a log or a journal or some way so that they can see, Oh, I was doing this. I started with Tom on March 1st and here it's April 1st. And this is what I was able to do Marsh. Now this is what I can do in April. My pain's around the same, but look at how much more I can do, or maybe my pains a little less. Or do you, how do you keep track of all that? Do you give that to the patient to help them with their own sort of locus of control? And are you using the pain scale? Are you saying well, what is your pain March 1st? Let's compare that to April 1st. Let's compare that to March 1st.
Speaker 2 (26:01):
Yeah. I would try and see if we can monitor that goal activity because it's important to be able to see that they're improving and they're progressing towards their goal. If you've got quite a specific goal, like running a 5k in order to get that, you've give it a C you know, how, how far you're able to run. And that's the simplest question. How far can you run now? But that can be it could be steps for day. If someone's wanting to build up their walking, it could be minutes rather than miles with any activity, really. So I think it's a good idea to try and monitor what people are doing. I do, I do use the pain scale a little bit. It depends on, on how comfortable the person is with it, whether they like using that. I tend to perhaps make it a little bit more simple and just say, is your pain mild, moderate, or severe sort of break it down into those into those three sort of different categories, really.
Speaker 2 (26:58):
But the thing is with pain is there's so many different aspects of it. Are we talking about average pain day to day? We talking about peak pain. What did the pain get up to is it's at its highest, we're talking about pain frequency. So how often you've had that pain during the day, are we talking about pain distress, which I think is almost a separate thing. How distressing are you finding that pain? So if you're especially worried about it, that pain often will be more distressing, even if the severity isn't necessarily higher. Do you see what I mean? So I think, I think where possible we focus on the golf function and we, we try and take that focus off pain a little bit because as well, you know, if patients are monitoring it every day, that drawing that focus on pain every day, and they're asking ourselves, how much does it hurt?
Speaker 2 (27:47):
Even some patients have no one used the term morning MRI. I used to get up in the morning and do it, do a sort of stretching test on his Achilles. That was what he called his morning MRI to test the Achilles out and see how he thought it would be that day. We don't really want to do that. To be honest, we want to focus on what your valued activities let's really try and bring them back in, build those up and keep a kind of a little casual, casual notice of pain, let pain tell us if it's too much, if it's breaking through, into your attention and in telling you it's too much, that's probably when we need to act, if you're looking for it, if you're, if you're kind of really questioning, is it worse today? I'm less concerned about it.
Speaker 1 (28:26):
Got it. Yeah. So you don't want them to, you don't want your patients to be waking up and be like, wait, do I feel, do I feel more pain today? Weight you're you're well aware that you have pain.
Speaker 2 (28:38):
Yes. Yeah, absolutely. I think that calling is focusing on the pain as well. It's quite, it's quite a normal thing to do. I think we've kind of pathologized it a little bit. But I think actually it's understandable for people to do that. There's another layer of context around the pain and what it might mean and what that might mean for your, for your future. So I'll give you an example from myself. So I have I have psoriasis and I have nail bed changes with psoriasis and that increases the likelihood of you developing cirrhotic arthritis. So a couple of weeks ago and surfing on Twitter and someone posts a link to a research paper that says new studies shows link between nail bed changes and severities, psoriatic arthritis. And I start thinking, yeah, my fingers are a bit sore today, you know, and that's one of the areas where you can get psoriasis, arthritis, changes in the joints and the fingers.
Speaker 2 (29:41):
And then I throw it comes back a little bit later that day and for a few more days afterwards, and now I'm sort of noticing like achy thumbs hands are a bit stiff in the morning. And if I allow myself to keep focusing on that and measuring that and worrying about that, it would be understandable that that could become really quite a worry for me, because then you think, well, is it cirrhotic arthritis? That's been, that's known to actually affect the joint and perhaps even damage the joint. And if I've got nail bed changes, that means it can be very severe. And what impact would that have on my life? And these are all just normal things that we have as, as people, as health professionals that know quite a bit about pain. So I think we can acknowledge for someone who's not a health professional.
Speaker 2 (30:25):
There's probably a lot of that going on, particularly the pain's been there a long time and pains is a real nuisance because it can, you can kind of like stop worrying about it. And then, then you have the pain and it kind of reminds you and goes on about you and that can start worrying prices over again. So it is hard. And I think sometimes it's health professionals, we think like, well, I talked to them about their pain and I reassured them that pain doesn't damage tech. But that if you think that that is enough to wipe out that concern, we are. Yeah, but we may need to be consistent with that message several times. And we might need to encounter that worry coming up several times and to try and help someone contextualize their symptoms and to see that not what they're fearing, but what really is going on.
Speaker 2 (31:18):
And to look at a bit the now of how symptoms are. So with my hands, you know, I don't have any of the classic signs of cirrhotic arthritis. I don't have swelling. I don't have a loss of joint range. I've actually been tested for psoriatic arthritis and it was negative. So it was trying to contextualize it and see the reality is I've just turned 40 and I've got slightly stiff fingers. That's the reality. So let's focus on the now and what is real for you now and not what you fear might be coming up in the future.
Speaker 1 (31:47):
Yeah. And that's something that I say to myself every time I wake up and my neck's a little stiffer sore, you know, my upper back feels a little sore instead of my, what I used to do is, Oh, okay. I better not go to work today. I better just relax. Let me get a heating pad. Let me just, I don't want to do anything. I should probably just lay down. And these are all the things I used to do. And so now when I wake up or if I do have a flare up of neck pain or something like that, now I'll just say, okay, I know nothing is seriously damaged. I have the MRIs to prove it multiple. And you know, these are just things that I have to continually say to myself. And I think I'm pretty well versed in, in the science behind pain and, and even working with people with persistent pain. I mean, I do it every, but even for myself, I have to continuously sort of recite these mantras to myself in order for me to get through the day when I have a little bit more discomfort or pain. So the struggle is there, you know, and I think imparting that and telling that to your patients, especially your runners with persistent pain. I think that can be very powerful.
Speaker 2 (33:07):
Yeah, absolutely. And, and recognizing, as I said, the bigger picture of knowing the person and, and the things that make them make up them as a person. And if they are, for example, running to their mental wellbeing, what, what, what is the, the thing that, that they're running to help? And how does that link to their pain? Are they running to help anxiety? In which case are they someone who is perhaps going to struggle with negative thoughts about chain, and they're going to be drawn into ruminating about those negative thoughts about pain, and they're going to be looking for reassurance that those thoughts, you know, jumping on Dr. Google, I'm finding actually it makes it worse because they see all the negative outcomes they're afraid of laid out on a web page. So if they are someone with, with that, then they, they may need more, more help with that. They may need to, you know, you may need to work with a mental health professional to help them work with those thoughts and to find ways perhaps to not get drawn into that ruminating pattern and to look for other coping strategies, we show it to them. The long-term can be useful because they're less reliant and upon the sport, because they actually learn perhaps a slightly different relationship with that, with their thoughts and from that, then can help that their mental wellbeing.
Speaker 1 (34:22):
Yes. I agree with that. And Nelson, before we kind of wrap things up is there anything that we missed or that maybe we flew by a little too quickly that you want to elaborate on? And if not, what would be your best advice to a clinician that is working with AF that is working with people with or athletes with persistent pain problems?
Speaker 2 (34:54):
I think in terms of things we might have missed, I just would say that there's a, there's a nice paper from Halon as torn in 2017 that's well worth a look, which is, is actually looking at things a little bit more in terms of pain in athletes. And there's, there's quite a nice quote in that that I'll just briefly read now if that's the case. So they say even low level inflammation, for example, linked to sleep deprivation, ongoing stress and load exceeding the tissues capacity can reduce the athlete's mechanical nociceptive threshold sufficiently to make normal mechanical demands of sport painful. So that sort of Lincoln into this bigger picture stuff saying here, actually, if we're not recovering enough, or the load is excessive on the tissues, it's actually going to have an effect potentially on sensitivity know nociceptive threshold.
Speaker 2 (35:49):
So this is where it's quite important for us to see the bigger picture. They also say in that paper that the, the link between tissue change and pain is thought to reduce over time. So if you've got someone with very persistent symptoms, years' worth of pain, you should already perhaps be suspecting that this is probably not just going to be driven by the tissues. I mean, when is there ever a situation where pain is, but, you know, it's probably going to be a bigger picture here that we need to identify. And I think that's probably one of the key messages to take from what we've talked about. Hey, really, you know, you, you start right with the first question is perhaps just to, to try and see if you can recognize when you are looking at a more persistent pain state and to try and really get to know that person and the bigger picture, and what's driving that because then I think you're going to get better results with them and then try and see if we can work gradually towards their goals and just keep them on track with it and give it time.
Speaker 2 (36:45):
It will take time, you know, this, the patients I'm seeing, we're looking at at least six months, probably a year of working together because there's so much to work through. I think we sometimes say, Oh, we reassured them about their pain. Give them some exercises away. They go, it's not really like that. You know, it's going to be lots of ups and downs. We're going to have to stick with them for a while and just keep chipping away, but you can get some really good results with people and you can get them back to the sport that they, that they love. And that can be a really, really big thing for them.
Speaker 1 (37:13):
Yeah. that's a great way to to end our conversation here. One, one question, what was the, who's the author of the paper from 2017?
Speaker 2 (37:26):
I think it's Hamline at all. I believe it was in the but I can find a link to it for you to put in the, in the show notes, if you would.
Speaker 1 (37:36):
Perfect. That would be great. And I will look it up as well. But thank you for that. Now before we finish our conversation, where can people find you? If they have questions?
Speaker 2 (37:48):
Yeah. Come and say hello on on Twitter, I'm at Tom goo or an Instagram ad running dot physic. Also I've got my website, which is running-physio.com. So yeah, come and say hello, ask questions and things. So it's good to chat.
Speaker 1 (38:03):
Perfect. And last question. What advice would you give to your younger self knowing where you are now? And I know we've, you said this before is, and I have to say something different. Now you get a chance to give yourself a second piece of advice.
Speaker 2 (38:16):
Oh, good question. Oh now that I'm thought 14 spending a bit on top, I'd, I'd say really enjoy your hair while it's there. Yeah. now I don't know, in all seriousness, I think I would probably sort of say you know, really make sure that you kind of value value, that things are important in life friends and the family, you know, always, always try and put those things first because ultimately they're, they're the things that are most important for us. And I think a lot of people already know that and I've learned it, especially during COVID, but I think there's a lot to be said about, you know, focusing on family and friends and things first you can still have a very fulfilling career and things, but I think that that's the important, the important stuff. That's what makes, makes life great. Really
Speaker 1 (39:08):
Excellent advice. Well, Tom, thank you so much for coming on to the podcast again and sharing all this great information with us. I really appreciate your time. Thanks for having me back here. And it's been really good pleasure, pleasure, and everyone. Thank you so much for listening. Have a great week and stay healthy, wealthy and smart.
In this episode, Founder and Host of Entrepreneurs on Fire, John Lee Dumas, talks about the 71000-word, 17-step, 273-page success roadmap that is his first traditionally published book.
Today, JLD talks about the launch of his book, The Common Path to Uncommon Success, and we get to hear a few of the 17 foundational steps to success, and we hear about identifying what we want to achieve, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “The online experts in this world... will lead you to believe that the path to uncommon success is “secrets”, “hidden”, maybe it’s “complicated.” It’s none of those things. All of them [successful entrepreneurs] have taken what has turned out to be a very common path to uncommon success.”
- “Freedom is one simple word, but it’s so hard to attain.”
-
A few of the 17 steps to uncommon success:
-
Identify your big idea. “So many people are living and acting in a weak, pale imitation of somebody else’s big idea.”
- Discover your niche. “Identify, within your big idea, an unserved opportunity.”
- Create your content production plan.
Suggested Keywords
Uncommon Success, Roadmap, Process, Entrepreneurship, Wealth, Prosperity, Freedom, JLD, Entrepreneurs on Fire,
More about John Lee Dumas
John Lee Dumas is the Founder and Host of Entrepreneurs on Fire, an internationally-acclaimed award-winning podcast with over 1 million monthly listens and 7-figures of annual revenue. To date, he has interviewed over 3000 of the world’s leading entrepreneurs, including Gary Vaynerchuck, Barbara Corcoran, and Tony Robbins.
His first traditionally published book, The Common Path to Uncommon Success, is an amalgamation of the lessons learnt from the over 3000 interviews he’s done.
Get the book: https://uncommonsuccessbook.com
To learn more, follow JLD at:
Facebook: John Lee Dumas
Instagram: @johnleedumas
Twitter: @johnleedumas
YouTube: John Lee Dumas
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here:
Speaker 1 (00:01):
Hey, JLD welcome to the podcast. I am so excited to have you on
Speaker 2 (00:06):
Fired up to be here. Thank you for having me and listen. You've got a beautiful cat. I've got a beautiful dog. They might make a Paris's in this interview who knows
Speaker 1 (00:15):
It is possible. And I have to say, this is like a full circle moment for me, because I have always as a podcast or looked up to you for your podcasting, for your show entrepreneur on fire 3000 interviews. I mean, that is, that is amazing. And, and for all the listeners out there that is not easy to do. And now you've got a new book coming out. Your first traditionally published book. How exciting is that?
Speaker 2 (00:47):
Listen, I'm fired up. This is a combination of the 3000 plus interviews I've done over the last decade. I've interviewed some of the world's most successful entrepreneurs over the years, and I've learned from every single one of them. I mean, every one has been my mentor and I've been able to distill their genius down into what has turned out to be 71,000 words of my blood, sweat, and tears. Cause it took me 480 writing hours to write the 71,000 words, the 273 pages that comprise this book. But I couldn't take a single word out. This is a definitive 17 step roadmap to financial freedom and fulfillment. So if that's interesting to you, this book is your guy,
Speaker 1 (01:34):
Which is amazing. So it's the common path to uncommon success, the road to financial freedom and fulfillment. And you know, you, as we know, have been very successful online entrepreneur, but let me ask you a question. Sticking in that online entrepreneur have people been lied to by the quote unquote experts in the online business world.
Speaker 2 (01:59):
Listen, the online experts in this world. There's a lot of fantastic ones that are doing amazing things out there. And there's some not so fantastic individuals out there who will lead you to believe that the path to uncommon success is secrets. It's hidden. Maybe it's complicated. Listen, it's none of those things I've seen over 3000 successful entrepreneurs and I've interviewed over 3006 successful entrepreneurs. And I've seen that all of them have taken what has turned out to be a very common path, a very common path to one comma success. Now, by the way, it's hard work. It is absolutely hard work, but it's a common path. It's not secret. It's not hidden. It's not complicated. It is a very, very clear, very common path. And it's not something that, again, these so-called gurus that will try to, you know, sell you some key for $1,997 and 97 cents. Like, listen, that's the answer. The answer is clear. The content is out there. I've done over 3000 interviews. You have individuals like Karen and others who have done interviews. There's great content out there to be had. And I could tell you right now, just go listen to all 3000 of my episodes, but that's tens of thousands of hours or is distilled down into one book, 17 steps, 273 pages. And it's there for you. That's the common path to uncommon success.
Speaker 1 (03:29):
And when you look at success and we look at financial freedom and fulfillment, what, what do we really want to achieve here? What does that mean?
Speaker 2 (03:38):
So this is what I've really identified. That individuals really desire in life. Freedom. Freedom's one simple word, but it's so hard to attain, but think about it when you're free every single day to wake up and to do these three things, do what you want, where you want with whom you want. What else is there in life? Like when you can literally say, I get to do what I want to do, where I want to do it with whom I want to do it. I have that freedom. That's happiness, that's success. That's what people want. And this is what so many people have been able to achieve. You know, unfortunately, a lot of people don't think that's possible and they will never be able to achieve as a result. But those type of people don't listen to podcasts like this. So I know I'm talking to the right individuals right now. It's there. It's possible. It's, it's, it's a, it's a common path to your version of uncommon success.
Speaker 1 (04:38):
Now, you know, you say in the book, it's a 17 step roadmap. Most people will give you five steps or maybe eight steps, right? So what, what is the 17 step roadmap? If you can give us a couple of little snippets or details.
Speaker 2 (04:54):
So here's the process it's like when I interviewed these 3000 plus now individuals, and I've been able to really boil down and distill down the core foundational elements that all successful, aren't new or share in common. There were 17 of them. Like I wish there were 18 or 16. I like even numbers, but listen, it was 17. I couldn't take one away. I couldn't add one. It was just simply 17 foundational steps. And I was able to put them in a chronological order. And before me, I had the 17 chapters of the book and a step-by-step format, 17 steps to financial freedom and fulfillment. And let's go over a couple right now. Number one, this is where most people get it wrong, by the way, identify your big idea. Keywords, your big idea. So many people, Karen, they are right now living and acting in a week pale imitation of somebody.
Speaker 2 (05:53):
Else's big idea. They're like, Oh, look what Karen did or John. And they're having success doing these things. Let me just do that. And then they wonder why they're not successful most because they're a week pale imitation of those people that are trying to copy. They're copying somebody. Else's big idea. That person, it's their big idea. It's their zone of fire. That's why they're successful because they're living in their zone, a fire. You need to sit down maybe for the first time in your life, by the way, and really give yourself the time, the space, the open bandwidth to really come up with and identify your big idea. And your big idea is out there. Your zone of fires out there and chapter one, listen, it's not just words on a page. There are exercises. I teach you how exactly you get to your big idea.
Speaker 2 (06:42):
And that is a super critical part. That by the way, most people will die. Never even knowing what their big idea is because they never took the time to sit down and identify it. And it doesn't even take much time, which is the sad and scary part. But here's the thing here. If it was just that simple to identify your big idea, it would be one chapter in my book. And there were just be one chapter in my book. There's 17 steps. So there's a lot more to it than I than identifying your big idea. Let's just jump to step two. And then we'll skip a little ways ahead to, to show you any part of the book as well. But once you have your big idea, people are like, Oh my God, I'm so excited. Like I have my big idea. Let me go all in on this.
Speaker 2 (07:22):
That's a huge mistake because guess what? Your big idea is a great idea. And other people have had it too. And there's competition. That's out there crushing your big idea, which is a good thing because that's proof of concepts. That means that your big idea really is proof of concepts, but you can't right now launch against entrenched competition that's out there. So instead you go to step two, which is discover your niche. That means you're going to identify within your big idea, an un-served opportunity, a void that needs to be filled, that you can be the best solution to that real problem within your big idea. That's how you win. Like Karen, when I launched a podcast, that was just this broad idea, but then I was like, well, I'll launch a business podcast. That's a little more niche. Okay. It's still kind of broad.
Speaker 2 (08:14):
There's a lot of people there. Well what about an interview business podcast? Okay. There's like seven or eight other interview business podcasts. What about a daily interview? Podcasts of the world's most successful entrepreneurs, zero other competition. The day I launched entrepreneurs on fire, it was the best daily podcast interviewing entrepreneurs. It was the worst daily podcast interviewing entrepreneurs. It was the only daily podcast interviewing entrepreneurs. Like can't you see, like, that's why I won at such a high level. How can you be the best? Sometimes it means being the only, or it means niching down till you look around your competition is terrible. So you can kill them immediately. You can beat them up. That's how you discover your niche. Then of course, there's step three, four, and I take you all the way through and beyond. Let's skip forward right now to step seven.
Speaker 2 (09:09):
So every chapter in this books, an average of a three to 5,000 words, this chapter I wrote and I wrote and I wrote, and I wrote 13,500 words. By the time I finished this chapter, step seven, chapter seven, creating your content production plan. That is why we've won financially at such a high level because our content production plan is amazing. And I say that because it took us 10 years to get here. It's stunk at first, but now it's amazing. And I poured it all into this chapter and it is phenomenal and it's listen, it's not easy to emulate, but it's all there for you. And you will see after reading this chapter, why we're winning at such a high level and frankly, you know why you might not be because likely your content production plan is nothing in the same realm of what we have just like ours.
Speaker 2 (10:06):
Wasn't in this realm, obviously when we launched back into, you know, almost 10 years ago now, so that's just a glimpse of three of the 17 steps. And we have actually a bonus chapter called the well of knowledge. And it's a really cool chapter is chapter 18, a bonus chapter. And that's just the best pieces of advice, mentorship, inspiration, motivation that I picked up over the years. I just dropped it into this chapter. And this meant for you to really just take your ladle, dip it into the well of knowledge every now and then when you need it, when you need a little bump, a little boost. And man, that chapter is really cool because it's not meant to just read all at once. Like go there, consume it. One passage to passage, get the kind of inspiration you need, then get back to work. That's the process
Speaker 1 (10:56):
Amazing. Well, I mean, I don't know about anyone else listening, but I am so excited to get my copy, which it releases on March 23rd. So tell us, tell all the listeners here a little bit more of the details of the book launch so they know where they can get their copy.
Speaker 2 (11:11):
So listen, all the magic is going to be happening over at uncommon success. Book.Com, uncommon success book.com. You can head over there. You'll see the personal endorsements from Seth Godin, Gary Vaynerchuk, Neil Patel, Erica Mandy, Dorie Clark. You'll see a video of me describing more details about the book. You'll see. The first chapter is there for free just to read, to consume it, to see kind of like, well, how my writing process is plus the five bonuses that come with the pre-orders. So do not wait until March 23rd. You want to pre-order this book because it is amazing what we've done for these five bonuses. Just one of them, by the way, I'm to your door. All three of my journals, the freedom mastery and podcast journal. I'm literally shipping to your door at my expense. Well, drop them all. If you live in the United States of America, outside of the U S I'm going to give you the digital pack of all three immediately they're beautiful fillable versions. They're awesome. And there's four other insane bonuses. You can learn more about those other bonuses@uncommonsuccessbook.com.
Speaker 1 (12:21):
And I, I ha I will say congratulations are in order already. Cause an Amazon I checked today is already a number one bestseller on Amazon and it's not even out yet. And for the listeners, I am going to be giving away five copies of the book and you'll find all the details on my Instagram page. So check that out. Cause I will be giving away to five lucky winners, five copies of this book, because if you just go on to the website and read even the first chapter, you're like, man, I get it. You know, and I, and I also love the fact that you're vulnerable, that you're saying, Hey, this didn't happen overnight. And that's what a lot of people think. And that's what a lot of people sell. And it's so refreshing to see people out there experts like yourself saying it's hard work, it's work, but you can do it. So you're welcome. So I want to thank you so much for coming on the podcast. And one more time, where can people find all the info,
Speaker 2 (13:21):
Uncommon success, book.com, check it out a lot of great stuff there. And once again, much appreciated.
Speaker 1 (13:30):
Thank you so much. And everyone thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, sports physical therapist specialist, Dr. Alli Gokeler, talks about motor learning.
Today, Alli tells us about the process of motor learning, how patient autonomy is advantageous to rehabilitation, and how to motivate patients. How does Alli measure motor learning outcomes? Alli elaborates on his on-field rehabilitation model, and the importance of incorporating cognition in ACL injury rehabilitation.
Alli talks about RTS from a motor learning perspective, how to continue motor learning on the field, and he gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
-
Alli defines motor learning:
-
“In order to acquire motor learning, you need to practice. If you don’t practice, you can’t learn something.”
- “The learning process itself cannot be measured directly. It’s only something you can measure indirectly.”
-
“What motor learning should result in is: it should lead to relatively permanent improvement of motor skills.”
-
“Be careful how you interpret this process. Quite a few clinicians have a tendency to provide feedback because they intuitively try to correct a patient.”
- “Be a little bit patient with your patient, because learning takes time. Don’t interrupt the learning process too soon.”
- “Motor learning, as well as learning a language or math, is a non-linear process.”
- “One of the strong drivers of learning is intrinsic motivation.”
- “We provide our patients with a significant amount of autonomy, which means the patient gets a certain level of control over the exercises.”
“Providing autonomy during rehab enhances learning.”
- “Around 70% of people prefer to receive feedback after a good performance of an exercise. What happens in most clinical situations, with all good intentions, we typically give corrective feedback, which typically means you didn’t do something according to the standards of the therapist. This may affect their motivation.”
- “If you look at the brain activity of someone that is instructed to do something, or the brain activity of a person who has some control over what they’re going to do, you have completely different brain patterns. When you give them some control, they are much more engaged, and this is a prerequisite in order to learn something.”
- “If you want to be certain that learning has taken place, you need to measure, otherwise you can’t be sure that the patient has learnt something.”
- “If you’re good at something, it’s not challenging anymore. If it’s too difficult, then it’s overreaching.”
- “One-on-one training is not what’s needed for a football player. They are team athletes.”
-
Alli’s on-field rehabilitation model:
-
Neurocognition: Reaction time, decision-making, selective attention, inhibition and working memory.
- Motor component: Strength, range of motion endurance, and speed.
-
Sensory: Visual, auditory, and environmental factors.
-
“We need cognition during our motor control, and if we only work on pre-planned activities, we miss something from the on-field situation.”
- “An ACL injury isn’t just a peripheral injury, but it’s also a neurophysiological lesion, and that needs to be considered in rehab.”
- “With colleagues that work with paediatric patients, some of the motor learning principles that they use could be very beneficial for us working with orthopaedic, sports-related injuries.”
Suggested Keywords
Motor Learning, RTS, PDCA, ACL, Rehabilitation, Neurocognition, Therapy, Physiotherapy, PT, Training, Injuries, Sport, Wellness, Health, Recovery, Injury-Prevention,
More about Dr. Gokeler
Dr. Alli Gokeler has 28 years of experience as a sports physical therapist specialist.
In 1990, Alli graduated with a degree in Physical Therapy from the Rijkshogeschool Groningen. Following his graduation, he worked in both the US and Germany as a physical therapist. In 2003, he earned his Sports Physical Therapy Degree from the Utrecht University of Applied Science. In 2005, he started a PhD project at the University Medical Center Groningen, Center for Rehabilitation.
He is a researcher-clinician and a clinician-researcher with a passion for multidisciplinary injury prevention. He has over 40 peer-reviewed publications, and he regularly gives lectures worldwide. In his free time, he loves to do mountain biking.
To learn more, follow Alli at:
Facebook: Motor Learning Institute
Instagram: @motorlearninginstitute
Twitter: @Motor_Learning
YouTube: Motor Learning Institute
Website: https://www.motorlearninginstitute.com
ResearchGate: https://www.researchgate.net/profile/Alli_Gokeler
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Full Transcript Here:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everybody.
Speaker 2 (00:37):
Welcome back to the podcast. I am your host, Karen Litzy and today's episode is brought to you by net health. So net health is hosting a three-part mini webinars series on Tuesday, March 9th, entitled from purpose to profits. How to elevate your practice in an uncertain economy after 2020. I think you're going to want to sign up for this. So you're going to hear from a panel of guests that have over 50 years of combined experience working in the PT industry sign up will begin tomorrow, which is Tuesday the 23rd, February 23rd for this mini webinars series. So head over to net health.com/litzy to sign up once again, that's net health.com forward slash L I T Z Y. So check it out and sign up now. Oh, and it's free. Okay. So this whole month we've been talking about ACL injury and rehab. So today's episode is with Dr. [inaudible].
Speaker 2 (01:41):
He has 28 years of experience as a sports physical therapist specialist. In 1990, he graduated with a degree in physical therapy from I'm not even going to pretend to try and pronounce this. So you can just go onto the podcast website to find out where he went to school. Cause I'm not even going to attempt it following his graduation. He worked in both the us and Germany as a physical therapist in 2003 here in does sports physical therapy degree from you trick university of applied science in 2005, he started a PhD project at the university university medical center, grown again, center for rehabilitation. He is a researcher, clinician, and a clinician researcher with a passion for multidisciplinary injury prevention. He has over 40 peer reviewed publications and he regularly gives lectures worldwide in his free time. He loves to mountain bike and you can check out more from him and his research@motorlearninginstitute.com.
Speaker 2 (02:46):
Okay. So today we talk about just that we talk about motor learning. So the process of motor learning, how patient autonomy is advantageous to rehab, how to motivate, how to measure low motor learning outcomes on field rehab models and the importance of cognition and ACL rehab. And we talk about Allie's brand new model for Mona motor learning, which will be out hopefully in a month or so. So a big thanks to Allie. And of course, thank you all for listening to this month on ACL injury and rehab. Hey, Alli, welcome back to the podcast. I am happy to have you on once again.
Speaker 3 (03:31):
Thank you for inviting me. Yeah. It's been awhile pleasure to be here today.
Speaker 2 (03:34):
Yes. And so, as people, if you've been listening to the podcast, you know, that this month has been all about ACL injury and rehab. And so what better person to have on the new to talk about kind of the rehab process after an ACL injury and your specialty, which sort of motor motor learning. So the first thing I want to ask you is can you define motor learning?
Speaker 3 (04:02):
Yeah, that's it, that's a very good question. And I I've taken three, I think important aspects of motor learning that I think are relevant for clinicians that listen to this podcast. The first one is in order to acquire motor learning, you need to practice. If you don't practice, you can't learn something and that may be pretty straight forward, but I still think it's important. The second one, and that's a little bit of a vague one, but the learning process itself cannot be measured directly. It's only been some been something that you can measure indirectly. And I I'll touch back on that a little bit later. What I mean by that? And the third point is what model learning should result in is that it should lead to relatively permanent improvement of motor skills. And last year I gave the example of writing how to ride a bicycle for this year.
Speaker 3 (05:03):
I thought, Hey, maybe skiing is a good example. And so if you've taking ski lessons as a teenager and you became quite proficient in skiing, it could be for many different reasons for job or any other reason that you haven't been going to the Rocky mountains, but at the age of, let's say 35, you have some time again, and you have some financial resources and you'd, Hey, let's spend the week again in Vermont or the Rockies and maybe a little bit of rusty at the beginning, but perhaps after a day or two, you get the hang of it again. So this is I think a great example of what motor learning means. It means that you acquire something and it sustains over time. Now that needs to be distinguished from performance. And this is, I think one of my key messages that I would like to point out to clinicians when you work with your patient in the clinic and you have your patient doing an exercise.
Speaker 3 (06:11):
And this relates to my second point is that motor learning is not directly observable. What you see in the here and now is performance. Now I get, I can give you two examples. So let's say you have a patient after an ACL injury six weeks post-op and you want to have your patient work on balance, not patient number one comes in and stands on one leg. And actually what you're seeing, you're very happy, very stable not any excessive movements is able to maintain balance for 30 seconds. Okay. You're you might be happy with that. Now, your second patient comes in from the same surgeon, also six weeks post-op and when you have this patient perform the same exercise, you see that a patient sometimes needs to take the hands of the hips or needs to hold onto something, or puts the other foot down to maintain balance.
Speaker 3 (07:16):
And from these two examples, you may draw the conclusion that the first patient has better motor skills and has better learning potential. And the second one has poor motor skills and is not such demonstrating good learning potential. We don't know. We only, we only know that performance in patient one is better for sure. Performance in patient B is not as good for sure, but that doesn't mean that the dis says anything about the learning potential. In fact, it may be that the learning potential in patient one is, or has already been reached because this is at the max of his abilities, various for the second patient with poor performance, there may be a large learning potential. So that that's that's I think very important. And what you need to consider as a clinician is be careful how you interpret this process, because what I know from my early days, and also when I teach courses, is that quite a few clinicians have a tendency to provide feedback because they would intuitive to literally try to correct patient too, because you see that it's not able to maintain balance.
Speaker 3 (08:40):
So we need to say something. So we will usually do that in with feedback. And we typically do this with corrective feedback. And my second take home message would be, be a little bit patient with your patient because learning takes time. So maybe unless you feel that there is an unsafe situation, but if that's not the case, let the patient practice and re evaluate in the week or in two weeks time. But don't interrupt the learning process too soon. Because when I go back to the skiing example, remember when you haven't been skiing for for like 15 years or when you started to ski, it, it, it was probably something like this first day, quite difficult. Second day, still difficult. You might even get frustrated third day, no improvement. However, on the fourth day snow not being able to ski ski lift is closed.
Speaker 3 (09:55):
And on the fifth day means there was no one day without any skiing lessons on the fifth. There you go out again, Hey, and all of a sudden you feel like, Hey, I I'm, I'm better than I was on day three, although you haven't practiced in the day in between. So this is what I mean, learning is not only happening as you practice, but there's also some processing afterwards going on in your brain that helps to acquire those motor skills now. And if you interrupt that process like vote by providing a lot of corrective feedback you may actually, although with all good intentions, I don't want to disqualify that, but maybe it's better to leave the process happening and evolve and then provide feedback later on.
Speaker 2 (10:50):
Yeah. It kind of reminds me of have you ever heard the term helicopter parent? So it's the parent that's always hovering over the child, making the decisions, not allowing them any autonomy for themselves. And so it reminds me of that helicopter therapist who's on top like, Oh, I see that if you use the example of balance, Oh, I see that you struggled a lot with your balance. Why don't you try and do this? Well, why don't you do this, try this, try this, try this. And, and in that as the therapist, are you taking away the autonomy for the patient and what kind of, how can that affect the outcomes for that patient?
Speaker 3 (11:31):
Yeah, that's an excellent point. Karen C motor learning, as well as learning a language or learning math is a nonlinear process, which means how you learn how to ride a bicycle was probably different from how I learned it. So, but what we typically do as clinicians, we have this, this, this clinical guidebook in our, in our mind map that we think based on our experience or based on our beliefs, how we need to guide our patients from simple skills to more advanced skills from single task skills to do a test skill, whatever. However, we don't know how this patient is actively engaged in this process, actually, by example, that you were provided the, the patient is directed by the, by the parent or, or the child is directed by the parent and is actually a passenger. Now, I think one of the strong drivers of learning is intrinsic motivation.
Speaker 3 (12:41):
So what role do you give your patient if you direct them, where to go, what to do, and also you give them corrective feedback are these all strong drivers for self-organized learning? I'm putting a question Mark behind it. So people need to think about them for themselves. I can tell you what we do in, in, in our clinical situation. And that's based also on our research we provide our patients or in ACL injury prevention, we provide a significant amount of autonomy, which means an athlete or a patient gets a certain level, not complete control, but a certain level of control over the exercises. So they can choose, for example, out of 10 exercises, they can pick three exercises that they would like to do on that particular day, in an order they would like to do. And we know from a substantial body of research that providing autonomy during during rehab enhances enhances learning.
Speaker 3 (13:59):
And I can tell you this from a research point, but it can also give you a brief insight from a recent survey that we've done among patients that completed their rehab. And we sent them an open questionnaire about their experience in in the entire process of rehabilitation. And one thing that two things that really stood out were a positive environment, a positive environment with relatedness of the therapist towards the patient, and not as a patient, but as a person that's quite important. So it's not a ne it's not an ACL patient. No, it's, it's, it's a person with an ACL injury. That's quite, quite, quite an important distinction. And the second thing that stood out was and you, you touched on that before is the autonomy some self-control over the rehabilitation process. And this was a qualitative study that we did my PhD student while surveilling ran the study.
Speaker 3 (15:10):
So it's not something that I'm just saying as a scientist, but this is also what we get back from our patients. And when we ask them so going back to the clinical situation this is what we apply also by providing our patient with the opportunity, instead of me always providing the feedback I'm asking them, or I'm giving them the opportunity please let me know when you want me to give you feedback. That is a great example of of autonomy, the thing, easy question. Yeah. And, and, you know, what's, what's, what's what's quite important to understand is if w if we think how humans preferably like to receive feedback if we, if we, if we ask a healthy population and the same applies to to an injured population, it turns out that around 70% of the power of the people prefer to receive feedback after a good performance of an exercise, what happens in most clinical situations with all good intentions? I really don't want to question that, but we typically give corrective feedback, which typically means you didn't do something according to the standards of the therapist. That means that maybe seven out of the 10 people that you provide feedback to may not really like this, and this may affect their motivation. This may affect their learning potential because they like to receive feedback when something went well, they, they conversely they already know when something didn't go well and they don't need us to rub it in or to remind them they already know.
Speaker 2 (17:15):
So you, you touched on a word that I was just going to ask you about, and that is motivation. So why is motivation key in motor learning?
Speaker 3 (17:28):
If you look for example, at the brain activity of a person that is instructed to do something, or you look at the brain activity of a person who has some control over what they're going to do, you have completely different brain patterns. And I can tell you that the second one, the second example, when you give them some, and when they can choose, they are much more engaged, and this is a prerequisite in order to learn something.
Speaker 2 (17:59):
Yeah. And, and I think we can probably all look back on our own personal experiences of learning, whether that be academic learning, or learning a physical task. I think we all like to have a little bit of control over that versus just have stuff thrown at us without our IM without our input or without our thoughts on it. So I think that makes perfect sense. And now, so we spoke about how motor learning is, non-linear why motivation and autonomy is so important. Now let's talk about, we've got this patient with who had an ACL repair and they want to get back to sport. They, they are, they are ready mentally. So we'll put that to one side. They're ready mentally. So let's talk about the return to sport from a motor learning perspective.
Speaker 3 (19:02):
In my opinion, return to sports is we first need to define what we mean. And I think the 2016 consensus meeting gave us some leeway in that direction. And I think one of the most important things that stood out is that it's a continuum. It is not one moment in time. And I think what I read in the literature often is is that it's such a that coma to choice yes or no at at six months or nine months, whatever you're, you're, you're, you're believing in. I think what we need to understand is certainly in light of the high number of secondary ACL injuries, particularly in the young population, in, in, in pivoting type sports, that's number one. But also the second one is that, you know, only, I think a disappointed percentage of people reach their pre-injury level.
Speaker 3 (20:00):
So their performance is not up to par. So do those two factors. When we, when we look at that, I think it all starts prior to the surgery. So the rehabilitation, I think is one of the key factors that we need to, that we need to consider anything that's left. Unaddressed will show up even in higher magnitude, after the ACL reconstruction, which was the second trauma to the knee. And, and then in, during the entire rehabilitation process, something very simple. And I can't stress that enough if, if walking is not normal and how do, how do many clinicians assess a normal gait pattern? They usually ballpark it, but, you know, even a slight deficit of five degrees is clinically meaningful. And now, now just follow some logical sense. If you're walking is not normal, what do you think will happen with the running?
Speaker 3 (21:01):
W what do you think, what would you expect? How, how the squat will be executed by the patient and how will the single leg up will be done or a drop foot, a good jump. So that's why I think that all these elements from a motor learning perspective, and also we'll touch back on that a little bit later, of course, sound strengthening program, you know, no question about it, very important, but I think it is, it is very important to also incorporate the model learning process so that we make sure that the patient is learning or relearning those motor skills, but Mo and I can also stress enough. It's also important that we as clinicians really, really measure and boarding and, and I, we just completed and published a study among Flemish physiotherapist. And one of the things that came out of this study is that many don't use the evidence-based principles, meaning also they don't use two criteria as they don't assess and in order, and that's also coming down to model learning. If you want to a certain that learning has taken place, you need to measure, otherwise you can't, you can't be sure that the patient has learned something.
Speaker 2 (22:22):
And how do you, what are some examples that you can maybe give the listeners of how you measure these motor learning outcomes? Because I think that's important to let people kind of wrap their heads around that. And on that note, we're going to take a quick break to hear from our sponsor and be right back
Speaker 4 (22:41):
On Tuesday, March 9th, net health is putting on a three-part mini webinars series entitled from purpose to profits, how to elevate your practice in an uncertain economy after 2020, you're going to want to sign up for this. You're going to hear from a panel of experts that have over 50 years of combined experience working in the PT industry, signup will begin tomorrow for this mini webinars series. So head over to net health.com/litzy to sign up once again, that's net health.com forward slash L I T Z Y.
Speaker 3 (23:16):
Yeah. So I use, then that's something from, from the business that you probably know that the PDCA cycle, the plan do check act and the P and the plan, which means you do a baseline test. So first you need to let's say balance. So there's the patient have a balance deficit yes or no. You can use the star balance says you can use th the balance error scoring system. That's your baseline test. Now, it's up for you as, as a physiotherapist with your clinical reasoning. Does the patient need an intervention to target a balance? Yes or no, or are we happy with, but let's assume now there is a balance deficit. Now we go to the do, which means what is my intervention? So my intervention could be, I'm planning to do balance training for four weeks, with two therapy sessions in the clinic, and four sessions at home consisting of those and those exercises.
Speaker 3 (24:21):
And then AF in between I'm doing an interim evaluation, is the patient going on track as I'm expecting or not? I can still find tune my my intervention program, a training program. And then I do a final assessment after, after two weeks and preferably even one little bit later on as well to make sure that the effects of the balanced training are really sustained over time. Remember what I said about riding a bike or skiing and that's a very simple procedure you can use. It doesn't take a lot of time but it's, it needs to be integrated in your daily practice because if you don't measure, you don't know.
Speaker 2 (25:09):
Yeah, absolutely. And I love that. I think people can get behind that PDCA cycle and cause, you know, PTs love things that are regimented and you know, things that sort of follow a plan. So I think this is a really easy, and I think people can get behind it. And I also think that it will keep your patient on track and keep you on track and organized versus just like throwing whatever up against the wall and seeing what sticks, if you measure it, you're, you know, you're, you kinda know where this patient is going and that makes all the difference.
Speaker 3 (25:51):
Yeah. Which, which th that's a good point that you I, I forgot to mention it actually in the, in the, in the planning cycle, I'm incorporating my patient. So I'm discussing the baseline tests and I'm asking in my patients, so you have a balanced deficit. What do you think is needed for you to improve your score? What do you think is could be if you score eight out of 10, so zero would be no balanced error. 10 would be the maximum errors that you can acquire. So you have an eight, what do you think is reasonable to achieve in two weeks time, for example, and then the patient could say, yeah, I think I'm I can reach a seven. Hey, that's the interesting information. Why, why are you so conservative? Why can't, why can't you challenge yourself from, from an eight to a four, for example?
Speaker 3 (26:42):
So I always creating this interaction with my patient. You know, I can in conjunction with, with, with me and my patient, I can set goals that, and that's quite important as well. That need to be challenging for the patient, because if you, if you already a good or something, you're not challenging and it's not challenging anymore, if it's too difficult, then you then it's overreaching. But it, it has to be something that the patient sees. Okay. I really got to put some effort into this is again, which is, again, something for important for learning.
Speaker 2 (27:22):
I was just going to say that I said from a motor learning standpoint, if you do nothing that gives a substantial challenge to your patient, are they really going to see the benefits of those exercise or of your plan? Exactly. Yeah, yeah. Yeah. That makes perfect sense. Okay.
Speaker 3 (27:45):
And also going back to to the first example where the two patients with the balance exercise, if, if I give my patient an exercise, it is usually an exercise that creates difficulty for them. So if I see a perfect demonstration, then I'm kind of thinking, yeah, what is the learning potential here? So I purposely make the exercise a little bit more difficult right away. And I explained that to them, I'm explaining to them, don't expect to, to master this exercise today or tomorrow. And I always give that example of, of riding a bike and, and a lot of patients like that because, Oh yeah, I remember that I fell down quite a few times and and that that's in ACL rehab. It's, it's more or less the same process.
Speaker 2 (28:37):
Yeah. And, and I also want to switch, well, this isn't really switching gears just moving forward. So yes, we know that return to sport is a continuum you've got returned to sport and returned to performance, different things. And one of the things that I spoke about with Nicole [inaudible] is the importance of on-field rehab. So I know that's something that you're also passionate about. So do you want to kind of tie that into what, what therapists can do on field to continue to foster this motor learning within their sport, whatever that sport may be?
Speaker 3 (29:20):
Yeah. I think that's, that's something that's underappreciated and, and maybe that's because we haven't really integrated the motor learning processes in our rehab. And one of the things that we have to consider is when you observe your patient in the clinic and you a certain motor behavior, that's all what it means. It stems down to the interaction between the environment. The task at hand could be a jumping exercise, could be a single lag, actually, whatever. And, and, and, and to behavior that you're seeing. So there is a task athlete, environmental interaction, which means the movement that you see from that interaction only is valid for that interaction. You cannot extrapolate a jump landing strategy from a box in a physiotherapy clinic. And imagine how this athlete would play lacrosse or American football or soccer. It's completely different game, completely different worlds.
Speaker 3 (30:37):
So I think that's where one of the main reasons why single leg hop test and accessed by, by, by Kate Webster and, and, and Tim, you, it were shown not to be valid predictors of secondary ACL injury, because a hop test is something completely different than how an athlete performs on the field. So, in, in, in that regards I think we need to take the patient to the field and to see how the patient is performing based on that interaction that I just refer to the tasks, the environment, and the athlete interaction. And then you get meaningful information where the, where that patient is is add, which for example also means that one-on-one training is not what's needed for a football player. They are team ball athletes. So you need to do something with the ball. You need to be on the turf and you need to do something with teammates
Speaker 2 (31:43):
That yes, when you're working with someone with a team sport, you have to have those other I don't want to say distractions, but you know, other people, a ball scanning a field versus just going one to one with you.
Speaker 3 (32:02):
Yeah. And we, we've just completed an analysis of 47 non-contact ACL injuries in Italian professional football. Just this work that I've done with Francisco Della Villa from the ISO kinetic group. And what we did is we, we looked at the injury mechanism through a different lens and what we the lens we use was a neurocognition lens. So we looked at the inciting events that happened before the ACL injury took place, because so far the literature is predominated by the dynamic valgus collapse. And I totally agree. I totally agree. However, it doesn't tell you what led to the injury. It just tells you what the end point is. That's dynamic velvets now. And what we've done now is what are now some typical events occurring during a match play in which a non-contact ACL injuries took place. And we took two neurocognitive factors. One is the selective attention. So are you able to maintain attention to the relevant information in this regard and filter out irrelevant information? And the other one is, did we see some impulsive behavior of defenders? And they were running into a situation in which basically the attacker waiting for them to approach. And then at the last moment, they made a deceiving action that the defender did not entail.
Speaker 2 (33:40):
And now in the very small timeframe,
Speaker 3 (33:43):
The defender had to change the movements in a timeframe that you don't have enough time to coordinate those movements well. So if you think about this as a framework, how injuries may happen, we also need to consider this framework, how we integrate that in our rehabilitation process. And this is what I do from day one. And certainly this is what I do re related back to your question for the on-field this framework we use for the on-field rehabilitation. And I've created a model for that.
Speaker 2 (34:19):
Yeah. So I was just going to say, I know that you've created a model and it's going to be published soon. So let's talk about what that model is. And if you can kind of walk us through that, that would be great.
Speaker 3 (34:31):
So the model is consists of three main pillars. The first one is neurocognition and neurocognition, you need to think about reaction time. Decision-Making selective attention, as I mentioned before, but also your ability to control impulsive behavior. That's called inhibition. Can you, can you change your intended movement? Yeah. That's something to control your impulses. Very important. Working memory is another aspect. So those are the neurocognitive components. Then we have the motor component, and I think that's where most physios will be quite familiar with. So we think about strength, range of motion endurance speed, things like that. Yeah. That that's, that's I think pretty straightforward. Then we have the sensory part. So in the sensory part, we can have the visual components so we can alter the visual input, maybe quite relevant for ACL rehab as Dustin grooms has already shown. And also my colleague and part of borne, Tim layman has demonstrated that with EEG, that the patient may have some visual reliance, but also things like, do you have your patient do training with shoes on is, are you playing on the hard surface, soft surface lighting conditions, auditory information.
Speaker 3 (36:06):
Now those three factors, neurocognitive motor, and the sensory part. What I did in my model, I created like a gauge, so I can create an exercise combination in which I have a relatively simple motor skill. So not so demanding, standing on one leg, for example, but what happens now, if I, and more cognitive load, for example, by having them do math subtractions, or working on the synaptic sensory station by doing motion tracking. Now I can see what the influences is of an added neurocognitive load on my motor art, because those three shape my functional movement coordination. Likewise, I can turn back. My neurocognition lit and stay with the same exercise and do now something on the sensory part. And this is what we all do as clinicians. So we do a single leg balance exercise, and we have the patient stand on on the, on the foam surface, or we have them close their eyes.
Speaker 3 (37:14):
So we already doing this, but I think the model can help you. How do I plan my exercises within one rehab session? And I'm changing that from week two week. And why would this be important? Well, first of all, we all always need to consider that we have, we need cognition during our motor control. And if we only work on pre-planned activities that, that are often in happened, we miss something exactly what you pointed out already from the on-field situation. They have to perceive a lot of information. They have to process that information and then execute the movement. And here's where cognition comes in. And we do this by being aware of that, we can use these gauges. What we do is we actually create a rehab environment that we call in part a board. And we call that an enriched environment in which we constantly provide different stimuli to the patient.
Speaker 3 (38:22):
That means the rehab from week one to week two is not the same, which means variation, something new, something I haven't done before. Again, this could already motivation so significantly, and I can tell you from experience, patients love this. The second benefit would be since you're providing different stimuli, you actually confronting the brain every time with a new situation and the brain has to find solutions. And this is I think very important also from the motor learning perspective that we need to consider to enhance the neuroplasticity of the brain, because an ACL injury is not just a peripheral ligamentous injury. It is also a neurophysiological lesion and that's, I think, needs to be considered and rehab.
Speaker 2 (39:19):
I mean, I, I have to say for me, I really liked this model because it, it gives you a great way. Like you said, to plan out your session so you can maybe enlarge the motor component one day or take it back another day, do more, neurocognition move that back, do more sensory, do sensory motor, maybe not so much neuro do a little bit of all three. So it's sort of like, I just sort of see the Venn diagram, just expanding and contracting with all three of those bubbles, which I think is really great. And like you said, it gives you, it's almost from a therapist standpoint, a clinician standpoint, I feel like it gives me permission to play around and come up with some fun things and be a little more original.
Speaker 3 (40:06):
Yeah. And I think what it also does it, it, it may help you as a therapist to get a better understanding where some underlying deficits may be because we only, we T we typically like to measure the outcome. So let's say I'm doing an agility course, and I'm just looking at at the time. And then I see, Oh, the patient is not so fast. So I need to do more training. Well, what you could maybe do is try to untangle a little bit and to see if the patient from the motor perspective has all the necessary requirements in order to be fast. Maybe there's a deficit there, but let's assume it's not the case. So all, all the strength, all the rate of force development, all these parameters are satisfactory. That must mean that there's something else in the system that can't cope with the demands. And that could quite well be that there is an underlying neurocognitive deficit, and this may help you as a therapist to work more on those neurocognitive elements with the intended goal that the patient becomes faster, but maybe not so much, but we're doing more plyometrics and, and doing more speed now working on the neurocognitive aspect.
Speaker 2 (41:30):
Yeah. So it's, it's a, a treatment as well as an evaluative tool to kind of see where some deficits are and how you, you and your patient together can plan to move forward. Sounds great. When when will this be widely available?
Speaker 3 (41:49):
I hope we have it out in a month, the time from that pending on, on the, on the publication process, but please stay tuned.
Speaker 2 (41:58):
Okay, perfect. And we will let, we will let people know. I will put it on social media when that is out. So that sounds great. Well, I mean, thank you so much for coming on and talking about this, I've been taking copious notes. I think this was great. Before we get into where people can find you, I have one last question and I ask everyone this, and that's knowing where you are now in your life and in your career. What advice would you give to your, to your younger self?
Speaker 3 (42:23):
Good question. I think what would have helped me if I would have spent more time in the neurological field, I think in, in what I still see, or with colleagues that work with pediatric patients, I think some of the motor learning principles that they use could be very beneficial for us working with more orthopedic sports related injuries. That's something I did not understand back then, because my interests were solely in the, in the sports domain, but in retrospect, I should have spent more time in, in the neurological and pediatric field.
Speaker 2 (43:04):
Great advice and great advice for anyone who is maybe at that starting point in the sports or orthopedic rehab world and trying to figure out, Hey, what is there something I'm missing here? So I think that's great advice now, where can people find you and find all this great stuff, all your great info.
Speaker 3 (43:24):
All right. So we have a website from our company and our company's serves as the hopefully as the intermediary between academics and the clinical field. I, I work in both fields. I'm, I'm a clinician, I'm a researcher. And with our platform, actually our community model learning Institute, we want to create a bridge between the academic field and the clinical field, because I think we can all improve, but we need to find each other and we need to speak the same language and have respect mutual respect for one another. And if we engage in in such a culture by exploring, by facilitating one another, I think we can create a lot of new things and approaches with the overall purpose to help our patient. This website will be updated in a month from from now. So we will we will be offering completely new courses, which are also have the opportunity to get coaching from us. So it's not frontal education, but we offer for every course participant to receive life or written feedback on their progress during the course, because our premise is that we want to create a course in such a way that you can apply it into your setting after you've completed the course.
Speaker 2 (44:58):
That sounds amazing. And we will have links to to the website. We'll have also put the link up to your research gate profile so that if people want to look at some of the papers that you mentioned today, they can just go there and see all the papers that you have authored and co-authored do. I think it would be really helpful. And if people want to find you on social media, where's the best place to reach out to you there
Speaker 3 (45:26):
Would be Twitter, Instagram, or Facebook.
Speaker 2 (45:30):
Perfect. And what are the handles if you know them off hand motor learning Institute. Perfect. Perfect. Okay. So thank you so much. And like I said, I will have everything available up on the website at pod podcast at healthy, wealthy, smart.com. So Allie, thank you so much for coming on again. I really appreciate it.
Speaker 3 (45:55):
Thank you, Karen. And I really want to say, thank you so much for setting this up. I think this is exactly what we also stand for, that we create a platform in which we can exchange our ideas. We can ask one another question that that's the best way I think, to move forward. So really thankful for you to organize this and yeah.
Speaker 2 (46:16):
And so everyone, thank you so much for listening. Have a great couple. I have a great week and stay healthy, wealthy and smart. Well, a big thank you to Allie for coming on and sharing all this great information about motor learning as it relates to ACL injury and rehab. And of course thank you to our sponsor net health. So remember on Tuesday, March 9th, net health is putting on a three-part mini webinars series entitled from purpose to profits, how to elevate your practice in an uncertain economy. You're going to hear from a panel of guests that have over 50 years of combined experience working in the PT industry, signups will begin tomorrow, which is February 23rd for this mini webinars series. So head over to net health.com/ let's say to sign up once again, that's net help.com forward slash L I
Speaker 1 (47:04):
T Z Y. Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
In this episode, 3rd Year DPT Student at Rosalind Franklin University of Medicine and Science, Briana Zabierek, talks about her DPT Study Guide.
Today, Briana tells us about her experiences in PT school and the frustrations that led her to start the DPT Study Guide. How is the DPT Study Guide helping students? How does Bri find the time to do it all while still studying? She elaborates on the future of the DPT Study Guide, what students can expect to find in the guide and current developments.
Briana tells us about how the DPT Study Guide is compiled, finding her entrepreneurial interest, and she gives her younger self some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- How Bri manages her time:
Change of pace: Set a timer for 45 minutes. Put all notifications off, and just zone in on your work.
Master a topic, then move on: Be comfortable bouncing between topics. Master the main ideas before moving on to another topic. Don’t try to do a whole topic in one go.
- “The long-term goal is not just to provide products and merchandise, but to really make it a place where you know you’re stepping into a simplified version of PT school.”
- “If you have the passion for it, and this is something that you believe in, then you can make anything happen.”
- “You don’t have to be an entrepreneur to make these opportunities possible for yourself.”
- “Take more breaks and realize how valuable those can be for hitting reset with your mind and focus, and also make time to have some fun.”
Suggested Keywords
PT, DPT, Study Guide, Health, Prioritizing, Studying, Entrepreneurship, Efficiency, Physiotherapy, Time Management,
To learn more about Briana:
[caption id="attachment_9507" align="alignleft" width="150"] www.melissa-manzione.com[/caption]
Bri was raised in Lockport, IL. In 2017, she graduated with a BSc from the University of Nebraska-Lincoln, Double Majoring in Nutrition, Exercise, and Health Science, and Nutrition Science with a Minor in Psychology. She is currently studying toward her PhD in Physical Therapy at the Rosalind Franklin University of Medicine and Science, with her graduation expected in May of 2021. Her mission statement: To serve, encourage, and equip patients and students in reaching their full potential.
Follow Briana at:
Facebook: @dptstudyguide
Instagram: @dptstudyguide
LinkedIn: Briana Zabierek SPT
Twitter: @dptstudyguide
Website: https://dptstudyguide.com
https://dptstudyguide.com/downloads
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Read the Full Transcript Here:
Speaker 1 (00:01):
Hi, Bree, welcome to the podcast. I am happy to have you on.
Speaker 2 (00:05):
Thank you. Thanks for having me. Sure.
Speaker 1 (00:07):
And we'll give a shout out to Dr. Sarah Hague for putting us into contact with each other and telling me all about the great work that you're doing with DPT study guide. And we're going to talk about that today. So before we talk about the guide itself, why don't you share with the listeners, your sort of personal experiences with PT school, which you are still in your third year student at Roslyn Franklin. So share a little bit about your personal experience with PT school and maybe some of the frustrations that came up for you.
Speaker 2 (00:41):
Yeah, yeah, absolutely. So first and foremost, I think every student kind of encounters a little bit of a roadblock just starting out between my roommates and just our class itself, we had some pretty good comradery to begin with. And so I always felt that that was a good option to at least discuss, you know, areas that I maybe was struggling with or they were struggling with and just kind of have this like melting pot of different ideas and different ways that we could all just get the job done and kind of figure out what we need to know for exams. But as time went on, I think we all kind of fell into our own little like habits and patterns and maybe a little bit what we're comfortable with. And then what I realized was when I think it was about like the middle of middle or towards the end of first year we had our neuro unit and that is kind of where everyone hit a wall with our study habits and just retaining the information and just kind of collectively as a class, we were making our own separate study guides and they would be like these super, super long word documents.
Speaker 2 (01:56):
And I'm talking like 50 plus pages full of yeah. Like eight point text. And I was kind of like attached to them. Like we all would get on like our Google docs and like start typing up information and it just became really overwhelming. And so what I realized was like, I kind of have an opportunity for myself and for my colleagues is to just simplify things a little bit like I was getting sick of kind of going through the PowerPoint slides that were, you know, 120, 150 slides long and just little snippets of information on each. And so I kind of just took a step back and, and saw an opportunity to really simplify things, not just for myself, but something that I thought would be helpful just to transform any student's education going forward. And it was in again, late in our first year when I was inspired by different cash based physical therapists and kind of exposed to that world and realized that there was an opportunity for me to step into like a neat niche position. We kind of get started there kind of with like a side hustle. So that's kind of where everything stemmed from, and right now it seems to be going pretty well. Just looking forward to kind of like sharing the experience.
Speaker 1 (03:13):
Yeah. And so tell me a little bit more about the guide itself. Can you kind of give an example of a section of it and how it helps other students? Right.
Speaker 2 (03:26):
So one thing that I definitely picked up on when I started posting the information on Instagram, which is my, my primary platform that I use was trying to get the main points of any kind of lecture or chapter into about like eight to 10 pictures on Instagram. And so what I wanted to do was share that information to simplify things for followers and students in general. But the guides themselves are focused around that idea. So kind of finding information that is most relevant to clinical practice and then finding information that's most relevant for board exams, meaning safety, or, you know, most basic like phases of cardiac rehab, pulmonary rehab and stuff like that. And I, I always felt like I mentioned kind of going through so many chapters, so many pages, so many slides it was getting exhausting, trying to figure out what I needed to know. And so the whole point of the study guides is to just really get to the meat and potatoes of everything. And then if you need to find something to reference later on, that's when we obviously go back to our PowerPoints in our articles.
Speaker 1 (04:35):
And how are you simplifying or sort of taking out those pieces that you described for the meat and potato pieces. Do you have a system as to how you extract that information from these lectures or is it a group effort? How is that being done? A little,
Speaker 2 (04:54):
A bit of both. I, like I said, we collaborate a lot as friends and classmates throughout the years. And then I really actually took the advice from Dr. Sarah Haig. So another shout out to her, she mentioned just go back to the objectives, whether it's the lecture that you're sitting in, in PT school or it's the textbook chapter that really lays out a good I don't know, six to 12 main ideas, and then I go back there and try and figure out, okay, what information from this chapter, can I really pull and fit it into these like umbrella topics? So that's kind of where I started at. And then some of the samples that I have up on the website to reflect like, okay, let's just put the fancy details away. And what do I need to know if I'm seeing a patient or if I'm seeing these questions on a board exam
Speaker 1 (05:45):
And what has the response been from your fellow students?
Speaker 2 (05:50):
So my class, my classmates are really excited about it. I post a lot of daily questions in, for board exams and they're excited to see it, they've moved their head ideas themselves to start an Instagram just for studying purposes. And then having that collaboration aspect has been really helpful. So I'll even get messages from a few of them saying that, Oh, well, you know, this is something that I haven't gone over yet. So I appreciate you kind of like pushing me to review it and, and stuff like that. But even from complete strangers, like how much support I've, I've gotten has been overwhelming almost, especially with trying to handle studying for boards and preparing for my final clinical rotation overwhelmingly positive. And I kind of attribute that to the field itself. I think going into a profession where we're, we're taught to care for others and put others first and all those ethical principles people are just really grateful to have an opportunity where they can see the information and either like bookmark it and kind of synthesize it right away instead of having to go through all like the dirty work themselves.
Speaker 2 (06:58):
So it's been overwhelmingly positive and I just want to shout out to everybody who's following along. I appreciate the support,
Speaker 1 (07:05):
And now you hit upon something that I want to dive a little bit deeper into, and that is time. So where are you finding the time? Because I know that I hear from a lot of students that they feel overwhelmed. There's not enough time in the day to begin with. So do you have any tips or tricks that maybe other students or even practicing clinicians can learn as to how you parcel out your time to be able to do all of this?
Speaker 2 (07:33):
That is a great point. It has taken me probably the last three to four years, even before PT school to figure out what works best for me. And kind of even coming to the realization of, you know, you, you do need to manage your time before I would be a little bit of a procrastinator. As in like I would, I would start a project and then I wouldn't really finish it. And I was like, okay, well I've already started it. So I'll get to it later. It's almost like more of a, a productive procrastinator, I guess. And so what really has helped me is a change of pace. So I know I don't remember the exact name of the timer, but you either set 45 minutes or 30 minutes where you're just zoned in notifications are off. And you're just focusing on that topic for a little bit.
Speaker 2 (08:21):
And then also mixing in a variety. So in the beginning of PT school, I would try and get through all of my lectures that we had that day, the same evening. And that was just that wasn't going to happen. I tried my hardest, but it was just wasn't going to happen. So what ended up doing was bouncing between topics, even if it feels a little bit unnatural. What I've noticed with my classmates and with myself is we want to just master a topic first, before we move on. And I think the most helpful tip that I can give is to really just be comfortable with bouncing between things and just mastering the, the main ideas before moving on to another topic, because the more that you get caught up in the details, the more you're going to kind of lag and again, procrastinate going to other topics. So that is first and foremost, give it some variety, mix things up and then really set a timer. And then lastly, like I said, just taking a peek at the objectives of the lecture and the chapter is really going to tie together, you know, what you need to pull away for clinical practice or, or board examinations.
Speaker 1 (09:28):
Yeah, because I think so often we can sometimes get lost in the weeds and we don't pick our heads up to see those bigger pictures. So I think that's really great great advice for students and for physical therapists alike. So now we know why you started DPT guide and now have a better idea of what it is. So my next question is what, what is the goal for you of the DPT study guide
Speaker 2 (09:58):
First and foremost, I, I want to make it a community. I think the longterm goal is to be not just to provide products and merchandise, but to really make it a place where students and practitioners alike can come and just review without any, I dunno, egos or preconceived notions or anything like that. Just coming into a place where like, you know, you're, you're stepping into just a, a simplified version of PT school or PT practice. So that's the ultimate goal is just making a community for people to come together and not, not entirely making it about DPT study guide, but making it about the appreciation and respect for physical therapy itself. I do a lot right now on the page about daily, weekly posts covering a variety of topics, as well as sharing a lot of other students, other clinicians work that they are doing to promote the profession, promote their small businesses. And so that's, that's kinda, my, my longterm goal is to just make it this safe space, I guess, for PT students and clinicians alike.
Speaker 1 (11:12):
And now is this something that is meant to help people pass their board exams? Cause I just want to make sure that we're kind of differentiating so that people, especially students that are listening if they want to get this guide or get these guides from you, is this something that's like, you're gonna pass your boards if you do this. Cause I don't want there to be any information there.
Speaker 2 (11:36):
Right? Absolutely. My first line of products is geared towards the board exam, especially the MPTE. I think long-term, I would like to branch out and see, especially in Canada, my boyfriend is Canadian. So you kind of giving some respect, a little shout out there too. But first and foremost, yeah, it's going to be focusing on the MPTE and then down the line I would like to extend it into just clinical practice, you know, how things have evolved from our standardized examination to how things are in the clinic or in the hospital.
Speaker 1 (12:10):
Got it, got it. Okay. So what can people expect? What if I, if I am a student and I want to download this, what can I expect to find,
Speaker 2 (12:23):
Do a lot of aesthetics? So I try to pull in like I said, the information that is relevant to both clinical practice and board examinations by kind of seeing where the attention is going to be in terms of like the mind's eye. So transitioning from what we made in school during our first year with those 50 to 60 page documents with just white background, black text, it's really hard to find the information that you think is going to be important. And kind of just simplifying it into basic examination procedures, basic interventions phases of rehab medical screening, laboratory values. And like I said, kind of the meat and potatoes of everything that PT is just so that students don't get overwhelmed with the details. It's going to be like bright and bold big ideas and then kind of like,
Speaker 1 (13:21):
Got it, got it. And, okay, so now we have a better idea of where you would like this to go. So tell me, what else do you have in development? What are you thinking that you can add to this? And it looks like, so what I mean, when you're on the website, it looks like it, the addition to it is, can be infinity. So I think it's important for people to know that it's not like you go onto your website and it's one big gigantic guide. Right, right. So where do you see this going? What do you have coming down the pipeline?
Speaker 2 (14:08):
So first and foremost is getting out both PDF copies and paper copies of the study guides. And then once I feel like that has a pretty steady response rate, then I want to transition into maybe even tutoring one-on-one video instructions or even student courses where they can go through maybe a differential diagnosis and orthopedics or differential diagnosis medication review in neurology and even down the line. This is like probably five years from now. I have a very invested passion and pain science, and so kind of pulling those things together and offing offering courses for professionals and students alike. So I, I have high hopes. I think it's going to be a little bit of a learning curve and seeing what the demand is for students and professionals when the time comes. But I, I have full intentions to continue to grow with the demands that are out there for students and professionals.
Speaker 1 (15:16):
Awesome. And now, you know, this is obviously very entrepreneurial and which is very exciting. So where did that spark come from? Because not everyone has that kind of entrepreneurial spirit and nor do you need to have it to be an excellent physical therapist, but where did that come from for you
Speaker 2 (15:38):
First and foremost? I have to, again, shout out to a dear friend of mine. His name is Travis. Robertson. He is, he was a third year student when I was a first year student. And like I mentioned, during that neuro unit where things kinda got a little hazy with studying, he mentioned to me that like, you know, why don't you just take a chance and see what the market is out there? He was very invested in cash based physical therapy at the time. And so then I started looking into, I mean, all the major ones, Aaron LeBauer was first and foremost, Danny Mada, Jared Carter. I actually even kind of more on like the female entrepreneur side of things is when I found obviously Karen Lyndsey and Dr. Hague more, just more opportunities to see what those people were doing in their own journeys.
Speaker 2 (16:28):
And so he really inspired me to just take a peek at what's out there. The more that I learned about cash based businesses, owning your own PTP clinic, the more I realized that there's different opportunities with side hustles with other income streams. And that's when I, I kind of took my passion for simplifying PT studies into like the study guide form and realizing it's going to take a little bit of effort upfront. But you know, if you have the passion for it and if you feel it's like, it's something that you believe in and fit that this is truly something that I believe in, then you can make anything happen. Like you said, you hit the nail on the head. You don't have to be an entrepreneur to make these opportunities possible for yourself.
Speaker 1 (17:11):
Yeah, no, definitely not. Definitely not. As long as you can stay organized and motivated and at some point reach out for help. I know not necessarily in the beginning, but you know, as time goes on reaching out for help when you need it is always a great thing as well. Well, it sounds like you've got, it sounds like you've got everything under control. I think you might be more organized and, and, and you've got your, you know, what together, more than I do. So I may, I'm a little so now what, where can people find you? Where can they find the guide? Yes.
Speaker 2 (17:58):
So the website is plain and simple DPT study guy at.com. I also run primarily the Instagram account, which is the handle is DPT study guide. And then that same handle you can find on Twitter and Facebook. If you're interested in connecting to me personally I do have a LinkedIn as well, and that would be my first and last name Breeza Barrick. So we can connect there too, but yeah, everything is easily accessible from the website and from Instagram page.
Speaker 1 (18:30):
Awesome. And, you know, just so you know, it's also very easy to download and it is very pretty and it's very organized and looks very it looks great. So I highly suggest if you're listening to this, especially if you're a student and even if you're not, if you want to brush up on your open and closed pack positions for all your joints, definitely a check out to DPT study guide.com. Now the last question is something I ask everyone it's knowing where you are now in your physical therapy student journey. Normally I say, in your life and career, what advice would you give to yourself right out of PT school, but why don't we say, what advice would you give to yourself maybe before you started physical therapy school to where you from, where you are now?
Speaker 2 (19:16):
Oh, that's a great one. Looking back, I would make more time for breaks. I feel like students are way too hard on themselves in terms of, I need to be studying 24 seven. If I'm taking a break, it makes me weaker. It makes me less smarter or whatever the case may be. Take more breaks and realize how valuable those can be for just hitting, like reset with your, your mind, your focus. And also just making time to have some fun. I, I really feel that our class emphasize that a lot because we were also motivated to perform as best we could on test exams and really trying not to sweat the small stuff. Obviously, like I said, the whole goal of it was to let's focus on the big picture and maybe try and make it a little bit easier on ourselves throughout the way.
Speaker 1 (20:11):
Excellent advice. Excellent. Well, Bri, thank you so much. You are absolutely wonderful and makes me very excited for the future of our profession, knowing we have people like you getting ready to graduate and enter the workforce. So thank you so much for coming on the podcast.
Speaker 2 (20:29):
Yeah. Thank you so much for having me. I really appreciate it.
Speaker 1 (20:32):
My pleasure, and everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart.
In this episode, Director of Rehabilitation at OL Reign, Dr. Nicole Surdyka, talks about on-field rehab after ACL injury.
Nicole is currently the Director of Rehabilitation at OL Reign, one of the founding clubs of the National Women’s Soccer League, NWSL, which is one of the best professional women’s soccer leagues in the world.
Today, Nicole shares her 5-phase on-field rehab strategy, and the decision-making process in return-to-play and return-to-performance. What are the criteria that Nicole looks at to determine progress to the next phase of rehab? She tells us about delaying return to sport to reduce second-injury risk, the return to sport continuum and how to define it, and the use of the StARRT framework for the return-to-sport decision-making.
Nicole gives some valuable advice to her younger self, she tells us about integrating rehab with team activities, and communicating with athletes and coaches, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- Nicole implements on-field rehab in 5 phases.
Phase 1: Simple, pre-planned, linear movements. The focus is on quality of movement and cleaning up movement technique before moving on. Typically includes walking marches, walking lunges, side shuffles, and jogging. Nicole starts this at 70-75 quad strength limb symmetry index.
Phase 2: Pre-planned direction-changing movements. Typically includes accelerations, decelerations, sprinting, and change direction.
Phase 3: Adding reactive tasks without a soccer ball. Direction-changing with an element of reacting to an external event. Nicole starts this with at least 80% quad strength limb symmetry index.
Phase 4: Soccer-specific movements. The reactions are done in context – with a soccer ball.
Phase 5: This phase should look like a modified training session.
- Delaying return to sport: each month that you delay that, there’s a 51% reduction in second-injury risk, up until the 9-month mark.
- Return-to-participation: When athletes are participating in their sport in a modified way – participation with certain limitations on activities.
Return-to-sport: When there is no longer any medical reason to limit an athlete’s participation – “cleared to play”.
Return-to-performance: There are no restrictions and athletes are training to become better at their sport.
- “Be patient. Every experience is valuable, and you can relate any experience to what you eventually end up doing.”
Suggested Keywords
On-field Rehabilitation, StARRT, Injuries, ACL, Sport, Performance, Physiotherapy, PT, Therapy, Wellness, Health, Injury-Prevention, Recovery,
Recommended reading:
Consensus statement on return to sport: https://pubmed.ncbi.nlm.nih.gov/27226389/
On-field rehabilitation Part 1: https://pubmed.ncbi.nlm.nih.gov/31291553/
On-field rehabilitation Part 2: https://pubmed.ncbi.nlm.nih.gov/31291556/
More about Dr. Surdyka:
Nicole is currently the Director of Rehabilitation at OL Reign, one of the founding clubs of the National Women’s Soccer League, NWSL, which is one of the best professional women’s soccer leagues in the world.
Nicole is a physical therapist and strength and conditioning coach. She played Division 1 college soccer at St. John’s University and then went to Emory University where she got her Doctor of Physical Therapy Degree. Throughout college and PT school, Nicole coached youth soccer and worked as a personal trainer.
After PT, school Nicole worked in various outpatient orthopaedic and sports medicine clinics before starting her own practice in 2018 where she worked with youth to professional athletes. Nicole specializes in on-field rehab for soccer players to help bridge the gap between rehab and sport performance. She is passionate about the return to sport process and how we can make better decisions for athletes returning to sport after an injury.
Nicole has a website where she writes blog posts on rehab for soccer players, has eBooks available on specific injuries, teaches continuing education courses, and has presented at CSM and other national and international sports medicine conferences.
To learn more, follow Nicole at:
Website: Nicole Surdyka Physio
Facebook: Nicole Surdyka Physio
Instagram: @dr.nicolept
LinkedIn: Nicole Surdyka PT
Twitter: @NSurdykaPhysio
YouTube: Nicole Surdyka
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73
SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the transcript here:
Speaker 1 (00:00):
Hey, Nicole, welcome to the podcast. I am so excited to have you on.
Speaker 2 (00:05):
Thanks. I'm excited to be on.
Speaker 1 (00:07):
So this whole month we're talking about ACL injury and ACL rehab, and you are an expert in both. So I'm really excited to have you as one of the guests this month. And today we're going to be talking about something that is really your zone of genius, and that is the on-field rehab, a rehab techniques, I guess, that helped to bring that player back to performance. So can you talk about what is the on field rehab like?
Speaker 2 (00:45):
Yeah. So I guess it's a concept that I, you know, I was a soccer player. I was a youth soccer coach, and so I always kind of felt in the back of my mind when I was going through PT school, like, Oh, wow, I could blend. Like, if, if we're trying to get this adaptation or build up this physical attribute, we could do that through soccer. And so it just made, it was something that made sense to me trying to incorporate the sport as much as possible, but where it really all clicked and came together. For me, it was actually at the isokinetic conference that I went to a few years ago in Barcelona. And actually your previous guest on this in Arundale was the one who talked me into going. So that was great. And I saw a presentation by Matt Thorpe about on-field rehab. And of course he and Francesco via have published two different articles in WSPT on this, but kind of seeing that presentation really yeah, tied it all
Speaker 1 (01:42):
Together and made me have that aha moment
Speaker 2 (01:44):
Like, Oh, this is a thing I can make this happen. And so really what it is is it helps to bridge that gap between the gym-based rehab and then sending the athlete back for their sport. Because if you think about it, there's so much of a difference between doing a drop vertical jump in the gym and then landing from a head ball on the field. Like not even just physically that's different because the surface is different. Your shoe wear is different. The weather obviously is different, but there's also different things in your environment to make decisions based off of, and react to and respond to. So where are my teammates in space? Where is my opponent? Am I going to have a contact or an indirect contact, a perturbation while I'm in the air that I have to land on? Funny, where do I have to redirect my Ron to afterwards?
Speaker 2 (02:34):
And you can only prep for that so much in the gym. And at some point you really need to get them on the field and do in a controlled way, what they're going to have to do when they're playing with their team again. So on-field rehab. The way that I implement it is really based off of Matt, Matt backdoor, Ben for Jessica, Davey is research and there are papers on it, which is phase one, really simple pre-planned linear movements. And so that can start fairly early. They say in their paper that they want to start. When the athlete has 80% quad strength, limb symmetry index, I tend to start a little bit earlier than that. Typically, when I'm having athletes jog, then they can be doing phase one. So things like walking marches, walking lunges side shuffling is okay in this phase, jogging anything that the athlete is has pre-planned, it's a pre-planned movement and it's just linear.
Speaker 2 (03:34):
So no changes of direction yet. And in this phase, we really focus on quality of movement. And we start to address here before they move on to more complex tasks we address are they moving efficiently? And are there things we need to clean up with the technique of their movement? So something like a high skip or a walking March, are they getting a lot of trunk lean? Are they yeah. Are they kind of like looking like Gumby out there? And so we need to clean that up a little bit, and this is the phase that we can really take the time to do that. So again, I like to start this pretty early. Typically I want them to be at least 70 to 75% quad strength, limb symmetry index. But the, just as a caveat to that, the paper by Francesco and met, like they're up says 80%.
Speaker 2 (04:27):
So just be aware of that phase two, they then move on to being able to change direction. Everything is still pre-planned. So we can take those linear movements from phase one and make them a little bit more intense. So we can start working on reaching towards accelerations decelerations, maximum speed. So we start to work on sprinting here and exposing them to high-speed running on the multi-directional staff. We can have them do anything pre-planned so no reactive tasks yet, but they can start to cut decelerate, changed direction, all controlled everything throughout the unfilled rehab program is control first. Then we build volume and intensity. So after phase two, we can progress them to phase three. Now for this, I definitely want them to be at least 80% quad strength, limb symmetry index. And I would love for them even to be closer to 85% and depending on how they look functionally.
Speaker 2 (05:29):
And so this is when we start to add reactive tasks. So now change of direction tasks, but with a reactive component. So they're reacting to something external to them. So I like to mix up and I know Amy talks about internal versus external cues a little bit. And it's something that definitely is coming up a lot in ACL research with motor learning is that we want some external cues. And so that can be auditory. That can be visual. So I like to do kind of a combination of both. I'll use words that they're going to hear while they're on the field. So turn man on ball, you know, I'll use kind of those that verbiage. And then the visual is you can make it just simple. You pointing to where they have to cut to or change direction to. You can make it be, they have to follow the ball, they have to follow a runner.
Speaker 2 (06:25):
So they have to follow where the space is that you've set up with, however, you've set up the environment. So that's where we add the reactive components and they anything pre-planned they can now be doing at speed. Next, we're going to go into phase four, which is really going to be more soccer, specific movements. So now they can react with a soccer ball. So everything we didn't base three with the reactive movements is them without a ball at their feet. Now in phase four, we can add a soccer ball. So you have to turn and either dribble, dribble, or pass, or you know, you have to collect the ball and then make a decision based on what's going on around you or what the coach or the physio calls out. And then phase five really should just look like a training session, a modified training session. So I try to replicate what the team has done in their training session or what a typical team training session would look like as much as I possibly can within a more controlled environment. So that's kind of the five phases and then, yeah, and then I started to incorporate them into the team. Okay.
Speaker 1 (07:32):
So let's, I have a couple of questions. So we're just going to back up a little bit. So for most of these phases, certainly phase one phase two phase three is the player is the player alone on the field? Do they, are they working in tandem with another player on their team?
Speaker 2 (07:50):
So typically when I was, before I had my current role, I had my own practice and I would work with the athletes. So it would be me and the athlete. If they had a friend or a teammate who was available, it's always nice to add other players. Now here at LL rain. I have two athletes right now who are going through ACL rehab together, kind of they're at a little bit different spots, but I can still work together with them, which is really nice. And then I can always pull some of the other players. So, Hey, do you want to work on crossing and finishing today? Great, like come in for this session this time and I can pull other players and you can do it alone. Eventually you need to start adding other players because there's 22 people on a soccer field. And so they need to start being able to move and react to all of those different people on the field, around them. And you can still do that in a controlled fashion. Absolutely.
Speaker 1 (08:51):
I will say to, to play or one, I want you to run down to line and cut to the right as your athlete is within the midst of whatever you're asking them to do from a rehab standpoint. Correct.
Speaker 2 (09:03):
Exactly. You can say, okay, you're going to run up and defend them. I want you to force them to their right. You know, so that way I have that person has to go to their right, so you can control for it. Whereas in a game you can't tell them, or an even in a practice session with their team, you can't say to all the other players on the field, Hey, when you go and defend, so-and-so only for, for her to her right foot, okay. That's never going to happen, but in that nice in on-field rehab, you can control for those things. And
Speaker 1 (09:31):
The other question I have was what is the criteria for entering phase two?
Speaker 2 (09:35):
Good. So, and answering into any onto three high program. I mentioned the quad strength, limb symmetry index, but also there should be no joint pain or a fusion. They can have some muscle soreness at times if they had a patella tendon graft they can have some patella tendon pain. I'm okay with that. Hamstring graft, if they have hamstring pain, I'm okay with that. But, and then also no joint laxity. So I'll typically just do a Lockman's anterior drawer test, as long as those are negative and there's no joint fusion, then we're good to go. Now it's progressed through each stage, subsequent to that, as long as they're able to do those movements with control, and there's no increase in joint pain or a fusion during any of those stages, then I can progress them. Although I still want to bear in mind, like we're not just going to do walk like phase one stuff.
Speaker 2 (10:27):
And then it's like, Oh, they felt good. Okay. Now we can do phase two. Like I still want to make sure that we get a couple sessions in and it's always going to play back into the overall big picture of where they're at in their rehab. You know, we're still doing a gym-based strength program at the same time that we're complementing with on-field rehab. So it that's where it kind of the the art of coaching takes in a little bit. And you just need to understand where your athlete is and if they still need more time in that area before moving on. Got it. And
Speaker 1 (10:59):
I know this is a question that a lot of people constantly ask when it comes to ACL, what is the timeline? Right. You know, cause you're always here. You don't want to return to play for a year for 10 months, nine months, a year, two years. So as you are going through these phases, are you also taking into account where they are in that rehab continuum or in, you know, post-surgical so how do you question
Speaker 2 (11:26):
W so it's kind of the, the short answer to that question is we can go back to some of the research that's been done by the Delaware Oslo cohort, so that, Hey, grandam over at Oslo and Lynn center Mackler at Delaware, and they've shown that delaying return to sport each month that you delay that there's a 51% reduction in second injury risk. And really the whole thing of this is when we're sending out fleets back to sport after an ACL reconstruction, our goal is to not allow that to happen again, right? The rate of a secondary injury is so high that there's obviously a flaw in how we're sending athletes back. So I think that most athletes go back too soon. And so each month that we delay up until the nine month Mark and at nine months, we, after that, we don't really see that level of reduction in, in, in second injury risk.
Speaker 2 (12:22):
Now for a youth player, who's not really in a rush to get back. I will probably never let them go back before a year. I just, there was no reason it's not worth the risk. They're agreed so much more likely to have another injury. And like, why have two ACL injuries in high school before you even get to college? Right. If the goal is to, is to play in college, you're better off missing your entire junior year of high school to just rehab and then be really strong for your senior year. As opposed to feeling like, Oh, I have to show college coaches. I have to go to all these college showcase tournaments, which I know is, is pressure on the athletes, but what does it, do you any good if you go back and now you do it again and you miss all of senior year as well, right then by college, like that's not going to happen for you. Right. So more of the professional athletes, there's a little bit more pressure, it's their livelihood. Right. So I'm okay with moving or even college athletes. I'm okay with moving closer to nine months, but I will never go before that, unless I have somebody like an Adrian Peterson who is just one of those outliers, then they have to give me a really good reasons to let them go back.
Speaker 1 (13:33):
Okay. And this actually flows perfectly into the next topic I wanted to talk about. And that is that decision-making for return to performance, right? So we've got the return to play. And even if you want to talk a little bit about that distinction between return to play and return to performance and talk a little bit about what your your decision-making
Speaker 2 (13:57):
Is like. Yeah. So to talk about that continuum a little bit, and actually I just had a meeting with our coaching staff here about that to make sure you're on the same page about these definitions. And so how I define them is based off of the return to sport a consensus statement for that Claire and was lead author on where the return to participation phase is when, or end of the continuum is when athletes are participating in their sport, but in a modified way. So I have a couple athletes now who I say, I look at what the daily session plan is for, for the training session. And I'll say, okay, this athlete can do the technical warmup and they can do the [inaudible], but I don't want them doing the two V twos because it's too much deceleration cutting, et cetera. So they, that counts as returned to participation because they're participating, but I'm still putting restrictions or limitations on them.
Speaker 2 (14:53):
So anytime there's any kind of modification or restriction or limitation there in returned to participation, when the medical, when there are no longer any medical reasons to hold an athlete back, that's when they're in return to sport. So that's what I would define as saying like you're quote, unquote, clear to play, right? Is that I'm not putting any restriction on you, if you are not being selected for playing time or for your starting position. That's because the coach isn't selecting you, not because I'm holding you back, but then beyond that, because sometimes an athlete's not going to really be satisfied with that outcome, right? If you're used to being the starting center forward and scoring a goal, a game, and now you're cleared, but you're not being selected into the starting lineup, or you're not being selected to the game day roster, or you are, but you haven't scored a goal in five games.
Speaker 2 (15:44):
Now you're not performing at where you were prior to your injury. So there's no medical reason to hold you back, but maybe you're not playing as much or playing as well as you would like to be. And that's where we transition into return to performance. So return to performance is there's no restrictions on you, no medical limitations or anything holding, holding you back from a rehab perspective. And now we're training to get you to being better at your sport. And I think those are really important distinctions to make, because a lot of times athletes or coaches, and actually it will be back and cleared to play, but coaches like, well, why isn't she as fast as she used to be? Why isn't she scoring goals? Like she used to be? Is she still hurt? It's like, no, it medically fine, but we're just not at return to performance yet.
Speaker 2 (16:33):
So then to to kind of decide when to send an athlete back for each of those things, I tend to look back to the on-field rehab program and how that is structured. So I'm a big fan of integrating the team, the athlete into team activities as often, and as much as you possibly can. So if they're able to do the technical warmup with the team, I'm putting them in there because, and that would technique that would typically be if they're in stage two, right. Cause it's going to be mostly pre-planned change of direction tasks, maybe some accelerations D cells, depending on, on what the warmup looks like. Sometimes there's reactive components. And so that sometimes takes just a conversation with the performance director or the SNC coach or the sport coaches, just to say, what is involved in this? And then, you know, but if you, if that athlete is able to do those things and they've done them with you and an on-field rehab program, send them back into the team.
Speaker 2 (17:33):
Cause that is just to me is another level of like the cognitive awareness and their ability to see what's going on on the field, around them and adding more athletes into the mix that they have to interact with. So I'm a big fan of that. So I'll typically have them in that return to participation phase for a fairly long time, like a few months before I say, okay, you're good. So, and the example right now, I have an athlete, who's doing portions of training sessions, but I probably won't like clear her quote unquote, clear her to play in a game until somewhere in the middle of April. Right. So she'll be,
Speaker 1 (18:16):
Is she about like six months then? Post ACL? Yeah. Yeah. Yeah. Okay. Yeah. And I think it's important to mention all of this because oftentimes a lot of physical therapists and I, this is not to throw our profession under the bus or anything, but a lot of physical therapists tend to be a little bit more restrained. They won't want them to go onto field. They won't want them to do this on-field rehab until they're at 90%. Right. And or until the doctor clears them to return to play well, you can't just be cleared to return to play. And you've only done a weight training program, proprioception, maybe some motor control stuff and then throw somebody on a field.
Speaker 2 (18:56):
Yeah. And I've seen that way too often.
Speaker 1 (18:59):
Yeah. Yeah. And so it's, I think that I'm really happy that you're saying like, Hey, you know, at six months they can be with the team, they can do some things. It just, it sounds to me like it's a lot of communication and collaboration from the, all of the stakeholders, right?
Speaker 2 (19:14):
It is, it does take a lot of communication. And we have twice a day meetings, constant emails, constant communication about where each athlete is. And then, you know, there is things that come up that we have to adapt to, like this was the training session plan. And this athlete was going to be able to do this amount of load that day. And then based on what was happening in the session, the plan changed. And so we have to adapt to that. And then we just supplement that with it with more on field work, you know, if they weren't able to do as much in the session with the team, then I just will take them to the side and do more work with them on the field. Now I will say that this is a lot easier to do in a team setting. And now I didn't work in a team setting for most, all of my career up until very recently.
Speaker 2 (20:01):
And so what I did in that situation, working in an outpatient clinic, that doesn't mean that this doesn't apply to you because you can still use this. And so what I used to do is whatever I would see my athlete do in the clinic with me or on the field with me, I would say, okay, I want you to go do this in practice with your team. So I want you to do the dynamic warmup with your team and then that's it. And then report back to me if that felt okay for them, then I'll say, okay, you can do any technical drill. You can do rondos, you can do, you know, possession style games but no contact. You can be neutral player. And I'll tell the athlete that depending on their age, I'll also tell their parents I do or did before I was in my current, always try to reach out to their club coach or their high school or college coach and let them know what the restrictions were. I understand sometimes we don't get responses when we reach out. I didn't always get responses when I reached out. But as long as you talk to the athlete and or their parent about that, and just make it very clear to them, like you can do this, you can not do that and then have them report back. But I, my rule of thumb was I wanted to see them do that type of activity with me before I had them do it with their team.
Speaker 1 (21:18):
Makes sense. And, and I think it's also important to note that just because you work in an outpatient clinic, doesn't mean you can't take these athletes onto a field. I live in New York city. I see patients in their home. I have a 14 year old who had a ACL rupture and subsequent surgery. And when she was 12 she's 14 now. Wow. Yeah. And we still got her out onto a field, got her. We went to the park, we did as much as we could on field. And sometimes that was just me having to be the defender or setting up cones and having her do stuff. But I think it's really important that if you work in an outpatient clinic, don't kind of wall yourself in with the walls literally. Yeah, exactly. You can take them out onto a field somewhere. I mean, if I feel like if I can do it in the middle of Manhattan, then people could probably have a much easier time doing it in places with more space.
Speaker 2 (22:15):
Yeah. And I would even get like, I've worked in clinics where the only space we had was the parking lot. And maybe that's where we did that. Or again, you can always say like, okay, I've, we've done the 11 plus warmup in our, in our gym based sessions. So you can go do that with your team now. Or we've done some volleying and passing and moving, you just need 10 yards of space. Right. We've done that in the clinic. So now I want you to try that with your team, or can you go in the backyard with your mom, dad, sister, brother, whomever, teammate, friend. And I want you to do these types of exercises in your backyard, you know, like have that be their AGP instead of having them do straight leg raises for six months. I mean, I have that either ETP.
Speaker 1 (23:06):
Yeah. I had my patient probably much, much to her. Neighbors' dismay, but we would be in the hallway of the building. Yeah. Or go into the basement of a building. I see a girl now for she's a softball pitcher. We go into an empty storefront. That's kind of attached to the building. I mean, you make it work, you know, you just have to
Speaker 2 (23:29):
Exactly. And like, if you can't find a way to make it work, you have to ask yourself, should I really be working with this type of athlete? Right. If you can't find a way to give the athlete what they need to get back safely and appropriately, then maybe that's not the setting, the athlete to be seeing you.
Speaker 1 (23:47):
Right. So it's you do the, I call it the blessing release. Oh yes. More, you need more space, you need XYZ. So I'm going to release you to someone that can, can finish the job if you will.
Speaker 2 (24:01):
Exactly. And that takes, like, I feel like in all walks of life, like just not having an ego is such an important skill set to have. And just saying, I know that there's so much more that can be done for you. And I know that there are too many limitations on me to be able to do this. So here's someone who can help you and you should move on to this person.
Speaker 1 (24:22):
Yeah. Yeah. And I think that's fair. And again, patient centered. And when you think about that return to sport, decision-making a lot of Claire, our Dern's work is that patient centered decision returned to sport decision-making. And so what you just said is exactly that. And so I think it's important for people listening that it may not always be you. Yes. That is such an important point. Yeah. Now, is there anything that we missed or that I glossed over that you're like, Oh man, I really wanted to make this point. Did we hit everything? Yeah. We hit everything.
Speaker 2 (24:57):
The only thing I would add is just as something for people to maybe go look up and learn more about is in that consensus statement, they talk about the start framework and that's what I use to guide my return to sport. Decision-Making right. So it's really just a simple needs analysis. What are the demands that this athlete is going to have to face and are they prepared for those? And yeah. So the start framework is a really great method. It's what it's literally what I use to help guide decision-making because it doesn't just look at, like, it looks at the tissue health, it looks at the demands. It also looks at what are some modifiers of those. So is it preseason? And so we can err on the side of being a little conservative or are we in the playoffs and this is one of our star athletes and we need them on the field. And so we're willing to take a little bit more risk. So yeah, I think that that's a really important framework to utilize because it provides you with that context that surrounds the kind of the risk reward ratio.
Speaker 1 (25:59):
Exactly. Yeah. And that's what I said to my, this 12 year old, who's now 14, but you know, she, we waited a year, at least a year for return to sport and then COVID hit and that night Oh yeah. Which I have to say, I wasn't mad about two years, you know, that's awesome. But you know, like what I told her was exactly what you she's like, Oh, do you think I can like play in this, you know, showcase she's an eighth grade. Yeah. No Roland showcase. And I was like, listen, here's the deal. Can you do this? Yes. Will you be at your best? No. Are you going to college? Is if this, what? And I said, it was like, if this was your senior year and it was the last game
Speaker 2 (26:45):
Sure. Have at it, you know,
Speaker 1 (26:47):
But it's not, so you're not going to do it. Are we in agreement there? And, and that's the hard part, right. Is trying to say to like a 12 or 13 was 13 or 14, 13 maybe was, do you want to play in high school? Yes. Would you like to play in college? Yes. Well then you don't need to do this exam because we're not taking any unnecessary risks and that's kind of, how did that start framework is looking at that context and I'm sure you have those difficult conversations all the time.
Speaker 2 (27:15):
All the time. Yeah. It, and especially after something like Nazi has already been cleared by a physician or previous physical therapist or athletic trainer or whomever, and then it's like, Oh no, I know that you were cleared, but we'll, you are certainly not ready. And just having that conversation can be difficult, but as super important, because all they're going to do is go right back. And the likelihood of them getting another ACL injury within the first year or two is pretty substantial. So sometimes scare tactics, work a little in that regard.
Speaker 1 (27:46):
And it's not, it's just, you're just being honest. Yeah. Like you can't like, you're the professional, you're the expert. They're the patient they're going to you because you're the expert. Yeah. Right. And so you have to be honest and you have to be upfront and you have to give them all of the options that they have and looking at things realistically, because just, you know, people say, Oh, runners, they just want to run. Well, it's the same with any sport soccer players. They just want to play soccer, football, I just want to play. And so there there's a lot of mental gymnastics that can happen in one's brains in order to justify doing that.
Speaker 2 (28:21):
Definitely. I think athletes actually appreciate that when you say like, like maybe in the moment they're frustrated, but it's not with you. It's just with the situation. And I think that makes it easier to swallow is that like, Hey, like they appreciate knowing that you're taking that context into consideration. Like, say like, Hey, if you're going to get re-injured, it's going to be in the championship game, not in a preseason friendly, like what sense does that make? And I think they do for the most part, appreciate that and understand it. Even if, again, in the moment it frustrates them a little bit. Yeah.
Speaker 1 (28:51):
I mean, there's a little bit of disappointment, but you know, something it's upsetting
Speaker 2 (28:56):
Templating moment. Get over it. You'll be fine. I feel the same. Exactly. I've never said that, but in my head I'm like, you'll be fine. You'll be to sign. Yeah. Like 10 years. That's fine. If you do it again and have to go through another year of this
Speaker 1 (29:09):
Exactly. Like 10 years from now, you're not going to be like, man, I didn't get to play in this showcase when I was in eighth grade.
Speaker 2 (29:17):
Yeah. Definitely not. It doesn't make sense.
Speaker 1 (29:20):
So I think thank you for bringing up that start framework and we'll try and get links to all of this and put them into the show notes so that everyone if you're looking for those papers on on-field rehab, the start framework and the consensus, we'll get all those and put them into the show notes. So you one click and everybody can read all of them. So Nicole, before we end our talk is the question I ask everyone. And that's knowing where you are now in life and career. What advice would you give to your younger self?
Speaker 2 (29:51):
I would definitely tell myself to be patient. I came out of school thinking like, okay, I just want to work with athletes. You know, I have to find a place where I can just do that. And anything else I do is a waste of time. And what I will say, what I would tell myself is that every experience is valuable and you can relate any experience to what you eventually ended up doing. Even working with a, you know, if it working with the elderly population that has nothing to do with working with athletes, but teaching them a new skill. If you can teach it an older person, who's never worked out a new skill, you can teach an athlete, a new skill, right. It's somebody who's like coordinated and strong and athletic as opposed to an older individual who's never worked out before. So I think that I would tell myself again, just be patient there's value in every experience and yeah, you'll, you'll eventually get to what you're looking for. Just take it, take things in stride and learn from each experience.
Speaker 1 (30:56):
Excellent advice. Now, where can people find you on social media? I think you've also got an ebook available. So give us all the goods.
Speaker 2 (31:03):
Yes. So you could to reach out to me. I'm I'm on social media. Instagram is at Dr. Nicole PT. My Twitter is at Encirca physio and my website is Nicole Serta, physio.com. I have a blog there that I grew up on this. I'm going to try to write more. I took a little hiatus. You had,
Speaker 1 (31:28):
I had a major change of life yourself from California to Portland and a new job. And so I think we, we understand we'll give you
Speaker 2 (31:40):
We're in the middle of a pandemic. So yeah, I think somewhere in the middle of the Vietnam, I just kind of lost a little motivation there
Speaker 1 (31:48):
With you all.
Speaker 2 (31:51):
Okay. It's okay. There's no need to like, feel guilty if you're in the same boat, cause I'm right there with you. But yeah, I will be writing more on that blog. I have actually a couple of different topics on the blog. One is just kind of rehab of soccer related injuries. And then I talk about some of the social issues related to soccer, things like racism and soccer and inclusion and diversity and things like that. And then also I have this little fun part. That's kind of just for me as a little self-indulgent, but life lessons that I've learned through soccer. And so that's on there as well. I also have some eBooks on my website. You can get to just by going and Nicole Serta, physio.com and it's under the eBooks tab. So on an ACL injuries, ankle injuries maybe hamstring injuries too. There's a couple on there now. Awesome. yeah, that's it. Excellent. Well, Nicole,
Speaker 1 (32:42):
Thank you so much. This was great. I great addition to our month on ACL injury and rehab. So I thank you very, very much. Thank you
Speaker 2 (32:52):
For having me on carrying this. When I graduated PT school, this is the first PT podcast I started listening to. So it's awesome to be on it. It's come full circle. It truly has. Yes.
Speaker 1 (33:04):
Well thank you and everyone. Thank you so much for listening. Have a great week and stay healthy, wealthy and smart.
In this episode, Owner of Sisu Performance and Physical Therapy, Dr. Ellie Somers, talks about bone stress injuries, specifically in female runners.
Today, Ellie tells us about differentiating between the male and female runner, and she elaborates on a subjective and objective exam of a bone stress injury. We learn about the most vulnerable sites for a bone stress injury, the misconception about the severity of the diagnosis, and the strategies Ellie uses to get women on to strength and flexibility training programs.
Ellie talks about the concerns that many people have after a BSI, and she gives her younger self some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Female runners have a lot of particular and special needs and considerations when talking about evaluation from a physical therapist perspective, as well as from a communication standpoint, that need to be considered.”
- “When you’re getting someone into your clinic, you don’t want to make assumptions about their circumstance.”
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Things to consider in a subjective exam for a bone stress injury:
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Is the patient grasping why they got into this situation? A bone stress injury isn’t necessary about the shape of their body or foot, it’s a result of limitations of their dietary intake.
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Their menstrual cycle. This can be an uncomfortable conversation for many clinicians, but it is a required question for a subjective exam.
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“If a runner is coming to you explaining that they think they sustained a BSI because of their pronated foot or because they were wearing the wrong shoes, we’ve missed a huge piece of why bone stress injuries actually happen.”
- The most vulnerable sites for a BSI: The femoral neck, the first and second metatarsal, and the anterior tibia, among others.
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The objective exam:
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Palpation, single-leg balance, and walking.
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More explosive movements. These include the single-leg hops and taking steps up or down.
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“You can still be stressing bone and it’s going to heal. When we don’t stress bone enough, it could theoretically take longer and put that bone in a more vulnerable position.”
- “Women athletes are more prone to lower bone density than male athletes are.”
- “Runners kind of have this misconception that running itself actually strengthens bone. In reality, it doesn’t really strengthen bone as much as we’d like to think.”
- “History of bone stress injury is the number one risk factor for new bone stress injury.”
- “There’s no rush. You have your entire life ahead of you to work and refine. As long as you’re working on something, you’re working towards it.”
Suggested Keywords
Running Injuries, Rehabilitation, Therapy, Physiotherapy, PT, Training, Injuries, Sport, Wellness, Health, Recovery, Female Runners, BSI, Bone Stress Injury, RTS
More about Dr. Ellie Somers
Dr. Ellie Somers is a physical therapist, run coach, weightlifting coach and the owner of Sisu (pronounced see-su) Performance and Physical Therapy in Seattle, WA. She also serves as the team physical therapist for the women’s United States Australian Rules Football Team. As a private practice owner and coach, Ellie specializes in work with women athletes, specifically runners and field athletes.
To learn more, follow Ellie at:
Email: ellie@sisuwolf.com
Facebook: Sisu Performance PT
Instagram: @thesisuwolf
Twitter: @drelliesomers
YouTube: Sisu Sports Performance and Physical Therapy
Website: https://sisuwolf.com/resources/e-books/return-to-run (FREE gift!)
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
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Read the Full Transcript Here:
Speaker 1 (00:01):
Hey, Ellie, welcome to the podcast. I'm happy to have you on. Thanks for having me, Karen. So this month we're talking all about running injuries. Just so people coming onto the podcast is the first time you're listening this year, sort of changing up the format each month is a different we're focusing on a different topic. So last month was all about ACL injuries. This month, we're going to concentrate on running injuries, which is why Dr. Lee summers is here. And today we're going to be talking about the female runner. So Ellie, my first question is, are female runners, just little petite male runners, and it should be treated as such.
Speaker 2 (00:38):
Well, obviously the answer to that question is drum roll, please. No, yeah, yeah. I think female runners have a lot of particular and special needs and considerations when talking about evaluation from a physical therapist perspective, as well as from a communication standpoint that need to be considered.
Speaker 1 (01:02):
And what kind of, can you kind of differentiate that male runner from the female runner? What are kind of some of the big differences that if you are a physical therapist, a run coach, even a personal trainer, a strength and conditioning coach, what are some things that we need to be aware of in the female runner?
Speaker 2 (01:20):
You know, the way that I think about this, I actually think about it from a bio-psycho-social perspective. So what women are exposed to in our environments, in our engagement with other human beings, with social dynamics and things of that nature is very different than what men are typically exposed to. I also think of it as you know, generally speaking in terms of adaptability, women and men have the same traits and characteristics, but certainly things that need to be taken into consideration for women include our biology and physiology more specifically our menstrual cycle and hormone cycle. So I tend to think of it as a very holistic thing. And what are the things that female runners might be exposed to that set the stage for certain types of injuries or pain experiences that maybe male athletes aren't or are less likely to be
Speaker 1 (02:22):
Right. Got it. And so now let's take a common injury that you may see in a female runner, and let's talk about what you would how you would go about your subjective exam, and then we'll get into objective exam and some possible treatment options, but let's take a bone stress injury, pretty common in female runners. So first talk about, well, actually, let's talk about why is that common in female runners?
Speaker 2 (02:54):
That is a great question. Lots of there's probably a lot of nuance to answering that question. I think theories abound and I'm thinking of those series. I think that the primary thing that we get exposed to as female athletes is how do I want to phrase this considerations about our body and in the run community? I think it's a lot more pervasive for women athletes. So not only are women on the whole exposed to messages about their body, that they need to be smaller, that they need to be thinner in the run community itself. Women are then also exposed to this concept that you'd need to be in order to get faster. You need to be thinner. And that sets the stage for eating disorders and diet restriction and limitation that can lead to bone stress injury.
Speaker 1 (03:55):
Got it. Okay. So obviously very sensitive subjects. So the subjective exam becomes all the more important. So walk us through maybe how some questions that you would ask and kind of how you would asking keeping that sensitivity of this may be a person that's experiencing maybe some eating disorders or experiencing some body image body image issues. So walk us through your subjective exam.
Speaker 2 (04:27):
Yeah. So I think it depends on what they're coming to you for and what you know already. So depending on your clinical setting, you might already know they're coming to see me for a bone stress injury. And this person may have already seen a physician and had the imaging done at which point you may not need to dive into a lot of detail there, but I think what you want to try and capture is is this person grasping why they got into this situation. And I think as a clinical provider, that's working to reduce risk, prevent air quotes around prevent these types of injuries. You need to understand that this person knows that bone stress injury isn't necessarily a result of the shape of their body or the shape of their foot. It's the result of really limitations on their dietary intake. So when you're getting somebody into your clinic, you don't want to make assumptions about their circumstance, but I think it, it behooves you to start to ask questions around, you know, do they understand why they got this injury?
Speaker 2 (05:40):
And if their answer to you is while I was over-training, you might want to start to dig deeper and figure out if you can fill any gaps and holes there to help them understand that fueling strategies are a big contributor to these injuries. So subjectively there's that piece to cover. Then I think you also have to think about how do I want to say this their menstrual cycle basically. And I think for a lot of clinicians, these topics can be very uncomfortable, hard to, to talk about, hard to ask questions of, but when you're doing a subjective exam, this is a required question to be asking, what is your menstrual cycle? Like, are you having regular and normal periods? When did you start your period? At what age, if you're not comfortable asking these questions in a face-to-face manner, or you don't think it's appropriate for you, then they definitely need to be included on your intake forms. And you need to be reviewing your intake forms before you see that person in your clinic. So those would be, I think the two primary things that you need to sort of start to get a picture of, because if a runner is coming to you, explaining that they think they sustained a BSI bone stress injury because of their pronated foot or because they were wearing the wrong shoes, we've missed a huge piece of why bone stress injuries actually happen.
Speaker 1 (07:17):
And I really do like including that on your intake paperwork, because then even if, whether you're uncomfortable asking that question or not, or you are comfortable either way, I mean, either way, quite frankly, you should be comfortable asking that question. I don't care who you are. You're a physical therapist, you're a healthcare provider. That's a question you should be very comfortable asking because it is part of their medical record. And part of, of like can be part of the reasoning behind these bone stress injuries. But it also gives you if it's on your intake form, it also gives you more information so that when you are in your subjective exam, you can perhaps hone into that and you can even say, Hey, listen, on my on the intake form, I noticed that you're not having like regular periods. Can you tell me a little bit more about that and that's it.
Speaker 2 (08:16):
Yeah, exactly. Yeah. And I think all it will show you is, is this person having energy demand issues? You know, we know that if you've lost your period or you're having irregular periods, it can be a very clear objective indication that your energy in is not matching your energy out. And it's what we would call somebody suffering from low energy availability or in the, the more maybe more like broad terminology would be relative energy deficiency in sport. And this can cause a host of different and problems. And the last thing you want to do as a clinician or provider is I think miss that, especially in a female runner, because it just sets them up for recurring bone stress injuries, or recurring injuries. And that cycle will just repeat itself.
Speaker 1 (09:11):
Yeah. Now, okay. So you've asked those questions. Are you asking questions on how much are you running? How often are you running? Have you picked up your mileage and things like that? Is that something that you're asking as well?
Speaker 2 (09:25):
100%, because a lot of the times people who are training for a new distance of an event, right? So if I have a person who's like I was training for my first marathon, they might have sustained a bone stress injury as a result of some of that increase in strength in training while also maybe not matching that with their fueling. So it helps you get a picture of what this person is training for and why they're training for it and how much training they have. And then you can move forward from there with a more practical plan as a physical therapist on how we're going to strategize a graded return to activity.
Speaker 1 (10:07):
Got it. Okay. Any, what else are you asking? What else do you need to know from this patient,
Speaker 2 (10:19):
Everything else that you would need to know in a physical therapy exam? I think you know, I think for a lot of folks, these injuries are scary and they've disrupted their lives to a great degree. A lot of these runners will have to stop running for months of time. So all of the same questions you would ask, but then I would also add onto that. You want to know, sometimes you want to know, does this person have a registered dietician as part of their care team? Are they working with an endocrinologist? Have they had any blood work done to determine if they were suffering from relative energy deficiency in sport? Do they have a team of people that can help support their progression back to play? Now? I want to be clear. I don't think every single person who has a bone stress injuries requires a team of people. I think it's an ideal. And if I've got somebody who's come in, who's got a bone stress injury, and doesn't have a team of people I'm planting seeds to get them, that team. So that they're set up for success.
Speaker 1 (11:34):
Yeah, that makes sense. Yeah. And gosh, I just had a question and it was like in my head and just went it'll it'll come back. It'll anyway, it'll come back to me. I'll edit this part out. It'll come back to me. Cause it was a good one. It's there it's there. I just there's days. It's just it's. I was like, Oh, I got to ask this question anyway. If I think of it later, I'll ask it later and we'll just splice it in. No one will know the difference. Oh yes. Got it. It's back. Okay. So is there a difference when someone is coming to you via direct access, just versus someone has already been to a physician, they have been diagnosed with a bone stress injury. Let's say they had some imaging done. It has shown up where, what is the difference there? Is there a difference in your examination of this person?
Speaker 2 (12:28):
Yes, absolutely. Because, and I work primarily in a direct access capacity. So by when people come to me, they haven't typically seen anybody else. And now it's my responsibility to be able to pick up on these things and tell someone, you know, I need you to go see your physician. We need to rule out bone stress injury before we move forward. So from a purely exam standpoint, when somebody is coming to me, who is a runner who potentially has pain at a site that could be risk for bone stress injury, I need to have the evaluation skills to be able to, to rule that in or rule that out to some degree so that we can move them in the right.
Speaker 1 (13:15):
Got it. And what are those sites? What are the most vulnerable sites for a bone stress injury?
Speaker 2 (13:21):
Well, the femoral neck is one of the most vulnerable, I would say anyone who's coming in, who's a female athlete. Who's complaining of anterior hip pain. That's maybe a little bit vague and is presenting with some of those additional sort of risk factors changes in their menstrual cycle, low energy availability training, abrupt training changes. I'm starting to stew a little bit and get a little bit concerned. So that's going to be a high-risk stress fracture site, some other high risk stress fracture sites include the first and second metatarsal. And I want to say the anterior tibia as well. It's likely that I'm forgetting one, but yeah, some of those regions are considered high risk. High risk essentially means that the likelihood for healing is a little bit harder, I guess you could say.
Speaker 1 (14:18):
Okay. All right. Thank you. All right. Now let's move on to your objective exam. So what kind of things are you looking for? Are you going to say to this person, let's get you on the treadmill and see what you're doing with your run? Okay.
Speaker 2 (14:34):
That's the great part of the subjective exam because the subjective exam is going to lead me into thinking whether or not I need to test for bone stress injury before we pursue running. Right. And there are a couple of things that are going to lead you that some of which I've already talked about, but site-specific pain is definitely one of them, localized pain. Sometimes people will point directly to their pain and be like, it's right here. They can have pain in, I know femoral, neck stress fractures. They can have pain with offloading. So sometimes they'll say, you know, like stepping off of a step, I suddenly have pain in my hip. So there are things that you'll just pick up on and then you do not want to get on the treadmill at that point, if you're suspecting bone stress injury, you need to do the tests to sort of rule it out before you get to the treadmill. Some of those tests that I would do, I think first would probably be about palpation. So depending on the area, you know, the femoral neck is
Speaker 1 (15:42):
D that's tricky. That's a tricky one to help paint,
Speaker 2 (15:46):
Be able to get there with your hands, but certainly a medial tibial region or an anterior tibial region. You can palpate that with your hands. And we're looking for pretty pinpoint tenderness. From there we might get them up and then first have them walk. What's their walking look like, is there any offloading happening then I might have them do a little single leg balance. How does that feel? A lot of the times people may not have very distinct acute pain with some of these low level impact activities, right? So if they're presenting with no pain, now this sort of, I'm going to describe it as like this first level, no pain with walking, no pain with single leg balance. Now I want to get them doing a little bit of an explosive move, maybe a step up or step down and determine are they having pain with some more functional tasks? And I think the single leg hop test is a pretty, like just straight up and down. Three hops is a pretty decent maneuver for almost any lower extremity potential stress fracture site. You know, I don't know the statistics on reliability and validity, but it's one that I use very regularly with somebody I'm suspecting that. And then from there you can kind of make a determination about how you want to proceed. Typically, speaking of the folks that I work with, they're going to have pain in one of those moves.
Speaker 1 (17:20):
Yeah. And, and at that point, does it then come down to, if you're seeing them via direct access, explaining to them, Hey, listen, this is my hypothesis. Let's get you to a physician at that point. Yes.
Speaker 2 (17:34):
Yeah, yeah. Okay. Yeah. Usually I'm revealing at that point, I'm concerned for bone stress injury. I want to get you, you know, examined for that. So, and they can, you know, go to their physician that they know and that they trust. But I think it's important depending on the region that we get the right imaging. Certainly if I hip femoral, neck stress fractures suspected, I really want to push that person to try and push for an MRI. So you know, it kind of depends on your relationship with the person and where they're at on a lot of different levels, but, but that's what we're going to be going for.
Speaker 1 (18:15):
Okay. And so let's say this is someone who has already gone to the physician. They've had the MRI, this is diagnosed. So you've done your evaluation now, what do you do? I guess the question is, is, are they come, are they non-weightbearing at this point? What are, what are some things that we can do as physical therapists for these patients when they're coming in? They've already been diagnosed?
Speaker 2 (18:37):
Yeah. Well, so many of these athletes don't get referred to physical therapy in the first place, which I think is a problem. But yeah, if you are getting these people, we really do want to be loading those tissues. And bone responds really positively to stress as long as the environment is you know, a strong, healthy, robust environment as well. So depending on their level, we're going to be progressively loading those tissues all the way up into the point where they're cleared for a return to run. So, you know, squats step up step downs. If they're not cleared to weight bear, you know, we're definitely doing stuff on the table, that's just pull it using the muscles around that tissue. And even just by using the muscles around that tissue and the injury, you're stimulating bone adaptations that are positive.
Speaker 1 (19:37):
And so I guess the, the thing that might come into a patient or a therapist is, well, if I'm non-weightbearing, I don't really want to do anything with this side. Cause what if I make it worse? Right. So is it, is this injury, let's say we're talking about a femoral neck BSI, is this injury so fragile that if you're doing things in a non-weight bearing capacity, can that make it worse?
Speaker 2 (20:05):
Not typically. You know, I, I, I tend to think that people who have had BSI or are so much more resilient than they get credit for, I have had and seen, and I don't commend this necessarily. So many runners who have run through BSI and there is, there is some toxicity there to unpack that we don't need to do today, of course. But all that tells me is that you can still be stressing bone and it's going to heal. And I think what we know is that when we don't stress bone enough, it could theoretically take longer and put that bone in a more position. So in my opinion, all of these athletes with BSI need to go to a physical therapist so that they can load those tissues up. Yeah,
Speaker 1 (20:56):
No, that makes, that makes perfect sense. And I just wanted to kind of make that distinction because I'm sure if someone is told, Oh, you have a bone stress injury, you know, scary, scary, right. Very scary. And that's where I think the team comes in. Like you said, assembling this team around that, around that runner is so powerful,
Speaker 2 (21:20):
Right? I mean, gosh, I think those soft skills are invaluable when working with women who have had BSI, because so many of these runners it's like totally ruined their perception of who they are and their worth and their value. And so you have to be really good at being a kind and generous and thoughtful and considerate to that person's experience because it's still very much in a way I'm going to use the word trauma to them. And I think not everyone is going to be ready to work with a mental health therapist or work with a registered sport dietician. But I think as their support person, your job as a physical therapist is to really listen to what's going on and gain some of that trust so that you can softly nudge them in those directions and work them towards a more robust, healthy lifestyle.
Speaker 1 (22:23):
Yeah. Because you don't want this single bone stress injury to set off a cascade of other events. That could be really detrimental to them. Not only as an athlete, but just as a person.
Speaker 2 (22:36):
Right? Yeah. I mean, women athletes are more prone to lower bone density than male athletes are. I'm just women in general. Let's just use women in general and runners, you know, runners kind of have this misconception that running itself actually strengthens bone in reality. It doesn't really strengthen bone as much as we'd like to think. And all that means as women is we need to be thinking about other ways to strengthen our bones. If that's something we care about.
Speaker 1 (23:08):
Right. And that's where a good strength training program comes in for runners because I have spoken and I have treated plenty of runners and runners like to run when you tell them, Hey, you, we should get you on a robust strengthening program. It's like, what a no. So, yeah. So now let's say you're, we're still in the treatment process. So we're, we're past the, this vulnerable part of the bone stress injury. They're able to weight bear, they're able to do more. What strategies do you use to get these women on to strength, training, flexibility programs?
Speaker 2 (23:49):
Honestly I show them, I think that's like a big component of how I work with the people that come to see me is showing them what they need to be doing. And first of all, that it's fun and that it can be fun that it's not intimidating and that we can keep it really simple and easy. And it doesn't have to be a huge long laundry list of exercises to keep them healthy. And FEMA women especially are so subject to carrying, you know, a list of 20 to 30 exercises that they're doing to, you know, through the guise of staying, I'm going to use air quotes, healthy and keeping tissues healthy, and it's just way more than it's necessary. So I think part of why women, like working with me is I have been able to really speak their language, pare things down significantly. So that it's simple. It's, you know, 25 to 30 minutes, one, one to three times a week is really all runners need to, to keep that bar trending in the positive direction.
Speaker 1 (24:56):
Yeah. And I think that's an important distinction to make because oftentimes we think we have to work out five days a week and it has to be this like really complicated. I have to do a chest day. I have to do a leg day. I have to do a hamstring day. I have to do a quad day. I have to. And with all of that said, you're like, Oh, screw it. This is too complicated. I'm just going to run. Yeah, no,
Speaker 2 (25:20):
I do not blame them whatsoever for giving up on programs in part, because they're just so complicated. And for runners, we just need to keep it simple, keep it clean, keep it short and sweet and to the point and get on, get on our way.
Speaker 1 (25:37):
Yeah. Excellent. Excellent advice. Now, is there anything that we missed as far as that treatment aspect with these women with bone stress injuries, and obviously we're not going into like individual programming for an individual person because it's so varied. I'm sure. But I guess, are there X speaking of exercises, are there exercises that you do like to include with most of your runners?
Speaker 2 (26:06):
Yes. So they're getting lower extremity strengthening exercises. So, you know, a squat and a deadlift of some sort, all of my runners will give that we're also going to be incorporating and especially for bone stress, injury, plyometric, explosive exercise. So, you know, squat jumps, counter movement jumps, broad jumps, Pogo jumps. We don't have to do those in like a hit style. If that makes sense. We don't need to be like every minute on the minute you're doing this many jumps or whatever for runners, what we need to be doing is doing it to load the bones for one and two, doing it to create and foster tendon stiffness. And so I think there's a little bit of a misnomer amongst women athletes, especially that in doing plyometrics, they have to be really, really intense. And I'm of the opinion that we want your running to be really, really intense. We don't also need your strength training and your physical therapy to be to the nth degree, intense just needs to be targeted.
Speaker 1 (27:21):
Yeah. That makes a lot of sense. So you don't need to like kill yourself on your workout day and then go out and run the next day with like jelly legs. Right.
Speaker 2 (27:30):
Exactly. Exactly.
Speaker 1 (27:32):
Yeah. It doesn't make sense. It doesn't make sense from a running standpoint. It may make sense in, in another population. Yes. But you have to be specific with your population. And this is where the skill of a good physical therapist comes in to be able to tailor that program, to that specific runner and what their needs are, especially coming off of a bone stress injury. Right. Exactly. And is there a fear in the runner after a bone stress injury, and you say to them, let's start doing some jump squats. Like what lady are you kidding me? Yeah.
Speaker 2 (28:08):
Yeah. I think people are pretty forward with some of their concerns and their worries. And depending on the capacity that you're seeing them, you see it in their body language. Right. But that's why physical therapy is so advantageous because that's where we Excel is helping people understand why something is valuable and then why it's safe. So I think it's about addressing those fears, head on getting at the heart of what they're concerned about and meeting them exactly where they're at. You know, maybe if they're not ready for that, we just try something else. In the meantime, until they're building up confidence, there's not a single person that I've worked with who has had a bone stress injury that doesn't have some of those fears pop up. It is a very real piece of a return to sport on any level. So,
Speaker 1 (28:59):
Yeah. Agreed. Excellent. Now, is there, is there anything that we missed, anything that we glossed over that you feel like you want to explain to the listeners a little bit more, or do you think we've covered, you know, sort of the high level basics on how you would look at one of these patients with a bone stress injury?
Speaker 2 (29:20):
Yeah, I think we covered most of it. You know, I think in, you know, reflecting back, it's really just understanding that we don't want to make assumptions about somebody's circumstance. You don't want to assume that somebody with bone stress injury has an eating disorder. I've worked with a number of people who have bone stress injuries, who do not have what I would consider disordered eating to the level that it's clinical. They just didn't understand how much fueling might be required for their activity. So I think in your subjective and in your relationship building with these people, it's important to keep that in mind that we don't need to medicalize everyone that walks in our door with a bone stress injury, but certainly we want to prepare them better for the future. I should also add that history of bone stress injury having had one in the past is the number one risk factor for a new bone stress injury. So in your history, in your subjective exam, that's another great question to ask. Have you ever had a bone stress injury before? If the answer is yes, you're already starting to postulate that that could be a possibility.
Speaker 1 (30:33):
Got it. Excellent. Excellent. Well, this was great, Ellie. I think that you gave the listeners a really, really robust understanding of looking at bone stress injuries from the point of view of a physical therapist. So thank you very much. This was great. Thank you. Yeah, I appreciate being here. Of course. And then where can people find you?
Speaker 2 (30:57):
Yes. So you can find me on my website, www.cc wolf.com. It's brand new. I'm just going to say brand new France shine. You can also find me on Instagram handle of@theccwolf.com. And if you want to reach out to me personally, I love getting emails from folks it's Ellie, E L L I E at [inaudible] dot com.
Speaker 1 (31:23):
Awesome. Well, thank you so much. I have one final question for you and it's one that I ask everyone. And that's knowing where you are now in your career and your life. What advice would you give to your younger self? Let's say right out of PT school.
Speaker 2 (31:39):
There's no rush. There's no rush. I think, you know, as a young PT, it was like, I want to be the best now. And you have your entire life ahead of you to work and refine and you know, as long as you're working on something, you're working towards it. So there's no
Speaker 1 (31:58):
Excellent advice. I love that. So everyone, no rush, no rush to all those student physical therapists out there. Well, Ellie, thank you so much. This was great. I really appreciate your time. Thanks Karen and everyone. Thanks so much for listening. Have a great week and stay healthy, wealthy and smart.
Episode Summary
In this episode physical therapist, biomechanist, and researcher,Dr. Amy Arundale talks about how to decrease the risk of ACL injury.
Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher. Amy is transitioning to a new role as a physical therapist at Red Bull’s Athlete Performance Center in Thalgua, Austria.
Today, Amy tells us about injury-prevention programs, communicating with different stakeholders, and helping empower athletes through education. We also get to hear about her recent publication on Basketball, Sports medicine, and rehabilitation. How does motor-learning, creative thinking, and problem-solving relate to ACL injuries?
Amy tells us about implementation and compliance with injury-prevention programs, internal versus external cues as they relate to injury prevention, and the gaps in the research, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “We’ve got great information. We know these programs can work, but for them to work, you have to do them.”
- “You may be a physio, and you may have this injury-prevention knowledge, but you don’t have to be there for this to happen. It’s just as effective for you to run this program as it is for a coach or a parent to run it.”
- “It’s exciting to see where this next generation is going to be because I think we’re going to have some athletes that are more empowered to know more about their body.”
- “We need to be better at reporting our biases, looking at our subject populations, and funding and encouraging studies outside of ‘the global North.’”
- Giving yourself the space and kindness to recognise that you don’t know everything and make it a point to learn more is good therapy.
More about Amy:
Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher. Originally from Fairbanks, Alaska, she received her Bachelor’s Degree with honors from Haverford College. Gaining both soccer playing and coaching experience throughout college, she spent a year as the William Penn Fellow and Head of Women’s Football (soccer) at the Chigwell School, in London. Amy completed her DPT at Duke University and throughout gained experience working at multiple soccer clubs in the US and Norway. Amy applied this experience working at Balance Physical Therapy providing physical therapy for the Capitol Area Soccer Club (now North Carolina F.C. Youth) and the U23 Carolina Railhawks. In 2013, Amy moved to Newark, Delaware to pursue a PhD under Dr. Lynn Snyder-Mackler. Amy’s dissertation examined primary and secondary ACL injury prevention as well as career length and return to performance in soccer players. After a short post-doc in Linköping, Sweden in 2017, Amy joined the Brooklyn Nets as a physical therapist and biomechanist as well as The Icahn School of Medicine at Mount Sinai Health System as a visiting scientist. Currently, Amy is transitioning to a new role as a physical therapist at Red Bull’s Athlete Performance Center in Thalgua, Austria. Outside of work, Amy plays Australian Rules Football for both the New York Magpies and US National Team.
Amy has also been involved in the APTA and AASPT, including serving as Director of the APTA’s Student Assembly, a member of the APTA’s Leadership Development Committee, chair of the AASPT’s Membership Committee, and currently as a member of the AASPT Diversity and Inclusion Committee.
Suggested Keywords
ACL, Injuries, Recovery, Injury-Prevention, Learning, Sports, Physiotherapy, Research, PT, Rehabilitation, Health, Therapy,
Recommended reading
https://bjsm.bmj.com/content/54/21/1245
To learn more, follow Amy at:
Instagram: @squeakyedgar
LinkedIn: Amelia (Amy) Arudale
Twitter: @soccerPT11
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Read the Full Transcript Here:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy.
Speaker 2 (00:38):
Hey everybody. Welcome back to the podcast. I am your host. Karen Lindsay, and today's episode is brought to you by net health net health therapy for private practices, a cloud-based all in one EMR solution for managing your practice. That's right. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus a lot more in one super easy to use package. Right now, Neta health is offering a special deal for healthy, wealthy, and smart listeners. Complete a demo with the net health team and get $100 towards lunch for your staff. Visit net health.com/ [inaudible] to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y my last name very, very easy now onto today's episode. So what we're doing with the podcast this month, and really every month going forward is we're going to have several guests that are all going to talk about one topic in various forums.
Speaker 2 (01:40):
This month, our topic is ACL injury and rehabilitation. And my first guest is not only an incredible physical therapist, a great researcher, but also a great friend of mine. That is Dr. Amelia, Aaron Dale, or Amy Arundale. So Amy is a physical therapist and researcher originally from Fairbanks, Alaska. She received her bachelor's degree with honors, from Haverford college, gaining both soccer, playing and coaching experience throughout college. She spent a year as the William Penn fellow and head of women's football at the Chigwell school in London. Amy completed her DPT at Duke university and throughout gained experience working at multiple soccer clubs in the U S and Norway. Amy applied this experience working at balanced physical therapy, providing physical therapy for the capital area soccer club. Now North Carolina FC youth, and the U 23 Carolina rail Hawks. In 2013, Amy moved to Newark Delaware to pursue a PhD under Dr.
Speaker 2 (02:40):
Lynn Snyder, Mackler Amy's dissertation examined primary and secondary ACL injury prevention, as well as career link and returned to performance in soccer players. After a short postdoc in Linkoping Sweden in 2017, Amy joined the Brooklyn nets as a physical therapist, the biomechanics as, as the Icahn school of medicine at Mount Sinai health system, as a visiting scientist, currently, Amy is transitioning to a new role as a physical therapist at red bull's athletic performance center in Austria, outside of work, Amy plays Australian rules football for both the New York magpies and us national team. She has also been involved in the AP TA in the AA S P T, which is the American Academy of sports physical therapy, including serving as director of AP TA student assembly, a member of the AP TA's leadership development committee, chair of the AASP membership committee, and currently as a member of the AASP T diversity and inclusion committee.
Speaker 2 (03:37):
So what do we talk about today? All about ACL's right. So we talk about injury prevention and risk mitigation programs, how they work, what the pros and cons are how collaboration is so necessary amongst all stakeholders and why exciting new research that includes motor learning principles, creative thinking, and problem solving, and are there gaps in the literature and what can we, as clinicians and as researchers do about those gaps in the research. Now, the other thing Amy has so generously done for our listeners is she is going to give away one copy of basketball, sports medicine in science. This is a book that she was involved in as an editor, and it is over 1000 pages. The book is massive, it's huge. And she's going to give a copy away to one lucky listener. So how do you win that copy? All you have to do is go to my Instagram page. My handle is at Karen Lindsey, and you will find out how to win a copy of basketball, sports, medicine, and science. Again, that's go to my Instagram page at Karen Lindsey, and we will give this book away to one lucky listener at the end of the month of February. So you have the whole month to sign up for this. So a huge thanks to Amy and everyone enjoyed today's episode.
Speaker 3 (05:04):
Hey, everybody, welcome back to the podcast. So this month we're going to be examining ACL injuries and ACL rehab. And my first guest this month to help take us through the ACL Mays is Dr. Amy Arundale. So Amy, welcome to the podcast. Thank you so much. We're starting up at the beginning of the year with the A's with it. I didn't even think about that. Yes. But then next month we go right to running and just skip everything else in between. That's fine. Excellent. So Amy, before we get into sort of the meat of the episode, what I would love for you to do is tell the listeners a little bit more about some of your more current research projects, things like that. So I will hand it over to you. Sure. So I'm just finishing
Speaker 4 (05:58):
Up as a physical therapist and biomechanics at the Brooklyn nets. So I've been working clinically with them and then doing a little bit of kind of in-house research as well. And then on the side have been working on a few different projects. The biggest one right now is starting the revisions for the knee and ACL injury prevention me Andrew prevention, clinical practice guidelines. So those were originally published in [inaudible] in 2018 and clinical practice guidelines get revised every three years. So 2021 we're due for we're due for a revision. So that's my, the biggest project I've got going right now. And a few other things working with the United States Australian rules, football league on some injury surveillance and injury prevention, particularly on the women's side. And I'm getting ready to move to Austria to begin working for red bull and I, which I'm really excited about that.
Speaker 3 (07:04):
Amazing, amazing. They all sound really like really great projects. And since you brought up injury prevention, let's dive into that first. So there are a lot of injury prevention programs. So can you talk a little bit about those programs in general, and then talk about really, what is what's really key for injury prevention in our athletes when it comes to those programs?
Speaker 4 (07:34):
Absolutely. So there's a range of different programs that have all been published on and some of them are probably a little better known than others. The FIFA 11 plus, or what's now known as just the 11 plus maybe the, one of the most notable it actually came out of a program that was called the pep program. So the 11 plus was kind of aimed at soccer players, although it has been tested in other athletes and it's considered, it's kind of a dynamic warmup. So it has some dynamic stretching and some running, some strengthening, neuromuscular control, some balance exercises within it. And most of the programs that we see that have been researched are similar kind of dynamic warmups and include a variety of different things that help athletes kind of get warmed up. So some of the other ones that have been published on include the control or knee control program coming out of Sweden at the microburst and the ACL prevention in Norwegian handball has had some great success and great literature.
Speaker 4 (08:47):
There's the harmony program and then the sports metrics programs a little bit different. It's actually a program that was designed to be kind of a in and of itself. So it's a three times a week, 90 minute per program, primarily plyometric based. So it's a little bit different from the other programs, but has also been successful. So we've got a number of these programs that we've seen to reduce knee and ACL injuries in particular. And most of them actually have been quite successful at reducing just injuries as a whole. But the key components that we see in particular being important for ACL and knee injuries are that these programs have a strength component. So they're building strength, particularly in the hips, the quads, the hamstrings, but also in the core. So it kind of proximal in like terms of like hip and core strengthening, being important plyometric component seems to be important. To some extent a balance component may be important, although that's kind of questionable as to like how important that is. And that's one of the things that we still need more literature on is how do these components interact and influence each other? Because we seem to know what we think is important, but how much and how those different components interact. We still don't know as much about.
Speaker 3 (10:25):
And when we're talking about these programs, I would imagine some of the most difficult aspects of them, especially if we're looking at a younger population. So your high school, even collegiate athletes is doing them. Yup. So can you talk a little bit about implementation and compliance with these programs and how to instill that into these players and teams?
Speaker 4 (10:57):
Yeah, I think, you know, we've got, like you said, we've got great information. We know these programs can work, but for them to work, you have to do them. And that implementation piece, you know, whether that be in clinical research you know, we talk about that gap between research and clinical practice. We really see that here in ACL injury prevention. And part of that also is it's not just physios in implementing where we've got a whole range of stakeholders, whether those be the athletes themselves, to coaches who are often running training sessions to parents who really have to kind of be bought in to teams and clubs as a whole. Because if you have a culture that kind of instills the importance of doing a prevention program, then it's going to kind of, it may benefit in kind of trickling down. And that's also a wider culture as well.
Speaker 4 (11:58):
Social media scene pro teams do it. There's all sorts of layers to this. But what I think implementation really takes is identifying with that athlete or that team what's what are barriers what's important? What do we feel is, is most important? What's not as an important, and then coming up together kind of, kind of with a collaborative strategy to overcome what are those barriers? So we know information and knowledge kind of that buy-in is important. Why the why, why are we doing this in the first place? But then there's also some of the actual practical pieces of your athlete might not want to do an exercise lying down in the grass because that grass might be wet. They're going to be wet for the rest of their training session, wet and cold for the rest of their training session. So I think it has to be a really collaborative effort.
Speaker 4 (12:59):
And each in each situation that solution may look a little bit different. We've got some really kind of interesting information coming out. For example, the 11 plus has now a couple of studies on breaking it apart. So taking some of the pieces, for example, taking the strengthening pieces and putting them at the end of training sessions. So coaches often complained that, you know, these injury prevention programs take too long and when you've only got the field for an hour, they don't want to give up 20 minutes of their training session to do this program. So now let's take, maybe we can take this strength piece out. I means, all right. So maybe it's 10 minutes warming up at the beginning. That's probably a little easier for a coach to swallow. Then as we're cooling down, maybe we're off the pitch where we get everybody together, we finished those strengthening components. So we're still getting the entire prevention program done with that training session, but it's split up. And so thinking creatively like that are some of the ways that I think we can do a lot better in our implementation, rather than just saying, do this, here you go. Why aren't and then coming back and saying, well, why aren't you doing it?
Speaker 3 (14:18):
Right, right. Oh, that's, that is really interesting that and what is, does the research show that splitting it up is still as effective?
Speaker 4 (14:28):
Yeah. From what we know thus far, it does seem to be as effective. I think there's some other projects that are starting to look at, can you actually do that strengthening piece at home now there's other pieces that, you know, compliance at home, remembering doing those exercises the right way that could come into play there. But as of right now, what it seems like splitting it up does seem, seem to be splitting it up. At least within a training session does seem to be as effective.
Speaker 3 (14:58):
Excellent. And so aside from time and constraints on like you said, wet grass, things like that, what are some other common barriers that you have seen or that the research has shown to be a barrier to doing any of these? The above mentioned prevention programs.
Speaker 4 (15:21):
Yeah. I think coaching education is a really big one. So whether there's a few studies in Germany that we're just looking at a coach's awareness of the 11 plus and for a program that's kind of sponsored by FIFA, you know, it's promoted as kind of this soccer warmup, you would think that coaches would be kind of aware of it. And it's, it's very quite, it's actually quite surprising how few coaches are, are aware of it. Part of that is it's not in their coaching education. So at least in soccer, as coaches move up, what kind of within the ranks and, and in higher level teams, they've got a complete licenses, just like you have to complete a license to be a physio and complete continuing education in soccer coaches do to getting that program into that coaching education, I think is a really important piece.
Speaker 4 (16:18):
But then there's also the piece of helping them understand, again, coming back to that, why, you know, yeah, you want your players to be available. You don't want your players injured. And that's not just a, an immediate fact, but helping them understand the long-term implications, especially of something like an ACL injury, this is not an injury. That's just going to mean you don't have this athlete for a year. This is something that's going to affect how they play long-term it's gonna affect their knee long-term it could affect their career. So this has long-term implications. Buy-In also can come from kind of some of the performance effects, the stronger, faster, more talented athlete that's that there are some of those performance effects coming potentially from performing some of these injury prevention programs or injury prevention or injury risk medic mitigation programs that can help buy in.
Speaker 4 (17:22):
And then if we just look at Google would cut straight to the chase, is coaches want to win oftentimes and money. If you've got more players available, we know more players available equals a more successful team. And even Holly silver is actually in some of her dissertation work looked straight at the more you do the 11 plus the more successful the NCAA division one men's team was. So there's, there's she, she actually was able to draw a connection between doing the FIFA 11 plus and winning that those are the types of things that oftentimes coaches will latch onto and say, yeah, I want to win. Or clubs will say, yeah, we want to win. We want to do that thing that makes us that, that next level that makes us better at the higher levels that keeps us earning money.
Speaker 3 (18:18):
Okay. Exactly. So from, from what it sounds like is to get these programs implemented is you need a lot of collaboration from everyone, from all the stakeholders, whether it be the coaches, the trainers, the physios, the players, the owners, when we're talking about big league teams and, and with our younger, our younger subset of athletes, parents, coaches, and the kids themselves. And, and I guess communicating the value of these programs depends on who you're talking to, which is why, if you're the physio communicating the program, you really have to have a different set of communication bullet points, if you will, if you will, for each person on the, within that team, because you're going to talk differently to a parent than you are to an owner of a team, or you're going to talk differently to a coach than the player or the parents. So really knowing how to, how to talk to those stakeholders is key. And I think everything you just said will kind of help people understand how to have those different conversations with different people.
Speaker 4 (19:26):
Yeah. And I think there's all the other piece that some of those conversations is really empowering them. So there's the education piece and helping them understand, but there's also the empowerment piece that you may be a physio and you may have this injury prevention knowledge, but you don't have to be there for this to happen. It's just as effective for you to run this program as it is for a coach or a parent to run it. And we have, there's some good data on that that coaches can run really effective injury prevention programs. And so helping them kind of take on that role and say, yeah, no, I, I feel confident in taking my players through this. I feel confident in knowing why we're doing this there. I think that's the second piece too, is that it kind of empowerment piece, and maybe it's a player, maybe it's a captain that, that needs that education or that kind of empowerment as well.
Speaker 4 (20:31):
I think the generation of players that's growing up now is going to be very different from the generation of players say that you and I played played with we didn't understand or really have much of this. Whereas I think there's some really, there's some kids growing up now who are growing up with some amazing knowledge. And I think also coming with it, hopefully some better strength, some more and more neuromuscular control than maybe we had coming through puberty as well. So I think it's exciting to kind of see where this next generation is going to be, because I think we're going to have some athletes that are just like that more empowered to know more about their body. Maybe have a little bit more control maybe even coming with also potentially better talent who knows, who knows? Yeah. TBD to be determined. So you mentioned a little bit about motor learning. So let's dive into that a little bit because there is new research that includes motor learning, problem solving creative thinking. So what exactly does that mean in relationship to ACL injury?
Speaker 2 (21:51):
No, we're going to take a quick break to hear from our sponsor and we will be right back net health therapy for private practice as a cloud-based all in one EMR solution for managing your practice. That's right. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus lots more and one super easy to use package right now, net health is offering a special deal for healthy, wealthy, and smart listeners completed demo with the net health team and get a hundred dollars towards lunch for your staff visit net health.com/lindsey to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y.
Speaker 4 (22:38):
Yeah. So I think it's a really exciting area. And I think we're really just kind of tipping a little bit of the iceberg. People are starting to pay attention to some of the work that's coming out. And I think it's, it is really exciting and in the kind of prevention realm what we're seeing is people kind of pointing out that the programs that we have, we know we kind of have some principles of motor learning, but the programs in injury prevention that we have haven't really paid much attention to them. So at a very basic level one of the things that has been talked about from a motor learning perspective for a while now is internal versus external cues. So we know that giving an external cube, giving an output outcome focused, Q2 and athlete is going to help them keep that motion kind of more automatic. They're not going to be thinking about like, I need my hip in line with my knee in line with my toe and foot, my knee. Can't go too far over my shoe laces. I need to sit down.
Speaker 3 (23:50):
That's a lot to think about. Yeah. You can't
Speaker 4 (23:52):
Play a sport while you're thinking about all those things. Yeah,
Speaker 3 (23:55):
Yeah, no, no.
Speaker 4 (23:58):
So when that, if that cue is external or is outcome-based suddenly that athlete's much, much more, much better able to pay attention to the soccer ball that's flying past them or getting ready to, to bat.
Speaker 3 (24:13):
And can you let's if you wouldn't mind, just so people have a better idea of what an internal versus an external cue is. Can you give an example of, let's say a situation we'll use soccer as the example and give an internal cue and then give an external cue so that people can differentiate.
Speaker 4 (24:34):
Yeah. Yeah. So maybe, maybe we'll do say we're doing like a single leg squat, similar to what I, what I just said. So an internal cue might be, I want you to keep your hip, your knee and your foot all in one straight line that external cue might be giving them a we'll say a pole that's lined up in front of them and you might not even tell them what they're, what what's going on. Maybe you've got a pole in front of a mirror, so that's poles running vertically and they're, they're they're we, we just set them up so that their foot's in front of that pole and they're doing that single leg squat. So now you've got a visual line in front of them. You're paying their, their attention is going to be on that visual line. As they're doing that single leg squat, suddenly you see that they see that like, if their hips pretty far adducted or their knees collapsing in, you've got a line you can say, focus on that line. I'm going to focus on that line. Got it. That one, it isn't their body. Other cues, maybe like giving analogies I want you to think of your body as a column or that's, that's not a brilliant one. But you know, things like that. So analogies are helpful for external cues. They're also we'll get in, I'll get into that in a, in a sec, cause they're actually another,
Speaker 3 (26:10):
Go get into it, get into it.
Speaker 4 (26:12):
So analogies also bring in another piece of motor learning, which is called implicit learning. Again, kind of having that internal picture of what emotion should like should look or what that motion should feel like is implicit learning. So you've got external and internal, external internal cues, but you've also then got kind of implicit learning. So a great example of implicit learning is when you ask, you know, a really athlete to explain what they do on the court or on the pitch. And a lot of times they can't put words to what they do. And that's, that's kind of a good example of maybe implicit learning is they've got, there's no rules set to that learning. There is no order. It's just, I've got this internal knowledge, internal picture internal kind of motor memory of what, what that is. And I just execute that.
Speaker 4 (27:11):
I don't think about it. And so with those, all of my attention can stay to the game. I'm not thinking about how I'm moving. I'm just, just, just kind of to the game. So pulling those back to prevention are kind of injury prevention programs have said, here's a video or here's a picture. This is good. This is bad. Or they've given kind of implicit our internal cues. So those internal cues are those, keep your knee, your hip and your foot all in one straight line where we may benefit and where we might be able to bolster. Some of those programs is by adding some of these, these motor learning pieces at the very basic level, adding external cues, maybe adding some analogies or some implicit learning. Another, another way you can facilitate implicit learning is through dual tasking. One of my favorite things reading through some of the literature is in studying implicit learning. A few authors have taken novice novice golfers, and these novice golfers have, have to go and put, and while they're putting they basically yellow letters.
Speaker 4 (28:35):
So you literally just be out there like trying to learn to put you, you don't. I know how to put, you may not even get any directions, but you're just out there kind of yelling some letters, because if you have to generate letters, you can't be entirely focused on that pudding. So there's that aspect actually, of having two tasks going on at once. That means not all your attention can be on one of those tasks. How does that help? How does that help the movement? Yeah, so, so that's a very good question. What it means is, as you're learning, it it's like harder, but yeah, once you get to that kind of point where you're comfortable, you're able to execute that movement. It's an automatic movement, it's unconscious, it's automatic. And when we put that in the context of sport, that means that movement is happening without the athlete thinking about it and their attention remains, remains elsewhere. Their attention can remain on the game, that's going on the ball, that's flying at them. You know, that random thing that just flew by them that wasn't the ball and wasn't part of the game, but could be that perturbation, that in another situation could be distracting enough and could lead to an injury situation. Potentially.
Speaker 3 (29:58):
Got it, got it. Yeah. Like I, and you and I have had this conversation before, because I have a young athlete and we're doing, trying to do incorporate some of this stuff. So one of the things we're doing is I'm having her do some unpredictability drills with clock yourself, but we're trying to do them in Spanish. So she has to say things in Spanish as she's doing them. So that she's a little do. So she's accomplishing this kind of dual tasking. And, and I will also say it's fun. It's fun for the patients, fun for the therapist. And they kind of understand while they're why they're doing those things. And then every once in a while, just like throw a ball at her and see what happens.
Speaker 4 (30:42):
And you put this in the context then of some of those injury prevention programs and coach buy-in. So let's put Bali's in with single leg squats, but, but you know, squats and you jump into a header. There's already a little bit of some of that in some of the programs, but the more we can get that ball, some of those technical skills involved mix them potentially in with some of the movements that we're working on, maybe that might help with some of these, this kind of adding in some of this motor learning piece. Now I say all of this, none of this has been tested yet to change any of these programs we're really doing or to kind of, we need to go back and test them. And so, you know, this is where I say this, but it is kind of hypothetical, but in thinking about it, as well as we're kind of trying to overcome some of those barriers, that 10 minutes, that we're not, maybe we're at 10 to 15 minutes where we're trying to convince a coach to do something.
Speaker 4 (31:49):
Coaches are going to buy in a lot more. If there's a, if they can build some skills into that or they can see the sport reflected in it, rather than it just being kind of this abstract quote unquote injury prevention program. So can we get some of this dual tasking, can we get some of this kind of real world kind of environment type demands and challenges integrated in with some of those pieces that we're trying to build from a neuromuscular standpoint, can we mix them all together and end up with a maybe potentially more beneficial outcome?
Speaker 3 (32:26):
Yeah. And, you know, as you're saying all of this, it's kind of opening my mind up into these programs as being these living, breathing programs that aren't set in stone and that have the ability to change and morph over time as research continues to evolve. And I think that's really exciting for these programs as well, because you don't want to have these programs be thought of as stale because then that's going to not help with your buy-in.
Speaker 4 (32:55):
Yep. Yeah. And that's one of the complaints that you sometimes see about some of these programs is all right, so my team's done him for a season. They've all mastered, you know, all my players have mastered this program. They're bored of it now. And the likelihood that every single one of your players has mastered every single one of those exercises is that we'll put that into question, but we'll put that one on the side, but yeah, if you're doing the exact same program, the exact same exercise, every single training session for multiple years, yeah. Your players are going to get bored of it. And so are these, some of the opportunities where we kind of help with that buy in where we make it a little bit more creative, where we help kind of with some of those implementation pieces to make it more interesting to make it more long-term and to, to really help with people wanting to do them.
Speaker 3 (33:50):
I think it's great. And now we're, we've spoken a little bit about research here and there. So let's talk about any gaps in the research. So, I mean, are there gaps in the research? I feel like, of course, but are these gaps something that can't be overcome?
Speaker 4 (34:09):
No. All of the gaps that at least dive I'm aware of, and I'm sure there are more I just finished writing a paper alongside Holly and grant the Mark. So Holly silvers and, and Gretta microburst for the journal of orthopedic research. And, and one of the things that we did was kind of go through the literature and identify some of the gaps.
Speaker 3 (34:35):
What were, what were they, you don't have to say all of them, just give a couple of a couple of the big ones,
Speaker 4 (34:42):
But one of the big ones is a lot of our literature is focused on women, which is important, but in total numbers, we still have more ACL's happening in men. So we need more research in men. A lot of our research is in soccer and handball. There's a lot of other high-risk sports at there. So there were focused kind of on team sports but there is some pretty high risk team sports, something like net ball play ball volleyball have very high ACL injury numbers, individual sports things like gymnastics and wrestling. And those are also Tufts sports to come back to they're very high impact or they're very MBA. They've got some crazy positions that you don't see. So individual sports, I think have quite lacked outside of skiing. Skiing's got a lot of attention. One of the biggest ones that I think for me is really important is we don't have good reporting of the subjects and the diversity within the research that we've done.
Speaker 4 (35:51):
So most of the, the research that's been done has been done in the U S some in Canada and in Scandinavia, or at least in Europe as a whole, there's been a few studies that have been in in Africa. But we even within the studies that we have in the us and Europe and Australia, we don't, none of them have reported any of the, like really the, the, the race or ethnicity of the athletes who were part of them. So those may have implications and Tracy Blake did a amazing BJSM blog that was kind of a call to action for researchers. And it's one that I'd love to echo here that we need to be better at reporting our biases looking at our, our subject populations and funding and encouraging studies outside of kind of we'll call it quote, unquote, the global North. I think that's, that's a big gap that we need to fill and we need to be more aware of.
Speaker 3 (37:01):
Excellent. And on that note, we are going to wrap things up, but what I would like you to do is number one, is there anything that we didn't cover or anything more that you want to add to any of the subjects we covered?
Speaker 4 (37:16):
Ooh, I know you always ask this question and I always have never prepared for it.
Speaker 3 (37:23):
Well, you know, cause I don't want to like skirt over something and then the guests at the end is like, I really wanted to say this. And she just ended the interview.
Speaker 4 (37:32):
Think of it probably right before I go to bed. Probably.
Speaker 3 (37:36):
I can't think of anything right now. Okay.
Speaker 4 (37:39):
Excellent. Excellent. For any readers who haven't read Dr. Tracy Blake's BJSM post definitely go check it out. We'll put the link in.
Speaker 3 (37:47):
Yeah. Yeah. We'll put the link into the show notes here. So you can read her blog app over at BJSM and I agree. It was it was very well written and it was a really nice call to action and or call to awareness. Yes. Yeah, yeah. Right. Maybe not call to action, but certainly a call to awareness, which is step one in the sequence of actionable moves. Definitely. So yes, she's a gym. So now before we wrap things up I'll ask the same question to you that I asked to everyone and knowing where you are now in your life and in your career, what advice would you give to yourself as a new grad? Let's say like not new grad PhD grad, but new
Speaker 4 (38:36):
Duke grad, new, new grad coming out of Duke PT school. I'm trying to think of what I said the last time I was on.
Speaker 3 (38:46):
Well, don't say it again. No, I'm just kidding.
Speaker 4 (38:48):
Well, yeah, that's what I'm worried about saying the same thing again. I think what I said last time, but what is my like big thing is being more gentle on myself. When I came out of PT school, I started work. I was the first new hire new grad that they'd hired. And so I was working alongside some just phenomenal clinicians, but they had the least experience, one head, like 15 years of experience. And I came out of school, unexpected myself to kind of treat and operate on the, kind of the same experience level that they did. And I it's just not possible. So I've spent a lot of time kind of beating myself up. And so it takes a lot of reminding even now that like, I still have, you know, I've graduated in 2011. So I'm coming up on 11 years of experience and it's still not a lot in a lot of ways. So being gentle on myself that I don't have to come up with, you know, everything on the spot that I don't don't necessarily have the experience to know or have seen everything or every course or development. And so being okay with that and being gentle and allowing myself to be, to, to just be where I'm at is, is I think
Speaker 3 (40:08):
It's wonderful advice. And just think if you thought you did know everything, I mean, how boring number one and number two, you'd never move on for sure.
Speaker 4 (40:18):
Yeah. Yeah. Right. So
Speaker 3 (40:20):
You're stuck. You'd be pretty stuck. So giving yourself the space and the kindness to say, Hey, I don't know everything. So I'm going to make it a point to learn more is just good therapy. It's just being a good PT, being a good physio, you know, otherwise you're just stuck in 2011. I mean
Speaker 4 (40:41):
Gotcha. Yeah. 11 wasn't bad, but I'm glad I'm not stuck there.
Speaker 3 (40:45):
Yeah. I mean, what a bore, right. You'd be like so boring as a PT cause you would never advance.
Speaker 4 (40:51):
Yeah. So your ex
Speaker 3 (40:54):
Excellent advice. And now where can people find you on social media and elsewhere?
Speaker 4 (40:59):
So I am on Twitter at, at soccer, PT 11 I'm on Instagram at squeaky Edgar. I will note that's actually more personal but follow me anywhere cause you'll get some great, great adventures. And those are my primaries social media.
Speaker 3 (41:20):
Excellent. And before we hop off, can you talk quickly about basketball, sports, medicine
Speaker 4 (41:26):
Science? Oh yeah. I forgot to talk about that in my projects.
Speaker 3 (41:30):
Yeah. Let's talk about this quickly. Yes. So
Speaker 4 (41:34):
Was honored to be a part of an editorial group that just completed. I just got a book out. It's an ASCA public, a publication on basketball, sports medicine and rehabilitation. So it's a quite the book. But I say that because it is over over 1100 pages if I remember correctly. So it's, it's a, it's a, it's a chunk of a book. But we are, I've got an extra copy of it. So one of our allowed visitors really be getting a copy. Okay.
Speaker 3 (42:15):
Well Amy, thank you so much for coming on. I really appreciate your time.
Speaker 4 (42:19):
Thank you so much for having me. It's always fun.
Speaker 3 (42:21):
Everyone else. Thank you for listening. Have a great couple, have a great week and stay healthy, wealthy and smart.
Speaker 2 (42:28):
A big thank you to Dr. Amy Erindale for coming on the podcast today. And of course a big thank you to net health. Again, they have created net health for private, for net health therapy for private practice, which is a cloud-based all in one EMR solution for managing your practice. One piece of software that handles scheduling documentation, billing reporting needs. Plus a lot more. If you want to check it out, there's a special deal for healthy, wealthy and smart listeners. Complete a demo with the net health team and get a hundred dollars toward lunch for your staff. Visit net health.com/glitzy to get started again. That's net health.com/l I T Z.
Speaker 3 (43:09):
Why thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
In this episode, CEO of Fyzio4U Rehab Staffing Group, Dr. Monique J. Caruth, talks about how she, as a businesswoman, reacted to Covid-19.
Dr. Monique J. Caruth, DPT, is the CEO of Fyzio4U Rehab Staffing Group providing home health services in Maryland. She currently serves as the Southern District Chair of Maryland APTA and is the Secretary-elect of the Home Health Section of the APTA. She holds a Masters and PhD in Physical Therapy from Howard University, and she is a proud immigrant from Trinidad & Tobago.
Today, we hear what it’s like treating potentially Covid-positive patients, Monique tells us about the screening tool she developed, and we hear about the impact of the pandemic on mental health. Monique elaborates on the importance of Ellie Somers’s list of notable PTs, and she talks about her experiences of losing patients. How did she pivot her business to keep it afloat? How has her perspective as both a clinician and a business owner helped her pivot her business?
Monique tells us about obtaining PPE, offering Telehealth visits, and she gives some advice to Home Health PTs, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “We started seeing a spike in clients in mid-April when the hospitals didn’t want to discharge patients to the nursing homes; they were discharging them directly home, so the majority of our clientele were Covid-positive patients.”
- Monique has started compulsively disinfecting all surfaces.
- Monique’s screening tool:
Step 1: Check temperatures every morning before seeing a patient.
Step 2: Ask questions about symptoms, traveling, and possible contact with Covid-positive people.
Step 3: Ensure PPE is worn.
- “Gone are the days of spending extra time and doing extra work there.”
- “One of the biggest things for therapeutic outcome is having a good relationship with your patients. Going into the home, you’re probably the only person that they’re getting to talk to most days. I saw the need to improve on soft skills and being approachable with your patients.”
- “Some sort of contact needs to be maintained. Even though some patients may have been discharged, they would contact the physician via Telehealth visit and ask to be seen again.”
- “Everyone deserves to get quality care.”
- “Some people say, ‘this person probably got Covid because they were being reckless’. You can slip-up, be as cautious as possible, and still get Covid.”
- “We’re going to see a huge wave of Covid cases coming in the next few months. With elective surgeries stopped, that’s going to be our only client population. To prevent the furloughs from happening again, I would just advise to do the screenings, get the PPE, and go and see the patients.”
- Why don’t women get recognition in a profession that’s supposed to be female-dominated?
“People send out stuff to vote for top influencers in physical therapy. You tend to see the same names year after year, but you never see one that strictly focuses on women in physical therapy. I see many women doing great things in the physical therapy world, but because they don’t have as many followers on Twitter or Instagram, they don’t get the recognition that they deserve.” - “The thing that I love about Ellie’s list is she put herself on it.”
- “In doing stuff you have to be kind to yourself first and love yourself first. Many of us don’t give ourselves enough praise for the stuff that we do.”
- “You can’t save everybody. When you just graduate as a therapist, you think you can save everyone and change the world – it takes time.”
More About Dr. Caruth
Dr. Monique J. Caruth, DPT, is the CEO of Fyzio4U Rehab Staffing Group providing home health services in Maryland. She currently serves as the Southern District Chair of Maryland APTA and is the Secretary-elect of the Home Health Section of the APTA. She holds a Masters and PhD in Physical Therapy from Howard University, and she is a proud immigrant from Trinidad & Tobago.
Suggested Keywords
Therapy, Rehabilitation, Covid-19, Health, Healthcare, Wellness, Recovery, APTA, PPE, Change,
To learn more, follow Monique at:
Website: Fyzio4U
Facebook: @DrMoniqueJCaruth
@fyzio4u
Instagram: @fyzio4u
LinkedIn: Dr Monique J Caruth
Twitter: @fyzio4u
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Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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SoundCloud: https://soundcloud.com/healthywealthysmart
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Read the Full Transcript Here
Speaker 1 (00:01):
Hey, Monique. Welcome to the podcast. I'm so happy to have you on.
Speaker 2 (00:06):
Oh, thank you for inviting me. It's a pleasure to be on once again.
Speaker 1 (00:10):
Yes. Yes. I am very excited. And just so the listeners know, Monique is the newly minted secretary of the home health section of the APA. So congratulations. That's quite the honor. So congrats.
Speaker 2 (00:26):
Thank you very much. And
Speaker 1 (00:28):
We were just talking about, you know, what, what it was like being an elected position. I was on nominating committee for the private practice section. I just came off this year. Not nearly as much work as a board member. But my best advice was you'll you'll make great friendships and great relationships. And that's what you'll take forward aside from the fact that it's, you know, a little bit more work on top of the work you're already doing
Speaker 2 (00:57):
Well, I better get my bearings, right. So I will be on task from the one. Yeah.
Speaker 1 (01:04):
Yeah. I'm sure you will. And now, today, we're going to talk about how you as a business woman pivoted reacted to COVID. So we're, Monique's in Maryland, I'm in New York city. So for us East coasters, it really well, we know it hit New York city very hard in March in Maryland. When did that wave sort of hit you guys? Was it around the same time?
Speaker 2 (01:33):
I would say mid March, April because I had returned back to the rest of the first week of March. And then things just started going crazy. They were saying, Oh we have to be aware of COVID. But I was still seeing my clients that I had. Then we started getting calls saying that family members are worried that we'll be bringing COVID into the home. So they wanted to cancel visits. So we were getting a lot of constellations and then electric surgeries was shut down and that meant a huge drop in clients as well. Then we started seeing a spike in clients in mid April when the hospitals didn't want to discharge patients to the nursing homes, they were discharging them directly to home. So the majority of our clientele was COVID positive patients.
Speaker 1 (02:36):
And now as the therapist going in to see these patients, obviously you need proper protection. You need that PPE. So as we know, as all the headlines said, during the beginning of the pandemic, couldn't get PPE. So what do you do?
Speaker 2 (02:54):
Well, we were fortunate in Maryland that governor Hogan had PPE equipment ready at state health departments for agencies to collect. So they did ration them out. Also one of the agencies that I contract with MedStar hospital provided PPS to all the contractors and employees that were visiting COVID patients in the home. So we had the goggles face shield gowns mask, everything. There would be a specialized bag with vital sign equipment for that patient specifically that would be kept in that house and then taken back and disinfected at the end of the treatment. So we, we were shored through weekly conferences on what to do do South screenings and screening prior to each visit. So for my contractors, I developed a screening tool to ask questions if clients were having symptoms or if any family members in the home are having symptoms. And if they had exposure to anyone where COVID symptoms in the past 14 days, so we'll know what you will, that person as a person on, on the investigation or somebody who's COVID positive. So we had done the correct equipment when we go into the homes.
Speaker 1 (04:18):
And what does that, what does that look like? And what does that feel like for you as a therapist, knowing that you're going into a home with a patient who's COVID positive? I mean, I feel like that would make me very nervous and very anxious. So what was that like?
Speaker 2 (04:36):
To be quite honest, I was scared at first I try to avoid it as much as possible. But I got to a point where I needed to start seeing people or, you know, the business would go under. So you're nervous because nobody really knows how the disease will progress, what would happen. So it's a risk that you're taking. I, I probably developed compulsive disorder, making sure everything was like wiped down and clean. Even getting into the car, you know, this is affecting the stairway, the door handles double checking, making sure that they know the phone was wiped down. You know, as soon as you get in the house, after you strip washing from head to toe, making sure that, you know, you don't have anything that could possibly be brought onto the home.
Speaker 1 (05:35):
Right. And so when you say going back to that screening tool that you say you developed, what was, what was, what was, what did that entail for you for your contractors? Because I think this is something that a learning moment for other people, they can maybe copy your screening tool or get an idea of what they can do for their own businesses. Well, it's
Speaker 2 (05:58):
One that they we use to make sure that we don't have any symptoms. So checking the temperature every morning before you actually go to see a patient and asking the question, like certain questions, when, when you're scheduling a visit if they're filing in a coughing or sneezing when was the last time they got exposed or if they've been exposed to someone who traveled in the past 14 days or who's had any symptoms in the past 14 days. And so that was basically if they answered, no, then you be like, okay, fine. All you just need to do is wear the mask and the gloves and make sure that the patient that you're seeing wears the mask as well.
Speaker 1 (06:41):
Yeah. That's the big thing is making sure everybody's wearing a mask. Have you had any problems with people not wanting to wear a mask in their home when you go into treat them?
Speaker 2 (06:51):
We've had some, but most have been very compliant with, you know, wearing the mask because they realize that they, they, they do need the service. So like some patients who have like CHF or COPT that will have problems breathing while doing the exercises, I would allow them to, you know, take it off briefly, but I will step back six feet away and make sure that, you know, they get their respiration rate on the control. Then they put it back on. We'll do the exercise.
Speaker 1 (07:22):
Yeah. That makes sense. And are you taking, obviously taking vitals, pull socks and everything else temperature when you're going into the home?
Speaker 2 (07:31):
Yes. Yeah. Yeah.
Speaker 1 (07:34):
Okay. And I love the compulsive cleaning and wiping down of things. I'm still wiping down. If I go food shopping, I wipe everything down before I bring it into my home. And I realize it's crazy. That's crazy making, but I started doing it back in March and it seems to be working. So I continue to do it. And I'm the only one in my apartment, but I still wipe down all the handles.
Speaker 2 (08:02):
I would say don't lose sight of it though.
Speaker 1 (08:07):
I am. And I love that. You're like wiping down the car. I rented two car. I rented a car twice since COVID started. And I like almost used a can of Lysol one time. Like I liked out the whole thing and then I let it air out. And this is like in a garage going to pick it up for a rental place. And then I have like, those Sani wipes, like the real hospital disinfectants. And then I wiped everything down with those. And then I got in the car.
Speaker 2 (08:36):
Well, I saw it's very difficult to find Lysol here right now. So when you do find it, it's like finding gold. I know,
Speaker 1 (08:44):
I, I found Lysol wipes. They had Lysol wipes at Walgreens and I was like I said, Lysol wipes. And she was, yes. I was like, Oh my gosh. And then last week I found Clorox wipes, but in New York you can only get one. You can't there's no,
Speaker 2 (09:04):
Yeah. Care's the same thing. Toilet paper, whites, Lysol owning one per customer. So yeah,
Speaker 1 (09:09):
One per customer. Yeah, yeah, yeah. Oh, that's yeah, I was a thank God. I, I found one can of Lysol, one can at the supermarket and it was like, there is a light shining down on it and it was like glowing, glowing in the middle of the market. I'm like, Oh but I love, I love that all the screening tools that you're using and I think this is a great example for other people who might be going to P into people's homes who may be COVID positive. And I also think it's refreshing for you to say, yeah, I was nervous.
Speaker 2 (09:47):
I'm not going, gonna lie. You know, you still get nervous because you never know, like someone could be positive. And you're going in there, but you always want to be cautious because you're like, Oh my God, I hope I didn't like allow this to be touched or you forgot to wipe this and stuff too. So
Speaker 1 (10:07):
How much time are you spending in the home? Because there is that sort of time factor to it as well, exposure time. Right.
Speaker 2 (10:16):
It depends on the severity of the condition. But anywhere from like 30 minutes to like 45 minutes.
Speaker 1 (10:25):
Yeah, yeah, yeah. I know gone, gone are the days of, you know, spending that extra time and doing all this extra, extra work there, because if they're COVID positive, then I would assume that the longer you're in an exposed area, even though you're fully covered in PPE, I guess it raises your
Speaker 2 (10:48):
Well. Yeah. And, and the, in the summer, I would say, you know, depending on the amount of work that you had to do, like if you had to do like bed mobility and transfers with the patient, you'd be sweating under that gong. So you really want to want to be in there like a full hour anyway. But they were advising to spend, you know, minimum 30 minutes and to reduce the risk of you contracting it as well, too.
Speaker 1 (11:17):
Makes sense. So, all right.
Speaker 2 (11:20):
Decondition so they really can't tolerate a full hour.
Speaker 1 (11:23):
Right? Of course, of course. Yeah. That makes, that makes good sense. So now we've talked about obtaining the proper PPE. What other, what other pivots, I guess, is the best way to talk about it? Did you feel you had to do as the business owner? What things maybe, are you doing differently now than before?
Speaker 2 (11:49):
Well, as I said, I had to start seeing most of the cases to make sure that people were still being seen and like using telehealth. We started doing that. So eventually, well sky came on board to offer telehealth visits. So we were able to document telehealth visits as well. And people are responsive to those which worked out pretty well. So with some cases we'll do a one visit in the home and then do the follow-up visit telehealth. So one visit being in a home one weekend, one telehealth, if it was a twice a week patient. So that would also reduce the risk of exposure.
Speaker 1 (12:40):
Yeah. Yeah. Excellent. Now let's talk about keeping the business afloat, right? So yes, we're seeing patients. Yes. We're helping people, but we were also running a business. We got people to pay, we got people on payroll, you gotta pay yourself, you got to keep the business afloat to help all of these patients. So what was the most challenging part of this as from the eye of the business owner? Not the clinician.
Speaker 2 (13:07):
Well, you, you get fearful that you may not have enough patients to see, to cover previous expenses. So that was one of the reasons I did apply for the PPP loan. And as I mentioned to you before I was successful in acquiring that probably like around July and that, you know, cover like eight weeks of payroll, if that but it was strictly dedicated to payroll, nothing else. So everything else I had to do was to cover the bills and stuff, because that was just for payroll. Some of the agencies that we contracted for were having difficulty maintaining reimbursing. So that became a challenge as well, too. So what does that mean? Exactly. so when we contract with agencies, they're supposed to be paying us for this, the rehab services that we provide. Some of them were late with their payments as well, but I still had to pay my contractors on time.
Speaker 1 (14:19):
Got it. Okay. Got it. Oh, that's a pickle.
Speaker 2 (14:22):
Yeah, that's the thing. So that meant like sometimes some, you know, weeks of payroll, I would have to probably go over the lesson and making sure that the contractors were paid.
Speaker 1 (14:37):
And how about having a therapist? Furloughs? Did you have any of that? Did you know, were there any people, like maybe therapists in your area who were furloughed from their jobs and coming to you, like, Hey, do you have anything for me? Can you help? What was that situation?
Speaker 2 (14:54):
Yes. So I started getting free pretty among the calls about having to pick up to do work because they were followed or laid off. We currently have one contractor was working for ATI full-time that got followed. Now she's doing the home health full-time right now as a contractor we have some that are still doing it PRN, even though they went back to like their full-time jobs. But yes, we had people looking for cases to see, just to supplement the the income. Then we had a reverse situation where some people more comfortable getting the unemployment check than seeing patients at all. So, so that you had different scenarios, but it wasn't that we were in need of therapists during that time because people were willing to work.
Speaker 1 (16:00):
Yeah. Excellent. Excellent. And from the, I guess from your perspective being owner and clinician, so you're seeing patients you're running a business where there any sort of positive surprises that came out of this time for you, something that, that maybe made you think, Hmm. Maybe I'm going to do things a little differently moving forward?
Speaker 2 (16:30):
Yes. incorporating more telehealth visits. Definitely one of them and using the screening to there it helps in a lot of situations. So it makes you aware of what you might possibly be going into when you're going into the home. And I am realizing that there is one of the biggest things for therapeutic outcome is having a good relationship with your patients. So since most people aren't locked down, a lot of the patients that we do see they live by themselves, or they may just have one or two people in the home and they may possibly be working. So when going into the home, you're probably the only person that they're getting to talk to most days. So you, I saw the need to improve on soft skills and being approachable with your patients. So that was definitely a, a big thing for me.
Speaker 1 (17:46):
And how is that manifesting itself now? So now, you know, you figure we're what April, may, June, July, August, September, October, November, December eight, nine months in, so kind of having that realization of like, boy, this is this, I may be the only person this person speaks to today, all week, perhaps. I mean, that's can be a little, that can be a big responsibility. So how do you, how do you deal with that now that you're, you know, 10 months into this pandemic and yeah. How do, how do you feel about that now?
Speaker 2 (18:29):
Well, I still feel like some sort of contact needs to be maintained. So even though some patients may have been discharged they would contact the physician via a telehealth visit and asked to, you know, can you see it again? But you still maintain contact, make sure that, you know, you dropped a line and say, Hey, just following up to see if you're okay. That sort of stuff. So they, they will remember and they'll keep coming.
Speaker 1 (18:58):
Yeah, yeah, yeah. Oh yeah. It is such a responsibility, especially for those older patients who are, who are alone most of the time. I mean, it is it's, you know, we hear more and more about the mental health effects that COVID has had on a lot of people. So and I don't think that we're immune to those effects either. I mean, how, how do you deal with the stress of, because there's gotta be an underlying stress with all of this, right. So what do you do, how do you deal with that stress?
Speaker 2 (19:38):
Well, one was warmer. I would try to at least take the weekends off to go do something or those and like being around people where you can, you know, laugh and, you know, watch movies, you know, goof up, you know, I have to think about work, those things help.
Speaker 1 (19:59):
Yeah. Just finding those outlets that you can turn it off a little bit. And I love taking the weekends off every once in a while. I have to do that. I have to remember to do that. And I'm so jealous that you're just, you just came off of a nice little vacay as well.
Speaker 2 (20:19):
Well it was needed. I probably won't be taking one on till probably sometime next year, so yeah. But it was, it was definitely needed.
Speaker 1 (20:32):
Yeah. I think I'm going to, I think I'm going to do that too. All right. So anything else, any other advice that you may have for those working in home health when it comes to going to see those during these COVID times, whether the patient has, has had, has, or has had COVID what advice would you give to our fellow home health? Pts?
Speaker 2 (21:00):
Well, I know I've been hearing quite a lot of PT saying that they didn't want to treat COVID patients and they should not be subjected to treating COVID patients, but as we get more awareness of what the diseases and we take the necessary precautions, I think we will be okay. Cause everyone deserves to get quality care. And I know some people will say this person probably got COVID because they were being reckless and stuff. I mean, you can slip up, be as cautious as possible and still step up and get COVID. That doesn't mean you should be denying someone to receive that treatment just to make sure that you're protected when you do go in. Because we're gonna see a huge wave of COVID cases coming in the next few months and with elective surgeries being stopped and everything like that, that's going to be our only client population and to prevent the fools and the layoffs from happening again, I would just advise them, you know, do the screenings, make sure you get your PP and we'll see the patients. It's it's not as bad as, you know, they make it seem.
Speaker 1 (22:16):
Yeah. Excellent advice. Excellent advice. And now we're going to really switch gears here. Okay. So this is going to be like like a, a three 60 turnaround, but before we went, before we went on the air, Monique and I were talking about just some things that, that you wanted to talk about and recent happenings in the PT world, and you brought up sort of a list of influential PTs that was compiled by our lovely friend Ellie summers. So go ahead and talk to me about why that list was meaningful to you and why you kind of wanted to talk about it.
Speaker 2 (23:03):
Well, you know, for the past few years I've been noticing like people send us stuff to vote for like top influencers and, and physical therapy and stuff. Do you tend to see the same names like yesteryear? But you've never seen one that just strictly focuses on a woman in physical therapy. And I see a lot of women doing great things in the physical therapy world, but because they do not have as many followers on like Twitter or Instagram, they don't get the recognition that they deserve. For example, Dr. Lisa van who's I think she's doing incredible, incredible work with the Ujima Institute. I actually consider her a mentor of mine. She, she calms me down when I try to get fired. What's it and stuff,
Speaker 1 (24:03):
Not you. I don't believe it.
Speaker 2 (24:06):
So I appreciate her for that. So for Ellie to actually construct this list and, you know, I've, I've been observing her, her tweets on her posts for a while, and I see that she questions. Why is it that, you know, women do not get the recognition in a profession that is supposed to be female dominated. So for her to do the side, you know, it was, it was really thoughtful and needed.
Speaker 1 (24:40):
Yeah. Yeah. And you know, her shirt talk that she gave at the women in PT summit couple of years ago, I think it was the second year we did, it was so powerful. Like everybody was crying like in tears, she's crying, everyone else is crying. And that was the year Sharon Dunn was our keynote speaker. She got everybody crying. It was like everybody was crying the whole time, but crying in like in, in not, not in a sad way, but crying in a way because the stories were so powerful and really hit home and we just wanted to lift her up and support her. But yeah, and you know, the thing that I love the most about Ellie's list is she put herself on it. Yes. How many times have you made a list and put yourself on it? I can answer me. Never, never, never in a million years, have I made a list of like influential people to put myself on it? Never know. So I saw that and I was like, good for you. Good for you.
Speaker 2 (25:44):
Because you know, sometimes you, you and, and doing and doing stuff, you, you have to be kind to yourself first, love yourself first. And, and her doing that, I, I believe she's demonstrating that that is something that's that needs to be done. A lot of us, we don't give ourselves enough praise for the stuff that we do.
Speaker 1 (26:05):
Absolutely. Absolutely. It's sort of, it's a nice lead by example moment from her. So I really appreciated that list and, and yes, Dr. Vanhoose is like a queen. She's amazing. And every time, every time I hear her speak or, or I get the chance to talk with her through the Ujima Institute to me, it's amazing how someone can have the calm that she has and the power she has at the same time. Right. I mean, I don't have that. I don't, I even know how to do that, but she just, like, she's just gets it, you know? I don't know if that's a gift. It's a gift. Yeah, totally, totally. Okay. So as we wrap things up here, I'm going to ask you the one question that I ask everyone, and that is knowing where you are now in your life and in your career. What advice would you give to your younger self you're? You're that wide-eyed fresh face PT, just out of PT school.
Speaker 2 (27:16):
You can't save everybody. You can't save everybody nice. When you, when you just graduate as a therapist, you think you can save everyone a change, a wall. It takes time.
Speaker 1 (27:33):
Yeah. Oh, excellent answer. I don't think I've heard that one yet, but I think, I think it's true that having, and it's not, that's not a defeatist. That's not a defeatist thinking at all. Yeah.
Speaker 2 (27:54):
I think this year have thing come to more deaths as a therapist with patients than I have probably in the 12 years that I've been practicing. I'm sorry. Yeah, because you know, you do patients that you get attached to, you know, you have this person passed away and stuff like that. So it's good while it lasts, but to protect yourself mentally and emotionally, you just realize that you can save everybody. Yeah. I think this fund DEMEC is teaching us that too.
Speaker 1 (28:35):
Yeah. A hundred percent. Thank you for that. And now money, where can people find you website? Social media handles
Speaker 2 (28:47):
Social media handles are the same on Twitter and Instagram at physio for U F Y, Z I O. Number for you Facebook slash physio for you as well. And www physio for you.org is the website
Speaker 1 (29:01):
Awesome. Very easy. And just so everyone knows, I'll have links to all of those in the show notes under this episode at podcast dot healthy, wealthy, smart.com. So if you want to learn more about Monique, about her business I suggest you follow her on Instagram and Twitter, cause there's always great conversations and posts going on there initiated by Monique on anything from home health to DEI, to words of wisdom. So definitely give her a follow. So Monique, thank you so much for coming on. Let's see. Last time was a really long time. I can't believe it, it seems like 10 years ago, but I think it was really like three, three years ago. I think it was DSM like three years ago though. It seems like forever ago. So thank you for coming on again. I really appreciate it.
Speaker 2 (29:56):
You're welcome. And thank you for having me. Okay. Absolutely. And everyone needs to be safe. Okay. Yeah.
Speaker 1 (30:01):
Yes, you too. And everyone else, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Shannon Leggett, PT, DPT to talk about how to infuse yoga principles into physical therapy practice. Dr. Legget is a manually-based orthopedic physical therapist with 21 years of experience. I understand the complex nature of pain and the necessity to use a comprehensive, individualized treatment approach.
In this episode, we discuss:
- Shannon's journey to becoming a yoga teacher
- How to infuse the principles of yoga, not just the moves or poses, into PT practice
- Cases studies in applying yoga principles in PT
- The importance of breathwork
- How to be more present through yoga
- And much more!
Resources:
- Shannon's Instagram
- Shannon's LinkedIn
- Restorative Yoga
- A big thank you to Net Health for sponsoring this episode! Learn more about Net Health Therapy for Private Practice here.
More About Dr. Leggett:
I am a manually-based orthopedic physical therapist with 21 years of experience. I understand the complex nature of pain and the necessity to use a comprehensive, individualized treatment approach. I perform a thorough evaluation looking at movement, strength, flexibility and balance, as well as lifestyle. I believe that how we live influences our ability to heal. I combine my extensive background of treating musculoskeletal injuries with my training in mind-body techniques to formulate a holistic plan of care
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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SoundCloud: https://soundcloud.com/healthywealthysmart
Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart
iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the full transcript here:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everybody. Welcome back to the podcast. I am your host parents in today's episode is brought to you by
Speaker 2 (00:41):
Net health. So net health now has net health therapy for private practice. This is a cloud-based all-in-one EMR solution for managing your practice. It handles scheduling documentation, billing, reporting needs. Plus lots more in one super easy to use package. And right now net health is offering a special deal for healthy, wealthy, and smart listeners. If you complete a demo with the net health team, you'll get a hundred dollars towards lunch for your staff. Visit net health.com/see to get started, and you'll also get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y my last name now onto today's episode, we are going to be talking about how you can infuse yoga into your orthopedic physical therapy practice. And this is more than just infusing some yoga moves, but really infusing the background and philosophy of yoga into your physical therapy practice and to help us navigate that I'm really happy to have on the program, Dr.
Speaker 2 (01:53):
Shannon Leggett, she is an orthopedic, a manual physical therapy with 20 years of experience. She understands the complex nature of pain and the necessity to use a comprehensive individualized treatment approach. She performs thorough evaluations, looking at movements, strength, flexibility, and balance, as well as lifestyle. Shannon believes that how we live influences our ability to heal. So she has been able to successfully combine her extensive background of treating musculoskeletal injuries with their training and mind body techniques to formulate a holistic plan of care. And in this episode, we talk about just that, how to infuse yoga into your regular physical therapy treatments. And like I said, it goes beyond just some yoga poses and stretches, but really infusing the background and the philosophy of yoga in with your patient in with your patient treatments, but also with infusing your whole philosophy of physical therapy and how you work with your patients. So a big thanks to Shannon and everyone
Speaker 3 (03:00):
Enjoyed today's episode. Hey, Shannon, welcome to the podcast. I'm happy to have you on. Thanks, Ken. I'm really happy to be here. So today we're going to talk about how you have been able to infuse yoga and not just yoga the movements, but yoga, the principles into your physical therapy practice. And just for the listeners, I actually took one of Shannon's yoga classes online and it was wonderful. So thank you for having me joining. Yeah, it was great. So before we get into how you do this within your orthopedic physical therapy practice, I would love for you to let the listeners know how you yourself came into the practice of yoga. Well, it's actually kind of a funny story. I was probably in my mid thirties, which I'm not going to tell you how long ago that was. I'm not dating myself here, but I ended a relationship and I think as so many women do, it's like you either cut or dye your hair or you try something new. Okay.
Speaker 3 (04:06):
So trying to rock the pixie cut back then, like, I couldn't do anything with my hair. So I, I walked into my first yoga class of the New York health and racquet club on first Avenue on the upper East side. I know it, and there I was. And now that I know yoga, it was an Iyengar class, which is very alignment based very slow, very methodical holding poses. And I remember waking up the next day and being so incredibly sore and like a muscles. I mean, basically I should know what the muscles are, but like, Oh my God, that's what those feel like when you use them for long periods of time and the physical practice that, that sensation, that feeling kind of kept me going back for more. And then as time went on, I started to recognize the mental aspects of the practice that whatever I was walking into the yoga studio with or holding onto was kind of magically disappeared at the end of the class.
Speaker 3 (05:13):
And I am an anxiety sufferer, which I only have come to understand and realize what that was. And till like in a, within the last 10 years and yoga then became a very strong coping strategy for me. I found being connected to my body and connected to my person and putting an hour of self-care aside for me was absolutely essential. So it's definitely become one of my go-to tools to kind of handle the day in and day out stress of living, working in, in New York city. So I would think, especially now, during the times, yeah, hands down now it is. And I, and I was home for a couple of months, like everybody else. And it was, I was on my mat every single day. And then decided while I was home, I was like, well, why not see who else wants to practice?
Speaker 3 (06:14):
But yeah, so I, it has always been in the last like 12, 15 years, very much part of my life on a personal standpoint, it has led me to travel. I've met great people, I've taken amazing classes and explored studios in different forms. But it wasn't until probably within the last five or six years that I started to connect some dots professionally, right? Like how, how could this fit into what I do professionally? I, in terms of like a stretching standpoint, a strength building standpoint, yoga is amazing, but what about the body, the mind body connection. And I started to notice trends with a lot of my female patients I've been treating in Midtown for most of my career. And women would be walking into the clinic with your like standard orthopedic injuries, shoulder impingement, low back pain, and their response to an injury that would not necessarily be anything like, okay, just the pain was off the charts and difficult to get under control and not necessarily responding to what you would consider standard practice and you start to talk to them and they have fertility.
Speaker 3 (07:38):
They've had fertility issues. They've had gastrointestinal issues. They're working full time. They are full time moms too, trying to be the best they can be in both realms and self-care is last. They don't sleep well, they don't eat well. And I realized that the stress component was driving their inability to heal or meaning their ability to, you know, kind of get back to what they enjoyed. And I just was said to myself, well, how can I as a clinician kind of break into that stress cycle, how can I maybe help them Crump, you know, calm down some of their chronic systemic inflammation, how can we help them with negative thought patterns and, and whatnot. And that's not something that we traditionally are taught in physical therapy school and it, and is it my scope of practice and kind of going back and forth.
Speaker 3 (08:38):
So I started taking some continuing ed classes in the yoga world, and I've done some work with a clinical psychologist in Boston who treats her anxiety and depression patients with, with yoga and bodywork techniques. And, and she's a ton of research as to how mindfulness begins in the body that studies have shown that, that kind of short circuits, that stress response in your brain. So that kind of led me in that direction. And then I walked into my restorative yoga training, which I had never really taken, but it intrigued me. And because I just kind of felt intuitively that it was going to be the, like the last, not the last piece, because there's never a last piece, but a piece of the puzzle that I was missing. And it basically is how we can go from our sympathetic or fight or flight part of our nervous system into our rest and digest our parasympathetic sympathetic nervous system and how much our nervous system can drive, how we feel.
Speaker 3 (09:41):
And so often we have patients with chronic neck pain, chronic low back pain, like the massage, they feel better for an hour. It comes back and just this idea of chronic tension versus chronic tightness. And what restorative training does is it brings you into yoga shapes, but they're basically supported with props and it's a guided meditation and breath work. And as you move through the shape or state in the shape, you can flip the switch that vagus nerve stimulator, vagus nerve, and move into that rest and digest part of the nervous system. And I mean, in theory, like, okay, great. But four days of training and I always have neck pain, always. And I just attributed to everything we do. And that role was that from holidays and, you know, that's stressful time, but the month of December, yeah. Within four days, my neck pain was gone.
Speaker 3 (10:52):
It was incredible to me, how much of that pain was actually chronic tension and not necessarily this orthopedic tightness. So it was a kind of an aha moment for me in terms of what patients might carry. And I have used the teaching, the methodology in my treatment sessions, patients don't necessarily understand clients don't necessarily understand that they hold habitual tension. And so much of us, like when we say like, Oh, we have to relax. Like we sit down on the couch and drink a glass of wine and, you know, watch eight hours of Netflix. We're like, we're totally just chilling. But yet, like are holding our belly. Like our shoulders are up here, like clenching our jaw. Like we don't even know because we're relaxing. And part of, part of the restorative yoga is understanding where those patterns are. You get to know your body. Like for me, I'm a draw puncher, I'm a shoulder up late year. And, and, and once you understand that you kinda like kinda, I do like some check-ins during the day, like where are my shoulders? Where's my jaw. And taking a deep breath and kind of like letting that go.
Speaker 4 (12:11):
Yeah. As, as you say, this I'm unclenching my jaw a little bit. I'm a jock ledger also. So as you say this, I'm like, relax, the jaw, drop the shoulders. I am the same way. Well, it's, it's pretty amazing because it sounds like for you, and this happens, I've heard this over and over again, that it's this sort of personal experience. You have that aha moment. And then you say to yourself, well, I'm a clinician I'm trying to help people. So what can I do to improve my understanding as a clinician to help my patients? So you go, you take restorative yoga training, and then you are able to infuse that into your therapy sessions. And we were joking a bit before we went on the air. And Shannon said, well, it's not like I'm having someone who just had a labral tear, do a shoulder stand. Like that's not what it means to do, like yoga and PT. So when people think of yoga and infusing yoga into PT, I bet a lot of people think, Oh, you must do a lot of downward dogs and a lot of shoulder stands, but can you explain for a little bit more about what, what that means in, in your PT practice?
Speaker 3 (13:26):
Absolutely. I, if somebody comes in at, like, I was thinking a case, a case study, let's do I have a frozen shoulder? And how much of that again, tension versus tightness, how much of that tightness is being driven by the nervous system? So I'm, I always ask about stress levels. What's going on at home at work. You know, things that people do to, to, to maybe calm down or relax. And I might say, Hey, we're going to have a little bit of an experiment today. Okay. I am gonna prop you. We, I pull off of the blankets and the pillows and I'll put them in a very gentle chest opener because oftentimes you're doing a ton of stretching with a frozen shoulder or a lot of soft tissue work. If there's a level or component to stress or anxiety to that, that cranking is just going to cause your, your nervous system just clamp down and, and, and they're going to, you're going to get the exact opposite of it.
Speaker 4 (14:32):
Yeah, absolutely. And even like, we know if you're cranking on an arm and the, those first three to six months. No good, no good, no good. Not, not good for the patient, not good for the shoulder,
Speaker 3 (14:46):
Not at all. So I might spend a couple of sessions with a patient props, kind of guiding their nervous system into letting go. Typically the, you know, shoulders are rounded, pecks are tight, upper traps. So if I can kind of guide them into relaxing, letting go, I typically find a little bit more space. They're a little more trusting of me to like, maybe move them. Maybe I can modulate their pain a little bit. So they will be a little bit more, or a little less fearful of movement themselves because it's a big deal I'm to us are in pain and they don't want to move. They don't want to go in any direction that that is going to maybe reproduce their symptoms.
Speaker 4 (15:35):
Of course. Yeah. And, and so much goes into that sort of bucket when you're talking about pain. So there's so much that can fill that up. You know, we look at things through a bio-psycho-social lens, you know, you're asking about sleep and stress and all that goes into this, this sort of bucket. And then it gets to the point where the nervous system senses danger. And it's like, okay, that's it. We're gonna it's time. You know, the brain makes that decision. It's dangerous enough pain, right? Yep.
Speaker 3 (16:06):
We're going to fight, we're going to flight or we're going to freeze and think about a frozen shoulder, how much of that could be nervous system driven. And you know, and also too, just bringing in some of the mindfulness component of yoga, you know, the yoga sutras, which are kind of like the blueprint of yoga, the philosophy of yoga, the first Sutra is yoga is now that is, I mean, that is mindfulness. That is in the moment. That is the definition right there. So I use that idea of mindfulness or the tool of mindfulness to bring in throughout the day. Like I mentioned earlier, like doing a little check-in with yourself, oftentimes with my patients, I'll say, you know what, in the midst of your day, when you're like, Oh my God, if one more person calls me or how am I going to get these emails done?
Speaker 3 (16:54):
Or like, I have to make the train to get home to the kids. No, one's competing now. I want you to tap in or tune into your body and come back and tell me where you hold your attention. I want to know, are your shoulders up? And your ears are your jaw clincher. So often, do you hold your belly in? You think about our patients with urinary stress incontinence with low back pain. You know, I mean, if you're clenching your belly all day, that's, that is going to be, maybe unclenching will be part of the solution. So that idea of being present of checking in that is a tool I use throughout the day with my patients. That's great. And you know, with so many we're so externally focused, everything is outside. We're always 10 steps ahead. We just become very disconnected with our physical being. And I love bringing patients back into their body to teach them something that they didn't even know. You know? And I, I love when people are like, Oh my, my quadriceps. And they're like holding their hamstrings. Like we have this tool that we've been given this machine that we've been given, but nobody really educates us on how to use it or what it's about or how it moves. And I love bringing that idea of mindfulness and mindful movement into the physical therapy practice. Yeah,
Speaker 4 (18:17):
I think it's great. And the other thing, as you were talking about putting people into these different restorative poses that can then be transferred over to a home exercise program,
Speaker 3 (18:27):
Easy. I mean, honestly, like laying down on the floor, throwing your feet over the couch, the restorative doesn't even have to have props. It's basically the idea. Now don't get me wrong. The props are delicious, but the restorative is learning how to let go of that tension. As you breathe, it's letting the ground hold you up. It's letting the couch hold you up. It's letting, it's starting to kind of give into something else. You know, how much of us, like we put a coat of armor on every day, like, especially now to get through the day. And so in order to survive, we, we put on armor. Yeah. It's just in a physical structure. Yeah, yeah, absolutely. On the floor, legs on the couch, close your eyes and just breathe. And honestly, that's yoga.
Speaker 4 (19:21):
It doesn't have to be too complicated,
Speaker 3 (19:23):
Not at all. And sometimes when I start to bring things up, people like, Oh my God. Cause they think Instagram, they think poses, they think exactly very like thin, cute people, like by a pool. And it's just, it's mindfulness. It's the breath it's awareness. It doesn't have to be, it doesn't have to be twisty and credit. And I think, I think my practice is in twisting.
Speaker 4 (19:48):
Yeah. I think that's good to know, because I think a lot of people will look at yoga and they look at the show of it. You know what I mean? The spectacle, the show of, wow. Look at this person being able to, you know, do a handstand or a headstand and look at this and look at the positions. They can go, Oh, I can never do that. So
Speaker 3 (20:06):
I'm just not going to do it exactly like that. It's not for me. Or people feel ashamed and mean, especially like the, the men, they will not walk into a class because they don't want their I'd be embarrassed. And like, no one is looking at you. No one. And that's the thing I love about a studio. Like I'm an orthopedic physical therapist. I have, I'm not athletic. I love athleticism. I am not athletic. So when I love about the studio is like, I can move. I can breathe. I can exercise. No one's watching. Yeah. It's true. It's like in their own little world and that's speaks to the introvert in me like nobody's business.
Speaker 4 (20:49):
Yeah. Although sometimes I will say, if I go to a class, I will be looking at other people that being said one of the best yoga classes I ever did, we were blindfolded. All of that's extraordinary because it was a, it was a charity class for a charity called Achilles and Achilles supplies. Pairs runners who are hard of sight. Yeah. To do all different kinds of races from a 5k up to a marathon. And because the people they serve are usually blind. We did the whole class folded and I was thinking, Oh my God, I'm going to fall over because you know, vision is a big part of balance, but it was the best yoga class I'd ever taken because I wasn't comparing myself to everyone else. The instructor was giving really clear instructions and my balance was better because I was actually paying attention to myself versus looking at what everybody else was doing.
Speaker 4 (21:46):
Absolutely. And you really had to talk about a journey inward. Yeah. Right. And having to be in touch with like what your own body was doing and how you're going to assimilate. Yeah. Yeah. It was really interesting. The only weird part was the woman next to me, kept trying to hold my hand and I had to keep like, I'm like, what are you doing? And then after it, she was like, Oh, I'm sorry. I thought you were my friend. I'm like, I kind of kept taking me out of the vibe a little bit, but that is a loving community. Community is a loving community. Yes. But I really, I really loved the way I felt after that. And it, it, you know, it really got me thinking like, wow, this is something that I should be doing with my patients when we're just working on general movement is kind of have them close their eyes and really feel the movement and get into it. But now let's you, so you talked about some of the the tenants of yoga. One is yoga is now being very mindful. What other aspects of yoga aside from, you know, positioning people, restorative, what other tenants of yoga are you using with your clients or with your patients?
Speaker 2 (22:59):
And on that note, we're going to take a quick break to hear from our sponsor. And we'll be right back with Shannon's answer net health therapy for private practice as a cloud-based all in one EMR solution for managing your practice. That's right. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus lots more and one super easy to use package right now, net health is offering a special deal for healthy, wealthy, and smart listeners completed demo with the net health team and get a hundred dollars towards lunch for your staff. Visit net health.com/see, to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y
Speaker 3 (23:49):
I definitely, yes, I use the restorative, but I also use a little bit more of the, the poses, the strength building poses, the even some small sequences. I, I look at maybe look at the system as a whole, right? The fascial system, everything is connected especially my patients that sit all day. So that front body, everything is tight. Tip lecturers, chest front neck. I will give them maybe sequences of some easy poses that they can do at home to open that whole space. My runners runners don't like to stretch. They just want to run. So I always say, okay, we need to do some flexibility. And some mobility work to keep you running healthy. There's nothing better than yoga as far as I'm concerned. Thank for the buck. Especially looking through like fascial systems, you give someone a downward facing dog.
Speaker 3 (24:54):
Well, they're opening their shoulders, calves, hamstrings, low back. They're working on their core. So I love, I love the physical poses to help my runners, my sequences, my restorative, my breath work. How could I forget my breath work pranayama? Right? What's one of the eight limb path of yoga is breath work. And I pretty much teach every single patient who walks into my space to breathe. It is one of the most powerful tools that we have to connect to ourselves to calm our nervous system. But again, our low back pain patients, our neck pain patients, how many neck pain patients do we see that are breathing they're with their accessory muscles. So using maybe even to dossena another pose mountain pose, which is basically standing straight it's posture. So everybody learns to Dawson. And then from 2000, and once we get into that, that rib cage of pelvis alignment, we work on our breath and diaphragmatic breath, finding the belly, maybe then connecting to pelvic floor, especially for my women.
Speaker 3 (26:15):
So I definitely use Tadasana as my, like one point as to finding, finding a good position, finding a good home base and breath and how they can use breath work to help them with their stress response. And part of what I love is sometimes I'll teach my core patients and I don't even tell them what the breathing like. I'll tell them, listen, you know, reading is important for core, and it might with your neck pain and low back pain. So we're just, that's what we're going to start. And what I love is when a couple of visits later, they're like, you know, we feel really calm. I feel calm after I do that. And I'm starting, and I'm starting to use that like during the day. And I secretly love that
Speaker 4 (27:02):
Really giving tools that they can use throughout the day and that they can also see the difference. And we know that once people see the difference in the tools, we give them, they'll use them.
Speaker 3 (27:13):
Yes. And that's how I listen. Some people I know right off the bat that I can like infuse and introduce yoga and they're going to be all for it. Other people I know that are going to be skeptical. So that's,
Speaker 4 (27:25):
That's a good point. You bring up because a lot of people like yoga. So how do you, and so do you use then use the breath work to kind of open the Gates a little bit
Speaker 3 (27:34):
Sometimes, or I'll say, Hey, you know, the yoga has some amazing, you know, stretches that might help you with what's going on. And because they stretch multiple fascial systems, they can be very effective or, you know, not effective, but efficient everybody in the city wants to be efficient. True. So if you give them a couple of things and then they become more curious or I'll work on some mindfulness, or I will educate them, maybe how stress response can be driving their pain how having a hobby or movement can like also be an effective part of their healing process. So I, I kind of sneak it in, in, in different ways. Got it, got it. No, that makes a lot of sense. And also too, for like my, my runners, I have run a bunch of half-marathons. I did in New York city marathon in 2018, yoga is a tremendous compliment to running and read, like, it got me to the finish line. I don't think I'll ever do it again, but you never know. I've never say never, never say, never say never. So that's where, you know, anytime you tell a runner that you could help them be better, faster, stronger of they're onboard. Yeah. Very, very true.
Speaker 4 (29:04):
Now, what advice would you have to other physical therapists or other clinicians
Speaker 3 (29:10):
Who maybe
Speaker 4 (29:11):
Are interested in yoga or interested in infusing yoga into their practice? What are some good starting points
Speaker 3 (29:20):
For them? I would say, start taking some classes, yourself, understand how it makes you feel, understand the language, the sequencing the poses, you know, I, I think experience is one of the teachers. I learned by doing things in my own body and that makes me a much more effective clinician sometimes. So I would say, start taking some classes, notice the benefit yourself, listen to maybe even how yoga teachers instruct. I learned some of the best cues and best instruction from some of the yoga teachers that I have gone and work with. And starting to maybe infuse it a little bit in your sessions, in your, in your PT sessions and see how the patients respond. And then from there, there are continuing ed classes out there for physical therapists who don't necessarily want to take the 200 hour training that can learn how to use yoga in healthcare.
Speaker 3 (30:30):
Yeah. I took a, a great one threes, physio, yoga they are amazing. They're, they're great to follow on Instagram, if you want to learn a little bit more. I have, but they have they just did a class that I took, do I want to, no, it was maybe last year again, it's the whole thing of how to infuse yoga and physical therapy. So there there's plenty of stuff out there. There's plenty of PTs out there that are, that are doing this, that have Instagram pages. So just starting to follow, take classes easy. That's what I would do. It is so easy. It's easy. Yeah. I mean, I didn't do my yoga training until, you know, 2016, but I was using the poses and using some tenets like long, long before I was just from my own experience.
Speaker 4 (31:22):
Yeah. No, I love the advice to kind of take it yourself, see how you see how it feels. Cause listen, you may think you want to infuse it into your treatment and then you may take it yourself and be like, Oh, I don't, I'm not feeling this. And that's okay. You can, you can.
Speaker 3 (31:37):
Okay. Absolutely. It doesn't resonate with everybody.
Speaker 4 (31:40):
That's right. That's right. That's right. And that's okay. Awesome. So now before we kind of wrap things up, I think we, we have your one biggest takeaway is to start taking yoga classes yourself. Anything else that you want the listeners to walk away from this conversation?
Speaker 3 (32:03):
There are many modalities out there to help the healing process. And there are many practitioners that have different ideas to help you get there. And I think that I encourage people to find what works for them. And that sometimes some of the less traditional practices can be extraordinarily helpful. I mean, I think I personally think yoga is an extraordinarily powerful tool from the mind body perspective, we understand how much chronic pain does become a central nervous system, you know, issue that it's not just all biomechanical. So we do have to treat the whole person. We have to treat mind as well as body. And I think that yoga can be a very powerful tool, the combination and to, to, to seek and to try and to find what resonates and find what helps you. And to just, you know, it's not ever linear, it's not ever a straight trajectory. Healing is totally a journey and to not give up and just because you've tried one thing, does it mean nothing? Nothing is going to work, update, curious, stay active stay moving, find something you love to do. It doesn't have to be yoga, but move and movement is meditative. It's mindful. You know, the body, the body responds to movement.
Speaker 4 (33:53):
Absolutely. And now before we wrap things up, this is a question I ask everyone knowing where you are now in your life and in your career, what advice would you give to your younger self who graduated right out of PT school, a newly minted PT.
Speaker 3 (34:11):
I wish I had forged my own path earlier. I wish that I had listened to, you know, nothing has ever really fit for me until I brought yoga into my profession. It speaks to me. It makes sense to me. I wish I had, you know, when we did the webinar with sturdy, like let your freak flag fly, you know, be like, don't be like everybody else. I wish I had listened to that earlier, like towards my own path to not try to not try to fit myself into someone else's business model. Yeah. It's okay to want something different. It's okay. To think outside the box. It's okay.
Speaker 4 (35:01):
And sometimes,
Speaker 3 (35:02):
You know, what, what you think at first is going to work doesn't and then you find another tool. Totally have a huge toolbox. Yeah.
Speaker 4 (35:12):
Oh, I know. That was such good advice, you know? Cause I think so often, especially in physical therapy, as we discussed during that webinar, it's like physical therapists tend to be type a, we want to, you know, we want to be the best we wanted. We want to do good. We want to help others. And so we tend to kind of just stay in the lane totally. And are afraid to like, let the freak flag fly if you want is very hard to say, but it's true. It's true. And I thank you for reminding me and reminding the listeners of that now, where can people find you? Yes. Be true to yourself and where can people find you speaking? You can find me on LinkedIn and Instagram and what's your handle on Instagram? That's funny. That is, that is my nickname. My family, my nieces call me Shanny.
Speaker 4 (36:03):
S H a N N Y O G a P T and my C O very long. Very cute. I get it. I get it. Shen yoga, PTM, YC. Perfect. Perfect. Awesome. So people can find you there and we will have links to all of what Shannon spoke about today, resources and things like that. We'll put them all into the show notes at podcast on healthy, wealthy, smart.com. So one click will take you to everything we discussed today. So Shannon, thank you so much for coming on and talking about how to use yoga in your physical therapy practice. So thank you. Oh, thank you, Karen. It was a pleasure. I love, I love, I got to share the best of like my favorite part of the world. Awesome. Thank you so much. And everyone who's out there listening. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Speaker 2 (37:01):
Big thank you to Shannon for sharing how she incorporates her passion, which is yoga into her physical therapy practice. And of course thank you to net health for sponsoring today's episode net health therapy for private practice is a cloud-based all-in-one EMR solution for managing your practice. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus lots more in one super easy to use package net health is offering a special deal for healthy, wealthy, and smart listeners completed demo with the net health team and get a hundred dollars towards lunch for your staff. Visit net health.com/ let's see to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y.
Speaker 1 (37:53):
Thank you for listening and please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Joe, Tatta, PT, DPT to talk about using acceptance and mindfulness-based interventions to build resilience and overcome chronic pain. Dr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development.
In this episode, we discuss:
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Psychological variables associated with chronic pain
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What is Acceptance and Commitment Therapy (ACT)
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How is ACT different from traditional cognitive behavioral approaches and pain education?
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How is ACT different from mindfulness, like the kind we encounter in popular culture?
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How does ACT help physical therapists’ function better and prevent professional burnout?
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Dr. Tatta's latest book “Radical Relief: A Guide to Overcome Chronic Pain
Resources:
Radical Relief Book
ACT for Chronic Pain Professional Training Course:
Mindfulness-Based Pain Relief Practitioner Certification
RELIEF: and online mindfulness community for pain care.
Facebook: @drjoetatta
Instagram: @drjoetatta
Twitter: @drjoetatta
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
More about Dr. Joe Tatta:
Dr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development. For 25 years he has supported people living with pain and helped practitioners deliver more effective pain management. His research and career achievements include scalable practice models centered on lifestyle medicine, health behavior change, and digital therapeutics. He is a Doctor of Physical Therapy, a Board-Certified Nutrition Specialist, and Acceptance and Commitment Therapy trainer. Dr. Tatta is the author of two bestselling books Radical Relief: A Guide to Overcome Chronic Pain and Heal Your Pain Now: The Revolutionary Program to Reset Your Brain and Body for a Pain-Free Life and host of weekly Healing Pain Podcast. Learn more by visiting www.integrativepainscienceinstitute.com.
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Read the full transcript here:
Speaker 1 (00:00:01):
Hey, Joe. Welcome back to the podcast. I'm happy to have you on again.
Speaker 2 (00:00:06):
Hi Karen. Thanks for inviting me. I'm excited to be here.
Speaker 1 (00:00:08):
Yes. And today we're going to be tough. Well, let's not let's, let's roll it back for a second. So it seems like each time you've come on, we've talked about some different aspects of pain, right? We're both in that chronic pain world, we love treating people with chronic pain and talking about chronic pain or persistent pain. And we've done that quite a bit. We've talked about the psychological variables associated with persistent pain and how psychologically informed physical therapy is so important. So let's talk about which variables we should be most concerned about with regard to effectively treating pain, big question right out of the gate.
Speaker 2 (00:00:52):
It is, and it's a, it's a great place to start. And that's a question that all of us are asking ourselves and researchers are asking this question more and more and we're trying to figure out, okay, what is like the key variable? Is there one key variable that we should be paying attention to? And it's interesting if you look at the evolution of chronic pain and I think both you and I have been practicing for about 25 years. So we've really have seen things transitioned from this biomedical biomechanical model, right? And the core of that was let me figure out, let's try and figure out or identify what's wrong with the physical body. Right. Pretty easy.
Speaker 1 (00:01:34):
And then the pain goes away.
Speaker 2 (00:01:36):
Exactly. And we were all there at one point, then this bio-psycho-social model comes in and we're like, okay, there was there a psychological variables that we should pay attention to. And what's interesting is when I talked to physical therapists about the psychological variables, they bring in a little bit of that older biomedical model in the sense of how can I identify what's wrong. And then if I know what's wrong, then I can fix it. And it makes sense. And that even shows up in some of our mental health colleagues as well when they approach people with pain. So when we look at, you know, there's kind of like five big ones pink catastrophizing, can you see your phobia, fear, avoidance, depression, anxiety, those five persistently show up in the literature as variables that are associated with poor outcomes with regards to chronic pain. So you see them all the time and we have ways we can test for it, right? Pain, catastrophizing scale Tampa kinesiophobia scale, et cetera, et cetera, evolve are well aware of these. And we all use them. What I want people to consider for a moment is these are all what we would call vulnerability processes. So this is what makes someone vulnerable to transitioning, let's say from acute pain to chronic pain and they may be important and they are important, but I would like people to consider for a minute. If you flip the coin over, what's the opposite side of vulnerability.
Speaker 2 (00:03:13):
And this is really important when we think about chronic pain, because our job as professionals is not necessarily to identify here's, what's wrong. You physically, here's, what's wrong with you psychologically or emotionally. And now I'm going to fix, modify or change those variables. We want to focus on as professionals. The other side of that coin is how can I help someone be more resilient? How do I develop, build or foster a sense of resiliency. So that other side of the coin, which is really what has interested me the most, I'd say in the past 10 years is looking at those positive, psychological factors that are associated with resiliency. There's three of them. We can kind of talk about them a little bit each but there are pain, self-efficacy pain, acceptance, and then values based living.
Speaker 1 (00:04:01):
Okay. So let's dive into each of those. So let's start with pain. Self-Efficacy what the heck does that mean?
Speaker 2 (00:04:09):
Yeah. And we hear the word self-efficacy used a lot, and I want to make sure that we tag on the word pain with that because just normal quote unquote self-efficacy you can measure self efficacy, but really as a pain professional, whether you're a physical therapist or another licensed health, professional, or certified actualize professional someone's confidence or their ability and their confidence in themselves to function and figure out what the cause of their pain isn't to overcome. It is basically what we identify as pain self-efficacy. Now you can actually have good self efficacy and have poor pain self-efficacy so it's important as professionals that we look at him as, okay, how can I help someone with pain self-efficacy with regard to their rehabilitation and overcoming pain.
Speaker 1 (00:05:04):
And so say that one more time for me, I'm going to edit some of this out, but I just want to get that into my own brain.
Speaker 2 (00:05:15):
No, no problem. So paint, self efficacy is one's confidence regarding their ability to function while they experience a while they have pain.
Speaker 1 (00:05:24):
Okay. Got it. Got it. All right. That makes sense. And that is coming from someone, the long history of chronic pain. That's not easy. Can I say that? Is it okay to say that that's not easy?
Speaker 2 (00:05:41):
Absolutely. And it does go back to what I mentioned a little bit earlier, where okay. If I have pain, it's this message this signal, if you will, that something's wrong. And it's perfectly normal that your mind goes to the place of, I want to stop. I want to eliminate, I want to resolve this pain with acute pain. That's fine. With chronic pain. It's something very different. And if someone gets kind of caught up in that Whirlpool, if you will, of constantly spinning and trying to figure out, okay, what is the cause of this? And they go down that biomedical route, that's where people wind up in trouble and where they don't find a solution for their pain and why pain persists. So pain self-advocacy is interesting because it's like, okay, do I have the knowledge? Do I have the tools? I have the ability in myself, right?
Speaker 2 (00:06:36):
Because if we're not looking at vulnerability for looking at resiliency, really what we're saying is somewhere within, inside you deep inside you actually, you have the ability to contact something that you haven't contacted yet, or maybe you've only contacted a piece of it. But if I can help you with that, if I can help you along that path, if I can help you along that journey, then we can improve your pain, self efficacy. And it's potentially the research is still kind of unclear, but it's potentially the number one factor, the number one resiliency factor with overcoming chronic pain.
Speaker 1 (00:07:13):
Oh gosh. As you're, you're saying that I, in my head, I'm going back, you know, 10, 15 years to when I was in pain all the time. And yes, I was searching for that fix. And what I found when my pain started to recede, I started to feel better was that I was always looking for that external fix. When in fact I had to look into myself to see how, what I can do to overcome this and, and to kind of move forward and make the best decisions I can at the time, the information that I have and be okay with it and then move forward. And that was the thing that really helped to kind of flip the switch for me.
Speaker 2 (00:08:00):
That's right. And there's, there's two really important things embedded in what you just said. The first is, as physical therapists were very aware of pain, avoidance painted warnings is almost when I look at pain avoidance now after studying acceptance and commitment therapy, I look at painted. William says, it's too simple. So it's like, if the, you know, if you put your hand over the flame, I pull my hand away. I avoid pain. If there's a rock in your shoe, you want to walk differently or take the rock out. What you're saying in your experience, Karen, which is common in many, people's almost every single person's experience you've had chronic pain. Is that the pain persisted for so long that not only did I avoid pain, but I started to move away from everything that was important in my life. And I moved toward only those potential areas on the, on, toward the potential causes that could alleviate my pain.
Speaker 2 (00:09:00):
Now in the act that's called experiential avoidance. And again, it's a little bit different than regular pain avoidance because experiential avoidance means the entire experience. The entire capsule of my life what's encased in there is only to seek out the elimination or the control of pain. And when that happens, that's when people go down sometimes sad and sometimes very scary routes of things like surgeries that don't work and one medication or multiple medications, or we see, you know, behaviors lead to passive treatments you know, leaving work and disconnected from personal relationships, all the things that we see that our patients struggle with. So it's what you say is really important. And to try to make those distinctions for therapists, I think are also important as well, because we can skim along the surface of pain, avoidance, so to speak. But I really believe if we want to be effective with pain, we need to go on this deeper level with people looking at that pain, self efficacy, looking at pain acceptance. And then the last one looking at values based living, which is what ha, which is actually the flip side of experiential avoidance.
Speaker 1 (00:10:15):
And something that you just said that sort of avoidance becomes all encompassing. And, and I will agree. That's exactly what would happen. Like I can remember doing things like going to an acupuncturist and having them put all these needles in my ear. And then I had to walk around the plinth counterclockwise three times. I mean, when you think about that, you're like, what? But I was so desperate. Like I was doing anything and everything for that fix. When I knew even as a physical therapist that walking counterclockwise around uplift three times doesn't really make a difference. But yet here I am doing it and doing that instead of, I don't know, meeting up with friends, right. Relaxing, going to the gym. Like I was avoiding all that other stuff because I was so laser focused on finding this cure, so to speak
Speaker 2 (00:11:21):
That's right. And as you're talking to me and I'm imagining what it's like for YouTube and in that experience, and you're talking about going to an acupuncturist with which, you know, I tell people, look, if you have one passive treatment that you engage in each week as a, as a means of, stress-relief totally fine by me. I have those as well. So we're not suggesting that people avoid anything that's passive, but as I listened to you, and at first you started, well, I went to the acupuncture was for my pain, but you continue to talk what you actually revealed was most important. The real pain was, yes, it was physical, but the real pain was what, it's, what it's stolen, what it Rob for my life. Right. I think you mentioned relationships. That's kind of like, all right, there's pain avoidance here, but what's the real pain underneath that.
Speaker 2 (00:12:16):
Cause that's what I'm curious to talk to people about. And that's what I'm curious to learn about patients when they come to me and they say they're suffering and they say, they're struggling. I want to know, okay. What about your life? Do you miss? Who do you miss in your life? What aspects of your life do you miss? Because the truth is Karen. If we look at the, the vast body of research that reaction now have with regards to chronic pain, most things, no matter what it is, if you apply just one, intervention works minimally and the outcomes are not spectacular. So they're minimal and they're not spectacular. But when you start to combine different things together, then you see more moderate improvements in clinical studies and you see a change in someone's quality of life. But ahead of all of that, some of the most important outcomes that we're looking for is to look at, okay, what's meaningful in your life. And how do I help you reconnect with that? And I really believe that the resiliency processes that are out there, they exist in all of our practices and an acceptance that can move therapy kind of has a bunch of different processes that really lend well to this. But if we can engage people with these positive psychological responses and move away from the negative sodas, because people are aware that they realize they're scared, hell of pain, there is trouble.
Speaker 1 (00:13:45):
Oh yeah, yeah. When I had pain, like I totally understood. Yeah, I have it. I don't want to I'll avoid anything to have it that yes, we totally, 100% get that.
Speaker 2 (00:14:00):
Right. They realized, they realized, they think about it a lot. They realize they're a little sad or depressed about it or anxious about it. They realized that it consumes their time, but they really want to know is how do I get my life back? There's a whole chunk of my life over here. Yes. When you sit down with somebody who has pain, the first thing they're going to talk about is physical pain and that's Norma. And we should, we should make an attempt to validate that for them. But later on, as you're working on their self-advocacy and as you're working on that third week relationship, which really needs to start like the first 10 minutes of the treatments, it really does. Doesn't it doesn't start like three weeks later. What's the first five minutes. These are the questions that we should be asking ourselves. And these are the questions that we should be asking our patients to help them navigate what's happened to them.
Speaker 1 (00:14:48):
Okay. So let's, let's talk about that. So you're
Speaker 3 (00:14:52):
The physical, I'm the physical therapist, right? How do I broach these topics or these questions with the patient without offending them without coming across, as you know, you may have patients say, Oh, that's too personal. Do you know what I mean? So how as physical therapist, and this is where, you know, you had mentioned acceptance and commitment therapy, right? So how has physical therapists, can we incorporate, act into our treatment practice? How can we do this without being offensive,
Speaker 2 (00:15:34):
The best place to, and I'd like, I like the word offensive because I do believe as even though I'm a big fan of psychologically informed physical therapy, and I've talked about this on podcasts and everything, I've done books, et cetera. We have to realize as physical therapists, there's a cognitive dissonance there, which means when someone comes to see us, they don't expect that we're going to be talking about psychological variables. They don't expect that. And nor should they, we have a long, long, long way to go. Not only in our own profession, but in the entire healthcare system, before we get there.
Speaker 2 (00:16:15):
When you're talking about interviewing someone or evaluating someone or assessing someone during the evaluation, which is really where you should start to talk about values based living, there are a couple of just simple questions that you can add into your evaluation. So again, this is psychological informed care, right? We're not becoming psychologists. We're just using principles of to inform our care so that our outcomes are better. So for example, one of the most important questions, which I always get positive responses from, and people never feel taken aback by this is if you didn't have pain right now, what would you be doing with your life?
Speaker 2 (00:17:00):
And it's an open-ended question, right? What kind of weaving in like, you know, principles of motivational interviewing. It allows someone to think, wow, if I didn't have pain, what would I be doing? And you, and I may be able to, to kind of access that very easily or rapidly. However, someone who's had pain for a long time. It's like, there's been a smoke screen in front of their eyes. They're no longer able to see that. Okay. There's another aspect of life for me, somewhere that I can begin to kind of work on. Another really simple one kind of a nice metaphorical one is if I had a magic wand and I can wave the magic wand and make your pain go away, what would you do? What would you do tomorrow? Or who would you visit? Who would you go see and spend your time with? So a couple of just really simple open-ended questions that you include an initial valuation. And I recommend, you know, when people first start training with me, I give them lots of different handouts with regard to values, because you can spend a whole hour on this, but if you're new, just seeding this into your practice just a little bit, day by day or session by session. So to speak, it's a nice way for you to change because there's behavior change. That's involved for us as professionals as we start to use these new interventions.
Speaker 1 (00:18:20):
Yeah. And I think as the, the healthcare professional, the physical therapist, like you said, there is still that unconscious bias of I got to fix it. Right. So I think I would imagine you can correct me if I'm wrong, but the more patients that we see and the more that we ask these questions, the more that I think we'll be able to kind of delve into this other part of the person sitting in front of us. Because the one thing that comes to mind when you said if you didn't have the pain, what would you be doing? What if someone's like, I don't know. I can't even picture it. You just put, I don't know. I can't picture it and move on to the next question. What, what, what happens next?
Speaker 2 (00:19:11):
Well, there's a couple of different parts there. Karen. the first part I just want to mention, so physical therapist and other health professionals who work in rehab are excellent at goal setting. And in fact, I think physical therapists and probably OTs are the best at goal setting, probably in the profession, in the, in the healthcare professions. Historically, we've not been very good at talking about meaningful or value based activities. What if I told you as a professional, that it's more important to help clarify someone's cloudy values instead of setting really precise short-term and long-term goals like we've been trained. So what I'm really saying is we have to challenge ourselves and look at our own practice and say, okay, what am I doing? That's effective and what am I not doing? That's effective. Now, the reason why it's called acceptance and commitment therapy is because with regard to pain, acceptance, that's, one's willingness to acknowledge pain as part of their life experience.
Speaker 2 (00:20:15):
And with that acknowledgement, they avoid the, they avoid the attempts to control or eliminate it. Now pain acceptance is important for people living with pain, pain. Acceptance is also vitally important for practitioners who treat people with pain because of the research is clear that we don't have a really spectacular way right now to eliminate someone's pain. I'm not saying that we can't do that. I believe it does happen, but what I'm proposing. So people who are listening to this episode is that in many ways, we put the cart before the horse, and we've said, I'm going to make your pain go away first. So we have all these ways to make your pain go away. And then you'll return to life.
Speaker 2 (00:21:03):
When in essence, we have to say, let's talk about how we can start to clarify what was important to you in life. Take little steps toward that. And then with that, your pain will start to go away. They're very different messages and they're also very different ways to approach a patient. So if someone turns to you Karen and says, I have no idea. I've had pain for 10 years. It's affected me so badly. I lost my job. I've lost my personal relationships. Let that person talk about their loss because just like that vulnerability process, right? They're talking about how they're vulnerable. Well, on the opposite side of that, they're really saying, I want to, I want to maintain relationships. I want to get back to work. So allow people some room, actually many times when, when questions like that come up, this is going to sound strange to people.
Speaker 2 (00:21:56):
But I just sit there in silence. I maintain eye-contact. I maybe move a little bit closer to the person. And I just give them some space to process that and to process the, the idea that someone's asking them, someone's interested in their life beyond just pain relief. And that can be really difficult, especially for physical therapists, because we went to school. And even if you go to like DPT program websites right now, it says like, you will learn how to like resolve someone's pain. And then we get out into the world. We got out into, you know, the profession. I mean, we figure out, Hmm, maybe I'm not as good at this. As I thought,
Speaker 1 (00:22:36):
This is, this is really hard. Am I missing something? I must have, they didn't teach me this in school. Am I, what do I need to learn to do this?
Speaker 2 (00:22:46):
That's right. So the question is, you know, what, if the way to help someone contact her values is to just sit with them and allow them some space to start to think about that. Because chances are, if someone's wrapped up in experiential avoidance, they're not thinking about that on a daily basis. They're thinking about, I need to take my medication this morning. I need a hot bath. I need to take my magnesium. I need to take my nap. I need to do some distraction activities. So I don't think about pain. That's what their mind is preoccupied with.
Speaker 1 (00:23:26):
Yeah. Or yeah, a hundred percent. A hundred percent. Yeah. Everything you're saying, I'm like, yep. I can remember like, Hmm, okay. I have to figure out what pillow I'm going to use. I have to figure out how much I'm going to put my bag. So it's not that heavy. When I walk around, do I have a break during the day? Did I take Advil? Did I? Yeah. So on and so forth, but that is, that's all encompassing during your day. And, and I don't think I had, well, yeah, well, when I sat with David Butler, he's like, well, what, what would you be doing? Right. And I, my answer is, I don't know. I, I never thought about it. Right. You know, and, and, and being able to send, he did exactly what you just said. He's like, well, think about it.
Speaker 2 (00:24:17):
And I w I want to, you know, reinforce what you're saying is that for some people it's extremely difficult for them to think about it. Yeah.
Speaker 1 (00:24:24):
Yeah. It's and it's really uncomfortable and it's uncomfortable. So just think of it's in control for the patient. And you're the therapist on the other end, is it uncomfortable for you as the therapist to watch someone be uncomfortable and wiggle in their chair, so to speak?
Speaker 2 (00:24:41):
Yeah. I love that. And my response to that is empathy for the people we work with involves a little bit of us feeling uncomfortable and sharing that unpleasantness with the person that's in front of you. And in many ways we mirror people actually. So as they're struggling and suffering as a human, who cares about someone we're struggling and suffering too, because ultimately, ultimately every physical therapist I've ever met. And, you know, I've interviewed a lot of therapist. Karen, when I asked him, why did you want to become a physical therapist? And they would say, well, I want to, to help people. And if I always dig, dig in there more, there's always a story of, well, when I was in high school, my, you know, my grandfather had a stroke and he wound up living with us and I saw the PT come in the house, or I was an athlete and I had an ACL repair. And I saw all these people in this PT place and how I could help them. So, you know, there's a, there's an aspect of human resiliency built in with that. I lost my train of thought. Sorry. one thing you can try for people who are having a hard time connecting to their values, their personal values is to ask them, Hey, if I were to share some information with you about how we can alleviate pain, who would you share that with in your life?
Speaker 1 (00:26:13):
That's nice. So then
Speaker 2 (00:26:15):
It takes it off of, it takes a little bit of the pressure off the person or off the patient.
Speaker 1 (00:26:20):
Yeah. Yeah. It takes a little bit off them and puts it onto someone else. Right.
Speaker 2 (00:26:25):
Right. And in general, we all want to help other people. And especially people with pain, they really do care about other people. And they really have an interest in not seeing other people's struggle the way, the way they've been struggling. So it's a nice way to just kind of shift the conversation a little bit. And if you continue with that, what you'll eventually see kind of like in ourselves when we learn things right. And when we teach things, we actually wind up implementing it into our life in a way that's more effective.
Speaker 1 (00:26:52):
Yeah. Yeah. That reminds me of Sharon Salzberg, loving kindness, meditations. So when she does those meditations, she sort of starts with, you know, think of someone else and, you know, offer them like a life of ease, a life of love, a life of serenity or kindness. And you kind of repeat that mantra for awhile and then just say, offer it to the world and you offer it to the world. And she's like, okay, now offer it to yourself. So that you've practiced someone else you've practiced the world. And then you can turn it back onto yourself. And it's, I always felt like, Oh, this is nice. Now I don't feel bad. Wishing myself a life of ease or a life of ex you know, love or XYZ. Right. Cause I think sometimes when you, I think a lot of people feel this way. They have a hard time being kind to themselves and allowing themselves to not suffer.
Speaker 1 (00:27:50):
Even though with chronic pain, you are suffering and you don't want to be suffering yet. It's hard to recognize that in yourself. You'd rather put it onto someone else or wish that for someone else. But it's just so hard to wish it for ourselves because maybe if, if you've had chronic pain and I'm just, I don't know if this is true or not, but you can't, it's hard to see yourself out of it. Right? And so it's hard to even think of yourself, elevating yourself up to something that maybe you'll never get to. So then you'll, won't be disappointed.
Speaker 2 (00:28:25):
That's right. I, I talk about this in my book, in the, in the sense of self-compassion, which can be difficult, as you said, it's a little bit easier to be compassionate toward other people. And it can be more challenging to be compassionate toward ourselves. Where I see this show up with regard to chronic pain is people have been taught. You have to fight pain. Yes. You have to overcome pain and you see this online people even come in, I'm a pain warrior.
Speaker 1 (00:28:50):
Yeah. Right. You gotta be tough.
Speaker 2 (00:28:52):
Right. You have to be tough. You have to fight it out. You have to struggle with it. And my question really with regard to that is, okay, there's definitely some work that we have to do here. There's some effort that we have to put into this and there's some behavior change. We know that as professionals, but if you enter into a battle with pain, what kind of message is that sending your mind?
Speaker 1 (00:29:17):
You're always on guard. You're always on high alert. And that's kind of the opposite of really what we want when we're working with people with chronic pain. That's right.
Speaker 2 (00:29:25):
And even, even Karen, because I can see you on video right now, as you do that, you're stiffening your whole body up. Right. And we know that things like spasm, muscle spasm, tightness is an outcome of some of these psychological variables. We're talking about being a warrior. Imagine you see holding a gun or holding like a spear they're stiff and very contracted, right. Really what we do with act. And many of the mindfulness and acceptance based approaches is we start to soften to the idea that maybe I don't have to fight this. And that may be my fighting. This maybe the battle with this is the worst, worst, worst part of this. And if I can just let this go just a little bit and allow it to be that maybe not only will my physical body soften, but also my mind will start to release a little bit with regard to some of the things that I've been struggling with or some of the things that I've been grappling with with regards to pain.
Speaker 2 (00:30:21):
And we know that when that happens, people work toward more pain acceptance. Not only does the quality of their life improve, but as I mentioned before, or that kind of cart before the horse, that's also when pain relief happens, why does pain relief happen with that? And that's, I think it's an important point to talk about, well, we have a reward system in our brain, right? That produces its own opioids. When you engage in activities that are meaningful and important to you, it kind of, you know, twinges that reward system in your brain over meaning it makes you feel good. Right? So engaging in things that make you feel good or rewarding or engaging in things that are rewarding, make you feel good, they bring you pleasure. Right. They bring you joy. And with that, it alleviates pain. So yes, there are ways for us to help with pain control. And there are ways for us to help people be a little bit more willing to engage in their life, even with a little bit of pain and both work effectively and both work synchronistically together to help people.
Speaker 1 (00:31:35):
Yeah. I know. I always look back and think, you know, there were days where I couldn't turn my neck from side to side, like I would be crying during the week, but then on Saturdays I pitch a double header and I was a windmill pitcher. No pain felt great, really good because I loved pitching. I love being with my team win or lose. It was awesome. Even if I got like hit with a line drive or something, I just, like, I was hit with a line drive in the shoulder. Didn't bother my neck at all. Didn't even think about it, no problems doing that. Right. And people would always, that's why, when you have someone with, in my case, like chronic neck pain or chronic back pain, and you see them doing something like pitching a double header, a fast pitch softball game, well, there's no way they could have pain because they're doing this. Right. Right. And so it's, it's from what you just said for me, this was really valuable in my life was meaningful. It gave me joy. So I was able to do it with
Speaker 3 (00:32:40):
Very little, if any pain, but on the outside, people are thinking she's faking it. Right. So what, what, what do you do in that respect? Yeah.
Speaker 2 (00:32:51):
Well, I just want to what you're saying resonates well with me, it takes me back really to like the first year I was practicing, which is like 25 years ago before I studied anything about acceptance and mindfulness based approaches. And I had a, a young woman who was, she was the same age as me at the time she was 26 and she was walking down one of the beautiful tree line Brown street, brownstone streets of Brooklyn on it's on a Saturday evening and a drunk driver. Kim wants to the curb and pinned her between the car and the steps of the brownstone. And instantly she was an above knee amputee on one side and the below knee amputee on the other side. And she was a patient of mine pretty much the first, entire six months of my career, basically. And the beginning of her rehab was so smooth.
Speaker 2 (00:33:44):
It was wonderful. And you know, it was a physical therapist. We just feel good because we're helping someone walk again and we're fitting them for prosthetic limbs and we're making them stronger. And that went all really well until two things happen. Once you start to lose some weight because she was in the hospital and eating better and exercising. So the prosthetic didn't fit as well. So it was a constant struggle with the prosthetics every day. And then two, she developed a neuroma on her, on her. One of her legs, there was a period for about two weeks where she was so utterly depressed and unhappy. Cause she was in so much pain and suffering so badly. And all of us, the PT, the OT, the nurses, the psychologists, I mean, everyone went into her room and try to motivate her. You know, we use these like rah, rah, watch your tacky.
Speaker 2 (00:34:36):
Yeah. Cheer her up kind of thing. So one day I went into her room and I just sat next to her. And I said, I don't, it doesn't seem like you want to walk today because that was my job. Right. As a PTA, she said, no. And I said, okay, well, what do you, what do you want to do? Then? I said, you can't stay here. You can't stay in this bed forever. You know that, you know, eventually you they're going to send you home. And she said, there's only one thing I want to do. She said she was engaged at the time. Actually. She's like, I want someone she's like, I want to get married. And I want someone to wheel me out into the dance floor in my wheelchair. I want to stand up and I want to dance with my dad.
Speaker 2 (00:35:23):
And that's all she wanted to do. She didn't want to walk. She didn't want to walk 50 feet in a hallway with a Walker times two. Right? Nope. Didn't care about that. She didn't care about the prosthetic legs. Really. She didn't really actually that at that time she didn't even really care if she was in a wheelchair, the rest of her life. That's what she wanted that moment. So you know what we did together. Okay. Put your hands on my shoulders. Stand at the edge of the bed. I put some music on and all we did was weight shift. Now, could I have done something more therapeutic from like a physical therapy perspective? Of course I could. Was there something, was there anything that was more important to her in that moment? No. No.
Speaker 1 (00:36:10):
Yeah. And now, now given the knowledge that you now have and what we know about pain and what we know about this more value-based activities and mindfulness and act, looking back on that, what does that do for you? What does that make you think of now where you are now looking back on that as such a young therapist?
Speaker 2 (00:36:36):
Well, it makes me think two things. First I am eternally grateful for the skills and knowledge I have now that I try to share with people as much as I can. And then I also reflect on who didn't I help? Oh, that's a can of worms, right? Yeah. Who slipped through my fingers that I wasn't aware of. And that makes me reflect back on, okay, what are we not teaching licensed professionals, especially physical therapists in school, right? So the amount of time we spend on evaluating the structure, function, the structure and function of a joint is in my opinion, at this point in my career is kind of absurd.
Speaker 1 (00:37:23):
That's the word? That is. So that's the word that came into my mind too.
Speaker 2 (00:37:27):
The reason why it's absurd and not no offense against, you know, our colleagues in academia is that this is so much packed into a PT program now. Yeah. So we have to get better at, okay. What do we have to, obviously we have to, we have to understand how to measure strength and range of motion, function, et cetera. But it's perhaps most important that we learn how to motivate and change behavior.
Speaker 1 (00:37:56):
Yeah, absolutely. Because when you, when you think about pain and certainly chronic pain, but even acute pain, what does acute pain do to us as humans? And then as a result, chronic pain, it changes our behavior. It forces us to change our behavior. If we sprain our ankle, we've got a big puffy ankle. Are we going to walk and run for the next week or so? No, it's going to change our behavior. And in chronic pain, that behavior change becomes more than just a few weeks of a behavior change. It becomes an embedded behavior change into personality and into everything that we do.
Speaker 2 (00:38:39):
That's right. And the reason why acceptance I commend therapy is so important for physical therapists is because when we look at all the literature on cognitive behavioral therapy, traditional cognitive, behavioral therapy, and even pain science education, and both of those I'm I'm in favor of, and I support, but the outcomes actually may be a little better with act with an act approach specifically for the pain, the population of those living with chronic pain and as physical therapists, knowing that we function in practice settings, where we come face to face with people who are in acute pain. And if we can start to deliver some of this during the acute setting, right, then we can prevent the transition to chronic pain. And I think that's the most important. So if you're in acute orthopedics, if you are working in inpatient rehab, I mean home care, all the various places that we function, physical therapists are in the perfect position to take the brain and the body or the minds and the body put them together and help someone overcome their pain.
Speaker 1 (00:39:50):
Yeah. And, and it goes back to what you said in the beginning, it's sort of fostering that resiliency in people, and that can happen the day one, you injure yourself. You know, last summer I, I had a partial tear of my calf muscle. And the first thing that came into my mind was, well, the first thing was I felt down when it happened, I was like felt for my Achilles tendon. I'm like, okay, the Achilles tendon is there. I'm good. And isn't that amazing? Like I, anything else to me was like a nothing thing. Right. But the first thing I needed to do was I felt down, I was able to point and flex my foot. My Achilles tendon was intact. I got up, I lived up the field fine. I was like, okay, I'm good. But the next day I was like, Oh my gosh, what if this doesn't go away?
Speaker 1 (00:40:41):
What if this, because of my own history with chronic pain, it's what if this is chronic? What if it never goes away? But, and I, instead I went the next day, I went to see an orthopedist and he did kind of what you're saying. He was like, listen, this is what's going on. This is what's going happen. And he gave me out like a timeline of expectations and for me, and, and the way that I function, that was a great way to build up my resiliency to know, Hey, first of all, it's not my Achilles tendon. And second of all, this is what's going to happen over the next couple of weeks and over the next couple of weeks, what he said happened. And so I felt okay, I'm good. It's a little sore. It's a little painful. I'm okay. With the backdrop of that chronic pain history was really meaningful to me.
Speaker 2 (00:41:30):
Yeah. There are variations of informed consent, just informing someone, okay, what here's what's happening. And here's how this is potentially going to play out. Can be really, really important and powerful for someone. It can help ease someone's anxiety. It can help ease their worry and concerned about it. And as I mentioned before, these are the places where, you know, we thrive as PTs actually, especially with regard to pain. I mean, if you look at pain education in licensed health professional training, PTs have the most more than psychologists were than the other mental health professionals, more than OTs. So, you know, we're putting all these pieces together. And in fact, when you look at what are the most important factors to help someone with pain it's pain education, right? So we talked about that some type of cognitive behavioral therapy, acceptance and commitment therapy is a third wave generation, cognitive behavioral therapy. And then something related to lifestyle, probably the most important factor with regard to lifestyle is movement is exercise and physical activity. So when you put pain education together with act together with helping someone or promoting physical activity, that's probably the kind of trifecta. Those are the, that's the secret sauce, if you will, of helping someone with pain.
Speaker 1 (00:42:52):
Yeah. I, I agree a hundred percent and now let's dive in just quickly. If you can give the listeners kind of like, what's the difference? You, you sort of alluded to it now between acceptance and commitment therapy and cognitive behavioral therapy, and also the difference between act and mindfulness.
Speaker 2 (00:43:19):
Sure. All really important distinctions. Thanks for the question. So cognitive behavioral therapy is kind of the first therapy that was used with regard to people's thoughts, beliefs, and emotions around pain. Most of that work focuses on identifying or challenging problematic, problematic, or modifying thoughts. And with that, as someone modifies their thoughts, you hope that it modifies and changes their behavior. So restructuring thoughts, we've heard these words before restructuring thoughts, reframing thoughts even the reconceptualization of pain, which is a purely from like a pain education perspective. It's still a more traditional cognitive behavioral therapy model, helping someone identify their thoughts, and if their thoughts are maladaptive, how can we change those thoughts now they're important. And there's a place there for that. What I propose to people when they start to look the literature on changing thoughts, specifically with pain or the route with regard to pain, it can be quite difficult and quite sticky to do that.
Speaker 2 (00:44:29):
There's some pretty good research that shows that there's a small group that will reconceptualize their pain really early on. There's another smaller, equally small group that will never change. And then most people are kind of somewhere in the middle. So they understand what you're saying. They understand that, okay, the herniated disc in my back, isn't the only factor with regards to my chronic lower back pain. And they understand that, you know, thoughts about your thoughts about pain, negative thoughts about pain are not necessarily good, but they don't reconceptualize. They don't change those thoughts on a hundred percent. The difference with acceptance and commitment therapy and even mindfulness, they're both what they call third generation cognitive behavioral therapies, which instead of targeting these maladaptive thoughts and beliefs, we simply help people observe that they have thoughts about what's happening. And instead of changing that we help people understand or identify, recognize that they can have those thoughts and beliefs, but still continue on with the things that are important to them in their life. So it's a big distinction. It's especially challenging for physical therapist who spent a lot of time studying pain education. And there's a physiotherapist from Ireland that came into my act program and she studied pain education for a long time. And then she studied cognitive functional therapy, both two evidence-based wonderful ways to treat pain, but she found that there were some people, a lot of patients actually, that they understood didactically what you were saying to them, but it didn't change their behavior.
Speaker 2 (00:46:10):
So what's wonderful about act is that act is a behavior change model. It's really based in behavioral therapy. And there's also something nice about not having to struggle with someone to change their thoughts and beliefs all the time. It takes a little bit of pressure off the person who has pain and it takes a little bit of pressure off of the therapist,
Speaker 1 (00:46:30):
Right? Because sometimes when you try and change those thoughts and behaviors, and I don't know about you, but I've heard this when I first started you know, really studying more about pain science and, and understanding how, how pain affects people in so many different ways. And when I first would talk to people and I bet, you know what I'm going to say here? What, what would they say to you? So you're saying it's all in my head. That's right. Right.
Speaker 2 (00:47:00):
And the, you know, when that happens, people feel invalidated and it kind of takes us full circle to the beginning of our conversation is it focuses on their vulnerability. Oh, so you're saying there's something wrong with the way I'm thinking. And the truth is if someone thinks about their pain, a lot, that's 100% normal. Cause that's, that's a pain supposed to do. Pain is supposed to alert you to something that's potentially harmful or something that's dangerous. So just normalizing that everyone's mind my mind, Karen, your mind, someone who has pain, we all think all, most of our thoughts throughout the day, our thoughts about how do I avoid things that could potentially harm me, things that are potentially uncomfortable, helping people just observe that actually can be the step before even the reconceptualization of pain, because how can you, how can you expect someone? How can you help someone to target thoughts and beliefs about pain if they haven't even thought about, okay, what are my thoughts?
Speaker 2 (00:48:12):
What are my beliefs about pain? What am I thinking right now? The average person has somewhere between 6,000 and 12,000 thoughts per day. And the truth is most of them are negative because it's a survival instinct, right? We brought this through with survival instead. How can I observe these thoughts? How can I observe my emotions? How can I be getting to observe the physical sensations in my body, whether that be anxiety, whether that be physical pain and realize that I can have contact with that, but not let it impact my behavior. So that's really the biggest difference between an act or a mindful, acceptance based approach versus a more traditional cognitive behavioral approach.
Speaker 1 (00:48:57):
Yeah. Thank you for that. That is very helpful. Cause I'm sure you get that question quite a bit. So it's nice to be able to clear that up. So now let's shift gears slightly ever so slightly and talk about your new book, right? So your new book, radical relief, a guide to overcoming chronic pain. So let's talk about it. Why the title why'd you write it? Go ahead.
Speaker 2 (00:49:27):
Well, after my first book came out called heal your pain. Now in that book, I had a section called the brain and pain. And at that time, the author only gave me so much space to write about the mind, so to speak. So I had to, I had to include small sections about mindfulness and about act and in general about the mind and how the mind responds to pain. And it kind of forced me to take a very didactic approach to pain. And people would reach out to me all the time. I want to learn more about mindfulness for pain. I want to learn more about this thing. You mentioned act about pain. So both professionals and people were coming to me. So I couldn't put it in that book. And I really firmly believed that deserved its own resource because there are solid mental skills, training and exercises that are in this book, radical relief that wasn't in my, in my first book.
Speaker 2 (00:50:24):
Second is it's a little bit tongue cheek, so to speak, it's a radical idea to think that two physical therapists want to spend their Thursday evening talking about the mind and mental skills training with regard to pain. So as we said before, like there's a little bit of a cognitive dissonance in there, but we know that physical therapists have a very important part with regard to helping people cope both physically as well as psychologically and emotionally. You know, the third aspect is just in general to give people this notion that it's not a radical idea to use your mind, to use mental skills training, to use mindfulness, to overcome pain. And that can be a part of your treatment. And in fact, as you and I are sitting here counting, I can guarantee you there's someone right now, who's being treated for pain who are not being offered these types of skills and you know, you, and I think it's absurd actually, but this is still happening. So radical relief really is a short book. It's only about a hundred pages. It's a workbook that includes over 50 cognitive and mindfulness type exercises to help people overcome their chronic pain in essence. And it's also written for practitioners to use as a guide in the manual that they can use in clinical practice.
Speaker 1 (00:51:45):
Yeah. And the one thing that I liked about the book aside from, as we were talking before we went on air, it's very, very pretty all of the illustrations are quite beautiful. But I like the fact that within each chapter there's like exercises and you have to literally write things down, pen, take pen to paper, and you can do it right in the book. Or you can grab the extra sheet of paper or what have you. But I like the fact that you have to write things down because there is something to that, you know, there is something to writing to the physical act of writing something down on paper versus typing it out or just thinking about it. And so that's something that I really appreciated throughout the book.
Speaker 2 (00:52:30):
Yeah. And I learned that from my first book as my first book was a very education based approach. As we mentioned, pain education is important, but it, it doesn't do a great job of changing behavior when you get involved with act, act as a very experiential therapy. So you're not sitting across from someone like talking to them, you're actually engaging with them in a lot of different ways. So what I really found was, and people can, you know, note this down for themselves. The average person doesn't want to flip through 300 pages of a book to learn about pain. They want something that's relatively short. They want something that's clear. They want something that's useful that they can really pick up, you know, now and start to use. And I think it's the same with practitioners, right? There's only so much theory and philosophy we can think about before we say, okay, what do I do with my patient today? What am I do with patient? I have at nine o'clock tomorrow, who's been suffering with fibromyalgia for 10 years. So that's why I tried to approach this book very differently from, from the first book.
Speaker 1 (00:53:35):
Yeah. And, and before we went on air, you, you asked me if I had a post-it note to which I said, I have a large sheet of white paper and you said, no, it needs to be a post-it note. And I said, well, I have a mini post-it note, will that do the trick? So please, please tell me why I needed a post-it note and not a large white sheet of paper. And perhaps the listeners, if they have a post-it note, they can go and grab one as well.
Speaker 2 (00:54:05):
Yeah. So if everyone has a post-it note and a pen or a pencil, please hit pause and grab that and come back. But as you mentioned, Karen, it's a workbook. And you said putting pen to paper changes things, right? Because in some ways it's it's experiential. So I was, as, as I was mentioning before, we don't have a good way to change thoughts and beliefs. So with that, we have to help people relate or respond differently to thoughts and beliefs. Right? All of us have things in life, thoughts and beliefs about ourselves that are somewhat unpleasant and painful, right? Some of them are really, really horrible things about ourselves. And some are, some of them are things like, you know, not so horrible. So if you'll kind of engage in this with me, I'd like you to just reflect on yourself and your own life experience and think about one negative, thought about yourself, not the worst thought possible, but one thought that, you know, maybe on a scale of one to 10 with like one the least impactful and like 10, the worst, maybe you're somewhere like a four or five. And then I want you to write that down on the post-it note.
Speaker 3 (00:55:19):
Okay.
Speaker 2 (00:55:20):
So we can't change this thought, right? The thought is there and just rip it off a little post-it pads,
Speaker 3 (00:55:31):
Still writing. Okay.
Speaker 1 (00:55:42):
My pen's running out of ink, but I remember what it was. It's, it's half written. It's written. I just, my pen ran out of ink, but okay. We can, we can go on. It is written.
Speaker 2 (00:55:52):
I'm going to do this with you actually. So it's written there and what I want you to do is pull it off the, pull off the post-it pad. Okay. And I want you to hold it up. I don't know, maybe about a foot or so away from your knees. I want you to look at it. And in your, in your mind, I just want you to repeat the word nice and slowly, and really kind of get lost in that word just for a moment. And then as you get lost in that word, just notice if you feel anything different in your body.
Speaker 1 (00:56:37):
Yeah. Looking at the yes.
Speaker 2 (00:56:39):
Right? Okay. So you see how thoughts have an impact on how we feel now, what I want you to do is I want you to take your arm and stretch it out as far as you can go. And I want you to look at that word. And what I want you to do is I want you to flip it upside down. Now, just turn it 180 degrees and now look at it and now see if it has any less of an impact on how you feel.
Speaker 1 (00:57:07):
I mean, maybe a little,
Speaker 2 (00:57:09):
A little bit right now. What I want you to do is I want you to maybe prop it up on the computer screen in front of you, and I want you to push back. So maybe you're 10 feet or so.
Speaker 1 (00:57:22):
Okay. Go. As far as my mic, as my ear, phones will take me
Speaker 2 (00:57:28):
And then maybe just stand up as you're there and now look at the word and then notice if there's any difference in how you feel or how you relate to that word.
Speaker 1 (00:57:43):
Yeah. Maybe a little bit, now that I'm standing and people can't see me, but I think I automatically stood up in the power pose.
Speaker 2 (00:57:49):
I noticed I still noticed put your hands on your hips. Right. So would you say there's less of an impact as you move away from the words so to speak? Yeah. Great. Okay. Come back forward. So what I just did is what they call cognitive distancing. So it was a way to distance yourself, literally as well as figuratively. So now what I want you to do cameras, I want you to take that same post in them. I want you to fold it up into a little square And I want you to put it in your back pocket.
Speaker 1 (00:58:24):
Okay. I don't have one. So I'll pretend I do.
Speaker 2 (00:58:28):
Yeah. Just stick it up your sleeve there. Okay. So now you have this unpleasant unwanted thought about yourself. It's not going away cause it's in your back pocket or it's in your front pocket or wherever it is, wherever you placed it. And my question for you is would you be willing to be with that thought and to be with those uncomfortable sensations you feel on your body, if it meant you could be a more effective physical therapist or be a more loving daughter sure. Or a more supportive wife or a girlfriend, or a more effective member of your community or a leader of your profession.
Speaker 1 (00:59:14):
Yeah. I can do that. Right.
Speaker 2 (00:59:16):
So it just shows you that we can change how people relate to thoughts. We didn't change the actual thought. Still there. We can change how people relate to them, to it. And we can also show people how, okay, this thought can be present with us and I can still experience it and not feel good about it, but I can still go about my life. And what I do with patients is I have them take these thoughts. Like I have a big herniated disc at L five S one. Okay. Write that on a piece of paper, put it in your back pocket in your briefcase and carry it around with you today and notice how at times that thought wasn't even present and didn't talk to you at all. And other times maybe it was present a little bit, you thought about it, but it didn't stop you. And other times it was like a big barrier. Right. And within those three, they're really important teaching moments that we can help patients with.
Speaker 1 (01:00:09):
Yeah. Oh, that's great. Great, great. Is that in the book? So
Speaker 2 (01:00:14):
The book is full of
Speaker 1 (01:00:17):
Nice. Nice. Yeah, no, I think that's great. And, and for, you know, physical therapists or other healthcare professionals that might be listening, that my hope is that this podcast will plant a seed in them to say, you know, maybe, maybe I'm I need to do a little bit more, you know, and what can I do to do more
Speaker 2 (01:00:43):
The biggest ask the biggest, one of the great gifts that I have come across in teaching physical therapists about act is yes, it helps your patients, but physical therapists notice a change in themselves from it. Because look, we struggle with not being able to help people. We get burnt out because of it. Absolutely. We have our own personal challenges that cause us pain and suffering. So to speak that we struggle with outside of our clinical work, that this type of work becomes really important to you. And the truth is, as you know, Karen pain will show up in life. Yes, it will show up when you least expect it. And these are effective skills that I really believe all of us need to learn and adopt not only for our patients, but for us to be effective clinicians and effective professionals for us to embody them in ourselves, then we can help people with these types of aspects and these, this type of care.
Speaker 1 (01:01:44):
Yeah. I don't disagree with that. I think that's great. And you know, I was just going to ask you to sort of put a bow on this conversation, if you will, and what would you like people to take away from it? I think you gave a little bit of it just now, but is there anything you'd want to add on to that?
Speaker 2 (01:02:06):
What I want people to take away from a mindfulness and acceptance based approach to care is that there's hope in it. And that hope really resides in helping helping, giving you the skills that help someone reconnect with their life. And that resilience that we spoke about in the beginning, the hope is really what people are looking for because they feel helpless. They feel hopeless. And this work is really about, okay, maybe there's some things in your physical body we have to work on. Maybe there are some thoughts and feelings and emotions that are difficult for you. Let's yeah. Let's kind of work on those, but know that you're whole, as you are, as a human being and everything that's required to overcome this already exists in you, I'm just going, gonna help you contact that in a way that's more efficient that moves you along this path in a way that's faster. So the whole part is really important and that's really what people are coming to us for.
Speaker 1 (01:03:07):
Yeah. Yeah. That's great. And then last question or no, well, last question before we get to, how do we contact you and all that other fun stuff, but, and you know what this question is, I think I've already asked it to you like three times, however many times you've been on the podcast, but let's say knowing where you are now as a therapist and as a person and in your life and your career, what advice would you give to your younger self? Maybe not right out of college, but let's say 10 years ago, before you really started delving into working with information surrounding chronic pain,
Speaker 2 (01:03:48):
I would say, give yourself space to fail and just allow that stuff, exploration of exploring different things and realizing, Hey, I didn't do that so well, or I wasn't so great today and allow yourself, there's a lot of pressure on us as professionals to be this, you know, master healer, so to speak. And I really think it's damaging to us as professionals.
Speaker 1 (01:04:20):
And I think that can lead to burnout, all that pressure on you to be the person, the one person in someone else's life. That's going to take away all their pain or take or add this, or take away that boy, that's a lot of pressure.
Speaker 2 (01:04:37):
That's right. I, I actually, I asked therapists now, who are you to take away someone's pain. Cause really think about what that really means.
Speaker 1 (01:04:46):
Like the wizard of Oz,
Speaker 2 (01:04:48):
Right? Like, is there some like magic fairy dust that you have that the rest of us don't have? And again, it doesn't mean that we can't help people with their pain. I mean, we can alleviate some of that pain, but that's not what, that's not what we're there for. We're there to be a witness to someone on their journey to overcome whatever it is that they're struggling with. And the kind of take that into a mindfulness realm, allow yourself to be your own witness as you move through the profession and you navigate and negotiate. Okay. Here's what I'm really good at and why I want to kind of cultivate and things that I don't have to necessarily engage with that.
Speaker 1 (01:05:29):
Yeah. Well said now, where can people find you? Where can they find the book, social media websites? What do you got for us?
Speaker 2 (01:05:39):
Easy. People can go to my website. The website is integrative pain, science institute.com or one very long word, integrated pain science institute.com. The book is called radical relief, a guide to overcome chronic pain, which you can find on Amazon in most countries. If you go to either one of those two places, you'll find the book and all the information about me. I also want to plug another book Karen, in which you're involved in.
Speaker 1 (01:06:03):
Oh yeah, yeah, yeah. That's right. It's a couple of months out still. Yeah,
Speaker 2 (01:06:08):
I'm working. I'm the chief editor on a book that involves about 45 different physical therapists, some from academia, some from private practice and it's with regard to how physical therapists can use lifestyle interventions and practice that book will come out probably in the fall of 2021. And I want to plug it because it's an awesome book with, you know, as I mentioned,
Speaker 1 (01:06:32):
Amazed some amazing people involved,
Speaker 2 (01:06:34):
Amazing people. And Karen is one of those amazing people. Who's doing the chapter where she's offering the chapter on private practice, physical therapy and how to integrate lifestyle interventions into private practice PT. So yes. Check out my book, radical relief now, but look out for that book.
Speaker 1 (01:06:50):
Yeah. And you, and, and our lovely ginger garner. Yeah.
Speaker 2 (01:06:54):
Ginger Gara and I are the chief co-editors. Yeah. And then we're fortunate enough to have about 42 other amazing PTs from all over the globe actually.
Speaker 1 (01:07:03):
Yeah. Yeah. On different topics. Yeah. It's going to be cool. I'm looking, I can't wait to read everybody else's chapters. It's going to be awesome. And then social media, I think your social media is pretty easy. I think it's at Dr. Joe Tata across the board. Am I right?
Speaker 2 (01:07:19):
I've spent so much time just getting that. Yes. It's at Dr. Joe Tatta across the board. You can find me on Instagram, LinkedIn, Facebook, Twitter, all the main ones.
Speaker 1 (01:07:28):
Yeah. Awesome. Well, Joe, thank you again so much. It's always, always have a great conversation. When you come on the podcast and you make me think of a lot of things past and present, so thanks so much for coming on. I appreciate it. Thank you so much. And everyone else. Thanks for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Drs. Julie Sias and Jenna Kantor to the show for our annual end of the year review. I also wanted to welcome Dr. Alexis Lancaster in spirit. All three of these incredible women are the team that makes this podcast happen every week and I am eternally grateful for all of their hard work, support and love throughout the year.
In this episode, we discuss:
- The ups and downs of 2020 for each of us
- How to deal with fraudulent Google reviews
- Being a brand new mom and a private practice PT owner
- What we are hoping for in 2021
- And so much more!
Resources:
Jenna Kantor Physical Therapy
Newport Coast Physical Therapy
Renegade Movement and Performance
Karen Litzy Physical Therapy
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
More about Julie, Jenna and Lex
I received my Doctor of Physical Therapy and Bachelor of Science in Biology degrees from Chapman University. I became a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association to better serve my wellness clients. I am also a member of the American Physical Therapy Association and Private Practice Section. In addition to working with my physical therapy and wellness clients, I provide consultation services for children and adults with neurological conditions. In my free time, I produce the podcast Healthy, Wealthy and Smart which features leaders in physical therapy, wellness and entrepreneurship.
Fun Fact: I love the sun! I am thankful there are 277 days of sunshine a year in Newport Beach! From hiking Crystal Cove, sailing in the ocean, scuba diving the seas and kayaking through the back bay — there is so much to take advantage of! As your Doctor of Physical Therapy, my goal is to help you maintain your active lifestyle because working with you inspires me daily to get out of my comfort zone and try new things here in Newport Beach.
Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, Regional Dance America Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre.
Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia.
During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media.
Lex is originally from the Finger Lakes Region of New York. She graduated from Utica College with her Bachelor’s in Biology and her Doctorate in Physical Therapy. She also earned a graduate certificate in Healthcare Advocacy and Navigation.
She is very passionate about empowering the people she works with and is driven by their success. Lex has worked with people of all ages and her passion lies within the treatment of performance athletes and pregnant and postpartum women.
For Lex, the most important part of physical therapy care is ensuring that every person who sees her is given one-on-one attention, a personalized treatment program, and a plethora of resources to ensure ongoing results.
Outside of Renegade Movement and Performance, Lex practices in pediatrics, owns and operates her website design company, and is an Adjunct Professor at Utica College. She enjoys hiking and dogs of all kinds.
Read the Full Transcript below:
Speaker 1 (00:01):
Hello, welcome back to the podcast, everyone today, we're having an end of the year wrap up. We've done this every year, almost every year since the start of the podcast. And I'm joined by Dr. Jenna Kanter, Dr. Julie CEUs, and perhaps Dr. Lex Lancaster. She is currently driving through parts unknown in Vermont, so she can hop in. She can, if not, maybe we'll get her in at at at another time. But I just want to highlight the people who make this podcast happen because it is certainly not my, myself and myself alone. It's just impossible. So Jenna has been doing interviews for a couple of years now, and Julie has kind of been on board since the beginning almost I would say close to the beginning. Right.
Speaker 2 (00:54):
I think it's been five years. Yeah,
Speaker 1 (00:56):
Yeah, yeah. So she's been a part of the podcast behind the scenes doing the show notes beautifully. And then Lex Lancaster has been on board for the past year doing, helping with graphics. So I just it's for me, this is a big thank you to, to you ladies for being so wonderful and generous with your time and your gifts. So thank you so much. And let's start. So what I wanted to kind of start with is kind of talking about our highs and lows of 2020. So if you're listening, I mean, we, we all know that 2020 has been an exceptionally difficult year for almost everyone started out okay. For most people and then really started to go downhill pretty quick. So let's talk about, and then hot, like even through this, I think it's also important to note that good things have happened as well. So Jenna, why don't we start with you? Why don't you let the listeners know kind of, what's been your high and what's kind of been your low of 2020.
Speaker 2 (02:08):
Hi mom. I just want to first give a shout out to my mom, like I'm on a TV show. So I just want to say hi mom, I love you so much. Thank you for giving birth to me that one beautiful morning or afternoon. I'm not sure. Ooh, 20, 20, well, the low, I would say where, Oh, I want to talk about this because I know there are other practice owners who have dealt with it and I was a I was bullied and harassed online. And and, and this was for a group in which I do musical theater readings. It's a great group. I it's, that I've run into where I get a lot of patients, but the majority of people I know on there, I just know through musical theater and just performing, doing readings. And there were people who did not like how I ran the group.
Speaker 2 (02:59):
It's just like any place. There are people who don't like what you do. So they go off and do their own thing. And I eventually made a decision to block them out of my life because I didn't want this small section of people to still be present and judging me. I mean, I don't know about you. I like to feel the love in the room, not the hate. So I did that as a gift for myself finally, which did was very good. I was dealing with a lot of anxiety, just even knowing that they were around. Unfortunately, I wasn't strong enough to just handle it. I wish I could say it was, but I was like, Nope, I'm really unhappy right now what their presence. And they decided to go after my business and write false Google reviews. I was fine with the public social media posts on Facebook and everything.
Speaker 2 (03:42):
You know, didn't saying mine, you know, denouncing me. I was fine with that. I knew they were going to do that. That's why I kept them in my life for so long because I was so fearful of the public humiliation they would be aiming for. But then I was very okay with it. By the time I did it, you know, you come to that piece. But to me, the lowest part was having instilled, dealing with it, dealing with these false Google reviews where they've never been paid patients ever, ever. So I think that was, was a big, low yeah. And, and knowing that we're all going through it. And it's a hard year for so many of us. I felt like I had less people I could talk to about it because everyone's dealing with so much crap right now. So I would say that was like a very, very low point for me. And I know people have had so much worse. So I do want to acknowledge that this is so minuscule. I'm lucky my family is healthy. My, my friends have been healthy during this very, very lucky, but that was my own little piece of hew, toothpicks as positives go.
Speaker 1 (04:54):
I'm trying not to swear. I'm doing a good job
Speaker 2 (04:59):
This America way to network as, and do positive right back to back.
Speaker 1 (05:04):
Yeah, sure. Go ahead. Oh, right. Yeah.
Speaker 2 (05:07):
Cause it is I would say is, I'm not going to talk. I'm going to focus on business since I was already talking about business. So I'll keep it on that. Was the different branch. My practice took every business in physical therapy has been dealt with some sort of crap if they haven't, I'm so happy for you. But a lot of us have really dealt with some sort of big shift and, and stress and strain and sleepless nights, especially at the beginning of this and some States it's pretty new. It's new for the practices. For me during the shift, I was focusing on expanding more in-person and then of course I started doing more tele-health and now I'm a hundred percent tele-health yes. I refer out if they're not appropriate for tele-health yes. I'm a hundred percent. I don't see myself going because one, I love it.
Speaker 2 (06:00):
And that's the first thing to the performers I work with. Most of them can't afford that in person. Most of them can't, most of them don't have health insurance. And then the last thing with my practice I've developed these wellness programs. Yes. They're injury prevention, but honestly, no performers are Googling injury prevention. They're like my ankle hurts. I can't do boots. What's up. So, but with these wellness programs, it's not physical therapy. It's the many humans out there in the singing, acting, dancing world where they get the help they need from a PT. And then they're discharged when they're, you know, quote healthy, but their body's still not functioning to where they ultimately want it to be. That's where I'm coming in. And it's great. It's this, these group programs it's really supportive. I definitely have my own jokes in there. I'm a hundred percent myself.
Speaker 2 (06:55):
If anybody knows me, you're like, got it. And it's, and it's just a joy. The bonding, the, the growth everyone gets physically to get to where they are is just, it's, it's been the such a rewarding discovery and, and a lot of work to make it happen, but well worth it because just I'm happy, man. Like when you really get to do what you really want to do without even knowing that's what you really wanted to do all along until you actually get to do it. That's what I'm living right now. So yeah, I'm pretty happy about that. So that's my positive and I'll take it to the bank.
Speaker 1 (07:31):
Great. Now let's, let's take a step back to not to harp on the negative, but because I think this might help other people listening. What did you do when you were like, Oh my gosh, I'm getting these Google reviews for my business. I've never seen them. What did you do to mitigate that situation or if it's even possible
Speaker 2 (07:55):
Crying and vomiting? Let's see. What was the next? So I, I vomit when I get really stressed out. That's a new discovery in 2020. I don't recommend it. It doesn't make you slimmer just saying. So I do not promote that. Okay. [inaudible] so I already have a lawyer, but I even, I contacted Erin Jackson who is a great human my lawyer Stephanie wrote in, but I just, you know, who do I contact first? Because I knew this was now in some sort of it's the physical therapy where we have HIPAA. We have so many things legally we need to be careful about. And as much as I say, swear words, and I joke like there's liability for these things. Like, but this was just how do I handle this? Because Google reviews specifically, which I was fearful, I pre reported these people before it happened, because there was no way to block them on Google.
Speaker 2 (08:52):
Not because they were going to, I was going a little bit in the Cuckoo's nest. Like, how do I keep preventing? Cause they're doing all this stuff fine on social media, but just in case let's pre protect, there was no way to, well, getting Google reviews is difficult. So here's some things that you can do by hand that are suggested they, you can have friends report it. And if you have friends report it, make sure you have a written out exactly where they need to click step by step, what they need to do. And, and boom bought a bang. Another thing that I did is I contacted the patients. I felt comfortable contacting, cause that is a thing I'm saying, this is going on. I've never gotten a review from you. Would you please write a review so I can get some actual from actual patients on here.
Speaker 2 (09:38):
So I did outreach to those individuals as well. Which was great in that sense. I mean talk about like, you know, unexpected, positive. So that was good. Then with my lawyer, which we're still in the process of doing so a little bit slower in the holidays. It also, I'm just personally, not in any rush because I got so stressed out about it that just like, I'm okay, I've got, I've gotten zero patients from Google reviews, so it's not the end of the world. But she's writing out in legal jargon, what I'm going to be now sending to Google to ask it to be, and it's according to their policies, why these are inappropriate reviews. And so that is what our next step is. I have not met with anyone else yet, but because of enlight of how bored people are, are during the pandemic.
Speaker 2 (10:29):
And they're putting a lot more emphasis on these negative things, no matter how small or how big they I am in the process of being connected with the lawyer, through my lawyer to learn when I need to do a cease and desist. And when I, when I know it's actually necessary, I still am getting a little bit harassed by them, but I I'm. I'm okay. I'm good right now. But I do want to know, and that I look forward to learning, to be able to share with people like, Hey, here is when you hire the lawyer officially, because that is a good question. Lawyers should get paid for what they're doing, but it's just knowing when you bring that in, which is a very big deal that I think should just be common knowledge. And then where we were able to get one review, Oh, there's also a thing after you submit in there's you can write a post about it on Twitter and you tag people with Google.
Speaker 2 (11:28):
I forget who you tag. You guys will have to Google it. You'll have to Google the Google thing, but it you can do, I didn't get that far. I also was so hesitant to do that because then it would take it into the physical therapy world at large of, Oh, what's the going down with Jenna. I'm like, Oh my God, like it's literally children who are upset about musical theater. Readings has nothing to do. Like, no. Okay. And then my husband was helpful. He was able to get one of the reviews down by reporting the person's profile.
Speaker 2 (12:04):
And that was very good. So that was one there's still two that have written reviews. There are three with just one star reviews without writing anything. And none of them have been patients. And we believe that they created two false profiles to put in two of those one star reviews. Interesting. but at the end of the day, they're not in my Rolodex of patients, so they're not patients. So yeah, it's been a bit of a journey dealing with it, but that's a little bit of what I did. There's not one way to do it. There are suggestions on responding to the person where you can say, Hey, I'm so sorry to hear of this complaint. I don't have any records of you as a patient. Please feel free to email me at because there's no conversations that happen within the feed. It's like your reply and that's it. And people can look at it. That's
Speaker 1 (13:02):
Actually, that could be pretty helpful.
Speaker 2 (13:05):
My, my lawyer said right now, don't just because we, she was like, let's just, let's just, I'm fine with waiting right now. You know what? The level of stress gets so high, it got real bad for me to be throwing up from stress is a big thing. So the fact that I'm not throwing up, I'm doing well is good. So I'm okay with it being a slow occurrence because my body does start to shake going back into that world, which to me is also just another recognizer of why it's important to know when it's time to block certain people from your life. If they're making you shake and vomit, because you're stressing, like they're just not meant to be in your life. It's fun. It's that simple, you know? But yeah, no, it's, it's, it's it's a very humbling, very embarrassing situation to be dealing with. But I have learned that there are, there are definitely a lot more businesses right now dealing with that, unfortunately. Yeah. I wish people invested more time in the positive stuff to raise up to be the positive changes that we want rather than let's just tear people down because in that action, the wrong people are being torn down.
Speaker 1 (14:20):
Yeah. Well, thanks for sharing that. And also, thanks for sharing what you did to kind of help as best you can at the moment. Kind of rectify some of that because now if people are listening and they go through that as well, they'll have at least an idea of like, okay, well here's a place where I can start. So thank you for that.
Speaker 2 (14:36):
Yeah. If anybody ever wants to talk some crap about what you're dealing with, I'm here for you.
Speaker 1 (14:41):
Yeah. Great. All right, Julie, let's go to you to your, your, your ups and downs of, I have a feeling that your, your and low point might kind of be the same thing, but I don't, I don't know. So go ahead. I'll, I'll throw it over to you. Yeah,
Speaker 3 (14:59):
Yeah. So I actually remember when we did the show last year, I said that I wanted 20, 20 to be more of a focus on more of my personal life and focusing on family and things in that direction, because in the past it had been all about my business and everybody has had challenges in the physical therapy world with their business. And we have with Newport coast physical therapy, we've actually come out strong. And that isn't really what I wanted to focus on because it's supposed to be personal. So I guess for my lows. Hmm. So me and Wade we've been together for 11 years. We had our 11 year anniversary. And when we're thinking about starting a family and everything, we were like, okay, we have to kind of celebrate the last year that we're going to have together. Just me and you. So 2020 we had like, all these things planned for our relationship.
Speaker 3 (16:03):
We were going to go to Switzerland, literally the day of the lockdown, that was our flight to Switzerland. And we were like, Oh no. Okay. So we can't do that. And then we had planned some things in the States, like going to national parks and all of those ended up closing down. And then, and then I I'm pregnant. I was pregnant with twins throughout all of this. So then as you know, I get further along in my pregnancy, it's getting harder to do anything just because pregnancy can for wound baby, but with two babies, it was just like, ah, I could give birth at any day. So I don't really want to be too far away from the hospital and everything. So I would say that for the lows, me and Wade didn't really get to kind of celebrate our last year together just as us and which is fine. You know, we, we, we made it work and did some other things, but I think that we didn't get to kind of grieve that aspect of our relationship changing. So that was a little bit of a challenge, but the highs, obviously
Speaker 1 (17:15):
I had my twins August
Speaker 3 (17:19):
In Westin and they're three months old right now. They are actually let's see, they're one month adjusted. So they were born two months early and they spent about two months in the NICU. So that was a little bit of a challenge, but given all the COVID and everything going on, luckily there was plenty of resources for my babies and they had great medical care and are super healthy now. So yeah, my highest definitely having my two boys, they're adorable and they're definitely a lot of work, all consuming basically, but hopefully in the next year, I'll get a better swing of, you know, balancing family life and managing my business and everything. So that's kind of a bit of a summary of my 2020
Speaker 1 (18:11):
Now let's, let's talk about quickly for, cause you know, a lot of people that listen to this podcast, they're physical therapists and might be entrepreneurs, women kind of around in, in your stage of life who are thinking about I'm going to have children and what's going to happen to my business. How am I going to do this? So do you have any advice and, and what have you done with your business as, and I mean, twins, I goodness, but we should say that Julie is also a twin, so it's not shocking that you had twins.
Speaker 3 (18:41):
I wasn't surprised when they see that as having twins, I was like, you know what? There was a chance that was going to happen. Yeah. But I would say that for anybody that's in kind of a similar life stage, I fortunately, since my business model is pretty flexible in the sense that I can pick and choose when I take on patients, I don't have much business overhead just because of the, the mobile concierge practice model. That it's good for being a mom because I can kind of pick and choose when I want to take on clients. I would say that if you're, you know, the breadwinner of the family, that's a really tough position to be in because it's, it is really hard to balance everything because I'm going to be able to, you know, pick and choose clients that I want to see when I want to see them.
Speaker 3 (19:35):
And not everybody has that flexibility. So if you do own your business, it is a good time that maybe you could take a step back and be more on the business management side of things, where you can do things from home, from your computer and then hire somebody to go out and actually do the service. And I actually have a therapist that is doing some client visits for me right now, which thankful it's my best friend. So she's really chill to work with. But that could be a strategy that some people take on is that they end up doing some of the business management side of things instead.
Speaker 1 (20:15):
Yeah. So you're still working in the business. You're just not out in the field, so to speak because I mean, when you have a new, a new a newborn, I can only imagine that it takes up a lot of your time.
Speaker 3 (20:30):
Yeah. Every two to three hours, which, you know, if you're, you've never been around kids, I was surprised they eat that frequently. I was like, Oh my goodness.
Speaker 1 (20:43):
And you've got two of them, two miles to feed. Oh, that's so funny. And what, I guess, what has been your biggest aside from, you know, not getting a lot of sleep from being a new mom, is there anything that surprised you aside from how much children eat? You're like, what the hell? Why did no one tell me this?
Speaker 3 (21:08):
I'm trying to think. I think that the reality of taking care of a baby, like, I guess I thought it would be not as much of my time, but maybe it's because I have twins. I don't know. I don't know. I don't know any about anything about this, but it literally is like a 24 seven type situation right now. And I can only imagine for people that are going back to work at this point, because technically I've been off work for three months and not a lot of women are able to do that. They have to go back to work. I could see how challenging that would be. Cause if my twins were still in the NICU, so say I took off that six weeks of maternity leave and then had to go back to work before they even came home. That would be so tough to juggle. So it is a lot of work. Like it's the hardest job, just, just the physical toll it takes to be up and take care of babies. It's it's tough.
Speaker 1 (22:08):
And have you had pelvic health physical therapy?
Speaker 3 (22:11):
So I actually, haven't gone to a pelvic health physical therapist, not because of anything against it. I just haven't noticed any symptoms. Okay. So I do actually have a couple friends that are specialists in pelvic floor PT that I could reach out to. Maybe they would be testing me for certain things and be like, we need physical therapy. So that could be something I do in the future, but it's yeah. I fortunately have had like a very good recovery and haven't had to deal with anything on the surface at least.
Speaker 1 (22:47):
Excellent. That's so nice. Well, I love hearing your, your ups and downs and, and we should also say, cause I don't know that Lex is going to be able to come on here. Maybe we can splice her in later, but she did get married. So I can assume that would be her high point. If it's not, then she's, she's going to have some answering to her new brand new husband. I would assume that's her high point. And she also started her own practice in New Hampshire, which I would assume could, would also be a high point for her as well. And then what do you see happening moving forward? What are you, what are you, what are your goals, your dreams, if you will, for 2021, Jenna, I'll throw it back to you.
Speaker 2 (23:34):
Goals and dreams. Well we are moving to Pittsburgh. It's taken almost a full year, so I'm looking forward to moving there with husband and I have a dream office room cause I'm an actor as well still, and it's going to be decorated Disney theme. So I'm really excited to decorate and make my imagination finally come through and have the walls of tangled with the lanterns, hanging from the ceiling and have all my different collectibles up on display and my lights and my cameras and everything up permanently. So I don't have to keep putting it down and putting it under the bed in a New York studio apartment. I, that will be like
Speaker 1 (24:21):
For me, cannot wait, cannot wait, Julie, how about you? I'm definitely going to be going to Switzerland. Does I rebooked these tickets like three times and I don't know it's going to happen in 2021. I'm not from eight or tots with me. Well, yeah, go ahead Karen. I was gonna say I, if, if all goes well with 2021, I'll be in Switzerland in November. So you could come to a course, write it off. Oh my goodness. That's a great idea. What is the course? The course is only one day and if it happens I will tell you about it. Cause I don't think it's been announced officially yet. But it's just a one day course. So you can go to Switzerland, just pop over to burn for one day and then you pop out. Oh my goodness. It's it's the the, I think it's like the Thursday or Friday before Thanksgiving.
Speaker 1 (25:25):
All right. That'll be good. Cause the twins will be over one years olds. Okay. Throwing it out there. You guys, I will be in Switzerland. It's going to happen. Awesome. Well, I have to say Switzerland is really, really beautiful, so I'm sure you will love it. Love it, love it. I don't know. Should I talk about my highs and lows, I guess highs and lows. So I guess my lows were I think when, when everything happened here in New York and Jenna can probably corroborate this, but it was an, it was a little scary, you know, because it was everything locked down, nip. It, it locked down so quickly, but and nobody really knew what was going on. And I think that was a big, low, and I think I had, again, the sleepless nights and the anxiety about, well, what's what, what will happen with my practice?
Speaker 1 (26:29):
W what am I going to do? I see people in their homes, like you couldn't go anywhere, couldn't do anything. And, and so I think that, that, that sort of stress around that was definitely a low point professionally and then personally, well, my boyfriend and I broke up, but that's probably for the best in the long run. And then my sister had some health trouble, so it was a big sort of just like everyone else. 2020 was like a big sorta show. But that being said, the not knowing what I was going to do for work and being stressed as a low point turned into, I would say a high point along with Jenna is I started integrating tele-health, which is something I will continue to do. So now I do probably see half the people in person and half people via telehealth.
Speaker 1 (27:23):
And I love it. I love doing it. I think it's it's working very well. And I was also able to launch a business program to help physical therapists with the business and the business side of things. And that's been really fulfilling and getting nice reviews from that from people who have taken the course. So that, which makes me very happy because my whole anxiety was wrapped around. That was like, what do people take it? And they hate it and they think it's stupid and they don't want to do it. What am I going to do? And, and so, you know, you have all these doubts about like self doubts about what you do as a person and what you do as a therapist professionally. So I think those were, it was sort of a mixed bag of highs and lows.
Speaker 1 (28:08):
And I guess what I'm looking forward to, I too, am looking forward to going to Switzerland. And and just being able to travel and see people, like, I would really love to see my parents who I haven't seen in almost a year. And so that would be lovely because we did not, I did not see family for Thanksgiving or Christmas and probably won't until we all are vaccinated. Just to give everyone a little sense of that, like we're doing the right thing. So I think that's my, the biggest things I'm looking forward to is seeing my family, being able to see friends in person and colleagues in person, because, you know, we miss seeing all of you guys too, you know, so I think that's the things that I'm most looking forward to for 2021 is, and I don't, I don't think that things will go back to the way they were quote unquote, but I think that they'll be an improvement on where we are now. I don't know. What do you guys think?
Speaker 4 (29:18):
Yeah. I think having our support systems slowly return is going to be really, really fulfilling to just for humans. Like we love human contact and our relationships having all those kinds of slowly come back together is going to be amazing. Yeah.
Speaker 1 (29:35):
Yeah. I love the way you put that. Having our support systems back is huge. Yeah. Hugging. Yeah. I miss hugs. I know, I know one of my friends hugged me like a friend that lives here in New York. She hugged me and I was like, you know what to do? I froze up. I was like, Oh my God, what is she doing? Hugging is so good.
Speaker 2 (29:57):
Why my husband gives me time limits for my hugs. Cause I'll keep hugging. I love hugs and I miss hugs. I even miss the Wilson's a musical theater specific thing, but go into a musical theater audition and all the annoying screens of people reuniting with someone they only saw just a week ago, you know, cause we won't want to feel cool, but the people will see and know, but then we do it too. When we run into the people we haven't seen. Who's guilty of it. But yeah, hugging, hugging is just beautiful.
Speaker 1 (30:32):
Yeah. Human contact.
Speaker 4 (30:36):
What if on my flight to Switzerland, I have a layover in New York and then I can see you.
Speaker 1 (30:45):
Yeah. What is that quick? Have a quick one day layover and then Optus. Switzerland. Oh, I know. I forget. You're in California, such a long flight.
Speaker 2 (30:54):
You need to get pizza. You would need to get Levine's cookies. Oh yeah. And what else, what else would the food wise I'm thinking? I was thinking,
Speaker 1 (31:06):
Yeah, I just had, I just had a Levine cookie a couple of weeks ago. I eating live only a couple blocks. So the vain bakery was, it got really, really popular because of Oprah. It was like one of Oprah's favorite things like maybe a decade ago. Yeah. That's why they're so popular. But the cookies are like scones, like they're thick and gigantic. Like I got a cookie, it took me like three days to eat it.
Speaker 2 (31:31):
Yeah, no they're thick. It's,
Speaker 1 (31:33):
It's a lot, it's a lot of cookie dough there. But they are, they are pretty delicious. Now. You'd swear. We were sponsored by Levine. Speaking of sponsors, I have to say thank you to our sponsor net health.
Speaker 4 (31:47):
Great segue right there.
Speaker 1 (31:50):
Just getting it to me. So net health has been sponsoring the podcast for a couple of years and I'm really, really grateful and thankful to them and their support, their continued support. And net health has grown by leaps and bounds since they first started sponsoring the podcast. And so I'm really happy to see their growth, their Pittsburgh company, by the way, Jenna. Oh yeah. Pennsylvania company. And and so I'm really, it's really been exciting for me to see their growth and their movement upward and the fact that they are doing their best to help healthcare providers, which I think is awesome. And they also have, and not that they're telling me to say this, but they really do have some really good webinars. So they're usually free. So if you want like good webinars, business-wise they really have some good stuff, especially if cash based or non cash based. So I would definitely check out their webinars because they're all pretty good and usually free. I like free. Yeah. And everybody loves free. Okay. So I guess I'll ask you guys one last question, knowing where you are now in your life and in your career, what advice would you give to your younger self?
Speaker 4 (33:05):
Okay. I should be prepared for this because you know, this happens every single episode and did not think this question was coming at me. Okay. So the first thing that comes to mind, and I think it's important is that you should always maintain a sense of curiosity about everything going on in your life professionally, personally, I think that if you're open-minded and you can kind of think on things a little bit differently, just because you're not closed off, you might be able to see solutions in ways that you didn't think of before. So that is very theoretical, but I just think that that kind of vibe, if you maintain that sense of curiosity about everything, it can kind of lead you in new directions. What do you think? I think that's great advice.
Speaker 2 (34:00):
Oh my God. I'd love that. I, I I feel like I should have gone first because it naturally segues to what you just said. Oh let's
Speaker 4 (34:10):
Oh no,
Speaker 2 (34:11):
No, no, no. I think it's perfect. I loved it. I was like, Oh, you know, like for me, I get my best ideas on the toilet, but I still, I thought that was amazing. I was thinking the first thing that popped into my head was don't waste your time on the, focus on where, what your vision is for your life and put all your energy into that as it, and this is why it's like, why it's so good to yours. And now like the candles, I was like, Oh my God, this is perfect. It's so great for us.
Speaker 1 (34:42):
Perfect. I think that's both great advice. And, and I know I asked this question every time and how I would answer it, knowing where I am now in my life and in my career. I think that what I would tell myself, even like fresh out of, out of college is when it kind of goes along with maybe what a combination of what you guys both said. But what I would tell myself is to don't limit myself by what I see other people doing. Because sometimes like when I first graduated, I knew PTs worked in a hospital, they worked in a clinic and that was kind of it, you know? And so I didn't never saw that sort of broader vision. And so I think I would tell myself to look to people outside of the profession to help you your state in your own profession and seek out those people that have, that genuinely have an interest in you as a person and, and want to be a part of your life and a part of your success. Because I think I've fallen victim to people who I thought had my best interests at heart, and I'm a trusting person. And as it turns out they didn't. So I think really, I think as you get older, you sort of, you maybe, maybe I just have a better sense of who I am and what I want. And so I'm no longer kind of easily swayed and convinced by people who in the end don't really have my best interest at heart,
Speaker 4 (36:28):
But that's one of the qualities I love about you though. Karen is how trusting you are. I think that does serve you too in your life. So I think that don't ever lose that. That is something that it's, it's a gift and not everybody can be vulnerable. And I think that you wear that really well.
Speaker 1 (36:46):
Oh, well, that's nice. Yeah. I don't think I would, I'm not going to become that cynical of a new Yorker, but I'm going to, Jenna knows what I'm talking about. But I think that I'm just going to just be a little bit more discerning on the people that I choose to kind of surround myself with. And I think that I've been doing that more recently over the last couple of years, and I think that it has served me well, but that's what I would tell my younger self out of college anyway. Yeah. All right. So any last bits, any last, anything
Speaker 4 (37:23):
We're all gonna make it we're all gonna survive hopefully. Yeah.
Speaker 1 (37:27):
Yes. Rules. Yes. Jenna will be going to Florida next year because she missed it for CSM. I know, I know no CSM in Florida this year, but we did videotape our performance, little plug, Jen and I to have a thing at CSM on February 11th at 7:00 PM. Join us for our prerecorded topics on social media, social media. Yeah. Basically. How do you social media, mainstream media to improve your presence as physical therapist and then I think, but I'm not sure we might have a live Q and a afterwards at 8:00 PM. We're so clear.
Speaker 1 (38:10):
So we'll find out. So anyway thank you so much, Julie and Jenna and Lex for all of your hard work and all of your commitment and I love you all, all three of you. I was going to say, I love you both. And then a Lex, and I'm just getting, I love all three of you. And I really, from the bottom of my heart. Thank you so much. Thank you as well. All right, everyone. Thank you so much for listening. I wish you all the very best and, and fingers crossed for a better 20, 21 and stay healthy, wealthy and smart.
In this episode, John Honerkamp talks about all things running.
John Honerkamp, affectionately known as Coach John, has coached runners of all ages and abilities for more than 20 years. A graduate of St. John’s, John was an eight-time All-Big East and six-time All-East (IC4A) athlete while running for the Red Storm. He earned 12 Big East All-Academic accolades and was the youngest semi-finalist in the 800-meters at the 1996 U.S. Olympic Trials.
John is deeply involved in the New York City running community. He launched the Off the Hook Track Club, a local training group based in the Red Hook neighbourhood of Brooklyn and created The Run Collective — born out of a desire to unite the running community and connect, collaborate, and celebrate all efforts from various clubs, crews, and people in the city.
Today, we hear some of the mental blocks and physical issues that John often sees with his students, and how he creates milestones to motivate himself to keep running.
John tells us about choosing the right shoe, when to replace them, and he gives some advice to new runners, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Everyone’s a runner. Some people just choose not to run.”
- “You can’t change overnight.”
- “It takes 3 or 4 weeks to find a rhythm, sometimes even longer. Just be patient, slow down, and make sure it’s fun.”
- “Taking care of yourself is really important. There are a lot of little things like massage, stretching, eating right, and all these things that are small things that add up to bigger gains.”
Suggested Keywords
Running, Coach, Exercise, Jogging, WaterPik, Massage, Wellness, Health,
To learn more, follow John at:
Website: Run Kamp
Facebook: @johnhonerkamp
Instagram: @johnhonerkamp
LinkedIn: https://www.linkedin.com/in/johnhonerkamp
Email: john@runkamp.com
WaterPik Power Pulse Showerhead
WaterPik Water for Wellness Council
Subscribe to Healthy, Wealthy & Smart:
Website: https://podcast.healthywealthysmart.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264
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Read the full transcript here:
Speaker 1 (00:00):
Hey, John, welcome to the podcast. I'm happy to have you on.
Speaker 2 (00:05):
Thanks for having me. Yes.
Speaker 1 (00:06):
A fellow new Yorker, just over the bridge in Brooklyn.
Speaker 2 (00:10):
That's right. I'm a couple blocks from prospect park. So I do a lot of my running and activities and in prospect park. So I feel fortunate to have access to that space.
Speaker 1 (00:20):
Perfect. Perfect. So now let's talk a little bit more about you before we go on. So people know you're a run, a running coach and you've been running for the good portion of your life, but can you kind of fill in some of the gaps and let the listeners know a little bit more about kind of what led you up to where you are today in the running world?
Speaker 2 (00:40):
Yeah. I was fortunate to have an uncle that lived next door to me, and he was trying to lose weight and training for the marathon. Either the New York or the long Island marathon or both, this is probably like 1982, 83. And to DeVos's neighbor, he would just bring me along to some of these 5k and 10 K races. And that was kind of like in the first kind of first a second running boom. And, you know, I do the kids fun run, which to be honest, not a lot of kids were doing, it was usually about a mile distance. And then it gradually, I would, you know, after a year or two, I would, you know, take a stab at the 5k, which was a pretty far distance for seven or eight year old. But I just got exposed to running at an early age and, but not really, I mean, competitive against myself, maybe the clock, but not super serious.
Speaker 2 (01:24):
I did other sports, but when I w when I got to high school, when I went out for the cross country and track team, and we had a pretty good high school in sports in general. And I kind of had a leg up as far as I've been running for races for a couple of years. And I kind of had, you know, a little bit more experienced than the average freshman, but I definitely was better at running than basketball, football, baseball. I was very good on defense and I realized that equates to like, not scoring a lot of baskets, but it really annoying the other competitors where I had a good engine. And so, you know, I ran very well in high school. I got recruited and I went random, got a full scholarship to St. John's in Queens and ran there for four years.
Speaker 2 (02:10):
And I was fortunate enough to get better each year. And I had a really good year, my junior year and 1996, I qualified for the Olympic trials and the 800 meters. And that was also the year that the Olympics were in the U S and Atlanta. So it was just actually that kind of a perfect year. It was 20 years old. I got, I just advanced really, really well. That's, that's that's spring season dropped about four seconds of my 800, which is a pretty good chunk of time for that distance. The next thing you know, I found myself at the NCAA at the Olympic trials competing in Europe as the 22 and as a 20 year old. So that was kind of the beginning of it. And then obviously I got into professional running post-collegiate Lee. I ran for a team Reebok team based out of Georgetown university, but the legendary coach, Frank Gagliano.
Speaker 2 (02:51):
And I did that for a couple of years training for the trials in 2000. And in 2001, I moved and I was living in DC for those three years. And then I moved back to New York and I was still competitive. I ran for the New York athletic club, but I had to gradually kind of turned from competitive runner to not necessarily weekend warrior. I was still running a fair amount and I'm still competing, but I was focused on other things and then got into coaching and initially at running camps over the summer as a college kid, and then I coached high school was my first gig when I was coaching. When I was running professionally, I coached high school down in Virginia and then got up here in New York. And next thing I know I was coaching. I worked for the New York Roadrunners for five plus years and handled all their training and education and launched virtual training platforms where I was coaching 5,000 runners for the New York city marathon. At one time, the life I was just emailing people all the time, but it really gave me a nice quick you know, again, it's just different. I mean, there's a lot of same principles and at whatever level you're at and running, but coaching the folks that maybe aren't elite or don't have two hours to take a nap every day and do all the recovery things that we'll probably talk
Speaker 1 (03:55):
About are most people.
Speaker 2 (03:58):
Absolutely. I got a really, you know, a crash course in coaching, like the everyday adult who has two jobs and has kids and running as again, as I can sneak it in on the weekends, trying to get in before your kids get up, I'm finding I do that myself now being a father too. Yeah, so I started early and I never got burned out from it. I always had great coaches that didn't run me into the ground. And there's plenty of stories out there where kids, whatever sport we're talking about, or even other disciplines like music or dance or art or whatever, if you do too much, and it's not fun anymore, and you start not liking it. And I was able to, even though I didn't enjoy it all the time for the most part, I really enjoyed running throughout my life and at different levels of competitiveness.
Speaker 2 (04:40):
And and I'm very proud that I, I do, I do call myself a I've run races and stuff, but I'm not offended anymore when people call me a jogger or they asked me how my jog was. I actually realized that I was doing a lot of jogging, even when I'm at the elite level, the recovery runs were very easy paced. So I'm quite proud to be a jogger. And but yeah, that's kinda like my quick and dirty version of how I got into running and the kind of trajectory that I've been on. And again, I've been running for about 35 years and probably kosher for close to 25 at various
Speaker 1 (05:12):
Amazing. So you've coached, we can easily say you've coached thousands of people.
Speaker 2 (05:17):
Absolutely. Yeah. The technology and the online platforms recently, it does make it easier, very scalable. And you can say, yeah,
Speaker 1 (05:24):
Yeah, amazing. And just so people know the way John and I met was through so people who who listened to this or see me on social media, you know, that I'm part of the water Waterpik water for wellness council as is John. So they've got two new Yorkers and we're both council members. And one of the things that we have been working with is a Waterpik power, pulse, therapeutic strength, massage, shower, head, try and say that 10 times fast. But we'll talk about kind of how, how John sort of incorporates that with his runners and any benefits that they're seeing from, from switching a shower head, which is pretty easy. But before we get into all of that, John, let's talk about some of the common complaints or common issues that you're seeing with your runners. And just so people know, we spoke a little bit before we went on the air here. And the one thing I really want to hone in on first before we get to the physical things that everybody thinks of that happens with runners, but there's the mental side of it too. And sometimes that could be the more important side. So talk to me about what kind of mental blocks you're seeing from your, your students.
Speaker 2 (06:40):
Yeah, I mean, mentally it's it's funny because people, when they find out that I've given coaching all these years and been running and maybe I was faster and fast and slow is a relative term, but you know, competed at the Olympic trials, they're always Oh, well, you wouldn't want to coach me because I'm not a real runner or, Oh, I don't run like you. And I'm like, how do you run? You put one foot in front of the other, you leave the ground and move forward. It's very simple. And so people often have a love, hate, or just hate relationship of running because either it was a punishment for other sports growing up, we had to do laps. Oftentimes it had to do with pre-season conditioning. And if you're coming off the summer and like, you like me in high school, the first couple of years, you didn't do your homework over the summer. So you show up and you're, you know, you're out of shape and you're doing laps and it's hot. I remember that in football practice as an eighth grader, just being like miserable and like running was, was, was terrible,
Speaker 1 (07:30):
Especially in the Northeast when you've got the heat and the humidity and everything else. Yeah.
Speaker 2 (07:34):
So or they, you know, it was a gym class and they had it, they know the presidential fitness test and they had to do a time tomorrow on a terrible thing. But like, I was actually good at that because I liked running ahead at like an early traction to running. And I was doing pretty well at it, but for the most people, it was not fun. And it was just an awful experience. So whether they come to they're new to running in their adult life, or they were even if they were faster and fitter and did other sports as a, as a youngster that maybe they took 10, 20 years off based on whatever. And now they're getting back to it. And they're really the mental block of, Oh, I'm not a runner and maybe I shouldn't do this. And you know, and that is really oftentimes getting people to accept that they, that they're falsely claiming that they're not a runner when they're really just, I always say, everyone's a runner.
Speaker 2 (08:22):
Some people just choose not to run or they don't know how to start. So I really enjoyed that process of getting people over that mental hump, if it exists of, Hey, you're a runner I want to find out where you're at, and then we're going to take you from there to where you want to go. And you need to know where you are before, you know, where you're going. And so it's really like, I think oftentimes changing their mindset and saying, it's okay to run 10 minute miles or 12 minute miles or seven minute miles. I don't care. I like numbers and data when I'm crunching numbers about your training and maybe how you paced properly or improperly. So I'll get geeky about that. But I don't really care. I, I coach someone who runs 15 minute miles the same as I would someone coaching seven minute miles.
Speaker 2 (09:01):
And so it's just the mental space that they're in of, Oh, I shouldn't be here. I don't belong. I'm not really doing it right. And oftentimes they'll say, Oh, I'm not running is not for me. I get this all the time. I can't run more than a block. And I'm always like, well, what block you running up? Is it uphill at altitude when you're carrying a backpack of weights? Because probably most people could run a block and they're just running too fast. And they think of running as being painful. So that has to hurt. But to be honest, most of my training, especially for like a marathon, for example, I have a lot of first-time marathoners and most of the running is actually easy. Pace. Marathon pace is actually quite easy. It's just hard to do for 26 miles. So the barrier of like not pacing yourself or not going out too fast for a couple of minutes where they have to stop, those are quick fixes in my opinion. And that's the mental side of things. And then there's a couple of common physical issues that come up, which I can talk about for sure as well.
Speaker 1 (09:54):
Yeah. I know. I love the, that sort of mental barriers, because I think if we're talking about new, new to new to running folks or folks who maybe took a year, five years, 10 years off, and they're coming back to it, like you start and you think to yourself, God, it's taking me 15 minutes to run a mile. I feel like such a loser, everyone else, like, cause you hear Oh, eight minute mile, seven minute miles. Like that's where you should quote unquote, should be. If you want to run a marathon, you don't want to be running for seven hours. This is, you know what I mean? And, and I think that that's, that can be really difficult for people and kind of turn them off before they even start. So what kind of techniques do you have for someone like that who's coming to you saying, I feel like such a loser. I can only run a 15 minute mile or 18 minute mile, whatever it is.
Speaker 2 (10:48):
Yeah. I think I also encourage people to have a running log or a diary, which is an extra step, but it also helps you get progress. It also helps you with injury prevention and to deal with injuries when you do have them, which I'm sure we'll get into, but I often buy I'll run by minutes. So it's like today you're doing 20 minute run versus a three mile run or a five miles. So they don't honestly know how many now, if they have a GPS watch and they're tracking things, they'll know after the fact that, Oh, that was the 13 minute mile or whatever, but I'll run by minutes. So you don't, you know, and then that, I think sometimes it's a different mindset or a way of tracking where it does free you up a little bit of not having to do the three miles in 30 minutes.
Speaker 2 (11:23):
That's easy math. That's only 10 minutes or whatever it is. You just run for 20 minutes or whatever it is, 30 minutes, 40 minutes. And even when you get in your longer runs for longer distances, you're, you're, you're increasing by five or 10 minutes, not a full mile. Sometimes I liked that worked and that's kind of how I'd run anyway. I'll just do a 30 minute shakeout run or something and I'm not right. Especially if it's not a workout, it's a workout quality day where I'm doing six times 800 or I'm doing something like that. It'll, it'll be more important to know the pace and effort, but most of the running, just getting out there and doing it. Yeah.
Speaker 1 (11:55):
So it's like, you, you can accomplish that 20 minutes. You get that win and you gradually build your confidence, right? Yeah. No, that makes perfect sense. I really liked that. And I also like keeping a running log or a running diary. It's the same thing. We tell people if they want to lose weight, one of the, almost every nutritionist or dietician will tell you to keep a food diary. I do that with patients with chronic pain, I'll have them keep a pain diary so that they can kind of keep track of maybe what they did and what their pain levels were and things like that. So it doesn't work for everyone, but I think it works.
Speaker 2 (12:28):
I have a quick story about that when I was just just first year as a professional runner, I had all these shin problems. I got down to DC and I felt like this kind of like loser, cause everyone was just professional runners. They're all qualifying for the Olympics and trying to qualify for the Olympics. And I had shin splints. So I was like running 20 minutes by myself and I couldn't work out. And I was seeing like a, you know, PT person and I was doing exercises and just seemed like I wasn't getting anywhere. It wasn't improving. And then the PT said, Hey, you should really just monitor your pain on a scale of one to 10. And obviously you have a left shin and a right shin and both were hurting me. So I thought that was really silly and kind of stupid as a, as a 22 year old.
Speaker 2 (13:05):
And but I started doing it cause I had nothing else. I wasn't running riding much of my youth log. Other than I ran 20 minutes. I didn't have to take me a long to write what I did cause it wasn't a lot. So I had stuff to write about and to be honest, you know, say I had a six out of 10 or seven out of 10 was the pain level. And then all of a sudden, as I was ranking it throughout the weeks I was doing these PT exercises and, you know, strength exercises. And I'm like, are these really working kind of going through the motions? But then I did realize like one week or so in the sixes were fives and the fives were four weeks. And so I w if I didn't have that to document, I wouldn't know, I wouldn't be able to see the trend of in the right direction.
Speaker 2 (13:43):
So then I got more excited and I was more diligent about the exercises and I did them correctly. It was more intention. And that was really helpful because I could see progress where if I didn't have that, I would just be like, Oh, my shins hurt and not, you know, see, you know, again from five to four and everyone has their own relative scale of that, but it's just for that each person. And so that, I always tell that story. It was, I thought it was really silly, did it anyway. And it really helped me kind of snap out of that mode where I was like, wow, that really I could see progress. And I wouldn't be able to do that without having the data or the, or the documentation that I have it writing it down. So I'm a big believer in that. And I really it's, it's fun to see that you're, you're doing that with your patients as well, because that's one way to, you know, this, you can't remember everything and it's, we're all busy.
Speaker 2 (14:29):
And so if you can write it down and go back to it, even if they don't see the trend that you look at their, their, their diary, they might not see. And they're not going to be able to remember all these things, but if you can like read through their notes, you oftentimes, the coach will we'll pick up stuff before the athlete. And that's just like being a detective. Oftentimes I'm a detective as a coach, try to piece together. And the more information we have as coaches or detective detectives, you can get the root of the problem quicker. So document everything, it's, it's kind of like old school, but I, I can't speak more highly about that because that's really a game changer for me as a young 22 year old, but even to my athletes today.
Speaker 1 (15:09):
Yeah. Awesome. And now you mentioned shin splints. So let's talk about it. One of the common complaints that you get from your runners are shin splints. So as a running coach, what do you do with that?
Speaker 2 (15:21):
Yeah, it's funny. I was thinking about this in prep for this. And I got the same similar injuries as an elite athlete, as I do now is like weekend warrior. You know, dad, Bob jogger you know, shin splints and, and that's, shit's meds are pretty common because someone who's new to the sport either they're doing nothing. And now all of a sudden they're running 10, 20 miles a week, or they're someone who maybe was jogging and then they're training for a marathon all of a sudden, and they're upping their volume. So it's usually just an overage, an overuse issue. It can lead to stress fractures and things, a little more serious, but for the most part, if you have a good pair of shoes, which is super important, you don't need a lot of equipment, although it is getting colder here in the Northeast, and you do need to layer up a little bit, but you really just need a good pair of shoes.
Speaker 2 (16:04):
So that's really important and making sure that you're not doing too much too soon, because if someone is not shepherded you know, they're worried about calling themselves a runner and they get excited. If for whatever reason they get into the New York city marathon through the lottery or something, it's very easy to get overexcited and do too much too soon. And then you're kind of sitting on the sidelines. So it's really just kind of, and then I think a lot of new runners or new athletes, it's tough for them to decipher between pain and injury or soreness being uncomfortable. It's a guy I got to run through it that could lead to like, well, actually that pain is telling you something to slow down or to back off. And sometimes it is kind of navigating through aches and pains that just come with doing something new and doing it more often. So that's something that's always tough to decipher first time through, like, if you've never had shin splints, you're like, what are they? Like? You can ignore them and they don't go away and they become bigger problems. So shin splints, plantar, fasciitis, Achilles issues muscle poles it band with junk currently dealing with now my knee. Those are just kind of the common things that any runner will get, whether you're a professional at being or someone just starting out.
Speaker 1 (17:13):
And what are your thoughts on cadence? So oftentimes we'll all read or I'll see that if sometimes if you up your cadence and shorten your stride length when you're running that it's beneficial for some of these injuries, what are your thoughts on that?
Speaker 2 (17:32):
Yeah, I think if there's a chronic issue that keeps reoccurring, I definitely will kind of look at that, but oftentimes, and actually this is a good kind of tip for someone who's new to running. They often want to me to see them run the first time and like fix their form. And if they're 45 years old, like I am, you've been running for 45 years a certain way, or maybe 44 years because you didn't run as a six month old. But and my son just took his first steps this week. So that's exciting, but it's, you know, you're gonna get you, I, if you gotta get chased by a dog, you're gonna run a certain way. And so you don't need to change something you've been doing drastically, unless it's a chronic issue. That's always happening. People often say there's a breathing.
Speaker 2 (18:15):
How do I breathe in through the nose, the mouth? I said, however, don't even think about it. It's when you have a side cramp, that's keeps reoccurring that I tell people to kind of pay attention to that. But for the most part, don't worry about your form. Don't worry, your breathing just kind of get out there. And if it's something where you want to pass the time and count your steps, or there's some GPS devices that help you count. I really just pay attention to that. If there's something that's reoccurring, because otherwise I feel like you've been doing something and creating all this muscle memory for all these years and to drastically change form. And I often I'll hear this a lot where, Oh, my doctor told me I should run on my toes. I'm a heel striker. Well, then I see people running on their tiptoes in the park.
Speaker 2 (18:55):
I'm like, what are you doing? I know you can't just go from that to that. Yeah. When you run faster, you're naturally up on your toes. There's obviously certain shoes will help facilitate that. But like this, a lot of fast runners that run up their heel strikers, you don't have to be a toe runner, but I, I hear that a lot where my doctor said, or my coach or someone said on my toes and I'm like, not like a ballerina. So those are things where I think if you hear someone say, do this or work on your form, I think there's things to work on, but it's it's not something we want to change overnight because that could lead to overcompensating. And just other issues that I think people may make you maybe worse off than you were with just kind of figuring out something else, but your current form.
Speaker 2 (19:37):
And you can always improve things with drills and stretching and flexibility, which obviously the the power pulse therapeutic strike massage is, has helped us do. And we do even in my mid forties where I'm spitting up and spending a couple minutes a day focusing on that. But you can't change things. Even if you're 25 years old, it's still a lot of muscle memory made it. So you can't change it overnight just to be patient with that. And don't worry about it until it's kind of a problem that you see a persist, you know? Totally.
Speaker 1 (20:07):
Yeah. And you mentioned shoe selection. So this is always a question that I get as a PT. I'm sure you get it all the time, multiple times a week or hundreds of times a season, what shoes should I get? What sneakers should I get? And everyone wants to know what brand, what this would that. So what is your response to, what shoe do I get? Do you get, do you have like some guidelines to follow or what do you tell your, your athletes and your runners?
Speaker 2 (20:34):
Yeah, that's, you're absolutely right. I get that a lot. And it's really, I always tell folks, there's like, you know, everyone knows they're running brands, you know, there's new balance, Nike, this Brooks, you know, they all Saccone Mizuno, Hoka is on. Elena is new on running as a new, at a new company out of Switzerland. All those shoes will have the gamut. They'll have super neutral shoes, neutral being like you don't, you have a high arch, you don't need a lot of support. They have kind of the middle of the road where you have some support, some cushion, then you have like, you know, the Brooks base, for example, it's called the Brooks beasts or the new balance nine nineties. They're, they're meant for heavy duty. You know, someone might have a flat foot. And so there's the whole gamut. So there's usually, there's a shoe that's in that line.
Speaker 2 (21:24):
That's going to work for you. And you might not know that. And I was people tell people to go to a running store if they can, because, and they get intimidated by the Wallace shoes and they go for the pretty ones, oftentimes, but every shoe brand will have the same kind of like kind of small, medium, large, or they'll have the categories of neutral cushion all the way to really support and really corrective shoes and some shoes that are going to fit certain feet better. You know, and I've done some brand work for my business where I'm affiliated with a certain brand and I have to wear those. I'm always hoping that I can wear those and they're going to keep me healthy. But even when I'm repping those brands, I'll say, I don't, you don't have to wear the shoe that I'm wearing, even though I'm getting paid by that company to do various things, the shoe companies should want you to be healthy because then you can run and do more and more.
Speaker 2 (22:12):
So you know what one or two shoes might brands might work better for your foot? And some shoes are just run bigger. Some run wider as far as the shoe brands, but if you'd like a certain brand, historically, that's what you will and others haven't. But try on a bunch, take notes, document how you feel in them, but that every, every shoe company will have something for you. It's just going into a shoe store or doing some research of asking questions. And I was people that always afraid to go into a running store. They're there for mainly for beginner runners, because once you're like me and you know what you like, you just, you can, you can either get it from the store or you order it online shoes. I it's, you know, and obviously if I work for the new brand, I need to kind of re if I have to familiarize myself with different options, but it's really, I can't tell you, I mean, I can look at your foot and kind of see, okay, you're have a wide foot, you have no arch.
Speaker 2 (23:06):
You probably need a supportive shoe, but that's not like a blanket thing. You know, you also look at the wear of people's shoes from previous shoes and you can see where they're wearing down and I'm a podiatrist. But again, back to being a detective, you can, if you can look at things and say, but even my neighbor, the other day was like, what shoes should I wear? I don't like these they're too squishy. I'm like, well, you probably need a little bit more support. They're probably not too soft for you. Sure enough. I gave him the middle of the road running and these are great. It's also probably, I don't know how old the ones he was wearing were. So that's another problem. You go to the running store, you try on something a, maybe you're wearing heels all day at work, and then you go and try this awesome shoe on it's fluffy, and it's great.
Speaker 2 (23:45):
Then you go home and run out on a couple of times. And it's like, ah, maybe this is rubbing me the wrong way. I'm getting a blister. And oftentimes there's also the sizing. If you're a size 10 dress shoe, you might be a 10 and a half running shoe. And I'm someone who actually is 10 and a half in dress shoe and running shoe. But some of my spikes and performance shoes like flats and more racing shoes made it might've been a 10 because you actually want them either. So those are some other things to kind of think about sizing.
Speaker 1 (24:13):
What is the, what is the running, the mileage that you put on your sneakers before it's recommended to change?
Speaker 2 (24:21):
Yeah. I think the industry says the two 50 to 500, which is a big range. So it also, it depends on how often you're running, what surfaces, if you're running on the treadmill every day, then obviously you're probably getting less wear and tear than if you're running on the trails, getting them all dirty and stuffing them up on rocks and stuff like that. So, I mean, I would say close to the, and sometimes people say, I'll just say you should get shoes depending how much you're running like two a year. If not more, if some people would wear the same shoes for three years, I'm like, you probably be, yeah. So you need to invest in that, put that on your, on your shopping lists for the holidays or whatever. But I mean, I'll, and I also do this where I don't wait for the one pair of shoes to kind of run out, especially if I, if I like a shoe and I'm especially to train for a marathon, I might be, I might have one pair of shoes for a couple of weeks.
Speaker 2 (25:09):
I'll get another pair of shoes and I'll start alternating them. Actually one gets cycled out because you kind of know, people often say, how do you know, well, your knees start hurting more. You shouldn't start hurting more and it's not an injury. It's just more of an achy soreness and that's usually stuff. And also I get much more motivated when I put new shoes on you kind of like, you're more anxious to get out there and you know, you do have to break them in sometimes depending on what type of shoe they are. And, you know, I would just jump in, in a marathon without breaking in those shoes. But I mean, I've heard, I would say two 50 or 300, I feel better about, but I've read and I've seen, you know, up to 400 to 500, which is a little higher than I liked, but depending on what type of running you are and how hard you are on the shoes and what surfaces you, you, you could last, but definitely I think, you know, more than one pair of shoes for sure for the year. Yeah.
Speaker 1 (25:59):
Great, great, excellent advice. And now before we start to kind of wrap things up, what I'd love to hear is maybe you have a new runner, right? Because the majority of people, like we said, let's be honest, are more recreation. Runners are not professional runners. They might be new to running, or they're running after a little bit of a break. So if you could give that runner who you've probably seen thousands of times what would your top three tips be for those new runners?
Speaker 2 (26:34):
I would say, give it have some patience. It's like, you know, again, even if your S your pace is too fast at first block and you're stopping, you know, I always said, like, it takes three or four weeks to kind of find a rhythm sometimes even longer. So just be patient slow down, make sure it's fun. Whether that's, you know, I love the running community here in New York. It's so vast. It's actually a card to keep track of all the things that are going on. And even if you're in a smaller city, it's usually like their local running store and there's, there's, you know, you go get a beer or coffee afterwards. It's a great community sport. Cause it's, there's a lot of, there's a lot less barriers involved in entering the sport and you can also be a Walker everyone's kind of invited to the party.
Speaker 2 (27:13):
So, so yeah, I would say, you know, give it time patients make it fun, make it community oriented. Although I do my best thinking and problem solving when I'm running by myself. So definitely, you know, you don't always have to make it about a group training, but that's something that I think it's a great way, appreciate and meet new people in a new city and then take care of yourself. I think don't ignore the things that bother you get good shoes. I mean, my number one, when people are injured, come to me, they often come to me almost too late where it's, so their pain is so bad and their Shannon or their knee,
Speaker 1 (27:45):
Then they're thinking I should get a coach. Like that's the impetus for them to get a coach.
Speaker 2 (27:49):
So you're like, you know, take care of yourself. And to be honest, this might be a good segue for what we're talking about, because my first line of defense is go see a massage therapist because massage throughout my running career is like, you know, you go to a doctor and they say, it hurts when I run, they're going to say, don't, don't run. It's like my mom said back in the day, mama hurts when I do this. Okay, don't do that. That's kind of, that's often, but some doctors will say like, Oh, that's bothering. You just don't do it. Well, we want to do it. We want to be active. We want to keep doing it. So taking care of yourself is really important. And there's a lot of little things like massage and stretching, eating, right. And all of these things that are small things that really add up to bigger gains. And it's, it's fun to, to improve at it. You know, I mean, I'm never going to run a PR again because I ran faster than my youth, but I have, I have to make up goals now, like fastest mile as a dad. You know, whatever. So if these are all things that I have to kind of reinvent to kind of give me the motivation to get out there, but the self hair, the self-care piece is super important and often neglected.
Speaker 1 (28:52):
Yeah. And that self care involves sleep, recovery, nutrition. I think the massage, and like I said earlier, we're both on the Waterpik water for wellness council. And one of the, a couple of things that they're, and again, power pulse, therapeutic strength, massage, shower, head a couple of things that they have actually been shown that clinically shown to provide, like to help soothe muscle tension, to increase flexibility and to improve restful sleep. So the way I look at it as a PT, and I'm sure you may say the same as a run coach. Like we like to keep the risk continuum a little bit more on the reward side and a little less on the risk. Right. So if you can recommend things for people that have less risk and more reward, great. And if you can recommend things to people that are economical. Great. And I think that that's where that the power pulse massage shower kind of comes in along with, like you said, seeing massage therapists one of the things that I'm so glad that you mentioned is about the community oriented part of running. Cause I think a lot of people think that if you're running, you're just running on your own.
Speaker 2 (30:21):
Right. And then that's been the biggest challenge for me. It's just my own running is I've actually, I've been running 60. I usually run five or six days a week and it's done a lot of mileage cause it's, you know, being a dad and, you know, jogging stroller and whatnot. But I was running the same amount of times per week, but I was running and say 30 miles a week. And then I was running like 20 and I'm like, how am I running less? You know, I have more time to one degree. And I wasn't like, I would actually often rely on, especially for longer runs is to go to prospect park, which is very well trafficked with runners. And I know a lot of runners, so I, I usually run into people. I know. And then we go, we can, we run a mile or two or add on, and I didn't have that because everyone was running alone or, and so I was like, Oh, I'm not getting that extra motivation or, Hey, Hey, Karen run into Karen and we do an extra three miles because we're talking way and catching up.
Speaker 2 (31:07):
And so that's something that the community piece to that my mileage is that definitely I mean, I since realized that and, and try to pay attention to doing a little bit more, but I'm like, how am I running last? I'm still running six days a week. And that was the number one thing that I was different was I didn't have the buddies and I was running by myself all the time and that you weren't casually running into people and adding on. So but yeah, I think, and everyone says, you can run with people. It's just doing it safely. Yeah. Certain protocols. So it's just, and some of that was new in the beginning. And so, but there's definitely been a second kind of volt. Second, third, fourth, depending on who you talked to like many running boom, because gyms were closed and other things, so you have less, you know, nature get outside, walk run. So I guess a lot of more questions from new runners, especially neighbors because they're out there running and they knew, Oh, this guy runs on the block all the time and he must know something and all the questions that we went over already getting those. So it's you know, as far as silver linings to some of this stuff, that's going on.
Speaker 1 (32:08):
And now before we finish, I have one last question for you. And it's when I ask all of my guests. So knowing where you are now in your life and in your career, what advice would you give to your younger self? So maybe that 20 year old at the Olympic trials in 1996, what advice would you give to that kid?
Speaker 2 (32:30):
Yeah, well, I mean, back then running, talk about love. Hey, like it was so nerve wracking once I got the certain levels. And even that I ran the 800 meters, which is arguably one of the toughest events in track and field, they say the 400 hurdles experts today, the 400 hurdles and the 800 meters are the toughest. I think the 10,000 meters on the track is twenty-five laps. That that's hard puzzle to me because the hard I can't do it to cath on and heptathlon is all these different things. I think those are harder, but as far as the body and the body makeup that that event is kind of in between speed and endurance. And so but it, it just was so nerve wracking at the, at, when I got to that age, in that level, that running was and if I was running well and healthy, the world is great, but there was times where running was not so fun and I was sick or I was injured.
Speaker 2 (33:21):
And so I guess I would probably say, you know, it's tough to say, don't take yourself too seriously because I was training for the Olympics and it's really scary, really focused. But and actually, I, I, once I stopped competing, I actually took on a couple of years off where I don't even know how much I was running maybe once a week. And I definitely got out of the Cape. And I think when I was like maybe mid to early thirties, I got reengaged that there was a local team that needed some people to run for. And I kind of said, all right, I'll help out. And then I was kind of needed again, it felt somewhat relevant, but then the community of that as well, the peer pressure in a positive way got me into the fold. And I actually got, was able to get pretty fit again in my mid thirties.
Speaker 2 (33:58):
But it was one of those things where I did it to be really good. And then once that was no longer the goal, it was like, why do it, and sort of, it's a little bit of a gap there that, you know, probably mentally and physically, it was good to have because, you know, I get healthy and kind of cleared my head a little bit, but I wish I didn't take that long of a gap because there was only one reason to do it was to get fast, to win races, to make limpic teams. And as we all know now, and I know now is there's many reasons to run released best, you know, be competitive with yourself, you know, have be part of a community. See nature. Even though I started one of these things recently where I took a bunch of runners to to Ireland and I called it a run location and we spent four days and you actually can explore a lot of people.
Speaker 2 (34:40):
I coach where they're training for the marathon, we'll say, Oh, I can't, I can't run these two weeks. I'm going to be on vacation. I'm like, well, tell me more about this vacation. And it turns out that, like I had someone run on a cruise ship once and they actually sent me their GP. I'm like, there's probably a track on the, on the cruise trip. It's probably not that exciting, but don't say you have to take two weeks off. I would kind of like a little tough love there. And someone, I think of some woman sent me, she was going across the Atlantic to like Norway and her GPS was over the water, three 30 pace per mile. And it said she ran like 50 miles would showing around like 10. Oh. Because she was more like, not trying to get out of running. She was just like, Oh, I have to, I'm on vacation.
Speaker 2 (35:19):
I can't run. And I was like, you can make it a part of your everyday, regardless of where you go and you often can see more on foot then. So it's one of these things that would just I don't know, you can make it part of your life or it's not such this arduous thing and horrible thing. It, most of the time it could be pretty pleasant and fun. And I mean, I don't, I don't knock myself too much for being so serious about it, but I wish I didn't. I let myself off the hook a little bit and when I was younger and enjoyed it more and didn't take it so seriously all the time, even though there's reasons for that.
Speaker 1 (35:50):
Yeah. Oh, I think that's great. I think that's great advice to your younger self and John, where can people find you? What's your website? Where are you on social media? How can they get in touch? If they have questions they want to work with you, they want to learn more about
Speaker 2 (36:02):
The programs you have. Yeah. My, of a website is run camp and that's R U N K a M P. And I'm spelling incorrectly because my last name is Hunter camp with a K. Yeah. So nice play on words. Yeah. So run camp, you know, and you know, it's all things running, whether a training for a race or just getting fit or travel in this case, once we can travel again. And then my Facebook and Instagram is just John Hunter camp. My name's spelled so you can find me that way. And then email me a john@runcamp.com. If you have any questions, you, you know, you want to get ahold of me for any reason, I'd be happy to chat and help you through your training journey as, as you see fit. And as, as, as you see necessary.
Speaker 1 (36:41):
Perfect. And of course we will have the links to everything at the podcast and the show notes for this episode at podcast at healthy, wealthy, smart.com. So, John, thanks so much for giving us a little bit of your time today. I really appreciate it.
Speaker 2 (36:57):
Thanks for having me. It's a pleasure to join. You're happy to do this again and stay in touch even though we're so close so far.
Speaker 1 (37:03):
I know, I know just over the Brooklyn bridge but thanks so much for coming on and everyone else. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.
In this episode, Dr. Steffan Griffin talks about his research into ‘Rugby Union, and Health and Wellbeing.’
Dr. Steffan Griffin is a junior doctor based in London, pursuing a career in Sport and Exercise Medicine. He is a Sports Medicine Training Fellow at the Rugby Football Union, deputy editor at the BJSM, and a part-time Ph.D. student at the University of Edinburgh, where he is researching the topic of ‘rugby union, and health and wellbeing’. Steffan also works clinically with a range of elite sports teams including Chelsea Football Club, and London Irish Rugby Football Club.
Today, we learn about the different forms of rugby, and Steffan elaborates on the findings of his research regarding the health and wellbeing benefits associated with playing rugby. What does the review mean to those who are interested in gaining the health benefits from rugby? How does this review affect policymakers? What does the review mean for researchers?
Steffan tells us about the common misconceptions surrounding rugby, and how his research aims to change that, and he gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways * “There are 10 million people playing the game rugby, and they don’t play this blind to the fact that there are risks associated with ” * The different forms of rugby:
Contact Rugby: It’s the “collision game” that you typically see when tuning in on a Saturday afternoon.
Touch Rugby: It’s a glorified version of “tag” with a ball.
Tag Rugby: Players wear a belt with Velcro strips, and a tackle is when players manage to grab one of those Velcro tags.
Wheelchair Rugby: Nicknamed “Murderball”.
- “Our research found that all forms of rugby can provide health-enhancing moderate- to-vigorous intensity physical ”
- “Symptoms of common mental disorders were higher in professional players compared to general ”
-
“People are well aware; rugby compared to other sports has a higher injury ”
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“What the review isn’t doing is saying that everybody in the world should play rugby… It provides an objective piece of work that can help people make a decision based on evidence and not on emotion and ”
- “We need to try and move away from just looking at studies where all the participants are white middle class ”
- “One of the potential conclusions that a reader could get from this study is that non- contact rugby is the holy grail of rugby, but actually there aren’t any level 1 studies looking at the injury risk of ”
More About Dr. Griffin: Dr Steffan Griffin is a junior doctor based in London, pursuing a career in Sport and Exercise Medicine. He is a Sports Medicine Training Fellow at the Rugby Football Union, deputy editor at the BJSM, and also a part-time PhD student at the University of Edinburgh, where he is researching the topic of ‘rugby union, and health and wellbeing’.
Steffan also works clinically with a range of elite sports teams including Chelsea Football Club, and London Irish Rugby Football Club.
Suggested Keywords Rugby, Health, Wellbeing, Injury, Research, Review, Benefits, Risks, Sport, Policies, Union, Activity,
To learn more, follow Dr. Griffin at: Website: Rugby, Health and Wellbeing
Twitter: @SteffanGriffin
Review: https://bjsm.bmj.com/content/early/2020/11/23/bjsports-2020-102085
Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com
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iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927
Read the Transcript here:
Speaker 1 (00:00):
Hey, Steffan, welcome to the podcast. I'm happy to have you on
Speaker 2 (00:04):
Thank you very much for the invitation, Karen. So it's a real privilege to have been asked to come on and to have a good chat with you.
Speaker 1 (00:11):
Yes. And for those of you who may think to yourself, God, this voice sounds familiar it's because Stephan is the host of many, many podcasts for BJSM. So if you have the chance definitely, and you haven't listened to BJSM podcast, definitely go over and listen to all of them because they're all really wonderful. So but this is your first time on the other side, which I find hard to believe
Speaker 2 (00:36):
It is. Yeah, absolutely. As you said, it's something I've been doing for a few years for the journal now and yeah, it's the, it's very strange to be on the other side of the podcast. So I'm a different set of nerves. I'm really looking forward to it.
Speaker 1 (00:49):
Great. Well, thank you so much. And today we're going to talk about a recent review that was published in the British journal of sports medicine, the relationship between rugby union and health and wellbeing, which was a scoping review with you and also our good friend Nim but amongst other wonderful authors, but let's start out with the basic why behind this review.
Speaker 2 (01:19):
Yeah, sure. And I think that the main, why about this is that it was just, it's just a completely unexplored area. So I'm sure that, you know, for people in America, maybe their perception of room B probably comes from our friends at absurd with Ross, where I think he comes out pretty battered and bruised. And actually that's actually not too dissimilar to a lot of the perceptions in the, in the kind of the health and the sports science, sports medicine research landscape. We know about rugby's relationships with injuries and concussions. They're highly publicized and probably rugby is a victim of its own success in that because it's leading on player welfare and it's, you know, really pushing the boundaries in terms of trying to make it as safe a game as possible. Everyone's very aware of of the injury injurious nature of forgetting.
Speaker 2 (02:12):
But what I think for me personally, I've, I'm, I'm Welsh by birth. So I brought up on rugby and, you know, there are 10 million people playing the game of rugby and they don't play this blind to the fact that there are risks associated with it. So we know people know there are benefits to it, but looking at the actual scientific literature, there's nothing really providing a big picture overview of some of that, the health and wellbeing benefits associated with the sport. And really as we know, to make an informed decision about anything in life, be that sport, be that buying a car, for instance, people need to know the, the data surrounding the risks and the benefits, and, you know, we had a lot of the former so what we, what this really has been as aimed to do is provide, you know, some, some evidence not just emotion around some of the benefits associated with the sport. So really is a piece that hopefully prides balance to that, to the wider picture now.
Speaker 1 (03:17):
And what did, what did the review find? So what were those benefits to health and wellbeing?
Speaker 2 (03:23):
Yeah, sure. And before we jumped on the call, we kind of discussed the different types of members. So I'll probably just spend a tiny bit of time just covering and providing a tiny bit of context. So what we wanted to do is rugby, as we've mentioned, the friends app. So there is the contact form of rugby union, which is, you know, this collision gamers, if you're tuning in on a Saturday afternoon, typically here, especially in well-established rugby countries like England, like New Zealand, and it is growing in the U S and over in Canada as well, you know, that's the contact forms of the game, and there are other forms of rugby. So there's, non-contact rugby such as touch rugby, which is basically a glorified version of, of the game tag with a ball involved. And there's also something called tag rugby, which generally people wear a belt with the Velcro strips and tackle is where you manage to grab one of those Velcro type tags off.
Speaker 2 (04:17):
The other form of rugby then that we looked at was wheelchair rugby, which is I think given the lovely nickname of Murderball. But actually we want to, so you may have some of the listeners may have heard admirable being referenced and there are some wonderful documentaries on Netflix, you know, that really provide a good insight into the game. So basically by breaking it down to the type of rugby, we then wanted to break it down further. So people who read the review could really look to see exactly where the benefits lay. So if we kind of look at it from and I'll split it into, into some themes that some listeners might be might be familiar with. So as we know a big, I mean the world health organization, physical activity guidelines came out yesterday. So if we look at physical activity, so we know this is a huge global health priority at the moment, and our research found that all forms of rugby be that contact be that non-contact and wheelchair rugby can provide health enhancing, moderate to vigorous intensity physical activity, which, which really wasn't well known before.
Speaker 2 (05:27):
And then now it puts, it allows people like governing bodies and policy makers to align the sport of rugby with some of those global health priorities. As, as we all know, as practitioners, as practitioners, that muscle strengthening balance coordination and huge parts of these physical activity guidelines. And although we didn't find any studies that really look, look at that, per se, we found that lots of national population surveys, which are really based on expert consensus, consider rugby and all sports such as rugby to provide some of these benefits as well. So again, that was a kind of a landmark finding of this study in terms of the, we then looked at different kinds of health benefits. So we, first of all, wanted to look at physical health and we stratified by that by different domains. So for instance, cardiovascular health, respiratory health, musculoskeletal health, probably the best way to summarize this is non-contact rugby and wheelchair rugby have very supportive research kind of around that, you know, that rugby can provide quite significant physical health benefits into the contact drug B, which is kind of the traditional form of the game.
Speaker 2 (06:43):
There's a real mix there, lots of mixed studies and also just a lot of conflicting findings as well. Although a lot of the studies that look at that, you know, look to control for things like age you know, some of the demographic variables did show some supportive data that is conflicted by some other studies. And you know, what we couldn't do as part of this scoping review was really delve into the pros and cons of each of those individual studies. So in terms of, in terms of contact rugby, slightly more mixed findings in terms of physical health mental health and kind of wellbeing. So psychosocial measures such as quality of life and things, again, non-contact rugby or wheelchair rugby, rugby can provide a real wide raft of of mental health and wellbeing benefits. And most of the research in the contact game was, was, was focused on professional athletes and that fans that have symptoms of common mental disorders were higher and in professional players compared to general population though that is, you know, similar actually to professional athletes in other sports, such as football and things.
Speaker 2 (07:58):
And then the last thing is, as we've discussed right at the very top was the injuries associated with the game because we were very aware of is that it wouldn't be all well and good. That's just providing the health benefits, but also, you know, we didn't, we, although we didn't have the capacity to look at every single injury study to do with rugby relate to all the systematic reviews and Metro analyses around this. And as people are very, Oh, well aware, rugby compared to other sports has the higher injury profile and especially around concussion and things. So, so yeah, so sorry, that answer probably a bit tiny bit longer, but just to kind of try and break it down a little bit you know, in terms of the different types of rugby and then the various kind of health domains.
Speaker 1 (08:38):
Yeah. No, that was great. So let's break it down even further now. So let's say I am a player, or I'm a parent of a child who we want them to have these benefits of physical activity. And if rugby is something that maybe we're looking at to accomplish that what does this review mean to that parent or to that player?
Speaker 2 (09:08):
Yeah, sure. So, I mean, six months ago, if you, I mean, if I was a, if I was a, if I was a parent, you know, I was thinking about, you know, do I want my kids to play rugby, then I probably would have done, you know, Google search health and wellbeing rugby. And the vast majority would have been around purely to do with, you know, concussion injuries and not letting my kids anywhere near this kind of sport. Although, you know, rugby unions and, and people know there are loads of testimonials. As I said, at the top of the podcast, there are 10 million people playing rugby. They ha there has to be a benefit. It's just probably the scientists a bit slow to catch up. People can, kids players can reach all their physical activity guidelines and tick that box by playing any form of rugby.
Speaker 2 (09:51):
And then it's about individual perception of risks and benefit as to what kinds of rugby they want to play. So for instance, you might have, I might have, I might have a child for me. I don't know that, you know, the research says that participants in contact rugby, they say they, they there's Reese qualitative research really supporting the fact that it could provide a lot of psychosocial benefits that instills lots of confidence in people that builds teamwork. And people will say that they feel stronger by doing it and that's across across women, across youth players, across adult players. But also at the same time, you know, I think what there isn't doing is saying that everybody in the world should play rugby. It's providing people with the, with kind of a, some objective data so that, you know, someone else might come along and say, okay, we want our kids to be getting know taking all the physical activity boxes.
Speaker 2 (10:43):
Cause we know that it reduces the incidence of diabetes, heart disease. We know it provides X amount of benefits, but for me, the injurious side of it means that I don't want my kids or I don't want to expose myself to that risk. So what I'm going to do is look for a non-contact form. And I'll, I'll try and get and get, you know, reap the benefits by, by going down that route. So yeah, we hope that it provides an objective piece of work that can just help people make a decision based on, on evidence and not just pure kind of emotion and headlines,
Speaker 1 (11:19):
How novel, especially in this day and age now let's go, let's move on to what does this mean for the researcher?
Speaker 2 (11:29):
Yeah, she also, I mean, we, we found offset strategy. We found six Oh six and a half thousand studies of which we included 200 studies. And, you know, as, as I can, as I kind of said, like having broken it down into different forms of rugby in different healthcare domains there are some huge research gaps. So for the research right there, you know, we've identified we've identified a lot of research gaps that really, you know, there are some real low hanging fruit there that could really help them inform, help inform decisions further and provide more evidence in these areas. So for instance, I think there's a real pressing need to, first of all, look at populations outside of just the white, 70 kg male playing player. So we know that I think women's rugby had a growth from 2018 to 19.
Speaker 2 (12:24):
Excuse me, if the, if the exact percentage is off, I think it was that 28% increase in participation and it's growing in, in areas such as Asia, especially. And, you know, we, we, we need to try and move away from just looking at looking at participants and looking at studies that look at the benefits or look at, you know, studies where all the participants are, as I said, kind of white middle-class males, that's one big thing. And looking then at, you know, we do need to do more research. We need to, we need to try and quantify how rugby integrates with the physical activity guidelines even further. We need to be looking at more you know, how rugby interacts with various health and wellbeing outcomes you know, across more diverse populations, as I said. But also then I think, you know, I think one of the potential conclusions that really could get from this study is that non-contact rugby is, you know, the Holy grail now with rugby, but actually no, there aren't any kind of level one studies looking at the injury risk of that. So, you know, there are a ton of research areas that we've identified that that are going to be really important moving forward to allow people to make fully informed decisions.
Speaker 1 (13:39):
Excellent. And then moving on, how does this review then affect policymakers? You touched on it a little bit earlier and also international federations.
Speaker 2 (13:53):
Yeah, sure. So again, I've been very fortunate to have to work NAFA 18 months with the rugby football union, which is the essential England's national governing body for rugby. And two of the medical services director and the head of medical research that Simon Kemp and Keith Stokes to, to they for part of the scientific committee of the, of the PhD and their co-authors of the study. So we what's been great at doing this research and doing this PhD is that we're trying to answer questions that we know are relevant to governing bodies and to policy makers. So for governing bodies, for instance, you know, we're now able to provide the English from BMC, the RFU the likes of world rugby. Who've been really receptive to this kind of research with again, objective health objective scientific data that allows them to align the game with some of the current global health priorities, you know, be that physical activity or be that, you know, that we know physical activity levels are down because of COVID and because of lockdowns and you're could the sports such as rugby, such as football, tennis play a role in actually getting, you know, increasing health globally and then says as a policy makers, again, it's it provides because, you know, we know that sports such as rope in your needs, look at football or soccer.
Speaker 2 (15:12):
Now, you know, there's such a huge debater on head injuries and things, and these are, there's a sense that sensationalized to a certain degree, but they're also brought up in pretty in high places, you know, and government level. And, you know, what I'm hoping that this kind of research does is it provides, you know, a big picture for them to see and to look at it and say, well, actually, you know, we can promote rugby before. You know, whether it be that to kids, we can, you know, we need to make sure that rugby is a it's the welcoming environment for all types of all types of people and, you know, across society, because we know that it could provide people with lots of benefits and yes, we know that it might be more injurious relative, but, you know, as long as we put pressure on rugby to keep on making it as safe as possible, and that's where it's great, you know, that we're dropping all these governing bodies have player welfare as they're kind of strap by the number one priority, but it just provides a, you know, a broad picture that people government bodies and policy makers, like you said, can start to actually, you know, start promote things and to provide you filter that down to individuals and groups.
Speaker 1 (16:22):
Yeah. I think that's wonderful. And I love the thing that I really liked about this review. And we sort of spoke about it before we went on the air is I love that you included wheelchair rugby. I did not know that was murder ball, but now that I, now I'm like, Oh, okay. Yes, I get that. But I thought that was really important to include that because there are a lot of people in, across all countries who are wheelchair bound or who maybe cannot participate fully in, you know non-contact or contact rugby. And to include this, I thought was, was really, really great. And it, even in the wheelchair, rugby still had all of these physical, it's still taking the physical activity boxes, right. And still increasing muscle mass and improving cardiovascular and mental health and that feeling of a team. And so I thought that was really great. And to me, the non-contact rugby seems like a much much more forgiving game for people who are like, I would never do rugby. Cause I would like literally be in, you know, laid out for days or something like that because it looks so intimidating.
Speaker 2 (17:38):
Yeah, absolutely. And actually that's a lot of what you just mentioned, actually, it's pretty much going to be our next steps in terms of what we, what we do, because what we don't want to do is we don't want to set up in awards in like a research ivory tower and say, this is our research now go forth and do what you want to there. We really now want to see how people perceive our research. And I think rugby and rugby also wants to know what, so there's no point us, one of the, you know, one of the main points of the resets being, you know, playing rugby, which is your contact, rugby is good for you. Therefore everybody should do it because we need, what isn't known at the moment is how different population groups might perceive those risks. So for instance, if, for instance, you know, if someone's never played the game before, you know, is the fact that there are only really contact versions of the game available locally, is that a huge barrier to them then getting involved?
Speaker 2 (18:36):
So, so I think, yeah, you've touched nicely upon, you know, some of the real practical key issues there. And that's really what we want to be going into next is kind of being able to now piece together and also pretty much providing a toolkit to not just participants, but to governing bodies that says, you know, if you want more people involved, this is what matters at the, at the coalface and this is what you need to be providing. So no, you're, yeah, you're completely right. Because, you know, look watching, you know, watching 20 stone, you know, 250 pound blokes run into each other on a Saturday sometimes quite hard to think, how am I going to get from the sofa to that? Yeah.
Speaker 1 (19:13):
You can't even, you can't even picture it. You can't even imagine. Imagine it because it looks so scary. You know, and even as let's say, as a woman, if I were interested in playing, I wouldn't even know where to start. Right. So this research eVic, and I'm sure there's places I'm in New York city, there's gotta be rugby clubs and things like that, but I wouldn't even know where to start. And so I feel like this might spark some curiosity among people to say, Hey, listen, I can't do the contact. I just can't do it nor do I want to do it, but Oh, I didn't even realize there was a non-contact option. Or if you're wheelchair bound, gosh, I didn't even realize that this is something that I can do so great parts of the research.
Speaker 2 (19:59):
Oh, thank you. Yeah. and yeah. And just to kinda touch on you at the wheelchair, every point. Yeah. We were, we wanted to make this as big picture, as inclusive as possible. And that was one of the real, almost surprising things that the, that the evidence of, you know, of benefits associated with wheelchair rugby were so significant and so wide ranging. It was yeah. A really pleasant surprise. And the population group that isn't as well studied, you know, as we know.
Speaker 1 (20:25):
Excellent. All right. So before we start to wrap things up here, what do you want the listeners to take away from this discussion and also from this, from this research article, from this broad scoping research?
Speaker 2 (20:38):
Yeah, sure. I mean, I think some of it is, is probably a bit broad in that, you know, trying to, you know, we, so, so for when, so for instance, in my role with in revenue, we're looking at how to reduce concussion. We're looking at exactly, you know, nailing down what the incidence is kind of across various playing groups. You know, and that is the kind of thing that generates headlines in terms of you know, cause it, well, it's actually, as soon as something's published, it's now concussion rates up down the same for X consecutive year. That it's, it's, it's a, it's a common thing. Whereas hopefully what this does, it just provides the people. If people are aware that this now exists and there's this research going on, that they can touch base with either the paper with the website kind of with with any of our kinds of sites, social media platforms as well.
Speaker 2 (21:32):
I can just see what that, you know, if I do know someone, if I know a parent's a play, who's looking into it, this is actually, you know, this is where I'd go to make to be able to make a fully informed decision. So yeah, we're not, you know, the, the point of the research wasn't to show that rugby, you know, is this all singing, all dancing, wonderful sport you know, we're, it's always sunshine and rainbows just by the fact that for some people, it, it really is. But you know, it's just, it's just something that can provide, you know, as you, as you said, what sometimes feels like a bit of a novelty at the moment, just an objective overview, so people can make fully informed decisions.
Speaker 1 (22:11):
Excellent. And before we end, I'm going to ask you the question I ask everyone, sorry, I didn't bring this up to you earlier, but surprise now. So knowing where you are now in your life and in your career, what advice would you give to your younger self?
Speaker 2 (22:27):
I think just, just keep going, just keep doing what you're doing head down and hopefully everything so far, it all ends up working out. Yeah, just work hard and keep going.
Speaker 1 (22:40):
Excellent. Excellent advice. And now where can people find you social media websites, et cetera?
Speaker 2 (22:49):
Yeah, sure. So I'm probably I'm most active, especially from a kind of a professional research point of view on Twitter. So is that Stefan Griffin with Welsh spelling? So it's too, otherwise I'm not would kill me. Yeah. And then there's a website www.rugby, health and wellbeing dot com and, and yeah, and, and as, as you, as you've mentioned at the start, we publish the scope review and the question was sports medicine. So it's very easy to find to find the scrap from view on there as well. So, yeah. And if anyone has any questions and you, you know, once access to the PDF or anything, so unfortunately it is behind a paywall, then I'm obviously more than happy to provide all of that.
Speaker 1 (23:30):
Awesome. And we will have all of this information at podcast dot healthy, wealthy, smart.com under the show notes. Thank you so much stuff for coming on. This was great. Lovely to catch up, lovely to see you and congratulations on a great article.
Speaker 2 (23:45):
Thank you very much, Karen. It's lovely to know to chat to you and that's here. Everything's going well.
Speaker 1 (23:49):
And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
In this episode, Founder of Working Simply, Inc., Carson Tate, talks about making any job your dream job.
Carson has a BA in Psychology from Washington and Lee University. She also holds a Master’s in Organization Development and received her Coaching Certificate at the McColl School of Business at Queens University. She has 15 years of experience working with organizations across the globe, helping them each to improve employee engagement, productivity, and efficacy. Carson is the best-selling author of “Own it. Love it. Make it Work”, a sought after public speaker, as well as a staunch advocate for fair and flexible workplace practices. Her Productivity Style Assessment featured in the 2017 Guide to Being More Productive by Harvard Business Review.
Today, we learn about the 5 areas that we need to explore in order to make our current job the best job, and Carson gives us 3 ways to identify our strengths. She tells us about her Abilities Opportunity Map, and provides the tools to avoid the “inevitable burnout”.
Carson gives us the template we need to say “no”, we hear about the 15-Minute List and the importance of “protecting your 90”, and she gives some advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways
- “Any job can be your dream job because you define the dream.”
- You’re in a job – how do you make it the best job?
Carson has identified 5 areas that we need to explore: Recognition and reward, Strengths, Relationships,
Recognition and Reward – What kind of recognition and reward do you need? “I’m talking about praise and acknowledgement.” We’re all human beings, and we really need to be seen for our work.
Strengths – What are those things that you do almost at near perfection? “You can’t not do them. Even on your day off you might try to do them… The reason they’re so important is because this is what you bring to the relationship with your employer.”
Relationships – Having real, authentic relationships at work is essential, not only for performance, but to be happy, fulfilled, and engaged.
Development – This is about owning your own professional development.
Meaning, Purpose, and Joy – Meaning is not defined by what happens to you; it’s your interpretation of the events in your life. “Every job has significance. Every job is meaningful. It’s up to you to figure out what that meaning is.”
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There are 3 ways to find and identify our strengths: Reflection, Performance Reviews, and Highlighting Successful Tasks.
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“The relationship with your employer is a relationship, and any relationship is based on social exchange theory – both parties bring to the relationship and both parties receive. In a relationship that’s healthy, both parties work towards mutually-beneficial goals.”
- “When we are working from our strengths, the work is easier, there’s less effort but greater impact, more joy, and more flow.”
- “Even at the end of the darkest week, you can pull back and find a source of hope for the meaning.”
- “Every time you say no to something, you’re saying yes to something else.”
- “Clarity creates opportunity. Doing the work to identify what your dream job looks like opens up infinite possibilities for you in your current job and in future jobs.”
- “In play, that’s where you’re going to find those brilliant insights and connections, and the juice to not be burnt out. The one reason we get burnt out is we don’t play; we just work all the time.”
More about Carson
Carson Tate believes that work can be the full expression of who we are – the vehicle that takes us to a place where we reach the full potential of our greatness. As a visionary in the field of personal productivity and organizational excellence, Carson uses practical advice and empathetic training to guide and support her clients, helping them shine more brightly than they ever imagined possible.
A best-selling author, teacher and coach, for 15 years Carson has worked with organizations of all sizes around the world to help them improve the engagement of their employees, the productivity of their workforces, and the efficacy of their leadership. It is her mission to change how and why we work so that we can each make a greater impact on our own lives, on our communities, and on the world at large.
Central to Carson’s vision is her belief that when we do work that matters to us, it leads to greater success and wealth. It becomes the foundation of a harmonious life where we have the time, space, mental clarity, physical well being, and emotional energy to take care of ourselves and others.
Carson Tate is also the founder of Working Simply, Inc. where she equips organizations with tools, strategies, information and insights that inspire employees and leaders to use their gifts and talents to build their legacies.
Carson’s signature courses include:
- Mobilize Your Inbox: How email can work for you.
- Work Well With Others: Find joy in teamwork.
- Work Smarter, Not Harder: Get up close & personal with work.
- The WORKshop: How To Work Simply and Live Fully.
- Carson Tate Masterclass: Own it. Love it. Make it Work.
A prolific public speaker, Carson teaches audiences how to identify what success looks like from a personal and professional vantage point; how to move beyond the way we’re working today, into a new world of productivity and accomplishment; and how to “own it, love it, make it work” by breathing life and inspiration into work.
Carson is a staunch advocate and champion for fair and flexible workplace practices that create healthy, nurturing environments for workers everywhere. Her goal is to shift the focus from output to impact – our value as workers is meant to be measured by our contribution.
There’s nothing Carson loves more than connecting with people. In her uplifting and empowering courses, one-on-one coaching, speeches and workshops, Carson shares surprising ideas and insights that clients and audiences can immediately apply to create fulfilling lives that align with their values and priorities. She inspires people to craft a future for themselves in which their work plays a joyful role. Above all, Carson believes that work is where your mission meets your spirit.
Book Mention
Own It. Love It. Make It Work: How to Make Any Job Your Dream Job, by Carson Tate
Suggested Keywords
Productivity, Job, Work, Career, Burnout, Strengths, Relationships, Meaning, Opportunity, Possibility, Play, Recognition, Reward, Purpose, Reflection,
To learn more, follow Carson at:
Website: https://carsontate.com
https://www.workingsimply.com
Facebook: @thecarsontate
Instagram: @thecarsontate
Twitter: @thecarsontate
LinkedIn: https://www.linkedin.com/in/carsontate
YouTube: https://www.youtube.com/c/CarsonTate
Subscribe to Healthy, Wealthy & Smart:
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Read the Transcript Here:
Speaker 1 (00:00):
Hi, Carson, welcome to the podcast. I am happy to have you on Karen.
Speaker 2 (00:04):
I'm so glad to be with you. Thanks for the invitation.
Speaker 1 (00:06):
Absolutely. And now, today, what I really love to talk about is how to make any job, your dream job. So this is the title of your, well, the subtitle I should say of your book own it, love it, make it work, how to make any job, your dream job. So let's talk about how to do that because there are a lot of people now working in areas or positions or working in ways that maybe they didn't think they would ever be working because of the COVID pandemic. Right. So let's talk about making your job, your dream job. So how do we go about doing that? It's just an easy question.
Speaker 2 (00:47):
Easy question. I love the easy questions upfront, right? Yeah. Great. Well, first of all, let's go ahead and make sure folks aren't going to give me the eye roll forever. So here's, here's the qualifying statement. So any job can be your dream job because you define the dream. So to create your dream job means that you're going to identify what that is for you and not believe there's a one size fits all or a must or should, but it's what do you need to be engaged and fulfilled in your current job? Because the other reality for most of us is that we can't just quit and go be a lavender farmer. And the South of France that sounds blissful or entrepreneurship might not be the right option for all of us. So we're in a job and I don't want you to stay in suffer.
Speaker 2 (01:46):
So how do we make it the best job? So there are five areas that I found in my research and work with clients that we need to explore for ourselves. The first is recognition and reward. So what type of recognition and rewards do you need? So I'm talking about praise and acknowledgement because we're all human beings and we really need to be seen for our work. But Karen, you might be the kind of person that just wants the email, great job, Karen, that goes out to the whole team and you're like, Oh God, I feel good. I might be the person that wants yeah. The boss to stand up in front of the whole group, have me there and this great grand presentation of my excellence, but we're all different. And so it's knowing what I need is the first step. So admitting that you have recognition needs and knowing what those are.
Speaker 2 (02:38):
And then the second one is strengths. And so you're in health care and a bit, a lot of your listeners are as well, physical therapists. So you went into your profession because you had an interest in probably an aptitude in science and working with people. The second step is to really identify and own your strengths. What are those things that you do almost at near perfection? You were really good at you. Can't not do them. So even on your day off, you might try to do them. And as something you want to develop and grow, so you might read about it. You might take courses. You're the one that has the magazine that you want to look at. Those are your strengths. And the reason they're so important is because this is what you bring to the relationship with your employer. Your strengths are what enables your employer to serve their patients, their customers, and earn revenue.
Speaker 2 (03:37):
And so knowing what the strengths are, a column, your relationship currency with your employer, they're the gold. And when you work from your strengths, your performance goes up, you're more in the flow and you're just generally more happy and fulfilled. So we want to spend more time working from your strengths. But the only way to do that with our employer is to demonstrate how they benefit your employer. So you have to know what they are, and then you okay to help you achieve your goal company. When I do more of this type work, we generate more revenue. We have more customers you're satisfied. So
Speaker 1 (04:13):
When we're talking about identifying your strengths, you don't only want to just identify them for yourself. You want to share them with your friends
Speaker 2 (04:22):
Employer. Yes, exactly. And in not sharing with your employer, Karen, it's being very direct and intentional with your employer around how those strengths support the company's goals. So when I do this work, we are faster. We are better with clients. We earn more money because what you want, the goal here is to do more of them. You want to be able to make an ask, Hey manager, I have a couple of tasks that we really are not driving revenue. And aren't really serving the company that I can see when to let go of those and do more of this.
Speaker 1 (05:02):
Yeah. That makes sense. And if you're working from your strengths, you would probably enjoy it a little bit more, cause you'll see more success.
Speaker 2 (05:09):
Absolutely. And I am, I come from the school of positive psychology. So I take a strengths-based approach, which means we're going to work on your strengths because I can get a 10 X lift, 10 X, times performance out of a strengths-based approach versus working on your blind spots or your, your growth areas. It doesn't mean we ignore them, but I'm not going to spend a lot of time and energy on those because the return on that time investment for the output and the impact isn't as great. Got it.
Speaker 1 (05:41):
How can, how do we go? How do you recommend people go about finding their strengths?
Speaker 2 (05:46):
Yes. So there are three ways you can do a reflection, big fan as a coach of journaling and reflection. So you reflect, what was your best day at work? What do your friends, your colleagues, praise you or acknowledge in your work day? Where do people ask you for help or advice or support? Great place to start. Then if you have any type of performance reviews or three 60 reviews, always a great place to go, to start to mind for those core strength themes. But my all-time favorite way to do it is to look at your task list in your calendar list and go through with a marker and highlight those tasks, those meetings, those calls, the podcast where you were on fire. I loved it. It was really good, strong outcome. And then you start to identify some of your core strengths that way.
Speaker 1 (06:42):
Let's say you are not an employee, but you're an entrepreneur. So do you give yourself performance reviews?
Speaker 2 (06:54):
Really? I've never been asked that question. I would say your performance reviews come from your clients. It would be, you know, that email that you get, or maybe you do a survey with your clients. You ask your clients for feedback. That would be your performance review. Got it, got it. And if you're an entrepreneur, that's where the calendar and task list analysis is super helpful for them. Because if you're not working in that formal structure of the yearly performance review, and as an entrepreneur, initially you have to do it all. And ultimately if I'm coaching you, I want you really working from your strengths and we want to start to figure out how do we automate or outsource those other items.
Speaker 1 (07:39):
Okay. All right. That makes sense. All right. So we've got recognition and reward, which I love and, you know, quick story on that, a friend of mine works for a publisher and she said so do you know what happened the other day? She said, I got this package in the mail and it was from the company. And it was just like some gourmet teas and a mug. And it, and it was a card that says, you know, so-and-so, you're just doing a great job and we appreciate all the work. And she was like, you know, some people need big bonuses. Some people she's like, this is what I needed. So she sort of recognized like my reward is, is just someone identifying, I'm doing a good job and writing a nice note and you know, she doesn't need like the grand fanfare. So I think it's really interesting when you said that it came to my mind and it got me thinking, what do I really like as, as reward and recognition? And I have to say, I sort of like the, just a nice email letter. Like I don't need to be on stage. I don't need it to be in front of a lot of people. And that is what really makes me feel good. Yes.
Speaker 2 (08:49):
Yeah. And how empowering, just to name and claim that, and then what you're going to want to do if you work for a manager is let them know how meaningful it is. And so for you, as you're as an entrepreneur and business owner, how do we create more opportunities for you Karen, to get those affirmations from me who I'm like, Oh my gosh, you know, I had this terrible injury and now I'm running again. And I just finished my first 5k. I mean, that's what we want in your inbox. Exactly.
Speaker 1 (09:24):
Yeah, exactly. Okay. So we've got recognition and reward. Strengths is number two, what's number three.
Speaker 2 (09:30):
This is all about relationships because none of us work in a silo. We all work on teams. And what's interesting is that social pain. So conflict feeling excluded from the group is processed in our brains the same way as physical pain, which is, was show interesting to me in my research. So having really authentic real relationships at work is essential. Not only for performance, but we're talking about being happy, fulfilled, and engaged. And if you don't feel like you've got a best friend or that you can talk to someone or work through conflict, which is part of business, that's a problem. So in this chapter, what we do in the book is we explore your work style, which is how you think and process information, because this is how you're going to work with other people and then identify their work style and learn to communicate with each other in a way that you aren't triggering each other and making each other one of, yeah, I'm not going to work with you and ultimately recognizing where you might be unconsciously undermining that relationship by treating everybody the same way.
Speaker 1 (10:43):
Yeah. That's so important. Yeah. I'm a huge fan of relationships. And I mean, I have stayed in jobs longer than I probably should have because I love the relationships. I was like, I don't want to leave. I love it here.
Speaker 2 (10:57):
Yes. And that that's exactly it, the people are important, right. And those relationships that is so important and we've got to do the work right. And that's why that this whole pillar is around cultivate, which requires some self-reflection, but really intentional, thoughtful work to build these relationships that bring us joy and really stretch us and help us grow. That's the fourth one is the development and it's the develop. We call it the five pillars or the five essentials. And the fourth one is to develop new skills. And this is about owning your own professional development, not waiting for your manager, not waiting for your team member to say, Hey, Karen, I think you might like this course. Or have you thought about this position? No, this is about what do I want, how do I want to grow? What's my next step. And being really about putting your own development plan together and then asking your manager to support you. So they might have an internal training program you can join, or maybe they would pay for the conference for you to continue to Uplevel your skills.
Speaker 1 (12:06):
Yeah. And you know, I think, again, that probably takes a little bit of identifying where, what gaps you might need to fill. So can you sort of, when you went and looked at your strengths and maybe you did find some weaknesses, is this where you would want to start developing those? Or would you take your strengths and continue to strengthen them? I guess, as an individual, you know,
Speaker 2 (12:33):
So I'm going to suggest that, and this is just my training and background. Let's further refund strengths because I know that the outcome of that is greater. And we also talk about a tool that I created. I call it an abilities opportunity map, where you start to look at the leadership competencies in your organization, certifications did you not get a position? The best person in your field does this? And we don't do it from a place of comparison or judgment. It's just an awareness. Ah, okay, this person has this skill set or this certification I don't just looking. And then once you build this abilities opportunity map, then you go and say, what do I really want to focus on? And how am I going to develop it?
Speaker 1 (13:26):
Yeah. That makes sense. And kind of looking at your organization and maybe looking at the organization and saying like, I could take, let's say from a physical therapy standpoint it's this great clinic, but while no one's doing pelvic health in this clinic. So perhaps I can develop my pelvic health skills to plug this hole, because like you said, we want to bring more to our employer so that they see us as, you know, boy, this person is a real asset to our company and then you're doing what you love to do. And then they'll continue to promote that. So it sort of circles around, right?
Speaker 2 (14:05):
It does because the framework and the thesis that I'm operating off of is that the relationship with your employer is a relationship. And any relationship is based on social exchange theory, which is give and take both parties, bring to the relationship and both parties receive. And in a relationship that's healthy, both parties work towards mutually beneficial goals. So developing a pelvic health program is exciting for you. You're passionate about women. This is a way to really expand your skillset, huge win for you, huge win for your clinic. It might not be the only clinic in the city that does this. So this is a beneficial win, more of what you want revenue for your company, your company is distinguishing itself. So that's where it's the employee has an equal and powerful voice in this relationship, right?
Speaker 1 (15:05):
Yeah. Okay. Makes sense. What's number five.
Speaker 2 (15:08):
The last one is design your work for more meaning. So this is where we talk about meaning purpose, joy.
Speaker 1 (15:19):
Hm.
Speaker 2 (15:20):
Point our point here is that meaning is not defined by what happens to you. It's your interpretation of the events in your life. So we go back to where we started with my premise at any job can be your dream job because you just, you define that dream. And I believe every job has significance. Every job is meaningful. It's up to you to figure out what that meaning is for you, and then start to craft and shape your work for more meaning. So let's say for example, Karen, for you, one thing that brings meaning and purpose to you is helping women that have been struggling for years within contents, so that it's damaged their self-esteem. Maybe they're not going out in public as much. And this is really important that you help these women. It feels like a passion calls for you and meaning, okay. So by developing the skillset for the pelvic therapy, and then you bring it to your company, we're creating meaning you're doing more of what you love and we're generating revenue for your company. The meaning is in the service to these women and how you were an agent of change in their life,
Speaker 1 (16:40):
Right? So the meaning goes beyond can go beyond just you and just your clinic or just your office or your job, but it can go into sort of the world as a whole, as a whole, which I think is what a lot of people hope that their job can do.
Speaker 2 (17:00):
Absolutely. And I would suggest every job does that. If you will just step back and look at it. So if we go back to I'm a runner and I'm always injured. And so physical therapists, you are my heroes because you need to doing what I love. And so just a big shout out because you keep me up, right? Cause I'm invariably always doing something and not stretching. So, but if you keep me running and I'm staying engaged and I'm healthy and I'm able to care for and keep up with my kids, like we're now talking about a ripple effect of positivity that you can draw meaning from, but you just gotta reframe because what happens, I'm guilty of this. Karen is that we get really caught up in the transactions of our day at 14 patients to see, Oh my God, have you seen my inbox? The paperwork sucks. Yes. I'm not saying that's not hard, but if we can come back and look at our task as a collective whole, that's where we can draw the meaning from.
Speaker 1 (18:08):
Yeah. And I'm so happy that you brought up the emails and the paperwork and, you know, cause everybody, I don't care what line of work you're in. You can relate to the emails, the paperwork, the meeting after meeting, after meeting patient, after patient, after patient. Right? So this can often lead, I think, for a lot of people to state of burnout. Right? So how can we use these five tools to help us avoid that? That what some people think is an inevitable burnout?
Speaker 2 (18:40):
So I'm an, a challenge. Inevitable is I don't believe anything is inevitable. I here to put quotes, air quotes. No, I'm just gonna push back. Cause I think we're aligned on that. I think we better they're like no enough, you know? So two ways, one, we double down on strengths. So when we are working from our strengths, the work is feels easier. There's less effort, but greater impact, more joy, more flow. So the more we identify connect that to how it helps our employer and really intentionally push ourselves to keep doing more of that work can help tremendously the other, Oh, there's two more things. The other thing is back to this meaning that we'll want to pull on. So even at the end of the darkest week of, I am beyond exhausted been doing this, you know, my student loan debt does not seem to be going anywhere.
Speaker 2 (19:40):
I'm chipping away at it. Can you pull back and find a little source of hope from the meeting? And then the third piece is the productivity. So where are you getting really thoughtful about? Let's take your inbox. I believe your inbox can be the best personal assistant you've ever had. The technology is powerful. We just don't use it. So why are we not automating our email management? So you can write rules, you can automatically schedule and send emails. We can create whole systems that filter what comes in. We can create templates. There's so much that can be done with not a lot of effort that can save you hours. So I think sometimes in the burnout we're like, Oh, it's going to take me energy and time to spend 10 minutes in my inbox, setting up that rule and two templates and
Speaker 1 (20:30):
Yeah, exactly. I'm like, ah, one more thing.
Speaker 2 (20:35):
And you're not saying no way. You're probably having an expletive in there. And I'd say, if you do this set a timer, 10 minutes, I'm going to set up one rule and write one automatic template because people ask me this question all the time. I just want to be able to use it over and over again, and then I'm done. But those two actions could potentially save you hours. So it's 10 minutes on productivity tools, looking for automation saying no to meetings that you don't need to attend because they're going to print everything they talked about and posted on the bulletin board. Or you're not even sure why you're there and there's no agenda. And it's just going to people rambling. Don't go say no.
Speaker 1 (21:23):
Yeah. I think that's a huge thing for people. And I've just really come to get better at the saying no thing. Of like when it's not like, when, if it's something that's not working for me, like I have to get better at saying no, because then I over-schedule myself and then I'm all stressed out.
Speaker 2 (21:44):
Right. And it's a self perpetuating hamster wheel. Right. Just keep on it. And the no is freedom. So one way to look at it is every time you say no to something, you're saying yes to something else. Right.
Speaker 1 (22:02):
So how do you, what's a gracious way to say no,
Speaker 2 (22:06):
At this point, I'm not able to take on any more projects with the level of attention and detail that I like to bring to projects. So thank you so much for thinking of me. Well, that's good. I like that. Yeah. Thank you for inviting me to your meeting on Friday. I can't attend. If there's anything that you would like for me to think about or reflect on in advance, please let me know. And I'll send you an email.
Speaker 1 (22:30):
Oh, that's nice too. Oh, very good. Very good. Hopefully people are taking notes on those. Yeah. That's really good. That's a nice way to say no, versus just saying, Oh, I'm sorry. I don't have the time.
Speaker 2 (22:44):
Right. And the other piece of the, no, I learned this the hard way and I'm sure your listeners have tucked up, but I live in the South. And so Dan said, we've got a little polite niceness culture going on. And part of a, no is not inviting the second email or you not busy now, Karen, how about now to meet for coffee? So we want to know that has a firm boundary that isn't going to get the creeping back.
Speaker 1 (23:14):
Yes. Yes. And that's hard. So, cause I know sometimes I'll say, Oh, you know, I'm, I'm really busy for the next couple of months, but why don't you check back later? No, no. Should not be doing that.
Speaker 2 (23:24):
No, no, no. And there's also an, I think there's tremendous value of going back to my first example of you value and respect that person you value and respect to the board, the project, the ask enough to say you aren't going to get the best of me. I can't, I can't bring you what you deserve, what this organization deserves. Thank you for thinking of me.
Speaker 1 (23:50):
Yeah. Kind of putting, putting them before you. Yes
Speaker 2 (23:53):
It's because ultimately I, I do believe we want to do our best work and when we're stretched so thin, it's just not possible. And then we began disappointing ourselves and others and that's not a cycle we want to be on either. So the door firmly don't get the creepy crawlies coming back, asking how about now? It's two months later. Where are you? No, I'm still not available.
Speaker 1 (24:17):
Yeah. No, that's so good. That's so good. Have a firm close to that door. Gosh, that's great. Yeah. I love that. Now is there anything else that you kind of want to add on here? That maybe we didn't cover on, on allowing people to really love their work and love their job?
Speaker 2 (24:39):
Yes, but I have to share, I'm going to give you one more productivity hack. Can I do that?
Speaker 1 (24:44):
Oh my God. I didn't want to, you can give me 10 more. I didn't want to keep asking on what, what about this one? Do you have three more that I want to give you? I can't help myself
Speaker 2 (24:57):
Then listeners bear with me. If you don't like this, just speed up just fast forward. Okay. So the first one was stack. So stack saying no is hard. So what I coach my clients on is let's create a template and email to say, no, these are the no templates, no, to be on the board. No, to do this project. So you think about it. You write the know and when you get that ask click.
Speaker 1 (25:25):
And so when you have a template, so do you mean you sort of just keep it in like a word doc and then copy paste into your email.
Speaker 2 (25:33):
So depending on your email platform, so I'll start with outlook and outlook. The best way to do this is to create multiple signatures. So an outlet, people think about a signatures. Haven't, you know, Karen and your phone number. Well, you can create as many, many signatures as you want. So you go in and create a signature that is gracious. No to project ask you type it, you save it. Then when I send an email, Karen I've gotten great new task force really wants you to be on you. Hit reply, insert gracious, no project signature. And in 30 seconds we've saved time. And we haven't gone through the angst of how do I say no? How do I let them down? How do I close the door? No, we do the thinking on the front end. And we just use this over and over again. So we're stacking two habits here and leveraging technology.
Speaker 1 (26:36):
Nice. Yeah. That's great.
Speaker 2 (26:39):
In g-mail you can set up templates too, as that function the same way and absolutely care. Nothing wrong with the word doc I'm copy and paste key is we write it once and you use it over and over again. We don't do the rework time. Copy paste, drop and go. Yeah, that's fabulous. The second one that is one of my favorite ones for healthcare workers is so your day is scheduled for you patient, patient, patient. And so what happens during the day is a lot of things that you could potentially do, like little tiny task or maybe call. I don't want to get your hair cut or whatever doesn't happen. And so you have all this buildup of tasks that now you're trying to do on the margins of your day. So I tell my healthcare providers build something called a 15 minute list, and this is a list that lives with you.
Speaker 2 (27:31):
So put it in your lab jacket as a piece of paper, put it on your phone. I don't care Magnasco and how you get it around, but it needs to be with you. And these are tasks you can do in 15 minutes or less. So schedule your cats, that checkup prep for the one-on-one with your team member, call and cancel call all of the little itsy-bitsy things that don't take a lot of time. And then what you do is when you have that patient, that's 10 minutes late, you pull out your list and you go because I can get these things done and these micro segments of our day. So it's a really efficient way to stay on top of the nits and NATS that can add up and feel overwhelming. Great. And then the third one that works well and healthcare and for everyone, but a love it from a healthcare providers is something we call protect your 90. So this is 90 minutes a day on your strategic priorities. So it could be professional development. It could be, you might be doing some research, writing a paper, it could be catching up on your charts, whatever it is. But the way it works is it's 90 minutes a day. That's focused now it's not 90 continuous minutes.
Speaker 3 (28:54):
That's what I was just going to ask. Yeah, no, I made only unicorns have that and without I haven't met a unicorn.
Speaker 2 (28:59):
Yep. So this is the power of it. So it might be 20 minutes that you choose during lunch to do your focus. Then you have another little 10 minute window where you might do another little sprint focus, but the goal is 90 minutes a day because the power and five work days, that's seven and a half hours of focus time. That is a game changer. I have had physicians write really complex research papers using this strategy because we're just chunking just yeah. Intention, intentional chunks focused, and then we go back, but it's the consecutive effort over time that up. And it doesn't feel overwhelming. I mean that versus saying I need seven and a half hours of your time.
Speaker 1 (29:47):
Yeah, no, that's great. Very good. Very good. I love it. Okay. So I feel like we've gone over so much but I'm loving the productivity, hacks and tips, and also loving your sort of five step template or plan to kind of love your job again. So is there anything else about that? And like I said, productivity hacks, we can go for days. People can go to your website and find more. But anything anything else on people loving their job and loving what they do? What would you like people to really remember about the chat
Speaker 2 (30:25):
Clarity creates opportunity. So doing the work to identify what your dream job looks like, how you want to be acknowledged and rewarded what your strengths are, the relationships you want to develop, the skills you want to grow in the meaning you bring, it opens up infinite possibilities for you in your current job. And I would suggest in future jobs, that knowledge is power.
Speaker 1 (30:55):
Yeah, that's great. And before we sort of sign off and find out where everyone can get in touch with you, I have one more question that I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to your younger self? Whether it be fresh at a college or what, you know, what advice would you give to yourself?
Speaker 2 (31:16):
Play more? I'm a type, a perfectionist recovering. Some days, some days I'm not recovering and I will get in that strive mode and I've done it since I was 18 years old and would go back and say, it's okay, play a little more. The work's going to be there. And what I've come to learn now is that in play, that's where you're going to find those brilliant insights and connections and the juice to not be burned out. So one reason we get burned out is because we don't play. We just work all the time.
Speaker 1 (31:52):
Yeah. That is great advice. And I have to say, I've heard that from a couple of people on this question is to just kind of like chill out a little bit more relaxed, a little more play a little bit more. So that is great advice. Now, Carson, where can people find you if they want more information about you and what you do and, and all of and yeah.
Speaker 2 (32:11):
And your book. Yeah. So the book own it, love it, make it work. All of your favorite retailers, Amazon is available online. And then my website, Carson, tate.com. Check out the blogs. If you want productivity hacks, they're there tips on loving your job. We've got assessments. All the goodies are on the website. Carson, tate.com. Awesome.
Speaker 1 (32:32):
And then for social media,
Speaker 2 (32:35):
Yes, LinkedIn, the Carson Tate. Awesome. Well, thank
Speaker 1 (32:40):
You Carson so much. This was great. I think you gave my listeners so much to work with, so I thank you so much.
Speaker 2 (32:47):
Thank you, Karen. I appreciate it. And thank you guys for all that you do for us.
Speaker 1 (32:52):
Thank you. Thank you. And everyone who's listening. Thanks so much. Have a great couple of days and stay healthy, wealthy and smart.
Episode Summary Are you willing to experience anything?
In this episode, the Founder and CEO of MEG Business Management, Brian Gallagher, talks about the power of the intrapreneur and entrepreneur in private practice.
Brian graduated with a BSc in Physical Therapy from Daemen College in 1992. Soon after, he founded Gateway Health Services, which quickly became one of the largest staffing companies in Maryland. In 1999, he founded Cypress Creek Therapy, which was awarded the Anne Arundel County’s “Most Family Friendly Business” for several consecutive years, and in 2011, Advance Magazine awarded CCT as the “National Practice of the Year”. In 2006, Brian founded MEG Business Management and has grown to become among the top 10% of private practices across the US.
Today, we learn about the difference between an intrapreneur and an entrepreneur, the four types of PT owners, and Brian gives practice owners some advice on the interview process. He tells us why he sold his practice with a contingency, and how the current environment is ideal for entrepreneurs.
We get to hear about the 4 C’s, how we can become a successful Go-Getter Owner, and Brian gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways • “Typically, an intrapreneur is a manager within a company who assumes no financial risk, but they’re willing to promote and execute on the development and implementation of innovative products or services.”
“An entrepreneur is similar, but it’s one who will find the needs out there within the business community, and simply fill them by developing their own ideas into actualities, by assuming the full financial risk and development of that idea through a business model of their choice.”
• “Your practice is a reflection of you as an owner. Figure out which type of owner you are first.”
• “The secret to successful hiring so that you can be correct 85% of the time is that you have to get the entire team involved in the hiring process.”
• There are 4 types of PT owners: The Innocent Owner, The Caregiver Owner, The Know-It-All Owner, and The Go-Getter Owner.
The innocent owner – the person that falls into ownership, and is managing based on census. They never really thought about being an owner; they just had an opportunity.
The caregiver owner – they assume the perspective of a clinician first and owner second. They tend to run their clinics like it’s a democracy.
The know-it-all owner – through their life’s experiences, they’re not open to new ideas.
The go-getter owner – they have an entrepreneurial spirit, they like to manage based on performance, and they’re in a continuous pursuit of knowledge.
• “This is an entrepreneur heaven right now.”
• “If we’re going to sit here and go through our profession, and continue to colour inside the lines and make our picture like everybody else’s, you’re only going to get that.”
• “When you ask what the common denominator is to all success, the highest thing would be confidence.”
• “Transparency breeds trust.”
• “The secret to success is giving.”
“I hate a win-win relationship. A win-win relationship implies that I’m going to allow you to win as long as you help me win.”
• “Don’t react; respond.”
Book Mention The Go-Giver, by Bob Burg and John David Mann Suggested Keywords Intrapreneur, Entrepreneur, Owner, Courage, Capability, Commitment, Confidence, Success, Listen, Introspection,
To learn more, follow Brian at: Email: info@megbusiness.com
Website
YouTube
More about Brian:
In 1997, Brian founded what became one of Maryland’s largest therapy staffing companies, while at the same time launching a multi-site private practice that resulted in a sale in 2006. Brian re-acquired the practice in 2008, thus doubling it, before winning “Practice of the Year” in 2011. MEG Business Management began in 2006 as an educational coaching company training owners and their key employees on innovative practice management strategies. Today MEG has taken another major leap forward by developing a Virtual Training platform that practice owners can now have the tools and training resources to professionally enhance, track and manage employee performance, and hold in compliance with every employee in the company. This platform is available 24/7, 365 days per year. When Brian is not coaching, or working on the VT training platform, he can be found giving lectures at the APTA, PPS and CSM Annual Conferences, as well as APTA State Chapters and DPT Schools across the country. Brian believes strongly in giving back to the profession of physical therapy and does so by supporting the APTA through lecturing, writing articles, and performing webinars.
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Read the transcript:
Speaker 1 (00:01):
Hey, Brian, welcome to the podcast. I'm happy to have you on,
Speaker 2 (00:05):
Oh, thank you so much, Karen. Thanks for taking the time and hooking up with me and doing the show.
Speaker 1 (00:10):
Yeah, well, I'm actually really looking forward to the topic today because it's something that I've spoken about a lot and that I have friends of mine who are business owners and, and love to empower their employees. So today we're talking about the power of the intrepreneur and the entrepreneur in private practice. So before we get into it, can you define the difference between those two terms?
Speaker 2 (00:39):
Yeah. And there's lots of definitions out there. I think if we Google it or YouTube, it you're all gonna, you know, find various forms of definitions for this. But for me, and I've always operated under this basic definition that typically an intrepreneur is a manager within the company who assumes no financial risk, but they're willing to promote and execute on the development and implementation of innovative products or services. In our case, it would be services and they do that via marketing branding, or other various forms of public relations, but they're innovating within somebody else's company. And that's my definition, that's my operating definition of an entrepreneur.
Speaker 1 (01:19):
And so when you're, when you're thinking about an injury, an intrepreneur and it can be a person who takes the initiative to maybe start a new program and within a physical therapy practice or right, something like that,
Speaker 2 (01:41):
Something like that, it could be as basic. And as simple as that, where they've taken an idea, they've worked it through to a concept and then they've developed that concept into an actuality. So that's what I really see with an entrepreneur. I have certain characteristics that we look for, and I think we'll talk about a little bit later that will really give you the identifying markers of an entrepreneur and what you should seek in an entrepreneur within your clinic, because an entrepreneur is similar, but it's one who will find the needs out there within the business community, whatever the market is that they're in and simply fill them by developing their own ideas into actualities by assuming the full financial risk and development of that idea through a business model of their choice, through the development of their business operations. So innovating within your own company is more of that, of an entrepreneur, assuming that financial risk. And that's really the defining factors between the entrepreneur and entrepreneur.
Speaker 1 (02:37):
And so what does, what does it take for one to stand out as an entrepreneur? So if I'm the entrepreneur, I own the business. What am I looking for for this? For a standout entrepreneur? Okay.
Speaker 2 (02:52):
All right. Well, I have a good story for that. And just to give you an example of a, of an entrepreneur, you know, it was several years ago. I, my clinics are in Maryland and I live in Florida and so I had six offices in Maryland and I was running them from Florida and I had a team that I had built. And so I had a chief operating officer working for me. Her name is Denise, she's now the CEO of Meg. And she runs our whole billing division. But at the time she was running the clinics and our largest clinic, it's a, you know, a 8,000 square foot office. And I got to talking to her on one Monday morning and I was asking her about, you know actually I didn't do my normal, that, that's how it actually came up. I was talking to her Monday morning, I got right into business, which is unusual for me.
Speaker 2 (03:33):
I'm usually like, how was your weekend? And how's the kids what's going on, you know, fill me in and all right, let's get start. But I was in a rush and I just got right into it. And she just started spouting off the things I wanted to know and just hitting it. And then I caught myself and I said, you know what, Denise, I'm so sorry. I apologize. I didn't even mean to ask you about your weekend. You know, how's your weekend go. And to my surprise, she says, well, you know, the air conditioning unit kind of backed up and it flooded the whole place I had to bring in a fan system. And my husband, I lifted the carpets and we dried them all out and got them down. We didn't miss a beat. We were ready Monday morning when the, when the patients got in here.
Speaker 2 (04:05):
So we're all, you know, find a good, I'm like, Oh my gosh, I had no idea. Like she never called me. She never made that problem. My problem. And I remember getting off the phone and saying to myself, what a level of responsibility, you know, what a level of responsibility. And that's one of the key factors that I look for in an entrepreneur. Now, in this case, I'm not giving you that shining, you know, example of somebody who started a women's health program or a pediatric program. I mean, she's obviously had done that through her time with me, but just this personality characteristic of I'm going to own the responsibility of this situation or this individual or this environmental breakdown, because it is my level of responsibility. And that's somebody who is thinking beyond themselves. And that always stuck with me that she just took that being this on, if you will, of an entrepreneur, when in fact this isn't even her clinic and that's really the sign of a true entrepreneur.
Speaker 1 (05:00):
Yeah. So someone who's really willing to take the initiative and to kind of really think of the, it sounds like someone who's really going to think of that clinic as, as their own, and really have a stake in it. You know, a true sort of emotional stake in the clinic and a sense of pride in, in where they work and what they're doing
Speaker 2 (05:21):
Exactly. And they typically come to the table, you know, if you're hiring well, and you're building that management team around you, you're looking for the foundation, right? I mean, every bridge is only as good as the foundation. And the foundation that I'm always looking for is does this individual have the personality, characteristics of confront, right? Are they willing to say what needs to be said to whomever? They need to say it to now, of course you communicate in manners. You never go out manners, but you can't shy away. And we live in a culture. Now we're in an environment where nobody really wants to offend anybody. Nobody literally wants to tell anybody anything they don't want to hear. But in fact, if you're raising children and many of your listeners probably have children, you can't raise your kids and say yes to everything for a month.
Speaker 2 (06:02):
Yes. Chocolate cake for dinner. Yes. You can go to bed when you want. Yes. You can have candy in the grocery store line, I'll visit your house a month later. It'll be chaos. It'll be a nightmare. Right? So when we run our clinic, we have to have that level of discipline. And that means you have to have that quality of confront. I need to be willing to confront my staff, say what needs to be said, always within good manners. And that's when it comes down to the, the, the equation of communication, you know, how can I communicate in a manner that I can bring about understanding, right? Because after understanding comes agreement, and we're always striving for agreement, but you know, that's the final as the final marker. And then the, the last two building blocks of foundation, I think that really make an intrepreneur entrepreneur is accountability and responsibility.
Speaker 2 (06:43):
And the difference between those two in my mind is accountability is one who's who owns the obligation and willingness to be accountable for their own actions. But responsibility is like the example I gave of Denise, where she took full responsibility for the whole wellbeing of the clinic and everybody inside it. So just to summarize, I'm always looking for who has a high level of confront who can communicate and bring about duplication and understanding and the art of their communication and who can be accountable to their own actions as well as responsible to that of others as well as situations. So I'm always looking for that and if I don't have them, how can I grow me?
Speaker 1 (07:19):
And, you know, I love the fact that you're always looking for that. So what advice do you have for a practice owner who is interviewing people, you know, to come and work in their clinic? Cause it's, I think it's hard, let's say in one or two interviews to kind of get those for confrontation communication, you'll get countability responsibility. So what advice do you have for business owners in those first couple of interviews to hire someone to kind of get this, this type of intrepreneur, if that's what you're looking for in your clinic.
Speaker 2 (08:00):
Yeah. And if you're looking to get distance from your practice, if you're looking to get freedom and flexibility, that's typically what we're trying to hire. Right. So that's a great question. You're asking a fantastic question. I think my answer is going to surprise you. I don't think it's going to be the path that you may be expecting. I think what my advice would be based on my experience now, I've been in and out of 400 offices. I've been in every state in the United States, helping practice owners throughout the whole United States, except for four States. And in doing that, I've come to the conclusion that it has to start with you. It really has to start with us looking at ourselves in the mirror and asking ourselves, what kind of owner are we right. I mean, to some extent you're, you're you're and I like to use family analogies a lot.
Speaker 2 (08:38):
I don't know, maybe because I had a pediatric clinic and adult clinic. And so I always saw the dynamics there, but I think your family you know, performance, your children are somewhat of a reflection of you as parents, right? I think your practice is a reflection of you as an owner. So I think you really need to look at yourself. So my first bit of advice is look at yourself and kind of know what your own strengths and weaknesses are. You know, there are four kinds of owners out there, and I think we'll talk about that. So figure out which type of owner you are first, second, when it comes to the interviewing, which is kind of what you were leading to. It's a, it's a five stage hiring process, and I've been, I've been pushing this and teaching on this for, well over a decade.
Speaker 2 (09:17):
Now it's a five phase hiring process and the secret to successful hiring so that you can be correct. 85% of the time with every single candidate you're trying to hire is that you have to get the entire team involved in the hiring process. Your entire team know selectively, right? There's some key individuals, some individuals where you're like, Nope, that's not going to be a fit, right? But for the most part, you need to include everyone in your clinic, in that process. And let me just quickly summarize. So first and foremost, it starts off with phase one, the ad for the ad, you know, you're advertising for somebody you're trying to recruit somebody. Let's say you're looking for a therapist. Let's just pick what everyone's thinking about. Well, here's, here's, here's a tip. Always open your ad with a question, always open your, a question. When you start the ad with a question, it prompts the person to think and reflect on themselves and raises their curiosity.
Speaker 2 (10:06):
You know, here's an example. Let's say you were to say, you know, are you GM's next? You know, senior financial analyst. And then before you even get the next sentence, the person who read that for sense of like, I don't know, maybe I am, maybe I am qualified. Are you the next senior manual therapist who can work in an autonomous work environment? The therapist's coming? I don't know. Maybe I am. So it gets their interest in. So the ad really has to stimulate their interest and then step two, they have to reach in for a phone call, phone screen. Now the phone screen, here's the, here's the death to any interview process. Don't talk about you. Don't talk about the clinic. Don't get into that. Don't sell your clinic. Don't sell yourself. Look, you have to, this is dating one Oh one. You have to be more interested than interesting.
Speaker 2 (10:47):
Now what happens here is once you're demonstrating your higher level of interest, their comfort level goes way up when their comfort level goes way up, their natural persona, their natural personality is going to be there. And that's what you're really striving for in the interview process. You know, phase three, they come into the clinic, they meet the front desk. They, they introduce themselves, give them the application, they fill it out, then let some other member of your team, give them a tour of the clinic. It shows that you're so confident in your staff. You're so confident what you built, that you can leave that potential applicant alone with another staff therapist who can just give up five minutes who are, and now that candidates going to ask, you know, the popular questions you know, how, how do you like the way they run the schedule here, right?
Speaker 2 (11:28):
That's always a difficult question in, in, in hiring or what do you think of the EMR system, right? Encourage that, encourage that outflow and encourage that dialogue with another individual. And then of course you bring them into the interview process. And then finally, you're going to wrap it up and potentially offer them a position, but you have to ask the questions that are getting them to reflect on themselves. And I'll, I'll end with this in the interview and this one of my favorite questions, you know tell me about a time when you last help someone. You know, it's really interesting when people go blank and they pause, you know, I don't want to hear about work. I want to hear about like, when you genuinely tried to help someone, it tells me a lot about the person and how they live their life, because I think striving to serve others and adding more value to other people around us is what's fulfilling. And so I'm really looking for that when I'm hiring. I know I can make somebody a better therapist. I can't always make them a better person.
Speaker 1 (12:19):
Very true. Very true. And thank you so much for outlining that interview process. And hopefully that gives a lot of the entrepreneurs listening, a better idea of maybe how they can do that on their own and kind of make it their own. Now, before we went into that, you said there are four types of PT owners. So let's go back to that. And I want you to let, let, let, let us know what are those four types of PT owners.
Speaker 2 (12:43):
Okay, good. Now this is just based on experience, you know, for the thousands of engagements I've had going all the way back to, you know, I started the business in 2006, but I've been a physical therapist since 92. And so what I see out there and what I've been able to categorize is four types of owners. The first one is the innocent owner. All right. And I think we've all met that person. This is the person who falls into ownership and, you know, they're, they're, they're managing based on census, right? They're like a poll taker, you know? But they're always open to help. They're always willing to get help. They're always willing to seek some advice and some help, but they're the type of person like, yeah, I was in this clinic and the owner just decided to retire and they didn't really want to move on with it.
Speaker 2 (13:25):
They didn't want to get out on the market. You know, they told me a hundred thousand, I could just buy it out. And so, you know, it's less than a Tesla. So I bought the clinic. Right. So, you know, that kind of owner who never really thought about being an owner or whatnot, but they just had an opportunity and they just jumped out and they did it. They didn't give it much thought and then they quickly find out, wow, there's a lot more to this than just treating patients and being great therapist. Right. similar to that owner, you, you run into the caregiver owner and I, I run into this a lot, especially out in the Pacific, on the, on the West coast. You know, Karen you're on the East coast, I'm on the East coast. The average collections per visit in the U S is like 83 to $85 a visit.
Speaker 2 (13:58):
But if you get up in that New Jersey, New York area, you know, it's not happened. And I have clients and stereotypes. Yeah, exactly. It's such a, Oh my gosh, $68 a visit $73 a visit. But if I'm over in Portland, Oregon, 125, $127 a visit. So you get some of these owners that are in these very high reimbursed environments predominantly. And they're what I call the caregiver owner right there, that caregiver. And they go into practice. And they're the one who assumes the perspective of a clinician first, an owner second. And they can be a bit of a martyr. Right. And they tend to run their clinics like, like a democracy, like it's a vote like everybody has equal say, right? And so these are the people that, that call me and, you know, come to find out, they're paying themselves, you know, 45, 55,000. And they've got, you know, therapists two, three years out of school making 85,000, you know?
Speaker 2 (14:52):
And so, but they're always, they're always justifying well, will we put our patients first? And it's all about the patients. And I'm like, so is that to assume that the other 30,000 private practices in the us are not doing that? I mean, really let's, let's just keep this in balance, right? So you really have to, you know, my success with them is I really have to coach them that the minute you open up your clinic, your senior responsibilities to your, your flock, you know, to all the people coming into your clinic, you own that responsibility. You have to be an owner first and clinician second. And then one of the most frustrating owners, number three is the, know it all owner, right? This is the owner has been around a while. They've had some wins, they've had some losses and through their life's experience, they're not really open to a lot of ideas.
Speaker 2 (15:34):
They're not really very open-minded. They got off fixed ideas. They're a little resistant to change. And here they are like, you know, reaching out to us, Hey, Brian, how do you do your social media marketing? Or how do you do your hiring process or what's your, you know pay for performance model and you start going into it and they start, boy, I know that, or I do that, or I don't do that. Or that, you know, this, this know it all kind of thing. Well, you're only going to be as good as you're willing to open up and willing to look at new thoughts and ideas. If you're not willing to look, you're not gonna learn anything. So that's a real shutdown right there. And that's really hard to, to get past that the suite owner, the one that I go for every day, I'm striving for.
Speaker 2 (16:10):
I love it's usually my startups that I've run into that are the go getter owners. These are the ones that, you know, they have an entrepreneurial spirit. They like to manage based on performance. And they're in a continuous pursuit of knowledge. You know, they're just continuing to pursue their knowledge. You know, I always tell people I'm 52. I want to be a better 53 year old. And I was a 52 year old. The only way I know how to do that is listen to podcasts like yours, read books, do audible. I mean, there are so many great people that are adding value to people's lives. You just have to go and get it. You have to take it in. So that go getter that go get her owner. That's the one, that's what we're trying to move everybody into that bucket.
Speaker 1 (16:47):
Okay. So how do we do that? So we're ending 2020. It's been a hell of a year. A lot of unpredictability moving into 2021. I think it's safe to say we're still there still a lot of predictability. So how do we, how do we become that go getter? How do we become successful as that go getter?
Speaker 2 (17:11):
All right. So I was listening to Gary V earlier today, I was watching one of his interviews and he was talking about this exact moment in time. And he said something that I just could not agree with. More, just could not be more in agreement. And I know it's probably going to shock everybody when I say it, but this is an entrepreneur heaven right now. This moment in time, this period in our life and our society in our profession is an entrepreneur. Have it? I mean, this is a 89 degree swimming pool. This is perfect time for you to jump in. And I see it in my business. I mean, we're having our record year. This is our most, most expansive year, yet on record going all the way back to 2006. And I think it's because if you really think about the true essence of an entrepreneur, an entrepreneur like you, Karen like myself, and so many others that we meet, I mean, look, you and I were talking earlier about your practice.
Speaker 2 (18:06):
You have a mobile PT practice. You're doing tele-health, you're willing to color outside the lines. You've always been willing to color outside the lines. If we're going to sit here and go through our profession and continue to call her inside the lines and make every picture like everybody, else's, you're only going to get that. That's all you have available to you, but if you're an entrepreneur and you're a willing to experience anything, and that you got to think about those words, I have to be willing to experience anything. When I sold my practice the first time. So my practice, the first time, two years later, it's tanked the people. I sold it to tanked it. They stopped making their note payment to me. I had a clause in my agreement that if you stop making the no payment, I come back and I buy the clinic back for a dollar.
Speaker 2 (18:48):
I bought the clinic back for a dollar. I bought this product for a dollar. Yup. I was 30 years old, two years later, they tanked it, bought the clinic back for a dollar. I got rid of all of the offices. I kept two. I lost half of the staff. And my wife says, you know what, honey, you can go up there and rescue that clinic. But I am not going to live here in this house in Florida with these two little girls all by myself. That is not what I bargained for. So you can go away for two weeks at a time, but you have to come home for at least three to four days. And then you can go back. And I said, I promise that's what I'll do. I ended up doing that back and forth, back and forth. I turned that clinic around two years after I took that back.
Speaker 2 (19:24):
It became practice of the year practice a year. Why? Because I was willing to experience anything. It had vendors that I owed $150,000 to, it had taxes that hadn't been paid for a year. It was in a middle of a Medicare audit where the patient was seen 141 times a Medicare patient, 141 times. And when Medicare audited them, they failed the audit a hundred percent. I'm like, you didn't even sign your name. Right? And so then I come in and I take it over. And I, I said, I sat on the phone for four hours to finally get to the person whose desk that was running. The Medicare audit, who advanced the R we are an advanced documentation, right? Who are notes were being mailed to mailed to this person in Alabama who was reviewing the notes. Right? And so we found who person was.
Speaker 2 (20:18):
And I said, I'm going to talk to you every single week. I'm getting off this ADR as quick as possible. She says to me, and this really funny Southern accent, and she's like, I've never seen anybody get off an ADR in six months or less. It's going to be at least that, you know, they only pay you one third of your Medicare dollars. I got off that advanced documentation review that Medicare I got off in three months, I was a hundred percent success in three months. And she, she caught us off, but that was me being willing to experience anything in pursuing the knowledge that leads to greater. And that's all that was Karen was, I didn't know anything about that. I didn't know how, what it took to get off an advanced documentation review. I didn't know how I was going to pay those vendors back or rebuild a whole operation with half the staff, but I did what needed to be done.
Speaker 2 (21:00):
And that is what I think really makes an effective leader. Who's really going to be that go getter owner. And the last two P the last three things about that is I'll say I was listening to a audible book by Dean Graziosi. You know, he was mentored by Tony Robbins and he talks about the four CS courage commitment capabilities that naturally grow confidence. I think every successful person who's in this space, who's, who's in this entrepreneurial space business space. When you ask, what is the, what is the one ingredient that is the common denominator to all success? I think they'll all say if you took a tally, the highest thing off the chart would be confidence. It takes confidence, but you're not going to competence. If you don't have courage, like I had to go back and rescue that clinic. If you're not going to be committed to it, like I was going to go the distance, no matter what, if you're not going to have the ability to go to podcasts, read books, go to courses, go to seminars, invest in yourself and get the capabilities to actually do it. I ended up you know, took that clinic back, made it practice the year, two years after I took it back, I took it back in 2009 and it was practiced a year in 2011. So I like to pull from those natural experience. I like to pull from those and share them with everybody. I mean, that's, that's wild. It was a rollercoaster.
Speaker 1 (22:19):
And now, so when you, I have to, I have so many questions. So now when you sold this practice, so you sold it with the contingencies. So you didn't just sell it and be like, okay, I'm selling this and I'm outta here. So why did you not do it that way? Because I think that's an interesting question to ask for people who may be, might be in similar situations.
Speaker 2 (22:40):
Absolutely. I do a lot of mergers and acquisitions and sales. I have three owners right now that I'm working with helping get them, getting them connected to selling their practice and connecting the right people. So at that time, I had spent $115,000 between three different consulting firms and training firms to really train up my management team, train up myself. And that's what I did. And so I invested that money 115,000 to hook a home equity line out of my house. Now you're going to find like, I'm not your typical speaker. You know, when I do my podcast and I'm on other people's podcasts, I believe this Karen, I, and I hope you don't mind. I believe a hundred percent of my DNA that transparency, breeds trust transplants. So I'm willing to just like wear it on my sleeve no matter where it goes. So what happened?
Speaker 2 (23:26):
I manned up this management team. I invested 115,000 into this group. I got back to 2005, 2006, I'm working 15 hours a week. I'm making like $45,000 a month. I'm a thousand miles away living in Florida. I'm living the dream. I'm living the dream. I'm like, okay, I'm going to devote the rest of my life to showing other pet owners how you could be a remote owner and make this happen. A year of that goes by. I get a phone call my management team, the leader up there says, Hey, we want to buy your practice. So I said, all right, let me talk to my wife, Lisa, and I'll get back to you. So I tell my wife, I was like, absolutely not. Why in the world, I am not, we we've worked our whole lives to get to this point. This is, I am not. I said, Lisa, let's think this through. If I call them back and say, we're not interested. What's their next action.
Speaker 1 (24:15):
Find someone else to buy it. They're going to leave. Oh,
Speaker 2 (24:19):
Because they're thinking, well, wait a minute, I'm running this, this $4 million operation, $6 million operation at, why would I stay here? If I don't get a piece that I'm, I'm going to go. So I literally flew up. I wrote on a napkin at dinner, I wrote $6 million. They said, we can buy that. We're going to give you a third up front and we're going to give you no payments on the rest. And I'm like, well, I love these guys. Right? I built them. I groomed them. I put them in a position. I want to see them win. Right. Done deal. Now the nice thing about doing it that way is I already have the skills and knowledge to know how to run the business. So what's my risk. My risk is exactly what happened. They tanked and they crashed it, but I have the skills and knowledge and ability to go back and rescue it.
Speaker 2 (25:00):
Right? So that was the, that was the risk that I had to be willing to accept. What's the upside. Well, two thirds and a note I'm making, you know, fi was a 6% interest on that money. So I'm getting well over my asking price over the course of the time that I'm making, making the payments. It also gives me this guaranteed income, which I made for the two years. And I could go do other things with it. Right. So it was a really good win-win, but the nightmare happened. They defaulted. I had to step in, I had to do. And that goes back to my, you know, my four CS courage commitment capabilities. I had the ability to, I knew myself well enough to go do that. So of course that's what ended up happening. But in 2017 I sold it all again. So it's kind of like in the big scheme of things, it really worked out. But in 2017 I won and done, you know, here's the keys. Thank you. Here's the check. I love it. One and done. So it was a different, it was a different, so I've, I've lived through both experiences. I've lived through both of those opportunities. And that's how it went.
Speaker 1 (25:57):
Yeah. Wow. So I think it's great for people to hear that there are different ways to even sell a practice and, and that it really behooves someone who is in that position to find someone, to help them guide, guide them through that.
Speaker 2 (26:13):
Right. Absolutely. You know, even tiger woods has a coach, right. And he's the best golfer at the time. You know, Tom Brady has a quarterback coach. I think every practice owner needs a coach when you're running the practice. And especially when it comes time to sell your practice. You know, I paid somebody $5,000 just to be a sounding board for me when I sold my practice. Like, because it's an emotional rollercoaster. I said, I don't really need you to do anything. I just need you to pick up the phone when I call, I just need to bounce ideas off of you. And just tell me I'm crazy or tell me I'm being too emotional or tell me. And I just needed somebody to consult with. You know, I just needed a little counselor to help keep me on track. And, and that, that was well worth the $5,000 for me to, to move it on through, you know, I kind of despise the idea of people brokering these deals and taking 6% of somebody's livelihood that they built their whole business for 15 years for like a four month transition.
Speaker 2 (27:01):
I like to just coach people through the sale. I like to help coach them through it, just pay for the time don't pay a percentage of business, but that's me, that's just my opinion on it. You know? I mean, how many of us have sold a house in real estate? And the realtor, you know, blows in and sells a house in 60 days, blows out and walks away with 50 grand. I'm like, I don't care how many website things you did. There's no way I can justify that 50,000, but that's the market. Right. That's how that industry works.
Speaker 1 (27:24):
Right, right. Wow. That's a great story. Thanks for sharing that. And now, before we start to wrap things up what would you like the listeners to take away from what we just spoke about? What are your key discussion points? Well,
Speaker 2 (27:44):
I'll start with what is one of my most favorite books, and if you're going to start there, I think you, if you, if you get this book and you'll listen to it on audible, or you read it, it's, it's the Go-Giver by Bob Burg and John David Mann, that book completely changed my life. And what I got from that book was I got this, that the secret to success is actually giving the secret to success is giving all successful. People will keep their focus on what they're giving and that's what actually gives them their success. You know, I grew up on welfare, you know, my mom raised three boys on her own, you know, government, cheese, bread, butter, food stamps, the whole nine yards, no car. And, you know, I was always of this mentality. Like once I get successful, I'm going to give back. Once I get all my, you know, shelter and security and this and that, I'm going to give back.
Speaker 2 (28:37):
And along this journey, I realized that was completely false. That was completely false, like right here on my computer. I'm talking to you right now on zoom. And I'll just rip off this post-it note and just put it right in front of your camera. I mean, that is what I look at every single day. And it says strive to serve, strive, to serve. And I realized the more I embrace that philosophy of it's about giving more in value than you ever expect in return. I hate a win-win relationship, a win-win relationship implies. I'm going to allow you to win as long as you help me win. I want to see you win in spite of whether I'm winning or not. And I think once I really grasp that, and for those of you with are listening, the more you can focus on surrounding yourself in improving the lives, both personally and professionally of the people you work with. I think that gift of giving is going to pay off tenfold to your community, to your patients, to your employees, to your family and to yourself. That's what I, that's my message on that. That, that's what I've learned. It's been a long haul. It's been a lot of ups and downs, but I'm, I'm convinced that that is what has led to my success and the success of so many other people I've worked with. I've been blessed to work with over my lifetime.
Speaker 1 (29:49):
That's awesome. And now I feel like I'm going to ask you the question I ask everyone, and, but maybe you just answered it. I don't know, but looking at where you are in your life and in your career, what advice would you give to your younger self? Let's say right out of, you know, right out of college.
Speaker 2 (30:07):
Oh my gosh. Right out of college. Well, I think the advice I would give my younger self is to be more introspective, you know, be, be a better listener, you know? Don't, don't be so full of your own fixed ideas, you know, be willing to be willing to step down off of that and, and embrace the ideas of others, no matter how foreign they may be to you. So I've looked at it like that. I think that's really changed my perspective over the, over this, especially this last decade, but I've learned to not think of my thoughts. First. I've learned to focus on what's being said to me first and literally take it in, duplicate it to its fullest. Meaning before I communicate back and I'll leave this one phrase and this rattles through my head all the time, whenever I'm in a situation, I'm always reminding myself, don't react, respond, don't react, respond. And so many wild things are happening in our society today. And I think a lot of people respond, respond, respond, and I tend to sit back and take it in a little bit more. And I like to give an approach. I mean, react, react, react. I like to give an appropriate response rather than just be so reactive. So I think that's really changed a lot about me. And that's, that's about all I can say about that.
Speaker 1 (31:38):
Yeah. That's great advice. I mean, great advice. I love the respond, not react and guilty, guilty here of, of reacting maybe too much when I need to just sit back and respond. So it's something I'm going to remember now, where can people find you? If they have questions they want to get in touch with you, they want to learn more about you, the business, all that stuff.
Speaker 2 (32:00):
Oh, great. Well, they can reach out to us. You know, we're on Facebook at Meg business management, you know, that's our handle there and you can follow us on Twitter at Meg business or Instagram at Meg business management as well. Our website is www.megbusiness.com. One of the things we really like to do is we like to, like I said, give and without, so we give free practice assessments. We give free practice stress tests. So if they want to reach in, you know, they can email us@infoatmegbusiness.com, for sure. And for your listeners, you know, special for your listeners for this year, you know, until we hit 20, 21, any service they want to do with us any training they want to do with us, they get a 10% discount. We'll just take 10% off anything they want to do. And that's just for your listeners. Karen, all they have to do is reach into us and say, they heard us on this podcast and my team will just go ahead and honor that anything we can do to add value, I'm happy to do it.
Speaker 1 (32:51):
Awesome. And just so everyone out there listening, of course, we will have all of the links to this one, click away at the podcast website at podcast at healthy, wealthy, smart.com. So if you didn't take everything down, don't worry about it. It's will all be in the resources section under this episode. So Brian, thank you so much for coming on. This was this was wonderful. A lot of great advice, especially as we're winding up the year and kind of moving into 2021. I think this is the perfect info for all of those physical therapy, business owners and entrepreneurs, and intrepreneurs out there. So thank you so much. You're welcome.
Speaker 2 (33:30):
You're welcome. You know, I think we should look into next year and everybody should have a handle on the bottom of their email. I know when my email signature goes out, it always says, expect to do well. And that's one of the things I like to get people just wake out of bed, wake up out of bed, start every day, expecting to do well.
Speaker 1 (33:46):
Awesome. I love it. I may, I may add that as a little sticky note on my refrigerator in the morning. I'll frame it. I love it. Thank you so much for coming on and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
On this episode of the Healthy, Wealthy & Smart Podcast, I welcome Dr. Theresa Marko, PT, DPT, OCS, to talk about advocacy efforts in physical therapy. DR. Marko is a Board-Certified Orthopaedic physical therapist & Certified Early Intervention Specialist with over 20 years of experience. She is the owner of Marko Physical Therapy, a private practice in New York City, specializing in orthopedics, adolescents, and pediatrics.
In this episode, we discuss:
-Her path to advocacy
-Federal Bills that are important RIGHT NOW: 9% Cut, Telehealth permanence, Student loan Debt
-State vs. Federal Advocacy
-Traditional Advocacy vs Armchair Advocacy
-Key Contact: APTA & PPS
-Social Media importance: AMPLIFY, Access, Recognizable, Find others
Resources:
Dr. Marko on Twitter
Dr. Marko on Instagram
Dr. Marko on Facebook
Dr. Marko on LinkedIn
Advocacy is not a Spectator Sport
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
More about Dr. Theresa Marko:
Dr. Theresa Marko, PT, DPT, MS is a Board-Certified Orthopaedic physical therapist & Certified Early Intervention Specialist with over 20 years of experience. She is the owner of Marko Physical Therapy, a private practice in New York City, specializing in orthopedics, adolescents, and pediatrics. She has helped thousands of people to overcome injuries, optimize their movement, and return them to work and sports pain free and better than ever.
When she is not caring for patients, Dr. Marko can be found in legislative offices in Washington, D.C. or Albany, New York. She is passionate about making a change in healthcare and has made advocacy a cornerstone of her practice. For over five years, and hundreds of hours, she has lobbied on behalf of her patients and her profession on topics such as repealing the Medicare cap, reducing student loan debt burden, and lowering copays. She forms public policy priorities as part of the American Physical Therapy Association’s Public Policy & Advocacy Committee, the advisory council for the board of directors of the association. In 2020, she was awarded the prestigious Doreen Frank Legislative Award, given to only one person a year, by the New York Physical Therapy Association for her outstanding advocacy work.
Dr. Marko’s expertise is featured in The Wall Street Journal, PopSugar Fitness, Self, Cosmopolitan, Muscle and Fitness, Business Insider, LiveStrong, and Healthline. She has spoken at Columbia University, Duke University, & Touro College about patient and physical therapy advocacy. She was recently appointed to the editorial board of SpineUniverse as the first and only physical therapist on the board.
She lives in Brooklyn, NY, with her husband of 13 years and her French Bulldog, Rondo.
Read the Full Transcript below:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only, and should not be used as personalized medical advice. And now here's your host, dr. Karen Litzy podcast. I'm your host today's episode
Speaker 2 (00:40):
Is brought to you by net health. So net health has created the reduct patient portal, which provides a secure line of communication between you and your patients. You can use it for video conferencing for tele-health for secure messaging, to respond to non urgent questions from patients. You can share documents and photos, and your patients have 24 seven secure on demand access to their therapy, health information without phone calls and voice messages. If you want to learn more about the Redarc patient portal, contact them at redox that's R E D O c@nethealth.com. Now on to today's episode, we're going to be talking all about advocacy for the profession of physical therapy. And I couldn't think of a better person to have as my guest to talk about advocacy. Then the 2020 Doreen Frank legislative award winner, which is given to only one person a year by the New York physical therapy association for outstanding work in advocacy, dr.
Speaker 2 (01:44):
Theresa Marco, she's a board certified orthopedic physical therapist and certified early intervention specialist with over 20 years of experience. She's the owner of Marco physical therapy, a private practice in New York city, specializing in orthopedics, adolescents, and pediatrics. She has helped thousands of people to overcome injuries, optimize their movement and return them to work in sport pain-free and better than ever when she's not caring for patients. Dr. Marco can be found in the legislative offices in Washington, DC or Albany for over five years and hundreds of hours. She has lobbied on behalf of her patients and the profession on topics such as repealing the Medicare cap, reducing student loan, debt burden, and lowering copays. She forms public policy priorities as part of the AP TA's public policy and advocacy committee. The advisory council for the board of directors, her expertise has been featured in the wall street journal, PopSugar fitness, self Cosmo, muscle, and fitness business, insider live strong and health line.
Speaker 2 (02:45):
She has spoken at Columbia university, Duke university and Touro college, and she was recently appointed to the editorial board of spine universe as the first and only physical therapist on the board. So what are we talk about? So today we're talking about her path to advocacy and how you can get involved and why advocacy is so important. The federal bills that are important right now, which includes a 9% cut to Medicare, very important, call your legislator, tell them not to do that. The difference between state and federal advocacy, how to find your legislators and find out what Theresa calls, armchair advocacy, what key contacts are, social media around advocacy. And so, so much more. So this is a great episode. If you are at all, considering getting involved in advocacy efforts, then you're going to want to listen to this whole thing. Theresa gives a lot of really easy ways to get involved. So thanks to Theresa and everyone enjoy,
Speaker 3 (03:49):
Hey, Theresa, welcome to the podcast. I'm happy to have you on. Thanks for having me, Karen. Yeah, absolutely. And today we're going to be talking all about advocacy. This is one of your specialties. So you've been involved in advocacy around the American physical therapy association for the profession of physical therapy. For many years, you're a mentor to many up sort of younger physical therapists and physical therapists. Who've been around for a while, but are just new to advocacy. So why don't you give the listeners a little bit more about why this is one of your passions? Sure. So I didn't start out on this path and this is not something that I thought I would be involved in. There's two main events that kind of propelled me towards this. And, you know, the first is I've been a physical therapist now for about 20 years.
Speaker 3 (04:43):
So I'm older than I look. And what happened was I started to get some hip and back pain that was pretty substantial, you know, MRIs. They wanted me to get an injection. We were talking about surgery and unfortunately the things that I had done to try to rehab myself, didn't get me that much better, but I found dry needling. And I found a physical therapist who became an acupuncturist. Bianca bell, Deni leveraged a death, and she's a master at dry needling. And I loved what she did. And basically, you know, I had a severe spasm in my opterator internist that was killing me and my hip flexor and they were fighting. So I loved the needles. They made such an impact in my life. I can now walk around and not feel that pain in my hip and going down my leg every day.
Speaker 3 (05:28):
And I wanted to use the needles because I loved them so much, but we can't use them in New York. Why? Because it's the law. So that made me upset and I wanted to change the law. And I was really interested in that and why dry needling was such a, you know, variation from state to state, but it's a state law. So that was something I found out then kind of soon after that, or during that time, I also decided to go back and get my transitional DPT. And I took a professional development course. They talked a lot about advocacy and it just dawned on me. And I had an aha moment that basically all the things that I didn't like, the Medicare plan of care, the authorization, the way that you get like six visits than four visits than three visits, you get kicked off with some insurances.
Speaker 3 (06:14):
These things that I had been practicing inside the system for so long that I found so frustrating and so annoying, I realized where because of the law and that they could be changed. And I just decided that one day after taking that class, that it was going to be my mission to try to change these laws, to make the profession better for me, for those generations coming after me for our patients and basically for everyone. And it also dawned on me that legislators in general really don't know what we do. And if no one tells them, they won't know, and they won't make the laws in our favor that will help us our profession and our patients. So, you know, whether anyone likes it or not, we all have to operate in quote unquote, the system. And, you know, that's the government, the democracy, the bureaucracy, the politics. And in order to change that you have to be involved in advocacy. So that's, that's my why. And the other thing that I'd like to add is, you know, what's the alternative to not say anything, to stand by yourself, to get swallowed up by another profession that has a bigger association and a bigger lobby who would be our voice. So if not you then who I love,
Speaker 4 (07:28):
I love it. And I think that's a great reason to become an advocate for the profession. And so often, even when I ask people, why did you get into physical therapy? It's always, you know, you have these aha moments. You have these times in your life where you're like, well, this isn't right. And, and as you dig deeper, you think, Oh, there's actually something I can do about it. I can use my voice. I can speak to my local legislators. I can speak to my, my national or federal legislators. And so let's talk about that. So you've got each state has a state government, and then we obviously have our federal government. So how, as a, as a physical therapist, like, what's the difference? How do we, how do we advocate to each of these groups?
Speaker 3 (08:21):
So when I had to made that decision, that I wanted to become an involved in advocacy, it was tough to figure out at first. And that's one of my other passions is trying to help other people figure out the path because the path is not easy. And these things are very frustrating and confusing. So some things are, remember that. I get asked a lot of questions about art to remember that we have state government and we have federal government. And some of these laws are state laws. And some of these are federal laws. So when you look on the AP TA's website, under advocacy, apa.org, backslash advocacy, it'll show you the federal bills and the things that we're, you know, constantly fighting for now. And then if you go to your state chapter and they should have hopefully an advocacy page on there, on their website, it'll show you the state laws. So dry needling, as I mentioned before, is a state law. Whereas something like making tele-health permanent for the entire country, that's a federal law. So that's kind of, you know, you need to know the difference in like what you want to fight for. Do you want to fight at a federal level? Do you want to fight a state level or do you want to fight it? Both me personally, I think they're intertwined. So I go for both
Speaker 4 (09:33):
And there, but there are some laws that are very specific to the state, right?
Speaker 3 (09:40):
Yes. Like direct access. So that's another one, right? So direct access is super important in the state that you and I live in New York, we have a direct access that allows us 10 visits or 30 days, whichever comes first. So currently on the New York physical therapy associations agenda, we are trying to fight for unrestricted direct access. And that means you don't need a physician's prescription to go see a physical therapist. And again, when we talk about, you know, legislators don't know what we do, patients also don't know what we do. And I found that out and that's become another passion of mine is to get the word out and let society as a whole know what we do. And I repeat myself over and over. No, you don't need the prescription to go see a physical therapist, look up the direct access law in your state, all States now all 50, have some form of direct access. Some are a little bit better than others. But like, I think Texas, right now, you can only go see an evaluation and then you have to get a prescription, but that is a state law. And that does vary from state to state.
Speaker 4 (10:40):
Right? So if you are interested in advocacy, I think the bottom line between state and federal is know what your state is fighting for, and then know what, what the, what you're fighting for at the federal level, which brings me to my next question. And that is what are the federal bills that are important right now, as we speak today is Monday, November 2nd. What is important right now? And FYI, as we all know, tomorrow is tomorrow is election day. But that being said, what are the bills that the AP TA is fighting for right now on the federal level?
Speaker 3 (11:23):
So there are so many bills, but the two, you know, cream of the crop right now are going to be reversing the 9% cut that CMS centers for Medicare services has instilled upon the profession that will start January 1st, 2021. And the reason why this is so important. So this is federal okay. If CMS decides to cut Medicare recipients, 9%, that for some businesses is going to be, make or break, even with the pandemic loss revenue and everything, they might have to close their doors. They might have to stop taking Medicare patients. Medicare patients will have less access, there'll be less clinics. So that's, that's one aspect of it. But here comes the second aspect, you know, of the trickle down possibilities, whatever Medicare does is generally the precedent for what all the other insurances do as well. So the other insurance will probably start to follow suit and there you have cutting reimbursement to our profession.
Speaker 3 (12:20):
Again, more businesses closing all patients, having less places to go, less availability, less access through my years of advocacy, one of the phrases that I've come to realize is barriers to care, you know, access to care. There are all these stumbling blocks that make it hard for people to get the services that they need, you know, instead of seeing physical therapy, because it's difficult, you have to get a prescription or you don't only have, you know, six visits. It is easier to go see a physician and get an opioid prescription, things like that. So certain things drive it. So advocacy is intertwined with all these things. So that 9% cut is really important for that reason. And then the other hot button item right now is tele-health during the pandemic you know, here in New York city where I live, I shut down for a little while.
Speaker 3 (13:10):
I know a lot of people did. I didn't have tele-health set up with my practice at that time, but then I implemented it you know, in late March and many people across the country, physical therapy practices did have tele-health. We were not able to use it before for Medicare recipients, CMS applied a waiver, allowing us to use it. And it ends when they declared the pandemic over. So there we are going backwards again. So one of the things we're fighting for is to make tele-health permanent permanent again, access that people can get in the door and see their physical therapist. And I've used it. I had a patient who she fell down and she hurt her foot in the pool. And she said, Oh, someone at the you know, pool was a, I guess, a personal trainer, no disrespect to them, but they said, Oh, it's not broken. And I took one, look at it. I said, Oh no, your foot's broken. I could just tell. I was like, we need to get you in a boot. You need to go see, you know, get an x-ray. So, you know, tele-health is invaluable to people. They can get any immediately, the minute they hurt themselves. So making tele-health permanent is really important
Speaker 4 (14:18):
Because if we're supposed to be really taking care of the most vulnerable, especially during a COVID pandemic and the most vulnerable are over 65, it only makes sense to allow those people to have tele-health appointments.
Speaker 3 (14:34):
Yeah. I mean, also I used it with the patient the other day. She said that she wasn't feeling too well out of an abundance of caution. She was going to get a COVID test, but she opted for a tele-health session. So we switched from an in-person to a out just like that same time, same, same day. She was able to do that. She just didn't want to put me at risk. And I appreciated her watching out for my safety. So during these times we need that, you know, also people who live in areas where they have to travel far or snow treacherous conditions. Do we want people out in these conditions tele-health could be useful for that? I had a patient who I'm currently treating for her knee. She woke up the other day, her back was an agony. She said, Oh my goodness, my back's hurting.
Speaker 3 (15:18):
I don't know what to do. I said, let's get on a tele-health we did some gentle movements and some stretching. And she said, wow, by the end of it, my back feels much better. Thank you so much. I didn't know that a telehealth session could help that much. And all I did was show her some things to do to give her some advice. So telehealth is so useful in so many situations that I do hope that we can make it permanent. Yes. So do I? Okay. So now we know what federal bill bills are important. Your state bills, obviously you'd have to go on to the, your state PT association. And like you said, before we went on, hopefully there is an advocacy tab within your state physical therapy association website. And that's where you can find out what is on your state legislative docket right now. I mean, we're not going to go through every all 50 States. So for the people listening out there, that's where you would find it. Am I correct? Exactly. Yeah. Okay. All right. Now here's a question. How do we find who our state and federal legislators are? And on that,
Speaker 2 (16:28):
No, we're going to take a quick break to hear from our sponsor and be right back with Theresa's answers. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for tele-health secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com.
Speaker 3 (17:16):
So at a federal level a PTA makes it so easy for you. If you go to the APGA action app and that's downloadable in the I store and also Android. And I think you just type in APGA advocacy and the Apple pop-up. And if you're a member or non-member, you can use it. You just, I think if you're a non-member you just type in your address and it will, auto-populate all of your legislators. I actually think it does federal and at the state level too. So one way, but if you want to do it, you know, without that you could also, for federal, you could go to gov track.us, and that would look up your federal legislators, but then at a state level, your state Senator, and your state house or assembly person, you would have to just probably go to the, each one's website and look that up. Like in New York, we have a state assembly and state Senator website that you can search it for. So it's not that hard.
Speaker 4 (18:13):
Okay, awesome. Very easy. So people people understand how simple it is. Just one click or one downloaded app. So now let's talk about the act of advocacy, right? So we talked about why you wanted to be an advocate, how to find those legislators what bills are on the docket? How do we reach out to advocate? How do we do it?
Speaker 3 (18:37):
So the traditional way of advocacy is what we call lobbying. And that would be to go in person to have a meeting face to face with your legislator and ask them to do what's called co-sponsor the bill. That means like, say for the tele-health. If we have a bill number that has been introduced into the Senate or the house you would go, and you would ask them, would your member of Congress sign on to that bill? And then when you get enough co-sponsors you can get a vote. And that's how the bill can get passed into law. So that's traditional. And we can do that both at the federal and the state level. You could go to your state Capitol, like here in New York, it would be Albany. I could go there. So you can do advocacy, AKA lobbying to either one of those, but there's some stumbling blocks with that, that I found people.
Speaker 3 (19:30):
One are a little bit intimidated to do that, too. It can be far three. You have to take off time from work, usually because it's only during weekdays. You know, for me, I live in Brooklyn, Albany's a hike. So it takes a while. So there are some stumbling blocks with that, but that's their traditional way. It is a really fantastic experience. Anybody who wants to can come to Washington DC, the APGA does have a federal advocacy forum every year. It's generally in March this year, it will be in September because of the Centennial, but it's pretty exciting to walk the halls of Congress. And hopefully, you know, the country opened back up and we can have those face to face meetings this year. We did those kinds of meetings, virtual on zoom. It was okay, but I wouldn't say exactly quite the same energy.
Speaker 3 (20:15):
So that's the traditional way. But here comes my favorite part. I call it armchair advocacy. Literally things you can do while you are just sitting, you know, watching a movie, half watching. So there are things you can do where you can you know, go to the action app. You can fill out one of the templates there. The APGA has made for you where you can just send an email. You can go to your legislators own website and send them an email. There. There's always an email me button. You could just donate some money to PT pack to let other go do these things for you, let your money do the talking. But one of my favorite ways would be Twitter, right? So Twitter is free. Your legislator has an account. They're always there. You can follow them. You can like them. You can engage with their tweets.
Speaker 3 (21:05):
Just yesterday here in New York city, you know, speaking of legislators, I heard that mayor, bill de Blasio, he had to stand in line to go to early voting for three hours and he was complained. His back was her. And so I sent him a little tweet saying maybe he needs some physical therapy. So, you know, they're always on Twitter and you can send them a message anytime you want. You could also send them a message asking them to co-sponsor bills. I send out tweets to them doing that all the time. But one of the amazing things that I love about Twitter is you find like-minded individuals, you support them, you amplify their message. And, you know, you can kind of collaborate with people on advocacy there. Some other ways is that your member of Congress generally has virtual town halls these days, and they will post it on Twitter or Facebook usually only a day or two before. So you have to kind of watch out for that, but you can attend the virtual town hall and you can make comments and you can ask questions. I've been to several of my members of Congress town halls, and I asked them questions. I asked them about the 9% cut. That's something I will use support, you know, revoking this 9% cut. Those are the questions that I put in there. So, you know, lots of ways that you can do the armchair advocacy.
Speaker 4 (22:19):
And can you also talk a little bit about the key contact programs? So there's key contact programs. I know for APG as a whole, we're both part of the private practice section. They have key contacts. So what exactly is that and how can someone get involved if they're, if they want?
Speaker 3 (22:39):
Yeah, so AVTA has good point. APGA has key contacts and basically what a key contact is. It sounds a little bit more involved than it is. It just means that you are going to be that liaison to your member of Congress. That you're going to basically try to let them know what it is physical therapy does. And you're going to ask them to co-sponsor our bills. So the ask is, and you can be an apt, a key contact. And if you're a member of the practice,
Speaker 4 (23:06):
Have a
Speaker 3 (23:06):
Practice section, you could be a PPS key contact, and you can be a key contact for both APA and PPS. If you remember PPS. So what you would do is whenever there's a bill coming out, like say, there's going to be something coming out about the 9% cut. You would get an email from the key contact email list or from the PPS key contact email list. And it would just say, send this email and they generally give you a template. You could just copy and paste and you could send them the email on their website. You could send them a tweet. You could call the office. It's basically just asking your member of Congress to support our legislative agenda and our bills. And you would do that, you know, through those pushes. And then in August, we have August recess. When the members of Congress, your Senator and your house person comes home to the district to do district work. And generally we ask you to try to get a meeting with them, either on phone or zoom or in person, you know, before COVID to ask them to co-sponsor some of our bills then. So it's, you know, really a big push in August for those August recess meetings. But throughout the year, it's just a little pushes for the current bills that are going on. So it really doesn't take that much time. And how successful
Speaker 4 (24:19):
Are the, is the key contact program
Speaker 3 (24:22):
It's very successful because the whole point is good point. I forgot to mention this most members of Congress. If I called up your member of Congress, he is not going to be so interested in me because I'm not a constituent, that's the magic word. I don't vote for him. So yeah, he will care what I say, but his ears are not going to perk up as much as if you called because you are a constituent. So that's what key contacts are. They are a voting member in that person's district, AKA constituent. And so then the member of Congress cares more and they will listen more closely to that person. So you become that link, that voting constituent between the physical therapy profession and your member of Congress. And it's been very successful. We've had a lot of people sign on to bills, you know, currently with the 9% cut. I forget how many people signed on recently to a congressional letter, but it was the most that we've ever had. It was I think a couple hundred. And you know, hopefully that's something that we can get overturned and that's because the key contacts reached out to their member of Congress to ask them to sign on to this congressional letter.
Speaker 4 (25:31):
Yeah. So for me, what I'm getting out of this talk is that there's so much happening behind the scenes to advocate for our profession and advocate for our patients. But I think a lot of people don't realize, and if you want to make a change, then you have to let your voice be heard and advocating for the profession, whether you're a key contact or you're sending a template letter that you can easily get on the app is such a great way to get involved. And it doesn't take a lot of time. It doesn't take a lot of money and it's a way to help advocate for the profession and push us forward. So, you know, it sounds cliche, but like you, you want to be the, what is it? You want the change you want to be in the world or something like that, but be the change you want to see in the world. So if you're not in it, then, you know,
Speaker 3 (26:25):
Yes, absolutely. One thing I did want to mention is that APA has something called the advocacy network. If you just Google APJ advocacy network, it will take you to that link sign up for that newsletter, basically, that is part of the advocacy army. And you will get all of the news alerts of what's going on and they will send you, you know, literally a template that you could just fill out. We have this thing called voter voice, which it's just a automatic template. You input your name and address, and you can fill that out and you send a letter to your member of Congress. So sign up for the advocacy network. That way you'll always know what's going on. I am in a lot of Facebook groups and I see people upset and complaining. And I understand I used to feel the exact same way, but they are some uninformed and don't know what's going on. So join the network, know what's going on. You know, I always say one of my things is that I firmly believe the bigger voice, the bigger impact. If we can get a bigger collective voice, we already have a pretty big one, but let's make it louder. You know? And let's, let's make more of an impact and see real change because legislatively is the only real way to make the system different.
Speaker 4 (27:39):
Absolutely. And I was going to say what, you know, as we start to wrap things up, what do you want people? What's the message that you want to leave for the listeners, but I think you just said it, is there anything you want to add to that?
Speaker 3 (27:53):
Yeah. Join the advocacy network. And honestly, I would say, you know, don't be afraid of Twitter and come on Twitter because you can, we can build the army because when other, when you say something on Twitter and then you can amplify each other's message and then it kind of catches on and people, people, you know, get more informed and you can spread the message. So being able to amplify and spread the messages.
Speaker 4 (28:15):
Awesome. And now, before we leave, I'm going to ask you the same question I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad, fresh out of physical therapy school?
Speaker 3 (28:32):
I would say get good at what you do, your skills of being a PT. That was really important to me at first, but don't forget the professional aspect of it. That was something that I was lacking. And I think that, you know, recently I was also featured in an article for APGA on burnout that just came out last week. And I think that that was one piece I was lacking and being involved professionally in advocacy and not just, you know, becoming a super PT and good at my hands. But having that professional aspect, I think also does help prevent burnout because you, you see that there's a bigger mission and you see that there's something beyond yourself and you're fighting for that bigger mission and you feel part of the community. And I think it's
Speaker 4 (29:16):
Awesome. Great advice now, where can people find you? Where, where are you on Twitter? You mentioned a couple of times and then give us all the info.
Speaker 3 (29:24):
So of course I'm on Twitter. It's Theresa T H E R E S a Marco, M a R K O P T. And then I'm also on Instagram, dr. Theresa Marco, and I have a Facebook page, Marco therapy
Speaker 4 (29:42):
And LinkedIn too. You can find me there. Teresa Barco. Perfect. Very easy, very easy, very easy. So listen, if anyone has any questions, they want clarification on advocacy, Theresa is your go-to person. So I encourage you to follow her on social media to reach out with any questions because she will get back to you. So, Teresa, thank you so much for coming on and giving us such a succinct and informative episode on advocacy. Thank you so much. Thanks for having me and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Speaker 2 (30:19):
Thank you to Teresa. So hopefully now everyone has some good action items that they can add to their list, to become advocates for physical therapy. And of course, thank you to net health for sponsoring today's podcast. They have created the Redarc patient portal, which provides a secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages to learn more, contact them at redox that's R E D O C at net. Hell.Com.
Speaker 1 (30:59):
Thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Gina Kim, PT, DPT to talk about making the move from a physical therapist assistant to a physical therapist. Dr. Gina Kim is the owner of Maitri Physiotherapy, LLC in Central Ohio, the producer and host of The Medical Necessity Podcast, is certified in Integrative Dry Needling, is pursuing certification in MDT, and also uses her 10-year background in Tibetan Buddhism to educate her clients in mindfulness meditation.
In this episode, we discuss:
- How to transition from a PTA to a PT
- What is a bridge program for PTAs
- The benefits of being a non-traditional physical therapy student
- The ups and downs of physical therapy school while juggling work and life commitments.
- And much more!
Resources:
Maitri Physiotherapy, LLC
Dr. Gina on LinkedIn
Dr. Gina on Instagram
Dr. Gina on Facebook
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
More about Dr. Gina Kim:
Dr. Gina originally wanted to play the trumpet when she grew up. Performance anxiety in high school changed her mind. But what was more worrying was the low back pain that began around that time. She endured that pain for years, but X-rays and muscle relaxers didn’t help. She was fortunate to work with a physical therapist.
Being free from back pain was so dramatic that she decided that’s what she wanted to do with her life: Help people change their lives by treating pain, especially back pain, without drugs or surgery.
She stated at the bottom as a rehab aide. Next, she earned her license as a Physical Therapist Assistant and worked for years in settings ranging from outpatient orthopedics to acute care to home health. While working as a PTA, she completed her Doctorate through the University of Findlay Weekend College Bridge Program.
Dr. Gina is certified in Integrative Dry Needling, is pursuing certification in MDT, and also uses her 10-year background in Tibetan Buddhism to educate her clients in mindfulness meditation. She is also the producer and host of The Medical Necessity Podcast.
Read the Full Transcript below:
Speaker 1 (00:01):
Hello, Gina. And welcome to the podcast. I'm so happy to have you on,
Speaker 2 (00:06):
Well, I'm happy to be here, Karen.
Speaker 1 (00:08):
So you've got two podcast hosts here. So now you're on the other side of the mic.
Speaker 2 (00:15):
Oh goodness. It's great to be.
Speaker 1 (00:20):
So today we're going to talk about sort of your non-traditional route to becoming a physical therapist. So as, as a lot of people know, or maybe some listeners don't know the physical therapy profession, we're now a doctoring profession. So people are going to school for an undergraduate degree and then usually going right into physical therapy school as their graduate school of choice. But Gina made a definite detour from college through to where she is now as a physical therapist. So I will throw it over to you, Gina, and just kind of tell us your story, because I'm sure it will resonate with a lot of people.
Speaker 2 (01:04):
Oh my goodness. So my bachelor's is in computer science and I won't say how long ago, but let's say windows 95 was the hot new thing. Everybody was getting a computer science degree. I was even, I was even a company's webmaster for a time. So here's the thing, here's the thing. I have zero patience for technology longstanding low back issues. Okay. And especially sitting at a desk job, you know, we all, you know, PTs, you know, now I, now I know well when I was working one particular job, you know, and couldn't take the back pain anymore. And what do I do? I go to see my, go, to see my family doctor and it's x-rays and muscle relaxers, and guess what? Didn't help shocker shocker. And I can't tell you how many years passed between then. And finally, someone I remember I had hired a personal trainer who was himself, a physical therapist, and he said, Oh, you need to see someone who really specializes more in the low back, you know, cause so sky was kind of more on the equipment sales end of things.
Speaker 2 (02:38):
So I found I found my PT and he it's it's so trite, you know, saying he did his magic on me. It's like, I know what he did on me now. But I went from unable to touch my toes. You know, being in pain, you doing, doing that shuffle walk too. Hey, I don't hurt anymore. Yeah. And his reaction was right. And I'm like, wow. And I kind of went away and being kind of in the transitional phase that I was in with a kind of not loving, you know, computer, you know, computer science, you know, that kind of field and also being kind of a gym rat myself. So I was hanging, I was hanging out with with my PT and kind of, you know, kind of doing my own observation hours and doing my due diligence and asking about the education and everything.
Speaker 2 (03:46):
And he said, well, you know, because I was already I think at that point out of my twenties, right. He S he said, well, you should think about getting, becoming a PT assistant. So I looked into that, it's like, okay, I've got my bachelor's let me go to community college now, which, which involved you know, of course there was like a well years waiting period. And, you know, so I'm taking my anatomy and this, that, and the other completed that in 2013 and then worked as a PTA and all the time thinking, you know, I, I just want to go ahead and be able to practice on my own. So then that led to well basically looking at my, looking at my options for grad school and especially being someone by this time, let's see, what was I doing?
Speaker 2 (04:57):
I, I was, I w I'm trying to think about my day as a, as a like during my PT assistant time, I was going to school and then going to work as a rehab aid. And that at night I was going to skate with the Ohio roller girls. It's like, I don't know how I did it. So then I'm thinking if I go into a graduate program in, you know, physical therapy, I there's going to be this age difference at age and experience difference. And I remember I interviewed with one school and the she was, she was the admission secretary. And I won't say which school, but she said, you know, people are working later in life.
Speaker 3 (05:55):
Yeah. Yeah.
Speaker 1 (05:58):
So I,
Speaker 2 (05:59):
I had heard about the bridge program up at university of Findlay. We can college bridge program. So that required preparation, as far as retaking physics taking, you know, my chemistry series, you know, thank goodness I had already taken exercise fits, but doing, you know, doing the thing so I could apply. And then that I got in, and at the same time, I was still required to work as a PTA as we went up to Finley every other weekend. And when I say we, I say, I met with my cohort from who came in from all across the country. So I had a two hour drive. There were people flying in from Seattle.
Speaker 1 (06:51):
And where is, so is Findlay college in Ohio
Speaker 2 (06:55):
And like colleges in North West.
Speaker 1 (06:59):
Okay. And can you explain a little bit more about what a bridge program is, should that people kind of understand what that means from like a PTA to a PT?
Speaker 2 (07:10):
Sure. So it's a bridge in the sense of you're a PTA and you want to become a PT, here's the thing. You will need your bachelor's degree. Okay. So I had that check you know, plus prerequisites, you know, check. And then since part of the requirement for working was to help with assignments that we would have, you know, and we would be given so we could focus more on the evaluation part of because we were all over the treatment part, you know, and there were people in my class who were already directors of rehab. So I, I was in a very very well-experienced and pretty, pretty smart class. It was, it was pretty intimidating. But also you get that benefit from, you know, all this co-mingling. So then it's basically like any other DPT program. It was three years, you know, with clinicals at the end, and then you take your boards and your, then I became dr. Dr. Gina.
Speaker 1 (08:38):
Right. And so within that, those bridge programs, how many of those programs exist in the United States?
Speaker 2 (08:46):
My understanding is only two, this one and one in Texas whose name is escaping me. Right. But but yeah, and here's the thing too because I always always kind of had in the back of my mind, well, I can always apply to the bridge program. It was, it was kind of like in my, in my back pocket, right. University of Findlay is a private school. So you also have to keep in mind the two wishes that goes with it, right. Plus travel accommodations, and also time off work when you need to, you know, do certain things, you know, such as your, your research and projects and, and all that. Right.
Speaker 1 (09:38):
And when it comes to then your clinical affiliations. So at that point, do you have to leave your PTA job in order to do your clinical evaluation or your clinical placements?
Speaker 2 (09:50):
Yes. And I would say it was a little messy because we were, we were pretty much we work, we were kind of responsible for finding our placements. Right. so yeah, so then you are going off, you know, working someplace now you don't have the income. Okay. So you have, you have that to deal with. And there were Oh, I don't even know how many people in my class had children, some had young children but you know, somehow they managed, you know we got a big heads-up from the class before us, you know, like in our orientation, spoke to us and said, you guys are gonna need a team to help you get through this. You have to rely on each other. You have to rely on your spouses, your partners, your friends, you know, some things as basic as have a food plan. And I'm not even kidding because, you know, between, between working, coming home and studying, you're done, you're done. You know, so my, my husband, you know, I, I started out, you know, like with the food prepping and the making the healthy food and every, by the end, we're eating pizza.
Speaker 1 (11:26):
Yeah. I was going to say, are you going to be, yeah,
Speaker 2 (11:30):
Can you, can you please, you know, pick up, pick up something? Yeah,
Speaker 1 (11:34):
Yeah. It's it's pizza and take out at the end. So I think that brings up a lot of really important considerations for people. So if you are a physical therapist assistant and you are looking to become a physical therapist, we know there are maybe just two bridge programs in the United States. And that there are a lot of considerations that you have to think about before you go into that program. Like when did you do your clinical placements? You kind of can't work at your job as a PTA anymore. Right? Absolutely. And what did you do? What would be your best tips for time management? We know, obviously you just gave away that by the end you're it's pizza and take out now I'm just joking, but what, what are some good tips on, on time management, as you said, you have to study, do research, and you're still working as a PTA.
Speaker 1 (12:33):
My, my time management, I think number one you know, God love him. I, you know, I have cats, I don't have children, you know, on it, honestly, I didn't know how the parents did it. And I think they were even better time managers than I was. So for them, it was, you know, working around, okay, the kids, the kids are in bed or it's before the kids are up. And for me, it was kind of the same thing. Like if I wanted to, you know, spend time with my, with my husband, you know, occasionally it would be up, you know, first thing in the morning because I'm more I'm and it also depends, you know, if you're morning person, evening person, you know, cause I'm like out like a light, you know, if I've got something to do, I'm up at 5:00 AM, no problem.
Speaker 1 (13:32):
And I guess the thing that I'm taking away here, and this, this might be my like naive T here, but I thought like a bridge program going from a PTA to a PT would be, I don't want to say easier than your traditional program, but that, because you're already in the field, that it would be easier. Do you know what I mean? And that's clearly not the case. Like I didn't realize it was three years. I thought, Oh, maybe it's like two years and most of it's clinical. So I think this is really painting a clearer picture for people of like, no, this is still a three-year commitment, three years of financial commitments, perhaps loans, everything else that goes along with it. Was there anything about the bridge program that surprised you? Because I'm surprised number one, that it's three years and that it's, you know, I don't, I don't know what I was thinking, but this was not it. So I'm glad that you're bringing all this up. So is there anything about the program that really surprised you?
Speaker 4 (14:35):
And on that note, we'll take a quick break to hear from our sponsor and be right back with Gina's answer. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for tele-health secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com.
Speaker 2 (15:23):
Biggest surprise for me was for a program that had been a browned, as long as it had been that we still had to work around a university and kind of the cap, the system that I think really, really wanted us to be a traditional program, you know in the sense of, for example, I know after us clinicals were starting to be changed to, I think, get people into the field earlier, which was, which was, you know, once again kinda messing with people's employment. So they were, they were serving us, you know, would you prefer, you know, to do like two weeks at the beginning and we're thinking, well, how, how are we going to do that? If you know, our, you know, our clinic, our staff, you know, wherever we're working needs us. Yeah. Not that, not, not, not what you would have expected.
Speaker 2 (16:32):
And yeah, I guess the next question is and you sort of alluded to this when you said you were looking at other physical therapy programs and the woman said, Oh, well, you know, people are working later in life, but let me ask you, which is kind of an interesting thing to say, but what, what do you feel like, or would you feel that you're kind of coming into the doctorate of physical therapy, not coming straight out of high school or straight out of college? What advantage did that give to you? Coming into the field as a newly-minted DPT? I think it gave us a huge boost of confidence because I know that in, in my career, as a PTA, I worked for probably a dozen different PTs seeing how they worked you know, what what they could have done better, you know, what they did great how patients responded, you know, and plus you know, I've, I've got all my treating already, they're already in place. Okay. so I even, I even find it a little hard to imagine. Wow. If I were, if I were coming out of a traditional program and I've heard this spoken about a little bit of, you know, just trying to build that confidence in that first year. Well, I came out and it was kind of like, well, you know, I just had evaluations to what I'm doing.
Speaker 1 (18:20):
And when, let me ask you this, when you were a physical therapist assistant, what was your experience like as a physical therapist?
Speaker 2 (18:31):
It really depended on the PT. A lot of them, I felt had a lot of trust in me because they, you know, they saw that, you know, their patients were getting results and I had good rapport with them and, and so forth. Had a few, it became, it became a little more interesting once I was in school. Because I know there was, there was one particular person who he was, he was pretty fresh out of school and he seemed to want to challenge me a lot, like, you know, kind of like, you know, pop quizzes and, you know, things like that. It seemed a little light gatekeeping a little bit. But I mean, that was, you know, that was minor compared to, you know, the other the other PTs that I worked with.
Speaker 1 (19:33):
Yeah. Well, that's interesting. I know, cause I, I, I often wonder what that experience is like. And then, so for you moving from the physical therapist assistant to the physical therapist was all about having a little more autonomy and agency over your career, is that right? Absolutely. Yeah. And when you graduated, what were your, how did you feel then? So, you know, cause it's, it's, it was a difficult to make that transition. Did you kind of fall back into old habits after you graduated? Or was it more like I got this, I'm doing it,
Speaker 2 (20:10):
You know, I, I would think it, it really felt like I was ready for this. Now, the part that I didn't expect, and I think this was from my experiences in my clinical rotations as a PTA and then do it in doing it again as a PT and also couple of affiliations. They were kind of more in kinda more of those mill like settings. So I didn't go into PT school thinking I'm going to become a owner, but once I was finished, I was adamant that I needed to create my own career.
Speaker 1 (20:57):
And you knew that. So when did you graduate from physical therapy school? Couldn't get your DPT.
Speaker 2 (21:03):
So let's grow graduation was end of 2018. Yeah. And then test it for my boards in what was wow. May how, sorry, how soon we
Speaker 1 (21:20):
Forget. I know you seem to have blocked that out.
Speaker 2 (21:22):
Yeah. I'm sorry. April, April. Okay.
Speaker 1 (21:25):
Okay. So, so it sounds like the experience that you have previously really set you up to then say, I'm ready to, to become that entrepreneur. I'm ready to kind of do this.
Speaker 2 (21:39):
I think as far as mindset. Yeah. Still in our, our business class was kind of the classic. Okay. Let's write a business plan about how to build a brick and mortar clinic. So then the business knowledge some of, some of it I, you know, took away from the free resources on the AP TA website but being a solo clinician and cash based I felt that I needed to look for kind of more support, you know, as far as networking and, and all that. And because I was dealing with different issues than say a larger clinic with, you know, accepting insurance and several therapists and whatnot. Yeah.
Speaker 1 (22:38):
Right. So, I mean, and of course, like moving on through the business, that's a whole other discussion, which, you know, maybe one day we will have on here as well. But what I think it's important to note is that, you know, you mentioned it briefly is the mindset part of it. You're like, Oh, I had the mindset part and kind of skimmed over that. But that is so important because like I said, when I graduated from PT school, no way in hell, did I ever think I'd be able to own my own business? Just wasn't even on my radar, you know? So what advice would you give to, I guess, newer, newer grads, whether they're traditional or non-traditional like yourself who are thinking about starting their own practice
Speaker 2 (23:25):
To find people in and hang out with people who, who were doing what you would like to be doing, you know? Yeah, there were already folks in my class who, you know, they were, they were having their plans in place. Like one of them was going to be, become a partner in a clinic. You know, I mentioned several were directors of rehab someplace, another guy he already had, you know, his his athlete and sports training practice up. I mean, he was, I mean, he was running that well, he was doing everything else.
Speaker 1 (24:07):
Yeah. So it seems, I think what's so interesting is, is that sort of non-traditional path to physical therapy. It seems like it, you know, because people have already gone through so many life experiences or maybe different jobs and they feel like, boy, they're really ready to be in the space that they're in and own it. Yeah, absolutely. Yeah. Yeah.
Speaker 2 (24:34):
And I definitely, I definitely know that confidence was there. And even, and at the same time, I know of a few classmates, they were already looking at residencies, you know, they were looking at specialization.
Speaker 1 (24:54):
Yeah. So, I mean, I, so I think to my big takeaway here is to all of the more traditional PTs out there who maybe have a non-traditional student or a physical therapist in their class, or who are in class with people who may be were our, our physical therapists assistants and, and going for that DPT is to make sure that you seek them out and learn from them because they've got these life experiences that when you're 21 and 22, you just don't have, you know, and so seek those people out in your class and, and definitely learn more about them and learn where they're from and where they want to go. Because I think that as a, not as a traditional student, and when I say traditional, I mean, you know, you came out of high school, went to college and now you're in PT school is sort of straight linear track. That there's so much more that the non-traditional student can can offer because you've got some more life experiences under your belt. Absolutely.
Speaker 2 (26:05):
Let me add another point to that. As far as the confidence part, because especially working with older clients, they seem to have a little bit more comfort working with someone my age.
Speaker 1 (26:23):
Mm. Yeah. And yeah, that makes sense. Sometimes kind
Speaker 2 (26:29):
Of already assumed that I was a PT
Speaker 1 (26:33):
Working there even as you were a physical therapist assistant.
Speaker 2 (26:41):
Yeah. As I said, I was a student
Speaker 1 (26:44):
Yo, as you were a student. Yeah. Oh, that's interesting. That's interesting. Yeah, yeah, yeah. I didn't even think about that. So, so the, the confidence, not just that you exude, but that, that the patients can kind of feel it and yeah, that's interesting.
Speaker 2 (27:01):
Yeah. And also I think the the ability to quickly develop rapport and all those, all those good skills, you know, like listening and responding and, and hearing and seeing how people are presenting instead of, you know, being, you know, well, you know, I'm still learning these basic you know, I have to learn all the things I, I have to learn how to evaluate, you know, but also how to treat and progress and this, that, and the other I've already, I've already got the, you know, I'm already thinking ahead, you know, to what their course of treatment is going to look like, you know, because I've seen it. Right.
Speaker 1 (27:47):
Yeah. You've got the experience. Yeah. Yeah. And experience, as we know, is, is so important. So, so let me ask you as we start to wrap things up here. So I gave you what my biggest takeaway was, what's your biggest takeaway and what would you like the listeners to take away from, from our discussion of your journey of this, of being a non-traditional PT?
Speaker 2 (28:10):
My biggest takeaway. So you have the benefit of the non-traditional experience, you know, meeting all these people with different, you know, different knowledge bases and certifications and things like that. Also at the same time, there's a, there's a challenge to doing things such as, you know, say going to a conference, you know, like CSM, because you're, you have to think about, you're going to be in school when a lot of these events happen. So it's like you, if you really, really want to go, you have to plan, you have to make plans for it and, and, you know, get, get an excused absence, you know, for want of a better word. So that, that can really, I, I think you need to then really, really work on your networking when you're finished. I think because of that. Yeah.
Speaker 1 (29:20):
Yeah. That may be aware of that. Yeah. Yeah. Yeah. That makes a lot of sense. And then, you know, I'll ask you the same question I ask everyone, and that's knowing where you are now in your life and in your career. What advice would you give to your younger self? And let's not say when you graduated PT school. Cause that was like a year ago. So let's maybe go back little bit more like maybe when you graduated undergrad or something. Yeah.
Speaker 2 (29:45):
Back in the day. Not, not everyone who gives you advice knows what they're talking about.
Speaker 1 (29:58):
True story. Yes.
Speaker 2 (30:00):
Because that's how I ended up in computer science, which was not the right career path for you, which was not the right career path. Right? Yeah. So yeah, the thing, the thing that I wish I would have done a lot more of was extracurricular, so I could have, could have known myself a whole lot better. That's great. But to make, yeah. To make make a better guided choice.
Speaker 1 (30:29):
Mm great advice now, Gina, where can people find you? So first of all, talk about your podcast and then where can people find you?
Speaker 2 (30:36):
I would be happy to, so I am the producer and host of the medical necessity podcast where I help guide people through the flood of medical information out there. I love it. Yeah. Available on wherever you get your podcasts, pod, bean, Spotify iHeart radio at iTunes and my business is called my tree physio-therapy LLC. You can find me@maitri.physio. And I practice in Ohio. I'm licensed in Ohio. I bring a world-class world-class physical therapy to your home or via tele health. So you can, you can find me there and I would love to treat that
Speaker 1 (31:36):
Awesome. Well, we will have all of the links to everything at the show notes at podcast out healthy, wealthy, smart.com. So if you didn't, weren't taking notes, don't worry. One click will get you to everything, including your website and your podcast and social media as well. Jean has got a great Instagram page where she shares a lot of great free information with everyone. So you'll definitely want to check out her Instagram, what's your Instagram handle
Speaker 2 (32:06):
At medical underlying necessity.
Speaker 1 (32:09):
Awesome. So Gina, thank you so much for coming on. This was great. And I think it gives people a lot to think about, especially those physical therapist assistants out there who may be there on the edge, maybe they're thinking, Hmm. Do I want to go on? So I think you gave a lot of great information, a lot of great insights, so I appreciate it.
Speaker 2 (32:30):
Well, thank you. And I hope absolutely anyone who has questions about this bridge program, feel free to reach out to me.
Speaker 1 (32:39):
Awesome. Thank you so much. And everyone who's listening. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Smith, PT, DPT to discuss how women can cultivate their core confidence. Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically, women who wear many hats and desire to leave a legacy with less burnout and greater personal joy.
In this episode, we discuss:
-How women focus attention on external approval and achievements/external successes.
-Why we need to be connected, aware and in tune with our pelvis.
-Messages the pelvis (and body) may be giving us that we are missing
-Core Confidence-what it is. why it is so important
-How does reducing urgency in daily life payoff- how the mental affects the physical body.
-How mental and spiritual Core Confidence and awareness of our Core can affect physical core strength.
Resources:
Dr. Sarah’s Facebook
Dr. Sarah’s Instagram
Dr. Sarah’s LinkedIN
Activate Your Core Confidence Workbook
Discover Your Joy Coaching Session w/ Dr. Sarah
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
More Information about Dr. Smith:
Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically women who wear many hats and desire to leave a legacy with less burnout and greater personal joy.
Her unique approach focuses on connecting women back to their Core which holds authenticity, choice and immediate solutions so one can thrive both personally and professionally in all life situations.
This activation is vital so that women leading their families, communities and companies can stay fully present in all situations in order to
- Communicate & interact authentically and calmly
- Finally feel their private life & success matches their professional success with greater freedom, confidence, peace, focus and direction.
- Flow through daily tasks and commitments with more focus, ease and an organized plan
- Improve physical strength & major health gains
- Live Wild & Bright- meaning! connected to our true, authentic, soul calling
She has blended her professional expertise as a Doctor of Physical Therapy- specializing in Women’s Health and Chronic Pain Management, Certified Yoga Instructor & Certified Wellness & Life Coach. With every personal & group experience Dr. Sara Smith offers, she is dedicated to the goal of assisting women of all ages to step back into their Core Confidence.
Read the Full Transcript below:
Speaker 1 (00:01):
Hey, Sarah, welcome to the podcast. I'm happy to have you on,
Speaker 2 (00:04):
Thank you so much for having me, dr. Litzy. It's glad to be here.
Speaker 1 (00:08):
Yeah. And so obviously I'm a physical therapist as are you, you have specialized in pelvic health and women's health, and then you have also kind of made that transition for at least part of your career into coaching, mainly other women from around the world. So before we get into the meat of the interview, I would love for you to share with the audience a little bit about your sort of career trajectory.
Speaker 2 (00:40):
Absolutely. Yes. So it's a, it's a little professional and it's a little personal, so it's the story tends to track with a little bit of both. I also went and got my yoga certification and that was actually the first thing that I did after physical therapy, you know, from, from physical therapy. A lot of that came because you know, in our profession we have a high turnaround and burnout ratio there at times. And I was a chronic fixer and helper and I was good at what I was doing to the point where I, you know, anybody came in and I was ready to, you know, help them with their issue. And so I went to my first yoga class, really just to chill myself out, get a little bit grounded and get, get real. And then from there it really almost overnight, it, it drastically shifted the way I was showing up and treating my patients at the time.
Speaker 2 (01:42):
I realized that kind of less was more, I realized that it was more important for me to listen instead of coming in with a plan and, you know, my own action sheet and really meeting people where, where we were, I think I was always empathetic, but it, it really enhanced that. And on top of that, I stopped getting sick. I was averaging, you know, a sinus infection once a month and just burned out already and young because I didn't want to, you know, you didn't want to fail having that syndrome. So really yoga kind of came first and then that solidified me for a while. I kept into the physical therapy world. I've always lived in rural areas in Virginia and I was on the Eastern shore of Virginia and I'm an only child. So I do like to be the only one doing something I like to be a little special.
Speaker 2 (02:40):
And, and so I realized nobody in the area was doing pelvic floor work. I had in all of my internships had some sort of connection to pelvic floor and women's health work. So I, I learned about it. I kind of knew about it. I didn't know if that was something that I wanted to get into. But I knew that it was a niche in the area that I was in. And so it was when I got into pelvic floor physical therapy work that I really professionally started to see this and, and chronic pain management has always been something that I just love helping people that have been to lots of therapists, physical therapists, and in there need assistance with that. But I was just seeing this mind body connection. I was seeing how with all of these individuals, and for some reason, I just happened to be working with a lot of leaders, professionals, directors, CEOs, you know, it just was kind of happening that way.
Speaker 2 (03:41):
Even some like rockstars lawyers, I don't know, Olympic swimmers, all these different people and stress was also happening mentally. You know, there were things going on either in their personal life or their professional life. That just seemed to be kind of also coming into what I was noticing in their physical body. So I was learning about it personally and just my own interest. And then I also was seeing it professionally and I was seeing when I started incorporating some of the yoga, you know, some of the mindfulness based practices and stress management breathing that I was getting better results. And I just am a result junkie. You know, I'm not interested in putting a patch on something. I want somebody to come back to me six or seven or 10 years later and be like, I'm still using what you did. So there was that.
Speaker 2 (04:34):
And then on top of that what I got into pelvic floor therapy, my started having children and my, our, our first child who's now seven was we found out at a very young age that he had an ultra rare genetic mutation. So it was de Novo. It wasn't for my husband or myself and severe speech apraxia. So I started getting, you know, deep into the world of executive functioning and,ureally learning more and more about kind of, I always loved the nervous system, but, you know, I became even more fascinated with how to manage that,uand, and work with it. And so that, those two things kind of happening simultaneously are what brought me into, into coaching. Umnd specifically working with female leaders, hecause that, I don't know, that's just like a deep within personal mission is I feel like women are here to make a major contribution.
Speaker 2 (05:42):
I feel like the time, the time is ripe, the time is now. But we've learned and write in it in a great way. We've learned from a very male dominated structure,uwhich doesn't always work for women. And,uit can, it definitely works. It's not that it's, you know, not working, but there, there are some things that need to slightly shift and,uI'm just, I really want to be able to contribute to women, being able to be in these leadership roles and do it without as much burnout do it without as much self-sacrificing,ufamily sacrificing community sacrificing. Uso yeah.
Speaker 1 (06:32):
Awesome. Well, thanks for that. Thanks for kind of letting the listeners get a little bit deeper into kind of who you are and why you do what you do, because it all leads into our discussion today. And it's, it's really all about as you say, why we need to be connected, why we need to be aware and in tune with our pelvis. So as a physical therapist, we can all agree that yes, we need to be in tune with that area. Everyone has a pelvis, everyone has that musculature and, and the functions of but coming from, I think your unique perspective of both physical therapist and coach and looking really beyond just the pelvic floor, which we should all be doing anyway. So, so give us your take on why we need to be connected.
Speaker 2 (07:25):
Yeah. You know, I've seen in, in the realm of success, leadership, entrepreneurship anybody who's, who's type a you know, th there's a lot of overthinking long to do lists. There's a lot of being up in our head, you know, w where do we go next? And I say, we, because this, you know, I've, you're only a great teacher if you've been there yourself, right. And, and are still in the depths of it. And so, you know, we th there's lots, that's constantly swirling up in our head, but we also know, and, and, you know, a variety of different resource research sources have shown us this, that we can't access all of the solutions to our biggest professional, personal life challenges. If we're in constant thinking mode all day long, not to mention, you know, roughly 80% of all thoughts are habitually negative, which is not very helpful for solving problems. And so the reason that I am so drawn to what I call, you know, well, it's not just me calling it a core confidence and getting people specifically into their pelvis and back into their body is, is reducing the overthinking so that we can access again, creativity, focus, productivity, you know, improved, sleep, stress, relieving, you know, hormone responses. You know, I could, I could go on and on.
Speaker 1 (09:01):
Yeah. And so you brought up the, the the words, core confidence. So can you explain what, what does that mean? Because I have a feeling it may mean a couple of different things to a couple of different people, but in the work that you do in helping people become more productive, improve their leadership, improve their life, what does that, what does core confidence?
Speaker 2 (09:28):
Yeah. I love how you said that, you know, it means something to, there's lots of different ways to describe it in there. There really is. You know, to me, and also the, the clients that I've worked with for many, many years now, it means freedom. It means expansiveness. It means seeking joy. It means effectively, you know, being effective at what they do. Meanings means also having more energy core confidence really is being able to go within yourself and access that wellspring of inner wisdom really access your, your yes or no. And a lot of times, and this is, this is actually comes from, from those in the research field. Core confidence also is a mixture of self-efficacy of hope of optimism and resilience. External confidence. I don't think we should be talking about core confidence without also touching on external confidence and external confidence is what the majority of us learn to, to seek after.
Speaker 2 (10:43):
And we're constantly seeking after it. The external confidence is, you know, does dr. [inaudible] Like me, or, you know, what I should be doing right now, or, you know, these are the, the, the dreams that, that others are doing. So this marketing strategy has worked for them. This app has worked for them, let me do this, let me, you know, follow this meal plan. And so, you know, we're constantly as humans chasing others, things that have worked for them. And, and we're very often, again, not realizing we're up in our head and we're not really checking in with the, the little voice that's like, that's kind of a waste of time.
Speaker 1 (11:32):
Yeah, totally. I, I always find that it's so much easier to look for that external validation and get our confidence from that external validation, then what we do than what we think we are doing. Does that make sense? Solutely yeah, so I, I mean, and, and we're all human and all humans fall into that trap. So can you kind of give us an example of how you might work with someone to help develop this core confidence and help to bring in more joy and help get them a little more grounded into themselves? Are there any sort of exercises or things that you do with people that you can give this as an example? Yeah,
Speaker 2 (12:15):
That's a, that's a great you know, I I'd say one of the main tips that I, that is probably ended up being my, my signature Sarah move,uhas been really, you know, so listening to somebody, I really love deep listening. I mean, I think when you start listening to someone, at least for me, I don't know this is, this is, h gift that I have is I start reading between the lines. Umnd actually I'm kind of diverting for a moment. A lot of times when I work with people, I don't do it over zoom. We don't do video. Umecause when you look somebody in the eye, sometimes it's hard to be a hundred percent truthful, you know, or again, you kind of fall into the, the external competence trap. Umnd so we do it all over the phone or, you know, with the video off so that I can really deeply listen.
Speaker 2 (13:09):
And what I'll do is, you know, if there's a belief in there for example, I was working with somebody the other day and she shared, you know, while we were talking about her personal life. And and she was like, you know, if I kind of keep having these, these, if I close the door on this relationship, I'm probably actually going to have to do a lot of hard work on myself to pick up the pieces. And what I asked her was, well, well, is that true? That working on yourself has to be hard.
Speaker 1 (13:47):
And when
Speaker 2 (13:47):
We, I call it, like, we've got to, we've got to go. I like going down the rabbit hole with somebody of like, really being like, why, why are we fearful about this? Like, let's, let's talk about it. Let's get to the root and let's shine the light on what, what the narrative is with this overthinking piece. Once we shine the light on it, half of the work is done because we've brought in awareness. And whenever you bring in awareness works time.
Speaker 1 (14:18):
Absolutely. Yeah. And it's, it's, you know, that you're right. Being able to listen and listen well is a gift, but it's also something luckily that can be practiced and can be worked upon as physical therapists. I think a lot of us, a lot of us are pretty good at listening. But when you work with, like you said, that chronic pain population, you really get, I think, a lot more in tune to what the person is saying. And you also learn how to ask those questions to draw out more thoughts.
Speaker 2 (14:54):
Absolutely. Yes. And here's the interesting thing that I've found. Okay. and, and I, a lot of this comes from like archetypes and youngian psychology is we have different aspects of our, of our psyche and of our personalities. Right. And a lot of times what you'll find is we learn these skills, we practice these skills professionally, but when it comes to the, behind the scenes for ourselves, we're almost like different people. I had a client the other day, you know, she is a director and has, has a large, very well-known board behind her. And and she's like, you know, if the board was to be a fly on the wall and kind of experience my personal life, they they'd be like what, you're not even the same person. Because suddenly things become matters of the heart. They're no longer again, the, the head, you know, so professionally relating people through this very well yet, we're not really sometimes having that, that advisor, that best friend, that we didn't even know we needed behind the scenes to help us hash out our own stumbling blocks. And that's where I think in, in leadership and entrepreneurship and being a CEO of, you know, your business and your life and trying to be healthy, wealthy, and smart, I think that's, we need that now.
Speaker 1 (16:22):
And why do you think that's so hard
Speaker 2 (16:24):
To,
Speaker 1 (16:27):
To confide in others of, you know, it's, it's a lot easier to say, Oh, you know, I, I didn't have any new patients this month. So, you know, I really w what do you think, how can I help? How can I get more patients? That's easy, right. To talk about our business and, and to talk about our our professional life. But why do you think it's so hard for people to confide in others on a more personal level?
Speaker 2 (16:55):
Hmm. I love this question. I really love it. Of course, I'm sure it's very multifactorial. I find that I don't, you know, I don't have any research on this, but I find that if you start looking back even into it and not like massively, but you start looking back into childhood, you know, where a lot of habitual patterns are formed and thought patterns are formed. A lot of times you'll see, you'll see trends there, but, you know, one vein of research shows that about half of all CEOs, those at the top are experiencing loneliness and loneliness in the sense that, you know, there has to be a level of healthy ego and confidence, right? B core confidence or confidence in order to want to succeed. You know, all sorts of people are teaching us out there and showing us that, you know, you gotta have some grit, you gotta have some resiliency if you wanna play this game.
Speaker 2 (18:01):
And it is a game. And so, you know, there there's factors of like, you can't trust everyone, right. If you have team members underneath of you traditionally that's really changing, I think, but traditionally we're taught, you know, you don't mix business and personal life. You don't do that. That's a no, no. Now you'll see that changing. And that's continuing to change because you know, many psychologists are beginning to study really resiliency and entrepreneurship and, and understanding more specifically how they're tied together, because it's, th that's really just a new field of, of understanding. He can't trust people, you know, and I think many have experienced, again, maybe it was in the past or more recently you know, you do share some of those personal moments and it might come back to bite you or suddenly the, the inner critic and other thought thought in the brain comes up and says, Ooh, that was not a good idea. You're probably that is going to backfire. You know, that could make you look weak. So I think it's very multifactorial.
Speaker 1 (19:16):
And I guess this is kind of where having someone, you know, outside of your direct business to have as a resource and to help you as a coach I guess I would, I'm assuming that that's where coaching comes into play, because you can kind of be that person to sort of help with the personal and the professional, because I can only assume that they're closely related.
Speaker 2 (19:44):
Right. They are way more closely related than people realize. And your professional self that like the way you act professionally is often different than the way you act and your personal life. Like, can you, can you relate to that?
Speaker 1 (20:02):
Yeah, of course. Okay.
Speaker 2 (20:05):
And so, you know, cause I, I, yeah, same thing for me too, but I'm always interested, you know, in what, what somebody, his answer would be.
Speaker 1 (20:12):
Yeah, no, there's, there's no question that, that we're a little different in our personal life than in our professional life. And, you know, it's funny to say, because I was having thoughts around that yesterday. Because you know, we're all human, right? Every once in a while, like we screw something up, we say something we didn't want to say we regretted afterwards. And yet you're vilified for being a human being. You're vilified for saying something that, yeah, like maybe what you said, wasn't the best thing to say, but you take ownership over it. You say, Hey, listen. Like, yeah. I mean, I, you know, I let my emotions get the best of me, which never ever happens in my professional life. Right. Right. In my professional life never happens. And yet all of a sudden you're demoted in the eyes of so many people, but all you did was you were just a human being and you said something, or you wrote something that you later like, ah, I can't believe I did that. And because it's not a podcast, we can't go back and edit it out. So I think that there is this, this weird kind of, if you start to melt the two together, you're going to be screwed.
Speaker 2 (21:33):
Yeah. It's a way or another, it's a belief. Absolutely. And I think that we need guidance to blend them appropriately, you know, because the answer is not, well, you'll see this as a marketing strategy now. Right. Where it's like, okay, show the behind the scenes and show yourself and be yourself and dah, dah, dah. Well, I think that there's always a, a middle ground to all of that, that we need to be aiming for. And again, it has to feel true to you, you know, like you have to get back into a state of checking in with yourself and not checking in with the head and the thoughts of like, okay, is this an alignment for me? And so, you know, in a lot of cases when you're blood, when you're, I like drawing on the professional self, like let's say, I might say, okay, what would professional dr.
Speaker 2 (22:23):
Litzy do when we're talking about something personal, because that's how the, the, the two aspects of you can really start blending together and start working together as a team and be like an integrated, whole healthy, beautiful person, right. Uwho can stay true to your individual values? You know, we get to like explore what those individual values are and being true to those,uin, in order to make it work for us, I've ever really cool example of a client who,ushe's in the hospital system and I'm pretty high up. And she was offered. We had been working for, I don't know, probably three to six months or something we'd been, she had been, and we were mostly working in the personal field, you know, but of course the professional always, always blends in. And she had been offered this incredible opportunity to lead this team.
Speaker 2 (23:25):
This was just in addition to her goals that she already professionally had for the year. And as she sat with that, and as I sat with that with her, she realized, you know, if this had been last year, I would have said yes to that. And I'm very flattered, but the truth is, is if I say yes to that, then all that I'm doing to take care of myself so that I can show up to meet my professional goals is actually going to be derailed. And so at that moment, it wasn't in alignment for her. And what was even better about that was then she was able to go to her boss and to communicate that I call it like, you know, communicating from the core, but communicate that not from up in the head like, Oh, no, I wonder what I'm doing. I hope, you know, hope I'm not really screwing this up, communicating it with authenticity, with crowdedness, with strength, right. With empowerment. And, you know, her superior was like best decision you ever made. I really appreciate it. Really championed to her now, how awesome would that be if we could have more of that in our small businesses and in all of our workplaces and all of our organizations,
Speaker 1 (24:43):
I mean, that's an ideal situation when the ideal situation, but I think it's hard when you're constantly kind of seeking out success and seeking to be quote unquote the best at what you do and to get that recognition and to build your business and to make more money. So you can live the lifestyle that you want to live and provide for your family or your friends or whomever is in your, your world. But how does, how does making these decisions, like you said, these sort of more grounded decisions where, where they are emotional versus making these decisions as strictly like pros and cons, like an intellectual pro and con list, you know what I mean? So how do you, how do you coach people in that tug of war?
Speaker 2 (25:41):
I hope I can answer the question of how do you coach people, because sometimes you just have to see it, you know, and experience it. But you know if you look, if you talk to anyone in the financial world, the stock market is emotional emotions drive everything. That's true. Right. And you know, if we're the faster, we're aware of that, the more tapped in that, that we're going to be. And so that's actually, what's happening is a, is a lot of times where we're making these leadership decisions, we're making these personal decisions when we're in a state of emotion. And often when we're, you know, emotions are coming from thoughts, right. You know, you know, the, the, the little wheel starts going and then suddenly, you know, we have these emotions with us. A lot of times you don't even know what the sensation is in the body, because we're, again, we're kind of more of in the head.
Speaker 2 (26:36):
And so when you can access, and what I do is often just really helping somebody with very challenging. Like I prefer the challenging situations, you know, where it's like, okay, why do I keep getting into this relationship? Why do I keep not, you know, being able to climb the ladder? Why is it I can't get, get know fit in the self-care pieces of it. And when we get to the root of it, a lot of times it's because things are happening in an emotional realm. And we've got to be aware of that, go down the rabbit hole of the actual, like fear and worry. And why, like, why are we responding the way we're responding? Why are we doing that? And then once you get to that, then you can actually get to the clarity piece where you get the clouds and the, you know, the fog out from your face. Right. You can go, okay, pro this con this dah, dah, dah, dah. Okay. Now I've got my marching orders go. And I, I don't know about you, but I like marching orders. I like to know the next step.
Speaker 1 (27:37):
Yeah, absolutely. And, and I think, you know, a lot of people who are in leadership positions or who are going out to be that entrepreneur, their dreams, like you are a type a person. I think you are a lot of just pros and cons. But I do think that the emotional segment of things does have to come into play because if your pros and cons from a very sort of robotic sense is, is okay, I guess, but then how is it going to make you feel, how is it going to affect your life? Are you going to be happy with your decision? Are you doing something because you feel pressure to do it because you have to do it, quote unquote. So I think being able to tap into that core confidence in that and your core values in order to help you make decisions is important. So it's like, I don't want to be on either pole, like purely emotional, purely cerebral, but you want to have, you want to be able to kind of get in there and go down that rabbit hole, which is not easy and takes a lot of self-awareness.
Speaker 2 (28:44):
Yes, no, it does. And that's why it usually takes a guide. Yeah, exactly. It really does. It takes a guide and you know, again, kind of that core confidence model that was not created by me, but having self-efficacy hope, optimism and resiliency, you know, these are things with, with a lot of difficult situations that, that our, our brain just has not been able to figure out the answer to. We tend to go down on the scale of those things, right? We're not trusting ourselves efficacy. We're not feeling very hopeful about it now, fascinatingly enough, you know, those that are fixers and types day and, and, and leaders if we can't fix something, if we don't know the solution to it, we're going to avoid it
Speaker 1 (29:25):
Totally a hundred percent. So it was easier and it's so much easier.
Speaker 2 (29:30):
We are to, to help and to show up for others and to fix the things that we know we can fix. And so again, then you see an imbalance and often times it's with the most challenging things that dealing with, again, personally, or professionally that we don't want to talk about. One of my clients, the other day was sharing,uyou know, this situation just resolved, but she was like, you know, I have been sitting on this,uspace like this, this land and space for the last 10 years. And I didn't know what to do with it. Now, when we got to the root of it, it was actually extremely emotional because she's in a family owned business. And it was something that a family member prior to her set up and, you know, really loved. And so it, it, it, it was way too. She couldn't make the decision because of the emotions connected with it. Uyou know, but she was like, I've been sitting on this forever and just avoiding it because I don't know what to do. So I can think of 50,000 other things to spend my time doing. You know, you can fix the kids, you can fix your friends, you can bring it into your professional career. And then meanwhile, some of the, you know, the other aspects are, are, are missing.
Speaker 1 (30:44):
I know I, when I get into those, those bouts of, Oh God, I can, I like will. And it's what I'm doing right now, which is why, when you said that you could do so, so many things to avoid. I'm like redoing my bookshelves, I'm doing some shredding of papers. I'm like crazy with the home edit. And now everything's in a rainbow, you know, I've got a lot of plastic bins hanging out everywhere. That's what I do when I'm trying to like, avoid looking at deeply at other things, you know? So that's what I've been doing for the past couple of weeks is I have been like cleaning out. Like my doorman was like, are you moving? I was like, Nope, not moving. Just, just finding stuff to do around the apartment.
Speaker 2 (31:30):
Exactly. Just being a great, you know, leader in the liver of life.
Speaker 1 (31:35):
Yeah, exactly. Cause I'm like, well, you know, if you come home to a nice clean apartment, it's better for your head. You can concentrate more when, you know, I probably need to go dig a little deeper and see, why am I doing all of this? And I know it's not just from watching the home edit, although it's a nice show. I'm sure it goes a little deeper.
Speaker 2 (31:56):
Well, it does, you know, and I'm glad you brought that up, you know, your, your personal situation, because I think that that helps all of us so much, you know, it's always nice to know when we're not alone. Right. And but you know, one of the biggest things that I've found in doing this work for as long as I have is people say to me, yeah. You know, I just, you know, everything you do sounds really great. Like that sounds awesome. It sounds like it really be helpful for me. And like, I don't really think I will, but I don't really think I want to go there. Uand we think, again, we think it's going to be hard, right? Like I was mentioning the client, the client earlier,u
Speaker 3 (32:40):
I have found that,
Speaker 2 (32:44):
And I think this is just my personality, but it's like, we got to make this fun and we gotta make this. Or action-oriented we kinda got to get the show on the road. So it's like, you know, again, if, if we're, if we're trying to leave a legacy, if you're trying to, you know, be productive and not give up on the idea that we have, you know, have success, then we are in a state in our country and in the world where, where we, we, yes, we can all, you know, afford to sit down on the couch with the weighted blanket and the wine and the ice cream, you know, but, but I just don't believe that, that we can afford too much of that anymore. I really don't, you know, like I, I need, I really feel so strongly that like, I need everybody to be functioning at a high level and it, it can be fun.
Speaker 2 (33:40):
It doesn't have to be like, Oh gosh, I'm, I'm, doesn't have to be so stressful. Yeah. Or like annoying, you know what I mean? Like, nobody really wants to like, look at themselves and see their shortcomings. And it's not about that. Like anybody that's trying to tell you it's about that. Th that's probably just perfectionist behavior showing up. It's not about that. It's about like, you've got to tap into your greatness. And when I say your greatness, meaning like just our essence, like our purpose of being here on earth, like something greater than ourselves, we've got to tap into that. We've gotten away from that. You know, that, that radical act of self-love that that's not just let me go draw a bubble bath. You know, that that is radically like, you know, we're all beautiful and we're here to share something great.
Speaker 2 (34:37):
One of the, one of the most upsetting thing, NGS, m don't know if you've ever experienced this, but, you know, as a physical therapist, when somebody has, host a limb or their pelvic floor is not working and they're upset with, you know, they have prolapse and they're like, Ugh, Ugh, this uterus, or, you know, gosh, my arm just looks awful. Now that pains me to my soul because I'm like, Oh, you know, like, gosh, your body has done so many miraculous things. I understand. And I empathize why you feel that way, but it, it makes me sad. And one of the things that has made me sad and being, you know, an advisor and a best friend to, you know, leaders who didn't even know if they needed that. Um,e of the things that makes me sad is when somebody comes to me and they're willing to just for a second share, I don't know if I can keep doing this anymore.
Speaker 2 (35:35):
I've thought about just giving it all up and going back to a simpler way of life and the same sort of thing. It makes me sad. Cause it's like, no, no, no, no, no, we don't. We don't have to do that. Like, you know, you, we don't have to, we just have to find some balance, right? Like you said, we don't need to be on one extreme. We don't need to be on the other extreme. We need to be somewhere in the middle and finding that is like super, super small finite changes. It's not the giant crazy things that changes that we like to make in our lives that we, you know, we think are going to be the solution. Yeah.
Speaker 1 (36:10):
I, I agree a hundred percent. And I think on that note, because I could keep talking about this all day. It's sadly, I don't know if the listeners want to listen to it all day. I'll do. I think they might. But I feel like we could keep going on and on here. But that being said before we wrap things up, just a couple of other things, number one, what, what are some of the big takeaways, or if there's one in particular takeaway that you want the listeners to leave this conversation with?
Speaker 4 (36:46):
Wow.
Speaker 2 (36:47):
I wasn't prepared for that. Dr. Lindsay. There is what I would say. The big takeaway that I really hope everybody understands is that when we get out of our head a little more often and start listening to the messages of the body, start listening to the messages of within then we really activate that core confidence. We step into a more effective way of leading and living and that's available to everybody and it's time to take it. Beautiful.
Speaker 1 (37:26):
That's a beautiful takeaway. Now you're welcome. And then of course, the last question that I ask everyone is knowing where you are now in your life and in your career, what advice would you give to yourself right out of PT school, a newbie.
Speaker 2 (37:42):
Ooh. Oh, this is, this is a fun one. So when I was in PT school, I knew PT was going to be a jump jumping off point for me. Ubut I, I didn't feel confident in that. And so honestly, what I would have said to myself then is, you know, yeah, you're a little bit of a fish.
Speaker 1 (38:06):
Yeah. You're doing things a little bit differently
Speaker 2 (38:08):
And it's okay. Just own, own your worst, keeping you which I'm sure I've always been doing, you know, but, but really telling myself that and gifting that to myself, that it's okay. It all starts lining up just one step at one step at a time.
Speaker 1 (38:25):
Awesome. And where can people find you? So social media or what's the best way? Yeah. So the best to get in touch with you,
Speaker 2 (38:36):
There are just so many ways to get, to get in touch with me. Of course social media let's see Facebook and Instagram is dr. Sarah Smith official. I'm also on LinkedIn, dr. Sarah Smith. It is Sara without an H. Usually people always are putting an H on my name, which is like,
Speaker 1 (38:52):
Denise is a Sara without an H. So I am very well aware of it.
Speaker 2 (38:56):
Thank you. And then www dot dr. Sara, D R dr. Sarah smith.com awesome. And website.
Speaker 1 (39:06):
Perfect. And we will have all of those links up at the podcast website podcast at healthy, wealthy, smart.com under this episode. And you saw, you also have an activate core confidence workbook that dr. Sara has so generously given as a free gift. So if you go to www.dot dr. Sarah smith.com/core hyphen confidence, did I get it right? You did. Perfect. And again, that will also be in the show notes, if you want your free gift from dr. Sarah, which is very generous. Thank you very much for all of the listeners, go and grab it from the show notes. So Sarah, thanks so much. Like I said, I could talk about this forever. It'll turn into a therapy session and that's not what you're doing here. I will not take advantage of you in that way.
Speaker 2 (39:57):
We can, we can do it at that.
Speaker 1 (40:03):
Thank you so much for coming on and sharing all of your knowledge. I appreciate it.
Speaker 2 (40:07):
Oh, you're so welcome. Thank you for having me.
Speaker 1 (40:09):
Of course. And everyone listening. Thanks so much. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Smith, PT, DPT to discuss how women can cultivate their core confidence. Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically, women who wear many hats and desire to leave a legacy with less burnout and greater personal joy.
In this episode, we discuss:
-How women focus attention on external approval and achievements/external successes.
-Why we need to be connected, aware and in tune with our pelvis.
-Messages the pelvis (and body) may be giving us that we are missing
-Core Confidence-what it is. why it is so important
-How does reducing urgency in daily life payoff- how the mental affects the physical body.
-How mental and spiritual Core Confidence and awareness of our Core can affect physical core strength.
Resources:
Dr. Sarah’s Facebook
Dr. Sarah’s Instagram
Dr. Sarah’s LinkedIN
Activate Your Core Confidence Workbook
Discover Your Joy Coaching Session w/ Dr. Sarah
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
More Information about Dr. Smith:
Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically women who wear many hats and desire to leave a legacy with less burnout and greater personal joy.
Her unique approach focuses on connecting women back to their Core which holds authenticity, choice and immediate solutions so one can thrive both personally and professionally in all life situations.
This activation is vital so that women leading their families, communities and companies can stay fully present in all situations in order to
- Communicate & interact authentically and calmly
- Finally feel their private life & success matches their professional success with greater freedom, confidence, peace, focus and direction.
- Flow through daily tasks and commitments with more focus, ease and an organized plan
- Improve physical strength & major health gains
- Live Wild & Bright- meaning! connected to our true, authentic, soul calling
She has blended her professional expertise as a Doctor of Physical Therapy- specializing in Women’s Health and Chronic Pain Management, Certified Yoga Instructor & Certified Wellness & Life Coach. With every personal & group experience Dr. Sara Smith offers, she is dedicated to the goal of assisting women of all ages to step back into their Core Confidence.
Read the Full Transcript below:
Speaker 1 (00:01):
Hey, Sarah, welcome to the podcast. I'm happy to have you on,
Speaker 2 (00:04):
Thank you so much for having me, dr. Litzy. It's glad to be here.
Speaker 1 (00:08):
Yeah. And so obviously I'm a physical therapist as are you, you have specialized in pelvic health and women's health, and then you have also kind of made that transition for at least part of your career into coaching, mainly other women from around the world. So before we get into the meat of the interview, I would love for you to share with the audience a little bit about your sort of career trajectory.
Speaker 2 (00:40):
Absolutely. Yes. So it's a, it's a little professional and it's a little personal, so it's the story tends to track with a little bit of both. I also went and got my yoga certification and that was actually the first thing that I did after physical therapy, you know, from, from physical therapy. A lot of that came because you know, in our profession we have a high turnaround and burnout ratio there at times. And I was a chronic fixer and helper and I was good at what I was doing to the point where I, you know, anybody came in and I was ready to, you know, help them with their issue. And so I went to my first yoga class, really just to chill myself out, get a little bit grounded and get, get real. And then from there it really almost overnight, it, it drastically shifted the way I was showing up and treating my patients at the time.
Speaker 2 (01:42):
I realized that kind of less was more, I realized that it was more important for me to listen instead of coming in with a plan and, you know, my own action sheet and really meeting people where, where we were, I think I was always empathetic, but it, it really enhanced that. And on top of that, I stopped getting sick. I was averaging, you know, a sinus infection once a month and just burned out already and young because I didn't want to, you know, you didn't want to fail having that syndrome. So really yoga kind of came first and then that solidified me for a while. I kept into the physical therapy world. I've always lived in rural areas in Virginia and I was on the Eastern shore of Virginia and I'm an only child. So I do like to be the only one doing something I like to be a little special.
Speaker 2 (02:40):
And, and so I realized nobody in the area was doing pelvic floor work. I had in all of my internships had some sort of connection to pelvic floor and women's health work. So I, I learned about it. I kind of knew about it. I didn't know if that was something that I wanted to get into. But I knew that it was a niche in the area that I was in. And so it was when I got into pelvic floor physical therapy work that I really professionally started to see this and, and chronic pain management has always been something that I just love helping people that have been to lots of therapists, physical therapists, and in there need assistance with that. But I was just seeing this mind body connection. I was seeing how with all of these individuals, and for some reason, I just happened to be working with a lot of leaders, professionals, directors, CEOs, you know, it just was kind of happening that way.
Speaker 2 (03:41):
Even some like rockstars lawyers, I don't know, Olympic swimmers, all these different people and stress was also happening mentally. You know, there were things going on either in their personal life or their professional life. That just seemed to be kind of also coming into what I was noticing in their physical body. So I was learning about it personally and just my own interest. And then I also was seeing it professionally and I was seeing when I started incorporating some of the yoga, you know, some of the mindfulness based practices and stress management breathing that I was getting better results. And I just am a result junkie. You know, I'm not interested in putting a patch on something. I want somebody to come back to me six or seven or 10 years later and be like, I'm still using what you did. So there was that.
Speaker 2 (04:34):
And then on top of that what I got into pelvic floor therapy, my started having children and my, our, our first child who's now seven was we found out at a very young age that he had an ultra rare genetic mutation. So it was de Novo. It wasn't for my husband or myself and severe speech apraxia. So I started getting, you know, deep into the world of executive functioning and,ureally learning more and more about kind of, I always loved the nervous system, but, you know, I became even more fascinated with how to manage that,uand, and work with it. And so that, those two things kind of happening simultaneously are what brought me into, into coaching. Umnd specifically working with female leaders, hecause that, I don't know, that's just like a deep within personal mission is I feel like women are here to make a major contribution.
Speaker 2 (05:42):
I feel like the time, the time is ripe, the time is now. But we've learned and write in it in a great way. We've learned from a very male dominated structure,uwhich doesn't always work for women. And,uit can, it definitely works. It's not that it's, you know, not working, but there, there are some things that need to slightly shift and,uI'm just, I really want to be able to contribute to women, being able to be in these leadership roles and do it without as much burnout do it without as much self-sacrificing,ufamily sacrificing community sacrificing. Uso yeah.
Speaker 1 (06:32):
Awesome. Well, thanks for that. Thanks for kind of letting the listeners get a little bit deeper into kind of who you are and why you do what you do, because it all leads into our discussion today. And it's, it's really all about as you say, why we need to be connected, why we need to be aware and in tune with our pelvis. So as a physical therapist, we can all agree that yes, we need to be in tune with that area. Everyone has a pelvis, everyone has that musculature and, and the functions of but coming from, I think your unique perspective of both physical therapist and coach and looking really beyond just the pelvic floor, which we should all be doing anyway. So, so give us your take on why we need to be connected.
Speaker 2 (07:25):
Yeah. You know, I've seen in, in the realm of success, leadership, entrepreneurship anybody who's, who's type a you know, th there's a lot of overthinking long to do lists. There's a lot of being up in our head, you know, w where do we go next? And I say, we, because this, you know, I've, you're only a great teacher if you've been there yourself, right. And, and are still in the depths of it. And so, you know, we th there's lots, that's constantly swirling up in our head, but we also know, and, and, you know, a variety of different resource research sources have shown us this, that we can't access all of the solutions to our biggest professional, personal life challenges. If we're in constant thinking mode all day long, not to mention, you know, roughly 80% of all thoughts are habitually negative, which is not very helpful for solving problems. And so the reason that I am so drawn to what I call, you know, well, it's not just me calling it a core confidence and getting people specifically into their pelvis and back into their body is, is reducing the overthinking so that we can access again, creativity, focus, productivity, you know, improved, sleep, stress, relieving, you know, hormone responses. You know, I could, I could go on and on.
Speaker 1 (09:01):
Yeah. And so you brought up the, the the words, core confidence. So can you explain what, what does that mean? Because I have a feeling it may mean a couple of different things to a couple of different people, but in the work that you do in helping people become more productive, improve their leadership, improve their life, what does that, what does core confidence?
Speaker 2 (09:28):
Yeah. I love how you said that, you know, it means something to, there's lots of different ways to describe it in there. There really is. You know, to me, and also the, the clients that I've worked with for many, many years now, it means freedom. It means expansiveness. It means seeking joy. It means effectively, you know, being effective at what they do. Meanings means also having more energy core confidence really is being able to go within yourself and access that wellspring of inner wisdom really access your, your yes or no. And a lot of times, and this is, this is actually comes from, from those in the research field. Core confidence also is a mixture of self-efficacy of hope of optimism and resilience. External confidence. I don't think we should be talking about core confidence without also touching on external confidence and external confidence is what the majority of us learn to, to seek after.
Speaker 2 (10:43):
And we're constantly seeking after it. The external confidence is, you know, does dr. [inaudible] Like me, or, you know, what I should be doing right now, or, you know, these are the, the, the dreams that, that others are doing. So this marketing strategy has worked for them. This app has worked for them, let me do this, let me, you know, follow this meal plan. And so, you know, we're constantly as humans chasing others, things that have worked for them. And, and we're very often, again, not realizing we're up in our head and we're not really checking in with the, the little voice that's like, that's kind of a waste of time.
Speaker 1 (11:32):
Yeah, totally. I, I always find that it's so much easier to look for that external validation and get our confidence from that external validation, then what we do than what we think we are doing. Does that make sense? Solutely yeah, so I, I mean, and, and we're all human and all humans fall into that trap. So can you kind of give us an example of how you might work with someone to help develop this core confidence and help to bring in more joy and help get them a little more grounded into themselves? Are there any sort of exercises or things that you do with people that you can give this as an example? Yeah,
Speaker 2 (12:15):
That's a, that's a great you know, I I'd say one of the main tips that I, that is probably ended up being my, my signature Sarah move,uhas been really, you know, so listening to somebody, I really love deep listening. I mean, I think when you start listening to someone, at least for me, I don't know this is, this is, h gift that I have is I start reading between the lines. Umnd actually I'm kind of diverting for a moment. A lot of times when I work with people, I don't do it over zoom. We don't do video. Umecause when you look somebody in the eye, sometimes it's hard to be a hundred percent truthful, you know, or again, you kind of fall into the, the external competence trap. Umnd so we do it all over the phone or, you know, with the video off so that I can really deeply listen.
Speaker 2 (13:09):
And what I'll do is, you know, if there's a belief in there for example, I was working with somebody the other day and she shared, you know, while we were talking about her personal life. And and she was like, you know, if I kind of keep having these, these, if I close the door on this relationship, I'm probably actually going to have to do a lot of hard work on myself to pick up the pieces. And what I asked her was, well, well, is that true? That working on yourself has to be hard.
Speaker 1 (13:47):
And when
Speaker 2 (13:47):
We, I call it, like, we've got to, we've got to go. I like going down the rabbit hole with somebody of like, really being like, why, why are we fearful about this? Like, let's, let's talk about it. Let's get to the root and let's shine the light on what, what the narrative is with this overthinking piece. Once we shine the light on it, half of the work is done because we've brought in awareness. And whenever you bring in awareness works time.
Speaker 1 (14:18):
Absolutely. Yeah. And it's, it's, you know, that you're right. Being able to listen and listen well is a gift, but it's also something luckily that can be practiced and can be worked upon as physical therapists. I think a lot of us, a lot of us are pretty good at listening. But when you work with, like you said, that chronic pain population, you really get, I think, a lot more in tune to what the person is saying. And you also learn how to ask those questions to draw out more thoughts.
Speaker 2 (14:54):
Absolutely. Yes. And here's the interesting thing that I've found. Okay. and, and I, a lot of this comes from like archetypes and youngian psychology is we have different aspects of our, of our psyche and of our personalities. Right. And a lot of times what you'll find is we learn these skills, we practice these skills professionally, but when it comes to the, behind the scenes for ourselves, we're almost like different people. I had a client the other day, you know, she is a director and has, has a large, very well-known board behind her. And and she's like, you know, if the board was to be a fly on the wall and kind of experience my personal life, they they'd be like what, you're not even the same person. Because suddenly things become matters of the heart. They're no longer again, the, the head, you know, so professionally relating people through this very well yet, we're not really sometimes having that, that advisor, that best friend, that we didn't even know we needed behind the scenes to help us hash out our own stumbling blocks. And that's where I think in, in leadership and entrepreneurship and being a CEO of, you know, your business and your life and trying to be healthy, wealthy, and smart, I think that's, we need that now.
Speaker 1 (16:22):
And why do you think that's so hard
Speaker 2 (16:24):
To,
Speaker 1 (16:27):
To confide in others of, you know, it's, it's a lot easier to say, Oh, you know, I, I didn't have any new patients this month. So, you know, I really w what do you think, how can I help? How can I get more patients? That's easy, right. To talk about our business and, and to talk about our our professional life. But why do you think it's so hard for people to confide in others on a more personal level?
Speaker 2 (16:55):
Hmm. I love this question. I really love it. Of course, I'm sure it's very multifactorial. I find that I don't, you know, I don't have any research on this, but I find that if you start looking back even into it and not like massively, but you start looking back into childhood, you know, where a lot of habitual patterns are formed and thought patterns are formed. A lot of times you'll see, you'll see trends there, but, you know, one vein of research shows that about half of all CEOs, those at the top are experiencing loneliness and loneliness in the sense that, you know, there has to be a level of healthy ego and confidence, right? B core confidence or confidence in order to want to succeed. You know, all sorts of people are teaching us out there and showing us that, you know, you gotta have some grit, you gotta have some resiliency if you wanna play this game.
Speaker 2 (18:01):
And it is a game. And so, you know, there there's factors of like, you can't trust everyone, right. If you have team members underneath of you traditionally that's really changing, I think, but traditionally we're taught, you know, you don't mix business and personal life. You don't do that. That's a no, no. Now you'll see that changing. And that's continuing to change because you know, many psychologists are beginning to study really resiliency and entrepreneurship and, and understanding more specifically how they're tied together, because it's, th that's really just a new field of, of understanding. He can't trust people, you know, and I think many have experienced, again, maybe it was in the past or more recently you know, you do share some of those personal moments and it might come back to bite you or suddenly the, the inner critic and other thought thought in the brain comes up and says, Ooh, that was not a good idea. You're probably that is going to backfire. You know, that could make you look weak. So I think it's very multifactorial.
Speaker 1 (19:16):
And I guess this is kind of where having someone, you know, outside of your direct business to have as a resource and to help you as a coach I guess I would, I'm assuming that that's where coaching comes into play, because you can kind of be that person to sort of help with the personal and the professional, because I can only assume that they're closely related.
Speaker 2 (19:44):
Right. They are way more closely related than people realize. And your professional self that like the way you act professionally is often different than the way you act and your personal life. Like, can you, can you relate to that?
Speaker 1 (20:02):
Yeah, of course. Okay.
Speaker 2 (20:05):
And so, you know, cause I, I, yeah, same thing for me too, but I'm always interested, you know, in what, what somebody, his answer would be.
Speaker 1 (20:12):
Yeah, no, there's, there's no question that, that we're a little different in our personal life than in our professional life. And, you know, it's funny to say, because I was having thoughts around that yesterday. Because you know, we're all human, right? Every once in a while, like we screw something up, we say something we didn't want to say we regretted afterwards. And yet you're vilified for being a human being. You're vilified for saying something that, yeah, like maybe what you said, wasn't the best thing to say, but you take ownership over it. You say, Hey, listen. Like, yeah. I mean, I, you know, I let my emotions get the best of me, which never ever happens in my professional life. Right. Right. In my professional life never happens. And yet all of a sudden you're demoted in the eyes of so many people, but all you did was you were just a human being and you said something, or you wrote something that you later like, ah, I can't believe I did that. And because it's not a podcast, we can't go back and edit it out. So I think that there is this, this weird kind of, if you start to melt the two together, you're going to be screwed.
Speaker 2 (21:33):
Yeah. It's a way or another, it's a belief. Absolutely. And I think that we need guidance to blend them appropriately, you know, because the answer is not, well, you'll see this as a marketing strategy now. Right. Where it's like, okay, show the behind the scenes and show yourself and be yourself and dah, dah, dah. Well, I think that there's always a, a middle ground to all of that, that we need to be aiming for. And again, it has to feel true to you, you know, like you have to get back into a state of checking in with yourself and not checking in with the head and the thoughts of like, okay, is this an alignment for me? And so, you know, in a lot of cases when you're blood, when you're, I like drawing on the professional self, like let's say, I might say, okay, what would professional dr.
Speaker 2 (22:23):
Litzy do when we're talking about something personal, because that's how the, the, the two aspects of you can really start blending together and start working together as a team and be like an integrated, whole healthy, beautiful person, right. Uwho can stay true to your individual values? You know, we get to like explore what those individual values are and being true to those,uin, in order to make it work for us, I've ever really cool example of a client who,ushe's in the hospital system and I'm pretty high up. And she was offered. We had been working for, I don't know, probably three to six months or something we'd been, she had been, and we were mostly working in the personal field, you know, but of course the professional always, always blends in. And she had been offered this incredible opportunity to lead this team.
Speaker 2 (23:25):
This was just in addition to her goals that she already professionally had for the year. And as she sat with that, and as I sat with that with her, she realized, you know, if this had been last year, I would have said yes to that. And I'm very flattered, but the truth is, is if I say yes to that, then all that I'm doing to take care of myself so that I can show up to meet my professional goals is actually going to be derailed. And so at that moment, it wasn't in alignment for her. And what was even better about that was then she was able to go to her boss and to communicate that I call it like, you know, communicating from the core, but communicate that not from up in the head like, Oh, no, I wonder what I'm doing. I hope, you know, hope I'm not really screwing this up, communicating it with authenticity, with crowdedness, with strength, right. With empowerment. And, you know, her superior was like best decision you ever made. I really appreciate it. Really championed to her now, how awesome would that be if we could have more of that in our small businesses and in all of our workplaces and all of our organizations,
Speaker 1 (24:43):
I mean, that's an ideal situation when the ideal situation, but I think it's hard when you're constantly kind of seeking out success and seeking to be quote unquote the best at what you do and to get that recognition and to build your business and to make more money. So you can live the lifestyle that you want to live and provide for your family or your friends or whomever is in your, your world. But how does, how does making these decisions, like you said, these sort of more grounded decisions where, where they are emotional versus making these decisions as strictly like pros and cons, like an intellectual pro and con list, you know what I mean? So how do you, how do you coach people in that tug of war?
Speaker 2 (25:41):
I hope I can answer the question of how do you coach people, because sometimes you just have to see it, you know, and experience it. But you know if you look, if you talk to anyone in the financial world, the stock market is emotional emotions drive everything. That's true. Right. And you know, if we're the faster, we're aware of that, the more tapped in that, that we're going to be. And so that's actually, what's happening is a, is a lot of times where we're making these leadership decisions, we're making these personal decisions when we're in a state of emotion. And often when we're, you know, emotions are coming from thoughts, right. You know, you know, the, the, the little wheel starts going and then suddenly, you know, we have these emotions with us. A lot of times you don't even know what the sensation is in the body, because we're, again, we're kind of more of in the head.
Speaker 2 (26:36):
And so when you can access, and what I do is often just really helping somebody with very challenging. Like I prefer the challenging situations, you know, where it's like, okay, why do I keep getting into this relationship? Why do I keep not, you know, being able to climb the ladder? Why is it I can't get, get know fit in the self-care pieces of it. And when we get to the root of it, a lot of times it's because things are happening in an emotional realm. And we've got to be aware of that, go down the rabbit hole of the actual, like fear and worry. And why, like, why are we responding the way we're responding? Why are we doing that? And then once you get to that, then you can actually get to the clarity piece where you get the clouds and the, you know, the fog out from your face. Right. You can go, okay, pro this con this dah, dah, dah, dah. Okay. Now I've got my marching orders go. And I, I don't know about you, but I like marching orders. I like to know the next step.
Speaker 1 (27:37):
Yeah, absolutely. And, and I think, you know, a lot of people who are in leadership positions or who are going out to be that entrepreneur, their dreams, like you are a type a person. I think you are a lot of just pros and cons. But I do think that the emotional segment of things does have to come into play because if your pros and cons from a very sort of robotic sense is, is okay, I guess, but then how is it going to make you feel, how is it going to affect your life? Are you going to be happy with your decision? Are you doing something because you feel pressure to do it because you have to do it, quote unquote. So I think being able to tap into that core confidence in that and your core values in order to help you make decisions is important. So it's like, I don't want to be on either pole, like purely emotional, purely cerebral, but you want to have, you want to be able to kind of get in there and go down that rabbit hole, which is not easy and takes a lot of self-awareness.
Speaker 2 (28:44):
Yes, no, it does. And that's why it usually takes a guide. Yeah, exactly. It really does. It takes a guide and you know, again, kind of that core confidence model that was not created by me, but having self-efficacy hope, optimism and resiliency, you know, these are things with, with a lot of difficult situations that, that our, our brain just has not been able to figure out the answer to. We tend to go down on the scale of those things, right? We're not trusting ourselves efficacy. We're not feeling very hopeful about it now, fascinatingly enough, you know, those that are fixers and types day and, and, and leaders if we can't fix something, if we don't know the solution to it, we're going to avoid it
Speaker 1 (29:25):
Totally a hundred percent. So it was easier and it's so much easier.
Speaker 2 (29:30):
We are to, to help and to show up for others and to fix the things that we know we can fix. And so again, then you see an imbalance and often times it's with the most challenging things that dealing with, again, personally, or professionally that we don't want to talk about. One of my clients, the other day was sharing,uyou know, this situation just resolved, but she was like, you know, I have been sitting on this,uspace like this, this land and space for the last 10 years. And I didn't know what to do with it. Now, when we got to the root of it, it was actually extremely emotional because she's in a family owned business. And it was something that a family member prior to her set up and, you know, really loved. And so it, it, it, it was way too. She couldn't make the decision because of the emotions connected with it. Uyou know, but she was like, I've been sitting on this forever and just avoiding it because I don't know what to do. So I can think of 50,000 other things to spend my time doing. You know, you can fix the kids, you can fix your friends, you can bring it into your professional career. And then meanwhile, some of the, you know, the other aspects are, are, are missing.
Speaker 1 (30:44):
I know I, when I get into those, those bouts of, Oh God, I can, I like will. And it's what I'm doing right now, which is why, when you said that you could do so, so many things to avoid. I'm like redoing my bookshelves, I'm doing some shredding of papers. I'm like crazy with the home edit. And now everything's in a rainbow, you know, I've got a lot of plastic bins hanging out everywhere. That's what I do when I'm trying to like, avoid looking at deeply at other things, you know? So that's what I've been doing for the past couple of weeks is I have been like cleaning out. Like my doorman was like, are you moving? I was like, Nope, not moving. Just, just finding stuff to do around the apartment.
Speaker 2 (31:30):
Exactly. Just being a great, you know, leader in the liver of life.
Speaker 1 (31:35):
Yeah, exactly. Cause I'm like, well, you know, if you come home to a nice clean apartment, it's better for your head. You can concentrate more when, you know, I probably need to go dig a little deeper and see, why am I doing all of this? And I know it's not just from watching the home edit, although it's a nice show. I'm sure it goes a little deeper.
Speaker 2 (31:56):
Well, it does, you know, and I'm glad you brought that up, you know, your, your personal situation, because I think that that helps all of us so much, you know, it's always nice to know when we're not alone. Right. And but you know, one of the biggest things that I've found in doing this work for as long as I have is people say to me, yeah. You know, I just, you know, everything you do sounds really great. Like that sounds awesome. It sounds like it really be helpful for me. And like, I don't really think I will, but I don't really think I want to go there. Uand we think, again, we think it's going to be hard, right? Like I was mentioning the client, the client earlier,u
Speaker 3 (32:40):
I have found that,
Speaker 2 (32:44):
And I think this is just my personality, but it's like, we got to make this fun and we gotta make this. Or action-oriented we kinda got to get the show on the road. So it's like, you know, again, if, if we're, if we're trying to leave a legacy, if you're trying to, you know, be productive and not give up on the idea that we have, you know, have success, then we are in a state in our country and in the world where, where we, we, yes, we can all, you know, afford to sit down on the couch with the weighted blanket and the wine and the ice cream, you know, but, but I just don't believe that, that we can afford too much of that anymore. I really don't, you know, like I, I need, I really feel so strongly that like, I need everybody to be functioning at a high level and it, it can be fun.
Speaker 2 (33:40):
It doesn't have to be like, Oh gosh, I'm, I'm, doesn't have to be so stressful. Yeah. Or like annoying, you know what I mean? Like, nobody really wants to like, look at themselves and see their shortcomings. And it's not about that. Like anybody that's trying to tell you it's about that. Th that's probably just perfectionist behavior showing up. It's not about that. It's about like, you've got to tap into your greatness. And when I say your greatness, meaning like just our essence, like our purpose of being here on earth, like something greater than ourselves, we've got to tap into that. We've gotten away from that. You know, that, that radical act of self-love that that's not just let me go draw a bubble bath. You know, that that is radically like, you know, we're all beautiful and we're here to share something great.
Speaker 2 (34:37):
One of the, one of the most upsetting thing, NGS, m don't know if you've ever experienced this, but, you know, as a physical therapist, when somebody has, host a limb or their pelvic floor is not working and they're upset with, you know, they have prolapse and they're like, Ugh, Ugh, this uterus, or, you know, gosh, my arm just looks awful. Now that pains me to my soul because I'm like, Oh, you know, like, gosh, your body has done so many miraculous things. I understand. And I empathize why you feel that way, but it, it makes me sad. And one of the things that has made me sad and being, you know, an advisor and a best friend to, you know, leaders who didn't even know if they needed that. Um,e of the things that makes me sad is when somebody comes to me and they're willing to just for a second share, I don't know if I can keep doing this anymore.
Speaker 2 (35:35):
I've thought about just giving it all up and going back to a simpler way of life and the same sort of thing. It makes me sad. Cause it's like, no, no, no, no, no, we don't. We don't have to do that. Like, you know, you, we don't have to, we just have to find some balance, right? Like you said, we don't need to be on one extreme. We don't need to be on the other extreme. We need to be somewhere in the middle and finding that is like super, super small finite changes. It's not the giant crazy things that changes that we like to make in our lives that we, you know, we think are going to be the solution. Yeah.
Speaker 1 (36:10):
I, I agree a hundred percent. And I think on that note, because I could keep talking about this all day. It's sadly, I don't know if the listeners want to listen to it all day. I'll do. I think they might. But I feel like we could keep going on and on here. But that being said before we wrap things up, just a couple of other things, number one, what, what are some of the big takeaways, or if there's one in particular takeaway that you want the listeners to leave this conversation with?
Speaker 4 (36:46):
Wow.
Speaker 2 (36:47):
I wasn't prepared for that. Dr. Lindsay. There is what I would say. The big takeaway that I really hope everybody understands is that when we get out of our head a little more often and start listening to the messages of the body, start listening to the messages of within then we really activate that core confidence. We step into a more effective way of leading and living and that's available to everybody and it's time to take it. Beautiful.
Speaker 1 (37:26):
That's a beautiful takeaway. Now you're welcome. And then of course, the last question that I ask everyone is knowing where you are now in your life and in your career, what advice would you give to yourself right out of PT school, a newbie.
Speaker 2 (37:42):
Ooh. Oh, this is, this is a fun one. So when I was in PT school, I knew PT was going to be a jump jumping off point for me. Ubut I, I didn't feel confident in that. And so honestly, what I would have said to myself then is, you know, yeah, you're a little bit of a fish.
Speaker 1 (38:06):
Yeah. You're doing things a little bit differently
Speaker 2 (38:08):
And it's okay. Just own, own your worst, keeping you which I'm sure I've always been doing, you know, but, but really telling myself that and gifting that to myself, that it's okay. It all starts lining up just one step at one step at a time.
Speaker 1 (38:25):
Awesome. And where can people find you? So social media or what's the best way? Yeah. So the best to get in touch with you,
Speaker 2 (38:36):
There are just so many ways to get, to get in touch with me. Of course social media let's see Facebook and Instagram is dr. Sarah Smith official. I'm also on LinkedIn, dr. Sarah Smith. It is Sara without an H. Usually people always are putting an H on my name, which is like,
Speaker 1 (38:52):
Denise is a Sara without an H. So I am very well aware of it.
Speaker 2 (38:56):
Thank you. And then www dot dr. Sara, D R dr. Sarah smith.com awesome. And website.
Speaker 1 (39:06):
Perfect. And we will have all of those links up at the podcast website podcast at healthy, wealthy, smart.com under this episode. And you saw, you also have an activate core confidence workbook that dr. Sara has so generously given as a free gift. So if you go to www.dot dr. Sarah smith.com/core hyphen confidence, did I get it right? You did. Perfect. And again, that will also be in the show notes, if you want your free gift from dr. Sarah, which is very generous. Thank you very much for all of the listeners, go and grab it from the show notes. So Sarah, thanks so much. Like I said, I could talk about this forever. It'll turn into a therapy session and that's not what you're doing here. I will not take advantage of you in that way.
Speaker 2 (39:57):
We can, we can do it at that.
Speaker 1 (40:03):
Thank you so much for coming on and sharing all of your knowledge. I appreciate it.
Speaker 2 (40:07):
Oh, you're so welcome. Thank you for having me.
Speaker 1 (40:09):
Of course. And everyone listening. Thanks so much. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Helene Darmanin, PT, DPT, CSCS to the program to talk about physical therapy during and after pregnancy. Dr. Helene Darmanin is an orthopedic and pelvic health physical therapist with over a decade of experience facilitating healthy, empowering movement for her clients as a PT, and fitness and pilates instructor. Inspired by her own motherhood and ardent feminism, she specializes in preparing and healing pregnant and postpartum mamas.
In this episode, we discuss:
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Helene's experience with miscarriage, pregnancy, birth, postpartum
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Body positivity in pregnancy and postpartum and how it can optimize outcomes
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American College of Obstetrics and Gynecology guidelines for exercise while pregnant
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Reasons to go to PT when pregnant
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Reasons to go to PT postpartum
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And much more!
Resources:
When & Why To See A Pelvic Floor Physical Therapist
10 Ways to Love your Body
Helene's website
Helene's Instagram
Helene's LinkedIn
Helene's Facebook
Danford Works
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
More Information about Dr. Darmanin:
I am an orthopedic and pelvic health physical therapist who specializes in preparing and healing new and expectant mothers. I am currently seeing clients virtually through Danford Works, and am also the creator of Quarantoned, body-positive HIIT at home.
I practice guilt-free PT—physical therapy which fits easily into your day and improves your quality of movement and life. Research has shown that exercise and patient education are the two most effective interventions for positive long-term outcomes, and these can both be offered successfully virtually.
I have over a decade of experience facilitating healthy, strong movement in my clients' everyday lives. I have a Doctorate of Physical Therapy from New York University, and a Bachelors in Exercise Science from Smith College, and am a Certified Strength and Conditioning Specialist, and a Kane School-certified pilates mat instructor. I give workshops and webinars about fitness, pelvic health, and being guilt-free in your pursuit of wellness; I am published in peer-reviewed journals, blogs, and have presented at national conferences. Most importantly, I am a proud mama to my one year old son, and my calico cat.
Read the Full Transcript below:
Speaker 1 (00:01):
Hey, Helene, welcome to the podcast. I am thrilled to have you on welcome.
Speaker 2 (00:06):
Thanks so much, Karen. I'm so grateful to be here.
Speaker 1 (00:09):
And so today we're going to be talking about pelvic health or women's health after pregnancy, during pregnancy, which, you know, a lot of longtime listeners of this show will know that I've had a lot of episodes on this, but I'm particularly excited about this one, Helene, because you're going to, I think, bravely share a little bit about your story about your birthing experience and, and your experience with your body and how it changes and continues to change even after. So I'm just going to throw it to you and just kind of let you tell your side of the story. Thanks.
Speaker 2 (00:48):
Yeah, I know that in my, I have a my son is about to be one on Monday in just six days. So I know that in my time, since I gave birth or while I was pregnant hearing other women's stories always helped me to not, not feel alone, even though I knew what to expect because I specialized in pregnancy and postpartum long before I got pregnant. So I am really excited to share some of my story. The biggest, the biggest thing that, that happened when we first started trying to get pregnant was when we were trying to conceive and we got that positive pregnancy test. We were so excited. But then, and I remember, cause it was Thanksgiving. And all my family was so, so, so excited cause we shared right away. Cause I figured no matter what happened, I wanted to have the support of my loved ones.
Speaker 2 (01:43):
A few days after Thanksgiving, I started to have some bleeding and I started to have some cramping and it, it was before I had even gone for my first prenatal visit with my OB. And when I showed up for my first prenatal visit, she said, congratulations. I said, I'm pretty sure I'm having a miscarriage right now. And, and sure enough I did miscarry at about seven weeks which is early enough that some people don't even call it a miscarriage. It can be called a chemical pregnancy. My OB was incredible. And she said to me, they say, when it's this early, that you shouldn't be comforted because it was probably a chromosomal abnormality. And you know, it, it just naturally aborted itself. She said, but that didn't help me when I had two miscarriages. So I, I feel you that meant the world to me.
Speaker 2 (02:36):
Cause it was, it was it was a hard thing because we wanted the pregnancy so badly. And then actually I had a lot of trouble with continuing to bleed. And then I ended up needing an emergency DNC because I had a blood clot that was actually blocking the full shedding of the uterus. So that was, you know, in the midst of all the, the sadness, it was also scary and confusing. But I was really fortunate. I had some great practitioners and made it through, made it through. Okay. And then actually we were really lucky because we were able to conceive then the first month that we were allowed to start trying again, I had to get my normal period back, which took about six weeks and then we were able to start trying again. So I feel really fortunate that we were able to do that. And that time I texted my OB right away, I actually used progesterone depositories, which are really uncomfortable. They're like frozen popsicles of progesterone that you have to insert vaginally every night. There's really mixed evidence about them. There's nothing very conclusive, but my OB was like, it'll make you feel like you're doing something at bare minimum. You'll get that great placebo effect.
Speaker 1 (03:50):
And w what does it, what is the reasoning around using that?
Speaker 2 (03:55):
So there's some thought that the fetus won't implant, if the progesterone levels are too low, so you're causing a local increase in progesterone to help facilitate the fetus implanting. Got it.
Speaker 1 (04:06):
Got it. Okay. So sadly, you had a miscarriage, which, you know, for a lot of people listening to this, now, if you follow social media, we were talking about this before Chrissy Tiegen and John legend were very, very open about their miscarriage, which, which happened. I don't know how many months along she was, but enough. And that the comments were, Oh my gosh, I'm so glad you're, you're talking about this. No one talks about this. Women are so ashamed of it. Couples can be ashamed of it. Did you go through any of those feelings or was it like, okay, this happened full steam ahead. Let's keep trying, you know what I mean? I think you've got like both ends of the spectrum. Yeah,
Speaker 2 (04:51):
Yeah, yeah. I think I was somewhere middle of the road. I think I feel very fortunate that I'm was my awesome support network and my great care that I had from my OB and my acupuncturist to who I saw who helped me recover that I, I didn't feel guilty. I didn't feel like some I've I've heard people talk about feeling like their bodies had failed. But I did feel a lot of sadness. I didn't necessarily share right away, except for, with my very close circle. But I've certainly never kept it a secret. I've never felt like it was a shameful secret. And I I've always wanted to share it in case it does help someone else who has that experience, because as it turns out, the more I talked about it, the more women who I talked to said, Oh, yeah, that happened to me. Oh, that happened to me. Yeah. In fact, a lot of, a lot of my friends were like, I feel like over 30, the first one is like a trial run. And like, you kind of, a lot of women, their pregnancy was that chemical pregnancy or miscarriage.
Speaker 1 (06:01):
Yeah. So all of a sudden you're not quite so alone. Yes. Oh my goodness. Yeah. So, so now let's talk. So you get pregnant. So let's talk about your pregnancy, the birth postpartum, because all of this, part of your story, we're going to be tying into things that the listeners can do if they're in any of those phases.
Speaker 2 (06:24):
Yep, absolutely. So I was really lucky during the first trimester. I didn't have too much morning sickness, some slight nausea that usually eating a croissant helped. Unfortunately it was always a croissant. Well,
Speaker 1 (06:36):
Lucky you. Yeah. And
Speaker 2 (06:39):
But I was exhausted a hundred percent of the time. My first trimester, like I have always been super energetic. I've been a fitness instructor, like for my whole adult life. And I just wanted to sleep where I was standing all the time. So exercising was really difficult, which was hard for me because it's such a part of my life. And I would like put on an episode of Outlander and get on a stationary bike and be like, as long as your legs are moving, it counts. It's exercise, you know, was like no resistance on the bike. And that would be, I would get to my 30 minutes and counted as a win. So that, that was the first trimester. Second trimester is, was pretty awesome. That's kind of where it's at. Cause you're starting to show, which is fun. And then and energy levels come back up, but you're not like a whale yet, which is great.
Speaker 2 (07:32):
Well, by the end of the second trimester, when I was starting to get kind of big, then I started to have a very typical pregnancy symptoms of back pain. Interestingly my back pain was the worst kind of at that transition between the second and third trimesters. And then by the end of the third trimester kind of disappeared. My body kind of figured out how to be that size. I felt like I also had extreme swelling in my hands and feet. So I was wearing compression socks wearing wrist splints at night while I was having a lot of risk banks. I was actively working as a physical therapist on my feet and manually treating patients. So that was, that was hard to handle. I tried a cortisone shot, actually. I tried PT, of course. And then I tried a cortisone shot and none of that really helped. I had pretty bad carpal tunnel until I gave birth. And, and it would just like my hands and feet looked like little sausages, which was really pretty funny. And, and by the end of the third trimester, I was again, really tired, but I managed to work until I was 38 and a half weeks pregnant. On my feet demonstrating exercises, even though I gained well over the recommended amount and I gained 47 pounds, which interestingly was exactly what my mother gained with both her pregnancies
Speaker 1 (08:51):
Beard. And so what is the recommended? Isn't it like 20 to 35 or six 25
Speaker 2 (08:56):
To 35 is the midline though. The most recent American college of obstetrics and gynecology recommendation is anywhere from 11 to 40. So there's a little more acknowledgement that now there's a broader range that can be considered normal. Got it.
Speaker 1 (09:09):
Okay. Great. And so I think it's also, it's also good to note that what you were feeling back, pain, swelling, these are all, like you said, these are pretty typical, right? It's not outside the realm of, of normal to have these symptoms when you're pregnant. Right. Okay. So then you go in, you give birth. Yup. Yup. So,
Speaker 2 (09:30):
So I I had one day of false labor, which was very frustrating. I wanted that kid out by 39 weeks. I was like, Nope, done out. And then a week later I went into real labor. I had a doula, I was just ready to have my vaginal unmedicated birth. That's what I always wanted. I got to the hospital and luckily I was six centimeters dilated, which is when they consider active labor is starting. So they were able to keep me at the hospital, but Oh my goodness, was I tired? I started having contractions on a Friday, late morning, went into the hospital by about 3:00 AM, Saturday morning. I had gotten maybe three hours of sleep. My duals recommended that I sleep more and I was, and of course that's what I recommend to all my clients. And I was like, no, no, no, I don't need to sleep. I'm going to keep walking cause that'll help my labor progress. So I walked around my block 1 million times. And so by the time I got to the hospital, I was so tired. That's mostly what I remember is just being exhausted. And I had, you know, I advise on changing positions during labor and, and how to best facilitate things. And my doula was like, let's get on hands and knees. And I was like, Nope,
Speaker 3 (10:45):
Not moving. I am not moving.
Speaker 2 (10:49):
And then actually did have some complications during labor where my son had a cord wrapped around his shoulder. So every time I would push the cord would become compressed and his heart rate would drop. But my actually it wasn't my OB. I went in just after she got off call that night at midnight. And I got into the hospital at 3:00 AM. And let the OB who delivered me was sent Hastick. She was really, really fantastic and knew that I was really committed to having an unmedicated vaginal birth. So there was never a moment where she was not where she was considering anything else. She just kept kept me charging. And I ended up giving birth in exactly the position I didn't want to, which is lithotomy position. So on my back with my niece, Fred and doing directed bowel salvia breathing, which I also didn't want to do.
Speaker 2 (11:39):
Cause both of those things increase the likelihood of vaginal tearing. But it was the only way that we were going to get that kid safely out with his heart rate dropping. And, and we did, as she was, she was able to cut his before he was fully out and were able to get him delivered vaginally on medicated and safely. So that was, that was quite an experience. And it was really funny actually, my husband was like, yeah, like that's how you do it. You, you unmedicated. And he like, we're all these sissies who need, who need epidurals. And my doula was like, no, no, no, no, no, no. You don't understand. 90% of women in New York city get epidurals. Like your wife is nuts. So I was like, yeah, you don't get to judge. That's not an experience you'll ever have.
Speaker 4 (12:29):
Exactly. yeah. So it was, it was,
Speaker 2 (12:35):
It was a roller coaster and then I still didn't sleep because I was so excited about having my son. And so that was really like a crazy up and down day then that Saturday when he was born that morning. Yeah.
Speaker 1 (12:51):
Wow. That's dramatic. That's a lot of, that's a lot of drama for, for one birth. But it's, it's also, I mean, I can, I can imagine the relief of having him born safely and there you are, you're in the hospital, you take your baby home, you know, you're, you've been teaching other women on how to work with their postpartum bodies for a long time, but now let's talk about you get home and, you know, a couple of weeks go by and you have the, we all talk about the dad bod, but you know, there's like you have like the mummy tummy or the mom bod. So how do you, what advice do you have for people to kind of stay body positive during this whole period, whether it be during the pregnancy postpartum and, and what, what being body positive can do for you?
Speaker 2 (13:50):
Yeah. so I have always been an advocate of body positivity and this was the time in my life where I felt like it really paid off. In general, I think that body positivity creates this cycle of self-care where if you take care of yourself, then you feel good about yourself. And if you feel good about yourself, then you're more likely to take good care of yourself. And it becomes a very positive spiral. So I've often used that with my clients and and it was definitely my turn to use it for myself. I was a ballet dancer, so I definitely have had an awareness of body image for most of my life. When I was pregnant, I, I kept, I felt like when I was pregnant, it wasn't as hard to have positive body image because everyone was just telling you how beautiful you are and you're glowing.
Speaker 2 (14:43):
And it's so exciting and the thrill so you get a lot of positive reinforcement from outside, but I feel like a lot of that ends after you give birth. In fact, just, I was, we were just talking about the New York times in her words newsletter today was a mom who was talking about her experiences postpartum and saying that a lot of times, even if you had a complicated birth that you were in a lot of pain, people say, Oh, well, at least the baby's healthy and they completely brushed aside the mother and her experience and her symptoms. And I'm very much of the thought that, yes, it's wonderful, the baby safe and healthy, but in order to be a good parent and effective caregiver, you need to put on your own oxygen mask first. So starting to take good care of yourself and feeling good about yourself is going to make you a better parent in my opinion.
Speaker 2 (15:40):
Plus it's just it, regardless of your status as a parent, it's important for especially women because we're often ignored in this regard to feel good about ourselves. So in terms of staying body positive after I gave birth, I actually strangely I found it very helpful to spend some time like with my body and kind of noticing the changes. So I took a little longer in the shower where I w I would kind of be grateful to different parts of my body while I was showering, like, wow, thanks to my stomach that was able to stretch and hold my son, like thank you to my breasts that are able to produce breast milk and nourish my son. We did have a lot of struggles with breastfeeding. So I was very grateful when we got it down, Pat. And you know, I've got rid of a lot of clothing because anything that was squeezing me or making me feel uncomfortable you know, instead of trying to squeeze back into my old clothes where every time I would shift or move, I would feel like the pinching of my old jeans or you know, like the bra cutting into my sides.
Speaker 2 (16:52):
I got rid of all of that, unless I really thought it was realistic that in which case I put it aside and I didn't even look at it. I lived in leggings and nursing tops for at least three months because it was comfortable. So I wasn't constantly reminded that I was a different shape that I wasn't it wasn't my old body. And I, and then I started moving pretty early in my recovery. I was discharged with the hospital with the very old school instructions of you know, wait six to eight weeks before you start exercising. And then about three weeks I was losing my mind and I was like, Hey, wait a minute. I can give medical advice too. And I can exercise under my own medical supervision. So I I started exercising. I started really gently. And, but there's even, there's at least one study.
Speaker 2 (17:46):
I believe there are a couple studies that have shown that even one bout of exercise increase, improves your body image. So getting moving and feeling like I was in control of my body and really starting to feel what it was capable of for myself, not just feeling what it was capable of in terms of giving birth to a human, which was also incredible. But, but starting that again, feel like, Oh, look, I can lift this weight. I can do this movement. And, and all the positive feelings that come from exercise definitely also helped.
Speaker 1 (18:21):
Yeah. And, and kind of again, taking agency over your, over your body. And I really love the, you know, giving yourself a little extra love in the shower. I think that's great advice for anyone, if you had birth, if you gave birth or not, you know, sometimes just getting older things change, you know, and being able to acknowledge that things change and that's okay. And you're still, you know, in love with everything that you have. I love that. That's great advice. So now you talked about exercising. You sort of went back about three weeks after, but let's talk about exercising while pregnant. So there can college of obstetrics and gynecology. They put out guidelines on exercise. So do you want to kind of fill us in on maybe what those guidelines are so that if there are women out there listening that are pregnant at the moment, they can have a better idea of what they can and can't do.
Speaker 2 (19:20):
Absolutely. I'm really excited about them actually, because there are new ones this year that are much more forward thinking in their recommendations. So there has been a lot of fear-mongering about exercising while you're pregnant in the past. And this year, the recommendations are that virtually everyone can exercise while they're pregnant, whether you exercise before you were pregnant or not. They do recommend that everyone obtain a medical clearance first with a, with a thorough exam to talk about any possible medical complications that could arise from exercising. But you know, there used to be the wisdom used to be that if you didn't exercise before you couldn't start, while you were pregnant and they have completely changed that and they, even to the point where if you are an athlete or someone who regularly exercise at high intensity, they say that you can continue to do that through the third trimester safely.
Speaker 2 (20:20):
And they recommend exercise because it actually decreases the incidence of diabetes, of gestational diabetes and other blood pressure complications while pregnant like three clamps SIA. It decreases the likelihood of pre of giving birth preterm and decreases actually the incidents of low birth weight, interestingly, and it also decreases recovery time postpartum. So it improves postpartum outcomes kind of sets you up for success, especially during time where you might not have time or might not be able to exercise yet right after giving birth. And it actually increases the likelihood of having a vaginal birth. So if that's something you desire, exercise can help you get there. And it decreases the likelihood of postpartum depressive disorders. So those endorphins that you get while you're exercising kind of carry through to the postpartum period. Well, that's a lot of positives for exercising while pregnant. Are there any sort of big no-nos and on that,
Speaker 1 (21:18):
No, we're going to take a quick break to hear from our sponsor and be right back. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for telehealth, secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com.
Speaker 2 (22:05):
A lot of it's on an individual basis and getting assessed by a PT who specializes is a great idea to see if you're able to still engage your transversus abdominis and see what positions might be best for you. If they do continue to recommend that you don't stay supine on your back for longer than two to three minutes, past 20 weeks of pregnancy, because you can become hypotensive because of the weight of the fetus on your on your blood supply. And they also recommend that you, they also really emphasize staying well hydrated. And if you're doing anything vigorous for more than 45 minutes to really make sure you have adequate calorie intake before maybe during and after to avoid hypoglycemia, which is not uncommon in pregnancy with my clients, I still recommend avoiding isometric exercises. So planks are awesome.
Speaker 2 (23:01):
Just make them dynamic somehow to help the body regulate the blood pressure, because it's just a lot of demand if you're holding a position and you're holding that tone in the muscles and you're trying to support a fetus it, it helps a little bit to keep those muscle pumps helping the blood pressure regulate. Besides that it's, it's on a very individual basis. It's what you're familiar with. It's how your pregnancy has been progressing. So it's really a good idea to talk to somebody. Okay. And speaking about talking to somebody, everybody who listens knows I'm a physical therapist, you're a physical therapist. So let's talk about reasons why women should go to a physical therapist when they're pregnant. I mean, it doesn't have to mean you, it doesn't mean you have to go every week of your entire pregnancy, but talk about why
Speaker 1 (23:47):
Every woman should be seeing a physical therapist when they are pregnant. Yes. Period.
Speaker 2 (23:53):
I love that. Yes, they should. So in the same guidelines this year, Aycock says that back pain has an incidence of about 60% in pregnancy, but that's extremely under-reported because most women just consider it a normal part of being pregnant. So I think back pain in pregnancy is pretty much universal. So that's one great reason to go to PT because it can help alleviate that back pain. And I did see a physical therapist myself when I was pregnant to help with the back pain. Also if you're having experienced experiencing things like sciatica wrist pain, which I had one kind of wrist pain while I was pregnant, different kind of risk pain after I gave birth, partly just because of the increase in fluid in the body. But then also changing joint mechanics because your ligaments are looser. If you have pelvic pain or pubic synthesis dysfunction, which you would know, cause your doctor would tell you, or you'd have a lot of fat in the front of your pelvis or even sprained ankles have a higher incidence in women who are pregnant. Because again, if those joint changes but also
Speaker 1 (24:57):
If you are having the perfect
Speaker 2 (25:00):
And see, which would be amazing and you have no pain whatsoever, you're that miracle person you can still help prepare for giving birth. There are PTs who specialize in helping with things like breathing, breathing techniques, preparing your pelvic floor muscles, and it might be a simple consultation. One time, two time to get some advice on, on what you can do to help yourself prepare. And also if you have any history of injuries or any current pain, then also PTs can help advise on what positions might be good for you and they can help coordinate with your OB or your midwife, whoever your burning professional is.
Speaker 1 (25:36):
Absolutely. And now all great reasons. Now let's talk about after you give birth the fourth trimester, right? So Aycock has came out with these guidelines about the fourth trimester. So first, can you tell us what the fourth trimester is for those who are not aware and then how, what is the physical therapist's role in the postpartum period?
Speaker 2 (25:57):
Absolutely. So fourth trimester kind of a tongue in cheek, a way of describing a three months after giving birth. Because the idea is that you're still, your body is still changing and your baby is also still changing a lot. There's some thought that when we were primates, our babies would have just dated for longer and come out further along, but our heads became too large and that's why babies started to be born earlier and earlier. So that's part of the reason that human babies are so vulnerable when they're born, as opposed to other species, like, you know, drafts who like pop out and run away from their mothers. And meanwhile, our kids can't, can't see, or
Speaker 1 (26:40):
Little blobs on my back. They're adorable blabs, but yeah,
Speaker 2 (26:44):
They, they can't do anything. So and one thing I hear a lot about the fourth trimester is women trying to get their bodies back which I need to bounce back quickly. I think it's just so depressing because, because you're not going back, why would we ever want to go backwards in your life? So why not take your body forwards with you? I love that. And, and you know what I, I will say just personally, like I, I gained, like I said, 47 pounds while I was pregnant. I have since lost all 47 pounds. I am still breastfeeding though. So we'll see what happens, but I am shaped totally differently than I was. And it's, it's not a good thing or a bad thing, at least to me, like it's just different. My body is totally different now. And that's, that's okay.
Speaker 2 (27:38):
You know, I, I'm really excited about what it can do. I love being a mom, so that's really important, but anyway, and physical therapy in the world of physical therapies. So again, it's a lot of similar reasons, usually back pain, but that can be again from a, it can be from how you gave birth. It can be from if you're, especially if you're still breastfeeding, you still have a lot of those quote unquote pregnancy hormones that cause the ligaments to be a little bit more flexible. Plus if you're breastfeeding the way that you're holding your child also if you're even just picking the kid up and down and getting on and off the floor and changing diapers, which can like, by the time they can turn over, sometimes it's like a circus you know, that that can cause back pain, wrist pain.
Speaker 2 (28:30):
And then of course you have your pelvic recovery, which I, for the first week, I, I don't think I was thinking about myself very much, but every once in a while I would realize that I felt like my vagina was on fire and sitting was horrible. It was the worst thing ever. I remember going, we were taking my son to his pediatrician, visit his first pediatrician visit. And I was sitting in the car like sideways on one butt cheek to try to avoid putting my perinatal area on the seat because it was so uncomfortable. So that, you know, that's normal for the first week, unfortunately even if you've had a Syrian birth that can you still have that huge change in, in your pelvis after it, no longer has this weight on it. And you have all these hormones released, so it could still be very uncomfortable and tender in your perinatal area.
Speaker 2 (29:25):
But yeah, that, that brings me to another point. Scars are big thing that should be treated. You would treat a scar from any other surgery or massive injury. So I don't know why it's not routine to refer for scar therapy after if you've had any vaginal tearing with giving birth or if you've had a cesarean birth those scars that can really cause a change in function. They're not as elastic as the tissue around them. And that excessive tissue that's there can disrupt the function and cause a lot of discomfort. So I had grade two vaginal tearing because of my birth experience. And I, I saw a PT myself to have my scar tissue manually worked on and work on some release techniques from my pelvic floor, which was super tense because it was trying to hold everything together during that postpartum phase. So I'm not, and that also for me, I had pain with penetrative sex after, you know, you go to the opiate and they're like, yup, healed, done. Yeah. You know, go back to doing whatever you want. And I was, I was terrified of resuming sexual intercourse and I'm very grateful for my PT who helped me figure out how to comfortably and safely get back to, to having sex. Yeah.
Speaker 1 (30:52):
You know, all these things, like you said, like so many women are experiencing these things and I think it's so important to just vocalize that and put that out into the universe so that women could be like, Oh, wait a second. Oh, I can go to a PT and they can help with that. Or I can go to PT and they can help with incontinence afterwards, or they can help, you know, like you said, have sex with my husband or my partner afterwards. I mean, wow, this is revolutionary for a lot of women, you know, to know that this resource exists. And you just have to find that physical therapist, preferably one who is trained in pelvic health and who understands understands the pelvis in a more intimate way. And, and that doesn't necessarily mean that they're, your therapist has to be a woman. There are also men who specialize in pelvic health as well. So I want to give a shout out to all of our colleagues doing that around the country as well.
Speaker 2 (31:50):
Yeah. Oh, go ahead. Sorry. I was just gonna say you know, also there are PTs who have been trained in helping support breastfeeding in terms of what positions to use treating clog ducks, or even just education on you know, effective techniques. There's also pelvic organ prolapse and incontinence, as you mentioned, which can happen regardless of if you've had a child or not. And that can also be treated with physical therapy. Again, some incontinence after giving birth is actually normal for up to a month or two, but if you're still leaking after that, then you should definitely seek help. And again, even, even like you said, it was pregnancy like why every pregnant woman should get PT. Everyone should get some advice, professional advice on how to safely return to movement, whatever movement you want to do, whether it's, you know a yoga class or a couple of group fitness classes or going back to playing a sport. And that's, that's something where we that's something we specialize in is movement. Yeah.
Speaker 1 (32:51):
And, and in many countries it's, everyone goes to standard care. It's a standard of care, you know, and, and hopefully now that these are part of the guidelines by a cog, that that is something that will become a standard of care. You know, I interviewed dr. Camila Phillips, who is an OB GYN at Lenox Hill and she recommends all of her patients to see a PT and I love it. And that was awesome. Brilliant. But I don't know. She might be in the minority. I'm not sure I think she is, but, you know, experience. Yeah. But I just, I just love that she is so forward-thinking, and, and for women to know that you have all of these resources, it's so empowering to kind of help you back, get back to not get back to, but help you move forward. I love that. I almost say get back to, well, get back to doing what you like to do. Yeah, yeah, exactly. Get back to doing what you like to do and whether that be any kind of movement or running or, or a high intensity sports, you know, just because you have a child doesn't mean that, that you can't return to the things you were doing before. And I think that's where the PT comes in.
Speaker 2 (34:03):
Absolutely. And with the help of my PT and like my own expertise at like five months, I was back to boxing and high intensity interval training. And I will tell you though, the first time I tried to do a jump after giving birth, I mean, I don't, I don't remember how long postpartum I was, maybe three or four months. I was like, Oh my God, I am an elephant. Like, I just felt like I had no pep, no spring whatsoever. I felt like every time I landed, I was like sod. It took a good few months for me to feel like I had my, my spring back, my like pep in my step.
Speaker 1 (34:36):
Yeah. Yeah. And, and again, you know, this is, I think this is all great for people to hear. Like we don't, I think women don't give birth and then, you know, go back to like walking the Victoria secret runway show like Heidi Clume, you know, like it's, that's not normal. No, do that like four weeks after you give birth, not normal. Like that is an exceptional human being there who has very good genetics, I'm assuming. And also it's her job.
Speaker 2 (35:04):
Yes. And a lot of expensive support
Speaker 1 (35:07):
And a lot of expensive support that us average Joe's just do not have. Nope. Don't have it. All right. So Helene, what would you like to leave the listeners with, if you could leave them with, you know, your, your top tip or your takeaways from this? From our discussion here,
Speaker 2 (35:27):
That's a tough one because there's so many good tidbits in there. Yeah, I think my top tip is, is just to love, love where you are. I would love your body, where it is, love it for what it's done, love it for what it can do right now. And, and get some help if you need help loving it. If you need help you know, getting it to do what you wanted to do, there is so much help available. It's just a matter of finding it, which shouldn't be as difficult as it is, but it is there. Yeah.
Speaker 1 (36:01):
Fabulous. And now last question that I ask everyone, given where you are now in your life and in your career, what advice would you give yourself as a new grad fresh out of physical therapy?
Speaker 2 (36:15):
Cool. Well, I would say trust your intuition. My program was very into evidence-based physical therapy, which is awesome and everything should be grounded in evidence, but never forget that clinical expertise in clinical experiences, also a level of evidence.
Speaker 1 (36:36):
And I've heard that many times from people on the show.
Speaker 2 (36:40):
Sure. You have that. I've heard it. I've heard it on your show too.
Speaker 1 (36:43):
Yeah. Many times. Well now, where can people find you? Where can people get in touch with you if they have questions or they want to know what you're up to.
Speaker 2 (36:50):
Ah, great question. I'm on Instagram at Halloween B underscore PT. That's the best place to find me I'm currently practicing at Danford works. And so you can find me there or I would love to hear from anybody via email, it's HD the pt@gmail.com. Perfect.
Speaker 1 (37:10):
And we will have all of those links in the show notes for this episode at podcast at healthy, wealthy, smart.com. So if you didn't have a pen on you, you didn't write it all down. Don't worry. One click will take you to everything Helene. And I will say she also on her Instagram account, really great exercises, advice, and support. So if you're looking for for that, then definitely follow her on Instagram because you give a lot of great XYZ and support, especially for women throughout an after pregnancy. So definitely give her a follow on Instagram. So Helene, thank you so much for coming on. This was wonderful. And thank you for sharing your story because I know it's not easy. Thanks, Tara and everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Haag to talk about exercise and urinary incontinence. This interview was part of the JOSPT Asks interview series. Sarah is the co-owner of Entropy Physiotherapy and Wellness in Chicago. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.
In this episode, we discuss:
- The prevalence of urinary incontinence
- Is urinary incontinence normal
- Pelvic floor exercises
- Pelvic floor exam for the non-pelvic health PT
- Sports specific pelvic health dysfunction
- And much more
Resources:
Entropy Physiotherapy and Wellness
JOSPT Facebook Page
JOSPT Journal Page
More Information about Dr. Haag:
Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Teacher.
Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
Read the full transcript below:
Read the Full Transcript below:
Speaker 1 (00:06:25):
So, and hopefully it doesn't want to lose what we're doing here. We'll see. Okay. Going live now. Okay. Welcome everyone to JLS. PT asks hello and welcome to the listeners. This is Joe SPT asks the weekly chat where you, the audience get your questions answered. My name is Claire Arden. I'm the editor in chief of Joe SPT. And it's really great to be chatting with you this week, before we get to our guest. I'd like to say a big thanks for the terrific feedback that we've had since launching [inaudible] a week ago. We really appreciate your feedback. So please let us know if there's a guest that you'd like to hear from, or if you have some ideas for the show today, we're in for a very special treat because not only are we joined by dr. Sarah hake from entropy physio, but guest hosting [inaudible] asks today is dr. Karen Litzy who you might know from the healthy, wealthy and smart podcast. Dr. Lexi is also a new Yorker. And I think I can speak for many of us when I say that New York has been front of mind recently with the coronavirus pandemic. And I'd like to extend our very best wishes to everyone in New York where we're thinking of you. So I'm going to throw to Karen now. We're, I'm really looking forward to chat today on pelvic floor incontinence and exercise over to you, Karen.
Speaker 1 (00:08:25):
Hi everyone, Claire. Thank you so much. I really appreciate your giving me the opportunity to be part of J O S P T asks live stream. So I'm very excited about this and I'm also very excited to talk with dr. Sarah Hagar. Sarah is an educator, a clinician, and an author. She is also co-owner of entropy wellness and our physiotherapy and wellness in Chicago, Illinois, and is also a good
Speaker 2 (00:08:56):
Friend of mine. So it's really a an honor for me to be on here. So Sarah, welcome. Thank you so much. I was really excited that all this came together so beautifully. Yes. And, and again like Claire had mentioned, we're all experiencing some pretty unprecedented times at the moment. And the hope of these J O S P T asks live streams is to continue to create that sense of community among all of us, even though we can't be with each other in person, but we can at least do this virtually. And as Claire said, last week, we want to acknowledge our frontline healthcare workers and colleagues across the world for their dedication and care to those in need. And again, like Claire said before, a special shout out to my New York city colleagues, we are they are really working like no other.
Speaker 2 (00:09:52):
And I also want to acknowledge not just our healthcare colleagues and workers, but the scientists, the grocery store workers, the truck drivers the pharmacist, police, firefighter paramedics, they're all working at full capacity to keep the wheels turning around the world. So I just want to acknowledge them as well and thank them for all of their hard work during this time. Okay. So, like Claire said today, we're going to be talking about the pelvic floor, which is something Sarah loves to talk about because what I also, I also failed to mention is she is a certified pelvic health practitioner. So through the American physical therapy association. So she is perfectly positioned to take us through. And as a lot of, you know, we had, you had the opportunity to go onto Slido to ask questions. You can still do that. Even throughout this talk, just use the code pelvic that's P E L V I C, and ask some questions.
Speaker 2 (00:10:57):
So we do have a lot of questions. I don't know if we're going to get to all of them. So if we don't then certainly post them in the Facebook chat and maybe Sarah can find those questions in the chat below. And we'll try and get to those questions after the recording has finished. All right, Sarah. So like I said, lots of questions and the way the questions were, were written out, kind of corresponds quite well with maybe how you would see a patient in the clinic. So let's start with the patient comes into your clinic. They sit down in front of you. Let's talk about the words we would use in that initial evaluation. So I'll throw it over to you. Okay. So being a pelvic health therapist, obviously most people when they're coming to females, Things that happen in the pelvis, I like to acknowledge it, that there's a lot of things happening in the past. So I have
Speaker 1 (00:11:54):
Them tell me kind of what are the things that have been bothering them or what are the things that have been happening that indicate something might be going on? Like if something's hurting, if they're experiencing incontinence, any bowel issues, any sexual dysfunction. And, and I kind of go from there. So if the talk that's the title of the talk today includes incontinence. Continence is a super common issue that let's see in general might pop in. And if you would bother to ask there's actually, I think it's like one out of two people over 60 are experiencing incontinence of some kind. The answer is going to be yes, some, so you can start asking more questions. But starting out with what, what is bothering them is really what I like to start with. Then the next thing we need to know is after we vet that issue or that priority list of things that are bothering them in the pelvis, and it's not uncommon actually to have.
Speaker 1 (00:13:00):
So let's say they start with a discussion of incontinence. I still actually ask about sexual function, any pain issues, any bowel issues, just based on the innervation of the various, the anatomical arrangement of everything. It's not uncommon to have more than one issue, but those other issues might not be bothersome enough to mention. So it's kind of nice to get that full picture. Then the next thing we really want art. So there are times I've met women who come in and they're like, Oh yeah, you know, I have incontinence. And you're like, okay. So when did it start now? Like 25 years ago. Okay. Do you remember what happened then? Typically it was a baby, but sometimes these women will notice that their incontinence didn't happen to like four or five years after the baby. Hmm. So that's information, that's very help if they say my baby that was born six weeks ago, our interventions and expectations are going to be very different than someone who's been having incontinence for 25 years.
Speaker 1 (00:14:05):
So again, knowing how it started and when it happens, when the issues are happening, I just kind of let them, it's like a free text box on a form. Like just, they can tell me so much more excuse me. And when we are talking about things, we, I do talk anatomy. So when it comes to incontinence, I talk about the bladder and the detrusor, the smooth muscle around the bladder, the basically the hose that takes the urine from the bladder to the outside world. I do talk about the vagina and the vulva and the difference between the two. And then actually we do talk about like the anus and the anal sphincters and how all of that is is all there together and supported by the pelvic floor.
Speaker 1 (00:14:54):
Cause that's in physical therapy, it's going to be something with that pelvic floor or something. Drought, does it need to be more, more pelvic floor focused or does it need to be behaviorally focused, which is the case sometimes, or is it that kind of finding that perfect Venn diagram of both for those issues that the person's having? And let's say you're in a part of the world. One of the questions was what if you're I think this question came from Asia and they said, what if you're in part of the world where you have to be a little bit, maybe more sensitive around even the words that you use. I know we had gotten a question a couple of years ago about a woman in the Southern part of the United States that was from very conservative area. And do we even use these words with these patients?
Speaker 1 (00:15:48):
So what is your response to that? My response is that as healthcare providers, we are responsible, I think for educating people and using appropriate words and making sure people understand the anatomy like where things are and what they're supposed to be doing. However, definitely when I'm having this conversation with someone I want them to feel at ease. So like I will use the Ana vagina anus, anal sphincters Volvo, not, it's not a vagina, it's a Volvo it's on the outside. But then if they use different terms to refer to the anatomy, we're discussing, I'm happy to code, switch over to what they're most comfortable with because they need to be comfortable. But I think as, as again, healthcare practitioners, if we're not comfortable with the area, we're not going to make them feel very comfortable about discussing those issues. Right.
Speaker 1 (00:16:43):
And that makes a lot of sense. Thank you for that. So now let's say you, the person kind of told you what's going on and let's, let's talk about when you're taking the history for women with incontinence, especially after pregnancy, are there key questions you like to ask? Yes. So my, my gals that I'm seeing, especially when they're relatively relatively early in the postpartum period, are the things I'm interested in is did they experience this incontinence during their pregnancy? And did they have issues before pregnancy? And then also if this is not their first, tell me about the first birth or the, or the first two birth. So the first three birth to really get an idea of is this a new issue or is this kind of an ongoing marked by so kind of getting a bigger picture of it.
Speaker 1 (00:17:49):
And then also that most recent birth we want to know, was it vaginal? Was it C-section with vaginal birth? If there's instrumentation use, so if they needed to use forceps or a vacuum that increases the likelihood that the pelvic floor went over, went under a bit of trauma and possibly that resulted in a larger lab. And even if there isn't muscles, it's understandable that things might work well, if it's really small and if it's still healing you know, different, different things like that. So understanding the, kind of like the recent birth story, as well as their bladder story going back. So you've met first baby or before that first baby so that we know where, where we're starting from. And the, the reason why I do that is because again, if it's a longterm issue, we have to acknowledge the most recent event and also understand there was something else happening that, that we need to kind of look at.
Speaker 1 (00:18:58):
So would I expect it all to magically go away? No, I wouldn't. There's probably something else we need to figure out, but if it's like, Nope, this onset happened birth of my baby three months ago, it's been happening since then three months is, seems like forever and is also no time whatsoever. It took 10 months to make the baby. So it's you know, if you tear your hamstring, we're expecting you to start feeling better in three months, but you're probably not back to your peak performance. So where are we in that? And sometimes time will cure things. Things will continue to heal, but also that would be a time like how good are things working? Is there something else going on that maybe we could facilitate or have them reach continence a bit sooner. Okay, great. And do you also ask questions around if there was any trauma to the area?
Speaker 1 (00:19:56):
So if this birth was for example, the product of, of a rape or of some other type of trauma, is that a question that you ask or do you, is that something that you hope they bring up? It's, that's honestly for me and my practice, something, I try to leave all of the doors wide open for them to, to share that in my experience you know, I've worked places where it is on it's on the questionnaire that they fill out from the front desk and they'll circle no to, to any sort of trauma in the past.
Speaker 1 (00:20:34):
Yeah. They just, they don't want to circle yes. On that form. So and also I kind of treat everybody like they might have something in their past, right. So very nonjudgmental, very safe place, always making them as comfortable in a safe as possible. And I will say that there's anything I can do to make you feel more comfortable and more safe. We can do that. And if you don't feel safe and comfortable, we're not doing this w we're going to do something else. Cause you're right. That it's always one of those lingering things. And the statistics on abuse and, and rape are horrifying to the point where, again, in my practice, I kind of assume that everybody has the possibility of having something in their past. Okay, great. Thank you. And now another question that's shifting gears. Another question that came up that I think is definitely worthy of an answer is what outcome measures or tools might you use with with your incontinence patients? So with incontinence, honestly, my favorite is like an oldie buddy, but a goodie, like just, it's an IC, it's the international continents questionnaire where it's, I think it's five or six questions. Just simple. Like how often does this happen? When does it happen?
Speaker 1 (00:21:58):
There's a couple of other outcome measures that do cover, like your bladder is not empty. Are you having feelings of pressure in your lower abdomen? It gets into some bowel and more genital function. Can you repeat that? Cause it kind of froze up for a second. So could you repeat the name of that outcome tool as it relates to the bladder and output? Oh, sorry. I see. IQ is one and then, but like I see IQ vs which renal symptoms, right? So there are, there's a lot of different forms out there. Another one that will gather up information about a whole bunch of things in the pelvis is the pelvic floor distress bins questions about bowel function, bladder function, sexual function discomfort from pressure or pain. So that can give you a bigger picture. I'll be honest. Sometimes my, the people in my clinic they're coming in, and even though I will ask the questions about those things, when they get the, the questionnaire with all of these things that they're like, this doesn't apply to me. I'm like, well, that's great that it doesn't apply to you, but they don't love filling, filling it out. So sometimes what I will go with is actually just the pale.
Speaker 1 (00:23:24):
Can you say that again? Please help me. Oh yeah. Oh, so sorry. The patient's specific functional scale where, where the patient says, this is what I want to have happen. And we kind of figured out where they are talk about what would need to happen to get them there, but it's them telling what better. Right. Cause I've had people actually score perfect on some of these outcome measures, but they're still in my office. So it's like, Oh, I'm so patient specific is one of my one of my kind of go tos. And then there's actually a couple of, most of these pelvic questionnaires finding one that you like is really helpful because, because there's so many and they really all or discomfort. So if you have a really good ability to take a really good history, some of the questions on that outcome measure end up being a bit redundant.
Speaker 1 (00:24:26):
So I like, and you know the questions on there, make sure people are filling them out. You look at them before you ask them all the questions that they just filled out on the form for you. Yes. Good. Very good advice. So then the patient doesn't feel like they're just being piled on with question after question and cause that can make people feel uncomfortable when maybe they're already a little uncomfortable coming to see someone for, for whatever their problem or dysfunction is. So that's a really good point. And now here's a question that came up a couple of times, you know, we're talking about incontinence, we're talking about women, we're talking about pregnancy. What about men? So is this pelvic floor dysfunction? Is this incontinence a women only problem? Or can it be an everybody problem? So it very much can be an everybody problem. Incontinence in particular for men, the rates for that are much lower. And typically the men are either much older or they are they've undergone frustrate removal for prostate cancer.
Speaker 1 (00:25:33):
Fleur plays a role in getting them to be dry or at least dryer. And then it's like the pelvic floor is not working right. That can result in pain. It can result in constipation. It can result in sexual dysfunction. It can result in bladder issues. So it's, so yes, men can have all of those things. In fact, last night we had a great talk in our mentorship group at entropy about hard flacid syndrome. So this is a syndrome with men where everything is normal when they go get, get tested, no no infections, no cancers, no tumors, no trauma that they can recall. And, but the penis is not able to become functional and direct. And with a lot of these men, we're finding that it's more of a pelvic floor dysfunction issue, or at least they respond to pelvic floor interventions.
Speaker 1 (00:26:30):
So having a pelvic floor that does what it's supposed to, which is contract and relax and help you do the things you want to do. If, if we can help people make sure that they're doing that can resolve a lot of issues and because men have pelvic floors, they can sometimes have pelvic floor dysfunction. Okay, great. Yeah. That was a very popular question. Is this a woman only thing? So thank you for clearing up that mystery for everyone. Okay. So in going through your evaluation, you've, you've asked all your questions, you're getting ready for your objective exam. What do you do if you're a clinician who does not do internal work, is there a way to test these pelvic floor muscles and to do things without having to do internal work? My answer for that question is yes, there are things that you can do because even though I do do internal exams, I have people who come to see me who are like, no, we're not doing that.
Speaker 1 (00:27:31):
So, so where can we start? And so the first one is pants on and me not even touching you pelvic floor, I wouldn't really call it an assessment or self report. So even just sitting here, if you, if you were to call me up and and this actually goes into, I think another question that was on Slido about pelvic floor cues. So there is actually then it seems more research on how to get a mail to contract this pelvic floor then actually females. But I would ask you like like this is one that my friend Julie, we would use. So like if you're sitting there and you just sit up nice and tall, if you pretend you're trying to pick up a Ruby with your PA with your vagina is not on the outside, but imagine like there's just a Ruby on the chair and you'd like to pick it up with no hands, breathe in and breathe out and let it go. So then I would go, did you feel anything and you should have felt something happen or not. So if, if you did it, would you mind telling me what you built? You're asking me, Oh my goodness. Oh yes. I did feel something. So I did feel like I could pick the Ruby up and hold it and drop it.
Speaker 1 (00:29:04):
Excellent. And that's, and that, that drop is key. Excellent. So what I would say is this is like like a plus, like a, I can't confirm or deny you that you did it correctly, but I like, I would have watched you hold your, like she holding my breath. Is she getting taller? Cause she's using her glutes. Did she just do a crunch? When she tried to do this, I can see external things happening that would indicate you're might be working too hard or you might be doing something completely wrong. So then we'll get into, I mean, you said, yes. I felt like I pick up the Ruby, but if it's like, Hmm, I felt stuffed, but I'm not really sure we would use our words because they've already said no to hands to figure that out. But again, I can't confirm it. People are they're okay with that.
Speaker 1 (00:29:48):
And I'm like, and if what we're doing based on the information you gave me, isn't changing, we might go to step two. If you can send in step two is actually something, any orthopedic therapist honestly, should not feel too crazy doing. So if anyone has ever palpated the origin of the hamstring, so where is the origin of the hamstring facial tuberosity? If you go just medial to that along the inside part get, don't go square in the middle. That's where everyone gets a little nervous and a little tense, but if you just Pell paid around that issue, tuberosity it's pretty awesome. If you have a, a friend or a colleague who's willing to let this happen is you ask them to do a poll of our different cues with that in a little bit. You say that again, ask them to do what to contract the pelvic floor.
Speaker 1 (00:30:44):
Okay. And again, figuring out the right words so that they know what you're talking about. We can talk about that in a minute, but if they do a pelvic floor contraction, you're going to feel kind of like the bulging tension build, right there may be pushing your fingers. You should feel it kind of gather under your fingers. It shouldn't like push your fingers away, but then you can be like, well, you could test their hamstring and see that you're not on the hamstring and you can have them squeeze your glutes and you can kind of feel the differences. The pelvic floor is just there at the bottom of the pelvis. So you can palpate externally, even through BlueJeans is a bit of a challenge, but if they're in you know, like their workout shorts for yoga pants, it's actually very, very simple. And, and honestly, as long as you explained to them what you're doing and what you're checking for, it's no different than palpating the issue of tuberosity for any other reason.
Speaker 1 (00:31:36):
And with that, I tell them that I can, it's more like a plus minus, so I can tell that you contracted and that you let go. That's all I can tell. So I can't tell you how strong you are, how good your relaxation Wells, how long you could hold it for any of those things. And then I tell them with an internal exam, we would get a lot of information we could, we can test left to, right? We can, I could give you more of like a muscle grade. So like that zero to five scale be use for other muscles. We can use that for the pelvic floor. I can get a much better sense of your relaxation and see how was that going and I can even offer some assistance. So so we have two really good options for no touching.
Speaker 1 (00:32:19):
And then just as long as we understand the information we might gain from an internal exam, we can, we can, the information we gathered from the first two ways, isn't sufficient to make a change for them. And then as let's say, the non pelvic health therapist, which there might be several who are gonna watch this, when do we say, you know, something? I think it's time that we refer you to a pelvic health therapist, because I do think given what you've said to me and you know, maybe we did step one and two here of your exams. I think that you need a little bit more. So when do, when is that decision made to reach the point of, they have a bother that I don't know how to address so we can actually go to like the pelvic organ prolapse. So pelvic organ prolapse is, is when the support for either the bladder, the uterus, or even the rectum starts to be less supportive and things can kind of start to fall into the vaginal wall and can give a feeling of like pressure in with activity the sensation can get.
Speaker 1 (00:33:39):
So then we have two options, which is more support from below with perhaps a stronger meatier pelvic floor by like working it out to hypertrophy. So like if, if I had someone who had that feeling when they were running and we tried a couple are lifting weights, let's go lifting weights. No, like I feel it once I get to like a 200 pound deadlift. Okay, well, let's see how you're lifting when you're doing 150 and let's take a look at what you're doing at 200 in fresh with your mechanics or what's happening. And if there's something that is in your wheelhouse where you're like, well, can you try this breath? Or can you try it this way and see if that feeling goes away? I'm good with that. And if the, that the person who's having issue is good with that. Awesome. But if you're trying stuff or the incontinence is not changing, send them to a pelvic floor therapist, because what we love to do is we can check it out.
Speaker 1 (00:34:41):
We're going to check it out. We're going to give some suggestions. And then my, the end of every one of those visits that I get from my, from my orthopedic or sports colleagues is I'm like, excellent. So you're going to work on this, keep doing what you're doing. Cause another really common thing is like, is I don't really believe that they can make a lot of these things worse doing the things that they're doing. And by that, I mean, they can become more simple MADEC, but in many cases you're not actually making the situation worse. So if the symptoms seem to be not getting better or even getting worse, doing the things they're doing, they go come back to the pelvic floor therapist. And then that pelvic floor therapist also has a responsibility that the things I'm asking them to do, isn't helping them get there.
Speaker 1 (00:35:29):
You can try something a little more intense, still not helping. Then that's when I actually would refer for females, especially with like pelvic pressure. So Euro gynecologist for an assessment in that regard. Yeah. So I think I heard a couple of really important things there. And that's one, if you are the sports therapist or the orthopedic physiotherapist, and you have someone that needs pelvic health support, you can refer them to the pelvic health therapist and you can continue seeing them doing the things you're doing. So just because they're having incontinence or they're having some pressure, let's say it's a pelvis, pelvic organ prolapse. It doesn't mean stop doing everything you're doing.
Speaker 3 (00:36:12):
Okay.
Speaker 1 (00:36:15):
Correct. Okay. Yeah. It may mean modify what you're doing. Stop some of what you're doing, listen to the pelvic floor therapist. And I'm also seeing, well now we're, aren't we this great cause we're creating great team around this, around this person to help support them in their goals. So one doesn't negate the other. Absolutely correct. And I, and I think too often even, even within the PT world is people start to get kind of territorial. But it's not about what each one of us is doing. It's that person. Right. so telling them to stop doing something, especially if it's something they love it seems like a bad start. It's like, okay, let's take a look at this. Tell me what you are doing. Tell me what you want to be doing. Tell me what's happening when you do that. And let's see if we can change it.
Speaker 1 (00:37:02):
Cause like I said, like the, the other, that being something they're going to make worse and worse and worse is if symptoms get worse and worse and worse, but they're not causing damage, they're not causing, I mean, what they're doing and say leaking a bit. Got it. And now I'm going to take a slight detour here because you had mentioned pelvic organ prolapse. You had mentioned, there comes a time when, if that pressure is not relieving, you've tried a lot of different things. You would refer them to a urogynecologist now several years ago. They're so you're, you're a gynecologist. One of their treatments might be surgery. So there was pelvic mesh sweats. It's hard to say pelvic mesh surgery that years ago made some people better and made some people far, far worse with, with some very serious ramifications. So can you talk about that pelvic mesh mesh surgery and where we are now?
Speaker 1 (00:38:04):
Oh, the last bit cut out a little bit. So the pelvic mess, mess surgery and, and Oh, the most important part and kind of where we are now versus maybe where we were, let's say a decade ago or so. Awesome. Yeah. So, so the pelvic mesh situation certainly here, I think it's not a universal problem. I think it's a United States problem is if you're at home during the day, like most of us are now you will see law commercials, lawyers looking for your business to discuss the mesh situation on what's happening is there was there were, it was mesh erosion and the resulting fact that that was a lot of pain because they couldn't just take it all out. And it was several women suffered and are still sad.
Speaker 3 (00:38:55):
Mmm.
Speaker 1 (00:38:55):
But that was from a particular type of surgery with a particular type of surgical kit, which thankfully has, was removed completely from the market and isn't being used anymore and mesh surgeries, I would say at least for the last five to 10 years, haven't haven't been using that and mesh surgeries are being done with great success in resolving symptoms. So I think it's important that if a woman isn't responding
Speaker 3 (00:39:27):
Yeah.
Speaker 1 (00:39:30):
Well changing their breath or making a pelvic floor or changing how they're doing things is to have that discussion with the Euro gynecologist because they do have nonsurgical options for super mild prolapse. There are some even like over the counter options you can buy like poise has one where it's just a little bit of support that helps you. Actually not leak because if you're having too much movement of the urethra, it can cause stress or it can be contributing to stress incontinence. But so there's some over the counter things or there's something called a pessary, which I think about it. Like I'm like a tent pole, but it's not a pole. It's a circle don't worry or a square or a donut. There's so many different shapes, but it's basically something you put in the vagina and that you can take out of the vagina that just kind of holds everything back up where it belongs, so it can work better.
Speaker 1 (00:40:21):
And that it's not awesome. But there are also people who are like due to hand dexterity, or just due to a general discomfort with the idea of putting things in their vagina and living them there that they're like, no, I'd rather just have this be fixed. So, so there are, it's not just surgery is not your only option. There are lots of options and it just depends on where you want to go. But with the surgery, if that's what's being recommended for a woman, I really do. Some women aren't worried at all. They've heard about the mash, but they're sure it won't happen to them, but there are when we're still avoiding surgery, even with significant syndromes, because they're worried about the mesh situation. And I would still encourage those women to at least discuss us, to see if that surgeon can, can educate them and give them enough confidence before they move forward with the surgery.
Speaker 1 (00:41:18):
Because the worst thing I think is when I had one patient actually put it off for years. Not, not just because of the mesh because of a lot of issues, but the first time the doctor recommended it, she had a grade four prolapse. Like that means when things come all the way out. And she it was so bad. Like she couldn't use the pastory okay, so she needed it, but she avoided it until she was ready and had the answers that made her feel confident in that having the surgery was the right thing to do. So it might take some time and the doctor, the surgeon really should, and most of them that I've met are more than happy to make sure that the patient has all the information they need and understand the risk factors, the potential benefits before they move forward.
Speaker 2 (00:42:03):
Excellent. Thank you so much for that indulging that slight detour. Okay. Let's get into intervention. So there are lots of questions on Slido about it, about different kinds of interventions. And so let's start with lot of, lot of questions about transverse abdominis activation. So there is one question here from Shan. Tall said studies in patients with specific low back pain do not recommend adding transverse abdominis activation because of protective muscle spasm. What about urinary incontinence in combination? What do you do? So there is a lot on transfer subdominant as you saw in Slido. So I'll throw it over to you and, and you can give us all your share your knowledge.
Speaker 1 (00:42:55):
Okay, well, let's all do this together. So I don't know how many people are watching, but if we just sit up nice and tall and I'm going to give a different cue for the pelvic floor. So what I want you to squeeze, like you don't want to urinate, like you want to stop the stream of urine. Okay. So as we're pulling that in anything else other than the underneath contract, what did you feel Karen?
Speaker 2 (00:43:24):
Well, I did feel my TA contract. I felt that lower abdominal muscle wall started to pull in.
Speaker 1 (00:43:32):
Yes. So, so the, the way I explain it is that the pelvic floor and the trans versus are the best is to friends. And this makes sense when you think about when you remember the fact that the pelvic floor, isn't just there regarding like bowel bladder and sexual function. It's one of our posture muscles. So if we're totally like, like slacked out and our abs are off and all of that, our pelvic floor is pretty turned off as well. And then if I get a little bit taller and like, so I'm not really clenching anything. Right. But this is like stuff working like it should, my pelvic floor is a little more on, but not, I'm not acting. It's just but then I could like, right, if I'm gonna, if I'm expecting to hit, or if I'm going to push into something, I can tend to set up more and handle more force into the system.
Speaker 1 (00:44:21):
So I like to think about it in those in those three ways, because the pelvic floor, isn't just hanging out, down there and complete isolation it's, it's part of a system. And so in my personal, like emotional approach to interventions is I don't want them to be too complicated. So if I can get someone to contract their pelvic floor, continue to breathe and let go of that pelvic floor, then we start thinking about what else are you feeling? Cause I don't know that there's any evidence that says if I just work my transverses all the time, my pelvic floor will automatically come along for the ride. So a great quote. I heard Karrie both speak once at a combined sections meeting and she goes, your biceps turn on. When you take a walk, it's not a good bicep exercise. So just the fact we're getting activity in the pelvic floor when we're working other muscles, what's supposed to work. And also if you want to strengthen that muscle, you're going to need to work out that muscle.
Speaker 1 (00:45:26):
And that makes a lot of sense and something that people had a lot of questions around where we're kind of queuing for these different exercises. And I really love the can. You've made it several times comparisons to other muscles in the body. So can you talk about maybe what kind of queuing you might use to have someone on? I can't believe I'm going to say this turn on and I use that in quotes because that's what you see in, in a lot of like mainstream publications for, for layman. So it might be something that our patients may see when they come in. So how do you cue that? To, to turn on the pelvic floor? So honestly I will usually start with floor and I do if I'm able to do a public floor exam, that's usually, again, a lot more information for me, but I'm like, okay, so do that now.
Speaker 1 (00:46:27):
And I watched them do it or I feel them do it and I'd be like, Oh, okay. What did you, what did you feel move? And I start there. And then I always say it's a little bit, like I get dropped into a country and I'm not sure what language people are speaking. So sometimes excuse me, one of the first cues that I learned was like, so squeeze, like you don't want to pass gas. Okay. So everybody let's try that. So sitting squeeze, like you don't care and you got taller. So I think you did some glutes.
Speaker 1 (00:47:00):
It's like, OK. So like lift, lift your anal sphincter up and in, but activating mostly the back part. So if you're having fecal issues, maybe that's a good place to start, but most people are having issues a little further front. So then we moved to the, can you pick a upper with your, with your Lavia? I had a, I learned the best things for my patients. One woman said it's like, I'm shutting the church doors. So if you imagine the Lavia being churched doors, we're going to close them up. And that, that gives a slightly different feeling. Them then squeezing the anal sphincter. Now, if you get up to squeeze, like you don't want to like pee your pants, like you want to stop the stream of urine. That will activate more in the front of the pelvis. Look, men who are like if it gets stopped the flow of urine, I wouldn't be here.
Speaker 1 (00:47:57):
So what else do you get? What's really cool is in the male literature. So this is a study done by Paul Hodges is he found that what activated the anterior part and the urinary sphincter, this rioted urinary speaker, sphincter the most for men. What a penis or pull your penis in to your body now for women. So when I was at a chorus and it's like, so let's, let's think of like other cues and other words, but even if, so, I don't have a penis this fall that probably don't have a penis. Even if you don't have a penis, I want you to do that in your brain, shorten the penis and pull it in.
Speaker 1 (00:48:42):
And did you feel anything happen? Cause we do have things that are now analogous to the male penis, if you are are a female. So I'll sometimes use that. Like I know it sounds stupid, but pretend to draw on your penis and it works and it does feel more anterior for a lot of people. So I'll kind of just, I'll kind of see what's, like I said, sometimes it's like the 42nd way of doing it that I've asked them to do where they're like, Oh, that, and you're like yeah. So then also just another, it's a little bit of like a little bit of a tangent, but so as you're sitting, so if you're, if you're sitting I want you to pick the cue that speaks most to your pelvic floor, and I want you to slouch really, really slouch, and actually to give yourself that cue and just pay attention to what you're feeling. So when you squeeze, give yourself that cue, breathe in and breath out and then let go, we should have felt a contraction, a little hole and a let go. Now, the reason why I say breathe in and breathe out is if you breathe in and out, that's about five seconds and also you were breathing. Cause another thing people love to do when they're trying to contract their pelvic floors, just basically suck it in.
Speaker 1 (00:50:10):
And so that's, that's not great, but we want to feel the contraction and we want to feel it, let go. And that's super important. I think that was another question on the Slido is that yes. For any muscle we're working, you should be able to contract it and let it go. There's not a muscle in our body where I just keep it contracted. It's going to do much. It might look great. Eventually, but like I couldn't get my coat on, like getting a drink of water would be a little weird. It's not very functional muscles have to relax so that they can contract. So that's a big, yes, it's just as important that the contraction pelvic floor that cue and we felt where it happened, not tall, like, like you're sitting out at a restaurant and you just saw someone looking at you and you're like, Oh, what are they looking at? And then you're going to do the exact same cue and you're gonna breathe in and breathe out and let it go.
Speaker 1 (00:51:07):
And then did it feel different than menu or slouch that it did it change position? I feel like Karen's Miami. It feels different. Now what I want you to do is if you can, depending on how you're sitting really give me like an anterior pelvic tilt, really happy puppy and then do the exact same thing and then let it go. And so again, some more EMG work from, from Paul Hodges is that when you're in a posterior pelvic tilt, you tend to activate the posterior portion more, which is fine. And if you're not having problems in the front, if you're having problems activating and maintaining continence in the front, actually increasing that lordosis can favor the front a bit. So this is, that's really awesome when people can feel that difference. Because I want you to think about, if you start to leak on your fourth mile of a half marathon, there's no way, no matter how awesome you are, but you're going to be able to squeeze your pelvic floor for the rest of that race.
Speaker 1 (00:52:15):
Like there's just, there's no way. But sometimes if, because remember your pelvic floor is still doing its thing while you're running is if you're like, well, hold on, when you're at your fourth mile, are you starting to get tired or hopefully not if it's a half marathon, but you know, like is something changing and how you're using your body. And can you, when you get to that point, remember to stay tall or lift your tail a little bit, or is there a cue or something they can change that will help them favor the front instead of going about four steps with the contracted pelvic floor and then losing it anyway. So there's, there's a lot of different ways you can actually make that your intervention for the issue you're having and then let's just get it functional. Perfect. And since you brought up running a question that's been, got, gotten a couple of likes on Slido is how would you approach return to running after pregnancy?
Speaker 1 (00:53:15):
Do you have any tips on criteria for progress, timeframe and a recreational runner versus a full time athlete? Because I would think the majority of physiotherapists around the world are seeing the recreational runner versus the professional or full time athlete. So first, how would you approach return to running any tips for progress? So that's going to be after pregnancy, sorry. After pregnancy. Yeah. So this is where I was really excited. So just last year I'm going to say her name wrong, but Tom goom Gran Donnely and Emma Brockwell published returned to running postnatal guidelines for health professionals managing this population. And the reason why I was super excited is because even though it was just published last year, it's the first one. There was definitely a lot of emotion and feelings about, about women getting back into sport after having a baby, but to be perfectly Frank, there's very few actual solid guidelines for recreational or others.
Speaker 1 (00:54:30):
So I have not personally had a child, but I will tell you of all the women I've seen over the years, basically doctors are like, it's been six weeks ease back into it, see how it goes. I'm not really even mentioning if you have a problem come back so we can figure it out. It's just kind of like good luck with that. And as a result, what happens is a lot of women don't get back into exercise or they get back into exercise and and kind of freak themselves out because stuff feels different. So to get back to the question of what do I do, actually this this guide from Tom and team really, really helpful. I think, and, and it's just basically it's it does have a series of exercises that I've actually started to use with my postpartum moms to go like, look, if you can do these things without feeling heaviness, you're good.
Speaker 1 (00:55:30):
You're good to start easing back into your running program, but get up, get walking because I'm going to post Sandy Hilton and like, you can't rest this better, like just waiting, isn't going to make it all go away. But it can also be deceiving because again, with polo, you don't feel that heaviness and you don't leak. And so I'm just going to stay right here where everything is fine. So that's obviously not a good option longterm option for a lot of reasons. So, so what do I do? I do look at the patient's goals, their previous running history, and if they're having any options I recently had a patient who she was runner exercise or sr after baby number two for a bit, some feeling of happiness that got completely better, baby number three came along. So I saw her a bit while she was pregnant because she got, I think two thirds of the way through pregnancy before she started to feel that heaviness. Again, she was still running,
Speaker 1 (00:56:38):
Tried to see if we could change that feeling while she was running. And she could until about the, when did she start? I think she didn't stop running to her 35th week, which is pretty impressive. But then she wanted to do a half marathon. I think it was just three months postpartum. Right. So this is like going from having baby to running 13. You think that a lot of people would probably feel that was too soon, too much too fast, but she was able to do it completely symptom-free. So as she was training and she was really fast, she was timing it so that she could get back in time to breastfeed. Like I was like, Oh my gosh, like I, that would disqualify me. Like, there's no way I could run fast enough to make that happen. But she was able to, to work it out where she could perform at her level without symptoms. And I was really happy that I was able to support her in that she did all the hard work. For general people recreational, where you a runner before, or is this completely new and are you having any symptoms and is there any thing you're worried about? Again, a lot of women are worried about giving.
Speaker 1 (00:57:53):
It's actually really hard to perhaps to give yourself one baby babies are a great way to do it. But that's like the risk factors I look up for something else a couple of years ago, I haven't looked recently, but like you really have any prolonged lifting. So not like your CrossFit three days a week, but like your, your physical labor for eight, eight hours, 10 hours a day every day could eventually do it also having babies. So like once you get to every baby increases your risk of pelvic organ prolapse, which makes good sense. And that, and that is what it is. So kind of looking at what are their risk factors, are there any, and letting them know that if they feel it more, it doesn't mean they made it worse. They just made it more symptomatic. Got it. Great.
Speaker 1 (00:58:40):
All right. So we have time for maybe one or two more questions, and then I'm going to throw back to Claire. Cause we're coming up onto an hour here, maybe time for one more it's so w what am I going to ask? I think I'm going to go with the gymnasts I work with all believe it's normal to leak a little urine during training or competition. And this is something we talk about a lot. It might be common, but is it normal? You already gave me the answer. What is it, Karen? No, no, no. And so, yeah, so the, the short answer for that is no. Or I agree with the question where it is very, very, very common, and it is still, I would say, not to leak urine. Unfortunately, so there's any researchers out there who want to get together.
Speaker 1 (00:59:26):
Let me know. We haven't, we have information on athletes and incontinence, but mostly it's prevalent that it happens a lot and gymnastics and dancing and volleyball. There's, there's even some swimmers who have it, right? So there's, there's incontinence across the spectrum, which basically tells me, yep. People have incontinence. Some of the some of the sports are more likely to have urgent continents. A lot of them though, we're looking at stress incontinence, however, for none of the athletes, have, we really had a great study that says, this is what we're finding. We're thinking, this is the cause of this incontinence. And we certainly haven't gotten to the point where it's like, and this is what we should be doing for these women in particular. So I'm, I'm pretty curious as to what we would have to do as, as a profession, as, as a team with researchers to figure out what do we need to look at in these athletes, especially the female athletes, because most of these are also they've never had babies, right? So a lot of these athletes are the liberos. And so we can't, we can't blame them. There's something with how things are working. That seemed to be the situation it's not necessarily trauma or anything like that. So what do we need to look at? What do we think is happening? Can we measure it and assess it? And then can we get an intervention?
Speaker 1 (01:00:56):
My brain, obviously, something isn't working as well as it could. So could something like that improve their performance, even I don't, I don't know. I'd like to think so. Yeah. That would be distinct study. Yeah. But we ultimately don't know. So if anyone has any ideas for studies or doing studies, let me know, because I can't wait to read them. But I think maybe the first step is to let coaches and parents and young gymnast know very common. Don't be ashamed. Don't let it stop you from doing what you want to do. But also don't just ignore it. Maybe we can figure this out.
Speaker 2 (01:01:30):
All right. One more question with a short answer, if you can. So, and I'm going to ask this question because I feel like the person who posted this I think posted this in earnest. So that's why I'm asking, this is the last question. So a female patient age, 20 years still bedwetting from her childhood, otherwise she is normal, no incontinence. So other than this, just while sleeping, she tends to urinate any thoughts on this or any place you can direct this.
Speaker 1 (01:02:04):
Yeah. So I did, I was like, Oh, great question. And I did actually do a little research for this specific question. There's a lot of reasons why nocturnal enuresis, which is what bedwetting is called in the literature happens. And I think it's really important. So I don't know what kind of tests or studies this person has had done or what other issues they may be having. So things like sleep apnea is is something that could be related if there's any medications, any sort of diuretics, any kind of sleeping medications. Again, the fact it's kind of carried on since childhood, I, I would really wonder about how, how is the bladder functioning? The fact that it's working fine throughout the day makes me wonder what's changing at night. And I did find a study where it talked about when they look compared adolescents or adults who were bedwetting to people who weren't, they did have like detrusor overactivity. So like basically like an overactive bladder that they could see on the testing. So I would, I would really encourage this person to find a urologist that they trust if they haven't already and really to maybe investigate some of those other, other factors that could be contributing so that they can get some better sleep and not have that problem anymore.
Speaker 2 (01:03:28):
Excellent. Excellent. Oh, okay. Claire says we can go for one more question. So I'm going to listen to the boss here.
Speaker 1 (01:03:36):
And, Oh boy, are you ready? Because this is a question that did kind of get a lot of thumbs up. Okay. So we spoke about
Speaker 2 (01:03:44):
Briefly before we started.
Speaker 1 (01:03:47):
So let's see treatment of nonspecific, pelvic girdle pain, not related to pregnancy, which strategy with no susceptive pain mechanisms and which strategy with non nociceptive pain mechanisms would you incorporate with this patient? Okay. So I would say in the clinic, it's, it can be pretty hard. Like, I don't know how I would distinguish being nociceptive and non nociceptive or what even like non nociceptive might be if we're talking more central issues or stuff like that. I don't, I don't know. But honestly I would just look at, so in Kathleen's Luca has a great book about looking at the different types of pain or the different categories of pain and the most effective medications for it. Right. So we're really good in pharmacology. Like if you had this inflammatory process and, and inflammatory and anti-inflammatory should help, if you're having neuropathic pain, you want a drug that addresses that when we get into like physical therapy interventions, what's really cool is exercise is in all the categories.
Speaker 1 (01:04:59):
And it's one of the things we have the best evidence for. So regardless of pelvic girdle pain in pregnancy or not pregnancy, and regardless of how it may have been labeled by somebody else is I would, I would mostly want to know when did the pain start? Is there anything that makes it better? Anything that makes it worse and see if I could find a movement or change something for that person. Or that made me sound like I was going to do a whole lot of work. If I could find something for that person to change for themselves to have that hurt less and have the I tend, I would tend to keep it simple, mostly cause in the clinic again, we could do a lot of special tests that might say, Oh, Nope, they definitely hurt there, but it's still, if we're looking at what's going to be an effective intervention, that that patient is going to tell me what that is.
Speaker 1 (01:05:54):
Sorry. It would help a fire mute myself. So looks like we have time for one more. And I, I really, Claire was not clarity did not pop up yet. So we've got time for one more and then we're going to work. We're wrapping it up. I promise stroke patients, dementia patient. We just got the no go. Yes, no, it's a super short answer if you want Claire super short answer. Okay. So stroke dementia patients with urinary incontinence, any useful ideas for the rehab program? Yes, but not get an idea of their bladder habits, their bowel habits, their fluid intake. Because a lot of that's going to end up being outside caregiver help with the, with the stroke, it's much different. It depends on the severity and where it is and all of that. But for people with dementia is if you just get that, like if you can prompt them or take them to the toilet, a lot of the times that will take care of the incontinence.
Speaker 1 (01:06:48):
It's not a matter of like Cagle exercises. It's more management. All right, Sarah, thank you so much. I'm going to throw it back over to Claire to wrap things up. Thank you both for a wonderful and insightful discussion. Sarah and Karen. So many practical tips and pointers for the clinician, especially I was loving learning about all of the things that I could take to the clinic. So I hope our audience find those practical tips really helpful as always the link to this live chat will stay up on our Facebook page and we'll share it across our other social media channels. Don't forget. You can also follow us on Twitter. We're at Dow SPT. You can also follow us here on Facebook. Please share this chat with your friends, with family colleagues, anyone who you think might find it helpful. And if you like JSP T asks, please be sure to tell people about it at that what we're doing so they can find this here, please join us.
Speaker 1 (01:07:46):
Next week when we host our special guest professor Laurie from the university of Southern California, Larry is going to be answering questions on managing shoulder pain. We'll be here, live on Wednesday next week. So Wednesday, April the eighth at 9:00 AM Pacific. So that's noon. If you're on the East coast of the U S it's 5:00 PM. If you're in the UK and at 6:00 PM, if you're in Europe, before we sign off for the evening, there's also really important campaign that I'd like to draw your attention to. And it's one that we at Joe SPT supporting and it's get us PPE. So we're supporting this organization in their quest to buy as much a, to buy much needed personal protective equipment for frontline health workers who are helping us all in the fight against the coronavirus pandemic. So if you'd like to support, get us PPE, please visit their website, www dot, get us ppe.org, G E T U S P p.org as always. Thanks so much for joining us on this stale SPT asks live chat, and we'll speak to you next week. Bye.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Haag to talk about exercise and urinary incontinence. This interview was part of the JOSPT Asks interview series. Sarah is the co-owner of Entropy Physiotherapy and Wellness in Chicago. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.
In this episode, we discuss:
- The prevalence of urinary incontinence
- Is urinary incontinence normal
- Pelvic floor exercises
- Pelvic floor exam for the non-pelvic health PT
- Sports specific pelvic health dysfunction
- And much more
Resources:
Entropy Physiotherapy and Wellness
JOSPT Facebook Page
JOSPT Journal Page
More Information about Dr. Haag:
Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Teacher.
Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
Read the full transcript below:
Read the Full Transcript below:
Speaker 1 (00:06:25):
So, and hopefully it doesn't want to lose what we're doing here. We'll see. Okay. Going live now. Okay. Welcome everyone to JLS. PT asks hello and welcome to the listeners. This is Joe SPT asks the weekly chat where you, the audience get your questions answered. My name is Claire Arden. I'm the editor in chief of Joe SPT. And it's really great to be chatting with you this week, before we get to our guest. I'd like to say a big thanks for the terrific feedback that we've had since launching [inaudible] a week ago. We really appreciate your feedback. So please let us know if there's a guest that you'd like to hear from, or if you have some ideas for the show today, we're in for a very special treat because not only are we joined by dr. Sarah hake from entropy physio, but guest hosting [inaudible] asks today is dr. Karen Litzy who you might know from the healthy, wealthy and smart podcast. Dr. Lexi is also a new Yorker. And I think I can speak for many of us when I say that New York has been front of mind recently with the coronavirus pandemic. And I'd like to extend our very best wishes to everyone in New York where we're thinking of you. So I'm going to throw to Karen now. We're, I'm really looking forward to chat today on pelvic floor incontinence and exercise over to you, Karen.
Speaker 1 (00:08:25):
Hi everyone, Claire. Thank you so much. I really appreciate your giving me the opportunity to be part of J O S P T asks live stream. So I'm very excited about this and I'm also very excited to talk with dr. Sarah Hagar. Sarah is an educator, a clinician, and an author. She is also co-owner of entropy wellness and our physiotherapy and wellness in Chicago, Illinois, and is also a good
Speaker 2 (00:08:56):
Friend of mine. So it's really a an honor for me to be on here. So Sarah, welcome. Thank you so much. I was really excited that all this came together so beautifully. Yes. And, and again like Claire had mentioned, we're all experiencing some pretty unprecedented times at the moment. And the hope of these J O S P T asks live streams is to continue to create that sense of community among all of us, even though we can't be with each other in person, but we can at least do this virtually. And as Claire said, last week, we want to acknowledge our frontline healthcare workers and colleagues across the world for their dedication and care to those in need. And again, like Claire said before, a special shout out to my New York city colleagues, we are they are really working like no other.
Speaker 2 (00:09:52):
And I also want to acknowledge not just our healthcare colleagues and workers, but the scientists, the grocery store workers, the truck drivers the pharmacist, police, firefighter paramedics, they're all working at full capacity to keep the wheels turning around the world. So I just want to acknowledge them as well and thank them for all of their hard work during this time. Okay. So, like Claire said today, we're going to be talking about the pelvic floor, which is something Sarah loves to talk about because what I also, I also failed to mention is she is a certified pelvic health practitioner. So through the American physical therapy association. So she is perfectly positioned to take us through. And as a lot of, you know, we had, you had the opportunity to go onto Slido to ask questions. You can still do that. Even throughout this talk, just use the code pelvic that's P E L V I C, and ask some questions.
Speaker 2 (00:10:57):
So we do have a lot of questions. I don't know if we're going to get to all of them. So if we don't then certainly post them in the Facebook chat and maybe Sarah can find those questions in the chat below. And we'll try and get to those questions after the recording has finished. All right, Sarah. So like I said, lots of questions and the way the questions were, were written out, kind of corresponds quite well with maybe how you would see a patient in the clinic. So let's start with the patient comes into your clinic. They sit down in front of you. Let's talk about the words we would use in that initial evaluation. So I'll throw it over to you. Okay. So being a pelvic health therapist, obviously most people when they're coming to females, Things that happen in the pelvis, I like to acknowledge it, that there's a lot of things happening in the past. So I have
Speaker 1 (00:11:54):
Them tell me kind of what are the things that have been bothering them or what are the things that have been happening that indicate something might be going on? Like if something's hurting, if they're experiencing incontinence, any bowel issues, any sexual dysfunction. And, and I kind of go from there. So if the talk that's the title of the talk today includes incontinence. Continence is a super common issue that let's see in general might pop in. And if you would bother to ask there's actually, I think it's like one out of two people over 60 are experiencing incontinence of some kind. The answer is going to be yes, some, so you can start asking more questions. But starting out with what, what is bothering them is really what I like to start with. Then the next thing we need to know is after we vet that issue or that priority list of things that are bothering them in the pelvis, and it's not uncommon actually to have.
Speaker 1 (00:13:00):
So let's say they start with a discussion of incontinence. I still actually ask about sexual function, any pain issues, any bowel issues, just based on the innervation of the various, the anatomical arrangement of everything. It's not uncommon to have more than one issue, but those other issues might not be bothersome enough to mention. So it's kind of nice to get that full picture. Then the next thing we really want art. So there are times I've met women who come in and they're like, Oh yeah, you know, I have incontinence. And you're like, okay. So when did it start now? Like 25 years ago. Okay. Do you remember what happened then? Typically it was a baby, but sometimes these women will notice that their incontinence didn't happen to like four or five years after the baby. Hmm. So that's information, that's very help if they say my baby that was born six weeks ago, our interventions and expectations are going to be very different than someone who's been having incontinence for 25 years.
Speaker 1 (00:14:05):
So again, knowing how it started and when it happens, when the issues are happening, I just kind of let them, it's like a free text box on a form. Like just, they can tell me so much more excuse me. And when we are talking about things, we, I do talk anatomy. So when it comes to incontinence, I talk about the bladder and the detrusor, the smooth muscle around the bladder, the basically the hose that takes the urine from the bladder to the outside world. I do talk about the vagina and the vulva and the difference between the two. And then actually we do talk about like the anus and the anal sphincters and how all of that is is all there together and supported by the pelvic floor.
Speaker 1 (00:14:54):
Cause that's in physical therapy, it's going to be something with that pelvic floor or something. Drought, does it need to be more, more pelvic floor focused or does it need to be behaviorally focused, which is the case sometimes, or is it that kind of finding that perfect Venn diagram of both for those issues that the person's having? And let's say you're in a part of the world. One of the questions was what if you're I think this question came from Asia and they said, what if you're in part of the world where you have to be a little bit, maybe more sensitive around even the words that you use. I know we had gotten a question a couple of years ago about a woman in the Southern part of the United States that was from very conservative area. And do we even use these words with these patients?
Speaker 1 (00:15:48):
So what is your response to that? My response is that as healthcare providers, we are responsible, I think for educating people and using appropriate words and making sure people understand the anatomy like where things are and what they're supposed to be doing. However, definitely when I'm having this conversation with someone I want them to feel at ease. So like I will use the Ana vagina anus, anal sphincters Volvo, not, it's not a vagina, it's a Volvo it's on the outside. But then if they use different terms to refer to the anatomy, we're discussing, I'm happy to code, switch over to what they're most comfortable with because they need to be comfortable. But I think as, as again, healthcare practitioners, if we're not comfortable with the area, we're not going to make them feel very comfortable about discussing those issues. Right.
Speaker 1 (00:16:43):
And that makes a lot of sense. Thank you for that. So now let's say you, the person kind of told you what's going on and let's, let's talk about when you're taking the history for women with incontinence, especially after pregnancy, are there key questions you like to ask? Yes. So my, my gals that I'm seeing, especially when they're relatively relatively early in the postpartum period, are the things I'm interested in is did they experience this incontinence during their pregnancy? And did they have issues before pregnancy? And then also if this is not their first, tell me about the first birth or the, or the first two birth. So the first three birth to really get an idea of is this a new issue or is this kind of an ongoing marked by so kind of getting a bigger picture of it.
Speaker 1 (00:17:49):
And then also that most recent birth we want to know, was it vaginal? Was it C-section with vaginal birth? If there's instrumentation use, so if they needed to use forceps or a vacuum that increases the likelihood that the pelvic floor went over, went under a bit of trauma and possibly that resulted in a larger lab. And even if there isn't muscles, it's understandable that things might work well, if it's really small and if it's still healing you know, different, different things like that. So understanding the, kind of like the recent birth story, as well as their bladder story going back. So you've met first baby or before that first baby so that we know where, where we're starting from. And the, the reason why I do that is because again, if it's a longterm issue, we have to acknowledge the most recent event and also understand there was something else happening that, that we need to kind of look at.
Speaker 1 (00:18:58):
So would I expect it all to magically go away? No, I wouldn't. There's probably something else we need to figure out, but if it's like, Nope, this onset happened birth of my baby three months ago, it's been happening since then three months is, seems like forever and is also no time whatsoever. It took 10 months to make the baby. So it's you know, if you tear your hamstring, we're expecting you to start feeling better in three months, but you're probably not back to your peak performance. So where are we in that? And sometimes time will cure things. Things will continue to heal, but also that would be a time like how good are things working? Is there something else going on that maybe we could facilitate or have them reach continence a bit sooner. Okay, great. And do you also ask questions around if there was any trauma to the area?
Speaker 1 (00:19:56):
So if this birth was for example, the product of, of a rape or of some other type of trauma, is that a question that you ask or do you, is that something that you hope they bring up? It's, that's honestly for me and my practice, something, I try to leave all of the doors wide open for them to, to share that in my experience you know, I've worked places where it is on it's on the questionnaire that they fill out from the front desk and they'll circle no to, to any sort of trauma in the past.
Speaker 1 (00:20:34):
Yeah. They just, they don't want to circle yes. On that form. So and also I kind of treat everybody like they might have something in their past, right. So very nonjudgmental, very safe place, always making them as comfortable in a safe as possible. And I will say that there's anything I can do to make you feel more comfortable and more safe. We can do that. And if you don't feel safe and comfortable, we're not doing this w we're going to do something else. Cause you're right. That it's always one of those lingering things. And the statistics on abuse and, and rape are horrifying to the point where, again, in my practice, I kind of assume that everybody has the possibility of having something in their past. Okay, great. Thank you. And now another question that's shifting gears. Another question that came up that I think is definitely worthy of an answer is what outcome measures or tools might you use with with your incontinence patients? So with incontinence, honestly, my favorite is like an oldie buddy, but a goodie, like just, it's an IC, it's the international continents questionnaire where it's, I think it's five or six questions. Just simple. Like how often does this happen? When does it happen?
Speaker 1 (00:21:58):
There's a couple of other outcome measures that do cover, like your bladder is not empty. Are you having feelings of pressure in your lower abdomen? It gets into some bowel and more genital function. Can you repeat that? Cause it kind of froze up for a second. So could you repeat the name of that outcome tool as it relates to the bladder and output? Oh, sorry. I see. IQ is one and then, but like I see IQ vs which renal symptoms, right? So there are, there's a lot of different forms out there. Another one that will gather up information about a whole bunch of things in the pelvis is the pelvic floor distress bins questions about bowel function, bladder function, sexual function discomfort from pressure or pain. So that can give you a bigger picture. I'll be honest. Sometimes my, the people in my clinic they're coming in, and even though I will ask the questions about those things, when they get the, the questionnaire with all of these things that they're like, this doesn't apply to me. I'm like, well, that's great that it doesn't apply to you, but they don't love filling, filling it out. So sometimes what I will go with is actually just the pale.
Speaker 1 (00:23:24):
Can you say that again? Please help me. Oh yeah. Oh, so sorry. The patient's specific functional scale where, where the patient says, this is what I want to have happen. And we kind of figured out where they are talk about what would need to happen to get them there, but it's them telling what better. Right. Cause I've had people actually score perfect on some of these outcome measures, but they're still in my office. So it's like, Oh, I'm so patient specific is one of my one of my kind of go tos. And then there's actually a couple of, most of these pelvic questionnaires finding one that you like is really helpful because, because there's so many and they really all or discomfort. So if you have a really good ability to take a really good history, some of the questions on that outcome measure end up being a bit redundant.
Speaker 1 (00:24:26):
So I like, and you know the questions on there, make sure people are filling them out. You look at them before you ask them all the questions that they just filled out on the form for you. Yes. Good. Very good advice. So then the patient doesn't feel like they're just being piled on with question after question and cause that can make people feel uncomfortable when maybe they're already a little uncomfortable coming to see someone for, for whatever their problem or dysfunction is. So that's a really good point. And now here's a question that came up a couple of times, you know, we're talking about incontinence, we're talking about women, we're talking about pregnancy. What about men? So is this pelvic floor dysfunction? Is this incontinence a women only problem? Or can it be an everybody problem? So it very much can be an everybody problem. Incontinence in particular for men, the rates for that are much lower. And typically the men are either much older or they are they've undergone frustrate removal for prostate cancer.
Speaker 1 (00:25:33):
Fleur plays a role in getting them to be dry or at least dryer. And then it's like the pelvic floor is not working right. That can result in pain. It can result in constipation. It can result in sexual dysfunction. It can result in bladder issues. So it's, so yes, men can have all of those things. In fact, last night we had a great talk in our mentorship group at entropy about hard flacid syndrome. So this is a syndrome with men where everything is normal when they go get, get tested, no no infections, no cancers, no tumors, no trauma that they can recall. And, but the penis is not able to become functional and direct. And with a lot of these men, we're finding that it's more of a pelvic floor dysfunction issue, or at least they respond to pelvic floor interventions.
Speaker 1 (00:26:30):
So having a pelvic floor that does what it's supposed to, which is contract and relax and help you do the things you want to do. If, if we can help people make sure that they're doing that can resolve a lot of issues and because men have pelvic floors, they can sometimes have pelvic floor dysfunction. Okay, great. Yeah. That was a very popular question. Is this a woman only thing? So thank you for clearing up that mystery for everyone. Okay. So in going through your evaluation, you've, you've asked all your questions, you're getting ready for your objective exam. What do you do if you're a clinician who does not do internal work, is there a way to test these pelvic floor muscles and to do things without having to do internal work? My answer for that question is yes, there are things that you can do because even though I do do internal exams, I have people who come to see me who are like, no, we're not doing that.
Speaker 1 (00:27:31):
So, so where can we start? And so the first one is pants on and me not even touching you pelvic floor, I wouldn't really call it an assessment or self report. So even just sitting here, if you, if you were to call me up and and this actually goes into, I think another question that was on Slido about pelvic floor cues. So there is actually then it seems more research on how to get a mail to contract this pelvic floor then actually females. But I would ask you like like this is one that my friend Julie, we would use. So like if you're sitting there and you just sit up nice and tall, if you pretend you're trying to pick up a Ruby with your PA with your vagina is not on the outside, but imagine like there's just a Ruby on the chair and you'd like to pick it up with no hands, breathe in and breathe out and let it go. So then I would go, did you feel anything and you should have felt something happen or not. So if, if you did it, would you mind telling me what you built? You're asking me, Oh my goodness. Oh yes. I did feel something. So I did feel like I could pick the Ruby up and hold it and drop it.
Speaker 1 (00:29:04):
Excellent. And that's, and that, that drop is key. Excellent. So what I would say is this is like like a plus, like a, I can't confirm or deny you that you did it correctly, but I like, I would have watched you hold your, like she holding my breath. Is she getting taller? Cause she's using her glutes. Did she just do a crunch? When she tried to do this, I can see external things happening that would indicate you're might be working too hard or you might be doing something completely wrong. So then we'll get into, I mean, you said, yes. I felt like I pick up the Ruby, but if it's like, Hmm, I felt stuffed, but I'm not really sure we would use our words because they've already said no to hands to figure that out. But again, I can't confirm it. People are they're okay with that.
Speaker 1 (00:29:48):
And I'm like, and if what we're doing based on the information you gave me, isn't changing, we might go to step two. If you can send in step two is actually something, any orthopedic therapist honestly, should not feel too crazy doing. So if anyone has ever palpated the origin of the hamstring, so where is the origin of the hamstring facial tuberosity? If you go just medial to that along the inside part get, don't go square in the middle. That's where everyone gets a little nervous and a little tense, but if you just Pell paid around that issue, tuberosity it's pretty awesome. If you have a, a friend or a colleague who's willing to let this happen is you ask them to do a poll of our different cues with that in a little bit. You say that again, ask them to do what to contract the pelvic floor.
Speaker 1 (00:30:44):
Okay. And again, figuring out the right words so that they know what you're talking about. We can talk about that in a minute, but if they do a pelvic floor contraction, you're going to feel kind of like the bulging tension build, right there may be pushing your fingers. You should feel it kind of gather under your fingers. It shouldn't like push your fingers away, but then you can be like, well, you could test their hamstring and see that you're not on the hamstring and you can have them squeeze your glutes and you can kind of feel the differences. The pelvic floor is just there at the bottom of the pelvis. So you can palpate externally, even through BlueJeans is a bit of a challenge, but if they're in you know, like their workout shorts for yoga pants, it's actually very, very simple. And, and honestly, as long as you explained to them what you're doing and what you're checking for, it's no different than palpating the issue of tuberosity for any other reason.
Speaker 1 (00:31:36):
And with that, I tell them that I can, it's more like a plus minus, so I can tell that you contracted and that you let go. That's all I can tell. So I can't tell you how strong you are, how good your relaxation Wells, how long you could hold it for any of those things. And then I tell them with an internal exam, we would get a lot of information we could, we can test left to, right? We can, I could give you more of like a muscle grade. So like that zero to five scale be use for other muscles. We can use that for the pelvic floor. I can get a much better sense of your relaxation and see how was that going and I can even offer some assistance. So so we have two really good options for no touching.
Speaker 1 (00:32:19):
And then just as long as we understand the information we might gain from an internal exam, we can, we can, the information we gathered from the first two ways, isn't sufficient to make a change for them. And then as let's say, the non pelvic health therapist, which there might be several who are gonna watch this, when do we say, you know, something? I think it's time that we refer you to a pelvic health therapist, because I do think given what you've said to me and you know, maybe we did step one and two here of your exams. I think that you need a little bit more. So when do, when is that decision made to reach the point of, they have a bother that I don't know how to address so we can actually go to like the pelvic organ prolapse. So pelvic organ prolapse is, is when the support for either the bladder, the uterus, or even the rectum starts to be less supportive and things can kind of start to fall into the vaginal wall and can give a feeling of like pressure in with activity the sensation can get.
Speaker 1 (00:33:39):
So then we have two options, which is more support from below with perhaps a stronger meatier pelvic floor by like working it out to hypertrophy. So like if, if I had someone who had that feeling when they were running and we tried a couple are lifting weights, let's go lifting weights. No, like I feel it once I get to like a 200 pound deadlift. Okay, well, let's see how you're lifting when you're doing 150 and let's take a look at what you're doing at 200 in fresh with your mechanics or what's happening. And if there's something that is in your wheelhouse where you're like, well, can you try this breath? Or can you try it this way and see if that feeling goes away? I'm good with that. And if the, that the person who's having issue is good with that. Awesome. But if you're trying stuff or the incontinence is not changing, send them to a pelvic floor therapist, because what we love to do is we can check it out.
Speaker 1 (00:34:41):
We're going to check it out. We're going to give some suggestions. And then my, the end of every one of those visits that I get from my, from my orthopedic or sports colleagues is I'm like, excellent. So you're going to work on this, keep doing what you're doing. Cause another really common thing is like, is I don't really believe that they can make a lot of these things worse doing the things that they're doing. And by that, I mean, they can become more simple MADEC, but in many cases you're not actually making the situation worse. So if the symptoms seem to be not getting better or even getting worse, doing the things they're doing, they go come back to the pelvic floor therapist. And then that pelvic floor therapist also has a responsibility that the things I'm asking them to do, isn't helping them get there.
Speaker 1 (00:35:29):
You can try something a little more intense, still not helping. Then that's when I actually would refer for females, especially with like pelvic pressure. So Euro gynecologist for an assessment in that regard. Yeah. So I think I heard a couple of really important things there. And that's one, if you are the sports therapist or the orthopedic physiotherapist, and you have someone that needs pelvic health support, you can refer them to the pelvic health therapist and you can continue seeing them doing the things you're doing. So just because they're having incontinence or they're having some pressure, let's say it's a pelvis, pelvic organ prolapse. It doesn't mean stop doing everything you're doing.
Speaker 3 (00:36:12):
Okay.
Speaker 1 (00:36:15):
Correct. Okay. Yeah. It may mean modify what you're doing. Stop some of what you're doing, listen to the pelvic floor therapist. And I'm also seeing, well now we're, aren't we this great cause we're creating great team around this, around this person to help support them in their goals. So one doesn't negate the other. Absolutely correct. And I, and I think too often even, even within the PT world is people start to get kind of territorial. But it's not about what each one of us is doing. It's that person. Right. so telling them to stop doing something, especially if it's something they love it seems like a bad start. It's like, okay, let's take a look at this. Tell me what you are doing. Tell me what you want to be doing. Tell me what's happening when you do that. And let's see if we can change it.
Speaker 1 (00:37:02):
Cause like I said, like the, the other, that being something they're going to make worse and worse and worse is if symptoms get worse and worse and worse, but they're not causing damage, they're not causing, I mean, what they're doing and say leaking a bit. Got it. And now I'm going to take a slight detour here because you had mentioned pelvic organ prolapse. You had mentioned, there comes a time when, if that pressure is not relieving, you've tried a lot of different things. You would refer them to a urogynecologist now several years ago. They're so you're, you're a gynecologist. One of their treatments might be surgery. So there was pelvic mesh sweats. It's hard to say pelvic mesh surgery that years ago made some people better and made some people far, far worse with, with some very serious ramifications. So can you talk about that pelvic mesh mesh surgery and where we are now?
Speaker 1 (00:38:04):
Oh, the last bit cut out a little bit. So the pelvic mess, mess surgery and, and Oh, the most important part and kind of where we are now versus maybe where we were, let's say a decade ago or so. Awesome. Yeah. So, so the pelvic mesh situation certainly here, I think it's not a universal problem. I think it's a United States problem is if you're at home during the day, like most of us are now you will see law commercials, lawyers looking for your business to discuss the mesh situation on what's happening is there was there were, it was mesh erosion and the resulting fact that that was a lot of pain because they couldn't just take it all out. And it was several women suffered and are still sad.
Speaker 3 (00:38:55):
Mmm.
Speaker 1 (00:38:55):
But that was from a particular type of surgery with a particular type of surgical kit, which thankfully has, was removed completely from the market and isn't being used anymore and mesh surgeries, I would say at least for the last five to 10 years, haven't haven't been using that and mesh surgeries are being done with great success in resolving symptoms. So I think it's important that if a woman isn't responding
Speaker 3 (00:39:27):
Yeah.
Speaker 1 (00:39:30):
Well changing their breath or making a pelvic floor or changing how they're doing things is to have that discussion with the Euro gynecologist because they do have nonsurgical options for super mild prolapse. There are some even like over the counter options you can buy like poise has one where it's just a little bit of support that helps you. Actually not leak because if you're having too much movement of the urethra, it can cause stress or it can be contributing to stress incontinence. But so there's some over the counter things or there's something called a pessary, which I think about it. Like I'm like a tent pole, but it's not a pole. It's a circle don't worry or a square or a donut. There's so many different shapes, but it's basically something you put in the vagina and that you can take out of the vagina that just kind of holds everything back up where it belongs, so it can work better.
Speaker 1 (00:40:21):
And that it's not awesome. But there are also people who are like due to hand dexterity, or just due to a general discomfort with the idea of putting things in their vagina and living them there that they're like, no, I'd rather just have this be fixed. So, so there are, it's not just surgery is not your only option. There are lots of options and it just depends on where you want to go. But with the surgery, if that's what's being recommended for a woman, I really do. Some women aren't worried at all. They've heard about the mash, but they're sure it won't happen to them, but there are when we're still avoiding surgery, even with significant syndromes, because they're worried about the mesh situation. And I would still encourage those women to at least discuss us, to see if that surgeon can, can educate them and give them enough confidence before they move forward with the surgery.
Speaker 1 (00:41:18):
Because the worst thing I think is when I had one patient actually put it off for years. Not, not just because of the mesh because of a lot of issues, but the first time the doctor recommended it, she had a grade four prolapse. Like that means when things come all the way out. And she it was so bad. Like she couldn't use the pastory okay, so she needed it, but she avoided it until she was ready and had the answers that made her feel confident in that having the surgery was the right thing to do. So it might take some time and the doctor, the surgeon really should, and most of them that I've met are more than happy to make sure that the patient has all the information they need and understand the risk factors, the potential benefits before they move forward.
Speaker 2 (00:42:03):
Excellent. Thank you so much for that indulging that slight detour. Okay. Let's get into intervention. So there are lots of questions on Slido about it, about different kinds of interventions. And so let's start with lot of, lot of questions about transverse abdominis activation. So there is one question here from Shan. Tall said studies in patients with specific low back pain do not recommend adding transverse abdominis activation because of protective muscle spasm. What about urinary incontinence in combination? What do you do? So there is a lot on transfer subdominant as you saw in Slido. So I'll throw it over to you and, and you can give us all your share your knowledge.
Speaker 1 (00:42:55):
Okay, well, let's all do this together. So I don't know how many people are watching, but if we just sit up nice and tall and I'm going to give a different cue for the pelvic floor. So what I want you to squeeze, like you don't want to urinate, like you want to stop the stream of urine. Okay. So as we're pulling that in anything else other than the underneath contract, what did you feel Karen?
Speaker 2 (00:43:24):
Well, I did feel my TA contract. I felt that lower abdominal muscle wall started to pull in.
Speaker 1 (00:43:32):
Yes. So, so the, the way I explain it is that the pelvic floor and the trans versus are the best is to friends. And this makes sense when you think about when you remember the fact that the pelvic floor, isn't just there regarding like bowel bladder and sexual function. It's one of our posture muscles. So if we're totally like, like slacked out and our abs are off and all of that, our pelvic floor is pretty turned off as well. And then if I get a little bit taller and like, so I'm not really clenching anything. Right. But this is like stuff working like it should, my pelvic floor is a little more on, but not, I'm not acting. It's just but then I could like, right, if I'm gonna, if I'm expecting to hit, or if I'm going to push into something, I can tend to set up more and handle more force into the system.
Speaker 1 (00:44:21):
So I like to think about it in those in those three ways, because the pelvic floor, isn't just hanging out, down there and complete isolation it's, it's part of a system. And so in my personal, like emotional approach to interventions is I don't want them to be too complicated. So if I can get someone to contract their pelvic floor, continue to breathe and let go of that pelvic floor, then we start thinking about what else are you feeling? Cause I don't know that there's any evidence that says if I just work my transverses all the time, my pelvic floor will automatically come along for the ride. So a great quote. I heard Karrie both speak once at a combined sections meeting and she goes, your biceps turn on. When you take a walk, it's not a good bicep exercise. So just the fact we're getting activity in the pelvic floor when we're working other muscles, what's supposed to work. And also if you want to strengthen that muscle, you're going to need to work out that muscle.
Speaker 1 (00:45:26):
And that makes a lot of sense and something that people had a lot of questions around where we're kind of queuing for these different exercises. And I really love the can. You've made it several times comparisons to other muscles in the body. So can you talk about maybe what kind of queuing you might use to have someone on? I can't believe I'm going to say this turn on and I use that in quotes because that's what you see in, in a lot of like mainstream publications for, for layman. So it might be something that our patients may see when they come in. So how do you cue that? To, to turn on the pelvic floor? So honestly I will usually start with floor and I do if I'm able to do a public floor exam, that's usually, again, a lot more information for me, but I'm like, okay, so do that now.
Speaker 1 (00:46:27):
And I watched them do it or I feel them do it and I'd be like, Oh, okay. What did you, what did you feel move? And I start there. And then I always say it's a little bit, like I get dropped into a country and I'm not sure what language people are speaking. So sometimes excuse me, one of the first cues that I learned was like, so squeeze, like you don't want to pass gas. Okay. So everybody let's try that. So sitting squeeze, like you don't care and you got taller. So I think you did some glutes.
Speaker 1 (00:47:00):
It's like, OK. So like lift, lift your anal sphincter up and in, but activating mostly the back part. So if you're having fecal issues, maybe that's a good place to start, but most people are having issues a little further front. So then we moved to the, can you pick a upper with your, with your Lavia? I had a, I learned the best things for my patients. One woman said it's like, I'm shutting the church doors. So if you imagine the Lavia being churched doors, we're going to close them up. And that, that gives a slightly different feeling. Them then squeezing the anal sphincter. Now, if you get up to squeeze, like you don't want to like pee your pants, like you want to stop the stream of urine. That will activate more in the front of the pelvis. Look, men who are like if it gets stopped the flow of urine, I wouldn't be here.
Speaker 1 (00:47:57):
So what else do you get? What's really cool is in the male literature. So this is a study done by Paul Hodges is he found that what activated the anterior part and the urinary sphincter, this rioted urinary speaker, sphincter the most for men. What a penis or pull your penis in to your body now for women. So when I was at a chorus and it's like, so let's, let's think of like other cues and other words, but even if, so, I don't have a penis this fall that probably don't have a penis. Even if you don't have a penis, I want you to do that in your brain, shorten the penis and pull it in.
Speaker 1 (00:48:42):
And did you feel anything happen? Cause we do have things that are now analogous to the male penis, if you are are a female. So I'll sometimes use that. Like I know it sounds stupid, but pretend to draw on your penis and it works and it does feel more anterior for a lot of people. So I'll kind of just, I'll kind of see what's, like I said, sometimes it's like the 42nd way of doing it that I've asked them to do where they're like, Oh, that, and you're like yeah. So then also just another, it's a little bit of like a little bit of a tangent, but so as you're sitting, so if you're, if you're sitting I want you to pick the cue that speaks most to your pelvic floor, and I want you to slouch really, really slouch, and actually to give yourself that cue and just pay attention to what you're feeling. So when you squeeze, give yourself that cue, breathe in and breath out and then let go, we should have felt a contraction, a little hole and a let go. Now, the reason why I say breathe in and breathe out is if you breathe in and out, that's about five seconds and also you were breathing. Cause another thing people love to do when they're trying to contract their pelvic floors, just basically suck it in.
Speaker 1 (00:50:10):
And so that's, that's not great, but we want to feel the contraction and we want to feel it, let go. And that's super important. I think that was another question on the Slido is that yes. For any muscle we're working, you should be able to contract it and let it go. There's not a muscle in our body where I just keep it contracted. It's going to do much. It might look great. Eventually, but like I couldn't get my coat on, like getting a drink of water would be a little weird. It's not very functional muscles have to relax so that they can contract. So that's a big, yes, it's just as important that the contraction pelvic floor that cue and we felt where it happened, not tall, like, like you're sitting out at a restaurant and you just saw someone looking at you and you're like, Oh, what are they looking at? And then you're going to do the exact same cue and you're gonna breathe in and breathe out and let it go.
Speaker 1 (00:51:07):
And then did it feel different than menu or slouch that it did it change position? I feel like Karen's Miami. It feels different. Now what I want you to do is if you can, depending on how you're sitting really give me like an anterior pelvic tilt, really happy puppy and then do the exact same thing and then let it go. And so again, some more EMG work from, from Paul Hodges is that when you're in a posterior pelvic tilt, you tend to activate the posterior portion more, which is fine. And if you're not having problems in the front, if you're having problems activating and maintaining continence in the front, actually increasing that lordosis can favor the front a bit. So this is, that's really awesome when people can feel that difference. Because I want you to think about, if you start to leak on your fourth mile of a half marathon, there's no way, no matter how awesome you are, but you're going to be able to squeeze your pelvic floor for the rest of that race.
Speaker 1 (00:52:15):
Like there's just, there's no way. But sometimes if, because remember your pelvic floor is still doing its thing while you're running is if you're like, well, hold on, when you're at your fourth mile, are you starting to get tired or hopefully not if it's a half marathon, but you know, like is something changing and how you're using your body. And can you, when you get to that point, remember to stay tall or lift your tail a little bit, or is there a cue or something they can change that will help them favor the front instead of going about four steps with the contracted pelvic floor and then losing it anyway. So there's, there's a lot of different ways you can actually make that your intervention for the issue you're having and then let's just get it functional. Perfect. And since you brought up running a question that's been, got, gotten a couple of likes on Slido is how would you approach return to running after pregnancy?
Speaker 1 (00:53:15):
Do you have any tips on criteria for progress, timeframe and a recreational runner versus a full time athlete? Because I would think the majority of physiotherapists around the world are seeing the recreational runner versus the professional or full time athlete. So first, how would you approach return to running any tips for progress? So that's going to be after pregnancy, sorry. After pregnancy. Yeah. So this is where I was really excited. So just last year I'm going to say her name wrong, but Tom goom Gran Donnely and Emma Brockwell published returned to running postnatal guidelines for health professionals managing this population. And the reason why I was super excited is because even though it was just published last year, it's the first one. There was definitely a lot of emotion and feelings about, about women getting back into sport after having a baby, but to be perfectly Frank, there's very few actual solid guidelines for recreational or others.
Speaker 1 (00:54:30):
So I have not personally had a child, but I will tell you of all the women I've seen over the years, basically doctors are like, it's been six weeks ease back into it, see how it goes. I'm not really even mentioning if you have a problem come back so we can figure it out. It's just kind of like good luck with that. And as a result, what happens is a lot of women don't get back into exercise or they get back into exercise and and kind of freak themselves out because stuff feels different. So to get back to the question of what do I do, actually this this guide from Tom and team really, really helpful. I think, and, and it's just basically it's it does have a series of exercises that I've actually started to use with my postpartum moms to go like, look, if you can do these things without feeling heaviness, you're good.
Speaker 1 (00:55:30):
You're good to start easing back into your running program, but get up, get walking because I'm going to post Sandy Hilton and like, you can't rest this better, like just waiting, isn't going to make it all go away. But it can also be deceiving because again, with polo, you don't feel that heaviness and you don't leak. And so I'm just going to stay right here where everything is fine. So that's obviously not a good option longterm option for a lot of reasons. So, so what do I do? I do look at the patient's goals, their previous running history, and if they're having any options I recently had a patient who she was runner exercise or sr after baby number two for a bit, some feeling of happiness that got completely better, baby number three came along. So I saw her a bit while she was pregnant because she got, I think two thirds of the way through pregnancy before she started to feel that heaviness. Again, she was still running,
Speaker 1 (00:56:38):
Tried to see if we could change that feeling while she was running. And she could until about the, when did she start? I think she didn't stop running to her 35th week, which is pretty impressive. But then she wanted to do a half marathon. I think it was just three months postpartum. Right. So this is like going from having baby to running 13. You think that a lot of people would probably feel that was too soon, too much too fast, but she was able to do it completely symptom-free. So as she was training and she was really fast, she was timing it so that she could get back in time to breastfeed. Like I was like, Oh my gosh, like I, that would disqualify me. Like, there's no way I could run fast enough to make that happen. But she was able to, to work it out where she could perform at her level without symptoms. And I was really happy that I was able to support her in that she did all the hard work. For general people recreational, where you a runner before, or is this completely new and are you having any symptoms and is there any thing you're worried about? Again, a lot of women are worried about giving.
Speaker 1 (00:57:53):
It's actually really hard to perhaps to give yourself one baby babies are a great way to do it. But that's like the risk factors I look up for something else a couple of years ago, I haven't looked recently, but like you really have any prolonged lifting. So not like your CrossFit three days a week, but like your, your physical labor for eight, eight hours, 10 hours a day every day could eventually do it also having babies. So like once you get to every baby increases your risk of pelvic organ prolapse, which makes good sense. And that, and that is what it is. So kind of looking at what are their risk factors, are there any, and letting them know that if they feel it more, it doesn't mean they made it worse. They just made it more symptomatic. Got it. Great.
Speaker 1 (00:58:40):
All right. So we have time for maybe one or two more questions, and then I'm going to throw back to Claire. Cause we're coming up onto an hour here, maybe time for one more it's so w what am I going to ask? I think I'm going to go with the gymnasts I work with all believe it's normal to leak a little urine during training or competition. And this is something we talk about a lot. It might be common, but is it normal? You already gave me the answer. What is it, Karen? No, no, no. And so, yeah, so the, the short answer for that is no. Or I agree with the question where it is very, very, very common, and it is still, I would say, not to leak urine. Unfortunately, so there's any researchers out there who want to get together.
Speaker 1 (00:59:26):
Let me know. We haven't, we have information on athletes and incontinence, but mostly it's prevalent that it happens a lot and gymnastics and dancing and volleyball. There's, there's even some swimmers who have it, right? So there's, there's incontinence across the spectrum, which basically tells me, yep. People have incontinence. Some of the some of the sports are more likely to have urgent continents. A lot of them though, we're looking at stress incontinence, however, for none of the athletes, have, we really had a great study that says, this is what we're finding. We're thinking, this is the cause of this incontinence. And we certainly haven't gotten to the point where it's like, and this is what we should be doing for these women in particular. So I'm, I'm pretty curious as to what we would have to do as, as a profession, as, as a team with researchers to figure out what do we need to look at in these athletes, especially the female athletes, because most of these are also they've never had babies, right? So a lot of these athletes are the liberos. And so we can't, we can't blame them. There's something with how things are working. That seemed to be the situation it's not necessarily trauma or anything like that. So what do we need to look at? What do we think is happening? Can we measure it and assess it? And then can we get an intervention?
Speaker 1 (01:00:56):
My brain, obviously, something isn't working as well as it could. So could something like that improve their performance, even I don't, I don't know. I'd like to think so. Yeah. That would be distinct study. Yeah. But we ultimately don't know. So if anyone has any ideas for studies or doing studies, let me know, because I can't wait to read them. But I think maybe the first step is to let coaches and parents and young gymnast know very common. Don't be ashamed. Don't let it stop you from doing what you want to do. But also don't just ignore it. Maybe we can figure this out.
Speaker 2 (01:01:30):
All right. One more question with a short answer, if you can. So, and I'm going to ask this question because I feel like the person who posted this I think posted this in earnest. So that's why I'm asking, this is the last question. So a female patient age, 20 years still bedwetting from her childhood, otherwise she is normal, no incontinence. So other than this, just while sleeping, she tends to urinate any thoughts on this or any place you can direct this.
Speaker 1 (01:02:04):
Yeah. So I did, I was like, Oh, great question. And I did actually do a little research for this specific question. There's a lot of reasons why nocturnal enuresis, which is what bedwetting is called in the literature happens. And I think it's really important. So I don't know what kind of tests or studies this person has had done or what other issues they may be having. So things like sleep apnea is is something that could be related if there's any medications, any sort of diuretics, any kind of sleeping medications. Again, the fact it's kind of carried on since childhood, I, I would really wonder about how, how is the bladder functioning? The fact that it's working fine throughout the day makes me wonder what's changing at night. And I did find a study where it talked about when they look compared adolescents or adults who were bedwetting to people who weren't, they did have like detrusor overactivity. So like basically like an overactive bladder that they could see on the testing. So I would, I would really encourage this person to find a urologist that they trust if they haven't already and really to maybe investigate some of those other, other factors that could be contributing so that they can get some better sleep and not have that problem anymore.
Speaker 2 (01:03:28):
Excellent. Excellent. Oh, okay. Claire says we can go for one more question. So I'm going to listen to the boss here.
Speaker 1 (01:03:36):
And, Oh boy, are you ready? Because this is a question that did kind of get a lot of thumbs up. Okay. So we spoke about
Speaker 2 (01:03:44):
Briefly before we started.
Speaker 1 (01:03:47):
So let's see treatment of nonspecific, pelvic girdle pain, not related to pregnancy, which strategy with no susceptive pain mechanisms and which strategy with non nociceptive pain mechanisms would you incorporate with this patient? Okay. So I would say in the clinic, it's, it can be pretty hard. Like, I don't know how I would distinguish being nociceptive and non nociceptive or what even like non nociceptive might be if we're talking more central issues or stuff like that. I don't, I don't know. But honestly I would just look at, so in Kathleen's Luca has a great book about looking at the different types of pain or the different categories of pain and the most effective medications for it. Right. So we're really good in pharmacology. Like if you had this inflammatory process and, and inflammatory and anti-inflammatory should help, if you're having neuropathic pain, you want a drug that addresses that when we get into like physical therapy interventions, what's really cool is exercise is in all the categories.
Speaker 1 (01:04:59):
And it's one of the things we have the best evidence for. So regardless of pelvic girdle pain in pregnancy or not pregnancy, and regardless of how it may have been labeled by somebody else is I would, I would mostly want to know when did the pain start? Is there anything that makes it better? Anything that makes it worse and see if I could find a movement or change something for that person. Or that made me sound like I was going to do a whole lot of work. If I could find something for that person to change for themselves to have that hurt less and have the I tend, I would tend to keep it simple, mostly cause in the clinic again, we could do a lot of special tests that might say, Oh, Nope, they definitely hurt there, but it's still, if we're looking at what's going to be an effective intervention, that that patient is going to tell me what that is.
Speaker 1 (01:05:54):
Sorry. It would help a fire mute myself. So looks like we have time for one more. And I, I really, Claire was not clarity did not pop up yet. So we've got time for one more and then we're going to work. We're wrapping it up. I promise stroke patients, dementia patient. We just got the no go. Yes, no, it's a super short answer if you want Claire super short answer. Okay. So stroke dementia patients with urinary incontinence, any useful ideas for the rehab program? Yes, but not get an idea of their bladder habits, their bowel habits, their fluid intake. Because a lot of that's going to end up being outside caregiver help with the, with the stroke, it's much different. It depends on the severity and where it is and all of that. But for people with dementia is if you just get that, like if you can prompt them or take them to the toilet, a lot of the times that will take care of the incontinence.
Speaker 1 (01:06:48):
It's not a matter of like Cagle exercises. It's more management. All right, Sarah, thank you so much. I'm going to throw it back over to Claire to wrap things up. Thank you both for a wonderful and insightful discussion. Sarah and Karen. So many practical tips and pointers for the clinician, especially I was loving learning about all of the things that I could take to the clinic. So I hope our audience find those practical tips really helpful as always the link to this live chat will stay up on our Facebook page and we'll share it across our other social media channels. Don't forget. You can also follow us on Twitter. We're at Dow SPT. You can also follow us here on Facebook. Please share this chat with your friends, with family colleagues, anyone who you think might find it helpful. And if you like JSP T asks, please be sure to tell people about it at that what we're doing so they can find this here, please join us.
Speaker 1 (01:07:46):
Next week when we host our special guest professor Laurie from the university of Southern California, Larry is going to be answering questions on managing shoulder pain. We'll be here, live on Wednesday next week. So Wednesday, April the eighth at 9:00 AM Pacific. So that's noon. If you're on the East coast of the U S it's 5:00 PM. If you're in the UK and at 6:00 PM, if you're in Europe, before we sign off for the evening, there's also really important campaign that I'd like to draw your attention to. And it's one that we at Joe SPT supporting and it's get us PPE. So we're supporting this organization in their quest to buy as much a, to buy much needed personal protective equipment for frontline health workers who are helping us all in the fight against the coronavirus pandemic. So if you'd like to support, get us PPE, please visit their website, www dot, get us ppe.org, G E T U S P p.org as always. Thanks so much for joining us on this stale SPT asks live chat, and we'll speak to you next week. Bye.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Leigh Hurst on the show to discuss breast cancer awareness. Leigh Hurst is a breast cancer survivor and the founder of the Feel Your Boobies® Foundation, which she started to educate young women (under 40) by reminding them to "feel their boobies" - a call to action that can save their life. Feel Your Boobies® is one of the largest followed breast cancer awareness foundations on Facebook and has inspired women all over the world to feel for lumps starting before they are formally screened for breast cancer. And, most importantly, it has directly resulted in countless women finding lumps early and giving them a better shot at living a full, meaningful life after their diagnosis. The Feel Your Boobies® Foundation has been featured in The New York Times, New York Daily News, and other national publications. At one point, Feel Your Boobies® was the largest cause on Facebook, with more than 1 million supporters.
In this episode, we discuss:
-Leigh’s experience advocating for her own breast cancer diagnosis
-The story behind the Feel Your Boobies Foundation
-Why women need to prioritize self-care
-The voices of breast cancer survivors in the book Say Something Big
-And so much more!
Resources
Leigh Hurst Website
Say Something Big Book
Say Something Big Facebook
Say Something Big Instagram
Feel Your Boobies Website
Feel Your Boobies Facebook
Feel Your Boobies Twitter
Feel Your Boobies Instagram
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information Leigh:
LEIGH HURST is a breast cancer survivor and the founder of the Feel Your Boobies®
Foundation, which she started educate young women (under 40) by reminding them to
feel their boobies - a call to action that can save their life. Feel Your Boobies® is one of
the largest followed breast cancer awareness foundations on Facebook and has inspired
women all over the world to feel for lumps starting before they are formally screened for
breast cancer. And, most importantly, it has directly resulted in countless women finding
lumps early and giving them a better shot at living a full, meaningful life after their
diagnosis. The Feel Your Boobies® Foundation has been featured in The New York Times,
New York Daily News, and other national publications. At one point, Feel Your Boobies®
was the largest cause on Facebook, with more than 1 million supporters.
Hurst is also the author of the new book, Say Something Big: Feel Your Boobies, Find Your
Voice. Stories About Little Lumps Inspiring Big Change (Oct. 2020)
Beyond her work with Feel Your Boobies®, Leigh regularly speaks to audiences large and
small, sharing her own personal journey and inspiring others to “Say Something Big”
amidst life’s hurdles and hardships. She resides in Pennsylvania with her family.
Feel Your Boobies® uses innovation around media to reach women across the world with
their important message.
For more information, visit www.leighhurst.com or www.feelyourboobies.com, and connect
with Leigh on Instagram, Facebook, and LinkedIn.
Read the full transcript below:
Karen Litzy (00:01):
Hi, Leigh, welcome to the podcast. I'm happy to have you on.
Leigh Hurst (00:05):
Thanks for having me, happy to be here.
Karen Litzy (00:07):
Yeah. And now we're in the month of October. And for those of people who don't know October is breast cancer awareness month. And in the past, I've had shows about breast cancer during the month of October, but this is the first time I am speaking to a breast cancer survivor. So thank you so much for coming on and sharing your story because I know it's going to be so helpful for other women and men listening to this podcast. So before we kind of get into everything, I'm going to just throw it over to you so that you can just kind of tell your story how old you were when you were diagnosed. How did you find out? So I'll send it over to you.
Leigh Hurst (00:51):
Okay, cool. Thank you. So I was officially diagnosed when I was 33 that I had felt the lump for some time leading up to the actual diagnosis. So I think I was probably around 30 or 31 when I started to notice the lump. And I was living in New York city at the time and I was a marathon runner. So really health conscious, certainly educated about my health felt very kind of plugged into that kind of thing. And for a little while, I didn't really think much about it. I just thought it was, you know, something no big deal. I really small breasts. So I felt like when I'd go to the doctors, I'd let them sort of do their exam of my breasts and they would never notice it until I would point it out. So I would literally take their hand, put it on my boob and say, this kind of feels a little different to me.
Leigh Hurst (01:39):
I don't know if you notice it or not. It's like a ridge on the outer side of my left breast and then they would feel it and then they would say, I don't really think that's anything to worry about. I had no family history, so I wasn't exceptionally worried about it. Although, as I know now, that's not necessarily a primary risk factor. It is, but most women diagnosed don't have a family history. So I was pacified about that for a while. You know, that kind of went on for maybe a year or two. I eventually decided to sort of simplify my life and I moved out in New York city. I was in a really kind of super corporate job, traveled a lot for my work on a weekly basis. And I was just trying to find ways to sort of step out of that.
Leigh Hurst (02:20):
And so I moved back to central PA, which is where I live now. I'm kinda got set up on a house was back near my family and it came time for my annual exam. And I went again to the doctors and again, it wasn't noticed, but I mentioned it and it was the first time someone's like, Oh, she probably should just get a mammogram. It can't hurt to sort of just see if it's something or not. So that's how it started and ended up having the mammogram showed some areas of concern, took me right in and did an ultrasound and eventually at the biopsy a couple of weeks later and it did turn out to be cancer. So that was 2004. And you know, needless to say, I was very concerned because I knew I had had the lump for quite some time, so I wasn't sure what to expect, but it didn't turn out to be stage one, so early stage breast cancer.
Leigh Hurst (03:09):
And so, yeah, that's kinda how it started with, you know, finding out that I had a lump and went through treatment. I decided to have a lumpectomy, the lump was small stage one had no lymph node involvement. So that was good. And I did do chemotherapy because I was young. So they suggested that because of being premenopausal and being so young at the time, it was some preventative. So I did chemotherapy than I did seven weeks of daily radiation treatment to the lump site. And then I took five years of a pill called Tamoxifen, which is estrogen reducing medicine at the time they were still prescribing it for five years. I believe now the regimen is 10 years. But so the actual treatment itself was about six months start to finish. And then it was the five years of the Tamoxifen following that.
Karen Litzy (03:59):
And at the age of 33, you must have been kind of shocked. Right. Cause it's not something that we hear a lot of, you know, like even to get a mammogram, they don't suggest getting a mammogram until you're 40.
Leigh Hurst (04:15):
Correct. Yeah. And you know, it was, you know, looking back on it, I remember thinking, gosh, I never talked about breast cancer, never talked about it. I didn't know anybody who had had it. I'm not even really sure. I knew anybody who’s mother that had had it. So I was really taken aback by that when I was diagnosed and I was single at the time really hadn't thought about having a family quite yet. You know, I was living in the city, it was very common to still be kind of doing your thing. And so there are other issues that came up other than of course the life or death issue with breast cancer. There were the other possibilities of losing your fertility through chemo. Certainly that's a possibility certain decisions that you might be faced with can also, you know, if you decide to remove any of your female organs, ovaries, whatever, to minimize your risk, of course, those are big decisions when you haven't started a family yet.
Leigh Hurst (05:08):
And I wasn't really sure I was going up, but I didn't want that choice to be taken away from me. I didn't want it to be something that I couldn't do at a later date. So yeah, it was, it was shocking. And you know, out of that, I really started to like, think about why didn't I talk about this? Why didn't I think about this? And so that's kind of how the feel your boobies idea came about is that I just made some t-shirts for friends. Cause I would joke around during my treatment, I was actually still running and I didn't get sick. So I was really happy about that. And I just made sure that said, feel your boobies for fun. I'd always wanted to make t-shirts. I was kinda crafty kind of thing, you know, hobbies on the side.
Leigh Hurst (05:47):
And so my friend and I mocked up a tee shirt and I got a hundred made, put a website up, my background's in technology based learning. So I was kind of techie and I'm just send it around to my friends that had lived in the cities where I had moved after grad school. And I started selling shirts to people. I didn't know, very quickly, it just kind of went viral. I was getting checks in the mail from people. I had no idea who they were. And so, you know, that whole idea of, of using a message, like feel your boobies, which is lighthearted, but very pointed in terms of what it's trying to get you to do. Made me think about, you know, is this really creating behavior change? Is this creating a meaningful dialogue among a population of women like me that never really talked about it before? Or if they did, it was the third serious town and it was about their mother or it was in the context of a doctor's office. And so to that accidental t-shirt, that was just a hobby sort of evolved in time into something that took over my life quite honestly, and quickly I had to figure out what I was doing with it. So that's how the foundation itself came to be.
Karen Litzy (06:53):
Yeah. It's amazing. The things that happen to you that can just do a 180 and change your life. Right. So you could have had this diagnosis and then just went on and got a job and just went on your way. Right. But instead you were like, wait a second, like I'm young, I never talked about this. There's gotta be other people out there just like me. So how can I reach them?
Leigh Hurst (07:15):
Right, right. Sort of back fitting it. Right. Because I didn't create the tee shirt with that in mind, but I watched it happen. And that started to make sense to me with my background in behavior theory and that kind of thing. And so I kind of ran with it and, you know, we were able to support ourselves for quite some time just through t-shirt sales. So fortuitously, unlike other nonprofits that you know, have to submit for grants and you know, really the funding side of it is the tricky part. We were fortunate in those early days the t-shirt sales themselves allowed us to do a lot of creative things through social media before that was a standard way of spreading our message. And so we really tried to leverage the idea of media and the peer to peer sharing because what I saw when somebody would wear the tee shirts, like a happy hour or a cookout was I was watching like a 20 something talk to another 20 something or a guy even who might say your shirt says feel your boobies.
Leigh Hurst (08:16):
Can I feel your boobies? And then they would say, it's not about that. It's about breast cancer. Or you got to feel your boobs to see if you find a lump. And to me that was a productive conversation. It was somebody articulating something very simple, but in a playful and a more friendly and lighthearted way than trying to impart stats or other types of things that I think a lot of campaigns do, or certainly they have the aesthetic and the sensibility that feels like it's for an older woman. So you may relate to it because you're trying to just be proactive and educate yourself about health. But the messaging itself is not really created for you. It's not created for the younger population, the style of the images, the style of the graphics, and even the use of the channel that you use to spread it.
Leigh Hurst (09:01):
Right? So a tee shirts, just one way you can not, but you can do that in many other ways. You know, we flew aerial banners up and down the Jersey shore in the summertime on all the very populated beaches. And I'm thinking of these young women that are like dragging themselves out to the beach after going out Friday night. And they see a, you know aerial banner and they say, Oh my God, that says feel your boobies. And I'm like, that's wonderful. That's a great way to kind of intersect with them where they are in a way that they can relate to. And, you know, it's created testimonials from women that say, that's why they found their lumps. So very proud of the campaign. And eventually I went on and left my corporate career and ran the foundation full time. So it really wouldn't do that 180 for me, that you mentioned about changing your life. It was definitely that for me.
Karen Litzy (09:50):
Yeah. So we can definitely see how your life has changed after diagnosis, but what are the big lessons that you learned?
Leigh Hurst (10:00):
Well, you know, I definitely learned I'm type A, very much of an ambitious overachiever and, you know,
Karen Litzy (10:06):
Well, I mean, you were in New York city in a corporate job, we get it, that came across.
Leigh Hurst (10:12):
Right. And so you kind of like play these scripts out in your head. Like I really should slow down this. Isn't really how I want to spend my time. I'm really too busy. I wish I could make more time for X and part of my move home quite honestly, before breast cancer was in an effort to sort of really operationalize some of that stuff to sort of extract myself out of the environment that wasn't really fueling me anymore. It was draining me. And so, you know, earlier in my career, there's coast to coast flights on a Monday morning to get to a meeting on time. That was exciting. And as I got older, I'm kind of like, I don't really want to do that anymore. I don't care how much money I make. I don't want to be on a plane. I want to be involved in the place that I live.
Leigh Hurst (10:55):
And so my move was in part to get that going right, to really start to be outside more to, you know, I decided to go part time cause I kept my job in New York city. So I didn't need the amount of money I was making where I lived anymore. But I didn't truly step out like that until breast cancer came. And then I quite honestly, I got depressed at the end of my treatment, I got depressed and I took three months off work. I called it my be nice to me times. So I like got weekly massages. I went to get therapy because I felt like I needed to sort of sort through some things, you know, I felt like I should be getting back to normal, but nothing about my life felt normal. Everything had changed, you know, whether or not.
Leigh Hurst (11:39):
So I think during that time is when I started to realize what it meant to say no, that you can say no and not give a reason. And that having lots and lots of friends, which I had is great, but having a lot or having fewer really good friends became more important to me. People that I could really keep in touch with and have meaningful conversations. And my family quite honestly, too, was a big part of that. So I would say that that was the biggest thing slowing down. And I still struggle with that because that's not my genetic makeup. My genetic makeup is to, you know, attack a problem, and make a change and go through something like breast cancer, trying to get back to normal is tricky because you really can't change the future. You never know if it's going to come back.
Leigh Hurst (12:26):
That's just a fact with breast cancer. And so I think learning to live with the ambiguity of not knowing, you know, and accepting that, truly accepting that that kind of translates out into other parts of your life, where you can, if you really allow yourself to sit in that space, you can apply that to other uncomfortable things that come up, right. Things that happen with your job or relationships or other things that make you feel anxious. Like you want to make a change or you want a resolution immediately. I think I have a better sense of pause around that where I trust that in time things will sort themselves out and I will have a greater sense of peace around whatever it is. I'm stressing about things that came out of that period of time in my life. Yeah. That's so powerful. I don't do it well by the way, but I work at it all the time.
Karen Litzy (13:19):
Well, I mean, I think the fact that you were able to identify that as, Hey, listen, this is something that I know I need to work on. And of course we're all a work in progress. Nothing's perfect. But to just be able to recognize that and say, I need to make a change. Like this is too much, that's so powerful. And then to be able to kind of leave the city, move to central PA and say, I know I'm doing this for me. And that was even before the diagnosis. So you were already, you know, heading in that direction. And I also really appreciate that. You said at the end of treatment that you were depressed, that you were unsure, you know, because I think oftentimes when people see breast cancer survivors or they hear from, or just looking at a picture, let's say, right, it's a person smiling or it's I beat it, or, but you don't really get into the background of that.
Leigh Hurst (14:22):
I talk about the mental health side all the time, because I think it is something that's not discussed as much as it should be and not everybody gets depressed, but I do think everybody has down days. Of course, I mean, when you're struggling with something that's life or death and that happens at different times for different people. For me, I was fight or flight during the treatment. For me, it was like a project, right. I knew I had a plan and I had to do it. And the tricky part for me was when I entered into that gray space where I was kind of released from all of that care. And I had to make sense of my life on a day to day basis, be my own cheerleader, quiet those voices in my head that would raise all those scary thoughts and realize that this was going to be forever. You know, like you can't let this consume you. And you know, being brave enough to say I'm depressed. I wasn't brave enough to say that right away. You know, I went into therapy, very hesitantly feeling like, what do you have to be upset about? It was stage one, you got through it, shouldn't you be happy with it?
Karen Litzy (15:22):
That self-defeating language, right? There's someone worse off than you.
Leigh Hurst (15:27):
Right? So therefore you can't feel any sort of emotion around your own words is not true and very dangerous by the way. And so, you know, I really try to bring that up when I speak to women who are going through it or who have gone through it, who I sense might be struggling with a little bit of that, because there's so much, and it's different for everybody. If you might be balancing kids, I wasn't, but it might be balancing kids, little children and trying to mask what you're going through to keep them from being afraid. And so that you're hiding your own emotions for some period of time, or same thing goes for spouses that can have issues. So finding a place where you can be truly honest with your own feelings and dealing with that is I think really important because it delays your ability to heal. If you don't find your way.
Karen Litzy (16:18):
You have to say to yourself, okay, this is the situation and I need to live with this. What's the best way I can move forward. Right. We discussed that a lot with people who have like chronic pain. So the pain may never go away, but can you get to a point where you're still doing all the things you want to do, but in order to do that, you kind of have to accept it.
Leigh Hurst (16:48):
Yeah. And the way you choose to do that, whatever steps you take to make that possible in your life. The biggest thing for me was realizing that other people don't have to get it right. Like if I had a choice, things that make me able to have good days or days that I need to step out for a little bit, I don't have, I shouldn't have to worry, or I can't worry if that makes sense to somebody else, because the only thing I can do is reconcile within myself. What makes me the best version of me, the fullest version of me, for the people that need me. And the way I choose to do that is probably not going to be the same as the way someone else chooses to do that, or should it yeah. Nor should it be. Right. So looking for affirmation about those decisions outside of yourself is a real challenge. You know, if you're a pleaser or you're, you know, sometimes you just gotta bone up and do what you have to do, right. You always just satisfy your needs. But the times when you have choices to flake out on plan that you just don't feel up for, or push something that you thought you should do today to tomorrow those things are okay to do, and you don't need someone else to tell you they're okay.
Karen Litzy (18:01):
Right, right. It comes down to like giving yourself the permission and the grace and the ability to do what you need. Like you said, to do what you need to do in the moment at that time, that's going to be best for you. That's going to allow you to show up fully as the person you need to be.
Leigh Hurst (18:20):
Right. Yeah. That makes total sense. I thought it was a great way of putting it as like self care is not the same as selfish. So making those choices, you have to be, you know, polite, honest, a good person when you're doing all of those things, but taking care of yourself, the self care part of it is not being selfish. It's about being in touch with what makes you the good person that you are.
Karen Litzy (18:46):
Right. And I think also being able to communicate that to someone maybe it's your partner or your spouse or your children or work, I think the way you go about communicating, that makes all the difference, right. Because there's a difference between, listen, right now, maybe you might have felt, you know, I just need to be by myself for a couple of hours, you know, that's what's best for me, but if you don't communicate that properly or if you just flake out and go stout on people like that is not that that's how you, you create a lot of friction. Right. So what advice would you give to people if they do have to make these decisions to do what's best for them? What's the best kind of language? Cause I know you're very good at communication and all that other stuff.
Leigh Hurst (19:38):
So I have two small children. I had kids after breast cancer and I'm a single mom now. And I was since they were very little good friends with their father and all of that, but still, you know, being I'm 50 now, but I was 40 and 42 when I had them. And so, you know, the loss of independence around raising two children alone when you're used to like literally flying coast to coast, you know, rewind five years. And it was like, the world was at your feet. So I found myself becoming extremely protective of my space when they were not with me. And, you know, so I was very cautious about making plans. And I would just be honest about that if it was a weekend that I didn't have them and somebody invited me to go away for example, Oh, we're having a girl's weekend.
Leigh Hurst (20:24):
We're going to go to a winery. Do you want to come? And I would say, well, I might, I might want to come if you need a commitment though. I can't commit because a lot of times when the kids go away, I just like to have some quiet time to myself. I don't like to come back from a weekend and be tired. So I would, I mean, that's just being honest, you know, some things, those are, it's not as easy as something like that, but you know, I think with work where there's deadlines and it's a little trickier to push things off I've gotten better at prioritizing where I'll say it has not really in it today. I know I said I would have this by two o'clock is it possible I could have it tomorrow by maybe 10. So I'm not telling them all the inner workings of what's going on in my brain, but I'm floating the idea that I'd like to shift the priority around because I think it would work better for my mental state. You know, so those are just some ideas for how I do it.
Karen Litzy (21:20):
Yeah. That's great. That's great. Thanks for sharing that. And now what I'd also like to talk about is your book. So you're about to release, well, this will be out the first weekend of October. So the book should hopefully be out by then, right? They will be. Okay. Perfect. So say something big, feel your boobies, find your voice stories about little lumps, inspiring, big change. So first of all, congratulations, because writing a book is no joke. So tell us a little bit about why you wrote the book and what's in it.
Leigh Hurst (21:57):
So I wanted to write this book for quite some time. You know, I do a lot of speaking and people often say, Oh, your story is so inspiring about how you just created something and then you ran with it and you saved lives. And now you have this big foundation. And I do realize that that's inspirational, but I kind of tire of my own story over time. So every time I would sit down and try to write about it, I was like, Oh my gosh. But what I found inspirational enough to get me going this time. And it was really an honor of our 15th anniversary, which was last year. I was hoping to have it done by them, but that's the 15th anniversary of the foundation. And it was also my anniversary from breast cancer is the same as the foundations university.
Leigh Hurst (22:39):
So I started writing it back then and the way I got inspired to really get into it was as I started writing about my own story, I was things were coming to mind about these other women that I had met over time through my path, as you know, being very involved in the breast cancer community and quite honestly, their stories while different were very similar. So they were young when they were diagnosed, they found their own lump and they made some sort of change that was remarkable that they hadn't really pivoted from one path to another and really in an effort to give back. And so, as I started seeing that sort of common thread through some other women that I respected, I thought, well, what if I wove their stories into mine? And so, you know, our stories are different. So how I felt it, this part of the journey, you know, when I found the lump, the way I found it is different than the way one of the other women found it and how I felt during chemo is a lot different than the way some other people felt during chemo.
Leigh Hurst (23:38):
So if I can weave their stories in to mine, then it will relate to so many more people because can kind of say, Oh, I really relate to Leigh. When she was deciding if she wanted to have a mastectomy or lumpectomy, but I really, really related to Holly during chemo, cause I'm really struggling with it. And she struggled with it too. And so there's lots of tidbits of inspiration and advice that come out of all of these stories. And so after each chapter, I write a little piece that's called big lessons from little lumps. And it's basically trying to suss out the things that I felt were common through each of the women's stories at each stage of the breast cancer journey. And then of course at the end, you know, they've all sort of found their voice. They've started their own nonprofits, where they started a company to create underwear, lingerie line that's meant to make you feel sexy, even if you've had your breast removed.
Leigh Hurst (24:35):
And that was because that particular survivor did not feel sexy after she was diagnosed and had surgery and she was a designer. So she decided to do that. And so I just found great inspiration and listening to their stories and trying to weave them into mine. And, really at the end of the entire book, what I found were basically three ideas that I saw across all the women that I think can relate to anybody that's going through any sort of difficult time, not just breast cancer. And one of them was that I really noticed that each woman found a frame for their situation that really focused on the idea of looking forward into the future versus looking only backwards and only wishing they could redo it differently. Right? Like being sad about what had happened. They all had those emotions, but the way they ultimately framed things was with the idea of looking forward.
Leigh Hurst (25:31):
Then each of them also talked a lot about finding a passion, something that really, you know, gave them those goosebumps or that feeling you get in your stomach when you're doing something right. And that is what they chose to spend their time on. And they really made an effort to strip anything out of their life that got in the way of them being able to focus on that type of activity. And then the thing that we talked about earlier, but the third thing is that they all recognize that change is continuous, right? It's not like you flip a switch and say, I'm going to make this change, or I'm going to start fuel your movies. And all of a sudden I'm happy because I started a nonprofit and it does good things. I mean, it has all the same challenges that a normal job has.
Leigh Hurst (26:11):
So change is truly this continuous thing, but because of the passion and they're focused on the future, they were able to realize that, sure, there's going to be some bad days throughout this process, but nothing is going to get in the way of my path to create this change towards the way I really want to live my life. And I found that so powerful when I saw that kind of trend throughout each woman. And I really think a lot of people will benefit from watching how each of them kind of, you know, injected that into their own lives.
Karen Litzy (26:44):
And isn't it amazing how storytelling creates such great learning moments, right? I think that's the way to do it. People they remember the stories, they think it's digestible, they internalize it. Like you said, what someone may not relate to you, but they may relate to someone else in the book. And it's those stories that weave through that come up with these great themes that anyone can relate to. So I just always think that I'm such a huge fan of storytelling and storytelling makes things real and relatable.
Leigh Hurst (27:16):
And I think that's an important way. It's one of the things we try to do with the foundation too, is when we do provide messaging or things, we try to really make it relatable. And that we're telling a story about someone who is real, someone who was young when they were diagnosed. So when you say that looks like me, I can relate to that. I also think women who are brave enough to share their story and I, by no means think it's wrong to not share your story. I think you're a private person and that's how you heal, then that's what you should pay attention to. But for those who choose to, and they don't always realize they've chosen to one of the women in the books that she never talked about it. The first time she was diagnosed, she was 26 and she was embarrassed.
Leigh Hurst (27:56):
And then she unfortunately was rediagnosed nine years later with metastatic cancer at 45, which means it's terminal. And at that point she really became braver to start talking about it and she realized how much strength she got from sharing her story. And so I think when women put their stories out there they have no idea how many people they touch when they do it, because no one's gonna necessarily walk up to you and say, I really respect that. You said that, or I want you to know that that really made a change in my life that day, but it does. It does. And it goes beyond what you will ever actually know.
Karen Litzy (28:32):
Absolutely. Yeah. And I love that sort of women pushing other women forward and building them up and paying it forward. It's just such a lovely, a lovely lesson for anyone. But as we all know, you know, the power of women in groups is very powerful.
Leigh Hurst (28:52):
Unstoppable. Exactly.
Karen Litzy (28:54):
Exactly. That's better unstoppable. Yes, absolutely. And so before we kind of wrap things up, what I would love from you is what would you like the audience to sort of take away from maybe from your experience or from our talk today? Cause I know that you do and you also, I also want to point out that you also talked to a lot of young people, college students, things like that, right?
Leigh Hurst (29:18):
Yeah, I do. I do. Yeah. So one of the aspects of our campaign in the past has been what we call our college outreach program, which we provided free materials to college health centers nationally through sororities and women's centers and so forth. And that was in an effort to get our message out to the college campuses. And we've also started running a media campaign which we did last year called are you doing it was a minority outreach campaign focused on young African American women in low income areas. African American women have a higher, are diagnosed at an earlier age than white women. And once they're diagnosed, they have a higher mortality rate as well. And so it's a very important audience to target. And so we funded a campaign that leveraged billboards, bus shelters, bus wraps, as well as targeted digital outreach to that demographic of women specifically to spread the message and that incorporated five local survivors, real survivors who were diagnosed at a young age, we did a photo shoot, shot a video with them.
Leigh Hurst (30:22):
And we shared that through all the channels that I mentioned, but we got over 6.2 million impressions with that campaign. Amazing. Very amazing. So, yeah. So we reach out to that younger population, like you mentioned in a lot of different ways, but I mean, I think if you asked me what the one thing is, I want someone to take away is that, you know, it sounds cliche, but I really do believe that one voice matters. I feel like the ripple effect from one person's passion and when one person's devotion to an idea can really make a difference and they don't have to be big actions. The things that you choose to do, don't have to necessarily change the world, but you can start small. And the actions that you choose, the words that you choose and how you choose to navigate your life, I think affects other people. And this book really showed me that in the smallest of ways, people can have the biggest impact in their communities and in other people's lives. And that's, I think that's a really great lesson for anybody to take away.
Karen Litzy (31:24):
Absolutely. And now if people want to get in touch with you, where can they find you? Where can they find the book?
Leigh Hurst (31:31):
So the book will be available on Amazon. Starting October 1st, I believe. You can read more about the book leighhurst.com. You can follow the book on Facebook, which is, say something big as well and Instagram to say something big. So those are all the channels. And then of course, if you're interested in feel your boobies and the work that we do, the Facebook pages you know, at feelyourboobies on Facebook, Instagram, and Twitter, and our website is feelyourboobies.com.
Karen Litzy (32:08):
Awesome. And we'll get all of those links. So for everyone, if you don't have something to take it down, or you're not right in front of the computer, we'll have all of the links. You can go to podcast.healthywealthysmart.com. And we'll have a quick link to everything that Leigh mentioned today throughout the podcast. So not to worry, everything will be right there. So Leigh, thank you so much for sharing your story. I just know, like you said, even if one person hears this and they say, Oh, well maybe I will feel my boobies, mission accomplished. Well, thank you so much for sharing your story and coming on the podcast. I appreciate it. And everyone out there listening. Thank you so much. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Sandy Hilton, David Butler and Bronnie Thompson on the show to discuss persistent pain during COVID-19.
In this episode, we discuss:
-Shifting current healthcare curriculum to better educate clinicians on persistent pain
-Can passive modalities empower people to pursue more active treatment options?
-How to create more SIMS during the COVID-19 pandemic
-Can telehealth appointments adequately address persistent pain?
-And so much more!
Resources:
International Association for the Study of Pain Website
Factfulness Book
David Butler Twitter
Sandy Hilton Twitter
Bronnie Thompson Twitter
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information Bronnie:
I trained as an occupational therapist, and graduated in 1984. Since then I’ve continued study at postgraduate level and my papers have included business skills, ergonomics, mental health therapies, and psychology. I completed by Masters in Psychology in 1999, and started my PhD in 2007. I’ve now finished my thesis (yay!) and can call myself Dr, or as my kids call me, Dr Mum.
I have a passion to help people experiencing chronic health problems achieve their potential. I have worked in the field of chronic pain management, helping people develop ‘self management’ skills for 20 years. Many of the skills are directly applicable to people with other health conditions.
My way of working: collaboratively – all people have limitations and vulnerabilities – as well as strengths and potential. I use a cognitive and behavioural approach – therapy isn’t helpful unless there are visible changes! I don’t use this approach exclusively, because it is necessary to ‘borrow’ at times from other approaches, but I encourage ongoing evaluation of everything that is put forward as ‘therapy’. I’m especially drawn to what’s known as third wave CBT, things like mindfulness, ACT (Acceptance and Commitment Therapy) and occupation.
I’m also an educator. I take this role very seriously – it is as important to health care as research and clinical skill. I offer an active knowledge of the latest research, integrated with current clinical practice, and communicated to clinicians working directly with people experiencing chronic ill health. I’m a Senior Lecturer in the Department of Orthopaedic surgery & Musculoskeletal Medicine at the University of Otago Christchurch Health Sciences.
I also offer courses, training and supervision for therapists working with people experiencing chronic ill health.
For more information Sandy:
Sandy graduated from Pacific University (Oregon) in 1988 with a Master of Science in Physical Therapy and a Doctor of Physical Therapy degree from Des Moines University in December 2013. She has worked in multiple settings across the US with neurologic and orthopaedic emphasis combining these with a focus in pelvic rehabilitation for pain and dysfunction since 1995. Sandy teaches Health Professionals and Community Education classes on returning to function following back and pelvic pain, has assisted with Myofascial Release education, and co-teaches Advanced Level Male Pelvic Floor Evaluation and Treatment. Sandy’s clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women. Sandy is the co-host of Pain Science and Sensibility, a podcast on the application of research into the clinic.
For more information on David:
Understanding and Explaining Pain are David’s passions, and he has a reputation for being able to talk about pain sciences in a way that everyone can understand. David is a physiotherapist, an educationalist, researcher and clinician. He pioneered the establishment of NOI in the early 1990’s. David is an Adjunct Associate Professor at the University of South Australia and an honoured lifetime member of the Australian Physiotherapy Association.
Among many publications, his texts include Mobilisation of the Nervous System 1991 The Sensitive Nervous System (2000), and with Lorimer Moseley – Explain Pain (2003, 2013), The Graded Motor Imagery Handbook (2012), The Explain Pain Handbook: Protectometer (2015) and in 2017, Explain Pain Supercharged. His doctoral studies and current focus are around adult conceptual change, the linguistics of pain and pain story telling. Food, wine and fishing are also research interests.
Read the full transcript below:
Karen Litzy (00:00:23):
Hello everyone. And thank you for joining us today for this webinar. For those of you who are here live, you got to hear a little bit of pre-conversation which is great. And of course in that pre-conversation we were talking about all the things happening in the world today, specifically here in the United States with a lot of unrest and protests for very, very good reasons, in my opinion. And so we just want to acknowledge that and that we see it and that we are trying to learn, and we are doing our best to be allies to our fellow healthcare workers and citizens across the country and across the world for all of the other countries who have been showing solidarity. So I'm Karen Litzy, I'm going to be sort of moderating this panel of minds and I'm going to now go round and just have each of them say a little bit about themselves. So Sandy I’ll start with you.
Sandy Hilton:
Okay. Hi, I'm Sandy Hilton. I'm a physiotherapist here in Chicago, Illinois with Sarah Haag. We have entropy physiotherapy and our clinic is predominantly working with pain. It's like a hundred percent of my case load is people in pain and about 80% of that is pelvic pain in particular. But I still see, you know, the rest of humans.
David Butler (00:01:49):
Hi, I'm David Butler from Adelaide Australia. I'm a physio, although I'm completely a professional and I believe everybody has the exact same role in treating pain. I'm trying to hire, but I can't retire. And then in world, our changing knowledge and our changing potential just keeps me, keeps me on track. So yeah, any sort of pain I'm happy to talk about.
Bronnie Thompson (00:02:16):
I’m Bronnie Thompson, I'm an occupational therapist by original training with some psychology thrown in, and I'm an educator and clinician as well, but a teeny tiny bit of research, but not much. And I'm a painiac and quite proud of it actually.
Karen Litzy:
Excellent. So again, everyone, like I said, if you have questions as we go along, please feel free to put them in the Q and a part. And I will be looking at that as we're going through now, like I said, we've got some questions ahead of time, but before we get to some of the questions that some of the listeners and viewers have wanted to ask, I also want to just quickly acknowledge that we've got a bit of a mixed audience, so we've got healthcare practitioners and clinicians and we've also got people living with pain.
Karen Litzy (00:03:11):
And so as a clinician for me, it's a great opportunity. I think to address people in pain who maybe don't have the access or the ability to kind of get this information that's in their town or where they're living. So I am really, I'm really looking forward to this discussion, especially for those people that are watching that are living with persistent pain. So the first question I'm going to ask is and I'll ask this of all of you. If you were to give a piece of advice to a new professional or a healthcare professional that is sort of newly working with people with persistent pain, what would that piece of advice be?
Sandy Hilton (00:04:11):
I'm in Chicago. I'm just going to take it. I really like to stress, especially to students that, you know, we get this concept that the longer you've been in the field, the better you are at it. And, I think that maybe we make different mistakes, but everyone is learning this. And there's so much about pain that we're learning. And so if you're just starting in, I don't know that you might have an easier time because you have less bad habits to get rid of and can start with some of the better newer research and avoid some of the mistakes we made.
Bronnie Thompson (00:04:50):
So she's doing the popcorn approach. She looks at me. And so I think my advice would be, listen, listen very carefully to what people tell you and trust that they're telling you your experience. Don't try and read stuff into it, just listen and reflect, show that you're listening by reflecting what you've heard. So you can give that you've understood one another, because it's really easy to come out of school with all of this knowledge packed up and your brain thinking, Oh, I've got to do an info dump just like that. And it's not that great for the person, stop and listen.
David Butler (00:05:37):
They are lovely comments. I'd add. I would welcome anybody to the most new and exciting area of health. And there is a true pain revolution out there. And I would say to anybody, when you come in to just lift your expectation of outcome or what, might've been five or 10 years ago, because the clinical trials and our knowledge of the potential for humans to change is just increasing so dramatically. And I say, now we can say think treatment, not necessarily management because for many people recovery or some form of recovery is on the cards and what's leading the charge is the talking and the movement therapies. It's not the drug therapies for chronic pain. And, I just like to reflect as an older therapist now, patients who maybe 10, 15 years ago with maybe complex post pain surgery or Phantom limbs or complex regional pain syndrome would have thought, and I can't really help here. Now we welcome them through the door and you can get such pleasure, pleasure from treating these people no matter how long they've had the problem.
Karen Litzy (00:06:48):
Great. And, I would echo what Bronnie said is, you know, really listen and also believe, you know, they're giving you their experience. So try and take your bias out of it and believe what they're telling you and try not to talk them out of it because you see this quite a bit of, Oh, I have pain with this. And well, do you really have pain with that? Or is your pain really that much? And as the patient, it's very frustrating to have someone try and tell you what your pain is. So I'm looking at it from the person who has lived with the really chronic and at times debilitating neck pain is just listen, which is good. Believe them, and try not to talk people out of their experiences because it's very frustrating and it's very sort of dehumanizing for the patient, you know?
Karen Litzy (00:07:54):
And when I look back at when I first met David and went up to him at an APTA event and said, would you like to be on my podcast? And he said, yeah, sure, but I'm going to New York. I said, Oh, well, that's great. Cause that's where I live. And so then he met me at my, where I was working at the time and spent two hours with me. And I just, after that felt like, Whoa, like this is the first time that someone really listened and didn't interrupt and believed what I was saying and really set me on a path that just changed my life. Like, I don't know where I would be, had I not had that encounter with David. I think it was like 2011 or 2012. And so I always reflect on that and try and be that person, because I know what it felt like.
Karen Litzy (00:08:45):
And then when someone does come in and, and gives you their full attention and their time and their understanding, and then says, well, challenges your beliefs in a positive way, it was something for me that, you know, and I've talked about it many times that just completely changed my pain and my life. And so, you know, try and be that person is what I would say to people.
Bronnie Thompson:
It's like, we've got to remember that people with pain and I live with fibromyalgia, those of you that don't know that's my reality, it's our experience and what it's like to live without pain. You know, what it feels like to know the things that sit at off things that settle it down and our relationship to it, to that pain and conditions. We come in with a whole lot of knowledge about other people and what we've seen. So we are experts and a whole lot of stuff, but what we're not experiencing as this person's life, their experience via what they're wanting from us even, what's important to them. And that's where when we meet and we can kind of share the hidden paradigms things that we don't know about each other, then we've got a chance to make a huge change and that as we know, I just feel so good about what I do. I just love it. I'm such a pain geek.
Sandy Hilton (00:10:09):
And I think the pain science or the science of pain really gives as a clinician, a lot of comfort to the listen to them, believe them, you don't have to prove it. You don't have to go. And like they say, I hurt here. You don't have to go poke it to reproduce the symptoms to believe it. And that's how I was taught of you have to reproduce the symptoms so that you can document that it's true. And it was like, that's a giant piece of unnecessary that we don't even have to do anymore, which really saves us a lot of time, not to mention establishing that trust and not being one more person. That's poked them in the sore spot. But, that's the thing that I was taught in school.
Bronnie Thompson (00:10:58):
So the question is, do you think that all chronic pain patients were not treated particularly when they were having the first or second episodes of their acute pain or are they in any way destined to become chronic pain patients? Well, my story is I hurt my back. I was what, 21, 22, doing a tango with the patient and a doorway patient was bigger than me. I landed on the floor on my back and I had all the best evidence based treatment at the time, maybe not, maybe not all the ultrasound, but you know, they didn't lie. They're really and relax a bit.
Bronnie Thompson (00:11:48):
But I didn't recover. I was then seeing the Auckland regional pain Center with amazing dr. Mike Butler, who is a rheumatologist and founded, and basically was one of the first in this initiations of bringing the international association for the study of pain to New Zealand, good friend of Patrick Wall knew her stuff very well. Gave me the book the challenge of pain to read. So essentially an explain pain paradigm back in the eighties, I know pain pretty well. My pain has not gone away. So there are some people who will not have a complete recovery of all of their pain, but because none of our treatments provide a hundred percent abolition of pain and actually I'm comfortable with it. I live with the pain and it gives me some stuff that some other people don't have access to. I know what it's like to have every bit of my body feeling really rotten.
Bronnie Thompson (00:12:53):
At the same time. I'm not limited by my pain. And I think sometimes we look at pain removal is that end goal. But I think our end goal is to help people live full, productive, satisfying, joyful and enriched lives. And some people will bring the pain along with them and many people won’t have to and that's amazing. Let's let the person make that decision about what is the most important outcome. But yeah, sometimes we can do all the right things, but if you have a spinal cord injury and you've got a smashed up spine, probability is that at the moment, our technology doesn't give us a solution. We can help, but we can't always take it all away.
Karen Litzy:
David, what are your thoughts on that, that sort of movement from acute pain to chronic pain? You know, what are your feelings on that is, is like you said, are you destined to have it are I know, cause I get this question a lot from people like, well, you know, it started out with like an ankle sprain or it started out with a knee sprain and now it's turned into this. So did I do something wrong or was something not done?
David Butler (00:14:12):
I think you’re not destined to have it, but I think our treatment or therapies and the politics of treating acute pain probably gets in the way. And I also think if someone's hurt their back or any part of their body bad enough to see a health professional, the data is that 50 or 60 or 70% will have a recurrence in the following year. Now most health professionals think a recurrence is a reinjury, but if they really explored what happened, that reoccurance probably happened at a time when they would look at down and flat the immune system's a bit out of balance and they might've just done something simple, lifted up and picked something we would now from pain science, reconceptualize that as well, that's quite good. It's your body testing yourself out like a fire alarm with all the stuff you've been through in the past. It's no wonder your brain. Wouldn't want to play it again to check out how your systems are working, but that just simple piece of knowledge and usually should check to make sure nothing serious has gone on because you check and you can normally say, well, that should ease in a couple of days. That's an example of a little bit of knowledge dampening down. They don't have to go through the old acute process again of more, x-rays more tests, more power.
David Butler (00:15:31):
I think if that's correct, that observation was seen for many years, it could save governments Billions.
Bronnie Thompson (00:15:37):
Oh, absolutely. We've got a great thing. The language we use don't we, is it an injury or is it just a cranky body?
David Butler (00:15:46):
That whole linguistics? And for me and my treatment, you're now a physio by trade. I feel it says important to help someone change the story, to have a story, to take their experience out into society and let it go. That to me is as important as having healthy movement, although they obviously like go together.
Sandy Hilton (00:16:07):
I was gonna say that the saving of money for systems, for sure, but also the saving of time for people and the saving in our healthcare system. Every test you go do is going to cost you a lot of money. And, that time that it takes to get it in a time away from work and family and the concern of what the test results will be. If we can divert them wisely to not do that when it's not really indicated, that's just so good.
Bronnie Thompson:
Yeah. And then I also for, you know, I've had a test now I'm going to wait for the results and now I'm going to wait for what are they going to do as a result of those results? And then, Oh, it's the same. And it just feels very demoralizing to people. And I think that's something we need to think about with make the decision about when and we to stop doing investigations often. That's the sense of the clinician worrying that something, are they going to sue me? It’s not a good way to practice.
Karen Litzy:
Yeah. here's another, we'll do this from Louise. She says, picking up on something David had said earlier, how do we move towards being more, a professional? How do we move the pain industry toward this goal? Excellent question Louise.
David Butler (00:17:51):
There's a lot of answers to it, but a couple would be, I think you just got a quite badly out there would know sports trainers who could deliver an equally good management strategy to some physios, to some doctors, et cetera, right? This pain thing is across all spectrums, which is why the national pain society meetings are so good. And why everybody there is usually humbled and talks to all the other professionals because they realize the thing we're dealing with is quite hard. And we need all the help that that's a weekend get, but it ultimately comes back to provision of pain education throughout all the professions and that pain education should be similar amongst all the professions it's not happening yet. We've tried pushing it, but it's not out there. And it's incredible considering the cost of pain is to the world is higher than cancer and lung diseases together.
Karen Litzy (00:18:51):
Yeah. The burden of care is trillions of dollars across the world. And, you know, even in the United States, I think the burden of care of back pain is third behind heart disease, diabetes. And then it was like all cancers put together, which, you know, and then it was back pain. So, and, and even I was in Sri Lanka a couple of years ago and I did a talk on pain and I wanted to know what the burden of disease of back pain was in Sri Lanka. And it was number two. So it's not like this is unusual even across different, completely different cultural and socioeconomic countries. And, you know, David kind of what you said, picks up on a question that we got from Pete Moore. And he said, why isn't it mandatory that pain self management and coaching skills isn't taught in medical schools? Is it because there isn't expertise to teach it? Well, I mean, David's right here. He's semi retired.
David Butler (00:19:58):
Why isn’t that mandatory? That's a big, big question. I would say that the change is happening. Change is happening. I would say that at least half of the lectures or talks I give now are to medical professionals and out of my own profession or even more than half. So yeah, change is happening, but it's incredibly slow. It needs a bloody revolution, quite frankly. A complete reframing of the problem and awareness that this problem that we can do something about it and awareness that there's so much research about it let's just get out and do it now.
Sandy Hilton (00:20:40):
The international association for the study of pains curriculum and interdisciplinary curriculum would be a nice place to start. And I know some schools here in the States are using it in different disciplines to try and get at least a baseline.
Bronnie Thompson:
The way we do it as the core for the post grad program, that I am the academic coordinator for it. Doesn't that sound like a tiny, tiny faculty. But anyway the other thing that we know is that looking at the number of hours of pain, education, Elizabeth, Shipton, who's just about completed. If she hasn't already completed her PhD, looking at medical education and the amount, the number of hours of pain, it's something like 20 over an entire education for six to six or more years. In fact, veterinarians get more time learning about pain then we do then doctors medical practitioners do, which suggests something kind of weird going on there.
Bronnie Thompson (00:21:50):
So I think that's one of the reasons that it's seen as a not a sexy thing to know about and pain is seen as a sign of, or a symptom of something else. So if we treat that something else in pain will just disappear, but people carry the meaning and interpretation in their understanding with them forever. We don't unlearn that stuff. So it makes it very difficult, I think for clinicians to know what to do. Because they're also thinking of pain is the sign of something else not is a problem in its own, right? Persistent pain is a really a problem in its own right.
Karen Litzy (00:22:29):
Yeah. And wouldn't it be nice if we were all on the same page or in the same book? I wouldn't even say the same chapter, but maybe in the same book, across different healthcare practitioners, whether that be the nurse, the nurse practitioner, the clinical nurse specialist, the physician, the psychologist, the therapist, physical therapist, it would be so nice if we were all at least in the same book, because then when your patient goes to all these people and they hear a million different things, it's really confusing. I think it's very, very difficult for them to get a good grasp on their pain. If they're told by one practitioner, Oh, see, on this MRI, it's that little part of your disc. And that's what it is. So we just have to take that disc out or put it back in or give a shot to this.
Karen Litzy (00:23:25):
And, and then you go to someone else and they say, well, you know, you've had this pain for a couple of years, so, you know, it may not be what's on your scan. And then the patient's like, who am I supposed to believe? What am I going to do? And, and you don't blame the patient for that. I mean, that's, you'd feel this that's the way I, you know, I had herniated discs and I say, you just get a couple of epidurals and the pain goes away and then it didn't. And I was like, Oh, okay, now there's so my head, I was thinking, well, now there's really something wrong.
Sandy Hilton:
That's the problem. Because yeah, if you think it's the thing you did that helped you or didn't help you, then you lose that internal control.
Karen Litzy (00:24:13):
Yeah, yeah. Yeah. So I think, I think it's a great question and, and hopefully that's a big shift, but maybe it'll start to turn with the help of like the international association for the study of pain and some curriculum that can maybe be slowly entered or David can just go teach it virtually from different medical schools, just throwing it out. There is no pressure, no pressure. Okay. Speaking of modalities, we had a question. This is from someone with pain and it's what can be the appropriate regimen for usefulness of tens, for acute and chronic cervical and lumbar pain of nerve origin. So Bronnie, I know that you had said you had a little bit of input on this area, so why don't we start with you? And then we'll kind of go around the horn, if you will.
Bronnie Thompson (00:25:24):
I think of it in a similar way to any, any treatment, really, you need to try it and see whether it fits in your life. So if you are happy and tens feels good and you can carry it with you and you can tuck it in your pocket and you can do what you want to do. Why not just is, I would say the same about a drug. If you try a drug and it helps you and it feels good and you can cut the side effects, there's nothing wrong with it. Cause we're not the person living life. It's more to think about it in a population. How effective does this? And my experience with tens is that for some people it does help and it gives a bit of medium, like a couple of hours relief, but often it doesn't give long sustained relief and you have to carry this thing around. That's prone to breaking down and running out of batteries, right when you need it. So to me, it's agency, but then I put the person who's got the pain and the driving seat at all times to say, how would this fit in your life? Do you think you want to try this one out? It's noninvasive it's side effects. Some people don't like the experience and sometimes the sticky pads are a bit yuck on your skin, but you know, that's more bad. So yeah, that's my, my take on it.
David Butler (00:26:44):
I haven't used it for 40 years after the second world war. When you start to stop, when they, I was friendly with the guy who invented it and I'm thinking it'd be happy pet we'll would be happy to, with these comments that I agree with what Bonnie said. Absolutely. I would also say that, hi, wow, you have got something there which can change your pain by scrambling some of the impulses coming in. You can change it, let's add some other things which can change the impulses coming in or going out as well. So let's use that. Let's get you building something, maybe something repetitive or something contextual or something as well. So you you've shown change you're on the track. So I would use it as a big positive to push them on keep using it, but on the biggest things.
Sandy Hilton (00:27:32):
Yeah, the advantage is it's. So it's gotten so inexpensive. So for something that has minimal to no side effects and has the potential of helping them to move again, which I think is always the thing that we're aiming for. It's not very expensive. But now like several hundred dollars, right? You can order it online. Now you don't even need a prescription or approval or anything like that.
Karen Litzy (00:27:59):
Yeah. Yeah. That's true. And something that I think is also important is, you know, you'll have people say, Oh, those passive modalities, that's passive. You know, I had a conversation with Laura Rathbone Muirs. Is that how you say the last name? I think that's right. Laura. And we were talking about this sort of passive versus active therapies and, you know, her take on, it was more from that if they're doing these passive modalities, they're giving away their control. And, she said something that really struck and, kind of what the three of you have just reinforced is that no, they still have that locus of control. Cause they're making that conscious effort, that conscious choice to try this, even though it's a passive modality, they still made the choice to use it.
Karen Litzy (00:29:03):
And I think that coupled with what David said, Hey, this made a difference. Maybe there's some other things that can make a difference that I think that I don't think they're losing that locus of control, or I don't think that they're losing they're reliant on passivity, right.
Sandy Hilton:
When they have their own unit and they're not coming into the clinic to have it put on you. And you lie there on the bed while you do it.
Bronnie Thompson:
It's something that you have out in the world. It's not different to sticking a cold compress on your forehead when you're feeling a bit sick, you know, we did it. That's just another thing that we can do. So I see it as a really not a bad thing. And it is in the context, you know, if you can do stuff while you've got it on, then it's the hold up problem, as long as you like.
Karen Litzy:
Great, great. Yeah. As long as you like it. Exactly. Yep. Okay. so we've got another question that we got ahead of time and then there's some questions in the queue. So one of the questions that we got ahead of time was how do we explain pain responses like McKenzie central sensitization phenomenon in modern pain science understanding.
David Butler (00:30:35):
I'd answer that broadly by saying that the definition that we've used and shared with the public in the clinical sense is that we humans hurt when our brains weigh the world. And judge consciously subconsciously that there's more danger out there than safety. We hurt equally. We don't hurt when there's more safety out there, then danger. So somebody who's in a clinic and is bending in any way and it eases pain. There will never be one reason for it. So it might just be, that might just be the clinic. It might be the receptionist. It might be all adding up. It might be the movement. They might've done one movement. And so, Oh, I can do that. And then all safety away, we go again, the next movement helps within that mix. There may be something structural. You've done to tissues in the back and elsewhere that might have eased the nociceptors that barrage up. But by answer will always be that when pain changes, it's multiple things are coming together, contributing to them. And they'll never never just be related to nociception.
Sandy Hilton (00:31:49):
I have to say this to say, I am not McKenzie certified. So this is my interpretation of that. I like the concept of you can do a movement. That's going to help you feel better. And we're going to teach you how to do that throughout the day. Maybe as a little buffer to give you more room, to challenge yourself a little more knowing that you'll have a recovery. And I just pick that part and use that.
Bronnie Thompson:
I heard the story of how it all came about and it, and it's you know, it's an observation that sometimes movement in one direction bigger than another. And that's cool. It's like, you're all saying, let's make this little envelope a little bigger and play with those movements because we're beasts of movement.
Bronnie Thompson (00:32:50):
We just forget that sometimes we think we've got to do it one way. And you know, I can't tell my plumbers who crawl under houses. Look, you've got to carry things the way, you know, the proper safe handling thing. And I wasn't, I was the same safe handling advisors like me. But you know, there's so many ways that we can do movements and why can't we celebrate that? And the explanation, sometimes we come up with really interesting hypotheses that don't stand the test of time. And I suspect it might be some of the things that have happened with the McKenzie approach. It's same time. What McKenzie did that very few people were doing at the time was saying, you can do something for yourself that as we are the gold ones, that's what changed.
David Butler (00:33:40):
Bronnie, what's really helped us to start the shift away from poking the sore bit, come on, do it yourself. And, and I always give great credit to Robin McKenzie for that shift in life.
Sandy Hilton (00:33:53):
Yeah. And an expectation that it's going to get better. Right.
David Butler (00:34:00):
You think that’s showing something in the clinic that helps. Wow. Let's ride let's rock.
Karen Litzy (00:34:07):
Yeah. And oftentimes I think patients are surprised. Do you ever notice that Sandy, like, or David, or, you know, when you're working with patients, they're like, Oh, Oh, that does feel better. And they're just sort of taken aback by, Oh, wait a second. That does feel better and it's okay. I can do it. Yeah. And then you give them the permission to do so. And like you said, is it's certainly not one single thing that makes the change. But I think everything that you guys just said are probably the tip of the iceberg of all of the events surrounding that day, that time, that movement, that can make a change in that person. And I think that's really important to remember. That's what I sort of picked up from the three of you.
Bronnie Thompson:
But the stories like that kind of convenient ways of, for us to think that we know what we're doing, but actually within what this person by what this person feels and how they experience it. And the context we provide us safety, security. And I'm going to look after you, that's, you know, changes, motivations about how important something is and how confident you are that you can do it. We can provide the rationale important part. The person ultimately drives that. So we can also provide that sense of safety and that I'm here. I'm going to hang around while you do this stuff. Let's play with it. Let's experiment. And if we can take that experiment, sort of notion of playing with different movements in, we've got a lot more opportunity for people in the real world to take that with them. We can't do that. Or forgive people are prescribed. You will do this movement. And this way perfectly I salute, but the old back schools, Oh, I know scary, And they did get people seeing the other people were moving. And that's a good thing that we can take from it. It's always good and not so good about every approach.
Karen Litzy (00:35:11):
Now I have a question for David and then out to the group, but you know, we've been talking about Sims and dims and safeties and dangers. And so for people who maybe have no idea what we're talking about, when we're talking about Sims and dims, can you give a quick overview of what the Sims and dims, what that is so that people understand that jargon that we're using?
David Butler (00:36:40):
Okay, it's a model we use. There's lots of other similar models out there. So basically based on neuro tag theory, the notion of a network that there's danger danger in me networks out there, and there's safety in me networks, rather simple, structured thinking here, and we've looked at these this has emerged due to the awareness, the pain science that we have a network in our brain. But me as an old therapist, when the brain mapping world came in and we realized, hang on pain, isn't just a little nest up there. There could be thousands of areas of the brain ignited indeed the whole body ignited in a pain experience. And one of the most liberating bits of information for me and my whole professional career, because what it meant was that many things influence a pain experience and a stress experience, move experience lab experience, and many things can be brought in to actually try and change it.
David Butler (00:37:39):
And all of a sudden means that everything matters. So this is where dims danger in me, safety sims in me, it was just a way to collect them. So an example of a dim with categorize them could be things you hear, see, smell, taste, and touch. So for one person, it could be the smell of something burning or looking at something or hearing something noise. The things you do could be a dim. It could be just doing nothing, but then there's Sims, gradually exercising, gradual exposure seems in things you hear, see, smell, taste, and touch could be going out. One of my most common exercises I now give somebody is to go down to our local market and find four different smells, four different things to taste, four different things to touch. And then they'll say, why should I do that? Because you can sculpt new safety pathways in your brain, which will flatten out some of them, some of the pathways they're linked to pain and it comes to of the things you say important.
David Butler (00:38:37):
You know, I can't, I'm stuffed, I'm finished. I got mom's knees. We try and change that language too. I can, I will. I've got new flight plans. I can see the future, the people you meet, the places you're with. So it's a way of categorizing all those things in life into either danger or safety, we try for therapy, we try and remove the dangerous. It is often via education. What does that mean? And we try and help them find safety and health professionals out there are good at finding danger, but we're not used to getting out there and finding those liberating safety things. And of course the DIMS SIMS thing. It's also closely linked in, we believe to immune balance. So the more dims you have, the more inflammatory broad immune system, the more sims you have, you move more towards the analgesics or the safety. And so it's the way to collect them. It's a way to collect as we try and unpack and unpack a patient's story listing to it within to unpack it and then to re-pack it again with them in a different way. Did that make sense?
Karen Litzy (00:39:49):
Absolutely. Yes. I think that made very good sense. And I believe you, there is a question on it, but I believe you answered it in that explanation. It says, have you had patients that cannot find Sims or it's difficult to identify and if so, how can you teach them what a SIM is? But I think you just answered that question in that explanation.
David Butler (00:40:11):
Once they get it. They're on their way. And we send people on SIM hunting homework. So for example, the same might be places you go, okay, if you can get out, just walk in the park or walk somewhere, then power up the SIM by feeling the grass, touching the box, spelling something. And we pair it up by letting them know that if you do that, your immune system gets such a healthy blast, that it can also help dampen down some of the pain response.
Bronnie Thompson (00:40:39):
And with regard to our current situation, sort of around the world COVID-19 and all the subsequent stuff. And also the situations in the U S at the moment, is it any wonder that lots of people are feeling quite sore because we’re eating this barrage of messages to us. And so I would argue that at the moment it might be worthwhile if you're a bit vulnerable to getting fired up with the stuff said, it's a good idea to ration, how much time you're spend looking at the stuff, not to remain ignorant, but to balance it with those other things that feel good, that make you feel treasured and loved and committed. And for me, it's often spending some time in my studio, walking the dog, going outside, doing something in nature. And there is some really good research showing that if you're out in the green world nature, that there is something that our body's really relish, kind of makes sense to me.
Sandy Hilton (00:41:42):
So taking that concept into what's going on right now, there's been a challenge clinically of the things that helped people balance that out, got taken away from them. Yeah. So it was a complicated it still is. It was a complicated thing where it wasn't your choice to stop going to the swimming pool because it made you happy and it gave you exercise and balance this out. Someone closed the pool and told you, you couldn't go. And so there's all different layers of loss in that and lost expectations and loss of empowerment and all of these things. So we have had to help people rediscover things that they could access that could be those positives. And that's been hard and really working my muscles of how to help people find joy or pleasure or happiness or safety in an unsafe environment to really get that on a micro level when you've lost the things that used to be there. And, it's been like a lot, but you can do it. It just takes concentration.
David Butler (00:42:57):
An important thing. That's so important. I think a question for therapists health professionals should be a sane question should be, you know, what's your worldview at the moment. And I would ask that, and it's usually not good, but I chat and have a chat. And actually I'd like to take people through some graphs that the world is not as bad as it really is. And if you look at I've been reading a book by Hans Rosling called factfulness. And really over time, our world is getting better. There's less childhood diseases, a whole range of things, getting better, bad, and bad things, getting better. This is a hiccup. This, for example, I had a musician recently and I had a graph I could show her that say that there's now 22,000 playable guitars to a million people in the world. But 12 years ago, there was only 5,000. All right, this is just one little thing. All right, cool. There's a lot of stats that show that our world is improving, you know, children dying, amount of science, a whole range of things. And this hiccup we have that I'm hopeful humanity can get, can get through, but just a little message I pass on is therapy.
Bronnie Thompson (00:44:13):
Even though we can't do stuff, we can't access places. What can't be taken away as our memory of being there. So it's really easy to take a moment to back a memory that feels good to say, actually, you can't take that one away from me. I might not be physically getting there, but I can remember it, feel those same feelings. And then being mindful.
Sandy Hilton:
This is funny because if you look at Bronnie's background, that's one of the memories I've been using. When I lost the lakefront, I was like, okay, I'm just going to sit there and pretend that I'm not at that beach by that pier. So it's, it's fabulous. And even pictures or recordings of things that you've done before is like, okay, now there is still good stuff. I might not have it right here, but they're still good stuff. So that's really funny. As soon as I saw the picture, I'm like, yeah. And gratitude and just, yeah.
Bronnie Thompson (00:45:05):
The other thing as well, we've always got something that we can be grateful for all that. It might feel trite, you know, I'm living in winter, but I've got a roof over my head. I can have a damn fine cup of coffee and probably a nice craft. I'll at the end of the day, these are things that I can do and can have any way. So we can create the sense of safety insecurity inside ourselves without necessarily having to experience it.
David Butler (00:45:38):
Right. Just a quick comment. I would share that with patients who can't get out are saying the things you do when you're still can be as important as the things you do when you move. Right? So let's explore. If you can't do things, you can still really work you yourself with the things you do. And you're still calm. The introspection reading, thinking, contemplation memory enhancement, go through the photo album, et cetera. And I'd also like to always say to someone to link that in that is a very, very healthy thing to do to your neuro immune complex.
Karen Litzy (00:46:13):
And that sort of brings, I think we answered this question. This was from a woman who is living with chronic pain and at high risk with COVID-19. So how do we get past the fear of going out where people are crowding areas to get the exercise we need to maintain our fitness and muscle tone to reduce our pain. She said, even though I'm doing exercises and stretching, I've lost the ability to walk unaided on uneven grounds through weeks of lockdown. And the hydrotherapy pool is closed. She said, she knows, I need to get out and walk more, but shopping centers, which are the best place to find level floors are out. And a lot of places that she used to go are now very crowded because people are, don't have the access to gyms and things like that. Are health professionals able to suggest options when she lives in a hilly area with only a few but all uneven footpaths or sidewalks. And she has a small house.
Sandy Hilton (00:47:18):
That's the kind of thing that we've been doing since it's like, okay, let's problem solve this out. Because yeah, you have your carefully set way to get through this and then it's disrupted.
Bronnie Thompson:
Yeah, boy, I like having lots of options for movement opportunities. So we don't think of my exercise, but we think of how can I have some movement today and bring that sense of, we are alike to be like, if I can imagine I'm walking along the beach while I'm standing and doing something and, you know, doing the dishes or watching TV or something that still can bring some of those same neuro tags it's same illusion, imaginary stuff activating in my brain. And that is a really, really important thing because we can't always the weather can be horrible, especially if you're in Christchurch and you can't go out for a walk.
Bronnie Thompson (00:48:27):
Yeah. But you know, we can think novelty is really good. So maybe this is a really neat opportunity to try some play. And I've been watching some of the stuff that our two chiropractor friends do with you put, let's put, at least try some obstacle courses and the house so that it's not we're not thinking of it as exercise. And I've got, do three sets of 10, please physios change that. Let's do something that feels like a bit of fun. There's some very cool inside activities that are supposed to be for kids. I haven't grown up yet. I'm still a baby.
Sandy Hilton (00:49:16):
Yeah. A lot of balance and things like that you inside that would help when you have your paths back outside. Yeah, yeah.
Karen Litzy:
Yeah. Great. And then sticking with since we're talking about this time of COVID where some places are still in lockdown, some places are opening up. Bronnie and David are in an area of the world where they have very, very few cases, very, very few cases, Sandy and I are in a part of the world where we have a lot more than one. So what a lot of practitioners have had to do is we've had to move to tele-health. And so one of the questions David Pulter, I believe, as I hope I'm saying his name correctly is do we perceive that our ability to be empathetic and offer effective pain education is somehow diminished by a tele-health consult. So are we missing that? Not being in person.
Sandy Hilton:
I have found it equally possible in person or telehealth cause you're still making that connection. We do miss stuff. We can't read the microexpressions in people as easily. So we as therapists have to work harder, but for the person on the other end, think about what the alternative is.
Sandy Hilton (00:50:46):
And it's been really cool for the people with pelvic pain, that every single time they've gone to a physio it's been painful. And on tele-health it's the first time she has been able to talk to someone about all of her bits and pieces without being afraid that it's going to hurt because there was no way to see somebody inside somebody's home.
Bronnie Thompson:
You get to know something more about me. I've met more pets than ever thought. It was wonderful. This is a privilege that occupational therapists have had for a long time. And I'm so pleased that other other clinicians are getting that same opportunity, because we know so much more about a person when we can see the environment that they live with. That's just fantastic, but it's harder.
David Butler (00:51:39):
I find I've come back into clinical practice. I thought I was going to retire because I wanted to go, but also doing it. I was hopeless at first, but I'm really enjoying it. And I actually believe, I actually believe for the kind of therapies we're doing it's equal or better than face to face. Ideally, I think I'd like to have one face to face or maybe two but then to continue on with the tele health, particularly for people are in rural areas and it's almost no this kind of therapy was coming anyway, but the COVID has hastened it. So I found myself getting anecdotally here a much more emotional, closer, quicker link to patients by the screen. They were in a safe place. They're in their house. That's number one. They're not in a clinic you're there. And you can actually look at that face in the screen, as we're doing now, I'm looking at your faces, maybe one or two feet away, and I'm just keep looking at you.
David Butler (00:52:46):
And there's this connection, which is there. And there's also these other elements it brings in like, you start at 10 o'clock and you finish at 10:45. So there's open and closure, which isn't really there in some of the, in some of the clinics, the difficulty I'm having with it though is I was never in face-to-face practice a very good note taker. I used to make notes at the end. I was talking too much, but what you have to do here, my suggestion with face to face is you really need to plan and make your notes straight after. What did I tell that one on the screen, last clinical context, to sort of remind you of all the little juicy bits that we've got in the interaction. So it's really, for me, it's coming back to curriculum and mind you, I'm glad I'm not doing dry needling or just manipulating it with the talking therapy, but my suggestion is to have the habit curriculum.
David Butler (00:53:44):
So I've got my key target concepts. I know that I've addressed them in that particular session in the next session. I know I've gone back and I've done teach them the self reflection as well. Then to come back to see if I can get it all, or if I've translated my knowledge into something functional or some change. So I'm really, I'm really loving it. And I think there's something rather new and special with this, with this interaction. But maybe that's just me as a physio who sort of used to the more physical stuff. Maybe this is something more natural to the psychologist, its perhaps, but I'm with it.
Bronnie Thompson (00:54:22):
I’ve been doing the group stuff. And I found that has been, I've seen, I like it because they don't have to go and travel someplace. It does mean that we can offer it to people who otherwise can't get here. You know, they can't seek people, especially rural parts of New Zealand, low broadband is not that great in many parts as well. So it gets that it's an opportunity. I'd like to see the availability of it as an option. So we can use like we do with our therapies, we pick and choose the right approach or the right piece at the right time and the right place that doesn't have to be one or the other, like you said, you could see him a couple of times in person and then a couple tele-health and then maybe they come back again and then you do mix and match.
Karen Litzy:
We have time for one more question here, maybe two. So David, this was one you might be able to answer it really quickly. As a practitioner, what is the utility of straight leg raise slump and prone knee bend test and the assessment of chronic back pain. Is it still relevant?
David Butler (00:55:38):
Oh gosh. Oh gosh. I'm going to dodge that question and would say it, it would depend on the client who comes in so I think those neurodynamic tests, which I still do. I think the main principle from them is you're testing movement. You're not testing a damaged tissue and anytime you're doing a physical examination, the deeper thing is the patient is testing you. You're not testing them. So what that patient, what that patient offers back in terms of movement or pain responses or whatever, depends on so many things. I might however, have a client and they are out there who do have maybe a specific stickiness or something or something catchy, whatever that may well, the scar around it might well be polarized by action, where I might spend a little bit more time taking a closer look at it. Now that might be relevant. Someone might have, for example, someone might come out of hospital and have had a needle next to the IV drip, next to their musculocutaneous or radial sensory nerve there where it's really worthwhile. Let's explore all the tissues here and see that that nerve can move or slide or glide. But in the second case, I'd made a clinical decision that we probably have issues out in the tissues, which are with a closer evaluation. That's a really broad answer.
Karen Litzy (00:57:11):
I think it's a tough question to answer because it, sorry, got a cat behind me. I felt my chair moving and I was like, what's going on? Just a large cat. So last question. So how to manage tele-health when the patients may be kind of embarrassed of their house or context or spaces or family it's very common in low socioeconomic patients. So they may not want to turn on their camera.
Sandy Hilton:
Yeah. I've had that shaking well, and I've had people in their car or very clearly like I'm kind of angled cause there's a lot going on in my house and I don't have a green screen. So where it's like, and there's just a wall behind me and it's one of the reasons like I'll talk to him ahead of time of if I'm in the clinic, it's clearly the clinic, but I'll tell them I'm at my house.
Sandy Hilton (00:58:12):
Cause of COVID. So, you know, no judgment, you're going to see a wall and probably a cat and just kind of be up front in the beginning of this as a thing, I've had people that start with the phone on or turn it off or whatever, you just, you roll with it. But I have those conversations ahead of time, before we even do the call.
Bronnie Thompson:
It's about creating a safe space for people. You know, if somebody feels, you know, was not having the video, it won't be that long before. I hope we've got some rapport and it feels better. I'm just, I'm doing a bit of a chuckle because the reason I've got my green screen behind me as my silversmith studio, which has an absolute shambles because it's a creative space. So I'm just disguising it because it's works.
David Butler (00:59:07):
There is something about delivering a story of some talking in the patient's room and there's cupboard doors open and you're looking in their cupboard at the same time. And you know, looking at that, then I just look at that thing. We’re safe here.
Karen Litzy (00:59:26):
Well, listen, this has been an hour. Thank you so much. I just want to ask one more question or not even a question, more like a statement from all of you that, what would you like the people who are listening and they're, like I said, there were clinicians, there were non-clinicians on here. And I think from the comments that we're seeing in the chat is very valuable and very helpful. So what do you want to leave people with?
Sandy Hilton:
I'm gonna echo how I started. We're learning more every single week. I'd say, day but I'm not reading that often. So even if you've gone or you've treated someone and you couldn't quite figure out a way to help them, don't give up because there's more information and more understanding and more ways to get to this all the time. And I don't think you're stuck if you hurt.
David Butler (01:00:26):
I'd like to mirror those comments, explore the power of tele health, lift your expectations of outcome for those patients, people who are suffering and in pain, who are listening for those who are getting into pain treatment there's a science revolution and a real power in that revolution behind what you do. So just go for it.
Bronnie Thompson (01:00:52):
I think don't be hung up on with the pain changes or not, be hung up on does this person connect with me. We create trust. Am I listening? Can I be a witness? Can I be there for you? Because out of that will come this other stuff. There are some people whose pain doesn't get better. It doesn't go away. And that's a reality, but it doesn't mean that you have to be imprisoned or trapped by your pain. That means you develop a different relationship with your pain. And I think that's a lot of what we are doing is creating this chance to have some wiggle room, to begin to live life. That's what I'm looking for.
Karen Litzy (01:01:53):
Beautiful. Well, you guys thank you so much. And for everyone that is here listening, I just want to say thank you so much for giving up an hour of your time. I know that time is valuable, so I just want to thank you all and to Bronnie and to David and to Sandy. Thank you. Thank you. Thank you. And kind of on the fly. So I just want to thank you so much and to everyone. I guess the thing that I would leave people with is, if you're a clinician or if you are a patient, the best thing that you can do, if you are in pain is reach out to someone who might be able to help you, find a mentor, find a clinician, ask around Google, do whatever you can try and find someone who like Bronnie and David and Sandy I'll echo everything. You said that number one first and foremost, you connect with and that you feel safe with. You want them to be your super SIM, you know, like Sandy's my super SIM.
Karen Litzy (01:02:48):
So you want them to be your super SIM. And, if you can find that person, that clinician just know that that there can be help, you know, whether you're struggling as the clinician to understand your patients or your the patient struggling to find the clinician, I think help is out there. You just have to make sure that you be proactive and search for it. Cause usually they're not going to come knock on your door. So everybody thank you so much for showing up. Thank you, everyone who is on the call and to everyone who is watching this on the playback I hope you enjoyed it. If you have any questions, you can find us we're on social media and various websites and things like that. So we're not hard to find.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Eric Miller on the show to discuss how to maximize the value of your physical therapy practice. Eric Miller has been in the financial planning industry for over 20 years. He is the Co-Owner of Econologics Financial Advisors and the Chief Financial Advisor. He has a degree from Capital University and is a Registered Financial Consultant® and licensed insurance agent. He takes pride in helping practice owners become the financial heroes of their own stories and has taken this passion to over 600 families in the past decade.
In this episode, we discuss:
-How to maximize the value of your practice
-The business systems that add the most value and are most attractive to potential buyers
-Financial considerations when planning your exit strategy
-Simple strategies to minimize your tax bill every year
-And so much more!
Resources:
Econologics Financial Advisors Website
Econologics Financial Advisors Youtube
Eric Miller LinkedIn
Econologics Financial Advisors Facebook
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information Eric:
Eric Miller has been in the financial planning industry for over 20 years. He is the Co-Owner of Econologics Financial Advisors and the Chief Financial Advisor. He has a degree from Capital University and is a Registered Financial Consultant® and licensed insurance agent. He takes pride in helping practice owners become the financial heroes of their own stories and has taken this passion to over 600 families in the past decade. During this time, he’s had over 15,000 conversations with practice owners regarding money, investing, practice expansion, practice transitions, taxes, asset protection, estate planning, and helping them shape their financial attitude toward abundance. Econologics Financial Advisors is an Inc. 5000 honoree for 2019 as one of the fastest growing companies in the US.
Read the full transcript below:
Karen Litzy (00:01):
Hey, Eric, welcome to the podcast. I am happy to have you on.
Eric Miller (00:05):
Well, thanks, Karen. I'm really excited to be here. Yeah.
Karen Litzy (00:08):
Before we get into our talk on, you know, how to maximize the value of our practice, in your bio, I read that you're a registered financial consultant. So can you explain to the listeners what that is and maybe how that differs from a financial advisor, an accountant? What is the differentiation there?
Eric Miller (00:31):
No problem there. So I think when people hear that I'm a financial advisor, I mean, people kind of have the same impression that all financial advisors are alike, so to speak. And that's not always the case. You know, there's some financial advisors that specialize in working with you know, ministers and teachers and all different kinds of professions. I just happened to work with private practice owners. Now, as far as am I licensed to do what I do in the financial world, there's something called being a fiduciary. And when you're a fiduciary, that basically means that you have to do what's in the best interest of your client, not all financial advisors adhere to that standard. What's called a registered investment advisor and we're held to that standard under the SEC guidelines. And then as a registered financial consultants, it's a designation that I picked up along the way. And it just basically, you know, there's certain criteria that you have to use to be able to get to that designation that's system.
Karen Litzy (01:41):
Got it. Yeah. So, you know, we were talking before we went on and it's kind of like if you're in the physical therapy world, which I am, and you go on to become, you know, like a clinical specialist in orthopedics or a clinical specialist and in pediatrics, it's like going on for a little bit extra education and certification and what you do is that right? Okay. That's exactly correct. Perfect. Perfect. All right. So now let's get into the meat of this interview. So today we're going to be talking about how to maximize the value of your practice, perhaps plan for an exit of that eventually. And we're going to weave in some critical tax strategies that you might be able to use to save you money. So no one likes to leave money on the table. No one likes to feel like a dope because they didn't know what they were doing. So, let's start with maximizing the value of your practice. So first, what does that even mean?
Eric Miller (02:42):
That's a great place to start because I think people automatically assume that when I say maximizing your practice value, it's just about money, right? It's just about, Oh, the, you know, what's the enterprise value of my business. And then that leads into, Oh my gosh, he's going to talk about like profit and loss and EBITDA and all these really technical terms. But in my viewpoint maximizing practice value. Isn't just about money. It's about the other parts of owning a business that you get value for like time, right? Like you would want to build a business that gives you a lot of time. You'd want to build a business that gives you great relationships with either your employees or recognition from your community. So when I say, if you're trying to maximize the value of your practice, it's not just about the money.
Eric Miller (03:31):
It's about all of those other things, because you know, you look at it, most people that own a private practice that is your largest investment. You know, it's like the thing that provides the most cash flow to your household, and it is an investment and anybody that's owned a business for any period of time knows that it's something that you have to care for. And that you have to make sure that you're treating like an investment and putting in the time and the money to make sure that you get the most value out of it. That's our definition for that.
Karen Litzy (04:04):
Yeah, absolutely. So how can we as practice owners then maximize the value of our practice. If let's say in the event, we want to sell it, we want to exit our practice in whatever way we want that exit to happen.
Eric Miller (04:21):
There's definitely some key areas like, yeah, you have to kind of assume the viewpoint of a buyer. Like if I'm going to buy your practice, Karen, like what are some of the things that I would like to see in place that would allow me to give you, you know, top dollar for it. And I think number one is your personnel organized? Okay, do you have organized personnel? Do people have job descriptions? Do they know what they're doing? Do they know who to report to? So, you know, I think that that is that's key because obviously if you have people in your organization that are aligned and are all kind of working together, you know, you're going to have a really powerful organization. If you can do that, if you don't, then you're going to have, you know, this scattered business that everyone's kind of doing their own thing and that's not good.
Eric Miller (05:13):
So that's certainly one thing. And then of course, just having good stable systems that are built in your business so that there's procedures that people have, that they can follow. You know, there should be an organization chart somewhere where people know like who's in charge of what I think that's going to all add value to your business. Certainly if you look at like the facility, what's the facility look like, is it in good shape? You know, do you have, if you lease the building, do you have a good lease on it? You know, is there new carpeting is, I mean, is it a nice place where people feel safe to come to, you know, certainly a buyer's going to think about that. And then I think from an income standpoint, obviously you have to be solvent.
Eric Miller (05:57):
You certainly don't want to have a lot of, you know, outstanding accounts receivable out there. You want to make sure your books are up to date and current, you don't owe any back taxes on the practice. You have multiple income streams in the business that you like multiple services that you provide because no one wants to be reliant upon one of anything. So I think those are all, some really key areas that if you can get those things in shape and you can get them systematized, you're really going to have something that someone else would want and they would value. And they're going to pay you a much higher amount for that.
Karen Litzy (06:33):
Yeah, that makes sense. So what I'm hearing is you really want to have an organization that's sort of a well oiled machine where people know why they're coming to work. They know what they're doing once they get there and reasonably happy at their jobs, if not very happy at their job.
Eric Miller (06:52):
Yeah. And I think that you're exactly right. And I think the key as the person that's in charge of it is that you have to know what your role is in that business. So I think a lot of people that are in private practice, and maybe you can attest to this when you first started out, you're just trying to make things happen and go, right. And, you know, as you go on, you kind of realize, look, I'm not just a practitioner, I'm also an owner and I'm an executive and those are completely different roles. And I think over time, if you can really make sure that you understand that those three roles are separate and that you have to make sure you master them to that degree, or at least hire someone that can do those things, that that's really going to create you a valuable practice, you know?
Karen Litzy (07:41):
And I mean, when you first start out, like I work with a lot of like first time entrepreneurs, you are the owner, the therapist, the executive, the marketer, the pay, you know, you're everything, right? So, so let's say you have a practice like that, where maybe you are a single owner practice, right. Or maybe you have one person part time person. So you don't have this sort of robust, huge practice. Can you sell that?
Eric Miller (08:12):
Well, you can, you can sell anything. It's just as a matter of how much you're going to get for it. So, again, looking from the buyer's perspective, he wants to buy something. That's not dependent upon one person. He wants something that's going to be basically, he can assume that there's free cashflow there. That is going to be worthwhile to him as an investment. So if you have like a single doctor practice or you're a single practitioner, I mean, you can certainly sell it. It's just not going to go for a very high, multiple, see, most of the practices that we're talking about, you know, are going to sell for maybe like a one to two times earnings. Whereas if you get a bigger organization that has, you know, seven, eight, nine, 12, 20 PTs on staff, there's executives in the office, it's going to go for a much higher, multiple could go as high as eight to 10 of your earnings. So it is, it is that kind of a game, but that's, you know, that's the journey.
Karen Litzy (09:08):
Right? And, you know, you had said you want to have a lot of systems in place, in your opinion, what are the most valuable or most important systems to have in place within your business? Looking at it from a value standpoint?
Eric Miller (09:23):
I think definitely having a good financial system is really key because look at what, you know, a lot of businesses, business owners, don't like to confront the finance part of their business, and that's why they don't have much in reserves. And, you know, they're always kind of struggling for, gosh, I can't make payroll this week. And it's just a constant battle when you don't have good financial systems in place, because they're just, they're not paying attention to their money lines. And unfortunately, when it comes to your practice, that that is the most important thing is keeping that practice solvent, which means that there's more money coming in than what's going out. So that personally, I think that's the most important. Some people would say a marketing system is really key because let's face it. If you don't have more patients coming in and buyers definitely going to want to see that he's going to want to see that you are, you have a system in place where you're constantly getting new patients in the door. Right. And then, you know, I think a good quality control system is, is really, really key. Because if people aren't, you know, getting better and you don't diagnose that quickly of, you know, why aren't people getting better because that's what you do as a physical therapist, your job is to get people pain-free, you know, or reduce their pain. So I think that's a pretty key area too.
Karen Litzy (10:42):
Nice. Yeah. I just had this conversation about the importance of a financial system. Cause I sort of switched my financial system within my practice around, over the last couple of years and it's made such a huge difference. You know, I started looking at the financial system in percentages sort of going off of Mike McCollough, the book profit first. And so, yeah. So how much stays in the business? How much goes to me as an owner, how much goes to taxes? How much goes to profit, how much goes, and then making sure that when that money comes in, it is automatically divided up into those percentages and it's made a huge difference.
Eric Miller (11:22):
That's so awesome to hear it, does it because you've instilled control over your money right now. Right. And when you look at like what's a barrier for a lot of practice owners is that they don't feel like they have control over their money. Right. And, when you start putting in good control, it's kind of like when you're adjusting somebody or you're getting someone to feel better, right. You have to kind of put control in on that person. Like, I need you to do this and move here and do that. It's the same thing with your money. You have to kind of allocate it so that you know, your expenses are you channel your money to places where it needs to go to handle whatever expense that would be. Certainly, you know, you're yourself. I think, you know, is the most important person that you need to pay first.
Karen Litzy (12:07):
Well, that's what profit first says. No, it's true. Like, and once I started doing that, it made everything just lighter. So now like quarterly taxes are coming up September 15th or depending on when this airs that might've just been that September 15th date. And I remember like years ago, I'd be like, Oh my gosh, I don't know how, how do I not have them now? I'm like, Oh, totally fine, my money's where it's supposed to be. I am good. Like, this is exactly where it needs to be.
Eric Miller (12:43):
That actually is kind of like an underlying goal and purpose that I have is I, you know, people always ask like, what's the product of a financial advisor and people think it's, you know, Hey, you know, you made me 20 or 30% or you know, helped me save in taxes. Not really, you know, I like people to feel relaxed about their financial condition and just what you explained to me right there. You're definitely much more relaxed about your condition now because you have control over it and it doesn't control you. That's really awesome.
Karen Litzy (13:13):
Yeah. And it's a little stressful at first because it's different and it's a change. So I always tell people if you're starting out now start off this way. And Holy cow you'll be so much easier. Everything is just, I feel so much easier. Yeah, just a sense of ease that I now know, like, yes, I have money set aside for this. It's already paid, like it's basically already paid for.
Eric Miller (13:39):
That's it that's right. But it also does another thing too. It does make you look at and say, you know what, maybe I'm not making enough money in my business because I can't cover some of these other things. And I think that's the most important thing that people have to realize. And I'll go off on a little tangent here, but there's really two basic rules of, for me, income and expenses. The first one is that just get used to the fact that your business will try to spend every dollar that it makes. And then some, and, and that's not just for a business, that's like a government or any household or organization just, it's just going to try to spend every dollar that it makes. And then some, but at the same time, it will also make the exact amount of money.
Eric Miller (14:25):
It thinks it needs to make to survive. So when I say that, people are like, what does that mean? I'm like, well, look, you know, if you know that you have expenses coming up, somehow miraculously, the business does make enough to cover it. Doesn't it? It's just like, it's just, that's the way it is. So the trick to it is simply to make sure that your reserves and your profit and your taxes are just part of what the business thinks it needs to make to survive. And if you can get that in as what you said as part of that profit first book, I think that's what he's talking about is that it sets the right income target for what the business really needs to make, because that's the biggest outpoint that I usually see with, with practice owners is that I'll ask them, Hey, what's your income target? They'll say, well, you know, I need to make $30,000 a month to pay my bills. And I'm like, well, no, that's not what you need. You actually need 45. If you want to include your profits and building up reserves and paying your taxes that they're operating on a wrong income target. So I think that's really key is to make sure you're operating on the right number.
Karen Litzy (15:30):
Right. So don't underestimate it completely because I think oftentimes people will just look at, well, this is my rent. These are my utilities. This is my payroll. If you're paying people and these are, you know, overhead costs that maybe we have to pay, you know, phone bills, things like that. And that's it. And they're like, okay, so that's all I have to make.
Eric Miller (15:55):
That's right. And that's where their demand for income is. But, and if, but if they put in, Hey, I need another $10,000 a month for myself. I need another 5,000 for taxes. I need another because I want to make sure I have reserves. So if I have to shut down for another month, I can handle that. Right. You start putting all those things in. Now the number changes from Oh, 35, I need to make 50. Oh, right. Okay. Well, that's fine. How many more patients do I need to see a week? Right. To be able to make that number, it just gets them, you know, being a problem solver now, as opposed to like, I can't do anything about it kind of mode.
Karen Litzy (16:32):
Yeah. And I do that. Like people always ask me, well, how many patients, you know, do you usually see a week? And I said, well, it's not, how many do I usually see it's this is what I need to see to make X amount of money per week. So that I know per month, this is what I'm making. And my costs are a little bit lower because I have a mobile practice. So I'm not paying a lease on a brick and mortar facility, but I still have to pay my own rent for my apartment. And I still got to eat. You know, these are all the things that you have to put in. So it's not just, what does the business need, especially if you're a solo preneur, what do you need to survive?
Eric Miller (17:12):
Yeah. And I think this is where a lot of people, yeah. A lot, a lot of practice owners and entrepreneurs gets, think that their business is more important than their household. And you know, I'm under the, you know, our philosophy, our viewpoint is that your household is like a parent company. Okay. You think about this, you look at all the big corporations out there and you know, people have opinions of them, but they do understand money pretty well. And they certainly understand that let's take Facebook. For example, Facebook owns, I don't know if you do this, like 83 other companies and they're the parent company to all of those other companies, but everything flows to the parent company. Okay. We're your households, no different, you know, you own, you have a, let's say you own a house, a business, maybe a piece of real estate 401k plan, the bank account. Right. Those are all assets of the household. So you really, you know, once you start treating your household, like the parent company, then you set up the system so that, you know, your household you're meeting the goals and purposes of the household people. I think they don't do that. They don't take care of themselves like they should.
Karen Litzy (18:19):
Yeah, no, I think that's great advice. Thank you for that. Alright. So we've got those financial marketing quality control systems, obviously three very important systems and we can go on and on and systems. That's a whole other conversation. So we will take those and people can run with them as, as sort of prioritizing their systems. So now we've got, we've got all of our systems in place. We've especially our financial system. So how do we plan? Let's say we're getting towards the end of our treating career, whatever your clinical career, whenever that may come. And it may come at different times for different people. How do we efficiently plan for an exit? What do we do?
Eric Miller (19:05):
As far as like getting the business ready to exit out.
Karen Litzy (19:09):
Yeah. Like let's say, let's say you're getting ready to kind of exit out of your business. Now we know that maybe you can try and sell it. Or what if you're just like, this is the business is done. You're just done. What do you do?
Eric Miller (19:24):
Yeah. Well, I mean, I think the first thing you gotta realize, you gotta look at your own financial readiness. Like, can you afford it? You know? I mean, I think a lot of people, they get into a position where they're tired, they get exhausted, right. Because they've been doing things for themselves or I'm sorry, just for the business. And then they just get burnt out, you know? Well, you know, burnout, you know, what burnout is, it has nothing to do with that. It's just that you don't have a bright enough future in front of you. That's what burnout comes from. Right. And I can see why a lot of practice owners getting that conditions. Like I just keep doing the same thing every day and I can't see a bright future for me, so I might as well just sell the thing. Okay.
Eric Miller (20:06):
So the first thing that I do is just, I try to rehabilitate, like, do you remember why you decided that you wanted to be a business owner? Do you remember like what the purpose was? And if you can revitalize that, I think you can get that person back on track, but look at the end of the day, if you don't want to do it anymore and you want to sell your business, then you know, certainly, you know, hiring a broker can help. Certainly finding someone or just finding another PT that, you know, in the area that would be willing to take, you know you know, sell, you can sell the business to, for Goodwill or it's not going to be very high price, but certainly you can find someone that would be willing to buy practice for some costs. Right. That may just not be very much. Right.
Karen Litzy (20:52):
And then what, if you were ready to just wrap it up, you don't want to sell it. Are there things that one needs to think about as they wind it down?
Eric Miller (21:02):
You mean just like, just close it down?
Karen Litzy (21:04):
You're closing it down. You're moving on to greener pastures, if you will. So you decided to close it down. Are there any financial considerations that one has to think about in that scenario?
Eric Miller (21:16):
Well, you know, certainly look at how much money that you make from your business. Even, you know, money that through the cashflow that you make, it's sometimes a lot more significant than what people think. And certainly you can own the business. You can just, I mean, if you're a physical therapist, you can just go work for somebody else if you want to. But you know, I think people just have to realize that, that their business does provide them a pretty good living and they just have to analyze that and say, do I have enough to replace that? Or can I go to work for somebody else and replace that income? You know, it's certainly not a good thing to do. You know, there's seven different ways to exit out of business. And that's one of them just shutting it down. It's probably the most, it's the worst way to do it, but I know that it does happen.
Karen Litzy (22:05):
Yeah. Yeah. What are the other ways you could just name them? We don't have to go into detail.
Eric Miller (22:13):
So you can die with your boots on, you can close it down. You can sell to an associate. Okay. You can sell to a competitor. Okay. You can sell to private equity. Okay. You can gift the practice to somebody else. Okay. Or you can have your employees buy it through, what's called a Aesop plan. Those are the seven ways that you can exit out of your practice. Okay. Great. What happens with most practice owners is they either sell to an associate to a private equity group, the size of the practice.
Karen Litzy (22:54):
Yeah. Yeah. And so now let's talk about taxes.
Eric Miller (23:03):
Yes. So, Oh, taxes. Hey guys, when you could see your eyes got big.
Karen Litzy (23:07):
Who likes to pay taxes, right. Nobody likes to do it, but we all do it because we need, we need the services that they provide. Right. So let's talk about some tax strategies that might be able to save us some time.
Eric Miller (23:21):
Yeah. Yeah. I think the first thing on taxes is that you have to realize that your accountant may or may not understand the tax code completely. And it sounds really weird because everyone assumes that they have an accountant, Hey, he's going to try to minimize my taxes. That's not really what their goal is. Their goal is to make sure that you are compliant, that you file your taxes on time. They're not necessarily doing tax planning for you. They're not trying to minimize your taxes. Okay. So I think that's the first thing is that you really have to make sure you're working with an accountant that has the viewpoint that I want to try to minimize this tax bill as much as I can, because it won't happen by itself. You have to be proactive. You cannot take a passive role in minimizing your taxes, or you're just going to end up paying the most.
Eric Miller (24:09):
Okay. The tax codes, 3 million words, and, you know, no one's going to know every single passage of it. That being said, there are definitely some strategies out there that you can utilize. One that is that I've been talked about a lot is that you can actually rent your house out for 14 days out of the year and you can collect that money completely tax free. And you're probably thinking like, well, how, how would that benefit me? So where this came about was that in a, I don't know what year it was, but if you've ever heard of the masters golf tournament, there's a lot of, there's a lot of guys that have big houses there and on the golf course and they rent their houses out for thousands and thousands of dollars. Okay, well, legally they can collect all of that money, completely tax free.
Eric Miller (25:08):
Okay. Because the IRS code says, you can rent your house out 14 days out of the year and get that money complete tax free. And you probably thinking, how do I take advantage of that? Well, if you own a business, your business can rent your house out for 14 days out of the year. And as long as you have a legitimate meeting at your house, maybe you have with a key executive or even with yourself, right. You have an executive meeting at your house and you document that, then you can rent, you can have the business pay for that. Okay. It's a business expense. And then you get that personally. And as long as you do it correctly, you can get that money completely tax free. All right. That would be certainly one strategy you can use. It's called the, it's called the Augusta rule. You can look it up online and, and certainly there's. Yeah, yeah. That's where it came from. That's one and, you know, right there, 14 days, let's say that it's a thousand dollars, that'd be $14,000 that you could expense out in your business. And then you can get that personally. Oh, you have to do it right. You have to have a legitimate meeting. You have to like
Karen Litzy (26:14):
Say it's $10,000 a night.
Eric Miller (26:17):
I don't know. In New York, you may be able to write.
Karen Litzy (26:20):
I don't know. That might be a stretch too.
Eric Miller (26:22):
If you needed to rent out like a hotel or a restaurant, that's what you would need to do. You need to go get like an estimate like of where you would normally hold that meeting just for documentation purposes, but like anything else it can be done. You just have to follow through and have documentation, you know? And I just have the accountant guide you on how to do that. That's certainly that's one that would be, you know, 14, 15,000. So if people have kids, they can put their kids on payroll and they can, you know, show them that would be another deduction that you can use. You know, there's certainly a lot more, I could probably go on all night. But you know, I think another thing that people can do is just look at how they take their income.
Eric Miller (27:06):
Like you own a business, right? And most physical therapists are escorts. And you know, a lot of accounts will tell them to take bigger salaries than what they actually need to be taking. Right? So you can actually adjust your salary downs as long as it's a reasonable compensation and then take more an owner draws. That's going to help minimize the Medicare tax as well. So it really just boils down to, you know, finding the right information, finding a right advisor that can help you and, you know, provide tax deductions that your accountant can work with to minimize it. It can happen like you should, it's your responsibility. And I say this a lot. It's like, I've never read anywhere where it's my responsibility to maximum fund the IRS. Right? Like I know I have to pay taxes. I get that. But there's no one that said that I have to like pay, you know an ungodly amount of tax. But that's the way the IRS works. They just assume that your money is their money and you have to be proactive to show them otherwise.
Karen Litzy (28:11):
Yeah. I know this year when I paid my taxes, when I did my taxes for 2019, I was so excited. Cause I only owed like $309 after doing my estimated quarterly taxes, which I thought, well, this is great because I'm not giving them more throughout the year. And in fact I was almost like, spot on. That's pretty good. Yeah. That was pretty good. Because like, you don't want to, like, I understand when people get refunds, but if you got a refund, that means that you gave them more than was necessary throughout the year. Correct. Right. Yeah.
Eric Miller (28:53):
So it is something that you have to stay on top of because as your business grows, you know, your tax liability personally is going to be higher. So you really have to make sure you stay in good communication with your accounts. Like you should be talking to them every quarter, especially now recently where I think a lot of people have gotten the PPP loan. And if you, you know, if that gets forgiven well, you know, physical therapists didn't really shut down. I mean, some of them did, but you were still collecting money. So you know, you may have, you really have to make sure that you're not going to have a tax problem for 2020, it could happen. So just, you know, just getting in communication with your accountant. I think that that will help.
Karen Litzy (29:32):
Yeah. During the PPP loan phase and covert, I was thinking, I was talking to my accountant like literally every other day. Yeah. I'm like, does this make sense? Should I do this? Should we do this? Should I do this? Can I do this? Does this, is this the right form? Do I feel, and I did get a PPP loan because in New York, you know, we were done, like when I say shut down, like shut down, nothing, you know? And eventually I started doing more telehealth visits, but in the beginning it was quite scary. And so I said, you know, I better apply for a loan and, and I did get it. And now they haven't even asked, we haven't even filled out the forgiveness paperwork yet, but now I'm in contact with him like weekly, like, is this the right form? Did I fill this out? Right? Is this the right documentation I need? And he's like, yes, yes, yes. You're all good. So now when the time comes, I'll be able to get that in really quick.
Eric Miller (30:27):
Yeah. And it won't be a problem and you know, you'll have your attention on other things that'll help expand and that's good. And then that's just, that's not my experience. Most practice owners, they kind of don't confront it, they ignore it. And then it becomes a bigger problem down the line. And that's really needless. Right.
Karen Litzy (30:44):
I think that's how I used to be, but I have now been rehabilitated financially. So yeah, this was great. Now, what are in your opinion, what are the key messages that you would like the listeners to kind of take away from this conversation?
Eric Miller (31:02):
Well, I mean, you know, for me look, I mean, you can, regardless of what your financial condition is, like, you can do something about it. Right. And I think that's always been a pretty key, you know, philosophical viewpoint that I have. Like, I don't think that there's such thing as an unwinnable game and I know that even things get a little murky and they get a little dark and you know, sometimes you don't really see, you know, the future as bright as it could be, but if you just kind of like, just do one thing right. And complete that cycle of action and then go onto the next, then I think that starts to create more freedom for yourself. Like people get overwhelmed so fast. Right. And there's like, there's so many different things to do, especially financially. Right. That they just, they don't just do what's in front of them while they're doing it. Like just complete one thing at a time. And then you can go on to the next one. Right. Like do the next thing and then go on to the next one. And then to me, that's the key to success, right? There is, is getting interested in something that you don't want to do. Right. And completing it. And I think once you do that, you'll start to see a much brighter future, better things happening to you.
Karen Litzy (32:14):
Yeah. Great, great advice. Thank you so much. And before we get going, I'm going to ask you the same question that I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to your younger self?
Eric Miller (32:29):
I would simply tell myself that there are destructive and constructive actions that you can do in life, right. And that those destructive actions, while they may appear fun at the time will certainly prevent you from getting to your potential and leading the life that you want to lead. Right. I know we're all young. We all kind of make stupid mistakes and that's just part of the learning curve. But I would certainly tell myself, you know, your personal ethics is really part of your survival, right? And to the degree that you kind of keep yourself in good shape morally, and you do the right thing better things are gonna happen to you in your life. It's going to create more abundance for you. And I would tell myself that is just make sure you pay attention and do the right thing more often than you do the wrong thing.
Karen Litzy (33:22):
Excellent. And now, where can people find you on social media website?
Eric Miller (33:27):
Yeah. So if you want to go for a wealthforpts.com wealthforpts.com, you can download a free ebook that we have. You can certainly go to our website www.econologicsfinancialadvisors.com And then we have a YouTube channel, www.econologicsfinancialadvisors.com. And those would be three places that you can go to connect with us.
Karen Litzy (33:48):
Perfect. And all of that will be at the show notes at podcast.healthywealthysmart.com under this episode. So one click will take you to everything. So Eric, thank you so much. This was great. I was taking copious notes and you know, every time I have these conversations, I'm always thinking to myself, Hey, what do I need to do? What do I need to act on? And you know, a lot of the conversations that I've had with folks like yourself, accountants, even on this program and in my own personal life have just really been so valuable. So I thank you so much for taking the time out today. Thank you and everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Stephanie Weyrauch on the show to discuss budgeting. An active member of the national physical therapy community, Stephanie has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Stephanie is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership.
In this episode, we discuss:
-Stephanie’s experience paying off student loans and still enjoying her lifestyle
-The budgeting tools you need to manage your expenses
-Why an accountability partner can help keep your budgetary goals on track
-How to incorporate pro bono work into your practice
-And so much more!
Resources:
Stephanie Weyrauch Instagram
Stephanie Weyrauch Twitter
Stephanie Weyrauch Facebook
Email: sweyrauchpt@gmail.com
Dave Ramsey’s Complete Guide to Money - Hardcover Book
The Total Money Makeover
Dave Ramsey Podcast
Every Dollar App
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Stephanie:
Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.
Read the full transcript below:
Karen Litzy (00:00):
We are the facebook group so we'll be checking the comments regularly, but just know that we will be checking and we'll probably be a couple seconds behind you guys. So if you are on and you are watching throughout any point in our talk today about setting a budget definitely write your comments down like questions. Whether for me mostly directed to Stephanie and we will get to those questions as well throughout the talk or throughout this very informative talk. I was saying before we went on the air that I'm really excited to listen to this because I have always been impressed with the way that Stephanie and her husband Deland have been able to create their life and their budget, and it's still full and they get to do the things they want to do and go where they want to go all while maintaining a budget and all while they both have student loans.
Karen Litzy (01:07):
So what I'll do first is it's for people in the group who aren't familiar with you, Stephanie just talk a little bit more about yourself and then we'll talk about how you set your budget and what kind of framework you follow.
Stephanie Weyrauch:
Well, thanks Karen, for having me on, I'm really excited to talk about this because I'm running a budget as something that was really hard for me to do for a long time. I wasn't really raised to think about money growing up. So it's not, when I went through PT school, I just got my student loans and spent my money as I saw fit. And didn't really think about my money. So I'm Stephanie, Weyrauch, I'm a physical therapist here in Orange, Connecticut. I work at a private practice called physical therapy and sports medicine centers.
Stephanie Weyrauch (01:55):
And I do a little bit of consulting work privately through four different companies to try to help with occupational medicine and try to prevent any type of work injuries that happened in the workplace. So that's kinda my background a little bit, but when I went to, when I graduated from PT school and went to my first job, and at the time I was working in Minnesota, my student loans were becoming due and my husband is a physician. So he has a lot of student loans as well. So at the time total, we had pretty close to $300,000 in student loans. So quite a bit. And when my student loans were coming due and my boss hands me this little application for my 401k and like all these other very adult things, I just, I panicked. And I was like, I don't even know what a 401k is.
Stephanie Weyrauch (02:44):
I don't know how to pay my student loans. My husband was in medical school at the time. So I was the only one working. And my boss was just like, hold on. He's like, it's okay. I can help you. And so he handed me this book called the total money makeover by Dave Ramsey. And I read it and it changed my life. It changed the way that I thought about money. It changed the way that I handled money and it really empowered me to pay off my student loans and to not be afraid of debt to basically conquer it. So that's kind of the background behind it in the book. And also on his podcast, the Dave Ramsey show, he talks about how to manage a budget and how to set up a budget and how to stick to a budget. So the app that I use is called every dollar it's free.
Stephanie Weyrauch (03:30):
You can download it on, you can download it on Apple or Android, it kind of looks like this. So you can kind of set up, you can put in how much money you make and also what your expenses are for the month. Basically, it's very easy to use. You can use it on your phone or your computer. And so I started using that at the time, we were a one income household. I did pick up an extra job in a skilled nursing facility because my goal was, I didn't want to accumulate any more debt. So my goal was to try to make enough money and save enough money that we could pay for my husband's last year of medical school, which he went to an instate school. So his tuition was $25,000, which is very cheap, I think, by medical school standards.
Stephanie Weyrauch (04:19):
And we were able to cashflow that entire year of medical school, just off of the extra job that I was working at the skilled nursing facility. So every month, basically what I do is I go into the app before the month starts, I put in how much money I'm expected to make. Now, one of the things that happens when you're in private practice, especially if you're starting out is you may not know exactly how much you're going to make. And so it's hard to put in your budget like, Oh, I'm going to make, let's say, as Karen was talking about in the last course, you know, paying yourself by, let's say by biweekly or by month bi-monthly I'm gonna make $2,000 this next two weeks. Like you can't necessarily do that in Dave Ramsey's book. He has a sheet that you can use that lays out how you can do a budget based off of an income that fluctuates.
Stephanie Weyrauch (05:11):
I've never had a fluctuating income, so I've never used it, but he talks all about that in his book. And it's very easy to follow because he also talks about that if you are in debt and you're trying to pay off your debt, there's a certain amount, certain things you need to pay first. So food, shelter, lights, those are like the main things that you need to make sure that you focus on first. And then also the next thing would be like clothing. If let's say you're, you need to buy clothing. For some reason, I have really don't buy a lot of clothes. So I don't necessarily have to worry about that. And then after that is, comes your debt and any other miscellaneous things. So in this budget, you set up your income. If you were planning on giving any of your money away and like doing some charitable giving, that's something that he puts in there.
Stephanie Weyrauch (06:02):
If you're saving any money, there's a section for that. So then you can set aside how much money you want to save. And then for housing in my budget, I have my rent electricity. I put my cell phone cause that's my phone bill in there, my internet, and then my laundry. So those are like the five budget items that I have in there. And then in that month I set how much money I'm going to spend. And he thinks of a budget, not necessarily as a restriction, but permission for you to spend your money. So like throughout the month, if let's say your needs change, you can kind of rearrange how much money you're putting aside. So let's say for transportation, I need, let's say I'm taking my car. Cause I'm going to drive to a couple of patients’ houses. But this month, most of my patients are within a two mile radius of me.
Stephanie Weyrauch (06:53):
They're not far away, so I don't have to drive as much. So at the beginning of the month, I thought maybe I have to drive more. So let's say I set a hundred dollars for my gas and auto budget, and now I'm realizing I don't need that much. So what I could do with that is let's say I only need $50. So that extra 50, that I'm saving, I could potentially move to, let's say my savings, or if I have debt that I need to pay, I can move it down towards my debt. So you're giving yourself permission to spend that much money per month. The next item line item is food. So I've had groceries. And then I have, we have a section for restaurants. So if we want to eat out now with the pandemic, one of the things that was kind of nice about the pandemic is we weren't eating out nearly as much, but our grocery bill went like way up.
Stephanie Weyrauch (07:38):
So I noticed that we've been spending a ton more money on groceries. And I think it's mostly because food has gone up. So I had to adjust our budget based on that. Now this month we're, you know, things are starting to open up a little bit more here in Connecticut and Deland and I really haven't been able to go out and eat very much. And so now we're trying to put a little bit more money towards our restaurant budget because we want to enjoy that experience since we haven't had it for so long. So typically I set aside maybe $150 a month for restaurants, but this month we doubled that just because we haven't hardly eaten out at all in so long. So again, it's permission to use your money in the way that you think is going to be good for that month.
Stephanie Weyrauch (08:27):
And then there's a section for lifestyle. So I put like my subscriptions in there. So my Peloton subscription and my Netflix subscription, and then I have a vacation with my mom, hopefully coming up. And so I've been, you know, find some hotels and stuff for that. So I've been putting that under that, and then this one's going to be big if you're in private practice insurance and taxes. So there's another section for that. So if you have your, let's say it's the month where you have to pay your quarterly taxes, or let's say, instead of saving all this money and doing it in one month, you divide it up into three months. Well then you can kind of equally divide that four month, and then that way you're not forgetting to pay it. And then of course the last line item is debt. And so how much money you're going to be spending towards your debt that month.
Stephanie Weyrauch (09:20):
And then what happens is it will take, it'll give you like a picture and a graph of how much you're spending. So let's see if I can bring that up. So, so basically this is my debt and how much I spend this, this past 12 months on different things. So you can see that most of what I've been spending has been on my debt is debt, the green light, this light green color, this big one, that's all how much money that I've spent on debt this year, so far this year. So, you know, Karen had mentioned the other day that deal and I paid a lot on debt and we have, since I've been on this budget, I have been dedicated to becoming debt free.
Stephanie Weyrauch (10:09):
And our goal has been to be debt free in a total of seven years. So right now we're in year four of that. And within those four years, we've paid off $150,000 in debt, which is a lot. And that includes the cashflowing of Deland’s medical school, plus our move that we had to cash flow from North Dakota to here in Connecticut. So I'm not saying it's easy, like I'm not saying I live a luxurious life at all, but I would say that I definitely, like Karen said, I'm able to like go, I'm able to go well before the pandemic, I'm able to go to New York city, like once a month and see Karen and like hang out with my friends. But I plan for that every month. And if something comes up where I'm not able to do that, then I just have to make sure that I don't do it.
Stephanie Weyrauch (11:00):
And so it takes discipline, which you're all in private practice and you've started your private practice. So you obviously are all disciplined individuals. I will say that when you're managing a budget too, it always helps to have a partner who will keep you accountable. I am a spender and Deland is a saver. And so if I had my choice, I would probably go over our budget every month. But Deland is very good at saying now, Stephanie, do you really need that. And I fortunately must admit many times no. So having an accountability partner is really important. If you're in a private practice, that accountability partner can be your spouse or your partner, or it can be your business partner, or it could be a trusted friend. So having maybe you guys are both managing budgets at the same time and you can kind of be each other's encourager.
Stephanie Weyrauch (11:53):
So that is something that's how I run our budget. It is definitely, I definitely don't live a very luxurious lifestyle, but I wouldn't say that I'm just sitting at home, eating ramen noodles all the time either. So I'm able to put most of the money that we spend every month goes towards debt. So probably half of our budget each month goes towards debt, but that's just because we are dedicated to making sure that we become debt free within the next four years. So, yeah. And, and there may be people on here who have no debt and don't awesome. Right? And so that part of the budget and the app, I mean, how wonderful, if you don't have student loan debt, maybe you have credit card debt, and you're putting something towards that each month. But I think if you don't have, if you're past the student loans or you didn't have to have, you didn't have to take out any student loans, then you can certainly take that money that would go to debt.
Stephanie Weyrauch (12:57):
It would be substantially smaller if we're just talking about credit cards and you could say, you know, I'm going to dedicate it to XYZ. Now what happens? Oh, quick question. So what was the Dave Ramsey book? I put two books. One was the total money makeover and the other's complete guide to money. I put them both in the comments section here, but where was the one that said he had like that's total money makeover. Okay. The total variable with the variable income. Yep. That's at the very back of it. And you can just copy and I mean, I'm sure that there's a copy of it too, on the internet. You could Google it and it's palatable.
Karen Litzy:
Okay, great. Yeah. I think that for me, I look at, you know, this I'm taking care of your budget. I think a big part of it is writing everything down, right? It's the same way when we say to our patients to keep a journal or an exercise log, or if you've ever done weight Watchers, you have to write everything that you eat using weight Watchers. This is kind of the same thing. It sounds like this app, and you're really having to write everything down each month is definitely keeps you accountable, but also gets you into the habit of doing it.
Stephanie Weyrauch (13:44):
Yes. I definitely agree with that. And you know, the other thing too, that Dave Ramsey talks about in his book is he has these specific baby steps that you work towards to building wealth. So obviously I think all of our goals, some days to be financially stable and successful, right? So even utilizing his principles towards your business, I think is really important, especially because look at what happened to us during this pandemic.
Stephanie Weyrauch (14:34):
I mean, 80% of Americans are living paycheck to paycheck, and a lot of us needed PPP loans. And like some people's businesses just weren't prepared for this. So in his book, he talks about like having a small saving, like emergency funds, you know, paying off debt so that you can become debt free would be the next step after that. And then saving three to six months of expenses. And, you know, after this pandemic, one of the things I think I've learned is having that six months expenses saved is like so important and notice that it's six months of expenses, not six months of your monthly budget, but expenses. So then when you have an emergency, like something that you just can't even control, like you feel more in control, you're able to maybe provide more for your employees, or if you, you know, or even your help your patients out a little bit more pay your bills.
Stephanie Weyrauch (15:31):
And then the last three steps, which if you're a business owner, I mean, it's pay for kids' college, which you don't have to worry about that as a business owner, but pay off your mortgage. So if you have a brick and mortar practice paying that off, and then the last one would be to give charitable giving. And if there's one thing I think this will therapist are really good at it's giving to charity, i.e. giving out our services for free sometimes. So, I mean, at that point, when you're in that point in the baby steps, like you hypothetically are set enough that potentially you could do some pro bono work with your business, which would then put your business on the map as being a very solid community practice as well. So, I mean, I think a lot of the day to day principles that he talks about in the total money maker, that's meant for day to day stuff could easily be applied to business.
Karen Litzy (16:21):
Yeah. And I'm glad that you brought up the pro bono because the question that Gina had was, how do you decide on that pro bono? How does that fit into the budget? What kind of a sliding scale do you use and how do you do that? If you are a private practice, what kind of sliding scale are you using and how do you decide what to charge? And, you know, I say like I have a real Frank discussion with the individual patient. And if they say, you know, listen, I really need the help. If they were referred to me from another therapist who they were seeing using their insurance. And they say, you know, so-and-so says, you're the best person. You're best equipped for this. This is what I can afford. Can you do it? And because my business is at that point now where I don't, I can, I'm able to offer that kind of service.
Karen Litzy (17:11):
Then I say, yes, I can do it for this price. You know? So that's kind of how, and it's also depends on like, if the person, if I have to travel an hour and a half to get there and an hour and a half back, then it might not be best. Which in which case, I'm happy to find them, someone that will work for them. So I think when you're looking at the pro bono costs, if you're traveling to patients, you have to look at your travel time. You have to look at how that's going to cut into your overall budgeting and your overall key performance indicators, which we'll have a whole other talk about KPIs. But I think the bottom line is you have to know how much does your business need per month to be able to do everything you just said, right Stephanie.
Karen Litzy (17:57):
To be able to keep the lights on, to have shelter. So how much does your business need each month just in expenses? Have you met that goal, then? How are you able to pay for your insurance and your taxes, which I would say go into just the sheer expense of running the business. Yes. I would agree with that too. So that's the sheer expense of running the business. Do you need another new fancy gym equipment or this, that, and the other thing? No. Right. So if you can forego that to maybe help someone else at a pro bono rate or at a reduced rate, then my inclination is to forgo the fancy new treadmill and to treat the person that needs it. So I think how you decide what that pro bono rate is, I think depends on the person in front of you.
Karen Litzy (18:51):
And you could say, you know, you can ask, ask around and just say, Hey, listen, this is what other physical therapy practices are doing. This is what I'm comfortable with. This is what the least amount I can charge so that I break even. And I think people understand that. So I think when you're thinking about what's the lowest charge you can give to someone that would be it, or you can go perfectly free. If you can say, you know, I can treat, I can do one session free per week, and I'm still, you know, in the green and I'm not in the red, then go for it, you know, but I think you have to know how much you can make to keep your company in the green, and then you can decide, well, this would be my lowest pro bono charge.
Karen Litzy (19:37):
And then if someone comes in, who's really, really of need, or you're volunteering through an organization or something like that, where you're treating someone for free, then, you know, I think in my opinion, I think that's the best way to go about it. I'm sure there's some legal aspects around that. But from what I can tell in speaking with lawyers, they say, it's your rate. You know, you just have to be clear about what it is. You, Stephanie, where are you where you are? Do you have a pro bono rate?
Stephanie Weyrauch:
Yeah, so typically our pro bono rate is like $40 per session is what we'll do, but we are flexible. I mean, again, our practice, luckily my boss, he's been an amazing leader throughout all of this. We didn't have to fully lay off any of our physical therapists and we have five physical therapists, but we were very strategic with how we worked and when we worked.
Stephanie Weyrauch (20:30):
And so we've had that freedom from kind of how we've been running our practice to allow for us to sometimes even treat patients where they pay like $10 for a session. So, I mean, it varies from situation to situation. Things that we consider is how dedicated is the patient? Is this a patient that's actually going to come to therapy? Or is this a patient that's going to flake out on us because we don't want to save them a spot and then they not show up consistently also we've had instances where we've had maybe some where we've thought the insurance was one thing and it came out somewhere else. And so we ended up using the visits that we were given and the insurance company won't give them any more visits, which is a mistake on our part. So we always want to do, we always want to do right with any mistakes that we make.
Stephanie Weyrauch (21:21):
That is another thing that we'll consider, or sometimes if we have a Medicare patient that can't afford their copay, you know, we'll exchange services and other ways, you know, whether it be like they come in and maybe fix something in our clinic. And then we exchange that with our services, bartering, bartering. Yeah. So, we've been able to be flexible. But again, we built up our practice enough. We've been in business now for over eight years and we're a well established in the community that we are able to do that if you're starting out, you may not be able to do it right away, but you can work up towards that as you start to manage your money and start to make a profit.
Karen Litzy (22:12):
Yeah, yeah. Yeah. Thanks for that example. And I think that you'll find that in most physical therapy practices, they have a pro bono rate. They work with people they're flexible. Every practice I've ever been in the owners have been super flexible because in the end, we're all in the business of getting people better. And sometimes that business, maybe doesn't yield a profit of $200 per person. Maybe sometimes it's 10, but if our business is to get people better, then that's what we want to do. And I will also say this just because that person let's say your patient needs that pro bono care, they can't, it doesn't mean that they don't know people who they will scream to the rooftops of how wonderful you are and how great you were and how easy you were to work with too. A lot of their friends or to their communities. And then all of a sudden you're bringing in more business because you did a good thing.
Karen Litzy (23:05):
So don't discount that. And perhaps, you know, that person can be the stellar Google review you need, they can be that video testimonial on your website. They can be that written testimonial on Yelp or on your website. So these are all ways to like, incorporate your pro bono services by saying, Hey, listen, we're happy to do this. If you're pleased with your service, if you feel better, we would love for you to put up a thing on Google or put up a review on Google or Yelp or on our website, if you're comfortable doing that. Right. I totally agree with that. That's another great way. So that's right. It's the same thing as, like I said what would the other night talking about lead magnets, put something out there that people can use. They then give you their email. And all of a sudden you've made this really fruitful transaction for the both of you.
Karen Litzy (24:00):
And that's what that pro bono type of situation can do. So just always think there's always ways to leverage a visit that has nothing to do with money. That's right. So, all right. So Stephanie, let's talk about if you would like to sort of wrap it up on the big budget issues that people need to be aware of. And I also put just so people know, I also put every dollar, the app in the comments as well.
Stephanie Weyrauch:
Perfect. So I would say that the first thing that you need to know is you need to stick with the budget. I mean, there's no point having a budget and you don't stick with it. Accountability partner, I think is key. Having somebody there that will keep you accountable. I mean, you're in private practice. You're probably a very accountable person, but it's still good to have somebody there that asks that says, do you really need that this month?
Stephanie Weyrauch (25:02):
Or are you sure that this is what you want to spend on this specific line item? So having the accountability, I think is the key and sticking to your budget is the absolute key. I think that if you allow yourself to go over your budget and you're like, Oh, it's just one month that develops bad habits. You just gotta break all your bad habits right now. And that budget is like your gospel. You need to have a monthly budget meeting with your staff. If you have a staff, if you don't have a staff, it's just you with your accountability partner and say, this is what I'm going to spend. You know, I have a little bit of extra money that I can spend it on. What, what should I spend it on? Should I spend it on my charity work?
Stephanie Weyrauch (25:48):
Should I spend it on my debt? Should I spend it on getting new equipment and have that accountability partner help you with those decisions? If you want somebody to help you, but at least they can be there to basically ask you those questions of is this really necessary? I think if you can stick to your budget, you will feel so much better about your business. You will be less stressed. Like Karen said, you will feel like you've been like you, you have all this extra money because you know where all your money is. And the reason that the every dollar app is called every dollar is because you give every dollar a name. You don't have any extra money floating around in your budget. You put it where it goes for that month. The other thing is, is that to think of the budget as permission to spend money versus being super strict with it.
Stephanie Weyrauch (26:41):
So you still have the bulk amount of money that you're spending that you, that you have for the month. But, you know, if you notice again, like let's say you don't have to drive as much, you can take that extra money that you would typically spend driving and put it towards a different line item, but just make sure that your budget always adds up to all these total $0. You have nothing left. Everything is going to something in the budget and it has a name. Your budget is your baby. You would not name your baby nothing. Well, no, I'm just kidding.
Karen Litzy (27:26):
Yeah, no, I think that's a really great point. And even if that money is savings, right, it goes, it has a name. So nothing thing, I'm just going to leave it in the bank. It's going somewhere every month. I love that. All right. So we have stick with it. Don't break it, give it a name, anything else? And just accountability partners. Yeah. All right. Well, this was great, Stephanie, and I hope that people this gives everyone an idea of having a good starting point, downloading the app, maybe reading the book. Like I said again, to repeat the name of the book, the total money makeover by Dave Ramsey, and every dollar.com or every dollar app. And in there, it also has in the book, like Stephanie said, it also has information for people who don't have that steady every two week paycheck. But if you're an entrepreneur, it gives you ways in order to kind of work around that as well.
Stephanie Weyrauch (28:27):
And if you do end up, if you guys are podcast listeners, and if you download the Dave Ramsey show podcast, a lot of his podcasts focuses on entrepreneurship and on business ownership. And so he has a lot of really great advice on running a business and budgeting for business. The budget that I talked about is more, it can be both used as a personal budget or a business budget, but he does talk a lot about business ownership in his podcast as well. So I would definitely recommend checking that out. If you have extra time and want something to play in the background, it's a good podcast to listen to in the background. You don't have to sit there and like learn from it. It's just kind of there. And he's a pretty entertaining guy. Yeah. I took one of his it was like a longer course a couple of years ago. So I still have all of the materials and everything like that. So yeah, he's very entertaining and he knows what he's doing and it works.
Stephanie Weyrauch (29:15):
And I will say, you know, you can have a personal budget and a business budget. You don't have to have just one. You can have personal, you can have business and then you'll know exactly where literally every dollar in your business and every dollar in your personal life is going. And like I said, on our talk, you know, after reading profit first from Mike, I just found it amazing of like, yeah, I know now where every dollar is going to. So now that I know where every dollar is going to my big buckets, I can now use this to see where it goes to the very last dollar.
Karen Litzy:
Right. Yeah. And like I said, when you do a budget, it's amazing how much extra money you have. And you're like, wow, I didn't know. I had all this money. What was I spending on before?
Stephanie Weyrauch (30:03):
Right. What kind of nonsense was I doing before?
Karen Litzy:
Yeah. That's one thing that I have to tell you after instituting profit first, I was like, the hell was I doing like, seriously? What was I doing before? Because I have so much more money in savings. I don't have to worry about paying taxes. Everything's awesome. Like, what was I doing? I can't explain it, but now it's like, yeah, now I get it. Now I understand. And I feel like you know, like you said, Oh, this is a grownup thing. Oh yeah. So I was like adulting hardcore when I learned this. So I think that's great. And now Steph, before we jump off, where can people reach out to you or find you social media if they have questions?
Stephanie Weyrauch:
So I'm on Facebook. Stephanie Weyrauch. Or you can find me on Instagram or Twitter at theSteph21 and I'm available on any of those platforms.
Karen Litzy:
Perfect. Well, thank you so much. And everyone, thanks for indulging us, at least here in the Northeast on a very rainy, very rainy Saturday to talk about setting your budget, sticking to your budget and creating more wealth from the money you're already taking in. So Stephanie, thank you so much. And everyone, thanks so much for listening.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Adam Culvenor on the show to discuss ACL injury. Dr. Adam Culvenor is a physiotherapist, leader of the Knee Injury and Osteoarthritis Research Group and Senior Research Fellow within the La Trobe Sport and Exercise Medicine Research Centre in Melbourne, Australia. Adam’s research focusses on the outcomes of anterior cruciate ligament (ACL) injuries, in particular the prevention and management of early knee osteoarthritis in young adults following ACL injury and reconstruction.
In this episode, we discuss:
-The short-term and long-term burdens following ACL injury
-Why patient rapport is integral to effective treatment post-ACL injury
-Optimal loading strategies for non-surgical and post-surgical cases
-The latest research on prevention for early-onset osteoarthritis
-And so much more!
Resources:
Adam Culvenor Twitter
La Trobe SEMRC Twitter
Email: A.Culvenor@latrobe.edu.au
La Trobe Adam Culvenor
La Trobe University Blog
For knee injuries, surgery may not be the best option
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Adam:
Dr. Adam Culvenor is a physiotherapist, leader of the Knee Injury and Osteoarthritis Research Group and Senior Research Fellow within the La Trobe Sport and Exercise Medicine Research Centre in Melbourne, Australia. Adam’s research focusses on the outcomes of anterior cruciate ligament (ACL) injuries, in particular the prevention and management of early knee osteoarthritis in young adults following ACL injury and reconstruction. His work has identified important clinical and biomechanical risk factors for post-traumatic osteoarthritis, and he is currently testing novel osteoarthritis prevention strategies in young adults following injury in a world-first clinical trial. He has published over 60 peer-reviewed articles in international journals.
Adam has worked in teaching and research at universities in Australia, Norway and Austria and is a graduate of Harvard Medical School’s Global Clinical Research Program. His research has been awarded American Journal of Sports Medicine most outstanding paper 2016, Australian Physiotherapy Association Best New Investigator 2013 & 2017 in musculoskeletal and sports research, and Sports Medicine Australia best Clinical Sports Medicine paper 2019.
Read the full transcript below:
Karen Litzy (00:01):
Hey, Adam, welcome to the podcast. I'm so happy you're here. And I'm excited to talk about ACL injuries with you. So welcome.
Adam Culvenor (00:08):
Thanks very much for having me, Karen. It's great to be here and chat.
Karen Litzy (00:11):
So now the bulk of your research is in ACL injuries and not the mechanism of injuries for ACLs, but what happens after that injury? So before we get into, and we'll talk about the burden of ACL and optimal treatment and osteoarthritis and why that happens. But what I would love to know is why are you interested in this subject matter? Sort of, why did you make this kind of the centerpiece of your research?
Adam Culvenor (00:43):
It's a good, good question. So about 10 years ago, also, now I had done a couple of years of clinical practice as a physiotherapist in Melbourne where I'm based and was interested in pursuing a bit more of the research line into ACLs because we had a patient come to myself and one of my colleagues who was a young guy, about 35 years old, who had a very active, healthy life up to that point, he'd suffered an ACL injury about when he was 20 years old, he was about 35. Now it had a number of issues. He'd got back to sport without any problems, but then now about, you know, 10 to 15 years later, started having some pain, unable to do the things he normally would love to do. Couldn't go back and play anymore.
Adam Culvenor (01:33):
Sport couldn't start, couldn't really play with his kids. He'd seen an orthopedic surgeon, he'd had an Arthroscope, had a bit of a cleanup now going back to the surgeon and he was really in want of a knee replacement because he could no longer do the things that he wanted. And the surgeon basically said to him, you're too young to have a knee replacement go and see, Adam and Tom, our colleague. And so what we can do, and that really opened our eyes from a clinical perspective about these types of patients and this particular young guy had on x-ray most of his changes were actually in his patellofemoral joint. So in the patella and the trochlea, and that really set my mind up to go and look into the literature in this space and see what's out there in terms of not only osteoarthritis in these young people. And clearly it was very burdensome to this young guy, but also why are we seeing this in the patella femoral joint in particular and why is it causing so many problems? And so that really set us off for my PhD, about 10 years ago, looking into these medium to longterm outcomes, ultimately trying to help these people get back to do the things they wanted to do without the pain and the symptoms that come with osteoarthritis a lot of the time.
Karen Litzy (02:48):
Yeah. Oh, great story, that's a shame 35 years old. Gosh, that's so young. I can understand why that would really peak your interest because you don't want to see these patients coming into you or when you do see them, you want to be able to help them with the best evidence and best things that you can. So you had mentioned in your explanation there as to why this subject interests you, is that there is this sort of burden after having this ACL injury. So could you talk a little bit more about the burden of an ACL injury and subsequent surgery?
Adam Culvenor (03:27):
Sure. So I'm sure it goes through a lot of people's minds, as soon as they hear that pop or click, that if they know they've had an ACL injury, that's the initial burden is, you know, that worry of, I can no longer play sport. And often if you do go and have a reconstruction surgery, it's often the nine, 10, 12 months of extensive rehabilitation, as we know, and not going back to sport that often people find a lot of personal satisfaction and get a lot of mental health benefit from playing sport and from their peer involvement and social interaction. So it's that initial burden of the extended period out of sport. Some people do really well with great rehab. They can get back to their sport. They want to play at back to the same level of performance, but there's a certain percentage at about 50% of people we know in the evidence will develop longer term, not only persistent symptoms from a patient reported outcome perspective, but also ongoing functional limitations.
Adam Culvenor (04:26):
And ultimately the development of osteoarthritis be that on radiographs, on x-rays. And some of our work is which we can go into a little bit more detail in a moment is looking at the earlier changes on some more sensitive imaging like MRI to try and detect these types of people who might be more at risk of developing longer term changes. So as I said, some people do really well following an ACL injury, but rehab only, or surgery. And we can chat about the differences in the treatment options later as well, but about 50% of people at the moment. And the evidence suggests that they will have osteoarthritis within about 10 years of their ACL injury. So if we think of the typical patient is, you know, the adolescent or the young 20 year old patient playing sport, they rupture their knee only 10 years, 15 years down the track.
Adam Culvenor (05:16):
They're still only 30, 35. That young gentleman I spoke to earlier. And they've got a knee of essentially that looks like on imaging of a knee of a typical 70 or 80 year old. And we know that imaging findings on x-ray don't necessarily match up particularly well with what we see clinically. So that's not necessarily, you know, a sign that they're definitely going to have functional limitations on symptoms, but it certainly increases the risk of that happening. And that burden at a time when people often have really important family commitments and young family commitments work commitments, and they often still want to be active in participating in sport. And so when you bring all of those in to a knee that might not be has have recovered as well, following an ACL injury, you might still have some muscle weakness if that wasn't addressed initially and create the picture of more of a persistent pain problem, then you start getting into being quite a burdensome condition that we say these types of patients clinically come back in often five, 10 years following their injury.
Karen Litzy (06:20):
Yeah. And I can imagine along with that, persistent pain comes decreased activity, decreased movement, and we all know all of the sort of cascade of events that can happen when you're not getting an exercise. You're not getting in movement. You know, then you have risk of obesity, risk of diabetes mental health issues. So all of that stuff can kind of stem from, you know, this burden of an ACL, which, you know, for a lot of people, I don't think that even would flash in their mind when you're looking at a 20 something year old who just tore their ACL, because we know that population who does tear are usually pretty athletic.
Adam Culvenor (07:03):
Exactly. And that's the thing prior to their injury. They're often very healthy and, you know, never seen a doctor or never been to hospital before and having the ACL injury can often be that initial. Unfortunately, you know, the cascade where you become less physically active in, might not be able to get back to the sport. You really want to start putting on weight. And that increases the risk of all of these other conditions, as you've just said. And I think there was a recent article a research paper actually showing that having an ACL injury increased your risk of a cardiovascular disease by about 50% longer term. So for me, that was a real wake up. This knee is not just a knee, it's actually affecting the whole person. Exact reasons you just mentioned that it can spiral into, you know, less physically activity, the pain putting on and then being the increased risk of all of the comorbid conditions as well.
Karen Litzy (07:55):
Exactly. And now, so you mentioned a couple of minutes ago about treatment. So you could have surgery, you can not have surgery. So can you talk a little bit as to what the optimal treatment is after an ACL and how one comes to that decision, whether you're the clinician or you're the patient, how does that work?
Adam Culvenor (08:18):
And that's the $64 question. And so I can have extreme of the spectrum. You can have one end, you can have everyone has surgery. The other end is no one has surgery and the truth probably lies somewhere in the middle. So if we look to what the evidence suggests in the literature, there's very little high quality evidence comparing the two treatment options. There's really only one, what we call randomized control trial. That's compared about 120 people. Who've had an acute ACL injury and they were either allocated to having early surgery. So a couple of months of having the injury and then an extensive rehabilitation period I've nine months or so, and then the other group. So exactly the same rehabilitation. The only thing is they didn't have the surgery. And so the only difference between these two groups of patients was the surgery or not.
Adam Culvenor (09:15):
Now the group who didn't have the surgery initially could have the option of having surgery later on if they had ongoing problems or symptoms, or desired to have the surgery later on, and they could cross over to the surgery arm. And what this study showed is initially this was published back in 2010 now. So we've not done this for over a decade, is that there's very little differences both at two years after surgery five years. And I think that the authors are about to publish their 10 year outcomes, but certainly the two and five year Mark, there's very little differences, whether you have surgery or not, in terms of pain symptoms, strength returned to sport the need to have more surgery, quality of life, and indeed radiographic knee osteoarthritis. So I was fortunate enough during my time in Europe, conducting a research fellowship recently to work with this group of researchers based in Sweden.
Adam Culvenor (10:07):
And we looked at the MRI outcomes in this population, as I said earlier, trying to identify people maybe earlier in the process initially after that ACL injury, to see if we can identify those more at risk of longer term problems, which might present opportunities to intervene a little bit earlier to stop that cascade of negativity and what we found really, interestingly, when we looked at the cartilage on MRI between the time of injury to two years and to five years, is it the group that had early surgery actually had more cartilage loss compared to the group that didn't have surgery and you sort of asked, well, why might that be? Because, and I think I haven't had an ACL reconstruction, I'm injuring myself, but I know from colleagues and working clinically that the ACL surgeries is almost a secondary trauma. Like you're going in there, you're drilling tunnels, you arthroscopically opening the joint.
Adam Culvenor (11:04):
You come out of surgery, having a very angry, hot red, swollen knee. And so I think that whole cascade of inflammation can soften the cartilage, can create a knee that's not particularly happy. And then when you go and potentially, you know, put that knee through load, maybe going back to sport and whatnot, then that might actually be related to the development of osteoarthritis more so than if you don't have the reconstruction. And so we've actually done a little bit more work on the return to sport type of thing. And, thankfully in a group with ACL reconstruction, it doesn't seem to increase the risk of osteoarthritis if you do go back to sport. So that doesn't seem to be the main things. That's a good thing for patients knowing that if you've had an injury or reconstruction, you can go back to sport knowing that you're not going to put your knee at more risk, but it's probably more the inflammatory markers, the secondary trauma of that that's reconstruction surgery that increases the risk even longer term as well.
Adam Culvenor (12:03):
So I think what I always tell my patients is that you should always trial a non-operative period. First, you can always go and have surgery later. And I think, I always say, you need to prove to me that your knee is unstable. So some people can do really well without having surgery because their neuromuscular and muscle systems can compensate for that ruptured ACL and the mechanical instability, the neuromuscular system, the humans are very clever. They can really compensate quite well, and they feel you don't need the ACL. If you're only going to perhaps not go back to that high level pivoting sport, where you put your knee at high stress, a lot of the time, then if you just want to run straight lines and play with the kids, then you're likely not needing to have the reconstruction. If for instance, you try a really intensive, progressive rehab strengthening program and you're starting to run, or you're starting to get back into a bit of sport and your knee starts to become unstable at that point at the level that you want to get back to, then that sort of probably instigates the conversation.
Adam Culvenor (13:12):
Well, maybe your knees actually not able to overcome the structural instability to the level of activity that you want to achieve. Maybe let's have the discussion of a reconstruction as a potential option, but always get them. You need to prove that your knee's unstable by going through this rehab and putting yourself through these activities. But it's not going to do well without surgery because we know that the outcomes that are quite similar for the majority of people if you have early surgery or even delayed surgery and doing a period of rehab, irrespective of whether you go and have surgery or not, will be beneficial, if you do go and have surgery. So that prehab, if you like. So that's, I think it's my take home is it's probably actually just educating the patient to empower them with the evidence because they're the ones ultimately that need to make the decision. And so presenting them with all the best available evidence and guiding them for the initial rehab stage often can change their mind that they need surgery once they realized they were actually doing quite well without it.
Karen Litzy (14:17):
And when you're saying to the patient, let's do a trial for a non-operative phase, so that you can prove to me that this knee is unstable. What kind of length of time are you talking about for that rehab process and knowing that it's going to vary person to person obviously.
Adam Culvenor (14:37):
Oh, of course, of course. So I think a period of two to three months is sufficient to provide an intensive strengthening program. Let the knees settle down initially and then actually start you know, within the first month and even two months getting them to start really loading their knee. That's the thing, if you actually don't have surgery and actually responds a lot quicker because you don't have any of the graft morbidity, you're not taking out some of the hamstring or the patellar tendon. There's no real reason why we need to be conservative about you know tearing a hamstring or whatever that might be cause of the graft or rupturing the graft because you haven't had the graft reconstructed. So it's different for everyone because different people will respond differently, but actually there's no real hard and fast rule with this because you need to rehab them to get them to a point where they're starting to do the activities that they want to get back to.
Adam Culvenor (15:37):
And at any point in that step ladder of increased physical activity demands that they might fail or start having, you know, severe giving way episodes. Then that's the point that you might have that conversation with someone, but if you're running and you start giving Y and these people want to go back and play elite football, then clearly maybe you're not getting, being able to run without a stable knee. You're probably not going to be able to play football with that with a stable knee. Then that might be the point where you revisit, you're running no problems and you tried playing football and it starts giving way, but really you actually just want to run, right? Playing football is just something you tried, but didn't really want to do. Then you probably don't need the structural stability. If you just want to run off another thing, I like to set a patient's, is it like a seatbelt?
Adam Culvenor (16:28):
Is it, we all wear a seat belt when we drive, but very rarely do we have a crack and we rely on that seatbelt to keep us safe. So if you're someone who walks around and might run, then the ACL is a bit like a seatbelt, is that you actually don't need that seatbelt on because you're not having a crack. You're not putting the need through that real pivoting type movement to rely on it. So unless you're going to go back to a high level sport and, you know, put your knee through those pivoting jarring mechanisms of movement, then you probably don't need that seat belt. You don't need that ACL to protect the knee. Does that make sense? Yeah,
Karen Litzy (17:06):
That's perfect. That's really great. And it sounds to me like when, if you're the clinician working with this patient during, let's say this non-operative trial period where they have to prove, again, the instability, every single person is different. So what you're going to be looking at is different meaning, right? So if I just want to be able to play with my kids, I wasn't a runner before I don't really need to run. I just want to ride a bike or, you know, you want to put people through the things that they want to be able to do. And that would kind of be the way you would test for that instability. But are you also using sort of standardized tests when it comes to seeing if people have the stability in the knee?
Adam Culvenor (17:54):
Exactly. so it's really a goal based discussion with the patient come. The desires of the return to activity comes is driven by the patient. And as clinicians, you know, it's good to have that discussion to then work out, you know, what level do we need to get at, but certainly there's a number of standardized clinical tests and really great patient reported outcomes that we can use with these patients. So the very common ones are the strength tests. So if you have the resources, you know, a dynamometer, an isokinetic dynamometer in the clinic to look at the three range of quads and hamstrings strengths and making, you know, the criteria we typically use in the literature is meeting 90% of the strength compared to your uninjured side. Now, there's obviously some pros and cons about doing that.
Adam Culvenor (18:44):
And the other tests are typically hop tests. So single leg hop, as far as you can, with a balanced landing site, decide hop tests. There's a number of different tests we can use to try and assess the stability, the functional stability and confidence of the knee. Having said that though, we've actually just done some work I've led by Brooke Patterson here as part of our team, looking at the limb symmetry index, which is the ACL rate constructively comparing to the, I mean, delayed and what we found sort of between one and five years after their reconstruction is that often the non-injured leg isn't that healthy gold standard cause that often deteriorates because it's a period of an activity, you be back playing the sport you’re back to. So that's sort of the crisis in capacity. So it's not that reference standard that we should necessarily be comparing our rate constructed.
Adam Culvenor (19:44):
And so there's been a couple of other bits and pieces that people have looked at alternatives to this type of measurement. And whether it's, if you have say someone initially after injury, it's a great opportunity to start doing these tests is actually the estimated pre-injury capacity. So to estimate that it's best to try and do it as soon after injury as possible, given that patients might have some fear and confidence, you know, respect that obviously, but actually trying to do a hop test quite early before that other leg has the chance to start decreasing in capacity because often the limb symmetry index overestimates, what the reconstructive legs capacity actually is. And so they're the functional type of measures that I think we should be using in this patient population, not only to assess outcomes, but also patients get in my experience really like seeing their improvements and getting feedback about having, going along their journey totally. And then an objective test of strength or a hop test they can see right in front of their eyes, how far they're hopping and if they are improving and if they're not, then why not have that conversation. And so that can be great for adherence motivation because this journey of a rehab, irrespective of whether you have a reconstruction or not, can be quite long and tedious, it can be boring. You're sitting there doing strength exercises, you know, any type of motivation to get people to continue is going to be beneficial.
Karen Litzy (21:14):
It's always, one of the biggest complaints is, gosh, these exercises, when do we get to the X, Y, Z, you know, that you see on, on Instagram or on YouTube. And I was like, you know, you're a month in buddy. This is it.
Adam Culvenor (21:28):
Exactly. And I think as physios and the evidence suggests that, we're very good at doing the early stage of the rehab because patients are probably more compliant at that point as well. But there's evidence actually coming out of Australia that less than 5% of people who have had an ACL reconstruction, so less than 5% actually go through a period of rehab beyond six months and include and return to sport type training. So I think whether it be a lack of understanding from a clinician standpoint, or also that, you know, financial and motivational points of view from the patient after six months of like, I've had enough, I'm out, I've good enough. I don't need that extra, you know, icing on the cake to get back to sport. They tend to drop off. And that's when not having that really high level agility capacity returned to school at top training, you increase the risk of re rupture. And that obviously is a devastating impact for these patients and increases the risk of longer term negative outcomes as well.
Karen Litzy (22:27):
Yeah. And I know here in the United States, not so much in other parts of the world, but insurance will oftentimes cut people off at three or four months.
Adam Culvenor (22:36):
Okay. So it's different everywhere. Yeah.
Karen Litzy (22:38):
So it's like, okay, so the person can walk and run and then, then what do they do? You know what I mean? So it kind of depends on your clinic model and things like that. But I mean, I've been lucky enough that I've been able to stay with my patients for 12, 13 months and upward. So it's been really great to be there the week they are out of the OR to getting them on the field and actually doing things that are going to, you know, mimic their soccer, their football place. So, but it's, yeah, there's so many obstacles. It seems.
Adam Culvenor (23:25):
Totally. And I think there's some really great evidence coming from Scandinavia that for every month that you delay the return to sport up to nine months, it actually reduces your injury risk by 50% that's mind blowing for me. So not only, you know, it was it from a rehab point of view, but actually from a range, point of view, having that nine months will actually you know, reduce your risk substantially of re rupturing when you do go back to sport. And I think that is why it's so heavily on people's minds when they're first going back to sport. That fear that's a huge impact psychologically for these types of patients. And I think often an ACL injury can happen. So innocuously, like you've done this movement a thousand times at training before, so why this time and that fear of, Oh, it wasn't a major blow when I first did it, like it wasn't someone running across and really hitting my knee. It was, I was on my own. And so what's stopping that from happening again. And that's that, I think that feeds into the fear of what could happen anytime again. Yeah. So I think I often try and say to patients while you injured your ACL, initially let's get your knee back to better than it was before you injured it, to prevent it from happening again. Because once we know once you have one injury, the biggest risk factor. So the biggest risk factor for a second injury is having a first.
Karen Litzy (24:51):
Exactly, exactly. And I've quoted that that study of that nine months reducing 50%, especially when you're working with kids who think I'm fine. Now I can walk. And I was like, listen, this, and you have to have that conversation with the child and with the parents. And once the parents hear that, they're like, okay, like we get it. Even though her physician was onboard, like you're not playing until you're one year out from surgery. I mean, wherever it is on the same page, but it's hard to keep. It's hard to keep everyone on the same page, but being able to use the literature and say, listen, I'll send you the study here it is.
Adam Culvenor (25:34):
When actually pulling it's actually for some people it's not in needing to encourage them, it's actually needing them to pull them back. That's where your education and clinical reasoning and discussions with patients will differ quite a bit is that some people are so gung ho in their rehab and they just want to get back to sport. You actually have to, as I said, pull them back, whereas the opposite might be true for some alpha people. So it's really interesting how different people respond differently to this type of quite devastating injury.
Karen Litzy (26:03):
Right. And how they respond, how you can use, like you mentioned the study of Scandinavia, how we can use that study with both of those extremes of people, right? So the people who are afraid and the people who are gung ho, so again, it's having this good rapport with your patient and their other stakeholders to kind of get them through safely through their rehab. But now we talked about it earlier on and that's osteoarthritis. So 50% of people will develop some sort of osteoarthritic changes in their knee. So what do we do about that? Are there prevention strategies? What can we do?
Adam Culvenor (26:54):
So this is something that we've been looking at for a few years now and obviously you know, we'd love to be able to have a treatment to stop this from happening, but we're not actually there yet. There's a lot of really nice longitudinal studies investigating risk factors for the increase prevalence of osteoarthritis in this population. And there's a number of risk factors that we can start informing how we might treat these people initially as well. So the number one risk factor is having a combined injury with a meniscus tear or a cartilage lesion. So if you have not only an ACL injury and very rarely, is it just an ACL injury, it can often be combined with a meniscus tear, cartilage lesion, bone marrow lesion, et cetera. So that more severe sort of type of injury will automatically put you at risk longer term of having osteoarthritis.
Adam Culvenor (27:46):
That's not that exciting because as clinicians, we can't do much about that. It's not really modifiable. So we're really trying to identify some factors that might be modifiable that we can address. So things like BMI being overweight, we know increases the risk of osteoarthritis longer term not only after injury, but in people of older age who have the traumatic type of osteoarthritis what's coming emerging from the literature more and more is the quadriceps weakness. So quadriceps in particular the muscle weakness in that muscle and also the functional impairments. So we talked about hop tests and in a balance in your muscle control a little bit earlier. So they're actually starting to become more and more prominent as risk factors for the medium and longterm outcomes for osteoarthritis. So we've just published a paper in the British journal of sports medicine, which looked at this exact question.
Adam Culvenor (28:44):
So do functional outcomes. So typical tests, we might use to clear someone to return to sports, a hop tests and strength tests. Do these actually have a relationship with future osteoarthritis? And what we found is, so this is a one year we tested them. And then at five years we measured their osteoarthritis on MRI. So quite sensitive measure of osteoarthritis, but also an X ray. And what we found is we combine a lot of these tests together into a test battery. So side to side hop test, single leg forward hop test. If you have a poor outcome at one year in these tests, then you're more likely to develop osteoarthritis at five years down the track. And so there's other studies that show quite similar findings in this space as well, which is really, I mean, it's upsetting because they're more at risk of osteoarthritis, but it's quite encouraging as clinicians.
Adam Culvenor (29:34):
This is our forte. We can actually do something about it in the initial stages of rehab. And again, this can be a great education motivational tool to say on this test, you're not achieving at a level that you need to achieve. This is not only going to put you at risk of reinjury. The research shows that this is actually going to increase your risk of developing arthritis. And we need to be a little bit careful about how we inform our patients about this. Cause as I said, some people can be really fearful and terrified about reinjuring and worried about what it is going to look like. And so presenting them with, Oh, you're going to be, you're going to have arthritis in 10 years as well. Might not be quite the right moves to allay that fear at that point in that patient.
Adam Culvenor (30:16):
Whereas other people having a knowing that information can be really motivating to try and get them feedback to the best possible condition that it can be. So again, it's very personalized how we educate our patients, but I think it's really important to educate them along the journey about that increased risk of OA and encouragingly. There's some, some really positive signs that we might start to be able to modify that risk with some really great rehab, getting back to the strengths, getting back to improving function in our clinical work as well. So I think that's really, really exciting moving forward.
Karen Litzy (30:50):
And that's great news for physical therapists because this is where we live, so wow. We can really make a difference in someone's life by good comprehensive rehab within that first year after ACL injury. And again, that's, regardless of whether they have surgery or not, is that correct?
Adam Culvenor (31:08):
Exactly. Yep, exactly. And as I said earlier about the return to sports, so we've also done some research which should be published shortly, hopefully looking at the fact that again, encouragingly, if you have an ACL injury or reconstruction and then decide to go back to these pivoting type sports, some people say, well, you shouldn't go back to that. You know, the high impact sport, because that's going to put your knee at undue stress and you're going to have more arthritis longer term, is that what we've found is actually that's not the case. So we can be confident that we can give these people you know, the advice to go back to sport. If that's what they really want to, for their quality of life and mental health, they do drive a lot of social pleasure from playing sport. The good thing is, is if you have a great functional and strong knee, then that's not going to put your knee at further risk by going back to sport. Sure. It's going to perhaps increase your risk of re injury compared to sitting on the couch at home. I heard that from a lot of mental health and also physical health being physically active and involved in sport has so many more benefits to our general health as well.
Karen Litzy (32:11):
Absolutely. And now can we, if you don't mind talk about the patient that I think a lot of physiotherapists are going to see, and it's like the patient that you saw 15, 20 years after their ACL. So we're not, we're not seeing them one to five years, but now we're seeing them 10 to 15 to 20 years later. That's when a lot of people are going to come to us with knee pain. So what can we do for these patients? Do we want to look at these hop tests in these patients? Does that make a difference? What happens then? Cause that's a big bulk of our population.
Adam Culvenor (32:54):
You're exactly right. And it varies about again what their goals are, but often if they're 10 to 20 years down the track and they've got osteoarthritis, we can look to the literature in the osteopath writers field. And in that space, it's very, very compelling evidence that exercise therapy and education provides the strongest effect for pain and symptoms and function in this population. And so that's almost reassuring that it's quite similar to what we're seeing in the early post-operative or post-injury stage is that whatever level on the spectrum you are post-injury and the development of osteoarthritis, essentially your treatment's going to be quite similar where you're developing the strength that underlies everything that we do in day to day activities. And indeed, if we want to get back to sport and also the functional capacity, so ask for the, what they want to do, what they can't do because of their pain and symptoms and make it a really goal oriented treatment.
Adam Culvenor (33:54):
And I think it's really important to also ask them what physical therapy have they actually done. A lot of those people come to us and they've seen five different surgeons and they've got different opinions. And when you actually question them and interrogate them, they've actually never had a gym program or they've never done any strength training. And it's like, well, of course you're having a few problems. So let's start you from the very basics. And not, you know, not flare them up by going too hard, too fast, but actually educate them around the importance of strength and functional control that the knee will benefit a lot from that. As well as from a function symptomatic point of view and start building on their strength, capacity and functional capacity to be able to meet whatever goal that they want to get back to. So I don't see it as being a totally separate patient from the post-injury one to the osteoarthritic, it's on a spectrum. And a lot of the treatments going to be very similar in principle depending on what their goals and their goals might change over time. So the treatment can as well.
Karen Litzy (34:58):
Yeah. Yeah. Well, thank you for that. That's great. Now, can we talk about the study that you are currently undertaking at La Trobe University. So can you tell us a little bit more about that? What is it and what are your goals for it?
Adam Culvenor (35:18):
We're super excited. Pardon the pun. So this is a project that's really stemmed from over the last 10 years of our work. Looking at identifying those risk factors, as I've talked about earlier to then be able to get some funding. So we've got some funding from the Australian government health and medical research council to perform this really world first randomized control trial, to see if we can actually prevent early osteoarthritis and improve symptoms and function through an exercise therapy intervention. So in essence, we're going to get a whole lot of people, about 200 people who are one or two years following there ACL reconstruction. So they've had that initial period of rehab to get better. Cause some people do really well. We need to remember that, that some people do great following the injury and surgery and don't need more intervention longer term.
Adam Culvenor (36:14):
So we want to try and capture the ones that have some ongoing symptoms and functional impairments. Haven't got back to doing what they want to do at one year post op to two postop at a point where they should be able to do those things and because they are going in out by some of the research, that's just, those people are more at risk of developing longer term problems. So we want to capture those at high risk and we're going to separate them into two different groups. In our clinical trial. One group will get a really intensive physio therapist, led exercise therapy program. So a lot of strengthening, agility, neuromuscular control, education, around physical activity you know, loading of the knee return to sport. And then that's over a period of four months initially. And then the other group gets what we're trying to say is usual care.
Adam Culvenor (37:06):
So very little intervention, they get a little bit of education and some booklets with the types of exercises I could do if they want to essentially, which is what they'd probably get it from their GP or their surgeon. Similarly, am I going to then assess their needs and their general health and symptoms and function from baseline and that changes over four months. And then also look at the changes up to 18 months as well because the MRI is one of our main outcomes looking at early collagen changes, which is our osteoarthritis marker. And some of these can take a little while to show up. So if you have an MRI on one day and then go and have an MRI the next week, chances are, you're probably not going to see much difference. So we need that period of, you know, 12 to 18 months to be able to see an effect of our exercise therapy intervention.
Adam Culvenor (37:56):
Whereas the symptoms of function we're expecting to be able to improve quite a bit within the first four months, which is going to be the most intensive period. And so yeah, our hypothesis is yeah, is that there's really strong, intensive, progressive rehab program strengthening, getting nice knees back to better than what they were before is going to be beneficial for their symptoms, function, general health quality of life, but also hopefully be able to show that that's actually preventing the early changes that we see on MRI or indeed maybe slowing the changes. So we know that cartilage thickness decreases. So we have a loss of cartilage, bone marrow lesions can start developing also for small osteophytes and bony spurs can start developing over a course of one or two years. And so we want to see if there's a difference in the development of those features in the two different groups. So we are ready to hit, hit, go on this study and a little bit delighted with COVID effecting us at the moment as well. So we're really excited to get going on this study and hopefully be a really impactful research project, moving the field forward and empowering clinicians to say, we actually can make a difference in this space for these patients.
Karen Litzy (39:07):
Yeah. I love it. Well, I look forward to when you guys can actually get started and maybe 12 to 18 months from then. So it sounds like a great study. And like you said, it's something that can be so empowering for physical therapists or physiotherapists to then pass on to their patients and kind of transfer that power from the physio to the patient to give them a greater sense of wellbeing, which is exactly that's what we do, right. That's why we became PTs or physios. So before we sign off, I have a couple other things. Number one. What are your biggest sort of takeaway messages for the listeners?
Adam Culvenor (39:55):
So I think the biggest thing is probably when you first see the patient, whose had an acute ACL injury in front of you and they're devastated. They often might come into your rooms and have heard particularly here in Australia. Our media is very centric on if you've had an injury, you need reconstruction because the elite athletes tend to have the reconstruction and I want the best treatment. And therefore I need a reconstruction is actually having a conversation with them and saying, presenting them with the evidence as I spoke about earlier. And there's no problem trialing a period of non-operative management for a couple of months, because that's going to be a great help if you do go down and have surgery afterwards. And it's, I think the reality is that a lot of people given the opportunity to do is to not pretty, very happy, actually can change their mind over the course.
Adam Culvenor (40:45):
And I realized actually, my knees gone really well. I actually don't need to have surgery where I was. I thought I would. So that's instead of just going gung ho into surgery, I think the evidence is very clear that a period of non-operative management is beneficial. Most patients almost all. And then the second key take home for me is, is during a postoperative or post-injury rehabilitation is actually working these patients intensively and progressively, I think we tend to shy on the side of being a little bit cautious, particularly after they've had a reconstruction, we worry about the graft rupturing. And of course we have to respect the surgeons requests of what we need to do with the patient from a restriction standpoint. But I think there's evidence growing now that we can be a lot more intensive early on and progressive with our exercises and looking to the strengths and conditioning research like these guys are trained specifically to develop strength and conditioning programs.
Adam Culvenor (41:46):
And I think as physios where we're pretty good at it, some better than others. And I think meeting the American college of sports medicine, you know, criteria for strength gains is actually, you need to work really hard. You need to get sweaty, you need to actually be working at an intense level. And so unless we put our patients through that, those sort of levels of intensity, we're not going to see the best outcomes that these patients can then can achieve. So there my two take homes is I think try non-operative period of rehab initially and revisit that along the course of the program. And then don't be afraid to actually build a lot of strength in those people because that's going to be beneficial. So they short term prevent re injury and the longterm of preventing arthritis, likely down the track as well.
Karen Litzy (42:31):
Awesome. And then number two, next question is, and it's something I ask everyone knowing where you are now in your life and in your career, what advice would you give to yourself right out of a physiotherapy school?
Adam Culvenor (42:51):
Ooh, good question. I'd say don't worry so much about things. Things will work out. I think in the research I'll probably have my research hat on a little bit, is often clinicians who want to start in research or even researchers who want to continue in research is that the funding can be really you know, tricky and really competitive and can often make and break careers. But I think some general, you know, I'd tell myself is don't worry too much about that. Just link up with good people and strong mentors. So, and I think finding, I'm sure you've had other guests say this as well, but finding good people who can mentor you really well and put your interests or your goals in your career sort of forward to their collaborators. So you can meet new people and open doors.
Adam Culvenor (43:46):
I think I was always worried that it wasn't gonna be enough doors opening, but I've been really lucky in my career that I've been surrounded by a great team throughout and doors have inevitably even though I don't expect them to keep opening. And so having the being in the right place at the right time is important, but you can, you can help to create more instances of being in the right place and more instances of being in the right time by putting yourself out there and meeting new people and surrounding yourself with really good mentors.
Karen Litzy (44:20):
Great advice. And number three, last question. Where can people find you?
Adam Culvenor (44:25):
Peak pool can find me in my lantern at the moment I'm up? No. So I'm have a Twitter account @agculvenor. My profile's on the Latrobe sport and exercise medicine research center page at Latrobe university. So we have a blog at our research center with a lot of really nice impactful easy to digest, short blogs, short videos, infographics designed for clinicians designed for patients. So you can take them off the blog and give them to your patients so I can not recommend that resource highly enough. And then my email, feel free to email me. You can find that email address on the La Trobe website page as well.
Karen Litzy (45:13):
And, we'll have all the links to that at the show notes for this podcast over at podcast.healthywealthysmart.com. So we'll have a link to your Twitter and to your page at Latrobe and also to the blog. So people want to get those resources, they can, and we'll also put in links to the papers that we spoke about today so that people can go and kind of read those papers as well. So we can link up to all of that. So, Adam, thank you so much was a great conversation. I appreciate your time.
Adam Culvenor (45:44):
That's been fantastic. Thanks Karen.
Karen Litzy (45:46):
You're welcome. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Michael Greiwe on the show to discuss telemedicine. Dr. Michael Greiwe is a practicing orthopaedic surgeon with OrthoCincy, near Cincinnati, Ohio, and the founder of the OrthoLive and SpringHealthLive telemedicine platforms. The platforms allow medical practices to deliver telemedicine visits through real-time HIPAA compliant video conferencing between provider and patient increasing practice revenue, efficiency and patient satisfaction.
In this episode, we discuss:
-The benefits of telemedicine for both the patient and provider
-Choosing the right telemedicine platform for your practice
-How to meet patient privacy and compliance requirements
-Practical tips for a seamless telehealth visit
-And so much more!
Resources:
Ortho Live Website
Michael Greiwe LinkedIn
Michael Greiwe Twitter
Email: mikegreiwe@ortholive.com
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Dr. Greiwe:
Dr. Michael Greiwe, M.D., is a surgeon by day and tech guru by night. He is a practicing orthopaedic surgeon with OrthoCincy, near Cincinnati, Ohio, and the founder of the OrthoLive and SpringHealthLive telemedicine platforms. The platforms allow medical practices to deliver telemedicine visits through real-time HIPAA compliant video conferencing between provider and patient increasing practice revenue, efficiency and patient satisfaction.
Dr. Greiwe is a nationally recognized expert on how telemedicine technology is changing the practice of medicine. TV news stations and podcasts across America have interviewed him about the future of telemedicine and how to use it to improve the patient experience.
He attended the University of Notre Dame, where he won the prestigious Knute Rockne Award for excellence in academics and athletics. He completed his Founder and CEO of OrthoLive orthopaedic surgery training at the University of Cincinnati Department of and SpringHealthLive Orthopaedic Surgery and Sports Medicine. In 2010, Dr. Greiwe completed his fellowship in shoulder, elbow and sports medicine at Columbia University, training with the head team physician for the New York Yankees, Dr. Christopher Ahmad.
Read the full transcript below:
Karen Litzy (00:01):
Hey Dr. Greiwe, welcome to the podcast. I am so happy to have you on today to talk all about telemedicine.
Michael Greiwe (00:08):
Oh, thanks so much, Karen. I'm glad to be here. I really appreciate you having me on the show.
Karen Litzy (00:11):
Yeah. So for any of the long time listeners of this podcast, you know that back in March and April, when the covid pandemic hit, we talked a lot about tele-health. But I think it's great to sort of revisit that now that we're a couple of months in and perhaps more people are using telehealth at this time, then were back then. But what I want to know is Dr. Greiwe, did you just start using telehealth when the pandemic hit or were you more of an early adopter?
Michael Greiwe (00:42):
Yeah, thanks for the question. I kind of carrying out with sort of like an early adopter. You know, I started using telemedicine back when it really wasn't cool, I guess. It was like back in the 2016 time period. And I knew it was great for my patients cause they live pretty far away. I had patients that live like two or three hours away and they would drive and try to meet me. And then you know, I'd only see them for 15 minutes. I felt really bad about that. So I started using telemedicine and it's been a great thing for my practice. And then of course, you know, recent things changed everything and it's now exploded.
Karen Litzy (01:16):
Right. And like I said, in your bio is that you're an orthopedic surgeon. So one question that I think is probably good that you probably get asked all the time is how in the heck do you see someone for an orthopedic condition when you can't put your hands on them and kind of feel what's going on?
Michael Greiwe (01:37):
Yeah, that's a great question. I get it all the time. And it's one of those things where, you know, for me, and I'm sure for you as a physical therapist, you know, so much when you hear about the history of that patient. So like the history gives you probably 80 to 90% of what you need. And then the rest is sort of verifying things through, you know, a physical exam and there's certain things on video that you can kind of catch. So like if I have somebody with the rotator cuff problem, I can watch their arm move. And I just know that the rotator cuff is bothering them. And then I'll maybe order like an MRI or something along those lines sort of confirm. But ultimately for me, it's more about like, you know, I may have to see this patient in the office at a certain point in time, but I don't always have to do that. It's kind of like depends on what the history gives me.
Karen Litzy (02:22):
Yeah. And I agreed from a physical therapy standpoint. I get that question all the time is, well, how can you do physical therapy on someone if you can't, if you're not in the same room. And again, it comes down to listening to the patient. Like they will tell you everything you need to help treat them to help diagnose them. If you just listen in the beginning and then you can tailor your program accordingly. Now of course, like you said, there are times where you have to see the person in person, right. And sometimes that's the same with PT. So I think oftentimes when people think about tele-health, they just paint with a very broad stroke and they think, well, how can you do that? So what do you say to people who sort of have that mentality of all or nothing?
Michael Greiwe (03:13):
Yeah. I think if they experience it for their, you know, themselves, they can sort of see that, okay. You know, this really works and it works because, you know, if you have somebody on the other side that's engaging you and asking the right questions, you're going to eventually come to the right answer. You know, I've had patients with a frozen shoulder and I'm sure you've treated patients with frozen shoulder. It sort of have classic signs and symptoms. Sometimes the history isn't like exactly, they're just sort of out, well, you know, my shoulder has been hurting and it kind of came on over the last several months and now I can't really move my arm as well as I used to. Or maybe you might not hear that. You just hear like, well, it hurts all over all the time, but if you kind of ask some leading questions, you have the right examiner, you can find out the answer. And so I think that's really, the key is having the right person on the other side of the screen, you know, asking the right questions. I'm sure you do the same in your practice with physical therapy.
Karen Litzy (04:06):
Yeah, absolutely. And you know, when we're talking about our different practices and our businesses because of the COVID pandemic, a lot of places had to shut down there in person I'm in New York city. So talk about being shut down. So we were shut down quite early. Now other parts of the country are flaring up and there's a lot of uncertainty here. So when it comes to tele-health and our business, how can tele-health help our practices grow and help our businesses grow?
Michael Greiwe (04:41):
That's a great question. I think it's something that people are sort of finding out more and more about right now. I mean, there's so many ways to be able to utilize telemedicine in our practices to help it grow. I mean, first of all right now as an orthopedic surgeon, I see patients from around my area because of COVID in the situation we're in right now, they don't want to come into the office, you know, so they're looking online and they find, Oh, Dr. Greiwe has got an open slot to be able to be seen via telemedicine. So we're kind of advertising that at ortho Cinc, where I practice to say, Hey, anybody that might want to come in for telemedicine appointment, you can. And it just gives me access a lot better than it normally would to be able to see patients. And then I think there's other ways too.
Michael Greiwe (05:25):
So for instance you know, for physical therapists, you might work with employers for instance, or workplaces that need a physical therapist and you put like an iPad there to say, if you need a physical therapist, here's how I can help you, you know, call me or whatever through this device. And so there's just so many ways for us to do that inside ortho, specifically postoperative recheck appointments, they open up slots of time that, you know, you typically wouldn't have because it's a lot more efficient to see someone via telemedicine than it is in person. And you know, also there's a lot of downtime kind of between surgeries for us too, so that downtime can be utilized for telemedicine too. So there's a lot of ways we can sort of generate you know, revenue through that and kind of open up our practice a little bit more.
Karen Litzy (06:13):
And, what I found is I can actually help more people.
Michael Greiwe (06:17):
Oh yeah, absolutely. Because you could probably have group visits too. Right. You could have you know, on those group visits or are you talking about just sort of more you know, area? Yeah.
Karen Litzy (06:29):
Like you were saying before we went on is sometimes you have people have to drive two to three hours to see you. Right. You know, that's really, that can be really difficult. So imagine if you have, you know, this really aching shoulder pain and you have to drive two hours.
Michael Greiwe (06:45):
Right. Absolutely. You're absolutely right. I think what helps, what helps you is, you know, with telemedicine, you've got the reach to be able to see somebody that's five hours away or even across the country that's heard about you or, you know, maybe they know that you have certain techniques that they like. I sort of developed like a posterior shoulder replacement where it's kind of a muscle sparing approach to the shoulder. And so I have people come from like California, Texas, Montana, you know, and now I can kind of see them postoperatively and preoperatively with telemedicine. So it's a really nice, it's a nice tool from that standpoint too.
Karen Litzy (07:19):
Yeah. That's great. Yeah. So you could see them preoperatively, if they're across the country, they come in, you do the surgery and then you can then see them postoperative. So they don't have to stick around by you for six weeks.
Michael Greiwe (07:33):
Right. So I'll have him stay for the first week and then we'll have the incision to make sure everything's looking good. Take x-rays and then they'll go back home and then I'll check in with them every four or five weeks, they'll be doing physical therapy kind of in their local area. Or of course I could refer them to you to remote therapy, but yeah. So that's how they do it currently is they go back home, they work and they get their motion back. And then we'll check in again, virtual.
Karen Litzy (07:57):
Now how about prescribing medications? Is that something that you can do via tele? How does that work?
Michael Greiwe (08:03):
Yeah, it still works pretty well via telemedicine, but I don't really do any like schedule three narcotics, you know, things like that. We don't do, but you know, anti-inflammatories, you know you know, if somebody has had some nausea like Zofran or, you know, things of that nature are pretty easy to prescribe and we still prescribe and have the same prescribing practice that we do in person, it's just, I get a little bit more wary and I think it's prudent to be more wary about, you know, narcotic prescriptions and things like that, especially in the world that we live in right now. We've gotta be very careful about that. So, we're super careful with that, but I think most of the other prescriptions are totally they're okay to do.
Karen Litzy (08:46):
And how about this is a question that I get sometimes is what about privacy and compliance and making sure that meeting all those standards. So how can we ensure that we're doing that as a healthcare practitioner on tele-health?
Michael Greiwe (09:04):
That's a great question. I think, you know, it is very important, obviously. So HIPAA compliance is what it's sort of called as you know, and it's what everybody's sort of, doesn't like to have to worry about, but it's very important for our patients, right? I mean, it's, people are very much in tune with their privacy. Data privacy is becoming like a really big thing right now, but really people's healthcare privacy and their you know, their medical privacy is very, very important. So the telehealth platform that you choose, you have to make sure that that is HIPAA compliant. And that means end to end encryption. That means like the data that starts out, you know, it's carried through the internet and it's encrypted and then wherever it's housed, it's also encrypted there too, so that no one can sort of get to that information. I think that's really critical, very important for our patients and most of the platforms they will advertise whether or not they're HIPAA compliant. And you want to know kind of how many you know, what type of bit encryption they are and things like that when you look at platforms.
Karen Litzy (10:06):
What was that last thing you said?
Michael Greiwe (10:09):
Yeah, it's sort of like, as the information is traveling across the internet there's sort of, you know, bytes of information, right? And so the amount of encryption can be sort of leveled up so that, you know, basically you can have like 64 bit encryption, or you could have 264 bit encryption there's certain levels. And so it takes, it's like a string of numbers. And so that string of numbers is how much it would take to crack the code essentially. So 256 bit encryption is like, you know, a massive amount of code breaking has to happen to catch that while it's traveling through, you know, the inner web.
Karen Litzy (10:50):
Well, no, that's really good because I think that's something that if people are choosing a platform, it's definitely something that as a provider you want to be looking at.
Michael Greiwe (11:00):
Absolutely. It's very important, you know, and most providers are pretty in tune with that, but right now, like, you know, they're allowing telemedicine to occur on FaceTime and some other platforms.
Karen Litzy (11:12):
Now FaceTime is not HIPAA compliant.
Michael Greiwe (11:17):
Yeah. So we don't want to really be using that right now. And there are some providers out there that are doing it, maybe just for ease of use and because the pandemic it's happened. But ultimately what we really need to make sure is that we don't use those platforms. Those platforms are not safe, not secure.
Karen Litzy (11:35):
Are there any other sort of things that you want to watch out for when you're let's say, well, first we'll start with looking at different tele-health platforms. So what are the things that you want to be looking for? And if you have any advice on a do's and don'ts, while you're actually in your tele-health session, I know some of them seem like, should be common sense, but you never know. So let's go with, what should you look at first? What should you be looking at in your telehealth platform?
Michael Greiwe (12:11):
It's a great question. I think the first thing that's really important for patients is making sure that, you know, the HIPAA compliance there, we covered that, right? So HIPAA compliance, probably number one, number two is, does this platform allow you to, you know, keep a schedule? So one of the most frustrating things as a provider of telemedicine is, and this is what I found out many, many years ago is that there is no schedule. You know, you have to send the invitation to the patient. The patient sort of says, yes, I'd like to do this. And then, you know, they link up eventually, but what you really want us to be able to schedule the appointments, that way you can move from one person to the next, and you're not really leaving a screen and trying to come back and forth just from an efficiency standpoint.
Michael Greiwe (12:53):
It's not very efficient to do that. Another thing that's important, I think is being able to chat with your patient. Sometimes it's important to be able to have a conversation. And it's also important to answer questions. And so being able to have kind of a text based chat that's secure as well, that might be, you know, maybe they can send you a picture. Maybe you can send them a video. Maybe you can send them sort of a document that gives them some exercises or what have you. And that's really important too. But I think one of the other things I was gonna mention is consenting. A lot of platforms don't have consent and of course that's part of the law. You have to consent that patient for telemedicine before you have a visit in most of the States, I think 45 of the States, you have to have a consent. So very important for the consent process to happen also. And that allows you to have a legal telemedicine appointment.
Karen Litzy (13:44):
And that consent process. Can that be in your initial paperwork? So if you're onboarding someone and, you have, I mean, we've all been to the doctor's office, you have to fill out a million different forms, right? So same thing with PT. So can that consent to tele-health be in that onboarding or does it have to be every time you connect for a telehealth visit, do they have to consent every single time?
Michael Greiwe (14:11):
That's a great question. And it's really just a onetime consent, so it doesn't have to be, you know, every time. So if they just come to your office first time, you're going to maybe have him sign some paperwork that says consent to telemedicine, and that's fine. You're good to go. But in the case where you have a new patient, it's very important to make sure that you have that consent process. And so for us and what we do at ortho live and spring health live, we just have them sign off one time that they agree to telemedicine. And then we assume every time they visit the platform, they know what they're doing and they've already agreed to it.
Karen Litzy (14:44):
Yeah. Yeah. Cause I have woo. You just gave me a little sigh of relief cause I have it again as part of my onboarding paperwork that people are consenting to their telehealth visits, but I don't do it every single time for each visit.
Michael Greiwe (15:00):
Right. Then I think it's just sorta like the billing practices in your practice too. And that people sign off that they're okay with billing and that they just do it once they're not signing it every time that they come back, it applies similarly to telemedicine.
Karen Litzy (15:12):
Got it. Got it. Okay. So those are the things you want to look at when you're kind of shopping around for a platform. Now let's talk about some things that you want to have in mind as the healthcare practitioner during your telehealth visit with your patient on the other end.
Michael Greiwe (15:30):
Yeah. It's a really good question. So the first thing is if you're going to use a phone, you know, and sometimes you're using a phone because you might be on the go or maybe your platform only allows you to have a phone it's really important to make sure that you don't like hold the phone, like right underneath your nose. Because it sort of gives you like kind of the up the nose shot a little bit. So I always tell people, you know, prop your phone up in front of you, like on your keyboard, maybe that's a really good place for it. Or if you're using a laptop, obviously like your face is kind of directly in front of that camera. And it just gives you more of a conversational type of appearance to your patient rather than you're not like talking straight down to them.
Michael Greiwe (16:06):
I think that's important. The other thing to sort of test out is just make sure that like, you know, when you move your right arm, like your right arm is like going up in the correct location in the camera. So you're not off to the side, you know of the camera when you're trying to show them kind of what you expect, I imagine for physical therapy and you can answer this, you know, too, I imagine for physical therapy that you may have to be seen, like your full body may need to be seen at some point in time.
Karen Litzy (16:33):
Yeah. Yeah. You definitely need like a decent amount of space so that you can lay down on the ground. You can come up to kneeling, you're standing you're so yeah, for physical therapy, you do need a good amount of space. So it comes down to finding those spaces, whether it's in your home or your office, where you can kind of get the right angle and good lighting.
Michael Greiwe (16:54):
Right. That's great. I think that's really important. You know, for your listeners on the physical therapy and for us, it's also being able to screen share too. If you can screen share, then you can show x-rays MRIs, things like that. And just getting tests sent out. Like I know for my practice, you know, we had a lot of physicians go live as soon as COVID hit and nobody had practiced. And so it was disaster on the first day, it was like, you know, it was like Groundhog day. And like no one knew what they were doing. And I was running around different pods trying to help everybody. But it's important to practice just like we would never go to surgery, not practicing what we're doing, you know, you practice to on your side to make sure that everything's working properly, your camera, your audio and all of that.
Karen Litzy (17:36):
Yeah. Do a couple dry runs with friends and family, make sure it's working well. Yeah, that's excellent advice. And now what do let's say, physicians or therapists what do they need to do now to kind of quickly adapt to this telehealth? Because from like, I look at, it's such old hat now, but I've been doing it since March. So now you have other parts of the country who are sort of trailed behind New York city. So they're in lockdown maybe for the first time and they really need to start adapting quickly. So what advice do you give to those practitioners?
Michael Greiwe (18:12):
Well, you know, providers of medical services always have a hard time with change, right? I think that's like one of the tenants of being a type a personality, the personality that ends up getting into medical practices or, you know, we're very particular. So we don't like to change. That's the first thing to recognize. And, and so there's going to be bumps in the road and they're just going to be hurdles. And I think it's really important to just understand like, Hey, you got to sort of roll with the punches a little bit, understand is not usually too difficult. We just need to kind of figure out what your plan of attack is going to be. Are you going to see tele-health patients in the morning and then see your regular, you know business in the afternoon, if you're completely shut down, how are you going to adapt to that? How are you going to get the word out? Are you going to be able to market this really, really important for you to make sure you kind of figure all that out on paper before just sorta like saying, yeah, I'm going to buy this telehealth cloud from when we get rolling, you know, it's like let's plan an attack and how we're going to be seen and how we're going to be able to see patients. I think that's really, really important.
Karen Litzy (19:12):
Yeah. Makes sense. And now let's talk about the platforms. Let's talk about the platforms that you're involved with and how you got involved. So there's ortho live and spring health live, right? So how are you an orthopedic surgeon with all of the work that surrounds that and then sort of this tech person entrepreneur on the side. So you must have some spectacular time management skills.
Michael Greiwe (19:44):
Well, I've got a very forgiving wife. I know that that's number one. But you know, it is like a it's a wonderful thing for me because I really enjoy doing kind of creative things. Things that might help my patients and telemedicine was one of those things I think really was, was a great thing for my patients ultimately. But for me, telemedicine was a way for my patients to be helped in a way that we couldn't really help them through anything else. And so there wasn't a great solution. So I decided to found ortho live about three years ago, that was 2016. And it was only because I was looking around to try to find a solution for patients and for providers that was really efficient and that worked really smoothly. But what I found was that really didn't exist and it was really hard to find the right solution.
Michael Greiwe (20:32):
And so I decided to create it after speaking with a CEO of a telemedicine company out in the California area, he kind of runs a lot of the video for MD live and some of the other larger companies. And he said, Mike, you know, this is a great idea. You ought to kind of through on your vision to do this for orthopedics. And so I did that with ortho live and it's been really successful and I kind of knew what we needed. We just, you know, we didn't have the efficiency in a way to be able to see patients in a streamlined fashion. So we created that within orthopedics, which I knew very well. And then we kind of branched out and now we're offering services to other specialties and subspecialties as well with spring health live.
Karen Litzy (21:11):
And within these platforms, do you have ways to do objective measurements within these platforms? Cause I know some do some don't so how does this, how does this work let's say from an orthopedic standpoint.
Michael Greiwe (21:27):
Yeah. So I mean, if you want true objective measurements we have to kind of integrate with braces and things like that. So, you know, we're like a smartphone application. And so we do have API APIs that can integrate and take in information like that. It's not something that, you know, orthopedic surgeons really use on a daily basis. I would see that more for physical therapists. So we kind of have the ability to integrate with you know, applications that give you range of motion and actual discrete data. I think that's really important because it does give you some actual feedback on a day to day basis, how a patient's doing. But from an ortho standpoint, we don't really need those, like the discrete data points we just sorta need to see, okay, well, how was that patient performing?
Michael Greiwe (22:09):
Are they having difficulties still, you know, moving their knee, let's see you bend your knee. And if it's not really going as well as we want, we know we need to up the physical therapy, we need some more intensity there. And it's more of a good stall for us. Less on the discrete hard numbers, but with therapy, I feel like it is really important to have that feedback to say on a day to day basis that patient's not doing well, how can we help them? Do we need to intervene sooner? So maybe that's what you're getting at, but, but yeah, we have the ability to kind of feed that information back into our platform.
Karen Litzy (22:39):
Yeah. Yeah. That's cool. Because a lot of times it's, you know, you could say, well, if 180 degrees of shoulder elevation is considered full, it looks like maybe they're at 75% or they're at 50%. So, but it's hard to get those, like you said, very discrete numbers because we can't measure it. Right. So having the ability to kind of integrate applications to be able to do that, I think is it can be really helpful. Although I, yeah, I guess sort of postsurgical when the patient is perhaps limited to X amount of degrees of movement, I think is where that comes in really handy.
Michael Greiwe (23:21):
Right. Right. And we have them sort of stand kind of at the side and like watch for inflection and things like that. So I think we get, you know, to within probably five to 10 degrees, but if you're looking for exact degrees, that's where those programs, which, you know, you can strap like an iPhone to your leg now and like move your knee. And it measures range of motion through like some little track pads and things like that. And there's ways to, to really effectively get that, that motion and understand what's happening with the patient and recovery, which is nice. And so we've allowed the ability to integrate those types of applications to our platform, which is cool.
Karen Litzy (23:56):
Yeah. That's really cool. I was working with some developers based in Israel who have an app for gait. And so you put it in your pocket and what it does is it can tell you the excursion of your hip range of motion from flexion through extension pairing side to side, your stance time steps per minute all sorts of stuff. I think there's up to like seven or eight discrete measurements, which is super cool. So again, in times like this, this is where the technology 10 years ago didn't exist.
Michael Greiwe (24:33):
Yes. A hundred percent.
Karen Litzy (24:36):
Having that now is allowing healthcare professionals to continue to help their patients during this pandemic.
Michael Greiwe (24:46):
No question. I was speaking with a group that has some special socks that like will measure stride length and things like that. So they know when a person may be like, you know, unsteady with their gait when they might be a fall risk which I think is a great, it's a great thing. And so, you know, understanding when patients may need some therapy to try to help with balance is critical. I mean, falls are a multibillion dollar issue in the United States today. And if we kind of cut down on falls, it's a great, great opportunity. And so we're, I think we're leveraging little things like, you know, from a data standpoint to be able to improve population health. I think it's great. Yeah.
Karen Litzy (25:26):
And where do you see telemedicine moving in the future? The pandemics over is everybody just gonna wrap it up and call it quits? Or what, where do you see that moving towards in the future?
Michael Greiwe (25:39):
No, I think telemedicine is here to stay Karen, I think you know, so-called genies out of the bottle, you know, there's a lot of great things that have happened with telemedicine recently. I think it's here to stay. We're gonna end up seeing telemedicine continue to spike. It was on the rise. Even before the pandemic, we were seeing multi millions of patients that were being seen every year. It was doubling every year. And now it's like, I mean, I think it's gone up by 10 X. So there's going to be a lot more telemedicine, I think, in people's future.
Karen Litzy (26:10):
Yeah. And as we were discussing before we came on the air hopefully the providers of insurance will also agree with that and say, we are going to continue paying for these because look at the advantages it's giving look at the money we're saving because of this. Cause like you said, if you can have a telemedicine visit with someone and it prevents a fall, which is a multibillion dollar industry, would you rather pay the $2-300? Whatever it, I don't know how much it is or have that person hospitalized for hundreds of thousands.
Michael Greiwe (26:48):
You're absolutely right. And so if there's any, you know, any of the insurance industry listening is very, very critical that we continue with telemedicine for their patients. And it's so beneficial, not only in protecting them during this time period, you know, we definitely don't want to let them go out of the house or 70 year old patients that are potentially sick and I'll really you know, it's for their safety and it's also for the benefit of the patient. I mean, it's way more convenient for them. And so I think without a doubt, it is so important to make sure that our legislature continues to support telemedicine and telemedicine billing.
Karen Litzy (27:25):
Absolutely fingers crossed fingers crossed that that happened. So I'm with you on that. Alright. Now, before we start to wrap things up, is there anything that we didn't cover or anything that you want the listeners to sort of walk away with from our discussion on telemedicine?
Michael Greiwe (27:43):
Oh, I think the main thing is, is that, you know, there's a lot of great people out there trying to provide health care. And many of them are trying this, you know, as a new you know, thing for them in their practices. And I think supporting them in that is important. I think everybody inside their local community is really trying to do things via telemedicine now and they weren't doing that before. And so being flexible, I think with those providers, I think is important, but I also think that telemedicine is here to stay. It's one of these things where there's so much benefit on both the provider and the patient's end that it'll just continue to be here and be a part of society and medical care going forward.
Karen Litzy (28:20):
Yeah, absolutely. And now I have one question left and it's a question I ask everyone, and that's given where you are now in your life and in your career. What advice would you give to yourself as a fresh medical school graduate?
Michael Greiwe (28:36):
That's a good question. I love this question. I think for me, I was such a you know, a worrier, like I was, I was always worried about, you know, what was I going to be good enough? Was I going to be smart enough? And you know, I always knew that I believed in myself, but I didn't trust myself back in those days enough to know that I was going to be okay. And I think the thing to remember is like, you know, you went into this medical profession for a reason you want to take good care of patients. You got to believe that, you know, you're a hard worker and you're going to continue to do as best you can to take good care of people. And you're not, you know, even a few fail it's okay. I think failure is it's okay to fail. I think that's another thing that I would tell myself to, because I was so worried about failing that I wasn't willing to like branch out and take risks. But I've learned that now. And I think if I could go back, I'd tell myself, don't worry about failure. Just you're gonna be fine. Just keep working hard.
Karen Litzy (29:36):
Great, excellent advice. And now where can people find out more about you more about ortho and spring health live?
Michael Greiwe (29:43):
Great. Yeah. Well, they can actually look at our website. So our website is www.ortholive.com and then www.springhealthlive.com. So for me, I can be reached at mikegreiwe@ortholive.com. That's my email address and I'll be happy to respond.
Karen Litzy (30:08):
Perfect. And just so everyone knows, we'll have all of those links in the show notes under this episode at podcast.healthywealthysmart.com. So Dr. Greiwe, we thank you so much for coming on. And, and like I said, I've spoken about tele-health before, but it was way back when this started. So it's great to get more information out there for people to know that it's not just something that we're doing during the COVID pandemic, but that this is something that can be incorporated into your practice. It can help your business, help your patients. So thank you so much.
Michael Greiwe (30:43):
Oh, thank you, Karen. I was glad to be here. Appreciate it
Karen Litzy (30:45):
Anytime. And everyone. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, Dr. Michael Weinper speaks with guest host Dr. Stephanie Weyrauch about the American Physical Therapy Association's Vision 2020. Passed by the House of Delegates in 2000, Vision 2020 was APTA's plan for the future of physical therapy. In his 2000 Dicus Award speech, Dr. Weinper discussed his predictions of where the profession would be in 2020. Dr. Weinper and Dr. Weyrauch revisit the elements of Vision 2020 and analyze whether our profession has accomplished a vision of the future set twenty years earlier.
In this episode, we discuss:
-How has the physical therapy profession evolved since the drafting of Vision 2020?
-The student loan debt to income ratio
-Advocacy efforts to achieve full direct access in all of the States
-The importance of lifelong learning and evidence-based practice
-And so much more!
Resources:
Stephanie Weyrauch Instagram
Stephanie Weyrauch Twitter
Stephanie Weyrauch Facebook
Email: sweyrauchpt@gmail.com
APTA Website
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Dr. Weinper:
Michael Weinper, PT, DPT, MPH, cofounded the company in 1985 with his partner, Fred Rothenberg, a former executive at Blue Cross of California. A physical therapist with more than 40 years of experience in clinical practice, management consulting, administration, and program development, Weinper is also a principal in Progressive Physical Therapy, a private practice, with four locations in Southern California.
Weinper received a Bachelor of Arts degree in Industrial Psychology and a Bachelor of Science degree in Health Science (physical therapy) from California State University, Northridge. He received a certificate in physical therapy from that institution in conjunction with UCLA Hospitals and Clinics. Weinper later received his Master of Public Health degree (M.P.H.) from UCLA in Health Services Administration and his Doctorate in Physical Therapy from the EIM Institute for Health Professions in Louisville, KY.
Weinper has been active in the American Physical Therapy Association (APTA). He has served as a member of the APTA’s Task Force on Physician Ownership of Physical Therapy Services, as a member of its Committee on Physical Therapy Practice, as the association’s chairperson on its Task Force on Reimbursement, on the Board of Directors for APTA’s California Chapter and national Private Practice Section, and as trustee of the APTA Congressional Action Committee (now known as PT-PAC). Weinper received the prestigious Robert G. Dicus Award from the Private Practice Section of the APTA in 2000, and he received the Charles Harker Policy Maker Award from the APTA Health Policy and Administration Section in 2011.
On behalf of the state of California, Weinper has served as a member of the Physical Therapy Subcommittee of the Division of Industrial Accidents, now known as the Division of Workers’ Compensation. He also has served as an expert to the Medical Board of California, where among his activities he has appeared on behalf of the People in insurance fraud trials. He has provided expert witness testimony on behalf of more than 20 insurance companies.
A former associate professor of health science at California State University, Northridge, Weinper is a frequent presenter for various professional associations including the National Managed Healthcare Conference, the American Medical Care and Review Association, and the APTA. He has authored many articles for both physical therapy and insurance industry publications.
For more information on Stephanie:
Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.
Read the full transcript below:
Stephanie Weyrauch (00:00:01):
Hello everyone. And welcome to the healthy, wealthy and smart podcast. I'm your guest host Stephanie Weyrauch and I am interviewing Mike Weinper who's the president and CEO of physical therapy provider network or PTPN as it's better known and also a private practice owner for progressive physical therapy in California. The reason that I wanted to talk to Mike today, as he won the Robert G Dicus award for the private practice section back in 2000, and he has been an instrumental person in practice, leadership, innovation, legislative, and political issues, healthcare reform, and a number of other areas where he's really had the opportunity to champion innovation and leadership. And one of the things that, you know, we know it's 2020, and obviously vision 2020 has something that has happened in the APTA was written back in 2000 and in Mike's Dicus award speech, he talked a little bit about where he thought the profession would be in 2020, in 2000. And so I'm really interested in kind of his take on where we are today. So Mike, welcome to the healthy, wealthy and smart podcast. And tell us a little bit about yourself.
Michael Weinper (00:01:21):
Well, thanks Stephanie, for the very nice introduction and it's a pleasure and an honor to be with you today. At some level, I’m considered by some, to be a dinosaur, having gotten my Dicus ward 20 years ago, and now long in my career, I'm just celebrating my 50th anniversary as a PT. So I hope that some people won't tune out just because of that. Maybe if nothing else, they can see me as a history lesson, any event, I can tell you that back in 1992 the California chapter of APTA now called California PT association created a long range planning task force that I was honored to serve on. And in that task force where a lot of leaders in the profession in California names that were household names, then probably names and most people would not know now, but our plan was to draft a long range vision.
Michael Weinper (00:02:21):
If you will, a crystal ball of what things would look like some 18 years later in 2010, kind of looking back, it's interesting to look at and we created, I believe 18 different points that would be goals if you will, of the association and the primary aspects of that working document, which was called PT 2010 by the California association. I'm sure if you were interested, you could look it up or get a copy of it. Then later became the working document for APTA called PT 2020. And since we are now in 2020, I wish we would have known then what we know now, because things have dramatically changed in many ways, but in other ways they have not. And so I guess I could give you some of the ideas we envisioned back in 1992, if you'd like, and then we can take it from there.
Michael Weinper (00:03:23):
So in that document, we said that PTs would be able to evaluate and diagnose conditions that's true today, perform specialized treatment procedures and work in teams with physical therapists and PT assistants. So all that did come true. Next, the PTs would be able to initiate services subsequent to their own evaluation diagnosis without referral from or diagnosis by another practitioner. And that in 2000 that had not yet been accomplished, but we, now we know we have independence and practice almost every state with regard to our licensure. In most therapists are, would be in independent press configurations with other therapists, maybe who would work in a hospital. In other words, there would be an opportunity to be clinically specialized in it with a board certification, which we now know has really grown quite a bit.
Michael Weinper (00:04:25):
And they would be sought out. These specialists would be sought out by consuming public and third party payers. Not as much. I don't think our profession has reached to the public well enough to get the public, to understand what a board certification really means and what it takes to become a board certified specialist in our profession, but I'm progressing for a moment. Anyway. So then we said that PTs would be able to be involved in the continuum of care from the hospital to the home, to the private practice. In other words, PTs would have hospital-based privileges and they would be able to go there. And then if the patient were home, many of them would be able to then go to the patient's home and treat them there and then follow them up in the office. And so that was another kind of idea we had way back then.
Michael Weinper (00:05:21):
So it would be basically following the patient through the episode of care from beginning to discharge and obviously getting them ambulatory and functional. We also said that this is a good one that PTs would become diagnosticians. And more importantly that we would be at the entry point in healthcare which wasn't the case in 2000, but in now in some places, it is that therapists are in fact these musculoskeletal specialists would be a cause we can do it musculoskeletal evaluation or diagnosis many states now recognize that. And some insurance companies have recognized that we can be an entry point into the system, which I believe going forward, it's going to become much more prominent because of the higher cost of care. And actually Stephanie, the difficulty we all experienced when we try to refer a patient to a specialist, state, an orthopedist or a neurologist to do an evaluation so we can follow the patient.
Michael Weinper (00:06:18):
We find that it can take several weeks for that patient to get in, to see the physician, whereas they can usually get in to see us in a few days. So I think that's something that we will see more of in the future, but back then we had it as a dream, but not a reality. We also said that at that time, that instead of 24 weeks of internship that were experienced by PT graduates back in those years, we thought internships would last one year. Now that I don't think there's a, but we have in fact seen fellowships and other levels of work where therapists are really going into specialization so that they in fact can do things over a year's period of time and then becoming sort of like specialists. So those were sort of the, kind of, I think the basic things that would be of importance today.
Michael Weinper (00:07:15):
We did also, this was a very important one. We identified that in the year 2010 PT would be a doctorate profession. That was what our key points of doctorate and profession. And lo and behold now our entry level is what a DPT, a doctorate. I'm very proud to say that I went back and got my DPT a little over 10 years ago. I talked back in 1982, and I certainly wanted to walk the walk before 2010. So cause that was our benchmark was 2010. So with that in mind I think it's important to realize that we have become doctoral people. In other words, we are now at a level of sophistication with our education and hopefully some research that gives the PT of today a much broader view of a patient, their wellness or their disability, and gives them better tools, which the function do the evaluation or assessment of the patient, and then follow up with treatment compared to how things were back when I graduated in 1969.
Michael Weinper (00:08:31):
So and I found that when I got my DPT that I learned quite a bit. I learned some of the things I learned actually were more on how to think differently than I had thought previously. And I will tell you that some of the things that I learned that were most valuable to me was how other people think so studying with other transitional DPT candidates gave me an opportunity for me because I was the oldest person in my class. Gave me an opportunity to hear people think and how they process, how they analyze and how they come to the decisions they do. And then how do they communicate it? I like to think I'm a good communicator, but oftentimes I get really wrapped up or wound up and, you know, I go off on a tangent and I probably go down the rabbit hole and maybe other people in today's world are much more succinct.
Michael Weinper (00:09:31):
And to the point also I can tell you that I was privileged back in 1975 to get my MPH at UCLA and the school of public health there. And I learned a lot about things that are important today, including epidemiology, which we now know is at the forefront of everybody's thinking and infection control and making for safe environments, which was only very basically touched in my DPT program. But one of the things that I really enjoyed was the differential diagnosis courses I took and the radiological courses I took that gave me a much broader sense for things that I'd studied back previously, or maybe taken some content courses, but went into much more depth and listening to other people discuss those kinds of things. So that's how things were back then. I can tell you also that insurance companies were perceived to be able to give PTs a lot more latitude. And it's only been in recent years that many insurance coverage industry to pay for PT. That's independent of physician referral. We're still working with Medicare on that. You and I know all the snow and I think the day will come that the feds will start to get a little wiser and realize the cost benefit of the PT being an entry point into the system.
Stephanie Weyrauch (00:10:58):
I think that that's a really great overview of kind of what you guys envisioned back in the early nineties and kind of correlating that with vision 2020. So the APTA vision 2020 and a couple elements that made that basically encompassed a lot of what you said. So autonomous physical therapist practice was one of them, direct access, evidence based practice, doctor physical therapy and lifelong education PPS as practitioners of choice and professionalism. So those were when the house of delegates discussed this, those were the main themes that they were looking for. So keeping those themes in mind, let's maybe start by talking about the doctorate of physical therapy. I mean, that was something that you were obviously very proud of. You will talk the talk, you walk the walk. So what do you think? Well, studies have been shown the DPT student debt now varies between 85,000 and 150,000. Okay. Do you think based off of what we're seeing today, as far as student debt, do you think that today's DPT is a good return on investment? And do you think that the salary for the physical therapist has kept up with the increases in training and inflation?
Michael Weinper (00:12:14):
Well, I'm very happy to hear you raised this question because it's a question that I not only think about a lot. I talked about a lot with my colleagues and I also talked with students who are becoming PTs and people have gone into residencies for a year post-doctoral now for purposes of gaining a better outlook on things. And I must tell you that when we gave thought to the idea of PT being a doctoral profession, never in our wildest dreams, did we think about the cost benefit aspects of it as it relates to educational costs back then costs were not inexpensive. You should teach part time at USC and Cal state university Northridge. And I remember students used to complain about the cost of education back then, but it was nothing as compared to today. So to get to your point, I am sad to say that we have not grown our income levels for PT to the level that they should be given the doctoral training that we received.
Michael Weinper (00:13:29):
And the depth that usually goes with that, unless you've got some kind of a rich uncle or a greatness scholarship, having said that most PTs coming out with a lot of debt, and then they find themselves in jobs that they don't want to do. Let me just elaborate a little bit on that. PTs in private practice is considered by many to be the desired venue in which to work because patients are coming to you. You have all kinds of equipment and resources and hopefully a nice facility to work in. And the patients for all intents and purposes are ambulatory or said differently. You're not going to be ambulating a patient in a hospital hallway and have something happen to your shoe. If you can get my drift in any event, it seems that most PTs that come out of school today are struggling with where they want to work versus where they have to work and where they have to often work or those places that pay more because they're less desirable.
Michael Weinper (00:14:35):
So as the desirability quotient increases, the unfortunately the salary decreases because of in part supply and demand. And also to a greater extent because insurance companies are not reimbursing PTs in private setting, like they are in the hospital, for example. So if I go to work in the hospital, I can make a lot more right out of school than if I go to work for an independent therapist in the same community. On the same side, I can go to work for a home health agency, not have this desirable of a work environment. Have you seen changes from patient to patient, but make better money, but then again, have other costs of doing business. And I think at the end of the day, those who do home health, and I don't mean to criticize those of you who do, but if you look at your cost of doing business and take that away from your income, you find that your true income is much less than you thought it was going to be.
Michael Weinper (00:15:30):
Whether it's wear and tear on your car, gasoline insurance, you have to carry on your own, whatever it may be, equipment you might have to buy and so on. So it seems to me that the desirability of where you'd like to work and the pay ratio is a universally, but proportionate with that in mind, it's a function of insurance companies, and this is where I really go down a rabbit hole. And that is why are PTs and private practice paid less? And the answer is because PTs in private practice accept less, they have an, I am very secure, experienced on this. Having started PTPN 35 years ago, a managed care company for PTs in private practice. And we have always advocated for higher reimbursement. And in fact, we Protestant have been successful in getting a higher reimbursement for PT and practices that are in our organization.
Michael Weinper (00:16:30):
Then PTs were in the community who are not in our organization. However, because PTs are willing to accept whatever insurance company pays. In other words, they don't want to lose business. They accept fees. They're much lower than they should. And that has driven down the value of PT in the mind of the insurer and that's led to lower salaries. And so to get to the end of this thought, PTs coming out of school, don't get proportion of the kind of income they should with a doctorate. And let's contrast that for just a moment to a PA, a PA has less training than we do. They will usually get a master's degree. They work in a physician's office, but the way that they can bill under the physician's license gives them much better reimbursement. It makes them more valuable to the physician and therefore their income is oftentimes much greater even out of school, you know, apples to apples. Then we get as a PT out of school.
Stephanie Weyrauch (00:17:31):
Yeah. I think you make a lot of really great points there. I mean, the doctor, the DPT was obviously great as far as, you know, gaining direct access, being more autonomous, but you know, the cost of education has obviously sky rocketing it. So based on, you know, your ideas, what do you think that the private practice section can do to help guide new graduates through the uncertainties of student debt?
Michael Weinper (00:17:57):
Wow. there's a lot of things that come to mind. First of all, we, as a profession have to be better educated to know when to say, no, that's a K N O W and N O in the same sentence. Know when to say no. In other words, if insurance companies are offering rates that are below what it costs us to business or below what we think we should be reimbursed, we need to learn to say no to them and walk away from that business. Maybe it's better to see fewer patients and make more money and be able to compensate our staff better than to take every insurance contract that comes down the road that pays less than it costs you to run your business. Those in private practice who might be listening to this podcast are shaking their heads affirmatively I'm sure because they get it.
Michael Weinper (00:18:47):
Those who are not in private practice probably don't understand what I just said. I don't need that it was criticism, but I think that at the educational level, during your basic education it's therapists need to learn more about socioeconomics as it relates to our profession. Supply demand economics certainly, and cost of doing business are key points. In years past for APTA taught courses on economics made easy for PTs because many of us come out of school even today without very much in the way of business knowledge or knowing much about economics. And once you learn more about that, things become much clearer and it makes it easier to make decisions that are in the best interest of our profession. So I think the PPS can, it does from time to time try its best to educate us on how to be better managers, if you will.
Michael Weinper (00:19:51):
And that includes things like the economics. But I think we, as a profession need to be top of mind with economics and learn how to advocate more as a group, as a profession, not just individuals because insurance companies will not look, listen to individuals. They will disappear to larger groups. To that point, larger groups get better reimbursement. So that point hospitals being really affiliated with one another or powerful entity as an association get better reimbursement. So I think that getting PTs together to understand I know APTA has advocated for many years better reimbursement. I worked with APTA in different retreats for payers. So there was a way to bring together a summit, a payer summit, they call it where they bring together many insurance companies. Actually I did one in Connecticut where you are cause that's a sort of a hodgepodge or location of many insurance companies.
Michael Weinper (00:20:55):
So we had several speakers who knew a lot about reimbursement, including Helene furan, a dear friend of mine and others who would speak to insurers about what is PT? What does a PT do? How do we evaluate patients? What does it cost to run a business to give these payers a better understanding, but remind you be reminded. These were not big association meetings. We brought peers together. So we might have 25 or 30 people in a room, some of whom which were larger decision makers than others, but when it came right down to it, we didn't have the ability to follow up with them and push them down the road to where they would be accepting of what we do. So we today, the cost benefit of coming to PT, I'm sad to say is very disappointing. It takes you a long time to work off your debt. Hopefully in the future, our government will see fit that people in professions like ours need to have better forgiveness of their debt in return for doing public service for the public we serve.
Stephanie Weyrauch (00:22:06):
Yeah. I think that you make a great point about the fact that we as private practitioners need to walk away from some of these more measly reimbursement contracts. And you know, one of the things that we hear a lot with incoming graduates is that there are a lot of private practices that have very high volume. And one of the reasons that they have low job satisfaction is because they're seeing so many patients. So I think that you make a really great point in saying that, you know, maybe it's better that we take fewer insurance companies, see fewer patients, but get paid more because now you're eliminating that burnout and that poor job satisfaction and allowing that new professional, or, you know, even if it's a veteran physical therapist, make the money that they actually deserve with the training that they have.
Michael Weinper (00:22:58):
Exactly right. And that's why we need to really advocate politically. And that's why the PT PAC is a very important thing to be involved with because we, as a profession can be heard through advocacy many, many years ago, I was one of the early trustees of what we used to call APTCAC American physical therapy, congressional action committee, which now PTPAC. And I always used to say, and I consider you to say today, if every PT would just give $25 to political action, how much more strength we could have because we live in a world where legislators listen to those who support them, support them with votes and support them financially so they can get folks important that we do get to legislators.
Michael Weinper (00:23:54):
We have a lot of people in Congress who are friends and have been our friends for many years, but we need more. And when things come up like budgetary cuts of Medicare, where they talk about an 8% reduction in Medicare reimbursement coming in next January, which I hope goes away. I think it will go away. I pray it would go away. But if it doesn't, I mean, think about that. You're getting a reduction in your reimbursement, which is not that great today. And they're going to reduce it even more. What's that gonna do to salaries? It's not going to help the PTs in private practice. And this is something that I think many people who are not in private practice, the students podcast may or may not, may not believe, but it has to be true.
Michael Weinper (00:24:40):
I've spoken to hundreds of PTs in private practice over the years. And I think many people would be appalled or shocked at least to realize that many people who own private practices do not make a lot of money. I spoke to a PT just last week here in Southern California, who was impacted by the rallies that were going on with black lives matter. And unfortunately, during that time, there was some looting and pillage went on by some bad actors, if you will, not people who were affiliated with the rallies themselves, but people who took advantage of that and broke into places and solving fuel and burn places. We all heard about that here in Southern California was one of those places in other parts of the country, the same thing that held true, that PT, when I talked to them and was trying to do what I could do to help them rebuild their practice. Cause your practice had been broken into and everything taken.
Michael Weinper (00:25:42):
I asked this individual if they would be willing to share with me how much they make per year. This person said to me, under $80,000
Michael Weinper (00:25:58):
And I pause for a second. And since not only for the problems they were experiencing because of the looting and stuffed up to their office, but for the fact that even under good times, they weren't making a lot of money and they were working hard. They're working 10, 12 hours a day, sometimes on weekends. That is because they were in a situation where their cost of doing business is almost as high as what they would receive in payment.
Michael Weinper (00:26:24):
And we know that owners of businesses get what's ever left over after paying all the other bills, including salaries and benefits and rent and all the other things that come to mind. And it's not uncommon to find people who own their own practices, who do not make a lot of money and you have to take a lot of risks. So it's one of these things that we need Congress to better understand that it's important to support physical therapy as a profession, because we are a very valid and important aspect of the health care continuum that if we aren't there the cost of care will go up because rehabilitation, I believe, and I'm sure you believe decreases overall cost of care. So getting Congress to vote that in and to budget more money for us and Medicare, and then hopefully getting insurance companies to understand that not every therapist is going to do things on the low ball side of it, but really are going to hold out for a higher compensation that they're entitled to.
Michael Weinper (00:27:36):
They're going to be more inclined more and as a parent more it's my idea that therapists should be able to own practices to be able to pay their staff more. I've always said, Stephanie, that I wish I could pay every therapist that works in our practice, $150,000. I think they're easily worth it, but it's a function of what we get paid. And I can tell you that, you know, my own practice, progressive PT my income hasn't gone up in over 10 years and I don't make, you know, I don't make a lot of money in it, but it's because I get what's left over after we pay everybody. I feel that we've got to give our employees reasonable compensation for what they do. And we don't use a lot of extenders. We don't do a lot of things that are in the realm of I'm doing it on the cheap side as many people do.
Stephanie Weyrauch (00:28:31):
Yeah. I think that your points about advocacy are really important because I know APTA has been working on that 8% cut. You haven't written to your Congressman. I definitely encourage those of you listening to this podcast today to log onto APTA’s website, whether you're a member or not and write a letter to your Congressman, it really only takes three seconds. Additionally, there has also been a legislation that has gone forward with trying to increase the loan forgiveness for DPT students. APTA is always trying to get us to have pay, be paid more so that advocacy piece is really important. So that kind of brings me into the next pillar or the next element of vision 2020 and that's full direct access. So we do have at the some form of direct access in all 50 States right now, however, there are three States where the direct access is extremely limited, where you basically can only do a wellness evaluation without a doctor's referral. And then there are about 27 States where you have direct access with basically limitations or rules attached to it. And a lot of those have to do with say diagnosis or with different interventions like dry needling or electrical stimulation. Those types of things. So kind of along that route, how can PPS ensure that we get full direct access in each state? What are some things that the association can do and that physical therapists can do?
Michael Weinper (00:30:04):
That's a wonderful question. And I think the answer is create stronger advocates in each state because what you're talking now is not about federal legislation, but state legislation. In other words, each licensing act is governed by the state legislature. So having a good group of PTs who can rally and lobby, if you will, or have a lobbyist, if there is a big enough state to meet with members of the state legislature to express how important it is in an effort to control costs in healthcare, to give therapists more clinical rights and abilities, that's where it starts. Once you get that, then you can get insurance companies to start to buy in because they realize that is legal in that given state. I have seen this happen throughout my career that has been slow to come. We've been shooting for direct access. And at the same time also trying to eliminate the need for there to be physician intervention in certain musculoskeletal situations where we now are trained as diagnosticians to be able to evaluate and treat these things.
Michael Weinper (00:31:17):
It's my hope in the future that we get the opportunity from a licensure standpoint to order x-rays, to order lab work and things like that, to where we can have more information at our fingertips, but then to have to refer out. But only where it's appropriate, where we're adequately trained to do that. You have to teach legislators what is PT and what is the benefits of PT and what are the cost savings that insurance companies, the public. And we all save by giving the opportunity for patients to be strong entry points into the healthcare field. It's certainly fond for us to evaluate patient. And in some States you can do, like you said, dry needling. I live in a state, California doesn't even allow dry needling. I have people in my practice who teach dry needling to therapists around the company because he used to do that where they worked in other States, very frustrating for them, extremely frustrating for me, but it takes legislation.
Michael Weinper (00:32:25):
It takes talks. It takes contributions to your local state PAC, and most of them have it now. And to be involved in APTA, I think is key that so many PTs I call nine to fivers. They come in and they do their nine to five and go home and they forget about their profession. People like you and others who are dedicated to making this a better profession for PTs of the future, not to mention the public that receives our care are the ones that make things happen. And so being more involved in our field through volunteerism obviously is key, I think, to change and too many of us look to the other guy to do it, whether it's writing a letter to your congressmen, or there's going to meeting with a state legislator, whether it's inviting your local state representatives into your practices, see who you are and what you do.
Michael Weinper (00:33:27):
All of the things bode well for growing our practice. And too few of us, unfortunately do that. We don't realize that it starts fortunately with regulations and what we can do and how we can do it. So the quest, if you will, or request, I should say would be that we as a profession, get more involved in our association because the association is the focal point for getting the information to legislators. It's our association that has the greatest credibility. And I can tell you that one of the reasons I went back and got my DPT was that I saw that when I would testify on a bill in Sacramento here, there would be people with a doctorate, not necessarily in our field, but just doctorates, so would speak against what we were doing it. And I would get up there and I would have 40 years of experience, and we have a master of public health degree then on my doctorate.
Michael Weinper (00:34:26):
And I were always, and I would like to think I had good presentation and good preparation and knew the facts. And yet it was those who had doctorates that were, or had the title doctor who were paid more attention to now, we as PTs have that title. And now we're sort of in a level playing field with other professions, from the term being entitled a doctor. And with that credibility, we need now to take more action, we need to spend more time trying to create change in my Dicus talk back in 2000, I said that people were afraid of change and it's true. And even today they're afraid of change and we all like the status quo, but the reality is we need as a profession to embrace change because with change comes progress and we need to progress as a field of profession. If you think about things it takes a village if say and certainly in our professional, it's no different, we have to be part of that village. We can't just be part of the tribe. We need to be active leaders of our village.
Stephanie Weyrauch (00:35:43):
Yeah. And I think, you know, if you look back at where we were with direct access 20 years ago, I mean, obviously we're in a much better state than where we were, but some of the resources that I know PPS has for people with their fighting, the direct access is they do offer grants to state associations if they're doing any type of lobbying. So if you haven't applied to one of those, it's a pretty hefty amount of money. It's like five or $10,000, which that goes a long way when you're paying the lobbyists to do the work for you. You know, they also have a key contacts program and they offer resources for practitioners that if you do invite a legislature in a legislator into your practice, or you are trying to advocate for a bill, like they provide all that information for you on their website and on the APTA action app.
Stephanie Weyrauch (00:36:29):
So, I mean, PPS does have resources out there that we can utilize to try to continue in our fight with direct access. And I mean, yes, we're in a much better place than where we were 20 years ago, but like you said, change takes time. And as a, you know, as a young professional, I definitely would love to see change happen even faster. So you know, the more people we can get together and build that village, the faster it's going to happen in your Dicus speech, you also talked about how you envisioned that physical therapist will be evaluating and diagnosing conditions, performing specialized treatment procedures and working with the PTA team. And then you also envision that there would be no referral needed by another practitioner. And I know you've kind of covered this a little bit, but give us an idea of where we are, where we're at with this prediction and what you think the future holds. Because as you know, a lot of these direct access bills that we have still restrict our ability to quote unquote diagnose conditions or even perform specific procedures. So kind of give us an idea of where we are compared to 2000 and where you see us going in the future.
Michael Weinper (00:37:41):
Well we are obviously light years ahead of where we were in 2000, just by hearing what you described to helping things in what I predicted. And I think from the standpoint of going forward, we need to be cognizant of the fact that we can change things if we put some effort to, and in other words, so many therapists don't do things because I think I hear people say, Oh, it doesn't make a difference, or they'll say somebody else will do it. And the truth is that we all need to be more involved. And I'm one of those key contacts and have been for many, many years. I can only tell you that how rewarding it is to invite a legislator or even somebody who works in their office, into your office, into your practice, to visit with you, see what you do, talk to you, the things that are your barriers to growth and barriers to doing for patients, what we should be doing and should have been doing for many years.
Michael Weinper (00:38:46):
And I think it's more important to understand what you can't do versus what you can do. And you only learn that by going to stage or talking to people in other States who have full privileges to do those things and have that true autonomy. So I think that by attending association meetings, for example, PPS is a great example or CSM when it comes back. And, and I say this, not just going to the meetings, but talking to people, not just your friends, but talking to people you don't know, but from other States where you might know there's a lot more progress, ask them what they did and how they did it, or talk to the leadership in those States, in those state associations and ask them, how did they accomplish what they accomplished? Because it takes a lot of work and there's a lot of resistance by other professions, physicians be it chiropractors, osteopaths, even dentists from time to time resist, having us grow to where we should grow.
Michael Weinper (00:39:53):
And the key again is educating the public, what we do. So when you're treating them, let them know what you can do, what you can't do all because of the laws, even though you might be trained to do these things. And sometimes the best advocacy doesn't come from ourselves. It comes from the people we serve our patients. So getting people to write letters to their members of the legislature is very important. But I think getting more people to stand up, write letters, attend hearings in your state Capitol become more involved, become more aware of the benefits you can create, not only for the professional, but certainly for yourselves as well. And that's one of the reasons that I've been very involved in APTA throughout my career was I felt that I had the ability to change things if I would only work at it.
Michael Weinper (00:40:47):
And I was very blessed. You haven't brought it up, but Bob Dicus for who the Dicus award is named obviously was one of my mentors. When I was a student, I got to meet Bob. He was already very deep in his ALS disease in Georgia. He was fully wheelchair bound and tied to a respirator, but that man had so much knowledge. He was one of the first private practitioners. And one should only go to the PPS website and learn more about Bob and what a great man he was and what a visionary he was for our profession. As a matter of fact, just to digress for a moment, he is the one who created the ALS society nationally. He was the inventor of that. He had a second professional. He was in, he was a motion picture producer in his later years when he couldn’t be a PT, he went into motion pictures.
Michael Weinper (00:41:48):
A lot of them had to do with rehabilitation and things that we do. They weren't necessarily featured like Sims, but he got involved in that kind of communication. So it always goes to the fact that I think some of the best PTs are the ones who are best able to communicate with their patients, with the public, with our legislator. Sure. Those are the PTs who really do the best, because if you're good with your patients in communicating, you're able to motivate them to do the right thing. Right. And communication is something that we need to study more perhaps in school. I teach a lecture on communicating with different generations because as I become part of the older generation and looking at the younger people, I see how you and others in your generation and younger generations communicate with one another as much different than what my experience is.
Michael Weinper (00:42:43):
I grew up with our computers. I remember the very first calculators. We were not what I was going through school in high school. We used an Abacus and a slide rule. And then going forward, we used a Texas instruments brand calculator, which was very expensive and very elementary looking back at it. That's an idea of technology when technology and communication are, I think are very interwoven. In other words, as technology increases, communication becomes dependent on that technology. And we tend to communicate less with one another or said differently. I can see my son-in-law and daughter at our house, sit on the couch, waiting for dinner, remake, and what are they doing? They're texting. And I said, who are you texting to talk to them? Wait, what answer? Just speaking with one another. And that's just the world we live in. And then all the little acronyms, all these simple things that you know are, are part of the lexicon today.
Michael Weinper (00:43:56):
Today's younger people, older people don't necessarily know. And when treating an older patient, it's key that you speak to them in a communication form that they're going to understand. And don't assume they understand. I mean, you're saying just because you're saying it, and the same is true for older therapists like myself, talking to younger people, you have to motivate them in a different way. Young people want it. Now they want things quickly. They're used to getting information quickly. You go with something up on Google and get an instant answer on something. Whereas back in my day an encyclopedia sales person used to knock on our door, trying to sell my family a big set of 30 books of encyclopedia. We were tell much to us what we needed for today's knowledge. And I don't think those people around anymore. If at all. If you wanted an encyclopedia, you've got it.
Michael Weinper (00:44:50):
Just look up something in Google or another search engine, and you've got instant. You got too many answers. Sometimes you get different answers for the same question, but with all that in mind, communication is key to success. And we as service need to communicate better, not only with our patients with one another, with our legislators and with the public in general, and to that point, having better PR public wise. And I think APTA is trying to do that. Now that we're into our hundredth year, starting there as your celebration or Centennial celebration. I think you're going to see a lot more information going out to the public, through electronic media and social media, to where we gain a higher visibility with the public.
Michael Weinper (00:45:38):
I had the TV on the other night, I was watching a game show and one of the contestants was a PT. And he was a young PTA until that. And he didn't want a whole bunch of them. I think it was, I believe the show was a wheel of fortune actually, which I don't watch too often, but it was on. And I've heard the word physical therapist. It's just like you, whatever you heard that word somewhere. Even as sitting in a restaurant, you hear somebody talking about their PT, your ears perk up and you sort of start to eavesdrop a bit. And we as a profession don't hear that word in the public as much as we hear about doctors or other things. So I think the public needs a better awareness of who we are and feel comfortable talking to us. And we need to feel comfortable talking to them and educating more about who we are for. They haven't needed to see us.
Stephanie Weyrauch (00:46:26):
I think you make some really good points about the communication aspect and that kind of leads into the next element of vision 2020, which is us being practitioners of choice. So in kind of going off of that with communication, it's too bad Bob Dicus, isn't around anymore to make the next hit healthcare drama on physical therapists. I mean, how many physical therapists and healthcare dramas do you see walking patients or stretching patients? You know, it's never really, they're never main characters in, you know, like Chicago med or Grey’s, you know.
Michael Weinper (00:47:05):
Anytime I see a PT portrayed in these situations. I cringe because first of all, they're wearing, and I hate to say this cause I'm going to probably, I'm going to take an issue with some of you they're wearing scrubs. I don't think I don't scrubs when I grew up were for people working in surgery. Now everybody wears scrubs. So you go to the grocery store. People were in scrubs. They, I think people not even in healthcare wear scrubs sometimes, but I think we should look more professional. We should be more professional and the public will respect us better if we act more professional. And so there are some times PTs who are brought in on dramas to be a technical advisor. I have been in that position before twice, and I have talked to directors and producers about what they need to show.
Michael Weinper (00:48:05):
And I can only tell you that what you tell them to do and what they end up doing sometimes is different because maybe they don't have the right equipment or the character. They thought they already lined up costumes for their characters. It becomes very frustrating, but getting in on the front end and getting the public to understand who we are, hopefully through drama and maybe through, you know, like I say, public service announcements or ads on TV where we're portrayed better or having the opportunity. Many of you are in smaller cities and towns, your local newspapers and television are hungry for local news. And you may be doing something you don't need to think second thought about, but it's newsworthy. Maybe you just purchased a very important piece of equipment to help with ambulation or suspension or something technical electronically to create new opportunities to treat patients your local TV stations would love to demonstrate, come to your clinic, film you doing that and have it as a segment on their TV show.
Michael Weinper (00:49:21):
And many of us don't even think about that. So and I, again, even in Los Angeles market, I've had the opportunity to do that a couple of times. And it can be a little bit overwhelming, a little bit scary, but you know, something at the end of the day, you feel really good about it and how you come across is much better than you perceived. You are going to come across when you're getting ready to do it. So don't be shy, but reach out to your local media and try to get them interested in what you do, because what you do, what I do is very newsworthy and very important for the public.
Stephanie Weyrauch (00:49:52):
Yeah. And you know, obviously people are following what the media says and listening to the media. So, I mean, the media is, has been a very powerful force that you can utilize to spread the gospel of physical therapy so that we can become the providers, the practitioners of choice, for the musculoskeletal system. And so the people actually know that PT means physical therapist and not like personal trainer or part time, people actually know what it means in your speech. You also stated that PTs would be recognized by payers as diagnosticians an entry point into the healthcare system. And I know you've talked, you you've touched on this a little bit, but how do payers recognize physical therapists and how do today's payers recognize us compared to back in 2000? Where are we at with that?
Michael Weinper (00:50:43):
Well, back in 2000, and even in day sense, payers felt we needed to be treating only under a physician's referral. If you looked at insurance policies that you might have, or if you spoke with payers, they would say that PT was a covered service when provided or the auspices of a physician referral or diagnosis today. Many of those policies from the same payers do not have that language. So because of the direct access laws and because of therapists and given States talking to their insurance companies, the payers they've educated them to where certain payers are starting to realize the benefits of PT first. And let's just take substance abuse and chronic pain. We know as musculoskeletal experts, there are lots of things that we can do for the patient to avoid surgery, to avoid downstream costs like expensive imaging that may be unnecessary. We can certainly get the patients treated properly and get them in a mindset to where pain is not top of their mind. I have a book sitting right behind me on my bookshelf. It's called explain pain. Are you familiar with this book?
Stephanie Weyrauch (00:52:13):
Oh yeah, that's a very familiar book.
Michael Weinper (00:52:16):
Okay. And this was a very good book for people to read. It's the authors are David Butler and Lorimer Moseley, and they're down in Australia, but they talk about dealing with the mental side of pain, the cognitive side of pain, if you will, and how to best creature patients in deemphasize of pain and emphasize wellness or health. And we need to do more of that as practitioners. And as we can educate our insurance companies, that by sending the patient to PT for four or five, six visits, we can avoid surgery, many cases, what is a cost benefit to the insurance company? Their insurance companies listen to money. And I know this from my experience for many years of working with many of them speak with probably too many insurance companies to not only remember, but to count. And they are driven by dollars and they do not put enough emphasis on times in their underwriting to allow PTs to do the things we do.
Stephanie Weyrauch (00:53:26):
Yeah.
Michael Weinper (00:53:28):
Shortsighted because they ended up then forcing patients to go to a physician first, wait, several days or weeks to see the physician where the patients only getting more deconditioned. And rather than just seeing us first, and we have the opportunity and the knowledge on doing things that get the patient out of the problem or fixing the problem, if you will, from a nonsurgical standpoint. So insurance companies in some cases have become much more enlightened and other cases are still in the dark ages. And those who allow us to treat without referral and pay us for what we're worth are the more enlightened ones, some insurance companies that I've dealt with now in recent years are paying for outcomes. There's concept of paper for pay for performance or P for P. I like to call P fro. It's really not what you do, the process of what you do, but really the outcome that you get.
Michael Weinper (00:54:27):
So if you can get a great outcome with fewer visits, then insurance company should be willing to pay you more because you reduce their costs. And, not only of what you did in terms of your crew cough, but in terms of what would otherwise cost them to treat the patient going forward. So I like to pay to pay for outcomes Peterborough, and that's why we, as a profession, need to do more in the way of outcome measurement, whatever tool we use and be able to communicate to the payment payer community, the benefits of what I do. So I'm going to go back now to the mid seventies again, when I got my master's degree we learned even back then that the definition of quality in healthcare was composed of three things. And the author of that was a fellow who's no longer with us.
Michael Weinper (00:55:22):
His name was Avitas Donabedin. He was a physician. He was very involved with the new England journal of medicine, D O N A B E D I N, if you want to look it up and Donabedinn even back then said that quality health healthcare was three things structure, which is where you do it and what you use in terms of equipment process, what you do okay. And outcome, or the results. So we all have been able to measure it structure, and we were able to mission measure the process where you, but not enough of us over my career have been able to truly prove that what they did was a benefit. And I think that that's one of those things that we have to focus more on proving the benefit of PT two outcomes or said differently because of what we do, patients get better quicker.
Stephanie Weyrauch (00:56:16):
And that leads us really nicely into the next element of vision 2020, and that's evidence based practice. So obviously APTA has done a lot over the years to try to improve how we're measuring outcomes. So you have the outcomes registry CoStar was created. If you look at how much the literature has been put out for, if you search, if you search up physical therapy, even in Google, it's, you know, an exponential growth since even 2000 and even the larger growth. If you think about it from even the 1970s, when outcomes were first described. So, I mean, this is something that, you know, we've been working on for a long time. I think that obviously it's come a long ways, but we still have confirmation bias in our literature. We still have group practice that people are practicing. We have treatment fads that really don't have a lot of evidence behind them. And we have practice variation that continues to affect our outcomes and affect our profession. How can PPS help offset this? How can we continue to go forward to mitigate some of these things that are occurring?
Michael Weinper (00:57:24):
Well, that's a $64 question, as we used to say my hero. I think it's important that we need to, you talked earlier about one of the goals of PT, 2020 is lifelong learning. And I see too many people in our profession who don't come to meetings of the profession, whether it's a local meeting in your area, whether it's a state conference whether it's CSM or PPS meetings, too many of our colleagues never go, or maybe they went as a student cause their school paid for them or somehow or another they're were to go. And they never ever go. If you think about people, you went to school with Stephanie, you never see them again. And you wonder, how are they getting their education? One of the things that has occurred a dream the last 15 years I would say is the requirement by States that each PT in order to continue, their licensure must have continuing education, a certain amount.
Michael Weinper (00:58:35):
And it varies state by state, as we know, and what things have to be parts of that, continuing education, again, vary by state by state, but at least we're being forced now as a profession to continue our learning. Having said that, and having taught in different venues in different ways. I can tell you, there are people who are serious learners, and there are people who we call lazy learners. The lazy learners are those who will buy the cheap level CEU kind of stuff, and do a quick read on something and take a test and not really spend the time to investigate what was being offered. And maybe some of the quality of that they're learning is really not up to date either. Versus those of us who will go to con ed meetings, we'll do things online. Now there's a lot of opportunity. PBS shows a lot of things out ABQ has a lot of things.
Michael Weinper (00:59:35):
I'm a member of the orthopedic session section and the oncology section. They have lots of stuff going on that, yeah, there's too much of it. There's just like there's like education overload. So you have to be selective, but do choose things that I think will be beneficial to you. And that are evidence-based. So it brings back to the evidence based part because too often I've heard people get up at meetings and start to talk about things. And then when challenged on what's the word, what's the basis of your comments? They sort of stammered. And they said they gave answers that weren't really appropriate. So we do need more focus on, on lifelong, which we’re mandated to do, but some people take the easy way out. You know, people, we all have people we know who will take the high road and others who take the low road and the low road may be the easier road that may not be the get to the right end.
Michael Weinper (01:00:29):
So we want to challenge ourselves to learn more each day. And I can tell you that when I went back and got my DPT, I thought it would be fairly easy. And some of the things that I was exposed to, I'd already learned in my master's level, but I can tell you a lot of things that I learned were new concepts that I had never even thought about. And that goes to the idea of this lifelong learning and evidence based practice you learn, most of you learned in school all about evidence-based theory and practice, and some of you embraced it very well and other views sort of gone a different path. So I would say, take a step back and look at the research that's coming out. There's all kinds of journals. And that's another thing that I have to digress on a moment.
Michael Weinper (01:01:17):
And that is, here's a question for each of you, how many journals or publications that are healthcare oriented, do you read or subscribed to, if you say only PT, then I think you're making a big mistake because there's so much literature and so many things that are appropriate for what we do in our field. And to validate what we do in other journals and research is being done that we miss the boat by not looking at it at other professional journals or other modes of information, or even attending meetings for physicians and so on. I used to specialize in the treatment of hand injuries. And so I would go to the society for hand search and they actually had a PT sub, a PTO to see subset of that that my friend, dr. Susan Mike Clovis, was very involved in and she got me involved and I would listen to physicians.
Michael Weinper (01:02:18):
We collegial meetings where PTs and physicians would interact to try and come up with the best ideas. And many of us don't really have any contact with physicians, except when we're talking to them in the halls of the hospital or when we're going out to market them, or we're trying to take lunch to them. We don't talk really about concepts and about theory. And what do you base this upon? And what can we do to learn more about the benefits of what we do? And that gets us to the idea of each of us having the challenge to do some research, research is fascinating. It doesn't pay a lot, but you can still do research in your clinic. You can be parts of research projects. If you just look for them, is they're out there to take advantage of. And if you do that, it opens your eyes so much more.
Stephanie Weyrauch (01:03:09):
And I think a lot of the things that you've touched on kind of goes with the last element of vision 2020 and that's professionalism. So when the house of delegates originally defined what professionalism means in vision 2020, it's that we as physical therapists and physical therapist assistants are consistently demonstrating core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability by working with other professionals to optimize health and wellness in individuals and in communities. So obviously one of the bigger focus is of APTA has been this optimizing society or optimizing movement to impact society. And we've been kind of taking more of a population health kind of perspective, trying to get out of the silo, physical therapy and move more into the interdisciplinary healthcare, healthcare, professional realm. Where would you say we are? As far as our professionalism goes in 2020, compared to where we were in 2000?
Michael Weinper (01:04:15):
Oh boy, I think many of us have because of our increased education, gotten more credibility with the medical profession. They tend to listen to us more rather than just seeing us as a technical entity or a technician versus a professional. Although I can tell you still today, physicians oftentimes don't see the benefit that we do even orthopedist. And we have come a long way in some with so many physicians, but we've missed the boat with others. I think it's critical than medical stuff, schools, especially if you're doing an orthopedic residency, that's a resident spend time with a PT. I was in a well known physician, internationally known physicians office recently with my wife who, when she had her shoulder surgery. And he has no to fellows at all times. And occasionally a PT will visit and come in and, and be there not to get paid, but just to talk and work with the physicians, educate the physicians and the younger ones, the fellows who are going to be out there real soon in their own practice.
Michael Weinper (01:05:34):
We need to do a better job of educating physicians. I said that a little bit earlier, but I really mean it. We can do it when they're in school, when they're doing their fellowships, we can invite them into our practices. We can go to doctor's offices and shadow them much more than we do. We can go into surgery with physicians and talk to them while they're there doing their procedure, learning why they're doing their procedure. And sometimes a light bulb will go on in your head say, Oh, I get that. And that's, I think there's something I could do a little bit differently with like, with your patients when I'm treating them by seeing what you're doing surgically and listening to what your concepts are. So I think there's a lot more collegial realism of that goes to being a professional. And to that point, if you don't see yourself as a professional others, aren't going to see you as fun and too many of us lose track of the fact that we are in it.
Michael Weinper (01:06:27):
When you say it's a profession, a profession requires one of the key points of any profession is that you learn, you keep current and you give back to society. And giving back to society means more than just treating people. It means educating the population, doing things from a wellness standpoint or avoidance of injury. I guess going back to my public health days where one of the key things is getting people not to have to see you clinically as a post op or whatever, but helping people to avoid surgery and do things the proper way. Ergonomics for example, is a good, good use of our skills and what we've learned as I sit up in my chair properly. And we doing things that people just don't think about. And when we break away from just being the PT, treating person and branch out to media with other professions, talking to them about what are their challenges, what can we do to help though, or thinking about things we can do to help them communicating better in collegially at different levels. Then we go a long way towards not only building those relationships, but most importantly, helping the patients we serve. So it's one thing to say your profession. That's another thing to give back to society and find different ways to give back
Stephanie Weyrauch (01:07:55):
What, you know, from this conversation. Obviously we've come a long way since 2000, we've achieved many things that vision 2020 set out to achieve, but we still have a lot that we yet need to achieve. So kind of on that note, Mike, you know, what is a clinical Pearl that you can kind of leave all of us with? What is some advice you could give a young graduate or somebody new in the profession that maybe you wish you would've known when you were coming out of school?
Michael Weinper (01:08:29):
Oh, that that's an easy question to answer because I oftentimes get asked by younger PTs, how did I become successful? I say very simply through volunteerism, volunteering your time to help your profession and help those we serve, whether it's going to a health fair and educating the public, you ever done that fascinating what they don't know and how the aha moments you see in the public. When you spend two minutes with them screening students preseason athletic screening, another great opportunity to follow tourism positions you're working with, Oh, that's how you do that. That's how you measure that. I didn't realize that. And that's another idea, again, of getting involved, getting I talked earlier about legislation, getting involved in legislation, getting involved in your association is what I think makes you successful. And to that point, I think that the best jobs of PTs get are not the ones they see through a Craigslist or three C on the association.
Michael Weinper (01:09:41):
Advertisements is from talking to other therapists, word of mouth learning, where are the best jobs to be had. And the only way to do that is not staying in your little house if you will, but getting out and talking to the PTs. That's like I said earlier, getting to know other PTs there's this PT pub nights that I see around the country, what a great idea I've gone to them. And they're actually fun. I stood out in the rain. They had an outdoor one here in Southern California, and you don't get a lot of rain here, but that particular night, we all were standing outside of this venue drinking our beverages of choice, getting soaked, but having a good time. And it's very memorable and getting to know other people and volunteering just goes a long, long way. I think, to learning more and learning what needs to be done, if you could learn what needs to be done and then not put it on somebody else, but say, I'm going to take responsibility again, getting back to I'm a professional.
Michael Weinper (01:10:43):
I need to be professionally responsible. I need to be the one who does this. I know you're one of those people. I'm preaching to the choir. Stephanie, when I say this and you know exactly what I'm talking about, but so many people who might be listening to a podcast like this, don't quite follow it. So my challenge to each of you would be get involved in your profession and spend a little time here and there, away from family away from work away from your social activities and back to your profession. That's part of being a professional. And as you give back, the more time you give the more you get. And I like to leave this thought with people. And that is for all the thousands of hours, I guess, at this stage of my career, I have given to my profession, whether it was the local district or my chapter or the national association or the private practice section or other sections I've been involved with or doing things in the public realm, getting involved in I was involved in a college board. So people got to know me as a PT and as an individual and get to know more about PT, getting involved in society, rather than just going home at night, turning on the TV, or turn on your computer or playing games, getting more involved with people and trying to do good things for the public benefits you directly.
Stephanie Weyrauch (01:12:11):
There were some wise words spoken by a true visionary of our profession. So thank you so much. And thank you for all of those who listened to this episode of the healthy, wealthy, and smart podcast and I'm your guest host Stephanie Weyrauch. And I hope that you stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, Dr. Michael Weinper speaks with guest host Dr. Stephanie Weyrauch about the American Physical Therapy Association's Vision 2020. Passed by the House of Delegates in 2000, Vision 2020 was APTA's plan for the future of physical therapy. In his 2000 Dicus Award speech, Dr. Weinper discussed his predictions of where the profession would be in 2020. Dr. Weinper and Dr. Weyrauch revisit the elements of Vision 2020 and analyze whether our profession has accomplished a vision of the future set twenty years earlier.
In this episode, we discuss:
-How has the physical therapy profession evolved since the drafting of Vision 2020?
-The student loan debt to income ratio
-Advocacy efforts to achieve full direct access in all of the States
-The importance of lifelong learning and evidence-based practice
-And so much more!
Resources:
Stephanie Weyrauch Instagram
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Stephanie Weyrauch Facebook
Email: sweyrauchpt@gmail.com
APTA Website
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Dr. Weinper:
Michael Weinper, PT, DPT, MPH, cofounded the company in 1985 with his partner, Fred Rothenberg, a former executive at Blue Cross of California. A physical therapist with more than 40 years of experience in clinical practice, management consulting, administration, and program development, Weinper is also a principal in Progressive Physical Therapy, a private practice, with four locations in Southern California.
Weinper received a Bachelor of Arts degree in Industrial Psychology and a Bachelor of Science degree in Health Science (physical therapy) from California State University, Northridge. He received a certificate in physical therapy from that institution in conjunction with UCLA Hospitals and Clinics. Weinper later received his Master of Public Health degree (M.P.H.) from UCLA in Health Services Administration and his Doctorate in Physical Therapy from the EIM Institute for Health Professions in Louisville, KY.
Weinper has been active in the American Physical Therapy Association (APTA). He has served as a member of the APTA’s Task Force on Physician Ownership of Physical Therapy Services, as a member of its Committee on Physical Therapy Practice, as the association’s chairperson on its Task Force on Reimbursement, on the Board of Directors for APTA’s California Chapter and national Private Practice Section, and as trustee of the APTA Congressional Action Committee (now known as PT-PAC). Weinper received the prestigious Robert G. Dicus Award from the Private Practice Section of the APTA in 2000, and he received the Charles Harker Policy Maker Award from the APTA Health Policy and Administration Section in 2011.
On behalf of the state of California, Weinper has served as a member of the Physical Therapy Subcommittee of the Division of Industrial Accidents, now known as the Division of Workers’ Compensation. He also has served as an expert to the Medical Board of California, where among his activities he has appeared on behalf of the People in insurance fraud trials. He has provided expert witness testimony on behalf of more than 20 insurance companies.
A former associate professor of health science at California State University, Northridge, Weinper is a frequent presenter for various professional associations including the National Managed Healthcare Conference, the American Medical Care and Review Association, and the APTA. He has authored many articles for both physical therapy and insurance industry publications.
For more information on Stephanie:
Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.
Read the full transcript below:
Stephanie Weyrauch (00:00:01):
Hello everyone. And welcome to the healthy, wealthy and smart podcast. I'm your guest host Stephanie Weyrauch and I am interviewing Mike Weinper who's the president and CEO of physical therapy provider network or PTPN as it's better known and also a private practice owner for progressive physical therapy in California. The reason that I wanted to talk to Mike today, as he won the Robert G Dicus award for the private practice section back in 2000, and he has been an instrumental person in practice, leadership, innovation, legislative, and political issues, healthcare reform, and a number of other areas where he's really had the opportunity to champion innovation and leadership. And one of the things that, you know, we know it's 2020, and obviously vision 2020 has something that has happened in the APTA was written back in 2000 and in Mike's Dicus award speech, he talked a little bit about where he thought the profession would be in 2020, in 2000. And so I'm really interested in kind of his take on where we are today. So Mike, welcome to the healthy, wealthy and smart podcast. And tell us a little bit about yourself.
Michael Weinper (00:01:21):
Well, thanks Stephanie, for the very nice introduction and it's a pleasure and an honor to be with you today. At some level, I’m considered by some, to be a dinosaur, having gotten my Dicus ward 20 years ago, and now long in my career, I'm just celebrating my 50th anniversary as a PT. So I hope that some people won't tune out just because of that. Maybe if nothing else, they can see me as a history lesson, any event, I can tell you that back in 1992 the California chapter of APTA now called California PT association created a long range planning task force that I was honored to serve on. And in that task force where a lot of leaders in the profession in California names that were household names, then probably names and most people would not know now, but our plan was to draft a long range vision.
Michael Weinper (00:02:21):
If you will, a crystal ball of what things would look like some 18 years later in 2010, kind of looking back, it's interesting to look at and we created, I believe 18 different points that would be goals if you will, of the association and the primary aspects of that working document, which was called PT 2010 by the California association. I'm sure if you were interested, you could look it up or get a copy of it. Then later became the working document for APTA called PT 2020. And since we are now in 2020, I wish we would have known then what we know now, because things have dramatically changed in many ways, but in other ways they have not. And so I guess I could give you some of the ideas we envisioned back in 1992, if you'd like, and then we can take it from there.
Michael Weinper (00:03:23):
So in that document, we said that PTs would be able to evaluate and diagnose conditions that's true today, perform specialized treatment procedures and work in teams with physical therapists and PT assistants. So all that did come true. Next, the PTs would be able to initiate services subsequent to their own evaluation diagnosis without referral from or diagnosis by another practitioner. And that in 2000 that had not yet been accomplished, but we, now we know we have independence and practice almost every state with regard to our licensure. In most therapists are, would be in independent press configurations with other therapists, maybe who would work in a hospital. In other words, there would be an opportunity to be clinically specialized in it with a board certification, which we now know has really grown quite a bit.
Michael Weinper (00:04:25):
And they would be sought out. These specialists would be sought out by consuming public and third party payers. Not as much. I don't think our profession has reached to the public well enough to get the public, to understand what a board certification really means and what it takes to become a board certified specialist in our profession, but I'm progressing for a moment. Anyway. So then we said that PTs would be able to be involved in the continuum of care from the hospital to the home, to the private practice. In other words, PTs would have hospital-based privileges and they would be able to go there. And then if the patient were home, many of them would be able to then go to the patient's home and treat them there and then follow them up in the office. And so that was another kind of idea we had way back then.
Michael Weinper (00:05:21):
So it would be basically following the patient through the episode of care from beginning to discharge and obviously getting them ambulatory and functional. We also said that this is a good one that PTs would become diagnosticians. And more importantly that we would be at the entry point in healthcare which wasn't the case in 2000, but in now in some places, it is that therapists are in fact these musculoskeletal specialists would be a cause we can do it musculoskeletal evaluation or diagnosis many states now recognize that. And some insurance companies have recognized that we can be an entry point into the system, which I believe going forward, it's going to become much more prominent because of the higher cost of care. And actually Stephanie, the difficulty we all experienced when we try to refer a patient to a specialist, state, an orthopedist or a neurologist to do an evaluation so we can follow the patient.
Michael Weinper (00:06:18):
We find that it can take several weeks for that patient to get in, to see the physician, whereas they can usually get in to see us in a few days. So I think that's something that we will see more of in the future, but back then we had it as a dream, but not a reality. We also said that at that time, that instead of 24 weeks of internship that were experienced by PT graduates back in those years, we thought internships would last one year. Now that I don't think there's a, but we have in fact seen fellowships and other levels of work where therapists are really going into specialization so that they in fact can do things over a year's period of time and then becoming sort of like specialists. So those were sort of the, kind of, I think the basic things that would be of importance today.
Michael Weinper (00:07:15):
We did also, this was a very important one. We identified that in the year 2010 PT would be a doctorate profession. That was what our key points of doctorate and profession. And lo and behold now our entry level is what a DPT, a doctorate. I'm very proud to say that I went back and got my DPT a little over 10 years ago. I talked back in 1982, and I certainly wanted to walk the walk before 2010. So cause that was our benchmark was 2010. So with that in mind I think it's important to realize that we have become doctoral people. In other words, we are now at a level of sophistication with our education and hopefully some research that gives the PT of today a much broader view of a patient, their wellness or their disability, and gives them better tools, which the function do the evaluation or assessment of the patient, and then follow up with treatment compared to how things were back when I graduated in 1969.
Michael Weinper (00:08:31):
So and I found that when I got my DPT that I learned quite a bit. I learned some of the things I learned actually were more on how to think differently than I had thought previously. And I will tell you that some of the things that I learned that were most valuable to me was how other people think so studying with other transitional DPT candidates gave me an opportunity for me because I was the oldest person in my class. Gave me an opportunity to hear people think and how they process, how they analyze and how they come to the decisions they do. And then how do they communicate it? I like to think I'm a good communicator, but oftentimes I get really wrapped up or wound up and, you know, I go off on a tangent and I probably go down the rabbit hole and maybe other people in today's world are much more succinct.
Michael Weinper (00:09:31):
And to the point also I can tell you that I was privileged back in 1975 to get my MPH at UCLA and the school of public health there. And I learned a lot about things that are important today, including epidemiology, which we now know is at the forefront of everybody's thinking and infection control and making for safe environments, which was only very basically touched in my DPT program. But one of the things that I really enjoyed was the differential diagnosis courses I took and the radiological courses I took that gave me a much broader sense for things that I'd studied back previously, or maybe taken some content courses, but went into much more depth and listening to other people discuss those kinds of things. So that's how things were back then. I can tell you also that insurance companies were perceived to be able to give PTs a lot more latitude. And it's only been in recent years that many insurance coverage industry to pay for PT. That's independent of physician referral. We're still working with Medicare on that. You and I know all the snow and I think the day will come that the feds will start to get a little wiser and realize the cost benefit of the PT being an entry point into the system.
Stephanie Weyrauch (00:10:58):
I think that that's a really great overview of kind of what you guys envisioned back in the early nineties and kind of correlating that with vision 2020. So the APTA vision 2020 and a couple elements that made that basically encompassed a lot of what you said. So autonomous physical therapist practice was one of them, direct access, evidence based practice, doctor physical therapy and lifelong education PPS as practitioners of choice and professionalism. So those were when the house of delegates discussed this, those were the main themes that they were looking for. So keeping those themes in mind, let's maybe start by talking about the doctorate of physical therapy. I mean, that was something that you were obviously very proud of. You will talk the talk, you walk the walk. So what do you think? Well, studies have been shown the DPT student debt now varies between 85,000 and 150,000. Okay. Do you think based off of what we're seeing today, as far as student debt, do you think that today's DPT is a good return on investment? And do you think that the salary for the physical therapist has kept up with the increases in training and inflation?
Michael Weinper (00:12:14):
Well, I'm very happy to hear you raised this question because it's a question that I not only think about a lot. I talked about a lot with my colleagues and I also talked with students who are becoming PTs and people have gone into residencies for a year post-doctoral now for purposes of gaining a better outlook on things. And I must tell you that when we gave thought to the idea of PT being a doctoral profession, never in our wildest dreams, did we think about the cost benefit aspects of it as it relates to educational costs back then costs were not inexpensive. You should teach part time at USC and Cal state university Northridge. And I remember students used to complain about the cost of education back then, but it was nothing as compared to today. So to get to your point, I am sad to say that we have not grown our income levels for PT to the level that they should be given the doctoral training that we received.
Michael Weinper (00:13:29):
And the depth that usually goes with that, unless you've got some kind of a rich uncle or a greatness scholarship, having said that most PTs coming out with a lot of debt, and then they find themselves in jobs that they don't want to do. Let me just elaborate a little bit on that. PTs in private practice is considered by many to be the desired venue in which to work because patients are coming to you. You have all kinds of equipment and resources and hopefully a nice facility to work in. And the patients for all intents and purposes are ambulatory or said differently. You're not going to be ambulating a patient in a hospital hallway and have something happen to your shoe. If you can get my drift in any event, it seems that most PTs that come out of school today are struggling with where they want to work versus where they have to work and where they have to often work or those places that pay more because they're less desirable.
Michael Weinper (00:14:35):
So as the desirability quotient increases, the unfortunately the salary decreases because of in part supply and demand. And also to a greater extent because insurance companies are not reimbursing PTs in private setting, like they are in the hospital, for example. So if I go to work in the hospital, I can make a lot more right out of school than if I go to work for an independent therapist in the same community. On the same side, I can go to work for a home health agency, not have this desirable of a work environment. Have you seen changes from patient to patient, but make better money, but then again, have other costs of doing business. And I think at the end of the day, those who do home health, and I don't mean to criticize those of you who do, but if you look at your cost of doing business and take that away from your income, you find that your true income is much less than you thought it was going to be.
Michael Weinper (00:15:30):
Whether it's wear and tear on your car, gasoline insurance, you have to carry on your own, whatever it may be, equipment you might have to buy and so on. So it seems to me that the desirability of where you'd like to work and the pay ratio is a universally, but proportionate with that in mind, it's a function of insurance companies, and this is where I really go down a rabbit hole. And that is why are PTs and private practice paid less? And the answer is because PTs in private practice accept less, they have an, I am very secure, experienced on this. Having started PTPN 35 years ago, a managed care company for PTs in private practice. And we have always advocated for higher reimbursement. And in fact, we Protestant have been successful in getting a higher reimbursement for PT and practices that are in our organization.
Michael Weinper (00:16:30):
Then PTs were in the community who are not in our organization. However, because PTs are willing to accept whatever insurance company pays. In other words, they don't want to lose business. They accept fees. They're much lower than they should. And that has driven down the value of PT in the mind of the insurer and that's led to lower salaries. And so to get to the end of this thought, PTs coming out of school, don't get proportion of the kind of income they should with a doctorate. And let's contrast that for just a moment to a PA, a PA has less training than we do. They will usually get a master's degree. They work in a physician's office, but the way that they can bill under the physician's license gives them much better reimbursement. It makes them more valuable to the physician and therefore their income is oftentimes much greater even out of school, you know, apples to apples. Then we get as a PT out of school.
Stephanie Weyrauch (00:17:31):
Yeah. I think you make a lot of really great points there. I mean, the doctor, the DPT was obviously great as far as, you know, gaining direct access, being more autonomous, but you know, the cost of education has obviously sky rocketing it. So based on, you know, your ideas, what do you think that the private practice section can do to help guide new graduates through the uncertainties of student debt?
Michael Weinper (00:17:57):
Wow. there's a lot of things that come to mind. First of all, we, as a profession have to be better educated to know when to say, no, that's a K N O W and N O in the same sentence. Know when to say no. In other words, if insurance companies are offering rates that are below what it costs us to business or below what we think we should be reimbursed, we need to learn to say no to them and walk away from that business. Maybe it's better to see fewer patients and make more money and be able to compensate our staff better than to take every insurance contract that comes down the road that pays less than it costs you to run your business. Those in private practice who might be listening to this podcast are shaking their heads affirmatively I'm sure because they get it.
Michael Weinper (00:18:47):
Those who are not in private practice probably don't understand what I just said. I don't need that it was criticism, but I think that at the educational level, during your basic education it's therapists need to learn more about socioeconomics as it relates to our profession. Supply demand economics certainly, and cost of doing business are key points. In years past for APTA taught courses on economics made easy for PTs because many of us come out of school even today without very much in the way of business knowledge or knowing much about economics. And once you learn more about that, things become much clearer and it makes it easier to make decisions that are in the best interest of our profession. So I think the PPS can, it does from time to time try its best to educate us on how to be better managers, if you will.
Michael Weinper (00:19:51):
And that includes things like the economics. But I think we, as a profession need to be top of mind with economics and learn how to advocate more as a group, as a profession, not just individuals because insurance companies will not look, listen to individuals. They will disappear to larger groups. To that point, larger groups get better reimbursement. So that point hospitals being really affiliated with one another or powerful entity as an association get better reimbursement. So I think that getting PTs together to understand I know APTA has advocated for many years better reimbursement. I worked with APTA in different retreats for payers. So there was a way to bring together a summit, a payer summit, they call it where they bring together many insurance companies. Actually I did one in Connecticut where you are cause that's a sort of a hodgepodge or location of many insurance companies.
Michael Weinper (00:20:55):
So we had several speakers who knew a lot about reimbursement, including Helene furan, a dear friend of mine and others who would speak to insurers about what is PT? What does a PT do? How do we evaluate patients? What does it cost to run a business to give these payers a better understanding, but remind you be reminded. These were not big association meetings. We brought peers together. So we might have 25 or 30 people in a room, some of whom which were larger decision makers than others, but when it came right down to it, we didn't have the ability to follow up with them and push them down the road to where they would be accepting of what we do. So we today, the cost benefit of coming to PT, I'm sad to say is very disappointing. It takes you a long time to work off your debt. Hopefully in the future, our government will see fit that people in professions like ours need to have better forgiveness of their debt in return for doing public service for the public we serve.
Stephanie Weyrauch (00:22:06):
Yeah. I think that you make a great point about the fact that we as private practitioners need to walk away from some of these more measly reimbursement contracts. And you know, one of the things that we hear a lot with incoming graduates is that there are a lot of private practices that have very high volume. And one of the reasons that they have low job satisfaction is because they're seeing so many patients. So I think that you make a really great point in saying that, you know, maybe it's better that we take fewer insurance companies, see fewer patients, but get paid more because now you're eliminating that burnout and that poor job satisfaction and allowing that new professional, or, you know, even if it's a veteran physical therapist, make the money that they actually deserve with the training that they have.
Michael Weinper (00:22:58):
Exactly right. And that's why we need to really advocate politically. And that's why the PT PAC is a very important thing to be involved with because we, as a profession can be heard through advocacy many, many years ago, I was one of the early trustees of what we used to call APTCAC American physical therapy, congressional action committee, which now PTPAC. And I always used to say, and I consider you to say today, if every PT would just give $25 to political action, how much more strength we could have because we live in a world where legislators listen to those who support them, support them with votes and support them financially so they can get folks important that we do get to legislators.
Michael Weinper (00:23:54):
We have a lot of people in Congress who are friends and have been our friends for many years, but we need more. And when things come up like budgetary cuts of Medicare, where they talk about an 8% reduction in Medicare reimbursement coming in next January, which I hope goes away. I think it will go away. I pray it would go away. But if it doesn't, I mean, think about that. You're getting a reduction in your reimbursement, which is not that great today. And they're going to reduce it even more. What's that gonna do to salaries? It's not going to help the PTs in private practice. And this is something that I think many people who are not in private practice, the students podcast may or may not, may not believe, but it has to be true.
Michael Weinper (00:24:40):
I've spoken to hundreds of PTs in private practice over the years. And I think many people would be appalled or shocked at least to realize that many people who own private practices do not make a lot of money. I spoke to a PT just last week here in Southern California, who was impacted by the rallies that were going on with black lives matter. And unfortunately, during that time, there was some looting and pillage went on by some bad actors, if you will, not people who were affiliated with the rallies themselves, but people who took advantage of that and broke into places and solving fuel and burn places. We all heard about that here in Southern California was one of those places in other parts of the country, the same thing that held true, that PT, when I talked to them and was trying to do what I could do to help them rebuild their practice. Cause your practice had been broken into and everything taken.
Michael Weinper (00:25:42):
I asked this individual if they would be willing to share with me how much they make per year. This person said to me, under $80,000
Michael Weinper (00:25:58):
And I pause for a second. And since not only for the problems they were experiencing because of the looting and stuffed up to their office, but for the fact that even under good times, they weren't making a lot of money and they were working hard. They're working 10, 12 hours a day, sometimes on weekends. That is because they were in a situation where their cost of doing business is almost as high as what they would receive in payment.
Michael Weinper (00:26:24):
And we know that owners of businesses get what's ever left over after paying all the other bills, including salaries and benefits and rent and all the other things that come to mind. And it's not uncommon to find people who own their own practices, who do not make a lot of money and you have to take a lot of risks. So it's one of these things that we need Congress to better understand that it's important to support physical therapy as a profession, because we are a very valid and important aspect of the health care continuum that if we aren't there the cost of care will go up because rehabilitation, I believe, and I'm sure you believe decreases overall cost of care. So getting Congress to vote that in and to budget more money for us and Medicare, and then hopefully getting insurance companies to understand that not every therapist is going to do things on the low ball side of it, but really are going to hold out for a higher compensation that they're entitled to.
Michael Weinper (00:27:36):
They're going to be more inclined more and as a parent more it's my idea that therapists should be able to own practices to be able to pay their staff more. I've always said, Stephanie, that I wish I could pay every therapist that works in our practice, $150,000. I think they're easily worth it, but it's a function of what we get paid. And I can tell you that, you know, my own practice, progressive PT my income hasn't gone up in over 10 years and I don't make, you know, I don't make a lot of money in it, but it's because I get what's left over after we pay everybody. I feel that we've got to give our employees reasonable compensation for what they do. And we don't use a lot of extenders. We don't do a lot of things that are in the realm of I'm doing it on the cheap side as many people do.
Stephanie Weyrauch (00:28:31):
Yeah. I think that your points about advocacy are really important because I know APTA has been working on that 8% cut. You haven't written to your Congressman. I definitely encourage those of you listening to this podcast today to log onto APTA’s website, whether you're a member or not and write a letter to your Congressman, it really only takes three seconds. Additionally, there has also been a legislation that has gone forward with trying to increase the loan forgiveness for DPT students. APTA is always trying to get us to have pay, be paid more so that advocacy piece is really important. So that kind of brings me into the next pillar or the next element of vision 2020 and that's full direct access. So we do have at the some form of direct access in all 50 States right now, however, there are three States where the direct access is extremely limited, where you basically can only do a wellness evaluation without a doctor's referral. And then there are about 27 States where you have direct access with basically limitations or rules attached to it. And a lot of those have to do with say diagnosis or with different interventions like dry needling or electrical stimulation. Those types of things. So kind of along that route, how can PPS ensure that we get full direct access in each state? What are some things that the association can do and that physical therapists can do?
Michael Weinper (00:30:04):
That's a wonderful question. And I think the answer is create stronger advocates in each state because what you're talking now is not about federal legislation, but state legislation. In other words, each licensing act is governed by the state legislature. So having a good group of PTs who can rally and lobby, if you will, or have a lobbyist, if there is a big enough state to meet with members of the state legislature to express how important it is in an effort to control costs in healthcare, to give therapists more clinical rights and abilities, that's where it starts. Once you get that, then you can get insurance companies to start to buy in because they realize that is legal in that given state. I have seen this happen throughout my career that has been slow to come. We've been shooting for direct access. And at the same time also trying to eliminate the need for there to be physician intervention in certain musculoskeletal situations where we now are trained as diagnosticians to be able to evaluate and treat these things.
Michael Weinper (00:31:17):
It's my hope in the future that we get the opportunity from a licensure standpoint to order x-rays, to order lab work and things like that, to where we can have more information at our fingertips, but then to have to refer out. But only where it's appropriate, where we're adequately trained to do that. You have to teach legislators what is PT and what is the benefits of PT and what are the cost savings that insurance companies, the public. And we all save by giving the opportunity for patients to be strong entry points into the healthcare field. It's certainly fond for us to evaluate patient. And in some States you can do, like you said, dry needling. I live in a state, California doesn't even allow dry needling. I have people in my practice who teach dry needling to therapists around the company because he used to do that where they worked in other States, very frustrating for them, extremely frustrating for me, but it takes legislation.
Michael Weinper (00:32:25):
It takes talks. It takes contributions to your local state PAC, and most of them have it now. And to be involved in APTA, I think is key that so many PTs I call nine to fivers. They come in and they do their nine to five and go home and they forget about their profession. People like you and others who are dedicated to making this a better profession for PTs of the future, not to mention the public that receives our care are the ones that make things happen. And so being more involved in our field through volunteerism obviously is key, I think, to change and too many of us look to the other guy to do it, whether it's writing a letter to your congressmen, or there's going to meeting with a state legislator, whether it's inviting your local state representatives into your practices, see who you are and what you do.
Michael Weinper (00:33:27):
All of the things bode well for growing our practice. And too few of us, unfortunately do that. We don't realize that it starts fortunately with regulations and what we can do and how we can do it. So the quest, if you will, or request, I should say would be that we as a profession, get more involved in our association because the association is the focal point for getting the information to legislators. It's our association that has the greatest credibility. And I can tell you that one of the reasons I went back and got my DPT was that I saw that when I would testify on a bill in Sacramento here, there would be people with a doctorate, not necessarily in our field, but just doctorates, so would speak against what we were doing it. And I would get up there and I would have 40 years of experience, and we have a master of public health degree then on my doctorate.
Michael Weinper (00:34:26):
And I were always, and I would like to think I had good presentation and good preparation and knew the facts. And yet it was those who had doctorates that were, or had the title doctor who were paid more attention to now, we as PTs have that title. And now we're sort of in a level playing field with other professions, from the term being entitled a doctor. And with that credibility, we need now to take more action, we need to spend more time trying to create change in my Dicus talk back in 2000, I said that people were afraid of change and it's true. And even today they're afraid of change and we all like the status quo, but the reality is we need as a profession to embrace change because with change comes progress and we need to progress as a field of profession. If you think about things it takes a village if say and certainly in our professional, it's no different, we have to be part of that village. We can't just be part of the tribe. We need to be active leaders of our village.
Stephanie Weyrauch (00:35:43):
Yeah. And I think, you know, if you look back at where we were with direct access 20 years ago, I mean, obviously we're in a much better state than where we were, but some of the resources that I know PPS has for people with their fighting, the direct access is they do offer grants to state associations if they're doing any type of lobbying. So if you haven't applied to one of those, it's a pretty hefty amount of money. It's like five or $10,000, which that goes a long way when you're paying the lobbyists to do the work for you. You know, they also have a key contacts program and they offer resources for practitioners that if you do invite a legislature in a legislator into your practice, or you are trying to advocate for a bill, like they provide all that information for you on their website and on the APTA action app.
Stephanie Weyrauch (00:36:29):
So, I mean, PPS does have resources out there that we can utilize to try to continue in our fight with direct access. And I mean, yes, we're in a much better place than where we were 20 years ago, but like you said, change takes time. And as a, you know, as a young professional, I definitely would love to see change happen even faster. So you know, the more people we can get together and build that village, the faster it's going to happen in your Dicus speech, you also talked about how you envisioned that physical therapist will be evaluating and diagnosing conditions, performing specialized treatment procedures and working with the PTA team. And then you also envision that there would be no referral needed by another practitioner. And I know you've kind of covered this a little bit, but give us an idea of where we are, where we're at with this prediction and what you think the future holds. Because as you know, a lot of these direct access bills that we have still restrict our ability to quote unquote diagnose conditions or even perform specific procedures. So kind of give us an idea of where we are compared to 2000 and where you see us going in the future.
Michael Weinper (00:37:41):
Well we are obviously light years ahead of where we were in 2000, just by hearing what you described to helping things in what I predicted. And I think from the standpoint of going forward, we need to be cognizant of the fact that we can change things if we put some effort to, and in other words, so many therapists don't do things because I think I hear people say, Oh, it doesn't make a difference, or they'll say somebody else will do it. And the truth is that we all need to be more involved. And I'm one of those key contacts and have been for many, many years. I can only tell you that how rewarding it is to invite a legislator or even somebody who works in their office, into your office, into your practice, to visit with you, see what you do, talk to you, the things that are your barriers to growth and barriers to doing for patients, what we should be doing and should have been doing for many years.
Michael Weinper (00:38:46):
And I think it's more important to understand what you can't do versus what you can do. And you only learn that by going to stage or talking to people in other States who have full privileges to do those things and have that true autonomy. So I think that by attending association meetings, for example, PPS is a great example or CSM when it comes back. And, and I say this, not just going to the meetings, but talking to people, not just your friends, but talking to people you don't know, but from other States where you might know there's a lot more progress, ask them what they did and how they did it, or talk to the leadership in those States, in those state associations and ask them, how did they accomplish what they accomplished? Because it takes a lot of work and there's a lot of resistance by other professions, physicians be it chiropractors, osteopaths, even dentists from time to time resist, having us grow to where we should grow.
Michael Weinper (00:39:53):
And the key again is educating the public, what we do. So when you're treating them, let them know what you can do, what you can't do all because of the laws, even though you might be trained to do these things. And sometimes the best advocacy doesn't come from ourselves. It comes from the people we serve our patients. So getting people to write letters to their members of the legislature is very important. But I think getting more people to stand up, write letters, attend hearings in your state Capitol become more involved, become more aware of the benefits you can create, not only for the professional, but certainly for yourselves as well. And that's one of the reasons that I've been very involved in APTA throughout my career was I felt that I had the ability to change things if I would only work at it.
Michael Weinper (00:40:47):
And I was very blessed. You haven't brought it up, but Bob Dicus for who the Dicus award is named obviously was one of my mentors. When I was a student, I got to meet Bob. He was already very deep in his ALS disease in Georgia. He was fully wheelchair bound and tied to a respirator, but that man had so much knowledge. He was one of the first private practitioners. And one should only go to the PPS website and learn more about Bob and what a great man he was and what a visionary he was for our profession. As a matter of fact, just to digress for a moment, he is the one who created the ALS society nationally. He was the inventor of that. He had a second professional. He was in, he was a motion picture producer in his later years when he couldn’t be a PT, he went into motion pictures.
Michael Weinper (00:41:48):
A lot of them had to do with rehabilitation and things that we do. They weren't necessarily featured like Sims, but he got involved in that kind of communication. So it always goes to the fact that I think some of the best PTs are the ones who are best able to communicate with their patients, with the public, with our legislator. Sure. Those are the PTs who really do the best, because if you're good with your patients in communicating, you're able to motivate them to do the right thing. Right. And communication is something that we need to study more perhaps in school. I teach a lecture on communicating with different generations because as I become part of the older generation and looking at the younger people, I see how you and others in your generation and younger generations communicate with one another as much different than what my experience is.
Michael Weinper (00:42:43):
I grew up with our computers. I remember the very first calculators. We were not what I was going through school in high school. We used an Abacus and a slide rule. And then going forward, we used a Texas instruments brand calculator, which was very expensive and very elementary looking back at it. That's an idea of technology when technology and communication are, I think are very interwoven. In other words, as technology increases, communication becomes dependent on that technology. And we tend to communicate less with one another or said differently. I can see my son-in-law and daughter at our house, sit on the couch, waiting for dinner, remake, and what are they doing? They're texting. And I said, who are you texting to talk to them? Wait, what answer? Just speaking with one another. And that's just the world we live in. And then all the little acronyms, all these simple things that you know are, are part of the lexicon today.
Michael Weinper (00:43:56):
Today's younger people, older people don't necessarily know. And when treating an older patient, it's key that you speak to them in a communication form that they're going to understand. And don't assume they understand. I mean, you're saying just because you're saying it, and the same is true for older therapists like myself, talking to younger people, you have to motivate them in a different way. Young people want it. Now they want things quickly. They're used to getting information quickly. You go with something up on Google and get an instant answer on something. Whereas back in my day an encyclopedia sales person used to knock on our door, trying to sell my family a big set of 30 books of encyclopedia. We were tell much to us what we needed for today's knowledge. And I don't think those people around anymore. If at all. If you wanted an encyclopedia, you've got it.
Michael Weinper (00:44:50):
Just look up something in Google or another search engine, and you've got instant. You got too many answers. Sometimes you get different answers for the same question, but with all that in mind, communication is key to success. And we as service need to communicate better, not only with our patients with one another, with our legislators and with the public in general, and to that point, having better PR public wise. And I think APTA is trying to do that. Now that we're into our hundredth year, starting there as your celebration or Centennial celebration. I think you're going to see a lot more information going out to the public, through electronic media and social media, to where we gain a higher visibility with the public.
Michael Weinper (00:45:38):
I had the TV on the other night, I was watching a game show and one of the contestants was a PT. And he was a young PTA until that. And he didn't want a whole bunch of them. I think it was, I believe the show was a wheel of fortune actually, which I don't watch too often, but it was on. And I've heard the word physical therapist. It's just like you, whatever you heard that word somewhere. Even as sitting in a restaurant, you hear somebody talking about their PT, your ears perk up and you sort of start to eavesdrop a bit. And we as a profession don't hear that word in the public as much as we hear about doctors or other things. So I think the public needs a better awareness of who we are and feel comfortable talking to us. And we need to feel comfortable talking to them and educating more about who we are for. They haven't needed to see us.
Stephanie Weyrauch (00:46:26):
I think you make some really good points about the communication aspect and that kind of leads into the next element of vision 2020, which is us being practitioners of choice. So in kind of going off of that with communication, it's too bad Bob Dicus, isn't around anymore to make the next hit healthcare drama on physical therapists. I mean, how many physical therapists and healthcare dramas do you see walking patients or stretching patients? You know, it's never really, they're never main characters in, you know, like Chicago med or Grey’s, you know.
Michael Weinper (00:47:05):
Anytime I see a PT portrayed in these situations. I cringe because first of all, they're wearing, and I hate to say this cause I'm going to probably, I'm going to take an issue with some of you they're wearing scrubs. I don't think I don't scrubs when I grew up were for people working in surgery. Now everybody wears scrubs. So you go to the grocery store. People were in scrubs. They, I think people not even in healthcare wear scrubs sometimes, but I think we should look more professional. We should be more professional and the public will respect us better if we act more professional. And so there are some times PTs who are brought in on dramas to be a technical advisor. I have been in that position before twice, and I have talked to directors and producers about what they need to show.
Michael Weinper (00:48:05):
And I can only tell you that what you tell them to do and what they end up doing sometimes is different because maybe they don't have the right equipment or the character. They thought they already lined up costumes for their characters. It becomes very frustrating, but getting in on the front end and getting the public to understand who we are, hopefully through drama and maybe through, you know, like I say, public service announcements or ads on TV where we're portrayed better or having the opportunity. Many of you are in smaller cities and towns, your local newspapers and television are hungry for local news. And you may be doing something you don't need to think second thought about, but it's newsworthy. Maybe you just purchased a very important piece of equipment to help with ambulation or suspension or something technical electronically to create new opportunities to treat patients your local TV stations would love to demonstrate, come to your clinic, film you doing that and have it as a segment on their TV show.
Michael Weinper (00:49:21):
And many of us don't even think about that. So and I, again, even in Los Angeles market, I've had the opportunity to do that a couple of times. And it can be a little bit overwhelming, a little bit scary, but you know, something at the end of the day, you feel really good about it and how you come across is much better than you perceived. You are going to come across when you're getting ready to do it. So don't be shy, but reach out to your local media and try to get them interested in what you do, because what you do, what I do is very newsworthy and very important for the public.
Stephanie Weyrauch (00:49:52):
Yeah. And you know, obviously people are following what the media says and listening to the media. So, I mean, the media is, has been a very powerful force that you can utilize to spread the gospel of physical therapy so that we can become the providers, the practitioners of choice, for the musculoskeletal system. And so the people actually know that PT means physical therapist and not like personal trainer or part time, people actually know what it means in your speech. You also stated that PTs would be recognized by payers as diagnosticians an entry point into the healthcare system. And I know you've talked, you you've touched on this a little bit, but how do payers recognize physical therapists and how do today's payers recognize us compared to back in 2000? Where are we at with that?
Michael Weinper (00:50:43):
Well, back in 2000, and even in day sense, payers felt we needed to be treating only under a physician's referral. If you looked at insurance policies that you might have, or if you spoke with payers, they would say that PT was a covered service when provided or the auspices of a physician referral or diagnosis today. Many of those policies from the same payers do not have that language. So because of the direct access laws and because of therapists and given States talking to their insurance companies, the payers they've educated them to where certain payers are starting to realize the benefits of PT first. And let's just take substance abuse and chronic pain. We know as musculoskeletal experts, there are lots of things that we can do for the patient to avoid surgery, to avoid downstream costs like expensive imaging that may be unnecessary. We can certainly get the patients treated properly and get them in a mindset to where pain is not top of their mind. I have a book sitting right behind me on my bookshelf. It's called explain pain. Are you familiar with this book?
Stephanie Weyrauch (00:52:13):
Oh yeah, that's a very familiar book.
Michael Weinper (00:52:16):
Okay. And this was a very good book for people to read. It's the authors are David Butler and Lorimer Moseley, and they're down in Australia, but they talk about dealing with the mental side of pain, the cognitive side of pain, if you will, and how to best creature patients in deemphasize of pain and emphasize wellness or health. And we need to do more of that as practitioners. And as we can educate our insurance companies, that by sending the patient to PT for four or five, six visits, we can avoid surgery, many cases, what is a cost benefit to the insurance company? Their insurance companies listen to money. And I know this from my experience for many years of working with many of them speak with probably too many insurance companies to not only remember, but to count. And they are driven by dollars and they do not put enough emphasis on times in their underwriting to allow PTs to do the things we do.
Stephanie Weyrauch (00:53:26):
Yeah.
Michael Weinper (00:53:28):
Shortsighted because they ended up then forcing patients to go to a physician first, wait, several days or weeks to see the physician where the patients only getting more deconditioned. And rather than just seeing us first, and we have the opportunity and the knowledge on doing things that get the patient out of the problem or fixing the problem, if you will, from a nonsurgical standpoint. So insurance companies in some cases have become much more enlightened and other cases are still in the dark ages. And those who allow us to treat without referral and pay us for what we're worth are the more enlightened ones, some insurance companies that I've dealt with now in recent years are paying for outcomes. There's concept of paper for pay for performance or P for P. I like to call P fro. It's really not what you do, the process of what you do, but really the outcome that you get.
Michael Weinper (00:54:27):
So if you can get a great outcome with fewer visits, then insurance company should be willing to pay you more because you reduce their costs. And, not only of what you did in terms of your crew cough, but in terms of what would otherwise cost them to treat the patient going forward. So I like to pay to pay for outcomes Peterborough, and that's why we, as a profession, need to do more in the way of outcome measurement, whatever tool we use and be able to communicate to the payment payer community, the benefits of what I do. So I'm going to go back now to the mid seventies again, when I got my master's degree we learned even back then that the definition of quality in healthcare was composed of three things. And the author of that was a fellow who's no longer with us.
Michael Weinper (00:55:22):
His name was Avitas Donabedin. He was a physician. He was very involved with the new England journal of medicine, D O N A B E D I N, if you want to look it up and Donabedinn even back then said that quality health healthcare was three things structure, which is where you do it and what you use in terms of equipment process, what you do okay. And outcome, or the results. So we all have been able to measure it structure, and we were able to mission measure the process where you, but not enough of us over my career have been able to truly prove that what they did was a benefit. And I think that that's one of those things that we have to focus more on proving the benefit of PT two outcomes or said differently because of what we do, patients get better quicker.
Stephanie Weyrauch (00:56:16):
And that leads us really nicely into the next element of vision 2020, and that's evidence based practice. So obviously APTA has done a lot over the years to try to improve how we're measuring outcomes. So you have the outcomes registry CoStar was created. If you look at how much the literature has been put out for, if you search, if you search up physical therapy, even in Google, it's, you know, an exponential growth since even 2000 and even the larger growth. If you think about it from even the 1970s, when outcomes were first described. So, I mean, this is something that, you know, we've been working on for a long time. I think that obviously it's come a long ways, but we still have confirmation bias in our literature. We still have group practice that people are practicing. We have treatment fads that really don't have a lot of evidence behind them. And we have practice variation that continues to affect our outcomes and affect our profession. How can PPS help offset this? How can we continue to go forward to mitigate some of these things that are occurring?
Michael Weinper (00:57:24):
Well, that's a $64 question, as we used to say my hero. I think it's important that we need to, you talked earlier about one of the goals of PT, 2020 is lifelong learning. And I see too many people in our profession who don't come to meetings of the profession, whether it's a local meeting in your area, whether it's a state conference whether it's CSM or PPS meetings, too many of our colleagues never go, or maybe they went as a student cause their school paid for them or somehow or another they're were to go. And they never ever go. If you think about people, you went to school with Stephanie, you never see them again. And you wonder, how are they getting their education? One of the things that has occurred a dream the last 15 years I would say is the requirement by States that each PT in order to continue, their licensure must have continuing education, a certain amount.
Michael Weinper (00:58:35):
And it varies state by state, as we know, and what things have to be parts of that, continuing education, again, vary by state by state, but at least we're being forced now as a profession to continue our learning. Having said that, and having taught in different venues in different ways. I can tell you, there are people who are serious learners, and there are people who we call lazy learners. The lazy learners are those who will buy the cheap level CEU kind of stuff, and do a quick read on something and take a test and not really spend the time to investigate what was being offered. And maybe some of the quality of that they're learning is really not up to date either. Versus those of us who will go to con ed meetings, we'll do things online. Now there's a lot of opportunity. PBS shows a lot of things out ABQ has a lot of things.
Michael Weinper (00:59:35):
I'm a member of the orthopedic session section and the oncology section. They have lots of stuff going on that, yeah, there's too much of it. There's just like there's like education overload. So you have to be selective, but do choose things that I think will be beneficial to you. And that are evidence-based. So it brings back to the evidence based part because too often I've heard people get up at meetings and start to talk about things. And then when challenged on what's the word, what's the basis of your comments? They sort of stammered. And they said they gave answers that weren't really appropriate. So we do need more focus on, on lifelong, which we’re mandated to do, but some people take the easy way out. You know, people, we all have people we know who will take the high road and others who take the low road and the low road may be the easier road that may not be the get to the right end.
Michael Weinper (01:00:29):
So we want to challenge ourselves to learn more each day. And I can tell you that when I went back and got my DPT, I thought it would be fairly easy. And some of the things that I was exposed to, I'd already learned in my master's level, but I can tell you a lot of things that I learned were new concepts that I had never even thought about. And that goes to the idea of this lifelong learning and evidence based practice you learn, most of you learned in school all about evidence-based theory and practice, and some of you embraced it very well and other views sort of gone a different path. So I would say, take a step back and look at the research that's coming out. There's all kinds of journals. And that's another thing that I have to digress on a moment.
Michael Weinper (01:01:17):
And that is, here's a question for each of you, how many journals or publications that are healthcare oriented, do you read or subscribed to, if you say only PT, then I think you're making a big mistake because there's so much literature and so many things that are appropriate for what we do in our field. And to validate what we do in other journals and research is being done that we miss the boat by not looking at it at other professional journals or other modes of information, or even attending meetings for physicians and so on. I used to specialize in the treatment of hand injuries. And so I would go to the society for hand search and they actually had a PT sub, a PTO to see subset of that that my friend, dr. Susan Mike Clovis, was very involved in and she got me involved and I would listen to physicians.
Michael Weinper (01:02:18):
We collegial meetings where PTs and physicians would interact to try and come up with the best ideas. And many of us don't really have any contact with physicians, except when we're talking to them in the halls of the hospital or when we're going out to market them, or we're trying to take lunch to them. We don't talk really about concepts and about theory. And what do you base this upon? And what can we do to learn more about the benefits of what we do? And that gets us to the idea of each of us having the challenge to do some research, research is fascinating. It doesn't pay a lot, but you can still do research in your clinic. You can be parts of research projects. If you just look for them, is they're out there to take advantage of. And if you do that, it opens your eyes so much more.
Stephanie Weyrauch (01:03:09):
And I think a lot of the things that you've touched on kind of goes with the last element of vision 2020 and that's professionalism. So when the house of delegates originally defined what professionalism means in vision 2020, it's that we as physical therapists and physical therapist assistants are consistently demonstrating core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability by working with other professionals to optimize health and wellness in individuals and in communities. So obviously one of the bigger focus is of APTA has been this optimizing society or optimizing movement to impact society. And we've been kind of taking more of a population health kind of perspective, trying to get out of the silo, physical therapy and move more into the interdisciplinary healthcare, healthcare, professional realm. Where would you say we are? As far as our professionalism goes in 2020, compared to where we were in 2000?
Michael Weinper (01:04:15):
Oh boy, I think many of us have because of our increased education, gotten more credibility with the medical profession. They tend to listen to us more rather than just seeing us as a technical entity or a technician versus a professional. Although I can tell you still today, physicians oftentimes don't see the benefit that we do even orthopedist. And we have come a long way in some with so many physicians, but we've missed the boat with others. I think it's critical than medical stuff, schools, especially if you're doing an orthopedic residency, that's a resident spend time with a PT. I was in a well known physician, internationally known physicians office recently with my wife who, when she had her shoulder surgery. And he has no to fellows at all times. And occasionally a PT will visit and come in and, and be there not to get paid, but just to talk and work with the physicians, educate the physicians and the younger ones, the fellows who are going to be out there real soon in their own practice.
Michael Weinper (01:05:34):
We need to do a better job of educating physicians. I said that a little bit earlier, but I really mean it. We can do it when they're in school, when they're doing their fellowships, we can invite them into our practices. We can go to doctor's offices and shadow them much more than we do. We can go into surgery with physicians and talk to them while they're there doing their procedure, learning why they're doing their procedure. And sometimes a light bulb will go on in your head say, Oh, I get that. And that's, I think there's something I could do a little bit differently with like, with your patients when I'm treating them by seeing what you're doing surgically and listening to what your concepts are. So I think there's a lot more collegial realism of that goes to being a professional. And to that point, if you don't see yourself as a professional others, aren't going to see you as fun and too many of us lose track of the fact that we are in it.
Michael Weinper (01:06:27):
When you say it's a profession, a profession requires one of the key points of any profession is that you learn, you keep current and you give back to society. And giving back to society means more than just treating people. It means educating the population, doing things from a wellness standpoint or avoidance of injury. I guess going back to my public health days where one of the key things is getting people not to have to see you clinically as a post op or whatever, but helping people to avoid surgery and do things the proper way. Ergonomics for example, is a good, good use of our skills and what we've learned as I sit up in my chair properly. And we doing things that people just don't think about. And when we break away from just being the PT, treating person and branch out to media with other professions, talking to them about what are their challenges, what can we do to help though, or thinking about things we can do to help them communicating better in collegially at different levels. Then we go a long way towards not only building those relationships, but most importantly, helping the patients we serve. So it's one thing to say your profession. That's another thing to give back to society and find different ways to give back
Stephanie Weyrauch (01:07:55):
What, you know, from this conversation. Obviously we've come a long way since 2000, we've achieved many things that vision 2020 set out to achieve, but we still have a lot that we yet need to achieve. So kind of on that note, Mike, you know, what is a clinical Pearl that you can kind of leave all of us with? What is some advice you could give a young graduate or somebody new in the profession that maybe you wish you would've known when you were coming out of school?
Michael Weinper (01:08:29):
Oh, that that's an easy question to answer because I oftentimes get asked by younger PTs, how did I become successful? I say very simply through volunteerism, volunteering your time to help your profession and help those we serve, whether it's going to a health fair and educating the public, you ever done that fascinating what they don't know and how the aha moments you see in the public. When you spend two minutes with them screening students preseason athletic screening, another great opportunity to follow tourism positions you're working with, Oh, that's how you do that. That's how you measure that. I didn't realize that. And that's another idea, again, of getting involved, getting I talked earlier about legislation, getting involved in legislation, getting involved in your association is what I think makes you successful. And to that point, I think that the best jobs of PTs get are not the ones they see through a Craigslist or three C on the association.
Michael Weinper (01:09:41):
Advertisements is from talking to other therapists, word of mouth learning, where are the best jobs to be had. And the only way to do that is not staying in your little house if you will, but getting out and talking to the PTs. That's like I said earlier, getting to know other PTs there's this PT pub nights that I see around the country, what a great idea I've gone to them. And they're actually fun. I stood out in the rain. They had an outdoor one here in Southern California, and you don't get a lot of rain here, but that particular night, we all were standing outside of this venue drinking our beverages of choice, getting soaked, but having a good time. And it's very memorable and getting to know other people and volunteering just goes a long, long way. I think, to learning more and learning what needs to be done, if you could learn what needs to be done and then not put it on somebody else, but say, I'm going to take responsibility again, getting back to I'm a professional.
Michael Weinper (01:10:43):
I need to be professionally responsible. I need to be the one who does this. I know you're one of those people. I'm preaching to the choir. Stephanie, when I say this and you know exactly what I'm talking about, but so many people who might be listening to a podcast like this, don't quite follow it. So my challenge to each of you would be get involved in your profession and spend a little time here and there, away from family away from work away from your social activities and back to your profession. That's part of being a professional. And as you give back, the more time you give the more you get. And I like to leave this thought with people. And that is for all the thousands of hours, I guess, at this stage of my career, I have given to my profession, whether it was the local district or my chapter or the national association or the private practice section or other sections I've been involved with or doing things in the public realm, getting involved in I was involved in a college board. So people got to know me as a PT and as an individual and get to know more about PT, getting involved in society, rather than just going home at night, turning on the TV, or turn on your computer or playing games, getting more involved with people and trying to do good things for the public benefits you directly.
Stephanie Weyrauch (01:12:11):
There were some wise words spoken by a true visionary of our profession. So thank you so much. And thank you for all of those who listened to this episode of the healthy, wealthy, and smart podcast and I'm your guest host Stephanie Weyrauch. And I hope that you stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jamey Schrier on the show to discuss how to develop your dream private practice. Jamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He’s an executive business coach and leadership trainer.
In this episode, we discuss:
-Jamey’s entrepreneurial journey
-The importance of vision and giving yourself permission to imagine your dream practice
-How to generate revenue even during unprecedented times
-Why building a team of experts is necessary for you to grow your practice
-And so much more!
Resources:
Jamey Schrier Twitter
Jamey Schrier Instagram
The Practice Freedom Method Facebook
FREE GIFT
Practice Freedom Method Website
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Jamey:
Jamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He’s an executive business coach and leadership trainer. Founder of Lighthouse Leader®, Jamey helps physical therapy owners create self-managing practices that allows them the freedom they want and the income they deserve. He is the best-selling author of The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion
A graduate of The University of Maryland Physical Therapy School, Jamey specialized in orthopedics and manual therapy. He was the sole owner of a multi-clinic practice for more than 15 years.
Jamey’s passions are basketball, tennis, golfing, and reading. He and his wife, Colleen, and there 2 kids live in Rockville, Maryland.
Read the full transcript below:
Karen Litzy (00:00):
Hey, Jamey, welcome back to the podcast. I'm happy to have you on again.
Jamey Schrier (00:05):
Karen. It's lovely to be here.
Karen Litzy (00:07):
Yes, no stranger to the podcast. That is for sure. And that's because we love having you on because you always give such good information to us PT business owners. So thanks for coming back now, you were a PT business owner yourself. People can go back and kind of listen to the past podcast that you did with us to get even a dive in a little bit deeper to your history and how you kind of went from a business owner to now coaching and mentoring in a training business. But can you give the cliff notes version for us now?
Jamey Schrier (00:45):
The cliff notes. That's how I got through school. Yes. Be happy to give the cliff notes. So I always wanted to have my own business ever since I was younger and went with my dad to his store. I thought it was the greatest thing. So when I got the opportunity to open up and put up my shingle, I went all for it. And I had my fiancé Colleen at the time. Now my wife who you have met, she was, yeah, she was my fabulous front desk. So it was a perfect scenario. Right? I was the quote, the doctor doing the treatments. It was the happy go lucky front desk. And it was a perfect scenario. And that lasted for a couple of years until we started to hire people until I said, honey, do you want to get married?
Jamey Schrier (01:35):
And she said, sure, boom. She left. She got 35 books on weddings. And she was like, not really there that much. So we had to actually grow a real business. Well, I really didn't know how to hire. I just assume everyone worked like I did everyone thought like I did. Everyone just did quote the right thing. And that's when a whole lot of stress and a whole lot of struggle started to happen, which caused me to create this sense of anxiety that I really didn't experience before. Definitely not as an employee, but I didn't experience for the first couple of years in business. So my hours started to increase. So not only that I have to do the treating and some of the other duties that I had to, but I also had to oversee them and all their stuff. So I took half of their job as well.
Jamey Schrier (02:23):
And about four years into it, a crazy thing happened, which I've shared before, but I will quickly share. It is my place burned down. We had a fire and it burned down and I was caught with these weird feelings of feeling relieved. Great. I don't have to go to work on Monday and feeling scared to death and feeling, Oh my God, what do I do now? Not just similar to what has happened with, COVID like, Oh my God, I wasn't prepared for this. What do I do now?
Jamey Schrier (03:00):
So after some soul searching, I realized, I don't know anything about how to build a business. I was a very good clinician. I thought being a good clinician was enough. It was not. So I spent the next nine years learning, trying, failing, learning again, trying and failing of how to build a business that can literally operate with a little bit of maintenance, but not me. They're doing all of it. And fortunately I figured it out and in January of 2013, I removed myself scared to death, but I did it anyways. Remove myself from the schedule no longer I was treating my team was handling it and my business shot up. So I got more time and I made more money and my team was great and my patients were happy and I was like, Oh my God. So I went on a webinar. I believe it was the private practice section webinars that they do. And I just shared my story. People reached out. And next thing you know, I was in the coaching business because they were asking me how I did it. And I've been doing that and being on a mission to help other practice owners try to build, grow their business for the last seven years.
Karen Litzy (04:11):
Awesome. And the name of your courses?
Jamey Schrier (04:19):
So the name of the company is Practice Freedom U, the letter U kind of playing off the university thing. And it is a really a business training and coaching firm. So we help the practice owners and we help their teams and grow and build the kind of business they like. So they can have the kind of life that they want.
Karen Litzy (04:40):
Awesome. And now you had mentioned in your story about when your practice burned down, you kind of weren't prepared for it. It's like kick in the guts. So the country, the world continues, not has been, but continues to live through the COVID-19 pandemic. A lot of clinics had to close. Some may still be closed as we tape this. I am in New York city. We are just reopening now. So as owners begin to reopen and restart, delivering their patient care, what are some of the not so obvious things that they should be aware of?
Jamey Schrier (05:23):
Yeah, that's a great question, Karen. What I learned in my experience when the place burned down and literally I had nothing to go back to, what was difficult about that was I was the only person going through that everyone else was just business as usual. And my initial instinct, because I am a high achiever because I am a doer was to do more like, okay, what do I got to do? What are we going to do? And it wasn't until maybe a couple days into it that I began to learn that, you know what me trying to do more me trying to be busy and filling up my day with just stuff. Even though I had no patience at all. And there was, by the way, there was no tele-health right. I mean, there wouldn't be telehealth right now if there wasn't a whole country, if it was just one person, the insurance companies wouldn't be changing all their rules.
Jamey Schrier (06:26):
So, but we didn't even have the technology for that. So what I did was I just started to sit and think and just sit with, well, okay, I'm going to rebuild this. If I'm going to rebuild this, what is it that I really want from this business? What wasn't working well. And I started to write out this, this idea, this outline of what I wanted the business to be. Now, mind you, I didn't know how I was going to get there. Right? I didn't know that, but the more I ask questions, the more I said, what would my business have to look like for me not to work 70 hours a week, which is what I was working, what would happen? What would my business have to be? If I didn't work the weekends, who would I need to hire ultimately to perhaps not have to treat or choose the people I want to treat.
Jamey Schrier (07:26):
So, as I started asking these questions and gave myself permission, love that word, I gave myself permission to imagine what it would look like. It started to create the outline. And this is exactly what I did and what I shared with other practice owners, what to do during this time. First of all, pause, acknowledge what the hell was going on right now, because it is unprecedented. I hate that word because everyone's saying it, but it is something that you are not prepared for. And it is something that everyone is going through. The people that are going to get through this and be better than they were before, or the people that are not trying to go back to where they were. It's the people that are pausing and saying what an opportunity to fix the things that were broken and to ultimately create what I want.
Jamey Schrier (08:21):
It doesn't mean it's going to happen today or even in a week, or even in a month, or even in six months. But it's something that can start to help you create the outcome you're looking for, which then causes you to focus on where do I work today, this week? Who should I keep? Who should possibly, I keep furloughed, right? If you're like me at the time I was treating for, you know, 12, 14 years, I was like, maybe you want to reduce your schedule. What would that have to look like to reduce your schedule? Because now's a great time to start searching for therapists. Cause they're out there. And then maybe you weren't as keen on some of the metrics you weren't as clear. Well, what a great time to start getting really organized. So I tell people the not so obvious things is for you to pause, reflect, and start to ask the question.
Jamey Schrier (09:21):
I love questions better than statements, but start to ask the questions. What would it look like in order to blank? What would it have to be? Who would I have to have in place? What technology we would have to be. You don't have to answer the questions. And that's the mistake that people make. They put all the pressure to have to answer them today because we are doers. We are problem solvers, give yourself a break, give yourself permission, just put them out there. And something interesting is going to happen. I know you and I have talked about this in the past. It's amazing how things start to happen. How people start to show up people that are like, wait a minute, fall into place. They start to fall in place. And it seems like this voodoo magic. It isn't, your mind will start to look for your subconscious mind will start to look for these and it could be right in front of you, but you never saw it before. It's kind of like, where's the salt honey, where's the darn salt. Then she comes in just right in front of you, your mind, wasn't seeing that. So that's kind of the things that I would initially suggest, and then that kind of guides you to. So what are the key elements that you have to do now, which I'm sure we can dive in.
Karen Litzy (10:34):
Yeah. So let's talk about that. So aside from the obvious safety of your staff and of your patients, that's clearly number one, right? And we want to make sure that when places reopened that that is number one priority. So putting that to the side, because that is hopefully a given for all physical therapy practice owners, right. If it's not, I think you need to go back and ask yourself some questions, but so that should be number one. I think the other thing that a lot of owners are struggling with is the lack of money, lack of revenue that you missed from your business, let's say over the past three months or so. So do you have any thoughts on how owners can build back that revenue?
Jamey Schrier (11:22):
Yeah. And that is from the people that I've spoken with the surveys we've done, I mean, that is the number one stressor. I mean, you would want to think it's safety it's to protection. Well, the thing that stresses us out is if we don't have any money, we don't have security and stability and we can't take care of our own family. And that stresses the living daylights out of us. Cause for many people, that's why we went into business to be able to have that control and freedom to create the lifestyle we want. So we know that the biggest stressor
Jamey Schrier (11:54):
Now, for many people, you have a PPP loan, you have maybe a EDIL loan. So it's important to get clear on what options you have find eventually. So some people are kind of coming out of that PPP loan, like the money's gone, they just reacted, they got the loan and they thought they were doing a good job by keeping their staff, even though their staff didn't do anything, except write some blogs and send out some YouTube videos, but it didn't generate anything. So you know, you have to look at what you have available. So that's number one, get your financials in check. So you know, for our business we brought in accountants, we brought in attorneys, I'm sure you know, Paul well so we brought in people and I know for me personally, when this happened, I reached out to experts in this area. I reached out to my accountant, to my financial advisor.
Karen Litzy (12:55):
Are you kidding me? I was on the phone with my accountant, like literally, almost every single day and emailing him several times a day and thank God for accountants, what gems.
Jamey Schrier (13:08):
Yeah. But you know, what's interesting, Karen, not everyone thinks like that. You see, we are rugged individualist at heart. What is this business? We struggled. We sacrificed, we studied, we got A's and that is not how you build your business. You need to be.
Karen Litzy (13:25):
Yeah. That's how I used to be. Now. I'm like could you help me with this, this, this, and this? I mean, because I don't, I'm not an account. I've never filled out. Like I got a PPP loan. I didn't know what I was doing. So I would take screenshots of everything, send it to him. And then he was like, put this number here, put this number here, put this number here. And I was like, did it digit to do? And guess what? It was approved. If I didn't have his help, I wouldn't have been able to do that. I have learned, I've seen the light.
Jamey Schrier (13:54):
Don't tell anyone. I did the same thing. I call my accountant very calmly. I said, Hey Greg, what should I do? He said, well, it makes no sense not to get the PPP loan. I mean, it's more or less going to be free money. Who knows what's going to end up happening with it. But go ahead and apply that. I said, great, can you have someone help me with that? Because if I don't feel like doing it and he's like, sure, yeah. So everyone's talking about PPP loan. Everyone's freaking out. I've had, I can't tell you how many dozens and dozens and dozens of conversations I've had with business owners. Because I asked him, I go, so who's on your team. Do you have an accountant, financial advisor, someone that understands this and they went, well, I have a friend or a neighbor that does my taxes. And I'm like, see there lies the problem because you don't look at your business as a team of people that are experts in different areas.
Jamey Schrier (14:52):
So if you're going to learn from this whole COVID thing, start building the experts in your business. So it doesn't fall on you to try to be the expert that you're not. And give yourself permission, Karen, like you did. And I did. I'm not the expert nor do I want to be. However, I do know enough to know that I need to talk to the accountant about this particular problem. Yeah. So talking to someone, even if it's your bookkeeper and start to design what you have available, because that is going to determine if you have literally no money available, then bringing back all your staff isn't feasible, right? It's just not going to happen. But if you have some money available, if you have some other loans, maybe you have equity in your house. Maybe you have some things, not that you're going to use it, but you have it there.
Jamey Schrier (15:46):
Then the next thing is, start to create the plan, have a plan. Now I typically teach what's called a 90 day sprint, right? 90 day sprint is what is the outcome? The number one outcome you want in the next 90 days, once you're clear on that outcome, let's say the outcome is I want to be a lot of outcomes for people. I know I want to be back up running the way we were before at the same level, it doesn't mean they're going to do it, but it's amazing how many people have believe it or not. It's amazing how many people have that. They are literally 80, 85% pre COVID and they just, you know, kind of reef officially grew up in a, you know, for six weeks ago. So it's amazing what happens when you put that scary goal out there. But the purpose of it is to just reverse engineer down to, so what has to happen this week?
Jamey Schrier (16:46):
What are the two or three things that have to happen this week for you to start moving towards that? So once you get clear on your financials, you got to start making decisions about your staff. The one thing I would be very weary of is diving back in. If you weren't that before, if you were not treating 40 hours a week, I would not knee jerk reaction to go back to that. The reason is this, I know it seems. Yeah, but if I do it, it's like free money because I'm not paying myself. Yes. That would seem to be the case, but it's not. It's actually going to cost you more money because your mind, your creative energy is all taken up by taking care of the patients in a very emotional setting, dealing with the notes and the insurances and all that. And you're not taking a step back and a 30,000 foot view and really seeing the different components of the business.
Jamey Schrier (17:50):
And if that happens, your natural response is going to be quick, impulsive decisions. Even you think you're a hundred percent sure of the decisions you can't trust yourself because of the emotional state that you're in. So if you've been a treater before, okay, if you want to go back to that fine, cause you still need to remove yourself at some point, even if it's cutting your schedule down, cause you need to look at things to run your business. So, but if you're not, take a survey of your staff, who's essential. Well, you need people that can generate money. I would choose the people that were the most productive before. COVID sounds obvious, but sometimes you kind of like so and so more, but even though they weren't a great therapist or not a producer and you make decisions like that, or you haven't really had numbers, you're not even sure what your metrics are.
Jamey Schrier (18:45):
We never really tracked productivity. I think this person was good. So look back at that. Or when, in doubt, who was sought after bring those people back. Now, if you're deciding on will Jamey, should it be full time or part time there's other models out there. I just got off a conversation with a guy that has a business around employment payment models. And he was talking about, you know, this model of shared risk is becoming more and more popular. So perhaps you do an hourly model. Perhaps you explore a shared risk model where the person gets maybe one third or 40% of their income and then they get targets and they make money based on that. You don't have to know what that is. You just have to know that someone is out there that knows what those options are. Your job is to go out there and find out about it and then share it with your staff.
Jamey Schrier (19:48):
So really getting clear on your team and who you need. I would absolutely bring a front desk back, obviously your billing and all that can be done from anywhere. And then the biggest thing is if you don't have patients in the door, none of this is going to matter. Your money will eventually run out. So I am a simple person, you know my stuff isn't rocket surgery. As one person once said it isn't rocket surgery. What was working before COVID hit? Like, what were you doing? I know most people will answer. I don't know. It was kind of word of mouth. I was kind of doing this. Like they weren't really clear on that. Well, first of all, moving forward, let's be really clear on that. What's working. What strategy was working. One of the most basic strategies you can use.
Jamey Schrier (20:39):
That's a human strategy is reach out to your people. If you haven't already, most people have reach out to your patients, reach out to the list of people, check in with them, see how they're doing. And they've been cooped up for months. I don't know about you, but I got problems all over the place. Cause I haven't been able to exercise the way I want I'm stress. Of course, stress goes to my back and my head shoulders, these people, it's not like COVID took their health. I mean, they still are human beings. They still have the same problems they did. If not worse, how can you help them? So approach it from, Hey, how are you feeling with all this? Well, my shoulder hurting, Hey, you know what? And then you just offered maybe a free consult. Then you do it either in person or through tele medicine.
Jamey Schrier (21:30):
Yeah. If you do that and you approach it genuinely like you want to help them, man, I've had people generate dozens and dozens of patients quickly. And I would put the people that are best on the phone that had the highest level of communication. Don't put someone that doesn't really like people that much, you know, like don't put that person on the phone. They're not going to like having that conversation. Same thing for your referral sources, same thing for your referral sources. And you know, can I share one strategy, marketing strategy, eight marketing strategy. And you and I were just talking about it right before this, you said, you know, I couldn't get half these people on my podcast and now what else are they doing? They're like, sure, I'll come and share all this stuff. Well, we have a simple strategy that is called an interview spotlight strategy.
Jamey Schrier (22:27):
And all you do, same thing. What we're doing here. You just reach out to a rep. We call them referral partners. But someone that oversees and has influence of your target audience, right? If you're going to do this, do it with someone that as you build a relationship can send you the kind of people you want and you offered to interview them and you choose the topic. That would be interesting to your audience, to your list of people. So do you specialize back pain? Are you a vestibular person? Are you pediatrics? Women's health doesn't really matter? And you say, Hey, I was you know, I was thinking we're starting in an interview. Spotlight interview love to interview you. It's all through zoom, 20 minutes, 30 minutes, whatever it is, we'll promote it to all of our people. So I'm sure you'll get some recognition and business out of it. And if you'd like, you could promote it to your people as well. And then you end up with marketing term leads, prospects as well. But what really happens is you start building a connection, a deeper connection with the referral source, who obviously is, you're going to be top of mind with them because you reached out and helped them. You weren't the person sucking on the teat did, give me, give me, you were actually providing something first.
Jamey Schrier (23:46):
One of my clients did this and he generated 50 cases, 50 in a very short period of time in New Hampshire, like massive town. And he said, this is like, I think it was like 52 people. Exactly. But he said, Jamey, this was easy. And it was fun. It was really a lot of fun. And because we're all used to zoom now, the technology is so easy to use. You just record it. Doesn't have to be video. You can do audio and you just save it and slap it in an email.
Karen Litzy (24:18):
Yeah. Yeah. That's a great marketing tip. Thank you for that. And just so people know it doesn't, you don't have to have a podcast to do that. You could just, like you said, save it, send it out to your list. Even if your list is five people or if it's 500 people just, you're just creating good content that people want to hear.
Jamey Schrier (24:40):
And you're meeting people, who's a great marketing, same and it can be used for anything. Always meet people where they are not where you want them to be. So if I was going to do this in New York and let's say reach out to some docs or reach out to some other people that may I'm like if you do with personal trainers or CrossFit or whatever your audience is, my approach in New York would be different than my approach in the Midwest. Of course, right now, the template's the same, but how you're going to do it, how you're going to, I mean, what you're going to talk about the content has to meet your people where they are. If you start talking about, Oh my God, we're opening up. Things are great. And all that. That's not going to land on a lot of people in New York.
Jamey Schrier (25:31):
So meet people where they are meet the doctor, meet the people, meet the other referral partners where they are and see how you can help start cultivating these relationships. And as your town opens up more and more and things get back to quote normal, whatever that is that bonding is what separates you. That's what keeps giving again. And again and again. So how many of these can you do? I mean, I know some people are doing like twice a month and they said, this is just fun and it's easy. And by the way, it does lead to other opportunities.
Karen Litzy (26:07):
Sure. Tell me about it.
Jamey Schrier (26:09):
I mean, your whole business is built on, you started this. You're like, I'm trying to figure this out and all of a sudden you've done. I don't know thousands of episodes. You've met all kinds of people. I know you used to travel around the world. So this is a formula. And it's a really powerful formula. I'll tell you the hardest part about the whole thing.
Karen Litzy (26:31):
Yes, absolutely.
Jamey Schrier (26:35):
Passion. Don't let the little critic on your shoulder go, but you can’t do it. I think you need to be, you need to learn more about zoom. Just do it, just do it.
Karen Litzy (26:37):
Yeah. So yeah, it doesn't have to be perfect.
Jamey Schrier (26:49):
It better not be, if it's perfect. It's too late. You're not doing something that's rusty, not rusty, but like just rough around the edges and stuff. You've waited too long. You need to get what is called the minimum viable product up running and out. Then you learn from it and your fourth interview will be a hundred times better than your first. And there's nothing you can do about it. Yeah. So true. So how quickly can you get to the fourth interview?
Karen Litzy (27:19):
Yeah, that's great advice. And now as we kind of wrap things up here I know that as we were going through this conversation, one thing that struck out as like, you just can't do all of this stuff on your own. It's what I should say. You can, but it's really, really hard, right? Why would you, so having a mentor coach, is something that can be so helpful. So where can people get in contact with you if they feel like, okay, I've got this business, I'm ready for it to grow. I don't know what the hell I'm doing. So where can people find you and learn a little bit more about what you're doing and if you've got any free resources and things like that for people that would be helpful.
Jamey Schrier (28:12):
Sure. So I want to just real quick, I know we're coming up on time here, but I want to address real quick with the idea of the coach or a mentor. You know, a coach isn't the end all be all it. Isn't the person that has all the answers and all the solutions to your problem. The way I got into coaching was I resisted it because I was a rugged individualist. Who's smarter than most people who could figure it out. And eventually I started looking at my bank account, looking at the amount of stress I was dealing with and looking at how many hours I put in. And I said, these aren't the results I want. So whatever I think I am doing, it's not getting the results. So can I just swallow my pride and my ego and go ask for help.
Jamey Schrier (28:55):
And that is so hard for high-achieving individuals like ourselves. So if you are at the place where you're like, you know what, I want some guidance because to me, a coach is guiding you. It's a co collaborative effort. It's strategic thinking partners. If you want that person go and find the person that connects to at practice freedom U I built our company based in part of providing people that kind of business coach, that kind of guide that helped them through some of these problems. Cause it's hard to think of it. I've had a coach for over 14 years. I'll never not have a coach because I don't trust my own thinking because I don't know what, I don't know. So if you're interested in that, you can certainly reach out. You can check out our site, practicefreedomu.com.
Jamey Schrier (29:50):
You you can get my email from Karen, but one of the things that I thought would be a great thing for your audience is to give them a little insight on some of the things we talked about today and a lot more other things that I think are very appropriate in how to restart, rebuild, and build your business the right way. I did write a book called the practice freedom method and it's 12 chapters of various things from marketing to hiring, to financials a lot with my story and all the struggles I went through. I share all the crap that I went through. So you can learn from it and I wanted to give it to your people for free. You can download it immediately. It's the entire book, but feel free to just go through the chapters it's in digital form.
Jamey Schrier (30:42):
You just go to practicefreedomu.com/healthywealthysmart-podcast, and you'll just get it immediately. So that would probably be the first place that I would go. And if some of my stuff resonates and you want to have a conversation happy to do so, if not, I would just seriously, you know, consider getting a mentor, finding someone or even maybe a small mastermind group, just people you resonate that can think differently than you to help you through things that alone will take you down a better path, regardless of the specific strategy or tactic that you use.
Karen Litzy (31:21):
Right. Excellent advice. And thanks for the free book. And that'll also be on the podcast at podcast.healthywealthysmart.com under this episode. So one click and we'll take everybody right to that site. And now last question, knowing where you are now in your life and in your career, what advice would you give to your younger self? Say a young pup, right out of PT school?
Jamey Schrier (31:49):
Young Jamey Schrier that's scary. Cause I was one cocky son of a bitch. God, I knew it all. Fear is a part of this fear is a part of growth and it is never the right time. You will never feel like you're enough. And if I had to talk to myself before I would've told myself, swallow your frickin pride and start hanging around people that you want to be like, that you're in that you're impressed by something of what they're doing. Just be there, just be with them. And just soak up some of that. I didn't do that a ton. I had a little bit of an attitude towards that. I don't know why. I don't know where it came from, probably because I wanted to feel improved to myself. I wanted to do it on my own. And the reality I look back and I was like, God, that was the stupidest thing I ever did. So whatever your passion is, whether it's business and you want to do your own thing, whether it's side hustle, I know that. Or whether you just want to be the greatest therapist or clinician or researcher, just connect with other people. People are so awesome in giving and providing, but they're not going to do it without you coming to them.
Karen Litzy (33:10):
Yeah. They're usually not knocking on your door while you're on your couch watching TV.
Jamey Schrier (33:15):
They're not going to come to you and what the successful people out in the world. I don't just mean financial success. I mean success and happiness success and just who you are as a person, just your own wellbeing. All of those people have these groups, these connections, these people, they reach out to, they all do. They might not talk about it, but they all do. They all have coaches. They all have mentors. They all have people they connect with. And when you do that, it just makes this so much easier and so much more fun.
Karen Litzy (33:48):
Yeah, absolutely great advice. So Jamey, thank you so much for coming on and everyone again you could go to a podcast.healthywealthysmart.com to get the book or go to freedom practice U the letter freedompracticeu.com/healthywealthysmart-podcast for the book. And you can also find out more about Jamey, what Jamey's doing to help so many physical therapy business owners around the country. So Jamey, thanks so much for coming on again. I appreciate it.
Jamey Schrier (34:25):
Oh, thank you, Karen. Enjoyed it.
Karen Litzy (34:28):
Great. And everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Erica Ballard on the show to discuss how to optimize your health and performance through nutrition. Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules.
In this episode, we discuss:
-The impact of optimal nutrition on performance
-How to detect and remedy vitamin and mineral imbalances in your body
-Mindfulness strategies to cope with quarantine stressors
-And so much more!
Resources:
Erica Ballard Website
Erica Ballard Instagram
Erica Ballard LinkedIn
Pantry Essentials Playbook
The Lies We've Been Fed Podcast
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Erica:
Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. Erica has her MS from Tufts University School of Medicine, got her CHC through the Institute for Integrative Nutrition, is a regular contributor to WTHR 13, and has been featured by Women’s Health, Lululemon, and the Young President’s Organization.
Read the full transcript below:
Karen Litzy (00:01):
Hey, Erica, welcome to the podcast. I'm so happy to have you on. And now, before we get into the meat of our discussion, I would love for you to talk a little bit more about you so that the listeners kind of know how you got from point a to point B to where you are now.
Erica Ballard:
Sure. So for most of my life, I have been a public health practitioner. People pleasing go getting type of gal. And so because of that, I thought I knew what healthy was. And so I was always trying to get there through the traditional means of, you know drinking the shakes, eating the bars, following the guidelines. But the thing about it was I never actually looked or felt the way I wanted to, which was again, so confusing because rule following people, please are working in public health.
Erica Ballard (01:02):
You think that I would look the way that I wanted to given that I knew quote, unquote, exactly what to do because I had these huge desires to not only have the body I wanted and look like the women I saw on TV or magazines, but I also had this like deep desire to be happy. And I thought that health or fitness, because I equated the two at the time was the linchpin for me because externally I had everything that one would desire, but internally I felt unfulfilled. And so the only piece that was missing in my exterior, you know, look was my weight. And so I was like, okay, that's it. So I did what everyone does, who tries to get healthy? I like, I count calories. I followed all the rules. I tried to outrun every French fry or glass of wine that I would have, and I just couldn't get there.
Erica Ballard (01:57):
And that all changed though, when I moved from East coast to Indianapolis, which is where I'm originally from, I moved here and I went to the Institute for integrative nutrition, even though everyone said, don't do it because I got my master's at Tufts medical. I had still student loans, all those things. I was like, no, this is the thing. And it was like, it was the thing. It actually taught me that, you know, food sleep, stress. Those are the drivers of health. And when I figured that out, I went out and I tried to share this information with people. And when I did, they were like, no, that's not right. And so while I started to get results, I would hear them or I would hear society saying girl, no. And so then I would stop doing the thing that made me feel better.
Erica Ballard (02:46):
And it was this weird up thing that would happen until finally I decided now I'm the expert on me actually. And I'm going to let feeling good lead the way. And when that happened, it's like weight dropped. I was able to hold conversations and happy. My mom likes me again. Right? Like I wasn't the worst human being who was like constantly snapping and more. So I just figured out that, like I was in charge of my happiness. I was in charge of my health and I knew best. And so doing that journey is what has brought me here today to help not only continue to help myself, cause you never just arrive at health. Right. But also to help others who are really desperate to get healthy, do it because most of the people that I help are high performers are people that are willing to do the work and are just like, I am doing it, but I can't. And I'm like, I got you. I've been there. And so walk them through the things that they can do in order to really enjoy their lives while being healthy.
Karen Litzy (03:49):
That's incredible. And now let's talk about that. Cause I love that you work with kind of high performance people, high achievers, high performers feel like I'm the same way in New York. I don't know a lot of people in New York who aren't that way. I think that's part of living in that might be a requirement for living in New York city. But let's talk about how we can optimize our performance through food, right? I'm a physical therapist. So we're used to optimizing performance through strength, training, stretching, pro programs, plyometrics, but as a physical therapist, I also know that just what you said, sleep food are paramount to when it comes to being able to optimize your performance. So I'm just going to throw it over to you. And I would love to hear your take on what that means.
Erica Ballard (04:42):
Sure. So it was up to two things when I have this conversation because so many people will tell me all the time, Hey, I get so much done. Even though I don't eat the way I should or I'm drinking these Cokes or whatever it is. So like screw you Erica. And I'm like, listen, you're only in second gear. Like think about that. Like you're only in second gear, you get to fifth, you have to get your food. Right. And the first reason I think that I think it's so clear that we need to get our food right for this is Maslow's hierarchy of needs. So at the bottom of Maslow's hierarchy of needs is psychological and within psychological is food. So that means in order to get the self actualization, the top that, you know, essentially self fulfillment, you have to get the base, right? So without it, you just can't be. And if that's not enough, cause social science, isn't always enough for people. The hard data is starting to show that our brain and gut aren't connected. So we know that if what you put in your gut is not good, your brain will not function. And if your brain will not function appropriately or to the best of its ability, you can't optimize because a lot of your decisions are made with your brain.
Karen Litzy (05:47):
Right? Absolutely. Yeah. And, and you know, when we talk about that brain gut connection and you can correct me if I'm wrong, but we are really one of the bigger there is that Vagus, Am I correct? In that a hundred percent? Do you want to talk a little bit about that?
Erica Ballard (05:58):
Well, I think it's one. So for me, when I work with clients, I can, but where I always find it being interesting is that when I talk with people about how to get healthy every single time, I don't know, this is what happens to you when I get into the nuances. They're not, they're like, yeah, the Vagus nerve that matters, but I'm like, yeah. Breathing, putting things in making sure that like the fibers in your gut, they're all going up to your brain, making sure that that's, they're talking matters, but the nuances I have found people don't care as much about.
Karen Litzy (06:36):
I can definitely relate to that because I deal with a lot of people who have pain, more chronic pain. And so when I sort of go into kind of the neurophysiology behind pain, people like get it for a little bit, but then they just don't want to go that much deeper into the weeds with it. Like you said, like the nuances, but for the purposes of our discussion, I would like to, so let's pretend I'm like your ideal client and I'm like, Erica, tell me what does all this mean?
Erica Ballard (07:10):
So for me, when I look at our nervous systems and how they're connected, right, we have this nerve that literally runs through our body that connects these two entities and for it to be functioning appropriately, to make sure that the fibers around it actually work to make sure that it, all of the things that it's also then connected to work appropriately. It's really important that we put in foods and fibers and vitamins that our body need for those things to communicate and talk. And so what we typically do, right, is we're like, we'll put whatever it's in and it doesn't matter. And if I just drop weight, I'm going to be the healthiest version of myself. And it's like, no, you have, you have the Vagus nerve, you have your entire nervous system. You have your gut lining.
Erica Ballard (07:58):
You have these, like you have these different pieces within your body that need to appropriately absorb all of the nutrients in order to make sure that everything is communicating the way that they should. And so when I think about how to optimize and when I think about food and Vagus nerve and all of those pieces is I like where my head often goes is in order for these things to function appropriately, we need the right amount of nutrients and we need our body to be able to absorb them so that these things can talk. But we were like, we think that supplements work by themselves. And we think that vitamins and minerals work by themselves, but it's a payer to make sure the communication is appropriate.
Karen Litzy (08:45):
Okay. That makes sense. Yeah. And I think you do see a lot, I don't know about you, but I see a lot of people Hawking different kinds of supplements and vitamins and this and that. And then you hear research on none of it matters, right? Like, Oh, why take this? Why take that? Why take a multivitamin or take a plethora cocktail of vitamins that doesn't work. You should get it all from food anyway. So what do you say to that?
Erica Ballard (09:11):
So I think there is, I can understand where they're coming from. And I think that from a health perspective, if you're at the beginning and you're like, I'm trying to get healthy, I can't quite figure it out. Start with food nine times out of 10, or I would, should say eight times out of 10, start with food, making sure that you have of the highest quality items. But when I think about the importance, I used to really agree with that. But now I'm starting to understand the importance of supplementation or I have fully grasp it of supplementation because the soil in which our food grows does not have all the nutrients necessary for our body, for the plant to grow to the best of its ability and for our body then to take in all the nutrients that exist. Like as a society, we are magnesium deficient as a society. We are vitamin D deficient. And as a society, we tend to be omega-3 deficient and you can't often get enough magnesium through your food, especially if you're trying to make up and provide them in D like if you're in a Chicago or Boston or in New York, it is listen, it's cold outside. Like it is hard.
Erica Ballard (10:22):
To get those things in. So while I believe that food is medicine, I do believe often food is the first line of defense. If your thyroid isn't working appropriately, if you're in a lot of muscle pain, if you're not sleeping so well, those are, they're probably supplementations that you need to bring into your body to make sure that it's optimized. But, before going to experiment, I would always say consult with a practitioner or like PT health coach, like certified health coach doctor nurse practitioner, because you can't like you can't really OD per se, but you can get the wrong results from these supplements.
Karen Litzy (11:04):
And do you suggest people take blood work? Like if you're working with someone, do you suggest they get blood work taken so that you have a clearer picture or to see like, Oh wow, you really are deficient and XYZ. And then here's a way I can plan this.
Erica Ballard (11:19):
So when I work with people, what I always recommend is first start with your diet. So straight up, like most people are not eating enough vegetables. You know, if you're listening to you are like eat vegetables, try to also clean up your diet, take out where you can. And if you can organics pasture, raised grass fed really just up that quality and see what happens. But if you do that and in a month, you're not moving towards the results you want. Blood work, I think is, can be extremely helpful because like, for instance, going to like to the thyroid, the amount of hypothyroidism underdiagnosed in this country is, is pretty high. And when you also look at inflammation markers, even though you're eating a clean diet, like if we're having food, like we're eating things that we're intolerant to, maybe you can't get that exact number in, or that exact food item in the blood work.
Erica Ballard (12:14):
But I do think it helps really show same with magnesium, vitamin D cause there's different protocols, right? Based on different deficiencies that you have. And so to be able to task, versus just to think I provides a piece of mind that a lot of people want, especially going back to the high-performer piece, like your mind is always going, like you're going a thousand miles a minute, but if you can get paperwork that will show you what's happening and different ways to track, it can feel really nice. And it also can feel like an accomplishment.
Karen Litzy:
Yeah, I agree. And I think that it gives you, like you said, a goal to work for, to work towards maybe like, I know I'm like a big numbers person, so I really like to see the numbers. So for me, if I had like a blood test, let's say I was vitamin D deficient, which I am by the way. And then I was like, okay, well let me change my diet or let me take this supplement. And then I got another blood test in six months and it was better than I would be like, okay, this is a little bit more proof for me. This is what I needed. And it would encourage me to stay on that healthy path.
Erica Ballard (13:09):
Yeah. And I think there's nothing wrong with that. I think that that's why there's such beautiful things with all the tracking devices and blood work and the availability of multiple different types of blood work now to test all these different things, because what I always find, and this is neither good or bad, it just is. It's not a lot of folks are sicker than they know that they are. And because they're so used to feeling a certain way, they don't even know that they're in deficient levels or dysfunction.
Erica Ballard (14:00):
And so that blood work can also, as a practitioner help us show that there are different ways to feel better. Because going back to the vitamin D example, I mean, vitamin D was all the rage. And then it was then were told it was a crock of, you know, stuff. And then now it's coming back in and it's like, if we could just show here's where it should be, that was conventionally what we said. Right. And here's where we need to be. It just fosters an easier conversation.
Karen Litzy (14:53):
Yeah. I think you get better buy in, you get people like, Oh boy, I don't think it's, and I don't think it's meant to scare people, but it's just meant to be like, Hey, you know, something may be some of your symptoms. Maybe they're correlated with this. You know, it may not be causative, but maybe it can correlate and let's see if we can change some and see, Do you feel different? And then retest, it's just a test retest, right?
Erica Ballard (15:03):
It's yeah. And if one scientific method, if you will, I'm all for that. And I think when it comes to supplier minerals, nutrition, like nutrients, things like that, it's really helpful. I think the only place I would say, and I would be interested in what you think that it's not as wonderful as doing the test on yourself is food intolerance. Because I find that the best model or the best testing out there is 85% accurate. Whereas the gold standard I have historically found is to pull it from your diet for three to four weeks and then systematically add it back in. Which you can do anything for three weeks.
Karen Litzy (15:40):
Yeah. Yeah. And I've done that in the past. And it was definitely very, very helpful. Like I took things out of my diet for a month and it's felt a huge difference. I had some autoimmune issues after getting the flu shot. So I had an auto immune reaction to that and it was quite painful and it lasted nine months. Yeah, it's called erythema nodosum it looked like somebody kicked me in the shins 500 times of the steel toed boots. Like it was swollen and red and purple. And I remember I was at the time dating this guy that lived in Baltimore and it was on one leg and it was like over Christmas. So it was in between Christmas and new year's and it was on one leg. I was like, what? And I remember I showed his mom like, what, what do you think this is?
Karen Litzy (16:28):
And she's like, she used to be an EMT. And she was like, I feel like you should just see a doctor. I'm like, why? And she's like now. And so I just went to like a ready care place, you know, like a city MD. And they thought it was like a staph infection, which I was like, this is I've seen or cellulitis. I was like, listen, I've seen cellulitis this ain't it. And then the next day I woke up and was on the other leg and I'm in Baltimore. And I said to my boyfriend, like, we gotta go to the ER. He's like, I don't know where to go in Baltimore, Johns Hopkins, Johns Hopkins immediately. And I went in and the doctor said, I'm in the ER. And he looked and he's like, it's erythema nodosum. I was like, what he's like, did you have any, like, do you get any shots lately?
Karen Litzy (17:08):
I'm like, well, I got a flu shot a week ago. He's like, yeah, it's the flu shot. Don't ever get a flu shot again. I was like, okay. So that was over Christmas. And then it finally, all of the symptoms went away in September. And, what I changed in September is I did an elimination diet and took a whole bunch of stuff out. So I don't know what it was, but I mean, I mean, I stopped sugar, gluten caffeine, which I didn't drink anyway. Dairy, everything, like just took it all out. Yeah. And then within a month I was like, and even like my boyfriend, he's like, you're so much brighter and you're back yourself again. And so that auto-immune really like knocked me out quite a bit. And so I do agree there is something to that pulling stuff out of your diet and just see what happens. I mean, it's the easiest thing you can do, right. Doesn't cost any money.
Erica Ballard (18:06):
I mean, there's so many now alternatives and just the auto immune piece of it. I work with a lot of folks who have auto immune disorders and gluten. I mean, whether or not you have an intolerance or not gluten, for some reason always seems to aggravate these autoimmune diseases. And so we're disorders. And so when you pull that out for a few months, it doesn't mean it has to be gone forever, taking it out and then allowing yourself to see if it works or doesn't is huge. And like you, like, it's the sugar and the caffeine. I know it can be really tough for people, but the rest of the stuff there are alternatives for all.
Karen Litzy (18:39):
Yeah, absolutely. And I mean, I don't really have a lot of sugar and I don't drink caffeine anyway. So that was easy. The other thing was no alcohol also fine. I can handle that. You know, the gluten was a little hard in the beginning, but then like you said, like I just had gluten free bread and gluten-free POS I mean, it's so easy. It's not like I was like Jones and for tea, like a loaf of French bread or anything, you know? So for me, I felt like, Oh, this was super helpful. And I have not had the flu shot since.
Erica Ballard (19:09):
I wouldn't either if I had to.
Karen Litzy (19:11):
Horrible. Anyway, so we're talking about optimizing performance through food, right? And so I think the listeners can now get an appreciation for how food should be the first line of defense. Then move into if you need vitamins or supplementation or minerals and nutrients and when these work together, your brighter you're quicker. Like you said, you're moving from second gear to fifth gear.
Erica Ballard (19:37):
Yeah. And the thing that always it's interesting for people when they do this is they never knew that they could feel this good. And now it's what makes continuing it so much easier. It's both a mix of like, I feel this good. And then being quite honest is when you start to eat better, like take supplements, do those types of things. When you put in things that your body doesn't like, man, does it fight back? Like you just feel the pain, you feel the grogginess, you feel the lethargy and you don't do it anymore. Because a lot of times people will say, well, you're healthy. It's easy for you. And it's like, Oh, it's either I feel horrible. Or I take care of myself because I've done enough. I find that the body always is trying to talk with you. It's always communicating and it will slap you in the face. If it does, if you do something, it does not like, and most of us can't feel it because we've put it in such a stressed out state. So that it's always feeling so bad that like, it's just hanging on because we're in survival mode. But when you get into that parasympathetic nervous system, when you get into thriving, it will literally have as many communications and conversations as it can that you move in the best direction for you.
Karen Litzy (20:53):
Yeah. And it sounds to me like what you're saying is the body would prefer not to feel like shit.
Erica Ballard (21:03):
Yeah. That's exactly in a nutshell.
Karen Litzy (21:05):
Okay. All right. That's what I thought. Okay. So you brought up briefly, they're talking about stress. So let's talk about stress. I mean, we're still as we're recording this, I'm in New York city, we're still on lockdown. We're in the middle of a COVID pandemic. So stress is a real thing right now. And when we're stressed, I think that's when people are like, I'll take that piece of chocolate, I'll take this, you know, so what can we do to help overcome the stress without falling back on those cravings if you will.
Erica Ballard (21:39):
That's a really good question. And I heard something this morning that I think was brilliant. So I'm going to share it here is when we think about stress, the idea is just, how do you get back into the present moment and how do you get back in to finding joy? I mean, it sounds a little corny, but that is that's it. And so in quarantine, what can be really helpful is identifying things that you could do that you would do on your vacation at your house. So whether you take naps on vacations or you take long walks, or you listen to music in the morning, instead of a podcast, doing those things that transport you into a state of calm is really helpful. And we can do those things in our house. We just completely forgot that we could, because we're so used to only doing them when we're out there.
Erica Ballard (22:36):
So that's the first thing that just came to top of mind when you were, when you asked that question. And I think the other pieces are just looking for moments of not solitude seems like the wrong word right now. But moments of peace, because while some people are not at the office, we're there were so available now. And at least we had these cutoffs, right? You go into the office, you leave the office like, and that was that. Now everyone knows we're not going anywhere. So we're getting the emails, we're getting the texts, we're getting those things. And if we could work our way in defining moments where we can shut down, whether it's the walk without the phone, whether it's actually closing your computer and not opening it back up, putting your phone away for half an hour, those things are really gonna help bring you down. Even though we don't think that they do like you feel it in your body, like 15 and another phone, you kind of, you're able to sink down into that couch wherever you're at and just be.
Karen Litzy (23:40):
Yeah. And you know, I've been hearing that from a lot of my clients who I normally see patients in their homes. And so at this, right. Nobody wants somebody coming into their home and I don't blame them. But they're also working from home and what everyone's saying, they're like, you know, when I'm at work and we have a meeting, I get up from my desk, I walk to a boardroom, I sit down, I go to the bathroom, I talked to other people. I come back, I walk to work. I walk home from work. I go out for lunch. I come back in or at least I go to the kitchen and I come back to my office. And now I said, you know, I'll have a meeting from two to three. And they're like, Oh, you're available at three. We're gonna have another meeting from three to four.
Karen Litzy (24:20):
Oh, you're available from four to five. She's like, so all of a sudden my patient, she was like, I'm not leaving my computer. Whereas when I'm at work, I do. And I also have the opportunity to get fresh air, but now I'm 12 hours. I barely have time for lunch. And I'm just, and I heard that again and again and again, so you're right. It's that, that feeling of, we all have availability and for some people, their only option might be a five minute break, you know? Like they might not be able to take that half hour break if they've got people sort of like breathing down their throat. So do you have any advice for those people to do like a five minute break or a three minutes something to help at least ground them a little bit.
Erica Ballard (25:04):
Yeah. So there's two ways to do it depending on who you are as a person. So I think standing up planting your feet from on the ground and just breathing in and out in a really calm, amazing fashion and like feeling the breath go through you is just such a great way to literally move yourself into a very present state. The other way is to move your body, right. It depends on who you are and what you need. When I have five minutes between meetings, I'm not even going to hide it. Like I, right now, I'm here for the Jonas brothers. You can judge me all you want. I turn on the Jonas brothers and I like dance in my house. Cause those songs are only like three and a half minutes. So I will literally put it on and I will just dance around my house because a music makes me happy. But also it like moves. My body moves. My energy moves like that stagnation. And so whether it's squats for you going up and down the stairs dancing, whatever it is, it's just shaking off what was for what is. And I find that that is very helpful when you're chained to your desk for 12 hours on end.
Karen Litzy (26:10):
Great advice. Thank you so much. So now before we wrap things up, is there anything that we didn't touch upon or anything like, what is the thing that you want the listeners to leave this discussion with?
Erica Ballard (26:24):
I would say that if you want to get healthier and you're not where you want to be really taking a look at your food and at your stress and seeing which one is holding you back. Cause I pretty much guarantee it's probably one of the two and then make a few decisions and change as necessary.
Karen Litzy (26:49):
Excellent. And again, the good thing about this is that doesn't take a lot of money, may take some time, but it certainly is not something that's going to break the bank. And, and again, because we're in these uncertain times right now, you know, people might be a little less wary of like, Oh, do I have to, you know, go and leave my apartment or my home and go and do this and go and do that. But if there are easy ways, like you said, look at your food, look at your stress easy. Now, if you are the kind of person that needs someone to help walk you through it, that's where someone like you Erica would come in, you know, at being a health coach, like that's where you would come in to kind of not hold their hand, but be their coach and give them the game plan.
Erica Ballard (27:41):
Yeah. And, that is why if you do need help, I'm so huge on working with a practitioner because like at the beginning, it's an N of one, you are actually the unique snowflake you think you are. And so helping you figure out the right things for you in a safe space is really important because health is so personal and you get a lot of feels when he's searching to move, try to move in the direction you want to move. And so I do really believe people can do it on their own with a little bit of support from online programs and things like that. But if you can't, asking for help is the best thing you can do.
Karen Litzy (28:26):
Yeah. And I know you have a free resource for the listeners. It's the pantry playbook. Is that right? So do you want to talk a little bit about that? And just everyone knows, we'll have a link to that in the show notes at podcast.healthywealthysmart.com, but talk a little bit about it and where people could get.
Erica Ballard (28:43):
Sure. So I heard from clients all the time, I want meal prep, I want meal prep. I want meal prep. And I was like, no, you don't, they don't want it. But it's what they kept saying that they wanted. What they really wanted though, was they wanted it to be able to make really quick meals on the fly that tasted good because three days into the meal prep, if throughout all of their foods, they're sick of it. So I said enough, that's like, yeah. I mean, I don't like five day old food either. So I get it. And so what I did is, I was like, well, I don't ever meal prep. I don't. And so I was like, why don't I meal prep? Oh, cause I have everything I always need on hand all of the time.
Erica Ballard (29:25):
And so I went to my pantry and started to look at, and then think about all what my clients do and me, and they're there, the special needs that go on and was like, Oh, I can create a list that if you always have on hand, it's going to be faster to make healthy meals than it is to go out and get takeout, because these are our options, right? We meal prep, we get take out or we make it home. And if I can help you make a fast healthy meal at home that cuts the meal prep and cuts the time it would take to get takeout. It works. So I have that resource for them and it'll be at https://www.ericaballardhealth.com/pantry-essentials-playbook.
Karen Litzy (29:59):
Thank you so much. And now onto the last question that I ask everyone, knowing where you are now in your life and in your career, what advice would you give to yourself after college? Let's say grad school
Erica Ballard (30:12):
That I love this question and I really, really wish I knew this, that you can do it your way.
Karen Litzy (30:22):
Mm, powerful.
Erica Ballard (30:24):
It's just with health. Like you go into people's homes. Like I go into people's homes via camp, like what, like, you know, zoom, you can do this thing. You were away. So don't follow someone else's rules. If it doesn't feel good inside.
Karen Litzy (30:41):
Excellent advice. And where can people find you social media website?
Erica Ballard (30:47):
Okay. So I play a lot on Instagram. So it's at Erica Ballard health. I'm actually on LinkedIn quite a bit. Website is EricaBallardhealth.com. And I had a new podcast that's actually dropping on June 2nd called the lies we've been fed. And it's an eight part series that walks people through the lies that we have been fed about food to give them a path forward.
Karen Litzy (31:12):
Awesome. It sounds great. I look forward to listening and thank you so much for coming on. This was wonderful. Thank you and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Erica Ballard on the show to discuss how to optimize your health and performance through nutrition. Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules.
In this episode, we discuss:
-The impact of optimal nutrition on performance
-How to detect and remedy vitamin and mineral imbalances in your body
-Mindfulness strategies to cope with quarantine stressors
-And so much more!
Resources:
Erica Ballard Website
Erica Ballard Instagram
Erica Ballard LinkedIn
Pantry Essentials Playbook
The Lies We've Been Fed Podcast
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Erica:
Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. Erica has her MS from Tufts University School of Medicine, got her CHC through the Institute for Integrative Nutrition, is a regular contributor to WTHR 13, and has been featured by Women’s Health, Lululemon, and the Young President’s Organization.
Read the full transcript below:
Karen Litzy (00:01):
Hey, Erica, welcome to the podcast. I'm so happy to have you on. And now, before we get into the meat of our discussion, I would love for you to talk a little bit more about you so that the listeners kind of know how you got from point a to point B to where you are now.
Erica Ballard:
Sure. So for most of my life, I have been a public health practitioner. People pleasing go getting type of gal. And so because of that, I thought I knew what healthy was. And so I was always trying to get there through the traditional means of, you know drinking the shakes, eating the bars, following the guidelines. But the thing about it was I never actually looked or felt the way I wanted to, which was again, so confusing because rule following people, please are working in public health.
Erica Ballard (01:02):
You think that I would look the way that I wanted to given that I knew quote, unquote, exactly what to do because I had these huge desires to not only have the body I wanted and look like the women I saw on TV or magazines, but I also had this like deep desire to be happy. And I thought that health or fitness, because I equated the two at the time was the linchpin for me because externally I had everything that one would desire, but internally I felt unfulfilled. And so the only piece that was missing in my exterior, you know, look was my weight. And so I was like, okay, that's it. So I did what everyone does, who tries to get healthy? I like, I count calories. I followed all the rules. I tried to outrun every French fry or glass of wine that I would have, and I just couldn't get there.
Erica Ballard (01:57):
And that all changed though, when I moved from East coast to Indianapolis, which is where I'm originally from, I moved here and I went to the Institute for integrative nutrition, even though everyone said, don't do it because I got my master's at Tufts medical. I had still student loans, all those things. I was like, no, this is the thing. And it was like, it was the thing. It actually taught me that, you know, food sleep, stress. Those are the drivers of health. And when I figured that out, I went out and I tried to share this information with people. And when I did, they were like, no, that's not right. And so while I started to get results, I would hear them or I would hear society saying girl, no. And so then I would stop doing the thing that made me feel better.
Erica Ballard (02:46):
And it was this weird up thing that would happen until finally I decided now I'm the expert on me actually. And I'm going to let feeling good lead the way. And when that happened, it's like weight dropped. I was able to hold conversations and happy. My mom likes me again. Right? Like I wasn't the worst human being who was like constantly snapping and more. So I just figured out that, like I was in charge of my happiness. I was in charge of my health and I knew best. And so doing that journey is what has brought me here today to help not only continue to help myself, cause you never just arrive at health. Right. But also to help others who are really desperate to get healthy, do it because most of the people that I help are high performers are people that are willing to do the work and are just like, I am doing it, but I can't. And I'm like, I got you. I've been there. And so walk them through the things that they can do in order to really enjoy their lives while being healthy.
Karen Litzy (03:49):
That's incredible. And now let's talk about that. Cause I love that you work with kind of high performance people, high achievers, high performers feel like I'm the same way in New York. I don't know a lot of people in New York who aren't that way. I think that's part of living in that might be a requirement for living in New York city. But let's talk about how we can optimize our performance through food, right? I'm a physical therapist. So we're used to optimizing performance through strength, training, stretching, pro programs, plyometrics, but as a physical therapist, I also know that just what you said, sleep food are paramount to when it comes to being able to optimize your performance. So I'm just going to throw it over to you. And I would love to hear your take on what that means.
Erica Ballard (04:42):
Sure. So it was up to two things when I have this conversation because so many people will tell me all the time, Hey, I get so much done. Even though I don't eat the way I should or I'm drinking these Cokes or whatever it is. So like screw you Erica. And I'm like, listen, you're only in second gear. Like think about that. Like you're only in second gear, you get to fifth, you have to get your food. Right. And the first reason I think that I think it's so clear that we need to get our food right for this is Maslow's hierarchy of needs. So at the bottom of Maslow's hierarchy of needs is psychological and within psychological is food. So that means in order to get the self actualization, the top that, you know, essentially self fulfillment, you have to get the base, right? So without it, you just can't be. And if that's not enough, cause social science, isn't always enough for people. The hard data is starting to show that our brain and gut aren't connected. So we know that if what you put in your gut is not good, your brain will not function. And if your brain will not function appropriately or to the best of its ability, you can't optimize because a lot of your decisions are made with your brain.
Karen Litzy (05:47):
Right? Absolutely. Yeah. And, and you know, when we talk about that brain gut connection and you can correct me if I'm wrong, but we are really one of the bigger there is that Vagus, Am I correct? In that a hundred percent? Do you want to talk a little bit about that?
Erica Ballard (05:58):
Well, I think it's one. So for me, when I work with clients, I can, but where I always find it being interesting is that when I talk with people about how to get healthy every single time, I don't know, this is what happens to you when I get into the nuances. They're not, they're like, yeah, the Vagus nerve that matters, but I'm like, yeah. Breathing, putting things in making sure that like the fibers in your gut, they're all going up to your brain, making sure that that's, they're talking matters, but the nuances I have found people don't care as much about.
Karen Litzy (06:36):
I can definitely relate to that because I deal with a lot of people who have pain, more chronic pain. And so when I sort of go into kind of the neurophysiology behind pain, people like get it for a little bit, but then they just don't want to go that much deeper into the weeds with it. Like you said, like the nuances, but for the purposes of our discussion, I would like to, so let's pretend I'm like your ideal client and I'm like, Erica, tell me what does all this mean?
Erica Ballard (07:10):
So for me, when I look at our nervous systems and how they're connected, right, we have this nerve that literally runs through our body that connects these two entities and for it to be functioning appropriately, to make sure that the fibers around it actually work to make sure that it, all of the things that it's also then connected to work appropriately. It's really important that we put in foods and fibers and vitamins that our body need for those things to communicate and talk. And so what we typically do, right, is we're like, we'll put whatever it's in and it doesn't matter. And if I just drop weight, I'm going to be the healthiest version of myself. And it's like, no, you have, you have the Vagus nerve, you have your entire nervous system. You have your gut lining.
Erica Ballard (07:58):
You have these, like you have these different pieces within your body that need to appropriately absorb all of the nutrients in order to make sure that everything is communicating the way that they should. And so when I think about how to optimize and when I think about food and Vagus nerve and all of those pieces is I like where my head often goes is in order for these things to function appropriately, we need the right amount of nutrients and we need our body to be able to absorb them so that these things can talk. But we were like, we think that supplements work by themselves. And we think that vitamins and minerals work by themselves, but it's a payer to make sure the communication is appropriate.
Karen Litzy (08:45):
Okay. That makes sense. Yeah. And I think you do see a lot, I don't know about you, but I see a lot of people Hawking different kinds of supplements and vitamins and this and that. And then you hear research on none of it matters, right? Like, Oh, why take this? Why take that? Why take a multivitamin or take a plethora cocktail of vitamins that doesn't work. You should get it all from food anyway. So what do you say to that?
Erica Ballard (09:11):
So I think there is, I can understand where they're coming from. And I think that from a health perspective, if you're at the beginning and you're like, I'm trying to get healthy, I can't quite figure it out. Start with food nine times out of 10, or I would, should say eight times out of 10, start with food, making sure that you have of the highest quality items. But when I think about the importance, I used to really agree with that. But now I'm starting to understand the importance of supplementation or I have fully grasp it of supplementation because the soil in which our food grows does not have all the nutrients necessary for our body, for the plant to grow to the best of its ability and for our body then to take in all the nutrients that exist. Like as a society, we are magnesium deficient as a society. We are vitamin D deficient. And as a society, we tend to be omega-3 deficient and you can't often get enough magnesium through your food, especially if you're trying to make up and provide them in D like if you're in a Chicago or Boston or in New York, it is listen, it's cold outside. Like it is hard.
Erica Ballard (10:22):
To get those things in. So while I believe that food is medicine, I do believe often food is the first line of defense. If your thyroid isn't working appropriately, if you're in a lot of muscle pain, if you're not sleeping so well, those are, they're probably supplementations that you need to bring into your body to make sure that it's optimized. But, before going to experiment, I would always say consult with a practitioner or like PT health coach, like certified health coach doctor nurse practitioner, because you can't like you can't really OD per se, but you can get the wrong results from these supplements.
Karen Litzy (11:04):
And do you suggest people take blood work? Like if you're working with someone, do you suggest they get blood work taken so that you have a clearer picture or to see like, Oh wow, you really are deficient and XYZ. And then here's a way I can plan this.
Erica Ballard (11:19):
So when I work with people, what I always recommend is first start with your diet. So straight up, like most people are not eating enough vegetables. You know, if you're listening to you are like eat vegetables, try to also clean up your diet, take out where you can. And if you can organics pasture, raised grass fed really just up that quality and see what happens. But if you do that and in a month, you're not moving towards the results you want. Blood work, I think is, can be extremely helpful because like, for instance, going to like to the thyroid, the amount of hypothyroidism underdiagnosed in this country is, is pretty high. And when you also look at inflammation markers, even though you're eating a clean diet, like if we're having food, like we're eating things that we're intolerant to, maybe you can't get that exact number in, or that exact food item in the blood work.
Erica Ballard (12:14):
But I do think it helps really show same with magnesium, vitamin D cause there's different protocols, right? Based on different deficiencies that you have. And so to be able to task, versus just to think I provides a piece of mind that a lot of people want, especially going back to the high-performer piece, like your mind is always going, like you're going a thousand miles a minute, but if you can get paperwork that will show you what's happening and different ways to track, it can feel really nice. And it also can feel like an accomplishment.
Karen Litzy:
Yeah, I agree. And I think that it gives you, like you said, a goal to work for, to work towards maybe like, I know I'm like a big numbers person, so I really like to see the numbers. So for me, if I had like a blood test, let's say I was vitamin D deficient, which I am by the way. And then I was like, okay, well let me change my diet or let me take this supplement. And then I got another blood test in six months and it was better than I would be like, okay, this is a little bit more proof for me. This is what I needed. And it would encourage me to stay on that healthy path.
Erica Ballard (13:09):
Yeah. And I think there's nothing wrong with that. I think that that's why there's such beautiful things with all the tracking devices and blood work and the availability of multiple different types of blood work now to test all these different things, because what I always find, and this is neither good or bad, it just is. It's not a lot of folks are sicker than they know that they are. And because they're so used to feeling a certain way, they don't even know that they're in deficient levels or dysfunction.
Erica Ballard (14:00):
And so that blood work can also, as a practitioner help us show that there are different ways to feel better. Because going back to the vitamin D example, I mean, vitamin D was all the rage. And then it was then were told it was a crock of, you know, stuff. And then now it's coming back in and it's like, if we could just show here's where it should be, that was conventionally what we said. Right. And here's where we need to be. It just fosters an easier conversation.
Karen Litzy (14:53):
Yeah. I think you get better buy in, you get people like, Oh boy, I don't think it's, and I don't think it's meant to scare people, but it's just meant to be like, Hey, you know, something may be some of your symptoms. Maybe they're correlated with this. You know, it may not be causative, but maybe it can correlate and let's see if we can change some and see, Do you feel different? And then retest, it's just a test retest, right?
Erica Ballard (15:03):
It's yeah. And if one scientific method, if you will, I'm all for that. And I think when it comes to supplier minerals, nutrition, like nutrients, things like that, it's really helpful. I think the only place I would say, and I would be interested in what you think that it's not as wonderful as doing the test on yourself is food intolerance. Because I find that the best model or the best testing out there is 85% accurate. Whereas the gold standard I have historically found is to pull it from your diet for three to four weeks and then systematically add it back in. Which you can do anything for three weeks.
Karen Litzy (15:40):
Yeah. Yeah. And I've done that in the past. And it was definitely very, very helpful. Like I took things out of my diet for a month and it's felt a huge difference. I had some autoimmune issues after getting the flu shot. So I had an auto immune reaction to that and it was quite painful and it lasted nine months. Yeah, it's called erythema nodosum it looked like somebody kicked me in the shins 500 times of the steel toed boots. Like it was swollen and red and purple. And I remember I was at the time dating this guy that lived in Baltimore and it was on one leg and it was like over Christmas. So it was in between Christmas and new year's and it was on one leg. I was like, what? And I remember I showed his mom like, what, what do you think this is?
Karen Litzy (16:28):
And she's like, she used to be an EMT. And she was like, I feel like you should just see a doctor. I'm like, why? And she's like now. And so I just went to like a ready care place, you know, like a city MD. And they thought it was like a staph infection, which I was like, this is I've seen or cellulitis. I was like, listen, I've seen cellulitis this ain't it. And then the next day I woke up and was on the other leg and I'm in Baltimore. And I said to my boyfriend, like, we gotta go to the ER. He's like, I don't know where to go in Baltimore, Johns Hopkins, Johns Hopkins immediately. And I went in and the doctor said, I'm in the ER. And he looked and he's like, it's erythema nodosum. I was like, what he's like, did you have any, like, do you get any shots lately?
Karen Litzy (17:08):
I'm like, well, I got a flu shot a week ago. He's like, yeah, it's the flu shot. Don't ever get a flu shot again. I was like, okay. So that was over Christmas. And then it finally, all of the symptoms went away in September. And, what I changed in September is I did an elimination diet and took a whole bunch of stuff out. So I don't know what it was, but I mean, I mean, I stopped sugar, gluten caffeine, which I didn't drink anyway. Dairy, everything, like just took it all out. Yeah. And then within a month I was like, and even like my boyfriend, he's like, you're so much brighter and you're back yourself again. And so that auto-immune really like knocked me out quite a bit. And so I do agree there is something to that pulling stuff out of your diet and just see what happens. I mean, it's the easiest thing you can do, right. Doesn't cost any money.
Erica Ballard (18:06):
I mean, there's so many now alternatives and just the auto immune piece of it. I work with a lot of folks who have auto immune disorders and gluten. I mean, whether or not you have an intolerance or not gluten, for some reason always seems to aggravate these autoimmune diseases. And so we're disorders. And so when you pull that out for a few months, it doesn't mean it has to be gone forever, taking it out and then allowing yourself to see if it works or doesn't is huge. And like you, like, it's the sugar and the caffeine. I know it can be really tough for people, but the rest of the stuff there are alternatives for all.
Karen Litzy (18:39):
Yeah, absolutely. And I mean, I don't really have a lot of sugar and I don't drink caffeine anyway. So that was easy. The other thing was no alcohol also fine. I can handle that. You know, the gluten was a little hard in the beginning, but then like you said, like I just had gluten free bread and gluten-free POS I mean, it's so easy. It's not like I was like Jones and for tea, like a loaf of French bread or anything, you know? So for me, I felt like, Oh, this was super helpful. And I have not had the flu shot since.
Erica Ballard (19:09):
I wouldn't either if I had to.
Karen Litzy (19:11):
Horrible. Anyway, so we're talking about optimizing performance through food, right? And so I think the listeners can now get an appreciation for how food should be the first line of defense. Then move into if you need vitamins or supplementation or minerals and nutrients and when these work together, your brighter you're quicker. Like you said, you're moving from second gear to fifth gear.
Erica Ballard (19:37):
Yeah. And the thing that always it's interesting for people when they do this is they never knew that they could feel this good. And now it's what makes continuing it so much easier. It's both a mix of like, I feel this good. And then being quite honest is when you start to eat better, like take supplements, do those types of things. When you put in things that your body doesn't like, man, does it fight back? Like you just feel the pain, you feel the grogginess, you feel the lethargy and you don't do it anymore. Because a lot of times people will say, well, you're healthy. It's easy for you. And it's like, Oh, it's either I feel horrible. Or I take care of myself because I've done enough. I find that the body always is trying to talk with you. It's always communicating and it will slap you in the face. If it does, if you do something, it does not like, and most of us can't feel it because we've put it in such a stressed out state. So that it's always feeling so bad that like, it's just hanging on because we're in survival mode. But when you get into that parasympathetic nervous system, when you get into thriving, it will literally have as many communications and conversations as it can that you move in the best direction for you.
Karen Litzy (20:53):
Yeah. And it sounds to me like what you're saying is the body would prefer not to feel like shit.
Erica Ballard (21:03):
Yeah. That's exactly in a nutshell.
Karen Litzy (21:05):
Okay. All right. That's what I thought. Okay. So you brought up briefly, they're talking about stress. So let's talk about stress. I mean, we're still as we're recording this, I'm in New York city, we're still on lockdown. We're in the middle of a COVID pandemic. So stress is a real thing right now. And when we're stressed, I think that's when people are like, I'll take that piece of chocolate, I'll take this, you know, so what can we do to help overcome the stress without falling back on those cravings if you will.
Erica Ballard (21:39):
That's a really good question. And I heard something this morning that I think was brilliant. So I'm going to share it here is when we think about stress, the idea is just, how do you get back into the present moment and how do you get back in to finding joy? I mean, it sounds a little corny, but that is that's it. And so in quarantine, what can be really helpful is identifying things that you could do that you would do on your vacation at your house. So whether you take naps on vacations or you take long walks, or you listen to music in the morning, instead of a podcast, doing those things that transport you into a state of calm is really helpful. And we can do those things in our house. We just completely forgot that we could, because we're so used to only doing them when we're out there.
Erica Ballard (22:36):
So that's the first thing that just came to top of mind when you were, when you asked that question. And I think the other pieces are just looking for moments of not solitude seems like the wrong word right now. But moments of peace, because while some people are not at the office, we're there were so available now. And at least we had these cutoffs, right? You go into the office, you leave the office like, and that was that. Now everyone knows we're not going anywhere. So we're getting the emails, we're getting the texts, we're getting those things. And if we could work our way in defining moments where we can shut down, whether it's the walk without the phone, whether it's actually closing your computer and not opening it back up, putting your phone away for half an hour, those things are really gonna help bring you down. Even though we don't think that they do like you feel it in your body, like 15 and another phone, you kind of, you're able to sink down into that couch wherever you're at and just be.
Karen Litzy (23:40):
Yeah. And you know, I've been hearing that from a lot of my clients who I normally see patients in their homes. And so at this, right. Nobody wants somebody coming into their home and I don't blame them. But they're also working from home and what everyone's saying, they're like, you know, when I'm at work and we have a meeting, I get up from my desk, I walk to a boardroom, I sit down, I go to the bathroom, I talked to other people. I come back, I walk to work. I walk home from work. I go out for lunch. I come back in or at least I go to the kitchen and I come back to my office. And now I said, you know, I'll have a meeting from two to three. And they're like, Oh, you're available at three. We're gonna have another meeting from three to four.
Karen Litzy (24:20):
Oh, you're available from four to five. She's like, so all of a sudden my patient, she was like, I'm not leaving my computer. Whereas when I'm at work, I do. And I also have the opportunity to get fresh air, but now I'm 12 hours. I barely have time for lunch. And I'm just, and I heard that again and again and again, so you're right. It's that, that feeling of, we all have availability and for some people, their only option might be a five minute break, you know? Like they might not be able to take that half hour break if they've got people sort of like breathing down their throat. So do you have any advice for those people to do like a five minute break or a three minutes something to help at least ground them a little bit.
Erica Ballard (25:04):
Yeah. So there's two ways to do it depending on who you are as a person. So I think standing up planting your feet from on the ground and just breathing in and out in a really calm, amazing fashion and like feeling the breath go through you is just such a great way to literally move yourself into a very present state. The other way is to move your body, right. It depends on who you are and what you need. When I have five minutes between meetings, I'm not even going to hide it. Like I, right now, I'm here for the Jonas brothers. You can judge me all you want. I turn on the Jonas brothers and I like dance in my house. Cause those songs are only like three and a half minutes. So I will literally put it on and I will just dance around my house because a music makes me happy. But also it like moves. My body moves. My energy moves like that stagnation. And so whether it's squats for you going up and down the stairs dancing, whatever it is, it's just shaking off what was for what is. And I find that that is very helpful when you're chained to your desk for 12 hours on end.
Karen Litzy (26:10):
Great advice. Thank you so much. So now before we wrap things up, is there anything that we didn't touch upon or anything like, what is the thing that you want the listeners to leave this discussion with?
Erica Ballard (26:24):
I would say that if you want to get healthier and you're not where you want to be really taking a look at your food and at your stress and seeing which one is holding you back. Cause I pretty much guarantee it's probably one of the two and then make a few decisions and change as necessary.
Karen Litzy (26:49):
Excellent. And again, the good thing about this is that doesn't take a lot of money, may take some time, but it certainly is not something that's going to break the bank. And, and again, because we're in these uncertain times right now, you know, people might be a little less wary of like, Oh, do I have to, you know, go and leave my apartment or my home and go and do this and go and do that. But if there are easy ways, like you said, look at your food, look at your stress easy. Now, if you are the kind of person that needs someone to help walk you through it, that's where someone like you Erica would come in, you know, at being a health coach, like that's where you would come in to kind of not hold their hand, but be their coach and give them the game plan.
Erica Ballard (27:41):
Yeah. And, that is why if you do need help, I'm so huge on working with a practitioner because like at the beginning, it's an N of one, you are actually the unique snowflake you think you are. And so helping you figure out the right things for you in a safe space is really important because health is so personal and you get a lot of feels when he's searching to move, try to move in the direction you want to move. And so I do really believe people can do it on their own with a little bit of support from online programs and things like that. But if you can't, asking for help is the best thing you can do.
Karen Litzy (28:26):
Yeah. And I know you have a free resource for the listeners. It's the pantry playbook. Is that right? So do you want to talk a little bit about that? And just everyone knows, we'll have a link to that in the show notes at podcast.healthywealthysmart.com, but talk a little bit about it and where people could get.
Erica Ballard (28:43):
Sure. So I heard from clients all the time, I want meal prep, I want meal prep. I want meal prep. And I was like, no, you don't, they don't want it. But it's what they kept saying that they wanted. What they really wanted though, was they wanted it to be able to make really quick meals on the fly that tasted good because three days into the meal prep, if throughout all of their foods, they're sick of it. So I said enough, that's like, yeah. I mean, I don't like five day old food either. So I get it. And so what I did is, I was like, well, I don't ever meal prep. I don't. And so I was like, why don't I meal prep? Oh, cause I have everything I always need on hand all of the time.
Erica Ballard (29:25):
And so I went to my pantry and started to look at, and then think about all what my clients do and me, and they're there, the special needs that go on and was like, Oh, I can create a list that if you always have on hand, it's going to be faster to make healthy meals than it is to go out and get takeout, because these are our options, right? We meal prep, we get take out or we make it home. And if I can help you make a fast healthy meal at home that cuts the meal prep and cuts the time it would take to get takeout. It works. So I have that resource for them and it'll be at https://www.ericaballardhealth.com/pantry-essentials-playbook.
Karen Litzy (29:59):
Thank you so much. And now onto the last question that I ask everyone, knowing where you are now in your life and in your career, what advice would you give to yourself after college? Let's say grad school
Erica Ballard (30:12):
That I love this question and I really, really wish I knew this, that you can do it your way.
Karen Litzy (30:22):
Mm, powerful.
Erica Ballard (30:24):
It's just with health. Like you go into people's homes. Like I go into people's homes via camp, like what, like, you know, zoom, you can do this thing. You were away. So don't follow someone else's rules. If it doesn't feel good inside.
Karen Litzy (30:41):
Excellent advice. And where can people find you social media website?
Erica Ballard (30:47):
Okay. So I play a lot on Instagram. So it's at Erica Ballard health. I'm actually on LinkedIn quite a bit. Website is EricaBallardhealth.com. And I had a new podcast that's actually dropping on June 2nd called the lies we've been fed. And it's an eight part series that walks people through the lies that we have been fed about food to give them a path forward.
Karen Litzy (31:12):
Awesome. It sounds great. I look forward to listening and thank you so much for coming on. This was wonderful. Thank you and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Kameelah Phillips on the show to discuss optimizing health during pregnancy. Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate. Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care.
In this episode, we discuss:
-The impacts of COVID-19 on pregnancy and post-partum
-Factors that impact the United States’ maternal mortality rates
-Six ways to optimize your health during pregnancy
-The importance of interprofessional collaboration
-And so much more!
Resources:
Calla Women's Health Website
Dr. Kameelah Phillips Instagram
Calla Women's Health Instagram
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Dr. Phillips:
Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate. Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care.
Dr. Phillips graduated from Stanford University with a degree in Human Biology with an emphasis in Women’s Health and Human Sexuality. After graduation, she worked at the San Francisco Department of Public Health in the AIDS office as a Research Assistant on HIV vaccine studies. She relocated to Los Angeles to attend the University of Southern California Keck School of Medicine.
During medical school, she received numerous community service awards. She was privileged to travel to Ghana, Cuba, and Tanzania on health missions during this time. Upon completion of medical school, she attended a competitive OB/GYN residency at the New York University School of Medicine. She also served on an emergency medical mission in Port-au-Prince, Haiti to provide women’s health care during the 2010 earthquake.
Dr. Phillips is an educator, mentor, and expert in women’s health issues. She loves to help women and girls feel comfortable with their bodies, so that they can be aware of changes or new developments. Her interests include Minority Women's Health and health care disparities, lactation, sexual and menopause medicine. Dr. Phillips is a member of the International Board of Lactation Consultants and speaks Spanish. She enjoys teaching residents and medical students.
Her guilty pleasures include reality T.V. As a Real World Alumnae, she has used this platform to travel nationwide to discuss domestic violence, smoking cessation, and other health-related issues. She loves a good bargain, flowers, and deep-tissue massages.
You can follow her on Instagram @drkameelahsays
Read the full transcript below:
Karen Litzy (00:01):
Hi, Dr. Phillips, welcome to the podcast. I'm excited to have you on. And this is the first time I'm having an OB GYN on the program. I've had lots of physical therapists who work with women's health and pelvic health. So this is really exciting to get a different point of view on women's health and on pelvic health. And now, before we get into the meat of the interview, we are still living in a pandemic, COVID-19 is still here. It has not mysteriously disappeared or vanished. And so there are a lot of women who are getting pregnant, who are living through pregnancy at this time and who might be a little nervous, a little concerned about what can happen during their pregnancy is COVID affected. So what I would love for you is any advice for those pregnant women in the time of COVID?
Kameelah Phillips (00:58):
Yeah, absolutely. You know, one thing I really try and impress on patients that is absolutely unique to OB GYN is despite what's going on in the world, whatever chaos is going on, women still have babies women still go into labor. Women still take healthy babies home. So for us in particular we've made some minor, not, I shouldn't say minor there there's significant, we've made some changes in how we deliver care and the hospital setting, but for us, it's really been, you know, not so huge of a change because you know, hurricane Sandy earthquakes in Haiti, I've been through both of those, we still deliver excellent care to women. So one thing I would ask them to do is just really take a deep breath and while things are going on around us remember that their primary concern is to take care of themselves so that they can take care of their baby.
Kameelah Phillips (02:11):
I have told patients that a little bit of their OB care is changing. So we might have fewer visits, but really the important things we will always make sure that we hit the important time points and hallmarks of a pregnancy. So you won't miss anything. I've been telling them that labor and delivery has changed a little bit. And I think this changes pretty much coming across country, but whereas it used to be a time where, you know, extended family was welcome. It's important that they recognize now that only one or maybe two people will be allowed to be present for labor and delivery. And our hospital in particular, both moms and support family are being asked to wear a mask. We do check moms for coronavirus. We use the nasal swab. The extended family is not tested, but they're expected to keep their mask on.
Kameelah Phillips (03:16):
And most of the time our moms are coming back negative, but if they do come back positive, you know, we have a discussion and education with them as to what it's going to be like, knowing that they're now corona virus positive and going to be taking home a newborn. So we talk about those things. But for all intents and purposes, women are coming in. They're having healthy, safe deliveries, both C-sections and vaginal deliveries. Their hospital stay we've shortened a little bit in New York, we're going back to keeping women two days or four days, but other places in the country are, are shortening. The hospital stays in an effort to get women home safely and so that they can use hospital resources for the people that need them. But we're having healthy and safe deliveries. There was a panic, I think, amongst the pregnant community at the beginning of the pandemic, and everyone wanted to have a home delivery that still continues to not be the best response to this.
Kameelah Phillips (04:28):
It is still safest to deliver in a hospital or birthing center, certainly not at home to have best outcomes. We still recommend that women breastfeed that's the best way to feed your baby despite Corona virus, even if you were previously infected. And when women go home, I just ask them to be considerate of the new immune system in their house, right? So limiting visitors, washing their hands. If people come over, keeping them not being afraid to say, Hey, keep your face mask on while you're with the baby or around the baby. And really using the technology that we have to their benefit. So while it's not what we're used to, the grandparents meet their babies over FaceTime or zoom now. And that's not going to be forever, but you know, if you have people who are unable to quarantine and can guarantee that they're negative, I asked them to defer visiting.
Karen Litzy (05:29):
Yeah. Thank you. That's all really great advice. And I should have mentioned in the beginning that we are both located in New York city. And so right now it's different.
Kameelah Phillips:
Yeah. So obviously New York was the epicenter of the pandemic, certainly in the United States, if not the world at one point we have now our numbers have gone down, but the safety for the pregnant and new moms have, has not is right. Yeah. Right. So we are still on top of new infections, preventing infections in the hospital, the doctors, the nurses, the people who clean your rooms, we're all washing our hands, wearing gloves, keeping our mask on because it is our priority that you come in healthy and that you leave healthy.
Karen Litzy (06:33):
Yeah. Perfect. All right. Well, thank you for that. And hopefully if there's any pregnant moms or other healthcare practitioners that are working with pregnant women kind of give them a little bit more information to pass along or to kind of keep in their heads. So now let's switch gears slightly here. I'd love to talk about maternal mortality rates in the United States now in the United States. We know, unfortunately that we do have a very high maternal mortality rate amongst advanced countries, or what's the best word for that advanced countries? Is that the right developed countries, industrialized countries, like we know what you're talking about, you get it right. So the questions that I have are what populations are most effected. And then what, in your opinion, do you feel like needs to be done to improve those maternal mortality rates?
Kameelah Phillips (07:32):
I am firmly under the belief that we can as a nation, as a country walk and chew gum at the same time to make these rates better. So to answer your first part of your question we have plenty of data that show that black women, African American women in particular are most vulnerable during pregnancy labor and delivery. And postpartum times the rates of increased death can be anywhere from five to seven times higher than their white counterpart. And these rates are abysmal for a developed country to have such a discrepancy in healthcare is really saddening and frankly just discussing it's unacceptable. But there are other ethnic groups that are also at risk that, you know, we always talk about black and white and really this country is so diverse, but our native American population is also significantly affected by maternal mortality rates that are poor as well as Alaska.
Kameelah Phillips (08:57):
We always forget about Alaska. So African American women, native American women and Alaska women, and it's complicated. It is a combination of access to care. It's unfortunate that we seem like we're talking about the same things over and over, but access is a big issue. We live in the biggest city in the United States, but you know, Manhattan alone, what the Island of Manhattan has four hospitals there used to be more, there used to be more can you imagine? But some of our outlying communities that are more ethnically diverse or Latino or African American have far fewer hospitals. And certainly in those hospitals, the resources aren't comparable to anything that you would see in Manhattan. So along with, you know, access there's hospitals, there's doctors there's birthing centers, all of these are less often found in lower resource places.
Kameelah Phillips (10:06):
So access is a big one education both on the part of the health field and of patients themselves is a problem. I think we're starting to really get some traction on the African American population, helping them understand that this is a very critical time in their life. And so they have to be hypervigilant about blood pressure, weight gain, diabetes, all of things, all the things that can be triggers for issues in pregnancy. Those are the big things that stand out access and education.
Karen Litzy:
And do you also find that, and I find this in other aspects of healthcare especially when it comes to feeling pain that oftentimes women are not believed as much as men are. And, that is in other parts of healthcare, certainly true. Do you find that women maybe during pregnancy or even post pregnancy, like maybe that the day they gave birth, if they're there trying to explain things that are going on and perhaps they're not being believed and are just yeah brushed to the side so that I think is absolutely the case for a lot of the issues that women experience around the maternal period.
Kameelah Phillips (11:22):
And it's not limited to women. It also crosses ethnic and socioeconomic boundaries. We have a real issue and I'm part of the establishment, right? I'm part of the medical community. So I feel free to air up our dirty laundry, that we have a real issue with bias and medicine and we talk about racial bias and how that can impact black people. But we have a bias against women. We have a bias against women and, you know, she's being hysterical, she's being dramatic or pain's really not that big women in our discomfort in our needs are routinely downplayed and even by other women, because we've sort of ingrained in our head that, you know, women tend to be more dramatic, whatever.
Kameelah Phillips (12:30):
We downplay the needs of poor patients who come in, Oh, you know, she's just being loud for no reason or, Oh, that's just how they're. So this isn't just an issue of women. It goes across class, it goes across ethnicities. But for us, when we're pregnant, it has to be addressed and highlighted because when a woman is saying something isn't right. Something isn't right. And that should be taken seriously because in the postpartum period we get lucky a lot of times because women are generally young and healthy, but when things go bad in obstetrics, they happen quickly and then its big. So for example, if a woman was like, my bleeding is kind of heavy and say, maybe she just delivered a baby, a woman could easily lose one to two liters of blood in like a few minutes. So we had a really bad postpartum hemorrhage the other day. And I was like, this is impressive when you see what the body can do. Especially in labor, it happens quickly. And so it's incumbent upon us as healthcare providers to take women seriously.
Karen Litzy (13:27):
And then I would also think there is, and again, I don't know if this is true or not, but I know kind of where I come from more looking at the pain world and from my own experiences, as I personally would downplay my own pain. So as not to bother someone. Right. And do you feel like in the world of OB GYN, if you're going for pregnancy, like, do you have to kind of really educate those patients to say, listen, if you're feeling something doesn't feel right, like you need to speak up, right. Well, like you're bothering us. Have you encountered that?
Kameelah Phillips:
I have encountered that. And it's really incumbent upon all of us to relearn these narratives that we've picked up just growing up in the United States of like not being the complainer or not being the squeaky wheel, not rocking the boat. Like those all have negative connotations right.
Kameelah Phillips (14:47):
In the obstetric space. When you don't speak up, we can have really negative, horrible outcomes. So part of my experience with patients is to listen to what they're saying really repeat back what they're saying, like, okay, I hear you're having X, Y, and Z. Did I get that right? And if it's something that is quote unquote normal in the space of a, you know, a growing uterus or a growing body part of my job is to really provide education, to help them manage their expectations for what they should expect. Growing uterus, growing weight gain, swelling, what they should expect from their body. If it's the first time they've been pregnant or the sixth time they've been pregnant, you know, all the pregnancies are different. And if we have a clear understanding her giving me her complaint, me giving her feedback on what I think she's saying, and then giving her the anticipatory guidance, I think she needs, and we still have an issue. Then it's incumbent on me to escalate it and really make sure that there's nothing there that's going to hurt her.
Karen Litzy (16:01):
Yeah. Great. That's perfect. And I love the kind of handling of expectations and monitoring expectations because that goes such a long way when, especially if it's your first time or not, like you said, your first or your six times, but kind of knowing what to expect at certain times is very comforting. And so then as if you're the patient, then you can say, Oh, you know, she said, this might happen, but I'm not, you know, it's not happening or it's going above and beyond what she said. So maybe this is time that I reach out and contact my physician on this, there are times where you may need to reach out to your doctor. And so knowing when those times might be, is really helpful.
Kameelah Phillips (16:53):
Exactly. So when a woman leaves the office and you know, it'll be maybe a month before I see her again, I tell her, you know, this is what I think might happen. It's okay. If it doesn't happen to you, but in the next four weeks, you might expect, you know, your pants size to change general discomfort in this area. You might feel something fluttering in your belly, like giving her those points to look out for. And again, managing those expectations and I'll get a phone call, Hey, this is maybe more I'm having this. Plus this is this in the realm of normal. No, it's not come in. You know, we can really help women out by giving them education cause it's empowering. And it helps us do a better job taking care of you.
Karen Litzy:
Yeah. And it also keeps people away I would think from dr. Google or far down the rabbit hole of how many doctor Googles do you get?
Kameelah Phillips (18:17):
You know what, I can't anymore. Just so many doctor Google's with doctor said, I can't even more. Or my Facebook friend Sally said, Stay off. And it's funny cause when their partner comes with them, the partner inevitably just looks at him and like glares at them because they know that they're on Google or they're on these, you know, small chat rooms where everyone is on the T level 10 when the patient's issue is actually maybe a one or zero. And so it freaks her out. Yeah. I encourage patients to stay off of Google. Because yes, there are some times when it might answer your question, but really we're aiming for individualized personalized care and Google doesn't offer that to you. And so I really ask my patients to stay off of it. That's what their visits are for to write down the questions as they go. And honestly, it's so funny. They'll come in with like, say there's five questions just in the scope of time, given them the anticipatory guidance.
Kameelah Phillips (19:17):
Like by the time they actually get to the appointment, they may only have two questions because they're like, Oh yeah, she said that was going to happen. They know exactly, exactly. It helps to stay off Google.
Karen Litzy:
Yes, yes, yes, yes. And now I think we've touched a little bit, I think on this, but let's see if we can delve into this more and that are what are ways women can stay healthy throughout their pregnancy so that maybe it can contribute to a decrease in the maternal mortality rate, even if it's just chinking away at the tiny little bit, because like you said, it's a big bucket with a lot of stuff going into it. But if there are ways that women can, like you said, empower themselves to stay healthy and give themselves the best chance, what advice do you give to women to stay healthy?
Kameelah Phillips (20:04):
Yeah. So in thinking about this, I have six points that I usually share with patients. So I'll go over them really quickly. But my first point is to find a doctor that you trust. I'm really big on that. I'm really big on that. I tell people to find someone that they trust because inevitably, you know, most pregnancies are fine, but if we get into some mess, I need to know that you know that I am your advocate and I am on your side. And if you hesitate or you don't feel like you can trust me a hundred percent, I'm going to ask that you explore other op, find another doctor because I want you to the best experience possible. And I even say this with my GYN patients, like if I tell a patient, you know, I really think you need surgery for this.
Kameelah Phillips (20:56):
I don't sign them up for surgery that day. I've let them go into the world, do their due diligence, meet with three other doctors. And I promise you, I have not had a patient not come back because they trust me. So that's a big thing. Find someone you trust. I think it's really important that patients meet with their doctor frequently, meaning that you come to your visits, you got to show up, right? So we can get data from you like your blood pressure, your weight how you're feeling, checking the baby regularly, blood work, this data that we're collecting at every visit. And it might not sound like a lot 15 minutes, but it actually gives us a picture of where we're going with your health. So that's important. I asked my patients also to stay active and exercise. I am not sure why there's this misconception that you should be sedentary during pregnancy first trimester.
Kameelah Phillips (21:55):
I get it that progesterone knocks everyone out there on the couch. They can't, you know, they're nauseous. They don't want to, I get that. But for the most part, when you feel healthy in pregnancy, I need you take care of yourself. And that means exercise and eating healthy and patients are, Oh no, but the baby really wanted the chili cheese fries. No, no she didn't the baby requests. Yeah. Did she send you a text message to get that? So really encouraging, like if you would feed your six month old, you know, a Coke and chili cheese fries for lunch, that's a separate conversation, but you know, trying to do as best they can. In terms of staying active and eating healthy education is a big piece for me. Every time they leave, I'm like, okay, we're entering this phase. These are the major risks for this phase.
Kameelah Phillips (22:53):
So I need you to go home and look at this website and read two minutes about diabetes, cause you're doing your diabetic test and this is why it's important. Being flexible is huge. Patients, I think often have the misconception that physicians or that I control their pregnancy. And really, I see myself as just like a tour guide, ushering your baby safely into this world. And so it's important that they're flexible to whatever the results come back as whatever the ultrasounds tell us, however, the baby is behaving in labor, that they're flexible. In my industry, I'm not sure what the corollary will be with physical therapy, but people who come in with very strict demands as to how they expect their process to be are the main people who have complications as opposed to just letting us do our job, to get you guys to the finish line.
Kameelah Phillips (24:02):
So being flexible is really important. And then my last one is to not refuse life saving treatments. We were, it was in the, I told you the other day I had a postpartum hemorrhage and I might back of my head. I was like, this woman's going to bleed. So as we were pushing or when she got admitted, I was like, you know, this is the type of situation where I see XYZ happening and when XYZ happens and she lost all that blood. When I came to her about needing a blood transfusion, she was already on board to not refuse treatment that could possibly save her life. So not refusing like blood products or blood pressure management, those are increased surveillance. Those are the big things that hurt and cause women to lose their life. So really not refusing important treatment.
Karen Litzy (24:58):
Yeah. And I think thank you, those are great ways that women can stay healthy. And you know, as you were saying, they need to be flexible. And I always go back to movies where they show the woman going in and she's got a birth plan and it has to be this and it has to be this. And there's no flexibility around that. So I could see how that could be really dangerous if you're going in with that kind of a mindset of, you know, I have to have this baby without any drugs and have to have it vaginally. When in fact there might be some complications where that's just not possible and it's just not possible. And, or advised or safe.
Kameelah Phillips (26:00):
And again, we don't decide that, right. The baby's position, the mom's uterus, the pelvis, like all of these things that are outside of our control decide that we're just here to make sure you both come out on the other side. Okay. And I can't underscore that. Cannot underscore that. Like I don't have anywhere to be there's this misconception that doctors always have like tickets. So like I have to be at the opera tonight. No, we don't have anywhere to be we're here for your baby, but you know, we have to have some flexibility, like let us just do our job and we'll get you through this.
Karen Litzy:
Yeah. I think that's great. And then of course, I always love the third point, which is stay active and exercise and move during your pregnancy. And I think I'll give a quick plug for physical therapists. I think this is where physical therapists and women there are a lot of physical therapists who are pelvic health specialists and who work specifically with pregnant and postpartum women. And this is where I think we can actually maybe make an impact in that maternal mortality rate as physical therapists.
Kameelah Phillips (26:54):
Yeah. Yeah. I spent the first part of my career in a group dynamic and it was very hard for us to think outside the box with complimentary specialties that can help make this process of pregnancy, which is physically mindblowing. Like people, if you haven't necessarily been pregnant before or been in an intimate relationship with someone who's going through pregnancy, you can not imagine how physically difficult it is to have a baby. And so when I was bringing up the options of like physical therapy, no, no, no, she's fine. The body heals itself. I'm like, but it's not like, look at her walk. You know, I'm looking at her. Diane is like, like, let's think outside the box. So in my new practice, I'm making much more of an effort and actively establishing relationships with people that, okay, you're having this issue.
Kameelah Phillips (28:07):
Now let's connect with the physical therapist because you know, the hips give women the most trouble, the hips, maintaining flexibility labor and delivery, the act of pushing literally separates your pelvis. You know, it's not, of course you have issues with your pelvis afterwards. Lacerations, you know, women who undergo episiotomies that pelvic floor has literally hit the wall and back. So to not expect that pregnancy is a hundred percent, the most physical activity you can do with your body just really undermines and belittles the whole process. And so part of my process now is to send women to physical therapy, postpartum, even if it's just for one visit so they can have an idea of how to improve their core, how to keep their pelvic girdle in shape and engaged because most women have more than one kid.
Kameelah Phillips (29:11):
So that's a lot of, you know, trauma to the body. And we can do better. We know that it works, we know that it's available, but it's up to us to provide the education and the next steps for them to heal.
Karen Litzy:
Yeah. Well said, well said I love it. And now as we wind things up here what would be, what would you like the audience to take away from our discussion today?
Kameelah Phillips (30:29):
I think that it would be helpful to really understand that most doctors do their best to provide women with excellent obstetrical and Gynecological care. I think that a good doctor is really open to receiving information from other specialties in this case PT, physical therapy as modalities that can compliment what we offer. That's not in opposition to what we do so that if we could somehow strengthen the relationship between obstetrics and physical therapists, everyone would win. Like it's for all of us, the patient the obstetrician, the physical therapist the patient's family. It's, you know, pregnancy is the deal. It affects literally you physically, emotionally, psychologically, and sometimes the physical impact of sometimes a lot of times the physical impacts the emotional and the psychological and your sense of wellbeing and health is so impacted by like how you physically look and feel. And you guys have a direct, you know, you have the keys to helping us, you know, improve women physically. So if we could strengthen that relationship and not see it as so oppositional, I think it's a triple win for everyone.
Karen Litzy:
Yeah, I agree. And the last question I have is one that I ask everyone. And given where you are now in your life and in your career, what advice would you give to your younger self?
Kameelah Phillips (31:41):
So I'm out of residency 10 years, and I'm just starting my first private practice venture. And looking back, I probably should have done this five years ago. And yet I had a lot of other things going on. I was like birthing my own children and that kind of thing. But at the root of it, honestly, I was scared. I was scared of failing. I was scared of the unknown. I was scared of doing things that I'd never been taught before. Like formally I didn't consider myself an entrepreneur, all these like negatives, right? Negative, negative, never didn't have it. Shouldn't wouldn't, couldn't like, and I would give my younger self, like a kick in the butt to like, just get out there and you know, unless it seems so cliche, but you don't know unless you try. And when you're young, there's nothing to lose.
Kameelah Phillips (32:53):
Except the fear that's like this imaginary fear that's holding you back. It's a time to be brave and courageous and adventurous. And so I would probably give my younger self like the little push off the ledge the encouragement that I needed to have started this venture and experience earlier. And I would just tell her to be fearless. What do you got to lose? You can always, you know, move back in with your parents. That's what we're doing these days. Right. So like, why be afraid to fail like that just now it's so funny. Cause I think about it cause I'm in it now, but what did I have to lose? Nothing. Nothing. Yeah. Like time, but that would have been a learning, you know, you would have learned so willing to learn.
Kameelah Phillips (33:52):
So yeah, I would have jumped sooner.
Karen Litzy:
Excellent advice. Thank you for that. And now where can people find out about you about your new practice? Where are you on social media? Where can we find you?
Kameelah Phillips (34:57):
So on social media? My main page is drKameelahsays, my practice page is Callawomenshealth, like the flower. I love the like beautiful erotic nature of the calla lily. So that's my practice Calla women's health. I'm on the upper East side of Manhattan, but also available for telehealth visits, physical visits throughout coronavirus. I've been on the grind in this office. So taking new patients of course also happy to see them.
Karen Litzy:
And for everyone listening, we will have all of this information, one click straight to all of the practice and the social media at the podcast.healthywealthysmart.com. Under this episode, it'll all be in the show notes. So if you didn't get it, don't worry, you can get it that way. So thank you so much for coming on. This was a great episode and I think you've given a lot of wonderful advice to healthcare providers and to women who may be pregnant or want to be pregnant or maybe has already been pregnant. There's a lot of stuff here. So thank you so much. I appreciate it. And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Susie Gronski on the show to discuss chronic pelvic pain syndrome in men. Dr. Susie Gronski, licensed doctor of physical therapy and board-certified pelvic rehabilitation practitioner, is the author of Pelvic Pain: The Ultimate Cock Block, an international teacher, and the creator of several programs that help men with pelvic pain get their pain-free life back.
In this episode, we discuss:
-What is chronic pelvic pain syndrome/chronic prostatitis
-Sociocultural barriers unique to men receiving pelvic pain care
-Male expectations and reservations during a pelvic health treatment session
-Strategies to increase patient self-efficacy
-And so much more!
Resources:
Susie Gronski Instagram
Susie Gronski Facebook
Susie Gronski Twitter
Treating Male Pelvic Pain Course for healthcare practitioners
Pelvic Pain: The Ultimate Cock Block Book
In Your Pants Podcast
Men's Online DIY program: use code painfree20 for $20 off!
One-on-One Intensive Program
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Susie:
Dr. Susie Gronski is a licensed doctor of physical therapy and a board certified pelvic rehabilitation practitioner. Simply put, she’s the doctor for ‘everything down there.’
Her passion is to make you feel comfortable about taboo subjects like sex and private parts. Social stigmas aren’t her thing. She provides real advice without the medical fluff, sorta' like a friend who knows the lowdown down below.
Dr. Susie is an author and the creator of a unique one-on-on intensive program helping men with pelvic pain become experts in treating themselves. Her enthusiasm for male pelvic health stretches internationally, teaching healthcare providers how to feel more confident serving people with dangly bits.
She’s determined to make sure you know you can get help for:
- painful ejaculation
- problems with the joystick
- discomfort or pain during sex
- controlling your pee
without needing to be embarrassed...
So whatever you want to call it, (penis, shlong or ding-dong), if you’ve got a problem ‘down there’, she’s the person to get to know. Dr. Susie is currently in private practice in Asheville, North Carolina specializing in men’s pelvic health.
Follow her on Instagram, Facebook, Twitter, YouTube and listen to her podcast, In Your Pants, for expert pelvic health advice without the jargon.
Read the full transcript below:
Karen Litzy (00:01):
Hi Susie, welcome to the podcast. I'm happy to have you on. And now as the listeners may know, I've had a lot of episodes about pelvic health, pelvic pain, but most of them were centered around female pelvic health and pelvic pain. And today, kind of excited to have you on Susie because today we're going to be talking about chronic pelvic pain in men. And I think this is a topic that is not spoken about a lot. I don't know if it's still considered taboo in many places. We'll talk about that today as we go through this podcast. But before we get into it, can you tell the listeners what is chronic pelvic pain syndrome or chronic prostatitis, which I don't know why I have a hard time saying that word and I'm looking at it and still have a hard time. But anyway, that's neither here nor there. That's my problem, not yours. So go ahead and just give us what is it?
Susie Gronski (00:52):
Well that's okay about the not able to say the word prostatitis because it is a bit of a misnomer when we're talking about male chronic pelvic pain syndrome. So it's okay. I wish that word wasn't used as frequently anyway to describe what we're going to be talking about. So the official definition that one might read in the literature is that chronic pelvic pain syndrome or chronic prostatitis is having recurring symptoms lasting more than three to six months without a known cause or pathology. And that typically results in sexual health issues, urinary complaints, and obviously a lot of worry to say the least. So that's the official definition of chronic pelvic pain syndrome.
Susie Gronski (01:46):
Now the NIH or the national Institute of health classifies, I put in bunny quotes here, prostatitis into four categories and briefly those categories are an acute bacteria prostatitis, chronic bacterial prostatitis, chronic non bacterial prostatitis, both inflammatory and non-inflammatory, which is the realm that physical therapist will work in. And then you have a category, interestingly enough, asymptomatic inflammatory prostatitis. And I think that's really important to stress that you can have quote unquote inflammation in the prostate, but you still have individuals who are asymptomatic. So when it comes to the word prostatitis and itself to describe male pelvic pain, I think it is a bit of a misnomer because a lot of cases are not bacterial related or infection related. And actually in fact 90 to 95% are not infection related or bacteria related. So I think we need to shift from using prostatitis as the main umbrella term.
Susie Gronski (02:52):
Because you know, it puts the blame on the prostate when we know that's not the sole cause or what we're dealing with in the long run.
Karen Litzy:
Got it. So that, that can be a little confusing for people. Cause I'm assuming if you're a man and you hear that diagnosis prostatitis that that's gotta be kind of unnerving to hear. Right? For one you don't know what it is.
Susie Gronski:
Yeah. It's like, well, and I don't want to stereotype, but I think when guys really hear prostate, anything, what's the first thing that might come to mind? Cancer, cancer. Right. And so now you're freaked out like what's wrong with my prostate? Am I going to have cancer? We know it's highly prevalent. And so yeah, I think it is a bit of a misnomer in terms of when you have pain down there especially without a known cause that leaves the fear of, well, they must be dismissing something.
Susie Gronski (03:50):
There must be something really seriously wrong that the doctors are not just finding.
Karen Litzy:
And what are some common symptoms? I know you mentioned a couple in the beginning there, but if you can kind of repeat those common symptoms that people may experience with chronic pelvic pain syndrome and is pain one of them. Yes. Right?
Susie Gronski:
Yes. Most often it is a sensation that is not typically pleasurable. It's painful. It may or may not be associated with urinary issues. In general. You'll have any sort of pain or discomfort in the abdominal or genital region. It could even be around the tailbone or even pain with sitting, sitting around, you know, around the sit bones in the groin. It may or may not be associated with sexual function. So for some men they might experience pain after completion or with an erection.
Susie Gronski (04:46):
They might feel pain with bowel movements. It might be testicular pain. It might be pain between the scrotum and the anus, typically known as the taint area. So there's a lot of overlapping symptoms that one might have. Again, everyone's so unique, but those are some of the common themes that one might hear in the pelvic health world.
Karen Litzy:
And so if you're experiencing these symptoms, let's say for more than a month, I mean, will people experiencing these symptoms for, let's say a couple of weeks before they go see a doctor or go to look up their symptoms and see what's going on?
Susie Gronski:
I think that varies on the person and their personality in terms of like their health and healthy behavior in terms of men health seeking behavior. We know that when you compare it to, for example, women, they don't tend to kind of seek out the help of doctors as women might do.
Susie Gronski (05:50):
Right. and I think that's across the board in terms of international standards as well in terms of the seeking behavior, health seeking behavior. I don't think I can have like a, I don't have a stat or factored on that, but I do think that men tend to kind of like watch and see what happens or you know, I think many of us do. Like if you feel something you're like, well that'll just pass. Right? I don't know if I gave an answer that fully. I just know that sometimes people wait and sometimes people go right away cause they're afraid or whatever the case may be. But I do think that the sooner that you can get reassurance for what you're experiencing in term, and I mean reassurance from not just take these antibiotics and come back and see me in six weeks, it should go away.
Susie Gronski (06:42):
Because that's typically what will happen when a guy will seek help. And I think the main one of the main barriers too is that where does a guy go get help from when something like this happens? Cause for females we have a gynecologist or a woman's doctor, right. But guys, like I know my husband just, he's like, I would have no idea where to even go. Who do I seek for help for this kind of thing. And so I think when we're talking about barriers for seeking help, that's one of them. I just don't know where do I go. And then you'll go to your primary care physician who may or may not be familiar with, you know, chronic pelvic pain or being able to differentiate, you know, whether it's an infection and what tests to do.
Susie Gronski (07:26):
A lot of times men are given antibiotics without even having diagnostic tests to see if there's an infection, which is unfortunate. And they'll do this for several rounds too. And so I think the longer that happens, the more that we're making the situation worse in terms of, you know, we know we've got microbiome, we'll plan to those pictures. Well it may or may not have been an infection that triggered this. We know the immune system plays a role in chronic pelvic pain. So, you know, I think having a well versed, fuzzy healthcare professional who can really help this person say, Hey, this is what could be happening. We know a multifactorial and multi-modal treatment approaches is very helpful for what you're going through and that, you know, these symptoms shouldn't last forever. Here go see a pelvic therapist if we know that's not happening.
Susie Gronski (08:23):
And I see guys several years later or years later before they even have an appropriate diagnosis, which I guess brings me to say that chronic pelvic pain syndrome is a diagnosis of exclusion. So, before they even come see or get a referral to see and see if they're lucky to get a pelvic health referral, they'll go through a lot of invasive tests. Cystoscopies colonoscopies. I mean, you name it. So I just think that by the time they do get the help, the right care that they need for the issues that they're experiencing, they've gone down a really dark rabbit hole by that point.
Karen Litzy:
Yeah, and that's sort of looking at, I mean, it's not that they're healthcare providers are intentionally doing them wrong, right? They just don't know. Right. So we're talking about, I guess this more traditional view of a medical process for men who are coming in. Having these complaints is saying, well, let's check this, this, this, this, this, and this. Like you said, a diagnosis of exclusion. And then years down the road they come to see you and I can't imagine, forget about their physical wellbeing. I can't imagine their mental and emotional wellbeing is doing all right either. And now the pelvic physical therapist has a whole lot of comorbidities to deal with.
Susie Gronski (09:21):
Absolutely. Absolutely. And with any type of persistent pain, not just chronic pelvic pain syndrome in men, but I think with any type of persistent pain, we really have to be looking at the psychological and sociological aspects of that person's experience. Because at this point now we're dealing with an emotionally driven process versus a purely nociceptive in nature. You know, it may have started that, but now we're dealing with this like this cat yarn, I don't have cats, but a kid, I know they like to play with yarn and you have this big ball of yarn that you're really just taking one strand out at a time to really unravel and everyone is so unique and very different.
Susie Gronski (10:30):
So yeah, I think that's where we're dropping the ball with getting quality pain care for these individuals. Number one, just getting rid of some of these barriers of a lack of education on the practitioners, you know, perspective of what do I do in this situation? Why do we need to have all these invasive tests done? In my opinion. I don't think we need to do that, but they're really not getting the referral to see qualified, you know, pelvic therapists who can really rule out, you know, biological triggers and even work with the psychological and sociological aspects of that person's experience. Just to, again, calm things down. And to reassure that person that things are going to be okay. And to that extent, I think this would be worth noting as well is some men do not have positive medical experiences in that they're not being validated, often being dismissed.
Susie Gronski (11:23):
And no one's really actually looking at their genitals. To this day, I still have men say it's all about just finger, finger in the butt, checking out the prostate, and no one's really addressing like, take a look at my testicles, look at my penis, like treat it like any other part of my body. And then you're then that kind of plays into the blame and shame of one's body. And just again, not knowing, no one's really looking at it. I want somebody to look at it to tell me I'm okay. And I think that's really being missed as well in those early encounters with medical providers. I think that's so important.
Karen Litzy:
And you know, you had touched on it a few minutes ago talking about not just what we see from a physical standpoint, but a socio cultural standpoint as well. So what are some common barriers that are unique to men from a sociocultural standpoint when receiving care for chronic pelvic pain?
Susie Gronski (12:25):
Well, the first one that I touched base upon as you said, was having an outlet to get medical care. So there isn't a, you know, male gynecologist per se for men. And so I think just having a lack of that awareness of where does a guy go get help for these types of things. Where would be the best physician, let's say for health urologist or urologist. But that isn't usually the first line of the encounter. It's usually an internist or primary care physician. And sometimes it could be even other healthcare professionals like a massage therapist or a chiropractor, an acupuncturist who's hearing these the symptoms or men feel comfortable enough with the trusted provider that they trust to talk about even what they're going through. Cause I think that brings me into the second, I think barrier is I think if I can say this, the masculine side of culture, right?
Susie Gronski (13:33):
Like, what should men like mentioned man up and not have these issues and what if something is going on down there? Like, you know, guys aren't really talking about their private parts in the locker room per se. And I speak, again, I'm speaking for the heterosexual male, but like, you know, I think it's just uncomfortable in terms of how the society that we live in to even have that conversation be brought up so that being one of the barriers is just, we're not really talking about sexual health issues and what could go wrong unless it's like, you know, erectile dysfunction. Right?
Karen Litzy:
Well, that's all over TV, so you can't miss that one. Right, exactly. Here's a pill for that. We know how to fix that. You know, you got Snoop dog talking about like male enhancement products, Pandora. Yeah. And I think, I think in terms of, you know, what are the conversations that we're having around men's health and really comes down to what's selling and what's not selling, unfortunately.
Susie Gronski (14:38):
But yeah, I think that that's one of the biggest barriers as well as just we're not talking about it outlets. There are no you know, taking a stand for men's health essentially. And the second thing too, or the third thing is when a guy has pain down there and they look it up on the internet, cause that'll probably the first thing we do. Absolutely dr Google will be first they're there and to get help, everything is women's health, women's pelvic health, a women's clinic, baby and mom, you know, like things like that that are coming up where that in itself is like, wow, this is a quote unquote woman's issue. Why am I having it? What does that mean for me? Because again, guys and everyone, I think unless something is going on down there, like we really don't talk about our pelvises or how things work and we're not taught, we're not really taught about like you know, what to expect and how things work and that you have actually pelvic muscles down there.
Susie Gronski (15:39):
So until you know, something goes South literally and then you have to like look things up and there's enough of crap out there to scare anybody. And so I think, you know, again, I think Google is helpful but it also can be harmful because we know, we know that anything can really shape someone's prognosis when they're seeking treatment and you have scary forums and you have people talking about how I'm living with this for several years. And then you have this person who's just starting to experience these symptoms, reading through these forums and looking at, you know, it could be cancer or it could be this or that. You know, it's like a life sentence. And that's really scary. And that I think is what part of the picture that takes things from acute to chronic in my opinion.
Karen Litzy (16:48):
Yeah. And you know, when people are involved in, and this isn't across the board, but oftentimes in those kinds of forums, it's people are writing about their experiences that have gone wrong, right? Or that you said, I've been experiencing this for years or I tried X, Y, and Z and it was horrible. So when you read those kinds of forums, cause I've gone on those, I think we, you know, a lot of healthcare practitioners should go on some of these forums to see what's being spoken about. But I've gone on them for like chronic neck pain and you're like, Oh my God, goodness. Right. This is, this is frightening. It's really scary. And so I can't even imagine someone going on there who is experiencing, like you said, some of the symptoms that you had mentioned before. Maybe they've been experiencing these symptoms for a couple of years or a couple of weeks and they look on these forums, they're like, Holy crap. Yeah. Like this is what my life is going to be now.
Susie Gronski (17:35):
Right. I mean that is really scary. Exactly. Exactly. And that we know, doesn't matter what body part we're dealing with, right. Tends to make the situation worse. Yes. Just cause of that. And so I think I'm a huge proponent of, I don't think I am a huge proponent of having good information knowledge. And like I said, reassurance for this group of people to say like, Hey, this isn't forever. This is what you can do about it. We can really work with this. It's more common than you think. And, it happens in this area, just like any other part of our body, you know there's muscles down there, there's nerves down there, there's everyday function that happens, like pooping, having sex, you know, all these things are quite normal. And I think just even experiencing some discomfort down there, just like you would have some back pain once in a blue moon is not, you know, something that needs to be perpetuated I think for many, many years.
Susie Gronski (18:41):
But I think we're talking about is that it's unfortunate because they will go down a rabbit hole of, well we've checked everything, we've done every scan under the sun and there's nothing that's showing up on scans. I just don't know what else I can do to help you. And then at that point the conversation is, well now it's all in your head and then, and I'm a goner. Like I'm doing. Yes, I'm doomed. Like and then, yeah. You know, when we talk about the interpersonal context of pain for that individual, it's am I going to be able to have a family, you know, if they don't have any, you know, or be in a relationship or to have kids or how about my job, I have to sit for my work. I can't do that. Or what about my sport that I want to play?
Susie Gronski (19:27):
Does that mean I can't do that anymore. I mean, there's so many like what ifs and uncertainty and that's one of the themes that men will talk about it's this uncertainty, this roller coaster ride of the symptoms that they experiences. It's fine, you know, one week and then it's terrible the other week and they just don't know what to expect because there's no rhyme or reason for it, for their triggers. And that's really, I think that's a really hard mental, yeah. How do I say that? Like a lack of words. It's really hard. Mentally. It is.
Karen Litzy:
Yeah. You know, you're absolutely right. And now let's say one of these guys they've been having these symptoms, they've gone to their doctor and miraculously their doctor said you need to go see a pelvic health therapist. Right. Yay. The doctors know what's up. So what are some reservations men might have before seeing that pelvic health therapist? And then we'll talk a little bit from the therapist background point of view after that. But let's talk about the men's point of view first.
Susie Gronski (20:26):
Yeah. So, the point of views that I'm going to be talking about are actually from the people that I've worked with. So I'm just reiterating or paraphrasing from their experience. But the number one thing is what is it? Cause the doctors aren't really telling them what to expect. So again, they'll go on to Google and they'll find like, you know, this is a woman's health issue and why am I going here? And you know, again that psychological aspects of I guess gender in general of what that means for me as a person. And that experience in itself might be one reservation.
Susie Gronski (21:17):
Like you know, this is a women's health issue. Like I don't want to go there. And so they might put that off. Which is common as well. I think the second thing is the actual procedure of having internal work or an internal examination. And this is one message I'd like to kind of get across to people is that you don't have to do internal work to get better. And I think there's this huge misunderstanding of like pelvic therapy being like, well, it's all about moving the genitals out of the way and just going for internal work and chasing trigger points. That's not really what it should be an in fact, I think unintentionally of course, I think that's more harm than good because we aren't really asking. Like if you ask the guy in front of you like is this something that you really like?
Susie Gronski (22:06):
First of all, what would be the purpose of doing internal work? Or even having that assessment, like why are you doing what you're doing? And number two is that in alignment with what that person wants, is that a goal of theirs? Is that functional for them? You know, why are we doing these things? Because we don't want, as for me, I'm speaking for myself, I don't want it to be another person to create medical trauma. I don't want to be that person that says, well this is what you need. When in fact like they're sitting up there on the table, you know, cringing and guarding and tensing. And I think it's funny for me, like it's not funny for the person on the table, but I think when they're pissed we'll say, Oh, you're really tight. You know, you're really tight.
Susie Gronski (22:51):
It's like, yeah, this is tightest I've ever seen. And I look at me and I'll tell my patients, cause they'll be told that. And I say, well, how did you feel on the table? Were you comfortable with what was going on? And they're like, no, you know, no. And I said, well, no wonder your muscles are tensing. And that would happen with anyone, you know, I'm like, but that doesn't mean that you're broken or that there's something wrong with you. And I think that's the message that's going across, not for every therapist. And I'm not speaking for every therapist, but it's just a theme that I see with men who come into my office who've had therapy in the past. And that's something that I think might be a huge reservation for someone seeking care as well, is having to have an internal assessment done.
Susie Gronski (23:36):
Although it is common, it doesn't have to happen. And if you're doing an internal, so now let's kind of go into the pelvic health therapist point of view. So this patient comes in, they've had chronic pelvic pain for, we'll say several months and why might you do internal work in or an internal assessment if the patient was okay with it, obviously. So what would a therapist be looking for? So if the person is agreeing to have this done, number one, I think it's, they want to have a thorough evaluation by a professional who works in this field. So that's reassurance. So you would do that because they're asking you to do that, to rule out whatever's putting their mind at ease, right? Again, if that's what they so, so want, I think that's the first thing that we're doing.
Susie Gronski (24:35):
Number two, if there's like pain with bowel movement or let's say that person's sexual preferences or pleasure has to do with anything anal that would also be applicable in order to just map out areas of tenders, tenderness, and then see if we can change that. So we're not, they're looking for golden nuggets, trigger points. We're there just to see, okay, can we change what you're feeling and can we give that person an experience of, Hey, it doesn't always have to hurt this way. And there are things that we can do to change things and essentially giving them back a sense of control of their own body. But I like to preface that it is a very awesome teaching opportunity for the person because you can say, well, how does it feel when somebody else touches you versus when you try to do this yourself and right then and there during the assessment, I will actually have, we'll compare, I'll say, okay, I want you to touch those areas at home and tell me what you feel.
Susie Gronski (25:39):
And then I'll say, if it's okay, I'm going to do the same thing and that might be my own individual hand. It might be hand over hand with that person's hand. It just depends on, you know, again, their comfort level. But essentially I'm just there to see if we can change their experience in their body and to prove that you don't have to hurt all the time and that things are changeable. So I love those moments. So that's the reason that I would do any internal work or any external work for that matter, is to see if we can change that person's experience in their body to create more safety and less danger. And so it makes sense. That's what I would do. So yeah, that's essentially why do that and it's not an hour long treatment session of you know, internal work.
Susie Gronski (26:31):
But, men do appreciate that you take the time to actually talk to them to address their body just like, or this part of their body just like any other part of their body. And that's a theme across every single man that I have worked with. I came into my office, you know, they'll say, I really appreciate how you just worked with me and worked with my intimate parts of my body but just considered it just like any other part of my body, like my nose. And they just felt like the sense of like they can feel vulnerable, they can be safe. They feel heard and validated because somebody is actually taking the time to work with them to ease their essential suffering around what it is they're experiencing.
Karen Litzy:
And I think that's really important. And so if you are working with a patient with this diagnosis and they are not comfortable with internal work, cause like you said, you don't have to do it. So what might be some other evaluative procedures you might do as the therapist to help this patient? Like you said, feel more comfortable in their body and get a better sense of understanding of what's happening.
Susie Gronski (27:45):
So the first thing is really just getting to know their story. So going back to giving them time to talk about what's going on for them. I think for men, having an outlet to be heard is really important because men don't typically kind of talk about these things. So once they know that you are accepting and you're there to offer that space for them to express themselves and the difficulty that they're going through with this, I think that's therapy right there. Just to give them that opportunity. So, having a supportive outlet. And the other thing is just if it's movement related, if it's an activity that they're having difficulty with, for example, sitting as a very common one. I have all sorts of like gadgets and toys in my office and I just bring some playfulness into the conversation.
Susie Gronski (28:39):
I have them sit on various different surfaces to see what would be something they like would actually explore, you know, again, I'm trying to see if we can violate the expectancy of, well, it always hurts and it's constant. I can't change anything. And so my role is really to see like can we change things and if we can, let's do more of that. So I try to bring a little fun into it. I try to incorporate like the passions, their hobbies that they once had done but have stopped since because of all this happening. Sometimes we don't even do any hands on work or any, even a formal assessment on the first day because we're really going through the story and we're reestablishing a sense of that person, a sense of what that person, who that person is. Because a lot of times you lose who you are.
Susie Gronski (29:38):
You know, when you have pain, persistent pain, you've gone through something. So life changing. So I think, you know, for me and for that person is establishing, well, what would life look like? What would life look like if this were no longer a problem? Who do you want to get back to being? And so I do vision boards. I'll do some sort of visioning exercise of where we can get to like the why, you know, why is this important for you? What do you want to get back to doing? How do you want to feel in your body? And then that becomes essentially the treatment plan or the plan of care. Anything that we can do to collaborate together in more of a coaching relationship to help you move forward, to attain I guess living in a way that you see yourself living, but also a values based type of approach.
Susie Gronski (30:28):
In terms of treatment. So I know that was like a mouthful, if it's the Bible, you know, I'm doing a bio-psycho-social approach, but I'm really, really having a being patient centered and patient led and I'm just there guiding them. So for some people it is really more of this, I need to figure out who I am, I need to start doing something. Well we figure that out before we go on the table. Cause there might be a lot of fear with that or they might have had certain traumas associated with, you know, medical experiences that may have had that may be negative. And so there might be a lot of reservation.
Karen Litzy:
And I think we as therapists need to recognize that that person might say yes, like yes, that's okay for you to do all these things like with touch. But we should also be responsible of actually paying attention to what their body is doing, what their autonomic nervous system is doing while you're touching them. Because they might say, yes, and I'm guilty of this too. I'll go for a massage and that person's touches firmer than I'd like. And they'll ask me, you know, how's my pressure? And I'll be like, Oh, it's good, it's good.
Susie Gronski (31:37):
That's my point. Exactly. That's what the person that you're working with is going through the same thing. And I think it takes a sort of a bit of a skill to recognize or to be more mindful of, you know what, this isn't necessary. I noticed that you're sweating a little bit more, that you're tensing up more. I see your facial expressions, what are your eyebrows doing? And then I'll say, you know, we don't have to do this. I don't think this is right. You know, your body is saying one thing and I know you, you know, I know intellectually, yes, they want it. They want to make you happy. They want to please you, they want to make you happy. And I think part of the treatment too is giving them permission. That's self-efficacy, that's giving them a sense of agency to make that decision for themselves.
Susie Gronski (32:21):
Do I want, you know, I want to be able to say no. You know, and I tell them right off the bat, you know, that may know I have a lot of tools in my toolbox and if we try something where you're willing to try something and it doesn't work for you, just let me know cause there's many other things that we can do and try out. It doesn't have to be this one size fits all, which we know never works. So yeah. Anyway, I guess in the long run it just depends on the person who is sitting in front of me and essentially what they're telling me they need. And they'll actually, I have a very long intake form, but it's more reflective, very open-ended. And so I'll know from that of like what they're telling me. It's just so it's this awesome cause you can see it like they actually write it out.
Susie Gronski (33:04):
Like this is what I need. So I think is happening. Great. Well I'm going to facilitate this process and we have a conversation around that.
Karen Litzy:
Yeah. And I think that's great. And I think it gives the listener, certainly other therapists listening have a better idea as to what a session treating someone, treating a man with chronic pelvic pain might look like. And now you had mentioned self-efficacy and we all know that as physical therapists one of our biggest jobs is to give people a sense of self efficacy and control over their body. So do you have any helpful strategies that you give to your patients for them to increase their self efficacy and to be able to manage their care when you're not there?
Susie Gronski (34:02):
Hmm. I love that question. So as you know, it probably depends on the person, but everything that we do together in a session, I make sure that they walk away with, well, here's what you can do for yourself. And it's really just a suggestion for them. I really want them to take it to experience it. So for example, I might say, you know, let's do some pleasure hunting. Probably if they've had experiences with you know, having an erection or participating in sexual activity, that was painful. We know that it's like all it takes is one time for things not to work and for things to be bad, to have a bad experience, to be worried about the next time and the next time and the next time. And unfortunately that's really strong for men and their, I guess their penis function, you know? And that's not uncommon to experience when you have pain down there. You know, the last thing you want to do is be like, yeah, I'm ready for sex. You know, it's a threat. Absolutely. and I think it's just educating, educating the person about like, this is completely normal what you're going through and it's common and it's not forever and let's see what we can do to start getting you to feel comfortable in your body again.
Susie Gronski (35:05):
And so, yeah, I think just having that kind of conversation, not being afraid to ask the questions and then asking them, well, what is it that you'd like to do or start with? Cause there's so many things we can do. What is it that you think is the most important thing to start with onto your recovery? Like I said, it could be sensory integration. So touching one's body, touching oneself and not being afraid and then having a recovery plan or a flare up plan. Cause we know that's common as well. So having some sort of structure around if I experienced this discomfort well what can I do next to help myself in this situation? Whether that's breath work a stretch you know, talking to a friend meditating, whatever it is for that person. Then we kind of put that into a plan to say, okay, next time, you know, if you try this cause you can't really, it's really hard to just, I think applied graded exposure techniques or graded activity to sexual function.
Susie Gronski (36:08):
Like you know, erections and having an orgasm and you're ejaculating. You can't like stop halfway. Like coming back from like, once you hit that climax, you know, and I think just letting them know that this is the process that happens in your body when you're having an erection and when you're ejaculating and here's what you can do to help yourself post. So, you know, I usually give things like recovery plan, but it's really collaborative with that person cause you know, everyone has their own way of living and their own lifestyle and whether or not it depends under relationship dynamics and sometimes we have to have a conversation around that. And then, you know, if any of those things are kind of coming into play, then we have to reach out to other, you know, a network of team members to help with all those dynamics that might be contributing to that person's experience.
Susie Gronski (37:01):
So, you know, like sex therapist or couples therapy or, you know, that sort of thing. So it just, you know, again, it depends on the person. So I actually want to do, I do want to make a comment about, you mentioned you know, so what is it that you give to your clients or to your patients? I think the other thing that I want to mention is that for therapists not to be afraid to address the genitals, this is one thing that I think is still common where female therapists will want to I think move male genitalia out of the way and just go to internal work. I think it's really important not to be afraid of, you know, addressing, we're touching a testicle or touching their penis. Because for them it's really important that you're doing that and then you're showing them what exactly, you know, showing them techniques or sensory integration techniques that you can do that they can do for themselves.
Susie Gronski (38:03):
So you don't have to do things. You're just showing them and then you're saying like, this is all completely normal or you know, or this is what we can work on. And having them experience, have an experience in their own body that's completely not sexually related at all. But I think as female therapists, we're afraid of like, well what if they have an erection right in front of me? You know, or like, and that's happened. You know, that does happen. I think that's one of the reservations is like, and speaking of reservations for the guy on the table, they're also afraid, maybe more so than you, that they're going to have an erection. Oh my gosh. You know, and then I always, I'm very candid about that too. I'm like, you know, we're touching parts of your body that have nerves and sense things and physiological reaction may occur.
Susie Gronski (38:47):
No big deal. If you need some time to yourself, I'll walk out of the room, you know? But you kind of address it before they even have a question about it. To put things at ease. So, sorry, I went on a tangent with that.
Karen Litzy (39:20):
I think that's important. That's really important to mention for sure. No, this is great. I mean, what great information. And so if you were to kind of take this conversation from let's say from the point of view of a man suffering from chronic pelvic pain syndrome, what would be your big takeaway for them?
Susie Gronski (39:23):
Big take away. How can I put this in one sentence? The big takeaway would be that this doesn't have to be forever. Like that this isn't permanent. That if there is something going on down there, don't be afraid to talk about it. I know you may not be surrounded by people who are very candid about talking about poop pee and sex. Like, you know, us as physical pelvic therapists. Anyway, we're so comfortable talking about that, that we forget that people, other people have reservations about talking about private parts. But yeah, not to be afraid to just, you know, reach out to a professional who understands what you're going through and who can relate to you because it doesn't have to be a lifelong sentence and a death sentence per se.
Susie Gronski (40:27):
You can get help for it and there's help for this. And yeah, I just, I guess that would be the main thing, just making, you know, having support and having that outlet for them to just be themselves and know that they're not alone.
Karen Litzy:
And what about to the physical therapist who, let's say you, if you are a pelvic health therapist, you're probably a little bit more informed about this, but what if you're not a pelvic health therapist and someone is coming to you with these symptoms, what advice would you give to them? I mean, outside of, I have some that I could refer you to, who is more well versed in the treatment of this, but what advice would you give to the physical therapist?
Susie Gronski:
You might be seeing a patient with chronic pelvic pain syndrome. I think just having more knowledge about what it is and what it isn't just as a practitioner so that you can have a conversation with this person who is experiencing pain because it in fact, you know, if the person you're working with has groin pain or the tailbone pain or sit bone pain, I think just being aware of like, there are other things that might be involved and asking questions, really not being afraid to ask questions.
Susie Gronski (41:48):
Maybe you put it in your questionnaire. I think there used to be Oswestry used to have a sex question in it. They took it out. So get the original one, keep the original one. But, yeah, just not being afraid to ask those questions and really just asking the person like, you know, I know asking permission without giving advice to, you know, just saying like, you know, I know a little bit about this. It's not within my scope, but how do you feel about having a consultation with a colleague of mine who works with men? Or who works in this field that can really help you out, we can really work together. It really is just opening up the conversation to say, Hey, you know, you're having these symptoms. There's something that we can do about it.
Susie Gronski (42:36):
It doesn't have to be, you know, it doesn't have to be like, well I don't know what to do for you, you know? Exactly, yeah. I think that's what it is. Like, you know, give them a resource or give them a website. There's so much free stuff out there. Like my website, I have all sorts of like blog posts and many others who work in this field have a lot of great literature on here's some things that you can do to just open up the conversation and what you can do to help yourself. So I think that's really the key. I think for PR professionals who are not pelvic health therapists but working with people who have pelvises that make a difference, you know, and you know they might be coming to you for low back pain but we know that low back pain and pelvic floor dysfunction and pelvic issues are correlated, highly correlated and in fact you know a lot of testicular pain can or can't originate because of low back issues and vice versa because of the connection there.
Susie Gronski (43:31):
And so just I think just having that conversation with your patients of saying like this is why it's all connected and this is what I think is what else is happening. How do you feel about getting, you know, getting a consult from so-and-so related to this because they might be, that person might be having many other struggles down there but not talking about it. Right. The first and foremost thing to do from a therapeutic perspective is let's have a conversation because we don't know what else might be going on for that person. And we can certainly be that gatekeeper, that liaison that says, Hey, I know I can get you to see so and so to help with these things issues. You don't have to just live with them.
Karen Litzy:
Yeah. Great. Great advice. Thank you so much. This was such a good conversation. I think from the standpoint of the therapist and the standpoint of a man maybe experiencing some of these chronic pelvic pain symptoms. Thank you so much. And now last question is one that I ask everyone and that's knowing where you are now in your life and your career, what advice would you give to yourself as a new graduate out of PT school?
Susie Gronski (44:52):
Oh, that's a good question. Okay. So what advice would I give myself as a new graduate from PT school? Hmm. You don't have to be so serious. I think that would be the advice of knowing that we're humans are all very different and we're built differently. And what we thought was once quote unquote true is always evolving and just use your own experiences to make those determinations. Like you don't always have to be, I don't know, taking word for word when everyone tells you, experience it for yourself and then make that decision.
Karen Litzy:
Excellent advice. So now let's talk about what you have coming up. So you've got podcasts, books, courses. So tell the audience where they can learn about what you're doing so that they can in turn help their patients or help themselves.
Susie Gronski (45:52):
Well, thank you for this opportunity to have a shameless plug. Here I am. Well, I'm currently working on the second edition or revised edition of my book, pelvic pain, the ultimate cock block, which is written for, you know, the average Joe who is suffering from pelvic pain. I have a podcast called in your pants that's also on YouTube. And I have several programs support programs for men who are suffering, who suffer from pelvic pain. Some are online DIY programs, others are support programs where myself and a psychologist and sex therapist have collaborated on. And I also have a course that I teach. It's called treating male pelvic pain eight bio-psycho-social approach. So I'm very busy. I have a lots of things go. It's awesome. But where can we find all of it on my website? drSusieg.com. I'm on Instagram @drSusieG. I'm also on Facebook and Twitter. Same handle.
Susie Gronski (46:54):
Awesome. Yeah, and we'll have the links to everything at podcast.healthywealthysmart.com under this episode. So one click will take you to all of Dr. Susie's really helpful information, whether you're the person living with a chronic pelvic pain syndrome or you're a health practitioner that wants to learn more. So Susie, thanks so much for coming on. This was great and I look forward to your revised book and all the fun stuff that you have coming out. So congrats. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jennifer Hutton on the show to discuss Anti-Racism & Allyship. Dr. Jennifer Hutton, aka Dr. Jpop, is a pediatric physical therapist from Nashville, TN. As a Black woman, Jennifer knows what it is like to identify as different, and it has helped in her quest to be an ally for children with disabilities inside and outside of the clinic. Now she is educating others on how to be effective allies to BIPOC and furthering her desire to create a diverse and inclusive space she calls Dr. Jpop’s Neighborhood.
In this episode, we discuss:
-How racial trauma impacts the biopsychosocial determinants of health
-The difference between an ally and a white savior
-Implicit bias in healthcare
-The lifelong process of Allyship
-And so much more!
Resources:
Jennifer Hutton Facebook
Jennifer Hutton Twitter
Jennifer Hutton Instagram
Jennifer Hutton Website
Anti-Racism & Allyship for Rehab and Movement Professionals
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Jennifer:
Dr. Jennifer Hutton, aka Dr. Jpop, is a pediatric physical therapist from Nashville, TN. She became interested in PT when her youngest cousin was diagnosed with cerebral palsy. Jennifer spent time observing him in different therapies, and subsequently determined that she would work with children in a similar capacity.
She graduated from Loma Linda University with her Doctorate in Physical Therapy in 2008, and moved back to her hometown. She spent two years treating in an ortho setting before finally transitioning to her dream job with children. Jennifer enjoys treating the developmentally delayed population, as well as children with neurological and orthopedic diagnoses, both congenital and acquired. While the world reminds children with special needs of their limitations, she believes they are all capable of the impossible and helps them see that their special gifts will help them be their best selves. Jennifer loves to showcase her “pop stars” and share creative treatment ideas on Instagram. She is also an instructor for RockTape and is currently working on her own educational content for pediatric movement specialists.
As a Black woman, Jennifer knows what it is like to identify as different, and it has helped in her quest to be an ally for children with disabilities inside and outside of the clinic. Now she is educating others on how to be effective allies to BIPOC and furthering her desire to create a diverse and inclusive space she calls Dr. Jpop’s Neighborhood.
Read the full transcript below:
Karen Litzy (00:01):
Hey, Jennifer, welcome to the podcast. I am so happy to have you on. And now for those of you who are, maybe don't know you by your full first name on Instagram and social media, she is Dr. J Pop and last week you gave a wonderfully informative thought provoking webinar, and we will have the link to that in our show notes. Cause people can still watch the replay to that, correct? Yes, the replay is up and it will be for the foreseeable future. So what I'll have you do quickly because I don't want to put words into your mouth, but I would love for you just to tell the audience a little bit more about what that webinar was about and why you did it.
Jennifer Hutton (00:58):
Yeah, so it was anti-racism and allyship for rehab and movement professionals. And I went through from the beginning, literally started with the history of white supremacy in healthcare, through slavery. The Jim Crow era talked about racial trauma and the effects that it can have psychologically and physiologically. Then I went through the stages of allies and all of the things that you can do in each stage. And then I have portioned it out for the examination phase and for the action phase and kind of let people know in their different settings, be it education, be it healthcare or fitness, the action steps and the questions that they can ask themselves to be a better ally. I just, I wanted to do it. It's been a passion of mine for awhile talking about cultural competency and diversity, and I could tell people were awake in a way that they've never been awake before, so they were ready to receive the message.
Jennifer Hutton (01:57):
So when everything happened with, you know, Brianna Taylor, I'm not arbitrary and George Floyd, it was kind of like the cherry on top that everybody now is ready to listen. And so I found this was a great way to just get my thoughts across.
Karen Litzy:
And obviously we're not going to have you retell that entire thing because people can go and watch the replay. Like I said, there'll be a link in the show notes but for me after watching it and I also watched the replay, so I sort of like went through it twice. Just because, you know, I want it to be really clear on what I didn't know. And good. Yeah. And so we're not going to go through all of it, but what I do want to touch upon today is, and you mentioned it in your description just now is racial trauma. And I also want to talk about allyship. So what can people specifically in healthcare do to be allies to our BIPOC community in healthcare?
Jennifer Hutton (03:00):
Right? So we'll get to that. But first, what I want to talk about is racial trauma. This was a very, very powerful part of the webinar for me. And it is certainly part of our social determinants of health. And as physical therapists, if we are treating under a bio-psychosocial lens, social is part of it. We need to be aware of what racial trauma is and how that may affect a person mentally, physically, and emotionally.
Jennifer Hutton (03:47):
Racial trauma is basically the cumulative effects of racism on an individual's mental and physical health. And I thought it was really important to highlight because we do a great job of talking about healthcare disparities. We do a great job of, you know, singling out the races and what you will see in the trends and the diseases. But we don't really look at the root cause of why this may be something that is more prevalent in different communities. So I kind of explained that racial trauma is likened unto PTSD. The only difference is we cannot separate ourselves from that toxic environment. So you start to see the manifestation of that stress. The weathering is one of the terms that you will hear when it just breaks down the body because of all of the stress that you are feeling and seeing. So you start to have increased suspicion, sensitivity to threat you know, physiological symptoms using other mechanisms like alcohol and drugs, increased aggression no thoughts of future.
Jennifer Hutton (04:54):
And I also have looked at research that where they look at the Holocaust survivors and how they actually saw changes in their DNA from the stress that they went through. And that's what they're starting to look at with our DNA as well, seeing that we pass these things down through generations, which is why it's called generational trauma. So to just say, Oh, well this, the African Americans are most likely to have these diseases. It's like, well, what are they dealing with outside of your clinic walls? That would cause this. And it was funny cause the students loved that part. The most, those were actually in professional school. Cause they're saying this would be extremely helpful to relate to patients when I actually go into the clinic or healthcare setting. So I focused on that and I also kind of showed way that you cope with racial trauma and all of the ways that you'll see in the communities is racial storytelling.
Jennifer Hutton (05:58):
So being able to tell you some of the experiences that I've had in this America validation, naming the trauma, understanding that the microaggressions that you're feeling are a part of the racial trauma that you're experiencing it. And the problem they're finding, even with some of these coping mechanisms is great for the moment. But what happens when the next event comes around, they're going right back through those stages of grief and stress. So I think it's important to see in every facet of life, there are the effects of racism, the effects of white supremacy. And so if you're hitting that on every facet of your life, you're more likely to present with physiological issues.
Karen Litzy (06:44):
And as a, let's say, as a clinician who might be treating someone who let's say does have high blood pressure or heart disease and is part of the African American community or BIPOC community, is it part of our job to then educate our patients on this? So cause they may say, well, you know, it runs in my family, right. I don't know why it runs in my family. So where does our job come in as the healthcare provider? What is our duty to those patients to address? Is it our duty to address that and to help with coping mechanisms? Or is it just a referral to someone else?
Jennifer Hutton (07:25):
Right. I think it's definitely our job to consider it when we are approaching different patients to consider that this may be something and a lot of times you'll hear it in their rhetoric. I think I had a student in the chat during the webinar say I have someone who said, he's afraid that if a cop actually comes and he can't put his hands up, that they'll feel like he's resisting. And it was because he couldn't get enough external rotation. Did you read that one?
Karen Litzy (07:56):
Yeah, I read that too. Yeah. Yeah.
Jennifer Hutton (07:58):
It was like, see that, that right there. That is something that probably wouldn't have come to your mind when you were thinking about his plan of care, but now maybe you need to change your approach because you're actually tapping into something that makes him feel outside. You feel something that just about the pain that outside and his wife. So I think we definitely have to keep it in mind and consider it. I also think we have access to and knowledge about so many different ways that we can take care of our body. So even if you were to start incorporating some of those into the treatment plan so that they can understand, these are things that you can use and you don't have to name it for them, you don't have to say this is because of racial trauma or give them all of the facts. But you, as a clinician recognize it might be something that's beneficial to them. So that's why I say to my Pilates instructors, to my yoga instructors, you know, you're a key to coping. You're a, something that could be helpful for them. And if they don't know that it, yeah, it is your job because you know about these things. So you can give them as a resource.
Karen Litzy (09:02):
Excellent. Thank you. And now, let's move on to the concept of being an ally. So before we start and get into how to be an ally certainly within the realm of healthcare, I would love for you to just, can you just define what an ally is?
Jennifer Hutton (09:25):
Yes. So an ally is a person group or nation that is associated with another group or others for a common cause or purpose. So that just means no, this is not something that affects your daily life personally, but you see that it does affect the way someone else's life is and you want to help make it better. So where you're using your privilege and your position to help further the cause.
Karen Litzy (09:51):
And how is that different than white savior racism?
Jennifer Hutton (09:56):
Yeah. So white saviors and still comes from the perspective that you are superior, that if you were not doing the work, then it would not be done and that you are absolutely needed. And I agree your voice is needed, but if you're still approaching it from a superior mindset, because you haven't done the work through those stages of allyship than it actually is a hindrance and it's not as effective.
Karen Litzy (10:25):
Got it. All right. Good, good change. They're good. Because I think oftentimes we maybe think we're an ally, but maybe we're not. And the concept of white saviorism, is that something that someone is consciously thinking or could that be an unconscious thing? Like you really think that you're there to help and you're trying to do your best, but you're may not be helping in the way you think you are.
Jennifer Hutton (10:58):
Right. And that's, to me, that's where the self-examination comes in. That's where those questions that you ask yourself about your upbringing, what you believed about black lives matter before all of this happened, what you thought about the killings that were happening in the people that were speaking out against them. How you viewed other races, the things that you said, the things that you've heard, because now you are able to see, yeah. Maybe you're not a racist, but you may have biases that are affecting your thought process, affecting your decisions. So I always say, check your intention. Like, don't just say, well, I intended to do good. Look at the impact that it had. If the impact does not measure the intention, then maybe we need to go back and do some homework on that intention. Because if you're doing something only to make yourself feel better, like, okay, I'm doing it. I'm that good person, not the best intention if you're doing it because like, Oh, they need me, like I talked about thinking that you have to give scholarships to all black people. Like they don't have the money to pay. That's why saviorism that is still coming from a bias mindset of, they are poor. They have less, they don't have the resources and I need to step in and save the day. But I don't think it's ever intentional. I still think it's just coming from your perspective and you really gotta check your perspective.
Karen Litzy (12:19):
Yeah. And I think we also hear the word implicit bias thrown around quite a bit. So do you want to define that and where that comes into play within this conversation?
Jennifer Hutton (12:29):
Yeah. So the official definition would be attitudes and stereotypes that affect your understanding, your actions and your decisions in an unconscious way. And I talked about thought viruses. And the way that I give a great example is the older person who only saw whites only signs and colored only signs everywhere that they went can, do you really think they couldn't have made some type of decision or thought about how black people are, how white people are based on what they experienced in their environment. So everything that you were taught and the things that you saw, the things that you heard, it forms your biases and that's on all sides and it mobilizes you. And it's how you act. So if you were surrounded by people who were racist, even if you think of yourself as a good person, you still may have things that were thought viruses that were planted that you have to check.
Karen Litzy (13:28):
Yeah. All right. Great. Okay. Now let's get into the stages of allyship. So stage one awareness. What does that mean? Does that just mean, Oh, I'm an ally. I'm aware. I'm sure it's much more complicated than that. So I'm just trying, I'm pointing out like the total ridiculous side of it, because that might be like what people think like I'm aware I watched the news. I know what's going on. I'm going to be an ally done. Yes.
Jennifer Hutton (13:57):
So awareness is that you see that there is a problem. You see the problem and you acknowledge the problem. You also acknowledge as an ally, your privilege in this world, the fact that you are viewed as different and sometimes better in your spaces. And then you say, I want to make this better. So the end of awareness is still an action step of committing and deciding and holding yourself accountable to learning and unlearning all of the things that have made you think this way so that you can be an effective ally. So the awareness, isn't just, yeah, I'm an ally. It's Oh, there's a problem. We got to do something about this. How do I help?
Karen Litzy (14:52):
Yeah. And could an action step in this awareness phase, be, you know, watching your webinar or watching 13th or reading a book or having conversations. And does that, would that fall into this category or is that sort of weave through?
Jennifer Hutton:
I think awareness is probably the step that you will visit the most. That would, that's the thing because you, the more that you educate yourself, so webinars, podcasts, Ted talks, documentaries, those are part of your education. Just like any, I think I said, create your own curriculum. Just like you would learn anything. You have to go through all of the information, but as you learn, you'll start to see these things in other spaces and that seeing those things is still your awareness. So I always say, don't think that you're going to escape the phase I'd be done and not come back to it. You're going to start to see these things in all the facets of your life on it. So not just awareness on, like I took a week off and now I'm more aware it's being aware on a daily basis of what you're seeing in your community, within your family, your friends, your peers, your colleagues, and then just do so are you aware of it? And you just make a little mental note, or it's more of a high and it sticks because if you're educating yourself, then what you see will help you process. If that makes sense. The scenario that you are placed in the things that you watch, you'll be able to refer back to. Oh, I remember when I watched, Oh, I remember when I read, when I heard this person say, now you're connecting that after you've educated educator in the process of educating yourself.
Karen Litzy (16:02):
Yeah. Yeah. And then we sort of jumped the gun. So you've got awareness and education. Is that kind of second stage or do those just sort of inter sort of weave together? They can't have it. Can't have one without the other, right? Yeah. You cannot. Okay. And then next, so kind of moving through these stages here, here comes this, this is a tough one.
Karen Litzy (17:00):
Here comes the sticky one self interrogation. So can you explain that and also explain why it's sticky it can be difficult.
Jennifer Hutton:
Yes, the reason self interrogation, this is when you really start to ask yourself a question, cause you're now trying to strip yourself or unlearn the things that have caused you to think the way that you have. So you really have to put your ego aside. And I always say, tell yourself, you're not a bad person. You just have thought viruses that you're trying to change. So you're asking yourself those questions. What were you taught about black people and people of color? Were there any times that you were in, you know, scenarios where there was racism and you didn't speak up or you feel like it was important to speak up? Have you allowed your privilege to mobilize you, but maybe not help someone else?
Jennifer Hutton (17:56):
Do you have friends of color? My favorite is, well, what were your thoughts about black lives matter 10 years ago in 2012, maybe when Trayvon Martin happened, what were you thinking about these same protests and these same people speaking out? Because if you can truly answer those questions, then you'll see that's where my bias is. That's where that was my blind spot. That is something that I didn't realize it was coming in, but it has affected me. So those were the personal questions and those are hard because it is really, you have to strip yourself of what you consider a part of you. A part of who you are a part of your upbringing. And if you're having those conversations with family members, I mean, I've heard people say, I didn't expect my parents to say the things that they said.
Jennifer Hutton (18:47):
I didn't expect my best friend to feel the way that she did about me posting my black square. And the conversation that we had was extremely uncomfortable for me and hurtful because I thought we were on the same page. So that's where the discomfort lies. And then it's in deciding, is this that important for me to continue? Even if other people don't continue with me asking yourself, that question is hard. Because you can't, you can't let go of family. That's not how it really works. I mean, of course, if it's toxic, I understand, but you really have to say, I might be doing this by myself and it is a tall task, so are you really ready for it? So that was the personal self interrogation.
Karen Litzy (19:34):
Yeah. It's sort of this cleaning out your cupboard, if you will, you know, and trying to see if you are ready to change your thoughts and your beliefs and what if you go through these questions and you're not ready. Okay.
Jennifer Hutton (19:59):
It's always comes back to the question. Once you get to that point of discomfort, you have to ask yourself why you're uncomfortable. You can't just escape the situation because you're going to end up coming back to it. If it was a part of your awakening, once you're awake, it's hard to not see things. It is really hard. So I always say, it's fine if you're not ready, but maybe the reason you're not ready is because you had an upbringing that taught you something that you can't shake. Maybe you need a therapist. Maybe you need to talk through some of those other things to actually help you get past this stage.
Karen Litzy (20:34):
And was there a point for you growing up where you had your first encounter with racism?
Jennifer Hutton (20:50):
My very first that I can recall it was mother's day out where you went like three days a week and I wanted to play with like, it's a daycare. It's kinda like daycare, but you don't go every day and you still learn things. So it's like a preschool thing pre K through year four or whatever you call it. But I wanted to play with the kids and I think there were two black kids and the entire mother's day out or my class. And I was told, no, we don't play with Brown kids
Jennifer Hutton (21:29):
I had another four year old. And so apparently went home. I remembered the act. I remember the kid. I could actually see his face even now, 30 something years later. But apparently I didn't want to tell one parent because I thought that parent would get upset and do something at the house. So I told my, I think I told my mom and that was when they first had to have that conversation of people are not going to like you because of your color and explain it. You imagine having to explain it to a four year old, like they're still processing how to count, pass a hundred, like, and you're telling them it's going to be a problem. Something that they identify with, that they see in the mirror everyday, they cannot shake is going to be a problem for people. So I think that was definitely the first time that I remember.
Jennifer Hutton (22:24):
And then I also remember the first time I said, Oh, this is unacceptable. And at that point I was like 14. And I had had an incident with a cop where I was profiled. And it was evident because I had white friends around me that were not treated the same for the same regulations I was given. And it was at that point that I said that I'm a fighter, it's time to go. I'm not going to accept this. And I'm not going to not be in these spaces because you don't like it either. I'm going to show up and you're going to see me and I'm going to speak and be loud about how I feel. Because I think my voice is extremely important.
Karen Litzy (23:05):
Yeah. Wow. I mean, I grew up in the most non diverse town in Pennsylvania and I went to a very non diverse school for college. It's much more diverse now. And when I moved to New York, so I'm in my twenties and it's the first time that I had a friend that I worked with. And he's awesome. But that's beside the point. And we were at work and he had said something about like he had to drive. He hated driving back out of the city at night. Sometimes I said, well, why I was like, is it, I was like, see, it wasn't a drinker or anything like that. It's like, he's drinking and driving. And I couldn't understand. And I was like, well, why wouldn't you, like, why would you worry about driving out of the city at night?
Karen Litzy (24:05):
And, and he was like, well, I wouldn't want to get pulled over. I'm like, why would you get pulled over? This is how like, night and I was not doing it. Like I was seriously wondering, why would you get pulled? Like, do you have a broken tail light? Did you do speed? And he was just looking at me and he was like, no, I'm like, well, why would they, why would the police pull you over then if you're doing everything right. And he was like, well, you know, when I was like, I don't, I don't know, like tell me why. And he was like, well, you know, because I'm black. And I was like, what? Yeah. And that was the first I was in my twenties. And that was the first time. And I was like, it's funny. I had a talking about, so that was the first time I ever had a conversation about that type of, about racism and how it affects someone who I only knew as like these. Awesome. I love him. He's my great, he's a great friend. He, to this day is still a great friend. And I just was like, I don't,
Karen Litzy (25:08):
I don't get it. I don't get it. Yeah, yeah,
Jennifer Hutton (25:10):
No, I didn't get in there. And I think part, my brother said it perfectly sometimes when you're in the same spaces with people, you think your experience is similar. So even if you had a black friend that was with you through all of those, you know, non diverse schoolings and situations, scenarios, and things that you were part of, you would still think our perspective has to be the same. Cause we're getting to do the same thing. So it kind of makes it harder for you to look outside of your experience.
Karen Litzy (25:43):
What a world. So that's a little bit on the self interrogation and what those questions when I asked myself those questions, I remember that incident. So clearly now and looking back on it, I was like, Oh boy. Yeah. I was just didn't know, I didn't know what I didn't know. And now I do. And now I do. Yeah. Period. Now let's go on. So we talked about self interrogation serve as a person, but let's talk about it now under the lens of being a healthcare provider. So how does that work?
Jennifer Hutton:
So the self interrogation as a healthcare provider, to me, just like I said, we're educated on health disparities, but not with them. What was your professional opinion? How did you form your professional opinion based on the things that you were taught?
Jennifer Hutton (26:44):
And this can even a great example is when you hear the word Medicare, what do you do mentally physiologically? Do you grown? Because it's like another Medicare patient. If you're a clinic owner, or even if you are a clinician Medicare, Medicaid, workman's comp, like, what are your thoughts when you see that come through the door, chronic. So that kind of pain. What do you think about chronic pain? People like that? These are you've formed a bias. And how does that bias actually shape how you treat shape the way that you develop plans of care? Are you able to actually change things based on what you see? Just like that student said, well, how do I work on external rotation? There's a million ways that you could actually work on it without it triggering them. So those are the things that you really have to ask yourself and then privilege in outside of just the clinic.
Jennifer Hutton (27:34):
What is your governing organization look like when you are a part of these masterminds and part of these panels and these groups and discussions, do you see other voices? Do you see other people that don't look like you in the room? Are there ways that you could leverage your privilege to actually open the door so that there are more voices in the room? And then how do you view the table? Like there was one person I was talking to last week and she said, you know, even the thought of saying, let's give them a seat at the table said that you own the table and you don't, none of us do. So you want to create a diverse perspective or diverse group of people in all of your spaces. And so you really want to ask yourself, how can I do that? And then patients like nonverbal communication, when you are working with them, when they are hearing conversations that might be triggering or how do you respond? Do you want to just go in a corner and not say anything? Do you want to just ignore it and shift it to the side? How does discomfort in your coworkers look when you are talking about certain things. So that's some of the self interrogation you can do as a clinician.
Karen Litzy (28:43):
And, you know, you sort of mentioned, well, if you're having conversation with patients, what happens when let's say a patient in a clinic, whether you're one-on-one or you're in a gym with a lot of people, if they say something that's just not right. Right. And if they sit there talking racist talk, or even saying things that maybe aren't blatantly racist, but still you're like, yeah, no, that's not right. What do you, what do you say? No, we spoke about this a little bit before we went on the air. And we said, it's a little different because we can, we were talking about coronavirus before we got on the air and how, you know, cases are going up in some parts of the country. And it's not just because of more testing it's because more people are sick and you can point those facts and figures. So someone says to you cases, aren't going up, it's the testing you can say, no, no, no. Here are the facts and figures here it is. This is the truth with this. It's a little more abstract, right? So how do we handle those situations as healthcare providers?
Jennifer Hutton (29:53):
I think just like you handle your patients, it's going to be a case by case situation. I can't give you a cookie cutter copy and paste way because everybody, even if they present with an implicit bias, it's still going to be different from the next person. So depending on your position, if you are a clinic owner, then if this is something that is explicitly, someone's explicitly racist, then you have to make it clear what your business stands for. That is extremely important first. I think it's important to have procedures and policies in place. And maybe even we tolerate everybody like this. Isn't an open space. This is, we accept everyone as they are. And that's something you can give to them. The first time they walk in the door. Cause that lets them know, I don't know who's coming in here is clearly a diverse population and they are tolerable of everybody.
Jennifer Hutton (30:48):
So it sets the standard sets that precedence before you even get started. And then it's those simple conversations. No, you can't spend your whole session educating them on, you know, the history of healthcare. But you can say, you know, there are some resources that I've read that have helped change my perspective. And if they are open, then give them to them. If they are not, then you need to have something in place that says, Hey, I understand that everybody has different perspectives, but here we respect everyone. And we don't want to trigger anyone in how in our speech. So we would really appreciate it if you would respect that. And honestly, they're gonna be some people who don't like it. And that is this journey. This is literally the journey of being a black person and being an ally. There are not going there going to be people that don't agree with you. And you just have to decide what your stance is and continue to go inside for that every time you face these situations.
Karen Litzy (31:48):
And I love, and I want to point out that the responses you just gave did not, they weren't accusatory, they weren't aggressive. It was more, Hey, I found this for myself or this is what we, as a clinic, believe it wasn't you. Or how could you say that? Don't say, I mean, that is just the wrong way to go about it.
Jennifer Hutton (32:12):
Especially the clinician is not professional. Got to that point. You do, you might have to say, you know what, we might have to end our relationship and maybe able to give you some clinics that would be more suited for you. But this, if you are, if you continue to look at this as person against person, we're not going to get anywhere to me. If you look at it, as these are thought viruses, I'm trying to change, it's a lot easier to have grace for other people as well.
Karen Litzy (32:44):
Yeah. Excellent. All right. Now that was a little bit of an action step, right? So let's talk about a very, very important step in allyship and that's action. So that was one and that's a great action, but what are some other things that would fall into the action category?
Jennifer Hutton (33:01):
So I split them up into immediate action and longterm action. And mainly because we're telling you slow down, educate yourself, and that can be hard cause like, well there's stuff that needs to be done. So your immediate action is you're protesting, signing petitions in the emails informing yourself about, you know, the politicians that are statewide local, all of those. And then speaking up against remarks. If you hear them now, one thing I want to say do not wear yourself out in the comments section of social media, because I'm sorry that anyone who comes into those comments extras, they're really not looking to learn anything and you're not going to teach them. So you have to let the energy out of it.
Karen Litzy (33:45):
Energy vampires, it's not worth, it's not worth it.
Jennifer Hutton (33:48):
It's not worth it. So that's not the action I need you to take. I need you to take that off the dock. Long term action would be continuing to having those discussions in your clinics, in your gyms, in your educational setting, to see where your blind spots are and what you really would like to do to move forward. I think I said earlier, you may get stuck at a step. And if you feel like it's something deep, rooted, get a therapist to actually help you talk through these things recognize it's a learning process, encourage others to do that work that you are doing. And if we're doing it already as healthcare clinicians, we learn things. We believe things. And then we use them in our practice, whether it be something in the biopsychosocial model about chronic pain, about certain, you know, systems that we use, we do it already. And you just have to decide that this is something that's important to you. And that honestly will be your guide when you get to that longterm action.
Karen Litzy (34:55):
And something that you'd mentioned in the webinar that I want to bring up again, is that when you're talking about these, this longterm action that it needs to be authentic and then you don't want it to do, you don't want to subscribe to tokenism. So we didn't really define tokenism. So why don't you define what that is and why we want to be authentic and not subscribe to it.
Jennifer Hutton (35:18):
So tokenism, the long and short is you are going to get that one person to represent diversity. I think I said, when we were talking before we started recording about if you are in an all white community, don't just go get a black person and say, that's our representation that is not authentic and it's probably not comfortable for them. Would you need to be able to identify that? So if you're just picking the black person or the person who's Mexican or Asian to say you have that voice, that would be your tokenism.
Karen Litzy:
Yeah. And, I think that we certainly see that in a lot of facets of society. Definitely. Definitely. All right. Any other actions that you want to cover or do you think we've hit everything?
Jennifer Hutton (36:20):
I think, I think we've hit everything. I know I did a lot of steps for examining in the webinar, which if they wanted to see it by setting, they're definitely able to go in there. But my biggest takeaway from this is, I know we're in a manic period still where everybody is happening on this quote trend. So don't burn yourself out. It is a marathon, not a sprint. And so it will, it might be sticky. It might be difficult. It might be uncomfortable, but you have to decide whether this is what you believe in to keep going.
Karen Litzy:
Excellent. Well, thank you. I was just going to ask what are your final thoughts and beat me to it. So thank you. Okay. Well on that, I have one last question that I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to yourself straight out of physical therapy school?
Jennifer Hutton:
Be patient be patient. I came out with the idea, I'm going to be a PT therapist and nothing's going to stop me and I'm going there and I'm doing this.
Jennifer Hutton (37:18):
And I had to take detours from the minute I graduated. My life did not look like what I thought it would, but where I am right now. I'm good. So it worked out how it was supposed to, so I would say, be patient.
Karen Litzy:
Excellent. I'm still need to learn that one. I feel like things still need to be done yesterday. Thank you for that advice. And now where can people find your webinar?
Jennifer Hutton:
Yes. So if you go to Instagram, dr. J-Pop, I actually have the link in my bio. I am probably by the time this comes out, it will be on my website as well. That replay is there and it will be there until that platform doesn't exist. So hopefully forever.
Karen Litzy:
Excellent. Well, thank you so much. I appreciate this. Like I said, I learned a lot, it was very introspective for me to go through your questions and to kind of understand the privilege that I came from, just for the fact that I was born with the skin that I have. Right, right. And it has nothing to do with, you know, just that one singular thing. It has given me privilege and listening to you and educating myself has really allowed me to, to see that, that very singular fact very clearly. So thank you very much for your webinar and for coming on. I appreciate it. And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Laura Rathbone on the show to discuss Acceptance and Commitment Therapy. Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS. Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands.
In this episode, we discuss:
-What is Acceptance and Commitment Therapy (ACT)?
-How the ACT framework compliments a biopsychosocial approach to patient care
-The importance of promoting active over passive interventions for patients with persistent pain
-Why clinicians should integrate psychologically informed physical therapy into their practice
-And so much more!
Resources:
Laura Rathbone Website
Laura Rathbone Twitter
Laura Rathbone Instagram
Laura Rathbone Facebook
Laura Rathbone LinkedIn
The Association for Contextual Behavioural Science
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Laura:
Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS. Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands.
She understands the need to see people from a 'whole-person' perspective and integrates modern, evidence-based physiotherapeutic and psychologically-informed approaches.
Laura is a UK chartered Physiotherapist and has a Masters Degree in Advanced Neuromusculoskeletal Physiotherapy from Kings' College London. She is part of the Le Pub Scientifique team which organise regular live learning sessions exploring the science of pain and produces a small podcast called “Philosophers chatting with Clinicians”. She runs her own courses on ACT and mentos clinicians regularly.
Read the full transcript below:
Karen Litzy (00:01):
Hi, Laura, welcome to the podcast. I'm very excited to have you here and today we're going to be talking about ACT. So thank you so much for being on the podcast.
Laura Rathbone (00:12):
Well, thank you for having me. I'm excited too. I like talking about something.
Karen Litzy (00:17):
All right. So now let's talk about ACT first, two questions. What is ACT and how did your interest in ACT come about?
Laura Rathbone (00:32):
So ACT stands for acceptance and commitment therapy. I suppose, you know, sort of efficiently, the way we talk about it is that it's a third wave cognitive and behavioral therapy. So it's born out of the behavioral movement and it's a psych it's essentially, it's a psychology framework. It came out of the world of psychology. And the aim of it is to recognize that when we are experiencing, you know, difficult unpleasant and invasive stuff, there's often a lot of all the aspects to that experience that add to the struggle and add to the suffering. And what we're working with from an ACT perspective is often can we compassionately and you know, empathetically and appropriately work with some of that, all the stuff that comes with the struggle and comes with a difficult experience. And does that help us manage our present moment experience?
Laura Rathbone (01:38):
Does that help us reduce some of the suffering so that we can move forward with some of the realities that are in our lives? Like for example if you're experiencing pain, which is where I come into it, you know, in the absence of having a really good predictable, effective cure for things like persistent pain, things like fibromyalgia, CRPS even chronic low back pain, which we, what we don't have these predictable sort of treatments that's going to take that away once the pain has started to become resistant, but in the absence of that, are we able to support people with their pain so that they can thrive. They can be a person who has pain and has a career and has a committed family life and has a social function and role, and they're able to thrive with it. And that's really what we're doing with ACT there.
Karen Litzy (02:38):
And where did your interest in ACT come from? How did you get involved?
Laura Rathbone (02:45):
Yeah, there were two answers to that really. First answer I guess, is that I just sort of fell into it like so many people, right. I graduated from university. I went into my first job. I had a really difficult first job experience in a difficult company and ended up working, noticing, I suppose, and working with people that had persistent pain. And so I was constantly seeking for better solutions and trying to figure out how we can do better by these people. And then I guess I just sort of navigate it that way naturally. And yeah, so I was interested in mindfulness, mindfulness, you know, you study things like the MBSR. So the mindfulness based stress reduction start thinking about how you can incorporate bits of that into practice. And before, you know, it, you end up into accepted therapy.
Laura Rathbone (03:41):
And then I was super lucky because I managed to get this brilliant job in the national center for pain at st. Thomas' hospital in London, where I was working at input, which is the pain center. And I was working underneath professor Lance McCrackin in their embedded ACT unit. So I got this great opportunity to really further my training and understand how it functioned as a framework and how we as physiotherapists could really be maximizing our therapeutic alliances and relationships and really integrating this model to create, you know, a psychologically informed approach, if you want to call it that or a compassion focused approach so that we just do better by people who are vulnerable and in pain.
Karen Litzy (04:26):
Well, that makes a lot of sense to me. Thank you so much.
Laura Rathbone (04:31):
If I was to give you a second answer, is that, you know, pain is a bit of a personal experience. It's a personal journey for me. My mom had chronic low back pain when I was younger. And I guess I'm only just now coming to terms with the influence of that on my career. Something that I haven't talked about a lot. But I do get asked about quite a lot. And you know, it would be silly to say that those early experiences of somebody with chronic pain, you know, didn't have an influence on me and seeing her go through a biomedical approach to treatment and not be heard and seeing her struggles and thinking, well, you know, and the injustice has probably built in me as the second generation and thinking, well, how do we restore some of that justice? And then how do we acknowledge that there is an imbalance here in terms of privilege, like clinician privilege versus patient privilege, and how do we start to restore that and make sure that we listen to the people we work with and do better.
Karen Litzy (05:36):
What sort of experiences did you see your mother go through that kind of led you into where you are today, when you say so for a lot of people, they might not be familiar with the biomedical approach and what that looked like, but what did that look like for her? And then what did that look like for you as a kid growing up?
Laura Rathbone (05:58):
Yeah. Like I say, something that I'm still really coming to terms with then, and the memories of what I saw my mom go through was still quite like emotionally charged. They're still very close. And we're talking about it, me and my mama talking about this more and trying to open it up a bit more and explain that. And then what I remember, you know, being in the car and my mom being unable to sit in the chair and the sound of her voice when we went over a bump or the car stopped that, that Yelp for pain, that, that real yeah. Terrorist pain really. And I remember her spending hours in the bedroom, not being able to get out of bed but, you know, she also, she was an amazing woman, you know, incredible first role model as a strong woman, really, because, you know, she's a nurse, she was working in the pediatric units, she's done everything really she's done a and a pediatrics domiciliary, which is community-based working.
Laura Rathbone (07:04):
And like, she used to get up every day, even in pain. And she would go to work in paid and, you know, do all these and just push and push and push until she was exhausted. And when she would be like posted on the weekend and then pushing herself and through the day, and I saw her just be hopeless. That was, I think the overriding feeling, if I really reflect quite personally, was that feeling of, there is no hope there is no way out of this. This is the norm and resigning to that. And that's because, you know, she'd tried physical therapy or physiotherapy in the UK. And, you know, she'd tried like acupuncture and she'd gone around the holistic meds you've been in and out of the doctors and things like that. And just really been told there's nothing that they can do, but yet also she had this image of why she had pain. So she was told that she had back pain because her Coccyx had dislocated during labor, which was my labor. So there's a bit of personal guilt as well.
Laura Rathbone (08:07):
And really those things where, like, she always felt that that image had stayed with her forever. Even now, probably if you talked to her and ASCO, which we were working through a little bit, which is hard to do an issue, mom, I, you know, trying to figure out what, how she views her body and her back is becoming a much stronger image, but she really had to find her own way out of that. And it was years later until she found a solution that she could, she felt she could predictively start to acknowledge and manage her pain. And, you know, it's not the traditional method that she found a kind of like a kind of massage tool, which is everything we wouldn't say right now, but it worked for her and it gave her a freedom. She felt all of a sudden I have something I can do when I have pain. And that was the most important moment for her. And it wasn't, you know, acceptance and commitment therapy or mindfulness. It was, it was a tool that gave her strength. It was a kind of extended part of her own ability to self manage. And she did that and it worked for her and I don't advocate those kinds of mechanisms and those approaches, but it worked for her. And there's something in that. There's something important in that. But yeah, I remember I remember her pain and yeah, it's still very personal.
Karen Litzy (09:27):
Yeah. And not easy, but thank you for sharing that. Cause I know that sharing personal experiences from my personal experience is not an easy thing to do, and it's not easy to put that out there where the world is going to hear that. So thank you. But I'm glad that you shared it because I guarantee you, there are going to be people listening to this podcast who are going to say to themselves, that's me. That was my mom. That's my sister, that's my friend, that's my patient. And so I think it's really important to allow the listeners to understand the magnitude of hope and of finding something that works for you, even if it's not physiotherapy or it's not XYZ doctor or whatever framework you're using. Because like I said, somebody out there is going through that same exact thing. And just to kind of hear that story and to hear how, not only did it affect your mother, but it affect you and your family and growing up and I think that's a really powerful share. So thank you.
Laura Rathbone (10:35):
Welcome. And thank you to my mom who continues to be an incredible voice in my growth as a person and who went through that journey and who still goes through that journey. Although she doesn't identify now as somebody who has chronic pain and that's a great moment for her, like she's now able to do so much more and really doesn't have back pain very often anymore. So, I guess the, you know, yeah, it's hard for me to share, it's not my story.
Karen Litzy (11:11):
Yeah. Yeah. Well, and we're going to get back to pieces of that story in a little bit, but I heard you say in the beginning of this podcast, talking about ACT as a framework, I would like to kind of bust a myth because I think a lot of people look at it as a tool to put in the toolbox. So what do you say to someone who's like, Oh, ACT, this is a great tool. I put it in my toolbox. I'll take it out when I need it.
Laura Rathbone (11:45):
Yeah, this is, Oh, I'm glad, I'm glad we're talking about this. Cause this is something that this is probably my personal opinion and there's probably people out there are acceptance and commitment therapists. You may disagree with me and that's absolutely fine this space resolve, but I do not think that ACT is a tool that we pick up when we think it's appropriate. First of all, how do we know that? That's certainly another thing, isn't it? You know, we don't, you know, and what I would say that acceptance and commitment therapy is how we are. It's a way of being with your clients and the people who choose to work with you in the service of their pain. It happens. It's how we make decisions. It's how we think about and how we facilitate those decisions and how we are part of, you know, the next step in that person's journey.
Laura Rathbone (12:37):
It's not something that we say, Oh, we've exhausted the biomedical approach. Now we're going to pick up the ACT approach. And it's a bit later the biopsychosocial approach that it just doesn't work like that. This is just another way of, you know, clinicians getting out of doing the hard work, which is listening to people's stories and empathizing and putting themselves in somebody else's shoes and trying to, you know, trying to get more of their life experience as opposed to showing off what they know about a particular joint. Like this is not how we work in pain. Pain is a very personal, it's a very unique experience. It's built off of life experiences, as well as memories and, you know, learning and worries and fears and all of that plays out in our physiology.
Karen Litzy:
And what can a clinician who's working with someone in pain and they are taking the ACT framework into the clinic. What does that look like?
Laura Rathbone (13:41):
Good question. Yeah. I mean, I guess it depends what your setting is, doesn't it really like if you’re setting is first line, so people are coming to see you and they have never seen anyone else with that problem, then of course, we're going to be thinking, okay, where is that person in the journey from that injury or the onset of their pain? Are they two years down the line? And this is the first person they see, or are they two weeks down the line? Cause that always is going to affect your approach to assessment and monitoring really. So it would make a difference in terms of where you start, but you're always thinking about okay, so if this person is two weeks from injury, then you're going to be doing your injury based assessments, your pathoanatomical approach to assessment.
Laura Rathbone (14:34):
And we want to want to make sure that this person hasn't done any serious injury. And we want to make sure that we, you know, use the most appropriate and effective science that underpins our physiotherapy framework. Right. But you're still thinking, how is this person managing this injury? You know, even though we might be assessing the tissue in some aspects that tissue belongs to a person it's in a human it's in a much wider system. So we're always going to be thinking, okay, and how is this person dealing with the fear of an injury? Are they able to make sense of this in a helpful way, are their behaviors of management helpful or unhelpful? And if they're unhelpful, then how can we facilitate an experience that allows them to update that behavior into a more helpful way?
Laura Rathbone (15:29):
And that's what we're doing with that all the time. So I guess in my setting, when people have probably been through lots of healthcare professionals, then I'm going to that it would probably look quite different. I would use ACT maybe in a more intense way from very early on. Whereas if you're in a very acute injury setting, you're going to be using it as part of your assessment. You are still going to be satisfying, those more traditional approaches to injury assessment and management, which is not my area. So I don't want to make assumptions.
Karen Litzy (16:24):
Right, right, right. Of course. And what is, let's say a patient has come to you and they've had a long history of pain and you're sitting down, then this is the first time that you are seeing them. What are some questions? I know this is, I'm using this very broad net here. We're casting a very broad net because obviously the answer is, it depends on the person. And I want everyone to know it depends on the person, but it depends on the person, but for people listening to this and not really quite grasping, that sort of ACT framework is there. I don't want to say an outline, cause I don't think that's the right word for it. It's just escaping my head at the moment. But can you give examples of maybe how that conversation might go or what you're trying to, to get from the person in front of you using this framework? And again, we're talking about people with more persistent or longterm pain problems.
Laura Rathbone (17:11):
Yeah. So when somebody comes in and sits down and starts telling me, you know, what their lived experiences of pain and they start in their story, wherever they feel is the most important place to start. And we give space for that to grow. I guess what I'm looking for, what I'm trying to pay attention to is you know how is this person making sense and applying meaning to that pain what is it that they're coming to me for guess is the first thing, like, what is it that they're here looking for? Are they here looking for something that I can't give them, in which case I need to be really open and honest about that? Or are they coming here because they're looking for they're wanting to move towards a particular goal.
Laura Rathbone (18:07):
So it, usually people come in and they're telling me about that pain. And of course that's really, really difficult as a person. Sometimes it's really difficult to listen to, to hear somebody else's pain. So I'm mostly working with my own resistance, but also thinking well, okay, what is it that how we want to find out? What is it that would, would give this person that would help this person find more joy, more meaning, what is it, what is the value that they want to move towards? And what is the struggle that they are coming up with? So, so where are they getting stuck? Like, what are they battling all the time? And I guess that's where the idea of acceptance comes in and an acceptance here is really not resignation. It's really not just, you know, getting on with it's an opening up of the experience to accept that there are difficult and painful and hard to look at experiences happening in the present moment. And so we're opening that opener and sort of acknowledging that those things are there. And also maybe giving space for the fact that there are other experiences beyond those as well, that there's a wider spectrum of experience here. And trying to find a way to be with those experiences and also be with the important things in your life. This is what we see commonly. And what we hear with in the clinic is that people who have, you know, people who are experiencing pain are also missing out on a loss.
Laura Rathbone (19:51):
And that's really, really, I think what a lot of people find the hardest. And when I listened to it, you know, what the people who choose to work with me say, it's actually that they're just grieving that they're unable to be part of their family moments or their community or their society, or, you know, the things that they really believe in and that they really want to be part of. And it's hard because when they go into more traditionally biomedical models, the clinicians are saying, Oh, well, when we've done this surgery, your pain will go and you can do that when we've done this injection, when we've done this treatment and, you know, yeah, great. If that works, then that's an absolute lesson relief and fantastic. But what if someone's been doing that for 10 years and the clinicians are still saying, well, when we do this treatment, your pain will go when we do this treatment, you know, you starting to chip away at someone's life.
Laura Rathbone (20:53):
You know, this is a lifetime that easily limited, you know, we don't have infinite lives to live infinite moments to be part of our job and probably the most significant part of our job, especially in persistent pain is helping people and facilitating opportunities for people to be part of those moments. And to make sense of their life in a wider spectrum, rather than just, how does my life make sense in pain? It's more like, how does my life make sense in the whole bio-psychosocial sphere? Am I able to be part of that? And that's what we're looking for, or certainly what I use acceptance commitment therapy for. It's a way of creating opportunities and creating space for us to support someone as they take their pain into really, you know, meaningful moments and find that there can be joy as well as pain. And that is a really, really difficult thing to acknowledge and to allow for when you have pain, because it means that in one aspect of your pain journey, you have to allow yourself to take a step forward with it. And that's really hard if you really want to get rid of it. And of course we should always be working towards that. That has to be a big part of our approach, but it might not be the only thing we focus on.
Karen Litzy (22:27):
I'm glad that you said that because you sort of jumped the gun on what I was about to say, because when people come especially to a physical therapist or physio, one of the main reasons they're coming is because they have pain, right? And so they're coming to us to quote unquote, fix it, fix the pain. I don't, once I don't have this pain, what's your goal. Zero out of 10 pain, no more pain. And so I think from the clinician standpoint, when you have those people sitting in front of you, it's very, very difficult to have those conversations of, and you say, well, what if you still had a little bit of pain, but you can do XYZ activity, or you can still take part in all of this stuff. And you can expand those areas of your life, even though you have pain.
Karen Litzy (23:26):
Is that the wrong thing to say to someone is, should that be a goal to work toward, or should the goal to work toward if their goal is 100% no pain, what does the clinician do? What do we do with that person in front of us when maybe we may think, well, but you can X, Y, and Z, and you can have this full life. If maybe you have a little bit of pain, but the person in front of you is very adamant and their goal it's no pain or nothing, no pain or bust. So, how do we, as the therapist navigate that? Cause that's very tricky because like you said, we're working towards reducing pain, but what if that's not enough?
Laura Rathbone (24:13):
Yeah. So this is a really difficult part of the conversation, isn't it? And I guess what happens probably more often is we come up against our own reflex to save everybody in front of us and our own reflex to be sure we know we are right, right. Our own privilege that we are the experts, but we have no idea what is right for that person in front of us and what is enough for them. And, you know, in the first few sessions, when you meet someone, you’re still in the process of relationship building and trust building. So those early conversations may well be communication of, you know, I am really struggling with this pain. I am really suffering and I need you to fully acknowledge that I am really suffering with this pain. And it may be a way, you know, and that might be that that's where that person is.
Laura Rathbone (25:14):
And it might not be that we can change that. And I put that in quotes because you know, what we're doing here is where we're with a second sense and commitment therapy specifically is we're coming from a place of no judging. So, what the behavior, the thoughts, the meanings of that person's coming off of, I have no idea if it is right or wrong for that person to keep seeking, you know, a hundred percent cure. I mean, I looked to my own, my own experiences and see how far people I love and in my direct family have come in their chronic pain journey and think, well, you know, I have no idea if it's going to be a cure or if it's not, if there is such a thing, I mean, we're thinking of cure. The word cure is almost decided that we know what the cause is.
Laura Rathbone (26:00):
And we don't fully know that yet. So we don't know what the end point of that person's journey is. All we can ask is right now, is this helping you in this moment as we take a step in this part of your journey. And if that's unhelpful, because it's not helping us to take a step in the direction that we've highlighted is a good one that you've decided you want to take, then we need to work with that urge that keeps coming in to go for a curative treatment, potentially curative treatment. If we've got one.
Laura Rathbone (26:36):
But I guess what I would suggest in that moment is that we as clinicians probably need to do the most work because our urge is to jump all over that and be like, no, no, no, no, no. The science says that you're never going to get that. And that's a cruel message and it's not accurate. We have no idea. You know, our urge is to educate the shit out of that person and make them feel better. Right. But we don't know. We don't know that. So maybe we need to sit with our allergies a little bit more. Maybe we need to pull ourselves back a little bit more in that moment and just hear what that person is saying and listen and acknowledge it and bring it into our decision making, bring it into our understanding about, you know, what that person is going through.
Laura Rathbone (27:19):
What in our experience might be a helpful step. And then we have that collaborative discussion. Do you think it's going to be a helpful step? Would you like to go in this direction and see what happens? See what comes out of it? It's hard because we are trained to know the answer. That's what that biomedical model is all about. Those, you know, assessment tools. We can tell you if you've got an impingement and you know, that the idea, the whole point of that is that we had an idea that we knew what was causing pain. We knew it was the musculoskeletal system, and we knew it was the nervous system. Then now we're starting to think, well, maybe it's the neuro immune system. And, you know, it's all this idea that we know what is the cause of a human beings pain. And I'm not sure I have seen any evidence that we're much closer. And that's just my opinion on what I see. So maybe in those moments, we need to check ourselves a little bit.
Karen Litzy (28:27):
And thank you for that. That makes a lot of sense. And you know, it brings me back to this idea that are we doing the best we can for the person in front of us at this time with the knowledge that we have and that has to be enough at that moment because that's what we have.
Laura Rathbone (28:53):
Yeah. And I think that's really an important thing to remember is that we are both two humans interacting on a human issue, which is the human experience of pain. And, you know, we are healthcare clinicians, not heroes, right? We're not the saviors, we're not in the, you know, the people that come to see us, they're not victims. They are humans trying to live their lives. And we are people who have studied physiology and people who have studied rehabilitation and people who hopefully are studying sort of communication and behavior change theory and the philosophy of just like a human experience. And, we're hoping that when those two things come together, something happens and the person who is struggling to come to terms with their pain, manage pain and find ways and solutions to their pain, right. We're hoping that the combination of these two things or these two people, these two worlds and worldviews come together and we can find and facilitate a way for that or the person, the person in front of us to move forward.
Laura Rathbone (30:03):
So, you know, yeah. We have to sort of remember that we are only doing our best and that has to be recognized on both sides, right. That there is also a responsibility for the people that choose to work with us to remember that we are people, we are humans. We do sometimes get it wrong. We are able to look back and say, Oh, that was not necessarily the thing that I would do now. And were able to change and update and evolve. Yeah, I guess that's where I come, that our job, our role is to make sure that we are reading the literature, that we are going to the podcast that we are listening and learning and evolving and evaluating our messages to say, is this still the best I can do? You know?
Laura Rathbone (30:52):
And to that end, I would say, I've had this conversation a few times with sort of new graduate clinicians who say, Oh, but you know, this person, I educate, I gave them the education and they just didn't get it because education has also been one session. And I say, okay, so you gave him the education. How did you deliver it? What was your approach to education delivery? You know, what training have you done in educating? And they touched, they took a weekend course, but if they've even done that, that's the point, isn't it. I try the CBT approach. Okay. So how did you train in CBT? What is the CBT approach? Yeah. You know, Oh, I've done mindfulness. Okay. So how do you integrate mindfulness since you're into your practice? And we say that we think that we know how to do these things, but we're not putting in the time and the effort to really fully train and upscale, you know, acceptance and commitment therapy is an entire psychological framework, right?
Laura Rathbone (31:53):
It's not a little bit that we just add in, it's an entire framework of being with the people that means you never finished learning. Right. I'm still learning. I still have people call me at my clinic and watch me. I still do peer review and make sure that people, people are listening and helping me understand how I apply ACT. And when I may say, or when I get it wrong. And so I can keep evolving, you know? And, that's the thing, isn't it, you know, we have to make sure that we are fully invested in our communication strategies, not just superficially, because otherwise we're not doing the best by the people that we work with. We're giving them a half-assed attempt at education, blaming them for not understanding what we were trying to say.
Karen Litzy (32:40):
Well, we don't even understand it. And, also being very cognizant of the fact that people communicate differently and people learn differently. So if you're giving quote unquote giving the education, well, I told them all about it. Well, maybe they're visual learners. Maybe they need to hear things in small chunks, not vomited all over with information, maybe they need follow-up. Maybe they need to watch videos. Maybe they need to take a test. Maybe I know I'm the kind of person who I like to take a test. It's a very weird thing. I took a continuing education course the other day on child abuse. And at the end, you know, they tell you to evaluate the course and I do. I'm like, well, where's the test, where's the test. How do they know? I know that I read. And my boyfriend was like, are you advocating for a test? Like you want to test?
Karen Litzy (33:32):
I'm like, yes, I want to test because I want to make sure that what I read that I understand it at least superficially right. So when you're talking, like I have had patients where I have explained things, explained pain, used a pain education approach to them. And I always try and follow that up with, you know, I'm going to send you a couple of videos. I'm going to send you some you know, and ask them like, do you understand? Can you kind of give me the highlights? What did you take away from that conversation? So you may educate them, but if you don't ask them well, what do you think? What did you understand from that? Does it matter what you said to them? If they can't understand a word that you just said?
Laura Rathbone (34:20):
Well, that, I mean, that is like one of the basic basic principles, isn't it of how do we communicate it? Does the other person even understand what we're saying? Are we using it an appropriate approach to communication? But I guess the other thing is, you know, the beauty of the ACT is that it came out of, you know, this struggle that we had in real time, behavior change, you know, like we can help people change their thoughts and they can change. They can, they can find a new narrative, but when pain comes, what do they do? What do we do when something difficult shows up, you know? And the skillset, in fact, the hex of flex, all the processes have changed at all. Within the hacks effects are there to be navigated and to be utilized in that moment, when pain comes, what do I do?
Laura Rathbone (35:19):
Is this helpful? Is this in service of something that I am working towards and not working towards, but that's, whatever the person in pain says it is, right. That's not all saying, Oh, we're in rehabilitation. Therefore we need to rehabilitate you to action. Or, yeah, I have no idea. You know, it might be that in that moment, the most important goal for that person is self care, right. That could be, I mean, and that's very legitimate and very, very valuable, you know, it's not, well, when pain comes, how do I push through it? It's what we're trying to figure out is okay, when your pain comes for you, what do you do? And is that helpful? And if it is, then all we want to do is facilitate that and to validate it. And if it's not helpful, then that's when we might say, okay, so how do we start opening this up?
Laura Rathbone (36:11):
How do we start finding a helpful thing? What do you think could be helpful? And our job is to facilitate that conversation so that the other person doesn't feel they are making all of the choices on their own. And they've all of a sudden, they've just had been dumped the responsibility of their own care on their lap. Our job is to compassionately titrate that conversation, what might be helpful, and to take our time, to explore it in a way that people feel they're able to meet in a way, not that people feel sorry, that isn't the right word in a way that people are able to make their own choices. And we are able to support them. That's it? And that's what ACT is.
Karen Litzy (36:55):
And to that end, I want to go back to the story of your mom and how you said she found this massager that really helped. And you know, you and I had a conversation the other day, and we had this conversation about the passive versus the active modalities and passive bad, bad, active, good only thing we should be doing. So let's talk about that within the ACT framework of your mom found a massager or whatever it is. And boy that really helped. So from an ACT framework, how do we make sense of that when we are supposed to be only advocating for active, active choices, not passive modalities, not a tens machine, not a massager.
Laura Rathbone (37:47):
Okay. So I would say this is probably the part of the podcast where I will, it's the most controversial part. Because if you are a person that advocates hands off therapy, then actually fit very nicely into your framework and you might be using it very X and you know, and doing great work. And if you are a hands on therapist, then you may have already decided the ACT is for the hands off people. So you're not going to go near him. And you know, my opinion on this probably changes quite often, but I would say that if a person is making an informed choice about how they, their pain that is helpful for them, that is active treatment, that is an active decision, but is that person and saying, this is helpful. So, I guess if we're going to use the way I would use ACT in that moment as somebody who typically doesn't use a lot of hands on therapy or a treatment delivery devices.
Laura Rathbone (38:58):
So we say, you know, I did my masters in sort of neuromusculoskeletal therapy. We did all the manual therapies stuff. I would say, okay, how much does it help? Let's talk about that helpfulness, because that's important because my job is not to make you feel bad about using something that helps you in your life. My job is to facilitate that and to support that and to see value in the bits that you might not be using, or the bits that you might not be doing. So if that person is able to say this right now is the only thing that is keeping me going, then we say, okay, it's helpful right now, helpful right now doesn't mean helpful forever. Right? Helpful right now means in this moment, in this context, with the knowledge that you have the skills that you have, the relationship that we are developing, this is very helpful.
Laura Rathbone (39:58):
So I'm not going to take that away because that's cruel, right? That's not nice. What we're going to do is we're going to work with that. I'm going to keep checking in and seeing, okay, is this still very helpful? If it's, and at some point it might not be, and it was, we're going to keep working on all this stuff, I would say, okay. So let's say, you know, a TENs machine, quite often, people that I work with are using tens machines, because it helps them to do something of value. That's it, that's what we're working for. But if they're saying I go to the physiotherapist or a particular physical health therapist, whatever, and they give me, let's say core exercises. That just for it, just rotate through their active therapies, right? These are hands off therapy, call exercises to strengthen my core.
Laura Rathbone (40:47):
And I do them. And I have worked with these people where they are doing them four or five times a day. And they're in pain when they do it. They're in pain after they do it, they're in pain the next day. And they've been doing it for months, some of them. And you're saying, well, actually, is that helpful? There's an active treatment. That's an active treatment in a way, that's the person doing it, but that is a passive approach to receiving therapy, right? Because they're not thinking and not enough. And don't feel like they're able to have the space for their own opinion on whether this is working for them. It hasn't been created in the therapeutic alliance. So, so that they're doing this in the hope that they get to the goal of the therapist that they're going to get, but they're not necessarily getting there, but they're still doing it cause they haven't the safety and the relationship hasn't been created. So that person can go back and say, actually, this isn't helping me. So we can say, okay, that's not helping. We can change. You don't need to do stuff that's not helping. If this is making your pain worse, then it's causing pain. Why are you doing it?
Karen Litzy (41:51):
Yeah. And it's so funny. I had that conversation a couple of weeks ago, the gentleman with chronic low back pain, it's been six months of low back pain. And the doctor said, we'll read this book and do these exercises. So he was doing press ups and press ups at an angle and press ups. And, and I said, well, how long have you been doing that? And he said, I've been doing for a couple months. I'm like, Oh, well, how does it feel? He's like really hurts when I do it. But you know, the doctor said to read the book and do what's in the book. So I'm just doing what's in the book. And I said the same thing. I'm like, well, there might be ways that we could alter this, or there might be other things that might be more helpful if you're doing this particular exercise.
Karen Litzy (42:38):
Exactly what you just said. Well, it hurts when I do it. It hurts more after I do it. And it hurts the next day more after. And I said, well, okay, let's explore this because I think there might be ways that we can make this work. And lo and behold, we found ways to make it work, but it's just, yeah, it's just that exact example of what you just said. And having the conversation was maybe a little uncomfortable at first, because this was something the doctor said to do. And so we had to do it.
Laura Rathbone (43:14):
Yeah. But I mean, that is a typical example where a clinician just has not invested in their communications strategy or their compassion for the person in front of them. They haven't even created a dialogue. They've just given somebody a book and said, your problem is so common that we've written a book on exactly how to get out of it. You just need to follow this. There is no dialogue that, and the thing is pain. Pain makes us very vulnerable, right? Pain creates a huge vulnerability in us. And we know that when we have pain, we are vulnerable and it's no different for the person in front of you. That's been living with it for years. They've just got more pain and had it longer, maybe feeling more vulnerable and more desperate to find a way out. And that's completely understandable. So shame on that clinician, because that is not okay.
Laura Rathbone (44:07):
We have got to invest in our dialogue abilities. We've got to commit to being good communicators and compassionate communicators and compassionate listeners. And, you know, really want to know about the human we're working with as opposed to dismissing their pain as something that a book can feel. And of course there are very helpful books out. There are helpful textbooks that have been written by very compassionate clinicians and some are better than others. And I'm not trying to say all self help tools are all bad because that's not, that's not the point here. The point here is that if there's no, there's no way, there's no space for the person who is living with pain to explore with you, the solutions that you're putting up, then, then it's very difficult for people to know what to do next. And it's very easy for them to feel like they're doing it wrong or that they're somehow not committed enough. So then they'll might do it twice as many times and more often and more days, and with more effort, because that's the only solution we've given them.
Karen Litzy (45:18):
Yeah. And then I think it also brings on for the patient sort of coming from my own experience is that, well, I can't even get this right? Like you failed yourself. You don't even know your own body. It takes you. I think it disembodies you even more than perhaps you already are out of protective purposes. And it just takes you further away from yourself and your person, if you will, because if you can't, you know, you read the book, you're doing it. The doctor said, you're doing what the therapist said, and you still can't get it right. Then you're just a failure. And it, again goes back to feeling hopeless. Like you said, like your mom felt like she didn't have any hope and she felt very hopeless. And I think these sort of faulty communications and inability to tune into what the patient is telling you leads to that feeling of hopelessness and failure from the patient point of view. And so I can totally see how using ACT as a framework and being able to acknowledge the person and what they're doing. And, are there some alternatives that can be used, maybe not now, but maybe in the future or where you are now and what can we do at this point? And it was working now, but let's keep in mind that there are some other things that we might be able to augment your program with.
Laura Rathbone (46:58):
Yeah. And I always say that brings me on to probably the next thing that really, I think, feel very, very passionate about. And there are many new ones to watch my Facebook page, but you know, this is, I think one of the big misunderstandings we have about integrating psychologically informed physiotherapy, right. Is that we still think that it's something we do to other people. And that's why I don't really like the term psychologically physiotherapy, because it's still, although I think it's the best one we've got right now. And I think that, you know, it's a lovely way of thinking about how we therapize people, but it still puts the workload and the part of our identity that is physiotherapists. It's still what we do when we put the uniform on or when we go into our clinical encounter.
Laura Rathbone (47:51):
And it's still something that we do as a thing to all the people. But, you know, if we think really and truly reflect on the idea of the biopsychosocial model and the hierarchy of natural systems, this idea that a human is embedded within their environment, then the clinician is a part of the external environment and the patient or the person that's chosen to work with us is a part of our external environment and has an influence on us. And we have an influence on them and we need the real richness with acceptance and commitment therapy is that it is something that we're thinking about, okay, what is happening in my present experience that I might be struggling with that might be coming up in me that might be having an influence on somebody else?
Laura Rathbone (48:45):
What is my reaction to that person's story or that person's behavior, or that person's diagnosis, right. You know, what's happening in me so that we can also remember that work with our own resistance and become aware, especially now become aware of our own privilege and how that might influence and take away from somebody else's privilege or equity or equality or justice or access. And this is something that we need to reflect on very, very deeply as clinicians working in an area like healthcare, where access is very, very important. And it's our role to make sure that we're delivering high quality care with open access. And so acceptance and commitment therapy is a way for us to also take that moment and be like, okay, well, what's going on in me here? How am I helping this person what's happening in my reactions and my emotions and my sense of self and is that always helpful? So if my goal is to deliver an open and evidence-based and compassionate approach to experiencing any resistance or challenges to doing that in this situation, and maybe I need to work with that.
Laura Rathbone (50:02):
I think that can be true. Across musculoskeletal health, when, you know, people see, you know, patients or people with pain coming in and they have persistent pain, and it's not going to get better in six sessions, three to six sessions, and we've all got those targets, right. And they're going to need more than 30 minutes. So we're going to have to explain to our manager why actually did more than 30 minutes. You know, all these sorts of things what's happening is our instinct to push them away to somewhere else, or to create departments where we, you know, where we don't accept people who have pain for more than three months, or, you know, then there are those departments out there that push the access away to somewhere else.
Laura Rathbone (50:49):
So there's a bottleneck in all the parts of our clinical approach. Actually, maybe we could just upscale a little bit and recognize that persistent pain is a very big part of our musculoskeletal population. And we all have a duty to be better at it.
Karen Litzy:
Yes, very well said. And like you said, especially in these times, so listen, Laura, I want to thank you for coming on, but before we wrap things up and get to a good, and now a nice announcement from you and what you're doing in regards to ACT, I'm going to ask you one more question that is knowing where you are now in your life and in your career, what advice would you give to yourself straight out of university?
Laura Rathbone (51:52):
Gosh yeah, I would say what I am learning is that I'm not always the right person at that moment. And sometimes my desire and urge to fix people quickly as well, and to do right the injustice of having pain and to really get rid of that pain as quickly as possible. Sometimes that has I think, taken away from the therapeutic potential in some environments and in some experiences. So, and also has just caused me in a lot of pain, you know, and we have to remember that we are humans in this, that we are not, clinicians are people that go home and try to, you know, keep going after hearing some very difficult stories of all the people and, you know, we're also not immune to when the people we work with don't get better in the way we want them to, you know, we take that on. Yes. One of the most important skills that I have been learning is to be more forgiving of myself.
Laura Rathbone (52:51):
And to remember that life is complicated and people are coming into our clinics with a whole lifetime of experiences that I am not aware of and not privileged to. And they are not aware of or privileged to mine and being slower, taking more time, being more gentle, not only with people who choose to work with me, but also with myself actually has brought me to a place where I am having a better relationship with my job. I'm getting better relationships with the people that I work with. And I just, yeah, I am able to sustain this work now for longer than I would have been, you know, eight years ago when I first started in particularly working with longterm pain, it was very hard for me and I went through my own version of a burnout when I was constantly finding, trying to find more information and be better and upskill, upskill, upskill. Yes. We need to upskill. Yes. We need to learn about these things, but we also need to find good supportive mentors and good environments that we can next explain and explore what we're going through and ask for help. If we're feeling very effected by what we're hearing every day, you know, good relationships with our colleagues, physiotherapists, occupational therapists, psychologists, social workers, help us to, you know, share our experiences and our load. And be more forgiving of that, I guess. I don't know if that's a good answer.
Karen Litzy (54:27):
That's an excellent answer. Are you kidding me? Fantastic. And now speaking of gaining skills in service of others, what do you have coming up? Cause I know you have like a course that you have put together. So can you talk about that and where people can find more information?
Laura Rathbone (54:52):
Yeah. So about six months ago, I started putting together and planning a two day course, right? Typical 15 hour, two day course, people would come to our room and we would do two days of ACT. And then, you know, the situation with COVID-19 and all of our lives changed, and that didn't seem like it was gonna make most sense. So it shifted into a sort of online collaborative learning and it's still, we're still figuring out how this is going to work, but instead it's going to be four sessions of three hours of contact and collaboration over four weeks. And then there's going to be like support and forums in between. And that will be going live hopefully at the end of July, if I can get the luck. But if people do want to come on a course with me, or they're interested in exploring ACT and they just got some questions, best thing they can do is go to my website for information for even better, because I'm basically always on social media, find me on Facebook or Twitter, whatever, flip me a DM.
Karen Litzy (56:03):
And now, so we'll have links to all of that under the show notes at podcast.healthywealthysmart.com, but can you just shout out your social media handles?
Laura Rathbone (56:17):
If I can remember them. @laurarathbone (twitter) @laurarathbonevanmeurs (facebook) @laura.paincoach (Insta) Yeah, that's more of a patient facing platform for me. So that's Laura.pain coach which is the title that I tend to prefer. So sort of working as a coach, as opposed to as under the strict title of physiotherapy yet. So that was, yeah, those are the three social medias I use the most.
Karen Litzy (57:02):
Awesome. Well, Laura, thank you so much. This is a great conversation. It's certainly got me thinking of the way that I work with my patients and my clients, and maybe how I need to do a little more introspective work and try and really check my biases, whether they're conscious or unconscious biases at the door and really see what I can do for the person at the moment and listen to them and see what I can facilitate for them. So thank you so much for coming on the podcast and sharing all of this information. Thank you.
Laura Rathbone (57:40):
Oh, no, you're welcome. There's lots of books and websites and patient information out there. Just want to give a shout out to Steven Hayes who really is responsible for the framework of acceptance and commitment therapy and the association for contextual and behavioral science, I think it is, but I'll make sure that you get linked with that and why there are you know, resources on there for people to learn about acceptance and commitment therapy, because you know, this work isn't being done, the research hasn't been done by me, it's been done by lots of other people. So I would like to just direct people to look that up as well.
Karen Litzy (58:21):
Awesome. Well, thank you so much for coming on and everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Anne Stefanyk on the show to discuss website optimization. As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs, and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp.
In this episode, we discuss:
-Why your website is one of your most important marketing tools
-The art of simplicity in branding
-How to track the customer lifecycle
-The top tools you need to upgrade your website
-And so much more!
Resources:
Anne Stefanyk Twitter
Drupal
Anne Stefanyk LinkedIn
Kanopi Website
HotJar
Google Pagespeed
Accessibility Insights
WAVE Web Accessibility
Google/Lighthouse
Use user research to get insight into audience behavior
How to make your site last 5 years (possibly more)
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Anne:
As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions.
Anne fell into the Drupal community in 2007 and admired both the community’s people and the constant quest for knowledge. After holding Director-level positions at large Drupal agencies, she decided she was ready to open Kanopi Studios in 2013.
Her background is in business development, marketing, and technology, which allows her to successfully manage all facets of the business as well as provide the technical understanding to allow her to interface with engineers. She has accumulated years of professional Drupal hands-on experience, from basic websites to large Drupal applications with high-performance demands, multiple integrations, complicated migrations, and e-commerce including subscription and multi-tenancy.
Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. When she’s not contributing to the community or running her thoughtful web agency, she enjoys yoga, meditation, treehouses, dharma, cycling, paddle boarding, kayaking, and hanging with her nephew.
Read the full transcript below:
Karen Litzy (00:01):
Hey Anne, welcome to the podcast. I am so excited and happy to have you on.
Anne Stefanyk (00:06):
Nice to see you. Thank you so much for having me.
Karen Litzy (00:09):
So before we get into what we're going to talk about today, which is kind of how to use your website as a marketing tool, and that's putting it lightly, we're going to really dive into that, but I want to talk about kanopi. So for a lot of my listeners, they know that I'm a huge proponent of female entrepreneurs of women in physical therapy. We have a whole conference for it every year. And I love the fact that kanopi is a majority female company. So can you talk about the inception and kind of the journey that you've taken with the company over the years?
Anne Stefanyk (00:47):
Sure, I'd be happy to. So I founded kanopi kind of off the side of my desk and it actually came from meeting a need that I needed to take care of with my family. My family became quite sick and I had to stop working and as a result it forced my hand to pick up some contract work. And that contract works. Certain cuts soon kind of snowballed into, Oh my goodness, I have actual projects. I probably should hire some people and get out of my personal email to run the business. But it did come from a place where I needed some lifestyle flexibility. So I built a company that is fully distributed as well. And as a result of the business model that we created, it allowed us to really attract and retain really great talent. Outside of major cities. And I have a lot of single moms or a lot of moms and I have some single dads too, but we really are able to, with our business model, attract and retain a lot of top talent.
Anne Stefanyk (01:39):
And a lot of those are girls. So we're over 50% women and there's only really two men in our leadership, a team of nine. So there's seven girl bosses out of the nine that run the company. And we really have focused on helping people with their websites and making it really clear and simple and easy to understand. We find that there's always too much jargon out there. There's too much complexity and that we all are just craving simplicity. So building the business was twofold, was one to obviously help people with their websites. What was also to really create impactful futures for my staff and give them opportunities to kind of grow and expand in new ways. So I'm really proud that as kanopi has formed our team, I'm part of our retention plan has to really been to take care of our families and put our families first.
Anne Stefanyk (02:28):
Because if we realize that if you take care of the family, the family takes care of you. And so we've extended a lot of different benefits to be able to support the family journey as part of the business. And we find that as a female entrepreneur, really recognizing and appreciating that we need flexible lifestyles to be able to rear children or take care of elderly parents or we have a lot of demands as females on us. I mean the men do too, don't get me wrong, but as a female I'm creating a space of work where we can create that space for everybody really makes me proud. And happy.
Karen Litzy (03:03):
Yeah, I mean it's just in going through the website and reading about it, I was just like, Oh gosh, this woman's amazing. Like what a great way to go to work every day. Kind of knowing that you're staying true to what your values are and your mission is and that people really seem to like it.
Anne Stefanyk (03:22):
Yeah. Yeah. We always say it's not B to B or B to C, it's H to H it's human to human. And what do we need to get really clear to speak to our humans to help them, you know, move forward in their journey, whatever that looks like for them.
Karen Litzy (03:34):
Right. And, so now let's talk about that journey and it's kind of starts with the website. So let's talk about how you can make your website an effective marketing tool. Because not everyone, especially when you're first starting out, you don't have a lot of money to throw around to advertising and things like that. But we all have a website or maybe we all should have a website and have some sort of web presence. So how can we make that work for us?
Anne Stefanyk (04:00):
Yeah, definitely. You need a website. It's like a non negotiable factor these days and it really doesn't matter. The kind of website you have, especially when you're just getting started. There's lots of great tools out there from Wix, Squarespace, even WordPress that comes with templates or pre-baked themes. And I think the most important part is to really connect with your user and figure out who your user is and what kind of website needs to support their journey. But yeah, definitely you have to have a website and you actually have to have a good website. Having a bad website is the non, like, it's really bad because it will detract people so quickly and they'll never come back. So you pretty much have that first impression. And then if you don't make it, they won't come back. I think there's a well known stamp that if your site doesn't load within four seconds or three seconds they'll leave. And if it doesn't load within four seconds, they will never come back to that URL.
Karen Litzy (04:56):
Wow. All right. That's a great stat. I'm going to be, I'm going to go onto my computer, onto my website and start my timer, you know, so there's some really cool tools.
Anne Stefanyk (05:06):
We can include them in the show notes, but the Google has a page speed test where you can actually put your website URL and see how fast it is and give recommendations on what to fix.
Karen Litzy (05:15):
Oh perfect. Yeah, and we'll put all those links in the website and we'll get to that in a little bit about those different kinds of tools. But let's talk about, you said, you know, you're human to human business. We have to know who are we putting our website out there for. So how do we do that?
Anne Stefanyk (05:34):
Yeah, that's a great question. So when you're first starting off, you probably all like if you're just starting your business, you're just trying to figure out who you serve, but you may have special things that you'd like to, you know, that you're passionate about or you specialize in. Like for example, maybe you really specialize in women's health or sports medicine or you know, one of those things. And just to kind of get clear on who is your best customer. If you've been in business for a couple of years, you probably have a pretty good idea who your ideal customer is and how they engage with you. So first off, it's really thinking about who your target audience is and what are their needs. So when we're thinking about a website and thinking about that user journey, you often identify them as certain people. So you may have like, Mmm you know, kind of creating different avatars or different personas so you can really personify these people and help understand their journey.
Anne Stefanyk (06:27):
And from there you kind of understand that if someone's coming to you for physical therapy, there's going to be different mind States that they come into you with. So when you first have your website, you're going to want to, of course, a lot of people just put up who they are. Like, you know, this is my practice, this is who I am. This is my credit, my accreditation, and my certifications. And maybe maybe here's some testimonials. And then we run and we go off to the races. And that's great to get you out the door. Once you started your business, you're going to recognize that you're people, when they call you, they're going to have a million questions and there's ways to answer those questions using your website. And as a solo entrepreneur, like I ran my business by myself for three years, which means I was everything and I wore all the hats.
Anne Stefanyk (07:09):
I was the project manager, I was the designer, I was all the things that was the marketer, was the, I know that feeling well. So it took me like three years to operationalize. And I think the first thing I did as a female entrepreneur, I hired an assistant. I would highly recommend that as being one of your first hires as an entrepreneur. And that's just someone who can do all the little itty bitty details and then move on to whatever that looks like for you. But when you're building your website, the next level you really need to take is it serving my humans? Is it serving my audience? So are they able to get the information they need? And I think this strange time that we're in, we're all, this is an opportunity for us to look at our own website and our own stuff and say, is this the best representation possible?
Anne Stefanyk (07:52):
Because no longer are they just picking up the phone and calling you because your practice is probably closed. You're at home right now, your phones, maybe you if you have them redirected, but either way they're going to your website first. So it's like having the right information there at the right time for the right person. And that really comes to the user journey and that's where you know, if someone is just broken their ankle and they're now told by their doctor, you have to go into physical therapy, that's their first stage as they now are going to Google and saying, you know, PT for San Francisco and interestingly enough as Google wants to keep you there, so here you are. You user is Googling for you or Googling for physical therapy wherever, San Francisco, San Jose, wherever, and up comes the Google listings. If you can get past that point, then they go into your website and they're going to click open a bunch of them.
Anne Stefanyk (08:43):
That's what we call, you know, your awareness phase. They're becoming aware of you. There's certain things that a user wants to see in that phase. So understanding of someone's looking for you, they're going to, Oh yeah, they specialize in ankles. And I really think you know, Oh, that's person's for me. Versus now they're in the consideration stage and now they've chose likely, but Sally over here and James and Jimmy and we're figuring out which PT to go to, then that's a different level of content and what are they looking at to compare and contrast. And then when they've actually decided to work with you, then there's another layer of content you have to consider. So, Oh, I've decided to work where they're located. How do I get there? Was there anything I need to prepare their forms I need to fill out in advance?
Anne Stefanyk (09:27):
And then you even have the persona of the user once they've actually gone through all your services as I imagine. And therapy. A lot of you folks are getting referral and word of mouth. Let's nurture that. Let's use the website to nurture the word of mouth and referral work. Let's give your patients a place to go really easily to provide feedback, which will then change, you know, getting those Google reviews up leads to a higher ranking on that Google page. So if you understand where they began and where they pop out at the end, kind of map it all together. You'll start to see your gaps.
Karen Litzy:
And is it possible to go through sort of a quick example of what that might look like? So if someone's there on Google, they hit Google, they click on your website, you just said if it doesn't load within a couple of seconds, they're gone.
Anne Stefanyk (10:14):
Right? So that's a good awareness phase situation, right? What else? Someone's there, they're just click, click, click trying to find someone. What is it that they're looking for in that awareness stage? Like what are they, what is going to be like, Ooh, I like this, this person. I'm moving them from the awareness bucket to the consideration bucket. Yeah, yeah. So they need to see themselves in the way that their problem gets solved. So when they look at the website, they can say, Oh yeah, that person had the same problem and they got help. And then, Oh, look at their results. Oh look, there's a picture of them, you know, back on their skateboard six months later as part of this patient follow-up log. Oh, we don't, you know. So that's the kind of stuff is that when users really want to just be able to see themselves, they crave simplicity.
Anne Stefanyk (11:01):
And so often I think that if we're too close to it, we don't actually see how complex our stuff is. And sometimes when we're really smart and we have degrees in specialized things, we use vocabulary that our users are not even aware of yet. So it's really when you're talking to getting them from that awareness into considering you, it's about using really basic common language. It's about guiding them through a bit of a story. People love to read stories. So showing them like, Oh, you know, I was really showing another patient and showing the patient journey that all, I considered multiple companies locally, but I ultimately went with Sally as a PT because this, and just showing those things helps the user kind of see the whole journey so they can say, okay, okay, if you've never broken your ankle before, have no idea what to expect. You've never gone to physical therapy, you have no idea what to expect. And just the anticipation, if you can show them what snacks they feel a sense of relief that they'll be taken care of.
Karen Litzy (12:04):
Yeah. So what I'm hearing is that your testimonial page on your website's pretty important, is that something that should be front and center on the homepage?
Anne Stefanyk (12:16):
Well, that's an interesting thing. I think the main thing you want to use that front and center is being really clear about what you do. Right? Some people like to put these big sentences up there, but getting to know your user and the problem they have and this, you know, getting to how you're going to solve the problem is the most important part of that, of that real estate upfront. I will warn everybody that please don't use carousels. They're a big fad and they're just a fad. They're from a usability standpoint. And what happens is the end user thinks that whatever you put in your carousel is what you do. So if you're promoting an event in your carousel, they'll think that you're just doing the events.
Anne Stefanyk (13:01):
They won't even know that you're a physical therapist. Really clear upfront about what you do. You know, like I help people with, you know, however it goes, and then provide supporting content. So a testimonial is wonderful if it can also be like imbedded within a bigger story. So it tells the full story. I like that video. I mean everybody has an iPhone. So, or at least access to video really easily. You could do a quick little video testimonial with one of your clients over zoom for two minutes to say, Hey, you're one of my favorite PT clients and can you get on a quick video with me and just do a video testimonial. That's great way to leverage video content on your website to help the user see themselves as what the solution's going to be.
Karen Litzy (13:47):
Yeah. Great, great, awesome. And then one stipulation I would say on that is talk to your lawyer because you'll need them to sign a release for HIPAA purposes, right? To make sure that they know exactly where this video is going to be. You have to be very clear on that. Okay, great. So we're out of the awareness phase, so we're in consideration. So let's say it's between me and one other PT in New York city. What should I be looking at on my website to get that person from consideration to yes.
Anne Stefanyk (14:20):
So one of the greatest ways to do stuff is actually a very tried and it's email marketing or text-based marketing. So if you can capture an email during that awareness phase, even if it's just like you know, Mmm. Interested in getting some tips and tricks on how to rejuvenate your bone health during, you know, it doesn't have to be like sign up for a newsletter or sign up for this. It could be just a very simple, if you know your user is coming there specifically for a thing and you can provide some type of value added content, then there might be some small way to get a snippet of data so that you can continue the conversation. Cause most people are just bombarded with information and overwhelmed. So if there's any way to connect with them so you can feed them information. But another great way to kind of pull them into that consideration content is once you've got their eyeballs hooked and you're in, there is again to kind of figure out what are the common things, questions they need to have, they have answers they need answers to.
Anne Stefanyk (15:22):
And this might be from your experience, just answering phone calls when people are starting to talk to you. But it's like the questions like you know, maybe how long does it take for me to heal, you know, will I have different types of medicine I'm going to have to take? How much homework will there be? Do I need any special equipment? That's kind of, you know, just showing that you're the expert in the field and you have the answers to questions they didn't even know they had to ask. That kind of aha moment makes them feel really trusted. They trust you because they go, Oh I didn't even think about asking that question. Oh my goodness, I'm so glad they thought about that. I feel so taken care of. And that's where I think a lot of websites drop the ball is they straight up say like this is what we do, here's some testimonials. And they don't put all that soft content and that builds the trust. Can be a little blog, a little FAQ section and this is all like non technical stuff. You don't need a developer to do any of this. It's mostly just your writing time.
Karen Litzy (16:18):
Yeah, no and it's making me go through my head of my FAQ, so I'm like, Hmm, maybe I need to revisit. That's the one page I just sort of did a revamp of my website. We were talking about this before we went on, but I actually did not go to my FAQ page cause I thought to myself, Oh, it's probably good. It's probably not. I need to go back and do a little revamp on that too, just to think about some of the questions that I've been getting from patients recently and how does this work and things like that. Especially now with COVID. You know, like what about tele-health? What about this or about that?
Anne Stefanyk (16:51):
Yeah. Google loves when you update your content. Google loves it. Google loves it so much. It is one of the biggest disservices you can do is build your website and leave it. That's just not healthy. People think you have to rebuild your website every two to three years. That's who we are. That's bananas. You have to do it. If you just take care of your website and you nurture it and you love it and you make it, you make it work and you continually work on it and maybe that's just an hour a week, maybe it's an hour every month, whatever it is. Just a little bit of attention really goes a long way and it is something that we believe a website should last for at least 10 years, but that means you got to take care of it, right. A lot of clients come to me and say, Oh well, you know we're going to have to rebuild this in three years, and I'm like, no, you shouldn't.
Anne Stefanyk (17:31):
It should be totally fine. It's just like if you get a house right, if you don't do anything with your house a hundred years later, it's probably demolished. Like you're going to tear it down versus you've got to do the roof and you've got to replace the carpets and you got to do the perimeter drain. Right. It's kind of the website stuff too. I mean, Google will throw you curve balls if you're spending a lot time on social. Unless you're getting direct business from social media, don't worry about it so much. Google has changed their algorithms, which means that social doesn't count for as much as it did. Oh, so if you're spending two or three hours a week scheduling social, unless you're directly getting benefit, like from direct users, finding one social tone that way down and spend more time writing blogs, spending more time getting you know content on your website is, that's what matters from a Google standpoint.
Karen Litzy (18:16):
Good to know. Gosh, this is great. So all right, the person has now moved from consideration. They said, yes, I'm going to go and see Karen. This is what I've decided. Awesome. So now how can I make their patient journey a little bit easier?
Anne Stefanyk:
So we started at Google, they got from awareness to consideration. They said yes. Now what? Yeah, now what? So it's continuing the conversation and creating kind of being ahead of them. So text messages, 99% of text messages are open and read. Okay. Yeah, I think it's like 13 to 20% of emails are open read. So it would be skillful for you to gather a phone number so then you can text them, alerts, reminders, et cetera. That's a great way. There's a wonderful book called how to, what is it? Never lose a customer again. And it's beautiful. It's a beautiful book.
Anne Stefanyk (19:11):
It applies to any business. And it really talks about like how when you're engaging with a new client, the first two stages of that are the are the sales and presales. But then you have six steps. Once a person becomes your clients on how to nurture and engage and support that client journey. And that might just be simply as like if they're deciding to work with you and they book their first appointments, there's a lot of cool video. You could just do a little video recording and say, you know, thank you so much for booking an appoint with me. I'm so excited. I really honor the personal relationship that we have together and I want to build trust. So this is a just, and then giving them like a forum to then ask the question to you. So just building that relationship. Cause even though your clients, I mean if they're coming for PT, they might just be a onetime client.
Anne Stefanyk (19:57):
But again, they also might have lots of friends and family and that works. So when their friends and family and network happened to have that, how do you also kind of leverage the website that way? But a lot of it is just clarity. And you'll notice that big way to find out what's missing is interview your last few clients that have signed up, find out what they found was easy, what was difficult, what they wish they had more information. And if they're a recent enough client, they'll still remember that experience and us humans love to help. It's in their nature, right? So you should never feel worried about asking anybody for advice or insights on this. You know, there's even a little tool that you can put on your websites. It's a tool, there's a free version called Hotjar, hot and hot jar.
Anne Stefanyk (20:47):
And it's pretty easy to install. We actually have a blog post on how to install it too. It's really, we'll put that blog posts, but what it allows you to do is it allows you to see where people are clicking and whether they're not clicking on your website. So you can actually analyze, you know it's all anonymous, right? It's all anonymously tracked, but you can do screencast and you can do with these color heatmaps, you can kind of see where people are going. You can track this and it's free, right? Three you can do up to three pages for free. So I feel like the guys looking at stuff like that, you kind of get the data that you need to figure out where your gaps are because what you don't know is what you don't know, right? So I first recommend like getting clear on who your user is, you know, if you specifically take care of a certain set, figuring out where their journey is, what kind of content you'd need for each of those and what the gaps are. And then filled out a content calendar to fill the gaps.
Karen Litzy (21:42):
Got it. And a content calendar could be like a once a month blog post. It doesn't have to be every day. And I even think that can overwhelm you're patients or potential patients, right? Cause we're just inundated. There's so much noise, but if you have like a really great blog that comes out once a month and gets a lot of feedback on it, then people will look forward to that.
Anne Stefanyk (22:11):
Exactly. Exactly. Exactly. And I mean, humans want to get clarity, they want to receive value. And right now we live in an intention economy where everything is pinging at them. So realistically, the only way to break through the noise is just to be really clear and provide what they need. Simple. It's just simple. It's actually, you just simplify it, remove the jargon, you know, make it easy. And I mean a blog post, it could be as short as 300 words. You don't need to write a massive thing. You can even do a little video blog. Yeah. You don't like writing, you can just do a little video blog and embedded YouTube video and boom, you're done. Right?
Karen Litzy (22:46):
Yeah. Yeah. I love this because everything that you're saying doesn't take up a lot of time. Cause like we said before, when you're first starting out as a new entrepreneur, you feel like you've been pulled in a million different directions. But if you can say, I'm going to take one hour, like you said, one hour a month to do a website check-in, right? One hour a month to get a blog post together or shoot a quick video. Like you said, we've all got phones embedded in every device we own these days. So it doesn't take a lot. And I love all those suggestions. Okay. So now I'm in the nurturing phase and what we've done is, because I didn't use jargon, I was simple, clear to the point, filled in the gaps for them. Now those patients that who have come to see me are referring their friends to me and we're starting it all over again. So it's sort of this never ending positive cycle.
Anne Stefanyk (23:41):
Exactly, exactly. And that's what we really frame. We call it continuous improvement, which is the methodology of that. You always need to be taking care of it, nurturing it, loving it. Because if you just let it sit, it will do you no good. Right. And that's where you know, when you're that little bit of momentum and it's about pacing yourself and choosing one goal at a time. Like if you're feeling like, Oh my gosh, where am I going to start? What am I going to do? You know, just say, okay, I just want my site to go faster. Just pick one goal. You run it through the speed test, it's scoring forward of a hundred you're like, Oh, I need to make my site faster. So then you look at that and you say, okay, I've learned, you know, big images create large page speed load. So it'll tell, you can go through and look at your images and say, Oh, I need to resize this image. Or maybe I need, if I'm using WordPress, put a plugin that automatically resizes all my images. You know, a lot of it is content driven that you can kind of make your cycle faster with an accessibility. Accessibility is so dear and near to my heart.
Karen Litzy (24:44):
When you say accessibility for a website, what exactly does that mean?
Anne Stefanyk (24:48):
I mean, yes. So that means that it is technically available for people of all types of ranges of ability from someone who is visually impaired to someone who is physically impaired, temporarily or permanently disabled. So if you think about someone who's got a broken arm and maybe it's her dominant arm. I'm doing everything with my left. Try using a screen reader on your own website and you will be shocked that if you can't type you know with your hands and you're going to dictate to it, you'll be a, is how your computer does not actually understand your words. So it's about making your website really technically accessible with consideration. Four, font size, color contrast. Yeah. Images need to have what we call alt tags, which is just a description. So if your image is like one, two, three, four, five dot JPEG, you would actually want to rename it as lady sitting in a chair reading in a book dot JPEG because that's what a screen reader reads. Oh. So it's about the technical stuff, so that if somebody needs to use a screen reader or if somebody can't use their hands from physical, they can't type, they're reading, they're listening to the website. It's about structural, putting it together correctly so the tools can output.
Karen Litzy (26:12):
Mmm. Wow. I never even thought of that. Oh my gosh, this is blowing my mind. Anyway, so there's tools out there to look, let's talk about if you want to just maybe give a name to some of those tools. So how about to check your websites?
Anne Stefanyk (26:28):
Yeah, so it's Google page speed and it's just a website that you can go in and put your URL. There's another plugin called lighthouse, and lighthouse is a plugin that you can use through Chrome. And then you just on that and it'll output a report for you. And some of it's a little nerdy, right? And some of it's, you know, some of it's very clear. I love it. They, they'll put some jargon, let's just say that they don't quite understand that not everybody understands laptop, but if you're on a tool like Shopify or Squarespace or Wix, which a lot of like first time entrepreneurs, that's a great place to start. It's really affordable. They take care of a lot of those things built in. So that's the benefit of kind of standing on the shoulders of giants when it comes to those. But lighthouse is a good tool because it checks accessibility, performance, SEO and your coding best practices.
Karen Litzy (27:28):
Oh wow. Okay. So that's a good tool. Cool, any other tools that we should know about that you can think of off the top of your head? If not, we can always put more in the show notes if people want to check them out. But if you have another one that you wanted to throw out there, I don't want to cut you off, if you've got more.
Anne Stefanyk (27:45):
Oh no worries. There's lots of different checkers and I think the big thing error is just to be able to understand the results. So I'm always a big fan of making technology really accessible. So if you do need help with that, you know, feel free to reach out and I can get more help. But generally we look at search engine optimization, which is are you being found in Google? And there's some tools like SEO. Moz is one. And then we look at accessibility, is it accessible to all people and then we look at performance, can it go fast, fast, and then we look at code quality, right? Like you want to make sure you're doing your security updates cause it's a heck of a lot cheaper to do your security updates than unpack yourself if there is.
Karen Litzy (28:27):
Oh gosh. Yeah. Yeah, absolutely. And, like you said, on some of those websites, that security part might be in like already embedded in that or is that, do you recommend doing an external security look at your website as well?
Anne Stefanyk (28:44):
Exactly. Most of the time when you're using a known platform like Shopify or if you're using WordPress or Drupal, then what you want to do is you want to work with a reliable hosting provider so they will help you provide your security updates. It's just like you would always want to lock your car when you would go out in the city. It's just like some do your security updates. So, but yeah, that's the benefit of being on some of these larger platforms is they have some of that stuff baked in. You pay a monthly fee but you don't have to worry about it.
Karen Litzy (29:14):
Right. Perfect. Perfect. And gosh, this was so much good information. Let's talk a little bit about, since we are still in the midst of this COVID pandemic and crisis and what should we be doing with our websites now specifically to sort of provide that clarity and calmness that maybe we want to project while people are still a little, I mean, I watch the news people are on edge here.
Anne Stefanyk (29:47):
Yeah. I think everybody's a little on edge, especially as things are starting to open. But nervous about it. All right. So I think the main thing that you can do is provide clear pathways. So if you haven't already put an alert on your website or something, right on your homepage, that speaks to how you're handling COVID that would be really skillful in, that could just be if you, you know, Mmm. Some people have an alert bar, they can put up, some people use a blog post and they feature it as their blog posts. Some people use a little block on their home page, but just something that helps them understand that what that is, and I'm sure most of you have already responded to that cause you had to write, it was like the first two weeks, all of our clients were like, we got to put something on our website.
Anne Stefanyk (30:26):
Right. And so, from there is I think being very mindful about how overwhelmed your peoples are and not trying to flood them with like tips and tricks on how to stay calm or how to parent or how to, you know, like that's where everybody's kind of like on overwhelm of all the information. So for right now, I would say that it's a wonderful time to put an alert up so people visit your site. If you've switched to telehealth and telemedicine, it'd be a great time to actually clarify how to do that. So if they're like, okay, I'm going to sign up for this and I want to work with you. Mmm. But how does it work? Are we gonna do it through zoom? Is it through Skype? Is it through FaceTime? Is my data secure? You know, like you said, updating all your FAQ is like, we're in this weird space where we really have almost like no excuse to not come out of this better.
Anne Stefanyk (31:16):
You know, as an entrepreneur we have this like lurking sense of like, okay, I gotta make sure I'm doing something. And the web is a great place to start because it is your first impression. And to kind of go through your content, and maybe it is if you don't have a blog set up is setting up a blog and just putting one up there or writing two or three and not publishing it until you have two or three. But it is kind of figuring out what is your user need and how do you make it really easy for them to digest.
Karen Litzy (31:41):
Perfect. And now before we kind of wrap things up, I'll just ask you is there anything that we missed? Anything that you want to make sure that the listeners walk away with from this conversation?
Anne Stefanyk (31:56):
I think the big thing is that this can all get really confusing and overwhelming very quickly. And all you need to just think about is your humans that you're servicing and like how can I make their journey easier? And even if it's like if nothing else, you're like, Hey, I'm going to get a text messaging program set up because I'm going to be able to actually communicate with them a lot faster and a lot easier. Or, Hey, I'm just going to focus on getting more five stars reviews on my Google profiles, so I show up. I'm just going to make that the focus. So I think the big thing is just a one thing at a time, and because we're in a pandemic, set your bar really low and celebrate when you barely hit it because we're all working on overwhelm and overdrive and we're all exhausted and our adrenals are depleted. Even in overdrive syndrome for like 11 weeks or something. Now I know it's kind of like, Oh my goodness, my websites maybe a hot mess. I'm going to get one thing and I'm going to give myself a lot of wiggle room to make sure that I can take care of the pressing needs and just being really like patient because it isn't a journey where you're going to have your website and your entire business.
Karen Litzy (33:00):
Yeah. We never got to turn off your website. Right. I hope not. Oh, you never will. Right. Telemedicine is going to give you a new kind of way to practice too. It's revolutionizing the way we treat patients. A hundred percent yeah, absolutely. I personally have have been having great success and results with telehealth. And so I know that this is something that will be part of my practice going forward, even as restrictions are lowered. I mean here in New York, I mean you're in San Francisco, like we're both in areas that are on pretty high alert still. But this is something that's definitely gonna be part of my practice. So if there is a silver lining to come out of this really horrible time, I think that is one of them. From a healthcare standpoint, I think it's been a game changer because you're still able to help as you put it, help your humans, you know, help those people so that they're not spinning out on their own. So I love it. Now final question and I ask everyone this, knowing where you are in your life and in your career, what advice would you give yourself as a new graduate right out of college? So it's before, even before you started.
Anne Stefanyk (34:21):
Yes, yes. Honor my downtime. I think especially as a girl boss, that's always like, I've been an entrepreneur pretty much since I was in high school. I never took weekends and evenings for myself until I became like a little older. I would've definitely done more evenings and weekends because the recharge factor is just amazing for the brain. When you actually let it rest, it figures out all the problems on its own, get out of your own way and it'll like just, you know, even this COVID stuff. I find it so interesting that you know, as a boss you feel like you want to do so much and you want to get it done and you want to help your staff and you've got to figure out how to be there for them and then it's like, wait, you gotta put on your own mask before you put it on the others.
Anne Stefanyk (35:04):
And I feel like healthcare professionals, it's like so important for you to honor that little bit of downtime that you have now. Yeah, I mean, if I knew that back then, I'd probably be way stronger way would have honored myself. And as a woman, self care seems, we put it like second to our business and our families and second, third, fourth, fifth. So it's like, you know, advice to pass out. Let's take care of you. Yeah. It will be great. You will do wonderful things. Take care of you. You'll feel great. You know, I broke my ankle because I wasn't taking care of myself. Yeah.
Karen Litzy (35:36):
Oh wow. What advice. Yeah. Honor the downtime. I think that's great. And I think it's something that a lot of people just don't do. They think that in that downtime you should be doing something else. So you're failing.
Anne Stefanyk (35:48):
Yeah. And it's just so silly. It's just this weird, you know mental game that we have to play with ourselves. I listened to one of your recent podcasts and I just loved the girl that was on there said like, you know, successes is 20% skill, 80% of mind game. And I could not agree with that. You know, having a company full of women, imposter syndrome is the number one thing that I help coach my females with. It's like, no, you know exactly what you're doing because nobody knows what they're doing. We all learn, right? There's no textbook for a lot of this stuff. Like we went to school, there was a textbook, there was structure. We got out of school and now we're like go learn. It's like okay, okay so I find the entrepreneurial journey so cool. And that means like kind of like also finding out other tribes like where can we lean into and that's why I love you have this podcast cause it really focuses on like building a tribe of entrepreneurs that are focusing on taking it to the next level. Like how can we be empowering them to do their best, be their best selves.
Karen Litzy (36:47):
Exactly. I'm going to just use that as a tagline from now on for the buck. Perfect marketing tagline. Well and thank you so much. Where can people find more about you and more about kanopi.
Anne Stefanyk (37:00):
So you can go to kanopi or you can simply just look for me just go to kanopi on the Googles and you'll find me. But if you want to reach out via LinkedIn or anywhere, I'm always just a big fan of helping people make technology really clear and easy to understand. So find me on LinkedIn or on stuff and we can chat more there.
Karen Litzy (37:23):
Awesome. Well thank you so much. And to everyone listening, we'll have all of the links that we spoke about today and I know there were a lot, but they're all going to be in the show notes at podcasts.healthywealthysmart.com under this episode. So Anne, you have given so much great information. I can't thank you enough.
Anne Stefanyk (37:39):
Well thank you so much for it. I'm really grateful for the work that you're doing. I think it's fantastic.
Karen Litzy (37:45):
Thank you. And everyone else. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Anne Stefanyk on the show to discuss website optimization. As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs, and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp.
In this episode, we discuss:
-Why your website is one of your most important marketing tools
-The art of simplicity in branding
-How to track the customer lifecycle
-The top tools you need to upgrade your website
-And so much more!
Resources:
Anne Stefanyk Twitter
Drupal
Anne Stefanyk LinkedIn
Kanopi Website
HotJar
Google Pagespeed
Accessibility Insights
WAVE Web Accessibility
Google/Lighthouse
Use user research to get insight into audience behavior
How to make your site last 5 years (possibly more)
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Anne:
As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions.
Anne fell into the Drupal community in 2007 and admired both the community’s people and the constant quest for knowledge. After holding Director-level positions at large Drupal agencies, she decided she was ready to open Kanopi Studios in 2013.
Her background is in business development, marketing, and technology, which allows her to successfully manage all facets of the business as well as provide the technical understanding to allow her to interface with engineers. She has accumulated years of professional Drupal hands-on experience, from basic websites to large Drupal applications with high-performance demands, multiple integrations, complicated migrations, and e-commerce including subscription and multi-tenancy.
Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. When she’s not contributing to the community or running her thoughtful web agency, she enjoys yoga, meditation, treehouses, dharma, cycling, paddle boarding, kayaking, and hanging with her nephew.
Read the full transcript below:
Karen Litzy (00:01):
Hey Anne, welcome to the podcast. I am so excited and happy to have you on.
Anne Stefanyk (00:06):
Nice to see you. Thank you so much for having me.
Karen Litzy (00:09):
So before we get into what we're going to talk about today, which is kind of how to use your website as a marketing tool, and that's putting it lightly, we're going to really dive into that, but I want to talk about kanopi. So for a lot of my listeners, they know that I'm a huge proponent of female entrepreneurs of women in physical therapy. We have a whole conference for it every year. And I love the fact that kanopi is a majority female company. So can you talk about the inception and kind of the journey that you've taken with the company over the years?
Anne Stefanyk (00:47):
Sure, I'd be happy to. So I founded kanopi kind of off the side of my desk and it actually came from meeting a need that I needed to take care of with my family. My family became quite sick and I had to stop working and as a result it forced my hand to pick up some contract work. And that contract works. Certain cuts soon kind of snowballed into, Oh my goodness, I have actual projects. I probably should hire some people and get out of my personal email to run the business. But it did come from a place where I needed some lifestyle flexibility. So I built a company that is fully distributed as well. And as a result of the business model that we created, it allowed us to really attract and retain really great talent. Outside of major cities. And I have a lot of single moms or a lot of moms and I have some single dads too, but we really are able to, with our business model, attract and retain a lot of top talent.
Anne Stefanyk (01:39):
And a lot of those are girls. So we're over 50% women and there's only really two men in our leadership, a team of nine. So there's seven girl bosses out of the nine that run the company. And we really have focused on helping people with their websites and making it really clear and simple and easy to understand. We find that there's always too much jargon out there. There's too much complexity and that we all are just craving simplicity. So building the business was twofold, was one to obviously help people with their websites. What was also to really create impactful futures for my staff and give them opportunities to kind of grow and expand in new ways. So I'm really proud that as kanopi has formed our team, I'm part of our retention plan has to really been to take care of our families and put our families first.
Anne Stefanyk (02:28):
Because if we realize that if you take care of the family, the family takes care of you. And so we've extended a lot of different benefits to be able to support the family journey as part of the business. And we find that as a female entrepreneur, really recognizing and appreciating that we need flexible lifestyles to be able to rear children or take care of elderly parents or we have a lot of demands as females on us. I mean the men do too, don't get me wrong, but as a female I'm creating a space of work where we can create that space for everybody really makes me proud. And happy.
Karen Litzy (03:03):
Yeah, I mean it's just in going through the website and reading about it, I was just like, Oh gosh, this woman's amazing. Like what a great way to go to work every day. Kind of knowing that you're staying true to what your values are and your mission is and that people really seem to like it.
Anne Stefanyk (03:22):
Yeah. Yeah. We always say it's not B to B or B to C, it's H to H it's human to human. And what do we need to get really clear to speak to our humans to help them, you know, move forward in their journey, whatever that looks like for them.
Karen Litzy (03:34):
Right. And, so now let's talk about that journey and it's kind of starts with the website. So let's talk about how you can make your website an effective marketing tool. Because not everyone, especially when you're first starting out, you don't have a lot of money to throw around to advertising and things like that. But we all have a website or maybe we all should have a website and have some sort of web presence. So how can we make that work for us?
Anne Stefanyk (04:00):
Yeah, definitely. You need a website. It's like a non negotiable factor these days and it really doesn't matter. The kind of website you have, especially when you're just getting started. There's lots of great tools out there from Wix, Squarespace, even WordPress that comes with templates or pre-baked themes. And I think the most important part is to really connect with your user and figure out who your user is and what kind of website needs to support their journey. But yeah, definitely you have to have a website and you actually have to have a good website. Having a bad website is the non, like, it's really bad because it will detract people so quickly and they'll never come back. So you pretty much have that first impression. And then if you don't make it, they won't come back. I think there's a well known stamp that if your site doesn't load within four seconds or three seconds they'll leave. And if it doesn't load within four seconds, they will never come back to that URL.
Karen Litzy (04:56):
Wow. All right. That's a great stat. I'm going to be, I'm going to go onto my computer, onto my website and start my timer, you know, so there's some really cool tools.
Anne Stefanyk (05:06):
We can include them in the show notes, but the Google has a page speed test where you can actually put your website URL and see how fast it is and give recommendations on what to fix.
Karen Litzy (05:15):
Oh perfect. Yeah, and we'll put all those links in the website and we'll get to that in a little bit about those different kinds of tools. But let's talk about, you said, you know, you're human to human business. We have to know who are we putting our website out there for. So how do we do that?
Anne Stefanyk (05:34):
Yeah, that's a great question. So when you're first starting off, you probably all like if you're just starting your business, you're just trying to figure out who you serve, but you may have special things that you'd like to, you know, that you're passionate about or you specialize in. Like for example, maybe you really specialize in women's health or sports medicine or you know, one of those things. And just to kind of get clear on who is your best customer. If you've been in business for a couple of years, you probably have a pretty good idea who your ideal customer is and how they engage with you. So first off, it's really thinking about who your target audience is and what are their needs. So when we're thinking about a website and thinking about that user journey, you often identify them as certain people. So you may have like, Mmm you know, kind of creating different avatars or different personas so you can really personify these people and help understand their journey.
Anne Stefanyk (06:27):
And from there you kind of understand that if someone's coming to you for physical therapy, there's going to be different mind States that they come into you with. So when you first have your website, you're going to want to, of course, a lot of people just put up who they are. Like, you know, this is my practice, this is who I am. This is my credit, my accreditation, and my certifications. And maybe maybe here's some testimonials. And then we run and we go off to the races. And that's great to get you out the door. Once you started your business, you're going to recognize that you're people, when they call you, they're going to have a million questions and there's ways to answer those questions using your website. And as a solo entrepreneur, like I ran my business by myself for three years, which means I was everything and I wore all the hats.
Anne Stefanyk (07:09):
I was the project manager, I was the designer, I was all the things that was the marketer, was the, I know that feeling well. So it took me like three years to operationalize. And I think the first thing I did as a female entrepreneur, I hired an assistant. I would highly recommend that as being one of your first hires as an entrepreneur. And that's just someone who can do all the little itty bitty details and then move on to whatever that looks like for you. But when you're building your website, the next level you really need to take is it serving my humans? Is it serving my audience? So are they able to get the information they need? And I think this strange time that we're in, we're all, this is an opportunity for us to look at our own website and our own stuff and say, is this the best representation possible?
Anne Stefanyk (07:52):
Because no longer are they just picking up the phone and calling you because your practice is probably closed. You're at home right now, your phones, maybe you if you have them redirected, but either way they're going to your website first. So it's like having the right information there at the right time for the right person. And that really comes to the user journey and that's where you know, if someone is just broken their ankle and they're now told by their doctor, you have to go into physical therapy, that's their first stage as they now are going to Google and saying, you know, PT for San Francisco and interestingly enough as Google wants to keep you there, so here you are. You user is Googling for you or Googling for physical therapy wherever, San Francisco, San Jose, wherever, and up comes the Google listings. If you can get past that point, then they go into your website and they're going to click open a bunch of them.
Anne Stefanyk (08:43):
That's what we call, you know, your awareness phase. They're becoming aware of you. There's certain things that a user wants to see in that phase. So understanding of someone's looking for you, they're going to, Oh yeah, they specialize in ankles. And I really think you know, Oh, that's person's for me. Versus now they're in the consideration stage and now they've chose likely, but Sally over here and James and Jimmy and we're figuring out which PT to go to, then that's a different level of content and what are they looking at to compare and contrast. And then when they've actually decided to work with you, then there's another layer of content you have to consider. So, Oh, I've decided to work where they're located. How do I get there? Was there anything I need to prepare their forms I need to fill out in advance?
Anne Stefanyk (09:27):
And then you even have the persona of the user once they've actually gone through all your services as I imagine. And therapy. A lot of you folks are getting referral and word of mouth. Let's nurture that. Let's use the website to nurture the word of mouth and referral work. Let's give your patients a place to go really easily to provide feedback, which will then change, you know, getting those Google reviews up leads to a higher ranking on that Google page. So if you understand where they began and where they pop out at the end, kind of map it all together. You'll start to see your gaps.
Karen Litzy:
And is it possible to go through sort of a quick example of what that might look like? So if someone's there on Google, they hit Google, they click on your website, you just said if it doesn't load within a couple of seconds, they're gone.
Anne Stefanyk (10:14):
Right? So that's a good awareness phase situation, right? What else? Someone's there, they're just click, click, click trying to find someone. What is it that they're looking for in that awareness stage? Like what are they, what is going to be like, Ooh, I like this, this person. I'm moving them from the awareness bucket to the consideration bucket. Yeah, yeah. So they need to see themselves in the way that their problem gets solved. So when they look at the website, they can say, Oh yeah, that person had the same problem and they got help. And then, Oh, look at their results. Oh look, there's a picture of them, you know, back on their skateboard six months later as part of this patient follow-up log. Oh, we don't, you know. So that's the kind of stuff is that when users really want to just be able to see themselves, they crave simplicity.
Anne Stefanyk (11:01):
And so often I think that if we're too close to it, we don't actually see how complex our stuff is. And sometimes when we're really smart and we have degrees in specialized things, we use vocabulary that our users are not even aware of yet. So it's really when you're talking to getting them from that awareness into considering you, it's about using really basic common language. It's about guiding them through a bit of a story. People love to read stories. So showing them like, Oh, you know, I was really showing another patient and showing the patient journey that all, I considered multiple companies locally, but I ultimately went with Sally as a PT because this, and just showing those things helps the user kind of see the whole journey so they can say, okay, okay, if you've never broken your ankle before, have no idea what to expect. You've never gone to physical therapy, you have no idea what to expect. And just the anticipation, if you can show them what snacks they feel a sense of relief that they'll be taken care of.
Karen Litzy (12:04):
Yeah. So what I'm hearing is that your testimonial page on your website's pretty important, is that something that should be front and center on the homepage?
Anne Stefanyk (12:16):
Well, that's an interesting thing. I think the main thing you want to use that front and center is being really clear about what you do. Right? Some people like to put these big sentences up there, but getting to know your user and the problem they have and this, you know, getting to how you're going to solve the problem is the most important part of that, of that real estate upfront. I will warn everybody that please don't use carousels. They're a big fad and they're just a fad. They're from a usability standpoint. And what happens is the end user thinks that whatever you put in your carousel is what you do. So if you're promoting an event in your carousel, they'll think that you're just doing the events.
Anne Stefanyk (13:01):
They won't even know that you're a physical therapist. Really clear upfront about what you do. You know, like I help people with, you know, however it goes, and then provide supporting content. So a testimonial is wonderful if it can also be like imbedded within a bigger story. So it tells the full story. I like that video. I mean everybody has an iPhone. So, or at least access to video really easily. You could do a quick little video testimonial with one of your clients over zoom for two minutes to say, Hey, you're one of my favorite PT clients and can you get on a quick video with me and just do a video testimonial. That's great way to leverage video content on your website to help the user see themselves as what the solution's going to be.
Karen Litzy (13:47):
Yeah. Great, great, awesome. And then one stipulation I would say on that is talk to your lawyer because you'll need them to sign a release for HIPAA purposes, right? To make sure that they know exactly where this video is going to be. You have to be very clear on that. Okay, great. So we're out of the awareness phase, so we're in consideration. So let's say it's between me and one other PT in New York city. What should I be looking at on my website to get that person from consideration to yes.
Anne Stefanyk (14:20):
So one of the greatest ways to do stuff is actually a very tried and it's email marketing or text-based marketing. So if you can capture an email during that awareness phase, even if it's just like you know, Mmm. Interested in getting some tips and tricks on how to rejuvenate your bone health during, you know, it doesn't have to be like sign up for a newsletter or sign up for this. It could be just a very simple, if you know your user is coming there specifically for a thing and you can provide some type of value added content, then there might be some small way to get a snippet of data so that you can continue the conversation. Cause most people are just bombarded with information and overwhelmed. So if there's any way to connect with them so you can feed them information. But another great way to kind of pull them into that consideration content is once you've got their eyeballs hooked and you're in, there is again to kind of figure out what are the common things, questions they need to have, they have answers they need answers to.
Anne Stefanyk (15:22):
And this might be from your experience, just answering phone calls when people are starting to talk to you. But it's like the questions like you know, maybe how long does it take for me to heal, you know, will I have different types of medicine I'm going to have to take? How much homework will there be? Do I need any special equipment? That's kind of, you know, just showing that you're the expert in the field and you have the answers to questions they didn't even know they had to ask. That kind of aha moment makes them feel really trusted. They trust you because they go, Oh I didn't even think about asking that question. Oh my goodness, I'm so glad they thought about that. I feel so taken care of. And that's where I think a lot of websites drop the ball is they straight up say like this is what we do, here's some testimonials. And they don't put all that soft content and that builds the trust. Can be a little blog, a little FAQ section and this is all like non technical stuff. You don't need a developer to do any of this. It's mostly just your writing time.
Karen Litzy (16:18):
Yeah, no and it's making me go through my head of my FAQ, so I'm like, Hmm, maybe I need to revisit. That's the one page I just sort of did a revamp of my website. We were talking about this before we went on, but I actually did not go to my FAQ page cause I thought to myself, Oh, it's probably good. It's probably not. I need to go back and do a little revamp on that too, just to think about some of the questions that I've been getting from patients recently and how does this work and things like that. Especially now with COVID. You know, like what about tele-health? What about this or about that?
Anne Stefanyk (16:51):
Yeah. Google loves when you update your content. Google loves it. Google loves it so much. It is one of the biggest disservices you can do is build your website and leave it. That's just not healthy. People think you have to rebuild your website every two to three years. That's who we are. That's bananas. You have to do it. If you just take care of your website and you nurture it and you love it and you make it, you make it work and you continually work on it and maybe that's just an hour a week, maybe it's an hour every month, whatever it is. Just a little bit of attention really goes a long way and it is something that we believe a website should last for at least 10 years, but that means you got to take care of it, right. A lot of clients come to me and say, Oh well, you know we're going to have to rebuild this in three years, and I'm like, no, you shouldn't.
Anne Stefanyk (17:31):
It should be totally fine. It's just like if you get a house right, if you don't do anything with your house a hundred years later, it's probably demolished. Like you're going to tear it down versus you've got to do the roof and you've got to replace the carpets and you got to do the perimeter drain. Right. It's kind of the website stuff too. I mean, Google will throw you curve balls if you're spending a lot time on social. Unless you're getting direct business from social media, don't worry about it so much. Google has changed their algorithms, which means that social doesn't count for as much as it did. Oh, so if you're spending two or three hours a week scheduling social, unless you're directly getting benefit, like from direct users, finding one social tone that way down and spend more time writing blogs, spending more time getting you know content on your website is, that's what matters from a Google standpoint.
Karen Litzy (18:16):
Good to know. Gosh, this is great. So all right, the person has now moved from consideration. They said, yes, I'm going to go and see Karen. This is what I've decided. Awesome. So now how can I make their patient journey a little bit easier?
Anne Stefanyk:
So we started at Google, they got from awareness to consideration. They said yes. Now what? Yeah, now what? So it's continuing the conversation and creating kind of being ahead of them. So text messages, 99% of text messages are open and read. Okay. Yeah, I think it's like 13 to 20% of emails are open read. So it would be skillful for you to gather a phone number so then you can text them, alerts, reminders, et cetera. That's a great way. There's a wonderful book called how to, what is it? Never lose a customer again. And it's beautiful. It's a beautiful book.
Anne Stefanyk (19:11):
It applies to any business. And it really talks about like how when you're engaging with a new client, the first two stages of that are the are the sales and presales. But then you have six steps. Once a person becomes your clients on how to nurture and engage and support that client journey. And that might just be simply as like if they're deciding to work with you and they book their first appointments, there's a lot of cool video. You could just do a little video recording and say, you know, thank you so much for booking an appoint with me. I'm so excited. I really honor the personal relationship that we have together and I want to build trust. So this is a just, and then giving them like a forum to then ask the question to you. So just building that relationship. Cause even though your clients, I mean if they're coming for PT, they might just be a onetime client.
Anne Stefanyk (19:57):
But again, they also might have lots of friends and family and that works. So when their friends and family and network happened to have that, how do you also kind of leverage the website that way? But a lot of it is just clarity. And you'll notice that big way to find out what's missing is interview your last few clients that have signed up, find out what they found was easy, what was difficult, what they wish they had more information. And if they're a recent enough client, they'll still remember that experience and us humans love to help. It's in their nature, right? So you should never feel worried about asking anybody for advice or insights on this. You know, there's even a little tool that you can put on your websites. It's a tool, there's a free version called Hotjar, hot and hot jar.
Anne Stefanyk (20:47):
And it's pretty easy to install. We actually have a blog post on how to install it too. It's really, we'll put that blog posts, but what it allows you to do is it allows you to see where people are clicking and whether they're not clicking on your website. So you can actually analyze, you know it's all anonymous, right? It's all anonymously tracked, but you can do screencast and you can do with these color heatmaps, you can kind of see where people are going. You can track this and it's free, right? Three you can do up to three pages for free. So I feel like the guys looking at stuff like that, you kind of get the data that you need to figure out where your gaps are because what you don't know is what you don't know, right? So I first recommend like getting clear on who your user is, you know, if you specifically take care of a certain set, figuring out where their journey is, what kind of content you'd need for each of those and what the gaps are. And then filled out a content calendar to fill the gaps.
Karen Litzy (21:42):
Got it. And a content calendar could be like a once a month blog post. It doesn't have to be every day. And I even think that can overwhelm you're patients or potential patients, right? Cause we're just inundated. There's so much noise, but if you have like a really great blog that comes out once a month and gets a lot of feedback on it, then people will look forward to that.
Anne Stefanyk (22:11):
Exactly. Exactly. Exactly. And I mean, humans want to get clarity, they want to receive value. And right now we live in an intention economy where everything is pinging at them. So realistically, the only way to break through the noise is just to be really clear and provide what they need. Simple. It's just simple. It's actually, you just simplify it, remove the jargon, you know, make it easy. And I mean a blog post, it could be as short as 300 words. You don't need to write a massive thing. You can even do a little video blog. Yeah. You don't like writing, you can just do a little video blog and embedded YouTube video and boom, you're done. Right?
Karen Litzy (22:46):
Yeah. Yeah. I love this because everything that you're saying doesn't take up a lot of time. Cause like we said before, when you're first starting out as a new entrepreneur, you feel like you've been pulled in a million different directions. But if you can say, I'm going to take one hour, like you said, one hour a month to do a website check-in, right? One hour a month to get a blog post together or shoot a quick video. Like you said, we've all got phones embedded in every device we own these days. So it doesn't take a lot. And I love all those suggestions. Okay. So now I'm in the nurturing phase and what we've done is, because I didn't use jargon, I was simple, clear to the point, filled in the gaps for them. Now those patients that who have come to see me are referring their friends to me and we're starting it all over again. So it's sort of this never ending positive cycle.
Anne Stefanyk (23:41):
Exactly, exactly. And that's what we really frame. We call it continuous improvement, which is the methodology of that. You always need to be taking care of it, nurturing it, loving it. Because if you just let it sit, it will do you no good. Right. And that's where you know, when you're that little bit of momentum and it's about pacing yourself and choosing one goal at a time. Like if you're feeling like, Oh my gosh, where am I going to start? What am I going to do? You know, just say, okay, I just want my site to go faster. Just pick one goal. You run it through the speed test, it's scoring forward of a hundred you're like, Oh, I need to make my site faster. So then you look at that and you say, okay, I've learned, you know, big images create large page speed load. So it'll tell, you can go through and look at your images and say, Oh, I need to resize this image. Or maybe I need, if I'm using WordPress, put a plugin that automatically resizes all my images. You know, a lot of it is content driven that you can kind of make your cycle faster with an accessibility. Accessibility is so dear and near to my heart.
Karen Litzy (24:44):
When you say accessibility for a website, what exactly does that mean?
Anne Stefanyk (24:48):
I mean, yes. So that means that it is technically available for people of all types of ranges of ability from someone who is visually impaired to someone who is physically impaired, temporarily or permanently disabled. So if you think about someone who's got a broken arm and maybe it's her dominant arm. I'm doing everything with my left. Try using a screen reader on your own website and you will be shocked that if you can't type you know with your hands and you're going to dictate to it, you'll be a, is how your computer does not actually understand your words. So it's about making your website really technically accessible with consideration. Four, font size, color contrast. Yeah. Images need to have what we call alt tags, which is just a description. So if your image is like one, two, three, four, five dot JPEG, you would actually want to rename it as lady sitting in a chair reading in a book dot JPEG because that's what a screen reader reads. Oh. So it's about the technical stuff, so that if somebody needs to use a screen reader or if somebody can't use their hands from physical, they can't type, they're reading, they're listening to the website. It's about structural, putting it together correctly so the tools can output.
Karen Litzy (26:12):
Mmm. Wow. I never even thought of that. Oh my gosh, this is blowing my mind. Anyway, so there's tools out there to look, let's talk about if you want to just maybe give a name to some of those tools. So how about to check your websites?
Anne Stefanyk (26:28):
Yeah, so it's Google page speed and it's just a website that you can go in and put your URL. There's another plugin called lighthouse, and lighthouse is a plugin that you can use through Chrome. And then you just on that and it'll output a report for you. And some of it's a little nerdy, right? And some of it's, you know, some of it's very clear. I love it. They, they'll put some jargon, let's just say that they don't quite understand that not everybody understands laptop, but if you're on a tool like Shopify or Squarespace or Wix, which a lot of like first time entrepreneurs, that's a great place to start. It's really affordable. They take care of a lot of those things built in. So that's the benefit of kind of standing on the shoulders of giants when it comes to those. But lighthouse is a good tool because it checks accessibility, performance, SEO and your coding best practices.
Karen Litzy (27:28):
Oh wow. Okay. So that's a good tool. Cool, any other tools that we should know about that you can think of off the top of your head? If not, we can always put more in the show notes if people want to check them out. But if you have another one that you wanted to throw out there, I don't want to cut you off, if you've got more.
Anne Stefanyk (27:45):
Oh no worries. There's lots of different checkers and I think the big thing error is just to be able to understand the results. So I'm always a big fan of making technology really accessible. So if you do need help with that, you know, feel free to reach out and I can get more help. But generally we look at search engine optimization, which is are you being found in Google? And there's some tools like SEO. Moz is one. And then we look at accessibility, is it accessible to all people and then we look at performance, can it go fast, fast, and then we look at code quality, right? Like you want to make sure you're doing your security updates cause it's a heck of a lot cheaper to do your security updates than unpack yourself if there is.
Karen Litzy (28:27):
Oh gosh. Yeah. Yeah, absolutely. And, like you said, on some of those websites, that security part might be in like already embedded in that or is that, do you recommend doing an external security look at your website as well?
Anne Stefanyk (28:44):
Exactly. Most of the time when you're using a known platform like Shopify or if you're using WordPress or Drupal, then what you want to do is you want to work with a reliable hosting provider so they will help you provide your security updates. It's just like you would always want to lock your car when you would go out in the city. It's just like some do your security updates. So, but yeah, that's the benefit of being on some of these larger platforms is they have some of that stuff baked in. You pay a monthly fee but you don't have to worry about it.
Karen Litzy (29:14):
Right. Perfect. Perfect. And gosh, this was so much good information. Let's talk a little bit about, since we are still in the midst of this COVID pandemic and crisis and what should we be doing with our websites now specifically to sort of provide that clarity and calmness that maybe we want to project while people are still a little, I mean, I watch the news people are on edge here.
Anne Stefanyk (29:47):
Yeah. I think everybody's a little on edge, especially as things are starting to open. But nervous about it. All right. So I think the main thing that you can do is provide clear pathways. So if you haven't already put an alert on your website or something, right on your homepage, that speaks to how you're handling COVID that would be really skillful in, that could just be if you, you know, Mmm. Some people have an alert bar, they can put up, some people use a blog post and they feature it as their blog posts. Some people use a little block on their home page, but just something that helps them understand that what that is, and I'm sure most of you have already responded to that cause you had to write, it was like the first two weeks, all of our clients were like, we got to put something on our website.
Anne Stefanyk (30:26):
Right. And so, from there is I think being very mindful about how overwhelmed your peoples are and not trying to flood them with like tips and tricks on how to stay calm or how to parent or how to, you know, like that's where everybody's kind of like on overwhelm of all the information. So for right now, I would say that it's a wonderful time to put an alert up so people visit your site. If you've switched to telehealth and telemedicine, it'd be a great time to actually clarify how to do that. So if they're like, okay, I'm going to sign up for this and I want to work with you. Mmm. But how does it work? Are we gonna do it through zoom? Is it through Skype? Is it through FaceTime? Is my data secure? You know, like you said, updating all your FAQ is like, we're in this weird space where we really have almost like no excuse to not come out of this better.
Anne Stefanyk (31:16):
You know, as an entrepreneur we have this like lurking sense of like, okay, I gotta make sure I'm doing something. And the web is a great place to start because it is your first impression. And to kind of go through your content, and maybe it is if you don't have a blog set up is setting up a blog and just putting one up there or writing two or three and not publishing it until you have two or three. But it is kind of figuring out what is your user need and how do you make it really easy for them to digest.
Karen Litzy (31:41):
Perfect. And now before we kind of wrap things up, I'll just ask you is there anything that we missed? Anything that you want to make sure that the listeners walk away with from this conversation?
Anne Stefanyk (31:56):
I think the big thing is that this can all get really confusing and overwhelming very quickly. And all you need to just think about is your humans that you're servicing and like how can I make their journey easier? And even if it's like if nothing else, you're like, Hey, I'm going to get a text messaging program set up because I'm going to be able to actually communicate with them a lot faster and a lot easier. Or, Hey, I'm just going to focus on getting more five stars reviews on my Google profiles, so I show up. I'm just going to make that the focus. So I think the big thing is just a one thing at a time, and because we're in a pandemic, set your bar really low and celebrate when you barely hit it because we're all working on overwhelm and overdrive and we're all exhausted and our adrenals are depleted. Even in overdrive syndrome for like 11 weeks or something. Now I know it's kind of like, Oh my goodness, my websites maybe a hot mess. I'm going to get one thing and I'm going to give myself a lot of wiggle room to make sure that I can take care of the pressing needs and just being really like patient because it isn't a journey where you're going to have your website and your entire business.
Karen Litzy (33:00):
Yeah. We never got to turn off your website. Right. I hope not. Oh, you never will. Right. Telemedicine is going to give you a new kind of way to practice too. It's revolutionizing the way we treat patients. A hundred percent yeah, absolutely. I personally have have been having great success and results with telehealth. And so I know that this is something that will be part of my practice going forward, even as restrictions are lowered. I mean here in New York, I mean you're in San Francisco, like we're both in areas that are on pretty high alert still. But this is something that's definitely gonna be part of my practice. So if there is a silver lining to come out of this really horrible time, I think that is one of them. From a healthcare standpoint, I think it's been a game changer because you're still able to help as you put it, help your humans, you know, help those people so that they're not spinning out on their own. So I love it. Now final question and I ask everyone this, knowing where you are in your life and in your career, what advice would you give yourself as a new graduate right out of college? So it's before, even before you started.
Anne Stefanyk (34:21):
Yes, yes. Honor my downtime. I think especially as a girl boss, that's always like, I've been an entrepreneur pretty much since I was in high school. I never took weekends and evenings for myself until I became like a little older. I would've definitely done more evenings and weekends because the recharge factor is just amazing for the brain. When you actually let it rest, it figures out all the problems on its own, get out of your own way and it'll like just, you know, even this COVID stuff. I find it so interesting that you know, as a boss you feel like you want to do so much and you want to get it done and you want to help your staff and you've got to figure out how to be there for them and then it's like, wait, you gotta put on your own mask before you put it on the others.
Anne Stefanyk (35:04):
And I feel like healthcare professionals, it's like so important for you to honor that little bit of downtime that you have now. Yeah, I mean, if I knew that back then, I'd probably be way stronger way would have honored myself. And as a woman, self care seems, we put it like second to our business and our families and second, third, fourth, fifth. So it's like, you know, advice to pass out. Let's take care of you. Yeah. It will be great. You will do wonderful things. Take care of you. You'll feel great. You know, I broke my ankle because I wasn't taking care of myself. Yeah.
Karen Litzy (35:36):
Oh wow. What advice. Yeah. Honor the downtime. I think that's great. And I think it's something that a lot of people just don't do. They think that in that downtime you should be doing something else. So you're failing.
Anne Stefanyk (35:48):
Yeah. And it's just so silly. It's just this weird, you know mental game that we have to play with ourselves. I listened to one of your recent podcasts and I just loved the girl that was on there said like, you know, successes is 20% skill, 80% of mind game. And I could not agree with that. You know, having a company full of women, imposter syndrome is the number one thing that I help coach my females with. It's like, no, you know exactly what you're doing because nobody knows what they're doing. We all learn, right? There's no textbook for a lot of this stuff. Like we went to school, there was a textbook, there was structure. We got out of school and now we're like go learn. It's like okay, okay so I find the entrepreneurial journey so cool. And that means like kind of like also finding out other tribes like where can we lean into and that's why I love you have this podcast cause it really focuses on like building a tribe of entrepreneurs that are focusing on taking it to the next level. Like how can we be empowering them to do their best, be their best selves.
Karen Litzy (36:47):
Exactly. I'm going to just use that as a tagline from now on for the buck. Perfect marketing tagline. Well and thank you so much. Where can people find more about you and more about kanopi.
Anne Stefanyk (37:00):
So you can go to kanopi or you can simply just look for me just go to kanopi on the Googles and you'll find me. But if you want to reach out via LinkedIn or anywhere, I'm always just a big fan of helping people make technology really clear and easy to understand. So find me on LinkedIn or on stuff and we can chat more there.
Karen Litzy (37:23):
Awesome. Well thank you so much. And to everyone listening, we'll have all of the links that we spoke about today and I know there were a lot, but they're all going to be in the show notes at podcasts.healthywealthysmart.com under this episode. So Anne, you have given so much great information. I can't thank you enough.
Anne Stefanyk (37:39):
Well thank you so much for it. I'm really grateful for the work that you're doing. I think it's fantastic.
Karen Litzy (37:45):
Thank you. And everyone else. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Gabbi Whisler on anxiety. Dr. Gabbi Whisler is no stranger to anxiety and depression. After years of struggling to find her path, she landed on physical therapy and has been combining the two worlds together, the use of physical therapy to help treat and coach patients with anxiety. No system ever works alone and when the physical, the mental, emotional and spiritual can be all addressed, then that is when true healing can be found.
In this episode, we discuss:
-When anxiety manifests in the career cycle of a physical therapist
-3 practical steps towards mastery over your anxiety
-Why communication is important to break down the stigma surrounding mental health
-The future role for physical therapists in mental health treatment
-And so much more!
Resources:
Gabbi Whisler Instagram
Gabbi Whisler Facebook
Mind Health DPT Website
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Gabbi:
Dr. Gabbi Whisler is no stranger to anxiety and depression. After years of struggling to find her path, she landed on physical therapy and has been combining the two worlds together, the use of physical therapy to help treat and coach patients with anxiety. No system ever works alone and when the physical, the mental, emotional and spiritual can be all addressed, then that is when true healing can be found.
“I've shared intimately my experiences with anxiety, panic attacks, alphabetizing, fixations, and suffering. Meds failed me. Doctors failed me. Anxiety controlled my life. I was drained, exhausted and defeated. I knew something had to change and I had to do it myself. I created freedom. You can too.”
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor(00:03):
Hello. Hello. Hello. This is Jenna Kantor with the podcast, healthy, wealthy, and smart. I'm here with Gabbi Whisler, like give a little whistle and I'm so excited to be jumping on and talking about anxiety and if you can tell from my energy, Oh gosh, I never deal with that. What physical therapist deals with anxiety. So first of all, Gabbi, thank you so much for popping on. What got you interested in really focusing on anxiety for physical therapists? Why this passion? Why not just treating patients and focusing on the patients and their anxiety?
Gabbi Whisler:
Yeah, so it's kind of an ironic story because I was out in California working as a travel PT. I was maybe four or five months out from graduation from PT school and I was miserable. I was like, I cannot do this the rest of my life kill me.
Gabbi Whisler(00:59):
I just can't. It was awful. And Andrew Tran, owner of physio memes is my now roommate, but he was actually across the country, I think in North Carolina maybe. And he was one of my colleagues that do travel PT to somewhere and I called him and I was like, Andrew, I can't do this. It's miserable. And I don't know what else to do. I just racked up $180,000 in debt. Like I'm supposed to love this. It's supposed to be great. I'm helping people but I hate it. What do I do? And he was like, well, what do you want to do? What are you good at? What would you love? And I was like, I honestly have no idea. So I had to go to the drawing board and really do some digging. And I was like, what would I love? And the very first thing that popped in my head is I dealt with anxiety all my life.
Gabbi Whisler (01:38):
I'm in a much better place. I can't think of anything better than helping other people to get to that destination as well. And I was like, I can do that as a PT though, right? And I called Andrew and I was like, am I even allowed to do this? Like is this a thing? And he was like, well it is if you make it. And something just clicked. And I was like, well that's kind of cool and ever since I still don't always know what I'm doing but I'm making the path to be able to do it. So it's a lot of fun. But I still, like I said, I don't know what I'm doing most days and I still deal with anxiety myself as well. So it's kind of this ironic but fun twist because that allows me to connect with my clients now on a deeper level than as a PT.
Gabbi Whisler (02:19):
I've never dealt with a shoulder replacement or a knee replacement or anything like that to really connect with my patients in the outpatient ortho setting or I've never really had like a major fall to connect with my geriatric patient, but to connect with a 28 year old woman sitting in front of me who's had major anxiety, doesn't want to take meds and it's like, what are my other options? And to show her how to use exercise and kind of monitor what she's eating and drinking and just a mindfulness approach to feel better is incredible. And we can do that. As PTs, we learned about breathing, we learned about reflexes, we learn about exercise and movement and it's a lot of fun.
Jenna Kantor:
So I love that. And, why do you think there's the whole thing with anxiety and PT? I think this goes hand in hand with burnout.
Gabbi Whisler (03:07):
Yeah, it does. So from a clinician perspective or from a patient perspective, because it's on both ends actually, which is really focusing on clinician focusing on the physical therapy. Yeah, a lot of it is burnout. A lot of it is expectations that I don't think we're prepared for in PT school. Well I think going into PT school, we have this grand idea that, you know, we're a doctor of physical therapy, we have all this autonomy and we have the ability to almost do what we want. And it's really quite the opposite out there for most of them. Until we realized that we are able to kind of break out of that mold. But in the traditional setting, we're very limited in what we can do and we're dictated and governed by doctors and other clinicians and our patients and insurance, and we think we're going to have all this freedom to make this what we want.
Gabbi Whisler (03:58):
Certainly cannot always do that. And I think that leads to a lot of anxiety that that gap in expectations, expectations from other people and expectations within ourselves in there are aligned. And that's what causes burnout as well. So it goes hand in hand.
Jenna Kantor:
Yeah, I totally get that for forgive the sounds, the grumbling sounds, I just want to give a complete, you know, story here that's construction in the building, not me being gassy. Okay. I just want that to be clear as we are all just massive ladies here for anxiety, for anxiety. You were saying, it's interesting where you're saying, I don't know anything about this, but then you clearly have a drive to know more in order to help other people. What is it within you that's getting you to help out other people when you are dealing with it yourself?
Gabbi Whisler (05:00):
Yeah. Yeah. So I know what it's like to be at like that rock bottom and not have any outlet. Cause when I was going through all of this, you know, dealing with anxiety, depression, OCD, I knew in my heart I did not want to take medications. I knew in my heart talk therapy wasn't for me. I had given it a try and I was like, this is just, it's awkward for me. And I never felt like I left there feeling better. So I was like, I'm not going to continue wasting my money. And it was one of those things, I sat down with my primary care doctor and I was like, okay, what's next? And he had no direction for me. And I just remember what that felt like. And now as a PT, I know. So I said, I know, I said I don't know what I'm doing. And that's true. I don't necessarily know the direction my career is going. Yeah. PT, I know what I'm doing.
Gabbi Whisler (05:38):
I know how to prescribe all of these exercises. But at the same time I don't, and I think that's how we all feel in our careers. So really it's not anything I'm normal but knowing that I have tools that other people are searching for, knowing that someone out there needs what I have to offer but I'm just too afraid to put it out there sometimes is what gives me that little motivation or that little push to go ahead and do it anyway. You probably deal with that too cause your niche is so specific and so focused and so high performance. I'm sure you encounter that as well too.
Jenna Kantor:
Yeah, I get that. I get that. I hadn't really dealt with anxiety until after the conference. Smart success physical therapy like just this past year. And it was when I came back home and I have a best practice where I work with dancers and all of them were better, which of course it's great, but as business goes freaking out, Oh my God, I was just like, this is the worst thing in the world and we're, for some people that would be something to brag about. For me that was something to significantly freak out about.
Jenna Kantor(06:55):
Awful, awful, awful, awful. I do not recommend anxiety and stress at all. Not even a little, Oh my God, this sucks so bad. So that's my experience with anxiety and it's gone. I've gotten better with it over time and I think that has to do with really acknowledging taking action for myself. So for you, with people, what are your like big overall tips that you just, when somebody reaches out to you and they're like, Oh my God, I'm about to like, collapse my anxiety so bad right now. What are things that you give them to kind of help them out at that point? Yes. So like top five things or three or 20 I don't know what your number, I'm just saying numbers.
Gabbi Whisler (07:54):
Very first thing I tell them is give yourself grace and permission. Cause so often we can find ourselves to the notion that anxiety is this horrible thing and cause anxiety and depression are just emotions truly like their emotions and we so often label them as good or bad emotions in general and we always strive to feel happy and we strive to run away from anxiety and depression. The very first thing I told girls or guys or whoever I'm working with is let it be your anxious, like accept it and just sit with it for a minute and allow your body to feel that because your body needs it. It's very uncomfortable. It's very uncomfortable. It's like not butterflies, but it's like, Oh it's very uncomfortable. It's hard. Her own skin. That's the best word that I can think of. Like you literally want to run out of your own body.
Gabbi Whisler (08:43):
Yeah, yeah. Lots of you can have a moment. So that's what I was like, give yourself the grace to be human. The fact that you're experiencing this and then use it as an indicator. So like, so often we're controlled by our emotions and they tell us how to live our life. You know, when we were anxious we want to sit in bed but instead use as an indicator. What's this trying to tell you? Like what's going on in life? You feel this way? And beyond that, what can you do about it? So like you said, action, what action can you take to move on from this? Cause so often we let it paralyze us, but that's really when we need to take some sort of action, whether it's to talk to someone or maybe getting a medication or going to talk therapy or going for a run or lifting weights or like what needs to happen to make you feel better.
Gabbi Whisler (09:31):
And it's different for every person. So those are my top three starting points. I guess. Three is my number, but really it's giving yourself that grace, using as an indicator and then taking action.
Jenna Kantor:
Yeah. Yeah, that definitely makes sense. When you're saying give grace, what are ways that you can, because it's not just like, okay, I'm giving myself grace. What are things where you could actively be, you know, literally taking actions, you know, like cleaning the dishwasher, you know, what are things that you could do to help you start learning what it is to give yourself grace? Do you know what I mean?
Gabbi Whisler:
Yeah. So I'll just share examples of what I do in my own day cause I think that might be easier. But when I get anxious, I literally will sit with myself and say, Hey Gabbi, it's really okay that you feel this way.
Gabbi Whisler (10:18):
And I just kind of let my body off sit with it for a minute, you know, I recognize, okay, my chest is tight, my fingers are tingling, my eyes, my vision sometimes changes just a little bit. And I'm like, this is normal. It's nothing to panic over. This is my body's response. Okay. It's okay in the moment. Like it doesn't take it away, but it's like, okay, I know I'm not dying in the moment because often we do, right? Like, we're like, Oh my gosh.
Gabbi Whisler (10:55):
So I'll sit with it and then from there, a lot of times what I'll do is I like to have one person in mind for, you know, if I'm feeling angry, it might be my sister that I call if I'm feeling hurt, it's my mom that I call who's really good at helping me through whatever I'm feeling in the moment. And I always have that on the back burner and that's the first thing that I'll do is get it out because the more we hold it in ourselves, the worst off we get. And sometimes it's not even talking to the most sometimes like I'll literally sit in my room in front of a mirror and talk to myself.
Jenna Kantor(11:46):
It’s cool you can out like get it out. Like you did get it out in the universe. You know, before we started recording today, you were sharing something with me about wanting to just get out in the, because once you do that, you're more likely to follow through and take action and feel better about it. It's true. It's true. Like I'm doing this, I'm doing this. It's true. But I never thought about it in a way where you would use it as a tool with when you're like feeling it because it's like a zit that's dying to pop.
Jenna Kantor(12:26):
Yeah. So for you, where do you find in the physical therapists life with people reaching out you a common time when people, are you actually, okay, I'm going to actually separate this out. Common point in someone's career, whether it be student, new, grad or professional, where are you finding a real, like this is where it's happening a lot specifically in the physical therapy career.
Gabbi Whisler:
The answer's kind of funny, but all of the above. So for students I'll kind of go through each one cause I think we all do, it's just a matter of like, so each stage will have points throughout it that are very specific when that anxiety is like greatest. But for students it's typically right before the NPTE or right before an exam, like a lab practical that students are reaching out to like, Oh my gosh, I'm so anxious.
Gabbi Whisler (13:18):
I don't know how to handle this. I've never really experienced anxiety until now. Usually that's when they're noticing it is in grad school. And they're like, what can I do? And then, you know, I'll try to talk with them through that. As far as anxieties go, a lot of new grads experience it. Cause again, it's expectations. They're in school for so long and they have people guiding them and now all of a sudden they're kind of fed to the wolves and they're expected to do things that they weren't, they weren't yet in their minds, comfortable with. And also seasoned clinicians, a lot of times they're like, it's either burnout, it's not finding satisfaction in their career. It's wanting something more like, not feeling, they're not necessarily burned out, but they're also, they feel like they're doing the same thing day in and day out and they're not contributing to the world in a greater way, I guess.
Gabbi Whisler (14:08):
Or they're not seeing, yeah, just frustrating for them, but also sad from an outside perspective. Cause they're still making a huge impact, but they're just, it's routine for them now, so they're not seeing, so it's not as fulfilling. They feel like they're very separate from what they're doing.
Jenna Kantor:
Yup. Exactly. Exactly. Wow. That's powerful. Right. Because they're still, they're changing people's lives. Like every 20 minutes are changing someone's lives, but they're just doing it so often they don't see it. Where does shame come into all this?
Gabbi Whisler:
Ooh, that's a good question. I think it's very specific person to, but probably again, that mismatch in expectations so they don't feel like they're providing the care that they should be for their patients and then in front of their patient, you know, they have to continue and be professional and carry on throughout their day, but inside their brain, they're like, am I really the best person to be helping this person? You know, we tend to tell our story ourselves, stories like that. So that's true. That's insanely true.
Jenna Kantor(15:44):
Yeah. Wow. Yeah. If there was going to be, I would say one big vision you have for physical therapists regarding anxiety, what would be your big like one day Do you know what I mean?
Gabbi Whisler:
So this is kind of a far stretch, but I'll bring it back full circle model clinician because right now as PTs we can't treat anxiety or we can't treat mental health. It's just not like fully within our scope of practice. So myself and another PT are actively working to try to get PT into, there's a world Federation for mental health and there's other countries that are participating in and it's specific to physical therapy. So we're hoping to get PTs in that role because I think right as PTs were very uncomfortable with the idea of mental health because it doesn't get talked about in PT school. We don't really talk about it with our patients. It's one of those things we try to skate around as much as possible and there's some clinicians out there who are great at it and I think we're as a whole, we're getting better.
Gabbi Whisler (16:36):
But the more we can certainly the more we can start talking about it to our patients, the more we feel comfortable within ourselves talking about it to other people and opening up as well. Cause if we can't get other people to open up, how are we ever going to open up ourselves? So it goes both ways. If we can't open up, then we can't get other people to open up. So I think once we're able to, as PTs kind of get into this role just a little bit more, and it's not that every PT has to treat mental health specifically, but we find ways of bringing it into, because we know if someone's struggling with their mental health, their physical health suffers. And so if we're not addressing that, it's so true. And if we're not addressing that first with our patients, then we're probably not getting them the results that we need.
Gabbi Whisler (17:22):
But if we can't do that, if we don't know how, and that goes back to our own lives as well. So it all kind of comes full circle. So my big goal is to get PTs to be able to go to conferences at CSM, for example, and have a course, have a talk on the side of mental health. Cause right now there's very little out there for us. So truly but surely like nothing. And it's because we're so uncomfortable with it. So that's my dream is to be able to get us in that scope of practice and also show clinicians how to handle in our patients. And I'm hoping through that they see how they can handle it within themselves as well. And kind of tackle it from that approach.
Jenna Kantor:
Yeah, yeah, that makes sense to me. Oh my gosh, this is perfect. Thank you so much for coming on. I would love to ask for you to just have your mic drop moment and this could be for anyone who may be dealing with anxiety right now and I would love for you to just acknowledge that person and just give him some big picture advice if they're really feeling stuck.
Gabbi Whisler (18:46):
Yeah. So, Oh my gosh, I have so much in my head right now. Start with the word you. So if you are feeling super anxious and having a hard time handling this, especially throughout the workday, my biggest piece of advice for, I guess this is the direction I would go, so specific to clinicians who are feeling anxious throughout the day. And I actually have a couple girls who I work with right now, her PTs and their new grads and they're feeling this way too. They feel like they have to compartmentalize this and they can't talk about it at work. Talk to someone like whether it's your boss or a coworker, someone there needs to know that you're dealing with this because if you continue to try to do this on your own, it's only going to snowball and then your boss is going to come to you one day and be like, what in the hell is going on right now?
Gabbi Whisler (19:35):
You know what, what? Cause your performances is often the way you speak to patients. So the earlier you can nip it in the bud and let them know, Hey, I'm dealing with this right now. I don't want to go into details. Or you can say whatever the heck you want to, but they need to know about it. And the more comfortable you get talking to your boss, the more comfortable your boss gets talking to their employees about it as well. So you might be opening up the door for another clinician right next to you because more than likely everyone in your building is dealing with some form of anxiety.
Jenna Kantor(20:16):
That's true. It's not talking about it. That's very true. That's very, very true for clinicians. I love that. Oh my gosh. Thank you so much for coming on. How can people find you, find you and contact you. Thank you.
Gabbi Whisler:
First, thank you for having me on. But yeah, @mindhealthDPT, that's my Instagram and Facebook handles, so they're free.
Jenna Kantor:
Got it. Wonderful. Thank you so much for coming on. This was an absolute joy. I think that this is going to be extremely helpful for people who are dealing with anxiety. So you guys don't be afraid to reach out to her. She's here to help you. In fact, you're one of many.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Christa Gurka on the show to discuss marketing. An orthopedic physical therapist specializing in Pilates-based fitness, rehabilitation, injury prevention and weight loss, Christa Gurka’s reputation speaks for itself. With two decades of experience training those of all ages and fitness levels, the founder/owner of Miami’s Pilates in the Grove, which serves the Coconut Grove and South Miami communities, believes in offering her clients personal attention with expert and well-rounded instruction.
In this episode, we discuss:
-Why you should design an ideal client avatar
-How a small marketing budget can make a big impact
-Crafting the perfect message to attract your ideal client
-The importance of continual trial and error of your message
-And so much more!
Resources:
Christa Gurka Instagram
Christa Gurka Facebook
Pilates in the Grove
Christa Gurka Website
FREE resources
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Christa:
An orthopedic physical therapist specializing in Pilates-based fitness, rehabilitation, injury prevention and weight loss, Christa Gurka’s reputation speaks for itself. With two decades of experience training those of all ages and fitness levels, the founder/owner of Miami’s Pilates in the Grove, which serves the Coconut Grove and South Miami communities,believes in offering her clients personal attention with expert and well-rounded instruction.
Read the full transcript below:
Karen Litzy (00:01):
Hi Christa, welcome to the podcast. I'm happy to have you on. So today we're going to be talking about three strategies for marketing for cash based practices. And the good thing about all of these strategies is they don't cost a lot of money, right? And that's important when you're starting a business. You know, we don't want to have to take out a bunch of loans, we don't want to have to spend a lot of our own money. We want to try and start up as lean as we can. And so I'm going to throw it over to you to kick it off with. What is your first strategy for marketing for cash based practices?
Christa Gurka (00:43):
Perfect. So one of the reasons I just want to start with saying why I'm a little passionate about this marketing thing is because myself included when I first started, I really kind of, I felt like I started backwards almost like from the ends. And I think it's really so helpful for people to learn to start kind of from the beginning. Right? So my very first strategy that I think is really, really important is to have a real good idea of who your ideal customer or who your target audience is. And I get often some pushback from people saying, well, everybody can use my services. Of course everyone can use physical therapy. Absolutely. And that doesn't mean you have to single anybody out. But you know, I think Marie Forleo said it or maybe somebody said it to her, but when you speak to everyone, you really, you speak to no one and so slew thing, your who, your ideal customer is, how they feel, how they think.
Christa Gurka (01:45):
It's very, very beneficial. So if you want, I can kind of go through like a few questions that I use to kind of narrow down who that person is. So one of the things to know when we go through our ideal customer, we actually give this person a name, an age, a gender demographic, married, not married, retired, not retired, education level, median income. And when we do anything in our business now, so we are ideal customer, her name is Georgia. And so we say every time we have a meeting we say, well what will Georgia think about this? Well Georgia like this, so we're Georgia not like this. So that's the very first thing. And we refer to that person as their name. And then you want to go through like what are their biggest fears about whatever problem they're looking to solve.
Christa Gurka (02:40):
People buy based on emotion. And so get into the underlying source of that emotion is really, it can be very powerful. So what are their fears? What do they value? Right? Cause when it comes to money, people paying for those, it's not always a dollar amount. It's more in line with what do they value? And if you can show these clients that you serve, offered them a value, the money, the dollar amount kind of becomes obsolete. So things like that. What could happen, what would be the best case scenario if this problem were solved for them? What would be the worst case scenario of this problem were never solved. So in terms of physical therapy, let's say generalize orthopedics, right? Back pain. 80 million Americans suffer from back pain. Yeah. So an easy one to start with, an easy one to start with, right?
Christa Gurka (03:35):
So let's think of, you know, back pain, it's so general, right? But if you can say, what is the worst thing that can happen because of this back pain, right? So maybe the worst thing that could happen is this person loses days at work because they have such bad back pain, they can't sit at their desk or maybe they have such bad back pain that there performance drops and so that cause they can't concentrate. And so now maybe they lose their job or they get emoted because their back pain. So the worst case scenario is maybe they're not, they ended up losing their job because of back pain. So you kind of take it all the way back. And then if you could speak to them about how would it feel if we were able to give you the opportunity to sit eight hours at a desk and not think of your back pain one time and what would that mean to you? So really kind of under covering a lot, a lot, a lot about who your ideal customer is. It's my number one strategy.
Karen Litzy (04:39):
And I also find that it's a great exercise in empathy. So for those that maybe don't have that real innate sense of empathy, it's a way for you to step into their shoes. And I always think of it as a what are their possible catastrophizations? So if we put it in the terms that the PT will understand, like when I did this number of years ago, I sort of catastrophized as this person. What would happen if this pain didn't go away? I wouldn't be able to take care of my children. I wouldn't be able to go to work. It would affect my marriage. My marriage would break up, I would be a single mom. I would, you know, so you can really project out really, really far and then reel it back in, like you said, and say, well, what would happen if they did work with you? What is the best case scenario on that? So yeah, I just sort of catastrophized out like super, super far and it's really helpful because when that person who is your ideal client then comes to you and you're doing their initial evaluation, you can ask them these questions.
Christa Gurka (05:51):
Yeah. Yeah. It's very powerful. And I love how you brought in, like you empathize with them and you know, and by the way, a lot of our clients do catastrophize, right? And we have to reel them, we have to reel them back in. So that was a really great point. I also think it can be sometimes on the flip side where somebody maybe comes in and their goal is very benign. Maybe it's, I really want to be physically fit. I want to look good. Right? So you kind of think, well, what's the catastrophe if that doesn't happen? But maybe, maybe they're in a relationship where they're a partner. Aesthetics is a big part of that. And maybe they feel insecure and they feel if they don't present well to their partner, their partnership may dissolve whatever the case may be. So now you're getting to an underlying, it really is more emotional than physical, right? So now you're being able to empathize with them in that way and speak to them in those terms, give them positive things that maybe they don't even realize they need.
Karen Litzy (06:53):
Exactly. And then it also seems like once you're in those shoes or walking in their shoes, in their footsteps, however you want to put it, that’s when that person does come to you, you can have a conversation with them that's maybe not so much centered around back pain, but that’s centered around their life. And that's when people make that connection with you. Right? So when we're talking to patients who are not sure that they want to start physical therapy, if we kind of get them, they're much more likely to come and see us. So it's not about the back pain, it's not about the knee pain. It's about how are we going to make a difference in their life. And if we can make that, like harking back to what you said earlier, it's an emotional experience and people tend to buy things based on emotions and their gut feelings and how they feel. So if we can tap into that in a really authentic way, then talk about a great marketing strategy.
Christa Gurka (07:58):
Excellent. Exactly.
Karen Litzy (08:00):
And then, okay, so we've got our ideal customer, client avatar. Now what do we do?
Christa Gurka (08:10):
Great. Now what? So you've got your ideal customer, right? And so by the way, people also sometimes think like, well, I don't want to pigeonhole myself into this, right? But by the way, your ideal customer may change. It's okay first of all to change. And he doesn't have more than one. You can have more than one. Certainly we have more than one in our business. And by the way, you may start out thinking about one ideal customer, but the people that keep coming back, maybe somebody else and you're like, Oh, obviously, maybe I have to rethink this. Right? And again, it doesn't mean that you can't serve someone else. It just means that when you're thinking about marketing and stuff, you're going to go after everything should funnel into one specific thing. So then the next step in the marketing is, okay, so where do these people live?
Christa Gurka (08:59):
And I don't mean live like literally what neighborhood do they live in? Where do they live in terms of getting their news information? Where do they live in terms of being on social media? Where do they live in terms of, you know, what do they value as far as like personal or professional life? So one thing I see is, you know, people you know are like, well, I'm gonna put an ad in the newspaper, that's great. But if you live in an area where nobody reads the newspaper, then you're putting your money somewhere that you're not going to be seen. Or maybe the flip side is, well, I'm going to do a lot of stuff on Instagram. Well, if you were, your clientele is over 65 studies show that most people over 65 are not on Instagram. That doesn't mean they're nobody is, it just means, you know, or vice versa.
Christa Gurka (09:50):
If your client is 25, they're probably not on Facebook anymore, right? So, then again you can be, this is why it won't cost you a lot because you can narrow down where you are going to spend your money, right? Also, if you're running Facebook ads, which will then go on Instagram you can narrow down in your audience when you build out your audience to be very, very, very specific based on are you a brick and mortar establishment? So are you trying to get people to come in to your place? Right? So you want to say, well, if people are not, if you know that your ideal customer's not convenience as important and they're not going to travel more than five miles, you shouldn't market to people that live or work outside of a five mile radius from your studio. Right? So that's important to know as well as also maybe your customer gets their information from friends or relatives, you know, or like someone said, you know, you need to go see Karen, she's been really great for me and that's how they get to you.
Christa Gurka (11:00):
So how can you then get in front of your client's friends, right? Maybe you could do an open house, invite a friend, bring them in. Let's do one-on-one, you know, just kind of like a talk, right? Maybe you could bring them in if, say your ideal customer, let's say your ideal customer is in their sixties, what are some things that people in that age group are going through? Maybe you can have a talk about that specific thing. Not necessarily a therapy, but now you get everyone to kind of come to you. It's not even about what you actually do cause you can need them based on where they are. And most people, by the way, they say there's the numbers range, but usually they have to see you about seven times or have seven points of contact with you before they're comfortable buying from you. So these are just way to get people to know, like, and trust you and then they'll buy from you. So that's strategy number two. Once you know really who your customer is and they could take a couple years to really start to peel back all the onion of that, then the next thing is be where they are, be in front of where they are.
Karen Litzy (12:13):
Yes, absolutely. And, I love that you mentioned the different types of social media and who's on where, because like you said, this is something that isn't going to break the bank because you have narrowed down exactly where you want to spend your money. Right? So we're taking who that ideal person is, where finding out where they like to hang out, what they read, who they're with, all that kind of stuff. So that when you build out a marketing campaign for your business, you kind of know who and where to target.
Christa Gurka (12:49):
Right? Exactly. Yes. And even so, even with Facebook, yeah. When you build out your audience, right? So you can have a variety of audiences. You can create lookalike audience, which I'm sure is like a whole podcast onto itself, but you can also target people that like certain brands. So when I do my ideal customer, I'm like, well what brand do they resonate with? In other words. So I would say that our brand is a little more towards Athletica versus like Lulu lemon. And that's not to say one is better than the other. It just means that's who my generally customer is. And why, what do they value? They value that customer service. You get, you know, Athletica has like a, you can take anything back all the time, right? So when you build out a Facebook ad, you can also target, that's right. They've bought from Athletica online. Right. So now you're reaching people. So you kind of near just keep narrowing it, narrowing it, narrowing it down, which can be, you know, other interests is your client. Do you do pelvic health? So obviously women, although men do it right, if moms can you target people that like mom influencers on Facebook or on the internet. So these are all just ways that the more you know about them, then you can use that in your marketing strategies afterwards.
Karen Litzy (14:15):
Absolutely. Fabulous. Okay. So know who the person is, know where they're hanging out. What's number three?
Christa Gurka (14:23):
Okay. So number three to me is the most important, the most, most important. And that really is messaging. So when you're working with your ideal, when you're working through that ideal customer you know, workbook getting to them, to you for them to use their own language for you. So I see this very, very commonly, and I am sure you can attest to it too. When physical therapists, we love what we do. We are passionate about movement and anatomy and biomechanics but you know what, the general population has no idea what we're talking about. None. Zero. Yeah. And so oftentimes I feel like, and by the way, I'm not saying I did this for a long time too. I think that we're trying sometimes to get other practitioners to say, Oh, that's a really good therapist. So we're talking about pain science and biotech integrity and fascial planes and the general population.
Christa Gurka (15:32):
The end consumers, like I have no idea what you're talking about. So you need to speak to them at their level based on what their problem is. And kind of like how we spoke about before. It's not always the back pain, it's what the back pain is keeping them from doing. Right. it's not always, let's take pelvic health for example. Right? A lot of pelvic health issues or not necessarily painful. Okay. So say you have moms, this is super, super common stress incontinence. They leak, they leak when they jump and they go to CrossFit and they're embarrassed to start with a jump rope because they, it's not, why? Why do women go 16 years after childbirth? Because you know what? It's not really painful. So they don't consider it a problem. Like physical therapy is not going to help me with it. So, but if you say to them, Hey, that might be common, but that's not normal, and guess what?
Christa Gurka (16:25):
There's a solution to that, you know? That is something that will resonate with them. Do you like things like, do you feel, do you worry when you're out at a restaurant as it gets later and later that the line at the bathroom is going to be too long and you stop drinking because you're afraid to wait in line for the bathroom? Right. So some women will be like, Oh yeah, I totally do that. Right? Are you afraid to chaperone your child's field trip? Because the bus ride is going to be three hours and you don't think you can hold it three hours on the bus without a bathroom. That's terrible for a mom. She can't chaperone her kids field trip because she's embarrassed that she might have to go to the bathroom. So using their language. So I like to send out surveys very frequently.
Christa Gurka (17:09):
Google doc is super easy. Survey monkey and ask them things like, what are your fears about whatever it is you're trying to sell. Right. what are your fears about exercise? What are your fears about back pain? How does it really make you feel? Okay. what are your, like maybe even if you could pay and if money was not an issue and you could pay anything, what would that look like for you? How would that make you feel and starting to, then you start to use that language. We've all seen marketing campaigns where you're like, yes, exactly. Totally. That's how you need to get into them. Right? And so maybe maybe as a physical therapist, it's tough for us because we're like, well, no, their hamstrings are not tight. It's not hamstring tightness. It's neural tension and it's the brain and the nervous system, but they don't, they don't understand.
Christa Gurka (18:06):
So you got to get them in. What they feel is that they have hamstring tightness. So you got to tell them that you can fix their hamstring tightness. And then little by little you explained to them that it's neural tension, right? But if you start off with neural tension, they're going to go somewhere else. And so I kind of like, I use this example a lot if you, cause I think we can all relate to this. We're on tech right now, right? Okay. So if you have, I have a Mac, I have an Apple. If I go to the Apple store, cause my computer crashes or my phone won't turn on and I go talk to what are they, what are the genius bar, the genius bar. And the guy's like, you know, so what I see here is the motherboard has this month and this software program, you only have so many gigabytes.
Christa Gurka (18:50):
I'm like, can you fix my computer? That's all I want to know. And if he says yes, I'm like, I don't care how you do it. So whether you use taping or I use myofascial release or somebody uses Pilates or somebody uses craniosacral therapy, it doesn't matter to them. So the end consumer, they just want to know that you can solve their problem. People have problems and they want to know that you have the answer to solve their problem. And that's it. So messaging is really, I think, crucial. It's the crucial point of the puzzle.
Karen Litzy (19:28):
And now let's talk about messaging. Let's dive into this a little bit further. So I think we've all seen different websites of healthcare practitioners, physical therapists and otherwise that kind of make us go like,
Karen Litzy (19:43):
Oh boy cause it's in cringeworthy in that it comes off as a little too salesy, a little too slick, a little too icky. So how can we compose our messaging to avoid that? Unless maybe that's what their ideal patient wants. I don't know. But yeah, how can we craft our messages that are going to hit those pain points, get that emotion going without being like a salesy, weird gross
Christa Gurka (20:18):
So the other thing I think that's important to understand is people's buying patterns. And when people say no to you, maybe they're not saying no to you, they're just saying this. It's not a value to me at this time. So one of the phrases, one of the things that I've really restructured, cause I used it, take it very personally, if someone will be like, no, I know and I'd be like, what you mean I could totally help you? And now I'm like, you know what? It's basically I look at it like if I'm at a party or I'm having a dinner party and I serve or Durham and I'm like picking a blanket and be like, no thanks. I'm like, okay, walk away. So I say therapy with Krista. No thank you. No problem. Let me know if I can help you in the future.
Christa Gurka (21:04):
Right? So the way that I say it is if you just speak honestly to your customer, honestly, to your customers. Nobody can be you at being you. So be your authentic self, whatever that brand is for you. And whether it's your company or you yourself, and let that come through in your messaging. Right? So in other words, like if your messaging is also about mindfulness and positivity and looking past the pain and what is your relationship with your pain or dysfunction that should maybe come through in your messaging that you're more holistic, that you're not going to be a treat them and street them type thing. But maybe if your messaging is, Hey, we're going to treat you and street you and you'll be out of here in 15 minutes, you're going to attract that type of customer. So either one is fine, but I just say really be authentic.
Christa Gurka (21:59):
And the other thing is, I would say send your website. I don't put a lot, a huge amount of stock in my website to be perfectly honest. I do love my website. I'm a very like, analytical person. So the colors and where everything sits is important. But I don't think as, I'm not a big believer that as much selling goes on your website as a lot of people may think, I think it's a place where yes, people are going to Google, someone gives you a reference at a cocktail party, they're going to Google your website, but they're basically going to look like, does this resonate with me? So what you want to hear is, you know, that tagline at the very beginning, you know, is does that tagline, the first thing that they see, does that resonate with that person? Right. So we use, because we're Pilates and physical therapy, we will, right now our website's a mess because it's got coven.
Christa Gurka (22:47):
We're close, we're not close. But helping people heal with love, every twist, every turn and every teaser. Teaser is a plot. He's exercise. So we stuck that with love in there because that is part of who we are. We are a community. We care about our clients. So you're not just going to come in here for like two things. We want to help you where you are. So that's, so if someone's like, yeah, that's cheesy for me, then it's okay, they can go down the street. Right. and we don't, I used, by the way, this has come with like 10 years of testing. You just got to test it. You got to test it and you got to see like who does it resonate with? Send it to a bunch of people and ask people for their honest feedback. Give me, you're not going to hurt my feelings. I need to know like, what do you see when you see this? What, how does it make you feel? So ask people their opinions and not physical.
Karen Litzy (23:45):
Yes. Yes. And you know, I just redid a lot of the messaging on my website and I sent my website from what it was and I'm in a group of female entrepreneurs, none of whom are physical therapists. I sent it to them, they gave me some feedback, I changed a little things. I sent it again, they gave more feedback, I changed some more things and now I feel now they're like, Oh see this sounds more like you. So before what I had in my website is what I thought was me. But then once I really got like had other people take a look at it, they're like, Oh, no this sounds more like you. And yeah, I love that tagline on the front. Like the tagline on the top of my website is world-class physical therapy delivered straight to your door,
Christa Gurka (24:28):
Which is short and concise and what you do. And it's what I do. Very easy. Perfect people. Oftentimes I see these like tat and they're like, you know, they had their elevator pitch. I'm like, what's your elevator pitch? You know, people talk about, Oh, what's the elevator pitch? I'm like, if you cannot describe what you do and like two sentences or 10 words or less, how do you think other people are gonna if you can't understand it for yourself, how are other people gonna right, right. Like you said, that takes time though. It does. It does take time. I struggled with this for a while, but me always, yes, but I think as physical therapist, one of the reasons we struggle is for a number of reasons. One. If we're business owners, we tend to be overachievers, right? We tend to have weak temp. We're bred from a certain mold.
Christa Gurka (25:18):
Right? the other thing I think is physical therapist, we're very analytical. We're very left brains, right? We are, I mean I think it's what makes me a really great physical therapist. But then the flip side of that is we're perfectionist. Everything has to be analyzed. And so we get so caught up in like the details of analysis and we went to PT school. So we have to show how smart we are. But being smart also means understanding what your customer's going to understand. And so you kind of have to swivel out of that. So sometimes even in groups when I'm like, when we see people like, Hey, what do you guys think of my website? I'm like, don't ask us, we are not your customer. Go ask your customers like what they think of your website. And so when I was in a group, you know, my coach challenged me to narrow things down as well. And they used to say things like, if you were running through a desert and you like and you were selling water, what would your tagline be like what would you, what would your board say? And you know, people will be like ice cold, dah dah dah. And he was like, just say water. If someone's running through a desert, all they need is water, water will suffice. Water will suffice. Clean water less is more free water. Even less. Yeah.
Karen Litzy (26:42):
And I remember, this is even years ago, I was doing like a one sheet, like a speaker one sheet. This is a lot off topic but talking about how we need to tailor our message to our ideal audience. So I had, you know Karen, let's see PT and I remember the person was like, does that mean like part time personal trainer? And I was like no physical therapist. Like you need to write that out then because the average person like PT. Okay. Does that mean part time personal? Like what does that even mean? So it just goes down to or sorry, it goes back to kind of what you said of like we have to speak the language of the people who we want to come to see us. Right? And the best way to do that is on our websites is we just have to simplify things and it doesn't mean dumb it down. It just means like simplify. And I'm going to give a plug to a book. It's called simple by Alan Siegel and it's all about how to simplify your language, your graphics, and how everything comes together to create a site that people, number one are attracted to and number two want to hang out at.
Christa Gurka (27:53):
Right? Exactly. And there's a lot of testing and I'm a big thing like testing. It's just testing, testing, testing. We test our sales page, we test even now with like some of my coaching stuff, working with other female business owners, testing, sometimes going in and testing, switching a graphic, have what you have above the fold. So the fold for those of you that don't know is like when you're on a website, it's you don't have to scroll. So everything is above where you have to scroll. I'll call to action a CTA right at the top. Changing phrases, you know, not using broad language like confidence, like what does confidence actually mean, but maybe making it more specific using language so that that's a really good thing. Helping or like, you know, reading yourself a back pain so that you can live the life you desire and deserve.
Christa Gurka (28:57):
Right? So changing little, and you can change that by the way, mid campaign, mid launch daily. You could change it if your Facebook ads are so one of the things, if you're, if people are clicking on your ad, but when they're not converting on your sales page, that usually means that either the messaging and your ad is really off and they're, once they get to your sales page, they're not understood. There was a disconnect between what you're offering or your messaging is great, but your sales page sucks. Or vice versa. Maybe nobody's clicking on your ad. Then whatever you're trying to sell them there does not resonate with them, right? So there has to be a connection. And usually when people don't buy, there's either a, with your offer or a problem with your messaging.
Christa Gurka (29:49):
So test means put it out there, see what kind of feedback you get, and then it's think of it as, okay, what we do in therapy, right? So this, what do we do when we get a patient in, we assess, we treat, and then we reassess, right? So what's going on? Let's try a treatment in here. Let's reassess. Is it better? If it's not better, what do we do? We go back, assess again, and then do another treatment and then assess, right? Reassess. So in marketing it's the same. So let's say you wanted to do, let's say you're working on like a sales page on your website, right? A sales page. I know it sounds salesy, but it's basically your offer, right? If people are getting there, so you see people you can track. By the way, with Google analytics, like people coming to your site, if a lot of people are coming to your site but they're not clicking on the call to action or they're not following through to check out some, there is some disconnect there.
Christa Gurka (30:56):
So maybe it's the messaging. So then maybe try to change the messaging, tweak the messaging, and then watch the outcome again, maybe people get all the way to the checkout and then abandoned cart. Maybe it means that something they got confused with something at the end. Maybe there's the customer journey wasn't right. They got to the end because they put something in the cart and then maybe your checkout structure is off or something like that. So test it and then just retest until your numbers are like, now we hit it. And by the way, it's taken me. I mean I'm still testing. Hmm. It seems like it's a constant reinvention. Constant, constant. Because the market keeps changing. Especially now. By the way, by the way, right now I don't know why there are. So at the time of this recording, we are in the middle of COVID. So when people come back, your messaging, okay. Is going to have to change, right? So we need to be aware of that.
Karen Litzy (31:49):
Yes, Absolutely. All right. So as we start to wrap things up here, let's just review those three strategies again. So who is your target market is number one, where are they hanging out? Where are they living? Not physically their address, but you know, where, what are they reading? Where are they hanging out, what are they doing online, what are they doing offline? And then lastly is making sure that your messaging clearly conveys part one and part two. And how you can solve their problem. Awesome. So now if you were to leave the audience with you know, a quick Pearl of wisdom from this conversation, let's say this might be someone who's never even thought about any of this stuff before. What did they do?
Christa Gurka (32:40):
So in terms of like, never even thought about marketing before or going into brand new, brand new out of PT school are, or brand new, like they want to kind of dive in and start doing their own thing, but they want to do it in a way that's efficient and that doesn't break the bank, right? So I would definitely say,
Christa Gurka (33:17):
Start with the end in mind. So that's from a great book, right? So so start with the end in mind meaning, but don't start at the end. I think a lot of people confuse that with, they start with the end in mind, but then they go right to the end and they go to marketing, right? So I like to equate everything back to physical therapy, right? So when we learn about developmental patterns, we all know, like we start with rolling and then Quadruped high kneeling, right? So if you take a patient that's injured and has a neuro, you know, and motor control problem and start them in standing off with multiple planes, you've missed a bunch of it, right? So you start marketing without understanding who your ideal customer is and finding out what they think and how they feel.
Christa Gurka (34:01):
You're going to spend a lot of money and you're not going to know why it's not working. You're just going to think Facebook ads doesn't work or I'm not good enough, which is a very common thing, right? So take the time to do the work. The ground work. Nobody loves to learn rolling patterns. But why is it important? Because if you work from the ground up, you take the time to instill these good patterns underneath. So take the time to do that. And the other thing I would say is just decide, you know, don't go through analysis paralysis. Decide and move. And the only way you're going to know is you got to put it out there. So you know, Facebook lives, Instagram lives. That's, you know, we didn't maybe start when social media was big, but which, so by the way, I have to make a point that I think that's why it's harder for us.
Christa Gurka (34:52):
So our generation did not, we didn't have, so I didn't even have a computer when I went to college. Nope. Like, so we didn't start with, I didn't have a cell phone like, so it's very different for us because this next generation coming up, they're comfortable on social media. We may not be, but the truth is, it's like everything else, just do it. The more you do it, the easier it becomes. So, and you know, if no one's what, well, I'm afraid no one's going to watch it. But who's watching it now, if you're not putting it out nobody. So you're no worse off. Right? So just do, create an action step. Like, you know there's a book and now I forget who the author is. It's called the one thing, right? And you just focus on thing. Focus on one thing that you can do today to improve on understanding your ideal customer. If you're already past that, what can you do today to understand more about your messaging?
Karen Litzy (35:50):
Easy. The one thing you could just, just choose one doesn't have to be a million things you don't have, it doesn't have to be perfect. No, and it doesn't have to be perfect. Just one thing. Just one thing. Awesome. And now last question is the one that I ask everyone, and that is knowing where you are now in your life and in your business and your practice, what advice would you give to yourself as a brand new physical therapist straight out of PT school?
Christa Gurka (36:19):
Woof. Mmm. I would probably say be open to the possibility. Yeah. Yeah. Just be open to possibility of what's possible. Yeah.
Karen Litzy (36:35):
Excellent advice. Now Christa, where can people find you if they have questions they want to know more about you and your practice and everything that you're doing? What the deal?
Christa Gurka (36:44):
So my business is Pilates in the groves, so they can always find Pilates in the Grove. All has everything about our business. But they can find more about me at christagurka.com. I have some freebies up there. So that's like Christa Gurka is more really about kind of business strategy. Okay, great. Like launch you know, mindset, that kind of stuff. And then the Pilates and the Grove website really if you want to look at what we do, brick and mortar wise, do it. But like I said, the websites kind of a mess. Right?
Karen Litzy (37:21):
We understand it's exceptional times. And, I know that you have some free resources and some freebies for our listeners, so where can they find that?
Christa Gurka (37:33):
Yep. So there is a link which we can either link up in your show notes, right? Or we can, so there's a marketing quiz that I created that basically will put people at, it'll kind of just give you an idea of where you are. Are you like a novice or are you a pro? Have you got this stuff down? And I could probably be calling you for advice. And then based on where you are, it kind of tells you kind of what you should focus on as well as then we have that lead you into. I have a social media and a Facebook live checklist. It kinda just gives you kind of a little bit of, I find structure helps me. So learning how to batch content, learning to say that like, okay, every Monday I'm going to do a motivational Monday post. Every Tuesday I'm going to do a Tuesday tutorial post. I think it just helps me map things out. And so I think it helps business owners also feel less overwhelmed when they can have a calendar. And we have national days. It has like a bunch of national days that pertain to our industry already built out for you, which is easy.
Karen Litzy (38:35):
Awesome. That sounds great. And I'm sure the listeners will really appreciate that. So thank you so much. This was great. And again, the thing that I love about all these strategies is it takes very little money to accomplish them. Just some time, which right now I think a lot of people have a lot of time. So thank you so much for taking the time out of your day and coming on. Thank you. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Javier Carlin on the art of listening. Javier A. Carlin is the Clinic Director at Renewal Rehab in Largo, Florida. He is originally from Miami, he graduated with his Doctoral Degree in Physical Therapy at Florida International University and is a Certified Strength & Conditioning Specialist through the National Strength & Conditioning Association.
In this episode, we discuss:
-The difference between nosy curiosity and coaching curiosity
-How to frame questions to dive deeper into conversations
-Verbal and nonverbal signals to watch for during client interviews
-How your clinic environment can help develop deeper client relationships
-And so much more!
Resources:
Javier Carlin Facebook
Javier Carlin Instagram
Life Coaching Academy for Healthcare Professionals
Phone number: (305) 323-0427
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Javier:
Javier A. Carlin is the Clinic Director at Renewal Rehab in Largo, Florida. He is originally from Miami, he graduated with his Doctoral Degree in Physical Therapy at Florida International University and is a Certified Strength & Conditioning Specialist through the National Strength & Conditioning Association.
Javier has always had a passion for health and fitness and his mission in life is to help you get back to doing the things that you love to do, pain-free. His goal is to inspire people to live a healthier, happier, more fulfilling live through simple and effective wellness principles; proper nutrition coupled with a great exercise routine and good sleeping habits works wonders in how you feel inside and out!
Javier enjoys spending time with his family, he loves being by the water either soaking up the sun on the beach or on a boat! He is an avid traveler, enjoys exploring new places and experiencing different cultures. He also has an adventurous side; bungee jumping, skydiving, rollercoasters, cliff diving!
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor (00:04):
Hello. Hello. Hello. This is Jenna Kantor with healthy, wealthy and smart. I am here with Javier Carlin, thank you so much for coming on. It is an absolute joy Javier. As a physical therapist. He runs a clinic. What is the name of your clinic that you run?
Javier Carlin (00:21):
It's renewal rehab.
Jenna Kantor (00:23):
Renewal. Rehab. In what area though? In Florida. Cause you're part of a chain.
Javier Carlin (00:27):
Yeah, it's in Largo, Florida. So close to Clearwater.
Jenna Kantor (00:30):
Yes. I feel like the key Largo, Montego baby. What are we going to make it? I feel like that's part of a song. Right? Well thank you so much for coming on. You also, Oh, you also do have an online course. What's your online course?
Javier Carlin (00:45):
Yeah. Yeah, so it's a life coaching Academy for health care professionals where I teach healthcare professionals how to become life coaches and get their first clients.
Jenna Kantor (00:54):
Freaking awesome and perfect timing for that right now with everything. Corona. Thank you so much for coming on during this time and giving us both something to do. I wanted to bring Javier in because he has a skill, a magic skill that if you don't know him or you do know him now, you know, he is a Supreme listener. The first thing we did when we got on this call is, he goes, he just asked me questions just to listen what's going on. And I don't, of course I try to emulate it, but I'm not as good at him. You know, like I asked a few questions and I didn't deep dive as well as he does. So I want to dive into his brain and with this pen that I have holding and I'm going to part the hairs, get through the skull into the cerebrum. And so we can really deep dive into how your brain works when you are learning more about others, the art of listening. So first of all, thank you for having that skill.
Javier Carlin (02:08):
Yeah, no, absolutely. I honestly had no idea I had it until someone brought it up. And then looking into, it's kind of one of those things where, you know, I guess you have a skill. But you don't really know it. And then you try to dissect, okay, what exactly am I doing? Right? So, you know, leading up to this interview, I'm like, okay, let me actually think about this and reflect on what it is that I do. And what is it that I don't do? So that I can actually, you know, hopefully provide some value throughout the next few minutes.
Jenna Kantor (02:40):
Yeah, I would love to know. I think I want to just go into our conversation even before hitting the record button. What was in your brain when you first came on? Was it, Oh, I want to know what's going on. I'm just honestly like what was in that led you to start the conversation that way?
Javier Carlin (02:58):
That's a great question. So to be honest, I mean, I haven't seen you in a long time. We haven't spoken in a while. And so, I really, you know, did want to know what's been going on in your life? I've seen your, you know, posts on Facebook, but really had no idea what it is that you've been working on. And I always know you're up to something. So I really had a deep desire to really find out exactly what you've been working on and the people that you've been impacting. Just to know. I don't know. It's like, it's just natural for me. So, yeah.
Jenna Kantor (03:38):
You're like a curious George.
Javier Carlin (03:40):
Exactly. Yes.
Jenna Kantor (03:42):
Do you think that is a big base of it? It's just true curiosity.
Javier Carlin (03:47):
Yes. I think it's a curiosity and definitely curiosity. I'm always you know, really in tune with what people are doing. Cause I feel like it just, you know, looking deeper at it. I feel like there's, it just, I come from a place of always wanting to learn more about someone, deeply understand what they're doing and why they're doing it. Cause I think there's a lot to say about that. And it's very similar with you know, health care professionals in the sense that we're working with patients all day and we are truly, really trying to figure out you know, what's going on and where they want to get to and understanding really what they truly want the outcome to be when it comes to us helping them throughout, you know, our physical therapy and other rehab professions. And it's no different. Like that's the same, the same curiosity that I have when I, you know I'm serving patients I have with people in general. So I do believe that curiosity is a big thing and having the curiosity that's a, not in a nosy curiosity but more of like a coaching curiosity and really figuring out what's behind the words that someone is saying.
Jenna Kantor (05:02):
What do you mean by nosy versus coaching? Would you mind going into more depth on that?
Javier Carlin (05:09):
So, yeah, absolutely. So I believe, and this is, you know, there's a clear you know, when you're having a conversation with a friend, you're not really thinking about all these things. And then I think deeper into the coaching side of things, you start to think about the specific things. So when it comes to a nosy curiosity, there's always a story that someone's telling you and sometimes the story isn't even related to what the person is actually dealing with. So people use the story to kind of, let's see how I can put this to separate themselves from the interaction that you're having. Cause it's sometimes it's stuff for us to have conversations with people and really get deep down into our own emotions. So the story around it as you know, as someone who's dove into life coaching the story is actually at times something to distract people from that. And sometimes what I mean by nosy curiosity is that we actually get involved in that story, which has nothing to do with why the person is talking to you in the first place.
Jenna Kantor (06:09):
So it's like this superficial, superficial kind of thing, superficial thing, right?
Javier Carlin (06:13):
So instead of being nosy and it's the actual story and talking about the people that were in their story, we want to, you know, kind of separate that from the actual person and have a conversation about them and why that situation affected them as a person, not, you know, bringing everyone else. So that's what I mean by nosy. And he knows he's trying to get involved in their story and you know, getting involved in not just their emotions but everyone else's emotions and why they hate their boss and why this and why that. So it's really separating that from what they're telling you.
Jenna Kantor (06:45):
Hmm. I like that. Yeah. Yeah. Could you just keep talking cause I don't even know what question to ask next just because I'm really taking that in right now. Just tell me something else more about listening. Cause I know you came prepared just because when you're going into this, you just opened up a world of how much, I don't know, just from even that concept. So I feel a bit of the, honestly a lot of loss of words for it because just even that concept of the superficial versus diving deep down in, I guess my next question would be then when you deep dive in and you're getting, doing those investigative questions to really find out what really is the core of what's going on, how do you phrase your questions too? Because you're probably going to get to some real personal stuff. How do you do it delicately with them? So that way as you are deepening, deepening your listening, you're not invading their space.
Javier Carlin (07:54):
That's a beautiful question. So, I think a lot of it comes before you know, before you dive into that. So you know, you've heard of obviously you're building rapport, building trust, and at the end of the day, if someone's coming for help it typically comes with an idea that, okay, I'm going to have to, if I want someone to help me, then I have to open up to them. Otherwise, you can't really help someone. So I think, you know, it comes with that understanding and I think a lot of it also comes from coming from a place of neutrality. So not tying your emotions and your ideas and your thoughts and your beliefs and your opinions to what the person is telling you.
Jenna Kantor (08:37):
That's hard. That's hard. Yes. Very hard. Yeah.
Javier Carlin (08:41):
It really is. And, that's where, you know, that's when someone can actually feel that you're trying to either push them in a direction that they don't want to go, or that's where that nosy type of know feeling comes in, where they're like, Oh, like why are you, why are you asking me that? But I think the second thing is whenever you make an opposite, whenever you make a statement that's more of an observation or a fact
Javier Carlin (09:08):
As opposed to, you know, something that's a bit more emotional, you want to always end with a question. So as an example, a question. So after every statement you want to end with a question saying, Hey, you know, what's true about that? Or what comes to your mind when you hear that? Those, two questions allow you to kind of pull yourself from Hey, listen, what comes to your mind when I say that? As opposed to I'm saying this because Hey, you should do this or you should do that. Or you know, that came out like pretty that that came out as if, you know, instead of saying, Hey, you sound angry. Right? It's saying, okay, like what, you know, when I heard that it sounded like you, you know, there was some anger and what's true about that and now you're giving them the ability to respond back to that.
Javier Carlin (09:57):
So now it's more of an observation as opposed to kind of like telling them, or you know, letting them know, Hey, you sound angry. Right? There's more emotion to that. It's more of like, Hey, you're coming at me now. That's when someone can get a bit defensive or feel like their space has been invaded. But when you just state a fact and then ask them a question, it makes it a lot easier to have that conversation moving forward. I hope that, does that make sense?
Jenna Kantor (10:25):
Yeah, that does. That does big time. It actually connects, it brings it back to a conversation I had with my brother. I'm going to go a little deep on my own thing. I remember my older brother and I don't have a good relationship, but this is back in high school and there's a point to this that's not just about me, even though if anyone knows me, I love talking about myself, but he, I remember there was one evening where he was more of a night elephant, and we started talking. It was a rare time, was a rare opportunity when you just get into a deep conversation about life and anything and we were already at least an hour or something in and I'm just feeling my eyes shut on me. And I remember going through this like I have two options to continue this conversation to continue this conversation with him.
Jenna Kantor (11:29):
So I remember I had this opportunity to continue the conversation and force myself to stay awake and I felt like it was a very vital conversation. There was this little thing that was like, if I cut this off, it will be cutting off something big in our relationship. Me not being here to be part and present when he's open and being open to talking to me, for me to be able to hear what he has to say. Do you think that and it has over time now we don't have more. We have more solidly not a strong relationship. Do think there are conversations like that that exists that if you are not present and listening and you push it away too soon, it could actually cause damage to that relationship long term.
Javier Carlin (12:33):
Oh, 150%. Yeah, absolutely. Absolutely. Yeah. Yeah. and you know, it's tough. You know, diving back into exactly, you know, what you were feeling and how you're feeling and why perhaps that conversation was maybe at that time of interest or something that, like you were saying, you know, you felt like maybe falling asleep.
Javier Carlin (13:03):
So, you know, there's a lot to it that we could dissect really. But yes, I do agree with that. I think what happens in many conversations especially, you know, looking into it even deeper, it's, you know, when people have make offhand comments you know, short little statements in between the conversation that you're having. Most people are quick to kind of just let that pass. But that's what the person truly deep, deep inside is actually feeling and really wants to talk about. Everything else is just surface level. So, you know, exploring those offhand comments goes a very long way. And that's when people really know that you're truly focusing on them. And listening to them and that's where you get into those deeper conversations now. Again, back to the story that you just shared. There's so many different factors when it comes to that, but I definitely do believe that that can have a massive impact on, you know, the relationship moving forward and with anyone with, you know, your patients, your clients, people remember how you made them feel and that really, really sticks.
Jenna Kantor (14:19):
Yeah, you guys can't see me, but I'm like, yes. Hey man, I feel like I just went to church on that. But it's how you made them feel. So then, back to the clinic, you could have say a busy time, a lot of people, a lot of patients and everything and your time is running short. How do you cater to these conversations? If you see that there needs to be more time or if you do need to cut it shorter, how do you continue to feed that relationship, that trust? So you can have find an opportunity maybe later to spend more time listening to them. If you don't have it right then.
Javier Carlin (14:52):
That's a great question. I think there's several different ways to do it. I'll speak to more cause there's a tactical way of doing it and that's, you know, with I guess you can call it, you know, nature and the relationship through other methods with text messaging, emails and all those things. Right. Where you feel that connection with someone and continue to develop that relationship over time through sometimes automated, you know, systems and or where you're actually just sending a mass email, you know, once a week where it can still actually help to build a relationship. Right. But on the other front, you know, with our clinic specifically the way that we do that, because we do work as a team cause we are, you know, we do have insurance based model.
Javier Carlin (15:40):
So we do see several patients an hour. Because of the team that we have where for us specifically, it's a PT, two PTAs and two techs. Once we have a fully established clinic and got into that point that is where the PTA is that we have actually step in to treat the other patients that are there. And if I noticed, cause there's a lot of so when it comes to listening, there's, you know, when people say active listening, active listening really is it's not just listening to the words that are coming out of someone else, someone else's mouth, but also painted with everything else that's going on the unsaid, right? You really want to explore the unsaid. And that comes with a body language. You know, a visual cue is a body posture. You know, the way someone says something, their tone, their pace, right?
Javier Carlin (16:28):
And obviously as you get to know someone, you really get to feel how they feel when they're having a great day and when they're having a not so good day. So, you know, not letting, again, kind of like not letting offhand comments go. You don't want to let those, the visual kind of feedback that you're getting you don't want to let that go either. So, when you do see someone that's in that specific state where they might be disappointed, angry, upset, frustrated, you want to make sure that you address that right there. And then, and the way that we do that specifically at the clinic is we take them into the evaluation room and we can do that because of the fact that we work as a team, everyone on the team knows exactly what every single patient should be doing and knows them at a deep level so I could actually step out and have that deeper conversation with whoever needs it at that time.
Javier Carlin (17:20):
We'll sit for, you know, five, 10, 15 minutes, however long we need, really to explore what is going on at a deeper level so that we can ensure that they don't drop off. Cause typically what happens is that when you don't, when you just kind of let that go, that's where you get a patient call in to cancel and then it happens not just once, but twice, three times, four times, and then they ghost you. So that's how we handle that situation.
Jenna Kantor (17:50):
Absolutely. Absolutely. I think that's a really important thing to put into place. So for clinics alone, how would you, if they don't have something set up and say they're a busy clinic and they don't have something set up where people can have the time to necessarily sit and listen, how could they start implementing that in order to improve the relationships with their patients and then they're showing up?
Javier Carlin (18:13):
Yeah, that's a great question. And I think there's so many variables depending on how the clinic is set up and ran. I believe that, you know, I think as you know, obviously as physical therapists ourselves, I think our first instinct is to always like go to like the physical, right? Like, you're feeling this way today. Okay, don't worry. Like, we're going to make you feel better after this. It's like, wait a second. Well maybe the person, maybe for those initial 30 minutes, they don't even need, you know, therapeutic exercises or whatever it is that we're prescribing them for that day. Maybe they just need to have a conversation, right, for 20, 30 minutes and just to let it all out. And those 30 minutes of actually just talking to them just because we can't bill for that time technically. That's going to be the difference maker between them actually seeing the results longterm and dropping off. So it's making that clear distinction and deciding, okay, what this person needs at this point in time is not, you know, to do a core exercises or to get manual therapy. What they need is to just have a conversation about what's going on in their world. Cause ultimately that's what matters the most event.
Jenna Kantor (19:28):
So yeah, true question. I think that was great. That was good. I just want you to know, okay. So then during this time, the Corona virus, what has your clinic been exploring on a listening standpoint with the switch to virtual to try to fit those needs? Like, I don't know, it's kind of an open ended question for you to interpret this however you'd like.
Javier Carlin (19:58):
Yes. So I think, you know, it's been, to be honest, it's been a challenge. And the biggest reason why is, you know, knowing that tele-health existed for, you know, the last year, two years, et cetera. And, has been existing, we didn't really make a push to have that as an additional service. So what's happening now is that it's like physical therapy, right? A lot of people still don't know what physical therapy is and it's not something that they necessarily want. It's just something that they need. Right? So, same thing with telehealth. It's something that, you know, now we're adding to things that people don't know, which is physical therapy and telehealth. And now we're, you know, most people are now trying to figure out, okay, how can we push tele-health without, you know, having any like, previous conversation about this.
Javier Carlin (20:53):
So that's where the challenge lies is that you have people who are, you know, the ones who do know what physical therapy is. We're coming in and you know, when they think of PT, they have this, you know, they have this picture in their mind because it's what they've been doing for the past, you know, X amount of weeks and now you're trying to get them to jump on to a different type of platform to, you know, provide a service that in their minds can only be done in person. So what we've seen started to do is we've started to offer complimentary telehealth visits. So the first visit is completely free 15 to 20 minutes in length. And offering that first, you know, giving the patient an opportunity to experience what it's like and showing them how valuable it can be.
Javier Carlin (21:39):
And then from there deciding to make an offer for them to actually purchase, you know, X amount of business. And typically, you know, your time is your time, so you want to typically charge the same that you would an actual in person session. But because this is so new, we have decided to offer it at a very, very low rate. So that barrier to entry is a lot less, especially in this time where you know, people's finances might not be at their all time high, or at least, they're not going to say, they're a little bit more reserved with what they're spending their money on. People are still spending money, but with what they're spending their money on. So that's how we're handling that now. A lot of, you know, constant communication through text messages, emails and just listening.
Jenna Kantor (22:34):
Yeah, yeah, yeah. Yeah. That's amazing. Thank you so much for coming on. Is there anything else you want to add in regards to the art of listening that you think is a key point for people to take home with them?
Javier Carlin (22:47):
Yeah, so I think the last thing, and this is actually a quote from Stephen Covey and I have it here cause I didn't want to butcher it, but basically he says most people do not listen with the intent to learn and understand. They listen with the intent to reply. They are either speaking or preparing to speak. So that's it.
Jenna Kantor (23:09):
That's great. That's a really good quote. Sums it up. Yeah. Well thank you so much for coming on Javier. How can people find you on social media? What are your addresses on Facebook, Instagram, all the above?
Javier Carlin (23:32):
Sure. So I'm on Instagram. I'm at @drJavierCarlin. So dr Javier Carlin on Facebook have your Carlin's so you can just look me up there and friend request me. I do have life coaching Academy for healthcare professionals a Facebook community. So you can always jump into that as well with a podcast coming out soon. And I think that's it. If you want to send me a, you know, text message and just link up my phone number is (305) 323-0427 to have a conversation.
Jenna Kantor (24:05):
I love that. I love that so much and if you guys want to see or hear him in action, if you're in the group or even in his future podcast, you'll see from the way he interviews and speaks with people how he really uses his curiosity and deep dives and learns more and listens so well. Just watching him in action alone, aside from just even experiencing it yourself, you'd be like, Oh wow, he's good at this. I feel very listened to, thank you so much for coming on. Everyone jumping in, thank you for joining and have a great day.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Tracy Blake on the show to discuss the evolving role of physical therapy in sport. Tracy’s desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author.
In this episode, we discuss:
-The preventative and reactionary roles of physical therapists in sport
-How to optimize the healthcare team’s strengths to amplify the organizational mission
-Equity and shifting power dynamics between the athlete and clinician
-COVID-19 and ethical considerations in sport
-And so much more!
Resources:
WCPT statement of diversity and inclusion
WCPT symposium on diversity and inclusion
2016 consensus on return to sport
Introducing patient voices
Coin model of privilege and critical allyship
Tracy Blake Twitter
For more information on Tracy:
The only daughter of Trinidadian immigrants, Tracy Blake and her youngest brother were raised in the multi-cultural, multi-ethnic, multi-faith, working class Toronto (Canada) neighbourhood of Rexdale on the traditional territory of many nations, including the Mississaugas of the Credit, as well as the Anishinabeg, Chippewa, Haudenosaunee, and Wendat peoples. Sport was a power source of connection and vehicle for connection throughout Tracy’s upbringing. Tracy’s desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author.
Read the full transcript below:
Karen Litzy (00:01):
Hi Tracy, welcome to the podcast. I am happy to have you on. And I'm so excited to get to speak with you one on one. I heard you speak at WCPT in Geneva last year and I think I've told you this. It was one of my favorite sessions and we can talk a little bit about that session later. We'll probably sort of weave it in as we go along here, but it was a great session at WCPT and I'm really excited to have you on the podcast today to talk about the evolving role of physical therapy or physiotherapy in sport. So I'm just going to hand it off to you and if you can kind of let us know what that role kind of maybe where we were and how you see it evolving and how it has evolved up to this point.
Tracy Blake (00:53):
Yeah, so I think historically, physiotherapy or physical therapy, I'm Canadian, so I tend to use both. Historically in sport was seen as reactionary. So injury happens, enter physiotherapist from stage 1 right. And I think over time what has happened is that both from a clinician standpoint and an organization standpoint in sport there has been a change in perspective with an increasing level of focus on primary injury prevention. And so what that has meant is physiotherapists are not only responsible for there reactionary role, the rehabilitation, the remediation of injury, but also there has been a serious investment both in their time and an organization's resources around preventing injuries from occurring at all. I think the other part of this is that part of the evolution has been in the team around the team. So historically speaking, there may have been a physical therapist and athletic trainer, a doc, and that would sort of be the primary set of your team.
Tracy Blake (02:14):
Now, more and more organizations are having maybe multiple therapists, strength and conditioning, nutrition, dietician, sports psychology, other disciplines are involved in the team, which both alters the way in which we gather information, gather experience, the way we develop as practitioners, and also the way in which we engage in our role and in our competencies. Within a sport context. And I think that there's sort of three arcs in which I see physiotherapy in sport, which is consultant. So in a consultant role, you may not be actually involved with front-facing athlete care at all. You might be making recommendations or talking to ownership or be brought in special cases for example. As a concept, then you have external service providers. They might have more regular athlete contacts, but they're not embedded in the daily training environment, which is the third aspect. Each one of those rules has a role to play in today's modern sport, particularly as you get into more resource abundance levels, your high performance or Olympic level or professional level. But the arc of change for each of them is going to be different. The arc of evolution is different. And what that means for the practitioner and the profession will also be different.
Karen Litzy (03:47):
And so when we talk about those tiers, so let's say you sort of outlined consultant the external service provider and those people who are really embedded with the team on a day to day basis. And before we went on, you sort of use the example of the NBA example. So can you talk about that just to make that a little bit clearer?
Tracy Blake (04:10):
Yeah. So there was a time where like if you were, the internet still existed, but maybe like online rosters and Google's worth weren't quite as prevalent, I know, usage, but you wouldn't have been able to just go on and find a physical therapist listed on an NBA team. There might've been one a decade ago, maybe two. And now in today's days and times, every NBA team has at least one and sometimes multiple that are working in various specialties within physical therapy. And so I think that that is also something to consider it, right? So what exactly is your contribution to the team in the context of both your profession, which is a healthcare paradigm and your occupation, which is in a performance paradigm in your sector. And so how do you reconcile those two in a way that allows you to contribute and to be of service?
Tracy Blake (05:11):
And I think we were, I mentioned this to you as well, that I think that the only way to reconcile that in a way that is grounded and sustainable is to be really clear about what your specific mission is as a physical therapist. And then making sure that whatever role you're in, whatever tier you're in, in the incredibly fast paced moving world of physio and in the fast, fast moving world of sport that you're grounded to that regardless, it makes you more responsive and adoptive, particularly in these days and times where on top of the unpredictability of sports and the fast paced moving to sports, we now overlay a global pandemic into that. And so you lose your footing. It's real easy to lose your footing in sport these days. And so if you are not grounded in something that is separate from your job professionally, it is very easy to lose your way.
Karen Litzy (06:10):
And especially now that there is no sport happening. Correct. While we're in the midst of this global pandemic, there is no sport happening. And so I guess being very clear on what your mission is, does that then allow you to find other ways you can contribute to the team aside from direct we'll say patient care, athlete care or direct overview of strength and conditioning programs and things like that.
Tracy Blake (06:41):
Yeah. So, then the question becomes is how is a team still a team when they're not playing? So when the technical has been removed from you, what makes you a team? And then in that context, what is your role in maintaining that team in contributing to that team? So I think when we were at WCPT when I had mentioned the idea of what is your mission, I had told people to think about it and you're not allowed to use the words rehabilitation, remediation, illness or injury in whatever your mission statement is. The purpose of that at the time was that you were having conversations with people in sport who do not come from your health care background. So if you only use language that relates to health care remediatory way or inaction reactionary way, you're undervaluing what you do. And you also run the risk if that's not understood in the same way you intended.
Tracy Blake (07:52):
It turns out that that actually works out in this case as well because now we've taken all of the trappings or all of the preconceptions that come with our role have now been wiped away. Right. So what are you contributing to the team in this context? Are you, for example, as it's somebody who is usually in the daily training environment? Having a team that is sometimes centralized and sometimes decentralized. I made sure that I continue to talk to my team and do check-ins even when they're decentralized. So now we're decentralized longer than we would have been because the Olympics aren't happening. Right. But their communication with me isn't somehow new.
Karen Litzy (08:42):
Smart.
Tracy Blake (08:44):
So that's not everybody's option. But that is for me, a way in which the relationships we've had, we're not based on strictly what was on court in the team context. So therefore the relationships are able to be sustainable when an earth shifting history shifting thing is occurring.
Karen Litzy:
And, I have a question for you. What is your mission statement? Without using remediation, rehab, et cetera, et cetera.
Tracy Blake:
So my mission in sports specifically is the optimization of health function and performance, whatever your age, stage or field of play.
Karen Litzy:
Excellent. I love it when people are prepared. That was great. And I think it's very clear. I think that's very clear. It's short and sweet and to the point and people get an idea of what your mission is and what your function is within that team setting. And now let's talk about the team, but not so much the team that's on the court or on the field. But let's talk about the team around the team. So you had mentioned you've got maybe a couple of physical therapists the MD, the ATC, a sports psychologist, nutritionist, but let's talk about how the team around the team functions for the good of the team that's performing on the field, on the slope, on the court, et cetera.
Tracy Blake (10:15):
Yeah, I think that there is, so my circumstances were particularly interesting in my current situation with volleyball Canada in that I was brought in with the strength and conditioning coach halfway through a quad. Like going into Olympic qualifiers, which is highly unusual. Well we were very lucky was that we had our conversation right out of the gate and we were of a mind so to speak philosophically in this way. So we had our first conversation, I say lucky, I think our director of sports science, sports medicine and innovation would say that he planted this way cause he hired both of us. But we were lucky that we were philosophically aligned in both what we thought our jobs could be for the team in this setting and in this circumstance. And then turns out how we work together also worked quite well that way. So that becomes, I think one of the first things is what's your mission? Does it align with the people who you work with? That's the first thing. And then from that spot, how do you use your strengths of each of those team members to amplify what that organizational or team goal is.
Tracy Blake (11:33):
And then how can you also identify gaps in each other and fill those in. Because that's the thing, like people love to talk about their strengths. To a team and what they can contribute with their strengths. They're less comfortable, particularly in sports, particularly an environment that is bred on competition and winning. And there can only be one. It is much harder to feel comfortable with vulnerability and opening up something that feels like a gap or a weakness or an area that you're not as confident in and trust that somebody else will fill it without exploiting it. So I think both parts of those need to happen for a team to be both functional and that function to be sustainable for anyone for time.
Karen Litzy (12:20):
Yeah. And I think that's also where the learning happens, right? When you have that team of professionals around the team, I would think me as a physiotherapist or as a physical therapist can learn so much from those other partners.
Tracy Blake (12:38):
Yeah, I agree. And I'm a nerd. There's no getting around it. I love a learning moment. I love them all the time. I want to know everything. And so for me, I feed on that, but that is not everyone's experience. And so what I've had to learn is timing and approach and repetition. Frankly, being not just clear on my mission once, but clear on it over and over and over again. How do I express my mission in the big and small things that I do in a day so that I'm consistent and I'm transparent so that at no point somebody can be like, well you said that at the beginning but you did this and this and this. That was inconsistent with that. And so I want my own way. And so in those kinds of circumstances I'll be like, look, this is where I was coming from with this.
Tracy Blake (13:30):
This is why I thought it made sense. I went to a school where when I say school, like entry level physio training, was that a school where we didn't have traditional lectures? Very much. Almost everything was small group learning. And so I feel like that environment really fostered the way that I work in the team environment, in sport where everybody had the same questions. We all went off and found the information and key information, excuse me, and came back to it with our own whatever that information is plus our own experience and perspective layered in on it. And then you figured it out together what was useful, what was not.
Karen Litzy (14:13):
Nice. Well that's definitely set you up for being part of a team, that's for sure. And now let's talk about, so let me go back here. So we spoke about kind of the different tiers that may be a physiotherapist might be in how being part of the team is so important to understanding your mission, staying true to that. And I think being self aware enough to know that you're being true to that mission and that you can stand by it and back it up. And now let's talk about how does all of this that we just spoke about, what are the implications of that for athlete health and for support in sport?
Tracy Blake (14:52):
So for me, the cornerstone of every relationship but particularly in the context of sport is trust. I work in sport obviously, but I also work in acute inpatient healthcare. And I also worked in private practice for a long time and people often assume that my private practice life, my private practice, orthopedics and my sport life are the two that are most closely aligned. Okay. Particularly in recent years, I've corrected that. And then I actually think it's my hospital life in acute care and my sport life, particularly in high performance that are the most aligned and the reason why is the relationship building and the communication that they require. So when I'm working with an athlete, the way in which I can get the best out of that athlete is if they trust, but I'm working to the same goal they're working to.
Tracy Blake (15:58):
Now that does not mean that I don't care about health, right? Because sport is inherently a risky situation, right? There's a level of risk acceptance that you have to participate in them, particularly when the levels get higher. And I believe there was an article by Caroline bowling, it's a couple of years old now that actually talked about injury definition and asked high performance athletes, coaches and sport physios. And in that article, all injury was negative effect on performance. There's no mention of it risk, there's actually no mention of illness or injury. So if I can't have a conversation with you about what I think the injury is doing to affect your performance negatively, I'm only filling in half the picture. So I need you to trust me. And the way in which I garner that trust. The way in which I build that trust is making sure that you always know that I have your goal, which has performance in mind. And so I think that that component of the relationship is the cornerstone. What cannot be left out of it, however, is the role of equity and the power dynamics.
Tracy Blake (17:23):
Physio is a health profession. Health professions historically are in a position of power or a position of privilege in the context of your practitioner patient relationship, right? If that's the situation already to start, how can you know that the person is giving you the accurate information if they're already in a position where the power is shifted out of their favor? So knowing that and understanding that concept, I've tried to be really intentional and again, really consistent in actively working to even the scales. I do that. Yeah. So I regularly consistently ask athletes, not just what they think, but I start with the part that they know the most about because as it turns out, I've never played professional volleyball, I've never played any sports at a high level, right? So if I start with the part that they know the most about the technical components of that, the way that training happens, the way practices are organized. If I start with what they know and ask questions about that, and then I work the way in which I build a program back from that, what I often say to people, not just athletes, but obviously this applies to athletes as well, is that I say I know bodies, you know your body and what we're trying to do is take what we know about those two things and put them together in a place that gets you to where you want to go.
Tracy Blake (19:02):
And anything that you think I'm doing that either doesn't make sense for that for you or that you think is working against that you need to tell me early and often. And so that's the framework. That's a conversation that's happening like right away. First day.
Karen Litzy (19:19):
Hmm.
Tracy Blake (19:19):
And then I give them opportunities to come back to that over and over. And not everyone communicates the same way. So you can't expect somebody to like just be like, you spit out five minutes of like clinical decision making information at them and they're going to be like, yeah, aha, Oh by the way, this, this, that and the third. Right. That's not going to be how it happens all the time. So making sure that people have time to think about it. Give time to reflect how the place to come back to you. Some athletes want to break it down into small bite size pieces. Some athletes want to be like, just fix it. I don't want to talk about it. And that's also my responsibility to make sure all of those different types of personalities, those people with different relationships with their bodies. How the power of the emboldened to be able to say what they need to say to meet their goal. And so that's what for me, that communication and relationship building part has to be the cornerstone because it's the only way we can get anything done with the kind of both the speed in which we need to get it done in the context of sport, but also in a sustained way. Because if someone keeps getting hurt, that is also not going to help anybody’s situation both from my job security or theirs.
Karen Litzy (20:34):
Right, right. Absolutely not. And so again, this kind of goes back to being part of the team. And so what I'm sensing is, and again, I feel like as therapists, we should all know this, but the team around the team also includes the team. You can't just have the team around the team making the discussions and these return to play decisions without involving the members of the team without involving that athlete.
Tracy Blake (20:48):
Correct. And one of the things that I found, like I'm saying a lot of these things to be clear, I'm saying them now and it sounds Zen, but I found out most of these things through failure to be clear of course a million times over. It has brought me to where I am having this conversation today, but I just wanted to be clear that I did not like walk out of entry-level physio with this knowledge on a smorgasbord. No, I know. Shocking. Shocking. What kind of program was this? You went to again, that didn't prepare you for high level sport athletes shawty is what it was. But the idea that the idea that an athlete, an essential part to their healthcare team still is radical for many and they see it, they see it.
Tracy Blake (22:03):
But what happens is when there actually requires an actual power shifts to make happen. Yeah. It's hard for people when it actually requires them to let go of some of their power if it requires them to acknowledge. There was a moment in the process of programming, in the process of delivery, in the process of recovery that they are not the expert in the room. It can be a blow, particularly people who've spent in our cases years getting to that point.
Karen Litzy:
Oh absolutely. And I think in several presentations I've seen in writings of Claire ardor and I feel like she goes through this which with such specificity and simplicity that it makes you think, well of course, kind of what you just said. Like for some people it's a radical view that the athlete should take this big part in their recovery and their return to sport or in their health. But when you listen to folks like you or like Claire, it's like, well yeah, it all of a sudden turns into a no brainer. So where do you think that disconnect is with those people who still considered a radical idea and the people who are on the other end who are like, well, of course they should be part of it.
Tracy Blake (23:09):
Some of it is experience. And so what I mean by that is not just like length of time experience, but I found that when everything's going well, it's going well, right? There is no impetus to change. There is no disruptor that actually acts to give you a moment to or recalibrate as you need. And so when I say experience, I mean I've had instances where, to be honest, I wasn't sure if it was going well. I wasn't sure I was doing what I thought needed to be done and I was doing what felt right. Again, I was aligning with the mission that I had because I didn't have any real world context in this specific sport or circumstance that I might've been in. And then something goes wrong. And you realize in the aftermath of that, whether it's an illness, whether it's an injury, whether it's something off court altogether, right? Whether it's an abuse and harassment situation, whether it's a boundary situation, whether it's a patient confidentiality situation, right? You realize when those things go sideways, but that's whereyour power and your metal is tested professionally.
Tracy Blake (24:46):
And so I think that's one part of it. I think another part is there's ability to what they call it mission creep, right? Where over time you sort of like, this is what you think your mission is, but then you did a little of this and you do a little of this and the next thing you know, you're far away from where you started. And I think that a lot of people, I think they're in service to the mission one in sometimes they actually end up in service to the business model. And particularly in sport where the jobs or when I say sport, like high performance sport professional sport, where the jobs are few, where the jobs are highly competitive. I don't think I've ever applied for a sport job that had less than 75 applicants and upwards of several hundred in some cases.
Tracy Blake (25:43):
Wow. Everybody wants that gig. And so people can sometimes get led by the, or creeped away from their mission by the instinct to do what is necessary to stay in the position rather than what is necessary to optimize the health function and performance of their athlete. So having a situation where you've been tested and sometimes don't, aren't successful and mission creep. Those two things I think are maybe the biggest ways that aren't just related to like personality. Like those are that things can be trained or modify. Those are like the modifiable things I think.
Karen Litzy (26:44):
Great. And then, you know, we had said as we are recording this, we are in the middle of the global covid-19 pandemic. And so there is no sport going on. And so to the best of your ability, and we're not asking you to be a future teller here, but what do you think will happen to the role of physiotherapy in sport and the medical teams in sport?
Tracy Blake (27:28):
I don't know necessarily what will happen. What I hope happens is that all healthcare practitioners, but particularly physical therapists in our case because I'm biased in that direction that they recognize their role in contribution to population health in the context of sport. So public health in the context of sport, we often think of sports as a bubble and it is to a certain extent, but that bubble is manufactured. That means all parts of an athlete's existence are manufactured, right? All parts of what the athlete is provided with from a health perspective are manufactured. So have gaps are left in that it's up to you as the person who is actually in the sport context to identify and try to remedy and resolve. Right? It's deeply problematic for athletes to not have the same information that somebody who works in the public house. It's deeply problematic for athletes too, not have access to labor rights. It's deeply problematic for athletes to not have be informed and be given informed consent to participate in mass gatherings during a time of pandemic.
Tracy Blake (29:02):
And I also think there is a strong ethical quandary that comes with providing services, two events that fly in the face of public health recommendations during times like this. And I've been on record with this, I said this a couple of weeks ago, I posted about it on Twitter where there was a massive wrestling tournament happening and I thought to myself, it's wrestling, it's a combat sport. It can't happen. Like they literally would have no insurance if there was no medical covenant medical coverage provided. So if you didn't have medical coverage, the event couldn't happen. So how does medical coverage or physio coverage or what have you happen against public health recommendations? We can't continue to act in separation with each other. We need to view sports as part of population health. And then we need to make sure athletes and those in the sporting community are acting in accordance with the public health.
Tracy Blake (30:11):
At the times demand as well. And I think the Rudy go bear situation was truly, genuinely shocking for a lot of people. They were unprepared at every level, not just sports medicine and sport physical therapy. And so what I hope lingers for people is that we think about emergency action plans a lot, right? We think about how we're going to get somebody off the court in the case of an emergent issue, Encore, how are we preparing them for life in that same context? How are we in preparing ourselves as professionals in that context? And I hope that those conversations, because it turns out you don't need to be in person for that.
Tracy Blake (31:01):
That people are reflecting on that now and that steps are being taken to improve both the gaps that are specific to the city, the situation with the pandemic now, but also how do we identify these things going forward. And I think some of that had already started to show its colors around issues of food insecurity, issues of education, issues of like the younger your players are coming in. Are you providing appropriate development? I went to you as a, you know, I went to the United nations last year for the sporting chance for him, which is around sport and human rights. And last year, 2019 was the year of the child. And so there had been a special rapport to report on the rights of the child and child exploitation and snails. There is an entire section dedicated to sport and how sport has been used as a vehicle for the exploitation of the child.
Tracy Blake (32:08):
And I think of things like that, like those are the kinds of gaps. But now that you know that these kinds of gaps exist now you know, you understand in a very real way and it's kind of, it's telling in some kind of ways that it needs to strike so personally close to people's wallets and they'll help. But now that we've had that touch, now that we've been exposed in this kind of way, can we continue to be proactive in the way we address other things going forward? That would be what I would hope to see.
Karen Litzy (32:40):
Well, and I think that's I feel like very doable hope. I don't think it's like a pie in the sky. Hope. I think all of those conversations can be had and hopefully can be had by everyone surrounding sports, not just the physiotherapist or just the medical team, but straight up to owners and players and everyone else in between. So Tracy, thank you so much for such a great conversation.
Tracy Blake (33:13):
Yeah, it's been great. And I think again, like physios are really well situated because you have physiotherapists who have really like have access to the player and have access to the coaching, the ownership, the administrative stakeholders. They're well situated to be able to bring these things to light on both sides and be involved in those conversations even if they don't have out right decision making power.
Karen Litzy (33:38):
Right. Absolutely.
Tracy Blake (33:39):
Yeah. Thanks for letting me out of the shadow.
Karen Litzy (33:42):
Oh, it was great. Thank you so much. And then before we sign off here, I have one more question that I ask everyone. And knowing what you know now and where you are in your life and in your career, what advice would you give to yourself as that fresh graduate, straight out of physiotherapy school?
Tracy Blake (34:04):
I would say that you need a mission early and you need to speak it into existence. It's not good enough to keep it in your head. You need to say it out loud to people and you need to get feedback from people and whether it's clear or not. And I also think that one of the things that I learned I was 36 almost 37 when I took my first dedicated health equity class and aye, it was a workshop. And in the beginning she said for some of you this will be new information and it was specifically targeted at health professionals, not just physio. And some of you would have learned this in, you know, your first year equity studies, first year gender studies kind of course. And after the weekend where I slept for basically three days because of all the information floating in my head, I was like, there are 18 year olds walking around with this in there. And so I think that if I could go back now, I'd be like, you need to start taking those courses early. You need to start embedding it into your thinking early. Maybe you'll be better at being intentional about how you use it earlier.
Karen Litzy (35:11):
Excellent, excellent advice. Now, where can people find you if they want to shoot you a question or they just want to say how great this episode was?
Tracy Blake (35:22):
So I'm active on the Twitter, so my Twitter handle is @TracyABlake. I am not as active on the on Instagram. My Instagram still private, but if you shoot me a message I usually find it anyway. So that also works. Same handle @TracyaBlake.
Karen Litzy (35:38):
Perfect. And just so everyone knows, we will have links to certainly to your Twitter at the show notes over at podcast.Healthywealthysmart.com. So Tracy, thank you so much. I really appreciate it. This is a great conversation. Thank you so much. This is quite the podcast debut. I appreciate it anytime and everyone, thanks so much for tuning in and listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Stephanie Weyrauch on advocacy mentorship. An active member of the national physical therapy community, Stephanie has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Stephanie is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership.
In this episode, we discuss:
-Why you need an advocacy mentor to help guide you through healthcare policy
-The benefits of being a mentor
-The key to having successful advocacy efforts
-And so much more!
Resources:
Stephanie Weyrauch Instagram
Stephanie Weyrauch Twitter
Stephanie Weyrauch Facebook
Email: sweyrauchpt@gmail.com
A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.
For more information on Stephanie:
An active member of the national physical therapy community, Stephanie has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Stephanie is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership. Stephanie serves as the Vice President for the Connecticut Physical Therapy Association. She is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery.
Stephanie is a Passionate Chicago Cubs fan who enjoys playing the saxophone, writing and weightlifting in her spare time. During business and leisure travels, she is always up for exploring local foodie and coffee destinations.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor (00:03):
Hello. Hello. Hello, this is Jenna Kantor. I'm here with Stephanie Weyrauch. You guys probably know. I mean she's not any stranger to this podcast. How many podcasts have you done on this specific one? I wish I could say third time as a charm as we go. But I wanted to bring on the good old Stephanie Weyrauch however you want to refer to her. Or you could be like, hello, master or master, whatever you prefer. I'm going to bring on Stephanie today because she's actually my advocacy mentor. And I wanted to bring her on to talk about this because I don't think people realize this can be a thing. And so I'm like you want to come on, she's all, yo, let's do it. So this is where we are. And I wanted to open this up, especially to any student physical therapist grads who are looking to get more involved with the APTA and just don't get that guidance from someone that they trust and who believes in that. So Stephanie, why do you think I wanted to work with you?
Stephanie Weyrauch (01:21):
I think that to do with the women in PT summit. I mean I know that, I remember the first time that we met Jenna, we were at the women in PT summit. I had seen a lot of your videos on social media and you and I were friends in social media and so I remember I came up to you and I said, Oh, you're going to at four. And you said, Oh my God, you've seen my stuff. That's so cool. Sort of talking and I think you based off of your interest in advocacy and based off of, I think you knowing that I was involved in advocacy, we just started talking about it and I think that that's just how the hell, it was a really organic thing. It wasn't anything that was really formal. It was just like, Hey, we have this common interest. We know we both enjoy. I mean we both are passionate about the profession and I think that's kind of what led you to me.
Jenna Kantor (02:12):
Yeah. It's funny to say it's not horrible, but to be, I remember when I asked you, I felt like I was asking you to be my girlfriend. Will you? Will you be my advocacy is a big deal. I think this is important to bring up as somebody who's really watched to continue my involvement with the APTA making changes that I foresee that will be so great for its growth. I really wanted to bring this up because it's necessarily easy to find the right person. I think of it as dating. At the end of the day, there's a lot of people who will give you tidbits, but for somebody like you or I can say, Hey, I need to talk to, they'll be available to talk to like brainstorm or whatever, or even if it's just a hard time, get through a Rocky space. Just brainstorming, but that's extremely valuable. A lot of physical therapists who are involved, they don't necessarily believe in beyond that level where I feel comfortable to be open.
Stephanie Weyrauch (03:23):
Yeah, I mean I think that, you know, you make a really good point about finding the right person because you know, while people say that you can go up to anybody and say, Hey, will you mentor me? I mean you really have to build that relationship, which is what advocacy is all about, right? I have been a really good advocate. It's all about building relationships and so finding that person that you can be yourself around yet that person is going to be honest enough with you to tell them you know, the things that you either need to improve on. Be that critical feedback, but also give you that positive feedback to reinforce that you're doing the things and finding that balance. So I think that you make a good point about making sure that you're finding the right person. And my advice to people is if you are interested in finding an advocacy mentor, just a mentor in general, try to foster that connection. That relationship is really important.
Jenna Kantor (04:27):
I remember it was a process for me because now they know what they're doing. They have what I want and everything, but I didn't feel a hundred percent and I think that is something we forget. You just think they're amazing, but how do they make you feel about yourself when you're with them? Do they make you feel good? I've had conversations with you where you've started to get me, you know, you're like, I think this, and I said our walls, that's not where you want. It may have been with the step never on me. Things that were my specific goals and values about within myself. It's been very helpful finding someone who I can be me all the way, which is a challenge.
Stephanie Weyrauch (05:28):
And I think that that's an important thing for mentors is that creating a mini, you're creating a person who is their own individual person and has attributes that they can bring to the table to make them strong advocate or you know, whatever the mentorship relationship is about, you're just moving them along. I always think that, you know, being a mentor is even cooler than accomplishing something yourself because the mentee accomplishes something in that route. And you foster that accomplishment by, you know, facilitating their growth and making sure that they're connected with the right people. I mean, that's just as rewarding and if not even more, all the extra people that you get to touch in addition to, you know, your own personal development as an advocate in your own personal development as a leader. So I think that, you know, it's something that not only helps you as the individual mentee, but you as the mentor, it allows you to have a larger reach and what you will have just in your little bubble who in your own advocacy thing.
Jenna Kantor (06:44):
Yeah, that's true. That's really, really true. And it's not easy because like you mentioned earlier, there are people who many people say, Oh yeah, I just spoke to anyone. So you have to make a decision for yourself. Are you good with getting snippets of people and having a law or would you want someone that's going to be viable for you, devoted to investing time, give you that advice and guidance? There's no wrong answer to that. I discovered that I needed only one. Stephanie became Michael B wonder what would be a Harry Potter reference.
Stephanie Weyrauch (07:30):
So I mean, Elvis stumbled or of course not Baltimore. Baltimore does not. Definitely not. No way. Don't compare me to Baltimore compared me to the more. I think that that's another thing about mentorship that can be challenging is the time commitment. And you're right, you can have multiple mentors that you know, don't really need, that you don't really need to spend a lot of time with. But again, if that mentor is really into facilitating your growth, they're going to be, it's going to be okay that they're going to invest time. And you know, it may not be like a one hour weekly phone call when you see them. Like they're going to want to spend two hours. You can just catch up and see how you're doing. Or they'll text you or email you back and forth. And those are the men. Those are the relationships that are built on, that are built on exactly what you said, relationship. It's not just built on a normal face to face. I mean somebody that you barely know, this is something that you've cultivated, watered, and now the seeds are growing in the beautiful tree is starting to really fester to help kind of bring about that relationship that's needed to have that effective mentor help you.
Jenna Kantor (08:57):
I'm realizing we're making an assumption here. So let's answer the question. Why is it good? Why is it beneficial to have?
Stephanie Weyrauch (09:04):
I think that the benefit for it is because it helps you prep, it prevents you from making mistakes that most people make. And when I think one of the best things about having a mentor, you grow and become better, faster than maybe somebody who had to figure out along the way. Granted there's been multiple people along in the history of time who've been able to figure out their own way, but potentially they could have burned some bridges along the way. They could have had some set backs, they may have missed opportunity. And if there's one thing we know about advocacy, it's all about opportunity. And it's all about presenting your argument in the right way, at the right time for the right things that are going on. And so understanding that and understanding that, especially in today's very polarized political environment, making sure that you are approaching these issues in a way that is proper and in a way that's going to be effective. Because ultimately when you're advocating, you're advocating for your patients, you might be advocating a little bit through your profession, but in general, when you advocate, you make sure that people are getting great care. And right now our healthcare policy is very polarizing. There's lots of different opinions about it. And if you are with the right person and they're guiding you the right way, you're going to go about it in a way that's not going to be as potentially detrimental to the message that you want to send.
Jenna Kantor (10:45):
Yeah. And you're hitting on lots of great. Just like anything, any relationship that relationships, and I'm going to sum it up with a word. You could get blacklist, you can't, it's not like there's a horrible place. Nobody that made no, ain't nobody got time for that. But if you're a person who's constantly coming out like a douche, you're not going to want to know you. Just like you make me feel like crap. That's a thing. So to get, and it's even if you think you are doing something, you never really realize. If you might be cutting down on someone who was put in a lot of hard work, a lot of hard work for zero reimbursement for the profession and that has to be considered even if you completely disagree with it.
Stephanie Weyrauch (11:40):
Right. Well and advocacy takes a long time too. I mean, it's not something that you can go to one meeting and all of a sudden now you have a law passed. I mean it takes 10 it can take up to 20 years as we saw with the Medicare therapy cap to have something actually happen. And that's like a long history of that's like a, Oh that's a history in itself. 20 years. I mean I'm only 30 years old. That means that when I was 10 stuff was going on that I don't even wouldn't even know about. And if I don't have that historical knowledge and that historical information, how can I be an effective advocate? So by having a mentor who knows that history and can help guide you along some of those talking points that you have, because either you don't know the history, you're too young to know the history or you just aren't as familiar with the talking points themselves. You have that person there can give you that. And then when you go to advocate, you have that much more credibility. If there's anything that is really important in advocacy, it's first off, it's credibility and second off it's relationships. What type of relationship have you built with that person? Because if you're a credible person and you have a relationship with them, the chances of them actually listening to you when that app comes, who's a lot better than you're just random person that has no credibility, right?
Jenna Kantor (13:09):
Does natural delight is the things that I personally want to change just for voices, lesser known voices too. That's my own little personal agenda is the important part of this podcast. Very important part. Very, important part of advocacy. Advocate for lameness. So after answering, why do you have to, is it a must in order to achieve what you want within the physical therapy profession? Advocacy wise?
Stephanie Weyrauch (13:50):
I mean I would say yes because I don't know how many of our listeners are experts in healthcare policy, but my guess is that there's not a ton that are experts in health care policy and if you are an expert in health policy, my guess is that you've had a lot of mentorship along the way. I know for me, I mean healthcare policy changes daily and for me, how I have learned has been from being by people who I would consider our healthcare policy experts in addition to them giving me resources that I can use so that I myself can become a health care policy, not to mention really keep emotion out of politics and that is path of what advocacy is, is trying to present a logical argument that isn't based off of emotion, was based off of somebody else's emotion. That's going to further the policy agenda that you're trying to advocate for. And I think one of the hardest parts about advocacy, personal emotion out of the picture.
Stephanie Weyrauch (15:10):
You're there to advocate for your patients. You're not there to advocate for yourself in the end. It doesn't really matter what you believe, it matters what is needed for your patients. And so having just a mentor there to guide you through some of those, that emotional roller coaster of politics and emotion, individual politics with societal politics I think is an essential part of being an effective healthcare advocate. Additionally, there's so much information and having somebody there to help you kind of focus that information and help you figure out what you need to learn and what you can focus on is also really important. I would say yes. Having a mentor is extremely important.
Jenna Kantor (16:02):
I love that and on that note person who has been on this podcast now for this is four times. How can people find you if they haven't listened to you?
Stephanie Weyrauch (16:20):
So you can find me on Twitter. My Twitter handle is @TheSteph21 I'm on Facebook and Instagram. You can find me there or if you want to email me, you can email me sweyrauchpt@gmail.com but I would say the best way to reach out to me is probably Twitter.
Jenna Kantor (16:48):
Tweet, tweet, tweet, tweet, tweet. Well, thank you so much Stephanie, for coming on. It's a joy to share your expertise, to share you with others. Even though I want to claim you all.
Stephanie Weyrauch (17:04):
Thank you for the wonderful opportunity to come on. I'm healthy, wealthy, and smart. Well, once again, and of course it's always great to chat with you about something that I really love. Advocacy.
Jenna Kantor (17:16):
Heck yeah, me too.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Andrew Ball on rehab after COVID-19. Dr. Andrew Ball is a board certified orthopaedic physical therapist with nearly 20 years experience in physical therapy. Drew has earned numerous advanced degrees including an MBA/PhD in Healthcare Management, and post-professional DPT from MGH Institute of Health Professions. He has completed a post-graduate fellowship in Leadership Education in Neurodevelopmental Disabilities (LEND) at University of Rochester, and a post-doctoral clinical residency in Orthopaedic physical therapy at Carolinas Rehabilitation in Charlotte, North Carolina. Clinically, Drew has mastered a wide-range of manipulative therapy techniques and approaches via continuing education and residency experiences (ultimately creating and co-creating several new techniques).
In this episode, we discuss:
-The pathophysiology of COVID-19
-Physical therapy treatment considerations in acute and outpatient settings
-Post Traumatic Stress Disorder among patients and family members
-Functional tests appropriate for patients following COVID-19 infection
-And so much more!
Resources:
Email: drdrewPT@gmail.com
Andrew Ball Instagram
APTA Cardiovascular & Pulmonary Section COVID-19 Resources
United Sauces Website
A big thank you to Net Health for sponsoring this episode! Learn more about The ReDoc® Patient Portal here.
For more information on Andrew:
Dr. Andrew Ball is a board certified orthopaedic physical therapist with nearly 20 years experience in physical therapy. Drew has earned numerous advanced degrees including an MBA/PhD in Healthcare Management, and post-professional DPT from MGH Institute of Health Professions. He has completed a post-graduate fellowship in Leadership Education in Neurodevelopmental Disabilities (LEND) at University of Rochester, and a post-doctoral clinical residency in Orthopaedic physical therapy at Carolinas Rehabilitation in Charlotte, North Carolina. Clinically, Drew has mastered a wide-range of manipulative therapy techniques and approaches via continuing education and residency experiences (ultimately creating and co-creating several new techniques). He is certified by the National Academy of Sports Medicine (NASM) as a sports performance enhancement specialist (PES) and was personally trained and certified (CMTPT) by Janet Travell’s physical therapist protégé (Dr. Jan Dommerholt of Myopain Seminars) in myofascial trigger point dry needling. Dr. Ball serves on the Specialist Academy of Content Experts (SACE) writing clinical questions for OCS exam, as well as research and evidence-based-practice questions for all of the physical therapist board certification exams.
Dr. Ball currently serves on the clinical and research faculty at the Carolinas Rehabilitation Orthopaedic physical therapy residency teaching research methods and evidence-informed clinical decision making, but also contributes to the clinical track mentoring residents in manipulative therapy and trigger point dry needling. His publication record is diverse, spanning subjects ranging from conducting meta-analysis, to models of physical therapist graduate education, to political empowerment of patients with physical and intellectual disability. Dr. Ball’s most recent publications are related to thrust manipulation and can be obtained open-access from the International Journal of Physiotherapy and Rehabilitation.
Drew is married to his wonderful wife Erin Ball, PT, DPT, COMT, CMTPT. Erin is Maitland certified in orthopaedic manual therapy (COMT), certified in myofascial trigger point dry needling (CMTPT), and has extensive training in pelvic pain, urinary incontinence, and lymphedema management. They live with their two dogs one of which is a tripod who was adopted after loosing his hind-leg in a motor-vehicle accident.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor (00:02):
Hello. Hello. Hello. This is Jenna Kantor with healthy, wealthy and smart. I'm super excited because I have Dr. Andrew Ball here who is going to be interviewed on COVID-19. Has anyone heard of it? Anyone? Bueller, Bueller and return to performance post infection. This is such an important conversation. I'm really excited and grateful to have you on Dr. Ball. Thank you.
Andrew Ball (01:26):
Well, first of all, please call me Drew. And second of all, let me thank you and your listeners for having me on.
Jenna Kantor (01:34):
Wonderful. It's really a joy. Would you mind telling people a little bit more about yourself so they can better get acquainted with Mr. Drew?
Andrew Ball (01:46):
I have been doing physical therapy for, I have a 20 year history in physical therapy. I've taught for a good majority of that time. I started out in pediatrics doing what I was told was the first fellowship in pediatric physical therapy and neurodevelopment at the university of Rochester, which has since kind of turned into a PTA accredited residency program at the strong center for developmental disabilities and then evolved into doing orthopedics. I hold an MBA, PhD in health care management. I went and did a post-professional DPT, but I got to sing. None of that matters really the salient point. And I think I'm using that word correctly. But don't go with it. Go with the pertinent point is that I could be any one of your listeners who treats in outpatient orthopedics who treats in sports.
Andrew Ball (02:48):
My passion is working with musical athletes. I started working with guitarists. I played piano at Peabody when I was a little kid, put that down and Mmm. And ultimately I got back into music by playing guitar, by being forced to play guitar because I was working with guitarists. And at some point it's like working with a football player and never having played football or treating dancers and never having dance. There's a point where there's a level of respect from your patients. You just don't have it unless you actually have, okay, I've done the work. You can't really speak the language. So I recognized that there were two ways, one of two ways to do that. One was to begin building guitars. So I started doing that. And then ultimately one of the guys that I built a guitar for who plays guitar for Carl Palmer formerly of Emerson Lake and Palmer in Asia.
Andrew Ball (03:58):
Basically he told me like, this guitar is great, but you really have to learn how to play or, yeah, I mean you really are going to have to learn the language of the little things like the posture and the whole, you can talk about holding the guitar, but you know, if you're a grunge player and you're playing bass, you've got to play that guitar and you gotta play that bass guitar and your name and it doesn't matter. Cause it doesn't look cool to have it in the right, you know, proper position. And the muscle memory that these guys had been in gals have been doing, you know, since they were you know, 12 years old you know, you're not going to change that. It's like changing someone's golf swing or if you're going to change it, they have to understand that it is going to be for a greater good.
Andrew Ball (04:45):
Like being able to play a 60 date tour versus having shoulder pain after 30. So, I kind of weaved and wobbled through trigger point dry needling. And I also teach for my pain seminars, but that got me into working with the Jamaican Olympic track and field team. It got me into working with the Charlotte symphony and I'm one of the physical therapists for them. But ultimately I am trust like any one of your performance PTs who is interested in that population and at the same time truly truly wants to help individuals that have a hard time finding care. And so that, is that correct?
Jenna Kantor (05:37):
Yeah, I think that's great. I mean you could go on for a very long time and I really want to get to the point because this man clearly he is a person to learn from. He has so much information to share and I'm really happy about this topic that we're diving into with COVID-19. Let's go straight into the point COVID-19. What are the effects that it has on the body that we need to start paying attention to?
Andrew Ball (05:57):
Like the first things that we have to just acknowledge cause this is going to be something new to us to consider. Right. So there's a lot of things that we need to consider. The physical I'll talk about first. And the psychological, which is a piece that we don't, that certainly performance, that's a huge issue, but that's certainly not something that most PTs outside of the performance training group really, really focuses on. So I'll start out with a friend of mine who was one of the first a thousand people to be diagnosed with COVID. She was in Washington state. She was one of the first 250. She's super, super bright. She holds a PhD in aerospace engineering or aerospace engineering design.
Andrew Ball (06:57):
She's a little bit younger than I am. How old am I? Not quite 48 years of age. And she was, is extremely fit very outdoorsy plays an instrument. So I just want to kind of walk through what she experienced. And this could be again, any one of your listeners on days zero, we'll call it before she was diagnosed. She was skiing I believe snowboarding, but skiing and had some aches and a dry cough and fatigue and experienced something that she had never experienced before that she described as chest awareness. Now your patients and folks that you work with are very acutely aware of breath.
Andrew Ball (08:06):
Right? So I kind of asked her, was that what you meant? She's like, no. I felt like I had to consciously think about every inhalation and exhalation that I chose. And that was before, before a diagnosis, but that was faint. She described it as on day one, which is the day that the fever tends to rise. Not everybody has a fever. So there's variability here that she spiked a fever of 102. She had difficulty breathing day two, that worsen. She had a dry cough and we should get into the idea of a dry cough versus a wet a cough a little bit later when we talk about the physiology of this and how it differs from a pneumonia. And had some GI dysfunction as well. And although we kind of talk about the upper respiratory issues, we also need to understand that the virus enters through the injury.
Andrew Ball (09:16):
The angiotensin converting enzyme to receptors. And, there's obviously the majority of those are or in the lungs, but there are some in the GI tract as well. They're actually all over the body, but and that's why some of the lesser talked about symptoms include things like GI disturbance and urinary issues. And in her case loose bowels by day three, that's when she had a virtual visit. And luckily because there were so few folks being diagnosed at that time, she was able to get a clinical diagnosis by that evening coded by Dave. Or that's when she went to the emergency department because she felt like she thought she had a pneumothorax. She felt like she was unable to fill her left lung with air. And they did a chest X Ray.
Andrew Ball (10:19):
They did the nasal swab. That was day four. She described it as touching her brain. I mean, it's a significant swap. /you have to go all the way up to the back of the throat in order to get right. Which is why many folks who feel like they have a mild case when they hear that they choose not to engage the healthcare system. And I really think that's a bad, bad, bad, bad decision. Because yes, 80% of folks are gonna have a mild to moderate case, but those 20% that you carry it to can have a severe reaction to the virus. That can be, it can be fatal. Five through nine, her fever began to break. Roughly day seven, she had a reflexive excuse me cough.
Andrew Ball (11:21):
She was unable to sleep. She felt like your ears were completely clog. She was coughing up blood and coughing so much that she had conjunctive like conjunctivitis, like that redness in the eyes. Day nine was what she described as noteworthy and describe that as intense exhaustion to the point where she had trouble lifting a spoon. She had trouble zipping up a jacket. And it wasn't until day 11 that she felt like having any kind of food or any kind of coffee. Now here's the critical point is performers or super, super attuned to the idea of I felt bad. The show must go on. I've got it. Push it there. And roughly day 11 through day 14, that's when the viral load is decreasing, but the inflammation is increasing. That's when people go on to ventilators. That's when people kick into this cytokine storm that we've heard of.
Andrew Ball (12:27):
And it's critical to understand that as a healthcare provider and certainly as a patient or performer, cause there have been a number of cases where people had mild cases and they push themselves during this phase a little bit too soon and died having had very, very mild symptoms and then took a turn as a day 14, she still had some difficulty concentrating. She was still exhausted. She found it exhausting to speak and still had a morning sore throat and that's considered a mild.
Jenna Kantor:
Okay. Wow. So I think that's, that's important to understand where these people have come from. You know, we don't, well we can get into the idea of ventilation and whatnot before we do it probably makes a little bit more sense to get into this kind of case and how we would treat them coming out of this when they can have contact and we can help them.
Andrew Ball (13:36):
Yeah, absolutely. Yeah. So kind of jumping forward into well let's take a step back before we do that. If you don't mind just into the pathophysiology a little bit, where would you like to jump back and forth? Let's if we do the pathophysiology, just because I don't want this podcast to be too long. Let's make it very brief, very, very brief so that way we can move forward. So I think it's important to understand that COVID-19 is not influenza, it's not cystic fibrosis, it's not pneumonia. And those are the diseases that when you took cardiopulmonary physical therapy, like that was the primary focus was these diseases where the airways would fill with mucus. That is not at all what happens in COVID-19. So a percentage of folks get acute respiratory distress syndrome and it's a dry cough.
Andrew Ball (14:32):
And the reason that it's a dry cough is that the airways don't fill with mucus. What's happening is that the capillaries begin to leak fluid into the lung tissue itself. So think that like lymphedema of the lung, which sounds horrible, right? So the airways are getting, a couple of things are happening, the airways are getting squashed, but still get kind of in and out, but the elasticity of the lungs is going to decrease considerably. And why she felt like she had pneumothorax. Exactly. So, the lungs start to stiffen. Much more fluid within the lungs in the lungs lining. So if you think of the lining like a balloon and having that kind of the alveoli, having that kind of consistency, normally it's as though you took Vaseline and you just slathered the balloon with Vaseline and then expect for the gas to exchange at the same rate in between that membrane and it just does a brand harder thinking of this and that.
Andrew Ball (16:10):
So the problem is not mucus. The problem is ventilation and perfusion. So part of the reason why I got very interested in this is there is a role obviously for quarantine workouts. And by that I don't mean, you know, our brave soldiers within our profession that are in acute care in the ICU and are turning patients so they don't get bed sores and turning them into prone for optimal ventilation profusion. That's not what I'm talking about. I'm talking about the therapist that the only thing that they're posting is information on what healthy people can do when they're stuck at home. And there's a place for that short, but I really feel like there is a role and a responsibility that our profession has to educate the public and to educate each other about COVID-19 and little things. So I started out just asking questions about what can we as physical therapists do?
Andrew Ball (17:20):
Right. You know, I went back to my cardiopulmonary books, you know, what is the role of putting people into a head down, a position that postural drainage. So they can get the mucus out. Well, newsflash, they don't have mucus, right? So that's not going to help. And it's not the best position for Benadryl for ventilation profusion. So that's important. And the other thing I started asking was, well, what about chest PT? You know, I was awesome at chest PT. I haven't done it since graduation, but I remember that as well. The problem with that, again, no mucus, the clear, the only thing that you are going to do if you are trying to help a performer with a mild case who is getting over COVID-19 is you will weaponize an aerosol the virus. So, you know, there were several folks that were suggesting that based on a poor understanding of the physiology and now we really have to retool and get the information out that no, the best position for somebody who has an active case of COVID-19 is prone because that optimizes ventilation profusion because of fluid dynamics and the anatomy of where the alveoli are.
Andrew Ball (18:37):
So I think that's important to understand because in performance, you know, we fast forwarding, we like to think about things like posture, right? Posture may, it can't hurt, but it's not going to make the huge effect that we think of. With some of the other respiratory structural kinds of problems. Can you see, Oh, taping can be somewhat helpful for folks who have breathing dysfunction and until folks get very, very, very far in their recovery process, that's probably not going to be helpful. When I talk about prone, these folks have been placed in a prone position for the minimum protocol I've seen is 12 hours, but usually it's somewhere between 16 and 18 hours a day and a 24 hour period to optimize ventilation perfusion.
Jenna Kantor (19:35):
Right. That's exactly right. Well, the other issue getting into the psychology of all this, Isolation, psychosis, delirium, and these are people who are in pain and I have a hard time taking a breath. Right? They can't have family members can't have family members in there. Right. So what do you think the impact of that is going to be when you see the patients six to eight weeks after the resolution of symptoms in outpatient or as a performance based therapist?
Andrew Ball:
Yeah, it's going to be probable in more than 50% of cases, 54% of cases. It's going to have a huge mental health impact that you can see at least 12 months later as PTSD. Now, I don't know about you and the musicians or performers that you've worked with myself included.
Andrew Ball (20:42):
I don't think that we're the least bunch and you layer, post traumatic stress a top that and what you end up with if you don't understand that walking into the room with the patient when you do the evaluation or when you treat them is a whole group of individuals, half of these folks who are going to have behavioral reactions to everything from the frustrations of making their appointments down to frustrations with the treatment process. It's just going to blow up seemingly out of nowhere. And I'm here to tell you it's not out of nowhere.
Jenna Kantor (21:25):
I get it. When you're talking about the psychological component, Oh, that's such an untapped situation. This is also new to us.
Jenna Kantor (21:39):
I don't know. I mean I guess it would just, I mean, off the top of my head would just how I am with my people when I'm with them. It's just really checking in, just checking in, asking. I would just keep asking and being like, are you okay? Let me know if this is starting to freak you out in any way. I think that that's gonna be the big thing. Like I need you to feel comfortable. I need you to feel safe and has to just be that level of, I mean, which we always have any way, but a new level of thought process, you know, sensitivity where something like going, even prone could make them go, you know, and they don't even know. They don't realize they're doing it. Their whole body could just even just naturally tense up and it could just become harder to breath just because they develop a new habit to feel like that's what it's going to feel like when they're on their stomach. We don't know.
Andrew Ball (22:28):
Fortunately or unfortunately, there's a ton of research. Oh, I'm working with patients with post traumatic stress as a function of you know, I don't want to get political here, but as a function of endless military action that are had over the course of the past years. So there's a fair amount of information on that, but awareness is going to be critical in working with these patients. Going back to infection though the question that I get asked probably more often than anything else is when is it appropriate to begin working with these folks without personal protective gear? And the answer to that is, there's some guidelines from the European rehabilitation society, but we really don't know. What we know is that patients can go stealth and can be contagious long after their symptoms disappear.
Andrew Ball (23:37):
And there's at least one case study a well written case study showing that the symptoms that the patient can shed the virus for 37 days after they're no longer symptomatic. And the problem with that is that here in the United States testing is scarce, right? To diagnose it, to say nothing of when are you clear completely of the virus. I'm not aware of widespread secondary testing. And then some of the guidelines from like the world health organization suggest that someone needs to be tested. I think it was in China. Needs to be tested twice and have a negative result twice before they're clear. And if we're not doing that, then we really have to wait six to eight weeks.
Andrew Ball (24:44):
And that's why, because you're going to be long, long past what we know to be the longest reported case. Now whether or not your patient is that, you know, new one that can where they stick around shedding the virus for 42 days or 48 days, you know, we don't know. And one of the scarier things from a public health perspective for me is the recognition that this is an RNA virus, which means that it's going to be harder to create a vaccine because like the common cold, like the rhino virus it slips, it mutates quickly. No, fortunately that has not happened.
Andrew Ball (25:49):
But there is every reason to be worried. And I don't want to freak people out, but there's every reason to be concerned that if we don't kill this thing this year, that it's going to come back every year in a slightly different form, perhaps more contagious, perhaps more stealth, perhaps more deadly. Perhaps it will shed the virus for a longer period of time before we were able to begin working with patients, which kind of gets to that economic effect. I understand that people are hurting. I understand that folks have private practices and cash based practices that have limited cashflow and they're hurting. I totally get that. Yeah. I mean, you know, and folks go, Oh, you don't understand. You work in a situation where you don't own your own practice.
Andrew Ball (27:01):
Well, that's true. You know, I have a significant impact income from teaching. So, you know, I get it. I understand that the dollars are tight, but if you told me that if we shut down for an additional two weeks and we can kill this thing completely, I would do that even if that meant a significant decrease in my salary. And at some point, I think that, and I'm not saying that everyone is a clinical doctor in our profession, I've gotten some feedback for that. But as a clinical doctoring profession, I do think that we have a solemn responsibility to the public in terms of educating on COVID-19 versus kind of filling the Instagram space with Mmm. Lots of home workouts, which are important. People need to keep fit and certainly keep their minds going while they're in quarantine.
Andrew Ball (28:10):
The problem is that there's so many outpatient private practice, cash based PTs that have a such a voice on Instagram that some of this information about just the mechanics of the disease, the physiology of the disease, how long you need to wait in order to protect yourself and your patient from either reinfection or infecting others just isn't pushing through. So, once again, thank you for allowing me to come on this podcast because I do think that those of us who have a voice in that space have an obligation to get some of this information.
Jenna Kantor (28:57):
Wow. Yeah. Yeah. It really, it is very valuable. I want to actually dive in, even though we've been going for a while, I think it is important to dive into now somebody who had the ventilator. Yeah. I think that, that we can't overlook that. There will be some people who've been that unfortunate. So could you talk about what that means with somebody who has been fortunate to recover from such a horrific.
Andrew Ball (29:28):
Sure. So, as I said, about 80% of patients are going to have a mild to moderate and they won't be hospitalized. They may, because of the stress and strain on their lungs, they may develop pneumonia, so they may actually end up, you know, having secondary sputum. But those are folks who, even with the pneumonia are going to have something that we consider a fairly mild case. 20% are going to be severe to critical. And the severe group are the ones who are going to have dyspnea. They're the ones who are going to have rapid breathing that's defined as more than 30 per minute. Their oxygen saturation is going to drop to 93%, and they'll have on a cat scan, you'll be able to see lung infiltrate. That looks like kind of a grounded glass appearance of about 50%.
Andrew Ball (30:30):
So, and then you've got 14% that are severe that fit that classification and about 6% that are critical. And that's respiratory failure, septic shock, multiorgan failure. And within that group, okay 20%, about 25%, we'll end up in the intensive care unit most of which or many of which will end up on a ventilator. And if you end up in the ICU on a ventilator, your chance of survival is about 50%. So what tends to happen with that ventilated population is on roughly about day 14 we talked about how the viral load increases and then decreases while the inflammation increases. Well as the inflammation in the lung increases okay. A percentage of those folks, as I said, will end up roughly around day 15 needing to be ventilated for about four to five days. And half of them will come off and half of them will not. So the people who come off their recovery. So their recovery we don't, again, there haven't been a ton of folks, so we don't know a ton. What we do know is that in severe cases, there's going to be ICU acquired muscle weakness. They're going to have a severe loss of lung function, a severe loss of muscle mass.
Andrew Ball (32:16):
Yeah, we're getting younger too, but just as things been saying percentages. Yeah. neuropathy, myopathy. The good news is, is that we can begin to protect recovery. And the greatest, what we know is that the greatest amount in physical function will be seen. If the patient falls into acute respiratory failure, we'll see that within roughly the first two months of discharged. So that gives us some kind of a gauge. In addition the degree of disability at about a week after discharge determines the one year mortality and recovery trajectory of that individual. So we have some guidelines as far as that's concerned from acute respiratory distress syndrome, right? So that's not necessarily coded, but we believe that we can extrapolate in general what we haven't talked about is the impact on them.
Andrew Ball (33:30):
And the fact that about 30% of family members of individuals with acute respiratory syndrome end up with PTSD. So now you have this group, we're 50% of folks who have been in the ICU have PTSD and 30% those folks have family members who have PTSD. How do you think that's going to go down or like, a lot of them can't go into the hospital, but they can do a FaceTime video. So what they get to see in that FaceTime video with their loved ones in the hospital, I'm talking about after they're discharged. I'm talking about later. Yeah. No, but I'm just saying the family members with the person, I'm like their interaction. That's what I'm referring to, their reaction with it. If you're prone for 16 to 18 hours a day, right?
Jenna Kantor (34:07):
Yeah. So what do you do with these folks when you finally see them? Right. So you're going to have chocolate. Chocolate makes people happy. Right? It's funny, it's funny you say that. I'm doing a webinar with some some other instructors that I teach with and we're kind of talking about the format. And I'm a huge fan of the old school. I love the daily show, but I'm a huge fan of the old daily show with Craig Kilborne. He used to do the thing where he would like ask opinion questions. I'll ask you Reese's pieces or M&Ms no, I'm sorry. The correct answer is eminence. No, I'm sorry you were wrong. No, I would agree. But that's what he would say.
Jenna Kantor (35:13):
He would end with those kinds of questions. Kind of like his version of the James Lipton kind of five questions. What do you hope that God says when you die anyway, we're getting off track. So what I'd like to kind of go through is you're going to have folks that have worked with you in the past. They are post infection. Ah, they’re your dancers, they're your musicians in the pit. They're your directors. They're your loved ones that are going to refuse to see anyone. But yeah.
Andrew Ball:
Right. And of those folks, you're going to need to know what to, you know, what to do. I would say if you hear nothing else from me, remember your vitals and there's, it has to be a Renaissance now of taking heart rate, taking respiratory rate, taking oxygen saturation, taking blood pressure with every patient.
Andrew Ball (36:12):
The functional tests that we're probably gonna have to start using are things like ambulatory distance, which is going to be severely decreased. We'll be lucky if some of these folks are able to walk 300 feet. Some of them, right, if they're severely impaired. You know, that's not far enough to get from your car to a doctor's office. You normally need about 500 feet for that to say nothing of getting back to your daily life and doing your own grocery shopping with which you need at a super target or R or Walmart, you need a good half mile, you need a good 2,500, 2,500 feet. But things like the five times sit to stand test or test that we're going to need to brush up on the six minute walk test. Fortunately we can remote monitor some of those things.
Andrew Ball (37:05):
Tele-Health isn't just you know, getting on a zoom call with somebody tele health, we need to think of that in an expanded way, right? There's apps that will allow for you to do a six minute walk test or your patient to do a six minute walk test and then send you those results remotely from there, from their app. Some folks aren't going to be able to walk for six minutes, right? So at that point we're going to have to back up into feet per second or four meters per second. And we have some metrics for that. You know, we know that somebody who's under 70 at a normal walking pace should be able to walk a good 2,500 feet at a 4.0 feet per second. So, you know, somebody comes in completely deconditioned and they're walking 1.5 feet per second for 500 feet. We've got some work to do.
Jenna Kantor (38:36):
Yeah, totally. Yeah. You know, don't forget about deep breathing, deep dive. And I don't just mean you know the breath, but I mean the breadth, I mean the deep diaphragmatic breathing, bringing it all the way down into your belly, your performers should be well for those dancers who sing, that's huge. That's so huge to reconnect with it, even though that may seem so basic with them before, but have they caught the disease. And, for sure to make sure that starts to get all connected and back in check and not a stressful
Andrew Ball (38:43):
Right. You know, and then I look into things that, Mmm, that as I've spoken with some cardiopulmonary specialist, you know, all of this comes from the European rehab society. I also want to plug the American physical therapy association. I shouldn't have done this at the very top of the of the discussion. But the pacer project, the post acute COVID-19 exercise and rehabilitation program, it is completely free, but it's time intensive. Mmm. You know, they've tried to break things down into 45 minutes or hour and a half lectures, but there's like eight or 10 of them. You don't have to watch all of them. It's free. If you want to get the certification and the CEO's is fine, go through the APTA learning center, but they've put everything up on YouTube and all you have to do is search APTA cardiovascular section and you'll get the the literature. I think a lot of orthopedic sports performance based PTs they're really tech savvy and they kind of want to get the information through podcasts or a like a one hour presentation. So that's, well, essentially what I'm trying to do is to translate.
Jenna Kantor (40:08):
That's what's so great. I mean I'm going to be sharing this in groups as well to keep spreading the information, which is absolutely wonderful. This is good.
Andrew Ball (40:21):
Well, I do add in a couple of things that I've kind of brought to there. Okay. So some of their attention and because they're kind of case study oriented, they're like, well, we're really not teaching that. But particularly for it can't hurt. And particularly for performers humming and I don't mean like humming a song. I mean a long, deep droning
Andrew Ball (40:52):
There's evidence to suggest that it temporarily increases carbon dioxide and it temporarily increases nitric oxide. And in so doing leads to temporary base or dilation, so it can't hurt. I don't know how long it actually lasts. Certainly the deep breathing and increasing walking distance and walking speed is more important. But if you're bored and have nothing else to do while you're in quarantine humming is probably not thinkers would appreciate that.
Jenna Kantor (41:28):
They'd be like, yeah, for sure. That will be a vocal way for them to get that all connected. Also nasal, yeah, there's a lot of stuff with training and staying vocally fit, if you will. So that would actually speak to there values.
Andrew Ball (41:44):
Yeah. Yeah. I could go into a lot more here. I just want to make sure that that folks have a good kind basic understanding here. You know, we've heard, you know, wash your hands, wash your hands, wash your hands. So I'll make a plug for wash your hands, wash your hands, wash your hands. And even in some other countries where the health care workers understood the severity of COVID-19 the healthcare workers seem to be a risk to themselves because they didn't properly and thoroughly and frequently wash their hands. I would say whatever you think you're doing, it's probably not enough. Okay. The other thing that I would say about the hand sanitizers that we tend to use the world health organization and FDA suggest 75 to 80% alcohol.
Andrew Ball (42:50):
And that is not what most clinics have. Most have like the foam sanitizer or the like the Purell, which is 60%. Okay. You know, plugging performers amazing, okay. Guitarists, my performance Buddha and spirit animal is Ron Bumblefoot fall who is in the band spun. Do you know who that is? No, it's not the name. He's in sons of Apollo. He was the lead vocalist for Asia this last tour. And those of you who love guns and roses he was the guitarist the main guitarist on the last guns and roses album. Chinese democracy is ridiculous as a player and he's amazing as a teacher as well in any of that. He also has a line of hot sauce and one of the, and I just love when performers do this and kind of take responsibility for the position that we're in, but a Unitedsauces.com which is the distributor that he works with has retooled one of their lines to put out hand sanitizer that is 75 to 80% alcohol.
Andrew Ball (44:20):
So that will in fact kill the Corona virus. So, Mmm. Great. Local company here in Charlotte. Highly, highly recommend and plugged them. Hey, you want to support a performer you know, during these times. And the last thing that I will leave folks with is as you are working with patients post infection, ask yourself, do you need to put your hands on this patient? Can this be done remotely? And I'm really more talking you know, it really more talking to the folks who do outpatient work, who have their own side hustle who do work in a healthcare system who are going to be pulled inpatient, right? You know, either somewhere like New York city where you are. And folks have to be kind of pulled in, you know, right down to the rural hospital you know, in the middle of nowhere.
Andrew Ball (45:32):
And there's two physical therapists, one inpatient, one outpatient, and they need help working because now they have more folks that are getting ill. You know, really ask the question, both inpatient in your cash practice, in your private practice for the sake of killing this thing. And for the sake of decreasing whether or not you're a force vector, do you need to provide that treatment? And is there someone else who can be your hands? Can you delegate that to a nurse? Can you delegate that to a family member? I really think that we're going to a friend of mine who runs another podcast Adam Meakins, has been talking about physical therapy in terms of AC DC during COVID and after COVID. And I really think that all areas of practice are going to change as a result ranging from the little things that I just talked about, you know, having to do vital signs with everybody right down to really asking the question, can I go from an interdisciplinary model of care to a transdisciplinary model of care?
Andrew Ball (46:58):
Can I let go of that professional boundary and ego. And I know that a lot of my contemporaries are not going to be comfortable with that. I think we have to be secure in the knowledge that we have more than the hands that we place on people. It's all important, but I do think that there's going to be a paradigm shift.
Jenna Kantor (47:30):
I love it. Thank you. So, for coming on, Drew, this was an absolute joy. Where can people find you and reach out to you either on social media or email?
Andrew Ball (47:39):
Well they can reach out to me. I'm on Instagram @drdrewPT. They can email me at drdrewPT@gmail.com. If I don't respond, I have a ton of spam filters. So don't be shy about reaching out to me through social media. But I really want to make it clear. I'm not the expert here. The true experts, you know, are people like Steve Tepper Ellen Hilda grass Angela a beta Campbell Telia polic you know, these are the folks that we really should be talking to are Eric. And if you really want more information, I'm happy to direct people to it.
Jenna Kantor (48:37):
That is helpful. Yeah, absolutely.
Andrew Ball (48:39):
The Easter projects, the post acute COVID-19 exercise rehabilitation project is really where folks want to go for more in depth information from physiology to post acute through the entire spectrum of post acute care.
Jenna Kantor (49:00):
Absolutely. Thank you. Thank you. Thank you for coming on. You guys give a big shout out to him if you have seen this, just so he can really see how he has impacted so many. Thank you so much for coming on, Drew. Have a great day, everyone.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Elizabeth Santos on the show to discuss burnout among new graduates. Elizabeth Santos is a Physical Therapist, Naturopathic Practitioner and Author of 'New Graduate's Guide to Physiotherapy: Avoid Burnout and Injury, Build Resilience and Thrive in Clinical Practice’ an academic style of book designed to be a supplementary text for final year students and new graduates. Elizabeth has a special interest in maternity health care and works for a talented team of physiotherapists in a musculoskeletal private practice that focuses predominantly on running and sports, pelvic floor health and pregnancy and postnatal care. She is also an active member of the Australian Physiotherapy Association, and a member of the University of Adelaide Physiotherapy Advisory Board.
In this episode, we discuss:
-Are new graduates prepared for clinical practice?
-Why new graduates are most at risk for burnout
-The signs and symptoms of burnout
-Elizabeth’s book, New Graduate’s Guide to Physiotherapy: Avoid burnout and thrive in clinical practice
-And so much more!
Resources:
Elizabeth Santos Facebook
Elizabeth Santos LinkedIn
Elizabeth Santos Website
New Graduate's Guide to Physiotherapy: 10% off with code: hwspodcast
A big thank you to Net Health for sponsoring this episode! Learn more about Secure Videoconferencing and Text Messaging for Telehealth.
For more information on Elizabeth:
Elizabeth Santos is an Australian physical therapist, naturopathic practitioner and author of ‘New Graduate’s Guide to Physiotherapy.’ Elizabeth completed a bachelor of physiotherapy at the University of South Australia in 2006 and then went on to work across a range of clinical areas, from acute care within the public hospital system, to aged care, rehabilitation in the home, and musculoskeletal physiotherapy where she now works exclusively. She has a special interest in maternity healthcare and works for a talented team of physiotherapists in a clinic that focuses mainly on running and sports, pelvic floor health and pregnancy and postnatal care. Elizabeth also completed a second bachelor degree in Health Sciences – Naturopathy in 2014 so that she could provide a holistic and integrative approach to her clients. Elizabeth is an active member of the Australian Physiotherapy Association (APA) and member of the University of Adelaide Physiotherapy Advisory Board.
During her career, Elizabeth became curious about the pervasive burnout she saw in the profession so she spent seven years reading literature on the subjects of injury, attrition and burnout in physiotherapy. Elizabeth has written an academic style of book that is full of the latest research to guide new physical therapists and is designed to be a supplementary text for final-year students and new and recent graduates.
The book covers key areas of clinical interest for new graduates, including how to successfully gain employment, find a mentor, understand insurance and medico-legal requirements, build relationships with clients and colleagues, and learn how to work through professional challenges as they arise.
Elizabeth provides one-to-one mentoring for new graduate physical therapists and also hosts in-person and online workshops for helpers and health professionals who wish to prevent burnout, build resilience and truly thrive in the roles they have chosen. She believes that when we take good care of ourselves we can be of greatest service to others.
Elizabeth’s intention is to help new graduate physiotherapists truly thrive in those first years of clinical practice and beyond.
Read the full transcript below:
Karen Litzy (00:01):
Hi Elizabeth, welcome to the podcast all the way from Australia. I'm so happy to have you on the program.
Elizabeth Santos (00:08):
Thank you for having me.
Karen Litzy (00:09):
And now a couple of weeks ago, this is just for the listeners, a couple of weeks ago, I interviewed Tavana Boggs on burnout and physical therapy and she was talking about some of the clients that she works with and yeah, we were sort of centering the talk around people who are 12 to 15 years out of physical therapy school. They've been practicing for a long time. So today we're taking a different take on burnout. So today we're going to be talking about avoiding burnout as a new graduate. And Elizabeth has written a book, new graduates guide to physiotherapy, avoid burnout and injury and build resilience and thrive in clinical practice. So we are going to talk about burnout with new grads because sadly it's a thing.
Elizabeth Santos (01:01):
Right? It is, it is. It's a thing.
Karen Litzy (01:04):
I wish it weren't, but it's a thing. So go. So talk about why you took the steps to write this book in the first place.
Elizabeth Santos (01:14):
Thank you for the introduction. And look. Firstly, I want to say it's a really exciting time to be a new graduate. I think there's so much opportunity for new graduates and for physiotherapists right now, particularly. I wrote this book last year. It was published. It really was the culmination of lots of reading and research over many, many years and actually took me seven years to put it all together. From the moment I started taking notes in the clinic one day just on some letterhead and I thought, Oh, you know, what's going on here? What's happening in the profession? I was curious about the burnout that I saw and also attrition. So physiotherapists leaving the profession because they were feeling unhappy or not really wanting to continue for some reason. I actually looked into some research on this and found a study from Curtin university in Perth, Western Australia. And that study showed that up to 65% of the participants interviewed who were new graduates anticipated leaving within 10 years. It was so, I thought, what's going on here? You know, why is this so high and what can we do about that?
Karen Litzy (02:33):
I mean that does seem very high. So they've just graduated and they already have the plans to get out of the profession.
Elizabeth Santos (02:42):
Yes, it was quite an alarming study and I've seen it those results actually communicated at conferences since and people bringing it up as a real talking point. Within the same study they found that 25% of participants predicted a long term career in physio therapy. So there were some people who were saying, you know, I am going to stick this out and I do see this as a long term plan, but not as many as you'd expect at that point in their studies. You'd be expecting them to come out fresh and excited and ready to take on the world.
Karen Litzy (03:17):
And what do you feel that it is a lack of readiness? Are they not ready for clinical practice? Are they not ready for the real world? I mean, what are your thoughts on that?
Elizabeth Santos (03:30):
That's a great question because that's also something that's been looked at in the literature a lot in Australia particularly, you know, that sense of our physio therapists actually ready to step into the real world and step into their shoes. As a clinician, you know, we try to make sure that physical therapists have adequate clinical placements and exposure to different areas of physiotherapy because we know that helps them to make decisions about their career pathway. You know, they've got that knowledge to draw on when they're choosing their first job or their second job. But there are other things that can help physio therapists prepare and feel job ready. So some of the things that have been highlighted in Australian research where that physios who have as students had experienced in sporting teams or had additional training in radiology. So people who've gone on to study and look at scans in a bit more detail, have had good experiences with that and that's inspired them to go on and perhaps work in orthopedics or musculoskeletal physiotherapy.
Elizabeth Santos (04:43):
We've also found that practicing building a supportive relationship and mentorships with colleagues, but also with other professionals. So whether that's social workers or psychologists or doctors and other allied health professions, that's become something that's really big. And there's lots of research behind that now as well. And just, you know, starting to think about which areas might interest you and what professional development you're going to go down. Which pathway are you going to go down once you graduate? And there's more and more internships which are becoming available too, which are privately operated internships through private practices and things. But yeah, so there's some of the things that new graduates can do to sort of help themselves feel that little bit more prepared and job ready.
Karen Litzy (05:32):
And so what I'm hearing is, you know, getting some inspiration from your placements, getting inspiration and that can come from different places, right? That can come from a mentor, like do they mention finding a good mentor, whether that be within your Institute, your educational institution or outside of, within the profession. Does that help with burnout?
Elizabeth Santos (05:57):
So there is some research to show that mentoring actually helps not only the new graduates, so the fresh physiotherapists coming through, but it actually helps the more experienced ones as well. It helps them to develop a sense of meaning in their work. So finding the right mentor is really crucial and I think for new graduates and for students really, you know, they've got that mentoring in built beautifully in the undergraduate training programs. So they've got these really inspiring, highly qualified, highly skilled therapists teaching them, taking them through step by step. And it's a really important relationship. But then when they become a new graduate, they suddenly lose that sense of being protected by the university. You know, they're out in the real world. It's like leaving home for the first time, you know, it's a little bit scary being out in the world.
Elizabeth Santos (06:52):
And then they've got to find mentors in other ways. And so there's two ways that you can go about finding a mentor and one is to have a mentor who's actually got really more of a vested interest in seeing you succeed. So they're the ones who probably your employer because they're going to want to see you grow and they want to see you help clients and they want to see you do the best that you can because it's going to be beneficial for you and it's going to be beneficial for the practice. But then there are other people who become mentors in your life because they've got some sort of interest in seeing you thrive as well. So it might be someone who's a family member who's a physical therapist or someone who's been an educator, but then you've formed a relationship that's perhaps, even outside the university, which does happen too with different training programs and things. So I guess it is a really important piece of the puzzle and something that, and new graduates can, you know, definitely look into and find someone who's gonna help them.
Karen Litzy (07:59):
Yeah. Yeah. And, one thing that I found very interesting from a conversation I had a couple of weeks ago about sort of helping new graduates find a roadmap for their career is to really be very clear on what your vision or what your individual mission statement is. Mmm. And it's hard, right? You really have to do some soul searching and find out what is your mission statement. And this is from Tracy Blake. She is a physiotherapist in Canada and she suggested that everyone have a mission statement and that that mission statement should not have jargon in it. It should not have physical therapy jargon, right? So you want to try and find what your mission is even as a new graduate. Write your mission out, repeat it over and over again.
Elizabeth Santos (08:53):
Tell it to people. So that becomes real.
Karen Litzy (08:56):
And I think that will help you gravitate towards the right mentor.
Elizabeth Santos (09:02):
Fantastic. I really love that. That's a great idea. And something that's really practical that the listeners who are tuning into this podcast can actually sit down and do it is it aligns with something that I read a while ago about new graduates and is actually in the book and I can't find the source unfortunately, but it was to picture your list in two years time and work towards it now. So if you can actually start, you know, that sense of who do I want to work with, what kind of clients really light me up, you know, who do I feel called to serve? And being okay with that changing over time as well and knowing that through different phases of your life. It, it may change for a little and that's okay. It was actually an experienced physiotherapist. I've just had a flash of the face where that quote came from, so I can't give him credit by name, but
Karen Litzy (10:06):
But that's fine. He'll know when he listened to that it was him. Yeah. And I always find that I love that you said it may change and morph over time because I think what gives people a lot of stress is that when you graduate, like let's say you say, I'm going to work with children, this is what I want to do, I know it, this is going to be my life's work. And then you start to work and you're like, you know, I kind of like working with athletes, I kind of like working with pregnant moms, moms to be right.
Karen Litzy (10:42):
I think to avoid some burnout and avoid some guilt, you have to give yourself permission to change because if you don't, I feel like you're carrying this baggage with you and can’t that also contribute to burnout. Especially if you're a year or two out and you're like, Oh wait a second, this isn't quite what I thought it was going to be. I kinda like doing this. But I said I was going to do this and now I guess I have to do it right. And I'm sure you've heard that before.
Elizabeth Santos (11:10):
Absolutely. And so knowing that the path will unfold step by step, job by job, and you may not be in the same role for 20 years if that doesn't feel aligned for you. And that's okay. And it's that sense of knowing and trusting, which yeah, it's just something that you cultivate over time and have to feel confident in. But it's hard in the beginning because I've heard a lot of new graduates say to me that they're concerned that if they take this first job in aged care, or if they take this first job in musculoskeletal private practice, then they're locked into that, you know, and there's no way out and there's no, and if they want to change their mind and do this, and quite often it's me then encouraging them just to make a decision. And I never you know, I never really help anyone to make a decision.
Elizabeth Santos (12:04):
I just help them to sort of look inside themselves and make lists of the things that light them up and like we've discussed. So that mission statement kind of idea is going to help them find the right path and then reconcile that and you know, and back themselves and go for it.
Karen Litzy:
Yeah, I think that's great advice. And now in the book, Mmm. You also say that burnout as we are talking about is an issue for new physiotherapists, right? So we talked about some things that maybe they can do, but let's back it up. Why are they at risk for burnout if they haven't even started?
Elizabeth Santos:
Hmm, good question. Because burnout is something that we know about and we've all talked about. We've heard about it, we've read articles, there's a huge body of research looking at burnout among nurses and doctors and psychologists.
Elizabeth Santos (13:04):
And there is a relatively smaller but growing body of research about burnout in physio-therapy too. And we know it's because there's parallels between those professions. And because physiotherapists in direct patient care, really with clients every day lots of different people from all walks of life. And there's lots of different social and psychosocial elements that go along with that. But on top of the therapeutic relationship that you're building with clients and all of those things, new graduates are juggling seeing more clients than before as well. So they might've been able to cope with seeing and processing, you know, the pain or the stories of three or four patients in one day. But then when they've got to do that for 20 or in some hospital environments and clinics, even more than that with classes and things, you know, it can take its toll. And so navigating that professional work environment and even for physiotherapists, you know, navigating their own personal processing of that can the mental load and it can add up to burn out.
Elizabeth Santos (14:15):
So I guess we can also hypothesize that new graduates are really trying to put their best foot forward too and they want to work really hard and they want to be as good as they can for their employers. So they're going to be at risk a little bit there too.
Karen Litzy (14:52):
Yeah. So it's a lot of external and internal pressures. Yeah. That kind of happened all at once. Right? You graduate and all of a sudden, boom, you've got all of these pressures from the outside. And how do you deal with that mentally and emotionally? And it almost makes me think that there should be a, maybe there are, I don't Sort of mental health support groups for new graduates so that they can almost like an alcoholics anonymous, right? So they can go in and discuss the things that are causing them to have these feelings of burnout. I don't know if that exists. Do you know, is that a thing?
Elizabeth Santos (15:09):
It doesn't to my knowledge, but it sounds like a great idea, you know, just that community. And look, I think there are some communities on Facebook that we possibly don't know about because we're not new graduates. And I do know of some student association groups and we certainly have some great new graduate programs through the professional association in Australia in terms of building those support networks in. So, you know, that's up and coming as well, which is really exciting.
Karen Litzy (15:46):
It's definitely a growth area. Awesome. All right. So let's talk about what are the signs of burnout? So signs of burnout. Let's say if you're the new grad or let's say you're someone like me who's been out for quite some time, can I see these signs of burnout in new graduates? So go ahead.
Elizabeth Santos (16:07):
Yes, you can definitely see signs of burnout in people. And I think it's important to differentiate signs and symptoms just like you would if you were, you know, a medical practitioner. Even as physiotherapists, we do look at those things separately. So the signs would be seeing that reduced employee engagement. So perhaps loss of enthusiasm for new projects or for jobs that you're given. Perhaps less willingness to contribute. A sense of lack of transparency around how you're really feeling or what's really going on for you. So quite often new graduates will try and hide their emotions a little bit or hide that vulnerability and just put, you know, hold their chin high and keep going instead of being honest about where they're actually at. If we look at symptoms, they're actually the things that you're feeling as a physiotherapist. So whether you're a new graduate or an experienced physiotherapists, they're going to be quite similar.
Elizabeth Santos (17:13):
So they will be things like fatigue. It's going to be different for everyone, but you might get headaches or you might feel nauseous at work or you might have a sinking feeling or that sense of dread about going to work. For some new graduates I've spoken to, they've even been in tears in the car going into the job in extreme cases where they're feeling not supported in their workplace or they're feeling like they want to quit or leave that particular role. So it's actually coaching people through those feelings, those emotions because they're the symptoms. You actually manifest in the body. But then there are the signs which are those bigger picture things which people on the outside looking in tend to see. If we look a little bit deeper, we can actually look at some of the research around this and look at the validated tools which have been used to assess the burnout in society.
Elizabeth Santos (18:13):
So particularly in the health professions, the mass like burnout inventory has been used. And this is a 22 item outcome measurement tool, which takes about 10 or 15 minutes to complete and it's been considered the gold standard since it was created in the 1980s it's obviously been updated since then and there are now five different inventories which are used across different settings. And they're used in the research a lot because they contain some great questions which respondents can answer. So things like I feel used up at the end of the day and you would score that with never being a zero through two every day being a six. And there's different subsets within the outcome tool so you can score each subset or each part of it. And what it does is it actually provides some information for people who are looking at burnout in different populations and it helps to categorize them into three distinct categories.
Elizabeth Santos (19:17):
So the first one is emotional exhaustion, which is where physical therapists become depleted and they might be starting to feel a bit fatigued or some of those symptoms I mentioned. And this then leads to that second stage of burnout, which is called depersonalization in which the physiotherapists stops empathizing as well as they normally would and they might even start to become detached from their clients or show signs of cynicism, which is unfortunately not a good sign as a practitioner if you're having a dig at clients or locking them in some way. Yeah, it's a sign of burnout and then that third stage, yeah, it's reduced personal accomplishment. So for new graduates this might look like, you know, compromised standards of care or reduced sense of personal achievement. Then starting to wonder if they're even a good physio at all, if they even know anything at all. And that kind of ties in with the imposter syndrome and you know, that sense of being a fraud, which I talk about in the book as well, that these are all things that you can look at if these signs are starting to emerge and take some action, talk it through, find some strategies.
Karen Litzy:
And I was just thinking as an employer, is this, let's say doing this Burt, the mass, like burnout, inventory, giving this to your employees, is that a good or a bad thing?
Elizabeth Santos (20:49):
I can a great question. I can't quite put my finger on that. It could go either way, couldn't it? It could, right? It could go either way. And sometimes just sitting down and having those honest conversations and actually you don't necessarily need to ask your employees if they're feeling burnt out, but you can check in on engagement and check in on, you know, are they feeling inspired? Do they have enough to work on? What kind of clients do they want to be working with? Looking at the personal mission statement stuff, sharing wins, you know, that's a big one. That sense of positivity. And that's something we do in the clinic a lot as a team, which is fantastic.
Karen Litzy (21:31):
That is fantastic. And, and I would imagine that all of that just becomes, just gives that new graduate, especially a sense of being taken care of. We spoke a little bit beforehand and we talked about the word comfort. So I can only imagine if you're the employer, if you're the more experienced, even if you're not the employer, if even if you're the more experienced physical therapist in the clinic or in the hospital and you're just checking in with people on a weekly basis, ask them, how are you doing? How can I help? What do you need help with? Are you stuck? I can only imagine that it would give, cause I know when people check in on me, it does give me a sense of comfort like, Oh, this person's in my corner. This is great.
Elizabeth Santos (22:16):
Yes. It's just that caring approach that we have to our clients that we need to then reflect out into the world, you know, for our team and checking in on people is a beautiful way to do that. And then extending that care to ourselves as well. So going, am I okay? Actually, no, I'm not. What's going on for me? What do I need to do about that? How can I take responsibility for changing that with the support of my employer?
Karen Litzy (22:44):
Yeah. Yeah. So again, we go back to having that both internal and external check-in, which seems to be a theme here. Okay. So what other big issues do new graduates face at the moment? So just so people know, we are recording this, it is in the middle of the covid-19 pandemic and there are changes in health systems, changes all around the world. How will new grads be affected by this?
Elizabeth Santos (23:15):
I think there is a level of uncertainty about the impact of covid-19 across the board at the moment. And we can hypothesize that the current situation is going to impact on physiotherapists who are final year students who are graduating out into the world. They're going to be unsure about what's available for them, you know, where they're going to be needed. Certainly clinical placements are going to be impacted. This at the moment, and this is something that I know in Australia we're working really hard on the Australian physiotherapy association as part of their advocacy role, which is wonderful. Just protecting those and making sure that we've got those roles for physiotherapy students and that they're getting all the experience they need because they do need that experience. I think we're going to see some really positive things in terms of the workforce because we're going to see more jobs.
Elizabeth Santos (24:13):
So it's actually a really positive time and a really exciting time to be a new graduate physiotherapists. So if you can look at that and think, you know, we are going to need therapy physiotherapists in key roles in assessment and treatment of injury both in the community, in the hospital setting, helping to increase or facilitate discharge I should say, and making sure that, you know, clients are actually, patients are leaving the hospital system in due course. You know, we really need those beds and the staff to be looking after people who of all walks, you know, they're still going to be in the hospital system, but yet really we need physiotherapists on the frontline as essential workers. We're seeing a huge uptake in telehealth at the moment, which is also really exciting. And that's because of the social distancing policies that are being put in place. Well clinics and hospitals remain open. Some people are still having services in those clinics and in the hospitals, but there is a large movement towards the telehealth sphere. So this is something really exciting that new graduates can learn about and put into their toolkit for use now and into the future as well.
Elizabeth Santos (25:34):
I don't see tele-health going away when social distancing rules are lessened. So I think as a new graduate it is really exciting to be able to have so many options. And because of the pandemic, all of these people who are sick and who are recovering, they're going to need our help. You know, like you said, we are essential and I think that as a new graduate that really at this point, yes, there's a lot of uncertainty but there's uncertainty across the board. But I don't think that new graduates have to be in great despair at the moment. I understand, you know those final year students who like you said, are trying to get their clinical placements, which is all over the place and just graduate for God's sakes are having a lot of stress at the moment. But I agree, I think that physical therapists or physiotherapists are in a unique position here to really show up and be part of the team.
Karen Litzy (26:44):
Earlier you mentioned being part of the team of physicians and nurses and doctors and psychologists. I mean we are going to be an essential part of that team. So hopefully if the research shows that being part of a team helps with burnout, it'll help with our new graduates now.
Elizabeth Santos (27:02):
Absolutely. And there are those vulnerable groups and vulnerable patients who are really going to need the support that physiotherapists have to provide and anyone in the community who's wanting to keep their exercises going and do those online classes and all of those opportunities which are unfolding. It's a great and exciting time to be part of the profession.
Karen Litzy (27:23):
I can't agree more. And now how can new graduate physios keep confident and keep positive? Right now we've said, Hey, it's, you know, it's not like it's a horrible time to be a PT, but how can they keep confident, positive and take care of themselves?
Elizabeth Santos (27:42):
That sense of reassurance I'd like to really impart, you know, just for new graduates to keep taking care of themselves. It's those simple things that they can do, like making sure that they keep their nutrition up and exercise and really try and inspire themselves at the moment and look after themselves and get plenty of sleep and those basic things which are useful for anyone to be honest. Because we all need to be practicing good sleep hygiene, keeping off our phones or having some boundaries around social media and the news and just looking for jobs, getting support with looking for jobs if they're in that phase, reaching out to a mentor, a debriefing if they've just started in a new role this year. So making sure that if things feel overwhelming or if they're unsure that they're asking for help and that they're asking questions and that they're supporting their teammates as well. You know, every country is going through lots of changes and there are some really sad and heartbreaking things happening in the world and we can't look away from those and we can't ignore them, but we can stay still keep moving forward as individuals and as a profession and feel hopeful about the role that we have to play.
Karen Litzy (29:01):
Yeah, I agree. And I think that was very well said. Now Elizabeth, let's talk, can you talk a little bit about the book.
Elizabeth Santos (29:09):
Good, thank you. I am really excited to reach as many new graduate physios who need this reassurance and this support the people who are looking for that sense of comfort or unsure about which role is right for them. So it's a mentor in your pocket style of book, which has an academic undertone. So there's lots of research in there. But then there's some light and funny comics which I had commissioned as well to kind of make it a little bit more enticing read so it wasn't dry because if it's too evidence heavy it can sometimes be hard to sift through. But our physiotherapists are good at that and it's designed to help you navigate all of the tricky areas as a new graduate. So things like negotiating a contract, building therapeutic relationships with clients, how to find the right mentor, how to choose professional development.
Elizabeth Santos (30:11):
So what you should be doing versus what your employer perhaps thinks you should be doing or what you know based on your mission statement I think is a good way to choose. But it also talks about the highs and the lows that you might experience and the mistakes that you'll probably make, which are part and parcel of being a physical therapist and then how to put all of that together and sort of trust the journey as it unfolds and build resilience over time. And it's written in the third person. So as I said in that sort of academic tone, but then there are some simple questions, journal prompts at the end of each chapter that you can workshop as well. And I'm happy to support people through because I think it helps to have that self reflection and actually to write some things down and go, what is working for me and what's not and what am I having trouble with here?
Elizabeth Santos (31:04):
So it's designed to help them kind of workshop and for it to be a little bit like a Bible for that first year or two. So if they have a really rough day, they can actually go home and flick it open to that chapter and go, okay, what happened here? What could I do differently? How could I learn from perhaps some of the mistakes that are talked about in the book, you know, and how can I integrate this and move forward and get the best outcome for myself and for the client, for the practice, for the team if I'm in a hospital or wherever I might be.
Karen Litzy (31:37):
Nice. So it's more than just a once read and done. You can go back to it and kind of use the tools in the book over and over again, which I think is great. And just for all the listeners for a limited time, Elizabeth is offering a 10% discount on her book when you use the code HWSpodcast at checkout. And we'll have her website, which is ElizabethSantos.com.edu over at podcast.healthywealthysmart.com and we'll splash it across social media. So we'll make it really, really easy to do this. So again the discount code is HWSpodcast. So Elizabeth, I've asked the same question to everyone at the end of each interview and I feel like in this particular episode it is the perfect question to end with. And that is knowing where you are now in your life and in your career, what advice would you give to yourself as a new grad?
Elizabeth Santos (32:37):
It's a lovely question. Funnily enough, I taught to my younger self a lot when I wrote this book because I needed her insights and I needed her stories and she had a lot of wisdom to share, which I wove through the book. And it wasn't just my experiences, it was all of the experiences of all the physiotherapists I'd ever known and spoken to. So it was a real collective of wisdom and inspiration that went into the book. And I'm grateful for that. And it's a nice moment to thank all of those people who were part of it in some way because it's created a meaningful resource. But if I could go back to 2006 I would say congratulations. And I know how excited I was at that time. And I would probably say straight up, listen, you're going to make some mistakes, you're going to make a lot of mistakes and you're going to really want to beat yourself up about those.
Elizabeth Santos (33:38):
And you're going to question the choices you've made in therapy and in your career. And you won't know if you made the right choice, but you'll have to back yourself and you'll have to know that you are enough and you have got a lot of knowledge to share. And you know, it's student experiences and it's life experience as well. So I always encourage new graduates to really draw on everything they have and know that they're always going to be in some small way, the expert in the room, you know, even if you think you don't know anything you actually do and you can draw on, okay. That strength and that knowledge in those moments. But I'd also really offer some words of comfort because it's hard to know if you're doing the right thing and it's hard to know if you've made those right choices.
Elizabeth Santos (34:30):
I'd tell myself to take some regular holidays too because I know I didn't do that enough in my first couple of years, so yeah, but just knowing that you can inspire others and that you can inspire yourself is probably the biggest and yeah, it's a really exciting time for all the physios out there and I hope that they can find some inspiration in this podcast and in these answers.
Karen Litzy:
Thank you. I'm sure they will. And now, Elizabeth, where can people find you on social media?
Elizabeth Santos:
So on social media, they can find me at whole living with Elizabeth Santos, which is my Facebook page, but the website, ElizabethSantos.com.edu probably has the most amount of resources and it has links to my new graduate mentoring and people can connect with me through email that way. And I do actually have a free chapter of the book available. If you want to jump on the email, you can do that and I'll send you a chapter to read and get a bit of a feel for what the book's about.
Karen Litzy (35:38):
Perfect. Well thank you so much. This was great and I just know that I think it will give new graduates inspiration. I think it will give new graduates a sense of comfort and of confidence as they go out into the world. So thank you so much Elizabeth. This was great. And to everyone listening, thank you so much. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
In this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jason Van Orden on the show to discuss personal branding strategies. Jason helps thought leaders to reach a larger audience with their ideas, create new income streams from their expertise, and build business models that align with their values and goals. As a consultant, trainer, and strategist, he draws from more than fourteen years of researching top Internet influencers and experimenting with his own personal experience. His experience includes creating multiple successful brands, launching over 60 online courses, teaching more than 10,000 entrepreneurs, generating seven figures in online course sales, and 8 million downloads of his podcast. His mission is to help visionaries with impactful ideas to connect with the people they serve best and the problems they can most uniquely solve.
In this episode, we discuss:
-Three keys to good brand positioning
-How to overcome imposter syndrome and position yourself as an expert
-The magnetic messaging framework
-The compounding effect of your impact on the world
-And so much more!
Resources:
Jason Van Orden Website
Jason Van Orden Facebook
Jason Van Orden Business Page
Jason Van Orden Twitter
Jason Van Orden LinkedIn
Jason Van Orden Instagram
Impact Podcast
Free Gift: https://impactdownloads.com/messaging
For more information on Jason:
Since 2005, Jason has worked with over 6000 students and clients, teaching them how to monetize their unique brilliance with content marketing, scalable courses, and automated sales systems. Many of his and students have built multi-million dollar businesses and have become top authors, bloggers, podcasters, and speakers in their field.
In September of 2005, Jason co-founded the first ever podcast about internet business and online marketing. It quickly became one of the top business podcasts in the world. To this day it’s one of the most profitable podcasts on iTunes — having generated millions of dollars in sales directly from his podcast.
Jason has spoken around the world at some of the biggest conferences (such as CES, National Association of Broadcasters, New Media Expo, and many others) teaching how to use Internet media to launch and grow influential personal brands. In 2006, he wrote the bestselling book, Promoting Your Podcast, in which he was the first to “crack the code” for optimizing podcasts to get maximum exposure on iTunes. His work has been used to teach marketing at the university level and has been referenced on sites such as Forbes.com and Entrepreneur.com. He also practices what he preaches, having created world-class, influential brands of his own.
Read the full transcript below:
Karen Litzy (00:01):
Hey Jason, welcome to the podcast. I am so happy to have you on today.
Jason Van Orden (00:05):
Well it's great to be here. Karen, thank you so much for having me.
Karen Litzy (00:08):
Yes, and as you know, I've been a fan of yours for a while and as my audience knows, I actually took your course on how to kind of juice up your podcast last year and I thought it was super helpful. So I want to thank you for that and I sort of raved about it to my fans on social media and here in the podcast. So it's such a, it's going to be so great to have you on today. So, yeah, thanks. And today we're going to be talking about if creating an irresistible brand and then once you have that brand, how do you create sources of income? Because of course we all want to make a living, we all want to help as many people as we can while we're doing it. But the first question I have for you is, what is your definition of a irresistible brand?
Jason Van Orden (01:04):
Sure, yeah. Good question. So in the work that I do, you know, I work with people who have expertise that they want to get out there in a bigger way and you know, some kind of message, some kind of stories. So you know, they really want to be recognized or known or even just increase their own ability to help and impact and reach people with what they do. So just to let people know, I'll be talking mostly in the vein of what a personal brand is. I know sometimes we would hear a brand and we think like Coca Cola or AT and T and certainly there are much bigger brand companies as well, but we also don't want to confuse it with brand identity like logos and like your letter head. And certainly, you know, those are assets that get used in order to maybe establish a recognition of a brand.
Jason Van Orden (01:49):
But really, yeah, what we'll be talking about and how I define as much more about like how are you perceived in the marketplace, especially by those that you want to reach and do business with you, you know, the people that you want to serve and that you want to perk up, pay attention, and listen when you've got something cool to share or sell or you know, offer as help. So, it has to do with, you know, them seeing, you know, here's who you are, here's what you do, here's who you help and here's what you have to offer to them. And hopefully those perceptions are accurate and complete and compelling so that you successfully can get their attention and move them towards doing business with you. So that's kind of an in brief how I would make some of the specifications of the word brand to make sure that we're clear about what we're talking about.
Karen Litzy (02:38):
Yeah. And I think that's really helpful because I think you're exactly right. When people think of brands, they do think of those big international, huge brands, like you said, Coca-Cola, Nike, Apple, which is certainly a brand. But I think for the sake of the audience listening to this, they want to know about that more personal brand identity that you were talking about. So let's talk about how to create that. So how do you create this sort of irresistible brand that you want your ideal customers, you want to be perceived as something that is so necessary for them. How do you create that?
Jason Van Orden (03:21):
So yeah, there are three pieces to having a good brand positioning. And, and by position, I mean, again, establishing that place in the marketplace that you want to sit. And so the first is to know like, okay, well here's who I ideally want to reach and serve and being very clear about that. I mean, there's an example I use for instance, digital photography is, I have a recently a client I was working with, who wanted, you know, a successful digital photographer wanted to get out there and help other digital photographers. You know, had great career, great clients and projects and things, and he knew there are a lot of people who kind of knew his work and wanted to be, do some of what he had been able to accomplish. And so, you know, I was like, okay, great.
Jason Van Orden (04:09):
I want to build up my brand more and not just you know, do this. This work where I got hired to go and do thermography and digital photography. And so I said, well, we need to get very clear about who do you want to help with these skills. Is it the already established professional? Is it the somebody who wants to make that jump now to being a professional, you know, they've studied and they've, you know, pretty serious hobbyist or something. Or do you want to help people who just have an iPhone and wanting to take more beautiful pictures with their iPhone? Like these are all different audiences, but under that umbrella of digital photography. So it's being very clear. And sometimes that's specifying a specific demographic though it needs to go. I think even in much, much deeper than that.
Jason Van Orden (04:51):
And you know, are there certain age groups, but the biggest thing to really understand is what are the outcomes or results that you want to help them to reach? I think it's really important to define the target customer, the intended customer in that way. Because when it comes down to it, I mean their age and their gender or these different things might help you if you're running ads and want to know where to reach them. But really ultimately the way you want to define them as it's like, Oh, these are their unfulfilled needs. These are what are the things they're actively looking for. These are the pains they're experiencing or the goals that they haven't met that they would like to meet. And those are the things that I can help them with, which is the second piece.
Jason Van Orden (05:35):
Once you know the ideal customer that you want to reach and serve, the second piece is, Okay, well how do you want to serve them? What are you going to deliver if you are there specific ones of their pains that you want to help them with or the unfulfilled goals that you want to help them with. And we call that, you know, the value proposition or the thing that you are presenting to them, whether, you know, and might be as services or products or other things we can get. It's a into that later. But so it's who are you serving, how are you going to serve them? And then there's also this third piece that's just who you are. And particularly in the work that I do and helping people with their personal branding there's a lot of noise on the internet and it can feel sometimes if you are somebody who ever does post on Facebook or put something out there and maybe you're hoping people might see it, it's easy to feel like, Oh, that's just going to get lost in this sea of sameness.
Jason Van Orden (06:31):
And so many people saying different things or the same seemingly the same things. And it's knowing that as tried as this might sound, you know, we each have our unique perspective, our unique approach, the experiences we've been through. We have our you know, our approach to things to bring to the table. And in the same way, here's my vision for people who want to have a personal brand is that in the same way that Spotify now has really trained us to be able to find whatever we want to listen to. I mean, whatever genre, whatever into your popular music like you can, there's a vast catalog and now it's not about what 100 CDs you own. It's like now you like near infinite choice. And so you have these very personalized playlist and stuff and Spotify is insanely good at them.
Jason Van Orden (07:19):
Making recommendations for us as well in that same way, be thanks to the internet over the last 10, 15 years, all the other myriad of problems and populations who need help out there and in solving and guidance, you know, there's a slice of the world that's looking for your approach, for your flavor. You are that hidden gem of a band on Spotify, quote unquote, right. So it's something about the way you show up and make them feel they're present the information or guide them or the values you have or some kind of shared meaning or something where you know, you seem a lot like they, you know, you've been in the place that they have in the past and they resonate with that. So that's the third piece of the personal brand is knowing what you bring to the table in those ways.
Jason Van Orden (08:06):
And it just really owning and realizing that you do have that perspective that many people will want to specifically hear from you.
Karen Litzy:
Okay. Wow. Okay. So I am going to recap that really quickly. So first you're where you want to be clear about who you want to serve. Then you want to be clear on how you're going to serve them. And then who are you and what do you bring to the table? I mean these are, I feel like number one kind of getting clear about who you want to serve. I don't know for me that's probably the easiest of the three. But getting, I think drilling down to who are you and what do you bring to the table that can be kind of difficult to pull out of yourself. Do you have any tips for the listeners on how they might be able to do that?
Jason Van Orden (09:04):
Absolutely. For me, I'm being totally selfish, absolutely not a problem. It can be hard to uncover those things. And one of the reasons why is that we often don't see what is interesting or special or valuable because it's commonplace to us and you know, and then just get old human nature. We haven't yet imposture syndrome or just feel like, Oh to like, you know, say, Oh, I'm strong in this area. Just feels not humble or something. So, you know, these things get in our way of seeing what we have to offer. And so in the work that I do, I have a lot of exercises and frameworks and things that I walk clients through to help them uncover and discover the different parts of their voice and that we're talking about. So I'll just drill into to one area here that I think is really important.
Jason Van Orden (09:53):
Like I said, very noisy on the internet, but if you can get this, this sense of resonance resonances, you know, if you've ever you know, maybe you've been seeing it in the shower or something happened, just hear it just the right note and it's just like, Ooh, it just gets really big. And because you hit just that right note that in that space sounds really big and that's what you want when somebody comes across you and your message. So here's a little framework in my research about personal branding, I've seen a lot of work. I've seen a lot of research I've done out there about the importance of purpose based brands. And when I say that I'm talking about companies like whole foods or Patagonia, there's a very specific identity. They stand for certain things. They have a certain vision of the future.
Jason Van Orden (10:38):
They guide their company according to that. Their messaging community, certain things in a very clear and compelling way. And that's just two of many examples I could go to. And the research is clear that that leads to more loyal customers, repeat customers, you know, fans and advocates that share your stuff with other people. And this is what consumers want today. Thank goodness. You know, I think 10, 15 years of some really just like shenanigans in the corporate world, not only I dimension, just upcoming generation of millennials, that purpose based stuff has gotten really, really important. So what does that mean for you? How can you you know, if you're feeling driven by all this, you probably do have some kind of purpose inside you. But what does that even mean to like clarify and communicate that? So here's a little framework that I have.
Jason Van Orden (11:23):
I went and I study kind of the work I've done helping build personal brands as well as some of these companies and what they do. And I came up with five elements. I'll just briefly go through, I call this the magnetic messaging framework and it is one of many facets he can pull up to really find that uniqueness about you. So first thing is beliefs. What do you believe at the core that drives the core of the work that you do? What do you believe about the world? What do you believe that maybe goes counter to what is popular, you know, wisdom in your industry. What do you want the people that you want to reach and serve? What do you want them to believe after they've worked with you or come across, you know, your offerings, what do you want them to believe about themselves and about the world?
Jason Van Orden (12:04):
So I'll just use myself as a quick example here. I have this belief that we do need more people out there building that personal brand, rising up and owning it and going and finding that slice of the world that they can help. And if we can have a ground swell of that will solve a lot more of the world's problems than if we were just to leave it to, you know, big corporations, big organizations, government, whatever. I mean, Hey, they have their part to plead to. But this is a wonderful opportunity the internet has given us. And that's a belief that I have one of many that drive my work. Second of all, vision, what is the vision you have of the future? I'm not talking about just a vision statement for your business and all that might be important, but paint a picture like this is the future I want to see and work for and create.
Jason Van Orden (12:44):
I'll give you an example from another woman that I was coaching where she is in the health. And actually she was in the dieting, you know, what you'd call even the dieting industry and she has as a recently in last couple of years, stop using that word at all. She came across some research and things. She said, that's it. I gotta stop talking about dieting when it comes to the women I'm working with, you know, with helping them love their bodies and different things. And, you know, she decided I have to take a completely different approach and she now believes it has this vision of the future where like we get rid of the dieting industry or that world, it may seem like a huge daunting task, which is like, we absolutely need to take that down. It is not serving us well.
Jason Van Orden (13:22):
So that's, you know, a big vision thing. It's bigger than her. And when people do business with her, they are, they also see themselves as being a part of that and people want to be part of something bigger. Again, going back to companies like Patagonia or whole foods, there is a certain vision you know, Patagonia is all about like the sustainable future, right? So what does that vision you want to create? So beliefs and vision, value, we always talk already talked about it a little bit as being very clear about what you offer to them, what's in it for them if they do business for you. The fourth thing is contribution. So what do you bring? What does your work do that goes beyond the monetary exchange and the value exchange with your customer. I mean, that's important and they pay you and you render a service or give them the product or whatever the case may be.
Jason Van Orden (14:04):
But how does that contribute to the community or the industry or even the world at large? And I'd like to think that in the work that I do helping elevate all of these thought leaders that it contributes in that will solve more of the world's problems. I mean, I'm not claiming that myself, I can go in and help enough people to solve all the world's problems, but I'll make more of the dent if I help more people find with their ideas and their expertise, the people in the problems in the populations they can help the most. And so that's how I see my work contributing even beyond what it does for directly to my icons, my customers. And then the final thing is a reason why you do what you do other than making money. And for me, once I was one simple example is I see it as a compounding of my own impact and specifically working with people who want to have a personal brand and be a thought leader or get their ideas and things out there in a bigger way.
Jason Van Orden (14:58):
It's like, well, Hey, it's like compound interest. I help you know, a person they go help 10 or a hundred or a thousand. Then I helped another person and they help 10 or a hundred or thousand. And so that's a reason why I do what I do besides money or the freedom directly benefiting to me. So those five things, beliefs, vision, value, contribution, and reason why, if you flesh those things out and then talk about them in your content and your keynote speeches with your clients in your marketing, in your say on your website, on your about page, on your social media, now you're going to be creating something that really has a uniqueness around it. And that's one key way to do that.
Karen Litzy (15:35):
That was great. Thank you so much. And I really loved that end piece. How you finished on that? That concept of compound interest. Yeah. Because oftentimes we don't think about what we do as effecting the, we kind of only think about it as I am working with a patient and I make a difference in that patient's life. Right? But I'm not thinking that because I made a difference in this patient's life. They were able to make a difference in their children or their parents or their friends or their family because they're going out and doing what they're meant to do because I help them do that.
Karen Litzy (16:18):
And I just, yeah, I just, I love that concept and I don't think I've heard it really put quite that way before. And I think it's just wonderful to think about it that way so that when, cause oftentimes as healthcare providers we can be a little shy, I guess it could be the word or uncomfortable with asking for monetary exchange for what we do. Right, right. And yeah, a lot of times, especially in healthcare, you're tied to that insurance system where, you know, you're waiting for the insurance to pay you or you could have a cash based business where the patient pays you directly. But so often there's this shyness or this inability to kind of ask for that monetary contribution. And I think people get so fixated on that that you forget about all the other stuff that you're doing. That sort of compound interest that you said goes beyond that monetary amount. Because I think if people see that, then the monetary amount, yes, we need to make a living, but people will be like, yeah, sure, here you go. I get it.
Jason Van Orden (17:33):
Yeah. Right. And when they understand yeah, and it definitely comes across again, by the time they do business with you, with this kind of messaging. Yeah. People, not only are they just like identified with you and like, no, I want, I want you, I want to be the one to help me. But yeah, they understand that and whether it's conscious or unconscious and says, yeah, this idea of like, Oh, I'm also part of something a little bigger than me here. This is cool. You know? And that's what people want these days.
Karen Litzy (17:59):
Yeah, absolutely. Well, now let's say we fast forward. We have gone through that framework. We feel like we have a good solid footing on what our brand is and our messaging. So let's step into now how to create sources of income from that messaging. And that messaging, of course, is using our expertise.
Jason Van Orden (18:28):
Yeah. So when it comes to creating different sources of income, there's one key asset to be very clear with. And then I can share another four-part framework. I'm big fan of frameworks and we've actually covered some of the pieces of that framework which are being very clear. So there's four pieces to coming up with some kind of offer. When I say offer, it could be a service, it could be a product, you know, something that you're offering to people to buy and exchange value with you. So the first piece is well, we already talked about knowing very clearly who your ideal audience, customer client is. And then the second piece is being very clear about understanding the outcomes and the results and the unfulfilled needs. What's most important to them, what's top of mind? What is their, what I call their tooth ache, pain and other, they literally have a two thing.
Jason Van Orden (19:18):
But I use that as an example because if we have a tooth ache and it's not going away, we're going to call the dentist and go get it checked out. Right? It suddenly becomes a top of mind thing. So how do you know what that is? Well, you go when you talk to them. I'm always encouraging my clients to go and do market research in the form of having conversations with people who fit the description of their ideal person, the person that they want to reach. And this could be current clients or past clients are also just people who aren't, haven't done business with them. But you know, for you, Karen could be listeners of your podcast or people who are on your email newsletter list and you know if you regularly get on the phone with them and it's not to say like, Hey, I have this idea for a product.
Jason Van Orden (19:59):
What do you think? It's really to listen a lot and ask good questions to hear about their experience. You know, what are they dealing with? What are they trying to accomplish? Why haven't they reached that? That's the big thing is why haven't they been able to do that thing that they want to do yet? What myths and misconceptions are they maybe dealing with? What questions do they have? What's not? What knowledge gaps, what tools do they need to acquire, what have they tried before that maybe didn't work for them? So you know, the better you understand their experience in this way, then you as the expert can, you'll see the through lines, the thread that draws the jury, that ties these conversations together. And you can kind of like read the tea leaves so to speak and go, Oh, okay, I'm seeing something that's missing here.
Jason Van Orden (20:36):
Or something that I think that I could do in a particularly helpful way. And then at that point, you've got, you know, those first two key components, your ideal customer and their ideal thing that's really important to them. And that's, we're going to come up with a great, a great offer. Now to get a little more specific at that point, you as the expert have some kind of process and this is the third piece, some kind of process for helping them get from a to B. You know, so if you're a physical therapist, I mean, I, I'm not claiming to know that much about physical therapy, right? But like I've done some before. I had a knee injury and then you need to get some range of motion back. Right? So the third, the physical therapist I went to see, you know, immediately, you know, it was assessing and everything and then in her mind was, you know, going, okay, yeah, here are the things we're going to need to do to do over the next several weeks.
Jason Van Orden (21:25):
Then a process to bring that to bring that about. I have a certain process that I go through to help my clients, you know, figure out what their personal brand is or you know, create and launch their first online pro, you know, I different. And so if you're very clear about what that process is and particularly kind of your unique approach to it, again, going back to what's unique about what you offer that process now is something that you can wrap in a variety of what I call experiences, which is the fourth piece. So we have the ideal client or customer, we have their ideal outcome. We have your process for helping them reach that outcome. And now it's just a matter of wrapping it in different experiences. Now, here's what I mean by that. If we imagine a spectrum and on one end of the spectrum is kind of your, what I call your high end high high touch offers.
Jason Van Orden (22:13):
So that would be, you know, as a physical therapist, the hands on one-on-one work as a consultant, as a coach showing up one-on-one or the, you know, so it's much more nuanced and direct and people are going to pay more for that kind of experience and expertise on the other end of the spectrum with clients that I work with is something that would be like purely hands off. Something like a digital course for instance, that you know, somebody can buy the so, you know, say I went online and I'm sure there's a lot of physical therapists can be like, Whoa, bad idea. You need to actually go to a physical therapist and understand that maybe you know, putting aside my ignorance about all of the physical therapy, you know, maybe then as a thing, after they worked with you for several weeks or whatever, there's some, you know, downloadable set of videos that then they can go through on their own at home or you know, whatever it is that you're wanting to help people with.
Jason Van Orden (23:02):
So that's at the other end of the spectrum, purely digital do it themselves. And then there's everything in between and you're basically asking yourself three questions. It's like, okay, how are people going to get access to me through this offer? And so, you know, is that going to be direct one on one? Is it going to be, maybe there's some kind of, you know, a lot of my clients end up performing some kind of like group Q and a or coaching calls, whether they can help a group of people at once. It's kind of like, you know, your Lyft or Uber share ride. If the driver has three people in the car, they're getting paid by three people as opposed to one person. Right? So that's a, you know, how do they get access to you and finding a more scalable way to do that.
Jason Van Orden (23:38):
The second thing is how do they get access to the information? And that might be, you know, through like you did that podcasting course. I did that, the information, there was a series of group calls, several people on a call and I was doing those trainings and then saying, here's where you can walk away now and the action steps and what to do next this week with what we've talked about. So how do they access the information or the knowledge or the tools? And then the third question is how do they access each other? And this is a powerful thing and wrapping in an experience. Because if you have a lot of people showing up, have similar goals and desires, it's actually you really valuable for them to be a part of a group of people who are working towards similar things and normalizes, you know, the issues that they're dealing with.
Jason Van Orden (24:22):
And they can get insights from others who are in the same place as they are. And this is where we see things like Facebook groups or LinkedIn groups or Slack you know, channels or ways that your clients can actually talk to each other, which again, it's huge value without your direct input. Other than that you connected them. So when you have those four pieces, the ideal client, their ideal outcome, your process for getting them there and then deciding of what is the experience, you know, now you can craft. And the cool thing about knowing clearly what that process is and maybe take that first piece of the process that's like an assessment piece or whatever the first step is. And you can make that a smaller product and make it lower price. So it's easy for people to go like, okay, yeah, I'll say yes.
Jason Van Orden (25:04):
Did that baby step into doing work? You know, or experiencing your expertise in some way. And then all the research tells us they're likely that way. More likely now to do business with you again and spend more money with you at that point. Or maybe you decide it's time to write a book. Okay. The book is maybe an overview of your process or you get invited to do a keynote. It's like, okay, there's, well here's one slice of my process, one, one, one piece of what I help people with. And that can be the basis for that for that keynote. Or maybe you decide, okay, now I want the entire process packaged up as a group coaching type experience that happens over eight weeks online or a two day workshop or right now you can, you can play with it in a lot of different ways, but that process is a really important asset. So those are your four steps and kind of how all those pieces come together.
Karen Litzy (25:51):
Awesome. Well, I love a good framework. So thank you for that. And there's one thing that you said as you are kind of going through that framework that I just want to back up and touch upon is that idea of being an expert. So oftentimes, and again, you touched upon this as well, is that feeling of imposter syndrome and things like that. Is that feeling of, am I really the expert? Like there are people out there who might have more experience than I do. How can I put myself out there as the expert? So what do you say to that?
Jason Van Orden (26:29):
Well, there probably are plenty of people out there who have more expertise than you. There always will be there. People have there have more expertise or experience in marketing branding to me. But again, it goes, there are too for people to do business with you. It's about trust. And trust is actually made of two components. It's made of credibility, which, you know, that's expertise. Have you, you know, done the hours of mastery. You've gotten the degree if you need it or whatever. It goes into that credibility. Have you gotten results for people before? And we lean on that a lot and that's okay. It is important. But then likability, credibility plus likability is trust. And often that likability is even more important than the credibility. Now again, you need to be able to deliver the results, but what does that likability, well, that goes back to resonance and for some reason, I mean, I think we've all, you know, I could have gone to one physical therapist and been like, yeah, something just doesn't drive here.
Jason Van Orden (27:16):
I need to go to another whatever for whatever reason. Right? And at that point, it wouldn't have been like, which one has more experience? It's like, which one do I vibe with? Or if you've ever gone to like hired a therapist or something like that, right? Just to kind of give a little more of an extreme example. But so that's one thing I would say. Another thing is that you know, if you do struggle with impostor syndrome, a great Google search to do is imposter syndrome celebrities. And you're gonna see a huge list of like Tina Fey and Tom Hanks and Maya Angelou and people who are like stories. Like, why are these people like doubting themselves? They're like, amazing. Then another thing that I would say to that is, you know, that process of going and having those conversations with your marketplace, those can be very energizing and actually confidence boosting.
Jason Van Orden (28:04):
Cause as you're talking and hearing their experience, it starts, you start going seeing it's like, Oh yeah, I can help with that and start getting excited about it and wanting to do it. And so that's another, you know, little anecdote to that. And in the end it's, you know, you don't ever have to be claimed to be something that you're not, you know, you very clear and you know, again, what your strengths are, where you can create results to what extent, and there are going to be people that just decide to work with you for a number of reasons. And it's not just going to be price or geography. Sometimes it might be, but again, if you know, that resonance piece comes in a lot too. So there's a few different things. And then the last thing is all I can say is like, go back to my belief that it's like, look, there's so many people in this world, 8 billion plus lots of problems to solve. Lots of people looking for guidance and help. So, you know, be that one specific band on Spotify, be that one person that knows that slice of the world is looking for. I'm going, you know what, you're the person I've been waiting for to hear this from. So how can I work with you? And that's what we're going for.
Karen Litzy (29:08):
Perfect. I love it. Now as we wrap things up here if you could leave the audience, although I think what you just said was probably, I shouldn't have even asked this question, but I'm going to ask it anyway because I want you to be able to kind of give the major points you want people to walk away with from this conversation, even though there were so, so many, I took a lot of notes.
Jason Van Orden (29:34):
Yeah. I mean, I'll just punctuate kind of the big point. And, and with just a very brief anecdote or story, and that is like back in 2008, I got a phone call from a woman in Austin, Texas. She had a child, she was pregnant or no, she had two kids at the time. And she, both of her pregnancies had been very high risk. In fact, she had gotten put on bed rest, you know, or you have to stay there for months and I'm sure that's gotta be so stressful. And it was a really difficult time for her. She from the African American community and she just found that particularly in that population, the resources for high risk pregnancies were really under like the date. There just wasn't enough of them. So, you know, fast forward, she's got her two healthy kids, thank goodness everything.
Jason Van Orden (30:19):
And she's like, I want, I need to share my experience and my story, you know, she's even gotten, you know, gone and gotten some what's the word I'm looking for, you know, accreditations or even, I can't remember exactly what she, you know, went and trained in, but she definitely got some that credibility expertise part, but then she also wanted to share her story. And so she said, can you help me launch a podcast? I said, yes, absolutely. So she hired me to coach her and consult her through that. And you know, fast forward a few months, or maybe it was a half a year or so, and she started getting emails from people in Ireland and Australia and Oman in the middle East. And you know, this one woman and in Oman said look, I gotta thank you for helping. Like save my child.
Jason Van Orden (31:04):
I hadn't, no, when I found out that I had to be on bed rest and there was this high risk of losing my pregnancy, like I didn't know what to do and where I live, there really isn't like what much support or empathy and so your story, your podcast, your perspective, your expertise gave me the strength, the will, the knowledge to be able to get through that difficult time. So what I'm trying to punctuate there is like how many of those connections are waiting for you out there, the listener, you know, who's listening to this right now and whether you reach them through a podcast or a blog or videos or through social media or speaking or whatever the case may be. There are absolutely those stories. You know, that that story can be true of you. And that's why I do what I do is to multiply that phenomenon that I've seen time and time and time again over the last 10 or 15 years.
Karen Litzy (31:54):
Yeah, I mean you just, you never know who's listening or reading or watching and you never know how the words that you say can truly, truly affect another person. And that's a great exit story is a great example of that.
Jason Van Orden (32:10):
And I don't know if you can hear a little bit of music, Karen? But somebody is having a dance party with their car suddenly. So that's not just me like, you know, winding down our interview with like, I'm going to do a saucer.
Karen Litzy (32:21):
You're in a play, you're going to play yourself off at the Oscars. Just slowly playing yourself off. That's so thoughtful. Well, actually before you exit, I have one last question. So I ask everyone this, knowing where you are now, in your life and in your career, what advice would you give to yourself as that young guy straight out of school?
Jason Van Orden (32:49):
Yeah. Well wow, that's a big one. I mean, I think what I would say is that, you know, you're only scratching the surface when it comes to what's possible for you and especially in getting to know yourself. So just, you know, keep searching, keep looking, keep discovering and uncovering the layers of yourself. And because, you know, that guy thought he was going to be an engineer for the rest of his life and so many other, I'm such a different person now and that's good. I mean a lot of growth and hard things and went very different directions than I thought, but it would just be that encouragement. It's like, look, you're just getting started and thinking is going to be very different. But you know, keep, keep digging and hoping and pushing and even when it gets hard.
Karen Litzy (33:35):
Great advice. Thank you so much. Now Jason, where can people find you?
Jason Van Orden (33:40):
Yeah, so I actually have a new podcast where we dive into stuff like this. It's a podcast called impact, a subtitle, how to build or how to grow your thought leadership brand and business. And so you can check that out and find it on all the major directories or at jasonvanorden.com. And then the one other thing I'll mention is if you go to magneticmessaging.download, you can download, you know, I went very quickly through those five aspects of the messaging, but you can download the framework, it's like a full guide with questions. Take you through that and if you want to dig into that exercise some more. So that's magneticmessaging.download.
Karen Litzy (34:20):
Awesome. Well thank you so much. And just for everyone listening, we'll have the links to everything that Jason just said. So his podcast, his website and the magnetic messaging over at the show notes for this episode at podcast.Healthywealthysmart.com. So if you weren't taking notes like I did, don't worry one click and we'll take you to everything that Jason just mentioned. So Jason, thank you so much for taking the time out and coming on the podcast. I really appreciate it. This was great.
Jason Van Orden (34:50):
Yeah, so much fun. Thank you Karen
Karen Litzy (34:52):
And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Dr. Lex Lancaster on student loans. Dr. Lex Lancaster is a Doctor of Physical Therapy with a passion for performance, pelvic, and pediatric PT. Lex Lancaster also designs websites for health and wellness practitioners.
In this episode, we discuss:
-Lex’s experience navigating loan repayment as a new graduate
-Considerations for pre-DPT students when applying to schools
-Helpful tips to start tackling your student loan debt
-And so much more!
Resources:
Email: AlexisLancasterpt@gmail.com
Lex Lancaster Twitter
FitBUX Website
Lex Lancaster Website
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Lex:
Alexis Lancaster is the graphic designer on the Healthy Wealthy and Smart podcast. She earned her Bachelor of Science degree in Biology, a Graduate Certificate in Healthcare Advocacy and Navigation, and graduated with her Doctor of Physical Therapy program at Utica College in Utica, NY. Lex would love to begin her career as a traveling physical therapist and hopes to eventually settle down in New Hampshire, where she aspires to open her own gym-based clinic and become a professor at a local college. She loves working with the pediatric population and has a passion for prevention and wellness across the lifespan. Lex also enjoys hiking, CrossFit, photography, traveling, and spending time with her close family and friends. She recently started her own graphic design business and would love to work with you if you have any design needs. Visit www.lexlancaster.com to connect with Lex.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor (00:00):
Hello. Hello. Hello. This is Jenna Kantor with Healthy, Wealthy and Smart. Really excited to be coming on and interviewing Dr. Lex. And what's really exciting is she is in the middle of this like name change possibility, so it may be Lancaster in the future or Brunel, her married name, we don't know. So you're getting an insight interview during the gray zone. Anyhow, want to thank you. First of all, thank you for coming on Lex for this interview. So for those who don't know, she actually works behind the scenes with Karen Litzy on this podcast and other things. She created the amazing logo for the women in PT summit and she's just kind of like really amazing on social media. For those who don't know, she's also a new grad who is dealing with loans. L. O. A. N. S. give me an L , give me an O, give me, ask him.
Jenna Kantor (00:57):
And that's right. That's what we are talking about. The fun, joyous roller coaster of student loans. Now before this. All right, before we go into details, right before we go into details of all your journey, if you were to compare the journey of loans, is it more the feeling that you get when you're going up the roller coaster and it's getting really, really high? You're like, Oh my gosh, am I going to live? Or is it that drop feeling like, Oh that first drop. So which one would you compare it to?
Lex Lancaster:
It's more like, I would say it's more like the drop, but that drop happens like halfway through your third year of PT school and then you're like, crap. Oh my God. I guess that's if you're lucky. Cause sometimes you don't think about loans until after you graduate and then the rollercoaster happens. Then I will say though that after that initial drop and you really freak out, it gets better.
Jenna Kantor (02:01):
You remind me of Oscar in the office where he's talking to an imaginary child or person saying it gets better, it gets better, it gets better. Well, I wanted to reach out to, Lex, when I reached out to her because she had done a post on social media about loans and that's what inspired this in the first place. And I thought, of course there's great experts out there like Joseph Bryan who is a wonderful resource for loans. But I wanted to get a student perspective on this from beginning to end. So what were the first steps you did before you even graduated for your loans?
Lex Lancaster:
So my first and second year, and really the first part of my third year, I didn't even think about loans. I kind of thought in the realm of it's just another drop in the bucket at this point. You know, I just didn't think like money. It's not that money wasn't factor.
Lex Lancaster (03:00):
It's that I had to pay for things. So it's not like I said, well, I can't really afford tuition, so I'll see you later. So it was just a drop in the bucket. And you know, I got to the point where $1,000, $2,000 books, whatever it ended up being, was just that drop in the bucket and halfway through my third year, aye, what to say? I saw a fitBux post about student loans and I think I actually got a bill from one of my loan companies and they had said, you owe money halfway through my third year of PT school. And I was like, Whoa, that is not okay. So I ended up contacting them and it was just a, you know, mistake on their end because we have that forgiveness for six months after we graduate or the deferment. However, at that point I was like, wow, this is what my monthly payment is going to be.
Lex Lancaster (03:56):
And that's what I had seen. And that was only one company. So at that point I kind of, I want to say it was January because I was on my last clinical and I reached out to fit bux and I just basically said, Hey, I don't know what I'm doing. It's all I said. And Joe was extremely helpful. I ended up setting up a class, an online class, because the third year, most programs, you're off campus. So with our program we were all on clinical and I figured my entire class was struggling the same way I was. So we set up a seminar, an online seminar with Joe and he went through, or Joseph, he went through every single aspect of student loans, what to expect, how to choose your plan, what works best, what doesn't work. And you know, for the students that attended, it was super helpful.
Lex Lancaster (04:44):
So we left that little online webinar with him with understanding definitions of the financial world. Because at that point in time, I had no idea what any of the terms meant, Mmm, you know, it's extended prepay, blah blah, blah, blah, blah. All of the things that they talk about that you need to understand before you choose your plan, make your payments and really get going on student loans. So at that point I felt okay. I was like, all right, we're good. We've got a plan and we understand the layout plan. And then what happened was I had to register for the NPTE, buy my study materials and for lack of better terms, wait around to get a job. So in that period of studying, cause I finished clinical in March, I took the test in July. So luckily for me, I had my online business to kind of keep me afloat to make a little bit of money within that period.
Lex Lancaster (05:49):
But without that, I mean I still took out, I put my NPTE on a credit card, I put my study books on a credit card and it was an interest free credit card. So I knew that I would be able to pay that off once I got a job. But I was still struggling because throughout college I did not save money. I had a job, I was a graduate assistant, you know, I had jobs, I just wasn't smart about it. I didn't save money throughout the entire process and that kind of put me in a position after I finished clinical. So while I was studying for the NPTE kind of saved some money, what I could save paid what I had to, but I did not pay on my loans. So I left my loan to start paying until the six months after I graduated.
Lex Lancaster (06:33):
And for lack of better terms, I cannot remember what it's called. But we have that six month period after we graduate that you don't have to pay on them. And then when six months hits you have to start. So I started at six months. But anyway, long story short, I met with Joe probably four more times. Just I think it was four times we went through every possible scenario after I got a job so that we could decide what, how much money I should be paying each month. And we went through the technology on the Fitbux website. That helps you decide what payment plan is best for you. So really fit bux helped me the most. I did not, there's a lot of podcasts out there that you can listen to, but I stuck with fit bux because it was one, it was free to talk to them and to Joseph pretty much, you know, he found time for me to talk and I really appreciated that.
Lex Lancaster (07:29):
So I guess like I said, it was the roller coaster. The drop of the roller coaster was when I got that bill and then it continued dropping until about November when I made my first payment. And now at this point I don't even think about it. I don't see the money, the money that I pay toward my student loans, I don't even see it. It just goes into an account. My student loans pay by themselves and I don't do anything. I'm on automatic payments. So now I'm kind of at that coasting I guess. So, yeah. Well and you post what, what? I forgot what your post was. It was a good one that was very pointed. I'm trying to like look it up literally during the podcast interview cause that's the way to go. Well. So discover sent me an email cause I have a credit card with discover, that's who I took out my interest rate credit card with last spring. And they sent me an email and I just said, are you paying too much in student loans? And I got the email and I just kind of chuckled and I was like, how'd you know? So I posted on my story. Mmm. Basically, how are you a mind reader discover? And then I've said, you know, I do pay, I pay $1,400 a month right now for student loans. Mmm. And I basically said that my payment is semi aggressive. It's aggressive by any means. If that was the case, I'd be paying close to two.
Jenna Kantor (09:00):
Mmm.
Lex Lancaster (09:01):
But then I had said, did you know that income based repayment is not guaranteed? Your forgiveness after 2025 years is not guaranteed. The interest rate on that can go up. Mmm. Or the tax rate on that can go up. Excuse me. And you have no idea what that tax rate can be. And when you forgive your loans, you have to pay that tax right then and there. So the way that I just look at it and everyone always says to me, well why are you paying so much on your student loans? They always question it. They're like, well you don't have to do that. But in reality, you know, I'm just like, yeah I am paying a lot my student loans, but I have to do it. Cause if I didn't do it, I'd be putting the same amount of money in a savings account to pay the taxes 25 years later. So I was frustrated at that. I think that day I was semi frustrated just because I had gotten an email and I was like, how'd you know?
Jenna Kantor (09:58):
Yeah, I am paying a lot. This is your post. It was sad realizations of being an adult on a high deductible plan. I pay greater than 500 a month for health insurance. I still need to pay 6,000 out of pocket before my insurance will help me. What a broken system. And I don't have a suggested solution because this is me right now. And you showed your brain like, Oh yeah, that was, that was my one about health insurance. Oh, that was health insurance. Oh my gosh. That's my health insurance. But I gotta pull up my story. I have it somewhere. Well that one's, that's another one. Another, another thing. If you want to reach out to her, that was a sidebar. It was smooth and yet totally off topic. It was so good. I'm glad you brought it up. It just felt so good to go there. So would you say you're out of that stress zone, you're out of that stress zone. Now that you have that plan going for you with your loans, you're just like, we're good.
Lex Lancaster (10:59):
You know? Yes and no. Yes, because I don't see the money come out. I know it's being paid. I know I pay a little bit over what I need to pay, so I'm paying it off a little bit more aggressive than I need to. And I'm on a 20 year plan right now, but my goal is to pay it off in about seven or eight years. I would say that because I'm transitioning from travel PT to permanent I'm back on the nervous train because with travel PT you make more money. You do pay more because you have a Oh, a tax home and you have a, you know, you duplicate your living expenses, so you do pay more in rent, et cetera, but you make more money because you don't have that permanent home and you're away from home. So I used my travel salary, most of the, I think I was putting close to 50%
Lex Lancaster (11:53):
Toward loans in the beginning. But then as soon as I found out that I was not going to be a travel PT anymore, I stopped. So I backed off. I took my monthly payment and my required payments and I decided to pay about $250 extra for both companies each month. So that's not even close to what I was paying. So I'm like I said, I'm back on that. I'm a little bit nervous. I don't know how I'm going to afford living. I don't know. You know, because I have a mortgage for a loan payment and my fiance Kyle also has a mortgage for a loan payment. He's also a PT. So we're both just kind of at the point where we're paying our required payment, paying a little bit over, and then we're going to see how it goes. Well, like I said, I don't see that.
Lex Lancaster (12:44):
I don't physically pay it every month, so I feel like mentally it makes me feel better. I'm not watching the money go out of my account more or less. It's already paid. I don't have to worry about it. It's paid on by the due date and then that's that. Mmm. So yeah, I would say talk to me in about two months and we'll see how I'm feeling when everything changes and I transitioned to a permanent.
Jenna Kantor (13:36):
That's hard too because when you are graduating, I did see this with a lot of my fellow classmates. Everyone had this, Oh, I'm going to go for this, this, I'm talking about niches. You know what they want to treat, and I saw a lot of people just start working for anyone and I think that's because when they see that number, those loans you owe, it's just you get, it's like, I need a job right now. I need a job right now. I don't talk to me. I just need a job I need. And it's really unfortunate and you're experiencing that now you're going, okay, now I want to go for what I'm dreaming of, like my dreams and doing that. You're seeing how that's causing that anxiety again about the financial situation, which is just, it just sucks what we owe in school. It's just horrible. And then even with what we get reimbursed for us physical therapists for most of us get paid on the low end as new grads, which I think that's just, I think those words are just an excuse for employers to offer lower pay. That's it. They were like, Oh, new grad. Cool. I can only afford to hire new grads right now. Right. So that's bad. That's bad. That's feeding into a really bad system there. That's my opinion. But that being said, it just, and so then you're just barely surviving with that. But then if you want to go off and do your own thing, if you are really going to be listen to your loans, you want to do it for 20 years. Exactly. More different 20 years cause you're like, Oh I need that.
Lex Lancaster (14:51):
Mean I think a lot of people do that. It's scary. Right? But then we get burned out.
Karen Litzy (15:05):
And on that note we're going to take a quick break to hear from our sponsor net health. This episode is brought to you by net health net health outpatient EMR and billing software. Redoc powered by X fit provides an all in one software solution with guided documentation workflows to make it easy for therapists to use and streamline billing processes to help speed billing and improve reimbursement. You could check out net hell's new tip sheet to learn four ways that outpatient therapy providers can increase patient engagement in 2020 at go.nethealth.com/patientEngagement2020
Lex Lancaster (15:39):
No I never see this money, but I hate my life. And that's, and that's the thing. It's like, you know, Kyle and I are starting a cash based PT on the side. Our side hustle. We are going to start that because we just want to, we want to treat how we want to treat and not be dictated by insurance, but that's a talk for another day. Mmm. And you know, that's, it's great for us. And you know, to be honest, we would, we would burn the ships and just do our cash business right now and just do that and not have a full time job. But we can't because we need to have money to pay our loans because the last thing we need to do is default. And you know, I guess our method of payment was based on travel PT, not based on permanent and a cash business.
Lex Lancaster (16:22):
So when we moved our loans from federal to private, we have to pay that payment. Now income-based isn't a thing. So we're required to wait. We need to wait because we need to have guaranteed income in order to not default on our loans. But like I said, as soon as you put out a budget, the loans are 1400 rent is 1800 and then you add food and you know, a little bit, you have to have fun money, a little bit of fun money. And that's almost 85% of our new salary. Yeah. So I don't, I don't really know how yet to fix that because what is your option? You know, you can't just make things, you can't make rent less expensive, you can't make your loans less expensive and they're not going anywhere. So unfortunately, I think that this is a scenario that a lot of people face out of school if they don't choose trouble. And that's why income-based is the most feasible. That makes sense because how else do you live on that? You know, I was just a grad student income. Right, right. You know, how else do you live? You don't have money to pay on those loans. And some States don't let you pay. Don't let you practice on that temporary license. Like New York state, a lot. A couple of my friends practice on temp licenses, so they were able to, you know, build up some
Lex Lancaster (17:50):
Money. But if you're not part of those States that allow you to do that, you can't practice until you pass your NPTE. So it's hard to build up that savings account. So that's one recommendation I have for anybody that's in school who's listening to this. Make sure you're saving money, whether it's 10 bucks a week, five bucks a week, it doesn't really matter throughout school. Save money and just put it somewhere and don't touch it because eventually you're going to need it. Even if you don't think you will neet it. And even if you think it's completely out of this world that you'll ever have a situation where you need a little bit of extra cash but save that money. Mmm. And for lack of better terms, I would not use it until you absolutely need to start the savings account now and don't wait until you have a job.
Jenna Kantor (18:37):
There's no reason why you can't save five bucks a week. Yeah, yeah, no, that, that does make perfect sense. And that's definitely been something that I've leaned on is having a savings account myself. So I get what you're saying. Yeah. And for anyone listening, I mean, if you might find yourself going, Oh, but where's the answer? It's the whole process of this interview itself is not necessarily to give you all the straight up answers. I really would like to just resort to the fact that it's good to know you're not alone. Yeah. And it's okay to talk about this with people. It's okay to be frustrated with your pay. It's okay to be freaking out about your loans. It's okay to feel burnt out because you're working somewhere you don't like just to get escape those loans. All of that's okay. I mean, this is unfortunately a very common struggle amongst new grads and something that the APTA is working, really trying to figure out how they can address this issue.
Jenna Kantor (19:34):
Cause really at the end of the day, it's the schools that are choosing to charge you guys as much. It's the Dean and it's not just the PT, it's the entire school that's saying, okay, let's increase the amount so we can make a new building or whatever they're going to use the money for. So with that increase in cost, it's all by school. That's where you need to look first in my opinion. Yeah. You need to look first. The APTA it’s like how we treat patients. You know, we sit there and we're treating the symptoms, you know, or do you look at what caused it all along? So same idea. And if you, I want to just focus on your own plate right now on what to do for yourself. Absolutely. If you really want to make a larger difference, it's talking to your institution and become the voice which works.
Lex Lancaster (20:28):
But if that's something you just made up right now that speaks to you? Well it makes sense because I have, I have people that I know that literally they graduated PT school with less than 70 grand of loans and that was putting everything on within a loan that was not paying for part of school out of pocket. They literally graduated with that much because their school cost that little bit of money. And when I heard those numbers and I'm, meanwhile I graduated after undergrad and graduate school. I was at about $220,000 is where I'm at. I don't know where I'm at today because I haven't looked at it to be completely honest cause it's like I'm just paying one month at a time. But I just, I was baffled. How did you get out of school with that little of loans?
Lex Lancaster (21:24):
Like how did you do that? And they basically said that when they chose a PT school, they chose a cheaper school and you know, I, I loved my school, absolutely loved my school. I would have not wanted to go anywhere else. That program alone has, you know, changed me as a person. I love Utica college. So I'm not saying that I would choose to go somewhere else. However, I was so baffled that the tuition is so different. I had no idea. I literally had no idea that different DPT schools have different such drastically different costs and that particular person almost has her loans paid off and she's, I think, Hmm. Five or six years out of school and she barely had to pay anything. Yeah. So I guess so what you're saying is so true. You know, we have to talk to the right people.
Lex Lancaster (22:22):
You know, why is this and it's an increased by, what is it like one or 2% for a year? It goes up. I have not kept up on that, but I do know that what our parents paid alone was significantly less than what we paid. Yes. So it's just, yeah, it's a really vicious, right now it's bad. It's bad. So, I mean, you could, you could sit there and think it's the loan company to get back. I'm like, no, it's your school. It's just school. They're the ones who said you need to pay this much. We don't get reimbursed that much to be able to pay that in a reasonable amount of time to live our lives. Yeah. That's very sad. It is very sad. And when our degree went up to the doctorate level, our reimbursement didn't increase. So it made it when we required more school. Yeah. Our reimbursement is actually now going down propose anyways, that 8% correct. That it's, that's for specific situations and it's not for sure yet. I say this now, but it's still being fought. We're not doing well in fighting it, but I believe it's not set in stone yet. Like I said, I don't know when they go out, so I'm curious.
Lex Lancaster (23:46):
The state of things will affairs will be at that point then. Yeah. The reimbursement doesn't reflect, we're just not paid enough reimbursement wise. So employers don't really have a choice. Yeah, it's, yeah, it stinks. It's a shame. It is a shame.
Jenna Kantor (24:06):
Well, thank you so much for coming on. I really appreciate it. Do you have any last words you would like to give just regarding loans and the stress of it that you would like to give to anybody listening? It's just really feeling helpless right now.
Lex Lancaster (24:20):
Mmm. My biggest piece of advice, well, I'll say two things. The first thing is, like I said before, start saving money. Now. Don't wait. And my second thing is reach out to the people who know what they're talking about. Don't try to solve problems yourself because you're going to waste time and you might even waste money. Mmm. Fit bux is completely free and it's a shameless pitch because of how much they've helped me. They are free to talk to. If you have questions please reach out to them. Joseph is incredible and his teammates are incredible and I still do not know what I'm doing down to the T. I use their program to decide what I'm doing. Reach out to those people. Don't waste your time trying to figure it out yourself and
Lex Lancaster (25:12):
Understand that it does get better. As awful as it seems when you first start out, it does get better and you start to figure out a plan and everything just kind of goes from there. Don't feel like you're stuck. Reach out to people. Twitter is amazing. You're not alone. A lot of people are going through this, probably every single PT in existence. So just reach out. Don't feel like you're alone ever. And yeah, I think that's it.
Jenna Kantor (25:41):
I love it. Thank you for coming on. How can people find you on social media or email?
Lex Lancaster (25:47):
So my email right now is AlexisLancasterpt@gmail.com and on social media. I am @LexLancaster_ So you can reach out to me there.
Jenna Kantor (25:57):
I love. Good underscore is nothing like a quality underscore. Well, on that note, thank you so much for coming on. Thank you everyone for tuning in and have a wonderful day.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
In this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jennifer Thompson on the show to discuss how to adapt your business during the COVID-19 Pandemic. Jennifer Thompson has served as President of Insight Marketing Group since 2006 and helps physicians and private medical practices throughout the U.S. attract and retain patients and rock-star employees. Jennifer has 20+ years experience in marketing and business development for start-up organizations and as a marketing director for a Fortune 500 company.
In this episode, we discuss:
-Understanding the Impact of Online Reviews on Your Bottom Line
-Why You Need to Provide Cross-Generation Communication Training to Your Staff
-The Death of Social Media Marketing and What to Do Next
-5 Ways to Create Big ROI with a Small Budget
-And so much more!
Resources:
Insight Marketing Group Website
Dr. Marketing Tips Twitter
Insight Marketing Group LinkedIn
Dr. Marketing Tips Podcast
Loom
InsightMG Podcast: Ep. 193 | Understanding the Impact of Online Reviews on Your Practice
InsightMG Podcast: Ep. 221 | How to Get Started on Telemedicine in a Hurry
InsightMG Podcast: Ep. 219 | How to Communicate During a Health Scare or Natural Disaster
Insight Courses
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Jennifer:
Jennifer Thompson has served as President of Insight Marketing Group since 2006 and helps physicians and private medical practices throughout the U.S. attract and retain patients and rock-star
employees. Jennifer has 20+ years of experience in marketing and business development for start-up organizations and as a marketing director for a Fortune 500 company.
In 2010 & 2014, Jennifer was elected to the Orange County Board of County Commissioners where she made decisions that impacted over 1.2 million citizens and 60+ million visitors. Jennifer was often recognized for her use of social media and community outreach in her elected role. In 2013, Jennifer’s company helped a client win the Social Madness competition in Central Florida and go on to place 8th nationally.
Jennifer is a serial entrepreneur who wakes up every day at 4 am ready to change the world. She has been invited to share her knowledge at multiple MGMA association meetings and conferences, the Florida Bones Conference, the American Academy of Orthopaedic Surgeons and AOA-36 on the topics of social media, reputation management, and leadership. She is also the co-host of the DrMarketingTips Podcast available on iTunes.
Read the full transcript below:
Introduction (00:07):
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life, healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr Karen Litzy.
Karen Litzy (00:41):
Welcome back to the podcast. I am your host Karen Litzy. And in today's episode our discussions around covid-19 and what health care businesses, physical therapists, physician practitioners, what they can do to continue to help their clients and their patients during this time. So today I am so happy to have on the program, Jennifer Thompson. She has served as president of insight marketing groups since 2006 and helps physicians, physical therapists and private medical practices throughout the United States attract and retain patients and rockstar employees. Jennifer has 20 plus years of experience in marketing and business development for startup organizations and as a marketing director for fortune 500 companies. Now in today's episode we talk about how healthcare companies need to change the way they're doing things during the covid-19 pandemic. Jennifer's very specific and goes through certain phases that your company must do to continue to help people in your community. We also talk about understanding the impact of online reviews.
Karen Litzy (01:57):
This is during a pandemic and once we get through this, why you need to provide cross generation communication training to your staff, the quote unquote death of social media marketing and what to do next and then ways to create big ROI or return on investment with a small budget. I'm telling you, everyone take out your pen and paper, your computer, take notes. Everything in this episode is practical. You could start doing it today and for those of us who are anxious or struggling because maybe we're not seeing the volume of patients we used to and our incomes are starting to see that, starting to reflect that most of the things that Jennifer is suggesting we can do takes very little or $0 million to achieve it. So I want to thank Jennifer for her time and her expertise. And if you are a health care practice owner, you must listen to this podcast from beginning to end.
Karen Litzy (03:12):
So much good information there. So a huge thanks to Jennifer Thompson and if anyone has any questions, you could go to the podcast show notes at podcast.healthywealthysmart.com. You've got all of Jennifer's information there, all of the things that we talked about, one click will take you to it. So a big thank you to Jennifer and of course I want to thank you, the listeners for tuning in each week. We would love it if you could leave us a review on Apple podcasts and tell your friends, tell your family thank you so much and enjoy.
Karen Litzy (03:51):
Hi Jennifer, welcome to the podcast. I'm happy to have you on and I feel like you're here at like the perfect time.
Jennifer Thompson (03:58):
Absolutely. Thank you for having me. It's great to be virtual and all of us are kind of hunkering down at home, but this is a great way to pass some time.
Karen Litzy (04:07):
Exactly. And like I said in your bio, you have helped physicians and private medical practices attract and retain their patients. You've been doing this for a very long time, but I have to think the recent pandemic has kind of shifted things a little bit for medical practices. So before we get into the kind of the bulk of what we had originally planned to talk about a couple of weeks ago, I would love to get your professional outlook on marketing, on finding patients on how we can do that in these times of this pandemic.
Jennifer Thompson (04:50):
Yeah. And I think that like it's just the right place at the right time. So when all of this was starting to come to fruition and it looked like we were going to be on restrictions and stay at home orders our team, that really shifted very quickly to reach out to all of our clients and say, Hey, look, we want to be a resource to you. You're not set up yet on telemedicine, but let's get you set up. So we've had the opportunity to help about two dozen practices get up and going with the Titan telemedicine solution in about 24 hours. And so once we got them all going and everybody's kinda rocking and rolling right now we started shifting the conversation to, okay, well how can we take telemedicine now as an option? Like a tool in your toolbox and market that and how do you market the practice when you're only, you know, maybe you have or you have limited hours or you have limited access and maybe you still have providers coming into the office, but you know, it's just a different environment.
Jennifer Thompson (05:50):
And the telemedicine in general is a different environment. So I think the first phase of how you attract, retain patients in this new kind of unchartered territory first is you got to do the stuff that's immediate and you have to kind of put out all of these immediate fires. And so that's like, you've got to update your website. You've got to reach out to your existing patients to let them know you're still seeing patients. And maybe it's just a different method. You've got to go out and update all your Google my business listings to include telemedicine, to include it in kind of changes to your hours. So there's some immediate things that you have to do. Of course you've got to update all of your social media and you need to, you know, start thinking about one, you want to let people know you're doing telemedicine.
Jennifer Thompson (06:39):
But then second is you want to figure out how is this going to look for the short term after I've put out the immediate fire, how am I going to now get more patients in? One area that we've seen a bunch of success in is going old school, you know, like your referring partners. And there's so many times where we'll send somebody from the office over to our referring partners to bring them lunch or to kind of build those relationships and whatnot. Well, we can't do that anymore. So now there's only one industry left in the entire world that actually has fax machines. And I just sent out faxes this morning for a couple of clients where we're sending out big bulk faxes to all of their referring partners from their EHR. They're pulling it out, pulling down that data.
Jennifer Thompson (07:28):
And we're sending out kind of, Hey, we're open and accepting telemedicine appointments. And so yeah, there's some things that you have to do that are thinking outside of the box. And that was kind of the immediate, and then the second piece is what do you do now to keep yourself relevant? And so I was on a call yesterday morning with a bunch of orthopedic surgeons. We always meet at like 6:30 in the morning because that's always pre-surgery. And we were talking about the numbers of, you know, new patients versus returning patients and how are we like balancing the telemedicine appointments in terms of other appointments. And it looked as if the marketing, it's good right now, you know, you want a market that you have this as a tool in your toolbox, but it wasn't necessarily driving new patient counts. The telemedicine option, what was happening is your internal sales, your internal folks are the ones that are driving telemedicine appointments because you're looking at those followup appointments, people coming in for you know, second and third appointments and trying to get your, the ones that you at the end of the patients that you already had on the sheet and getting them into a telemedicine appointment instead of a standard.
Jennifer Thompson (08:41):
And then now, Oh, we're looking at kind of the big issue with practices is that not only do folks need to know we're doing telemedicine, but for most practices, still maybe not in New York city, but for most practices, you know, in areas not as populated. They're still up and running for business. You know, they're still doing emergency surgery and things of that nature. So how do you let patients know that you are up and running and do it in a way that's memorable or that is going to cut through all the noise and the clutter. And so like before when I was saying you gotta to put out the fire, you put out the fire, the immediate. So part of the immediate plan is you need to put a red bar and we say red because Red's a good emergency color that in healthcare you really shouldn't be using.
Jennifer Thompson (09:26):
You put a red bar at the very top of your website and you go straight to your covid-19 resources or any of your important announcements. But that kind of red bar, you know, people aren't going to your website to check it out to make you relevant. So now we need to think about how do you brand yourself and how do you brand yourself in a way using social media. And because social media is still free and if you're good at it, you'll get some traction. And, I talk a lot about this idea that social media is dead and I will say social media, if you're just on it, it is dead now. But if you're in it, it's very much alive. And so now's your chance to be in social media and to get your message across. And what I mean by that is we have a group this morning orthopedic group who wanted to really get the point across that they're still open, put together a great little video of a doctor with an athlete who was in there for a knee injury.
Jennifer Thompson (10:24):
She signed the waiver, the release on it. They put together a great video showing how they're treating patients. So they're both in their mask. He's washing his hands, you know, and he does the quick exam. Then he washes his hands and she sits in a chair. He's about 10 feet away. They've got the video, they've got some music to it, and it's just, Hey, we're here and we're open. We have a PT practice that we're working with. They've started doing telemedicine across 26 different office locations and all day, every day they're sending us videos and great photos of them in practice showing how the physical therapists are doing their job with a computer screen and showing us the different things that we're doing. So it's just how can you be relevant now and kind of spreading that message and having fun with it. Because when people are at home right now, they're either watching TV where they're scrolling through their feeds. So how can you create that thumb stopping content?
Karen Litzy (11:27):
Excellent. And I love in the putting out the fires, the Google my business listings saying that you're doing tele-health. Hello. I have to do that today. The moment we end this call, I am going to Google my business and putting that in there. I did not even think about that cause I'm thinking about, I'm calling all of my individual patients, I'm emailing people, I'm keeping people updated, I've updated my website, I've done all that stuff, but I have not done that piece so that I need to do that as that should have been my phase one. And then I love the kind of how you're getting new patients because it's true. I think you're seeing in a lot of practice, at least what I'm hearing is that you're existing patients are doing tele-health, but how can we get new patients on board? So do you have any advice, let's say a new patient contacts me, I do a free 20 minute consult with them, kind of explaining tele-health. Are there any sort of must have pointers or any way that we can close that to help that prospective patient feel confident that they're going to get what they need?
Jennifer Thompson (12:37):
Yes, and I think that, I think part of that falls on you making sure that the patient is ready for what this new experience is. But we were so my teams, we do marketing, so we have, we're in the trenches on the marketing side of things and then we have a training side of the business. And so we were looking at updating a patient experience training that we've got currently. And then, how do you update it kind of with this telemedicine and telehealth component to it? Because we've been having a bunch of conversations about, it feels a little bit like the wild wild West and when the regulatory environment was kind of opened up, we would see providers and some of them, a lot of the ones we would work with. And we would call and say, Hey, do you want us to get you set up?
Jennifer Thompson (13:22):
And they would be like, no, I've already got this covered. I'm doing it on FaceTime, I'm doing it in WhatsApp. And we were like, no, you've got like they may be, they may be allowing you to make some mistakes right now just to get through this. But you've got to train at your patients from the get go of how you want this. And so you can't take somebody from a FaceTime call to later on doing a HIPAA compliant portal that they have to log into a remember a password. So we want to train our patients from day one. So I think that's part of the decision that you as a provider have to make is what's going to work for you. Not just for today but for long term. And then from the training side of our business, of course, we're always looking for a way to have fun with it from patient experience we put together and I'll send the student, cause we put together these great, I think they're great videos a day in the life from the provider's standpoint.
Jennifer Thompson (14:14):
And it's a series of tips of things that you should remember. Like for example, you shouldn't drive your car and do a telemedicine appointment. You shouldn't. That seems reasonable. You shouldn't, you should tell everybody in your house that you're with patients so they shouldn't be walking around in the background in their underwear because these things happen. I was going to say like it seems basic but it's not. Yeah, you gotta be patient with people because they're also going through this experience for the first time. Just because you’re not in the same room doesn't mean you have to shout. They can hear you. You've got to remember that you might have a great connection and you have, you know, your wifi is strong, but you may be talking to somebody and they're receiving it differently. And so we're all going through this for the first time together. And so I think understanding, like just taking a step back and remembering that this is unchartered territory. And so you know, are there things to pay attention to? Yes. But I think it starts with the provider and how you prepare the patient for that visit.
Karen Litzy (15:24):
Excellent. I love that. Yes. And definitely send those videos along and we'll put them in the show notes. At podcast.healthywealthysmart.com under this episode because I think people will definitely get a lot of value from them. And again, I can't believe you have to say like don't walk around in your underwear, do you as you're doing that. But like, like you said, the videos are made for a reason. So people were doing it.
Jennifer Thompson (15:52):
We had a provider this week or last week send something in. It was like a picture cause we asked everybody like send them photos of you doing telemedicine so we can use them for things. And he sent a photo and he had a shirt was like stained up and like, Oh over here. And we're like, doc, no, we didn't see patients day to day like this. So you can't see patients that way either.
Karen Litzy (16:17):
Yeah. And I think that's something that's really important I think because people think, Oh well I'm at home. I can be super casual, but you don't want to be casual to the point of a stained shirt and looking unprofessional. Right. There are ways to be casual, whether it be like smart athletes, your wear or a pair of jeans and a top, but you still want to look presentable because especially if this is a new patient who's seeing you on telehealth as a physical therapist when this is over, maybe you want them to continue to see you. So those first impressions still make a difference. So thank you for bringing that up.
Jennifer Thompson (16:54):
They absolutely do. And I think people just forget that. And you know, I think, I think it's okay to have fun with it too. Like, you've got to be professional and you need to be the regular provider that you always are. But from a marketing standpoint, a little levity goes a long way right now. And what are some examples of a little levity going along way, if you have any off the top of your head? Yeah, so we're having a lot of fun with these kinds of patient experience, customer service, telemedicine training videos, which we put out our first round of them yesterday. So we're just trying to have fun with them, like make fun of how crazy it is. We have a group that has it's an orthopedic practice that has a lot of athletic trainers that they employ.
Jennifer Thompson (17:38):
So one of the athletic trainers, because nobody's in schools right now, has been furloughed. And so what we're doing with him is he's got like a four year old son at home and he's doing a daily series on social media as the athletic trainer, providing tips on how you can stay active and how you can prevent injuries at home. So he's doing things like yesterday, he's sitting on the couch with the son reading a book and he's like, Oh, I see now you're here. You know, welcome to my living room. Here I am at home with my four year old son, Jackson. We're going to read two pages of book and then we're going to do jumping jacks and then we're going to run in place. But he's doing a series just so it's fun and it's cute, but it gets a lot of engagement at the same time. He's like getting the main message across and it's something that people are stopping on and he got great traction. Maybe a thousand people looked at it yesterday. So, Hey, it's good traction, no money. And it's keeping them relevant. Plus it's keeping him relevant in a furloughed position.
Karen Litzy (18:38):
Yeah. Oh, how great. What a great idea. Love it. All right now something that I think we can talk about that can help your bottom line and that can help your practice grow is the impact of online reviews. And that is one thing that I don't think has had that much of a change even during this time. So can you speak to the importance of those online reviews and understanding them?
Jennifer Thompson (19:06):
Yeah, I absolutely can. So I think a lot of times practices will come to me and say, what if I could only focus on one thing because I don't have any money? What would be the one thing that you would tell me to do? And I hands down, always tell them that you should focus on getting as many reviews as you can and not because reviews you don't need just five star reviews, but you need lots of reviews. And I referenced back to a study that that we found that was, that was cited in the wall street journal and it was a study by a company named Juan plea. And I will send you the details of this for the show notes. So wildly does study of at 25,000 freestanding medical clinics. And one plea is actually a credit card processing company. So they were looking at cash based business for 25,000 freestanding medical clinics and they were tying the revenue to the cash based revenue, two star ratings and reviews.
Jennifer Thompson (20:11):
And so basically the couple of the top line, top level findings that they have are like medical centers that claims their listings on three or more of those websites, meaning like rate Indies, healthcare, vitals, Google, things of that nature. See 26% on average more revenue than practices that don't. So if there's ever been a reason for why you need to really pay attention to online reviews outside of, it's the number one way people choose their provider and if there's ever been a reason, it's because it's directly tied to your bottom line. Medical practices don't respond to online reviews, make 6% less than practices that do. And I'm not suggesting that you, that you respond in a way that violates HIPAA, but you can respond in a way that doesn't even identify that somebody is a patient and you can provide them a phone number that if they have something negative that they can follow up on, that's a 6% difference in revenue.
Jennifer Thompson (21:10):
And the one that really gets me the most is that practices that are rated five-star across the board actually see less revenue than practices that are afforded to a 4.9 star. And that's because we all realize that everybody is not perfect and the general public is not ignorant to that. So they expect that you're going to have some negative reviews. But it was just most interesting that you can see that that indirectly court, there was a direct correlation and you know, focusing on star ratings and then going into reviews. And for me it's just, it was just good data because everybody loves good data. Sure. And I got really involved in, I mean we identified that reviews were probably a place to focus our business. You know, years ago and things were just starting out. But I was in politics for years and when I was in politics it was right when social media was starting to take off.
Jennifer Thompson (22:09):
And just like medical providers are limited in what you can say and respond to. As an elected official, I was limited in the state of Florida to the sunshine law and the sunshine law prevented a lot of what I was allowed to say and not allowed to say online. So I got really interested in this whole like immediate feedback. Everybody thinks that they've got an opinion now and how these opinions get shared and then what you can and can't say to them. And then I would have doctors that would come to me and the doctors would say, Jen, I just want you guys to get rid of that negative review. And I referenced orthopedics cause I have a lot of orthopedic clients and this would happen a lot with them, but when it was a work comp case and somebody who didn't want to go back to work or if it was somebody that wanted opioids and they just couldn't get their fix, they would go online and just bash these doctors.
Jennifer Thompson (22:59):
And it got to the point that work comp aside, I would have to say to the doctor, doc, if you're consistently getting negative reviews, we've got to deal with what the root of the problem is and not keep dealing with the negative review themselves. And so we would start doing sentiment analysis on the reviews. So easy tool, especially if you're stuck at home and you've got some time on your hand, pull all of your reviews offline and take, hopefully you're using a service, you just couldn't get them in a spreadsheet. But look at the reviews and look at that data and figure out what it's telling you. Because usually it's not between the provider patient that somebody is upset, they're upset about a billion process or upset about a wait time. They're upset about some kind of follow through about some kind of customer service issue and that's how you can get to the bottom of your reviews and then make changes at the practice level that are actually going to have a real impact on what people are saying about you a lot in public. So I think reviews are just a plethora of good information. If we start thinking about how we can use them to make small adjustments at the practice.
Karen Litzy (24:05):
Great. And how do you recommend clinicians ask their patients for reviews?
Jennifer Thompson (24:15):
I used to say suck it up and just ask for them and then it got to the point that I would say, here's a card to tell your patients where you want them to go. Now I would prefer the clinician not even be involved in the process at all. I would prefer that every practice out there work with some kind of third party partner that has a secure file transfer where you can send your list over of patients on whatever frequency you want. And then that provider, that software sends it out to your patients and they ask your patient for reviews. And that way every single patient gets treated the same. And you guys focus on delivering the best care possible and stop worrying about, you know, I'm not a sales person, I just want to focus on patient care. I don't want this person cause they might've been upset or I forgot to ask, don't worry. Like do I think that you should just remove yourself from that equation and just find a way to automate the process.
Karen Litzy (25:11):
Nice. And what are some examples of third party partners to help automate that process?
Jennifer Thompson (25:17):
So I exclusively use doctor.com now. But there's a bunch of them out there and so there's like review conciergedoctor.com. There's a bunch of them out there.
Karen Litzy (25:29):
Okay, cool. I've never heard of those, but that's really helpful. Thank you.
Jennifer Thompson (25:33):
Yeah, it is. It's a good way to get reviews and not to have to worry about it. And I will suggest this too, if you're at a practice that has like a lot of high volume have a page built on your website where you can capture internal feedback and then put signage up. Because that way if somebody is sitting in your waiting room and they're getting pissy that they'd been there too long, give them a way that they can get something off their chest so they feel like they need to go do, you know, leave you a negative review.
Karen Litzy (26:03):
Smart, smart. I like that. Right? So they can say, Oh, I've been here forever. Oh, I can complain here instead of complaining on Google or, Oh, fabulous. Exactly. Fabulous. So that could just be like a page on your website or something that says, Hey, if things weren't optimal for you, what can we do to help? Something like that. Feedback and feedback pages are very easy and everyone knows what to do. Yeah. Oh, excellent. Excellent. This is such good information. I'm taking so many notes. That's why I'm asking questions. I'm like, let's drill down into this further. All right. So something that seems like has been a constant theme from when we started about how do we kind of get through this pandemic in a way that's a positive for everyone involved and talking about reviews is communication. So let's talk about communicating with your staff and what do we need to provide within that communication training. I know it's a big question.
Jennifer Thompson (27:13):
So no, I love that you're asking it and I love that. I have some kind of relevant examples right now. So we do training for staff a lot around kind of employee engagement and everything kind of around how do you enhance the patient experience. So, and we put this together because of these docs saying, fix my reputation. And we said, you can't fix your reputation, so you focus on your people that plus unemployment's been at record lows. I mean, totally different conversation right now, but unemployment was at record lows. So how do you engage your employees? But we've been able to use the platform. So that's on demand training, delivering like 10 minutes a day type of thing. But we're using the platform to communicate with employees, but you don't need a platform to do this.
Jennifer Thompson (27:59):
So I think the very first step when you have a crisis is just to come up with a game plan and don't forget to think about it from a marketing perspective as well. You know, if you're going to communicate to your patients that you are offering telemedicine, don't assume that your employees know what's going on. And so, especially, if you're a large practice and you have people that work remotely or you're in multiple locations, consider putting together a weekly, maybe it's a video that you can send out. There's a great tool that I use all the time called loom L double O M love it free. You know, there's no reason not to and you don't have to house the videos. You can send it to people. Consider an email, like a regular email chain for those employees. But I've got a practice that I'm working with now that we actually got this off the ground this week and they have about 300 plus employees and they have multiple locations and a surgery center.
Jennifer Thompson (28:59):
And what we've done is basically we created a closed Facebook group for them and we are solely using it to communicate with employees that are now, some are in the practice, some are at home, some are furloughed. And the big concern is, especially in healthcare, is the bottom's not going to drop out from a revenue stream down the road. In fact, in a couple months, we're probably going to be working our tails off Saturdays and Sundays and nights because people are still going to want surgery. They're still gonna need their therapy. They're still, everything's going to happen. So you can't afford to lose furloughed employees. So now more than ever this practice in particular doubling down on communication and what they're doing is we're working so we manage the social for some of these accounts. So we're working on a patient facing social media, but now we're working on employee facing into closed groups.
Jennifer Thompson (29:56):
So now I'm reaching out to doctors saying, Hey, give me, send me a video offering words of encouragement. Show us how you're working from home. And then it's employees show us, you know, what you look like in your PPE. Show us how your eyes are having social distancing, talk to the people that aren't in the office and tell them how much you miss them. Celebrate birthday, celebrate anniversary. So it's this whole other thing. And I think that because social media allows us to create that sense of community and sometimes we lose that and not everybody's paying attention to emails and official communication. So it's working and it's a lot of work, but it's working and I think that it's going to do what it's supposed to do.
Karen Litzy (30:37):
Yeah, it's a great idea. And I think, I mean I have my own practice, I'm not an employee, but if I were an employee of a company and I saw that CEO or our owner getting on and giving us encouragement and at least acknowledging that we're still part of the company, even though maybe were furloughed or maybe were from home or now we're part time, I think that goes a long way. So I think that's a really a really great idea. And I'm assuming on these Facebook closed groups, you're not exchanging sensitive patient,
Jennifer Thompson (31:13):
Nothing like that. No, this is like top level and the CEO, this one, I've really got to commend him. He's being transparent, which I think is so important. Sharing the uncertainty of what's going on. You know, the practice applied for a PPE loan, they may not have gotten that PPE line. They've got about $3 million a month that they've got to deal with and overhead. So that's a big one. You know, as they typically give pay increases for working anniversaries, they had to tell everybody, you're not going to get these pay increases right now. We're going to deal with it in a couple months. Right now you're not. So just kind of communicating and answering questions that people are afraid to ask, but getting in front of it. And I think that that's a big kudo to that CEO.
Karen Litzy (31:56):
Fabulous. Good stuff. Good stuff. All right. Now we'll finish up with one more topic that I think we want to cover and again, relevant at this time, but ways to create some big return on investment or ROI with a small budget because I think now everyone's tightening their belts. We have, like you just said, what if you can't get these loans? What if you can't do X, Y, and Z? Everybody's budgets are shrinking. So how can, what are some ways that we can get some big impact on our shrinking or smaller budgets?
Jennifer Thompson (32:30):
All right. Couple of things that we're doing with our clients. So this is like real world may or may not be working, but we'll see. Cause we're pivoting like on an hourly basis sometimes yes. But first and foremost longterm strategies is double down on your online reviews. Thousand percent do that. Pay attention to where people are having conversations and become part of those conversations if you can. I say that specifically because we tell a lot of our clients, you know, you want to create great relationships with your patients, you want to get lots of online reviews but really what you want are like raving fans and those fans that when somebody new moves into a community or has a need, the first place they're typically going is like to next door or to Facebook. And they're asking for recommendations for someone and you know, to help them with whatever their need is.
Jennifer Thompson (33:27):
And if you've got patients out there that are really like singing your praises, they will do this for you for these recommendations. And so you want to make sure that you stay top of mind and stay in top of mind. Doesn't mean spending a bunch of money. It means being visible. So it goes back to don't just be on social media and schedule some lame posts three days a week through a scheduling software. If you're going to do it, do it. And I think the pandemic is, is forcing us to think about sometimes some things outside the box that we've always said, I want to get to this, to create this great content, but I don't have time. Well, you have time now, so create the great content because in a couple of months you're going to be so busy, you're not going to know what to do with yourself.
Jennifer Thompson (34:09):
And so I think that's really important. And then maybe start thinking outside the box of things that you hadn't thought about doing before. I have a large practice that I work with that hosts an annual seminar, a biannual seminar where they offer CEUs to athletic trainers and allied health professionals lots of physical therapy people that come into this and they have their ortho doctors on their panels typically. And then they'll invite others from all over the country to come in. They'll get the CEUs and then they'll offer them, well, chances are, and they get about 700 people every time that come to the saying it's great for them, the chances are they're not going to be able to do it this year. And so we're already having discussions with their providers who they already have the credits so they can get in the next couple of weeks here, taking that all online and getting with for them particularly they're gonna focus on athletic trainers right now because they can offer those credits.
Jennifer Thompson (35:10):
But we're going to transfer that to an online forum and these doctors are going to give the same talks live in a zoom setting and at the end they can have the survey done and they can offer seat use. But it's a great way to build relationships that they typically wouldn't get that chance to do. And so just kind of things like that out of the box thinking like we have class or doing live Q and A's on Facebook and you know, taking those live Q and A's and then recording them and then we can use them in videos and other things down the road. So I think we just need to be authentic, you know, have fun with it, but have fun in a strategic way and then double down on being where your potential patients are being part of those conversations and then just making sure at the end of the day you deliver great customer service to everybody.
Karen Litzy (35:55):
I love it. And none of that takes a lot of money at all. No. As a matter of fact, a lot of that was free. Yup. It was all free for the most part. Yeah. Amazing. Amazing. Well, Jennifer, thank you so much. I mean you have given us so much to think about and ways that we can pivot our practices to be relevant in this time and to prepare for the future when hopefully things start to open up and return to different. I don't even want to say return to normal, but we'll return to a form of normalcy. I think it's always, I think things are always going to be a little different from now on, but to at least get out of more of a lockdown situation where we can actually see more people in real life. And I think it's like you said, putting out the fires are important, but then looking to the future is I should also be part of our plan. At least that's the big takeaway that I got from this. Absolutely. I think you hit the nail on the head. Yeah. Awesome. All right. Now the last question I asked this to everybody. Knowing where you are now in your life and in your career, what advice would you give to your younger self? Say straight out of school,
Jennifer Thompson (37:13):
Stop stressing out about everything so much. Just stop stressing out. You know, if you work hard and you put yourself in the right situation and you prepare yourself academically and through experiences, don't say no to things. Say yes, go in there. Experience so much of it and realize that as long as you're doing what you need to do, you're going to end up where you're supposed to be.
Karen Litzy (37:35):
Love it. Thank you so much. Now where can people find you? Where websites, social media.
Jennifer Thompson (37:42):
Yeah, absolutely. So you can find me at insightmg.com which is insight I N S I G H T M as in marketing, G as in group.com and you can find me on anything social under the under the handle at dr marketing tips. So that's dr marketing tips. And you can find us on iTunes at the dr marketing tips podcast as well.
Karen Litzy (38:09):
Awesome. Well thank you so much. This was great and everyone we’ll have all of those links and the show notes at podcast.Healthywealthysmart under this episode. Jennifer, thank you so much again. This was perfect for the audience and I think they're going to take a lot out of it. So thank you so much. And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Karen Litzy (38:36):
Thank you for listening and please subscribe to the podcast at podcast.healthywealthysmart.com and don't forget to follow us on social media.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Daniel Chelette, Amy Arundale and Justin Zych on the show to discuss some questions from our presentation at the Combined Sections Meeting in Denver, Colorado entitled, Turning the Road to Success Into a Highway: Strategies to Facilitate Success for Young Professionals.
In this episode, we discuss:
-How work-life balance evolves in your career
-The physical therapy awareness crisis
-How to tackle the female leadership disparity in physical therapy
-Burnout and when to pivot in your career
-And so much more!
Resources:
Amy Arundale Twitter
Daniel Chelette Twitter
Justin Zych Twitter
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Daniel:
Daniel Chelette is a staff physical therapist at Orthopedic One, Inc., a private practice in Columbus, OH. He graduated from Duke University with his Doctorate of Physical Therapy in 2015. He is also a graduate of the Ohio State University Orthopedic Residency Program and Orthopedic Manual Therapy Fellowship Programs. He became a Fellow of the Academy of Orthopedic Manual Physical Therapists in April. Since June of 2018, he has served as the Chair of the Central District of the Ohio Physical Therapy Association. Daniel’s interests include evaluating and treating the complex orthopedic patient, peer to peer mentorship, marketing and marketing strategy and advancing the physical therapy profession through excellence, expert practice, and collaborative care.
For more information on Justin:
Dr. Zych currently practices physical therapy in Atlanta, GA as an ABPTS certified orthopaedic specialist (OCS) and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) with Emory Healthcare. Additionally, Justin is an adjunct faculty member with Emory University’s Doctor of Physical Therapy program and a faculty member of Emory’s Orthopaedic Physical Therapy Residency. Justin earned his Bachelor of Science from Baylor University, then graduated from Duke University with his Doctorate in Physical Therapy. He has completed advanced training in orthopaedics through the Brooks/UNF Orthopaedic Residency and OMPT Fellowship programs, while concurrently practicing as a physical therapist and clinic manager in Jacksonville, FL. Justin is actively involved with the Academy of Orthopaedic Physical Therapy and Academy of Physical Therapy Education. He has identified his passions lie in clinical mentorship and classroom teaching, specifically to develop clinical reasoning and practice management for the early clinician.
For more information on Amy:
Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher. Originally from Fairbanks, Alaska, she received her Bachelor’s Degree with honors from Haverford College. Gaining both soccer playing and coaching experience through college, she spent a year as the William Penn Fellow and Head of Women’s Football (soccer) at the Chigwell School, in London. Amy completed her DPT at Duke University, and throughout as well as after, she gained experience working at multiple soccer clubs including the Carolina Railhawks F.C. (now North Carolina F.C.), the Capitol Area Soccer League, S.K. Brann (Norway), and the Atlanta Silverbacks. In 2013, Amy moved to Newark, Delaware to pursue a PhD under Dr. Lynn Snyder-Mackler. Working closely with her colleague Holly Silvers, Amy’s dissertation examined primary and secondary ACL injury prevention as well as career length and return to sport, primarily in soccer players. After a short post-doc in Linkoping, Sweden in 2017, Amy took a role as a post-doc under David Putrino at Mount Sinai Health System and working as a physical therapist and biomechanist at the Brooklyn Nets. Outside of work, Amy continues to play some soccer, however primarily plays Australian Rules Football for both the New York club and US National Team. Amy has also been involved a great deal in the APTA and AASPT, including serving as chair of the AASPT’s membership committee, Director of the APTA’s Student Assembly, and as a member of the APTA’s Leadership Development Committee.
Read the full transcript below:
Karen Litzy (00:00):
Hey everybody, welcome to the podcast. I'm happy to have each of you on and I'm going to have you introduce yourself in a second. But just for the listeners, the four of us were part of a presentation at CSM, the combined sections meeting through the American physical therapy association in Denver a couple of weeks ago. And our talk was creating a roadmap for your physical therapy career. And afterwards we had a Q and a and we just had so many questions that we just physically couldn't get to them due to time constraints and the such at CSM. So we thought we would record this podcast for the people who were there and the people who weren't there to answer the rest of the questions that were in our Slido queue. Cause I think we had quite a bit of questions. So, but before we do that, guys, I'm just gonna shoot to you and have all of you give a quick bio, tell us who you are, what you do, what you're up to, and then we'll get to all of those questions. So Justin, I'll have you start.
Justin Zych (01:00):
Sure, so I'm Justin Zych. I'm currently with Emory university. I am teaching in an adjunct role with the DPT program and then also the orthopedic residency. I went through and did an orthopedic residency and manual therapy fellowship through Brooks rehab in Jacksonville and did my PT education with Duke university.
Daniel Chelette (01:28):
Hey everybody. My name's Daniel Chelette. I also graduated alongside Justin from Duke in 2015. And also completed an orthopedic residency at the Ohio state university and then stayed on and completed a fellowship and with manual therapy at Ohio state as well. And then worked in an outpatient orthopedic clinic for a couple of years and then was fortunate enough to have the opportunity to join on and work as a physical there, the player performance center with the PGA tour. So actually up to two months into that and it's been a pretty cool experience. So that's where we're at right now.
Amy Arundale (02:15):
Hi, I'm Amy Arundale. I'm a physical therapist and biomechanistic with the Brooklyn nets. I also went to Duke although a few years before Dan and Justin and then worked in North Carolina for a little while as a sports physical therapist as well as working with a large soccer club before going and doing a PhD at the university of Delaware under Ireland Snyder Mackler. So did research on primary and secondary ACL injury prevention did a postdoc in Sweden with Juan activist and Martin Haglins before moving here to do Brooklyn.
Karen Litzy (02:56):
Well, thank you all for joining me and allowing the listeners to get a little bit of a glimpse into our CSM talk for those who weren't there and for those who were, and maybe we didn't answer their questions while we were there. We can answer it right now. So Daniel, I'm going to throw it to you. I'm going to have you take the lead for the remainder here. So take it away.
Daniel Chelette (03:20):
Let's do it. All right, so just a quick little background of the foundation or basis for this talk. It really focuses on some lessons and things that we have learned through the four VAR unique experiences up until this point about professional growth and professional development and things we've learned, the easy way and things we've learned the not so easy way. And just tidbits of wisdom we've picked up along the way and we thought it'd be valuable to put it together and have a talk for CSM. And that's kind of what well what the basis of all this was. So towards the last portion of the talk we just opened up wide open Q and A. and we got through a few questions but we've got a handful more that we're going to go with. So we're going to start out with let's see. What do you recommend for the future PT that wants to get involved in a specific section of PT but wants to remain local to their community?
Amy Arundale (04:26):
I can start with that one. I think one of the nice things about being involved in the like sections is a lot of times they actually are based where you're at. So they don't necessarily, they may require going to conferences but they sometimes don't even require that. So it's really easy actually to stay local and still contribute and get involved in the sections. Really. The big piece there and is just reaching out and saying, Hey, I'm really interested in getting involved. How can I volunteer? And that might be, you know, helping with a membership that, which might be making phone calls or emails or following up with people who have maybe accidentally dropped their section or their APTA membership. It might be helping with various other projects, but a lot of times those are actually you know, maybe they're internet based or they're going to be through conference calls. So it's pretty easy to stay local.
Karen Litzy (05:27):
Yeah, I think that's a great answer. I'm pretty involved in the private practice section of the APTA and I would echo what Amy said. A lot of you can get involved in committees. So a lot of the sections have individual committees and most of that work is done online with, maybe you have to go to the annual meeting of that section, but that's just once a year. And the good news is if you're doing a lot of things online, you're meeting people. When you go to, let's say the section meetings each year, you'll get to know people in your immediate local area. And it's a great way to start making and nurturing those connections in those relationships. So then you'll have people in your immediate area that you can go to for guidance and just to hang out and have fun as well. But I think starting, like Amy said, just have to ask.
Daniel Chelette (06:27):
Yeah. That’s beauty of the age that we live in is that it's really easy to connect be a long distance. So technology allows us to do that. And I'm a part of a committee through the American Academy of orthopedic manual physical therapists. It's the membership committee. And everybody's all over the place where all across the country. And that was just something I got plugged into and I've met a lot of cool people through it and have made some connections within that realm. Be that, so there's a lot of different like online and long distance ways that you can get connected without being connected, which would be, is it helpful if there's a particular area you want to stay in, but you still want to get connected? Two people within your community but also outside.
Karen Litzy (07:17):
All right, Daniel, go ahead. Take it away.
Daniel Chelette (07:21):
All right. We're stepping it up here. This next, and this is a good metaphysical question. Do you compartmentalize your life? How do you approach the interaction between family and professional domains?
Justin Zych (07:36):
So yeah, that is a really deep question. I'll try to go through and answer to the best of my ability. I think that that intersects a little bit with my section of the talk, which really focused on trying to make sure that you could handle all of the new responsibilities that come with being a new physical therapist. I'm getting used to the responsibilities and productivity expectations, but while also at the same time understanding that it's important to have a balance outside of the clinic and a really good work life balance. So as far as compartmentalizing it, I don't know if I've specifically sat down and tried to put things into boxes. I do have a little bit of a blend. I mean, even my wife works for a different physical therapy company, so we share a little bit of a shared language with that.
Justin Zych (08:24):
But it's important that whether it's documentation or other things. When I leave the clinic, I try to leave and make sure that I have a little bit of time for me and time to focus on whether that's my own professional development going and taking advantage of opportunities like this to meet and talk with other people or just relax and kind of step away from the responsibilities that you go through throughout the day. So that's a great question, but a very, I think you're going to find a bunch of individual answers from it.
Daniel Chelette (08:56):
Yeah, I think it really, it's an individual question kind of like Justin mentioned in, I think for me. What I've found is, you know, maybe well work life, work life balance, particularly going through residency and a fellowship you know, work life balance, a 50, 50 split, maybe not completely realistic, it's a work life division. So where you just have, you have things within your life, be it relationships or activities or whatever. We are able to unplug a little bit from work. And those might be bigger parts of your life at different points in your life. But it's being able to, you know nurture and engage in all aspects of who you are as a person. And not just work, work, work, work, work but kind of be guided by what you're passionate about, what's important in your life. And those will take up bigger sections of your life pie at different points in your life. So it's just important to try to have a division but not necessarily think that you have to keep that division at a certain level at all times throughout your life because life changes.
Amy Arundale (10:11):
So my old advisor LENSTAR Mackler and I've also heard Sharon Dunn use the metaphor of juggling. And they talk about juggling rubber balls and crystal balls. So your crystal balls being the things that are like really, really important. The things that you have to keep in the air because if you drop they shatter, so those might be like family, they might be important relationships. They might be work. And then you also then also have rubber balls. So rubber balls would be then things that if you drop they'll bounce back. They're not quite as crucial to keep in the air all times. And, that balance between some of those rubber balls and crystal balls is always going to change. But that there are some things that you have to keep in the air and some things that you can let drop or you might have, they might have a different kind of juggling cycle than others.
Amy Arundale (11:07):
So yeah, I think it changes from time to time. You know, I've had periods of time where I've basically just worked full time. My postdoc was a great example. I was basically, you know, going to work during the day working on postdoc stuff and then coming home and trying to finish off revisions on my PhD papers. And I was in a long distance relationship at the time, so it kind of just worked that I was literally working, you know, 14 sometimes 14, 16 hours a day. That's not sustainable for a long period of time though. And I'm guilty of sometimes not being good at that balance. I would like to think as I've gotten older, I'm better at creating time where I'm not working or you know, actually taking vacations where I'm putting an email like vacation, email reminder on and not looking at emails.
Amy Arundale (12:04):
But it's going to change from time to time. Those priorities will change as your life changes. So I don't know if it's necessarily compartmentalizing, but prioritizing what needs to be, what's that crystal ball? Are those crystal balls and what are those rubber balls?
Karen Litzy:
Okay. You guys, they were all three great answers and I really don't think I have much to add. What I will say is that as you get older, since I'm definitely the oldest one of this bunch, as you get older, it does get easier because you start to realize the things that drive your happiness and the things that don't. And as you get older, you really want to make, like one of my crystal balls, which I love by the way, it's Sharon Dunn is genius obviously. But for me, one of my crystal balls I'm going to use that is happiness.
Karen Litzy (12:58):
And so within that crystal ball, what really makes me happy. And that's something that I keep up in there at all times. And at times maybe it is work. Maybe it's not. Maybe it's my relationship, maybe it's my family or my friends or it's just me sitting around and bingeing on Netflix. But what happens when you get older is I think, yeah, I agree. I don't know. And I think we've all echoed this, that I don't think you compartmentalize. You just really start to realize what's the most meaningful things for you. Right now. And it's fluid and changes sometimes day to day, week to week, month to month, year to year.
Daniel Chelette (13:55):
All right. And one, one quick thing on that last question. Kind of a hot topic, particularly in the medical doctor community is burnout and resiliency and you'll see those terms thrown around a lot. And I think a big thing is to realize that those types of things as far as burnout and kind of getting to a point, we're just sort of worn out with what with the PT professional, which do on a daily basis everybody's susceptible to it. You know, we can all get caught in this idea that maybe we're indestructable or you know, Oh, I can take on as much as I wanted to or need to like machine X, Y and Z. At a certain point it's a marathon, not a sprint. And you have to sort of like Karen and Amy alluded to that prioritization is huge. And definitely gets a little bit easier as you gain more life experience and kind of see what matters and maybe what doesn't so much.
Daniel Chelette (14:51):
Okay, now they're kind of good solid question here. So I'm going to paraphrase a little bit in, So companies, businesses usually do something really specific now for a specific product or a service or something like that. They focus on one thing.
Daniel Chelette (15:02):
In PT, we do many things. Is there an identity crisis within the profession of physical therapy? And how do we address it? So I’ll kind of get the ball rolling? That's a heavy question. I think to a certain degree, I don't know if I would say crisis, but I do think at times like I use the situation of if somebody asked me what physical therapy is. Initially I have a little bit of a hard time describing it. I think, I guess the mission statement of the vision 2020 is sort of what I fall back to. It's a really good snapshot of how we can describe what we do. It's basically helping to optimize and maximize the human experience through movement and overall health and, you know, but that in itself is a little bit vague and a big picture and sort of hard to really put a specific meat too. So, yeah, I think, I think to a certain degree it's a little bit hard to say what is physical therapy’s identity? What do you guys think?
Amy Arundale (16:21):
I would say, I don't know if we have an identity crisis, but I think we have an awareness crisis. I think the general public's knowledge and awareness of physical therapy and then also within the medical profession, the awareness and knowledge of what physical therapy is I think is a massive problem because that knowledge and awareness isn't there. And probably part of it then comes from us. I think, you know, Dan, what you're saying, I think that is that kind of, if we can't describe ourselves then no wonder other people can't figure out what we do or how we do it. So I'll give a shout out actually to Tracy Blake who's a physical therapist and a researcher in Canada. And one of the things that the last time when we sat down and had a chat was, she kinda gave me this challenge was if someone were to walk up to you and ask you what you do, come up with a way to describe what you do without using any medical terminology.
Amy Arundale (17:28):
So without using movement, without using sports, without using some of our fallback terminology, like come up with that elevator pitch of this is what I do. So I'm happy if you've got that at the ready. If you understand that, if you can kind of, yeah, the drop of a dime, give that, you know, five seconds spiel about what physical therapy is, then suddenly, you know, that person knows. But we've all got to have that at the ready and we've all that. I'd be able to do that so that we can put it in a common language that, you know, your next door neighbor can understand, that your grandmother can understand. So when they come to you and say, you know, you know, my hip's been bothering me for six weeks and I've been going to a chiropractor you've got that language to be able to say, well, have you thought about physical therapy?
Amy Arundale (18:29):
When you're talking to a doctor in a hospital or even just in a, you know, normal conversation you know, you've got that ability to say, well, Hey, you know, what about PT? Yeah, let's not put them on an opioid. Let's get them into physical therapy. So I think it's really a Big awareness crisis.
Karen Litzy:
Okay. So Amy then my challenge to you is to Tracy's point, how do you answer that question? And then I haven't even bigger challenge though I'll say to everyone, but how do you answer that question?
Amy Arundale:
So I've written it down. Let's see if I can get it right. The short version of mine is that my goal is to help athletes at all levels develop into their optimal athletic being as well as develop their optimal performance. What if someone says, well, what do you mean by optimal? That's a good question. What does that mean exactly? How do I help you become the best you can be?
Karen Litzy (19:27):
Okay. Not bad. Not bad. Excellent. Very nice. Very nice. So now I have a challenge for the three of you and let's see. Daniel, well, no, we'll start with Justin. Let's put him on the spot first. Great. All right. So I was at an entrepreneurial meetup a couple of years ago, and the person who was running this, Mmm gosh, I can't remember his name now. Isn't that terrible? But he said, I want everyone to stand up. In five words. So you have five fingers, right? Most of us. So in five words, explain to me what you do. So talk about stripping it down to its barest essentials. Simplifying to the point of maybe absurdity. It's hard to say what you do in five words, but Daniel, I'll start with you. So someone comes up to you and you say, I'm a physical therapist. Five words. This is what I do. Help people live life freely.
Karen Litzy (20:48):
Okay. That's not bad. Not bad. Justin.
Justin Zych (20:51):
I'm not going to use a sentence, but facilitate. Educate. Yeah. Facilitate. Educate. Empower. Does that count that I repeated like six. Now, restore, empathize. Throw the thighs in there.
Karen Litzy (21:09):
Nice. Yeah. When I did this for this little meetup, I said, I help people move better. That's what I said. Those were the five words. I help people move better. But I do like where I think maybe if we put our heads together and we mashed up all four of ours, I think we'd come up with a really, really nice identity statement that is maybe 10 words. So maybe we can put our heads together after this and come up with a nice identity statement made up of 10 words. And if we were at CSM, we would have the audience do this. This would have been one of their action items. So what I'd be curious is for the people listening to this, you know, put an action item put, what are your five words, what would you do to describe what physical therapy is? And then if you're on Twitter, just tag one of us. You can find all of our Twitter handles at the podcast, at podcast.healthywealthysmart.com in the show notes here. So tag one of us and let us know what your five words are because I'd be really curious to know that. Excellent. All right, Daniel, where are we at?
Justin Zych (22:42):
So actually I want to, I still want to go back to the last question cause I think there's a really good point in there. So Amy hit it really well with the awareness issue versus the identity crisis within our profession. I, I think one of the things that sets us apart is how dynamic we're able to be. And the skill set that we're given in, you know, when we have our DPT education and when we graduate, you know, granted, you know, we're using the term as a generalist where you can go and specialize further. But I think that that's a, that's a rare but very very powerful trait of our profession is that we're able to help across a spectrum of a lot of patients. The challenge that I would say if that question was worded a little differently is if we focus specifically just on one section, so is there an identity crisis within the orthopedic section?
Justin Zych (23:36):
If somebody comes in and they have hip pain, are they going to be treated differently by all four of us and then therefore does that make it really tough for us to come up with this five words, 10 words statement? Because we're, we're very heterogeneous in how we, how we address patients still kind of within specific subsets. So I think that's probably the bigger crisis if you will. We still have a, you know, even within specific sections, a 10 lane highway instead of, you know, two or three based off of specific patient needs.
Karen Litzy (24:10):
And do you think that publication of CPGs helps that it for people who, and this is going off on a totally other question, I realize that, but following up with that, do you think CPGs published CPGs help with that and staying, I guess up and current on the literature can help with that? Do you feel like that is something that might close that gap of huge variability?
Justin Zych (24:39):
Yeah, I think the way that they're designed, that's exactly what they're trying to do is they're trying to take all of this, this you know, research literature review that we should all be doing and put it in a really nice, you know, consensus statement for us and then give us, you know, specific things to look deeper into the CPG. So I think that it's there, it's just again, how do you, is everybody finding that? And if they are finding it, are they applying it properly, you know, towards their practice. So I like that the information is coming out there. At this point, I'm not completely confident that it's reaching throughout, you know, the spectrum of everybody that it should be. But hopefully, you know, it continues, especially with, as we have new people graduating, we really start to develop that as more of the norm. And then it's a lot easier to not necessarily standardize but get everyone in in a couple of lanes instead of 10 lanes.
Daniel Chelette (25:36):
So Justin, just to play devil's advocate what about the good things that come with having 10 lanes versus two? And there's some people that I completely am on board with what you're saying, but I think there are plenty of folks that would say, well that's the beauty of physical therapy is that it can, you know, you can really make it make it individualized and what it is to you and you can treat. Obviously there's principles that you abide by, but you can be different then the PT next to you and different to the PT next to them and I can still offer high value. What would you say to somebody who would say that?
Justin Zych (26:26):
I think that your statement you just said is completely fine. But, the issue that comes about that is that therapist who wants to provide the individual approach, have they, you know, exposed themselves to enough different approaches or different ways that they would look at it, that they can be truly individual to the patient instead of saying, okay, I'm going to focus on I’m a, you know, to throw anyone or anything under the bus here, but I am specifically a Maitland therapist. I'm specifically a McKenzie therapist. And then that approach fits that patient all of a sudden, as opposed to being able to expose yourself enough to be able to flow in and out. Again, based off of what you said, which is I completely agree with that individual approach. So making sure that you have that dynamic flexibility to cater your skills. Sorry, a little bit of a tangent there, but can't help myself.
Amy Arundale (27:37):
I'll piggy back and put a shout out to people who want to get involved. But one of the things that the orthopedic and the sports section, I'm going to go back to their old names, the orthopedic section and the sports section. In the newer clinical practice guidelines. One of the things that I think Jay has done a great job of is kind of forming committees around each guideline on implementation. So when we did the knee and ACL injury prevention clinical practice guideline, we actually had a whole separate committee that we pulled together that was in charge of how do we help disseminate this information and help clinicians implement it. So that was putting together a really short synopsis for clinicians, a pamphlet or just like one pager that can be like just printed off and given to a clinicians. It was two videos. So videos of actual injury prevention programs, one for field based athletes on one for court based athletes. But getting those out, just like you talked about Justin, you know, that that's sometimes where that or that is where that gap between research and clinical practice comes. And that implementation is so important, but it means that yeah, there's a chance to get involved for people who are interested in helping those guidelines really kind of truly get disseminated in the way that they need to be.
Karen Litzy (29:04):
Great. And I think that's also really good for the treating clinician because oftentimes as a treating clinician, we feel like we're so far removed from the researchers and even from the journals that you think, well, what is my contribution going to do? Like how can I get involved? I'm the J word, just a clinician. And so knowing that these committees exist and that as a treating clinician, you can kind of be part of that if you reach out to get involved I think is really important because oftentimes I think clinicians sometimes feel like a little
Karen Litzy (29:42):
Left out, sort of and left behind as part of the club, you know. So I think, Amy, thank you so much for bringing that up. And does anyone else have any more comments on this specific question or should we move on to the next one?
Daniel Chelette (29:59):
Alright. So Amy and Karen, this question is geared towards you guys. So the question reads while PT is a female dominated field, there is still a disparity in female leadership. Do you have advice for female student physical therapists who may desire those leadership roles?
Karen Litzy (30:24):
I would say number one, look to the APTA. Look to your state organization, look to your, even where you're working and try to find a female physical therapist or even look to social media, right? Look to the wider world that you feel you can model. So I think modeling, especially for women, for people LGBTQ for people, minorities is so important. So you want to look for those models. Look for the people who are like, Hey, this person is kind of like me. So I really feel like I can follow a model, this person, I would say, look to that first and then follow that person, see what they're doing, try and emulate some of, not so much of what they're doing in PT, but how they're conducting themselves as a professional. And then like I said, during our talk, reach out, you know, try and find that positive mentor of try and find that the mentorship that that you are seeking and that you need and that you feel can bring you to the next level, not only as a therapist but you know, as a person and as a leader within the physical therapy world.
Karen Litzy (31:46):
And I think it's very difficult. I'll do a shameless plug for myself here really quick. We created the women in PT summit specifically to help women within the profession, a network, meet some amazing female and male leaders within the profession and have difficult discussions that need to be had to advance females within the profession. And I will also say to not block out our male counterparts because they need to be part of the broader conversation. Because without that, how can we really expect to move forward if we don't have all the stakeholders at the table. So I would say speak up, speak out, look at people who are at the top of their game.
Karen Litzy (32:40):
And then in a high level positions, Sharon Dunn, Claire, the editor of JOSPT, Emma Stokes, the head of WCPT. All of these people, if you reach out to them or you hit them up on social media, they will most likely get back to you. It may not be really fast, but they will probably do that. So I would say look to the broader physical therapy community. Look to the world of physical therapy right down to your individual clinics because I think that you'll find there are a lot of people to model.
Amy Arundale (33:41):
Mmm, yeah. Yeah. I 100% agree. I think modeling and mentorship are huge. Finding people that you connect with and who can give you honest, upfront feedback but also support. So I feel like I'm pretty lucky in both having really strong women who I consider as mentors, cause I think that is important. When I was part of the student assembly, Amy Klein kind of oversaw the student assembly and she became someone who I really look up to and admire and will go to for, I know she'll give me it straight whether it's you know, good or bad, I know she'll give it to me straight and I need that. But then also Joe Black is somebody who's also been a longtime mentor of mine recently. And the Stokes I've connected with and that was just meeting her at a conference. And we connected at a conference and had an amazing conversation and that's developed further too. So I think mentorship and then getting involved seeking the opportunities. Mmm. And seeking and creating, cause sometimes they're not already there. Sometimes, you have to create them yourself. Some of those opportunities that you want going out and saying, Hey, can I volunteer here? Where they may not have had volunteers before. So finding those opportunities that you want and that you think will help you develop towards your end goal.
Justin Zych (34:53):
I was just going to say really quick of course you two have been, you know, great examples of how females can Excel and create their own path.
Justin Zych (35:08):
The thing about mentors is with mentors, it's so important to have a variety of mentors because you're going to pick out different things that the mentors are going to help you with. One of my most influential mentors was a female. She was, you know, I was involved with her in the fellowship program that I was in. And she really helped give me some really blunt but helpful feedback that helped a lot with some of my soft skills. So I'm kind of exposing myself a little bit, but she told me that after my lecture, it was on the cervical spine. She was like, yeah, like the content was great. You just weren't likable and just kind of threw that right at me, let me chew on it a little bit. But that actually really changed how I approached a lot of different things and helped me develop those soft skills.
Justin Zych (35:55):
So at the same time, she helped me through some managerial struggles that I was having. So that variety is incredibly important. And I've been a mentor too. You know, some of my mentees were females and they're doing amazing things right now and I hope that whatever feedback I gave them, they took the right things from and continue to move forward. So it's an issue that goes across, you know, the gender lines. And as males, I want us to be aware that it's going on as well. And not to lead into that discrepancy that Karen described, but still provide that same level of mentorship, same level of opportunity and consideration. So it's a great question and hopefully the gap narrows as we go forward.
Daniel Chelette (36:59):
Oh, here's another good one. Any recommendations for a PT that is two years out and feels completely lost and, or in the wrong setting?
Justin Zych (37:10):
Yeah, so I'll start with that one. You know, of course understanding that I probably don't have the exact answer here. This really tied into my portion of the talk, which was the importance of the clinical environment within your first couple of years of development. And then also making sure that you understood that we clarified the difference between being engaged in your environment, in your system, and even in your organization versus being burnt out. And how those two aren't necessarily exactly the same thing. Burnout is something that we describe as more of like a longterm reaction with like physical manifestations where engagement is more of deciding how you want to use your remaining effort in the day, the effort that you can discern as I can do this to go home and watch Netflix or I can do this to really give back into my system.
Justin Zych (38:06):
So I actually had somebody right after the talk come up to me and just say that she really appreciated just hearing it and understanding that there are a lot of people that have that same sense where your question's coming from. So I just want to put that out there first of all. So I would say first reflect on what first off what you want out of your clinic and see what they are and are not matching. And if you've been in that for two years, that's a pretty good trial run to figure out if there's a different environment that maybe you would want to consider that's going to work more on engagement. What maybe that you want to be more involved in a clinical instruction and be a CI. Maybe you want to do some project management, have some more specific mentorship or it's just the way that they're setting up their productivity. So is it a question that I'm glad you're steering into right now? But it's gonna take a little bit of reflection not only on what your expectations are of the clinic and how you see yourself as a therapist but going even further, you know, keeping your system, your clinic accountable for are they meeting or at least trying to meet and keep me engaged in those environments. So we should, I wish you luck with that reflection.
Amy Arundale (39:27):
Nailed it.
Daniel Chelette (39:29):
Crushed it, man. I just got, I mean, that was a sick answer, man. That was right, right on the money. And the one thing that I would highlight is what I spoke on in my portion of the talk is try to strip it back and think, okay, like what am I about as far as life goes? Like, what am I passionate about? What am I into? What gives me energy? And then kind of builds yourself back up, okay, what as far as work goes, what aligns with that? And then why do I feel a disconnect with where I'm at? And are there ways that I can change my current situation kind of within it? Or do I need to you know, do I need to move on or do something different?
Daniel Chelette (40:22):
So I would try to use your personal passions and sort of your foundation of who you are as a person to help you kind of reset and try to figure it out. But you know, I think that's a great question cause we all go through it at some point in time. And you know, the concepts of burnout. Mm. Oh, reduced engagement and things. That's all part of the game. And those are completely, but I think burnout obviously isn't a good thing, but don't feel bad or guilty if and when you run into those things. Cause we're all humans. And, they can happen but know that there are ways that you can move out of that and move past that. And that's one of the cool things about PTs. There's so much to so many different things to do and get involved in. But yeah, great question.
Amy Arundale (41:15):
That passion was just like the one word that I felt like we needed in that answer. So I think those two are perfect.
Karen Litzy:
So we're good. We hit all the questions. So I'm going to ask one last question. It's a question that I ask everyone and Justin, I'll start with you. Not to put you on the spot again, but given what you know now in your life and in your career, what advice would you give yourself as a new grad fresh out of Duke.
Justin Zych (41:47):
Okay. Yeah, no, that's an awesome question. I think the biggest advice that I would give myself is to not have expectations of quick motion, quick development. I'm going through. And in my talk I talked a little bit about, we were in Denver for CSM. So I talked about using the French fry approach with skis where you go down quickly or the pizza approach where you go slowly. So making sure that at times, I was looking at the, you know, what I would tell myself now is make sure that you're looking at just that next step and not focusing on the step that's three or four away. So that you're really present in those moments cause there's a lot of development things that you can potentially miss over as you're trying to really quickly make it to that next step. So take a little bit more of that ski pizza approach.
Amy Arundale (42:40):
Fabulous. Daniel, go ahead.
Daniel Chelette (42:42):
I think what I would say is it's a marathon, not a sprint. You know, it's as far as, you know, career goes in, life goes, it's not just, you know, going 110% each and every day. It's being able to look at the long game. So with the short game, kind of along the lines of with what Justin said, just keeping in mind that Mmm, it's a marathon, not a sprint. You have to keep the big picture in mind.
Amy Arundale (43:47):
For me, it would be like give yourself permission and that I think that extends to a number of different things. But you know, one of the big ones is kind of self care, you know, kind of giving your self permission to take that time off or to let something else be a little bit higher priority. Whether that's working out or spending time with people, kind of give yourself permission to you know, take that step back and look at things from that 30,000 foot view. So you can really see that big picture. So I think that would probably be mine.
Karen Litzy (44:32):
Excellent. And then I feel like I've answered this question in various iterations over the years, but I've really think what I would tell myself. Yeah, right. Knowing what I know now and when I first graduated, which was quite a long time ago, would be from a career standpoint to get more involved. Whether that be in the APTA or sections or things like that. Because I really wasn't involved and from a personal standpoint is like I needed to calm down. Yeah. Like the Taylor Swift song, like I needed to calm down and that's what I would tell myself. Like I was always kind of go, go, go, go, go and I have to do this and I have to do that. And so I would tell myself like, calm down.
Karen Litzy (45:27):
Things will happen. Kind of echoing Justin and Dan, like I really that's advice I would give to myself is like, calm, calm down, you'll be fine. So that's what I would give to myself. So you guys, thank you so much. All of you for taking the time out and answering all the rest of these questions I think will be really helpful for people who are there and people who weren't to get a little taste of what we spoke about at CSM. And like I said, everybody's social media handles and info will be on the podcast website at podcast.healthywealthysmart.com in the show notes under this episode. So you guys, thank you so, so much. I really appreciate it. And everyone, thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.
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In this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Adrian Miranda on the Academy of Orthopedic Physical Therapy. Adrian Miranda, class of Ithaca College Physical Therapy '07, was born and raised in Manhattan. He currently practices at Windsor Physical Therapy in Brooklyn, NY. In addition, he is a medical consultant and content creator at a Virtual Reality rehab start-up called Reactiv.
In this episode, we discuss:
-Educational resources available at the Academy of Orthopedic Physical Therapy
-Diverse mediums used to disseminate research to clinicians
-How to be involved in advocacy on the state and federal level for the PT profession
-The importance of research for both advocacy efforts and clinical practice
-And so much more!
Resources:
Email: AMiranda84@Gmail.com
Cell phone: (585) 472-5201
Academy of Orthopedic Physical Therapy Twitter
Academy of Orthopedic Physical Therapy Website
JOSPT Website
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Adrian:
Adrian Miranda class of Ithaca College Physical Therapy '07 was born and raised in Manhattan. He currently practices at Windsor Physical Therapy in Brooklyn, NY. In addition he is medical consultant and content creator at a Virtual Reality rehab start up called Reactiv. In the past Adrian has also worked in media including video producer and a television host for BRIC TV ("Check out the Workout") a local television station in Brookyn. Previously he was a faculty member in the TOURO College Orthopedic Physical Therapy Program as the Director of Clinical Residency education. He also was an instructor for Summit Professional Education teaching continuing education (Shoulder Assessment and Treatment) He is currently the Chair of the PR/Marketing committee for the Academy of Orthopedic Physical Therapy (APTA) and contributes to APTA Diversity, Equity, and Inclusion initiatives. He previously held positions in the NYPTA as Chair of the Minority Affairs committee of the NYPTA, member of the programming committee, and Brooklyn/Staten Island Legislative liaison. He also teaches media including video editing, video production at Brooklyn media non profit BRIC. In his spare time he swing dances, does crossfit, has a web series called Gross Anatomy on Firework, and dabbles in theater.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor (00:00):
Hello. Hello. Hello, this is Jenna Kantor. Welcome back to another episode on healthy, wealthy and smart. I am here with Adrian Miranda who is a physical therapist who you have probably seen on social media quite a bit. Adrian, would you first tell everyone exactly what your job is that we are going to be discussing and in which section of the APTA?
Adrian Miranda (00:21):
So my name is Adrian Miranda. I am the chair of the public relations committee for the Academy of orthopedic physical therapy.
Jenna Kantor (00:30):
Yes, that's right. A mouthful in which I could not get off. So I had Adrian saved for me. Well Adrian, first of all, thank you so much for popping on today for a nice little interview. So I want to first just dive in because I don't know anything about the orthopedic section in the sense of what is it is that you guys are doing for me as a new grad, I'm always thinking the JOSPT, that is a great resource and that is it. So we're going to be diving into more of what the orthopedic section is doing at this point so we can all learn and better appreciate it. And also for those who are considering joining the section, you'll go, Oh, this is for me. Or actually it's not for me. I'm just gonna be sitting with other sections instead. So first of all, what is the big focus for the orthopedic section?
Adrian Miranda (01:23):
Well, the orthopedic section does a lot of things. But let's talk about the focus on education. So as you said, the JOSPT that is actually a joint collaboration between the Academy of orthopedic physical therapy and Academy of sports physical therapy. One thing, so I became the chair, I guess I spent two years I believe now or going into my second year, but I was part of the community for about six months before that. And one thing I would challenge anyone or ask anybody to do is actually go to the website, orthopt.org. Look at all the tabs, scroll through it. And you can find so many things that when I became the actual a chair and I went, I'm just perusing and just looking at what the Academy does. Cause my goal was like I think the Academy does a ton of stuff that not many people know about.
Adrian Miranda (02:12):
You're going to learn so much about how much work and effort goes into and how many resources you can find for yourself or your colleagues educationally. There's a lot of independent study courses. The one that you may know if you've either going through residency finishing residency and taking your OCS, but it's the current concepts which is of, I say it's a staple. If you want to take the OCS, you should have the current concepts, you should be looking for the current concepts and reading through it. That's going to be a huge, huge resource and who get better to go to then the Academy itself. Besides that, cause there's so many courses, even things that I didn't know about. For example, there was actually a concussion independent study course. As you know, many of us, even myself in the clinic are starting to get more and more referrals for patients who have had a concussion diagnosis. So that's out there. There are other courses that are older. Some you get the current courses you get see you use for their courses that you don't get. For example, there is a triathlete course, there is a postoperative course, there is a work related injuries course, auto accident, all these are resources that anybody can use. And that's just kind of the tip of the iceberg as far as courses that you can purchase. And moving forward there are some free resources as well.
Jenna Kantor (03:31):
That's very helpful. So for somebody who doesn't have time, Oh, I feel like I'm speaking for everyone when I say that than going, Oh my God, I have to go and like playing the tabs. How much time is that? I have other things on my to do list. You just gave an overview of the education part, but what are some highlights on things that stood out to you personally within that that's being offered?
Adrian Miranda (03:54):
So none of us have time. You're right. And so I think one of the things that you're going to start to see is easier access to information. So for example, even if you look at any of our social media threads which if you’re looking at orthopedic within a you're gonna find, for example, we had a patellofemoral infographic. You're going to start to see some more smaller snippets because the Academy has realized that yes, people don't know how to digest the information and put into clinical practice right away. You have to really large clinical practice guideline is 70 pages or 50 pages. And then how to kind of digest that and to put it back out in the clinic. We’re trying to create easier versions of that, whether it's infographics. We are also partnering with podcasters like yourself to disseminate information from the authors themselves to give you the information so you can have passive listening.
Adrian Miranda (04:46):
In other words, you don't have to read, you can actually be driving to work going on the subway. You can be on your lunch break and listening to information from authors or researchers of these publications. So we're trying to make smaller tidbits to make it digestible in a form that's also accessible to most people. So we've been looking to long form writing. But right now it's infographics are trying to get onto podcast and educate more people, but we are looking into the fact that there is a time constraint in our physical therapy profession.
Jenna Kantor (05:20):
Yeah. That's excellent to learn. So for the orthopedic section, with the information that you have provided that they're already offering, which is incredible, who is your audience when you're creating the infographics or the infographics for us to better understand, are they infographics where we can reshare it to patients?
Adrian Miranda (05:45):
So good question. These are for us. So the push is actually for us clinicians to get a better grasp of this literature and a cliff notes initial format. However, if you look at JOSPT and I think moving forward, we're trying to also create a little bit of public awareness. So have you seen in JOSPT patient perspectives? That's one way that you can utilize and share it. And I actually remember when they first came out in my clinic, I printed them out in color, put it on the walls and the rooms and patients actually read it and ask questions about it. But as far as what you'll see further moving forward, like the infographics, it's going to be more for us, for the clinician so that we can actually suck in the information and be able to distribute it out to our patients in the easier manner.
Jenna Kantor (06:27):
Yeah, that's a big deal. As a clinician myself or I'm putting together a lot of dance research and creating it on this long form document with links to different research to have it disseminated will be great because the time is taking me to create that. It's a lot of time. It's a lot of time. And I know other clinicians don't have that, so I'm creating this for the dance community at large. So I think that's a really big deal that you guys are looking to make that information more available because there's always regular research and I just want to point this out because nobody can see it.
Adrian Miranda (07:05):
Anyways, I just wanted to put this out there before we continue. Another question. We are also looking for ideas. We want to engage with our members. So if you have any ideas about how to disseminate this information in a different way, we're talking about even long form writing. Some people love to read and that's totally fine. We're trying to look into different options. We're definitely looking for suggestions, people to collaborate with us people to a similar to what you are doing Jenna. To collaborate with us, give us new ideas. We're definitely looking for innovative ways even some old ways that we can bring back to help our clinicians better understand this information and be able to utilize it.
Jenna Kantor (07:44):
I love that. So this is a newer concept, but we have discussed about it. How is the orthopedic brainstorming, how to bring in other people who are providing information and education to help what we bring to patients.
Adrian Miranda (07:58):
I think it's people who are doing the work. Researchers, also clinicians, people who are in the clinic and researching, you know, we're in the clinic and researching. But the Academy definitely has some of the top researchers, people who have their pulse on newer topics. And one of the things that, that also stand in me was when the concussion dependence study came out. And I think that's to show that right now we're going to see an uptake in physicians referring concussion patients to our profession. And we have to be ready for that.
Jenna Kantor (08:31):
You are on the PR committee, so you know a little bit about the public and the relations. You're like Samantha from sex in the city, but not anyway, so I digress. What is it that you guys are doing and focusing on within the marketing committee alone and who is your audience for that?
Adrian Miranda (08:50):
We just want to show you stuff. We want to show you and teach you things. For example, if you look at our recent posts, we wanted to share what happened at CSM. We actually have the Rose award, which if you were in a, for example, a rural setting, if you're doing home health care, you can actually watch his full speech on his study. That had to do with how many visits was optimal for home health, physical therapists. So those are the things that we want to kind of bring you inside and say, Hey, look, this is what we're doing. We are finding committee members who are have skills in different aspects of the media. Which like I said, we're looking for people, we're always looking for people and new ideas. But when I came in, as I told you I wanted to share everything that the Academy was doing at one point I will look there's actually even some certification for imaging.
Adrian Miranda (09:43):
If you are interested in imaging or you think you want to dive into any type of imaging for your research, your PhD or even if you're a new graduate who says, Oh, I really want to learn more about imaging. There is a special interest group for imaging with resources and there's I believe there is either a discount or something and you can again, you can kind of scroll through the social media cause we did post it at one point. We just go through so much information that I can't tell you everything on the up the top of my head. But we're trying to share information that you would actually have to go and scroll and look for on the website. We're trying to make it more accessible. So there's just so many things that we want to it's like a media company really.
Adrian Miranda (10:23):
We're just trying to share what things we do and what opportunities. Oh, another example is the federal advocacy forum. So there is the money into the Academy will provide to a student to actually attend the federal advocacy forum. I believe the deadline has passed for that to apply for the scholarship or the grant. But those are things that we're trying to do. Before I was at CSM and the chair of the practice committee came up to me and said, Hey, is there any way that you can share this? And so those are things that we, even through email marketing, you may have seen it. There was also other programs like CoStar, which you'll have to kind of look it up or go online or go on the website or social media to find out about it.
Adrian Miranda (11:07):
It was about innovation and science. And it's not just for physical therapy. So there's a lot of opportunities, volunteer opportunities, ways to get involved, resources, educational materials. So the peer committees, just trying to say, Hey, you know, those of you on social media, there's all this stuff that you can do. Right now if you look online, soon enough there'll be like a residency Q and A. So there are many of you who are interested in going into residency or currently in residency and we're trying to reach out to that population as well. So there's a target population. It's really the Academy members. So we don't have new grads or old grads. There is a little bit more of a push to get attention from new graduates and students, but we want to be able to share as much information that will help our members. So we are a member facing organizations.
Jenna Kantor (11:58):
That's really great. That's actually fantastic. Okay. I'm going to ask a controversial question more because the concept and idea is definitely backwards was what we're pushing for in the physical therapy profession regarding research. We want to be research based, we want that these studies to back up everything we do. We're doctors for, you know, for sake. So what about physical therapists who are just going, I don't need the research in order to treat these patients and get them better. I'm not saying this to criticize them. I'm not saying this to separate us. For somebody who's not interested in all this data and everything, what do you guys have to provide for them that they would be specifically interested in where it is, where they treat primarily orthopedic cases.
Karen Litzy (13:00):
And on that note, we're going to take a quick break to hear from our sponsor and be right back with Adrian's response. This episode is brought to you by net health net house outpatient EMR and billing software. Redoc powered by X fit provides an all one software solution with guided documentation workflows to make it easy for therapists to use and streamline billing processes to help speed billing and improve reimbursement. You could check out net health’s new tip sheet to learn four ways that outpatient therapy providers can increase patient engagement in 2020 at go.net health.com/patientengagement2020
Adrian Miranda (13:34):
Well, I mean, you can believe that, but it's the cases that you need research to show data, to show numbers, to go to Congress, to go to insurance, to push things and push agendas.
Jenna Kantor (13:44):
Oh, I like what you're saying regarding going to Congress advocating, thank you. Continue. Yeah.
Adrian Miranda (13:48):
So you need to prove that things work. Now there's many things that you cannot get data on or you just haven't created the right methodology for it. So you haven't created the right structure, the right research methods, the right way to capture those results. We're in a big data-driven time right now. So whether you believe that you don't need research and that it's there and we have to utilize it and it is actually necessary to help with reimbursements. So it might not hit you right in the face when the patient walks in, but it's going to hit you somewhere. So yes, research is extremely important. And it's not the end all be all as well. The way we get research is from an evidence case reports from the things that just occur. And then you go back and say, Hey, why did this work?
Adrian Miranda (14:34):
It didn't work. Or it did work and it worked because for all the wrong reasons. But if you don't have a scientific method for that, you're never going to know. Listen in the PR committee. So I'll tell you something. And many of you may be in the technology sector, marketing sector and digital marketing. We analyze what our members were engaging with and it turned out that CPGs our members were engaging with and we actually pivoted a bit more to give you more of that content. And we're seeing that you are engaging with it more. So if we didn't have that data, we wouldn't be able to give you what you want or even what you need. It is very important. You may not see it right away, but there are things that help agendas be moved forward and prove our worth.
Adrian Miranda (15:20):
As physical therapists, you can say it all you want, but if you have numbers, you really can't argue with numbers unless you're dealing with larger entities that have bigger pockets than you. But even at the end of the day, you fight hard enough for it. You're gonna get it. Direct access is moving along okay. And they're saying, we don't have any restricted direct access, but if we didn't have studies that are coming out saying that early intervention, but physical therapy reduces costs of healthcare achieves healthcare savings, we can't push that bill forward because we didn't have the data. Now we do have the data. So I would say that the sometimes or the reason for not agreeing with research has, you know, personal experiences and negative experiences. Maybe not even understanding research and what it does. Maybe you're wasting money on. These are one large universities doing all this data and research, but you need to think about it a little bit differently.
Adrian Miranda (16:17):
And the more research we have, the better research and better data. The more that you'll see we're helping more people in the community. The more that you're seeing businesses, physical therapy, business thriving, and being able to kind of give back to the community and give back to their employees as well. So it's this kind of circle. It's almost like a spin diagram that without research, without the community, without the clinicians to enforce it, we're not going to go anywhere. So I would say those people that don't believe in research it's like air. It's there. You need it. Love that.
Jenna Kantor (16:50):
Start to touch upon it. I want to dive into it. More advocacy. What is it that the orthopedic section, say three things right now that you know of, that they're advocating for on Capitol Hill?
Adrian Miranda (17:03):
Okay. So one of the things that did for the 40th anniversary was create almost like a mini documentary. Which was eyeopening to me. I didn't realize how much the Academy of orthopedic physical therapy advocated for States and governor and national issues. They actually were very instrumental in practice things all over the country and even helping with the right access bills right now at this moment. I couldn't tell you specific things. But if you go look at that video, which I think it was ast year, CSM I interviewed a lot, most if not most of the past orthopedic presidents who actually served on the APTA board. And yes, and some of them currently do it will be enlightening to see how much advocacy in the Academy actually provides. So having said that I couldn't tell you on top of my head exactly what they are working on at this moment legislatively, but just know that they are and they're also helping other components with their efforts and their resource. So if you, again, maybe you don't want to be in the public relations and marketing, but if you have some type of legislative issue or some type of issue that you have reached out to the Academy, they might be able to either guide you, steer you or help you connect with the APTA itself. Anybody in the government affairs, we actually have a committee directly for government affairs.
Jenna Kantor (18:38):
That's great. And you can even go on the website I'm seeing right now there is a tab for governance. It's literally on the major main page, so you go to governance and when you put your little mouse or a little hand on there, it'll go down and you can get information on what they're doing in their strategic plan. You click on that and it will take you into vision statement and goals so you can really see what they're doing right now for the lines with you and what you want them to be fighting for or if you want, there are points you want them to address in which you can then reach out to them to make that difference. Thank you so much, Adrian, for coming on to speak and educate about the orthopedic section. I really am a beginner with this myself because I've been a member for, since I was a first year student and never looked into any of the resources until this conversation right now. I think this is literally with the exception of joining the performing arts special interest group. The only time I've really gone into the the webpage. Oh look and we just opened it up. So current practice issues right now.
Jenna Kantor (19:43):
In what month, we are March, 2020 direct access imaging, dry needling, mobilization versus manipulation and practice issues state by state. And then you can get more details on that as well on orthopt.org. You just click on that governance and it'll get you there.
Adrian Miranda (20:03):
Is that answering the question about what issues are being dealt with by the Academy?
Jenna Kantor (20:08):
Yes, that does. That does. And the one who clicked and fell and grabbed that page. So we could just go onto practice, current practice issues and boom, bada bang. Thank you for coming on. Are there any last words you have for anybody who is considering joining the orthopedic section? But they're on the fence right now.
Adrian Miranda (20:27):
Join. There's really no drawbacks. If anything, here's what I recommend to anybody. If you have, there's two aspects. If you really want to get involved, there's someone who has been involved in school or someone who really wants to help other PTs. You wanna help the profession get involved. There's ways to get involved. You can be a member and do nothing and just hang back however you can make such an impact. I've had people recently asked to join or to be able to assist in the public relations committee. If you are somebody who has a lot of gripes and is really upset with what we're doing, go ahead and join anyway because you could actually be a change. I remember having this conversation with somebody in New York state. I was at a PT pub night and they were complaining to me about what this time I was actually in the NYPTA and what the APTA does.
Adrian Miranda (21:11):
And I let him go and just vent. And finally after like 20 minutes of venting, I was like, you know, I'm the chair of this committee, I'm a part of this committee. I'm on the MIP team that the board needs. I thank you for saying all that stuff. And his whole face going to drop. Like, Oh my gosh, I'm talking the wrong person. And I said, no, no, no. The fact that you're that passionate about it, you should join and you should make a change. All of a sudden, you told me you should bring it up at meetings or talk to your district. That's at the state level. At the Academy level. You can do this same thing if you're upset at the laws of dry needling and your state joint Academy, see how you can be part of the practice committee if you're upset about direct access, if you want to get involved in writing, if you want to get involved in editing you know, there's small, obviously there's very few worlds for that, but there are opportunities if you wanna get involved with pure committee, please join.
Adrian Miranda (22:04):
But there's so many things that you can help fix if you're upset about something and there's so many things that you can help improve if you're pleased with it. So I think there are so many opportunities to also enrich your life, enrich some of your skills and goals and even your practice. So I don't think there's any drawbacks to joining. And then we would love to have as many members as possible. You also want to have members that engage. I think when I talked to the board, we have meetings, our main goal and the people who've been around longer is that our members engaged with us. And you're not just someone who's going to sit back and just watch. Although that is okay, we want to be members. But I think it's also important to if you have a skill, if you have a passion and if you want to help our profession or your community get involved in and find where your spot is.
Adrian Miranda (22:48):
There's so many areas. There are seven special interest groups, there's several committees. There are several task force that you can be a part of. So I would definitely encourage you to reach out and listen. Organizations are challenging. There's a lot of people, there's a lot of need out there. There's a lot of different opinions and even it might say, this is an issue in my practice is an issue. My employees is my employers. That reimbursement is patients, this the demographics. There's a lot of things that we can help with numbers. Just like we're talking about research, we have a lot of numbers can be powerful. So if there's anything I can impart is that you can help be part of improving or be part of a change.
Jenna Kantor:
I love that. Thank you so much. Adrian. How can people find you on social media and do you also have an email even for them to reach out to you?
Adrian Miranda (23:36):
Well, how about this? I'll do you one better because I learned it because usher and Gary Vaynerchuk are doing it now. I'll give you my cell phone. Feel free to reach out. I will give you my email just for sure. The social media Academy of orthopedic physical therapy. And my name is Adrian Miranda. You can find me at AMiranda84@Gmail.com. And my cell phone is 585- 472-5201. I'm very available. So I happy to talk on the phone cause sometimes, actually nowadays that's quicker than an email or even texting back and forth. Send me a text message. I would love to hear your input and hopefully we want to hear how we could be better as well.
Jenna Kantor:
Wonderful. Thank you so much for coming on. Have a great day. Everyone.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
Social Distancing for Rehab Therapists
Leveraging Part-B In-Home Care and Telehealth in Your COVID-19 Response
Recorded Thursday, March 26, 2020 | 2:00PM EST
In light of the recent COVID-19 pandemic, the CDC has recommended ‘social distancing’ as a key tactic to help reduce the spread of the virus. In this webinar, our guest speakers will discuss two options to help rehab therapists continue delivering care during COVID-19.
Hilary Forman, PT, Chief Clinical Strategies Officer for HealthPro-Heritage, a leading consulting and therapy management firm, will share best practices for effectively and safely delivering care through Part-B in-home care. Additionally, consultant Rick Gawenda, PT, President of Gawenda Seminars & Consulting, will discuss telehealth legislation now in effect, which supports the practice of ‘social distancing’ while continuing to deliver necessary outpatient rehab care.
Included in the webinar are details related to:
- COVID-19 pandemic and CDC recommendations
- Risks associated with traditional therapy ‘clinic’ settings during COVID-19
- Benefits and best practices associated with delivery of Part-B in-home care
- Telehealth legislation and application for rehab therapists
The continuation of outpatient rehab care plans during this unprecedented time requires careful thought as to how we adhere to new recommendations while providing the quality of care traditionally delivered in public locations such as outpatient clinics and gyms. This webinar is designed to help you as you seek ways to adapt your care delivery in today's new environment.
Resources:
Gawenda Seminars Website
Healthpro Heritage Website
Rick Gawenda Twitter
Hilary Foreman LinkedIn
For more information on Hilary:
Hilary is an experienced, sought-after health care reform expert with a dynamic approach to advising providers within the post-acute care industry. As a solutions-oriented leader and consultant, she meets the challenges of a rapidly changing health care environment with innovative clinical and financial strategies. With more than 15 years of experience in rehab management, Hilary has worked with hundreds of clients to optimize marketplace strategy, clinical program development, and compliance integrity.
Hilary has presented at several association meetings to share up-todate information and insights as well as her thought- provoking approach to meeting the challenges of health care reform initiatives.
She has established a reputation for facilitating meaningful partnerships between post-acute care (PAC) providers and upstream and downstream cohorts. Hilary’s philosophy encourages open collaboration, proactive communication, and honest dialogue regarding outcomes, safe care transitions, and financial opportunities/pitfalls.
With a keen sense of humor and a no-nonsense approach to solving problems, Hilary has the ability to assist groups in thinking strategically, challenge the status quo, and ultimately succeed in leveraging positive outcomes.
For more information on Rick:
Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.
He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services.
Read the full transcript below:
Tannus Quatre (00:00:02):
Welcome everyone. My name is Tannus Quatre and today I'll be kicking us off with our webinar on social distancing for rehab therapists. Before getting into our topic I'd like to take a moment to acknowledge and appreciate each of you that are on the call today, as well as the teams that you work with to serve patients in your communities. As a physical therapist myself and as part of an organization that proudly serves rehab therapists, this is a really heart wrenching time as we watched this coronavirus pandemic unfold and impact lives across the world, including the interruption of the care that you provide to your communities. As part of our effort to help rehab professionals continue to deliver care in your communities during a time of putting my hands in quotes here, social distancing and sheltering in place, phrases that are new to us, we've assembled a team to present for you two business models today, part B in home care and e-visits.
Tannus Quatre (00:01:03):
And we hope that these will facilitate the continuation of the care that you provide while helping your patients and your staff adhere to guidelines that require that during this time we limit our physical exposure to one another. We've got an amazing speaker lineup for you today. Starting off with Rick Gawenda, physical therapist, compliance and billing expert and president of Gawenda seminars. Rick's going to help us understand some recently expanded legislation regarding telehealth and e-visits for rehab therapists. We have Hilary Foreman, physical therapist and chief clinical strategies officer with HealthPRO heritage. Hillary is going to walk us through health pros, part B in home rehab model and how this model is uniquely positioned to help protect her patients and her team during a time of social distancing. And we have Sheila Cougras, registered nurse and director of compliance at net health, who together with Sarah Irey, also a physical therapist will be setting the stage for us today by introducing us to COVID 19 and considerations that impact us as rehab professionals.
Tannus Quatre (00:02:12):
Now, today's webinar represents our best efforts to help rehab therapists adapt to a very unique circumstance. We're working right alongside you to adjust and learn as things change and I know for all of us things are changing hour by hour at this point. So in our webinar today we'll be sharing some information that is both fairly broad in nature and then we're going to be zooming in to discuss details that are really pretty technical. So we hope that the information will help you stimulate thoughts and ideas that you can use to continue care for your customers, but please do know that the information is changing rapidly and you're going to need to verify if and how this information applies to your particular business. Now finally for me on a housekeeping note, we're going to be pretty fluid with this webinar today and we're going to take the time needed to cover the information that we have planned as well as time for Q and A at the end.
Tannus Quatre (00:03:06):
If you have questions that come up during the presentation, please use the Q and A function that you'll find on your desktop or your phone and we'll get to as many of your questions as we can. At the end of the webinar, we have about a thousand attendees on the call today, so we probably won't be able to get through all questions. So we'll be providing our contact information following the webinar so you can reach out to us for followup if and where that that is needed for you and for those that cannot attend, that may be within your organization or colleagues that you'd like to have attend this webinar after the live version. We will be sharing a recording following the live presentation today, so expect that in your inbox. So with that, I'm going to hand it over to Sheila Cougrass and Sarah Irie to introduce us to COVI- 19 and clinical considerations that apply to rehab therapists.
Sheila Cougras (00:04:00):
Thank you, Tannus. As Tannus mentioned, I'm a registered nurse and a certified wound care nurse that is certified in healthcare compliance. I have been at net health for the past 12 years and serve as the compliance subject matter expert for our products. But before I even get started, I really sincerely want to thank all of you on the front lines who are caring for our patients and communities. What you're doing is really, really appreciated and very much noticed throughout the world. I'm going to also first state that we recognize that all of you are being inundated with a lot of information for COVID-19 that's coming in through, you know, firehoses a lot of information and it only seems so appropriate though that we open with a high level of information we're receiving every day from the CDC to other regulatory and professional agencies across the country. It's also important to note the information is being updated every minute. Even as we speak. I'm reading and learning that new regulations and legislation is introduced at us at a startling pace. We already have over 500 bills and 250 regulations that have been introduced and proposed across the States and the use of the executive order has skyrocketed.
Sheila Cougras (00:05:17):
So we also recognize that this information varies for all of you. Depending on where you provide services, you may be in a home health, you may be in a SNF, acute hospital, private practices, assisted living facilities and with that said you may have a lot of variations with your facility and local policies and federal guidelines. So we want to keep that in mind. As we know, corona virus has been around for a long time. It is a group of related viruses such as SARS that causes disease in humans, in animals, the world health organization, they recently identify COVID-19 is a new virus group, Corona virus which typically respiratory illnesses and most will recover as we know without special treatment. As we've heard, it mostly impacts our elderly population and those that have specific underlying conditions or immunocompromised. We are also hearing about many of the treatments that are off label that are now being made available being introduced today for treatment. But currently there is no vaccinations and treatments are just now starting to be introduced off-label. It is active in all 50 States and I guess it's also active within our surrounding four jurisdictions of our country. And the last we seen reported I know that this is obviously probably updated since, but the last reported by the CDC is 27 are reporting community spread.
Sheila Cougras (00:06:46):
We are hearing that it is also being noted by the new England journal of medicine that COVID-19 is also stable in aerosols and on surfaces that can last from several hours to several days. So we want to keep that in mind when a person sneezes or coughs without proper coverage into their elbow or their sleeve, it creates a bubble of air that contains the virus. It could be suspended for hours and so with that said, if someone walks through that area an hour later, they could potentially pick up the virus.
Sheila Cougras (00:07:23):
So this slide is not only to share with you common recommendations from CDC and the world health organization, but also think about setting up competencies for your staff and educating your patients. We obviously want to maintain that good hand hygiene as being occurring washing for at least 20 seconds with soap and water and hand sanitizer with at least 60% alcohol reasoning is because those soaps we use contains surfactins which neutralizer removes the germs from the pathogens such as COVID-19 that has a crown like structure and outer membrane made of lipid molecules and protein that is then runs down the drain. Do not touch your face. We hear that a lot with unwashed hands is specifically your eyes, your nose in your mouth where there's much entry into your system. Where if face mask, if indicated by your facility policy protocols, we know there's a lot of uncertainty in this area due to the limitation of supplies.
Sheila Cougras (00:08:21):
So please check how and when you are to utilize face mask and the type of mask you should be wearing Disinfect your common touched surface areas. Often whether it be tables or knobs, countertops, desk, phones, keyboards in any other equipment that has commonly touched you. It's also helpful if you increase ventilation by opening windows or adjusting the air conditioning and we also want you to limit food sharing, stay home if you're feeling ill or have an ill family member and most importantly is you're going to hear threaded throughout this presentation and as Tannus mentioned is social distancing maintaining a safe distance three to six feet between you and others. It's so important given how this virus is transmitted. Sarah will speak to this further but before I hand it off to her, I want to share that a I have been listening to other professional organizations speak about ideas and best practices they're sharing.
Sheila Cougras (00:09:14):
I was on a call a couple of days ago with American hospital association in CMS with Sima Burma where she was encouraging the physicians to share ideas. Some are setting up tents outside of their offices to do the screening conducted prior to allowing the patients or staff to enter the building. Some are calling the patients prior to their appointments and asking a series of questions provided by the CDC to triage those patients. And many of you are hearing utilizing telemedicine and you will hear more from our other panel speakers on that topic. Additionally, I heard that in HPCO, which is a hospice professional organization just yesterday. They're getting so creative that they're providing care through windows and standing outside of the patient's home and looking at the patient through the window and addressing the needs with the caregiver at the door. So as we know, this is the time to really get creative and treat your patients safely as much as you can.
Sarah Irey (00:10:07):
Thanks for that great information Sheila. Before we start, I'll let you know a little bit about me. I'm a clinical liaison for net health, but my background is as a physical therapist with nearly 20 years of experience working in various settings including private practice, hospital outpatient and acute care and skilled nursing facilities. I'm lucky enough to use my clinical experience here at net health, but I do some clinical work still now and then. Let's continue to build on what you learned from Sheila. An important part of social distancing includes being able to identify patients and staff who have COVID-19 or who may be a risk of carrying or contracting the disease. Many facilities are now using screening protocols, as Sheila mentioned, to identify these individuals. If you're part of a larger organization, check your organization protocols to determine the process for screening patients and staff and know how to refer them for additional testing if they're possibly infected.
Sarah Irey (00:11:12):
If you don't have a formal protocol, you might want to consider creating one using sources from the CDC website as well as checking with your state. The CDC outlined some recommendations such as using your clinical judgment. Clinicians should use their judgment to determine if a patient has signs and symptoms of COVID-19 and should be tested so the signs and symptoms that you've heard about include fever, cough, and difficulty breathing. Other risk factors are having contact with someone who has or is suspected to have COVID-19 or pneumonia of an unknown cause within the last 14 days. Someone who's recently traveled outside of the United States or in an effected area and someone who has residents in an area with community spread of COVID-19. Like Sheila mentioned, your screening can actually begin before your patients arrive at your clinic. When you're making appointment reminder calls.
Sarah Irey (00:12:09):
You might want to consider asking screening questions and making recommendations for exposure risks in mildly ill or high risk patients to stay home per social distancing guidelines. We realized that many of you may still need to see patients in a clinical setting. So let's consider some ways to keep you and your patients safe while keeping social distancing in mind no matter where you treat your patients. First, follow the screening guidelines we just discussed to decrease your risk in your clinic. You also may want to ask patients to wash their hands prior to starting the treatment session and after you could even maybe consider having them stand on one foot to practice balance while they wash if it's safe, right? Wash your hands as well. Always follow standard precautions and use PPE per your organizational protocols. Be mindful to follow the six foot social distancing guideline in the waiting area and your treatment space.
Sarah Irey (00:13:09):
So you might need to modify your waiting area seating setup or your schedulings practices to support this model. Maybe use private treatment rooms for patient visits instead of the gym area. Avoid group and concurrent therapy treatment and consider treating patients in their rooms if they reside in a skilled nursing or assisted living facility. Also think about if you can change treatment and treatment plans to decrease physical contact with your patients, but still provide quality care. Examples of this might include instruction and self mobilization techniques instead of manual adjustments or mobilization or instructing the patient in use of tools for soft tissue mobilization such as foam rollers and trigger point release balls rather than direct therapist to patient touch. Also consider keeping your patients with one provider per visit instead of sharing care to decrease contact. So you may need to change your scheduling and staffing practices there. Finally consider educating patients on alternative treatment options such as part B in home rehab and eVisits. So let's learn more about part B in home rehab with Hilary foreman from HealthPRO heritage.
Hilary Foreman (00:14:22):
Thank you so much Sarah. And as Sarah said, my name is Hilary foreman. I am the chief clinical strategy officer at HealthPRO heritage. I am a PT by background and I've been lucky enough to be with HealthPRO for about 18 years now. I'm moving from operations into our clinical role. I have the honor of being in charge of our clinical and consulting business lines over our rehab services that span across the post-acute continuum. So as Sarah said, I wanted to talk to you about our first business model, which is part B in home rehab. Though HealthPRO heritage did not start this model in light of the current COVID-19 situation, it now more than ever in this era of social distancing has become one of our standards as it makes more sense as a consideration. This model can be used by both rehab companies and home health agencies to better meet the needs of some of our seniors.
Hilary Foreman (00:15:19):
So let's start with what is part B in home rehab. Very simply, it's the concept of the traditional outpatient therapy model being provided in a patient's home as opposed to a free standing clinic or the gym of a senior living community. Services still remain covered under Medicare part B. They may also be covered by managed B or some commercial payers as well. By being able to deliver this service in a patient's home, it provides a lot less anxiety for a patient and a much happier person. Patients in this scenario are not home bound, but due to other circumstances prefer to stay in their home, whether it be convenience, safety, or cost. One caveat to this model is that because patients aren't home bound, they can also not be receiving any part a benefits as this is a part B benefits. So those two insurances do have to be separated.
Hilary Foreman (00:16:27):
So why would we do part B in the home first? As I said, it would be convenience of care. According to some recent AARP statistics, over 89% of patients over 50 years old would prefer to receive these type of services in their home for many of their own reasons, but now in the era of social distancing, this can be a more protected setting. This can also be a great solution for protecting some of our most vulnerable patients, but continue to provide those essential rehab services with reducing the risk of illness or injury to those patients.
Hilary Foreman (00:17:14):
As we continue down the path of why we would do this, one of the other has to do with a lot of the regulations going into place. Many of us are looking to expand our referral base, so whether you're a rehab company or a home health agency, chances are you're looking for different partnerships in your community. In light of changes with PDPM on the skilled side and PDGM on the home health side and changes and just the level of competition in many markets, you may be looking at different ways to partner with other people in your community. Whether you're looking to expand with physician services, many outpatients we think of as partnering with orthopedic physicians. We all know that orthopedic physicians tend to use their own clinics or hospital based rehab settings. In this model. Healthpro heritage chose to partner more with primary care physician groups in order to better expand into the community.
Hilary Foreman (00:18:17):
These primary care physician groups, we're community-based or we're already partnering with many of the senior living and assisted living communities in the areas. This paired nicely with their house calls programs, so we just like the physicians would start making house calls. It became a very good word of mouth referral source for us as well as a network between different senior living communities who wanted to partner their therapy across all their levels of care. So having therapists provide services through the home health agency as well as part B in the home. This helped the therapist become a standard part of the community, whether it be on that campus or in the greater community. Another reason you may consider why we would do part B in the home is just to reduce overhead for providers. This model reduces costs associated with brick and mortar clinics and the costs associated with keeping those running or even dedicating space within an assisted living or independent living community for patients.
Hilary Foreman (00:19:27):
This reduces a lot of their anxiety. It may also save time, money and effort for them traveling, worrying about parking and worrying about keeping all their appointments straight by having us go to them. It is a lot of their worry. And lastly, in order to follow any of the trends in healthcare, we all have to change, diversify and grow. Most importantly, meeting people where they are and where they want to be. Chances are that is going to be in their homes. We wanted to be able to offer more alternatives to where they could get the essential rehab they needed. Now again, in the era of social distancing, we were able to meet them in their homes and it was a great new business model for us as well. So killing two birds with one stone, but now as Sheila shared in the era of COVID-19 we did have to take some additional rehab considerations.
Hilary Foreman (00:20:28):
So we at HealthPRO heritage, decided to do a few things before we ever entered someone's home. First, we implemented a very strict policy of staff monitoring where staff self-monitor temperature checks twice a day, attest to whether or not they have any signs or symptoms. We even instituted a smell check. Some of the more recent literature indicated that people ahead of coming down with the symptoms of COVID-19 had actually lost their sense of smell. We also reviewed contact or exposure history, looking at what would be a low or high risk exposure and choosing whether or not therapists would see some of our most immunocompromised patients in their homes or not. We also instituted patient screening calls as Sarah suggested, making sure that we not only asked about the patients themselves, but anyone else that might be in the home at the time of the visit.
Hilary Foreman (00:21:28):
So many of our seniors have their spouses or older children home with them. They may be caregivers for grandchildren, so we did want to make sure that in addition to asking just about the patient, we knew about them as well. We did follow the CDC guidelines on what we could and couldn't ask, but it also helped us explain to our patients what infection control steps we would take prior to coming into their home. We did focus a lot on our staff and making sure that they understood what those infection control steps were. We did add additional steps in light of the current situation, especially when it came to clean bag and equipment technique. We wanted to take extra care of everything we did or did not take into a patient's house and how we were able to take care of that.
Hilary Foreman (00:22:19):
The other issue we have run into, and I'm sure many of you on the call have as well, is the availability of PPE. In cases where we do have low risk or high risk situations, patients still may have required care and we did have to make sure that people had the correct availability of PPE and understood proper use and retirement of that PPE well in the home. We did ask our therapists to continue to maintain social distancing rules from others in the house, in the apartment or in that senior living community. We did see that there was a lot of opportunity there as well. We were able to be another set of eyes for our seniors in the community or in the senior living community. Looking for other needs they may have. Being able to address things such as medication that may need to be delivered, additional signs and symptoms of other issues outside of COVID-19 that may increase a patient's risk of rehospitalization and we were able to work better with our senior living communities in that way.
Hilary Foreman (00:23:29):
So now that you know a little bit about our model and now it's time to look to see if this is the right model for you as you're possibly considering this as part of your growth and diversification strategies. There are a few things both pro and con you should consider if you are a home health agency, there are differences between billing part a and part B. You still do have a homebound requirement. You have to look at what those billing differences as well as what the different therapy documentation rules might be because this is part B and the home. It does follow traditional part B documentation and billing guidelines with all of the modifiers attached. A benefit to this is for the home health agency. Being able to provide additional rehab services after perhaps nursing services have ceased as a need, gives you the ability to divert those critical nursing visits to more high risk patients that may be elsewhere in the community. In this case, rehab would focus mostly on safety in the home and basic ADLs. If you're a rehab company, there's a little bit more to consider here. We were able to, in different parts of the country operate this model either under a group practice or a rehab agency. These both models have specific regulations by state that vary and we did need to look into all of those different rules and regulations and setting up the different practices and different locations.
Hilary Foreman (00:25:05):
The other challenge we had was looking at our therapists and their skill sets. This is a unique model because you do blend the skillsets of a home health therapist by being in the home, being more innovative and looking at what you have available to you in a home to provide therapy while mixing it with true outpatient skills. So looking at our therapists being able to work at the top of their license and looking at things from medication management all the way down to manual therapy. As Sarah shared, we did have to make some alterations in the care we've provided recently in light of some of our infection control procedures. But to our patients still receiving that essential therapy was still most beneficial in some cases in making this decision, you may have to actually look for additional consulting services in your area to help you either set up this program or work through the regulations. I hope this gave you a good overview of this possible new business model. And now to talk about our second alternative business model, I pass to our next speaker, Rick Gwenda.
Rick Gawenda (00:26:16):
Thank you very much. My name is Rick Gawenda. I am a physical therapist. My wife, I and another business partner do own two clinics here in Southern California. And then also for the past 17 years I have been a national speaker and national consultant in outpatient physical occupational speech therapy as relates to documentation, CPT coding, diagnosis, coding, payment reimbursement compliance. And all stuff nobody really likes to talk about. So with that, we're going to talk today about telehealth and e-visits. As we go to the next slide. This information I'm going to share with you is current as of 2:00 PM Eastern time today. Cause obviously I used to say things, you know, change weekly or monthly things are changing hourly. We're seeing many state governors mandate insurance plans in their state cover telehealth. We're seeing insurance companies doing this on their own saying they're adding PT OT SLP as telehealth providers. And we are waiting patiently for updates from these centers for Medicare and Medicaid services. So again, everything is current as I speak today. Most likely things would change either tomorrow or early next week. We are in the Medicare program as well as maybe other insurances in many States.
Rick Gawenda (00:27:47):
So speaking with the Medicare program first, so CMS, the centers for Medicare and Medicaid services issued a document over a week ago and they talk about three types of virtual services that you see here on this slide. And the commom mistake I'm hearing people make is they're using the terms eVisits and Telehealth interchangeably synonymously, the same as, and they're not the same. They're completely different. So again, three types of virtual services per the Medicare program right now. Medicare telehealth visits, which we're going to give you the current status of that coming up, virtual check-ins, which were not apply right now to PTs, OTs and or SLPs. And then we're going to talk about eVisits that will apply to PTs, OTs and SLPs.
Rick Gawenda (00:28:45):
So as I speak to you today, now about, I believe it's around 2:30 East coast time, March 26, the Medicare program still does not pay for tele health services for outpatient, physical, occupational and or speech therapy services. They consider this a non-covered service because the Medicare program does not pay for these services for therapy and they consider it non-covered. You right now today can provide tele health services to your Medicare part B beneficiaries and charge them your cash rate for the telehealth services. And an ABN, an advanced beneficiary notice of non-coverage would not be required to be issued to the Medicare beneficiary. You can issue a voluntary ABN to the Medicare beneficiary if you want to and I do recommend you do that but it's not mandated. You issue an ABN to the Medicare beneficiary and the reason why it's not required is an ABN is only issued when normally the services are covered by the Medicare program, but under the circumstance you think Medicare is not going to pay or since right now today, March 26 telehealth services provided by PT OT SLPs or statuary, non-covered and ABN would not be required.
Rick Gawenda (00:30:24):
Also, if you are familiar with the ABN form in section G there's three boxes and the patient's supposed to select one of those three options in section G since your issue in a voluntary ABN, you are not going to ask the patient to choose an option. The patient does not need to sign and date the ABN because you're not going to be submitting the claim to the Medicare program. So people haven't been asking me, well, Rick, what CPT codes do we bill to Medicare for telehealth? You're not going as I speak today, you will not submit a claim to Medicare if you are providing telehealth services for outpatient PT, OT SLP to a Medicare part B beneficiary because it's statutorily non-covered. And since these services are non-covered, the mandatory claim submission is not required. Now I will say there is a barrel that we expect the house to vote on tomorrow called the creating opportunities now for necessary and effective care technologies.
Rick Gawenda (00:31:32):
The acronym is connect, C O N N E C T act, the connect act and in section three seven zero three of that bill. If it gets passed by the house passed by the Senate, everything stays in president Trump signs it. It's going to broaden the authority of the secretary of health and human services to wave tele-health requirements as they currently are. So we're hoping that once the house is supposed to take a voice vote on that sometime tomorrow followed them by the Senate. My opinion only, it should pass pretty easily. Hopefully the president signs it, then hopefully then the secretary of health and human services would then waive the current restrictions house for Medicare beneficiaries and allow PTs, OTs and SLPs divide those services and build the Medicare program for that. Also, as we speak today in the office of management and budget, there is an interim final rule regarding COVID-19 and some updates in that interim.
Rick Gawenda (00:32:43):
Final rule. Unfortunately we have no clue what's in that interim final rule. It could be some things way too. What I'm still going to talk about here today about E-visits could be about tele-health, could be about easing restrictions and supervision, requirements of assistance, could talk about certifications recertifications it could have nothing about therapy and you know, we don't know again, it's still in the office of management budget to OMB. Hopefully it leaves there either later today or tomorrow and then gets published in the federal register. But that's why I add that disclaimer. We expect things to change with the Medicare program here shortly. We expect clarification to come out from CMS on some things we're talking about right now during today's presentation.
Rick Gawenda (00:33:38):
Let's talk about now e-visits. So again, e-visits and tele-health are not the same. The two are completely different things. So CMS did come out over a week ago and say that they would pay for eVisits provided by physical therapists, occupational therapists and speech language pathologists. I cannot stress enough that top bullet point, they must be initiated by the patient for each E visit, which means the patient needs to reach out to you, the provider, either via a phone call, via an email request. In this E visit. Now CMS did clarify you, the provider of therapy services can educate the beneficiary on the availability of this service. So you can send out an email to your current established patients about the option for ae-visit and all of that. So you can quote I guess like a better word, advertise this service. However the patient must initiate this visit now, but we don't know.
Rick Gawenda (00:34:42):
Here's this third bullet point says patient must be an established patient with the provider who is conducting the visit. And what we're hoping to get soon from CMS is clarification and the definition of an established patient. Because these G codes I'm going to talk about in a moment on the next slide, they actually are brand new this year just came out January 1st of 2020 and to be honest with you, they were not designed for what CMS is allowing us to use them for right now. This is not the purpose of these codes. Now these codes are kind of a, a knockoff, kind of a shoot off of the nine eight, nine seven zero CPT code nine eight nine seven one CPT code nine eight nine seven two CPT codes that are used by physicians for evaluation and management services for these visits done through an online patient portal.
Rick Gawenda (00:35:45):
Now when you look at the physicians and the definition of established patient for a position, this is somebody that has, you know, maybe seen that physician within the last three years. We don't know how CMS is using that definition of established as it pertains to PT, OT, SLP. I'll be honest, it could be established patient as in this is a patient that you were currently seeing for therapy services and now they can't come into your clinic right now you've shut down your clinic, you want to do an visit. Is that what they mean by established patient? Could established patient mean this is the patient you've seen sometime in the past three months, the past six months. Are they going to have to go back, you know, quotes three years like they do physicians. We don't know the answer right now. What we do know though is if you're going to do an evisit any Medicare beneficiary that that patient could not have been seen by you for a physical visit within the previous seven days for the same condition.
Rick Gawenda (00:36:48):
And then once you do this evisit they're not coming in to see you within seven days for that problem. Now, CMS does say that you must use an online patient portal. And I'm giving you the definition of an online patient portal by the office of the national coordinator for health information, which is a secure online website that gives patients can be it 24 hour access to personal health information from anywhere with an internet connection. And there's the URL link for you cause people, you know, if you read the CMS information that's come out, you know, you saw, CMS mentioned that they're the lax scene, they're kind of easing the HIPAA rules and regulations. You know, you saw CMS mentioned Skype and mentioned FaceTime, they mentioned Skype and FaceTimes for tele health services, not for E visits. So right now again we're trying to seek clarification from CMS and boy, can you do a phone call, can you use FaceTime, can you use Skype before we get that clarification.
Rick Gawenda (00:37:57):
I've got to, you know, talk here and say you have to use an online patient portal. And again, you can go on the worldwide web, go to any search and you want to go to, I just use Google and type in a search box, you know, types of online patient portals. You know, what is an online patient portal? You know, I know my physician, and again, I'm not endorsing this product. My physician uses the call it, it's called charm, C, H, A, R, M, all capital letters where she can send me my test results. You know, my lab results. She can give me updates on my medications. You know, I create an account, I log in, I see my test results, I see her email, I can respond to her, she gets notification and with things like that. But again, it must be initiated by the patient for each E visit.
Rick Gawenda (00:38:54):
Next slide. So here are the three G codes, G 2061 G 2062 G 2063 and I cannot stress enough those words that are underlined, assessment and management, and then shooting the tib time during the seven days. So let's talk about what are the seven days. When is day one? When is day seven so here's my example. Let’s say on Monday, March 23rd the patient reaches out to you either via a phone call or an email requests in any visit. You don't respond to them until March 25th. March 25th is going to now be day one, which means six days later that's going to end that seven day period. So, so say you know, March 23rd the patient's sent you an email requesting any visit and they had some questions for you maybe about their home exercise program or should I use ice or should I use heat or how many times do you want me to do my exercises a day?
Rick Gawenda (00:40:03):
Things like that. You respond to them on March 25th and as I say, I'm going to make math easy here today. You spend five minutes typing out the instructions, answering their questions. You send that to them on March 25th on March 27th the patient responds, requested another e-visit with additional questions on Friday, March 27th and you spend another five minutes, you know, answering their questions, whatever that may be, send it back to them on Tuesday. March 31st patient requests another E-visit with additional clarification. They want some information from you. You spent another five minutes on March 31st answering their questions via email or via that secure online patient portal. You send it back to them. That's, and that's it. There's no more other e-visits within that seven day period. So I kept math simple. So you did three separate eVisits spent five minutes each time answering their questions via email, sending it back to them.
Rick Gawenda (00:41:12):
When you add up five plus five plus five that is 15 minutes, that's going to fall between 11 to 20 minutes. So on that last day to service, during that seven day period on March 31st you're going to bill one unit of G two zero six two because the QM to time during that seven day period was 15 minutes. And the question I know you want to ask me is, Rick, can we do more than one seven day period? You know, can I bill G 2060 to say from March 25th to March 31st but that from say April 3rd to April 9th, I spend 27 minutes. Can I do G two zero six three and ms dancer, you hate for me today, we don't know. We're seeking clarification from CMS because again, these codes were not developed for this purpose. We did not know COVID 19 epedemic was coming when these codes became effective January one of 2020. So we're not sure if CMS as well as other insurance companies are going to allow us to build these G codes for more than one seven day period. Now you see it says underlying assessment and management as the go to the next slide.
Rick Gawenda (00:42:33):
People always want to know what is a qualified healthcare professional. And this definition comes straight from the American medical association. So if you have a CPT book, you know, especially or more current one, but if you have like a 2018 2019 2020 CPT books at the beginning of the CPT book, a Roman numeral number of pages explains how the book works, where the AMA provides this definition of a qualified healthcare professional. And in really the key is the words or the sentence who performs a professional service within his, her scope of practice in independently reports that professional service. Well, as a physical therapist, an occupational therapist, a speech language pathologist, you meet this definition because in a private practice you enroll with Medicare, you enroll with other insurance companies, you get an NPI number, you can report the CPT codes independently of anybody else that people was asked for.
Rick Gawenda (00:43:35):
Rick, what about a physical therapist assistant or an occupational therapy assistant? Can they report these G codes you just spoke on was to go to the next slide. You can now see the definition of a clinical staff per the American medical association. And you see in that first bullet point is a person who works under the supervision that'd be physician or other qualified healthcare professional that goes on to say, but who does not individually report that professional service. So that would include a physical therapist assistant and an occupational therapy assistant. So right now it's my interpretation. I know APTA interpretation that PT assistants, OT assistants, you know, can't provide the evisit. And also if you get a definition, if you go back to two sides from replays, you know it says assessment and management and really who's assessing the patient, who's managing and changing what's going on with the patient. And that's really within the scope of practice of the therapist, not the assistant. Now again, we're hoping to be CMS allows assistants do these G codes. We don't know waiting for clarification, but right now I don't feel comfortable saying they can do it based on the definition of a qualified healthcare professional as well as the words assessment and management. Because that is done by the therapist, not the assistant.
Rick Gawenda (00:45:09):
Now how about modifiers? Now, CMS did say if you are submitting a claim on a 1500 claim form and if your Smith claims on a 1500 claim from you are a private practice, the Medicare program did say to attach this CR modifier to the applicable G code. If you are a non private practice, you submit claims you be zero for claim form. You would not only attach the C R modifier to the G code but you also need as a condition code the R. So again that R is not a modifier that R is a condition code. Now we are hearing issues and concerns from households around the country that these G codes can't be submitted, can't be built on the UBS or four claim form. We are still waiting for clarification from CMS on this. You know, can hospitals, can facilities that submit claims any UBS four claim form? Can they bill the G codes? A part of me thinks yes, I'll be honest. Part of me thinks no because again, these G codes, a kind of a knockoff of the nine eight nine seven zero (989) 719-8972 CPT codes which are really the physician codes and typically physicians are only been at any 1500 claim form. But again, we are just waiting for clarification with CMS as well as other insurance companies. Can non private practices bill these G codes and get paid by that insurance company.
Rick Gawenda (00:46:56):
Now, documentation for an evisit extremely important that at minimum each E visit you do must have the following documentation. You must document that the patient initiated and or requested the visit. You must document the patient consented to the visit and then you must document these services, the education, the training that you provided during that e-visit. So an example I gave where you did visits one on March 25th one on March 27th one on March 31st you would have a note for each date of service that will contain at minimum these three bullet points, but the billing would not occur to a date service March 31st
Rick Gawenda (00:47:51):
Now let's talk about telehealth and tri care. You know Tri-Care, believe it or not does cover house services and they've done so since July 26 2017 and that top moral point, that sentence is right out of the tri care manual that they cover telehealth services if these services are otherwise covered. Tri care benefits, well since Tri-Care covers outpatient PT, OT, SLP services, this means that they would cover telehealth services for PT, OT and or SLP services and nicely my Tri-Care is they allow payment for telehealth provided both asynchronous and synchronous. Now non-Medicare, it's the answer you hate. You've got to go check with every insurance company. And when I say every insurance company, we estimate they're over 6,000 insurance companies in the United States. Whether they cover telehealth, it's all over the board. If they do cover tele-health, which CPT code or CPT codes they allow or want to see all over the board, which modifier or modifiers do they want and every CPT code all over the board.
Rick Gawenda (00:49:17):
You know, this is changing hourly because we're seeing many state governors issue declarations, issue orders mandating all insurance plans in their state that are overseen by their insurance commission, you know, cover tele-health. That's great. You know, we've seen some insurance companies like Michigan blue cross California blue shield of blue cross blue shield of North Carolina do this voluntarily where they now expanded telehealth for PT, OT SLP on a temporary basis. And again, the CPT codes, IMC and I'll all over the board which ones they want. Just, you know, when to kind of maybe give you some guidance here. The most common codes I'm seeing be and allowed for tele-health a PT and OT are nine seven one one zero 30 exercise nine seven one one two neuro re ed nine seven five three zero safety activities, nine seven five three five self care, home management and for speech is nine two five zero seven.
Rick Gawenda (00:50:30):
The treatment of speech, language, voice communication, Archway processing disorder. You know, don't try billing ultrasound for through telehealth. A manual therapy would also be a no through tele health cause your hands have to be on the patient. The other thing to ask when you check with these insurance companies is are they covering tele-health for only patients that were already established. You know, you've already seen them for therapy. There's already an active, you know, plan of care going on and now they can't come to your clinic. Or are they also covering tele-health for new patients as well? That's something you're going to want to check. If you're in a private practice setting they usually want to see for the place of service code for telehealth be a zero two. So again, extremely important to check with each insurance company and their coverage of telehealth services.
Rick Gawenda (00:51:34):
You know, how do you keep up to date with all this, you know, number one, stay current with your national associations. APTA. Also check your state associations website. You know, most of them now have a dedicated page for COVID-19 many of them are, you know, doing daily updates and information that they find out. You know, why not go bookmark your top four or five, six insurance companies that you deal with in your practice. You know, and again, go to Google and search box. Just type in for example, Georgia Medicaid provider page, tri West provider page, Nebraska blue cross blue shield provider page. In those last two words, stay the same provider page. That's what you want to get to on insurance company's website to provider page. And most of them now have a dedicated COVID-19 page and they've got dedicated page for, you know, quote, telemedicine, tele rehab, tele-health and those three terms don't all mean the same thing we've got. I think we're using them synonymously right now and I'm okay with that. But they are different. But get on those payers websites. If you're not on social media, get on social media, get on Twitter, get on Facebook. Many of us are putting out tons of information hourly on all of the changes.
Rick Gawenda (00:53:02):
Not to get too excited about these G codes. Just so you know, the Medicare program has about 112 different payment localities across the United States on just using each choice, Michigan. And you see the approximate payment amounts here. And before we go to get questions. And one thing I really want to say about tele-health. You know, normally if you're gonna start tele-health in your practice in your organization, it's usually about a four, five, six, seven, eight weeks start up. Yeah, I know a lot of people are trying to start tele-health in 24 hours and 48 hours. Be careful, you know, even though CMS has eased the HIPAA enforcement doesn't mean you can be careless. Just because CMS has eased HIPAA does not mean other insurance companies may not come after you. You know, you got to make sure you have your policies and procedures in place.
Rick Gawenda (00:53:52):
They're going to do telehealth, you know, have you updated your consent forms to include telehealth services, have you gotten your consent forms to your patients for them to sign, you know, how you document in the medical record and keep a track of, is the patient consenting to telehealth, have they consented to be videoed and have that recorded and saved in case they want to look back at it? You know what happens if you are doing a telehealth visit and you're doing it with Tannus and you see Tannus all of a sudden he grabs his chest, becomes short of breath, he falls off his chair, there's an emergency situation. You know, what's your policy? What's your procedure to address those kinds of things because you could have a liability. So again, you need to check with a healthcare attorney to make sure you got the proper policies and procedures in place. Because my hope is those of you that initiate tele-health, like right now when the COVID-19 pandemic is done, I'm hoping you're not done with telehealth. I hope you continue to do tele-health into 2021 2022 2023 as I think this is an important aspect of your business growth. Keep in mind, tele-health is not appropriate, not applicable for all of your patients.
Tannus Quatre (00:55:16):
Outstanding. Thank you so much Rick. Hilary, Sheila, Sarah wonderful presentation. We're going to get into some Q and a now and I will go ahead and moderate this portion of the webinar. And while we're doing this, we have our contact information up on the screen. So for those that would like to get in touch with us, if you have further questions or would like to learn more about what each of us and our organizations are doing to help rehab professionals adapt to COVID-19. We want to have this up on the screen. So with that we've got a lot of questions coming in and I know that we're right up against the hour. Like I said before, we're going to be kind of fluid with this, so if you're able to stay on, we're gonna answer as many of these as we can and then anything that we're not able to get to, we'll figure out a way to follow up with you independently afterwards. So I'm gonna start with I'm going to start with one here. For Rick, would encrypted organization based email be considered a secure patient portal for delivering he visits?
Rick Gawenda (00:56:23):
Yeah. Great question. And again, my opinion, my interpretation as it stands right now today is yes, because the email is encrypted, which usually requires a patient, you know, to create a username and a password to then access that encrypted email.
Tannus Quatre (00:56:24):
Perfect. Another one for Rick here. Are these codes billable by home health organizations or just outpatient organizations?
Rick Gawenda (00:56:54):
Well you know, when you say home health, if you're doing quote part B in the home which we believe you can bill the G codes. Again, we're just saying for clarification where if you're talking to home health under say part a under a home health agency plan of care, the G codes would not be applicable to that setting.
Tannus Quatre (00:57:19):
Excellent. Thank you. And we're going rapid fire here with Rick. I've got another one here for you. What POS code should be used for hospital-based outpatient clinics with any commercial insurers? Should it still be zero two or does it need to be different?
Rick Gawenda (00:57:33):
Yeah, great question. And again, if you are a private practice, and again some hospitals you've got offsite clinics that are set up as a private practice and you submit any 1500 claim form if you do in telehealth services, the place of service code would be a zero two. If you are a non private practice, which again could be, you know, as a hospital outpatient department, you know, hospitals can I have clinics ops site but they still fall under the hospital umbrella. You submit claims, NAU B zero four claim form in place of service codes are not used, most likely what you're going to have to use, which we didn't really talk about today. When you go to CPT codes you plugging up to put you to modify your GT or a modifier nine five on the CPT codes and that indicates that it was tele-health provided through a synchronous communication.
Rick Gawenda (00:58:32):
Now I know the follow up question is going to be which modifier do I use? It depends on the insurance company. You know, some insurance companies may tell you to use modifier nine five some may say to use GT if you're not a private practice. So again, unfortunately you just have to check with every insurance company you want to do tele-health with. And that's why I'm stressing so much to make sure you've got your policies and procedures in place and you've checked this through risk-management your attorneys to make sure you got your I's dotted, T's crossed and all of that.
Tannus Quatre (00:59:08):
Excellent. Thank you. Okay, so one here about part B in home. So Hilary if you can unmute. How is reimbursement different for part B in home versus in a free standing outpatient clinic? Right.
Hilary Foreman (00:59:21):
Great question. It is not that is why if a home health agency does choose to implement this program, they are going to have to look into a different way to do their billing. So it is still done by CPT code with modifiers just like a traditional outpatient setting.
Tannus Quatre (00:59:41):
Great. Thank you. Hillary. Another one about part B and home, how long does it take to launch part B in the home? If I only have done freestanding outpatient therapy?
Hilary Foreman (00:59:55):
It would depend on two things. One, if you were going to go a group practice or rehab agency route group practice is much quicker to get up and running, but there are some restrictions, especially depending on the state that you're in. A rehab agency is a much longer process and does require some additional filings. Some of them depending on the state you're in, you can do some retro billing in some cases. So you are able to start before everything is completed, but it's very state specific. If you, whoever asked if you want to reach out and let me know the state, I'd be happy to point you in the right direction for those answers.
Tannus Quatre (01:00:36):
Great. Thank you, Hillary. Okay. Another one here for Rick regarding eVisits. So per webinar a previous webinar or attended Medicare calls, e-visit a non face to face consultation, therefore Skype and such may not be required can be done via email or phone call. Is this accurate?
Rick Gawenda (01:00:57):
I'm sorry, what? I'm not understanding the question. Are they asking, is Skype and FaceTime allowed for a e-visit?
Tannus Quatre (01:01:03):
I'm interpreting this as is it required. So this, I'm going to go ahead and restate it. So Medicare calls e-visit and non face to face consultation, therefore Skype and such not required, can be done via email or phone call.
Rick Gawenda (01:01:21):
Well again, as I said during the presentation when CMS discussed Skype and FaceTime in that publication they released, they were using Skype and FaceTime for quote telehealth services not for an E visit. So right now an E visit needs to occur via email or a secure online patient portal. We are waiting for clarification with CMS regarding a phone call. You know what a phone constitute that cause right now as you know, a phone is not considered an online secure patient portal. So right now I can't tell you to use a phone to do an E visit. So right now I would say use encrypted email or use a secure online patient portal such as charm or you know, other online patient portals that are available to you.
Tannus Quatre (01:02:17):
All right, thank you Rick. Okay. Another one on E visits. When asking for an evisit do they have to, so the patient, does the patient have to directly address it as this or can they electronically ask a question? So for example, through a communication portal for us to then address outside of the clinic and we can count this as a patient contact.
Rick Gawenda (01:02:41):
Yeah, it's a great question because you know, again, this is like not what these codes are designed for. So obviously if a patient sends you an email asking a question I guess my recommendation if you want to play it safest, which is what I really have to do right now on this kind of call, is do you respond to the patient and say, you know, would you like me to respond to your question via an encrypted email via a secure patient portal, as an E visit? And if that patient then responds, yes, I would, you know, then I think that that's the request. And then you, I think you then save that email and then you go and address their question or questions that they had. In my opinion only is I think CMS is going to kind of be lenient on this right now.
Rick Gawenda (01:03:34):
I think other payers would be lenient on this right now, but again, you just in case something were to happen, you kind of need to cover your rear end and have that documentation there. I also think that since these codes don't really pay a whole heck of a lot of money you know, when you look at that G 20, 63, you're spending, you know, 21 or more minutes with them during a seven day period, you know, that payment's going to be somewhere between 32 to $36 depending on what state you're in, what locality you're in. So I don't see CMS really doing a bunch of audits on all of this stuff, but it's more just from a legal perspective and to protect yourself in case something happened where it happened with the patient.
Tannus Quatre (01:04:19):
Great. Thank you. So I've got one here. I'm gonna pose this to Hillary and then Sarah, you may want to chime in on this as well. Are you tracking COVID-19 related cancellations? How are you doing this in your EMR?
Hilary Foreman (01:04:36):
We are tracking missed visits in our EMR. We just haven't placed in the notes section. And we're just trying to look at it. We unfortunately are seeing quite a few many more and the home health side then on the senior living side. But I think as we go we are starting to see more and more people I want to say get more comfortable with infection control both on their side and on our side. So we expect to see that pick back up. Our customers are able to, for some of our products create custom questions or custom cancellation reasons so that they can just click that that was the reason and then they can run some cancellation reports on cancellations due to COVID-19.
Tannus Quatre (01:05:30):
Great. Related, do you know or have an estimate of how many PT clinics are still open versus temporarily closing doors due to COVID-19. Anybody want to take a stab at that?
Hilary Foreman (01:05:47):
I can speak for healthpro heritage that's very state specific. We have some States where it was ordered that they all closed, voluntarily closed due to whether or not they were treating a very immunocompromised caseload. They voluntarily chose to close for safety reasons. But I would say maybe half and half at this point for us.
Rick Gawenda (01:06:19):
And this is Rick, I think, is this an educated guess? I agree. I think it is state specific. I would also say it's probably also region specific within a state and the number of cases going on. And as I said already, the types of patients you're seeing in terms of diagnosis and also the age of the patient, their comorbidities, their risk for COVID-19. You know, obviously, did you have a patient that was now diagnosed with COVID-19 and they were already in your clinic yesterday or two days ago, three days ago. Is that going to force you then shut down and quarantine your staff? I think it's going to be a tough number to really figure out until months down the road.
Tannus Quatre (01:07:02):
Yeah. And some of the tracking that I've had some visibility into from a new claim flow perspective, I'm seeing we're seeing about 40 to 60% kind of in that range, regional specific decrease in the flow of new claims. And so you can kind of extrapolate from there in terms of what utilization is looking like in some private outpatient practices. So thank you. Okay, so this one's for Rick. When billing the G codes on a CMS 1500 form, would we bill just the CR modifier or would we bill GP CR or a PT E visit?
Rick Gawenda (01:07:45):
That is a great, great question. And you're going to love my answer. I think everybody knows my answer by now. We're seeking clarification of CMS on this and now if you are familiar with what CMS calls always therapy or sometimes therapies, CPT codes, those are the ones that always have to have the GP, the G O or the G. And modifier attach them when submitted to Medicare if done under a PT OT SLP plan of care, we're in the 2020 version of always in. Sometimes there'd be codes G 2061 G 2062 G 2063 are not listed in that file, which means right now as we talk today, they're not considered always or sometimes therapy codes, which technically means then GP, G O G N would not be required. However, we are hearing rumors from CMS that for some strange reason they're going to actually add G 2061 G 2062 G 2063 as sometimes therapy CPT codes. Then that would require GP, G N G O modifier, which then means they would actually apply to the annual therapy dollars threshold. Now that's what we're hearing rumors that they're going to do again, so we don't know right now, you know, because we're waiting for clarification. You know, obviously people like me, we've submitted all these questions to CMS trying to get clarification, but as you can imagine, they're swamped. They're trying to figure things out and we're just waiting for those answers to come out.
Tannus Quatre (01:09:28):
Thank you. Rick. got one here for Rick or perhaps Sheila. Do some of these probable changes in Medicare also apply to Medicaid?
Rick Gawenda (01:09:39):
Well it's number one. No. so you think Medicare changes is for Medicare and again, as I always say as I use the word Medicare, that is traditional Medicare doesn't include Medicare advantage. Now would that be in said by law, Medicare advantage plans at minimum have to offer and cover the same services that traditional Medicare does while since traditional Medicare is now covering. So they say those threeG codes, 2061 2062 2063. That means the Medicare advantage plan is also supposed to cover those codes as well. But this is not applied to Medicaid because Medicaid is state specific.
Tannus Quatre (01:10:27):
Great. Thank you. Okay. Hillary how many patients per day can a typical therapist see in part B in home care versus traditional settings?
Hilary Foreman (01:10:42):
Oh, it'll be significantly less. It depends on if you are doing the party in the home. On a senior living campus where the residents are much closer together or if it is in the larger community. So it is very different than a traditional clinic. It would be much more aligned to a home health type where you're counting more visits per day. So when doing modeling for that if you have access to what traditional, depending on your geography productivity expectations on the home health side, where they would be much closer to that. So it could be again, depending on your geography could be 50 to 60% of what a traditional outpatient would be. Thank you. Rick. Regarding initiation and consent by patient, does this have to be written or can it be verbal?
Rick Gawenda (01:11:41):
Well, it's going to be verbal. You almost find a recorded. So I would get it written just to cover yourself. So that again, I, you know, any time you're on this, these kinds of calls and as a consultant, you always gotta, you know, give I guess the most stringent advice or whatever. So I would say to have it written. And it could be something too that, you know, do you send them a document out and once they request a visit, do you create a document that you can send to them? Again, I'm not endorsing this product, you know, via DocuSign or some other format where this is all typed out and you had the patient, you know, electronically sign and date, you sign and date and then you say, that document is what I would do because you also gonna need to figure it out if you're going to be doing tele-health because how you get an EMU consent forms and all of that, that they're going to be consented to telehealth if they can be consented to being videoed and it'd be recorded and all of that.
Rick Gawenda (01:12:41):
So I will always say to try to have as much written down that a patient signs or they sent you an email, something like that that you can save to show just in case you got called out on it.
Tannus Quatre (01:12:55):
Great advice. Okay. What is synchronous versus asynchronous?
Rick Gawenda (01:13:03):
You know, asynchronous would be like that online patient portal. So again, I'm not endorsing the product called charm, so it's kind of a one way communication. It's kind of delayed. We're not live together. My doctor sends me an email, she maybe sends it at 11 o'clock in the morning. I comes into my email box. I may not sign into my account to eight o'clock tonight. I go lead, but she says I may or may not respond to her today. I may wait till tomorrow. Send her a question back or say thank you for sending. When should I come see you were synchronous talk communication, which is really what I think I hope you're going to be doing. If you're doing tele-health. It's live simultaneous two way audio, visual communication. So you know, think of face time. Okay. But you know, there's, and again, as I say some of these platforms and not endorsing them, like doxy, zoom. I know Google has something out there. There's a lot of platforms out there, think of FaceTime. So I can see Ben, Ben can see me. I can demonstrate exercise to Ben, I can watch, do the exercises, correct him. So it's live, simultaneous audio, visual communication.
Tannus Quatre (01:14:20):
Great. Thank you.
Rick Gawenda (01:14:21):
And again, I love Google. Just go to Google and type in asynchronous versus synchronous communication and all that will come up and you can also find different platforms you can use as well.
Tannus Quatre (01:14:35):
Okay. Awesome. okay. Hillary. I'm a physical therapist in private practice. Am I allowed to do in-home part B or is it only for a group practice and or rehab agency?
Hilary Foreman (01:14:48):
It would be for a rehab agency or a group practice. So there are ways to convert into those to be able to, there's some filings, again, depending on the state you're in that can easily allow for that. But you do have to go through some of those hoops to get there.
Tannus Quatre (01:15:07):
Okay. Thank you. Rick. Okay. So this one says just clarifying that we cannot do an evisit to qualify as a fifth or 10th visit.
Rick Gawenda (01:15:20):
Correct. So as we understand it an e-visit is not going to count as a visit towards the Medicare 10th visit progress report. So, for example, you know, you had a patient you know, come in and they had already had eight visits and then you shut the clinic down. A patient is apprehensive about coming in for an actual visit and now you do two eVisits, that's the next, you know, on March 26 and March 31st that's not visit nine and visit 10 towards a 10th visit progress report. So as we understand it today, e-visits do not count towards the 10th visit progress report. They don't count as an actual visit where a patient came in to see you.
Tannus Quatre (01:16:12):
Okay. Thank you. Okay. And I'm doing a time check here. We're going to continue for a few more minutes. We got a lot of questions coming in so we will do some followup from here. But, but I am going to kind of roll through a few final questions here. So this one can be, this may be Hillary, Sheila, Sarah. What PPE do you recommend or are you seeing in use for an asymptomatic home therapy patient?
Sheila Cougras (01:16:41):
This is Sheila. Hi. I would definitely recommend that you check with your local carrier or not your local carrier, but your local facility protocols and what supplies are available and what they have set up. It's been strongly recommended that protocols are set up at the local levels and what your state, local health departments are recommending. That would be your first place to check because I'm not sure which state you're in, but there is a website for all the States and you can check your local Health department.
Tannus Quatre (01:17:19):
Yes. absolutely. So we can work that into our followup communications. Here's another one. Can you elaborate? This is for Hillary. Can you elaborate a little more on the differences between home health provided via home health agency versus rehab company or provide a good resource, which explains the difference.
Hilary Foreman (01:17:39):
I'm sure I could actually provide we have a side by side that I could provide that you could share as part of the followups from this. A lot of it has to do with the billing process. Some of it has to do with credentialing of the therapists. For example, in a group practice, there's eight 55 B forms where therapists have their own PTN numbers. Only therapists can provide services under a rehab agency. Different States, different filings. Assistants might be able to provide those services to do the part B in the home. So there are the state specifics and then there's the therapist specifics. And then there's the billing specifics. So those are probably the three big buckets. But like I said, we have a side by side that I'll make sure that you have to send out.
Tannus Quatre (01:18:32):
Thank you. Hillary. Rick, are eVisits covered at the same 80, 20 percentage as a typical outpatient visit where the patient is responsible for a 20% co-insurance or that 20% gets sent along to their supplemental or secondary insurance.
Rick Gawenda (01:18:49):
Yes. CMS did say that the, you know, the G 2061 2062 2063 that they would count towards, you know, any deductibles, any co-insurance would apply. So again, the Medicare program and on my last slide where I gave you the pricing for Detroit, Michigan, the Medicare program with the 80% of that allowed amount and if they have a supplemental plan your that their Medigap plan, hopefully they would pick up the other 20%. They don't have a supplemental plan and then the patient would be responsible for the other 20%.
Tannus Quatre (01:19:26):
Thank you Rick. Are work comp carriers, paying for telemedicine for PT.
Rick Gawenda (01:19:34):
And my favorite answer, yes. No maybe so it depends and again, I noticed the answer people hate. Unfortunately back when I graduated PT school way back in 1991, it was pretty easy for us back then because every state just had one worker’s comp. We've had Michigan worker’s comp, Nebraska work comp California work comp, but now we have all these middlemen like align network, one call, med risk, etc. You have unfortunately have to do due diligence and check with every insurance company. And I'll be honest, you could call an insurance company and we're just going to make it Ben and you talk to Ben Monday, Tuesday, Wednesday, Thursday, Friday. And you asked them the exact same questions. I have days in a row and Ben gives you five different answers on five different days. Now that's not because he has five different personalities, more, no offense to the people on the insurance lines right now.
Rick Gawenda (01:20:27):
They have an impossible job right now there that they're not knowledgeable on COVID-19 and all of these changes that are going on and things like that. Because I'm hearing people all the time say, why called United health care? And they tell me they pay for telehealth with therapy. Where did you get the link? Did you get the citation somewhere on their website? No identity. Because if you go to the UHC website, UHC, that paid for telehealth. So again, what you're being told on the phone may or may not be correct. So again, very important to know how you're asking the question. And maybe kind of go for the answer you want to get, you know, kind of phrase the question. So the answer may be your way, but you have to answer your way. Ask them for the citation, you know, ask them on your website. Where is it, you know, can you walk me to a site? I can see it in writing cause it was not in writing. It may or may not be true what they're telling you on the telephone.
Tannus Quatre (01:21:27):
Thank you. Okay. So we're going to do three more questions and then we'll go ahead and wrap up at that point in time. So I just want to do a time check here. We're mindful of everyone's time. Hilary, how are you documenting new patient screening calls prior to initiating care?
Hilary Foreman (01:21:47):
In a variety of our systems we were able to add an additional note. In some systems we actually added the screening questions. So either we would do the screening questions and then the patient note would be together. So then once we did the visit, they would be together. And in some cases we've done the screening questions followed by a withheld or a refusal. If something in that screening then indicated that we should not be seeing the patient that day or they refuse that day or whatever those challenges might be. But we actually had added those to the system for that exact reason.
Tannus Quatre (01:22:28):
Thank you. Sarah, do you have anything to add on that? I'm not sure if there's anything that you're seeing with customers documenting screening calls.
Sarah Irey (01:22:36):
I would agree definitely with Hillary. The only thing is, you know, check with your organization.
Sheila Cougras (01:22:42):
Depending on, you know, your organization might want you to put it in your registration software if you have a hospital interface versus the actual act up documentation application. But definitely important to document those screens.
Tannus Quatre (01:22:58):
Okay. Thank you. Okay. Rick, are there any differences for critical access hospitals with telehealth? Evisits billing or reimbursement?
Rick Gawenda (01:23:10):
You know, again, with the e-visits we are waiting for clarification and CMS on, you know, can non-private practices, you know, go for the G codes, be paid for the G codes. So once we get that answer, of course that would apply, you know, whether you're a hospital or a regular hospital a while. So, you know, put a class that's health was, you are not paid under the Medicare physician fee schedule. You are paid any cost ratio basis. That's the other code unknown. And again with Keller house, do you want to check your conditions or participation with the Medicare program as a telehealth provider? Again, Medicare does not pay for telehealth, then they have to meet the two contracts with the other insurance companies that you've signed. So again, I think whether you're a critical access hospital, a regular hospital, your home health agency, do you impart, be in the home, you're a private practice. It's kind of doing your due diligence and check in with all those other insurance companies.
Tannus Quatre (01:24:09):
Okay. Thank you. So, Sheila, I'm going to direct this one to you. And this is in, and then more broadly, we're getting a lot of questions have come in about specific guidelines with regard to protecting employees and patients and use of masks and PPE. So, the one question that I think encapsulates it here, do employees have the right to refuse to treat positive COVID-19 patients if PPE is not available? We know that PPE is in short supply and not available in some areas. And so the way that I think that we should frame this up is do you have a recommendation for resources that our audience can use locally that can help guide them in the right direction for some of these broad questions about safety of caregivers and how they're treating patients in this COVID-19 period.
Sheila Cougras (01:25:04):
Yes, that's a really tough question. There are some resources like you said, that they could check with our state practice acts as well as looking at their local professional chapters and seeing if they can provide guidance there as well as their local health departments. And what are their rights? Is employees and receiving that PPE, I am hearing that quite a bit. And it's all over the news. That PPE, is it a high demand and there's shortage everywhere across the country. So that's a really hard one for me to give guidance or advice on, but there definitely are resources where you could check where are your rights in protecting yourself when you're employed. So I would start with your state practice act as well as your professional organizations and your local health departments.
Tannus Quatre (01:26:01):
Great. Thank you. Okay. So we're about to wrap it. There have been some questions coming in about access to these materials including the slide deck. Yes, we will make this all available to you. The recording. I think it's going to come out to you automatically and we will find a way to get you the slide deck as well, whether that's an included in a link in that email or some other means. So yes, we'll make sure that you've got all of the information here. I want to thank our presenters. This is just you know, we spun this up very quickly you know, over the past few days, I really appreciate you taking the time and investing in our ability to help our rehab professionals get this valuable information.
Tannus Quatre (01:26:47):
So special thank you to Rick Gawenda and Hilary Foreman. Also Sarah and Sheila for helping us put this together and to all of you that are out there on the front lines adapting your business models to continue the rehab care that is needed in your communities. We just really appreciate you. Thank you and are thinking about you constantly. We will have additional webinars that are coming out of the net health organization by you registering for this webinar. We will be able to make contact with you and let you know about those if you would like to attend more sessions and once again thank you so much for attending be safe and be well.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Clay Watson, Tyler Vander Zanden and Kelly Reed on the Private Practice Section’s Key Contacts. PPS is more effective with the support of members who are dedicated to advocating on behalf of the industry. You can get involved in the section's advocacy efforts by becoming a Key Contact, joining the key contact subcommittee, or by taking action online via the APTA Legislative Action Portal.
In this episode, we discuss:
-What are the responsibilities of the PPS’s Key Contacts?
-How a Key Contact bridges the gap between legislators and constituents
-The personal and professional benefits of being a Key Contact
-And so much more!
Resources:
Tyler Vander Zanden Twitter
Private Practice Section Key Contacts
A big thank you to Net Health for sponsoring this episode!
Check out Optima’s Top Trends For Outpatient Therapy In 2020!
For more information on Clay:
Clay Watson a Physical Therapist and owner/operator of Western Summit Rehabilitation, a consulting and therapy services staffing agency for home health. He is a Past President of the Homecare and Hospice Association of Utah, a member of the Utah Falls Prevention Alliance and a recipient for an NIH falls prevention grant. This year I received the Excellence in Home Health Therapy Leadership Award from the Home Health Section of the APTA.
For more information on Kelly:
Kelly received her COMT (Certified Orthopedic Manual Therapist) from the North American Institute of Orthopedic Manual Therapy in 1994 and is an Orthopedic Certified Specialist (OCS). She received her Physical Therapy degree from Pacific University in 1983.
Kelly prides herself as being an excellent general orthopedic physical therapist. She specializes in lower-extremity dysfunctions, biomechanical assessments related to running/sports injuries, and assessments from minimalist training to custom-molded orthotics. She focuses on injury prevention through balancing the full body, not just the area of pain. Additionally, she has specialized in the area of Temporomandibular dysfunction (TMD) for over 30 years.
Most recently she has been active in starting a BreathWorks program focusing on evaluation and education related to breathing physiology and its effect on overall wellness and healing. Her clinical skills continue to move in a direction that empowers clients to achieve their highest level of function in a balanced fashion.
Kelly was a 3-sport collegiate athlete and continues her love of athletics through her own personal training, running, yoga and being a supportive presence at her kids’ sporting events. An outdoor enthusiast, she loves trail running, hiking, gardening, camping, and keeping up with her husband Greg and their 3 active kids.
For more information on Tyler:
Dr. Tyler Vander Zanden is the former Founder and CEO of Movement Health Partners, a private practice company partnering with federal, corporate, and educational agencies to provide physical therapy services. Tyler currently serves as a member of the Key Contact Subcommittee for the Private Practice Physical Therapy Section (PPS), where he meets with legislators to increase awareness of the key issues facing physical therapist-owned businesses and their patients.
Tyler earned his Doctorate of Physical Therapy from Marquette University along with a BS in Exercise Science. Upon graduation, he completed a post-doctoral residency in Orthopedics from the University of Wisconsin-Madison. Tyler is a board-certified by the American Board of Physical Therapy Specialties (ABPTS), as a clinical specialist in Geriatric Physical Therapy.
Tyler has an avid passion for high performance, technology and entrepreneurship and speaks regularly about finance and technology as it relates to the future of physical therapy. He currently resides in Austin, TX where he serves his church and community and is launching his next start-up venture.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor (00:00):
Hello, this is Jenna Kanter with healthy, wealthy, and smart. I am here with three newer friends this year. We all our key contacts with the private practice section and we're coming on. Well, they're going to do more of the talking here. I'm just going to be doing the questions and if we're coming on to just say, Hey, this is a great opportunity to get involved. If you do not like the CMS cuts, this is what we do. We go and speak with the legislators to talk about that. We're getting more people to come and join us in this huge movement to fight for our profession, especially the private practices for all you people are working for private practices. This is the committee to be a part of, so please, please join the APTA, come join us and be a part of this great movement. I am here with Kelly Reed, Tyler Vander Zanden and Clay Watson. Yes, you guys. First of all, thank you so much for coming on. So I'm going to hand it to you first. Kelly, how did you first learn of being a key contact?
Kelly Reed (01:06):
Yeah, so I've been a member of PPS since I got out of PT school and I've always been involved. I've been on the board of PPS and wanting to get back into it. And so I just put my name out there, who needs help, how can I be helpful, wanted to kind of get on the government affairs committee. And instead I got asked to be on the key contact task force and it's been amazing.
Clay Watson (01:33):
I'm friends with some other physical therapists who've participated in this project and we had some interesting legislative successes in our state that helped reform some payment policy issues. And it kind of led to them asking me to help out with the congressional level.
Tyler Vander Zanden (01:53):
I actually got invited last year at the 2019 Graham sessions in Austin and I live in Austin. And that really kind of propelled me to do something, a call to action and how can I get involved personally. And so I looked at PPS to see where I could be of service and one of the openings was this key contact position.
Jenna Kantor (02:15):
I love it. And just to make sure for any students who might be listening, PPS stands for private practice section. So it is a section of the APTA. Clay, I'm going to move to you just because my eyes just happened to look up at you. So what does a key contact do?
Clay Watson (02:33):
We have been asked to develop relationships with specific legislators and every member of the private practice section and the APTA lives in a congressional district or they have a Senator and it makes sense to pair up people who have vested stake in policy to have a relationship with a representative or a Senator from their state. And this program designed to help us have longterm relationships so that when policy needs are coming up, we'll have a listening ear and there'll be able to hopefully hear the sides of our argument that are most beneficial to our profession.
Jenna Kantor:
Kelly, what is the time commitment with this?
Kelly Reed (03:14):
Yeah, minimal. We are asked, well a couple things, we have a monthly meeting and we are given contacts of which you just email the people and try and hook them up with their legislator and that might take, depending on how long your list is, you know anywhere between 15 to 45 minutes. Then we have an hour meeting and then the bigger thing is that we are provided all the information we need and when an action item comes out they send it to us and then all we have to do is basically cut and paste a letter and send it off to our legislature.
Jenna Kantor:
Yes. Would you Tyler mind differentiating between being a key contact with private practice section and also being a key contact on the committee?
Tyler Vander Zanden (04:09):
Yes. So being a key contact in general, what we're asking of those individuals that they be a private practice member and that they live in the district to what we're trying to assign them to. So we want them to have a relationship with that Congressman or Congresswoman in their specific district. So like as Kelly said and clay said, when there's an issue at hand in the profession or just to private practice in general, that congressional leader has a name and face of a person or a clinic that they can say, Oh, wow, you know, Kelly or Jenna or clay, like, you know, you're dealing with this right now and you're one of my constituents. And so we can have that relationship. And so that's what it looks like more at the key contact level. For us, like Kelly said we're on the committee side.
Tyler Vander Zanden (04:55):
We're the ones who are providing education to that specific key contact in the form of emails. We'll kind of give them block templates. So when they have to make that communication, it's not so hard. We send them and the practice or a chapter here sends us emails that they can be kind of up to speed on these legislation things. And then we recently had shot some videos in DC explaining the roles of the key contact. And so there'll be some videos that we'll have on the PPS website that they'll be able to always link back to if they need more education.
Kelly Reed (05:33):
Yeah. And I just wanted to build on those videos. They're short snippets, they won't take a lot of your time, but it gives you a lot of key information, just the nuts and bolts of what you need and you can look at them at your leisure and really helpful information.
Jenna Kantor:
Yeah. Clay, does it work? Does making a phone call if instructed to do that to sending an email or meeting with the legislator? Does that or is that a waste of people's time?
Clay Watson (05:59):
Well, it wouldn't be a waste of time or we wouldn't do it. Right. I mean one of the most interesting things when we had a legislative fly in this fall, I was with another therapist who had actually written the letter to get the wife of one of our congressmen into physical therapy school and it was her first employer. Now she's a home health physical therapist and that's what I do. I'm private practice owner, but I work in home health and when we are asking him questions specific to our industry, he understands private practice and he understands home health better than almost any Congressman out there. And so that's just a huge listening ear that we wouldn't have if we didn't have those longterm relationships.
Jenna Kantor (06:41):
I really just want to add in person is more effective than on the phone. On the phone is more effective than email. It is like any other relationship. So really the best way to make no change is to not do anything. What we're doing is the best way to make a change. It's where we have this insane power as constituents. Now for you, Kelly, what has been the biggest thing that has moved you and how the private practice section runs and works with the key contacts? Like what do you think is just so incredible that they do to make us so efficient with what we do to put our message out there to the right people?
Kelly Reed (07:27):
Yeah, I've been really impressed with the amount of information that PPS already has put together and the task force and members before us that are currently on the task force. Basically they hand you everything you need to be able to do your job to make and develop a relationship with your Congressman. It's really easy and I want to say for those who may be put off a little bit about not getting politically involved, we have to, this is our profession and when we know what we know, we know what we love and all we have to do is communicate that message. We build relationships every single day and that's exactly what this is just talking about what we love.
Jenna Kantor (08:11):
I think that's excellent. And any last words that any of you would like to say in regards to becoming a key contact for anyone who might be hesitant on jumping in?
Clay Watson (08:23):
One of the most important things I've learned is the value of the mentorship I've received from participating in this. Every time I have a question about how to approach an issue with one of our legislators, I have three or four other therapists who are also doing it that I can ask. They may know context about the legislature themselves and how to approach them on specific issues and they know the nuance of the issues in a way that helps me understand them with a lot more depth. So it's sort of like a pretty high value team to help the whole situation move forward and that's invaluable.
Jenna Kantor (08:56):
I love that. Thank you so much. And if you're wondering, I don't know what this is for me, why am I listening to this? They're just selling me, telling me to get involved. This is where the change you want to happen. I get the most interactions on my personal Facebook page when I write the word happiness because people are happy in the physical therapy world. This is what we are doing to make that huge change. I am saying this statement very strongly. I know everybody can have their own opinion. This is mine, but this is the majority of the profession in which I interact with which are non-members. This is the big culture of unhappiness and this is where we make that change. The private practice section are movers and shakers and are listening and taking such great action. These people who are here, who I'm interviewing are passionate, kind humans. We are all volunteering our time. We are all not getting paid and we're all doing it for you and we would love for you to join us because your voice is valuable.
Clay Watson (09:58):
Well, I think most of the time the people who are unsatisfied with the profession are the least engaged and sometimes they are very engaged in are not happy. But generally speaking, the more you're involved with the APTA, the more voice you have and the more ability you have to affect change. As physical therapists, our whole life is based on helping people affect change. And if you feel disempowered or however you want to describe it, the way to get that power back is to follow your own practice and dig in and take responsibility for it as much as you can. And there are many times when you're going to do it for not, that's just how life works. But the truth is trying to get better is amazingly empowering. And once in a while you get lucky and you actually do make a big change.
Tyler Vander Zanden (10:46):
Yeah. And I just wanted to say one more thing to dovetail is you're not alone. So if you're right now, if you're stuck and you're trying to figure out what to do, you have to start somewhere. And one of the beautiful things about getting on this subcommittee now less than a year is the networking and everything that the PPS and all the people that I've been able to meet not only in private practice, but then as a result of this legislative work that we've done. So something really to consider and if your slot is taken if you want to get on here and we don't have a specific slot open in your district, you can always start these efforts on your own and we would always be able to help you with that education that's still on the website there for your use.
Jenna Kantor (11:28):
I love it. Thank you. Thank you to each of you for coming on, this has meant so much to me. I know it means a lot to you as well. If any of you want to learn more, you can go to the private practice section website. It's under the advocacy tab where you'll find committees and you'll find key contacts. That's how you can get involved. Thank you for tuning in. Take care.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
This episode of the Healthy, Wealthy and Smart Podcast features a Private Practice Section Webinar, “Telehealth NOW” to address ongoing concerns for physical therapy practices during the COVID-19 pandemic.
In this webinar, we cover:
-How to navigate telehealth terminology and different vendors
-State and federal telehealth regulations to frequently check
-How to effectively bill for telehealth services
-An example of a telehealth physical therapy visit
-And so much more!
Resources:
Lynn Steffes Twitter
Mark Milligan Twitter
Ali Schoos Twitter
PPS Covid19 Resources
ZOOM Recording of Telehealth Now Presentation
Telehealth NOW Presentation slides
PPS Promoting Telehealth to Patients
PPS Tips and Tricks to Starting Telehealth
PPS COVID19 FAQ
PPS Telehealth Coverage Policies during COVID19
For more information on Lynn:
Lynn Steffes, PT, DPT is President/Coach/Consultant of Steffes & Associates, a rehabilitation consulting service based in Wisconsin. Providing consulting services to rehab providers nation-wide working.
She has enabled providers to achieve optimum success in the delivery of high quality, cost-effective care to their patients/clients.
Coaching/consulting in:
- Marketing, program development
- Selection, training & support of Practice Marketing Specialists
- Customer Service initiatives, patient alumni programs
- Lifestyle Medicine Programs
- Negotiating managed care contracts, payer relations
Dr. Steffes is a 1981 graduate of Northwestern University and Transitional DPT in December of 2010 Evidence in Motion's Executive Management Program.
For more information on Mark:
Dr. Mark Milligan, PT, DPT, OCS, FAAOMPT earned his DPT at the University of the Colorado. He is a full-time clinician and owner of Revolution Human Physical Therapy and Education, a concierge PT practice and micro-education company. He is adjunct faculty for 3 Doctor of Physical Therapy Programs. Mark has presented at numerous state and national conferences about telehealth, pain science, dry needling and has been published in peer reviewed journals. He is the founder and CEO of Anywhere Healthcare, a telehealth platform for all healthcare disciplines. He is an active member of the TPTA, APTA, and AAOMPT.
For more information on Ali:
Ali Schoos received her degree in physical therapy in 1982 from the University of Puget Sound. She is a co-founder of Peak Sports and Spine Physical Therapy, practicing in Bellevue, WA.
Ali has been active in numerous roles in the Physical Therapy Association of Washington (PTWA) and APTA. She has chaired her state private practice Special Interest Group (SIG) and Orthopedic SIG, and currently serves on the APTA Private Practice Board of Directors. She is also currently serving on the PPS COVID19 advisory task force. She is a past board member of the Bellevue YMCA and on the King County Regional Advisory Group for the Alzheimer's Association
Read the full transcript below:
Carrie Stankiewicz (00:00:05):
Hello everyone. Welcome and thank you for joining us for this special webinar tele-health NOW. I'm Carrie Stankiewicz with education and program manager for the private practice section. Before we get started, I'd like to review a few procedural items to submit your questions. Please enter them into the Q and a box which you can access from the zoom menu. We'll collect your questions there and the speakers will respond to them. As we go through the presentation, we expect to have a large number of questions so we need to manage them carefully in a moment. Ali Schoos will give you some parameters around entering your questions. If you have a technical question, you can type that into the Q and a box and I will respond to you in text. Please note that with the extremely high volume of companies and individuals that are now using online platforms for conferencing, there is a strain placed upon the technology and the infrastructure. Our vendors have done their best to provide a high quality experience, but neither we nor they can control internet slow downs resulting from unusually high volume. In the chat box, we posted a number of resources for you to refer to. Please feel free to copy these links and save them for future reference. This webinar is being recorded and will be posted on the PPS website for everyone to view. And with that I'll turn this over to PPS board member Ali Schoos to get us started.
Ali Schoos (00:01:26):
Thanks Carrie. Hi everybody. I’m Ali. I am a private practice physical therapist from Bellevue, Washington. And thank you for that musical introduction. I am the cofounder of Peak Sport and spine physical therapy in the Pacific Northwest. And I do have the honor to serve you on the board of PPS. I'm also on the advisory task force around all things COVID-19 and this webinar is a result of that task force. Our goal is to bring you business owners relevant information right now to help you manage your practice through this crisis and come out whole on the other end. But the end a couple things about our question process. There are 500 of you on this webinar. So we do expect to have probably more questions that we can answer. So we would ask that when you post a question look and see if anyone else has posted a similar question so that we don't get bombarded with the same saying.
Ali Schoos (00:02:28):
Don't ask state specific questions that's relevant to the laws in your state and mandates in your state. So we're not going to be able to answer a state specific questions, although we will keep a copy of all the questions that come in and try to deal with them later. We will stop intermittently to answer as many questions as we can and I'm going to apologize in advance. I don't think we're going to be able to answer every single thing that you asked, but we'll do our best. I would like to introduce our main presenters. Dr. Lynn Steffes is a graduate of Northwestern university and earned her transitional DPT in 2010 from evidence in motion's executive management program. Lynn is the president, coach and consultant with Steffes and associates. It's a rehabilitation consulting service based in Wisconsin. Lynn provides consulting services to rehab providers among a wide range of services including marketing and program development selection and training and support of practice management specialists lifestyle medicine programs, negotiating contracts.
Ali Schoos (00:03:34):
And Lynn's also been a frequent provider of content, the educational webinars that KPS puts out. Our second presenter is Dr Mark Milligan who earned his DPT from the university of Colorado. Mark is a full time clinician and owner of revolution human physical therapy and education, a concierge, PT practice and micro education company. That was a new term for me, Mark as an adjunct faculty for three PT programs. He has presented at numerous state and national conferences on tele-health, pain science and dry needling. And he's also been published by peer review journals. Mark is the founder and CEO of anywhere healthcare, a TeleForm platform for all health care disciplines. And with that, I would like to let Lynn take it away.
Lynn Steffes (00:04:32):
Okay. So welcome to this webinar. And before I get started, the first thing I wanted to say to all of you is really we're here honoring you for the good work that you're trying to do in serving consumers in your marketplaces. So we know that all of you are incredibly dedicated, compassionate, amazing clinicians and business owners that are looking at this COVID crisis today. And then also looking forward and seeing how can we best serve our patients. And, many of you may be continuing to serve some people in your clinics or you may not be, but we certainly wanted to talk about this really important option. And to give you a little bit of background on some details with it. So with that, I'll jump into more of the content information. So the objectives that I'm in a primarily deal with are just looking at the position, talking a little bit about the statutes and rules that will govern your ability to deliver and access these services. And also some information about payment policy, whether it's federal, state, commercial, work comp. And then I'm going to turn it over to the real expert who is Mark Milligan. And so I kind of get stuck with the fun stuff, the payment and policy things. So next slide.
Lynn Steffes (00:05:58):
So APTA has long had a position that tele-health is an appropriate model of service delivery and as long as it's delivered with the same essence really that we deliver care. And so this isn't new to APTA to be looking at telehealth as a way of delivering care. At a state level. Different States have different rules or excuse me, statutes and rules that govern your ability to deliver telehealth care. So rather than us focusing on any one state today, what I'm recommending to you is that you reach out to your state level associations. APTA has a site that looks at state statutes and rules and determine what your current level of coverage is regarding tele-health. So there are two different aspects of telehealth that you would need to look at that are legal at a state level, which is obviously governs what you can do within your scope of practice. And the one is your statutes and rules that govern your scope. And the second one really is, are there specific tele-health laws in your state that would in any way limit you from delivering those services?
Lynn Steffes (00:07:17):
Keep in mind that if you've looked before or downloaded those policies before they may have been updated or there may be some emergency provisions in place. So I encourage you to begin there. So that’s an important first step. Certainly anytime you deliver outside your scope of services, your malpractice insurance is no longer required to cover you. So it's important to do. So one of the things that we want you to think about is as your considering telehealth we want you to first check your state practice act to verify just as I had mentioned, and then also find out if there are emergency provisions. It's possible that your state practice act is silent on tele-health and as long as there isn't a prohibition that I would turn to your chapter for guidance and they're examining boards need look further, you certainly are going to document legal and ethical reasons.
Lynn Steffes (00:08:14):
You're converting patients to telehealth visit, so if you've never done tele-health before or eVisits and you're going to start doing so, I think it would be important for your practice setting to document that transition and the decisions that were involved. You're going to also have to make sure that you are securing consent for each of your patients along with the right to refuse. I've been most of you know that your individual States have consent laws that govern what type of consent you have to get and it'll be important for you to get consent for telehealth or evisits and the format from your patients. Most of the time it will be fine to secure that consent verbally and to document when you received it carefully in the medical record. It's also a good idea to look at what types of emergency policy procedures you might need to put in place.
Lynn Steffes (00:09:10):
For example, if you were to be teaching a patient exercises and they're working on them in their home through a telehealth visit and they fell, what would you do to address the emergency? Are there other folks that their family members, caregivers there and then how that might be handled. And that's something you may even want to look at with your legal team. Keep in mind also if you're going to start using telehealth, that a secured portal is ideal and if you have a secure portal or something that is designed to share information over the internet or phone, you're going to need a business associate agreement in place that ensures HIPAA compliance. I think Mark's gonna deal a little bit later with some of the other HIPAA things that give us a little bit of wiggle room right now and then finally make sure and review your malpractice insurance policy to make sure you're covered.
Lynn Steffes (00:10:03):
I know HPSO provided guidance that we have a link on. And I also know PT1 PGM provided guidance on that saying you're covered. So, real quickly, I want to just start off by saying there are different types of visits. I think when this was first announced that Hey, Medicare is gonna cover a PT as a tele-health service. Everyone got very excited and what they didn't realize is that Medicare actually is not covering telehealth. Instead, we're going to talk about the distinction between the eVisits and then telehealth. We also have third party payers, commercial payers that are covering assessment and management visits and not tele-health, and then the actual telehealth visits. So we're going to kind of explore those three areas, but we want you to really listen for which area might fit your practice in your regulatory environment.
Lynn Steffes (00:11:03):
So true tele-health. Let's start with the good news. If we could do true telehealth and we can often, we're going to bill our 9700 codes. We're going to continue to apply the GPP PT modifier, but we're going to also use the OTU place of service code, which is going to communicate that we're doing tele-health. Now, some payers may actually be looking for either a different modifier or an additional modifier. So we're going to talk a little bit later about how you get that information from your payers, but it certainly is important.
Lynn Steffes (00:11:47):
I wanted to start off by saying that a lot of codes are out which are often used in telemedicine, which is physician covered telehealth 99421, 22 and 23. These are actually evaluation and management or ENM codes and those codes are really reserved for physicians or other qualified non physician providers such as PAs or NPs in general. These codes exclude therapist's ability to bill. However, we have been hearing occasionally that there are third party payers that want us to use that code. So I'm just going to say if someone suggests that you use those codes to bill those services, make sure that they provide a URL or a link for you so that you can see the policy that ensures that you will be covered for those codes. Because those are traditionally not therapy codes. Payment from Medicare. So we were super excited and we heard tele-health is covered. And really that was a misconception at the beginning. Medicare doesn't consider physical therapists as an approved telehealth provider. The list is in the bullet below. But Medicare advantage plans can actually make their own decisions and may choose to cover tele-health itself. A lot of times policies are carrier specific.
Lynn Steffes (00:13:20):
This slide is really pretty important and it's just to give you the sense that take a look at the date of this press release, CMS finalizes policies to bring innovative tele-health benefit to Medicare advantage. That was April of 2019, which seems like a hundred years ago right now. A very different time. And so Medicare advantage plans definitely had plans to expand telehealth services, but those plans also did not include PT, OT and speech. So this is not a new idea or a new fight that we're trying to leverage. However we may be in a unique position and I'm kind of a silver lining person and I'm hoping that this opportunity might actually give us a window to get in next. Your Medicaid programs. As you know, Medicare is more federal and Medicaid is state driven. So some Medicaid programs have tele-health policies.
Lynn Steffes (00:14:24):
The telehealth reimbursement policies vary state to state. Those are very fluid. We just have had multiple updates being published in the last three days in Wisconsin. So I know for a fact that you're going to have to kind of stay on top of that to determine if you're trying to serve the Medicaid beneficiaries in your state. How that policy might change in response to the COVID crisis. So keep looking and you're going to have to, this is a moving target. So keep in touch, keep going. So what type of virtual visit again and we talked about there's an evisit, there's assessment and management or tele-health. Let's look at what the actual definition for an evisit is in the 2020 physician fee schedule. Final rule, CMS described eVisits as non face to face, patient initiated. So I want you to really pay attention.
Lynn Steffes (00:15:21):
This has to be initiated. So the contact has to be initiated by the patient. Digital communications that require a clinical decision. So again, clinical decision, that's really important. So you are going to have to document that clinical decision making was made during the contact of a visit that might otherwise typically been provided in your office. So this is the definition of an e-visit and the code descriptors that Medicare is using. Our hick picks codes are related to the eVisits and they're really designed as a short term, kind of like a, I always think of it as like a bridge loan when you're building. They're designed to cover short term up to seven days of assessments and management activities that are conducted online or through a digital platform. And then again include clinical decision making. So what's an online patient portal? HHS has described a patient portal as a secure online website that gives patients convenient 24 hour access to personal health information.
Lynn Steffes (00:16:29):
Patient portal requires a secure username and a password in the absence of broadband access online accounts or smart phones or other means. CMS has indicated they want the service to the furnace, so they're giving us more flexibility. Mark's going to talk more about the technology a little later, but I just wanted you to know the Evisit has, you know, variety of opportunities including something like doing FaceTime with your patients. Go ahead. The billing and coding is what I think you're all waiting for. So physical therapists are eligible to use the Hicks picks codes and these codes require a CR modifier and the CR modifier really indicates that they're related to the COVID crisis. So we have G two Oh six one six two and six, three again, the definitions qualified, non physician healthcare, professional online assessment management. It has to be for an established patient.
Lynn Steffes (00:17:27):
And lots of questions come up. What is an established patient? It is a patient who you're currently seeing under a plan of care. And so what would happen is if you were seeing the patient, you'd have the next seven days to provide some type of E interaction with that patient that provided clinical decision making in input with them. That would be much like what you do in the office. And so the different code levels are really time-related. So imagine that you saw someone today's Wednesday. So imagine that you saw them in person on Monday. There would be a seven day consecutive day window at which time you could have one contact with them or you could have a couple contacts. Each time you had a contact you would have to document the contact information. But really when you actually go to bill the code, it would be a summary of the seven days and the documentation at that point in time would summarize what type of clinical decision making assessment and management occurred over those contacts. As you can see nobody's retiring with this funding. We've got the five to 10 minutes at 1227, 11 to 20 2165 and 21 or more minutes at 33 92 so pretty limited. The place of service is the location of the billing practitioner, which Medicare is suggesting that we would do places service 11 and you can deliver these services via the phone.
Lynn Steffes (00:19:10):
Assessment and management are comparable codes. Non hick picks but they're CPT. So nine, eight, nine, six, six, six, seven and six, eight and those are actually used for telephone assessment and management services, again by a non qualified physician health care professional to once again an established client. But this one further expands and says a parent or guardian. So these are again established patients and they have to be initiated by the patient. That doesn't mean that you can't contact the patient and offer them this service. It doesn't mean that you can't help them set up et cetera. It just means that the call itself that you're doing, the assessment and management code has to be initiated by the patient. The assessment and management codes have a little bit more parameters put around them. And one is that the call can't or it can't originate from the provider and it can't be within the previous seven days.
Lynn Steffes (00:20:13):
So the case I gave earlier for the visits, it would have to be seven days prior. And then it would be the assessment and management calls and then you couldn't see them again within the next 24 hours. So there are these windows of time, seven days prior you couldn't have had a physical one-on-one visit with them and 24 hours after. So as of right now, if you're going to be doing these assessment and management codes they would have those limitations. These are codes by the way that I'm starting to see emerging from some of the commercial pairs as covered in lieu of the hick picks codes.
Lynn Steffes (00:20:59):
These again are telephone discussion times thereby to 10 minutes, 11 to 20 and 21 to 30. And of course, because these are other payer codes, you'd have to look to the payer for coverage of the codes and payment. So true tele-health, we're back to that. There really isn't a specific CPT code for true tele-health. You would be using the therapy codes, the 9700 series paired with the OTU place of service code, which would indicate that it was provided remotely. Because if you're going to be providing these CPT codes, face these what are called face to face codes, which I would argue if you're doing telemedicine or telehealth, excuse me, they're face to face, you're going to have to verify that the payer allows you to use these codes when they're tele-health. So you can't just build these codes leading the pair to believe that they were provided in our office X. I wanted to say payer policy is fluid and that is followed by multiple exclamation points.
Lynn Steffes (00:22:07):
This is changing so fast. I literally just got off the phone before I stepped on this call saying we've got legislation coming in our state that's going to do some mandates. So you may have to check regularly. For example, in the state of Wisconsin, our governor just issued a stay at home order. So peers are going to have to reevaluate their policies if they want to continue to have their enrollees get services. So when you are, whether you hear from one another provider or whoever that someone covers telehealth or someone covers assessment and management or EAD visits, I would suggest that each time you call, you verify benefits and you're going to ask several questions, are you or the physical therapist eligible for telehealth payment? If so, which CPT codes would be completed via telehealth, so which CPT codes will be approved and then what modifiers are required.
Lynn Steffes (00:23:07):
So the modifier GT or 95 is often used in facility billing and the place of service OTU in independent practice billing. And then you're going to want to also find out what their payment rate is. So if they allow you to build nine seven one one zero will there be parity in what they pay you or equivalency and what they pay you based on telehealth versus in office. Are there any restrictions on the location of the PT or the patient? Because of course, right now if your PTs are practicing from home, that would have to be okay or your patient may actually live in a CBRF or other facility. Then what devices or applications do they have any restrictions on that and what if any consents are required and then any special documentation requirements. So those are some of the good questions to ask.
Lynn Steffes (00:24:00):
The other thing I will say is regardless of what they tell you, if you can get a link to their peer policy or anything in writing from them, I would highly recommend that you do that. And then don't assume that what is not covered today will not be covered tomorrow. And what someone tells you is covered may not be covered. I've already had providers that said, they called and asked about telehealth. They said it was covered and when they called back in a second patient, they said, well that's not what we meant. So be careful. And finally both Mark and I have been using this a lot. The center for connected health policy has a ton of great resources, but one of the best that I think you're going to want to download that will give you far more details than I'm able to give you in this brief discussion is their billing fact sheet. So the link to the billing fact sheet is here and I wish you the best. I think we can provide amazing services in person and also via these wonderful technologies. So thank you.
Ali Schoos (00:25:10):
Thanks Lynn. So a number of questions, they've come in and I answered a few of them. So if those of you who received the answer, if that wasn't enough clarity, ask it again. But then I'm just going to let you know what some of the questions are more clever. We can answer them. One, yes, you'll have access to the presentation after it's over. This is being recorded and it will be posted on the website, the next question, will we have access? Why need an option to refuse consent? Wouldn't the person just declined to sign consent? It said in the consent form that we have to give them the option to refuse.
Lynn Steffes (00:25:49):
Well, part of the option to review is, and that's a really good question, is if someone gives consent once, they still have an opportunity to withdraw consent or refuse it in the future. So someone tells you, you know, I'm happy to do telehealth or I'm happy to do evisits and they give you consent and the next time that you're in contact with them, they call and they say, I don't want this anymore. They always have that opportunity to review. So that's typically what that's for. I will say that each state practice act and sometimes an overriding practice act over healthcare professionals tell you what's required for consent.
Ali Schoos (00:26:28):
And then another person asked about the secure patient portal being ideal, but it didn't CMS make a, the HIPAA compliance issue more lax and the pre-cancers yes.
Ali Schoos (00:26:43):
Mark, he's got that later in the presentation. Can you build the e-visit code every seven days or just once and done?
Lynn Steffes (00:27:01):
As far as we don't, I don't know. We've been asking that question if it can be billed repeatedly. We've heard yes. And we've heard no. So I'm not sure. I don't know Ali or Mark, if you know anything more.
Ali Schoos (00:27:14):
It's the same thing. And I apologize, we cannot get a straight answer on that. I think some people are saying, I'm just going to do it more than once and see what happens. Again, it's not a big charge. You're not going to get rich or go broke. So if you want to try it, the worst that'll happen is that a bit tonight.
Lynn Steffes (00:27:30):
Right. And we haven't had to seven day periods to try it yet. They've been released. So it hasn't even been an opportunity.
Ali Schoos (00:27:36):
Right, right. And then does the evisit have to occur within seven days of the last in-person visit or could it be 10 days or 14 days after the last in-person visit?
Lynn Steffes (00:27:53):
I don't think there's a restriction that says it has to be within seven days. I just think it can't be sooner than seven days.
Ali Schoos (00:28:00):
Yeah, I understand. Okay. and then someone wanted an example on it, an example regarding the verbage to justify the clinical decision making to use an evisit
Lynn Steffes (00:28:16):
For an individual patient or the practice.
Ali Schoos (00:28:18):
So when you're documenting, you know, political decision making. Yeah.
Lynn Steffes (00:28:23):
Okay. So you could document that either the facility or the patient or the clinician made a decision that it was safer to do an evisit versus the in person visit. And that there was a good, a good reason to do that in your clinical decision making would reflect that you advise the patient or gave the patient it's specific instruction. The patient asks you questions, you update an exercise program, you perhaps revisited how they're doing on something and gave them feedback. So again, it's kind of like you're documenting a regular visit but the clinical, so I would decide that you did the visit you know, virtually for a fairly simple, straightforward reason that that was what was appropriate at the time due to the crisis or for the patient. Now, Mark, you may address this later when you're talking about tele-health on an ongoing basis because there's lots of good reasons to do it. But right now I think we're talking COVID.
Ali Schoos (00:29:29):
Right? And then Mark you want to address now or later what you might be documenting when COVID is over.
Lynn Steffes (00:29:38):
Right.
Mark Milligan (00:29:42):
So this is a new space to navigate. And so when this crisis is over, I think that this will be a normal part of a plan of care. Right? So it will be an expected plan of care that you will put forth in a patient that they will have a combination of both digital and in person visits. If you line it out from the beginning and set it up that way, then there no deviation or there a deviation from your initial plan of care. That's how I would handle it.
Ali Schoos (00:30:10):
And then one person did ask if you have, if the patient, if you do a second seven day visit, yes. The patient would have to initiate that phone call the second time as well or that contact the second time as well. Yeah. Can you see a Medicare patient per tele-health per cache? Some many visits are covered and I did answer earlier. Yes. You can see Medicare patients for past, since telehealth is not actually covered.
Lynn Steffes (00:30:39):
Absolutely. Any patient where it's not a covered service unless you have, for example, say you had a contract with a certain commercial payer that had a prohibition to doing any services, which rarely do they for a non-covered service. You would inform the patient that this is not a covered service and you could go ahead and bill cash for it. For your Medicare patients. And ABN is not required, it's optional, but some folks will use the optional ABN kind of as a backup to ensure that they feel that their Medicare patients were well informed that this was not a covered service.
Ali Schoos (00:31:17):
That's a great question. Wanting to know if your PTA can provide the telehealth service if the supervising PT is not online with them because it's virtual
Lynn Steffes (00:31:30):
Currently for Medicare. The answer I believe is no, but I don't know with other payers. And that would be a question. If you were anticipating a PTA providing the services telehealth services that you would ask. I would think that the visits because they involve clinical decision making and the assessment and management would likely not be covered. But I can't, I think telehealth would be flexible. What do you think Mark?
Mark Milligan (00:31:59):
Right, so Texas just, I think we also have to default to the rules and regs of the state level as well. Texas just eliminated the verbiage that eliminate, that took PTs away from delivering tele-health. So state rags may have a prohibition written that physical therapist assistants can't provide that care. I need, I'll pull up the Texas specific language that I believe there's a caveat that says that it cannot be used for supervision, but no one has defined whether or not a PTA can perform it being unsupervised. Does that make sense? PTs are not physically being supervised in all scopes practice, right? Like in home health settings. PTs are not digitally covered or supervised by or physically supervised by PT immediately. It's by phone contact. Right.
Ali Schoos (00:32:48):
Well I get in state law. Yeah. And obviously in a private practice for Medicare there has to be onsite supervision.
Mark Milligan (00:32:58):
Right. So state law and then I'll, yes, I can check with the Texas regs too, but it's a state regulated issue.
Ali Schoos (00:33:06):
Yeah. Very good question. And there they are pouring in now guys. So lots and lots of questions here. I'm trying to go through them. Should we keep going and let Mark deliver and then we'll go back and ask more answers. And some of these make an answer with Mark's presentations. We'll come back to these. Yup.
Mark Milligan (00:33:23):
All right. So thank you for allowing me to be here and being with you guys in this presentation. Lynn, I know that you said earlier that that's not the exciting stuff, but that's what everybody wants to hear. So regardless if it's exciting, it's definitely information that is necessary for all of us to continue to keep our doors open and see patients. Right? So again, I'm Mark Milligan, I'm out of Austin, Texas and we're going to cover, basically we're going to cover just what tele-health is. We're going to get some baseline terminology, technology who players in the game evidence and then kind of how to implement it in a practice. Then is going to actually talk to us how to implement it into practice, right. Ali is has implemented this into her clinic. She's delivered care.
Mark Milligan (00:34:09):
She's also as a clinic owner has implemented as a clinic owner. So she's going to give us the nitty gritty on how this actually looks for a private practice owner. So we're going to start with basic terminology because again, terms, words have meaning and terminology can be misleading. And there's been a lot of misleading terminology that's been spread around the physical therapy world since tele-health and eVisits have all been introduced. So tele-health really is just a very large, broad term that describes any type of health, education or delivery of care using telecommunications technologies. And as you'll see that it applies to almost every profession other than medicine. Telemedicine is specifically owned and basically utilized only and exclusively with physician deliver care and their extended providers. Right. So I think one of the bigger issues that came across our country earlier or late last week was when tell them when I think the president said that telemedicine is going to be available for everybody and that you know, that there's these broad sweeping terms where it doesn't really change if you hear the term telemedicine, it doesn't shift anything for physical therapists necessarily.
Mark Milligan (00:35:21):
So you have to do your due diligence when it comes to looking at the information about telemedicine and who that applies to. Right? And so also when you look at your insurance policies and, and other types of documents, make sure that you're referring to telehealth or telerehab for physical therapy services. If you ask about telemedicine benefits, you will not be considered a provider for telemedicine. So make sure that you make those two distinctions. So tele-health again is we help manage our patients through their own their own illnesses to improve self care and access to education support systems and treatment. Telerehab is more of our specific a tele term, if you will. So really it's about delivery of rehabilitation service over a communication that works and the internet. So you can do assessment and functional abilities in their environment and clinical therapy.
Mark Milligan (00:36:12):
So when you're looking at benefits, you can also check to see if they have tele rehab benefits. Telerehab benefits also shows up more in clinical research, right? If you do research and look into the efficacy and effectiveness of digitally delivered care, tele rehab will be a much more used, utilized term than tele-health for physical therapy specific. Tele-Health again really accomplishes and encompasses all types of providers, dentists, counseling disaster management, consumer and professional education. So really tele-health is one of those terms that is not a very good descriptor of exactly what we do. But during these times, it's the most accepted term of what we do. So out of the all those things, just make sure that telemedicine, you understand that does not apply to us as physical therapists. And to make sure that if you hear something about telemedicine that you clarify that or that you clarify that those rules apply or may or may not apply to us.
Mark Milligan (00:37:13):
Some other terms that are coming up across the country are models of telehealth, right? So some terms of delivery so right now currently, what you're watching and how we're interacting would be a live video or synchronous technology. So this is a live two way interaction between the person and the patient and the caregiver or the patient, a caregiver or provider using the auto visual [inaudible] communications technology. So this can be used for both diagnostic and treatment services. And it's just like anything you've done on a video call with your family. So as long as you're live face to face talking to the patient, you're good. Second term is asynchronous. You'll hear this term floated around a circle. The asynchronous modes of communication are basically or otherwise known as store and forward. This is non live communication, right? So this could be emails of HEPs.
Mark Milligan (00:38:05):
This could be a recorded video of exercises that you send the patient. This could be a recorded exercise where the patient demonstrates their exercises and sends it to you. It could be lab results, it could be any type of electronic communication that happens on non-life, a synchronous video. So that's the important differentiator in those two modes of delivering telehealth. So those in some States, these get specific, I in Texas, I'll just give Texas, I'm here in Austin and Texas, you can't initiate tele-health via asynchronous mode of delivery. You have to have a live synchronous session before you can actually utilize asynchronous care. So depending on the state that you're in, that may impact the mode and model of how you deliver telehealth. So please be mindful of these types of definitions.
Mark Milligan (00:38:59):
Also there's remote patient monitoring is another term that's used. This is really about data health data that's collected from an individual at one location and delivered electronically to another. So when this comes to a lot of patients that have chronic diseases that they need to be monitored or something needs to be checked on them regularly, like wait for patients that have CHF they have a digital scale, they can weigh themselves daily and then that data is uploaded into the physicians portal or cloud and then they're monitored on a daily basis remotely for any progression of weight gain. That could be a contraindication or a need to necessitate a medicine change due to CHF. Typically right now, not a lot of physical therapists are in this space. They may be monitoring some of those patients, but they're not too many PTs are actually delivering this model of care.
Mark Milligan (00:39:50):
Typically this is a physician or hospital base. And then mobile health really depends on or is determined by apps and different mobile devices and things that appear that can be very portable, including tele-health. So I would, I would umbrella tele rehab and M health together because you can deliver it via a PDA, cell phone or tablet. Right. So this is more just to the, the more mobile you are as a provider, you can do telehealth with someone on the beach. And depending on your place of service code, you could deliver telehealth while you're on the beach. So just think about that as, as we talk about more app based functions of some platforms that could be applicable to that. So some of the technology that's really out there that we'll pretend I'll briefly brushed these just so you're aware of them, but know that right now in this time of the COVID 19 crisis, some of these may not be the best thing to implement into your practice right now, but know that the virtual reality and tele rehab is an extremely that's a very quickly developing technology where patients put on goggles and they can meet and go into augmented reality and meet their therapist in different spaces to perform exercises or to see exercises demonstrated.
Mark Milligan (00:41:03):
So it's a really cool technology. There's motion technology where patients can see themselves on the computer. And so they were they were able to look through and see themselves moving or get the movement collected from their body and pushed into a system. So sensors and body body monitoring have been they're an interesting technology where you can actually wear a piece of clothing or have a different sensor that will sense your body positioning and space and alert you and change your posture. Haptic technology as really interesting to me. It's cloth and clothing that you can actually generate sensations through distantly. So I could, a patient could have on a haptic cloth and then I can manipulate something a hundred miles away and they could feel the sensation on their skin. So I know if anybody has a new car and they're, and they've, you know, kind of diverted out of their lane and their seat has vibrated on there.
Mark Milligan (00:42:00):
But think about that as haptic technology and how that can be utilized in physical therapy for tactile queuing and for input AI, artificial intelligence that will come into play when we look at a larger type of systems and startup companies that are leveraging AI in order to deliver a digital physical therapy PDAs, electronical medical records, wireless technology, mobile apps are all just different ways that people can connect and also get data and information that can be a really important for medical monitoring. Right? So I think we all notice the explosion with the Apple watch that started to take a heart rate and other sensors and other vitals. And so that would be an idea of wireless technology and then that would also tap into the Apple medical records. So it all kind of is encompassed and in those, in that realm as well.
Mark Milligan (00:42:55):
So just terms that you should be aware of, not necessarily in the immediacy for the deployment of telehealth into your practice, but just to be aware of. So for your business really to get down and dirty and tele-health, typically it takes some time to implement telehealth into a practice. So do due diligence. You need to come up with your business plan, your patient demographics, right? Some people will not want to tele-health or they wouldn't choose telehealth at a given rate. But now with the current situation, many people are seeing this as a really viable option to dilute, to get care delivered to them. But you also have to make sure and take into consideration general cultural and generational issues. And also there's a tremendous bias amongst the long low income patients because they don't have access to high broadband wifi or they may not have a tablet to get care or they may not have access to a safe space to exercise.
Mark Milligan (00:43:46):
So please take into consideration patient demographics and the ability to deliver care because that may be impacted greatly depending on the patient population that you serve. So you also need to have relevant current healthcare delivery systems to how you deliver care. If you you need to make sure it blends with your current type of care and the delivery method that you deliver to your patients, you need to have skills and responsibilities as a PT providing tele-health. I'll touch on this briefly. Ali's going to cover some of this is that you've got to have good video, adequate etiquette. You have to make sure that you have, you know, appropriate lighting room to move and you need to be able to communicate nicely over video. And so that's a different wait, I know some of you have always had been on a tele on some type of teleconference when there's 48 people talking.
Mark Milligan (00:44:35):
Understanding the rules and kind of engagement by a telehealth is important to know as well. You also need HIPAA compliance scripts for patient communication and the protection of PI, right? If you're delivering care in a busy area where other people can hear you, you're transmitting their PI. So making sure that you take precautions and steps in order to and to protect your patients who you're treating digitally and on the other end, patient needs to be protected as well. And you also need to make sure you have appropriate policies and procedures in place for consent for medical emergencies. What Lynn covered earlier to protect PI, I know there's talk about people recording visits, right? Some payers I know in Texas are requiring recording visits to get paid for a telehealth. And so that video becomes a part of the patient's PI.
Mark Milligan (00:45:21):
So how are you going to store that? Who, where are you going to store it? How long? I mean, you store it from the normal five years. Right? So making sure that you have all of your business practices and policies in place for procedures is really important. And then your IT development and installation. Every system is different. Right now across the board you could have a list of a hundred different ways to deploy tele-health in your business. Just depends on how that model fits into your business and your patient flow. And to your workflow. So right now because of this rapid adoption, there's a lot of trying to navigate in plug and play systems, which is pretty normal. But it's even become more apparent that the need for some centralized systems for delivering this digital care.
Mark Milligan (00:46:08):
So you need it. That's my second question. You need a strong IT department to make sure you have secure system set up in place with your policies and procedures and protocol, right? So your equipment, I really want to make sure you're HIPAA compliant because as lens that earlier there has been a lowering of the shield of HIPAA during this COVID crisis. I'm going to sit here and tell you that you should always choose a HIPAA compliant, secure platform to deliver care if it's available. If it is not, then you may in that circumstance use a non HIPPA compliant platform, which we'll talk about later. But you need to do your due diligence in documenting why you chose that. And you need to document the time, the approximate length of time that that patient's PI was could have been compromised and the patient needs to be able to consent to this non HIPPA delivered care.
Mark Milligan (00:47:00):
Right? So I think that's an important part that a patient, like Lynn said about denial of their consent. You need to inform the patient, Hey, you know what? This isn't a secure platform. This is not a HIPAA compliant encrypted platform. Are you okay with continuing to go through with this? And they may or may not say yes, right? So you need to make sure that your connectivity reliable, you need to have bandwidth, audio and video interface quality. You need to make sure that the staff can use and learn the equipment both easily and onsite and remotely when needed. So can this function when you can't get to the clinic? Right. That's a great question. And is the system compatible with your current hardware software? Most tele-health systems right now can integrate. It just takes time. There's a process, typically integration of a telehealth system, depending on how you deploy, it can take a couple of weeks and maybe two to three weeks depending on branding and depending on how you want it to look.
Mark Milligan (00:47:55):
And so the scope of how you can deploy it into your clinical practice, the timeframes can vary anywhere from 12 hours, six hours to two, two to four weeks to six weeks, depending on the level of integration and the level of branding and the level of system that you want to deploy in your practice. All right, so some simple, the beautiful thing about this is most systems operate with very simple hardware, right? So you have some wifi up and download speeds that need to be a minimum. The minimum requirements, they need a laptop microphone or a headset. I prefer a good old wired headphones, right? I know this seems antiquated, but most people are switching to battery power to rechargeable headphones and they're lasting for an hour or two and then they're dying. So if you're in the middle of a healthcare day, if you're treating and training and triaging patients, I highly recommend either having a couple of sets of rechargeable earbuds or headphones or just go old school with cables and you don't have to worry about that at all, right?
Mark Milligan (00:48:56):
The mobility may be a little bit limited, but it depends on how you function in that telehealth visit that this may be restraining or not. It just depends on how you're set up. But again, it's hard. It's very challenging. Once your headphones die to do a visit through just the speakers on your computer, the qualities, it goes down pretty quickly. And then you need to think about what you're surrounding yourself with. You need to create a neutral background. We need to have a quiet room. You need a room to move as Ali will show you soon. That movement and room for both the therapist and the patient are super important because this isn't a normal, this isn't a normal treatment in a clinic where you have a table and you have a confined space and you do everything within that space, right?
Mark Milligan (00:49:44):
This is an opportunity where you have to help the patient move and show them. So Ali was going to be an amazing demonstrator of how you need to have the space both for the provider and the patient and similar on the other side, the patient needs that wifi service or cell service in order to get those uploads and download speeds. And there's simple tools that you can send to your patient but they can check it's just you can, there's probably 20 free links that they could just click a speed test and it can check the speed of their wifi. So that's an easy way to make sure patients have the capability. So there are other technology out there like VR and all these fancy systems. But look, when the rubber meets the road right now we're trying to get everybody on and adopting telehealth as quickly as possible.
Ali Schoos (00:50:28):
And these are the bare requirements, the essentials that you need. So practice models of telehealth. Actually, I was just a good time to stop or is it for questions? Yeah. All right. Well let's pause. Well, you're muted though. There we go. That's smart. Thank you. I've been madly typing away, so I'm really trying to answer the questions that I can just to simplify things and if there are questions that I think the whole group has to hear, I'm trying to save them. So we've been doing a little bit of both Mark. You've got some really good questions and land these yeah. Either one of you. If a patient has authorized visits, do the telehealth visits count towards those authorized visits? So if they'd been given six authorized visits, would Pella and I have a telehealth visit? Would that be one of them?
Lynn Steffes (00:51:21):
I guess if you're authorizing the visits and you're authorizing tele-health and that is one of the visits. Telehealth itself. Yes. if you're doing E visits or the assessment and management calls, those are not counted. And so I think it depends. It's pay are going to be peer specific. Mark, I don't know if you have any, anything else, but to me a telehealth visit is a visit. It's truly therapy. It just doesn't have to be, it doesn't happen to be physically present. So I would say it would count. But in the case of the eVisits, we've been told they do not count either toward the therapy threshold or toward the visit count.
Ali Schoos (00:52:04):
Yeah. And if insurance isn't paying for the visit at all. So let's say you had two in clinic visits in one telehealth visit, if the patient, it's cash for the telehealth visit and that would not count towards their authorized business because insurance company isn't counting it. Oh, that's a good point. Yeah, absolutely. Yeah. And if you needed authorization for an in an in clinic visit, you would need authorization for a telehealth visit. If it's going to be paid for, unless your insurance company waives that. So you really have to ask every single one of your payers what their policies are around this. All right. Amazing. Just the language that you said just there is confusing enough for a million people to navigate that. I want to say that better Mark to explain it was part, no, I'm just saying it was perfectly explained yet. It's still so confusing. No. Yeah. somebody want clarification. The seven, they felt like the seven days after the last in clinic visit it helped the 70s started after the patient reaches out requesting the phone call. No, it's actually the plane. Right?
Lynn Steffes (00:53:13):
There's be a separation of seven days from the last at least seven days than the last time you saw the patient to build the assessment and management code and then you can't physically see the patient for another 24 hours. And so I think what they're trying to do is say, Hey, you know, this clinical decision making probably isn't need right away. I don't know if I agree with that, but if you're going to see them any way, they probably didn't need this call. I'm not saying I agree, but I'm just saying that's my interpretation. Mark. Do you know anything else?
Ali Schoos (00:53:46):
And, and I think just to clarify one more time when I think it's a misunderstanding when it's an assessment management versus,
Lynn Steffes (00:53:53):
Okay. So the Eve visit did not have that same restriction. It's assessment and management that has that restriction.
Mark Milligan (00:53:59):
Okay. So could you clarify when the visits can be seen?
Ali Schoos (00:54:07):
It has to be more than seven days after the patient was last seen and it has to be an on Epic open.
Lynn Steffes (00:54:14):
Yeah. To be an established patient on the product.
Ali Schoos (00:54:17):
Right, right. But it can be 10 days later, 14 newsletters throughout the COVID process actually.
Lynn Steffes (00:54:23):
And I've not seen anything that says you can't see them within 24 hours after that. I've not seen that. So do you guys have speak up? Yeah.
Ali Schoos (00:54:36):
Does the patient have to be in the same state of the time of the event as if there's a super important Mark?
Mark Milligan (00:54:41):
Yeah. So licenser compact rules and state licensure co licensures rule here, you must have a license in the state that the patient resides in to deliver care for that patient or have practice reciprocity through the licensure compact to provide care to that patient. There has been floating rumors around this country that are licensed. We now have national scope of practice and that w our limits of state have been dissolved by some magical powers, but that I can tell you that that has not occurred. And that we still have to maintain state boundaries for our licensure on a state level. So the location of where the patient is, you have to have a license in that or practice reciprocity in that state.
Ali Schoos (00:55:29):
Thanks. And then Mark, we are only, this person wants to know if they can only see current patients for telehealth purchase. Can they see new ones? And again, the answer is different if it's Medicare or commercial payers can explain that.
Mark Milligan (00:55:43):
Yeah, of course. So for Medicare, they've established that it has to be an established patient for an evisit. So for initiation of an evaluation, it's going to be state level. If you have any regs and rules for your state that that doesn't allow you to do that. I've not heard of that yet. In fact, some policies in this country are just paying for the evaluation only by a telehealth, which makes no sense. But you can, for cash based patients, you can do it at a treatment and about and evaluations and treatment based on your state rules and regs. And so same thing for commercial based on your state rules and regs, you can perform an evaluation and treatments. So we have to default to your practice act in order to make sure you can do those. But are you guys aware of any States that don't allow? Well, there are a couple of States that have been questionable, right? Arizona just came through this morning saying that they have tele-health abilities to practice that. But I'm trying to think off the top of my head. If any state doesn't allow telehealth for physical therapists, my brain is a little mush. Right.
Ali Schoos (00:56:50):
Wow. That Arizona. But they just changed it. That's when you said that just changed today. That's allowed it. But I couldn't tell you which ones still maybe don't.
Mark Milligan (00:56:59):
So defer to your state rules and regs. If you can participate as a provider and provide telehealth services, then that shouldn't limit you as to whether or not you can eval or treat. But it may, it may.
Ali Schoos (00:57:13):
Okay. I'm typing one more answer here. Someone asked if they could take care of patient, just skip over the whole evisit process and do a telehealth visit. And the easy answer is yes. You don't have to do EVAs. That's just because they have Medicare in favor of a telehealth visit.
Mark Milligan (00:57:29):
They have to pay cash for that telehealth visit though. Right?
Ali Schoos (00:57:40):
Sorry. I'll chance to seven days at the end, I think. Why don't you go ahead and keep going back.
Mark Milligan (00:57:45):
Yeah. Awesome. Sure. Thank you. Those are all great questions. And those questions, again, the beautiful thing about the ambiguity of this presentation is that all answers will not be valid within the time that they've left my mouth. So you can't, or Ali’s mouth or Lynn’s mouth. So things are changing on an extremely rapid pace. And so please be mindful and please be considerate or consider that these answers may not be applicable tomorrow depending on the circumstance. So current practices in telehealth, really I like to break these down in just three kind of buckets, right? Companies that provide a service for you as a business owner to connect with their patients and provide care. There's companies that have licensed providers that actually deliver care. And then there's companies that use technology and sometimes a human combination to deliver care, right? So this bar, so the bar, the top one is what I want to focus on with all the PPS owners, because that is who you want to connect with in order to provide your patients with care.
Mark Milligan (00:58:47):
Okay. The other two, I would consider these to be in competition, right? So video platforms are platforms out there that allow you to sign up either a monthly or subscription. Some are free, and you can use their services in order to deliver care through your staff to your patients. That's the important key here. Again, I'm the founder of anywhere.Healthcare. We are HIPPA compliant platform that allows schedule and messaging with the connection of video. We're a relatively inexpensive for now we have it as $10 a month for three months to get everybody on board. And as fast as possible, our normal prices, $25 per provider per month zoom, there's a free version, there's a free version that's not HIPAA compliant. But HIPAA compliant for zoom for providers is $200. Five providers is $200 a month, so $40 per provider per month.
Mark Milligan (00:59:36):
Coveo has a free system. Doximity has a free system. But these are just basic. You're, you typically pay for bells and whistles in these systems, right? So doxy.me we'll offer you a room based system where you just send a link to the patient, the patient meets in the room and that's what you do. There's no messaging and there's no other type of communication or ability to for the patient to sign on. I think that, you know, it's unique that I said platforms in here, but not all of these are actual platforms by definition of the secure platform from Medicare. So back to Lynn's point earlier, I think there's needs to be distinction that some of these like zoom and doxy and Skype they do not have portals, secure portals that patients have to sign into to qualify as a visit communication anywhere healthcare does.
Mark Milligan (01:00:25):
And I believe clock tree has a patient sign in as well. And so you need to be, when you look at these platforms, take into consideration the patient population that you're treating. So when it comes to, we'll get to the HIPAA compliance and just a little bit we know right now due to the lax of HIPAA rules and regs that you can use things like FaceTime or Google chat or Skype or Apple. What else? Facetime. There's Google. There's WhatsApp, there's lots of different communication platforms on your phone right now. They're advising that at this time that you can use those as long as you document well. But choose a platform that's secure if possible. All right, so tele-health platforms and systems and EHR is also anywhere healthcare Cario Bluejay in handheld med bridge now has a telehealth option practice.
Mark Milligan (01:01:17):
Perfect. EMR has a tele-health option. PT everywhere is an EMR with a telehealth option. So these are going to be a little bit more in depth and how they engage you and your system and your clients. So some of these, I know Indian health in handheld has a complete patient management or CRM, a customer relationship management system. You know, PT everywhere is an entire EHR. So some of these systems may not be right for your practice right now because of the integration needed at this point, not very many people want to go through an EHR integration or transfer during the middle of a healthcare crisis. So these are all opportunities as you look into the future. First kind of systems wide platform setups that you can take into consideration for your company. Companies like you, health, wellness, health, physio, physio, reflection, health there.
Mark Milligan (01:02:08):
Now these companies are companies where a patient can click on this website and be connected with a therapist by their company. So this would be in my consideration, the competition to private practitioners across the country, right? So these are companies that are providing tele-health for, for PT specifically and others in the game such as hinge health, simple therapy, Chi health and Kyo are all app based that solicit direct to patients. So you can search simple therapy or Chi health and they are an app base where a patient will pay a small monthly fee in order to get web delivered. An avatar directed exercises or exercise videos. And I bring this to mind because these four companies, this is a huge exploding space and musculoskeletal care because these are contracting with major employers to be their provider of musculoskeletal care or their first line in musculoskeletal prevention.
Mark Milligan (01:03:02):
So as private practice owners, we need to be really aware of this, of these companies in the space. Because just last year alone, those four companies had $165 million in capital investment, right? They had massive amounts of funding that were pushing at these because they're scalable and because they have infinite amount of users because they're AI driven and you can deploy them rapidly to, to huge audiences. So really be mindful in how you communicate about the services that we offer and the importance of what we do. Because there's people out there and there's companies out there, there are trying to eliminate the physical presence of physical therapy across this country. So knowing the rules is really important, right? The biggest important thing that you can know as a PT providing telehealth is that you can treat, you have to treat the patient person the same way as if in the clinic.
Mark Milligan (01:03:54):
This is paramount. So you have to have consent form signed. You have to have consent to treat, you have to have all your your dots. Dot eyes I's dotted and T's crossed. When you're treating patients to make sure that you treat them just like they're in person. This, just because you do a digital cash based visit doesn't mean you don't have to document. And I say that only because people have asked me that, right? This is a real patient. You have to treat it as a real patient, as a real visit. So please be constantly professional and how you manage patient care. Knowing the licensure compact is also super important. The patient, what I defer to earlier, the patient, you must have a license or practice reciprocity in the state that the patient resides in. There have been talk about, well, what if somebody goes on vacation?
Mark Milligan (01:04:38):
What if somebody goes on or their summer home? That that is a very gray area that hasn't been well defined to my knowledge. Have either of you heard of anyone defining them being out of their compact state for a defined period of time? I have not. So you're talking about the patient or the therapists, right. Let's say my patient in, I have compact reciprocity in Missouri. Let's say my patient in Missouri goes to Indiana for four weeks. Can I now treat them while they're in Indiana because they're not in a state that I have a license or compact or reciprocity?
Lynn Steffes (01:05:17):
Well, it really is, it's my understanding that it's the location of the patient at the time of the encounter. We've had lots of questions on this behind the scenes as well. Like what if my patient is, their residence is in one state and I'm doing tele-health and another if they were to come to me, I'd be covered, but then they would be in your state. So in the case of telehealth, it's my understanding that if you are licensed in the state, whether through your primary license or compact license that the patient is in at the time of the encounter, then it's covered. If not, it's not covered any different.
Mark Milligan (01:06:01):
I've just, there's been people argue like, what if my patient goes skiing in a state that doesn't cover in Nevada and they hurt their knee, right? And they're gone for a week and I still consult them while they're gone for a week. Technically, since they're not, you know, they're not a resident, they're not living there. So those questions are extremely gray right now. So I would default back to the current rules and regs that say that the patient has to be in the state that you have license to practice them.
Ali Schoos (01:06:24):
Yeah. I think people want them to be great because it sounds like they're only gone for a week, but that doesn't only gone for me as a Trump law. So unless we're specifically pulled, that is true. I would not do that.
Mark Milligan (01:06:37):
Right. And why should you care? One, you could, it could be damaging to your license too. You can pro, you can really do a lot of targeted marketing across those areas, right? So you can now reach people across the country. HIPAA, a fun topic. That's the old definition of HIPAA that we need to maintain or the telehealth provision we need to maintain it. But really current language means that we, they're going to, they're not going to impose penalties for noncompliance. And so under this notice, Apple FaceTime, messenger, video chat, Google Hangouts, Skype, Mmm. Can it be used to provide without risk that they will be imposed penalty on. However you need to notify those patients that these third party applications or predict potentially introduce risk and that you need to get an okay to use them. Again, this is temporary.
Mark Milligan (01:07:26):
Most of the information that we're talking about with insurances and compliance and everything are all temporary orders. So make sure that you're understanding that it's out of the essence that you maintain as much as you can. Cause separate costs a lot of money. All right, so why should we care? It works. Customers want it. I'll go through these pretty rapidly because right now customer driven decision making is not as, I don't think is as relevant, but after the fact that we need to come back to this when this is over, this is relevant. Customers want this. Customers by age group want to try a telehealth across all demographics. And so just make sure that you understand that before we had this crisis, many people would love for their care to be delivered digitally. And so across. There's different reasons that they have time savings, faster service, cost savings, better access to professionals.
Mark Milligan (01:08:21):
However, there were some perceived barriers as a person in person care was a preference. There's privacy concerns, uncertainly about reimbursement tech and then how to use it. All of these things can be alleviated during these current times with communication and helping your patient understand the technology that you're using. Right? But why should we really care as a profession because it works, right? There's been a lot of studies that look at the efficacy of our effectiveness of telehealth in tele rehab specifically. There's been over 50 studies that and more coming out that tele rehab is a benefit or as is no less than effective as in-person care. All right. There's one major study with Veritas from Duke that they looked at a 300 ortho patients that had total knee replacements. Half of them went to inpatient or half of them went to outpatient orthopedic and clinics.
Mark Milligan (01:09:12):
The other half went to home with an app to get exercises and there was no difference in longterm outcome or total cost in three months after discharge and they saved almost $2,800 per patient. So there are studies that are coming out and post-stroke MSK, pulmonary rehab, cardiac rehab, joint replacements, low back pain that have all demonstrated that digital delivered care, whether that be in person or some apps can be just as effective as in person care. So knowing that those are the cases that we actually can make an impact digitally. It's an incredible opportunity for us as a profession, right? But I think we also need to step into the space and own our profession because others recognize the viability and the validity of how we use technology to treat musculoskeletal conditions. And they're stepping into the space too in a hurry. So it's just the beginning and now I'm gonna turn it over to Ali who's going to you know, my back hurts. Ali, can you help me?
Ali Schoos (01:10:08):
So, yes, I can, I'm going to screen you via telehealth before I let you come into my office. So Carrie, I think you're gonna try to give me the full screen Mark when those are off. MarK Fullscreen.
Ali Schoos (01:10:28):
There we go. All right, so you guys, I asked him to put me on full screen. I don't have slides because I really want to talk to you in a way that you are going to be talking to your patient when you do a telehealth visit. So I had been thinking about doing telehealth for a couple of years and that's a whole nother story why I didn't get off the dime and do it. But when the COVID pandemic struck and it hit really in the Seattle area first, in fact, the nursing home facility that was the epicenter of the outbreak is just up the road from my office. I knew that we needed to get going and get telehealth in place. And although it feels like that was a year ago, it was really about 10 days ago and we've done it, we've gone from zero to providing telehealth in 10 days or less.
Ali Schoos (01:11:13):
Actually, actually we did it in six days. So the thought process that I went through was shoot first aim later and looked at, gosh, let's just go with a free platform. Let's just get going and do this. And the very first platform that I signed up for, I looked at I realized that tele-health was something that we want to be offering as a long game, not just a short game. And I wanted it to be more robust and then I would be paying for a platform regardless. So I looked a little deeper and decided that I the two things were most important to me was HIPAA compliance because I didn't want to change platforms because I'm not compliant now and I'm going to be compliant. And the second issue was really having access to someone who could walk me through the process.
Ali Schoos (01:11:58):
I didn't want a platform where I had to figure all of it out. I wanted someone who could tell me, I'm not a techie person, so tell me what that meant. Do I need, how do I, how do I set it up? What does the patient need? And so this is not a PPS endorsement. I did use I am using anywhere healthcare with Mark and he has walked us through the process. So you know right away when you were able to get I got all my therapists signed up before I even knew what I was doing. Got all a therapist signed up and asked them to go in industry and start using the platform. Have visits with coworkers, have visits with friends and family and just practice and get comfortable and make sure that they were able to do it at the office.
Ali Schoos (01:12:42):
Where did we want to do it? We ended up choosing my office as the best place. This is my home, not my in-clinic office. And then I asked everyone to look into their homes and make sure that they have the appropriate technology and appropriate space to do it at home as well. While they were doing all of that, we were working on the other side to make sure that we had the patient invitation letter or patient welcome letter that we had a letter that describes the patients what they needed to do on their end and have available. And then the consent form, which was all within the platform, which is all online and portal. And then I had my, you know, diving in like I do, I had my front desk start calling the patients who had been canceling their appointments to see if they wanted to take a tele-health option.
Ali Schoos (01:13:27):
And lo and behold, not very many of them did. So realized I think we need a transcript for how we talk to patients about telehealth. And I don't need to let the patient understand the value of tele-health, but to make sure my staff understood that about your health. And it made it pretty clear that people don't really understand how can you do physical therapy through a computer. You have to be able to touch me. Right. I mean, you touched me all the time when I'm in the clinic and it's very true. We do touch our patients and that's a very important part of what we do. But I think the majority of what we do is education and exercise. And that can be done very effectively across this platform. You have to make sure that your therapist and your patients understand that.
Ali Schoos (01:14:11):
So the next thing we did after a script that everyone would use is I created a video and put it on our Facebook page that is too long, but go ahead and go to my Facebook page and look at it so you can get ideas on what you want to do and don't want to do. How we did it for two reasons. One was to explain what we're doing during the COVID crisis, how are altering how we see our patients, and then explaining the telehealth option to them. And then I walked through with them what an actual visit looks like. And so they're looking at their computer while I'm talking to them and said, you know, if we're going to ask you the same questions that we're gonna ask you when you come in for a visit, I want to know what your history is.
Ali Schoos (01:14:55):
I want to know any special tests you've had done. I want to know what makes you worse and better. And then really critically, I want to ask you about red flags, meaning things that are important for me to know to make sure that you are appropriate for me to treat, to safely treat across the health platform, so that if there is something amiss, I can handle that by referring you on to another healthcare provider asking more questions. And again, in this crisis maybe doing a phone consult with another provider to make sure that we get you the appropriate care if telehealth is not. So you do need to make sure that your providers are asking the same red flag questions that they should be asking when the patient is in the clinic. So it's not really different, it's just enhanced importance for me.
Ali Schoos (01:15:42):
So the next thing we did then is have the physical therapists, Oh, let me back up a little bit. I do want to explain to you the other important thing about when you're on this call and what I did on my video was demonstrated for patients. What that visit after those questions would physically look like. So if I'm seeing the shoulders always easy to explain here, if I'm seeing a patient has shoulder pathology, I want to make sure that I have enough room and they have enough room for me to move around and show them what I want them to do. I can't just say, well, you know, flex your arms to 90 degrees or do XYZ because I can't touch them or cue them as easily. I need to be able to show them. So I'm going to ask them to raise their arms above their head.
Ali Schoos (01:16:25):
I just said, I can't really see what you're doing. I want you to push your chair away. Okay, stand up for me now. Go ahead and do this for me. So move your arms. Great. Now can you reach behind your back? Show me what that looks like. Let's go sideways and Oh, that's sucking kind of funny right there. I think Ellie has a rotator cuff problem and you know, go through all their emotions and I might say, well, can you resist yourself? So push down against your arm while you're trying to raise it. Does that hurt? Can you do that? Don't use right or left because that's backwards in a screen now it's even worse than are in the clinic. So say raise your involved arm or injured arm or however you want to do that and your resist that. Make it bend your elbow and push down against your arm.
Ali Schoos (01:17:05):
When you tried to touch your shoulder, just the same kind of cues, but show them what it is that you want them to do. If it's on their back, their knee, you're going to, I can only see part of you. Guess what? My screen moves and you are allowed to move during your tele-health. It's going to tell your patient, I want you to move your screen now so I can see your feet. I'm going to be able to see you. You know, do a little squat for me. Go ahead and hang onto the wall if you need to use the desk. So you're going to use the things that are around you. Turn sideways and then forwards. I can see what your back looks like. You have the ability to have your patients do quite a few things. You don't even, you know, you're looking at their shoulder.
Ali Schoos (01:17:47):
Let's just screen your neck out a little bit. So backwards, any pain going into either are so you can do quite a bit. And your history should have cleared out a lot of your red flags and, but you know, if you're concerned about something more serious that you can't evaluate across the screen. So once you've done all that therapist and a patient, well, much better idea that, Oh, I guess you can do this with me. And then you might want to ask your patient to have some things handy for you to be able to show them what you think they're going to be able to doing, whether it's stretching bands or foam rollers or some lightweights, or even teach them how to make some lightweights at home so they have something to left when you get to that point. Mmm. And then the final thing, two final things.
Ali Schoos (01:18:33):
I had our patient, our therapists call all of our current patients or who were current prior to the COVID crisis. Call all of them. Check in on, I'm asking how they're doing, is there anything that you need from us? And then explain our telehealth and e-visit options to them. Let them know that they can go to the Facebook page to look at the video to understand it a little bit better. And then just that personal touch. And then we are next emailing all of our patients through our patient engagement platform to let them how again that we have altered our in office visits due to the COVID crisis so that are stay in place, mandate by the governor. We will still be seeing extremely essential critical patients in the office. But our largest mechanism for reaching out to them and monitoring them and help them rehab during this time is through telehealth.
Ali Schoos (01:19:24):
So, and I think that's really critical so that when they think they don't need you today, maybe in a week or two, they realize, wow, I really do need to talk to my physical therapist. What did she say about how I could get ahold of her? And they'll go back to that email and find that information and reach out to you, especially if your office is closed, make sure that they know how to contact you so they can do that telehealth visit. And on many of these platforms, there's a mechanism for the patient. They can use the platform to reach out to physical therapists. And that's how we did it. So like I said, six days, we did our first visit from when we said go. So there you go. Mark, back to you and Lynn and let's answer some more questions. Yeah, that's great.
Mark Milligan (01:20:08):
That was awesome. Yeah, it was, I think the important thing that all providers need to understand is there's a learning curve here, right? There's a steep learning curve and you really have to, you have to practice it. Like Ali said, yet everybody practiced before this. And also you need to be, I like to term it humble and open with your patients and understanding that, look, this is new for everybody. This isn't how we've done things for years and now it's time to do something differently. So if you are, if you are if you're with your patient when I started doing this, I'd be like, you know what, John, this is the first time I've seen somebody with knee pain on a virtual visit. Let's figure it out together. Right? And, and work through it. And, and it also gives you opportunity to see where your patients live and the equipment they have.
Mark Milligan (01:20:50):
I know Ali said that you can, they can have equipment, but you know what a can of beans, some cans weigh 16 ounces, that's a pound, right? And they, most people have a belt. And so a belt becomes a great nerve glide or a stretch strap to do nerve glides with. And you know, you just have to get really creative and be a Ninja when it comes to a telehealth visit. IFor me it's really exciting for problem solving because you, you really just a giant problem solver. So thank you Ali. That was amazing.
Lynn Steffes (01:21:19):
Ali, we had a lot of questions. I wonder if I could take a minute and ask some questions that were specific. So one of them was can you talk a little bit about your patient demographics?
Ali Schoos (01:21:33):
Yeah, I think my patient demographics are pretty typical outpatient or so. We have about 20% Medicare 22 maybe it's going to range a little bit, but we see everything from junior high age athletes, kids through that Medicare population. I would say we have a fairly, our geriatric population is fairly active, but about 5% of them are pretty geriatric.
Lynn Steffes (01:22:01):
What about socioeconomic wise?
Ali Schoos (01:22:04):
Socioeconomic imagine value values on you guys? I'm like tech plans. So socioeconomically, I live in a high wealth area, but we also have one of the biggest immigrant populations in the United States. So there's a mix. You have a mix of lower socioeconomic status, but I'd say probably obviously higher than in much.
Lynn Steffes (01:22:27):
Yeah. There are also some questions just about the name of your practice and your Facebook and websites and maybe after you can take a minute to type it in.
Ali Schoos (01:22:36):
Yeah, I mean, I think Carrie, that's on the reason I was like, if not, I'll make sure it's on the resource link.
Lynn Steffes (01:22:42):
Okay. And then there was a question, a specific question. I don't know if you or Mark could take it about the vestibular patients. Give an example of how you might treat a vestibular patient.
Ali Schoos (01:22:56):
So that's a great question, by the way. That is one of the people that I think is essential. And so we have seven treating therapists. We will probably have one therapist in the office or going to the office as needed. I would say a really acute vestibular patient probably needs an in office visits. You could make sure that they're not having a stroke or that, you know, what's the problem? However, let's say, say someone you've seen before that has a recurrent problem or those of you who are vestibular therapists. I'm not, but we do have him in my office, so I don't want to misspeak here, but let's say you can do it on telehealth. I know therapists can demo an epley maneuver. She can actually have a plant and have her computer screens set up. Just got it for me and demo how to do an epley maneuver for the patient. So it is possible if that was your only choice, you don't have to think about what's best for the patient. And if the patient can't access anybody and they're scared to go to the emergency room and your office isn't open, you showing them how to do an Epley maneuver is better than what they're getting otherwise. So there's my answer.
Lynn Steffes (01:24:04):
That sounds good. Mark. There is a question that came in that I think would be perfect or two questions for you and one is that they indicated one obstacle I've been running into is getting the medical history and the body chart filled out on line. Do you have any advice on resources for getting people were converted to digital or interactive version?
Mark Milligan (01:24:24):
Oh yeah, so that's a great question. Great question. So there's actually a couple of companies that do intake digital intakes once, I think it's called intake queue. Is it actually a company that you sign up for their services and they do digital forms? But there's also, I have, when I first started my practice, I just, I'm not that, even though I'm in tech, I don't do a lot of tech, so I don't know how to convert PDF. So I just had, I went to fiverr.com and had somebody do fillable forms for all of my forms. So a fillable PDF form. You just email that to the patient and they can fill it out on their computer and sign it and then just save it and email it back to you. So that's been the easiest way that I've found to do a digital intake is just have your forms be PDF and fillable.
Mark Milligan (01:25:13):
You know, and, and in these times, like I've also emailed patients and had them fill it out at home and then hold it up to their camera and then I've taken pictures of that and then reviewed it. That's another way to do it. And then knowing that I'm going to see a patient in person, I'll often, or you could have them fill out some of the forms and have them take pictures and send it to you over a secure method or email it through you for their phones so pictures can work. So you have to get creative in that space for sure. But fillable PDF forms have been by far the easiest. I have my entire intake paperwork as a fillable PDF form.
Lynn Steffes (01:25:51):
Okay. That sounds good. There's a question about documentation of the sessions and I guess the biggest thing I would say is document. Like you're doing an in person, just go ahead and document that they gave consent, your location, location in the platform. I guess the other thing is the other question I thought would be good to answer live is how long are the sessions? Usually it's tele-health.
Mark Milligan (01:26:16):
Yeah, so that's a great question. Ali can also respond to this with our clinicians. So an initial eval can be anywhere from 30 to 70 minutes. It really depends on the patient. It depends on their condition. It depends on their comfort, the technology they're set up. But followups are typically in the 20 minute range, 20 to 25 minutes. They're not very long. Because you just get it done. You're not entertaining and asking about cats and seeing how their life is, you're really just getting in there and getting it done. For those cash based practitioners out there who want to charge patients cash, I would take your hourly rate and divide it by four and I would just bill in 15 minute increments. Right. Just give the patients manageable, manageable chunks of time that they can pay for and not have to think they have to see you for an hour for a PT visit. And so it makes it, I think, affordable and approachable for some patients. And you can still charge the same hourly rate. It's just broken down in chunks because some people don't need a lot of time. They may just need to review the hip hike and clamshell and, and S sideline abduction exercises that you gave them. That'll take 10 to 15 minutes. But so do it that way. From my experience. Evals anywhere from 30 to 70 and then followups are pretty much 15 to 25, some of them.
Ali Schoos (01:27:29):
Yeah, Mark. So that's what we're doing. We're doing initial evals for an hour because we want to make sure that if you get into this across again at via platform that you really haven't had time to ask all the important questions and all that. That's great. But that return visits have so far, 30 minutes have been adequate for us. Again, I think you can be a little bit more efficient. Some that chitchat doesn't happen. So I think you might even be a little bit more efficient. I'm a chit chatter myself. I'm with my patients and yeah, so I think that 30 and 60 is good. And there was a question about how we're getting reimbursed for these visits. We've been doing them for less than a week, well a week. So I have no idea in terms of if insurance is going to pay us, we have done our due diligence to the best of our ability as to who might pay us and we will bill those insurers. We're doing a cash rate when we know it's not covered and we reduced, we made the choice. Everyone has to do this for themselves. I think there's pros and cons. We reduced our rate mainly because so many people are going to be out of work right now and we don't tell her that's new to my clinic. So we reduced our rates, we didn't make them free, but we reduced our rates to encourage people to utilize the service.
Lynn Steffes (01:28:41):
Mark, there was one other question. I know we have to tie things up, but do you find that your telehealth clients over time, not just for this COVID crisis, but that they offer, may offer a brief first free visit or a sample visit as a way of helping people understand what to expect?
Mark Milligan (01:28:58):
Right. So I think the business owners on this call need to think about how they're going to integrate digital care into their practice when this is over. Right? And so one of the ways that I've seen to be very effective is to offer a button on your screen that just says contact for, would you like a free video consult, right? Just do a free consult just like you would in a free screen in your clinic. And that helps them both get comfortable with it, expect it. And also there's been some good, some good data that we've gathered that people that do that telehealth video visit and then show up into your clinic, have more, I have a higher rate of completed plans of care than if as if they do just a walk in free visit. So just because of the dynamics of the end of it where you, they have to sign up for care and it's awkward.
Mark Milligan (01:29:42):
So if a patient does a video visit and they show up, you know, they're invested, right? They get to meet you face to face before and so they're more likely to stay. So I think that when this is all said and done, finding ways to integrate telehealth into your clinical practice and how it makes the most sense will be necessary. But yes, there's, I mean, you can give away care to any body on this planet. It's legal to give care to Medicare beneficiaries. You can donate care. So you can you would a free screen or a free tele-health touch or free visit is perfectly appropriate way to help introduce people to digital care. I know we're at a time, how do you guys have it to tie this up?
Ali Schoos (01:30:26):
So if I can intervene and I guess I think, thank you Mark and Lynn, you guys just did a great job and everyone, they really have worked very hard. I had no idea how fast these guys are turning around this information for you. So thank you very much. I'm going to put a plug in for your keeping us an ABT boards. They are working their tails off to get people as current information as they can around rules and regulations and billing and tele-health and managing your practices. So when we're going to keep doing it, ups website is open to the public. We've taken a firewall down for all information about COVID, so please use it even if you're not a member. Lynn and Mark and I, and then we'll meet after this to decide if based on what happened today, we should do a follow up webinar. So if that's an interest to you, type something in real quick. And then just use the website. If you have more information or you know, reach out to one of us. Anything else that Mark you or Lynn would like to add? Dive in. Just dive in and do it.
Mark Milligan (01:31:28):
Yup. Just dive in. Just do it. Be kind to one another and understand that this is a working together. We can become a better profession because of it. So that's my final word. Bless you all for doing what you do. Thanks so much for serving as a sounding board.
Ali Schoos (01:31:45):
Thank you. All right, thanks everybody.
Carrie Stankiewicz (01:31:50):
All right, thank you all for attending today. As we've noted, this will be recorded and posted on our website along with a copy of the slide presentations and all of the links that we've referred to are in the slide presentation. And most of those links are to resources that are directly on the PPS website. On our COVID 19 page. So if you haven't already, please take the time to explore that page. Ali and Mark and Lynn, thank you so much for your time today and I'll wish everyone a great evening.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
Live from my personal Facebook page, I welcome Dr. Mark Milligan, PT, DPT from Anytime.Healthcare as he discussing how we can implement telehealth services into our physical therapy practice.
In this episode we discuss:
- How to set up a telehealth platform
- How to perform an initial eval and follow sessions
- How to bill (at least what we know right now)
- The paperwork you need to start seeing patients today
- And so much more!
Resources:
Anytime.healthcare
Doxy.me
Connected Health Policy/Telehealth Coverage Policies
State Survey of telehealth Commercial Payers
Telehealth Paperwork
For more information on Mark:
Dr. Mark Milligan, PT, DPT, is a board certified, fellowship-trained orthopedic physical therapist. He specializes in the intelligent prevention and treatment of all human movement conditions.
He is a full-time clinician with multiple patient populations and is the Founder of Revolution Human Health, a non-profit physical therapy network. Helping others create the best patient experience and outcomes through his continuing education company specializing in micro-education is also a passion.
His latest venture is creating the easiest pathway to access healthcare for providers and patients with Anywhere Healthcare, a tele-health platform. He is an active member of the TPTA, APTA, and AAOMPT and has a great interest in the pain epidemic, public health, population health, and governmental affairs.
Read the full transcript below:
Karen: (00:07):
Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information you need to live your best life, healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, dr Karen. Let's see. Hey everybody. Welcome back to the podcast. I am your host, Karen Litzy and in
Karen (00:40):
Day's episode. I am sort of re airing a Facebook and Instagram live that I did last Wednesday with dr Mark Milligan all about telehealth. So a little bit more about Mark. He is a board certified fellowship trained orthopedic physical therapist. He specializes in the intelligent prevention and treatment of all human movement conditions. He's fulltime clinician with multiple patient populations and is the founder of revolution human health, a nonprofit physical therapy network, helping others create the best patient experience and outcomes through his continuing education company specializes specializing in micro education is also a passion. His latest venture is creating an easy pathway to access healthcare for providers and patients with anywhere. Dot. Healthcare. This is a telehealth platform. He is an active member of the Texas PTA, P T a and a amped and has great interest in pain epidemic, public health, population health and government, governmental affairs.
Karen (01:41):
I should also mention that he is also on the PPS coven task force. So if you want to get the most up to date information on how the coven pandemic is affecting physical therapists in private practice, you can find that at the private practice sections website. It's all free even for non-members. All right, now onto today's podcast. Like I said, this is a recording from the Facebook live that we did last week. And in it we talk about what is telehealth. We talk about how to set up telehealth, how to implement telehealth, how to conduct a telehealth session for an initial eval or for a followup. We talk about how to get paid for telehealth and this is the information that we knew at the time. That was last Wednesday. Like I said, things are moving really, really quickly here. So the best thing to do in Mark says this is to check with your individual insurance providers, check with your state things are moving really, really fast.
Karen (02:45):
And of course finally we talk about answer a lot of viewer questions. So a big thanks to Mark and I think this is really timely and I hope that all physical therapists that if you're listening to this, that you can set up an implement your telehealth practice ASAP. Thanks for listening. So today we're talking about how to implement telehealth into your physical therapy practice. As we all know, the COBIT 19 virus is causing a lot of disruption in healthcare and we're hoping that telehealth can help at least mitigate some of that interruption for the sake of our patients, for the sake of our own practices and for our businesses and for our profession. So Mark, what I would love for you to do is can you just talk a little bit more about yourself, where you're coming from and why we're doing this interview.
Mark (03:34):
So Mark Milligan, Austin, Texas physical therapists board certified fellowship trained, but also for the last few years have stepped into a telehealth space and have anywhere healthcare, which is a digital platform for delivering healthcare. It's agnostic to provide her, so PTs, mental health providers, anybody that needs a HIPAA compliant platform to connect with patients. So the current situation is it's pretty mind blowing, right? We're seeing a, a world changing epidemic that will change the landscape of healthcare as we know it today. For several reasons. One is that people will be now exposed to a delivery of care method that they weren't otherwise are supposed to before. So telehealth and tele PT and tele medicine had been out there for a long time. Teladoc started in, in 1987, somewhere in there. So it's been around for a long time, but a rapid adoption of telehealth has really occurring right now for physical therapists.
Mark (04:30):
What we need to know and what are the most important things right now are how it applies to us in this landscape. How can we be the best providers to meet our patients? Demand to help quell fear, doubt and an anxiety for our patients as well as, as providers and our businesses. And so stepping into this space is, it's been a little bit overwhelming. It's been a nonstop 70, 96 hours really. And so everything that I say today may or may not be true and four hours or smart [inaudible] because of how fast things are changing. So yeah, I think that tees it up. You want to kick it off? Yeah,
Karen (05:10):
No, I think that's, that's great. That's perfect. So let's start out with, we got a number of questions from people from different therapists from around the country. And I think let's start with the number one question is how do you actually set it up? Totally basic one Oh one. So let's start with that,
Mark (05:33):
Right? So the first thing you have to make sure is that you have patients that want this. And right now everybody wants that, right? So patient adoption of technology can be challenging, especially especially generational. So the issue with in, yeah. Pre COBIT has been adoption by, by therapists and by patients just because of ease of use. Now it's a, it's a forced adoption. So now we're in a set up where we, where are going to want this regardless of whether or not they want it. So first thing is patient population. Second thing is you need to look at your business, right? You need to look at your patient workflow and your business flow. So you need to have the appropriate from a business standpoint, you need to have a liability to make sure that you're covered in the telehealth space. So in my experience over the past few years, almost every liability insurance cover, it doesn't see telehealth as a, is a different delivery mode for physical therapy.
Mark (06:26):
But with everything changing rapidly, it would be real. It would be highly advised that you contact your liability insurance provider and make sure that tele-health is approved as, as in your cupboard. All right? So that's logistics. Secondly, you need paperwork, you need onboarding paperwork for digital visits. You'll need a telehealth consent form and you'll need the digital release form. And if you're recording visits, you need to have a very specific form that that allows you to record patient visits. Some States don't allow recording some. And so you have to be very mindful of that. So onboarding paperwork, it's, it's good to have in fillable PDFs so that a patient can fill it out and then send it back to you digitally. Making sure that that transmission is is secure. You can also have E faxes, right? So they can electronically fax to you over a secure portal as well. So just basic things that we haven't really thought about as providers we need to adopt as mobile providers. Right. So, Oh, go ahead.
Karen (07:24):
I know, I was going to say, so when we're talking about who is the best, what is the easiest way for us as a clinician to get that paperwork
Mark (07:32):
Right? So they can email me. I've gotten a tele-health consent. I've got I've got that. So they can just email me at market anywhere. Dot. Healthcare. And I can send 'em I'm been sending that out over Facebook. I'm happy to share that with people. And of course you need to make sure and adapt it for your state in your practice. It's a word doc so you can switch out the logos and everything, but I'm happy to provide that for people. They can pass that that step.
Karen (07:57):
And then one more question on paperwork and things like that. So when we are calling our insurance, our liability insurance carriers, aren't there specific questions we need to ask them or like what is the best way to have that conversation with our liability insurance providers?
Mark (08:16):
Right. Just say in this facing time that we're starting to provide care digitally. Am I covered for providing telehealth as a physical therapist? Simple. Straightforward.
Karen (08:25):
Okay. And so you may already be covered in your current policy, it might be part of your current policy, you just don't know it and then you're not, is that then added as a rider to your yes.
Mark (08:38):
Typically it's a very inexpensive writer. Okay.
Karen (08:41):
All right. So before we set everything up, we get our liability coverage covered and we get consent forms, which can email to you or you can share them on under this post. It's whatever you feel more, most comfortable with or what might be easiest. And then we do what we got the paperwork covered. Now what?
Mark (09:06):
So you're sending that out to the patient. So they need to agree to be treated digitally. Right now it's really an interesting space. The CMS has waived temporarily a HIPAA privacy with when it comes to digital communication. I'm can't stress this enough that this is a temporary wave in, in the absence of mass abilities to communicate or HIPAA compliant platforms that patient that people are able to communicate via other means of non HIPPA compliant video software. So right now Skype and FaceTime are considered and what's the other one? Zoom and zoom and those well-known platforms are, are open, enable all those zooms just increased their prices yesterday. Yeah, so I would argue that you could use the, what's free and what's available right now in preparation as you prepare after this is over, you'll need to go back to HIPAA compliance. So in the immediacy video platforms are readily available across all. You cannot use public facing video platforms like tick talk or other things that mass put out your video. Okay.
Karen (10:22):
Instagram live or Facebook live. You can have your patient video, you can have your patient treatment sessions over live video,
Mark (10:30):
Right. That it means sounds, it sounds obvious, but you never know where people will do right by a group session. You can just do a giant group session. I'm going to train everybody on the East coast of America on a Facebook live.
Karen (10:42):
Yeah. Okay. All right, so good to know. So no one social media lives like we're doing right now, but for the time being during this outbreak, we can use face time, we can use zoom, we can use Facebook, zoom, Skype,
Mark (10:59):
Right. Totally. And you need to make sure that in your notes and documentation for your intake software or your intake paperwork, that you are waiting, that the patient is waiving their HIPAA rights during this time due to the COBIT outbreak and you are using this unsecured software and you will return to it as soon as possible. Right. Okay. This is a window. This isn't something that will last. And you need to note for your own CYA that you are, you acknowledged the existing coven scenario and that you will prepare for post that with, with my platform. Yeah. Yep. So technology on the technology side, it's really easy because you can plug and play as long as you get someone's if they have an iPhone or if they have Skype, easy set up, you can connect technology there. So once you get the form signed, you have the informed consent, the HIPAA, the HIPAA included waiver as well to sure that they understand that they are on an, they have to understand and agree to an unsecured network.
Mark (11:58):
Even though you can provide it, some people may not want it because FaceTime, that's all easily hackable. Right? So so they may not, or may, they may, they may not want to agree to that. So just have to be transparent with them in the, in your services. Right. So once you get that, I mean, it's really a matter of getting the patients, depending on your system, everybody's so different. So if you're, if you are a concierge PT and you're practicing out there for a fee for service cash base, you handle all your own scheduling when it comes for their time, you just flip them and you just call them on FaceTime, right? You collect their face, their number and you connect that way and you do your treatment, which we'll talk about in a bit, some other scheduling systems. You may have to, you know, type in a telehealth visit and your scheduling system or have some type of a demarkation for a telehealth visit versus an in person visit.
Mark (12:47):
And so work with your scheduling software, work with who you work with in order to make sure that that's appropriate so you can have the right amount of, or the right type of scheduling so you know where to go and what to do and how to bounce it. A billing, again, for the concierge practices out there, this is fee for service. Tele-Health doesn't take as long as normal to as normal PT. So I have my hourly rate broken down into 15 minute increments because it's roughly about 15 to 30 minutes. Is it an average tele-health followup evaluations in the last 40 to 50 minutes? But it just completely depends. So fee for service, it's really straight forward. You just charge per time, per minute, dollar, dollar, dollar, $52 a minute to 15 minute depending on your price point.
Karen (13:29):
Okay. All right. So now let's get into, so knowing how to actually set it up. So we've got a lot of these different things. What are some other platforms? I know anywhere. Dot. Health care. Doxy.Me.
Mark (13:46):
Yup. Doxy.Me co view. So anywhere. Dot. Healthcare is the platform that I created. It's straight forward. Right now I'm offering you a $10 a month, unlimited use for anybody for three months while onboarding everybody. So to, to help people get to see patients doxy dot. Me actually has a free version where that's a, a room where people meet. So you can actually sign up. The patient is sent a link, they click on a link and it drops them right in a meeting room. Super convenient, super easy. There's no bells and whistles and it's free right now. So you can do that. I think a couple of other platforms I've seen throughout the Facebook live of Facebook groups that I'm in a few platforms are pushing out a free entry level software right now. So it's everywhere. So I think
Karen (14:31):
We'll use G suite
Mark (14:32):
D suite, right? So G suite, if you have a BA with, with Google, you can use Google meet. Right now actually with the, with the HIPAA waiver that's happening right now, you can actually use Google hangout. That would be another appropriate thing to use as long as the other person has the G suite or Google doc, a Google suite downloaded on their computer. So there are lots of, there's literally lots of options now there, there are other companies that offer other features, right? As you get into anywhere that healthcare, not only as a platform, but also as a billing feature and a scheduling feature. Doxy dot. Me if you upgrade to the higher levels, has a scheduling feature, a messaging feature, all types of stuff. So it really looking for different platforms. You need to be, do your due diligence and test them out to see what fits your practice best. I mean, some, some have exercises that are completely a part of the package that you can just have an HTP that sends right out from the program. Some have an actual, a range of motion measuring system so people can move their arm or their body in front of them. The then they can actually measure range of motion live on camera, which is pretty cool. So it just really depends on the need for your, your practice and also the practice size.
Karen (15:44):
Got it. Yeah. Okay. So that's a lot of options for people going from free to low priced too.
Mark (15:52):
$200 a month for co for HIPAA compliance zoom.
Karen (15:55):
Right, right. Yeah. Yeah. Okay. So lots of options there for people. So we know we need some onboarding paperwork and we need to call our liability insurance carriers to see if they cover telehealth. Presently. And if they don't, then we need to ask them to put an addendum on and you can, they can do that immediately. It doesn't take like 30 days for that to happen. Right. Should be immediate. Okay. And so once we have all of the right paperwork and everything we decide what platform we're going to use and you just gave a whole bunch of different platforms that people can use. So all of those platforms are pretty easy to set up. And like you said, you send a link to the patient, they'd drop in and boom, there you go. And at this time we can use Facebook and Skype and, and not Facebook, sorry, Facebook. We can use Skype, regular zoom face time, all that. Okay. All right. Now
Mark (16:58):
You may need other equipment though. You may, depending on the situation you may need. So some people, a desktop versus a computer are versus a tablet versus a phone all matter, right? So a desktop computer tends to be really well for you to have good communication and see the patient really well. But it's also very challenging for me to move my desktop to show somebody how to get on the floor and exercise, right? So the part of being a a digital physical therapist is that you have to be able to move and your equipment has to move with you. So some people use, I, you know, some people use a selfie stick to demonstrate exercises, right? Some people have one of those little iPhone holders that can be multiple or wrap around something so they can have different angles or show people at different places.
Mark (17:41):
So understand that desktop can be good for this face to face interaction and the, and the immediate subjective interview. But maybe moving towards the objective exam or, or showing the exercise parts you may want to find or have a different device that's more mobile. So just thoughts for that. And you also need to think about your area or your headphones, your microphone and your lighting that can all add or take away from the experience of the digital experience. So making sure that you have those things. I use, I'm old school. I just use the old wired ear buds. They, when you're on the computer a long time, the wireless can die, right? And then all of a sudden you don't have new headphones. So I'm always a fan of just good old fashioned things that won't die on you after a long day of work.
Mark (18:26):
So something to think about. You also may want to get a tripod to hold up your computer or you can get a standing desk. So there's lots of options in that space. But also you have to be considered for your backdrop. I love your backdrop that you have there in New York here and with the, with the cherry tree, that's all. It's very Boston's. That's awesome. I just have a plain white wall. Just be mindful of the environment that you're delivering this care in, right? You don't want you to be distracted. You don't want the patient to be distracted. You need to connect with the patient. Some of the key things that you need to think about are the connection that you're going to have with a patient. Something you can do easier face to face. It's challenging to get the connection and to have the emotional connection with the patient by a digital care. So setting up the environment for not only you to feel safe and, and that you feel comfortable that you're, no one's going to bust in, but also your patient needs to feel safe in that space too, so they can communicate to you in a free way that their patient information isn't being broadcasted to other people as well. So backdrops, microphones, computers, tablets, all have to be taken into consideration while you're doing this, while you're doing this intervention.
Karen (19:32):
Okay, thank you. Those are great tips. How about cats that could, that could help or hurt you. Right? People love a cat. Great. If not, it can be a problem
Mark (19:44):
Or at least they're not allergic to it. They're alerted to it. It doesn't matter. Right? So
Karen (19:47):
Right. So pets can help or hinder, just kind of depends. Okay. So we've got, let's say now everyone has a better idea of how to set it up. And then the next question I got was how, Oh, they said this is great. Sound isn't great. I don't know why this sounds not great on, on Instagram, but, well, I mean it's going to be out on it as a podcast as well. So we'll, you'll be able to hear full sound tomorrow. At any rate, I dunno what to do. I could get my earbuds, but as we just said, what if they time out on me? Yeah. Okay. So let's talk about let's talk about how do you, what was it? How did, Oh, how do you actually execute a session?
Mark (20:40):
Yeah. So once you've got somebody on the line, once you've got a patient in front of you, right? We know from our PT and our PT exam that about 80 to 90% of your differential diagnosis occurs in the subjective. So you go back to your old way of being, you shut up and you listen to the patient. Right? So, you know, so this is also assuming that you're doing an evaluation via telehealth, right? So most people at this space have patients that they'll flip from brick and mortar or in person into telehealth. So that's a different beast, right? So that's followup. That's exercise progression. Those are obvious things, right? That you're going to show them. You're going to talk them through their progression and talk to them about what they need to do next. Maybe show them a few new exercises when you're, we're, we're going to get, what we're talking about right now is the new patient that you'd never met before and what, how do you gain information to get them treated?
Mark (21:33):
So subjective is key, right? You need to have your differential diagnosis hat on. You need to ask the next best questions, their intake form. You should have looked over, created your hypothesis list and make sure that you have a good idea of what you're trying to discover. It's your responsibility as a provider. I know it's written in the Texas legislation that if you, if the patient is not appropriate for digital care, you have to get them to an in-person provider, right? So doing your, you still have to do your red flag screens, you still have to do your due diligence and your differential diagnosis and make sure the patient's appropriate. Right? This is, you have to consider a digital visit to be no different than an in person visit. You have to take every precaution that you would take. I'm minus taking vitals unless the patient has their own, you know, portable, vital kit. You're gonna have them do that. But you have to take every precaution you would from an initial evaluation perspective as you would in a digital space. So going back to forms, you also have to have your intake form and consent to treat in there as well. That needs to be signed off as well.
Karen (22:31):
So the, the same sort of forms that someone would have if they were coming to you or if you're like a mobile practice like me, you have them sign that initial paperwork regardless of whether you're seeing them in their home, in your clinic or, or via telehealth completely.
Mark (22:48):
This is, you cannot be this any differently. Right? So take it, having all the consent to treat forms, signed all your intake paperwork done, differential diagnosis, red flags, you know, your three tiers. Are they appropriate for physical therapy or are they a treat and refer or they refer. You have to have that, you have to have that hat on. And so if they're presenting with sub with symptoms that aren't musculoskeletal and presentation, you need to be mindful of that and get them to the approved provider, right? So you have to be a triage at this point. So once you get through and determine their appropriate for intervention, you have to get your thinking hat on, right? This is where, this is where things change. And as a mobile PTM, I know that you have walked into somebody's house and been like, huh, how are we going to do PT in here today?
Mark (23:32):
Or you have to completely be a problem solver. Think about being a problem solver on steroids when it comes to digital health. Right? Because you didn't have, at least in someone's physical environment, you can see what they have available. Right? If you treating me right now, all you would know is I'd have a white wall behind me. You don't know what chairs I have. You don't know what equipment I have. You don't know anything that I have. So asking them about what equipment's available is important. I take all my patients, depending on what they have, if they have, my most common thing I treat is, is back pain. So most commonly about 20 to 40% of patients, that's 20 to 30% of patients will fit into some type of directional preference when it comes to low back pain. So I take them through an active range of motion our digital active range of motion to see what exacerbates or relieves their symptoms. And if, and if repeated extensions and standing it relieves their symptoms, I go why? Clear out other things, but I go right into treatment. Right. So you can use progressive movements, repeated motions right in your treatment from the get go the same way you would do in the clinic.
Mark (24:35):
Some of them prior,
Karen (24:36):
It's New York. I don't even literally grown even here at anymore. It's just did with something there. Is there the engine going up, I don't even hear it. Anyway.
Mark (24:46):
White noise. White noise. Yeah. So you have to go through your objective range of motion in your objective measurements just like you would in home or in the clinic at home. So knowing your physical exam and having a musculoskeletal screen is super important. So if I have somebody with radiating arm pain that I'm treating, where's my arm on my camera? If I have somebody with radiating right arm pain, I'm going to take them through cervical active range of motion. I've actually even had people do over pressure to themselves. Right. To see, I've had somebody to do their own spurlings to see if it's ridic. So you have to get really creative teaching someone how to do a UNL TT a on camera is because you have to back up. Right? That's another thing. You have to have visibility and you have to have the ability to see what the patient's doing and also correct them while they're doing their motion. So I take my patients, do as many physical exams that they can do on their own without, without me being present to do it.
Karen (25:45):
Yeah. So I think it's important to note cause my good friend Amy Samala said, can you do this for brand new patients in your practice or is this just to be used for existing patients? So I think Amy, I think we're covering that right now, that yes, Mark is sort of taking us through how he might do an initial evaluation with someone via telehealth.
Mark (26:05):
Totally. Totally. Now I think we should probably circle back to billing again and payment. I think we, we've,
Karen (26:12):
Yeah, yeah, yeah, yeah. Let's definitely talk about that. And one other thing that I, I want to make people aware of, Mark, is how using you want to have space. So not only you want to make sure that not only your patient has space or depth, but that you do as well as a therapist because you may need to step back to show them something and then come closer.
Mark (26:33):
Right. And I've I often, so I have a flat couch in the back, so I have this couch that's right behind me so I actually use that. I pushed my chair of the way and I show repeated extensions and prone. It's a six or seven foot long couch and I show double needs to test and I sh if I mirror exercises for patients. So you cannot do everything verbally, you can't. Could you imagine telling somebody, okay, I'm going to walk you through a double a single knee to chest with words only. It becomes extremely challenging. So you get up and you move. I just hop on the couch. I'm like, all right, so you're going to lay on your back. You'll grab both knees. You see my hands on the outside of my knees. Knees are slightly apart. We're going to pull that all the way up until you feel a big stretch in your back and I show them.
Mark (27:13):
I walked through the exercises with them. Same thing with, same thing with nerve glides, right? If I'm doing a U L T T a I'm going to say, I'll bring your a shoulder all the way up. Like you're going to put those little, or you CC that you're going to put the little ion right and then you're gonna lift your elbow up and see if that changes it. Right. And so you have to walk them through. It's easier for them to mirror you than it is to say, okay, you need maximum shoulder flection with external rotation. NOLA deviate. Like you can't do that.
Karen (27:39):
Yeah, we know jargon doesn't work. Yes. You can never say that in an NPR. If you are face to face them, you would never just sit there with your arms folded and be like, okay, flex your arm to hear externally. Like if you just want to do that, you wouldn't do it. I think it's important to know that we can still certainly in well versed in strong verbal communication in this space. Oh, that's nice. From work. Yes. Or there was a delay. Oh, okay. So I think we're good. So Amy said, yes, sorry, there's a delay. She's all the way in New Jersey, so forgive the Jersey part. Yeah, New Jersey. Okay. all right. So I think people get an idea that yes, this is how you can set this up. You just want to make sure that each of you have enough physical space to do everything that you want to do. That yes, you can do your initial evaluation. It's all about the subjective, in my opinion, in that initial evaluation anyway. Definitely. and then once you see them for the initial evaluation, as you start progressing them, like you said, it would be like any other exercise progression you're just not putting hands on, but it can be done.
Mark (28:51):
Definitely. Definitely. If you think about the interventions that we do in the clinic that you can apply to home. So I work with people that you know, that don't, they may not have good balance. So safety is a, is a concern in that space. Right? So I talk people in a corner, I show them what it looks like to get into a corner with a chair in front of me or in front of my couch or the chair in front of me and teach them how to do single leg stance while having my fingertips on the chair. Right eye. You have to physically show people what to do so they understand that better. And so like you said, it's about being able to show and speak at the same time, right? Because a lot of the field like nerve tension testing, a lot of times it's, you can feel the tension before the symptoms ever get there.
Mark (29:34):
So you have to educate somebody that has a really angry nerve that's a, it's a hot nerve and say, look, we're just going to take this up until you barely feel it. Right. We're just going to touch it. And then if you feel it there, just bring it back down. Right. You, you can't rely on your hands to feel that tension anymore. Not that we can reliably feel it anyway, but we want to make sure that we prime the patient for success. Right? Communicate expectations. Like we're going to do some discovery today. We're going to walk through a lot of different movements to see what's happening with your body. See if we can figure out ways that we can help you feel better through movement. Cause that's what ideally what we're going to do, right? We need to make sure that we enable patients and make them feel safe and comfortable that we're going to help them. We're going to take them through this. We just need to, we need to communicate to that. This is going to be something that I should be completely comfortable with. Yeah.
Karen (30:24):
Perfect. All right. Now let's get to the part that everybody really wants to know about billing. Someone. let's see. Oh, Mark Rubenstein also New Jersey. He had kinda some of the same questions. No, I have nothing against New Jersey, New Jersey. So he kind of had the same question I had before we went live. He said but Medicare will only pay now for existing patients as per info yesterday. So this is the info, I guess on that evisit versus tele-health. So can you kind of give us, cause I know just for background, Mark is a part of a PPS task force and he is really being updated a lot. And I'll let you kind of talk a little bit more about that and, and how you are helping to work the billing aspect of things and the difference between an evisit and tele-health.
Mark (31:20):
Right. I'd like to first shout out to the PPS members, Allie shoes and the I and alpha are our lobbyist for the APA. We are meeting for hours daily and we are, so everyday we have scheduled calls on this task who have a task force. We're pushing out content on the APA plus the PPS site. So there are 18 to 20 people that are hard at work to get, to gather information, to interpret it and then to question it and then make sure that it's legal. Right. Because there's information that comes out that it's great information, but it may not be legal for us to do based on practice act. So there's, there's a federal level, then there's the, then there's the PTA level, then there's the state level, then there's your individual insurance levels. So there's a, there's so many different paradigms. It's not just a cut and dry situation.
Mark (32:06):
So right now, some of the biggest things that we're working on behind the scenes with this PPS task force are really are defining out what it means from Medicare as it relates to the visit ruling. So E visits technically are not telehealth. Medicare is not calling these eVisits tele-health. They're calling them eVisits because they derive them from the medical, from the MD coding as, as a bra, a brief and abrupt follow up to a situation where the patient is in an engaged patient. So imagine somebody who may not be feeling well after seeing, having a doctor's appointment just to follow up to touch. So the visit codes right now can only be billed based on time, so their cumulative time and there are three levels. The max level is 21 minutes to be billed one time over a week. And so you add all the time for one week and over 21 minutes is the third code.
Mark (32:59):
And that can only be a build a once every, well in seven one time in seven days. There is a question right now about whether or not that code can be repeated the next seven days. That information has not been gotten yet. We have not had a clear answer on that. So please be patient while we investigate whether or not that code can be repeated the next week. So right now, currently we are still working on whether or not now that these eVisits have come out, the question is now whether or not CMS sees us as telehealth providers, which upfront does it look like they do. But we still haven't gotten for Bay. We still haven't gotten the, the appropriate word from CMS whether or not we are. We are providing tele-health, which they said we're not. So we can assume we can assume anything.
Mark (33:49):
But so they said we're not providing tele-health, but we think they will. They won't include us in the, as a telehealth provider, which is extremely important because if they don't consider us Medicare providers, then we can, well, I'll wait about Medicare billing Medicare patients, we'll, we'll wait to hear what happens. I'll have to have an update on that. And so right now we are not approved providers for telehealth, for Medicare. And we can build he visits with an established patient that has to make contact through a patient portal to the provider to request their evisit. Now it's been clarified that you can notify a patient that they have the option of that type of care. You can tell the patient, Hey, you know, we're not treating people in person, but you do have the option for an evisit. Here's how you do it. If you choose, if you were to choose to have an E visit, you would go to this part of our website to our port, your patient portal and request a visit so you can prime patients to go utilize that service. Whether or not you can only do that for one week or multiple weeks, that's in question.
Karen (34:52):
Okay. And a patient portal is not Skype zoom face time or any of the telehealth platforms that is not a patient yet.
Mark (35:04):
Well, some platforms have a portal, some, so it has to be a patient portal. So it has to be a place where a patient can log in and request a visit. And so we're still also waiting for a clear definition of a patient portal. But for our understanding the patient, it's a place where the patient goes to get their information or connect or message their provider. Right. So right now that's still being clarified through CMS on the other private payer front and medicate well, so Medicaid is being rapidly adopted by payers all across the country. Right. So we've seen, I know Louisiana is about to release a wording today at some point. I know that I think Minnesota, I think that a few others have already, Medicaid has already blasted that inflammation and that are, that are, that there are approving and paying for telehealth or physical therapists, payers on a national level are all over the place.
Mark (36:00):
So if you are a, in the work provider, you need to call your payers and ask very specific questions and we have people working on this across the country. You have to ask them if your patient has tele-health benefits, you need to ask them if those benefits are payable to a physical therapist. So if a therapist is a PT, a paid as a payable provider of telehealth services, if they need any modification codes, right? So like an Oh two location code modifier, right? That needs to be asked and then what CPT codes they reimburse for. Okay. Right. So manual therapy is not going to be one, but neuro, our neuro they're ex their acts home care, self care, all of those codes should be available. And it just depends on the, on the payer and the carrier. Okay. I have a Google doc that we can link that I'm trying to collect that data from across the country.
Mark (36:58):
So people can have open access to it that I can send you that link here and it's on a couple of Facebook pages. But we're trying to collect that data so people can see because, and you don't put any reimbursable fees, don't breach your contracts, don't talk about a fee per schedule, but where you're scheduling fees or your fee schedule. But I'm just put whether or not they pay if it's parody, right? Some States out parody. So here's the kicker. Parody States doesn't miss it necessarily mean payment, right? And this is a, this is a very confusing, a very confusing thing. So somebody says, Oh, we have parody in the state so that, and then we are going to get paid equal in person as we do digitally. Just because you have parody doesn't mean to pay your pace for telehealth, right? They may pay for physical therapy, but they may not pay for tele rehab, right? Yes. Check.
Karen (37:47):
Why can they just not make this easy?
Mark (37:50):
Right? So you can have parody in a state and you could have a parody law and then the payer not even pay for telehealth. Right? So there's nuances upon nuance, on nuance. And in some States, some carriers have contracts with larger telemedicine providers and their members can only have telehealth through that tele provider and they may not have tele, they might not have tele PT. So then they had no tele-health, physical therapy option for that payer. Does that make sense?
Karen (38:28):
Okay, so I'm going to just do this. So for example, I'm just going to take a for example, and tell me if I heard you correctly. Oh one more thing. So Rina said, we're talking about the visits, that's all specifically for Medicare patients only the egoist. Yes, yes.
Mark (38:46):
As of now we have, we are unaware. I am unaware. I'll say that of any payer that's adopted the evisit policy and that's as of our Medicare Copa. Our coven call ended at noon today. So I don't know. That may change.
Karen (39:02):
Okay. So let's talk about your individual. Let's talk. Oh, somebody said, Oh Mark, can you bring your microphone closer to your mouth? But you've got the ear buds in,
Mark (39:13):
Right? So I have my phone a lot. Loose ear buds are going to the computer, but now you see if you can bring the microphone closer to your mouth, then they see my giant fivehead here and I'm like, I mean, how about if I go, that's fine. We'll do that.
Karen (39:32):
We'll do that. It's fine. It's fine. Okay. Oh, so here, let me just ask some, get some of the questions. So Kim wants to know, she's in New Jersey also. He lives in New Jersey, but her practice is in Brooklyn. How do we find out if our state has parody?
Mark (39:51):
So again, I, the, I will link you guys to the center for connected health policy and I also have a link to the parody in the different States. So I have links to both of those that I can give you, that we can add to this.
Karen (40:07):
Yeah, we can put that in the comments under this Facebook under the live here.
Mark (40:12):
So where, and so the, the commercial parody book is only 150 pages of nice, easy light reading. Where should I go for Facebook live?
Karen (40:23):
Just go, if you go to my page, just go to me and then you can put it in. You'll see, you'll see us. You can put it in the comment section or we could put it in the comments section. When we're done with the live, we can add it in as well.
Mark (40:35):
Oh, there we are. All right. So I'm dropping it in the, yeah,
Karen (40:37):
You can drop it in right now too.
Mark (40:38):
There's the parody laws. Here is the fact sheet on the UpToDate. This is a live document on what's happening in the world right now. As far as tele-health policies and procedures across the country. So those two documents should have a lot of information. But here's the kicker. Just because the state has a parody law doesn't mean that, that, that the payers have a policy that reimburses tele PT,
Karen (41:08):
Right? So parody and, and just to be very clear parody means because you, you can do tele-health because you see them in person. So it's like
Mark (41:20):
No. So parody only means parody only means payment. So parody means if they have a parody law and they both reimburse for inpatient physical therapy and for telehealth benefits, they paid equal.
Karen (41:32):
Say again
Mark (41:33):
If the, if the, if a payer say let's let's say blue cross blue shield, if that, if that patient has a blue cross blue shield policy and they have a physical therapy benefits and they have tele-health benefits that a physical therapist can provide, they pay equal. Right. Okay. So it's the same face to face as the say. So because a lot of insurances will the 75% or 50% of impersonal versus digital. So it's literally a payment equality clause.
Karen (42:02):
I see. Okay. Okay. But you have to call blue cross blue shield because they may not actually, that patient's policy might not include tele-health.
Mark (42:13):
Right. And then even if they have a parity law, you're not getting paid for it.
Karen (42:17):
Got it. Right. I got it right. It's okay. Kim. I hope that my inability to understand help you. Dah, dah, dah, dah, dah. Can hear Mark fine. I'm physic. Oh, Deborah joy Sheldon. She said, is there a particular language that needs to be included in the documentation? So when we document the visit, how, so? Let's say we know how to set it up. We have the visit, how do we document it?
Mark (42:47):
Right? So you typically documented as a telehealth visit. So there's no you, your billing will coat it with an OTU location modifier, but you need to denote specifically that it was a digital visit. Okay. Yeah, that's the,
Karen (43:02):
Because we just got a question on what's the location coding for telehealth and you just answered it. So Abby, I hope that that helps you. And [inaudible] can we skip insurance and just bill cash or has this new E health stuff messed that up?
Mark (43:26):
So that's unsure right now. So the visit has, it's not considered telehealth by early information. That's not considered to be telehealth. We are still not telehealth providers by Medicare. So that should not impact that. That's my, that's my personal uninformed or relatively informed opinion. Please don't take that to anybody else. We're still discovering that. And private payers still do not, are not adopting that yet. That we've heard of. And so you should,
Mark (44:01):
If you are currently billing or having people pay cash in there and they do not have coverage, then you should be able to continue doing that. Does that make sense? Okay. Right. I mean, you need to check your contract language. Where we get sticky is, is this considered a non-covered service by a policy? Right. So this is where the sticky sticky comes in. Okay. Is tele-health considered physical therapy just delivered in a different manner, not a non-covered service, right? Yeah. Yeah. Well that V that opinion varies. And so if it's a non-covered service for Medicare, you can, they can, you can charge cash for that service. Right? And so, and that also applies to other payers. Correct. So if, if your payer has a policy that considers telehealth to be reimbursable by PTs, you wouldn't be able to pay, have them pay cash. But if
Karen (45:03):
Your individual patient's insurance does not cover telehealth right, then can you charge the patient cash?
Mark (45:12):
I'm not a healthcare attorney. But we're doing that.
Karen (45:16):
Where the heck, I know she's on here somewhere here in Jackson. I know she's watching, I saw her log on,
Karen (45:23):
Come on or Jackson answer that question for me
Karen (45:25):
Or an answer that question please in the comment section if you're still watching if not, maybe we can ask her or care Gaynor through the APA might be able to answer that question. So again, that question is if Aaron's still watching is if your patient's specific policy does not cover telehealth, again we'll use blue cross blue shield. So they have blue cross blue shield, they do not cover telehealth. Can you charge cash to that patient if they don't have it covered on their policy?
Mark (46:02):
That is a good question. Yeah, that's a great question. And I think, I mean I, I think I know what my answer would be but I cannot speak as
Karen (46:12):
Brought any information to anyone or misleading information. So maybe that's something we can ask Cara Gaynor on Twitter. Maybe she can answer that or if Aaron is still listening, maybe she can pop that into the comment section at some point. So
Mark (46:28):
And having amazing people that are listening that can help. Yeah, exactly. Taking, cause this is a, this is a mad house right now when it comes to legislation and information. So it's all over the place and apparently so yeah, it's just all over the place. We can't information that was [inaudible] I did hear that. Some of the bigger things for Rhode Island and for Pennsylvania this morning, that the governor, the governor assigned legislation that would massively require all payers to pay all providers for telehealth. All right. Yeah. Yeah, yeah. Okay. One other big question that comes up is location for these for, for billing. Right. And so the word from CMS is the, the, the POS code is the location of the billing practitioner. So in the case where remote services are rendered it does not matter where the corporate address of the billing provider is either, nor does it matter what the beneficiary's address, it matters where the services was rendered. That is where the biller is located. Okay. All right. So when that happened,
Karen (47:43):
Put that into like example.
Mark (47:45):
So when that happens, let's say yes. So if you are, New York has parody, right? Or you got to know you guys have compact revolution, right? Correct. I thought you did. So let's say you're a large provider and you have multiple States that you are in charge over that or multiple States. You treat patients and you're billing Medicare that the, the, the service in the, in the billing, in the service location code is the place where the provider is located.
Karen (48:18):
I see. So like for example, if we use something like Athletico like a big gigantic company or maybe someone like, I think Michelle Kali has some places in Rhode Island. I think she just went to Massachusetts, but the headquarters is in Rhode Island. So if you're a therapist in their Massachusetts office, you're using Massachusetts.
Mark (48:40):
No, you're using wherever you are and delivering the code. Deliver.
Karen (48:43):
Where do you get where you are? Okay.
Mark (48:45):
Okay. Yup.
Karen (48:46):
Okay. and then Michelle Townshend said, how does this work with EHR? Ours?
Mark (48:55):
Yeah. So eeh
Karen (48:57):
So she is looking at a separate telehealth provider from our EHR who also does our billing.
Mark (49:04):
Right. So EHR is, there's only a handful of the HRS in the physical therapy space that offer tele-health as a part of the platform. I think PT everywhere is a platform that has that has it built in. And self doc is another ER EHR that'll be live and in the next couple of weeks they'll have a platform within six weeks. But most of them are stand alone freestanding. So you just have to find the best system that are set up that can work simultaneously with your other systems. There's really no way to unless the company has an integration with your EHR, which the HRS don't like to integrate with people because that's patient data and it's a, it's a whole hot mess. So most of these are just freestanding side by side. So you'll have your EHR on one side and you're in your camera on the other. So you just do, and that's what I did with anywhere healthcare, it's just basic connection so you can document everything ever somewhere else. Okay.
Karen (50:03):
All right. And then Debra says, Mark, my state has parody related to my hospital being F, Q, H C I do not know what that means. Any insight on that? So what does FQHC mean? Any thoughts if not, maybe
Mark (50:25):
It's a federally qualified health center federally. Okay. So they have parody. I don't think I understand the question.
Karen (50:33):
Yeah. In my S my state has parody related to my hospital being FQHC. Any insight on that?
Mark (50:40):
Oh good. So she Oh, she said they have parody.
Karen (50:43):
Yeah, they have PR has parody. Yeah.
Mark (50:46):
I'm unsure on that. That has to parody is I've, I linked that doc into the live on Facebook. I can look up parody by state and by organization. Okay. Yeah.
Karen (50:59):
Okay. Let's see. Let me we already touched, so I'm just kind of, what paperwork do we need? We talked about that. Oh, what if you're not a Medicare provider? Gosh, all right. Dah, dah, dah. Oh, we are usingG suite and doxy.me. This is from,uKelly Dougan, I think. Yeah. But haven't started officially yet. We have an ABN and I wanted to have liability form as well. So those liability forms, that's something that we can, that you can maybe share also on this link here and people can make it their own. Is that by liability? Like the patient has to sign off on saying yes, I'm okay with having telehealth.
Mark (51:51):
Is that of course for me. Yeah, I would assume that what she's saying. Yeah. So I'll, I'll create a, I'll create a Google drive folder and drop a link in to the chat
Karen (52:05):
And then one other, we've got two other questions. So to clarify for service location code, so that you said that, is that like the OTU code? Right. Okay. If I or any of my PTs are in their own home while tele-health with patient, is she using her home address?
Mark (52:28):
Oh, that I can't answer that I haven't gotten, yeah, that would be a billing question. That hasn't been brought up, but I, we have a meeting tomorrow morning and I'll ask that question.
Karen (52:39):
All right, Kimmy, we will get to that.
Mark (52:43):
We're saying the PTs can just stay home and bill from there. But Medicare has specific guidelines on origination sites. And I know if origination sites apply to eVisits versus telehealth. That very question. Do origination, do originations, I'm writing it down so we can ask this to origination sites. Apply to eVisits. Yeah, cause that's, that's a game changer too.
Karen (53:11):
Yeah, yeah. Oh, sorry. She said, sorry, I meant to say service location. Did you clarify for service location address? If I or any of my PTs are in their home while doing telehealth, do they use their home address or does she use her address? So Kim, like lives in New Jersey, her practice in Brooklyn. So that's a really good question. So, Kim, maybe we can get back to you with that answer.
Mark (53:33):
And is she a Medicare provider?
Karen (53:35):
Kim, are you a Medicare provider? I think so. We'll see. We're on like a 22nd delay.
Mark (53:43):
Yeah. So I'll ask, I'll ask service location for employees versus brick and mortar versus mobile provider.
Karen (53:52):
Perfect. And then Sarah Catman says, if you are licensed in more than one state, but only practice, may single state, can you only do telehealth in the state you practice in or can you do, hello, hello, hello. Telehealth and States you are licensed in.
Mark (54:12):
Yeah. So that's where it comes to state rules and regs and yeah. So everywhere that you have a practice reciprocity or you have a licensed in other States, as long as they, you are allowed legally to practice tele-health in that state. Yes, you can practice telehealth in that state. I mean it's, but you have to sit, you have to make sure to abide by the rules and regs when it comes to our the licensure compact of the rules and regs of the state that the patient abides in or they live in. Right. Cause that's just compact language. So like I can do tele-health and Missouri, but they don't have direct access. So I would still have to have direct access or I'd have to have a referral for that patient if I want to open Missouri. Right. So like example. Yeah. so I think, yeah, so we have to make sure that you abide by the laws of the state that the patient resides in. But yes, you can do tele-health across the country. That's the beautiful thing about the compact, right. Compact allows for us to practice across this country with with little, with, without a lot of that a lot of restraint or not restraint, but a lot of challenge.
Karen (55:20):
Okay, perfect. All right, so we're at about an hour, which is as long as I think people's attention spans are, and I think we have an apparently as long as Instagram will go live. So if anyone has any other questions, please you can keep adding them into this feed here and we'll try and get to them as, as best we can. Thank you Mark for dropping that stuff into dropping those links in here. And again, we'll get some of the, the onboarding paperwork from you and maybe can drop it in here as well, or you can point us to maybe where it's been put in other Facebook Facebook links. But yeah, everybody, you're welcome. You're welcome. And Mark, thank you so much. This was above and beyond. I think what you had to do but I think we all appreciate you so much because we're in a time where there's a lot of uncertainty and tele-health is at least a way to one, keep our patients healthy and moving and to kind of keep our practices going as best we can in these times because we don't know.
Mark (56:38):
Yeah. We don't know.
Karen (56:41):
Okay.
Mark (56:43):
Yeah, I think, I think, I think as a profession we need to remain calm and PT on, right? Like there's a lot of things happening right now. There's to be the, the future is unknown for us as a healthcare profession. All I do know is that it's going to be changed on the other end. This will no longer be an exception to the rule. This will be an expected method of care. People will, will now grow to understand that digital health is a real opportunity in every aspect, not just in, in telemedicine. So I think if I can say one final thing is just be prepared to adopt this and, and, and set up your systems for the long game. Not for this short, immediate, even though the immediate needs to happen. We have things in place like the waiver for using different platforms just to make it happen while it is, but set your practice up, set your systems up for a long game to provide digital care to your patients. Because that's where we're going to go. Part of it is so yeah, but be patient with each other, love each other be kind and wash your hands,
Karen (57:49):
Wash your hands and don't touch your face. Yeah. And be mindful of the people if you are still, if your offices are still open, be mindful of the people coming into your office. If you are a home health therapist, be mindful of the people that you're that you're going to be treating because they may be in that vulnerable population. And because we, there's so much that we don't know, just be very mindful of how you're doing that and utilizing telehealth is a great way to have that extension of care for our patients, so.
Mark (58:27):
Right. And feel free to reach out to me market anywhere. Dot. Health care. I'm here as a resource. I'm trying to be as available as I can. I have to go to the bathroom occasionally or drink some water, eat some food, but I'm trying to be as available as I can in order to help help us transition and get through this, navigate this time.
Karen (58:45):
All right, well Mark, thank you so much. Got it. You've got everything there. Check out. Also, check out Mark's platform anywhere. Dot healthcare. I'll be happy to give a plug for that of course. And thank you so much. I really appreciate it. This is everyone else on this, on this call, so thank you.
Mark (59:01):
Beautiful. Thank you.
Karen (59:04):
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
LIVE from the APTA Combined Sections Meeting in Denver, Colorado, I welcome Tannus Quatre on the show to discuss marketing. Tannus Quatre is Vice President of Sales for Net Health, a leading software company serving therapists across the care spectrum. Tannus speaks nationally on the topics of entrepreneurship, marketing, and finance, and has been published in numerous publications including PT in Motion, Impact Magazine, and Advance for Directors in Rehabilitation.
In this episode, we discuss:
-What do new clients look for when they choose their physical therapy provider
-How to ask your practice ambassadors for a five-star review
-What branding strategies hold the best investment for your practice
-How to convert marketing touchpoints to new client leads
-And so much more!
Resources:
Tannus Quatre Twitter
Tannus Quatre Facebook
Tannus Quatre Instagram
Tannus Quatre LinkedIn
Email: tannus.quatre@nethealth.com
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Tannus:
Tannus Quatre is Vice President of Sales for Net Health, a leading software company serving therapists across the care spectrum. Tannus studied physical therapy at the University of California at San Francisco, and has practiced as a PT in outpatient, inpatient and home health settings. In 2007, he founded Vantage Clinical Solutions, a business services firm specializing in marketing and revenue cycle management for rehab therapists in private practice. Tannus speaks nationally on the topics of entrepreneurship, marketing, and finance, and has been published in numerous publications including PT in Motion, Impact Magazine, and Advance for Directors in Rehabilitation.
Read the full transcript below:
Karen Litzy (00:01):
Hey everybody, welcome back to the podcast. I'm your host, Karen Litzy. Today, as you can probably hear in the background, it's a little bit louder than it normally is and that's because I am recording this live at the American physical therapy associations combined sections meeting in Denver, Colorado, which has about 15,000 plus people and I am currently in the exhibit hall getting ready for a great interview about why patients come to see us. What is the why behind when the patient coming to see us, what can we do as physical therapists to reach those patients? As we know, there's a lot of people that need physical therapy and a lot of them do not come to see us. To help me through all this, I'm really happy to have Tannus Quatre here to talk about what we as physical therapists can do to help get patients in to see us and to be happy with their courses of care. So Tannus, welcome. All right, so let's just jump right in. Why don't you give the listeners just a little bit more about you and how you went from a practicing physical therapist into more kind of the marketing side of physical therapy.
Tannus Quatre (01:12):
Perfect. Yeah. I started as a physical therapist about 20 years ago. And in my clinical career, I had found that I was much more driven towards being curious about how patients find physical therapists, how physical therapists can run efficient practices so that at the end of the day they can grow their practices and be in business for a long time and care for lots of folks in their community. So I was just really programmed to be interested in those types of things. And so I went off and started my own company that focused in areas like that specifically in the areas of marketing, which a lot of what we're going to be talking about today.
Karen Litzy (01:56):
So then tell us now, why are first time patient s coming to your practice? So in your experience and what you've seen with people you've helped, why are they coming?
Tannus Quatre (02:08):
Yeah. So I mean there's a couple layers to this. So the obvious one is they're coming because they've got something that they need to be fixed or something they need to have addressed, right? They're in pain or, or some sort of, some level of function that they're not currently able to achieve. At a deeper level. And I think this really ties into where we need to be thinking with regard to our marketing strategy is a customer or a patient comes to us because they're looking for hope. They're looking for some better path towards a better life that they are not currently experiencing due to some type of functional limitation or pain or other illness or injury that they're undergoing.
Karen Litzy (02:46):
So oftentimes when people are seeking out a physical therapist, do you think the average person is saying, well, I'm going to look up this physical therapist. I'm going to look up their education. I'm going to see if they did a residency. I'm going to see if they're board certified. Did they do a fellowship or are they saying, how far is this from my home? Do they have parking? Can I get there easily? Do they have appointment times at work for me. So there's a lot of variables there. So what do you think weights as more?
Tannus Quatre (03:21):
Yeah, so really, really great question. I will answer that with kind of a story that pertains to me. I don't know the first thing about cars, but I know that I have to have a car that functions in order to have a productive life, get from a to B, take the kids where they need to go and so forth. So when I need to get care for my vehicle, I go to see a mechanic and I choose that mechanic based on interestingly what, what I think is, is a really good parallel to how customers choose us as physical therapists. I assume going in as I choose a mechanic that most auto mechanics are going to hit a certain threshold for quality. I assume that I go in, I pay my money, my car is going to come out and it's going to work.
Tannus Quatre (04:05):
Sometimes that's not the case, but the most times, and I've used different mechanics over the years, most of the time they hit that threshold. So then the question becomes what are all of the other things that, that not only brings me to find a mechanic in the first place, the one that I choose, but why do I keep going back time and time again? For me, that answer comes down to mostly trust. I in that trust had, there's a lot of tentacles to that rapport, likability, timeliness reliability and so on. But really I keep going back to someone or to a mechanic for reasons other than the fact that they've got the best pedigree and the latest state of the art equipment when it comes to fixing my car because my assumption is my car is going to be fixed when I leave.
Tannus Quatre (04:57):
And I think that that's a mindset that helps me calibrate around what are really truly the drivers of a consumer that comes in and chooses Karen Litzy as their provider and then stays with you over time. I think that assumption that we should be thinking from is that frame of mind shouldn't be that the assumption is the customer's going to get good care and they expect that, but that's the basic bar. It's all of the other things. How much do they like you? How quickly do you respond? How deep is that bond and that relationship you've created that makes them say, I'm going to come back and see you time and time again and not even bother Googling for somebody else that may be out there in their market.
Karen Litzy (05:37):
And I think, I love kind of taking an example outside of physical therapy and as you are saying that in my head I'm thinking like I get my hair colored and I love my colorist. She moved out of New York city. I tried someone else, like the color was good, but I didn't have that bond or that relationship. Like the color is just wasn't, we didn't click, we didn't vibe. So now I'm willing to take an hour and a half train ride to New Jersey to get my hair colored because of the relationship that I have with this stylist, with this colorist. And so I think if we can think about it in those terms, choosing a physical therapist should kind of be the same. So I think you are going for the culture, for the person, for the relationship. And like you said, the baseline should be you get better, right?
Tannus Quatre (06:33):
Absolutely. your hair looks beautiful by the way. But yeah, I think that's a great example. So, you know, another way to maybe say it is how I think about it is we're looking for peace of mind. We're going to have different challenges throughout our life, whether it's our car or our body and we need a doctor as a physical therapist or a medical doctor. We need folks that help us complete our life and our ability to have peace of mind that we have put together that network that is going to help us feel comfortable with the choices that we've made and be able to efficiently realize that the outcomes that we're looking for, even though technically speaking, maybe you could find somebody who is a better colorist for your hair that might even be closer to you, but you've got peace and you've got everything you need and you've got that relationship you need and your meeting that bar for quality. So you go back to time and time again. And I think that's really the threshold we should be thinking about with our customers.
Karen Litzy (07:35):
That kind of segways beautifully into what I wanted to ask next and what is success? So when we think about a successful plan of care or a successful business, is it good outcomes or great outcomes or is it good relationships or maybe it's a combination of both. I don't know.
Tannus Quatre (07:56):
Yeah, great question. So obviously outcomes are extremely important. So I look at that as a baseline. That's the proof that we've set out to achieve with our customers. So outcomes undoubtedly. But when you do look deeper beyond that and you're looking for metrics that help you understand, am I doing a good job of yes adhering to or you know, treating through a plan of care and making sure that I'm doing good in the moment with this one customer. Outcomes is definitely something you should be looking at. But looking deeper than that are we creating a lifestyle that is going to be sustainable beyond us? I start to think about things like, okay, how compliant is a customer or is a patient with the plan of care that I'm putting into place?
Tannus Quatre (08:50):
How good of a job am I doing at influencing that customer to believe they need to be compliant with what I'm asking or prescribing them to do? And then loyalty. Are they coming back? Are they completing their entire episode of care or not if they, you know, do I see them through one episode and then I never hear from them again for the rest of their life when I know for a fact that they're going to need myself or a substitute for myself at some point in time. To me those are really, really important indicators of success when it comes to how good of a job are we doing, not just being technicians as rehab therapists but as educators and ambassadors for the profession. That really the better job that we do there to set our clientele up to be able to know when to use us effectively and how to adhere to what we prescribed to them. To me, that's really where success comes in because by us planting those seeds correctly and motivating an influence in our customers to participate, that's ultimately how they're going to keep themselves healthy for a lifetime.
Karen Litzy (09:57):
I love that you use the word ambassador. I use that all the time cause someone asked me a couple of weeks ago, well I don't want to say, I don't want to say you're a referral source, I don't want to say Oh my patients are referral sources and there's something else I can use cause it just feels icky to this person. It feels icky to me too. And I said, well I, instead of saying referral sources, I say that my former patients or clients are all ambassadors for my practice. And that's what I say to them. Like, thank you for being such a great ambassador. So I don't have a referral fee or anything like that. I just have like a lot of thank you cards. They say thank you for being such a great ambassador. So I'm really glad that you use that because I think that's a mindset that brass people have to get out.
Tannus Quatre (10:48):
Yeah, absolutely. And I appreciate that point. I would say also that I love the word ambassador and I think that by that ambassador, being an ambassador is very empowering and empowering somebody is a gift. And we have the ability to provide that gift to our clientele by helping them feel like they're now part of the profession by going out and encouraging others to experience the same benefits that they have. And if we get that mindset right and we're really have a culture of ambassadorship both within our profession as our professionals and with those that we serve, sky's the limit for what we can create.
Karen Litzy (11:28):
And I think it goes beyond your individual practice, but it helps to elevate the profession of physical therapy.
Tannus Quatre (11:35):
Absolutely. Yeah. And it makes things like when we're talking about marketing, marketing is kind of like a logistical, tactical, strategic thing, right? It's like how do we attract people to us? It makes it very authentic and simplifies it quite a bit when we really think about it from the standpoint of building ambassadors through quality, passionate care that people want to go out and rave about.
Karen Litzy (11:58):
Absolutely. And now I know we've been kind of interchanging these words throughout the interview, but we've got patients, customers, clients. In your experience, what kind of clicks for that potential person coming to see you? What do they want to be called or what should we be calling them or does it matter?
Tannus Quatre (12:21):
Yeah, I think they probably want to be called by their first name. I think that what we want to I think that the mindset that we want to be in though is that, and this is my personal preference, but I'm an ambassador of this idea, so I'm going to be passionate about this is customers have a choice and choice is the key. If we look at that variable there, a customer can choose to come see us for the first time and they can come, they can choose to come see us time and time again. They can choose to be compliant with their prescribed therapies which sometimes are painful or not very enjoyable at all. Right? The choice is really that key term. And for me, choice equates to being a customer. Customers have a choice. So if when we use the word patient, although it's you know, in our vernacular and along the health paradigm in healthcare patient to me is being instructed or being prescribed as to what to do. It's the opposite of having a choice. And so for me, when I'm having this conversation with my customers who are private practice owners like yourself, I really I really advocate for the use of customer because I think it really represents what we're trying to do, which is have customers choose us. Time and time again.
Karen Litzy (13:46):
Be sort of more active, play a more active role. Patient can sometimes have more of a passive connotation that I'm just here waiting to hear what the PT needs to tell me what to do instead of having a shared decision making about their plan of care.
Tannus Quatre (14:00):
Yes, yes. And, as we know and more proof of the phrase customer. Our customers are researching us out before coming in. They're looking us up on Google. They're doing all the things that we do if we're buying a product on Amazon, right? So that those are customer behaviors. And I think by us really embracing that, it allows us to be more agile and strategic about our marketing efforts.
Karen Litzy (14:24):
So now let's talk about, you just mentioned Google. So people are going to Google us, they're going to look at Google reviews, Yelp reviews. So, what drives these positive reviews that people are reading hopefully reading about us.
And on that note, we're going to take a quick break to hear from our sponsor net health and we'll be right back. This episode is brought to you by net health, net health outpatient EMR and billing software. Redox powered by X fit provides an all in one software solution with guided documentation workflows to make it easy for therapists to use and streamline billing processes to help speed billing and improve reimbursement. You could check out net health’s new tip sheet to learn four ways that outpatient therapy providers can increase patient engagement in 2020 at go.net health.com/patientengagement2020.
Tannus Quatre (15:25):
So interestingly what's not driving the positive reviews is strictly about outcomes and the quality of care, which is really what we're all about at the end of the day. Right? We kind of started with that. What's driving positive reviews? I would just put it into one word, which is relationship. If you have a strong relationship and within that relationship you identify as part of it, like you're really, really an ambassador raving fan. It's not even if you were to request a happy customer, Hey would you, would you mind saying some positive about me? Absolutely. They're going to want to do that. But, if you think about what really drives someone to take it upon themselves to say, you know what, you are so damn good that I'm going to go out and do a solid for you because I want to help build your business for you.
Tannus Quatre (16:14):
That's based on a relationship. And I think part of it is the identity too, of feeling proud about the fact that like if you get the latest iPhone all right and you're stoked about it, don't you feel kinda good about the fact that you're the one going out bragging about the fact that you're one of the first on the block that's gotten the latest and the greatest in that same sentiment or that same idea is what drives us to go online and be public about positive experiences we have with our rehab therapists.
Karen Litzy (16:44):
And now let's say we're going to get to marketing in a second, but let's say you're a physical therapist, a private practice owner or you're working for a private practice. How do you bring up to your client or your customer like, Hey, I would really love for you to leave a review on Yelp or on Google, when is the right time to do that? And is there any verbiage that we want to avoid?
Tannus Quatre (17:10):
Yeah. Okay. I love the question. The answer is yes, there's a right time. What I coach therapists to be looking for is I just call it the opportunity and it's happening like right now as we speak. By the time we're done with this, it'll have that opportunity will have happened in hundreds of clinics throughout the U S as we speak. That opportunity can come by way of a customer saying, Hey, I feel great today. That's a lead for us, right? That's somebody who's happy and they're expressing that to us. It can be somebody who has achieved an outcome that they had not yet achieved or they met a goal that you had established together and you both acknowledge that in the moment. There's really deep moments too and we've all had them where a customer or a patient gives us a big warm hug and tells us that they love us and they've never ever been in this position before having met us and they're that emotionally bonded to us in that moment.
Tannus Quatre (18:11):
They might even have a tear in their eye. Those are all opportunities and there's infinite flavors of what those can look like. But the first thing we need to do is identify or be trained, really to like see that as truly an opportunity to now build an ambassador. Because now the next step is to empower that patient or that customer to go out and do something that's gonna make them feel even better and it's going to give back to the profession and it's gonna support your business. So once you identify that opportunity, it's a very, in a very authentic and sincere way to say, Hey, listen what you just expressed to me as, as my patient or as my customer means the world to me. And that's why I exist and I want is to help people just like you. Would you be willing to help me help others experience what you're going through in this moment?
Tannus Quatre (18:58):
Right now the answer is going to be a resounding yes. Now it's logistics. Okay? Would you like to know how this is what you can do? Are you on Google? Do you have a Facebook account? Are you on Yelp? You figure out what, what flavor suits your business needs best. We find that most, it's easiest on Google or Facebook because most people are there. But it's simply, Hey, if I provide you with a link and all you had to do is click that link and leave a positive review, would you be willing to do that? Would you make that commitment? To me, the answer is going to be a resounding yes. And we find that to be highly successful at tying the opportunity to the ask and to the results.
Karen Litzy (19:37):
Perfect. Thank you. I'm sure a lot of people will find that super helpful. So now we spoke about why people are coming to you for the first time. What does success look like? What drives those reviews? How we should be thinking about our customers or clients, patients, customers or clients. So let's now tie that altogether and talk about marketing. So how does all of that tie into the way we should or could be marketing our practice?
Tannus Quatre (20:09):
Yeah, I mean in infinite ways.
Karen Litzy (20:14):
It's an easy question, right?
Tannus Quatre (20:16):
Yeah. Well I mean to me that's all the fodder that the best marketing plans out there for large organizations or small should be using, which is do we have our fundamentals right? Do we have customers that we can benefit? Do they say positive things about us? Are there signs of success that they're coming back for more and more? Are they compliant? Are they loyal to us? If you have those two things you can now take that and deliver that out into your community as evidence or social proof that you are the provider of choice. And how do you do that? You know, how can that be constituted within the context of a marketing plan? We believe a lot in content marketing because really everything we do, including this podcast right here, it's all content, right?
Tannus Quatre (21:06):
And content is the best tool that you can be using for marketing. Cause you can use it to draw people near to you. So whether it's taking that a script that we just discussed to generate a five star review online, that by itself is one prong of a marketing plan. That is a content marketing plan that's driven by content that's coming from a happy patient that they're then posting online, taking testimonials or if you use outcomes tools and you're able to demonstrate that you're better in your market than your peers and taking that content and then dripping it out via social channels via the press, via email, name, the channel, it doesn't matter. But by dripping that out there into the community and using that to pique curiosity, curiosity and interest, that's basically leveraging your fundamentals into a very, very strong marketing plan.
Karen Litzy (22:00):
And let's talk about consistency. So we know that it takes a lot of touch points before someone will purchase. Like, I think I was doing some research a couple of months ago and came across this study where I think it took 20 touch points for someone to buy a chocolate bar and it was like 300 before they would buy an expensive set of headphones. And so a touch point can be just like you said, it could be something on social media, could be something they read in, in a publication or a blog or, so we know a lot of touch points are necessary for something that might cost a little bit more money or a little bit more time. Right. So let's talk about consistency of marketing and what, what can we do?
Tannus Quatre (22:41):
Yeah, it's a consistency of those touch points is, is really everything. So, we tabulate that basically in terms of impressions. So how many times do eyeballs or ears meet with the brand that we're promoting. And then in addition to that, you want to have a variety of how those touch points are experienced. So it would be one thing to have you just to use your examples. Let's say it's 20 touchpoints or 300 touch points through email. You think about that, that's going to have one type of impact on you, right? And that impact might be, I'm getting too much email. Okay, well but if you, if you get to that 20 or that 300 points and it's through a combination of certain percentage of email, social media, I'm getting some through the podcast, a little bit on the new station.
Tannus Quatre (23:34):
I'm getting, you know, something in my snail mail mailbox at home. All of those different touch points aggregated together. It's really how all the big brands do it. If you think about that when we buy an iPhone or we buy a Nike or something like that, we don't just see him in sports illustrated or the Apple store, we see it in multi channels every single day. We'll see. We have about 6,000 brand impressions that a customer is exposed to every single day. Right? And in order to permeate that as physical therapists, we have to have true consistency and volume when it comes to touch points, what that exact number is, if it's 20 or 300, it's going to depend on a lot of variables that are going to be unique to your market or your practice. But the key is you have to be consistent and you have to be, you have to be multichannel.
Karen Litzy (24:27):
Different spokes in that wheel, right. In that marketing wheel. It's not just snail mail or it's not just a Facebook ad here and there. It's a lot, especially in a world where people are bombarded on a daily basis by stuff. Right?
Tannus Quatre (24:45):
Yeah, no, absolutely. Yeah. So, so then I will sometimes get the same question, like, how many times do I have to, you know, touch a customer with a piece of collateral? Or how many times do I have to market to an influencer or a physician before I can expect them to do X, Y, and Z ? And that's the wrong question to be asking because there's no straight answer. It's iterative. If you track your data, you're going to know for you exactly how much budget and how many impressions you need to see in Facebook in order to generate a lead, right? It's going to look different maybe for email, but the key is to really understand your own business and don't be afraid to try something new. If you're not doing email campaigns, which I would suggest to you're doing right, try email campaign, track your conversion rates and see if it's something that's working for you.
Karen Litzy (25:38):
And you know, we'll start wrapping things up here a little bit, but if you could give a physical therapy, let's say a private practice owner, we'll use that. What would be, and again, knowing there's a million tips, but what are your top few tips on how to market efficiently and with integrity and to not feel like a used car salesman?
Tannus Quatre (26:06):
Yeah. okay. A couple of things. So the first thing is believing in yourself and your value proposition. That's the biggest threat that we have to our profession is that sometimes we feel like we're too expensive or we feel like there's too much cash that's owed up front from a patient. And we start to second guess ourselves so that in any marketing channel we were not as effective. Okay. So, so that would be the first thing I would say is really understand and believe in your value in everything you craft around that's going to have a lot of authenticity, sincerity, and passion and that will be felt and heard. Okay. And I think the second thing that I would probably offer is know your lane. There are if you take some of the big brands out there, they have resources to be able to succeed at a certain scale that doesn't work at a smaller scale.
Tannus Quatre (27:05):
Okay. So just because it can be effective to have the name of your company splashed on the, you know, the outfield fence, you know, for a major league ballclub doesn't mean it's right for you. Right. so knowing what your lane is and a lot of times if I kind of now bring it down to kind of the micro level and talk about a small private practice, a small private practice trying to do a whole bunch of different marketing things, man, it's going to be hard to do. And probably what's going to end up happening is you're not going to really hit the bar on any one of those things. So I would much rather counsel a private practice to say, Hey, we're going to dominate these three areas. We are going to lead our community with workshops.
Tannus Quatre (27:54):
We're going to do better than anybody else with holding workshops in our facility. We're going to do it consistently. We're going to pour the resources on and make sure that every single month we're doing workshops and we're also going to dominate Instagram. You know, if you said those are the two things, because that's, you know, it, it comes naturally to you. It's channels that you're familiar with and it was just those two things and you didn't do anything else. I think you're going to have more of ability, more of an ability to have success. And if you don't have success or you do to be able to understand and tweak your success if you choose those lanes because they can work for you. And I see far too many people trying to do a little bit of everything, throwing spaghetti at the wall to see what sticks and the reality is you don't meet the threshold anywhere and you really don't know what's working anywhere. So you don't know how to, how to tweak things and make them better over time. So I think that the authenticity and believing in yourself and really knowing your lane and choosing to stay in that lane are the two things.
Karen Litzy (28:55):
Some advice and it's, you know, if we put it into our client language, we would never give a patient 10 exercises on the first time we see them. We would give them maybe one or two so they can master those. Because if you are trying to do 10 you end up doing none. So I can understand that. If you're a small business owner, I'm a small business owner. If I tried to do a million different marketing ideas, I'd be like, forget it. This isn't, I'm not doing anything. I'm done. No more marketing. Yep.
Tannus Quatre (29:24):
And, and, and, and that's kinda what happens. It's a lot of back to you mentioned consistency. It's a lot of starting and stopping. When you try to do too much, it's you say, okay, I'm doing a lot of everything. I don't know what's working or what's not. So pivot, try something else. It may or may not be more successful. Right.
Karen Litzy (29:38):
Great. Great advice. All right, now it's a question I ask everyone. Knowing where you are now in your life and in your career, what advice would you give to yourself as a new grad right out of PT school?
Tannus Quatre (29:52):
Okay. love the question. Leave fear at the door. I spent too much of the early part of my career, probably the first five to seven years or so. Asking for a lot of permission. Thinking that there was a lot of things that weren't quite right for me and that there was some excuse or some magic wand that other people had to achieve things that I thought were really compelling or intriguing. Instead of just getting out there and saying, screw it, let's just fail fast, fail often and like get on the path to success. So I think that's the one thing that I would have told myself to do out of PT school.
Karen Litzy (30:33):
Excellent advice. And that could be at any stage of life. Great advice. So now where can people find you? Tell us a little bit more about your company and where they can find it.
Tannus Quatre (30:42):
Yeah, absolutely. So I am proud to be part of the net health company, so I can be emailed at tannus.quatre@nethealth.com. You can also find me on all of the social channels at Tannus Quatre.
Karen Litzy (31:02):
Awesome. Well, thank you so much for taking the time out and in the middle of CSM, and hopefully this isn't too loud for all of you listening. I don't think it is, but thank you so much, Tannus. This was great. And again, if anyone wants to reach out to Tannus, we will have all of those links in the show notes at podcast.healthywealthysmart.com so thank you.
Tannus Quatre (31:22):
I love it. Thanks for having me, Karen.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts
On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Domenic Fraboni on content creation for social media. Domenic Fraboni is a physical therapist in Los Angeles, California and lifestyle consultant focusing on mindset, movement and meals through online coaching.
In this episode, we discuss:
-How to choose the right social media platform for your target audience
-The importance of developing engagement with your content
-How to stay authentic and avoid the negativities of social media use
-And so much more!
Resources:
Domenic Fraboni Instagram
Domenic Fraboni Twitter
A big thank you to Net Health for sponsoring this episode!
Check out Optima’s Top Trends For Outpatient Therapy In 2020!
For more information on Domenic:
Domenic Fraboni is a Doctor of Physical Therapy and Certified Strength and Conditioning Coach. He earned this after graduating from Mayo Clinic School of Health Sciences in Rochester, MN IN 2018. He is a member of the American Physical Therapy Association (APTA), attending many events nationwide to advocate for the advance of the physical therapy profession as well as accessibility to higher quality of care. As a recent member of the APTA Student Assembly Board of Directors and active advocate for healthcare reform, Domenic likes to focus his efforts on systemic healthcare change. He was an avid coach, unified partner, and volunteer coordinator for Special Olympics. He now has relocated to Los Angeles where he coaches people into their bodies using a unique approach of Health and Lifestyle consulting in the areas of mindset, movement, and meals through his company, The Wellness Destination. Domenic focuses his services on the true and authentic connection he hopes to create with patients, clients, or those who looking for help on their health journey. Then he may be able to help empower individuals overcome some barriers and create true progress and independence in their lifelong healing journey!
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor (00:01):
Hello, this is Jenna Kantor with healthy, wealthy and smart, super excited to be here at Graham sessions 2020 with Domenic Fraboni, who I know from student assembly running for that, the board of directors and then also now on social media, which is our big focus because he has been putting a lot of work specifically on Instagram. So I wanted to have a discussion on this journey, I'm going to call you Dom now. Let's make it casual with Dom, so, first of all, thank you so much for coming on.
Domenic Fraboni (00:37):
Thanks for having me and being interested in what I might have to say. It's been kind of a journey this past six months with a lot of changes for me, especially career-wise, location-wise, and the social media thing. You just want me to dive in a little bit.
Jenna Kantor (00:50):
Actually first, let's start with why you chose Instagram, because when choosing a social media platform that you're thinking of a specific audience, so would you mind diving into that so people can start picking their brain and thinking, even if Instagram is where their audience is?
Domenic Fraboni (01:06):
I think my choice in platform had a little less to do with what I was wanting and just have more by chance. You know, I started dating somebody who has a big following and notice some of them started taking a liking in me or an interest in me. And it was at that point that I realized, Hey, Instagram, I've wanted to find a place I can start creating some content, whether it's recording exercises, whether it's just putting out thoughts, thought provoking things for potential clients or potential humans. I'm all about getting access to good information out to the humans so that they can make the decisions for themselves. And we know in this online era and the age of information, I would love to be contributing to what I think can be, you know, more trustworthy information that's online. So I started getting this Instagram following and I'm like, okay, let's do this. Let's put out some content. And I think it worked great for that because a lot of times people go to Instagram for content of that sort. So I'm like, Hey, great marriage. So that's kind of how choosing Instagram as a platform came about more by chance than by my direct choice.
Jenna Kantor (02:12):
How did you figure out what your content would be on?
Domenic Fraboni (02:19):
Yeah, that's another great question. I'm kind of in my purpose moving into this career as a professional. I always said I want to empower people to independence in their journey, right? And then kind of my themes that came out of that were movement. I'm a doctor of physical therapy. So clearly movement is huge to me and how I deal with clients and patients. Mindset. Cause I do also understand that in the psychosocial realm of how we treat humans and how we deal with humans, our mindset, our emotions, our mental state has a lot to do with how we feel physically and how we move and meals. So I'm like, Hey, maybe if my content surrounded those three themes, that can be my stick mindset, the movement and the meals. And it had a little, a little bit of a ring with the three M's there.
Domenic Fraboni (03:03):
So that's where I just started with those three things in mind and trying not to question myself was the biggest thing going in where you asked, Hey, how'd you know what kind of content to put out? I knew I had these people following me and that they might be interested in what I have to say. So my first step was just doing, it was starting to put out content and asking questions. If you ever have a time online where you have people following you and you don't know what they want, ask them. And so I started asking questions. I was very lucky to have people around me who had kind of gone through a transition like this into putting themselves out there. And a lot of what they said is just do it. You know what you're good at, you know what you're passionate about. These people have started following you for a reason, the ones that need to hear it will resonate and the ones that want certain things, we'll let you know when you ask. So I started asking questions to the people that were following me and they also just started putting out content and realizing what it was that people resonated well with.
Jenna Kantor: (04:04):
And for you, what were your measures that you are using to go, Oh, this is what they want to see from you?
Domenic Fraboni:
So I like to say that and a lot of people in social media want to try to separate the success of their posts and their media from the likes and the comments and that stuff. And it can get really kind of cloudy in our head as, Oh, why did this not have as many likes as this? And so really early on when I started doing this, I tried separating myself from likes. Everyone wants a lot of likes on their stuff and it really is not likes on your posts that mean people are engaging with it or connecting with it. The things that I really started to realize is the more direct messages, the more DMs or the more comments that people are connecting with are saying like, Hey, I love this.
Domenic Fraboni (04:56):
I tried it. It feels this way or I'm glad you shared that. Thanks so much for sharing more about yourself, whatever that means that I'm connecting with them personally in some manner. And so I liked to kind of dive into those ones that got a lot of personal direct messages or comments. And I'm big when it comes to feel and the energy between an interaction with people. So when I got interactions back from people that fueled that same purpose or energy, that was the reason I put that post out. There we go. Like those are my metrics. And I live in more of a subjective world myself because research makes me cringe a little bit sometimes. But it's the field that you can't get away from. So when I had people responding to me that made me feel something, I understood that maybe they took something away from that that made them feel something inside.
Domenic Fraboni (05:43):
So try to steer away from becoming obsessed with likes or comments and really steer towards and into the things that, you know, people feel something when they read it and will connect with it and reach out because of that. And I feel like I've helped to engage my audience a little more.
Jenna Kantor:
I love that. And with all the content that you're doing, how did you figure out how often you're going to be posting?
Domenic Fraboni:
Yeah, so like the frequency is huge too because consistency breeds trust, you know, people, although we are putting out this free content and it does take time to put together, you know, people like following, you know, people are content providers that they know are going to be there for them or that they know are going to be there and continue to put that out. So I'd say the first thing was like, okay, I need to be consistent.
Domenic Fraboni (06:35):
And initially when I was starting this, I had a little more time on my hands and I was, I decided, okay, I can take Sundays off and I'll post six times a week. And then I realized as I started getting more coming onto my schedule that that was a bit tough and so I landed on doing something about three times a week, three to four times a week and making sure I'm very consistent in that, but then also engaging when possible and making sure that those connections that are made aren't just done because I need to make my three posts a week again is all has to come from this intention inside me, so whether it ends up being two times a week or six times a week, I know that it's all still coming from this great energy that I trust and in behind what I'm putting out.
Domenic Fraboni (07:18):
Again to create those relationships, whether online or whether in person or whether just through DMs or comments. We are creating relationships and connections with these people in some way and so if the post I can put out has a slight influence on that energy that might drive them to be open to different options, then that's what I'm going to put out. I've landed somewhere in that realm of three or four days just based on how much other work I have in my collective sphere right now. But I think that's plenty for me to continue that frequency of engagement to make sure people know that I'm going to show up.
Domenic Fraboni (07:54):
Do you have to know everything to start something on Instagram? Yes. If you're not an absolute expert, then you no, absolutely not. And I think if you look through Instagram pretty quickly, you'll realize that not everybody is an absolute expert or knows everything in what they're posting. And I hear a lot of PTs or specifically younger PTs who will see other pages and be like, what the heck is this? Like, this isn't how it is or this isn't how you should do that exercise. Or like, wow, they aren't even paying attention to this. And my thing to them is like, we'll record an exercise and put it out or record a video of yourself doing it and say like, this is how I do it. Not to bash or be against that person. I'm very, very much so against calling people out. I put my air quotes over that even though we're on audio, but calling people out or having turf Wars with other people because you don't agree with them. We don't have to agree. We do also just have to understand that there are a lot of people that are open to those other routes. And this isn't for PTs.
Jenna Kantor (08:56):
This is for people.
Domenic Fraboni (08:57):
Yeah. So leave your ego at the door, leave your ego away from your phone and put out great content that you know you can stand behind and you won't have to worry about that as much.
Jenna Kantor (09:10):
I love that so much. What has been the biggest lesson you've learned since really diving into your consistency and all your content on Instagram?
Domenic Fraboni (09:19):
Yeah. Be authentic and trust yourself. It's really empowering. Well one, when you find that empowerment within you just to say like, I know what I know and I know where that comes from. And when you sit in that space, no matter what you put out or what someone says about it can impact that. And so yeah, I spend time on posts that I put out and they don't go anywhere. Maybe I have a slight bid or a question in my head like what happened there? Why did that not get that following? But I don't emotionally attach myself to any expectation on that. So the biggest challenge is the expectation of yourself or the comparison bug that might come out. Instagram's doing this thing where they're taking away the ability to see likes on a lot of posts now, which I think in a lot of aspects is great cause there are a lot of people in these younger generations that are going through anxieties and depressions because of this technology addiction, which is a whole nother topic.
Domenic Fraboni (10:17):
And that's the initial reason I never wanted to get into this cause I knew technology draws on these very addictive processes to get people to continue to use and to continue to abuse those processes until literally we are physiologically addicted. And that's why I stayed away from it. And instead knowing that that can happen and the intent from where I'm coming, I know that we can use these processes that may be addictive to get great information out to people and to help them understand and have access to that kind of stuff. So yeah, my biggest challenge, a challenge is going back to your initial question was you know, comparison and seeing what other people are doing, which is why I brought up the likes and like, Oh they got that many likes and they have this many followers and this and that. You know, like you start wanting to do that in your head again, shut those things down right away because you don't know what their purposes are, where the people that follow them are coming from or what they're looking for. And so be authentic and try not to get that comparison bug on your shoulder.
Jenna Kantor (11:18):
Boom, Shaka Laka I love that. So where can people find you on the Instagram?
Domenic Fraboni (11:24):
So if you type in doctor, just drDomDPT, it's drDomDPT, you can find me. I put out stuff on movement, mindset and meals. And my goal is to empower you to independence in your journey. Cause everybody could use a little bit of good information to maybe open up what other possibilities could be on your path.
Jenna Kantor (11:45):
I love that. So thank you for everyone who tuned in to listen to this podcast. You can also get that information on where to find Dom in the bio as well. Dom, thank you so much for coming on.
Domenic Fraboni (11:56):
Thanks. This has been amazing. Jenna. I love getting to see you here at Graham sessions and thanks for interviewing me.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE from the Graham Sessions 2020 in Nashville, Tennessee, I welcome Erica Meloe on the show to discuss how to create a brand ambassador. Erica Meloe is a board certified physiotherapist in private practice in NYC. After a decade solving financial puzzles on Wall Street, Erica took her MBA and her problem-solving skills into the clinic. She specializes in treating patients with persistent unsolved pain and her mission is to raise awareness of the physical therapy profession to a level like no other.
In this episode, we discuss:
-The lack of public understanding of the role of a physical therapist
-How to turn your patient into your brand ambassador
-Inexpensive acts of kindness that will make you memorable
-Why you should network outside of your profession
-And so much more!
Resources:
Erica Meloe Website
Tought to Treat Podcast
Why do I hurt? Book
Velocity Physio Website
Erica Meloe Twitter
Erica Meloe Facebook
A big thank you to Net Health for sponsoring this episode!
Check out Optima’s Top Trends For Outpatient Therapy In 2020!
For more information on Erica:
Erica Meloe is a board certified physiotherapist in private practice in NYC. After a decade solving financial puzzles on Wall Street, Erica took her MBA and her problem-solving skills into the clinic. She specializes in treating patients with persistent unsolved pain and her mission is to raise awareness of the physical therapy profession to a level like no other.
Erica is co-host of the podcast "Tough To Treat: A physiotherapist's guide to managing those complex patients." She is also a thought leader in the profession and helps her patients, as well as her colleagues, empower themselves to lead and live with purpose.
Erica has also been featured in Forbes, BBC, Women's Day, Better Homes and Gardens, Muscle and Fitness Hers, and Health Magazine. She is also co-host of the Women In PT Summit, held annually in NYC. Erica is actively involved in spreading the word on social media and at her website www.ericameloe.com
Read the full transcript below:
Karen Litzy (00:01):
Hey everybody, welcome back to the podcast today. I am here with physical therapist, Erica Meloe and we are live in Nashville, Tennessee at the Graham sessions. And for those of you that don't know, Graham sessions is all about bringing up big bold ideas, things that might be controversial, things that may be we're not talking about as much in the profession and it's like a big think tank. And so today Erica and I are going to try and take that in, miniaturize it down to a podcast. So one of the things that really I guess gets to Erica is the lack of knowledge of what we as physical therapists do, how we operate and how we can help people. So Erica, what are some things that you have maybe even experienced? I'm sure this comes out of your experience as a practice owner and as a physical therapist for many years. So I'm just going to hand it over to you and let you kind of talk about some of the things that really get to you. And if you have any suggestions or solutions for other physical therapists or the general public that we can do to perhaps mitigate this situation.
Erica Meloe (01:14):
Well, thank you Karen. Thank you for having me on the podcast. Graham sessions is wonderful in Nashville. I've never been to Nashville, so I know it's quite nice. One of my mentors or business coaches asked me a while ago, what can't you shut up about and what I can't shut up about? I mean, there's many things, but this so irritates me is that people still, consumers and other healthcare professionals do not understand what we do at all. They don't understand. They think we're all exercise. And I know that this is a topic that's been beaten around for many, many years. And for me it's just, it drives me crazy. And I'll just tell you a story related to Karen. I had a patient of mine who just texted me. I'm an out of network practitioner and she has a certain like a deductible.
Erica Meloe (02:03):
She has to meet. She's like, well, I'm going to wait to see you. I'm going to wait to see. I'm going to go meet my deductible. I'm like, well, why don't you meet your deductible with me? Am I not as my profession? Not as valuable to you in your mind. And I think as a profession we need to start when we can talk about the marketing and the branding, but that's not what this is about. We need to start at the grassroots level with our patients. I mean our patients are our voices and we need to develop relationships with them and we need to actually make the ask. I think we sometimes in our profession, we're not shy, but we don't make the ask and I'm guilty of this. We don't make the ask of our patients.
Erica Meloe (02:50):
What is your view of me as a therapist? What is your view of me as a profession? How can I get a seat at the table? For example, you know in a discussion in Washington, how can I get a seat at the table? You know, at an AMA conference. I know a lot of physical therapists out there are speaking at other non PT conferences. But I think it first starts with our patients developing, we talked about you know, a lot of these business and leadership skills, these soft skills and yes, those are very important. But the relationship with our patients, the patients will get that word out. I mean there are time and time again, we both experienced it. You treat so-and-so and the word gets out. This physical therapist is different, this is what they do. And I think that starting with the interpersonal relationships, relationships matter, I think it was on Twitter, somebody mentioned recently that she spent 40 minutes on the phone talking to an insurance company or a doctor and was that worth her time? And you know, she got a lot of comments and it was like relationships matter and that's value to the patient.
Karen Litzy (04:02):
Oh, absolutely. So I agree with you. It's all about relationships and those relationships, that Alliance that you create with your patient, that patient then goes out and they become your ambassador and not only an ambassador for you, but an ambassador for the profession as a whole. So instead of saying, which we heard today, people say, I went to PT and it was crap and they didn't do anything. But instead, wouldn't it be great if all of us PTs are forming these relationships, are treating patients with the latest evidence, are not wasting people's time, are making people feel better. Or I would even argue making people more functional, getting people to an elite level of sport. And that's what physical therapists can do. And I feel like a lot of patients, if they have gone to a physical therapist and they say, I did, they just put a hot pack on me and then some Estim, then do my exercises. And then I left. And you know who that patient was? My own dad. My own dad was like, well, why would I do that? He's like, I can put a hot pack on at home and go to the gym. Well that's not quite the care that your talking about.
Erica Meloe (05:21):
Right. So that was your dad. So you know, he would never say anything to you like you know he would not basically say, you know, all physical therapists are like that because you're his daughter. So you know, I talk about, you know, building relationship with your patient and your patients. Number one are your advertising or your marketing and your brand. You know, we can spend a lot of money and we, you know, a lot of people do on all of these business courses and that, you know, marketing and the branding and the social media and that's all great. But if you don't have a relationship with your patient, it doesn't matter.
Karen Litzy (05:58):
What are some tips that you can give to the listeners to create a good relationship with your patient.
Erica Meloe (06:03):
But say, you know, and I speak from experience and seeing other therapists work over my years, go the extra mile for your patient. Go. There are many times in patients, for example, they're going, they'll email me, they'll text me and on weekends and I answer those text messages and I answer those emails and they are like, thank you so much for answering an email on a weekend. And yes, that's a very basic example, but actually matters to these people.
Karen Litzy (06:37):
Well, the basics matter. That's the simple little things that you can do that takes two seconds of your time.
Erica Meloe (06:45):
And also just listening to your patients. And yes, I do have a tendency to run a bit late when I see patients, but I will tell you, Karen's laughing cause you know, but if someone asks you a question and you're 10 minutes late for your next patient, you don't just say, I can't answer it now. You know, and this is obvious, but that patient, they may have gotten a hundred percent better with you, but they're, Oh, they're going to remember it. That last encounter. You need to make every encounter matter, whether it's listening to the patient, whether it's you know, listening to them about something that's unrelated to physical therapy. And going that extra mile. And asking the patient, you know, what do you want from this relationship? It's a relationship and it's a trusting relationship. And, once again, you know all the branding is fabulous, but they're your voice.
Karen Litzy (07:49):
Yeah, absolutely. And I think it's also important to remember that this isn't a relationship of you being above your patient. It's a partnership relationship.
Erica Meloe (08:07):
And what do partnerships do? You know, they give and they take and there's a sacrifice, but I would offer this advice is your patient is your patient for life. Right? It's like that lifespan practitioner that we talked about so often and they should be treated as such. For example, when they leave your office for, let's say you've seen them for 10 visits, their back pain's gone and they're kind of good to go, but they're not really, once again, we don't discharge patients, you just, you know, see them and then they come back whenever they've got something else going on. It's not a word I like to use that. It's funny, I often say I don't use discharge anymore. I actually say you know, I'll see you if you have any other problems, just just come on back and I will keep in touch. I actually think using direct mail, and I've tried this, said this before really helps.
Erica Meloe (08:52):
I actually send birthday cards out and thank you cards and thank you cards after I have a a new patient, I will send a thank you card. Thank you so much. Nice meeting you. And patients are saying they come back and they're like, that was a great touch. I really appreciated your card. Honestly go into your database. I’d get an Excel spreadsheet of all your birthdays of all their patients birthdays. It is an easy thing to do and then just note them down and write them, go on a Sunday, spend an hour and a half doing that. It will matter. I know, it's funny because I had an assistant of mine do that and I was like, Oh, she has a birthday very similar to mine and you know, and, and they actually do appreciate that.
Erica Meloe (09:37):
And you know, I've been a patient myself and I, you know, we hope we can get the odd email and everybody's about, you know, the email marketing. Yes. However, it's not the same.
Karen Litzy:
No, it's definitely not the same. And, and I also can appreciate those tips that you just gave, listening to the patient, sending a birthday card, a thank you card and helping them kind of understand what we do and taking the time for them. These are not huge things. You don't need a certification for it. You don't have to spend money for it unless you get a stamp or something. It's very easy, accessible ways for everyone to enhance that relationship.
Erica Meloe (10:33):
Right. I think someone mentioned today that you might not be the best therapist in the world, but if you've developed a relationship with your patient, that's golden. And I received something from one of my coaches recently and it was a card and it said the best is yet to come. And I was like, Whoa. I was so touched by that. And it took her what, maybe five minutes to write that and not even, and that, and I remember that. I remember that. And when someone is sending that to you before you have to renew a coaching program or before you have to do something, I'm going to renew. I'm going, of course I'm going to renew because that was a great touch. You know, that's the customer service that people forget that we actually need to do in our field.
Karen Litzy:
Well, it makes you feel quite simply that you matter. Yes. And isn't it great that we as physical therapists can give to our patients the gift that they matter because they might not be getting that elsewhere. So if you can do that for your patient, they're your brand ambassador for life.
Erica Meloe (11:20):
Absolutely. You know, and when I started early on, you know, as a business owner, I was actually afraid to ask my patients for referrals. You know, I really was. And to this day it still is hard, but it comes out a bit easier now, you know, if you know of anybody else that could need my services, I really enjoy treating the difficult patients. Just, you know, send them my way and it comes out easier that way and we all have a different view, but they fade like you, you will do that.
Karen Litzy (11:54):
And I remember thinking to myself, Oh, I don't want to do that. It sounds so slimy. Like used car salesman. I don't want to do that. I don't want to be that person. And I remember somebody saying to me, but you're not slimy. So it would never come out that way. So if you're not slimy and gross and you ask someone, Hey, listen, I love doing this. If you know someone, definitely send them my way. I'm accepting new patients anytime. Like it's only slimy I think if you're a slime ball.
Erica Meloe (12:17):
Exactly. And it comes out very you know, with integrity, right? And it's not, of course not because, and if you say it with the passion, like you just did, you know, I love to treat these patients. I love to treat patients just like you. How special is that, right? That you make them feel special and they'll be like, Oh, of course, you know, it's like asking for reviews on a podcast. Oh, I didn't know I had to write a review. You know, can you write me a review? Boom. They don't understand it. And I think that is a good relationship. And once they realize that you'll be in the top of their brain and then they're going to be like, well, that experience was very valuable to me. You know, the birthday cards, the, just developing the rapport, rapport and just establishing relationships that, where it's a, you know, a given a take, but it's almost like a marriage in a way. I mean I'm not married and I certainly know I'm experiencing that, but when you have business partners or podcast partners, it's a given a take. And the ones that last the longest are the ones that, that work together. They collaborate. That's the best recipe for success.
Karen Litzy (13:24):
Right? And exactly what Erica just described is how we as physical therapists can help the general public know what we do, right? So it goes back to the thing that gets Erica every time is people don't know what we do, but there are what 300,000 physical therapists in the United States? It's a lot of people. And so if we can make a difference with every person, then can that cause a little ripple that can become a wave.
Erica Meloe (13:50):
Right. And I would also urge patient physical therapist to go to conferences that are not physical therapy related. Go to a leadership conference, go to a medical writing conference. Go to an urology conference or a women's health conference or that's the wheel. You'll develop relationships and you'll be the brand ambassador cause you'll be the only physical therapist there.
Karen Litzy (14:23):
Very true. Right. Great advice. Well what are the big things that you want the listeners to take away from this?
Erica Meloe (14:29):
That it's the small things that really matter. It's kindness. That's my word of the year by the way. I remember had the word of the year, that's my word of the year. Kindness. It's the little things that matter. Sometimes we need to go back to business 101 like direct mail that actually does work. You know, it really does. That's the main thing. And don't be afraid to collaborate with nonphysical therapist acupuncture as they're developing a relationship there. Cause you will educate them, you really will. And you have to be passionate about this. If you don't, if you're not as passionate about it as I am, you'll do it like half assed in a way. And you know, so, but start with your patients and pick a few patients you really like and you, you know, send birthday cards, send thank you cards, do it for one or two months and see if you get any return on your $1 investment. It's nothing.
Karen Litzy (15:27):
Great advice. And now what advice would you give to yourself knowing where you are now in your life and in your career? What advice would you give to you as a new grad right out of PT school?
Erica Meloe (15:40):
Stop overthinking. I analyze, overanalyze everything and that's good and bad. And I think that if I were coming out of PT school right now, it's not the latest and greatest social media course or marketing course or branding course. You could easily do those via YouTube. I mean, and obviously, you know, but it's really about what are your strengths? We talked about this at the women in PT summit. You need to play to your strengths. Like I like to problem solve. That's one of my strengths and so I would suggest anybody coming out of PT school, do a deep dive into what your strengths are, there's many StrengthFinders is a great one. I would really do a deep dive into looking at what your strengths are and play off of those. Get really good at those and you will find ways to apply those in physical therapy.
Karen Litzy (16:36):
Fabulous. And where can people find you?
Erica Meloe (16:38):
Oh gosh. Online. We've got an Ericameloe.com my velocityphysiony.com and I'm in New York city right across from Bloomingdale's and all my Facebook, Twitter, Ericameloe. My podcast with my wonderful cohost, Susan Clinton. Tough to treat. And my book, Why do I hurt? Discover the surprising connections that caused physical pain and what to do about them. That's on Amazon, Barnes and noble
Karen Litzy (16:50):
Awesome. And just so everyone knows, we will have links to all of Erica's information under this episode at podcast.healthywealthysmart.com so Erica, thank you so much. Thanks so much for listening and have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Keaton Ray and Scott McAfee on how to develop a successful business partnership. Keaton and Scott are MovementX business partners. MovementX is on a mission to heal the world through movement. We believe that if you can move your best, you can live your best. We are doctor-founded and patient-focused to help bring more convenient, transparent, and personalized physical therapy care to the world.
In this episode, we discuss:
-What is MovementX and how is it revolutionizing physical therapy practice?
-The importance of identifying the strengths and weaknesses of your team
-Why you need different channels of communication in a partnership
-The key elements of a successful business partnership
-And so much more!
Resources:
Movement X Website
Movement X Instagram
Keaton Ray Twitter
Scott McAfee Twitter
Email: info@movement-x.com
A big thank you to Net Health for sponsoring this episode!
Check out Optima’s Top Trends For Outpatient Therapy In 2020!
For more information on Keaton:
I am a passionate physical therapist and wellness/fitness specialist in Portland, OR specializing in reducing pain, increasing strength, restoring mobility and balance, and optimizing performance. I've worked with clients across the lifespan from those who have never exercised a day in their lives, to those who are afraid to exercise because of pain, to advanced athletes looking to take their performance to the next level.
For more information on Scott:
Dr. Scott believes in a world where anyone can move & live their best. The problem is that with today's healthcare system, finding the best care, avoiding crowded clinics, and dealing with insurance can be frustrating. That's why he chose to do things differently. Dr. Scott's practice is 100% mobile–he provides care in the comfort of your home, gym, or office. He brings a mobile treatment table and helps you decrease pain, increase strength/mobility, prevent injury, restore function, and coordinate your care plan. Wherever & whenever you need care, he can be there. It's convenient, valuable, & personalized to whatever you need. Dr. Scott works with a wide range of people, from youth athletes & avid runners to active grandparents & busy businesspeople. Call or text the number above to get directly in touch with him, and you can have a free phone consultation about what health goals you want to accomplish!
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor (00:00):
Hello, this is Jenna Kantor here with Healthy, Wealthy and Smart. I'm here with Scott McAfee and Keaton Ray and I am tired. We are at Graham sessions 2020 and I am so lucky to be interviewing the two of you on your partnership with movement X. So first of all, thank you so much for coming on. It's an honor to be speaking with both of you. So first, would you mind explaining what movement X is and then dive into how your partnership began?
Keaton Ray:
Sure. So movement X is a group of United providers across the country who are providing care in an inspired way. So we refer to it as the 11 star experience. We're going above and beyond the five star experience and providing care where people need it most, when people need it most, whether that's at their home, at their gym, at their workplace, on the track and field at their doctor's office. We're showing up and providing care that makes a difference. So improving lives on both sides of the treatment table for the provider and for the patient.
Jenna Kantor (00:58):
All right, and now your partnership.
Keaton Ray:
Sure. So where to begin? So Scott and I first connected on movement X in 2016 or early 2017. Started with a phone call. I knew that Josh D’Angelo and myself couldn't do this on our own, so we called up some trusted partners that we had known closely through the APTA. Scott was one of the very first people we talked to and immediately had a connection over the mission, which is you know, help people move their best so they can live their best. And I'll hand it over to Scott who can explain the transition from that first talk about movement X to him, actually quitting his job, moving across the country, dropping everything to help us with our vision.
Scott McAfee (01:50):
So it was a very exciting time for me. I was just finishing up my residency program in Southern California. And I loved the people that I was working with. I loved my coworkers. I love my patients. And it was really an amazing residency experience at this hospital. However, I was somewhat displeased with the with the environment of dealing with insurance companies and being somewhat limited in my ability to truly and deeply care for people that I knew I had the potential to as a physical therapist. And after my conversation with Keaton, I got really, really inspired of what the opportunity looked like for physical therapists in this more mobile cash pay model. And it was I think about a week after I had passed my residency when I knew, wow, there's some real opportunity here.
Scott McAfee (02:52):
And Josh D’Angelo one of the cofounders along with Keaton he had been in the Washington DC area for seven years, was very well connected out there. And at the time right when I was finishing up my residency, I was very comfortable down in Southern California. I had a very strong network. My life was just going straight according to plan per se. And I've never quite learned at any point in my life from a point of comfort and I wanted to flip that on its head. So I decided to move all the way to the East coast to join forces with Josh D’Angelo in Washington DC in addition with Fred Gilbert who moved from Alabama to Washington DC and that's how the partnership began and we began expanding from there and it's just been an absolute wild ride since
Jenna Kantor (03:49):
I love it. And I love how you two interact with each other. You're both good friends as well as definitely business partners. How the heck did you get to that point? Cause I would love for you to first go into your struggles and then what you did to implement something that would work between the two of you.
Keaton Ray (04:08):
That is a good question. So all of us, everyone who started the company actually started as friends way before we ever started at business partners. And that is both one of our deepest strengths as well as probably one of our greatest challenges as well. But from day one, it was intentional on our part to learn each other's strengths and be open to each other's weaknesses and communicate if not over communicate about each one of those. So there is times when Scott and I probably are just at each other's necks, including other people. I get frustrated on a daily basis with everyone and they get frustrated with me. And that is okay, that is normal. But what we've done is we've gone through intentional work where we set aside hours at a time, both on the phone and in person to be open about those strengths and be open about those weaknesses. And each and every one of us over the past two, three years has just grown because of that intention that we've put into growing each other. So it is not easy. It definitely changes the relationship, but it's worth the intention.
Scott McAfee (05:12):
And Keaton and I, we both go back to the student assembly board of directors, although we never served together. I learned so much about how I function on a team in that environment. And I would imagine that you learned the same. And I think once you truly understand yourself and then also once you truly understand and appreciate and realize the mission of what your team is trying to accomplish, that how you get to the end goal of accomplishing that task is irrelevant. You just have to get there. And yes, you are going to agree on certain things you're going to disagree on probably even more things if your team is actually functional. But at the end of the day, as long as you are on a team, it can get to the end goal. That's what matters most. And from there you walk out of the room, no matter what discussion happened inside of that room, all with the same mindset of, Hey, this is our goal. We may have disagreed on how we got here, but now we're all in agreements. Hey this is what matters most. And, you have a clear sight of where you're going.
Keaton Ray (06:27):
One thing I'll add to that, the other two areas of strength. You said it perfectly, Scott. I think one is putting infrastructure into being able to build a communication pathway. So we have a lot of various company languages that we use that help us recognize when we're falling into several habits that may affect the growth. So one example is the six thinking hats. So six thinking hats. You know, the red hat is the emotional hat, the white hat is the fact hat. The green hat is the innovation hat. The yellow hat is the optimism hat. The black hat is the devil's advocate hat. Josh D'Angelo would be so proud. I just remembered that. And so sometimes when we're in a heated conversation or we don't see things eye to eye, we need to recognize, Hey, I'm wearing my red hat right now and you're wearing your white hat. No wonder we're not seeing each other. And various communication pathways like this have helped us to recognize where we're falling short and where we need to improve. And so without those types of things, it would be a lot harder to grow as a team.
Scott McAfee (07:25):
I love how you brought that up as an example because not only does that help us make decisions in the board room per se with business it's also helped me make personal decisions, look at problems that I'm facing in my own life from many different angles, right? Hey, if I had a green hat optimist view of this versus a devil's advocate, why would I talk myself out of this? I think I've been able to look at things from somewhat of a stoic and very objective point of view rather than getting to red hat emotional about certain things. And it's also helped in personal relationships as well. So as much as you can grow together in the boardroom, I think you take away so many different things on a personal aspect as well. And yeah, I love that analogy. That was something that Josh D’Angelo initially introduced and has just been so helpful.
Keaton Ray (08:19):
One more. The last thing I'll say too is if you ever want an ego check, join a group of six. We started with six incredibly innovative, intelligent, outspoken leaders. Sit yourself in a group of six outspoken leaders and have them debate your mission and your vision and your processes and everything in the background there. There is no space for ego when you are working with this large and this capable of a team. So you cannot be a solopreneur and accomplish what we're trying to accomplish. So we've all really worked hard in our egos and it's not always easy, but every single person on this team has done a great job.
Jenna Kantor:
Would you mind sharing your own personal things you've learned about exploring how you work? I think that'd be interesting for people to hear. You're like, I am actually a person who's like this, I would love for you to share that. So then people could even learn how you are so different.
Scott McAfee (09:16):
So I might take a second to think about that. And that's something that I have learned about myself is that it often times helps me to take a second and think of getting my thoughts together on how to approach a certain question or an issue or how to solve a problem. Rather than to just speak my mind immediately. But I will say that right off the bat that going into this team, I'm in just awe of everybody who I get to work with on a daily basis. And people often ask me, Hey, why did you move to Washington DC? It wasn't only for this like larger mission and this larger purpose. It was to have conversations late at night with people who inspired me who I just looked up to in so many different ways. And that was a goal of mine when I was actually looking for different colleges to apply to. I was like, who could I surround myself with and have just really deep and insightful talks late at night with and I just feel so fortunate to be able to do that as part of this team and as our youngest member on the exact team that we have, I oftentimes do try to just be a sponge and take in as much information and inspiration from my team as possible.
Keaton Ray (10:41):
I was laughing through Scott's excellent explanation because sometimes I think we can explain each other's work habits at this point better than we can explain our own. And so I am the opposite of Scott, although it's gotten, I have the team probably operate the most similarly. But you know, there's differences between everyone. So I am very blend and I should take more time to stop and think first. But if something's on my head, it is right out in the open. And so one of the things that we've really worked on as a team between Scott and I, but also between all the team members is managing conflict. So some of us on the team are much more comfortable with conflict. Me being one of them, while others have a little bit more of a reservation around conflict. Now compared to other people, everyone is excellent at managing conflict, but it's a personal comfort as to how you actually deal with that.
Keaton Ray (11:31):
So I would say while Scott says he's much more, you know, maybe has to think about it in, in the background a little bit. I am much more of that writing your face. Oh, I don't agree with that. Or Oh, I totally love that. You know, kind of person. So a lot more forward facing. But what Scott and I have as an extreme similarity is that we are the doers. We're like, let's do it tomorrow. We have idea. Great. Okay, I'm going to stay up all night. We're going to crank this out. We're going to have a product tomorrow. We're going to launch it, we're going to test it a little bit and we're going to redo it. Whereas Fred and Josh tend to be much more of those visionary. Like, let's stop. Let's look longterm. Let's think of how this affects this. And, it is a wonderful combination because all of us compliment each other so well. You can't have one leadership style without the compliment of the other, but it can lead to frustration. You're moving too fast, you're not moving fast enough. You know, back and forth. So the communication puts us all in alignment and we're stronger because of it.
Scott McAfee (12:30):
Yeah. Actually one of the core values in our company is passion times purpose. And you can't have one without the other. And the way that I think about that is you cannot have action without strategy as well. And that's one thing that Josh and Fred are so instrumental in teaching us and teaching me and even keep me, is inspired me in so many different ways to behind everything that I do. Always have a strategy and don't skip steps in the action that you want to take. So I think that's very important.
Jenna Kantor (13:03):
I love that. I love that very much. What made you decide to hire out to figure out how to work better together? How did that, I'm sure alone cause you hadn't figured it had something in play like you do now. How did you get to that agreeing point to go, okay this is who we're going to invest in to improve our communication, to improve our partnership? How'd you get there?
Keaton Ray:
Yeah. So I think what you're referring to is the consulting work that we did for a team development. So we actually got incredibly lucky. We got chosen by a graduate program working on human resources and team development as their trial team to take a deep dive look into each one of our personalities and our work habits and then do basically a report. So we each had a one-on-one like hour long talk with this consulting firm and they went deep into our work styles.
Keaton Ray (13:53):
We'll look it up, we'll look it up. And so then they came back at us and basically gave us a very honest report about how our team is functioning and then gave us assignments on how to dive deep and improve the report essentially. So it was a really hard activity and emotionally draining, but it was so bonding and we're so much stronger because of that consulting work we did. You have to recognize your weaknesses. We knew we're not perfect, nobody's perfect. And so we're willing to invest in the team to improve because without this team, the mission of this company doesn't go anywhere.
Scott McAfee (14:33):
So it was a graduate program at Georgetown university.
Jenna Kantor (14:42):
Yeah, that's very cool. I love that you guys said that is still looking it up to see if she could get more information. And I want to find this information for the listeners in case there is somebody starting a business who might want to look this up and see if this program might help them as well. Because seeing how you two interact, like I said, there really is some magic, dare I say Disney magic happening between the partnership and I think that is absolutely spectacular. Did you find the name?
Keaton Ray:
So it was Georgetown's graduate program. Robin Goodstein graduated from that program and started her consulting firm called Balcony consulting. So anyone looking for team-based collaboration and consulting, she's incredible.
Jenna Kantor:
Now what are your biggest challenges that you have and the easiest things for you guys overall? Cause you guys have grown together, but what are just the constant things that you expect to be like, okay this is a little challenging and this is like easy.
Keaton Ray (15:58):
So this is a hard question. That's a great question. But I think that the easiest thing that we have now is a baseline understanding of how each other operate. The first few months in definitely year plus was just learning each other's habits, learning each other's needs and learning each other's emotions. And now I think we have such an intricate understanding of how we each operate that it's much easier to move the company with speed. Knowing that, I think the hard part is, is we're now in a place with the company that we're really truly starting to grow and we're going to run into barriers that are unlike anything we've ever had. And so, so far we've been able as a team to come together and hustle and make this thing work and create an amazing movement. But we're going to max out of our own knowledge. And so we're going to have to find new team members who come into our company who do not have the same intricate knowledge of one another. So now it's not just managing each other, it's managing other people and having them fit into the culture as strongly as we do.
Scott McAfee (17:00):
I think that's perfectly said because we agreed too much. No. because it's going to be so special and like I said, such a wild ride ahead as we do grow and with as many things that are going to change and as many new obstacles that we're going to face, I truly do believe that we do have a very strong foundation and like you said, baseline understanding and respect for each other and how we both operate. And that goes for everybody in our team and in our community. The more that we can better understand how we operate and all speak the same language they all have the same core beliefs and core values and share so much of the same culture. If you know from a deep level that binds you together, I definitely believe that no matter what obstacle may come your way, you can adapt your team in a very nimble way, in a very strategic way, in order to accomplish that. We're with as many problems as we face and with as much as we have accomplished you know, the sky's the limit. And, I think there's so much growth waiting to be had that it's just so important to have that foundation before you have anything else.
Jenna Kantor (18:21):
I love it. Thank you so much. You too, for coming on here at this crazy, magnificent time here at Graham sessions, you two really set a great bar that is possible for anybody to achieve at their business partnerships. So thank you.
Scott McAfee (18:36):
Appreciate those words, Jenna and I couldn't echo the same thing about you and Karen. You guys are great. This podcast has inspired me when I was a student. So I just feel very fortunate to have the opportunity to speak to your audience and hope that we've spread something valuable worth listening to. So I appreciate you
Keaton Ray (18:58):
Agreed all around. Thank you so much for this opportunity. The one thing I'll leave the listeners with is if you want to build a team and you want to grow a mission, you have to be vulnerable. You have to put yourself out there and let people see what you do know, what you don't know, your hesitations, your fears and your vulnerabilities. Because without that, there's no way you can connect with people enough to build something as meaningful as we're trying to do. So be vulnerable. Put yourself out there, let go of your ego and you're going to create an amazing company culture.
Jenna Kantor (19:37):
Thank you so much. I was wondering where can people find you online if they want to try to reach out to you?
Scott McAfee (19:44):
So we are on Instagram @movementXinc and we are a online also www.movement-x.com.
Keaton Ray (19:55):
Note, our company name is movement X. No space, no dash, but our website is movement-x.com.
Jenna Kantor:
Wonderful. Thank you so much. So thank you listeners for chiming in to this great discussion. This will also be in the bio as well. If you want to just check that out too, if you're having a hard time remembering what was just said on how to reach out to these fantastic individuals. Thank you so much.
Keaton Ray:
You can also reach us at info@movement-x.com. We want to hear from you. We're always willing to hop on a phone call.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE on the Healthy, Wealthy and Smart Podcast Facebook page, I welcome Chris Napier on the show to discuss the science of running. Chris Napier is a Sport Physiotherapist with a PhD in running biomechanics and injury prevention. He has an appointment as Clinical Assistant Professor in the Department of Physical Therapy at the University of British Columbia.
In this episode, we discuss:
-How to bring a wearable to market for running retraining and injury risk reduction
-What to look for when investing in wearable technology
-The importance of translating the research to both the clinician and athlete
-Science of Running: Analyze your Technique, Prevent Injury, Revolutionize your Training
-And so much more!
Resources:
Science of Running: Analyze your Technique, Prevent Injury, Revolutionize your Training
Chris Napier Twitter
Email: chris.napier@ubc.ca
Chris Napier Research Gate
A big thank you to Net Health for sponsoring this episode!
Check out Optima’s Top Trends For Outpatient Therapy In 2020!
For more information on Chris:
Chris Napier is a Sport Physiotherapist with a PhD in running biomechanics and injury prevention. He has an appointment as Clinical Assistant Professor in the Department of Physical Therapy at the University of British Columbia. In addition to working on research projects, Chris continues to be a practicing physiotherapist with Restore Physiotherapy and Athletics Canada. He has competed at the national level as a successful middle-distance runner, earning medals at the Canadian Track & Field Championships in 1996 and 1997. He is also an accomplished marathon runner with a personal best time of 2 hours, 33 mins.
Read the full transcript below:
Karen Litzy: 00:01 So welcome everyone. So for those of you who are watching live, thank you so much for taking the time out of your day and coming on to watch and learn. Oh good. I'm just making sure that it works. So I just had to check on my iPad to make sure we're live and we are. So thanks so much for taking the time out. As we go along. I may ask you just to kind of write in the comment section where you're listening from. If you have any questions, by all means, definitely, definitely ask. Now is your chance, I'm sitting here with Dr Chris Napier. He is an expert. He is a new author. We'll be talking about his book, the science of running in just a little bit, but Chris, just to kind of allow people to get to know you a little bit more. Why don't you kind of give the listeners and the viewers here a little bit more about you.
Chris Napier: 01:05 Sure. well thanks again for having me on Karen. I feel like I've really made it big time. Now. I'm on the Karen Litzy podcast. It's huge. So thanks again for having me on. So I'm a sport physiotherapist. I've been practicing for almost 20 years now. And, I've worked with a range of sports. But I sort of ended up coming back to the sport I'm most passionate about. The one I love which is running. About 10 years ago I started really focusing more on running and it was basically because I'm a runner myself. Out in the community running with the various sort of recreational races training with different clubs and so then and talking to people who are running all the time. So it really sort of just made sense for me to kind of work a bit more clinically in that field.
Chris Napier: 02:00 And at the same time I was getting interested in pursuing more research. And so I started my PhD in about 2012, 2013. And I focused on running and I was really interested in being able to quantify aspects of running in terms of running form and biomechanics. So my PhD was on running biomechanics and sort of clinical interventions using gait retraining to prevent injury. And so I finished that in 2018 and I've moved now more out of the lab so to speak out of the biomechanics lab but still interested very much in the mechanics of how we run. And I'm now working with a group of engineers at Simon Fraser university doing my postdoctoral fellowship there where they actually develop a wearable. And so we're doing some really cool stuff there in terms of actually developing potentially products that will be available to clinicians and to runners to measure their gait.
Karen Litzy: 03:13 Very cool. And I will also add that you are sort of at the helm of the third annual world conference of sport physiotherapy in Vancouver this year. It was an amazing event. You and the team you guys did such an amazing job and I'm sure that's the feedback that you've have probably got from the conference, from the people who attended. So I just wanted to give you guys some more accolades and a nice shout out cause it was a really, really well run conference with some great info.
Chris Napier: 03:48 Yeah, that is the feedback we've had, which was fantastic to hear from across the board. And, I'm really looking forward to our continued support for your therapy candidate conferences, which will be a biannual event and as well the next world Congress, which will be excellent, I'm sure as it's being hosted in Denmark.
Karen Litzy: 04:08 Yeah. Yeah. That'll be fun. And that's in 2021. So that'll be a good time. And again, if you're watching live, I know I saw a couple of viewers watching live at the end of this, hopefully we're going to give away Chris's book. It doesn't come out until February 4th, but if you write your name or a comment or where you're watching from in the comment section, you're automatically in the running for a free copy of the science of running by Chris Napier, which is very exciting. So Chris, let's talk about wearables. So when I think of wearables, to me it makes me think of like a Fitbit or maybe an Apple watch or something like that. So in your introduction, you'd said that you're working with a lab as a postdoc. So when you say wearables, is that what you mean or are you talking about something else?
Chris Napier: 05:11 Yeah, so I mean a wearable is really a broad category. And you know, for anyone who follows the consumer electronics show, which was just recently in Las Vegas you know, I think that area is huge right now across the board. And, we think of it very much in the health lens. But really a wearable, wearables, anything you can wear on your body that tracks something whether it's, you know, your heart rate or your breathing rate or your pulse or your blood pressure or skin temperature or joint angles, impact forces. I mean, it goes on and on. Really anything we can measure through something we can wear. So, you know, by nature it's something that's portable often, you know, connect with some sort of app either on a Bluetooth device or we'll sort of record onto the actual hardware itself or download later.
Chris Napier: 06:15 But you know, that's the other side of it is, you know, beyond the wearable, the actual interpretation of the data and the visualization of that and that sort of thing. That's a whole other field as well. But the lab I'm in is looking at wearables that can measure health-related metrics. And so some of the projects we have going on there are looking at recovery from stroke or looking at you know, more fine motor function, that sort of thing. And my area specifically is looking at an application to running.
Karen Litzy: 06:53 And so when, you know, I think about application to running and you think about, you know, perhaps using a wearable to enhance someone's running, whether it be their running gait, their endurance, their times. And what I think of right off the bat is a running analysis where you've got someone on a treadmill and you've got multiple cameras and they've got dots all over them and all their joints, which is not something that every clinic has the ability to do because those setups can be quite expensive. So what are you doing within your research that might be a little different and offer clinicians something that might be more practical?
Chris Napier: 07:40 Yeah, so what you described there that sort of motion capture 3d motion capture analysis which is sometimes done on an instrument, a treadmill, which will give you force information as well as the joint position movements. But that was my PhD. So that's what I did. I looked at basically a snapshot of people running and then assume that that's how they ran when they left the lab. Which is a big assumption, right? And so what we're doing is we're trying to get those same measurements but in something that can be worn outside of the lab and in the natural environment which gives us it opens a whole other world to what we can measure. We can measure things where, you know, rather than on a treadmill, which might be unnatural for a lot of people, we can measure them running on the road or through trails or uphill or downhill.
Chris Napier: 08:40 We can measure how their mechanics changed throughout the course of a run. You know, so we can see what happened when they start to get fatigued. We can measure in a race situation you know, when people perhaps run differently cause they're pushing themselves to their limits. And we can also measure over time, over a weeks or training blocks so we can see what happens to people's mechanics. As a more chronic sort of fatigue sets in. So there's a lot of stuff that we can study. And, in our lab we have sort of the ability to embed some of these wearables into garments. And so essentially we're developing smart garments. And we published a recent paper looking at using a set of running plates to measure hip, knee and ankle kinematics during running. And, we developed this and I think it compared to the gold standard, which is still the three D motion capture and these tights do very well at measuring that movement. Which is exciting cause then, you know, we can start to produce these and runners can start collecting data wherever they run.
Karen Litzy: 10:01 Yeah. Which obviously seems a little bit more practical than, like you said, just being on a treadmill. We know running on a treadmill is definitely different than running on the road or the track or real life situations. And is that something that a, let's say your average physical therapist practicing PT like myself, if someone comes to me with a running related injury and I mean, I don't have access to a three D running analysis, is this something that I would be able to say to this potential patient he lives in? I have some wearable technology that you can use that might give us a better picture as to what's happening when you're running.
Chris Napier: 10:49 Yeah, I mean, we're not there yet, but that's certainly where we're going. So, you know, I guess potentially we could, we could put this pair of tights on a runner and we could track their hip, knee and ankle kinematics while they run either on the treadmill in the clinic or we could send them outside and have them go for a run and come back. And or you know, these could be something that the clinic can loan out or rent out and maybe patients keep them for a week so we can track their running mechanics over the course of a week. And then that could potentially be uploaded to a cloud or brought back to the clinic and downloaded so that you can look at their data over time. And what we're using our strain sensors to be able to measure kinematics.
Karen Litzy: 11:38 And what does that mean? What's a strain sensor?
Chris Napier: 11:40 Well, essentially these are thread like sensors that the amount of strain produced can give us an idea of how much movement is occurring.
Karen Litzy: 11:52 That's sort sewn into the fabric.
Chris Napier: 11:54 Exactly. And we've done, you know, a lot of the research we do is looking at where we need to place these and how many sensors we need and that sort of thing. And so that was the big work sorta involved in developing these tights is to figure out how many, you know, can we get away with just having three or four sensors which reduces the you know, the cost of energy and also the amount of processing involved and where can we put those to optimize you know, the metrics we're looking at. But you can also then add inertial measurement units or I am use which have accelerometers and gyroscopes in them, which can then add a whole other layer so we can look at you know, impact. We can look at angular philosophy and things like that. So, you know, we're looking at integrating those things right now as well.
Karen Litzy: 12:53 And all of that can be so knit fabric of a pair of tights.
Chris Napier: 12:57 Yeah, yeah. We're talking about pretty small.
Karen Litzy: 13:01 That's wild. And so, you know, you did a study kind of taking these tights and looking at, well, how many sensors do we need and where do they need to be placed? And was this sort of a preliminary study, cause I can understand the need for knowing how many sensors you need and where to place them and then kind of recruiting a larger amount of runners to kind of study to see does this do what it says it's going to do it in a nutshell. So right now, just so that the viewer isn't, so that I myself get a better idea. So right now you're sort of in that developmental stage where you're looking at where to place them and how many, and do they work?
Chris Napier: 13:48 Yeah, we've done that. So basically this study was that, so we were happy with where they are and the number for what we want to measure. And so now what we're doing is can we use these to give us information about you know, the fatigue state that runners are in. So, you know, when we're getting into machine learning and that sort of thing as well with this. So you know, can we classify a runner as being fatigued or not? For instance, based on the information we're getting from these tights or, you know, and then as I said before, like, can we get these out now and actually get people using them so we can start collecting large data sets. You know, that's where it gets interesting. Can we get these out to hundreds and thousands of people to be able to start collecting data on those numbers and really start to refine the technology and perhaps see some interesting patterns.
Chris Napier: 14:49 And you know, there's some of the studies coming out of refurbish lab in Calgary have been doing that. They use the now defunct Lumo device, which I am used situated on the waste. And they've done some really interesting work with Christine Claremont leading that and Learn Benson looking at sort of classifying situations or types of runners based on the data they've gotten from those devices. So we'd be looking at maybe doing some similar work with ours.
Karen Litzy: 15:30 Yeah, I mean, very cool. And, I guess the next question is why should we care? So as physical therapists or even as runners, like, yes, this technology is cool, it has the potential to give us a lot of data and a lot of information, but why do we care about that?
Chris Napier: 15:54 Yeah, exactly. So, you know, I think first of all, we have to figure out, is this going to give us information? That is I think we can be happy that it would be reliable, but really we're looking at the validity. Are we getting information where we're going to see patterns that lead to injury. And that's again, that's kind of where we're going with this. But at this point we can't say that that's where we need those large numbers. And hopefully I think that's what we will find is that we can kind of see trends. I mean, there may be a time where, you know, these are sold in running stores and people just wear them and then, you know, they get injured and they come in and say, Hey, yeah, here's my data.
Chris Napier: 16:41 Check it out and, you know, see if you can figure out why I got injured. You know, maybe we'll get to that point. But I think for now it offers the clinician a chance to be able to analyze someone's running gait. So you get that kind of objective information. And then maybe they can use that over sort of repeated visits if they're looking at trying to retrain someone's gait or if they're looking for you know, some changes due to the intervention that they're applying, whether it's strengthening or gait retraining or something else. So I think that it gives us another tool really to measure something dynamically that, you know, until now we could only really do in a specialized biomechanics lab, which as he said, is very expensive and time consuming and really maybe only giving us a snapshot.
Karen Litzy: 17:40 Right. Right. Versus being able to see the bigger picture of a runner. Yeah. Yeah. Very cool.
Chris Napier: 17:49 And also, you know, maybe some of the work I'm doing is looking at monitoring, training load and you know, if you're kind of familiar with the training load research there's this sort of concept of internal and external load. And you know, the external load might be the number of kilometers or miles that you run in a week or the number of minutes that you run in a week. And the internal load would be some sort of intensity measure or rate of perceived exertion. And so, you know, my interest is, can we get a bit more specific perhaps about that external load. So we're not just looking at minutes or miles, but we're looking at you know, cumulative impact and that actually got a paper in review right now where we looked at that using the run scribe sensors, which are little pods you put on your laces on your shoes and they can measure shock, which is sort of a result of impact force results in acceleration when you hit the ground.
Chris Napier: 18:56 And we looked at whether there's a difference between looking at just a cumulative minutes, you know, run versus number of steps versus cumulative shock. And we found differences and with the cumulative shock we're going to know a deeper analysis. I'm not sure where we're looking for, are there changes depending on the type of run that the person did. So is it more specific measure? When someone is changing the terrain they're running on or changing their intensity on a regular basis? If someone goes and runs the same route every day at the same pace, then we're probably not going to get more information by a cumulative shock. But if they're running in trails one day and roads the next day and then they're doing interval workout or then they're doing a long run we might get more information out of cumulative shock or some similar measure as opposed to just the minutes or miles that they run.
Karen Litzy: 19:56 Right. Yeah. So just adding another element to, again, the overall picture of that runner. So like for example, like you said, you could have someone who says, Oh, I ran, I run 10 miles, I'm just making this up 10 miles every week and I haven't changed how many miles I run. But yet they're coming to see you for patellofemoral pain. Or maybe they're coming to see you with anterior shin pain. But what you're not getting is, well, I run the same amount, but this time I did on a trail and this time I did it on concrete and this was on a rubberized track or something like that. So I would assume that with that shock, you would be able to kind of see the difference and then as a therapist say, Hey, I don't want you to stop running, but maybe let's stop doing X, Y, Z.
Chris Napier: 20:52 Yeah. It allows us not only to look at what has happened, but also to prescribe in the future. Right. So potentially we can then say, okay, we need to keep that cumulative shock below a certain level or, you know, increase it gradually. And so if that's something that they can monitor on their own outside the clinic. Great. and I've done that a little bit with some people just more experimentally at the moment. But I've had people who are really interested in sort of tracking that. They've done that and it's actually been quite successful so far.
Karen Litzy: 21:24 Yeah, no, it sounds very reasonable to me as a therapist and certainly as I would think for the runner because, you know, oftentimes when runners get injured and first of all, they're told to not run. That doesn't go over very well.
Chris Napier: 21:42 No, no.
Karen Litzy: 21:46 And it's also not just the running, but it's part of stress-relief. It's part of what makes them happy. And so to be able to say, Hey, listen, we're collecting all this data on you and this is what we found. This is what you can do. I feel like it gives control back to the patient or to the runner so that we're not spinning. Right.
Chris Napier: 22:07 Yeah. There was a great paper just published last month that essentially looked at what their runners do when they can't run. Right. So if they're injured and they can't run, what do they do? And the answer was, Oh no, they didn't do other activities. They just say they just want to run. And that sort of, I think validated your feelings. You know, when you talk about cross training and, you know, go get on the bike or go on a full run or a swim. But I mean, the greatest thing about running is you can put on some running shoes and head out the door and you can fit it in anywhere, anytime. So it becomes much harder to fit in that exercise when you have to go to a pool or go to a gym, get it done.
Karen Litzy: 22:51 Yeah. And then I would think it must be even harder for some, not all, but some runners to get back to running after an injury. You know, there's fear involved there. They don't want to get injured again. They may sort of taper back to the point where maybe now they're not even happy with their running.
Chris Napier: 23:16 Yup. Yeah. And often, you know, we prescribed like a walk run program to get someone back in because it's sort of graded impacts. Right. So again, looking at that key middle of shock is what we're trying to do there is gradually someone back in to doing that. Even if they've kept the fitness even if they have been on the bike or something like that when you get back after prolonged period off of running, it's still, it can hurt, right. Of the impacts you don't get in other activities. And so again, that's where, if we can measure that and monitor it, I think that's a big advantage.
Karen Litzy: 23:53 Absolutely. Now before we get to the book, which I want to get to in a second, are there any other cool tech things when it comes to runners that may be you've worked with or that you've seen? Maybe not, you know, in the lab that you are in, but that might be coming down the pipeline that we can as runners or as healthcare providers we can kind of get excited about. And the answer might be a lot, but you can just pick.
Chris Napier: 24:26 Let's say a lot of the kind of more research grade or maybe not a lot, but some of the more research grade companies are starting to shift I think a bit more to a clinician or consumer level products. And one reason for that is the hardware is just getting cheaper. So, it's possible. And then also I think you know, the ability to fit these into or integrate these into apps where you have the visualization side and you can actually easy interpretation of the data. I think that's you know, we're going to start to see more and more of these devices available in clinical settings and consumer settings. And I think one that comes to mind is I measure you, is basically an IMU inertial measurement unit that now owned by VI con, but you know, they're starting to I think offer products that are a bit more clinician friendly where you can get real time feedback.
Chris Napier: 25:40 You can stop these on someone's tibia and have them run in the clinic and get some real time feedback and visualize it and give feedback if they're reaching certain thresholds. So if you're trying to keep them and you're trying to get them to run softly, for instance, you can get them to run. And this'll give you feedback when they're going over a certain threshold. Another, a Vancouver based company that I'm doing some research with. It's called plant Tika. This is actually their product here. It's just an insole. So you can just pop this into your shoe lacing. So on your shoe and in the bottom of it, I don't know if you can see here, but there's an IMU here. So it's very thin. Obviously it fits right into the insole and you don't really feel it when you're in there.
Chris Napier: 26:30 But it's a very strong piece of hardware and you can pop that into your shoe. And I say, well, that it's actually measuring that it measuring accelerations so it's got an accelerometer, but it's measuring that impact at that point where it's hitting your body so it's right underneath your heel. You know, and so we're doing some interesting work where we're looking at different footwear and how that changes the impact at that point, because today a lot of the research is using ground reaction forces, which are measured underneath the shoe, right? That's the shoe round interaction. Or they're using to bill accelerometers, which are, you know, measuring that force once it's gone through the foot and the ankle complex and is reaching the tibia.
Karen Litzy: 27:21 Some of those courses have already been disordered right through the ankle or through the shoe.
Chris Napier: 27:30 Yeah. So this is a cool tool and I think they're really keen to start using this. They're targeting clinicians because I think this is an easy one that you know what, I'm using it in the clinic right now where people come in. And when we did the gait analysis, I just slipped these into their shoes and just cause it's that much more information. It visualizes asymmetries really nicely as well. And, and they're also looking at beyond running. They're looking at you know, ACL rehab and that sort of thing as well.
Karen Litzy: 28:02 And are there any things you can think of that let's say your average physical therapist needs to watch out for? Right. So you have a lot of, cause I know you had mentioned more research based consumer products. I'm assuming that there are products out there that might not be the best things that we as consumers, you know, without naming names obviously, but things that we look at when we're looking at a company that's selling one of these like wearables and what their claims are.
Chris Napier: 28:35 Yeah. So I think first of all, the hardware has to be good. And when I say that, I mean you need to have a high enough sampling rate to be able to measure what you want to measure. So, you know if you have an accelerometer, that's a sampling it 60 Hertz for instance. If you're trying to, we capture that and you're gonna miss peaks of data and steps. And so it's just not going to be something that's reliable. You know, if you're measuring it at up at the waist crowds, then it's okay because we don't need high as high frequencies at the waist. So no for that we need to how you need to have a product that can sample at a high enough rate and there's papers out there that have looked at that, you know for kinetic and kinematic information, that sort of minimum requirement you would need.
Karen Litzy: 29:36 And what would that be? Do you know, off the top?
Chris Napier: 29:38 Perfectly genetic information and it's about a, you need like 500 Hertz for it could be more like 200 Hertz, you know, for the kinetics is going to depend on the placement for sure. But typically you want to aim for something that's about 500 Hertz, you know, a lot of consumer level products wouldn't have.
Chris Napier: 30:00 And then also something like the dynamic range would be important. And that's just essentially how many Gs they can measure. And so if your using a something that only measures up to 10 G then when you put that on your shoe and you're trying to, and, and there's impacts that are up around 20 G, then you're really not going to be capturing sleep. Right. It's missing that information again. So that, I mean, that's something to be wary of thought of it outside of the hardware would be looking at the output you get. And so some of these outputs you get are very general. You know, typically you'll have like a, you know, I put on my Garmin watch and go for a run and at the end of it it tells me I need to rest for, you know, 36 hours before my next effort or something like that.
Chris Napier: 31:00 And you know, I never really sort of regard that it doesn't really doesn't make sense. I can interpret that much better myself than relying on my watch. It also spits out a bunch of other metrics. You know, some of them might be useful. Others I would just sort of disregard and I think that's where, you know, probably clinical decision making comes into it. And having a knowledge of the activity and the person in front of you don't overly reliant on just sort of what the metric is outputting.
Karen Litzy: 31:40 So if you have, let's say a certain wearable on and it gives you again, making something up like 10 different kinds of outputs. I don't even know if that's possible, but you want to kind of take, is it sort of like you're taking what you need as it relates to what the patient's going through? Or are you buying something that says, Oh, it can give me all this information, so I'm just going to use all of it.
Chris Napier: 32:11 So, I mean, someone like me, I like raw data because I can play around with it and I can plug it into things. I can graph it and I can do whatever I want. And it's that raw data is, you know, the highest frequency and so the best data I can get, so that's what I want. But most clinicians don't want that because they won't know what to do with that data. Right. So it's gotta be processed somehow. And so that processing you can lose data and you can lose focus and you can have misinterpretations along the way. And so it can be something is it can be processed down to the point of where something might give you an efficiency score, right. Which is, you know, unit and listen in essentially meaningless where it says, you know, your efficiency on that run was good, average or bad.
Chris Napier: 33:08 Yeah. I mean that's something completely processed down to the end where it gives you this kind of, you know three categories. I mean, what does that really tell you? Probably not, or it could be somewhere in between. And so I think that's the hardest part here. And you know, what would be appropriate for a clinician isn't necessarily going to be appropriate for a consumer. So I think again, we're going to start to see products that are aimed more at clinicians and at more consumers as the hardware gets cheaper and more widely available and people are going to kind of sort through and find things that work for them.
Karen Litzy: 33:52 Right? Yeah. So I guess it's when it comes to the output, it's kind of like food. You don't want things to be overly processed it’s not good for you. Okay. Cool. Well now let's get to the book. So I'm just going to read. So the book again for people watching the book is called the science of running and it will be available on February 4th, but you can go to anywhere books are sold, Amazon or what have you and you can preorder. But I'm just going to read a quick description. I won't read the whole thing, but I'll read a quick description. Science of running goes further than any other running book to intergrate the anatomy. And physiology of the runner showing how running in walls and affects every system of the body, including the effect of oxygen on the muscles. The book breaks down the runner's stride, scientifically showing what's going on under the skin at every stage of the running cycle. Highlighting common injury risk based on a readers natural gait and showing how to correct them, takes a head to toe approach to 30 key exercises for runners, annotating the muscles, ligaments and joints involved, and showing how to perfect precision in those exercises to optimize their benefits. Sounds great.
Chris Napier: 35:12 I could have used more time.
Karen Litzy: 35:15 He probably did that in a weekend, but I mean, this is a very involved book. It's not like just a pamphlet.
Chris Napier: 35:24 No, no, it, it was a lot of work. I won't deny that. And it was a really interesting process for me. Essentially it's like what we just talked about sort of bullying down that kind of raw data or the raw science and being able to filter down to a level that's interpretable by kind of the general public or the, you know, the average runner. Cause that's essentially what this is. It's a handbook for runners about their bodies, right?
Karen Litzy: 35:55 So this is for the average person runner and for the clinician, right? So not like overly overly technical, but technically simplified.
Chris Napier: 36:08 Exactly. I mean it's not simple. There's a lot of information in there, right. And we've done our best you know, with the artwork and that sort of thing to be able to explain the science behind all of this. But there's a lot of information in there. I mean, it's not a textbook. And it's not an academic book, but it's very much for runners and clinicians, I think to have on hand. You know, whether it's in a clinical context, if you want to be able to explain, you know, an injury to a runner or you know, explain what you mean by you know, what's happening during running stride. There's a lot of you know, artwork and chunks of text in there that can kind of help to explain that. And for the average runner, I think it's sort of something that they can keep on hand and use you know, if they're training for a race or just in general or something to kind of, you know, refer back to over, over and over again. And there's also a whole chapter full of training plans. It was co-written by my coach Jerry Zack and again, that's a very comprehensive chapter there.
Karen Litzy: 37:31 Fabulous. And so I'm going to say it again, so for the people that are watching if you leave a comment or a reaction, you're automatically in the running to win a copy of this book. So please, you know, give a thumbs up or a heart or throw in and whatever like where are your lists, where you're watching from or listening in from. Because we'll pick a winner and I'll contact you when we're done with the interview and everything. But so when you talk about a book like this is there ever sort of misinterpretation of by someone to say, Oh, it's a book on how not to get injured when you run? This is a book on preventing injuries?
Chris Napier: 38:22 Yeah, I mean, yeah, I mean for anyone familiar with the research on running injuries, that's a pretty murky field at best anyway. I think what I tried to do in this book was present what the research does tell us and kind of show, you know, let's take foot strike for instance. Cause everyone knows about, you know, foot strike pattern and you know, we talked about, okay, what happens when you were first strike? What happens when you forefoot strike? And rather than taking the approach that one is inherently bad and we'll give you an injury we talk about, you know, how they affect your stride and where those forces go and that sort of thing. To be able to educate the runner on that rather than talk about, you know, this particular way of running will prevent injury. There's also a large section we've got about 30 different strengthening exercises in the book where you can you know, go through and again, it's a little visualize with artwork showing different stages of the exercises on specific running, strengthening exercises that you can do in the gym or at home.
Karen Litzy: 39:42 Awesome. Well, it sounds like it's a great resource for clinicians and the runner alike and are you going to, after doing this, and this was, I'm sure an arduous task that took quite a while. Are you going to write a followup in the works or are you like, Oh my God, let's publish this book.
Chris Napier: 40:02 I haven't really even opened this book yet. I got it. About three weeks ago, and I don't think I might've just opened at once to kind of flip through very briefly. So at this point I'm ready just to kind of keep it on the shelf and see what happens. But no, nothing in the works right now. I'm focusing on some other things right now and if that opportunity comes up, you know, down the line then perhaps a look at that then, but this was a very interesting process to go through. I have no regrets. I think it's pretty cool to see, you know. But I think I'll take a little break for awhile now.
Karen Litzy: 40:47 I get it. For you, as now an author, what was the best part of writing this book for you? Might've been like, as a person, as a clinician, as a researcher, what was like the big positive for you?
Chris Napier: 41:03 You know, in research we're always talking about knowledge translation, right? You have to kind of get that research to the end user. And how you do that. It's often very difficult for research. This gave me a lot of tools I think in my own field of how to get that research to the end user, whether it's a clinician or a runner themselves. So that's been really useful. Also I think working in the clinic it made me really think about what are the exercises I think are most valuable or what is the most useful thing that a clinician would get out of this book? You know, I'm often sort of pulling out a textbook to try and explain something to a patient who is in the clinic because they've got an injury and I'm talking about too much too soon or some of that. And I want to graphic where I can say, look, this is why too much, too soon is bad, or this is why, you know, running the way you're running might've led to this injury. And I'm often sort of ending up doing Stickman drawings or something to try and illustrate.
Karen Litzy: 42:14 Well we all do that.
Chris Napier: 42:16 Which is fine. But you know, this gives me a resource and hopefully others a resource in the clinic to be able to sort of say here like this is what I'm talking about and here's a nice sort of visualization and in some kind of bullet points as to what I'm talking about.
Karen Litzy: 42:34 Yeah. That's great. So I feel like it, to me it sounds like it's made you maybe a little more present, a little more thoughtful about what you're doing with runners and why you're doing it. Great. And I'm assuming that's also the goal of the book is have people be a little bit more present, understand the way their body works. This is for the runner, the way their body works and why they're doing what they're doing. And for the clinician may be taking a larger analytical view in as to the person in front of them, the runner in front of them, and maybe why they're getting the injuries that they're getting. And some options on how to rectify that situation.
Chris Napier: 43:16 Yeah, I mean, I think runners, runners are typically type a people, right? And they, you know, they get really into running and they want to know more and they want to learn like, okay, what's you should I have and what's, you know, what's the best way to run and what's the best way to train? And you know, so they're on Google and they're trying to get all this information. There's tons of conflicting information out there. Even from, you know, some of the top sources, right. Sort of the top sources for that. So again, hopefully this is something that kind of boils it down. It's very evidence-based and something that runners can rely on as a resource for all things running.
Karen Litzy: 44:01 Sounds great. Now listen, before we wrap things up, I have one last question. It's one that I ask everyone and that's knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad right out of physio school?
Chris Napier: 44:18 So I would right out of physio school, I think just get your hands dirty and see patients, try and get lots of different experiences. If you're interested in sports, volunteer with teams. You know, don't expect payment right away for those things. Get out and work with people and put in the time and you'll learn a lot and those will turn into opportunities in the future. I think getting out and I'm not saying no to things is a big, big thing. And I think that's how I kinda got involved in working with professionals and sort of national team athletics. It's because basically one opportunity led to another. And I didn't say no along the way and so it just, you know one thing snowballed into the next thing. So I think you know, that's probably my advice. Just get out, start getting your hands dirty and get the practical experience and don't say no.
Karen Litzy: 45:26 Awesome, great advice. Now, where can people find you if they have questions and they want to find more info about you and about the book, where can they find you?
Chris Napier: 45:35 Well, the best place is on Twitter. I'm fairly active on Twitter and they can find me @runnerphysio on Twitter and they can contact me through that. Also if people have, you know, wanting to access any of my papers, that sort of thing. They can reach me through my email address which is Chris.Napier@UBC.ca. I'm happy to send along papers or if you have any sort of specific questions, I'm happy to answer them if I can.
Karen Litzy: 46:07 Awesome. And what we'll do is when this broadcast ends, I'll go back in and I'll put a link to your Twitter and to some of the papers that we spoke about today and a link to the book. So people want to preorder the book, go for it. For all the people who are on and who had some reactions or comments. I will pick a winner for someone to win Chris's book and you'll be hearing from me. I'll get in touch with you via Facebook. So, Chris, thank you so much for taking the time out and coming on to do a live and then it'll be on the podcast as well but to do a Facebook live. So thank you.
Chris Napier: 46:45 Well, thank you. I've enjoyed it. It's been a good chat and thank you also for all your work in the lead up to the world Congress with all your Facebook live interviews with a lot of our speakers. Cause that was really great to be part of that.
Karen Litzy: 47:02 Yeah, that was my pleasure. It was great. So everyone who's on and watching. Thank you so much and have a great couple of days and stay healthy, wealthy and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome TaVona Denise on the show to discuss burnout in physical therapy. Atlanta-based business accelerator, success coach and avid cyclist, TaVona Denise lives and breathes by the motto, “success is 80% mental, 20% skill.” With certifications in life, weight and wellness coaching, her specialty is helping new entrepreneurs get past fear and overwhelm, get their business up and running, so they can help change the world.
In this episode, we discuss:
-Burnout in physical therapy and the tools you need to take the next steps in your career
-Why a gratitude practice can help shift your mindset and elevate your to-do list
-The importance of a coach that can identify your blind spots and keep you accountable
-How to channel your fears and build confidence so you can tackle your biggest goals
-And so much more!
Resources:
TaVona Denise LinkedIn
TaVona Denise Facebook
TaVona Denise Twitter
TaVona Denise Instagram
TaVona Denise Website
A big thank you to Net Health for sponsoring this episode!
Check out Net Health's 4 Ways to Increase Patient Engagement!
For more information on TaVona:
Atlanta-based business accelerator, success coach and avid cyclist, TaVona Denise lives and breathes by the motto, “success is 80% mental, 20% skill.” With certifications in life, weight and wellness coaching, her specialty is helping new entrepreneurs get past fear and overwhelm, get their business up and running, so they can help change the world.
Shortly after finishing college she started her first two businesses, but found herself burned out because they were not using her gifts. TaVona then used her skills as a physical therapist to start a physical therapy contracting company. Finally her own boss, the problem was, she basically created a job for herself, which was not the life she had envisioned.
It wasn’t until TaVona found the world of coaching, that she was not only able to successfully lose 80 pounds and keep it off, become an award-winning athlete, and build the business that would eventually provide the lifestyle she wanted.
Speaker and author of, Unstoppable Success: How to Finally Create the Body, Business and Lifestyle You Want, TaVona teaches entrepreneurs the steps she used to create lasting success as a lifestyle, in weight loss and in business. She believes there would be less addiction in the world if people were courageous enough to walk in their purpose. She is on a mission to help people find their zone of genius and make money by making a difference.
Read the full transcript below:
Karen Litzy: 00:01 Hey TaVona, welcome to the podcast. I am so happy to be interviewing you live here in Nashville, Tennessee at Graham session. So welcome to the podcast.
TaVona Denise: 00:10 Thank you for having me. Karen, I'm so excited to be here and to be speaking with you today.
Karen Litzy: 00:15 Yeah, and I'm excited to have you because what we're going to talk about today is when a therapist, we'll stick to physical therapy, but this really could probably apply to most people in healthcare, let's say. But we'll stick with physical therapists because that's what we are. That's what we know. And we're going to talk about when, as a physical therapist, you kind of hit that crossroads in your career where you're not sure if what you're doing is what you want to continue to do. So TaVona, yourself as a physical therapist and as a coach, I'm sure you've seen this quite a bit. So can you talk to when therapists get to that crossroads and what you've learned from interviewing over a hundred different therapists?
TaVona Denise: 01:03 Yeah. Well, it's a fascinating thing. I started to notice whenever I would remember to ask somebody, like, what year, how many years have you been in the game? What's going on with you? When they're coming to me for life coaching and they're thinking about making a change. The number 15 kept coming up. Every time I would write it down, they're like, yeah, I'm at year 15 I don't know if I was attracting them because that's about when I started to feel like, okay, I've been doing this 15 years. I know my job inside and out, backwards and forward, and I don't think I can do this for the rest of my life. And at that time I wasn't even 40 so I have plenty more work, work years left and I can't keep doing it. And so I just find that, especially for the women, either it's 15 years if they've gone straight through and sometimes it stretches to 20 if they have gone back into part time to rear their children.
Karen Litzy: 01:56 Okay. And in talking with all of these therapists, have you found any common themes that they get to this 15 to 20 year Mark? And they're like, Ugh, now what?
TaVona Denise: 02:09 Well, that's exactly what they say. It's like, now what? I know my job, I don't necessarily want to keep practicing in this way. I feel stuck. I don't know what to do next. And part of the problem is they do not have a passion for research, academia or management. And so many of them are thinking, well, should I leave the profession? And if so, what does that look like? What does that mean? Am I throwing my degree away? And so what are the options? There are several. I think one of the things that we have to do is take a look at, well, why did you get into the profession in the first place? And can you reconnect with that? Are there aspects outside of what you're doing that you can bring into what you do now to help judge it up and renew it? To me, some people have reinvented themselves and said, okay, well maybe I don't necessarily want to stay on the rehabilitation side, but maybe I want to practice prevention and wellness. So I think for some people that's an easier transition because they get the sense of I continue to use my degree and leverage it to do something that still helps people.
Karen Litzy: 03:20 And if let's say I'm coming to you and I'm saying, Oh TaVona I just, I don't know what to do, I'm really stuck. I'm getting, you know, I'm starting to feel like I'm not making a difference anymore. So how would you, we can kind of go through a mock coaching session here. So what are some things that maybe you would want to ask me or want to know from me that maybe can help me figure out what to do next or what's your process like?
TaVona Denise: 03:51 It really, really depends. Just like in an evaluation situation, like no two people are alike. So it depends on how they present, how they come to me. But I really want to know what do they enjoy at their job and what do they enjoy as a person working in a profession. Because sometimes there's an opportunity for a person to create a position for themselves or to create a program. And some of the clients that I've worked with have become what I call intrepreneurs. They have taken their skills, their expertise, their specialties, and then develop programs within the organizations that they work in, which it's a challenge. It's not as risky as being an entrepreneur and going off and doing it for themselves. They get to stay in that environment and not lose the years of service and PTO and all the perks and things. It's kind of like playing with the house's money so they get to do that. Sometimes it's a matter of just feeding the hobbies and things and taking time for themselves that they're not doing. Because we always hear the analogy of you have to put your own mask on first before you serve others. And so as caregivers, that's what we do. We care for others and sometimes we are forgetting to care for ourselves. So sometimes that's the approach we take. I find a lot of people, and this is also a strange one that I'm thinking about. A lot of people need to declutter their homes.
Karen Litzy: 05:14 Yes. 100% yes. I'm just going to say yes to that. I'm Marie Kondo in my home like five years ago and I have to tell you, decluttering my home kind of decluttered everything else for me, even part my practice and my thought process and I was able to then expand and do things that I couldn't even imagine were possible. So proceed.
TaVona Denise: 05:42 Yes, 100% it was interesting, I listened to a coach that specialized in a relationship. It was one time and she was like, you need to make space in your closet for the person that you want to come in and so if your closet is jam packed. There's no room for anybody else. And I think about that too. Now that we're talking about this, the decluttering process I think gives people space, like you said, expand space to think, to breathe. So that, that like every time they pulled into the garage and they see all the boxes in the junk, it's irritating them. And so that's just one more thing. If they can declutter that, that's something that they have control over where it doesn't have to do with the manager sucks, the coworker sucks, the patient's suck and all of this thing, we've got to go to all these meetings, we don't like you can control your space. So I think that's part of the empowerment process and having them have a sense of control over their lives and looking at how we do anything is how we do everything.
TaVona Denise: 06:32 Yup. And so once we take a look at that, then they can use the skills that they learned to, to go into other things. And it really goes into thought process too. So a lot of people are holding on to things that they shouldn't be. It's beliefs that they shouldn't. Stories that they shouldn't, grudges that they shouldn't. And we literally unpack that stuff as they start to declutter their homes. And I also found that when I decluttered my home, I mean I have a garage, but when I decluttered my home, when I would come home after a busy day of seeing patients, I was coming home to a space that was calm and that was peaceful and comfortable. And so I wasn't adding stress of ah, God, I gotta go home, I gotta put this away, I have to do this, I have to, I didn't have to do anything when I got home except take the time for myself and relax a little bit.
TaVona Denise: 07:30 And so for me, I felt like that was really helpful in almost like avoiding burnout, if you will, at that stage of my career, which is about the 15 year Mark.
Karen Litzy: Yeah, I think you made an interesting point about the word have to, whenever I hear someone say I have to do something, my antenna goes up because it's a very disempowering thing to think I have to do something and whatever we have to do, we kind of resist. And so part of the resent and resent, right? So the burnout is coming from this resistance like, Oh, you can't tell me what to do. And so if we can just make that subtle shift to I get to do this thing, sometimes just that subtle shift of people thinking that they have to go to work. And this is really important for those who are considering building a business and they need to bridge, they can't just quit what they're doing in bridge, you know, it requires a lot of effort and energy to start a business as you know.
TaVona Denise: 08:28 And so if we have that resistance and that resentment towards our job, that is actually paying the bills, right? We are exhausted at the end of the day and then there is no mental energy or emotional energy to put into our new baby over here. And so just one subtle shift. If listeners can think about anytime they say, I have to go to work, can you find the shift who I get to go to work and really be grateful and thankful. The things that go into work is providing you the opportunity to practice new skills, to make connections, to pay your bills without worrying about what it's doing to fund the software or the whatever that you need to in order to start this other venture.
Karen Litzy: 09:09 Absolutely. And I think I'm so glad that you brought up the get to versus the have to, because I admit I'm a have to girl sometimes and so now I am going to remember to say I get to, because you're right, when you get to, you're coming from a place of appreciation and of gratitude and we all know there's a lot of research out there on how gratitude can make you happier and gratitude can make you successful, can contribute to making you successful. And so I think that's a really important shift. And now what, are there any other, let's say little shifts like that that the listeners can do if they get to that point where they're like, Ugh, work, I don't want to do it.
TaVona Denise: 10:00 Well, one favorite exercise I like to give people, especially if people are just zonked at the end of the day and they like to carry work home with them. One thing I have people do is put a journal or notebook. It doesn't have to be fancy or expensive in the car. And so what it does is when you get into the car, you get the opportunity to let your brain have it. Say they get the fuss out, whoever they want to from the day they get to say everything that they didn't get to say. They want it to say they think they shouldn't have said and all of that on paper. And just that bit of detachment from it. They can more easily evaluated and see the truth or the lie of it. And when they do that one, the brain gets to say it and then let it be done. And I've found that many people have thanked me because in their relationships get better cause they don't go home complaining to the partner or the spouse. The other thing that it does is it gives a clear break from the day. So the brain can say, okay, we're done with work. I've said my say and I can go to the gym, I can go enjoy time with my honey, my children, my whatever. And there is that separation.
Karen Litzy: 11:06 And in your experience in coaching, a lot of therapists, do they return to work? Do they switch gears? Would you, if you were to put a percentage on it, and I know that's probably tough and I'm making you do this on the spot here, but if you were to say, you know, after we came up with better strategies, they found the joy in their work again, or after coming up with better strategies, they were like, Oh, I think I want to do X, Y, Z.
TaVona Denise: 11:34 I think it's so it's an interest in it, but it may be a 25 go back to work and they're excited and they're like, Oh, I'm renewed. 25% is like, thank you for those skills. I want to turn the page to the next chapter of my life and do my own thing. Whatever form comes in. And then there's this 50% that's kind of in the middle and they either don't move forward to practice the skills all the time. And we see this sometimes with fitness and anything in life, right? And I think, and here lately I've been wondering about that person, like what makes that person not move forward? And I've come to understand that that person is very much afraid. So we talked about those over 100 interviews I did last year. And in my note, taking some variation of the word fear came up in 90 something percent of those interviews.
TaVona Denise: 12:34 And I thought to myself, well, what is really going on here? And what I've been thinking about here lately is how we in healthcare are taught to follow certain protocols and we're breaking out of that now, right? So people are not recipes and things like that, but there's still this underlying mentality that we need to have certifications that we need to follow rules that we need to play inside the lines and get it perfect and get it right. Because, I come from acute care background. So things that I do we do could literally kill a person. And so it can be very scary to make mistakes for the rest of us. It's very competitive to get into PT school. We were higher achievers, many of us athletes were used to getting stuff done and doing it well. After you've been in the profession for so long, it can be very difficult to be a beginner again and then be in something that nobody's written out.
TaVona Denise: 13:28 A curriculum to tell you this is how to be an entrepreneur and be successful at it. And so people freeze. And I'm like, Whoa, I know the answer. Let's move forward. What? Why are we not moving forward? And it's something that I've come to understand is what I'm calling the confidence loop. So for example, a person may be uncomfortable in their situation and work, they want to make some kind of change is not really comfortable. They decide that they want to move to the next level. They're going to make some kind of change. The challenge is once they make that commitment, then the freak out occurs and it's like, well, I'm too old. I'm too young. I don't have this. I don't know what I'm doing. So and so failed. Right? So that's the freak out. What it requires is a bit of courage to take the first step and to keep on stepping.
TaVona Denise: 14:18 That part, I call the gauntlet because it's very challenging mentally, emotionally, spiritually, sometimes, physically, depending on what the goal is. But if you can continue taking the moves forward and be consistent, what happens is you find clarity and you find competence. And from that clarity and competence where you know what to do and you know how to do it, people are confident. Like when you know what to do and you know how to do it, you're pretty confident. But when you don't know those things, you're not going to move forward. That can be paralyzing, very paralyzing. The problem is we're so used to knowing what to do. We won't keep invoking the courage to do enough of the things to be clear about what to do in house so that we can be confident. And the interesting thing that I realized about that was that when we were in PT school, that consistency was forced, right?
TaVona Denise: 15:13 We had tests all the time that were given to us when we're in clinicals then should see, I would say go do that manipulation or mobilization or whatever, go take that as subjective like they forced us to do of it. If we decide to do something on our own, it's on us to keep moving through and to be courageous. And so that's what I call that pattern of the confidence loop that I've started to notice is why some people never get started in the first place. And the gauntlet part, that first part where it is where people get stuck.
Karen Litzy: 15:44 Yeah. And that's why people need a coach sometimes to keep us consistent. Right? Like I interviewed Steve Anderson a couple of months ago, so Steve is one of the founders of the Graham sessions. Like I said before, we're in Nashville and he is now doing executive coaching, not necessarily with physical therapists but with different C suite executives. And he was talking about the need for a coach. And one of them is accountability, which leads to consistency, right? And he said there's a reason why Roger Federer, who is one of the best tennis players in the world. You think, what does he need a coach for? He's already great, but he has a coach because that coach keeps him perhaps motivated and consistent and accountable. Yeah. And it's like, you know, we talk about doing exercises and we tell our patients all the time, you have to do this daily. Every other day. You have to be consistent and yet consistent physically, but being consistent mentally still changes the brain.
TaVona Denise: 16:47 Oh, 100% I think the other reason why coaches in the way that I coach people is in finding the blind spots, right? So one form of coaching is to hold a person accountable. Did you do what you say you were going to do? And that forces the consistency so that you can move into clarity, competence, and confidence. One of the things that I'm very good at and work on with my clients where you were talking about the mental exercise of, okay, the courage, where is the fear coming from and can I help shine a light in that blind spot so that you can see that it's not as bad as you thought it was. So the big example that I have is many times when we would do a total knee or total hip replacements, the moment I would open the door to the stairwell, people would freak out.
TaVona Denise: 17:33 Oh yeah. Because the fear of the fear or the anticipation of pain is worse than actually doing the thing. And so part of my job as a coach is to help coach them around that fear of anticipation of pain and to understand where it's coming from so that they can unlock themselves.
Karen Litzy: Yeah, I mean fear is a very powerful emotion and it can take many, many forms, which I'm sure you've seen, like not all fear is, Oh, I'm not going to do that. Sometimes fear could be self-destructive. We could be self destructive to ourselves or to others around us out of fear. And so if you were to give any advice for people who are at that point where they've got everything lined up but they're not taking the step because of fear, what do you say? Well that's a loaded question, right?
TaVona Denise: 18:43 So going back to the journal is a very, very powerful tool if you're not working with a coach and you're trying to do this on your own. But the simple question of what am I afraid of? What am I afraid of? And if you will, after you asked that question, don't just ask it and just have like in your brain, like actually write it down because there is some power in the scene, the written word, and you giving yourself that distance because once it's on the page and out of your head, you can actually analyze it and see is that true and how can I mitigate the things that I'm afraid of happening? So Tim Ferriss calls it fear setting as opposed to goal setting. So what am I afraid of? What's the worst that can happen? And he borrowed some of this technique from stoicism and he asks you to answer those questions for yourself and see, okay, well I'll be out on the streets.
TaVona Denise: 19:39 Well do I have family that I could stay with? He did. He actually went and did some couch surfing for a while before he took the leap. So he went and stayed on people's couches for a couple of weeks so that he could be in that space of is it actually that bad to have to sleep on somebody's couch or eat ramen noodles or something like that. So like what am I actually afraid of and write it down.
Karen Litzy: So, if I'm getting this concept correctly, and you can correct me if I'm wrong, so you write, what am I afraid of? Kind of write those fears. And then what's the worst that can happen if that fear were realized? Is that what you're kind of writing?
TaVona Denise: Okay, that's exactly right. So what am I afraid of? And what if this actually happened and how can I mitigate it? Got it. And he actually goes and practices it so that he can feel like, Oh, that's actually not that bad. Even if it does happen. And that you may even have more resources than you thought you did if your worst fear were realized. So again, I think it forces you to write things out and say, Oh well maybe isn't that bad.
Karen Litzy: 20:48 Or maybe it is really bad. I don't know. I guess it could go both ways. I'm not sure.
TaVona Denise: 20:54 Well, they could. So one of my mentors says, whenever you choose to do something or not to do something, make sure you like your reason.
TaVona Denise: So, so many people are one, unclear about what they want in the first place. And two, if they know what they want, they're just not taking action, but they can't articulate why. So I just think if you can just start with that, those two simple questions that will give you a lot of information to get started with. You can find your why right. In some minuscule way in your life. Right? You can kind of find that why, which is often elusive to too many people. Yeah, I can because a lot of people, I think that's another thing that I've found is just the simple act of asking you what do you want? Many people are quick to tell me what they don't want and when they're very clear on what they don't want, but they can't tell me what they do want, they're also not going to make a move.
Karen Litzy: 21:53 Got it. So all of these little tricks that we play in our minds can work against us in so many ways and we don't realize it until we either, like you said, journal it, write it down, have an external eye, take a look at what you're doing to kind of shine that blind spot right into your face so you know what's going on. And then also just, I think, like you said, decluttering and really getting to the bottom of why at this point in your career, are you feeling the way that you're feeling? Trying to recap a little bit here. Yeah. Is that good? Okay. All right. So now in before we kind of wrap things up, I have a couple other things to ask, those were the key takeaways from our conversation, but what do you want the listeners to really kind of take with them?
TaVona Denise: 22:50 I think we hold ourselves back unnecessarily. So I think it would be, if I were to give you like a step-by-step, if you will, a rough step-by-step is to one, figure out what you want, understand why you wanted, because the understanding of why you want it will help you move in the face of fear. Just like when we went to PT school, we had, there was a lot of fear involved and we moved through it anyway because we had a reason, right? So know what you want, know why you want it. Understand that fear is allowed to drive, ride the bus ride side car, but not allowed to drive the bus. And it's really going to be okay if you think about that confidence loop and I can share a diagram with you so that people can actually see a visual of it. But if you think about it, if you just keep going, you will get there. If you just keep going, you'll get there.
Karen Litzy: 23:53 Yeah. And I think to that point in a digital age where everything happens at the speed of light, that can be difficult because what if it takes longer than you think it should take? Right. So expectations, let's talk about that for a second.
TaVona Denise: 24:14 Yeah. Because speed of light microwave society, here's something that I've been noodling over here lately. We want our business to take off like in 60 to 90 days. And Jen and I were talking about that today. Oh yes. And I was just thinking about this, like, why is that even fair? You need to learn marketing. You need to learn sales, you need to build an audience. I mean, there's so many pieces that you need to learn. If you would just flip the switch. So from have to versus get to right. Here's another little mental switch. What if it was just like going to PT school? So what's the average length of PT school now? Is it two and a half, three years? Yeah, so let's just say three years. What if you just said, I am going to learn what I need to learn all of these pieces of business and I'm going to not expect anything for three years and if I'm not as consistent as I was in PT school, which is full time, I don't think anybody can work and do PT school. If I am not putting in that amount of hours in that amount of effort that I did in PT school for three years, then I need to add a year for however much time and effort I didn't put in. If we can do that and give ourselves the mental space, time and grace, if we thought about how hard we worked and how long we worked in PT school and apply it to business, nobody should expect anything before three years of full time work and then it'd be great if it happens in a year.
Karen Litzy: 25:45 Yes, I agree. I think oftentimes people are fed false hopes and expectations in marketing ploys and whatnot, and that's just not how it works. It just, it just doesn't work that way and you got to work at it. And I think I agree with you. I think your expectations have to be realistic and to have a successful business in 60 to 90 days is not realistic. It's just well put, it ain't going to happen. Not a chance. Yes. So expectations are huge. Thank you for touching on that. Okay. Did we miss anything?
TaVona Denise: 26:25 Not that I can think of.
Karen Litzy: 26:26 All right. Cool. Cool. All right, so then the last question before we get to how people can get in touch with you is knowing where you are now in your life and in your business, what advice would you give to your younger self as a graduate out of PT school? So this is advice to you from you, from future you, to past you from future. You got it?
TaVona Denise: 26:57 Mmm. Don't be afraid to take risks. It's all going to be okay. The things that you think were for you that don't work out actually happened for you.
Karen Litzy: 27:19 Excellent. Excellent. So again, going, looking back, you can say to yourself, man, I was so upset that X, Y, Z didn't work out. But look where I am now.
TaVona Denise: 27:31 Oh yeah, yeah. If I didn't get that great management position that I thought I was going to get. I wouldn't have gone to Costa Rica to Spanish immersion school if I didn't. If I got the other management position that I thought I was going to get that I didn't get, I wouldn't have written a book. I wouldn't be here talking to you all today.
Karen Litzy: 27:49 Amazing. What great advice. I love it. Now. Where can people find you and find out more about what you do?
TaVona Denise: 27:55 Yeah. you can find me anywhere on the web at TaVona Denise. I'm most of the time on Facebook, sometimes Instagram and Tavonadenise.com.
Karen Litzy: 28:11 Perfect. And just so for all the listeners, we'll have links to all of that under the show notes for this episode at podcast.healthywealthysmart.com one click will take you to everything that TaVona has an and can offer to you. So TaVona, thank you so much for coming on. This was great. All right, and everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Howard Luks on the show to discuss knee osteoarthritis. Dr. Howard Luks, MD is an Orthopedic Surgeon practicing in Westchester and Dutchess Counties in New York. He specializes in the management of complex knee and shoulder injuries with a focus on ACL injuries, Patella Dislocations and Shoulder Instability.
In this episode, we discuss:
-What is knee osteoarthritis and how is it diagnosed?
-Modifiable risk factors for developing knee osteoarthritis
-Indications for a total knee replacement
-The importance of managing expectations for good patient outcomes
-How to strengthen the physician therapist relationship for more patient centric care
-And so much more!
Resources:
Howard Luks Website
Howard Luks Twitter
Howard Luks Facebook
Howard Luks Youtube
A big thank you to Net Health for sponsoring this episode!
Check out Optima’s Top Trends For Outpatient Therapy In 2020!
For more information on Dr. Luks:
Howard Luks, MD - @hjluks - is a patient centric, Orthopedic Surgeon who has been in clinical practice for 20 years. Dr Luks utilizes his passion for patient engagement and his expertise in medicine and social media to educate a global audience through his website, twitter, facebook page and YouTube channel. He serves as a consultant, board member and adviser to many companies in the mobile health, online health platform, and medical decision making start-up spaces. He served on the External Advisory Board of the Mayo Clinic for Social Media - a recognized leader in this space.
“Technology is not about replacing physicians ... instead, we must remember, change brings opportunity — and we must use these changing times to scale great physician thought leaders.” - Howard Luks
Howard Luks, MD (@hjluks) is an Orthopedic Surgeon practicing in Westchester and Dutchess Counties in New York. He specializes in the management of complex knee and shoulder injuries with a focus on ACL injuries, Patella Dislocations and Shoulder Instability.
As an early adopter of Twitter, Howard Luks MD also runs a blog (>100,000 unique monthly viewers), a Facebook Page, a YouTube channel and a personal site to educate, interact and engage a worldwide audience.
Read the full transcript below:
Karen Litzy: 00:01 Hi, Dr. Luks. Thank you so much for coming on the podcast and really looking forward to this today.
Howard Luks: 00:06 My pleasure, Karen. I'm looking forward to it too.
Karen Litzy: 00:09 Okay. So today we're going to be talking about osteoarthritis. You had a great tweet thread back in, I believe it was the end of June, beginning of July, 2019 on osteoarthritis and got a lot of positive responses from people and I really wanted to talk to you a little bit more about osteoarthritis. First thing is what it is and what it isn't. So I will hand it over to you.
Howard Luks: 00:40 So the reason why I decided to put that thread up was based on the fact that I keep hearing people become worried thinking that their body is wearing out and that our arthritis is a mechanical process and wear and tear process. So they're going to stop walking. They're gonna stop riding, they're gonna stop running, they're gonna stop their exercise. So in other words, they're going to increase their risk of dementia, heart disease, hypertension, diabetes, and other metabolic disorders because they think they're saving the lifespan of their knee. So in order to get across that osteoarthritis is really a biological process where the articular cartilage is starting to degenerate for various reasons and that their activity actually, if anything is beneficial is what led me to write that whole series of tweets. And I followed up with another one a few months later. That then started to throw in all the exercise patterns and activities that people can in fact pursue, especially with respect to runners. See, since I seem to attract a lot of runners, I wanted to be known that running is not damaging for a knee that doesn't have any significant mechanical issue or is recovering from a fracture.
Karen Litzy: 02:22 And when we talk about osteoarthritis, oftentimes people will come to us as physical therapists and they'll say, Oh, well, you know, it's bone on bone. That's what the x-ray shows bone on bone. So how do you respond to that? And how should a physical therapist respond to the patient in those scenarios? And in a way that doesn't undermine the physician that referred them to us, but being consistent with the evidence.
Howard Luks: 02:51 It's quite a challenge, right? I mean, yeah. The interesting thing I always talk to our residents about is that, you know, I'm 56 now and I'm just starting to get really good at patient interactions and discussions and conversations in the office just in time for me to retire. And I talk about the fact that words harm, images, harm, and you really can't unsee your MRI or xray report. So it all comes back to communication and education. And that's one of the biggest problems in healthcare today, right? We're RVU driven. You guys are strapped if you're a network, you know, you can't make a living of $40 per hour. And so we're all seeing more people in less time and that really threatens our ability to have a good, actionable and meaningful conversation with people. Yet it's absolutely critical that we do so.
Howard Luks: 04:02 So if I put an X Ray up showing bone on bone arthritis, I then immediately enter into a conversation about how you really treat people, not an image. And that even though they're bone on bone, you know, most likely I'm talking to someone who doesn't have severe quality of life limiting knee pain more often than not, and you know, a bone on bone knee that's relatively dry, meaning it doesn't have a significant effusion, it's really not going to be too terribly painful. You know, the bone itself isn't what hurts, you know, bone marrow edema hurts, synovitis, hurts. But not the bone itself. So I explained that I've run with people that I know have bone on bone arthrosis yet. I explained that I've also replaced knees in those with less severe arthritis because they had severe synovitis or bone marrow lesions that just wouldn't go away.
Howard Luks: 05:16 So it's important to talk about the fact that the xray has only one small part of the overall evaluation and a very small part in determining what the treatment or treatments could be or should be. And that it really it's their story. It's their history, it's what they're telling us. And you know, when it hurts, how often it hurts and how severe that pain is. That's more important in terms of how we craft our treatment plan. And when, you know, I had a patient today actually asked me, well, when, when do you know, as the patient, when do you know that you need to have a joint replacement surgery and we'll stick with the knee.
Karen Litzy: 05:58 So when your patients come in and they asked you that question or you talk to them about the possibility of a total knee replacement or a partial knee replacement, what do you say and how does the patient know?
Howard Luks: 06:23 Huh, that's a great question. And it's one that I'll get probably 15 times tomorrow so the discussion usually goes as follows. It's, you will know you're going to wake up one day and say, I just can't take this anymore. I've tried X, Y, and Z. I've done my exercises, I've lost weight, I have adjusted my diet. I've tried over the counter medications, Savage's bombs, ointments, suction cups, tape and everything else that their friends have told them to try and their pain is limiting their quality of life. So that's, you know, a very important part of the decision making process is you have to dive into their goals, right? You can run into a lot of trouble with people between 40 and 65, 40 and even 70, depending on how active they were, because you might have someone who's miserable, but it's simply because they can't play singles tennis anymore.
Howard Luks: 07:37 Right? It's like having someone with shoulder pain in your office because they can't hit a second lob as like they used to. You know, that person who's going to be really unhappy with the results of surgery. Same with the knee replacement in someone who can't play a second set of tennis but could easily finish, you know, a three set doubles match. So we have to determine when the patient feels that their quality of life has suffered long enough that they wish to move forward. Then we need to dive into what their goals are. It should be simply that they want to get through their day without this horrible knee pain. Because if it's anything other than that they may not be all that satisfied with the end results of the surgery.
Karen Litzy: 08:33 Yeah, that makes a lot of sense. There's a big difference between the person who's having trouble walking from, you know, their bedroom to the bathroom or like you said, the person who can't get in another set of singles tennis. They're very, very huge quality of life differences there. Although that second set of tennis might be disappointing. It's different than not being able to walk a block.
Howard Luks: 08:57 Correct. And we know, you know, both of us know there are significant number of knee replacement patients who have persistent pain after surgery and who are not happy with the overall results. And many times that might trace back to false expectations. So it's a really important discussion to have. And we also know there are many different patients out there. You know, there are some who have achiness and pain when they roll out of bed, but by the time they're done with their morning shower, they feel fine. Yet those people, some of those people might tell you that they want to have their knee replaced. So again, it's really important to dive deep into the reason why these people want to move forward and what their goals are.
Karen Litzy: 09:54 Yeah, I think that's a great point. Thank you for that. And now I just want to go back to one thing. When we were talking about osteoarthritis, one thing we didn't talk about were factors that may lead people to be at risk for osteoarthritis. Do we know what some of those factors are? And if so, are they modifiable?
Howard Luks: 10:14 Sure. So first, you know, the, the big category now that requires everyone's attention is our metabolism. You know, we are bombarded daily now, especially on Twitter with all the ELA facts associated with a typical or standard American diet full of ultra processed foods. I'm not gonna get close to the Quito vegan world and subdivided. However, it's really important that people start to read this literature about the dangers of ultra processed foods. It's very clear that a calorie is not a calorie and that a hundred calories of ultra processed foods versus a hundred calories of real food is going to have very different metabolic affects on us. And we're finding that people with high homocysteine levels have a higher incidence of heart disease, cardio metabolic issues as well as joint related issues. We're finding the same with uric acid levels, which will my car lay with your fructose intake.
Howard Luks: 11:38 So high fructose corn syrup, we find a correlation with lipid disorders and the prevalence of osteoarthritis people's weight will certainly have an impact. A lot of people don't know that what each step you take, you're putting, you know, five to seven times your body weight across the knee with each step. If you're achieving 10,000 steps a day, you weigh 250 pounds, you have an extra 60 pounds on your knee across 10,000 steps. That's a lot of an added weight across that knee. Now for those who do not have osteoarthritis already, that might not initiate the process for those in whom the process has started. An MRI studies on asymptomatic people show that the process has started in a majority of us over 50, then that excess weight and force or stress burden is certainly going to increase the risk of developing a more rapidly progressive arthrosis.
Howard Luks: 12:50 Now by far the most common causes are genetics and people with structural issues. So a varus or Bodine or valgus or knock kneed that will set you up for unit compartmental changes or changes in either the middle or the lateral compartments. Why we seem to see a pretty severe patellofemoral disease and in some middle aged women, I'm not exactly sure, perhaps it's some degree of underlying map tracking. But in terms of the modifiable risk factors, without a doubt, our weight, our activity level, it turns out as we, as we just said, that's right. This is less common in runners. Cartilage likes that cyclical loading and likes to be exposed to force in a cyclical manner. I think we hit on many of them.
Karen Litzy: 13:54 Yeah. And then the only other thing I can think of is previous surgeries. So we know like ACL having an ACL surgery or ACL disruption, the majority of those people do develop osteoarthritis later in life. Especially if you're, you know, most of them happen when you're younger, usually.
Howard Luks: 14:13 True. So you're absolutely correct. So upwards of 50% of people who have had an ACL tear will go on to develop arthritic changes. Even having just one Hema arthrosis, you know, blood in your joint elevates your risk of developing osteoarthritis because it changes the chemical compounds that's present in the knee. Once that has happened, now you'd go ahead and you add a mechanical issues such as a meniscus tear and your risks really start to go up dramatically.
Karen Litzy: 14:54 Yeah. And, I mean I have seen patients in their forties you know, who have had multiple ACL reconstructions on their knees cause they were high level athletes in their younger years. And those are people who, you know, we were talking about the people who can't play tennis versus the ones who are having trouble walking down the street. Those are the people that are having trouble walking down the street and they know it, but they're doing everything they can to not have the surgery as well. So it's, it's an interesting group.
Howard Luks: 15:25 Correct. And they're not harming themselves. I don't care if you're limping if you can get away without having your knee replaced, you should do so.
Karen Litzy: 15:37 Absolutely. Absolutely. Certainly, certainly I think, you know, oftentimes people will hear, Oh, it's knee replacements are not that bad. It's not like it was years ago, but I mean, it's not great.
Howard Luks: 15:49 Huh? Yeah. So there's, you know, the only surgery without risk is a surgery on somebody else. Yeah. If you're assuming an infection after a knee replacement has a low incidence, right. A 0.7 0.8%, but it's a life altering permanent problem. You know, you're going to need one to three operations to try and eradicate that infection. And if it's a nasty bug, it's going to end in an amputation. So, you know, are there a lot of amputations that happen each year because of knee replacement infection? No, but there are not zero. And there are a significant number of people who have persistent pain. I've looked, I perform a lot of knee replacements and I think it's a great operation for the right person. So there are significant upsides to a well functioning knee replacement and the vast majority of people are not going to get infected. However, when you start to push indications and you start to stretch them if you get into trouble with one of those people, that's an awful place for them to be.
Karen Litzy: 17:06 Yeah. Yeah. No question. No question. And now what I'd like to do is we've got a couple of questions from listeners that some of them are about you in particular and the way that you practice others. Again, continuing on the osteoarthritis subject. So one was from physical therapy and they're all from physical therapists. Gina Kim said, how do you set expectations for patients, especially for active busy ones, that conditions such as osteoarthritis, frozen shoulder can take months to resolve or can be something that you're managing, let's say. Because I would say osteoarthritis is something that you're managing.
Howard Luks: 17:49 Correct. And sometimes the frozen shoulders too. So any of our patients with these longterm chronic conditions can get into trouble, especially when they're used to being high level weekend warrior as an athlete. The, you know, my goal is to keep that runner running. And most runners, if you sit down and say, look, we don't think that arthritis, we know that arthritis is most likely not caused by running. We really don't think that you know, running five miles at a reasonable pace is going to cause her arthritis to worsen more than it already has and more than the normal disease course will worse than that. So we think it's okay for you to keep running. 90% of real runners are going to take that and run with it, so to speak. They are not going to stop. And there's really no reason for them to stop, cut, stop.
Howard Luks: 18:54 Cause a runner that stops running is not a whole person anymore. It's really embedded in our psyche. They're very unique people to deal with. So oftentimes we’re seeing a runner with a little swelling after a run, we're seeing them a little, a little achiness and pain the next day. Perhaps they can't run as fast as they used to or they have pain going down Hill. So they will very readily work with you. So what I will immediately start doing is dive in to their typical week. How many miles are they running? What pace are they running, what zone are they running in? Are they Hills or are they technical trails and the carriage are they road? I don't necessarily push people onto trails or onto roads but I might pull them off a technical trail or off of steep Hills. And I'll try to work with them. Craft a workout pattern and running strategy with them that will lead to very much acceptable or tolerable levels of knee pain. And then once they understand that the etiology of a cause of their arthritis and they understand you really didn't do anything wrong, it's not the running that led them to this point, most are okay and most will fight through again, a reasonable level of discomfort in order to allow them to run.
Karen Litzy: 20:35 Yeah, and I think that's the last thing you said is so important because oftentimes when people have more persistent pain, and I can say this from my own experience is when, when we, I guess I can say we, I'm part of that group. Oftentimes when we do things and it results in pain, we think that we're causing more damage. And I think it's really important that last point that you made that, Hey, listen, you might have a little bit of pain, a little bit of swelling, but from what we can tell, we know this isn't doing further damage. It isn't sort of creating more wear and tear. And I think that's really important to get across to the patient.
Howard Luks: 21:16 I agree. I mean, if I start to get stress fractures and stress reactions and book painful bone marrow edema, lesions, you know, I'm going to change. But as I alluded to earlier, you know, imagine a runner who stops running out of fear not because of the level of pain. You know, they're now increasing their risk of any number of chronic diseases, right? Alzheimer's and heart disease and hypertension, diabetes and on in the, you know, in the hope that maybe they're going to save their knee and save the knee from what? So if, you know, a lot of them, even if, even if we knew that running caused it, they would sacrifice their need to keep, you know, their head clear from the benefit that they derive from their weekly run.
Karen Litzy: 22:21 Yeah, they're a motivated bunch, that's for sure. And, and motivated because like you said, it's the running. So when you're a runner, it's your running that allows you to do the rest of the things in your life. That may be work. It may be dealing with family, it may be dealing with colleagues that keeps your head clear. It could be meditative. So you're taking all of that away by saying you just have to rest. You don't, you shouldn't run anymore.
Howard Luks: 22:46 Correct.
Karen Litzy: 22:47 Dangerous. Okay. Dangerous stuff. So let's go onto another question, Miranda Henry, and I think this is a nice question is how do you see the evolution of the patient doctor physiotherapist role in the care of osteoarthritis? Cause we know we've got baby boomers getting older, osteoarthritis is most likely going to be more prevalent. So how do you see that evolution of care from those roles?
Howard Luks: 23:15 Sadly, in this environment I see it dwindling, which is really unfortunate, right? Because it should be increasing. There should be a direct electronic or otherwise communication between our offices. You know, we both have these five page electronic medical record nightmares that our office produced that we fax to each other, you know, for signatures to send back. Yet it doesn't have much actionable, useful and meaningful information. I have a number of a number of therapists who are my go to people in my region. And you know, we're on the phone a lot. Trying to share details about certain people in terms of progress yeah. Or roadblocks or other issues and what and why they're sending them back or why they're not. And it's, you know, an open channel of communications is just so critical. And we just have to keep in mind regardless of how busy and crazy our lives get as healthcare providers, that it really is a patient's life and wellbeing that's sitting at the end of these phone calls and things that are easily perceived as nuisance irritation. And so yeah, it is worth it in the end to go the extra mile and make that phone call.
Karen Litzy: 24:51 Yeah. And I think you just answered that with that answer. The next question is what do you see as the best way for that PT doctor patient to align themselves for best patient outcomes? Which I think you just answered. Just having good communication channels and being able to keep in mind that the patient is at the center.
Howard Luks: 25:13 Correct. Yeah. Can't forget that.
Karen Litzy: 25:15 No, that makes perfect sense. I think you just answered it. And then finally, this is from Mark Rubinstein said what or who inspired you in your holistic approach to promoting health? Combining traditional orthopedic medicine with sort of lifestyle medicine?
Howard Luks: 25:32 Ha. Good one. As I alluded to, as I said before, you know, you start to get much better at determining talking to people, listening to people asking the right questions. You know, my exam starts when I watch them walking in the hallway, you know, before you sit down on your stool, you know more about that patient. Then half the words they're going to say are going to tell you and you learn how to craft your messages and craft your, you know, your treatment plans accordingly and you find out that non-surgical management is often really effective. Then you realize, okay, you're 56, you know, what are you doing to change your life? So, you know, probably about six years ago I started to optimize my own lifestyle for my, not only longevity but health span, right? I want to go to the very end, hopefully running and then just drop off. I don't want to spend my last 10 years on cane's going to doctor's offices, being hobbled, being frail, et cetera. So as I started, you know, a lot of the more recent blog posts that I've written, I've just done in an effort to help me learn the topics.
Karen Litzy: 27:12 That's a great way to, it's a great way to learn.
Howard Luks: 27:14 Right? Because I'm pulling all these papers and I'm doing all this reading. I might as well write it down on my website and share it. And so it started with my diet and then it started with a sleep. I read Matthew Walker's book and then it started to, it was exercise and muscle mass and atrophy, sarcopenia and everything else written about. And then you start to dive into the metabolic literature and you realize, Hey, you know, this is really important for our patients. And that's another motivation to get it up and get it on the website. And as we all know, it's really hard to change many people's habits, but if they have actionable information, if they have a thorough understanding of why they need to do this I'm getting a lot further with people in terms of committing them to dietary change, lifestyle changes, activity changes than I ever had in terms of success before in my career. And I think maybe it's just cause I'm communicating it better and perhaps cause I'm leaving it up on my website for them afterwards to revisit and share it amongst their family.
Karen Litzy: 28:48 Yeah. And they can kind of take a deeper dive into it after they leave the office and say to themselves, Oh, okay, now I think this is making more sense. Cause like we've all been to doctors. I mean sometimes you go in and you're like, Oh man, I really wanted to ask this question and I didn't. Or Oh he said this thing but I forgot. And so to have that backup on your website I think is probably really helpful. And like you said, is most likely helping you get some greater buy in from your patients do I think is fantastic. And I think it's also important to note that when you're writing that you're, at least, this is what I get from your writing style, is it's very relatable and approachable and it's so, it's very, I think patient forward.
Howard Luks: 29:33 You'd be amazed at the comments that I get from editors editors or publishers or writers through channels, how unhappy they are with my writing style. I'm like, just, you just have to leave it alone. It is what it is.
Karen Litzy: 29:50 Yeah. And if it's relating, if it's relatable to your patient population, great. Correct. Great. All right. So before we wrap up, what are the big takeaways you want people to leave with this discussion today?
Howard Luks: 30:06 So yeah, in an effort to save your knee, don't throw the rest of your health under the bus. You're not gonna save your knee. You can't stop arthritis from progressing. You can't cure it. You're not gonna waste your money on $10,000 in STEM cells cause that isn't going to work. You will know the day that you need your knee replaced. And hopefully your surgeon or therapist will help you better define what your goals can and should be following a knee replacement. Don't forget how important our entire lifestyle is in shaping how much pain we are going to have, how long we're going to have that pain and how long we're going to suffer with it. Our sleep matters. Our diet matters, what we stick in our mouth matters and our activity levels matter. If you don't optimize for your wellness today, you're gonna end up preparing for your illness and frailty later. So there's no better time to get moving.
Karen Litzy: 31:18 Great advice. And now last question I ask everyone is knowing where you are now in your life and in your career, what advice would you give yourself as a newly minted doctor? A new graduate from medical school.
Howard Luks: 31:34 Yeah. you're not as good as you think you are. Right? You know, all these young docs on Twitter, I get a kick out of them, you know, they're great, but, and I wasn't any different. You know, the world is far more black and white when you're younger then as you get older but yeah, pay more attention to your elders. Pay more attention to your patients. You don't always have the right answer, you know, and just be willing to admit sometimes you don't know. And then look for the person with the knowledge and experience who can help you.
Karen Litzy: 32:22 Great advice. Now, where can people find you if they want to read your blogs and find you on social media? Very important.
Howard Luks: 32:28 Just put my name on Google. I think I own the first 10 pages.
Karen Litzy: 32:33 Perfect. And we'll also have links under this episode at podcast.healthywealthysmart.com So if you want to get all of Dr. Luks’ info, it'll be right on the website here as well. Awesome. All right, well thank you so much for taking the time out. This is a great conversation and I hope you have a great start to your 2020. And everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Ryan Burklo on the show to discuss financial planning for small business owners. Ryan Burklo, RICP® is a financial planner, host of the podcast Holistic Finance, and co-owner of Quantified Financial Partners. Through his work as a financial planner, he works with medical practice owners to protect their practice, keep them financially efficient and assist with their eventual exit.
In this episode, we discuss:
-How to manage debt financing and make it work for you
-What is tax efficient cash flow planning?
-Retirement options for small business owners
-The conversations you need to bring up with your financial advisor
-And so much more!
Resources:
Quantified Financial Website
Holistic Finance Podcast
Ryan Burklo Twitter
A big thank you to Net Health for sponsoring this episode!
Check out Optima’s Top Trends For Outpatient Therapy In 2020!
For more information on Ryan:
Ryan Burklo, RICP® is a financial planner, host of the podcast Holistic Finance, and co-owner of Quantified Financial Partners.
He lives in Seattle, Washington with his wife and two kids. After learning his son had a stroke while in utero he became an avid volunteer for Pediatric Stroke Warriors. He learned much about the medical professionals who cared for his son and truly enjoyed working with them both on a personal and a professional level.
Through his work as a financial planner, he works with medical practice owners to protect their practice, keep them financially efficient and assist with their eventual exit.
His firm and his personal mission is to simplify finances so that you can focus on what you enjoy most.
Read the full transcript below:
Karen Litzy: 00:01 Hey Ryan, welcome to the podcast. I'm happy to have you on.
Ryan Burklo: 00:06 Thanks for having me. Appreciate the invite.
Karen Litzy: 00:08 Yeah. And you know we're getting onto the end of the year and people are starting to think, look back on the year, look forward to next year talking about their businesses and maybe how they can move forward, expand, stay the same. Lots of stuff. But today we're going to talk about kind of the business side of things. And I absolutely love having people like you on the program because I didn't go to school to be a financial planner. I don't, I don't know what I, you know, this is not my specialty. So I love having folks like you on because I feel like I learned so much from you guys, plants and seeds in me that make me think, Hmm, maybe I need to make some changes in my practice. So thank you for coming on. Cause I'm definitely excited.
Ryan Burklo: 01:06 Yeah, I again appreciate being on. I actually started laughing when you said you didn't go to school to be a financial planner cause I was about to say neither did I. I think very few of us actually go to school to officially become a financial planner. I think it just kind of molds it's weighing falls into our lap. You know, life's events occur in the next, you know, you're, you know, you're in the industry and so it's very interesting. Had you told me that I would be a financial planner when I got out of college, I would have said you're drunk. I love what I do.
Karen Litzy: 01:41 Yeah. And here you are helping and I should mention that you do work with a lot of medical practices.
Ryan Burklo: 01:50 Yeah, that's really a majority of our focus is helping medical practices on the business side and merging that with the person side. Cause eventually we all exit our practice in some way, shape or form. And it turns into the personal side. So, you know, the two are married, yet business owners tend to only focus, they focus more on the business side because you know that that's the fun side. That's what they do every day.
Karen Litzy: 02:19 Exactly. Exactly. And so it's great to have people like you guys to help guide us through that. And now, you know, I've been taught, this has been in the news quite a bit. I had, you know interviewed someone a couple of weeks ago about debt and we hear debt a lot in the news. Mainly the focus is student loan debt, but there's all kinds of debt, right? And when you're a business owner, you may be in debt, you may not be in debt. But my question is, can debt work for you? Can it be a good thing sometimes.
Ryan Burklo: 02:56 Yeah. Yeah. I mean the quick answer is absolutely yes. You know, you brought up the media and everything we're hearing in the news and right now it's a lot of student loans. But you know, oftentimes there's also, you know, just debt is bad is the mantra and you should pay it off as fast as possible. And in some scenarios that makes sense in other scenarios that doesn't, you know, really depends on what kind of debt it is. You know, credit card debt for the most part isn't the best that I have because it tends to be high interest rate, right? You're getting in the double digits, 16, 17, 20% or so. But then there's other debts. Student loans can be one of them. You know, mortgages on real estate and other debts that are lower interest rates and you have to look at it at, if I'm going to put a dollar towards that debt, if I put my dollar elsewhere, how would that act?
Ryan Burklo: 03:52 How would that do differently? Right? And so the simple example of that is, you know, right now you can get a mortgage really, really inexpensive, you know, 3.8% or something like that on a 30 year mortgage. And so if your dollar can be put back into the business or put elsewhere and beat 3.8 at a relatively low low risk, well then you'd be better off putting your dollar elsewhere. Cause then you'd be making money on your money so you're leveraging that debt so your money can work harder. Whereas the credit card debt that I mentioned, you know it's a 20% interest rate. Well now I used to be 20% that's a lot harder and the risk is a lot higher.
Karen Litzy: 04:38 Got it. So, so for instance, if you take on the debt of a mortgage, whether that be, you know, let's say you bought a building for your practice or you bought space for your practice and like you said, the interest rate is 3.8% then that might be a good thing for your business because you're putting that money to better use for you or the equity is in the building is good. Is that kind of what you mean?
Ryan Burklo: 05:07 Well, to put it in another way, if you had $1 million of cash or $1 million sitting somewhere and you went to buy real estate and real estate was worth $1 million, we get to put the whole thing down, the million dollars sitting wherever it's sitting versus getting a debt and having to pay interest on that debt. You have to analyze what could that million dollars would be doing for you, and if that million dollars could be doing something better than a 3.8% yeah, we were just talking about why would you give the full million dollars to the bank. Got it, got it. And then you have the flexibility between it. All, right? Even if you're, maybe if you're just breaking even some people will get nervous about that too. We'll, again, you've got $1 million. How much more can you do with other stuff in your business because you've got that rather than just giving it to the bank, what type of flexibility do you possibly lose?
Karen Litzy: 06:15 Got it. Got it.
Ryan Burklo: 06:16 So that's just a simple example that I like to use. And that's not to say that you shouldn't pay off some debts. It does go by case by case, but you have to look at what your dollar could be doing elsewhere. And does that make more sense rather than only looking at it, well, Ryan, I'm going to pay more interest over 30 years. That's 100% true. And what could that dollar the other dollars be doing over the next 30 years?
Karen Litzy: 06:42 Got it, got it. So it could mean the difference between investing it into something that's going to give you a higher return or putting it to use elsewhere instead of hiring another doctor.
Ryan Burklo: 06:54 Well, another position that's going to grow revenue by X percent, that might be the better solution.
Karen Litzy: 07:04 Got it. Got it. See, this is why, you know, my brain does not work this way. This is why I need someone to kind of break it down and explain it to me as if you were explaining it to like a fourth grader.
Ryan Burklo: 07:18 Yeah. Well, my industry doesn't like to do that, but we like to confuse people. I try to make it as simple as possible because that annoys the crap out of me.
Karen Litzy: 07:25 Yeah. I appreciate that. All right, so that's a great way that we can kind of make debt work for us. If you have, are there other ways, I guess that you can make debt work for you? Any other easy, simple examples?
Ryan Burklo: 07:48 I threw a couple of examples just in that one. It's really about, again, it's just leveraging what you currently have. And so if you can get a loan, well, you know, let's just say we have a bit of a widget maker, right? And the widget maker needs to buy a machine to make more widgets. And they've got, they can go get a loan on it for X percent or they can just buy it in full. Well, what makes the most sense for your business? How are you leveraging your money to make it work as hard as possible for you? So it's a constant analysis of leveraging where the leverage is. Does it make more sense, can your money work harder outside of giving it to the bank?
Karen Litzy: 08:43 Got it. Yeah. So if you were to pay in full and you can make more widgets and sell more widgets to make more money, that might make more sense than making payments on that piece of equipment.
Ryan Burklo: 08:54 Exactly.
Karen Litzy: 08:55 Got it. All right. Excellent. Now I got it. Thank you so much. Sorry for being a little slow on the uptake there. Now the other thing that I really wanted to talk about is this idea of tax efficiency, cashflow. So in going through your website, I saw this and I thought, hmmm.
Karen Litzy: 09:16 This is really interesting to me because I don't know that I'm being as efficient as possible. So can you explain what tax efficiency cashflow means under the lens of, you know, your small business owner?
Ryan Burklo: 09:31 Yeah. So there's two sides of taxes, right? There's the taxes that you're going to pay now, right. Where the income that came in the door minus the deductions and everything that we can take as a business owner, what's leftover and what we're going to pay on taxes from that on the business side as well as from the income side and that's based on the rules and laws that are in place this year, 2019 then there's the tax side of what am I going to get taxed on 15 years from now, 10 years from now, 30 years from now, depending on where my money and my assets are sitting. That's the side that most people don't really consider because what they're only considered is I want to pay as little money in taxes this year.
Karen Litzy: 10:21 Yes, yes. Right.
Ryan Burklo: 10:24 So the next question you have to ask yourself, okay, 10 years from now or five years from now or whatever time period that is, where do I think taxes are going to go? And obviously we can't predict this. Oftentimes it depends on who's in office and what's going on in the economy, all that kind of fun stuff. But if you're of the opinion that taxes are going up, should you have a lot of money and assets where you have not paid taxes on yet?
Karen Litzy: 10:54 Yes. All right. I got it right.
Ryan Burklo: 10:56 Yeah, exactly. Because you've deferred the tax. So essentially if it taxes went up, now you're gonna pay more in taxes. Conversely, it taxes go down within, you wanted to defer the tax. And the problem is, is we don't know. And so much of this is,
Karen Litzy: 11:11 It's a gamble.
Ryan Burklo: 11:13 It's a balance is what I put in. So we talked about financial balance quite a bit and it's because we don't want all of our eggs in one basket, right? We don't want all of our assets to be tax deferred because what happens if tax go up? Conversely, like I just said, if taxes go down. Whereas we have our assets in different buckets now we can actually control what tax bracket we're in five, 10 20, 30 years from now. Just like kind of what we're doing right now in terms of lowering our tax bill this year.
Karen Litzy: 11:47 And so when you're looking at balancing and not having all your eggs in one basket, where would those eggs be?
Ryan Burklo: 11:57 Yeah, so it depends on what you're building in your medical practice or in your business. If your plan is, you know, take a solo practice, you know, at one doc and you know, the chances of a one doc practice being able to sell it is not very high, especially they're required. They're the ones that bring in the money anyways, right? You can't sell something if you're the person that you're trying to sell. So oftentimes those types of practices, they have to build side retirement accounts. Okay. Right? These are your traditional IRAs, your simple IRAs, your standard retirement accounts. And so you could be putting a bunch of money into those accounts where you deferred the taxes. So that's one asset. But we could be talking about, it's also an event. Conversely, if you've got the multiple doc practice, we've had a couple of partners and maybe it's an inside, say on, you're actually transitioning one doc out. Well, how do you consider the taxation of the business? What's the cost basis, and then how are we going to sell it? Oftentimes in insider sales, what they call that, oftentimes no one writes a lump sum check and says, here you go, doc, you're gone. It's normally let me pay you in installments over the next 10 years. I see. Okay, so now you have more taxes going on there.
Karen Litzy: 13:27 Oh, cause you, yeah. So you, if you are the doc that left the practice, you're paying taxes on that money that is coming to you in installments.
Ryan Burklo: 13:37 Correct. And if you're the doctor bought them out to pay that doctor, you need the revenue of your practice to be doing a certain amount. So there's taxations on both sides of that equation.
Karen Litzy: 13:50 Right, right. Oh my gosh. These are things like, I really thought you got bought out in one lump sum. That's why when you said that I started laughing, I'm like, Oh, okay. Yeah. I guess installments does make more sense.
Ryan Burklo: 14:04 Yeah. Do lump sum sales occur. Absolutely. That's not, that's not what normally occurs. What normally occurs is here's a 10 year buyout plan.
Karen Litzy: 14:15 Got it. That does actually make a lot more sense.
Ryan Burklo: 14:20 So yeah, the steps that I have our clients consider is, you know, which type of practice or which type of business are you, are you wanting to build for one? Are you building the business where you're at? And essentially you just kind of run off into the sunset and business kind of goes with you or you trying to build a practice or a business that you can actually sell. And early on it's kind of hard to know that, but as you're growing, you start to picture, you start to build towards one of those. And once you know that now you can get more efficient with your money and what's going on and where to put it, how to get after it. While it's taking into considerations, obviously we don't want to pay a lot of taxes right now, so how does this all come together in one cohesive plan? That's the conversation that people should be having with their advisors.
Karen Litzy: 15:14 Great. No, this is great. Yeah. And you know, we, you sort of mentioned the 401ks and setting up for retirement and things like that. And you know, I think we're, like I said, we're going into a new year, we're going into 2020, and maybe there are some listeners out there who are newer practice owners or perhaps they have not thought about their own retirement at the moment because they're building up their business. But can we talk a little bit about how one goes about setting up a retirement plan again, under that lens of a small business?
Ryan Burklo: 15:55 Yeah. So, you know, really depends on, you know, how many employees we've got. What type of plan do we have any employees that are what we would call a key employee. And so what I mean by key employee, if you have an employee that if they quit or left and it either cost you a lot of money because they were the customer service side of the business or they were the office managers. So now you've got to go train and hire someone else and go do their work. So you can build in a retirement plan that, that helps keep that employee active and engaged in yours. And you're a business. And that can also be part of that transition that we were just talking about as well. And so, so, so much of it is what is it we're trying to build?
Ryan Burklo: 16:47 If we're looking with a starter business that you were just talking about and if you've got a couple employees, you know, it's looking at something like a simple IRA. That way it's low cost, easy to set up. You can set up matching type of contributions for your employees. You know, you can do like a 3% type match where you can go as low as 1% in the simple that allows your employees to be able to contribute and you match. Now they don't contribute, then you don't have to match. Right. And it's low cost. The 401K side of things is more, it's better for when you have a lot more employees, like 20 plus because there's more costs involved and it gets a little bit more intricate. That's when you can start to design it and really mess with a bunch of different things. And because you can mess with a bunch of different things, it costs money.
Karen Litzy: 17:40 Got it. So if you have a couple of employees, I like this simple IRA, a 401k for a larger company. How about if it's just you, you're a solo practitioner. How do you set up, what is your retirement plan look like?
Ryan Burklo: 17:58 Yeah. Yeah. So you could do a set by IRA if it's just you and you don't plan on hiring any employees you can do the traditional IRA route as well. Then there's Roth IRA, so you can still do that, that standard stuff. The SEP has more, has a higher contribution limit than say the traditional
Karen Litzy: 18:16 And what does SEP mean? So for people who aren't familiar with what that is exactly.
Ryan Burklo: 18:27 Yeah. So the simple IRA, well, I'm sorry, you mentioned the SEP IRA, sorry about that. So if you're looking at the SEP IRA, we're looking at a simplified employment. I'm sorry, I've got that all backwards now. The simplified employment pension is what that stands for. So SEP, S E P simplified employee pension. Okay. And the reason they call it that is, is just for yourself. And you're kind of setting yourself up for your own retirement plan, which is why the word pension is in there. It gets a little confusing. It's pension. Most people think of a pension has guarantees. It's not necessarily guaranteed, it's just setting yourself up with a plan for retirement.
Karen Litzy: 19:10 Got it, got it. So as a solo practitioner, you've got a couple of different options, and again, this is where sort of you're taxed now or taxed then, is that right? Depending on like a traditional versus a Roth.
Ryan Burklo: 19:28 Correct. So the traditional side is what they would call qualified money. That's tax deferred. You're deferring paying the taxes this year, you'll pay it when you start to pull the money out. The Roth IRA is you're paying the taxes this year on your money, it grows tax deferred and you can pull the money out, tax free passed age 59 and a half.
Karen Litzy: 19:54 But with the Roth IRA, if you make a certain amount of money, you can't contribute to it. Is that correct?
Ryan Burklo: 20:02 Yes, there are limitations. There are what they would call a backdoor roth IRA option where you can do, you can kind of go round that rule and there's a bunch of implications there depending on from taxation standpoint. But in general, there are some income limitations to do a direct contribution to a Roth IRA
Karen Litzy: 20:26 Yeah. And again, does that matter what state you live in or is that a federal thing?
Ryan Burklo: 20:32 That's a federal thing
Ryan Burklo: 20:38 IRA's contribution is $6,000 contribution limit below the age of 50.
Karen Litzy: 20:46 Right, right. Okay. Awesome. And like I have sort of a mix of all of these things, but I've been, you know, kind of contributing to this for many years. So let's say your in your thirties and you don't have any of this setup yet, are you done?
Ryan Burklo: 21:08 Not at all. No, not at all. I mean, unless, unless you're planning on retiring when you're age 31 then maybe.
Karen Litzy: 21:17 Right, right, right, right.
Ryan Burklo: 21:19 You know, step one, have a conversation with a professional that understands what you're building for. And I know we're talking about retirement plans, but you know, I'm really of the opinion of what, what do you have set up for yourself prior to a retirement plan? Like if you don't have, say an emergency fund set up, start there. Like you don't have to contribute to a retirement plan. The retirement plan is not the savior for your financial status. It really isn't like you can have all of your money outside of retirement plan and actually still retire.
Ryan Burklo: 21:57 There's this misnomer out there that when you have to put everything into a retirement plan and you know, for retirement only purposes, yeah, that's a good place to put money. But what can happen to a 30 year old prior to retirement over the next 10, 20, 30 years? A lot. A lot, right? Practice, growth opportunities, buying a house, selling a house, a bunch of different things. So having your money in what we would call a liquid type of asset where you can actually get after it without having to pay a bunch of taxes and penalties is something to really consider first prior to a retirement plan.
Karen Litzy: 22:41 Yeah, that makes sense. Because like you said, a lot can happen between your thirties to retirement at 70 or 75. Got it. So setting up that emergency fund and looking at your, kind of what we spoke about earlier, looking at your debt ratios and how can you make that work for you and look at what taxes you're paying now and how you're paying them. And then finally then looking at, well, what do I need for retirement? What do I need to do for retirement that makes sense for me right now because I can put money elsewhere. Like you said, maybe it's into real estate buying a home or something like that. Oh my gosh. There's so much to think about.
Ryan Burklo: 23:23 Yeah. The biggest thing, I've already said this once, I'll say it again. You know, I was talking about taxes. It's also where your money sitting. Again, don't put all your eggs in one basket. If you have your money in different sovereign account, you know, some in retirement plans, some in just a straight investment, some in real estate, some in savings. When you have that kind of diversification of where your money's sitting, how much more flexible is your life just from a financial standpoint?
Karen Litzy: 23:52 Yeah, I would think much more flexible.
Ryan Burklo: 23:55 A ton more flexible because of everything sending or retirement plan and you want to pull some money out to put into the practice. That might be the best thing to do, but you probably didn't pay taxes and penalties. Right,
Karen Litzy: 24:07 Right. So then you're kind of losing money there. Exactly.
Karen Litzy: 24:12 No, that makes a lot of sense. Lots of sense. This is really good stuff. Thank you so much for sharing all of this. Now, something that I know you guys do is you look at people's sort of financial wellbeing, if you will, but you also look at the person themselves, right? And so what are some things that maybe we can look at as ourselves at our business kind of reflect upon for next year? Like what, you know, cause I know that your process is a little bit different. You're really looking at not, like I said, not just the business or the cashflow, but you're looking at the person and their goals and visions and things like that. So how do you, what advice do you have for listeners out there who kind of want to get their financial house in order? But I'm sure there are some things to think about before you even have that discussion.
Ryan Burklo: 25:13 You know, there's maybe two or three things I'll say to you, to your question. The first and foremost, and this is often not spoke about, and this is going to sound probably kind of weird, is what is your philosophy with your finances? What is your value? Right? So in my family, when we'd look at money, right? It's not about, especially in medical practice and naturopath, some physical therapists, right? Like typically you're not getting into the industry to make a ton of money, although that might be a byproduct you're getting into it to help a bunch of people, right? So the value of the money oftentimes when asked that question is, well, I want to help as many people. Well, to do that, my practice has to be very successful.
Ryan Burklo: 26:02 Like without the cashflow coming into the practice and building that growth in the practice. How are you helping more and more people, maybe it's a different way, but what does that philosophy, what that does that that alone will have you direct where your money's going. Okay. And then step after you have that kind of philosophy. Step two is going to be more around where is it you are currently at? Like, how do we, how would like, you could do a quick net worth equation, right? Like add up all of your assets, checking accounts, savings accounts, retirement accounts, real estate, add up all your liabilities, student loans, cards, mortgages, and then so track the two numbers. That's your networth as it is today. And if you did exactly what I just said, we actually listed out your assets in one column, listed out your liabilities on the other column. You just got a lot of your balance, your balance sheet on one page. How many people I've ever seen that even though that's a simple activity to do.
Karen Litzy: 27:09 Yeah. Yeah. Great.
Ryan Burklo: 27:12 And then you can look at what you’re building next year. Okay. If your plan is to hire another doctor or buy real estate or invest in your practice more, what's your plan? How are you currently sitting and how could you possibly do that if you don't have liquid cash and liquidity to do that? Well now you're first, you know, your first step next year. It's actually having some money set aside that's liquid or accessible to do that.
Karen Litzy: 27:41 Yeah. So really like you said, having your philosophy, your values, and your goals. Look at what you have and what you don't have and see if you can help make a plan for 2020 I think that's great advice.
Ryan Burklo: 27:57 Yeah, it's, you know, money in America's taboo, right. It's a taboo topic to talk about it. We don't like talking about it. We don't even know half the time we don't even talk to our children about it. Right. And it's a taboo factor. It's a business factor. It's all this wrapped in one and for someone to take, especially as business owners, you know, we're wearing what sturdy different hats. One of those hats needs to be CFO. Right. So in your, hopefully we're taking a day out of the business to look at how the business is financially and that could be an exercise for that.
Karen Litzy: 28:33 Yeah. I like that. Taking a financial business day.
Ryan Burklo: 28:39 Yeah.
Karen Litzy: 28:40 I really love it. I'm going to start doing that. I have to put it into my calendar cause you know, if it's not in the calendar it doesn't get done.
Ryan Burklo: 28:48 Yup. I'm like you, I get it.
Karen Litzy: 28:51 Yeah. Yeah. This is great. Thank you so much. Is there anything that we kind of didn't touch upon that you're like, Ooh, I really wanted your listeners to get this info?
Ryan Burklo: 29:02 You know, the biggest piece that I want your listeners to get and really anyone to get is have conversations about money with someone you know and trust.
Karen Litzy: 29:14 Yep. That's great advice.
Ryan Burklo: 29:15 It really is that simple because it starts there.
Karen Litzy: 29:21 Yeah, you're right. It does. And we don't talk about it enough. I know I'd have, I probably don't talk about it enough and need, probably need a little more guidance and things like that. So I think that's great advice. So have more conversations about money with people you trust is great advice. And now my question that I always ask everyone, speaking of advice is knowing where you are now in your practice and in life, what advice would you give to yourself right out of college? Especially knowing that what you said at the beginning of the podcast here, but as someone said, you'd be a financial advisor. You'd be like, what?
Ryan Burklo: 30:03 I think it would have been slow down. Mmm Hmm.
Karen Litzy: 30:08 Yeah.
Ryan Burklo: 30:09 I was your traditional person that got out of college and said, I want to retire early. And so I hit the ground running and I started just grinding away. And not that that's a bad thing, but you know, as I've gotten married and have kids, I look back at that time and I'm like, you know, I could have done a couple of different things. I'd just slowed down and it wouldn't have affected me in a negative way the way I thought. And even if it affected me in a negative way, it might've been worth it.
Karen Litzy: 30:37 Right. Yeah. A lot of people say that same thing and it's always kind of slowed down and you know, enjoy where you are in the moment and you are not alone in that train of thought. For sure. Well, Ryan, thanks so much. Where can people find you?
Ryan Burklo: 30:55 Yeah. So if you want to go to quantifiedfinancial.com and you can find all the information you could possibly want about me, whether you like it or not.
Karen Litzy: 31:07 Perfect. And of course we'll have a link to the website at podcast.healthywealthysmart.com under this episode. So one click will take you all to Ryan's info about his company and their philosophy and how they work. And I highly suggest you click on over there. So Ryan, thank you so much for coming on. I really appreciate it. And we did a nice podcast swap, which I always love to do. So thanks so much.
Ryan Burklo: 31:35 Absolutely. I appreciate being on.
Karen Litzy: 31:37 And everyone, thanks so much for listening. Have a great a couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Joseph Reinke on the show to discuss student loan debt solutions. Joseph Reinke is the CEO and founder of FitBUX, Inc which is introducing innovative finance products and technology to the student lending industry with a specific focus on physical therapists.
In this episode, we discuss:
-How family, work and financial goals effect your loan repayment options
-Why refinancing public loans may not be an optimal strategy
-Practical examples of loan forgiveness strategies
-The personal and societal importance of financial literacy
-And so much more!
Resources:
FitBUX Website
FitBUX Courses
A big thank you to Net Health for sponsoring this episode!
Check out Optima’s Top Trends For Outpatient Therapy In 2020!
For more information on Joe:
Joseph Reinke is the CEO and founder of Fitbux, Inc. FitBUX is introducing innovative finance products and technology to the student lending industry with a specific focus on physical therapists. Thus far in FitBUX’s beta test, they have helped PTs develop financial strategies on over $11mn in student loans. Joe has been in the finance industry for over a decade and is one of the few CFA Charterholders in the world who has experience in both wealth management and business valuation (globally, there are only 120,000 CFA Charterholders). He has hosted numerous live chats about student loans with SPTs across the country, presented at the California Student Conclave, appeared on podcasts, and written numerous financial blogs.
Read the full transcript below:
Karen Litzy: 00:01 Hey Joe, welcome back to the podcast. I am happy to have you back.
Joe Reinke: 00:07 Glad to be here. It's been a few years. I know that we see each other at different conclaves and different events and stuff, but it's been a few years since I've been on the podcast.
Karen Litzy: 00:16 It has. I know, I'm happy to have you. And, we'll talk a little bit about what a difference a couple of years make in a second. But the first thing I want to get to is student loans. So let's talk about first, cause I know you have a lot of data on this. You have a huge data set within fit box. So what is the average debt? And we'll stick with physical therapists. We don't have to go across the board, but the average debt for physical therapists loan debt.
Joe Reinke: 00:45 Yeah. So PTs or student loan debt. So we now have about 7,400 students and our platform, it comes out to about $900 million of student loan debt. The average is about $144,000 for PTs. We have some other graduate students that we also work with too. Before PTs, it's about $144,000 in debt. And like you just said too, it's like a moral, I know when we first came on the podcast years ago, we had like $30 million or something like that on the platform. And when I tell people we have like 850 $900 million down there, like, you know, congratulations like you know all the growth that you've had. And I look at it, I'm like, that's disgusting. Like the fact that there's graduates and it's like, okay, $900 million of debt, that must be a lot of people. It's like, no, that's only 7,400 people.
Karen Litzy: 01:35 Yeah, it's criminal, it's criminal. So let's say you've got 900 million in loans, the average of $144,000 which is mind blowing. So what are the options for these students coming out to help repay that loan?
Joe Reinke: 01:54 And the first challenge is trying to figure out how these things even play a role in the bigger picture. But then the government doesn't do us any favors. So right now there's nine different student loan repayment options and it's a minefield trying to figure out which one you should use. How does it play a role? Like what happens if I do this? What happens to my retirement, what happens to family planning? Can I get a mortgage? All these different things. And instead of just being like, okay, I'll pay back my loans, here's the answer. You've got gotta dig through all these things and that's where people get lost. So what we've done is simplify that into two strategies. Either you’re going to pay off your loans, or B, you're going to go on some type of loan forgiveness strategies. And the pay off loans is really dominated by the headlines of refinancing because that's what we get bombarded by in terms of advertisements.
Karen Litzy: 02:38 And what exactly does that mean when someone says they're going to refinance?
Joe Reinke: 02:43 Yeah. So refinancing means you go to a brand new lender and they offer you a brand new rate and a brand new loan and you're literally replacing your old loans with a brand new loan to get a lower interest rate. Okay, so like I know PTs they get bombarded by low road, which is one of our partners, but they get bombarded by a low road because a low road has a partnership with a PTA. So they just get bombarded. So we get everybody, everybody comes to us and like, well, I'm thinking about refinancing. I was like, well, why? It's like, well, I've got these things. That's what I see in my mailbox. And on the other side of that, they hear all these headline news articles about loan forgiveness and public service loan forgiveness and whatnot. So those two things dominate the headlines. But really it's even upload from that is either you're going to do a payoff strategy or loan forgiveness strategy.
Joe Reinke: 03:34 And what I mean by a payoff strategy is what we typically think about when we get a loan. Like you get a mortgage or a car loan, you make payments over a certain amount of time after that, it's over. You could do different things to be strategic with that. Like instead of doing a 10 year plan, you can do a 25 year plan. So you can make prepayment strategically and save money. You can do refinancing, you can see if refinancing is right for you. And those are the big things with the payoff strategies is just figuring out what's the most effecient way to make my payments. Now, unfortunately, one of the problems is that the loan servicers don't always apply your prepayments correctly, so you got to stay on them and make sure they're doing the right thing. But that's, that's a whole nother topic on that.
Karen Litzy: So quick question. When you say making prepayments, can you define what that is?
Joe Reinke: 04:16 Yeah. So when you have a payoff strategy so most of us on average, so like when a DPT graduates, they actually have between 10 and 20 loans. So when I say $144,000 in debt, it's not just one loan, it's like 10 to 20 loans. They're all different sizes, they're all different interest rates. And so what a required payment is the payments. They add up every payment on those loans and then say here's your required payments. So they might say it's $1,000 a month. So on that required payment, you don't have any say on that. You have to make that payment every single month. And then you don't have a say where it goes. They just throw it across all your loans equally. Okay. A prepayment is like the complete opposite.
Joe Reinke: 05:06 You have a hundred percent control of it, meaning you determine the dollar amount, you determine when you do it, but most importantly you can determine which loan that you want to go towards. So like if you wanted to pay your higher interest rate loans faster because that would save you the most money, you can do that. So the trick with payoff strategies is just knowing that general idea of the difference between a repayment, a PR, a required payment. And a prepayment is, well, how can I drop my required payment so I can increase my prepayment? Right? And so that's a lot of the tricks that we go through and mix and match the different plans to allow people to do that. And then you throw a refinancing on top of that and you can save even more. So that's really the payoff strategies.
Karen Litzy: 05:58 Yeah, it would seem to me that everyone should refinance to a lower percentage but like why wouldn't someone do that?
Joe Reinke: 06:03 It really depends. I'll give you a few examples. We might work with a travel PT for example, and with travel PTs. First of all it's harder because of the stipend. This is for OTs and nurses as well. It's a stipend, so it's actually hard to get qualified because they don't qualify that as income. So like we have nine lending partners, only three of them will do travelers first of all. So that makes it a little bit harder. But in that situation you're traveling so you don't know the cost of living when you're moving from place to place. You don't know how long it's going to be between contracts and you don't know, most importantly what your income's going to be when you stop traveling. So it's really hard to lock yourself into a refinance loan, even though you can always refinance again later, you might not qualify later to refinance.
Joe Reinke: 06:54 So oftentimes we do do refinancing with that, those types of individuals, but it's more strategic. So instead of doing like a 10 year loan, we might do a 20 year loan and instead of doing all their federal loan debt and refinancing, it might only be three or four of their higher interest rate loans. So just in case there's something there that they can't do they're not obligated to this huge monster payment every single month. So that's one example. Another example we see often times is, I'll give you an example. I just actually talked to somebody today. She had about $210,000 in student loan debt and she's paying it off. Mmm. And my thing was the tail are like, look, you know, slow down. Because when you do your budget and you're doing paper and pencil, all the numbers always looked like they make sense. But this individual just started working.
Joe Reinke: 07:49 They've never had a budget in their life. They've never had like real expenses in their life. It's like wait three or four months because you might decide that you can't make those payments. You rather do a loan forgiveness strategy and if you refinance, you can't do a loan forgiveness strategy anymore because private loans don't qualify for loan forgiveness strategies anymore. So just different situations will dictate. Does it make sense? And then sometimes the refinance rates are just not that good. So it just doesn't matter. Yeah, exactly. It's like stay there and just chip away at your loans. And I'll give you one more example, Karen. When you refinance, you also consolidate your loans. What that means is you merge your loans into one big, big, big loan.
Karen Litzy: 08:37 Got it. So for instance, if you took a loan from a bank or a federal loan or whatever, when you refinance did, so let's say you have a federal loan, does that federal loan is no longer a federal loan, it becomes a private loan.
Joe Reinke: 08:54 That is correct. And instead of having like 10 you might only have one big, big, big loan. So sometimes what happens, you have to understand how federal loans work though too. Like I said earlier, you have 10 to 20 loans, so every time you pay off one of those loans, your required payment actually drops. With the refinance loan, it won't drop because you have one monster loan, you never pay it off until the whole balance is zero. So sometimes people come to us and say, look, what am I goals is to buy a house in five years? And so if that's the case, we might turn around and say, okay, we'll stick in your federal loan. Because if you keep making prepayments and you pay these specific loans off, your required payment would go from $1,000 down to like $500 when you want to buy your house.
Joe Reinke: 09:37 Why is that a big deal? They use the required payment in the ratios for qualifying for a mortgage. So a lower lower required payment on your student loans, the easier it is to qualify for a mortgage. So that's some of the analysis that we would do to say, okay, well how much does a refi actually save you versus are you better off just trying to drop your monthly payment over time so you can qualify for your number one goal buying a house? And so that's what I meant earlier when I said these things. It is more than just the student loan strategy.
Karen Litzy: You've got to look at how does this thing play a role in the bigger overarching strategy, right? Because oftentimes I would think the student loan debt isn't the only debt. So can you explain how maybe you have to work around other debt as well and how to navigate all of that?
Joe Reinke: 10:27 Yeah. And I'll give you an example. We just did a poll and we also took some of the data from our members as well. And it was something like 68% have more than one form of debt. So that could be cars, mortgages, credit cards. And again, another example, I just talked to somebody today, and actually we get this probably four or five times a week where somebody calls us to talk about their student loan debt and we noticed that they have credit card debt. Okay. And we're like, look, you want to do this strategically with your student loans to drop your required payment as low as you can and focus on paying off your credit card debt. And it's like, I didn't even think about that. It's like, yeah, credit card debt, socks, get all of that stuff like as fast as you can and use the flexibility of refrigerator loans.
Joe Reinke: 11:10 That's another reason why you might not run a refinance is because the federal loans are more flexible. There's more options of what you can do. So if you have other debt, it may be allow you to pay that off faster. And that's why sometimes people go into the student loan forgiveness plans also in the short run is the drop that lower payment focus on something else and then go back to their student loan strategy and say, okay, now I'm going to go focus on that. What do I need to do to focus on my student loans now.
Karen Litzy: Got it. So it's all part of a bigger plan. So let's talk about quickly the student loan forgiveness because that's been in the news lately. I feel like there's been rumblings of that. It may not exist anymore, Betsy Devoss may cut it or what's the story?
Joe Reinke: 11:51 Yeah, so there's actually two different forms of forgiveness. Okay. And this is where people get confused. The actual repayment plan you're on is called an income driven repayment plan. And the government also says that these are things our student loan forgiveness plans. Long story short on these plans, your payment is based as a percentage of your income. And the payments really low is like 300 $400 a month. But for most of us, that means that we're not paying the interest that's being charged on loans, which means the balance of your loan Rose. And that actually will happen for about 20 or 25 years. And then under normal loan forgiveness at that 20 year Mark or your loans are forgiven, but you have to claim it as income and pay taxes on it.
Joe Reinke: 12:44 So your balance of what you owe will grow because they just add the interest of your balance, just like in your differing interests cause you're not making payments. Happens in these plans. Okay. So then you worked for 10 years or 20 years or whatever, and then your loan is forgiven. So in these plans loan forgiveness, they last for 20 or 25 years. Department of education forgives them. Okay. However, in this country, it doesn't matter what type of loan it is, it can be an auto loan, a mortgage, student loan. If it's forgiven, you have to claim that as income. Yeah, so like let's just use that example. $144,000 is the average person on our platform. If, you're single for those full 20 years, just working, whatever it is, your loan balance might grow, does being worth $200,000 in 20 years?
Joe Reinke: 13:44 So at that 20th year, the $200,000 is wiped out. You don't have to pay it anymore. But you have to claim that $200,000 as income, which means your ordinary income that you made that year. It's just here it is. You got to pay it. And so the goal on these plans is like the complete opposite. You're not trying to pay it off as fast as you can. You're trying to save for that tax liability as fast as you can. Cause like what we always tell people the number one risk on those plans, you don't know what the tax rate is going to be. That's right. It could be 35% it could be 80% it could be 60% now you also factor in like we just moved from California, so if you had $200,000 plus you made 120 grand because you're, you know, 20 years in as a PT in California and federal taxes, you're going to be in a 35 and 40% federal tax bracket. As of right now, plus a 12% tax bracket in California doubled on top of that. You should definitely move to Texas.
Joe Reinke: 14:50 But that's a big thing there. So that's normal loan forgiveness. Now there's another form of loan forgiveness. And this is the part that's been dominating the headlines where if you're on one of these plans, but you work for a nonprofit hospital, a hospital, it could be a full time teaching job. I mean you can say I don't even want to be a PT, OT, whatever anymore and I want to go work at Goodwill full time. I mean it just has to be at a nonprofit full time. And if you're on one of these plans working full time and you make 120 payments, your loans are forgiven in 10 years cause that's 120 payments and you owe nothing in taxes. Okay. And so those have been dominating the news recently because there's been 110,000 people that applied and only about a thousand people have gotten it actually approved.
Joe Reinke: 15:40 And people are like, Oh well that's less than 1% so that's like the big headline. You know, Loan forgiveness is failing. But when you actually dig into the numbers, over 90% of the people that have applied for that, it should never have even applied. Meaning, they don't even work in a nonprofit or they do work at a nonprofit, but they haven't worked for 10 years. Mmm. So they're finding the people for forgiveness and that they shouldn't even been filing it yet. And so that's where the news kind of distorts that stuff. But then at the same time, you have that percentage, two, three, 4% that is told the wrong thing by fed loan servicing. That's the company that, that does this. They're told the wrong monthly payments. They're told that their payments are qualifying even though they're not there. We're told that their employment qualified even though it's not.
Joe Reinke: 16:26 And so that's where the mass confusion comes in on that. I'm actually shameless plug. We just rolled out a new technology that actually tracks all that for you to make sure if you're on public service loan forgiveness, you're actually doing everything you need to do to get it forgiven. And we rolled that out. We rolled that out specifically because of all the headline news of all this stuff. People getting this stuff forgiven. They have nowhere to go to get the answer. So it's like well we can build this pretty easily. And it took us about three months to ramp it up and build it and it's like here it is and we're actually going to release that. We just got done testing it. It's going to be out in about a week or two. So yeah I'm excited about, it's given me a lot of gray hairs and a lot of sleep aside. I'm excited for it.
Karen Litzy: 17:07 Well I mean that's such a gift though. That's such a gift for people because there are a lot of physical therapists who work in hospital systems that would be considered nonprofits and so if they can just sign up for that and have something else, keep track of it for you. Like automation is so much easier in our lives. So this is a way to kind of automate your student loan forgiveness programs so that you don't have to keep track cause we've got a million other things that you have to keep track on. Because like you said before, you've got student loan debt, but then you may have credit card debt, you may have mortgage debt or you have a car loan. And so there's so much that kind of goes into this puzzle. I mean to say I did not realize that it was so, all this is so complicated because I graduated like in the stone age, you know, so I didn't really have all, I didn't have $144,000 in loans.
Joe Reinke: 18:01 Yeah, I mean it's amazing. And, that's why the big thing that I'm excited about. So like the average person that's gotten their loans forgiven so far has basically saved $62,000 okay. That's a lot. We're rolling this plan out for $5 a month and when we roll it out for the full 10 years, we're just charging a one lump sum fee of $300 if you just want us to track it for all 10 years. And it's like, you know, and we did that cause it's like guys, yeah cause somebody has, some of the people that signed up to beta test it for us. They're like dude we pay like a thousand dollars a year for this. I'm like no, no, no, no, no, no. Like the technology doesn't cost us that much to run like this stuff needs to be out there because again it plays a role in a bigger picture and fast forward, we haven't really disclaim this to very many people cause I don't know when it's going to actually roll out but it's supposed to come out next year.
Joe Reinke: 18:50 Like you said, all this stuff plays a role in the bigger picture. We're developing a technology where instead of just tracking the student loans, we track everything. Like, we help you set up the plan and as your 401k your retirement, your budget, your student loan plan, everything. And so to me, like when we say, Hey look, we're only charging, you know, $5 a month for this thing, it's making sure that it works. So when we roll out that bigger plan, it's like we got this piece checked off. We don't have to worry about it anymore. Cause again, I bring up those gray hairs. It gives me something else to worry about.
Karen Litzy: 19:25 There's always something else to worry about. So just one little part of it. So now, so let's talk about something that you had mentioned before we went on the air and it's, people don't really understand money.
Karen Litzy: 19:42 Tell me why you said that and tell me what people can do to better understand it. And on that note, we're going to take a quick break to hear from our sponsor and be right back.
Karen Litzy: 19:57 This episode is brought to you by Optima, a net health company. Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected and workflows that streamline patient care and save valuable time. You can check out, optimize new on demand video to learn what's in store for outpatient therapy practices in 2020 with some of the biggest industry trends along with tips and best practices to successfully navigate these changes. Learn about these trends for the new year at go OptimaHCs.com/healthywealthy2020
Joe Reinke: 20:36 Yeah, so we have this big thing that like if you watch our courses that we released or go on the new website that we just released, we talk about our method and it's understand, plan, implement those like the big three things. You've got to understand, you've got to have a plan, you've got to have a way to implement that plan. And there's been a lot of chatter because it's political season and we've seen all the stuff about, Oh, this politician is gonna forgive X amount of student loan debt. And then another politician wants to one up and then say, well we're gonna forgive X amount and another politician wants to one up them and say we're going to forgive everything. And so it's like, well, you know, went up in each other to see who can get the most votes for this. And you know, I get the question all the time is what do you think about these policies?
Joe Reinke: 21:18 And I just turn around and say to people, it doesn't really matter because they're missing the root of the problem. You can forgive all the student loan debt. But like I brought this statistic earlier, over 60% of the people on our platform have more than one form of debt is not just doing loan debt. And it's not like these things like money problems didn't exist before. Student loan debt. I mean just before this we had the mortgage crisis. Okay. Like before that we had savings crisis. We still have people savings crisis, like retirement savings. I mean we talked about baby boomers and stuff like baby boomers. Like it's something that I saw a report the other day that 65% of them don't have enough to last like more than five years.
Karen Litzy: 21:58 Yeah. And they don't have student loans. And then isn't it true that the majority of Americans don't even have like a retirement plan or don't have that savings?
Joe Reinke: 22:12 They don't have anything and that they're dependent on social security, which the social security was never meant to be a retirement plan. It's supposed to be a supplement to retirement. But for a lot of retirement age individuals, that is their retirement. And I'll give you even more. I discussed the statistic I was about to write an article about this. Is something like 43%. It's somewhere in the forties, I want to say the low forties. I've got to look at the article again. It's in the low forties, that the super, that percentage of people in this country don't have enough money in their bank account to cover a $400 expense. Okay. So when we sit there and we talk about, Oh, well, you know, if we just forgave student loans, the problems of the world would be over.
Joe Reinke: 23:03 And it's like, well, no, no, no, no. You know, like, I give this example in a workshop all the time. I used to work a lot with athletes and statistically 60, the 70% go bankrupt within three years of being out of league that's in the NBA and NFL. Well, in those three years that they work and play football or basketball, they will make more money than the average American makes their entire working life span. Yep. They go bankrupt. Within three years, they had the complete opposite problem. They had all the money in the world and they still went bankrupt. So it goes back to that fundamental root of not understanding. And that's actually one of the reasons why, like we used to do, or actually we still, I shouldn't say used to, we do workshops. Oh, it's the last time I came on the podcast, like it was, I don't think we had any workshops before that.
Joe Reinke: 23:55 And then we started doing them. I've done over 120 workshops at different DPT programs and conclaves different conferences. And that was one of the big things that like, everyone's like, we love his workshops. Well, where can we learn more? And it's like, how, how do you explain this? Understand, plan implementing? And I couldn't find anything. So I was like, well, we're just gonna roll out our own courses. So we rolled those out about two months ago kind of in a soft launch type of beta test. And the feedback that we've gotten off of them is fantastic. So that's like our new thing that we just rolled out was the courses. The next new thing is that that public service loan forgiveness solution and the next year is like the big solution that we're coming out with. So it's exciting. But yeah, those courses, it's fun to see people taking them and being like, Oh my God, like this stuff is, makes so much more sense now. And it's, it's actually simple. That's my big thing. Keep it simple. Don't make it complicated. So, that's the bigger thing when I see the student loan forgiveness hype and all these political things, like it doesn't matter what happens there. You got to get that understanding. You've got to develop your plan, you've got a whole way, have a way to implement it.
Karen Litzy: 25:02 Yeah. And just so if people want to learn more about it, if you go to the fitbux website, it's under monies.
Joe Reinke: 25:10 Yeah. That is cool. Yup.
Karen Litzy: 25:13 What would you say in your opinion and in your work with people, what are maybe one or two fundamental misunderstandings about money that people have?
Joe Reinke: 25:18 I don't even know. No, I will narrow it down. This is one of the big things and this how we start off our workshops now when we start explaining some of this stuff. So, you know, and this is about a minute or two explanation on this, but then when I was back in wealth management, I would ask people what are your goals? And I started bucking those into three main groups. They would basically say my family goals, I have my work goal and then financial security. And what I mean by like family is like, okay, I want to do this. I wanna be able to buy a house because I want to provide for my family, my daughter, whatever it is. My work, my work, I want to have my work, have a meaning on life and an impact.
Joe Reinke: 26:07 People like I joke around with all the time. No, none of you went to school because you couldn't wait to have student loan debt. You went to school because you wanted to help people. That's what I mean by career goals or life goals. And then the third one was financial security. And when I started asking people, yeah, rank these, it was always in that order, family, their work and then financial security. But when I would ask him, where do you spend the most of your time? They'd be like, well, I spend about 90% of my time on financial security. I'm like, well, that doesn't make any sense. That's like your third goal. Like that. And then I would ask them, here's like, when you say a misconception, I would say, what is financial security? And they kept telling me a lot of money and I'm like, wait, wait a second.
Joe Reinke: 26:47 I just gave you that example of NBA players and NFL players. Lottery winners are the same statistics. They all go bankrupt. They have all the money in the world and they can't manage it. I used to manage people money that had millions and they were financial train wrecks. I know guys on wall street that were making million dollar bonuses every year that are financial train wrecks, so that can't be the case. So then I started looking at it and saying, well, what is it? And that's where we came up with the understand plan implements. Like those things is you've got to have a simple understanding. I mean I give examples of people that I know that are, have been barbers for 40 years. I mean they have no college education, they have none of this stuff and they live in San Jose, California, the most expensive place in the country.
Joe Reinke: 27:30 And they’re millionaires, like they had an understanding, a simple understanding of money. They had a simple plan, you know, and I joke around all the time about my dad. Like when I was 22 years old, like I come home from college thinking I'm like this big investment guru guy, right? Cause I'm a 22 year old punk kid and I'm just like, Oh I'm going to tell my dad. I'm like dad, you know, his strategy was always just, you know, he started a business when he's 18. Yesterday, he started, he bought it from my grandma and you're just put money in the bank and they would buy a piece of property and that's all he did. He never did the stock market anything. I'm like, dad, dad, dad, check this out. Like, if you would have done it, you know, in the stock market it would've been worth like $10 million.
Joe Reinke: 28:09 And he's just like, I don't give a shit. Like I don't know anything about the stock market. All right. That was his plan. It was simple and it works for him. Great. And then you had a simple way of implementing it. That was a thing that really lacked Mmm. Is everybody that I knew that had an understanding it and had a simple plan, it would taking them hours to implement it because it would have to do their own Excel sheets or they had these files all over the place. I've got gotta do it all by hand, but they did that. But those are the three big things. And so actually that's why people always ask like what's the technology behind FITbux and why do we do this stuff for free? Like why do we actually have people call us? And if we walk through their plan for free because we say the understanding and part is free and then the technology that we're building, especially for next year is going to be the part that helps them implement it. So they have to spend hours and 90% of their time doing that and they can spend that time doing something else. You asked about the biggest misconception that is the biggest misconception is what is financial security? It's not having a lot of money. It's those three things. Understanding, planning and implementing.
Karen Litzy: 29:13 And if someone, let's say someone were like me, so I don't have any student loan debt or credit card debt or any debt really. So if I wanted to use this technology, like does it apply to someone like me who's like, well, I don't have any debt, but I definitely want to try and buy an apartment in New York city, which we know is like not cheap. I mean, in all seriousness, to buy an apartment in New York city to get a decent apartment is $650,000. Yeah. And that's a lot of money. If I want to get an apartment with two bedrooms, it's like over a million dollars.
Joe Reinke: 29:43 Yeah. I was going to sell our apartment in San Jose and they got appraised that $900,000. And instead I was like, I'm just going to rent it and it's like $3,000. And then like I tell people, so I moved to Texas cause really I wanted to have a backyard for my daughter. And we bought like, it's like 0.3 acres and it's almost a 4,000 square foot house. It was a way too ridiculous. Like I don't use half the house and it's just ridiculous. And it was like 300 grand but yeah they like the technology but really on the next year.
Joe Reinke: 30:37 Yeah, definitely for people like you, it's actually for anything, and this is why so many people, we talk about the student loan stuff, but we already have a piece of the technology out to help people plan. And this actually leads to like the number two misconception that I would have to say when we sit down and people talk about budgeting. They used to always come to me and they still come to me and say, Hey Joe, I spend like $1,200 a month on my student loans. Is that a lot? And it's like I have no idea. Right? Because $1,200 for one person might be nothing for somebody else. Okay. And so what that means is when it comes to money, absolute numbers mean absolutely nothing. It all has to be relative. And the way we do that as percentages, so like when people sit down and look at their budget, they always look at absolute numbers.
Joe Reinke: 31:23 So if you go onto these budgeting apps and all this stuff, it's all absolute numbers and it's like, Oh well I'm going to cut, stop drinking coffee, you know, and boil and make my own coffee. It's like, great, you save $2 you know, a day or $50 a month. Like that might be 0.04% of your budget, but you don't want to learn something about retirement savings and taxes. I can save you like 10% like learn the learn. And so when you start looking at percentages, you start seeing where you should focus your time on. And so that's number one thing. But the number two thing would that allows you to do is then we could sit there and say, look we break this down very easily here, right? So we say the first formula is income minus expenses equals discretionary income. With that discretionary income, you can then do two basic things.
Joe Reinke: 32:09 You can either build assets or pay off debt and before you even decide what to do with that, we can upload it and say, okay, on average, a new grad PT for example, can take 30% of their gross income and put it to those two groups, assets or debt. You just got to figure out how you want to do that. And so if you have no student loan debt like yourself, Karen, you'd be like, okay, well can I do 30% can I do 35% can I do 40% once you figured that out, then it's, well, now what do I do? Do I do my 401K you know, do I have self-employed income? So can I do a SEP IRA? What about a Roth IRA? What about HSA? What about just brokerage accounts? Oh, well I also want to say for a down payment for the apartment, what do I need to start saving for that?
Joe Reinke: 32:50 What do I prioritize first? And then that, so that's the part that we'll have the technology that we have built now what we're building for next year is where we can say once you say, okay, this percentage is going here, this percentage is going here, this percentage is going here, implement link all your accounts into the profile. And they would automatically track to make sure you're moving those percentages and that you're doing it correctly. And so yeah, right now we only help anybody with student loans. And then we track the student loan strategy to make sure they're doing it the efficient way. And then next year we're going to roll out the bigger piece of the technology. And that was part of the preview with the courses is the courses talk about all that stuff. And that was like the first phase of what we're launching for next year.
Joe Reinke: 33:35 We just got the courses down early and we're like, let's get 'em out. Like people are asking for them. So happy to get those out. But yeah, next year if you want to sit down and talk, let me know.
Karen Litzy: I think I might have, I'm thinking about a lot here. So is there anything else that we didn't cover that you're like, Oh, I definitely want to talk about this. I wanted to get this in.
Joe Reinke: Like we've talked about the percentages. The reason why I'm so adamant on that is because then it makes life easy. And what I mean by that is if you say, look, I know 5% is going here, 10% is going to here, percent going there.
Joe Reinke: 34:21 Well guess what? You get a raise every year, so all you have to do is calculate and say, okay, well no, I just have to increase how much I'm going into those, those different areas. It's automatic discipline. You don't have to think about it anymore. And not only that, but like if you get a bonus or a commission or a tax return. Yeah, you already know the percentages. Take this here, take this here, take this here, put it here, the rest I can go use on vacation. Hell have fun with it and you don't have to think about it anymore. Instead, I see a lot of people being like, Joe, I just got this $5,000 bonus. Like I'm stressing about, do I put it in my investments? Do I pay off my student loan debt? It's like, well, if he's had those percentages that you don't have to think about anymore, you already know what you're doing with it.
Joe Reinke: 35:00 So that's, you know, one more like they played it was one last thing to add. That's one of the big things is those percentages I strongly recommended. It doesn't matter who you are, where you're at, if you have student loan debt or not. If you're saving for a wedding, saving for college, saving for you know, kids. By the way, if you do have kids and you're saving for college for them, don't do it. Save for your retirement first please. They can fund college other ways. But make sure you fund your own retirement first before you can fund your kids. That's one of the biggest mistakes I see parents make. They want to fund their, call it kids' college education and their retirement is lacking. It's like no on your retirement first on their stuff later. So those are the big takeaways.
Karen Litzy: 35:42 Awesome. I mean, such good information. I really appreciate all of this. And now this question I been asking everyone lately who come on the podcast and it's given where you are now with your life, your business, what advice would you give to yourself as that 22 year old punk going home to his dad more than he does?
Joe Reinke: 36:03 I wish I would draw my ego level way before. That was, I was an athlete at that time too. So you get once, yeah, once you stopped playing sports and reality starts hitting then and all of a sudden it's like Mmm, well not on this pedestal anymore. You get shot down a little bit. But no, actually at that time for me, my big thing was I grew up around, you know, the rule of finance because that's what my degree was and everything. I was around wall street guys.
Joe Reinke: 36:41 I had a plan for money coming out of school, but it was simply just to make a lot of money. And you quickly find out that if your motivation is money, you're going to end up burning out. It doesn't matter what you do. If that could be going to take a certain PT job simply because it pays more because you need to pay off student loans. So I guarantee you, you didn't go to school for student loans. You went to school to be a PT. So if you're going for income and that's your only reason you're going to burn out. Okay. And like I said earlier, I've seen guys making half a million dollar bonuses on wall street that don't even work in finance anymore because they're so burned out off of it. And it took me a long time to realize that you're not money that shouldn’t motivate you.
Joe Reinke: 37:28 It's whatever you're trying to accomplish, that it'd be building a technology that'd be treating patients. And if all you do is strive to be the best at building that, that certain thing or focusing on those first two goals, I talked about your family and your work and you're really focusing on those, that the monetary side will take care of itself in the long run. Like stuff will happen and take care of itself if that's what your main focus is. And like, I mean, fitbux is the living proof of that. I've said it from day one to our investors and everything. Don't ask me about revenue. Don't ask me about shiny objects. Like we talk about business owners all the time. It's one of the hardest things to do because you see so many opportunities out there. You're like, Oh, if I just do that, just a little shiny object, it's going to make me a couple extra thousand dollars, but it's going to be a distraction.
Joe Reinke: 38:18 It is not part of your main thing. Now you're chasing money instead of being focused on why you are doing what you're doing. And so that was one of the big things that I had to learn was, you know, it's not about making a million dollars or $5 million or $10 million. It's focusing on what you love doing and the recipe, it will come true. I mean like Karen and you're, you're a perfect example of that. You love doing the podcast, you love getting out there doing that stuff and helping people and guess what you've been successful at doing it. You've been successful as your PT career, all that stuff falls in line. If you're focusing on the right things and money's not the right thing to focus on is the bigger picture. What does money actually represent to you? What does it mean to you? Why do you want it? Because you can have all the money in the world. Do you want it to do something? Focus on that. Do something first and then the money will come from that because you're going to be the best at what you do.
Karen Litzy: 39:10 Great advice. I love it. And now where can people find more information about you? Contact you find more about Fitbux.
Joe Reinke: 39:20 https://www.fitbux.com/ As the website. As you said with the courses, it's just underneath money school. If you drop down the header underneath solutions, there'll be money school on there. That talks about our courses. If you want to come on and, you already know for example, that you want to do the student loan forgiveness strategy and you just want to sign up for our $5 a month tracking solution. You just go into solutions and sign up. We have a payoff strategy. We also had the loan forgiveness strategy. If you want to go in and use our refinance service, it's free. All you got to do is build your profile and schedule a call. We'll walk through making sure that refinancing is right for you and then go shop nine lenders. And if you have no idea what you're doing
Joe Reinke: 39:59 And don't feel ashamed, about 70% of the people that come on our platform don't have a clue where to even start. And that's statistically true cause we asked them have you looked at anything? And they say, I have no idea. And so we, that's all free too. We'll have you come on, you build your profile, we go through the payoff options, we go through the loan forgiveness options. And then depending on which one you feel more comfortable with, we'd go deeper and deeper into how to actually implement that strategy. I mean that's all free too. You just go to the website and click join now and sign up, schedule a call and we'll be talking soon.
Karen Litzy: 40:30 Perfect. And just so if people aren't familiar, it's fitbux.com. So Joe, thank you so much for coming on. This was great info. I learned, I learned a lot. So thank you so much. Glad that we can teach and it's always fun and hopefully we'll see you at another conference or conclave or something soon and I'm sure talk more. And everyone, thanks so much for listening. Have a great, great couple of days and stay healthy, wealthy, and smart.
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Happy holidays to the Healthy, Wealthy and Smart family! This is a special episode where all the amazing women behind the show come together to discuss 2019 and what’s to come in 2020. Thank you for supporting us and we hope to continue to provide great conversations in the new year!
In this episode, we discuss:
-Why you should enlist a team to help grow your business
-How to gracefully ride the ebbs and flows of entrepreneurship
-Prioritizing your mental health to avoid burnout
-New year intentions from the team
-And so much more!
Resources:
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For more information on Jenna:
Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, RDA Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre.
Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia.
During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media.
Jenna Kantor currently holds the position of the NYPTA Social Media Committee, APTA PPS Key Contact, and NYPTA Legislative Task Force. She provides complimentary, regularly online content that advocates for the physical therapy profession. Jenna runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online course for performing artists called Powerful Performer that will launch late 2019.
Jenna continues to perform in musical theatre and lives in Queens, New York with her husband and two cats.
For more information on Julie:
Dr. Julie Sias, PT, DPT is the Producer of the Healthy, Wealthy and Smart Podcast. Julie received her Doctor of Physical Therapy degree from Chapman University. Julie loves to gain new insights and inspiration from the guests of the show in order to enhance her physical therapy private practice in Newport Beach, California.
For more information on Lex:
Alexis Lancaster is a student intern on the Healthy Wealthy and Smart podcast. She earned her Bachelor of Science degree in Biology, a Graduate Certificate in Healthcare Advocacy and Navigation, and is currently in her final year of the Doctor of Physical Therapy program at Utica College in Utica, NY. Lex would love to begin her career as a traveling physical therapist and hopes to eventually settle down in New Hampshire, where she aspires to open her own gym-based clinic and become a professor at a local college. She loves working with the pediatric population and has a passion for prevention and wellness across the lifespan. Lex also enjoys hiking, CrossFit, photography, traveling, and spending time with her close family and friends. She recently started her own graphic design business and would love to work with you if you have any design needs. Visit www.lexlancaster.com to connect with Lex.
For more information on Shannon:
Dr Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women’s Health Physical Therapist and is currently the only Board-Certified Women’s Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.
Read the full transcript below:
Karen Litzy: 00:00:07 Hey everybody. Welcome to the last live podcast of 2019 I am your host, Karen. Let's see, and today's episode is brought to you by Optima, a net health company. Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected, which is huge, and workflows that streamline patient care and save valuable time. You can check out Optima's new on demand video to learn what's in store for outpatient therapy practices in 2020 with some of the biggest industry trends along with tips and best practices to successfully navigate these changes.
Karen Litzy: 00:01:14 Learn about these trends for the new year at go.Optimahcs.com/healthywealthy2020 and we will of course have a link to this in the show notes under today's episode. And I also want to thank net health not only for today, but for being such an amazing sponsor to this podcast. We couldn't do what we do every week without their help. So a huge thanks to net health. So definitely check them out. And notice I said we now it's because of course I cannot do this podcast alone by any means. And today I am so excited to have the powerhouse team behind this podcast for amazing physical therapy entrepreneurs for strong, amazing women who help bring this podcast to life every single week. So in this episode, I'm happy to have on doctors. So they're all doctors, Julie Sias, Jenna Kantor, Shannon Sepulveda, and Lex Lancaster. And what we did was I had a conversation with Jenna and Julia.
Karen Litzy: 00:02:18 You'll hear that in the first half of the podcast. And then in the second half of the podcast with Lex and Shannon and we talked about what our sort of our year in review, what 2019 did for us as people and as women and as entrepreneurs and physical therapists. And one theme that came across was that we're all doing things that make us happy and that in 2020 we want to continue that and we want to sort of construct the life that we want to see us leading. So that's in our personal lives and also in our life as physical therapists. So the amazing thing is Lex, Jenna and Julie are new grad physical therapists. Jenna and Julie have started their own practices. Lex has her own business outside of physical therapy, helping people with websites and graphics. Shannon, has an amazing practice in Bozeman, Montana.
Karen Litzy: 00:03:20 She has started her practice about two years ago. It has grown exponentially. So she talks about how she did that. And it's amazing. We talk about what I have coming up in 2020 including an online course to help all those physical therapists or occupational therapists out there who want to start their own practice in a way that feels good to them in a way that's going to make them happy, bring them joy. And also the most important thing as physical therapists is our job is to get people better. And in our conversations in this podcast, we talk about how what we do as individuals not only affects us, but it's exponential. It affects everyone around us, our communities, our friends, our families, and of course the patients that we serve. And we're so grateful to that. And of course, as the host of the podcast and creator of the podcast, I just want to thank all of these women because without them I wouldn't be able to do this.
Karen Litzy: 00:04:14 There's no way I can do this on my own. Like one of my guests said, Stephanie Nickolich and we mentioned this in the podcast is if you try and do it all, it'll keep you small. And when I was trying to do it all with this podcast, it was keeping me small. I wasn't able to upcycle this as much as I have with the help of these four women. So I just want to tell all of them and I say it in the podcast as well as that I appreciate them. I think they're amazing and I wouldn't be able to do what I do without them. And I just want them to know that my gratitude for this past year of 2019 is so immense and looking forward into 2020. I'm so excited to see what we all come up with. So I hope you guys really take in this episode because I think it's really special and of course to the audience thank you so much for another great year of listening and interacting with the podcast and being able to meet so many listeners all over the world has been a real joy to me in this past year. So everyone, thank you so much. Have a very, very happy new year and we'll be back with brand new episodes in 2020.
Karen Litzy: 00:05:24 Hey Jenna and Julie, welcome to the podcast. Welcome back to the podcast. Since you've both been on several times. The reason being is because we all work together on the podcast to make it what it is. So well, welcome, welcome. So we're wrapping things up for 2019 and I thought, well, what better way to do that then with the people who make this podcast happen every year and who I'm eternally grateful for and appreciate so much for all of your hard work and your dedication and your fun and your being you. So, thank you guys for everything that you do. And now let's talk about 2019. Right? So we have January, 2019 to now. So a lot of things have happened within that year. So Jenna, we'll start with you. What are some highlights for you that's happened over the past year that you can kind of share with all the listeners?
Jenna Kantor: 00:06:34 Why hello listeners! Good, good evening and sun salutations. For me, I started my own practice literally on January 1st and we were driving back and I got my first patient that day. So literally my practice started this year. That was a big one for me. I also very quickly left all my PRN for those who don't know, that's working as needed, like a substitute teacher at a bunch of mills and I very quickly left all of them and I have been working for myself and it was the best decision I ever made. I have that musical theater background, which I'm sure listeners are quite familiar with, but if you don't know not, you know, and I was really not meant as a physical therapist to be sitting in one spot from nine to five. I really am not built that way and I love that I can make my own schedule, my own life and not feel like I'm really stuck in a location. It's a very, very big deal for me. That was something that was very concerned about as a performer. So I'm grateful to have made that move for myself.
Karen Litzy: 00:07:49 Awesome. And Julie, how about you? So what's happened from January till now?
Julie Sias: 00:07:54 So having been kind of mentored by Karen for the past three years, it was nice cause I also actually started my own practice and Karen was helping me along the way and everything. And January 1st yes, had my first patient and everything and it's been going really well, I haven't left my PRN jobs, but I do manage my concierge outpatient practice. And then I also see kiddos as like a consultation kind of gig. And then I work at a skilled nursing facility, PRN right now to supplement all that. But it's been a really exciting year because I finally have had a lot of control over all of my hours and it's been nice being out of school as a new grad.
Karen Litzy: 00:08:44 Yeah. And Julie, when did you graduate? What was your graduation?
Julie Sias: 00:08:49 So I graduated in the summer last year and then I took the licensing exam in November.
Karen Litzy: 00:08:56 Right, cause you had to wait that extra long time to take your licensing exam.
Julie Sias: 00:09:01 Yeah, so that was when I was just like a licensed applicant in California and I was working at the skilled nursing facility that I did a clinical rotation at. And then after I finally got my license, I was able to do all the paperwork to get a corporation and everything.
Karen Litzy: 00:09:16 Right, right. And Jenna, when did you graduate?
Jenna Kantor: 00:09:19 That is so cool, Julie. I graduated in May 2018, took my boards in August and then I had a baby. No idea. I felt like, I think it was the rule of threes and I didn't have a three so I made up one.
Karen Litzy: 00:09:48 That's so funny. Can you imagine now people probably be like, Oh my God, if they get like just a little clip.
Julie Sias: 00:09:54 That's Jenna's one liner for the episode. We should make a graphic. I had a baby.
Karen Litzy: 00:10:06 So great that the two of you were able to have a good idea of what you wanted to do and then we're able to execute on that and take action on that because it's certainly not an easy thing to do, especially when you've just graduated and you're trying to, you know, sort of make your Mark and kind of find your way. So to be able to know that before you even graduated I think is is amazing. And do you have any advice? Let's say there are some new grads listening or some students who are getting ready to graduate on what they can do to get some clarity around maybe where they would want to start their career at. And I'll have either one of you can jump in. Julie, do you want to jump in?
Julie Sias: 00:10:56 Yeah, I'm ready to rock. So it was good to have accountability from you Karen because I kept telling you every year that I was going to do this. So then when it finally came to the time I couldn't really back down. So that was good. Cause then I had told everybody so if I ended up backing down that wasn't really going to look very good. And then I was also really clear with how I wanted my life to be. And going this route is definitely more of like a, it's tough, it's been tough kind of cause it's feast or famine sometimes and that's kind of like the ugly side of being an entrepreneur. But I have to like pause and just be grateful when I think about like my day and I just go, you know what, this is actually my ideal day. I got to go for a walk in the morning.
Julie Sias: 00:11:54 I saw two patients. Maybe it's not like whether I want to be for like a full time job eventually, but I just have to like take a second and just be grateful. So it's good to have a clear vision about what you want your days to look like and then just know that when you put in the hard work eventually it will pay off.
Jenna Kantor: 00:12:41 Yes. Amen, this is Jenna. I could not agree with you more. I think that is such a good point with any new practice owner is to stop and essentially smell the roses because it's easy to be, Oh my God, this is where I'm at. Oh my gosh. You know, living sometimes paycheck by paycheck and yes, you're not going to be rolling in the dough right away. It takes time. It takes patience, it takes persistence, all that stuff. But exactly what you said I think is a great way to approach it. I think a big thing, well there's a lot of big things for somebody. Big things when you graduate and you're trying to find a job, but there really is, from what I have seen, I know there's always an exception to the rule. There's really no help with the idea of graduating and getting a job from your school. They are focusing on teaching you what you need to know. You've got to pass those boards, boom, bada Bing. So if you're not going to continue and try to teach at the school that you were just at, you're not going to really get that guidance. The big thing now unfortunately as most of the jobs are at mills, there are places where people don't want to work for a long period of time. That's why they're always hiring. It just is what it is. And you could have this idea similar to me where you want to work with performing artists or say you want to work with tennis players. Say you want to work with geriatric patients only, but not by the hair of the chinny chin, Medicare, chin. So you have a different vision on how you want to treat your patients. It's not easy to fully see that through when you graduate because you see this number of what you owe.
Jenna Kantor: 00:13:50 So you're in this like fantasy world. You're in school, you're learning like, Oh that's what I'm going to do. You graduate, you see your debt, that number and that number changes everything for everyone you've finished. You're like I need to get a job now. And it's just ah, and then you start work and then I've heard from some people, cause I spoke to a lot of new grads since then, I'm coming to me and I've only been out for a year and four months, you know, since taking the boards and then coming to me, just so fearful of
Jenna Kantor: 00:14:26 what if I quit? And that makes me look like a bad physical therapist. I always say the same thing. I don't care if it's your fourth, your fifth or 10th job that you're quitting. This is your life. None of us are living your life. So you got to make sure you are happy every time. You may get promises that, that they may not keep. And you need to keep track of that so you're not putting it on yourself. When you're not enjoying the job and you feel like you need to suck it up, you're not supposed to suck up life you’re supposed to enjoy life. You can't find that working for someone. You might be happy working at a mill. I'm not saying you wouldn't be, you wouldn't be, but most people aren't, unfortunately. So you're going to go through a journey most likely, unfortunately as a new grad of really having a hard time finding that fully right place for you to work long term.
Karen Litzy: 00:15:14 And I usually tell people to kind of when you're trying to figure out, well what do I want to do or where might I fit? I usually have people do a couple of different exercises and I mentioned this on the podcast before, but one is like, just make three columns. I'm a big column person, right? So you make three columns in the first, just put like what you love to do and the second column is what you're good at because they could be two different things. Just cause you'd love to do something doesn't mean you're good at it. Like I love to do graphics doesn't mean I'm good at it, but I love to do it but I'm not good at it. And then the third is what will someone pay you for? So if you can kind of find a through line there, I think it helps you to sort of drill into maybe what are your strengths, what are you good at? What do you love? What will someone pay you for? So I always say like, I'm really good at crocheting. I really love crocheting, but no one's going to pay me for it. So it's a hobby. See the difference, right? So you want to make sure that
Karen Litzy: 00:16:30 you're excluding your hobbies as being your full time job. But you know, for me, I some examples of what I'm good. Like I love curiosity, I love asking questions. I love, you know, networking and being with people and meeting new people. Those are things I really love and those are also things I'm good at. And so I was able to parlay that into a podcast and then parlay that into, through the podcasts and through networking into public speaking and into being asked to different conferences and stuff like that. So just know that not everything has to come from one singular job. You know like, and I think we can all say that here cause we've all got a couple of different things in the fire, stokes in the fire. Is that how you say it? I'm not really sure.
Karen Litzy: 00:17:22 At any rate I would say to new grads is to certainly find the job that's going to put food on your table and feed your family and feed yourself and feed your pets and feed your kids and feed whoever else is depending on you. But don't discount that this one thing is the only thing you're allowed to do. You're allowed to do a whole bunch of other stuff, you have to give yourself that permission to do that and then you never know where that's going to lead you. Because if I only stuck just to patient care, well I wouldn't have this podcast and I wouldn't be going all over the world speaking and I wouldn't be asked to coordinate social media for conferences around the world. I mean just wouldn't be a thing. But instead I just decided to do what I love and do it well and get paid for it. It's awesome.
Julie Sias: 00:18:28 Actually I have like a counter to that and that sometimes it's also good not to do what you love as a job cause it can be something that is your me time sort of thing. Oh that's like another counter to that. I was thinking about that maybe if you monetize something, it takes away the fun from it and then it becomes something where like I have to do this to make money versus I get to do this because I want to do it.
Karen Litzy: 00:18:59 Right. And I think when you reach that point,
Jenna Kantor: 00:19:03 Yeah, I agree. Cut the cord if you don't like it's for me with performing I did. That was before me professionally for many years in musical theater. And I started to, I got into an eating disorder and I had to take a backstep cause it felt like a nine to five job going to these different States and I started doing community theater again to refine and which I did. And then I started working professionally again. So really was just, I realized I was just working at the wrong places. It's not that they were bad places, just not right for me. So yeah, I definitely agree with it's just assigned to cut the cord
Karen Litzy: 00:19:41 Like Julie said, when you get to that point where I love doing this thing, but now it feels like a chore. I think you have to really do some self reflection and kind of see like, boy this is not, maybe, maybe I made a misstep here, so I need to take a step back and reexamine what I'm doing and let it go. Or you can see are there ways that I can make it even better if I give up some of the controls. Hmm, nice. Right? So I felt what Julie just said is what I felt about the podcast a couple of years ago. This very podcast, I was like, Aw man, I have to do another podcast. But then, and I was like pissed about it cause I was like, Oh, but I have to do this and this and this and Oh now I have to make time for this.
Karen Litzy: 00:20:37 And I thought, all right, let me take a step back and kind of re-examine what I'm doing here. Cause there's gotta be a way that I can make this better and that I can make it bigger. And the thing for me was asking for help. So once I ask for help and let the control go, now all of a sudden it's, you know, more enjoyable and it's something that I continue to be very proud of, but that I'm not like, Oh no, not again, damn you podcast. You know, so it's instead of cutting the cord, I just tried, I took a step back and tried to look at ways that I can improve upon it and the improvement came with bringing people on board. So that's, you know, another all very valid kind of ways to look at things.
Julie Sias: 00:21:49 Yeah. Another way to look at it too is that when you were under a lot of pressure, that allowed you to kind of be more creative too, to look for solutions and sometimes you go in directions that you wouldn't have thought you were going to go just because you were under that pressure and boom. That's where sometimes magic happens too.
Karen Litzy: 00:22:09 That's right. Yeah. I think what Ryan Estis who was on the podcast a couple of weeks ago, what did he say? Like, when you're comfortable it breeds laziness or something like that, I'm really butchering his statement. I was like, boy, I really butchered that one up pretty well. But I remember when you said that, I was like, yes, that's so true. And yeah, it was something to the effect of like if he was looking at it from the point of view of an entrepreneur, that when you get to the level where you know you're consistently making money and you're consistently successful and then does that then breed complacency and does that take away your creativity a little bit?
Julie Sias: 00:22:58 Yeah. That's not really the magic zone for growing.
Karen Litzy: 00:23:01 Right, right, right. Yeah. And that's when you need some outside eyes to kind of take a look and see, and like Steve Anderson said last week, what is the role of a coach? And he said to give you those external eyes and ears that opens you up to things that you're just not seeing. And that's for everyone.
Julie Sias: 00:23:27 Yeah. I actually have a perfect example of this and it was when I was just graduated and I was a licensed applicant and I had gone to all of my clinicals and asked for a job because I needed to make money while I was studying for the boards and stuff. And so ended calling Karen up and I was just like, you know, this one job offer, I got sure, like I'll have guaranteed money and guaranteed hours and stuff, but I just, it's not sitting with me well, I didn't really enjoy that experience as much as I could have. And then you were just like, Oh well maybe that's not the right fit for you. And then I got really creative and asked for referral for another clinic and ended up getting a job that better suited me at that time. So it was kind of nice having you there cause I was in the trenches like, Oh I need to make money right now. And you were just like, no, just take a step back. And then I had all these other opportunities present themselves.
Karen Litzy: 00:24:24 Right. Right. And Jenna, that's kind of what you were saying. Right. When you graduate, like you said, all you're seeing is like, I've got debt, I need to make money. So you just take what you can. And so, you know, we don't always want to take just what we can, but you know, we want in an ideal world, we want to take what fits from all perspectives, what fits for the employer, what fits for you as a potential employee, what fits for you, whether you want to be an entrepreneur or you know, a part time entrepreneur, full time, whatever. But I think as a healthcare provider, if you find that job that fits, it just allows you to help more people.
Karen Litzy: 00:25:19 Right? And in the end, we're in the business of making people better. And if you're not in the job that allows you to do that or you're not in the head space that allows you to do that, then the people who ultimately suffer are not you. I mean, you do a little bit, but it's the people that we’re out there to help. We're there to help people. That's what our job title is. And so if you can't, you're not in a good head space to do that or in a good physical space to do that. Then I think it becomes very difficult. Like Julie said, well, I had a great day. I was able to do the things I want to do that keep me sane. So that when you show up for your patients, your clients, you're showing up fully for them. That's where I think the PT profession can Excel for sure.
Jenna Kantor: 00:26:24 When I was filling in for PRN work, I would come in energized, positive. I would walk in and go, let's do some physical therapy. We're going to heal. And like people loved me, or at least I believe they did. I had the patients even though I was a substitute teacher, which is how I introduce myself.
Jenna Kantor: 00:26:45 Like I really bonded with these people, you know, and I have that energy, but Oh yeah. If I had one full day or Oh my gosh, forgot it, two or three, Oh, can maybe have at once. Oh my God. Full days in a row, I would need days to recover, days to recover. Like I was like, I was gone, I was gone. I was like sleeping, like just feeling so tired throughout the day and it really made it so apparent to me that everyone else is doing this six days a week, maybe five, you know, I don't know, depending on there schedule, but I was just, Oh my God, I can't, you know, hence here we are a private practice owners on this call. Yeah, exactly.
Karen Litzy: Now let's talk about what's in store for 2020 new decade. New year.
Jenna Kantor: 00:27:44 It's my birthday. I'm turning 40 years old. That means I'm going to be so mature. February 16th. I like flowers, see's candies and cats and Disney for anyone who wants to know. Yeah, we're getting a dog. But like I'm more of a cat person so, but it has to be cute cats cause there are those presents. But 2020 is going to be awesome. I'm sorry, I just jumped in. But I'm theater people love talking about themselves being the center of attention. It's great. So I am so excited about fairytale physical therapy. For those who don't know, Fairytale Physical therapy is where we bring musical theater shows to children in hospitals and teach choreography that’s secretly composed of therapeutic exercises. This whole past year we've been working on paperwork back and forth with the lawyers to get it done right.
Jenna Kantor: 00:28:42 And we're like almost there every time. Like people ask, it was just us liberal almost there. Right now we're trying to get the right legal name because it's not as simple as you would think. So we're trying to figure out that legal name where they're not straying too far from what we are. And so that's going to exciting. And then for me, I am doing a lot of one-on-one beta tests with performers, for one course an online course for performers to essentially, those are going to be mini courses like say you have, hip tendonitis. All right? Now the majority of non-union musical theater performers do not have health insurance. And if they do, they have extremely high deductibles. So they usually just don't get help. So this is creating a wellness program that will be on that boundary of like, Oh my God, you doing like physical therapy stuff, but y'all do.
Jenna Kantor: 00:29:42 It's about the patients. So I'm creating this for them. The people who don't have that access, they don't have the money, they don't have all that, where it's a program and right now I'm just testing it on people cause it's physical therapy. You have to test on people and see if it works, if they stick with it. And so that's really cool. So I'm literally doing it, I'm doing three different types of injuries, right? No, five injuries right now. And taking different people. They're essentially like patients where I'm talking to them every week and like upping the game and figuring out symptoms. So that's great. Move that over. Now I'm also starting next week, just walking into the new year one on one work with physical therapists who want to work with dancers and figuring out what they want to know to make them the confident, accessible and go to dance PT in their area.
Jenna Kantor: 00:30:35 So I am working with now five, it was originally three 50 minutes ago, became five. I'm working with five and figuring out what they learned and basically giving, creating a course from this. So I'm very excited about two things cause it's where I want my energy to go. I love doing, like we were saying, find what you like doing. I like doing the creation of online stuff. And I've just encountered so many people with limited access to performing arts, physical therapists who specifically know that. And if they do know that our hearts, they don't have the insurance. You know, there's a lot, a lot of people in this world who don't get it. So I'm very excited to be bringing that help to performers at large. Whether it be giving that education to physical therapists or providing a program to them directly so that is exciting!
Julie Sias: 00:31:36 Jenna, I was like, I'm going to bring like some California chill into the conversation because when I think about 2020 it's more just like, okay, I got my income streams and their proportioned a certain way. I want my business to grow more than the other ones and slowly phase those out. So that's like my intention for 2020 but then every other intention has nothing to do with physical therapy.
Karen Litzy: 00:32:12 I love it. That's good.
Julie Sias: 00:32:16 I’ve just been spending too much time thinking about physical therapy this year too much time, so next year I'm just thinking about more time with family, more time exploring hobbies and stuff. Maybe then I'll feel refreshed and have some inspiration to do more online type services and stuff like that, but just going into 2020, I have I don't want to say low expectations, but just I don't want to set too many things, just see where it goes.
Karen Litzy: 00:32:40 You have sort of more relaxed expectations, so not that they're low. I think phasing out your PRN jobs and increasing your income that’s a big job. And it's awesome. So I think that's a great thing to focus on. That'd be fabulous.
Julie Sias: Karen, you haven't told us about your 2020.
Karen Litzy: 00:34:09 Why I am going to do nothing? No, I'm just kidding. I'm just stepping back and I'm going to live the life of Riley for the whole year. No, no, no. I am going to continue obviously with my concierge practice because I love it. I would like to take on another independent contractor onto the practice as well. Just to, even if it's just one or two patients a week, you know, just something to kind of help offset the amount of time I'm spending with patients, which I love. But, it's a lot. So oftentimes I get caught up working in the business instead of on the business. So that's something that I'd like to kind of get a better balance of. And I am also in the final stages of putting together an online program. I know I said I was going to do this year, and I did it because I was too fearful and just was too afraid of like, no one's gonna buy it. I'm going to look so stupid. And with that, you know, it's clear that has been holding me back. But I've been working with Adrian Miranda also. So he helped me with some videos and worked with Joe Tata, to help me come up with a great plan. And I've been working with copywriters throughout the year and some business coaches. And so I have a program that I was calling strictly business mastermind, but now I think we're might change it to the private practice mastermind, but that might be changed. I think someone else has a name that's pretty similar.
Jenna Kantor: 00:35:20 You could do PP mastermind, so you could say pee pee like professionally, which would be funny. He'd be mad.
Karen Litzy: Oh boy. I didn't even think of that. Now that private practice mastermind PPM, I may need to rethink this. But we're hoping for like an end of January launch and it's not just me, there's myself, there's lawyers, there's accountants, there's PR professionals, marketing professionals, investment professionals, you know, investment 101 for entrepreneurs kind of thing. Got other successful physical therapists are going to come in and that's just the six week part of the course. So six modules over three months, but then it's a year long program. So each month I have new mentors coming into the group to talk about whatever the group is looking for. Whether that be, you know, practice succession or tax stuff, student loan stuff, whatever.
Karen Litzy: 00:36:38 So we'll have monthly webinars for the whole year. And then the best part is I'm doing the Marie Forleo model. So Marie Forleo started a B school, which is an online kind of business school, like abbreviated business school that she started several years ago. And once you purchase it once, that's it. So if we do it again and there are things added to it, you're always in the Facebook group. You don't get shut out of the Facebook group after a year. You don't have to pay for upgrades and all that kind of bullshit cause I think that's so stupid. So I'm going with the Marie Forleo model and it seemed to serve her well since she's made millions and millions of dollars and she's just helped so many people. And I think they just know that like, Hey, this is the deal. And so once you buy the program, once you're in it for life and you'll get the benefits of that for as long as you need or want said benefits.
Karen Litzy: 00:37:41 So I love it. I kind of liked that model. I just think it's, I dunno, it just fits my personality a little bit better, you know? So, we'll come up with a name, and then we'll unroll it hopefully at the end of January.
Jenna Kantor: Karen Litzy’s LIT program. Karen Litzy’s Master class cause you could do lit in LITzy. So that'll be like the fire. Oh, I see what you mean. That's a topless pizza delivery man. I dunno. I just, I was thinking lit. That's red fire color and nothing. What else is fire color? Oh, pepperoni. And then I went to pizza and that's where we got.
Karen Litzy: Well, I thought it was because I am from the pizza capital of the world, which I guess would make sense. That would be amazing. I love that. Yeah. Yeah. Old forge, Pennsylvania. Plug for my hometown, pizza capital of the world. But yeah, so, but that's pretty much. And then, I also am going to take a vacation.
Julie Sias: Where are you going?
Karen Litzy: 00:39:08 I don't care, but I'm doing it. I don't know where I'm going yet,
Julie Sias: You should go to Hawaii.
Karen Litzy: I love Hawaii. It's so nice.
Jenna Kantor: This morning you, I don't know what it is, but one, I have a friend that's gone on vacation that is when I decided to contact you. So it's not on purpose. It's just so when I'm contacting you I'll be like, wait a second. She's probably obvious. She's in Hawaii. She's in Hawaii.
Karen Litzy: So we'll see. I don't know, but 2020. I am definitely, cause I have not had like proper vacation in a long time. So my goal, one of my biggest goals, and this is not PT related, kind of like what Julie said, but is take a vacation and love that with Brett. He just doesn't know it yet.
Karen Litzy: 00:40:03 We just have to be after June. He worked for a state Senator in New York, so he's in session until in Albany, you know, you gotta, you gotta do what you gotta do. And then the other thing that I want to do, and Jenna can probably help me with this, is get a little more involved on the legislative side of things.
Jenna Kantor: Love that stuff, man. You want, it's that be the change you want to see in the world.
Karen Litzy: 00:40:50 That's another thing that I'd like to do, whether it's PT related or not PT related, but just try and push for things that I believe in that should be happening.
Jenna Kantor: So I think this has been the best podcast ever. I think for all of us were overjoyed to have us have cats. Julie, where's your pet?
Julie Sias: She's outside.
Jenna Kantor: There's that dog, a dog and two cats walk into a bar. Thank you so much for having us on Karen.
Karen Litzy: Yeah, this was great. And I'm just so happy to wrap up the year and I'm looking forward to lots of great stuff from everyone and with the podcasts and just kind of keep moving forward and trying to innovate and do some fun stuff. So that's the goal and I thank both of you. So Jenna, Julie, thank you again. Like I said in the beginning, I appreciate you guys so much for all of your hard work and help and making the podcast much better than it ever was. So thank you so much. And everyone we're going to take a quick break to hear from our sponsor and we'll be right back.
Karen Litzy: 00:42:20 This episode is brought to you by Optima, a net health company. Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected and workflows that streamline patient care and save valuable time. You can check out, optimize new on demand video to learn what's in store for outpatient therapy practices in 2020 with some of the biggest industry trends along with tips and best practices to successfully navigate these changes. Learn about these trends for the new year at gooptimahcs.com/healthywealthy2020.
Karen Litzy: 00:43:00 Hey Lex and Shannon, welcome to the podcast for our year end wrap up our year in review. So thank you so much for coming on and being on the other end of things for Shannon and the other end of things for Lex too. So thanks so much. So I spoke with Jenna and Julie the other day and now I have you guys here and I'll say the same thing to you guys that I said to them is that I'm so thankful and appreciative of both of you for being part of the podcast and really elevating it to a new level this year. Cause I really do feel like without your help and without your contributions that it just wouldn't have been what it was. So I just want to thank both of you and know that I appreciate both of you for your work in front and behind the scenes. So thank you so much. And now let's talk about 2019 because now is the time of year that everyone looks back on the year. So I'll ask the same question of both of you.
Karen Litzy: 00:44:14 Where were you at January of 2019 versus kind of where you are now. So Lex, why don't I have you start kind of what big things happened in your year? Where are you now? So it's way different than where you were in January.
Lex Lancaster: 00:44:32 Yeah. It's pretty crazy to be honest. I was thinking about it last night. This time last year, I was preparing for my last clinical physical therapy school, so I was actually going to New Hampshire. Mmm. I was going to be in an outpatient clinic for 13 weeks. I was super excited because it was my last one, but I was also getting that full 13 weeks in outpatient clinics. I was like my powerful clinical, so super pumped. So I finished that and then I went to graduation and I actually got engaged on white coat night. So that was really, it was awesome. Kyle did a really good job. And then I graduated PT school, it was so awesome. I was so happy. And then the NPTE came around and that was a different experience altogether. I will say that I underestimated that completely. Just the preparation for it as a whole, but then I passed. So that was great. And then now, so I had this dream of being a travel PT.
Lex Lancaster: 00:45:42 So, this past year, you know, I decided I was going to explore that. So right after I passed the NPTE, I accepted a contract with my fiance in Alaska. So we moved 3,500 miles away from home to an Island of 1200 people in Alaska. So now we're in Ketchikan where it's like the rain capital of the world. So I don't look at rain as like, let's keep me inside anymore. It's okay. It's always raining. It's never not raining. And it's pretty dark here. It's pitch black still right now. So we're currently in Alaska and an outpatient clinic. And to be honest, it's been a whirlwind transitioning from student to kind of a PT, but you're just studying for your exam to a full blown PT. It's been hard just because I didn't expect it. You know, I've done clinicals, I'm like, Oh, it's no big deal. It's totally different when you're the person. So I've spent a lot of time in the last 13 weeks just kind of getting used to that and getting the groove and I’m excited. I'm excited to see what the next year will bring because this year was just really, really awesome and I'm really excited for, you know, to see what's next.
Karen Litzy: 00:46:52 And you also, not to, I don't want to leave this out, but you also have an entrepreneurial streak in you. You have a company that you started this year as well. Am I correct?
Lex Lancaster: 00:47:05 Yeah, yeah. And I shouldn't, you're right. So I guess I initially launched it in like the end of 2018 but this past year has just skyrocketed. I just went from, I mean, I guess word of mouth is kind of the way that it really worked out. And I get to design websites and graphics and I am a virtual assistant, so I get to work with people all over the country and all different professions. I have so much fun doing that and I started it in PT school as I admit. I used to do it when I was bored in class. And then, you know, it got to the point where that was how I took study breaks. So that was the way I decompressed and I found that that was a big stress reliever for me.
Lex Lancaster: 00:47:56 So I explored that option and then I was kind of talking to Shante, movement Maestro and she was like, you know, you could really do something with this because I approached her at RockTape course and I was like, Hey, do you need an assistant? And that was right after I started working for you Karen. So like I was feeling pretty good. I was like, this is fun. I love doing this. And then I decided to do the whole web design business too and big changes for that coming next year. So yeah, it's been, it's been really, really cool. I've learned a lot about a lot of different people and I get to explore that all the time and I love it.
Karen Litzy: Yeah, I think that's great. What would you say to a physical therapy student right now? Who is set to graduate in, whether it be, maybe they're graduating now or maybe it's spring of 2020 given the huge changes that happened in your life over the past year. What would you say to them as they prepare to graduate or maybe they just graduated?
Lex Lancaster: 00:48:48 A couple things I would say I would say really explore your mental health. I think that I didn't take that route when, as I was graduating, preparing for the NPTE and I feel like I truly drained myself to the point where if I could go back, I would invest in, you know, even a coach just to get me out of that sympathetic drive because I feel like my life just kind of, I just devoted all of my time and energy to the NPTE and it really did drain me. And, it was just a lot to manage. So let's say explore your mental health, get that in check and you know, really be prepared to learn a lot and find yourself in whether you're in your last clinical or just starting your job, you know, if you're the smartest person in the room, try not, you know, try not to be that.
Lex Lancaster: 00:49:50 Like there's always something to learn and it's hard to go back to be in the clinic and be by yourself and not have someone to bounce ideas off of that's in your room. Like your CI. It's hard. And I truthfully would say get involved in Twitter. I've found that I've met the most incredible PTs on Twitter and I get so much good advice from them and I'm able to contact, you know, people have specialties that come into the clinic and I'm just like, wow, they could use some opinions on, you know, the vascular aspect and I'll find somebody on Twitter and they are more than willing to help me. I would say just reach out if you have any questions about patients because there are so many PTs on Twitter and social media in general that would help you. So I would say just keep your network huge.
Karen Litzy: 00:50:36 That's great advice. And you know, I feel like this, the first time I heard someone say take care of your mental health. I mean Shannon, like we've been the NPTE or the boards and on through to our career. Have you ever gotten that? I never got that advice to kind of take care of your mental health. I think it's great.
Shannon Sepulveda: 00:51:00 Yeah. I mean I think it's super important. I mean, one thing like when I was a runner and an athlete and so I always made sure that like I worked out every day cause that really helped. But I remember like, just wait until you take your specialized board exam because then you don't get your results for three months. So it's like three months of like, okay, like is it June yet? You know? And so you don't even like, and like when I took my women's health board exams also I was postpartum so that like added a whole new mental health aspect to it. But I mean I studied for, you know, probably six months, probably pretty intensely for three months. And then you take the exam and it's very similar to the NPTE where you're like, I don't know if I pass this because the questions are similar where you're just like, ah, yeah, I don't really know.
Shannon Sepulveda: 00:51:55 And then you have to wait three months to know if you pass. And so that's really hard.
Lex Lancaster: I'll say a week was really hard. So I give you a lot of credit. Yeah, I know it was a hard, and you walk out and you're like, then I have never felt like I have completely bombed a test, but I feel like I just bombed that and then everyone's like, don't worry, this is normal.
Shannon Sepulveda: Oh, it was sort of like, even with like my women's health exam and then I was like, I think I failed that. And then I ended up getting like in the top 10 or 25 it was something like I did really well on it, but I thought I failed it.
Lex Lancaster: It's so odd that our brains do that, that all we remember all of the negative questions. We forget how many good ones there were and then we just kind of wrap around that.
Karen Litzy: 00:52:51 Yeah. And that's life, right? That's why people always say to like, keep a gratitude journal at night. So then you remember the good things that happen to you every day and you don't get wrapped up in the negative because I think that's, like you said, it's kind of where our brains tend to go. We remember those negative aspects before we'll remember the positive ones. It is amazing.
Shannon Sepulveda: 00:53:15 Yeah. It's the same thing with patients. Like who do you go home and think about the one patient that didn't get better, not the six that you made better.
Karen Litzy: 00:53:27 Totally. And now, Shannon, speaking of changing lives, so going from January till now, what's been going on? What were your highs and lows and just so everyone knows, I mean they can go on the website, but you're a business owner. You're in Bozeman, Montana. And one of the only women health specialists in the state of Montana?
Shannon Sepulveda: 00:53:53 I'm the only one that's taking the board exam. A couple women in Montana who have done the Herman and Wallace pelvic floor and they're super highly trained and there's other people in Bozeman that are women's health physical therapists, but I'm the only one that's taken the plunge to take the exam. But yeah, so 2018 so I know, I was thinking about this question. So I've been in my own practice for a little over two years. And so I was thinking, I'm like, where was I in January? And so since I take insurance, January is always like dead pretty much, but December is always nuts. I think I was still building my business like last January. I didn't really like have a full schedule. I had been in business for a little over a year.
Shannon Sepulveda: 00:54:45 I changed my last name when I left my old clinic, just kind of to make a clean break with insurance and everything. And so I was still trying to get like name recognition and I do women's health also getting into like the Perinatal community in Montana. And so this year I'm finally like, like doctors know who I am and patients come in, they're like, I got referred by, you're like so-and-so. They said you're awesome. And so I'm getting like all of these women, especially postpartum women, that's generally who I see, who were like, Hey, so and so like saw you, you changed their lives and I'm here. And so I would say like probably well over 50% if not 80% of my patients are direct access word of mouth. And I'm just like, Oh, this is so nice because I don't have to like network anymore.
Shannon Sepulveda: 00:55:49 I don't have to like spend my nights at like local networking events and which I was doing just to get some name recognition and now I feel like I can, I don't want to like totally rely on word of mouth. I still think I need to get out into the community but it's really nice just to like check my phone. I do online scheduling and be like someone's requesting an appointment and another person's requesting an appointment and know that like the patients are coming without me having to like really go out and spend a lot of time, which, and I think doing that really helped me now. I think I had to do that but now it's nice where like it's almost like an exponential growth cause moms tend to talk, which is really nice. And so the word of mouth has gotten really great for me.
Karen Litzy: 00:56:37 That's awesome. And you know, I think you bring up a really good point that you were in business for a year and you had a patient flow but it wasn't like you were overwhelmed and you know, you didn't have this full, full schedule. And I think for people starting out in business that is so important to realize that you don't start your business and in two months, it's rare it could happen. Yes. You're not usually on a full schedule within a month or two.
Shannon Sepulveda: 00:57:09 No. And I think what was really important was like the time that I wasn't seeing patients, like I took that time to either like have lunch with somebody, like have lunch with a prenatal yoga instructor or like have lunch with, you know, really anybody, a doula and midwife, like whatever. And so I really like had a lot of lunches and coffees just to like meet people. So when I wasn't seeing patients, I was trying to meet people in the community. And I feel like those like one-on-one rather than like the big networking events were really important. And I sent like, it was great for me too because like I want to know who to send to for prenatal and postnatal yoga and I want to know who the good doulas are and who the good midwives and OBs are because I send people their way and who the good like trainers are that understand pregnancy and postpartum because I'm not a trainer. Like I get people to not pee their pants so they can go to the gym and see the trainer.
Karen Litzy: 00:58:10 Correct. It could be your slogan. And you know something that would work.
Shannon Sepulveda: 00:58:19 Yeah, it was funny cause Shayla, the one that I did the podcast on with the hats she wanted, I got a bunch of my hats embroidered and she wanted me to put on the back leak-free thanks to my PT and I was like, that's awesome. You know, I don't know if people will wear that, but that's a really good slogan.
Karen Litzy: 00:58:39 That's great. I mean, you're really good at what you do. No, I mean that's great because what do people want? They don't, like you said, like I get them to not pee their pants so they can do other things. It's that simple. You don't have to overcomplicate things. Yeah, but I love that you're still kind of doing business. I call it like business generating activities, you’re not getting paid for it, but it's business generating activities, so it's still like a moneymaking activity. And you're right, the bigger, like Lex said, the bigger network you have, whether that be virtual in your case, because your business is in Bozeman, the bigger network you have a Bozeman, the more people are going to come your way. And so you did all of that work and now you're really starting to see the benefits of it and it's really exciting.
Shannon Sepulveda: 00:59:28 Yeah.
Karen Litzy: 00:59:29 It's also good that you know the cycles of your business. So you know there's going to be really bit busy but January, not so much. You'd be like, okay, so January I'm going to set aside this time to do X, Y, and Z for my business. And if you know that those are the ebbs and flows because every business has an ebb and flow, then you know you can rely on that. And like I remember for me, my downtime is now around Christmas, new years, not a lot of people around. So that this would be the time where I would take a vacation or I would work on business plans for next year or I would, you know, just get things together. So, so to speak. So I think it's great that you brought up all those points. And Shannon, what would you tell a new business owner, regardless of what kind of PT business you have, whether it's a cash based business or your insurance or a hybrid, what have you learned that you're like, Oh man, I would tell everyone this.
Shannon Sepulveda: 01:00:29 Yeah, I've learned that if you're good at what you do and you get patients better, they will tell other people. And so I don't want to say think of every patient as a referral source, cause that sounds like you're, you know, it sounds like you're categorizing them. But think of every patient as like, this person is very important. It's very important for me to get them better because that's what I do and what I'm good at. But it's also very important for my business because if you get them better and you treat them well with respect and you do everything, they're going to tell other people, especially in a small town. And so like I am very, like sometimes I come home and like after seeing like patients for an hour, so like I see like seven patients and that's a big day for me.
Shannon Sepulveda: 01:01:22 And I am just like compassion fatigue is like full on set in because like I am so engaged for that period of time and with my population it's really important because it's really important for, they just need someone to listen to them. But if you think of every patient that way, it pays back. And every word that you use with the patient is very important. Because they come from like sometimes doctors that say things that I wouldn't necessarily say to a patient and they come in with, you know, thought viruses. Thank you Lorimer Mosley and you know, just talking to them but being really compassionate, you know, with all for your patients. Yes. Really in the end. And sometimes it's hard at like four o'clock at the end of the day, but it's really important.
Karen Litzy: 01:02:16 Yeah. And I always think of your patients instead of like you said, referral source, cause that is a little, that's, I don't know how to like how would you, I described them as ambassadors.
Karen Litzy: 01:02:30 So they become ambassadors for my practice. And that's the way that I don't treat them as a referral source. I treat them as an ambassador. So someone who chose because of the care you gave to them, you know, I would love for you to see this friend of mine or my daughter or my cousin or my, you know, X, Y, Z person, my coworker. Because like you said, you're listening to them, you're treating them with respect and kindness and compassion. And so to reduce that to a referral source is, I don't know, I agree with you. I like to use ambassador because they're new, that they want to be part of what you're doing. You pulling them in and saying, Hey, I'll give you a free X, Y, Z. If you refer me to five of your friends.
Shannon Sepulveda: 01:03:24 But because they're choosing to represent you and they're so excited to tell people like that's what is so awesome about what I do is like, like I'll see people and be like, thank you so much for referring your friend. They're like, Oh my gosh, I am telling everybody because like we don't have to pee our pants anymore and we don't have to have painful sex anymore and this is just so great. And I'm like, yeah, it's great.
Karen Litzy: And Lex, you'll get more of that as you practice more, you know, you'll get people coming to the clinic you're in specifically to see you, which you might've already gotten so far is you're in this small town, right?
Lex Lancaster: 01:04:07 Yeah. I actually wanted to say that because you used a word Shannon, you said, or a phrase, compassion fatigue. And I find that as a new grad, I'm learning how, cause that's me every day I do that. And you know, my patients come in and on the Island we don't, there's not a lot of doctors. The practitioners here, you know, they have to go down to Washington to see a specialist. So oftentimes people will come in with, you know, a lot of comorbid conditions and we have to sift through all of that and make sure they've seen the correct people. So there's nothing I love more than getting on the phone with four doctors for one patient. So, and I've found that like, that's caring about them and I'm like, Hey, look, I'm going to reach out to your doctor. And they love that. And, but I do find at the end of the day that I'm exhausted. And so I'm trying to find that balance where I'm giving, giving, giving, but also saving a little bit for myself at the end of the day. But yeah, there's been patients that are like that, Karen, they just, they're like, Oh, I've told my friend. And then that friend comes in and then they come see me and it's just like, this is amazing. And that's why I could see why having your own business, why that's so important. Because that word of mouth aspect, you really can't replace that.
Karen Litzy: 01:05:24 Yeah. Yeah. And you know, I think most PTs have that kind of compassion fatigue. And one thing that has helped me is, I remember it was at, Oh, I dunno, it might've been Jason silvernail might've mentioned it on Twitter. I'm not a hundred percent sure, but I remember. So I think it was him saying that the thing that helped him the most and he's in the army, the thing that helped him the most is, is finally realizing that somewhat he is not responsible for a patient's outcome, that the patient's responsible for their outcome. So and that's hard because you're investing your time and your compassion and your emotions into this patient and your skills. But once I realized once I was able to kind of separate myself from like I am not the fixer, I'm there to guide and to coach and to diagnose and treat but not to fix and can separate the fact that I'm not responsible for this person's outcomes, that the person needs to embody that.
Karen Litzy: 01:06:32 Then the compassion fatigue is less, it's still there because we're all humans, but it's much, much less. And when you instill that into your patients, it's really fun. Like I had a patient who had chronic neck pain for five plus years and came in and he had stopped running, working out, doing this, doing good, going to CrossFit, doing everything. And I said, well, why, why, why do you think that is? And I understand I was the same way. And so we got him back to doing things and I would see him once a week, once every other week now, just once a month. And he's like, yeah, so I had like a week. I was like, I really didn't have any pain. He's like, and you know, it's because he's like, I work out like almost every day now. He's like, so you're here but it's not like what you're doing to me. He's like, I'm working out and that's what's making me feel better. I'm like, yeah, exactly. He was like, what? You gave me permission to work out again? I was like, yeah, I can do this. And I was like, I was like, you got like, that's exactly what you hope to hear is like, yeah, got it. It clicked. And you can tell it like clicked for him at some point that week. Like, I'm helping myself get better. Oh, I see how it works. Got it.
Shannon Sepulveda: 01:07:51 Yeah. And that's, I think really like, it's hard. Like I try really hard not to make my patients dependent on me. Like I try really hard. I was like, my job is to empower you to get yourself better. Like I give you the tools to get yourself better and I don't tend to do a lot of like if someone's in like acute pain, I'll do some manual therapy, but I don't tend to do a lot of manual therapy because aye I can see like sometimes they'll become dependent and my job is to be like, no, you can do this. Like you, you can do this. It's all you.
Karen Litzy: 01:08:29 Yeah. And all the research that like Lex, I feel like, and I don't know Shannon, you could probably agree with me here, but I feel like Lex and like you guys and your new grads, like you guys are starting out on like second base. I started out, I didn't even start out in the dugout. Like when I started, I feel like I started out in like the showers. Like I didn't even get to the dug out yet.
Karen Litzy: 01:08:50 You know, with all of this sort of patient forward care and you know, the science behind pain and all this stuff that's this new research that has come out in the last 10 to 15 years. I feel like as a physical therapist it really gives us a headstart if you're keeping up with it. So like you're light years ahead of where I was.
Lex Lancaster: 01:09:14 And I would say a lot of it too is because of people that share things. Because you know, even like on social media, you see something and someone shares, whether it's at a snippet of an article or something, you're like, where did they see that? And then you go read that and you're like, Oh wow, that was awesome. So you know, people post the books that Lorimer Moseley's books and you know, you see those posts, you're like, Oh, I should read that. And you read it and you just gain all this knowledge. And like I said, I feel like a lot of it is dependent on people that share things. So, you know, all the podcasts that are out, especially, I mean, especially yours, Karen, to be honest, I'll say, I look at all yours and I'm like, Oh my God, that's so amazing. So yeah, I feel like we do have an advantage, I would say, especially with the pain science literature, new curriculums like that, that like just the education piece that I give for pain, people just are like, Oh, okay. And then it's like immediate buy-in and it's so easy to just get people to, like you said, get ready to help themselves
Lex Lancaster: 01:10:13 We're very ahead of the pain science literature.
Karen Litzy: 01:10:19 I know I looked back and I'm like, Oh man, I'm grateful. I'm so grateful. I'm better with these people.
Shannon Sepulveda: 01:10:22 Oh yeah. I mean, I graduated in 2011 and there was nothing really, Oh yeah. I mean, well, in my PT education there was, yeah. I started learning some stuff after that, but there was nothing in my PT education about pain sciences and that was like, so I would have had like didactic until about 2010 early, you know, so I know it's like 10 years ago.
Karen Litzy: 01:10:59 I know. And like David Butler first published on sort of pain science stuff in 1996. Wow. You guys look it up. It was 96 or 97. And so, you know, we have, they say research to practice takes like 15 years.
Shannon Sepulveda: 01:11:18 There it is. There it is.
Karen Litzy: 01:11:20 It's amazing. It's astounding to me. And, I find that if you stay engaged as a newer grad, that you really do have such an advantage, and advantage with your patients and I hope that people really no that and can appreciate that. Then new, newer ish grads can really appreciate how lucky they are coming up. As far as information, the information pipeline is so much easier. Now. I won't even tell you, like I had to do the Dewey decimals system. I'm so old.
Shannon Sepulveda: 01:11:56 We were cleaning my house and I had all of my PT books and like my husband, so he works for the US geological survey and he has a PhD and I had all my PT books, what are you doing with these? I was like, he's like, have you looked at these in 10 years? And I was like, no. And he's like, everything's online now Shannon, you can get rid of these. Yeah, yeah. And like everything.
Karen Litzy: I got rid of my mind a couple of years ago. I'm like, what did I doing? And even if it's all these journals, like physical journals in my apartment, I'm limited space here in New York. I'm like, I gotta get rid of these journals. They're taking too much space.
Karen Litzy: 01:12:52 So let's talk about what's coming up in 2020. So what are you looking forward to? Do you have any goals or expectations or plans, whether Lex, I'm assuming you're going to get married.
Lex Lancaster: 01:13:07 Yeah. So we finally set a date. The wedding has been interesting. So I didn't really want a wedding just because it is, it's overwhelming. It's a lot of stuff to plan. But then, you know, family, they're like, Oh, well you're the only girl. You really should do it. So we set a date for October 17th of next year, so we're going to get married in New York. I've done minimal stuff. I've gotten the venue, really making very slow progress.
Lex Lancaster: 01:13:36 So working on that and then you know, for 2020, you know, I'm really looking at bringing, I just applied for a trade name for my business so I could take my name off it and just make it a new name. So I'm really excited to launch that eventually once I get that all set in stone and really trying to bump that side gig up just because I have found the value in the last couple months of doing things you like to do more often. So Kyle and I were actually talking the other day and you know, we're seeing the value of providers that have their cash based or insurance businesses and these small towns in their hometown. And we're seeing the value here. Like you get to know people, you get to know doctors. I love travel PT, I do, but I'm very far from home so I'm hoping I get closer back to home and we kind of want to land in a spot where we can kind of start our own thing.
Lex Lancaster: 01:14:34 We were those people like we care, we want to reach out to people out. People know us back home. And we really wanted to start our own thing. So we're trying to get back toward, well and try to do that just because I see people, you know, as they have their own business, they make so many decisions that they get to see patients when they want to see for how long they want to see them. And sometimes, you know, I'm very jealous of that right now. You know, there are patients that I'd love to spend an hour and a half way, then I just can't. And so I think that's a major goal right now. It's just to get to that spot. And I understand as a new grad it's very hard. Yeah. I mean, I don't, and Julie did it, so I should probably reach out to her because, you know, everyone says like, it's really hard to do a business on your own as a new grad.
Lex Lancaster: 01:15:21 I should reach out to her because that's what we want to do. And you know, we understand that will probably be hard, especially with student loans and whatnot, but at the same rate, like we're trying to define, you know, what's your happiness worth? And we just kind of find that right now the quality of care that we want to provide is sometimes limited by you know, whether it's because of insurance, a lot of dancers and we're finding it hard to justify their care even though they need it with insurance and people can't afford to do X, Y, and Z out of pocket. So we're trying to find, navigate all of that. So, I dunno, trying to, that's a goal just to get to a place where we can build our own, you know, set of patients.
Karen Litzy: 01:16:04 Awesome. And you're in upstate New York?
Lex Lancaster: 01:16:08 That's where I'm originally from, but we're probably going to end up back in New Hampshire. Yeah, we both really love it there. And I don't think my parents will be in New York forever, so I think we're just going to go back to New Hampshire area. So we're close to Boston.
Karen Litzy: 01:16:23 Yeah, I think that's a great goal. And you should definitely talk to Julie about that. And the good thing is you have each other to give each other support. You and Kyle have each other so you can, you have that support from each other. And I think being able to do that with the two of you I think would be really exciting.
Karen Litzy: 01:16:42 If you build up your side gig, then you can slowly build up your practice. You know, you just to know where you have those income streams coming from. But I think that's cool.
Lex Lancaster: 01:16:52 I'll say after reading Danny McTay’s book, it kind of gave us both a little hope of just that you can do it. It's just you have to decide if you're going to burn the ship or do it as a side gig for a little bit. And I think we're more or less thinking side gig for a little bit, even if it's just something, something to let us treat, you know, the high level athletes that we can't justify insurance-based for right now.
Karen Litzy: 01:17:18 Yeah. Basically. Yeah. You should talk to Julie cause that's what she's doing. She's sort of building it up slowly. We talked about it for this podcast. So. Perfect. And how about you Shannon? What's coming up for 2020?
Shannon Sepulveda: 01:17:31 I was thinking about this, I'm like, what are my goals? So business is really good, which is awesome. I think one of my goals I need to try. So I really don't want to hire anybody. I do all my own billing, all my own scheduling. I see my patients. I need to try to figure out time management a little more. Because like I'll be in like I take Fridays off and I'm with my daughter and sometimes my son has off kindergarten on Fridays and I'll be like in the target parking lot. And now they know when I stopped the car and I like sit in the parking lot space, I'm like checking my email. They're like, mommy, don't check your email. We need to go into the store. And I'm like, like accepting patient appointments or just like, you know, I need to try to figure out how to do that because I want to do everything.
Shannon Sepulveda: 01:18:26 But for myself. And so it may just be like saying no, it may just be having a wait list and trying to figure out like the feast or famine of owning your own business, like these ebbs and flows where like this month is like just absolutely nuts. Like I had five people call me in the last week trying to get in before their deductible resets. And so like I have like, I'm taking next week off and I'm not seeing anybody but like the 30th and the 31st, I think I'm like seven patients a day or something like that. 31st I have patients to like five 30 on new year's Eve because like, they're like, Oh please. And I'm like, okay, okay. You know, and because I know January is going to be really slow. And it's really hard. I'm staying up till 11 o'clock at night to finish my notes. And so I think either I just have to accept that that's the way it's going to be or do a little bit more time management.
Karen Litzy: 01:19:26 Or even sounds like maybe just setting your boundaries or boundaries for yourself and something that you're comfortable with. I think that that is something I will say that really helped me is saying, you know, listen, the last patient I'm going to see at night is seven o'clock at night. Like I'm not going to go later than that or I'm going to take at least one day off. Yeah. It may not be, may not be a Saturday or Sunday, but I'm going to take one day off during the week and this past what I've done is that I'm going to take five hours or four hour chunk of time and have that just dealing with business kind of stuff. You not teaching care. So I think if you look at your schedule and kind of set your boundaries, then I think you'll find that your time management just flows within that. Or you can get a virtual assistant.
Shannon Sepulveda: 01:20:19 I know I could do that. Yeah. It's funny cause like for some reason my boundaries…
Karen Litzy: 01:20:24 Cause you're like me Shannon. I'm the same way. Like, I love to like keep everything close to me, but the moment you can like let just one little bit go.
Karen Litzy: 01:20:46 You'll be like, what the hell was I thinking? What would be the sooner? But you have to do it on your own timeline and when you feel like you can, you can let go of that. A little bit of control. Like I let go of like a smidge at a time. Yeah. And then for me it was easier then.
Shannon Sepulveda: 01:21:03 It's really interesting because I think about, I'm like, okay, as a business owner it is not worth my time to spend. Like I tried to keep my Mondays as admin days like that is not worth my time to do. It's worth my time to pay someone to do the admin stuff, but I keep holding it in.
Karen Litzy: 01:21:20 Yeah. Yeah. That's a good way to look at it. If you have whatever your fee is, let's say your fee is, I don't know, I’m going to make this up $200 an hour.
Karen Litzy: 01:21:31 Right. The task you're doing as an admin at $200 an hour task, $25 an hour task, or maybe it's a $20 an hour task. So, and when you look at it that way, it's like what am I doing? Like I could pay someone to do four hours of work and what I get paid in one hour. Do you know what I mean? So when you look at it that way, the financial offset makes a lot of sense because your time is money. And like you said that that four hours could be an hour that you get to spend with your kids having lunch. So it doesn't necessarily mean it has to be with your business, but or it could mean that's your time for, you can go to the gym or you can do X, Y and you can meet with a doctor or doula or whatever. So you know like that is $200 an hour time spent when you're having lunch with like a possible referral source doing like weird admin stuff that you don't need to do is not $200 an hour work.
Karen Litzy: 01:22:35 That's what I did and just really like looked at everything, wrote down everything I do and you can attach sort of a monetary value to it. And then once it's down on paper you're like, Oh my God, okay.
Shannon Sepulveda: 01:22:52 I know, I know and I haven't like it's interesting cause I hadn't gotten to that point until this December because like I'm still growing and so that's one of the things that I think I'm going to need to think about like, and I'm just going to see how like the ebbs and flows, like if it is still as nuts as it is right now, then like I got the, because the worst is, and honestly like the billing's not that hard. It's verifying the insurance benefits. And sometimes I can do it online and it's really easy. And then sometimes the online just tells me what their deductible is, not how much they've met. And so then I'm on hold with blue cross blue shield for like an hour while I'm trying to do other notes.
Karen Litzy: 01:23:40 And what you'll find is like you will grow, maybe not exponentially, but you will grow bringing help on, you know, I did an interview with this woman Stephanie Nicholitch, she's like a high performance coach and she said, you're trying to do it all. Keeps you small. Yeah. And, it's true, but you have to feel ready for it. So it's in your time and you'll know.
Shannon Sepulveda: Yeah, I think I'll know. And the other thing is like one day, the other Monday I just like sat in front of my computer and I did my QuickBooks and my billing and I came home and I was like, I don't even feel like I've worked today. Yeah. He's like, I hadn't seen patient, I hadn't had that compassion fatigue. So some of it's like, can I actually handle that many patients? You know, can I give good care when I see my caseload.
Karen Litzy: 01:24:26 Yeah. And these are the growing pains that you have to deal with and it's a good growing pains, growing pains. So hopefully you'll continue with those growing pains. We hear it out in 2020. I think you will. Thank you. I want to thank you guys because like I said, if you do it all, it'll keep you small. There's no way I could do everything that is required of this podcast to keep it of good quality and to have good guests and good interviews and good graphics and good everything and make the guests feel like we're on their side, you know, and that there putting their best foot forward on the podcast. And I think that's what both of you and Julie and Jenna do is creates a good experience, really positive experience for the people who are on it.
Karen Litzy: 01:25:28 Like Shannon, we were saying like, people bought those hats and Carol and which I think is amazing. But you just never know how far the podcast is going to go. And you know, yesterday I was with some friends and we were talking about the podcasts and what's it on and you know, it's on Spotify and it's on, well iTunes is no longer a thing. So now it's just Apple podcasts and I looked up under medicine and it's like 52 out of all podcasts. For this fully female run podcasts. That is pretty good I think. Awesome. Yeah, it was really cool to see.
Shannon Sepulveda: One of my PT friends in Bozeman. He like just moved to Bozeman a couple of years ago and he referred a patient to me and this was about a year ago and I called him and he was like, yeah, I was like listening to healthy, wealthy, smart. And you were on it. And I was like, Oh my gosh, she's in Bozeman. You were like randomly listening to the podcast and then you were like happy that it wasn't because I was in Bozeman, you were listening to it. He's like, no. And I was like, wow, that was awesome. It was a great moment.
Karen Litzy: 01:26:38 Yeah. And never know who's out there listening and you never know where, again, the podcast becomes a referral generator. We can call a referral generating. This we could say generates referrals, but it does and you never know who's listening and where it's going to kind of take you. So I think that's so good to hear. And like I was talking with a coach that I had on a couple of years ago and she's like, Oh yeah, I got two clients from you. And she referred one of her clients to be on my podcast, the one who was talking about poop. She ended up getting like three clients from being a guest. Whoa. All right. So I was like, Oh, that makes me feel so good that that's the case. So, you know, keep up the hard work and you know how much that I am thankful and appreciate it and wish both of you have very happy 2020 new decade so thanks again so much. And everyone out there listening. Thank you so much for listening all year and we all wish you a very happy new year and hopefully stay healthy, wealthy, and smart.
Karen Litzy: 01:27:58 And again, a big thanks to Jenna, Julie, Shannon and Lex for all of their work all year. And of course a big thanks to net health. This episode is brought to you by Optima net health company Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected and workflows that streamline patient care and save valuable time. Check out their new on demand video to learn what's in store for outpatient therapy in 2020 you can go to go.Optimahcs.com/healthywealthy2020.
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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Sarah Haag on the show to discuss pelvic health for the non-pelvic health PT. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
In this episode, we discuss:
-Intake questionnaires to screen the pelvic floor for patients with low back pain
-Pelvic health red flags
-How to address pelvic floor health with a conservative population
-Assessing the pelvic floor muscles without doing an internal exam
-And so much more!
Resources:
Oswestry Low Back Pain Disability Questionnaire: http://www.rehab.msu.edu/_files/_docs/oswestry_low_back_disability.pdf
Sarah Haag Twitter
Entropy Physio Website
Home Health Section Urinary Incontinence Toolkit
Rehab Therapy Operational Best Practices Forum
For more information on Sarah:
Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Teacher.
Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
Read the full transcript below:
Karen Litzy: 00:01 Sarah, I was going to say doctor Sarah, hey, it just feels weird because we’ve known each other forever. But Sarah, thank you so much for coming on the podcast to talk about pelvic health for the non-pelvic health PT. So there are a lot of physical therapists who I think are interested in pelvic health, but maybe they don’t want to like dive in literally and figuratively. So what we’re going to do today is talk about how we as physical therapists can treat people with pelvic conditions, with pelvic issues without necessarily doing internal work. What are the functions of the pelvis, really important for bowel and bladder health, right?
Sarah Haag: 00:49 I mean, it is very important for survival, sex, very important for quality of life and propagation of the species. So these are all things that matter. But also when people come in with low back pain, when people come in with hip pain, I always find it very interesting that people say, but I don’t do the pelvis. You know, the pelvic floor is only a musculoskeletal structure. We’re not trained in most programs to palpate or to touch. It’s just skeletal muscle. That’s all we’re assessing for really as pelvic floor PT’s. So I just think it’s interesting. It’s like a blurry void when you’re looking at a body diagram. Oh, there’s your knee. So it’s really important I think to understand what’s there and you don’t have to go there, but you have to know what’s there and know that some people need help there and help them find the help.
Karen Litzy: 01:34 So if someone, let’s take this person that has low back pain because that’s a diagnosis that we can all agree that we see on a regular basis. So what are a couple of questions you can ask during your initial evaluation?
Sarah Haag: So the subjective part of the initial evaluation that perhaps a lot of people are missing or that can take in that pelvic area. There’s a couple of ways that you can kind of like cheat your way in where you don’t even have to think about what to ask to begin with. If you have a red flag questionnaire, there is a bowel and bladder question on there. So, it’s really interesting because people will sometimes circle yes on those and then never discuss it. Like, wait a second, we asked the question, they said yes, it’s a thing.
Sarah Haag: 02:22 So there’s your in, it was like, I noticed you, you marked yes on the bowel and bladder changes. Can you tell me a little bit more about that? Most of the time it is not truly a red flag. Most of the time it is not a sign they need to be referred to a physician. Most of the time it’s like no one’s ever asked me that. Yeah. Stuff is different. There’s your in. And then also if you use the classic Oswestry. So it was modified I think in 2001 or 2002 to take off a sex questionnaire. The second question of the questionnaire and it was revalidated and all of those things, but if you use the original, it’s pretty awesome because now they’re like, Huh, nobody’s asked me about sex. And then you’d be like, ah, I see that this is an issue.
Sarah Haag: 03:06 One of my favorite Twitter stories is I get a direct message from someone asking me about a patient who was having pain with intercourse and I was like, thanks for reaching out. Absolutely. Can you tell me more about when they’re having trouble and where it hurts? Would you like to know where it hurt their knees in one particular position? And I said, fantastic. You can help with that. So, so it’s not always, it might be a sex problem, but it’s not necessarily that problem. So we have to not be shy about asking those. Low back pain is the most expensive health care problem we have in terms of multibillion dollar, probably millions and millions worldwide. And so of course addressing back pain, we’re still working on the best way to do that.
Sarah Haag: 03:52 But there’s a high prevalence of urinary incontinence and people who have low back pain. So if you’re seeing people who have low back pain and after, if anyone else went to the pregnancy talk this morning, after vaginal deliveries, the prevalence of incontinence goes ways up, goes way up. So if you’re seeing someone with back pain, if someone has had babies, all you can eat what you can do. So we were like, well I see this in your history cause that’s pertinent history for back pain. Correct. And then it’s like, Hey, I noticed this, any issues with this? And here’s the reason I’m asking because you can’t just go, do you pee your pants? Because people like, do I smell like what happened? Like, so if you’re just like, you know, there is a really high prevalence and the nerves in your back go to your pelvis and all of these things.
Sarah Haag: 04:32 So I’d be really curious to know are you having any issues in this area? Cause there’s help if you are. And then kind of go from there.
Karen Litzy: And I want to backtrack for just a second. When you were talking about red flags and said some are truly red flags and some aren’t. So just so that we’re all on the same page, what would be those truly red flags?
Sarah Haag: Truly in the pelvic world or in the entire rest of your body world is any unintentional weight loss or weight gain, 10 or 15 pounds over a short period of time. Also like fever, like temperature issues, loss of appetite when you have those other constitutional symptoms that go along with it. So just having some quirkiness with your bowel and bladder, it’s really no reason to panic. But if you have also a fever and also a recent traumatic event, no, no, we want to just make sure everything’s okay.
Sarah Haag: 05:26 And the cool thing is that if you go to the doctor, it’s like you don’t have a UTI. Everything else is looking fine. Awesome. Then I can help with that. But the red flags, there’s been a couple of great papers that have come out where it’s like, it’s not like if you have pain at night, freak out. No, no. If you have pain at night but also a sudden bowel and bladder change and also, okay, now we need to check in for it. But don’t panic if it’s the only one.
Karen Litzy: And now let’s say you’re using these questionnaires and someone puts on bowel, bladder or someone circles sex as something that they’re having difficulty with. And I love this question because this was something that was brought up last year at CSM. So there was a physical therapist there who said, well, I live in the south and these are not easy questions to ask because people are more conservative or they don’t want to talk openly about their bowel and bladder issues or about sex with their partners.
Karen Litzy: 06:28 And so what do you say to those people? Those therapists that, are dealing with a population that’s maybe much more conservative and they’re not sure how to approach those subject matters.
Sarah Haag: I always say just always with kindness and with a good intention and with a good explanation. So you can’t not do it because it’s awkward for you. You should be asking for a medical reason, right? So quality of life is in our wheelhouse, right? Like we’re doing all sorts of quality of life questionnaires. Pee in your pants is a huge detriment for your quality of life in many cases, not being able to have sex can impact your relationship with your partner, your feelings of ability to even have a partner, having babies. All of these things that end up being huge stresses, which is gonna make a lot of other things not as good either.
Sarah Haag: 07:28 Just start simple if you’re asking questions. So if someone comes in with like straight forward knee pain, I’m like, how sex, no, that’s not how, that’s not where we go with that. But if someone’s coming in with low back or pelvic issues, the way I usually approach it is to bring it up anatomically. So this is the anatomy. This is what we’re doing. These are where the muscles go. Most people don’t think about them. And when they’re, if they’re having issues like incontinence or have had babies, those pelvic floor muscles are muscles. Like everything else. We’re going to work in PT. So I’m going to ask you some questions and I try to do it in a spot where you have some privacy. I know some PT places you’re like in the middle of a gym.
Sarah Haag: 08:06 If you can find a quiet corner, do everything you can to put them at ease. But just to be like this is why I’m asking. And if you can see that resistance be like all right, like it’s not necessarily the number one priority for this treatment anyway, but if those things happen to be issues there is help, it can get better and you just let me know if you have any questions. Cause not everybody wants to talk about it and it’s not my job to convince you to deal with it. It’s my job to help you if you want help.
Karen Litzy: And if you’re a physical therapist that isn’t specializing in pelvic health, it’s a little bit different. Cause if you’re specializing in pelvic health and people are going to you because you specialize in pelvic health it’s way easier, you know, these questions are going to come up. But for those of us who don’t specialize in pelvic health, then those questions can be a little bit more sensitive. So I just want you to make that distinction there for people.
Sarah Haag: 08:48 Yeah. And also if you’re going to ask if you’re going to take that step and be like, all right, I’m going to ask about the incontinence. I mean cause sometimes you’re in situations where it is an obvious issue. Other times it’s like, well, based on their history they’re actually at risk for it. Then you can talk prevention, which has always been kind of fun. But just if they give you some information, especially if you got up the guts to ask them, then please, please do something with it. Don’t just be like, oh yeah, so great incontinence noted in the chart. I’ll put it on the diagnosis list, like how the plan and there are some things you can do without doing a pelvic floor exam that can make amazing changes.
Karen Litzy: 09:49 How can you evaluate pelvic floor muscles without having to go internally? I think that’s a question everybody wants to know.
Sarah Haag: Great question. I’ll be honest, some people don’t want you to touch him there like full stop. And so I will actually give people, I would say it’s kind of like a choose your own adventure. So we can actually, we can all check our own pelvic floor muscles right here. And I would basically talk you through it. You would tell me what you felt. I keep an eye on everything else to see what else you were doing. But it would be very honest that my assessment is going to be, I believe you, it seems you’re doing it correctly. Right? But I have to believe you, but you can actually palpate externally. As a clinician you can actually do it and you can do it in sidelying.
Sarah Haag: 10:33 You can do it in hooklying and some people will do it in prone. I’m not a super big fan cause I can’t see their faces. And also it can be kind of a vulnerable position. Basically if you just palpate, if you find the ischial tuberosity, you know about where the anal sphincters are. Okay. There’s normal human variation. So I always say move slow and make sure you’re asking for feedback. But you know, mid line is where the sphincters are going to be. We’re not going midline. So you just kind of find that ischial tuberosity and palpate your way around to the medial part of it. And that’s where the pelvic floor attaches. So then you can kind of talk them through, like I’d like you to squeeze and there’s a bunch of different cues.
Sarah Haag: 11:22 One of the most common cues, especially for the back end, is to like squeeze. Like you don’t want to pass gas and that’s awesome. But if you’re a main problem with urinary incontinence, that’s the back side, back side, not the front side. So how do we get it up there? So another cue that has been found to be very helpful, it’s only been studied in men, but it is, shorten your penis. But what’s interesting is ladies, I know we don’t have them, right? Imagine that feeling, right? So like just imagine like pulling in, right? It totally changed where hopefully if this is a class, it would have asked where did you feel it? But like it, it changes it from the back and biases it towards the front of it. So find a cue that gets them to go, oh my God, I felt something.
Sarah Haag: 12:07 You’re like, awesome. So if you’re doing a Kegel and like this happens, you’re probably not doing it right. If that’s happening, you’re probably not doing right. But if like I’m Kegeling now and then I let go, you shouldn’t have seen me get taller or tensor or breathe funny. It should be very sneaky. So as you’re palpating on the medial side of the ischial tuberosities your feeling for those muscles to contract. So it’s kind of like a gentle bulge and you can totally feel this on yourself here if you’re comfy or somewhere else. But when you feel it, it’s almost like when you’re feeling like if you have your biceps slightly bent and you kind of like contract and you feel at tensioning and like a little bit of a bulge, that’s what you’re feeling for.
Sarah Haag: 12:51 Okay but it can always be tricky cause I use the word bulge. Some people will have people push down. So we should also be able to like relax your pelvic floor and push down, like having a bowel movement. That shouldn’t happen when you’re trying to contract. So like when I say bulge, you should feel like a gathering of the muscle. That’s what you’re feeling. If you feel your fingers get pushed down in a way they’re doing the opposite of a contraction. So there they’re relaxing. It would kind of depend on what they were doing and the cues you were giving. So it could just be like, I’m pushing down like doing a Valsalva. But it is basically a lengthening into the pelvic floor. I don’t know if it’s always a relaxation, so to speak.
Karen Litzy: 13:33 It’s kind of lengthening. And what is the difference between that Valsalva or lengthening and that small bulge? Like why is that significant?
Sarah Haag: When you feel it, you’ll know it’s significant because if they’re pushing down in a way that’s not a contraction. So if you’re going for strengthening or more closure to hold things in, yeah, you want that kind of like tensioning and bulge. But if you’re actually the problems, constipation, I can’t get things out, you want them to be able to relax and link them.
Karen Litzy: Got It. Okay. All right. So now we know how we can kind of feel our pelvic floor muscles without having to do an internal exam. So once you figure out, and kind of what you said sort of leads right into the next question is if you have someone that’s coming in with incontinence and you are looking for that sort of tightening or gathering up of the muscle, which I think that’s a nice cue for people to understand because bulge can sometimes be a little confusing for people, but I liked the cue you’re feeling the gathering of that musculature.
Karen Litzy: 14:45 Is that something that you are then going to add into a home exercise program or like once you find that the pelvic floor muscles working or it’s not working, what next? What do you do?
Sarah Haag: Well, so I’ll be honest. It’s always I like him and people are brave enough and the patients were brave enough to be like, sure you can have a feel like let’s figure this muscle thing out. I usually try it in a normal active kid in a normal setting. So not a public one. No pelvic settings are normal too. But in like just a normal like say outpatient therapy, be it or orthopedics or neuro, I would actually have them ask more questions about incontinence before even checking the pelvic floor muscles. Because the different types of incontinence are going to kind of tell you a little bit more about what you should do.
Sarah Haag: 15:35 So some people have incontinence when they tried to go from sit to stand or when they cough or when they go running. So I want to know a little bit more about when is it happening because if it’s only ever when you’re putting your key in the front door or when you’re running into the bathroom, that’s more urgent continence. Would pelvic floor muscle exercises help? Maybe, but also probably looking at their overall bladder health, which is where a voiding log would come in very handy. And actually a shout out to the home health section and they have an incontinence urinary incontinence toolkit. It’s free for members for sure, but I think it might be free for everyone.
Sarah Haag: 16:15 So it’s a pdf that actually talks you through the different types of incontinence because the most common form of incontinence urge incontinence, which is you’re an urge incontinence is proceeded by a strong urge to go. So this is one of those things where, so there’s a bathroom at the end of the hall. So if you’re like, I’m totally fine, but then your eyes wander, you’re like, oh, I could go and I didn’t have to go. And then I would get up to go and I got to the bathroom and all of a sudden it’s like, oh, where did that come from? Like all of a sudden it felt like your kidneys did a big dump, but they don’t, that’s not how kidneys work.
Sarah Haag: 16:59 It’s just how it feels to you. So what that really is, is your detrusor muscle kind of going, I’m so excited. I imagine a puppy, like have you ever like gone to let a puppy out the door? Like, so they’re like, hey, I want to go out and you get up and you make a move for that door. And they’re like so excited. Your bladder is like that sometimes. So that’s more of a behavioral thing because what would you do with the puppy who’s now like, wait, every time I do this, she lets me out. Pretty soon you’re letting that puppy out every 10 minutes because yeah, because that’s what the puppy trains you to do. So that’s kind of more of a behavioral thing. And so that’s proceeded by a strong urge. So it’s not just when you’re going to the bathroom, but if you get a strong, unexpected urge and leak, and that’s usually a lot of people also experience some urgency and frequency.
Karen Litzy: So if you feel like you’re not getting to the bathroom in time, what would be a really logical plan to that?
Sarah Haag: 17:52 You’d go more often, you’re like, Ooh, maybe I need to not wait so long. But the thing is that then you’re training yourself to go more often, your bladder is perfectly capable of holding more that kind of sensitivity and those signals you’re interpreting or like, ah, no, I should go now. And then pretty soon you’re that person who can’t make it through a movie. You’re that person who can’t make it past a bathroom without needing to go. And you’re the person that no one wants to go on a road trip with because you’re stopping every like hour on the hour and every rest stop. But now is that because your brain is interpreting this as such? I know that there’s a physical manifestation obviously, but is that like have you trained your brain and to feel that way to interpret that as such? I would say yes because most of the time, even if it wasn’t intentional, like it’s kind of like a slippery slope. It’s like I almost didn’t make it that one time. I’m going to plan ahead. And then what starts to happen, especially if you’re like, all right,
Sarah Haag: 18:54 your bladder is filling up. You kind of feel like you need to go and you go to the bathroom and it came out and it’s like, all right, so that was nice and normal. But then imagine that time where you’re like, hold on, I almost didn’t make it, but you were stretched this much. You’re going to start going when the bladder stretches this much. And then pretty soon if you let it so you’re like, Ooh, now I’m going down here. Now I need to go sooner. And this is one way you can tell this is happening. And it can happen sometimes without ending up with a diagnosis of urgency, frequency or incontinence. But where you get to the bathroom and you feel like you’ve got a goal, but then nothing happened. Goals, like it’s the smallest tinkle and you’re like, I thought it wasn’t gonna make it, but that’s ah, that’s all that’s in there. And so that was like big urge little output. That’s kind of a mismatch. And that’ll happen sometimes.
Sarah Haag: 19:48 But like if you’re paying less than that, that’s not much more than your poster board then a nice healthy post void residual. So you don’t have to empty at that point if you’re bladder’s saying, empty me now. And that’s all that’s in there. Yeah. So it’s kind of like you’re the sensitivity of your bladder has turned way up. Just like how we would compare that to the pain. So the sensitivity is turned way up so that it takes less of a stimulus in the bladder itself to trigger that feeling of you have to go, even though the bladder is barely full.
Sarah Haag: And there’s actually some interesting conversations with urgency and frequency in that feeling of extreme urge, can that be considered a pain? And so it’s kind of interesting conversation because there is normal, there is a normal sensitivity of normal urge, but when that urge becomes pathological, yeah.
Sarah Haag: 20:47 Too bothersome. Does that crossover into it? Distressing emotional experience? I would think so. Like can you imagine if you’re like on a train or something like that and you have to really, really, you have, you’re having that urge. I mean, that’s very distressing dressing. That’s very distressing. That’s like you’re suffering. So if you have someone like that what do we have them do? So they keep a diary, which you can get on the home health section and we’ll have a link to that in the show notes. You basically ask them to keep track of things for a couple of days. I tend to keep it simple with what are you drinking and when and when, when are you going to the bathroom? If people are willing to measure, that’s the best, but not many people are willing to measure.
Sarah Haag: 21:37 So what I try to have them do is to kind of come up with their own plan. And I tell them this is not an exact science because you’re not measuring, but that’s okay because if you have a strong urge, which is kind of a lot, but you have like a little tinkle, that’s kind of a mismatch. If that only happens after your third Mimosa, okay, that might actually be like a normal bladder thing. Do you know what I mean? So we kind of look at things that they’re bringing in that may or may not be irritating to them. We look at are they getting enough fluid and bladder loves, loves water. But the first thing most people cut out if they’re having urgency, frequency or incontinence is water is they cut out their water. It’ll almost always backfires.
Sarah Haag: 22:19 So don’t do that anyone watching. It also makes you constipated, which you can increase your urgency and frequency. So, so yeah, so surprise. Everything needs to work well to work well. Okay. But yeah, so you kind of look at that and I just look for patterns and then I have people try to change one thing at a time. If all you’re drinking his coffee all day, but actually you have good data, good parts of your day and bad parts of the day. Is it the coffee? Because if you’re drinking coffee all day, you’re probably not going to be very nice to me if I say, how about you stopped drinking coffee? Um, emotional response up. So you just kind of look at it. It’s like, Oh, when does this happen? What do we need to change? And it can really help you narrow down. Is it really urge incontinence? Is it actually just frequency and they’re not leaking like they thought they were or you know, is this primarily a stress incontinence issue?
Karen Litzy: Well, so it sounds to me like there’s not a lot of hands on work there.
Sarah Haag: No, no, it’s more behavioral.
Susan: 23:27 Do you ever use pelvic tilting to get the posterior versus anterior pelvic floor?
Sarah Haag: So that’s a neat work with from Paul Hodges Group. So however you’re sitting, most of us are Slouchy, just do a pelvic floor contraction, however your brain tells you to do that, do it and just feel where you feel it. But then if you get yourself in a situation where you like get more of that Lumbar Lordosis, and so like you stick your tail out, you get more lumber lordosis and then you do the exact same thing. So you’re not changing your cue. For most people it’s cuts to the front. And it’s kind of neat because one of the things, one of my pet peeves is when we were talking about earlier is my pelvic floor therapist get tunnel vision and are just doing pelvic floor exercises, but not reintegrating it into how they’re, they’re using their body.
Sarah Haag: 24:18 So if you have a runner who’s a chronic but Tucker and she’s leaking out of the front, obviously, how would it feel if you like got those glutes back a little bit? Because you can’t run and Kegel at the same time. You can’t, you can try. It’s not going to go well. And certainly not for like a 5K and let alone not a marathon. So changing how that is biased because most of us don’t think about the pelvic floor until you have a problem, right? But they’ve been working, right? They’ve been doing their thing. You’re using them when you walk up those stairs you’re using them when you’re getting up off the floor. So they do something, the key goal is like your bicep curl. You want a stronger bicep, you’re going to do some curls, you want a stronger pelvic floor, you’re going to have to do some pelvic floor exercises.
Sarah Haag: 25:07 But that’s not your management plan. You kind of want to, someone said it yesterday, kind of like the core muscles are there like automatic, like when you get ready to do something you don’t think, okay transversus were good. Like it just all happens and you want to kind of get the pelvic floor back into that system and make sure it’s strong enough and coordinated enough to do its part. So you don’t think about it.
Dave: 25:37 So along those lines then, would you say that if somebody is more lordotic, they’re more likely to engage the anterior floor and then flat back more of the posterior floor?
Sarah Haag: 25:47 That tends to be what they’re finding on like EMG studies and what I will see clinically with people if they do a ginormous buttock. It’s really interesting if you’re like, how’s your breathing when you do that and, and how good is your squat, let’s say when you do that. And it’s like, Eh, it is what it is. I’m like, okay, so what if we do kind of take it into where some people, especially if they’ve been told by other practitioners to like watch your Lordosis, it’s kind of huge. Which isn’t really a thing. But you know, they kind of, they’re kind of like going in there, they’re like, I’m so scared but it kind of feels good and then you have them do that movement or try that exercise. Usually they’re like, that was way easier than I thought it was going to be.
Sarah Haag: 26:30 But again, if it’s not working, then we try something else cause everyone’s anatomy is different. Sometimes if they have a lumbar issue, getting into the ideal position for their pelvic floor, may or may not be easy for them, at least at first. But I think you need to play around with how it feels and how it’s functioning as opposed to, I mean, I’ve been guilty of it in my career of like, ah, you need more or less of what you’re doing with your spine and were just different. So it’s where it works best is where it should be.
Jamie: 27:03 So for a lot of the outpatient conditions and orthopedic setting, there’s still an emphasis on giving some kind of qualitative documentation to the muscle contraction, whether it’s a manual muscle test or something like that for payment purposes. So what are some strategies or tips for clinicians to be able to take that palpation externally and then relate that into their strengthening documentation?
Sarah Haag: 27:29 So if you’re just checking externally, like just palpating outside, it’s like a plus minus like, Yup, I felt it. Uh, they couldn’t find it. So kind of plus minus, cause you can’t give it more than that. We also have to remember, so when I write about pelvic floor strength in my documentation, I have a number I can put and you can grade it. You have to do that internally, which is why if you’re like, ah, we need to know more, refer him to a friend or go to the training. But I usually give a lot more information. So like, all right, so they, you know, they had like a three out of four, three out of five squeeze. The relaxation was not very coordinated and kind of slow, but then their subsequent contractions were five out of five.
Sarah Haag: 28:09 All right. Do you know what I mean? We have to, because of payment and insurance and all of those things, we have to write something down. So what I do is I write down what I find and I’m happy to talk about it. So if you want to deny it, I can talk vagina all day with you. And I have, and their questions usually get shorter and shorter. Um, because really they’re asking for information that isn’t necessarily the most helpful. So if you’re checking an externally plus minus, but also I’ve had people who five out of five but still incontinent,
Sarah Haag: 28:41 So then they’re like, well they’re not weak but you put down, you’re going to do strengthening. I’m like, well yeah, because it’s more of a strengthening, not just a strengthening with a functional goal attached to that, if that makes sense. So sometimes it’s more words, but don’t be shy about one. Well, first of all, please be honest, be as accurate as you can be, but also don’t be shy about doing the best care and be willing to stand up for it. If it gets denied. It’s not cause you gave crappy care likely. I mean, do you know what I mean? I’m like, I dunno how long you practice, hopefully. Good. But if you get denied, it’s not necessarily key because you gave bad care or even did a bad note. It’s because they decided they weren’t going to pay based on something. Hopefully logical that you can talk about. You can always appeal. So don’t let payments scare you away from giving the best care.
Sarah Haag: 29:36 Sorry. Another soapbox of mine. So that was urge incontinence. Stress Incontinence.
Karen Litzy: So let’s talk about that because I think that gets the more airtime, so to speak. So that’s when you see the crossfitters are the weightlifters or there’s a great gymnast pitcher yesterday going backwards where you there backwards over the pommel horse, not the pommel horse. It’s the worse just a horse. A spurt. Like it was, yeah. And you’re just like, that could be photo shopped, but also it probably isn’t. Yeah. Or like we’ve all seen like the crossfit videos where women are peeing and then everyone high fives them because they worked so hard that they peed, which, you know, not normal. We know that that’s been addressed by a lot of a pelvic health physical therapists.
Karen Litzy: 30:32 So I would like to know first I think we just gave the definition of stress incontinence, but I’ll have you give the definition quickly. But then I’d like to go back to something that the question that Dave had asked about the positioning and how that works within weightlifting or within, you know, waited or loaded movements. But go ahead and give the definition of stress incontinence first.
Sarah Haag: So stress incontinence is basically when there’s an increase in intrabdominal pressure that is greater than the closure of pressure of the urethra. And you have some sphincters as well as the pelvic floor helping keep all of that closed. But if you increase the pressure enough on the insides, and that’s why you hear, and again, it’s primarily women, but also a lot of men after prostate surgery, they cough and you get a spurt or you know, you jump and you feel it come out.
Sarah Haag: 31:21 Those are usually because the closer pressure has gone down or the intra abdominal pressure has gone up.
Karen Litzy: Okay, great. So now what does that look like? For the average physical therapist who’s not a pelvic health therapist. And let’s say they are seeing someone for hip pain and you ask them, are you ever incontinent? Or if they are, you know, heavy lifters are, they are adding load and they say, oh yeah, but that’s normal. Or they have low back pain and they say, yeah, but that’s normal. Everybody does it at my crossfit box or whatever at my gym. So how do you then, if you’re not you, you are someone who’s not a pelvic health therapist, how do you address that?
Sarah Haag: Well, first of all, what all of us should know while incontinence is super common, it is not normal.
Sarah Haag: 32:16 Not ever being dry is normal. So we need to get away from this idea that like, well, everyone’s doing it. It’s like does that make you want to do it? Like I feel like, no, I feel like no is the answer. So first of all, just, and sometimes they don’t know that. Like, I know that in some like young girl gymnastic teams, like the color of their leotards are chosen to like, not show the pee because they’re incontinent that young. Yeah. And I see a lot of women as adults sometimes before they’ve had babies sometimes after, right? So like what’s the, what came first? But they’ve had lifelong issues with what’s essentially public flourish. She’s with incontinence, sometimes pain with intercourse, all of those things. Competitive gymnasts, competitive cheerleaders. Dancers tend to be probably the biggest, runners or another group.
Sarah Haag: 33:12 There’s been some studies, there’s one study and I cannot recall it. I mean, it’s probably like 15 years old now. We’re 100% of this division one female track team reported urinary symptoms. 100%. Like every girl. So common. Heck yeah. Normal. So many girls. Yeah. So the biggest thing if you’re not a pelvic floor therapist is to check out their function. So if they can identify when they’re having issues, it’s when I get to this particular weight or it’s when I get to mile 17. Okay. And I usually throw in, like if I ran 17 miles, I’m not really sure what my body would do. Like I dunno, but it still shouldn’t leak. But if you can find out where that breakdown in the coordination in the endurance and the strength and whatever it is happens and look at what’s happening there.
Sarah Haag: 34:04 Because if you can run 17 miles or you can lift 200 pounds without leaking, but then you do, you’re not, you’re not weak. Right? Like if you can do all of that, something’s happening there to make this happen. Cause if you can lift 200 pounds in that league, something’s working, it’s just not still working when you try to live 210. Okay. So let, let’s look at what’s changing or number of repetitions. Right? That’s what you’re looking at.
Sarah Haag: 34:52 So if you collapse your chest and which I would probably do after running 17 miles and I’m like this. And now what happens when I collapse what happens to my bottom half when I collapsed my shoulders? Well my butt just tucked. Cause I’m just trying to get through now. The funny thing is the breathing is also harder. So while I’m doing this as kind of a mechanism to keep going, it’s harder to breathe because nothing’s working diaphragm to have a full excursion, right? Yeah. So, so I like to look at if you’re running fine for 17 miles, I want to see you at mile 16. I want to see what’s changing over that mile. I want to see what you looked through my team. And can you, when you start to get to that point, can you make an effort to change something?
Sarah Haag: 35:32 Do you notice a change in your breathing when you’re lifting 210 instead of 200 and kind of look at it from that way cause you’re not going to kegel why you do that. What do you mean? Oh well say to like precontract and prime and all these things and, and that’s fine, but it’s like if we go back to the running, you’re not kegeling and all that time your pelvic floor after like 30 seconds is like, dude, you don’t want me to get that tired. Like it’s going to be like, we’re going to stop that now. So yeah. So the way I would approach that, if you’re not me, yes and not going to do a vaginal exam, is you look at their performance. So if they said, I have knee pain when I do this, when I go from 200 to 210, they’re my squat.
Sarah Haag: 36:13 How they do, they’re looking at the mechanics. You would look at what’s happening, what is different? Cause you know, the joint can do it, you know, the muscles can do it. What’s changing. And you would address that. So it’s really no different if they can tell when they’re leaking, you’re just looking what can, what are the things that can change it? Usually the tail lift and looking at their breathing or two really easy ways to go about it.
Karen Litzy: Okay. All right. That’s great. And, and, and that goes with that. Does that also work with, let’s say instead of you’re not a runner weightlifter, but you’re like a new mom or something like that and you’re okay, but then by the end of the day after you’ve been maybe lifting the baby or you know, doing whatever you’re doing it, it doesn’t necessarily have to be sport related is what I’m saying.
Sarah Haag: 37:06 I think about like function, but definitely, I mean, you asked about, but no, just everyday if getting out of a chair makes you leak, that’s, but then it’s basically a squat. So you are, you’re looking at the activity that they’re having difficulty with and making small changes got in most cases.
Karen Litzy: So I think the biggest takeaway here for me is that not everything is solved by doing a kegel.
Sarah Haag: I think a lot of non pelvic health PT’s may have that, that misconception that if someone has incontinence, well Kegel time. Right? And that’s all you gotta do. That’s what most people do. If they go to the doctor and they mentioned it’s like, ah, you know, that’s pretty normal. It’s not, it’s common. And then they’ll be like, do some kegels and, and a lot of women and men don’t know how to do them.
Sarah Haag: 37:53 So then they’re just, I’m squeezing stuff and it didn’t work. And it’s like, Oh, before we get too far, can we check and see how you’re doing them? And I think that’s kind of a beautiful segway. So let’s say you have your new mom or you have your athlete or whatever and you are, you’ve tried some stuff, right? Cause none of this is life or death, right? I mean it’s fine to try some things. So already not doing anything about it. So trying to change up a couple of things is perfectly within your purview, especially again, you’re seeing them for hip or low back. It all, it’s all together. You’re good. But if it’s not changing, if it’s not getting better, if when you ask them, you know, can you contract your pelvic floor, what do you feel? They’re like, I got no idea.
Sarah Haag: 38:33 And they’re like, but please also don’t touch me there. Or are you touching there and you’re like, yeah, I don’t feel anything either. And I’ve used all my cards but I don’t know what to do. That’s when you refer. Because just like any other things, somebody coming to see you as a physical therapist, you’re going to do some things. And if those things are not working or they’re getting worse, you’re going to try something different. Or call the doctor or refer to a friend. Right? So if you change some things and you’re like, I’m amazing, they’re all better. Awesome. Do they need to go to pelvic floor therapy? I’d say no if their incontinence resolves or their pain resolves. But sometimes with especially we see it a lot more in I would say the more active athletic population is a pelvic floor that’s more like this.
Sarah Haag: 39:19 So it’s like tight and there’s a hundred people call it hypertonic or high tone or short pelvic floor and all these things and basically in my brain, the way I categorize it is like you should be able to contract your pelvic floor and you should be able to let it go. And we can all get better at that. But if you’re like, I’m here, how good is my contraction going to be? Because I’m not showing you my pelvic floor. Like it’s not going to, it’s going to taste like it’s going to not move very much. But if you get them to relax more or they’re like, oh, I didn’t know that was there, that’s better. Then you all of a sudden you have a good contraction.
Karen Litzy: How do they relax? Do you just say relax?
Sarah Haag: 40:01 Before somebody tells him to relax, the worst thing to do is be like, can you just relax? So I try to have them feel the difference between contracting and not contracting. Because what will happen and people use what the traps all the time is like. So like, ah, so much tension. All right. Again, telling you to relax your shoulders. Things I didn’t think of that. But if you squeeze and let go like as a little bit of like, Oh, I feel that, oh, oh there’s some more space there. So I start with that. Okay. The pelvic floor. But again, if they’re like, I just don’t know, that’s something that is so easy to feel with a vaginal or rectal exam. So that’s where it’s like, ah, you’re having some trouble. I would recommend, would you see my friend for one visit have this exam, they’re checking out your muscles and just see if he can feel that relaxation and then come up with like cueing or a plan that works for them.
Sarah Haag: 40:54 Cause it’s not just about like slacking everything out. It’s really feeling that that relaxation, that lengthening of the muscles there and being intentional about it. You don’t want to lie there would hope like maybe it’ll let go at some point.
Audience member: So you talked about kegeling and what about dosage or prescription and quality versus quantity and how you prescribe that to your patient.
Sarah Haag: There is no hard and fast rule as to like how many, how much. So that’s where, again, I would have them do some and see how the coordination goes. Cause if they’re otherwise neurologically intact and they’re kind of getting it, how many do they need to do?
Sarah Haag: 41:57 I would say it’s not unreasonable to go kind of basic strength and conditioning principles of, you know, like I know eight to 12 reps three times a day. That’s an okay starting point. And actually, I don’t know if you know this, so I’m writing a book on incontinence and the PT people have it, but it’s the editor just asked me, she’s like, well, since we don’t have like a hard and fast number, do we, should we put that in there? And I said, I think we do. So that’s a good starting point. Not everyone would be able to do that right off the bat, but also some people be able to do that and they’re not getting better. So it’s kind of like let’s start here and see what happens. And then you can kind of titrate it up and down. If I do an exam on somebody and they can’t contract for 10 seconds, they can only contract for five, I’m not going to have them contract for 10 seconds at home. I would probably honestly in that case, have them go, I need you to make sure you can feel the good contraction. So you actually also asked about quantity and quality. I want quality, because all of us can do 100 crappy ones. I’m not sure how much it would help. So really looking to be like, okay, so I feel that contraction and I’m breathing
Sarah Haag: 43:10 and I usually actually have stopped counting seconds. I’ve had people go by breath, so if you, let’s do it. We’re going to squeeze our pelvic floors and you’re just going to keep squeezing as you breathe in and breathe out normally. Nothing, nothing fancy. And then keep squeezing while you breathe in and breathe out and let go. And what I hope you felt was a squeeze to start with maintaining the squeeze. Some people will feel kind of like a little, a little wave as they breathe, which is not unusual. But then when you stop the breathing and you let go, you should feel that let go. So if you didn’t feel that, let go. I usually say that’s one of two things without feeling right. I can’t tell without feeling is that you got tired and you lost it or you forgot to let go.
Sarah Haag: 43:51 So that’s okay. Have a wiggle reset and try again. Because if you’re not feeling the contraction, what are you doing? Like you might as well take a walk because then you’ll actually be using your pelvic floor. I like going with the breath because a lot of people like to hold their breath when they’re like, they’ll do like they’ll just suck at it and it, you’ll feel a lift, but it’s just a vacuum. It’s not really your muscles doing their thing. So by doing the breathing, if you breathe in and out twice nice and slow, it’s 10 seconds. You don’t have to count. So if I have you do four of those, you just have to like count on fingers, two breaths come and arrest for two breaths. So much easier to keep track of. And then people actually do them. Cause if I could tell them to do ten second holds, one, two, three, four, five, six, nine, done. And that’s not really helpful either. So like the too slow breaths. Now you’re breathing and don’t have to count and you’re going to stay honest.
Audience member: 44:57 So trying to bring this into the neuro world for someone who’s post stroke and has stress incontinence or they’ve had neural damage of some sort and have stress incontinence, Are there any PNF techniques where you can incorporate the pelvic floor to help with that?
Sarah Haag: I haven’t had PNF stuff since college. And I’m old. So what I would say is, is if I’m recalling that they go through movement patterns and as you’re doing those things, there are things will be happening on the pelvic floor. It seems to make sense. What specifically, I don’t know, but if you’re kind of working more with that tone in general, I’ve only had a couple of patients come see me like post CVA and feeling their pelvic floors is amazing because while it makes perfect sense that one side might be like hypertonic are nonfunctioning until you feel it.
Sarah Haag: 45:49 It’s like, wow, that’s so cool. Like once I totally normal springy, they can contract and relax the other side just like they’re, they’re hemiparetic arm. It’s cool. With stuff like CVA or neurological involvement, you really want to make sure you’re on board with the physicians and you know that bladder function is still intact because depending on where the stroke is and what exactly happened or where the spinal cord injury is, you don’t want to mess around with screwing up the bladder or the kidneys. So if they’re not going to the bathroom or they’re only leaking during transfers, that could be stress incontinence or it could be overflow incontinence because their bladder is so distended with the effort. So that’s something you would really want to make sure you talk with their nurse or their attending physician and make sure, so how are things working?
Sarah Haag: 46:38 Because the other thing we need to remember is a lot of things we’re still working on people who have had neurological insults, right? So once you’re like, okay, bladder is relaxing as it fills, contracting, as it empties, it’s emptied fine. We’re not worried about this being overflow incontinence. I would actually start to incorporate stuff like blow before you go. Where you’re managing it the same way you would for someone not having a stroke, but half of that, the beam continent and actually going to the bathroom it seems, I can make it sound very simple, but I have a slide and of course that I teach where it has all the like the tracks up to the brain and all the tracks who, the spinal cord to the bladder. But we got the sphincters, we got the detrusor, all of this stuff just happens.
Sarah Haag: 47:25 And when I click the slide from this beautiful simple picture, it’s just font about this big, explaining all of the complex things that are happening so far as we know. So again, as long as they’re, bladder is functioning on that basic level where it knows when to empty and it can empty, I would treat him like a anyone else and not assume that it’s just because of a high tone pelvic floor on that one side. That’s the issue. But if you get that person and you do your PNF, please tell me what happens. And if it changes their incontinence, I would really like to know.
Karen Litzy: And when you’re looking at the bladder function, that is something the physician is doing through an ultrasound, is that how that works? How did they do that?
Sarah Haag: They can do it through an ultrasound so that that they are, they can look mostly at like post void residual.
Sarah Haag: 48:12 But then also there’s a test called neuro dynamics. And this is a test that involves, a catheter and there you’re a threat. And then a probe and another orifice down there to help measure for intra abdominal pressure. And it’s kind of a neat test. If someone wanted to do it on me for free, I would probably do it. But they’re also looking at an EMG the whole time. So they start to fill up your bladder was sailing so you know how much is in there and you’re awake for this test because they go tell us when you, when you feel the first urge to go and they mark where that is. And so you can see how much fluid is in there. And I’m like, tell us when you get like the, I should go to the bathroom now urge. And they mark that and then they’re like, okay, tell us when you can’t take it anymore.
Sarah Haag: 49:00 And they mark that. So then they know how much your bladder can truly hold. But also looking at what’s your detrusor doing, which is the smooth muscle around your bladder, what’s happening to your pelvic floor, where is the weakness? And usually when they’re full, sometimes they’ll have people cough to see if anything leaks or if any sphincters happen or sphincters what they’re up to. But it’s, it’s involved. But there’s a lot of good information. And interesting side note is that if you do so, that’s really I think really helpful for like a neurologic population just to make sure. I did have one patient I was lucky enough to work with a PT who became a physiatrist who specialized in neurogenic bowel and bladder and she let me come down to watch urodynamics of one of my patients who was really against cathing.
Sarah Haag: 49:46 He didn’t want to cath. So she came down, she brought him down to the urodynamics and as it and cause he’s like, I am voiding 400 to 600 milliliters every time I have a bowel movement. And like that’s pretty good. I mean like most are four to 600 CCS and turns out it was only under very high pressure. He was already getting reflects into his kidneys and after he voided four to 600 CC’s, he still had four to 600 left, which is too much. So even though he was having some output, that was the test that really made it clear to him like, oh, it’s coming out, but it’s not healthy. Like I need to cath.
Jamie: 50:41 What are some of the considerations that you might go through in your thought process when you’re dealing with a male versus a female pelvic pain or incontinence issue?
Sarah Haag: 50:53 That’s a lot. I could talk for days on that. Well I’m not sure. When you’re talking about considerations. We need to take into consideration our patient preference and what they’re comfortable with. We can tell when our patients are uncomfortable or we should be able to but then kind of try to work out, they might not want to talk to me about this, but who can I get that they would, cause a lot of people would assume that men aren’t really comfortable talking to females. But a lot of the men who come to see me, just want help, and we’ve had several male students come through and you know, they run into like women not wanting a male therapist to do it.
Sarah Haag: 51:36 It’s just finding that, right? Just like any other body part, finding the right person to help. But then if we go to, you know, bringing up those subjects, I don’t know that in my brain it’s so, so different. Male to female, you’re going to take into consideration their history for sure. I feel happy saying that because now with we have kind of like a gender spectrum, right? We have people who, who have transitioned in varying degrees and we have people who haven’t transitioned but totally identify with the gender. They weren’t assigned at birth and all of these things. So basically I take it functional. So can you just walk me through the issues you’re having, your questions, concerns when it’s a problem, if anything makes it better, does anything in particular make it worse? And then we problem solve from there?
Sarah Haag: 52:26 So I guess I didn’t really have a good, a good answer, man. Male to female. Their situations are usually different, but it’s kind of different across one gender or the other. Anyway. Is that kind of answer it? Yeah. Great question.
Karen Litzy: Well, thank you so much. Thank you. I think we covered a lot and I thank you guys for being here and I hope that you guys got a lot out of this and can kind of take this back to your patients now. So last question that I ask everyone and it’s so knowing where you are now in your life and your career, what advice would you give to yourself as a new Grad?
Sarah Haag: Ask more questions. To be honest on, I came out of school pretty much like, like the teachers know best and what I learned is right.
Sarah Haag: 53:16 And then when you get into the real world, I ended up thinking I was not very good at my job for awhile because like you would do what you were taught to do but it wouldn’t work. And then, you know, some things happen and I got older and more comfortable and when you start asking questions you realize there isn’t one answer. So if you start asking those questions, you’re part of, you’re part of the solution. By kind of pushing those boundaries and not like, I wish I would’ve just asked more questions sooner. I’d be so much smarter than I am now.
Karen Litzy: Where can people find you on social media if they want to get in touch with you?
Sarah Haag: Sarah Haig, PT on Twitter, you can find me on my website, www.entropy.physio and um, I mean Facebook, Sarah Hague.
Sarah Haag: 54:07 I don’t know what my picture looks like right now, but I’m friends with Karen, so if it says I’m friends with Karen, that’s probably me.
Karen Litzy: Awesome. And just so that everyone knows a lot of this stuff that Sarah spoke about, we will have links to it. We’ll have links to the home health section. We’ll have links to the testing, the urogenic testing. Is that neurodynamic testing? You could just send me a link or something about it. So we’ll have it all in the show notes. Thanks everyone for watching the live. We appreciate it and everybody, thanks for listening. Have a great couple of days. Stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Steve Anderson on the show to discuss leadership coaching. Steve is an Executive Coach with Orange Dot Coaching and the host of the Podcast, Profiles in Leadership. He is a former Board of Trustee for The Foundation for Physical Therapy and was the President of The Private Practice Section of APTA for 6 years between 2002-2008.
In this episode, we discuss:
-Why you should invest in a coach
-The importance of outside perspective when you’re pursuing excellence
-How to be open-minded and gracefully accept constructive criticism
-Redefining your daily operations with purpose and vision
-And so much more!
Resources:
Steve Anderson Twitter
Steve Anderson Facebook
Steve Anderson LinkedIn
Orange Dot Coaching Website
Episode 197: The Graham Sessions with Steve Anderson
Profiles in Leadership Podcast
Optima: A New Health Company
A big thank you to Net Health for sponsoring this episode!
For more information on Steve:
Steve Anderson is the ex-CEO of Therapeutic Associates which is a physical therapy company that consists of 90 outpatient clinics in Washington, Oregon and Idaho and a major hospital contract in Southern California. He currently is an Executive Coach with Orange Dot Coaching and the host of the Podcast, Profiles in Leadership. He is a former Board of Trustee for The Foundation for Physical Therapy and was the President of The Private Practice Section of APTA for 6 years between 2002-2008. He was awarded the most prestigious award the Section gives out annually to a physical therapist, the Robert G. Dicus Service Award in 2010. Steve received the APTA Leadership Advocacy Award in 2006 for his efforts in Washington D.C. and Washington State in the legislative arena. In 2012 Steve received the Distinguished Alumnus Award from Northwestern University Physical Therapy School. In 2016 Steve was awarded Physical Therapist of the Year by PTWA, APTA’s Washington State Chapter.
Currently Dr. Anderson works with business executives and their teams to improve their leadership skills and coaches them to improve communication skills and working together better as a team. He lives on Hood Canal in Washington state near Seattle with his wife Sharon.
Read the full transcript below:
Karen Litzy: 00:00 Hey Steve, welcome back to the podcast. I am happy to have you on. So thanks for joining me today.
Steve Anderson: 00:07 Well, thank you Karen. I'm very happy to be on and I'm looking forward to our discussion.
Karen Litzy: 00:13 Yeah. So last time you were on, we talked about Graham sessions and we'll have a link to that in the show notes to this podcast so people can kind of go back and learn more about that. But today we're going to be talking about the importance of having a coach. And first I'll swing it over to you if you want to kind of describe what you do as a coach and maybe what is your definition of a coach because there's a lot of coaches out there.
Steve Anderson: 00:45 Okay. So what I am is I'm an executive coach and so that means that I deal mostly with leadership training and communication skills and things like that. So what I do specifically is I work with people that are running companies, CEO types, and executives that are in leadership roles. And so helping them develop their leadership and communication skills. But then I also like to work with teams. And so I have clients that I work with, the CEO and their executive staff on how they can communicate together and how they can work better as a team when they're trying to run their business and grow their business and so on. So that's pretty much what I do. You know, but the definition of a coach is just somebody to help you, you know, figure out.
Steve Anderson: 01:40 I think what happens is we are in a very complex world and in our businesses and so on that they get very complex. I think a coach can help you simplify, look at things and simplified a little bit, help you kind of get out of your overwhelming rut, so to speak, and how you can start to look at things that are the smaller pieces and put that together and then just learn how to communicate with others and grow your business. And in a sense that doesn't seem so overwhelming or overpowering. I see a lot of my clients in that mode of, they're just, they're just overwhelmed and they've just got so much to do and so many things to look at that they don't really know what the next step is.
Karen Litzy: 02:27 Yeah, I hear you there. I definitely feel like that on almost a daily basis. Now before we kind of go into a little bit more about coaching, just so the audience gets to kind of understand where you're coming from. So you are a physical therapist and you owned a multisite practice, but let me ask you this. You could have retired and just kind of spent the rest of your retirement hanging out and you know, relaxing. So why make that shift to being a coach?
Steve Anderson: 03:04 Sure. So I was a physical therapist and came up through a company called therapeutic associates where I started out as a staff therapist and then I became a clinic director and eventually became the CEO of that company. And it had a very unique ownership structure in the sense that every director of every clinic in that company is an owner in the company. So I was certainly not the only owner in the company. I was one of many owners in the company. And so when I retired, you know, I retired fairly young, I guess when you look at what age people retire these days. And so I thought, well, you know, what do I want to do from here? I don't feel like I'm ready to just do nothing. And so I kinda did the soul search and say, what are things that I really like to do?
Steve Anderson: 03:54 And when it comes right down to it, what I really liked to do is I just really liked to grow leaders and work with people as they're going through their journey. And so, I went and got certified in a program called insights discovery, which is a communication system or style and started reaching out to people and I've got some clients and worked with them and learned, you know, how to improve and get better at what I was doing. And so now I do it on, you know, certainly a part time basis. I'm not doing this full time by any means, but it brings me joy. It feels like I have a purpose and it's something that I just really look forward to doing.
Karen Litzy: 04:39 I think that's such a great transition from the work you were doing as a physical therapist to the work that you're now doing as a coach. And for me, it gives a lot to think about because oftentimes, especially as a physical therapist, I know I felt this way when I graduated from college was, okay, I'm going to start working for a company and then I'm going to work there until I retire. And then that's it. So oftentimes, you know, it's hard for us to think far ahead, but being able to hear stories like yours I think can inspire a lot of people to say, Hey, wait a second. Like there's more to retirement or there's more to when, maybe whenever it is, you feel like your clinical work as a physical therapist is maybe run its course that you can use your physical therapy degree and you can use information, you can seek out new information in order to start a whole new career, but you're still firmly rooted in the physical therapy world.
Steve Anderson: 05:43 Right. I think you bring up a really great point in the sense that, you know, you don't, when you come out of school and you start your profession, start your career, you know, you can't see often that thing that you want to do. In other words, it's hard to visualize what exactly I want to do and what exactly I want to be. And I see new professionals coming out kind of tortured with that a little bit. Like they wanted to do something but they can't see it other than just the day to day. You know, we're working with the patient. So I can just share my journey a little bit in the sense that, you know, I was an orthopedic physical therapist and I worked hard at being good at that skill and then I became a director and I realized that I really liked working with the team and working with people and people don't always, they think I'm just messing with them when I say this, but I was kind of a reluctant leader. I didn't go in thinking that this is what I want to do, this is how it's going to look. And, I just kind of evolved into that leadership role. And then as I took steps going through my career, all of a sudden I was voted to the CEO of a very large company at 41 years old. And to be honest with you, I was scared shitless.
Karen Litzy: 07:03 I mean, I would be.
Steve Anderson: 07:06 Yeah, I was excited to be in this position, but I'm like, Oh my gosh, I mean, you talk about imposter syndrome and I was like, what do I do now? Everyone thinks I'm going to have the answers. So at that point I didn't really know what coaching was or what coaching services wasn't. As a matter of fact, it was fairly a new concept to have a coach. And so I didn't have an opportunity to reach out to one and I didn't really know what to do. And so when I look back on that time, gosh, I could've really used a good coach. And so what I did was I looked for other ways to try and improve my position or my skills. And so I took a few college level or I mean graduate level MBA courses and they were okay, but they weren't really, you know, just resonating with me too much.
Steve Anderson: 08:01 And so then I eventually found this group called Vistage and you may have heard of that, but that's an international group where they have CEOs that work together usually 12 to 15 in a group. They meet on a monthly basis and they basically just learn from each other and help solve each other's problems. And so it's like a group coaching, so set up and I was in that for seven and a half years and really, really learned a lot from that because I had, you know, peers to bounce things off or like could get vulnerable with you. Got to know him really well. And, I think when you can trust somebody and work with someone to get to that level of vulnerability, I think that's where the learning really takes place.
Karen Litzy: 08:50 And that group that was multidisciplinary group, that wasn't just specifically for therapists or even just for health care, is that correct?
Steve Anderson: 08:58 Exactly. In fact, I was the only CEO in that group from healthcare. And then they make sure that there's no competitors or you're not competing with anybody in that group. And so you start out kind of with people you don't know. And over a period of time you start to know and trust each other. And, and over a longer period of time you can really, you know, really get down to things that you have a tough time talking to most people about because you've really gotten to know these people. So I look at that as kind of a coaching relationship and the fact that my clients that I work with now, once they get to know me and once they trust me, you know, they can tell me the thing that they're afraid of or they can tell me the things that they don't know, without looking weak to the people they lead or without, you know, being their fear of, you know, people thinking maybe they don't really know what they're doing, but they can share that with the coach. And then we can get down to the real nitty gritty of that and what that means and how to work through that.
Karen Litzy: 10:08 And it sounds like you were able to take what you learned there and combine it with what you learned through your career and then the extra courses taken after retirement to kind of hone your individual coaching skills in order to better grow your clients.
Steve Anderson: 10:30 Right. And I think the emphasis on that scenario you just discussed was the experience. I think the experience you can't buy experience, you can't, you know, like when I look back on mistakes I made when I had less experience, you know, I wish I could go back and do those again cause I think I would do them a lot better. But yet that's how you learn. So hopefully a coach has the experience to help you, say this happened to me and this is how I went through it. And, and this is how I can see you maybe, you know, getting there. I do question or scratch my head sometimes when I see, cause I do see business coaches that have never run a business.
Steve Anderson: 11:18 So that always kind of makes me feel like, well, you know, I want somebody who's been in the trenches. I want somebody who has worked through this before and can help me see some ways through it as opposed to someone who's just read a lot of books and knows all the catch phrases and the authors and so on. But I think the experience is the key there. And if we look at it from the clinical side, you know, if on the clinical side as a physical therapist, we probably refer to it more as a mentor, maybe then a coach. But same thing there. You want somebody who has experience and who has seen, you know, tens of thousands of patients and has that experience that you don't have that can help you maybe see through some things from their experience. And to me that's what makes it a really good mentor and a really good coach.
Karen Litzy: 12:12 Yeah, I would agree with that. 100%. And you're right, there's nothing worse than seeing coaches advertise their services and they've had a business for less than a year. So, let's talk about pros and cons of having a coach. Let's get practical here. So what are the pros? So if someone's out there looking for a coach and they're on the fence, what are some pros to having a coach?
Steve Anderson: 12:43 Well, again, I think I said a little bit earlier, but I think a good coach can help you simplify what you're trying to accomplish. You know, I think a good coach can look at a complex situation and help you make it simpler. You know, coaches can be your external eyes and ears and provide a more accurate picture of your reality and recognize fundamentals that you have and that you can improve on. And then just breaking down some actions that you do to make them more practical. To me, one of the things that I work a lot with my clients with is it seems so simple, but communicating with others is so powerful. And if you really know how you communicate yourself or what motivates you and how you come across, and then you really get to know the people that you're communicating with and what resonates with them, then you construct your language and you construct your behavior in a way that connects with them.
Steve Anderson: 13:51 Because I can think that maybe my approach is I totally get it and I totally understand what I'm saying and I can look at the person across from me and they're looking at me like, you know, so I'm not connecting with them. So I have to know how to communicate that. And, you know, as we talk about it here, it seems simple, but I think there's a real skill to that. And I think there's a real ability to kind of craft your message in a way that connects with people.
Karen Litzy: 14:26 Yeah. And I think whenever you talk about relationships, whether it be a personal relationship, a business relationship, the thing that tends to break it down more than anything else is lack of clear communication. Right?
Steve Anderson: 14:47 I was just going to say, and it's like if you look at your family or you look at your people in your business, I've always believed that you don't treat everybody the same. I mean, you have to be fair, but when we're talking about communication, in other words, the way that I would approach one employee could be very different than another depending on who they are, and you know, how they communicate. And so I think a really good leader is able to go in and out of these different styles, I guess, of communication that resonate with that person. And it's not the same for everybody.
Karen Litzy: 15:29 Yeah. And it's funny, I was just about to bring that up because I was going to ask you a question of, let's say we'll take a scenario here. You're the CEO of your physical therapy business and you've got two people working in your front desk and you've got four physical therapists, and let's say you, I don't know, you notice that you have an unusually high cancellation rate with your patients unusually high. And so you kind of want to get to the bottom of it. So how you would speak perhaps to the people working at your front desk may be a little different than how you would speak to the therapist because they have different roles in your business, right?
Steve Anderson: 16:18 Absolutely. You have a different message for them. And, even when you look at your four physical therapists, let's say, out of those four physical therapists, you have an analytical person who thinks in very analytical terms. Well then the way to approach that would be to talk about the cancellations and no shows from a data perspective. You know, here's the numbers. Here's what it used to be. Here's what we want it to be here. You know, so you talk in very analytical ways. You may have someone else that has a real, you know, that they have more, they have a real caring about people in their feelings approach. And so you might talk to them about that situation and don't talk about analytics, but you might talk about, look at what our patients are missing. Look what we're not, we're not reaching their potential. We're not, you know, touching their hearts, you know, or whatever. So you talk more in those terms and then, other people, you will have different approaches. So I think that you have to know your people well enough to know that sitting in a meeting with six people, I'm giving the exact same message and expecting all of them to embrace it and have it resonate with them all at the same time is probably unlikely.
Karen Litzy: 17:35 Gosh, it's so much more complicated than it seems at the surface, isn't it?
Steve Anderson: 17:40 Well, it is, but I think that that's what most of us feel. And that's where I think a coach can come in and say, okay, it’s complicated, but we can make it simple. It's a step by step, day by day thing that we can break down. And then it's just like anything else, once you understand kind of the process, then it's practice and you just practice and you practice and you get better and you make some mistakes and yet you do some gaps. And yet, you know, you put your foot in your mouth. Sometimes you learn from that. And over time that's where experience starts to build and improve.
Karen Litzy: 18:17 Yeah, I guess it is. Once you have that framework, can it become sort of a plug and play kind of practice thing?
Steve Anderson: 18:28 It's good to break it down as simple as possible, but you're also dealing with humans. So just when you think that you just wouldn't, you'd think you've got it figured out. Someone will throw you a curve ball that you didn't see coming and so then you're going to have to, you know, readjust. But, it can be done much better than I think most people do it as just a general statement. You know, there's a great if I can put a plug in for this, a great Ted talk by Gawande, who most of us know who to go on deals and the title of the Ted talk is want to get good at something, get a coach. And he goes through the scenario of how, you know, he is a surgeon was thinking that he was doing pretty well and he improved and he improved.
Steve Anderson: 19:20 And then he got to a point where he just couldn't, he felt like he'd hit his limit. He just wasn't improving much after that. So his question was, well, is this as good as it gets? Is this how I'm going to be? And I'm pretty happy with that, but you know, does that mean this is where I'm at? And then he decided to go back to Harvard medical school and hire a retired professor who was a surgeon and had him come in and watch one of his surgeries. And as he's doing the surgery, he says, Oh man, I'm killing this. This is going so well and I probably just wasted the guy's time and the guys and my money. Cause what's he going to tell me? This was going great. And then the guy came back with a whole two full pages of things that he could work on.
Steve Anderson: 20:09 And he was kind of taken aback from it at first. But then he started doing that and he said, and I broke through that limit. I mean, he said, I'm a way better surgeon now. My infection rates are down, my outcomes are better. You know, and that just proved to him that anyone has a coach. And then he looks at the sports world and says, why is it that the number one tennis player in the world and the number one golfer in the world, they still have coaches. If they're the best, why would they have a coach? Well, because they need that extra eyes and that extra set of ears and so on to kind of help them break through the next level and the patients. And so I do think that that all of us could benefit from a coach or on the clinical side, a mentor. And I just think it's a really good way to spend your time and money to get to the next level.
Karen Litzy: 21:01 Yeah. And, I love that you brought up that Ted talk. I'm familiar with that Ted talk. And you're right, it just shows that even when you think you're at the top of your game, to have that external eyes and ears on you because you don't know what you don't know. And so to have someone there to point that out in a constructive way and in a way that is going to make you improve, I think is the key. I think opposite, but as the person. So if I'm looking for a coach, I need to be mentally prepared for that person to maybe tell me things that are going to make me feel uncomfortable or that might hurt my feelings. I say that in quotes. But I think you have to be mentally prepared for change. Would you agree with that? As far as the people that you have coached in the past.
Steve Anderson: 21:55 So, yes, you're exactly right. You know, as people that educate and all different ways, we know that the person who's going to learn something has to be in a position that they're ready to learn. In other words, they have to be open to the fact that they have to look at themselves and be willing to realize that there's things to learn and they need to be open to suggestion. And so, yes, I have had some clients where, you know, they kind of thought they were just doing really great and, you know, our discussions were more like them reaffirming, you know, that they did it right and that this is how it should be and whatever. And you're kinda on the other end of the lines, like, I'm okay, so then why am I on this call?
Steve Anderson: 22:49 You know, so it's almost like they're using you to reaffirm to themselves how great they are. That has happened. But, it's rare. It doesn't usually happen. Usually the people that I work with are people that want to work with me because they want to get to the next level. They know that they and I don't really have any clients that are horrible at this. You know, it's kinda like Gawande said is it's people that are really functioning at very high levels but just want to get to the next level. And so, I think the people that are really bad at it are so bad that they don't even recognize that they need a coach or they can improve. I think the people that are the best clients are the ones that are functioning at a very high level. But no, they could maybe just get a little bit further, a little bit higher, if they had a boost or if they had somebody that could help them get there.
Karen Litzy: 23:48 Yeah. That makes a lot of sense. And now we spoke about the pros. Let's talk about the cons. So I think maybe we might've just said one con that if you're not ready for a coach, then it might not work out so well for you. And that's coming from the person who's seeking. Right. So, yeah, I think you have to be really ready for it. And if you're not, then maybe it's not the right time, but are there any other potential cons that you can see?
Steve Anderson: 24:19 Well, I think that, you know, the, the obvious one is it costs money, you know, and it takes time. You know, so, the way that I would answer that is yes. But then also, you know, look at how much money PT’s spend on con ed and going to conferences and things like that. That takes a lot of money and a lot of time too. So it is just a priority. And, you know, I believe that the return on investment, so to speak, is very high in coaching. Because you really are getting that one-on-one approach. So, and then the other mistake that I see people make sometimes is, you know, I work with a client for awhile and then they kind of say, Oh, okay, this is great. Let's stop now and I'm going to go work on this stuff and then I'll get back to you when I've had time to work on it, practice it.
Steve Anderson: 25:15 And, I think that that's okay. But I do think that sometimes, just having a person continually working with you, even if it’s a lesser frequent time interval, I think it is good to reinforce that because it's hard to just take all this information and then drop everything and then just work on that without step-by-step approaches along the way. You know, it's kinda like I would make a reference to working with a patient that if you gave them a whole bunch of exercises and then say, okay, when you get all these exercises perfected, then come back and we'll go to the next one. Well, you can imagine what those exercises look like without some coaching along the way. If you returned in three months and said, okay, let's look at the exercises, you likely wouldn't even be able to recognize cause they changed them or they haven't done them. Right. And then they kind of, you know, one thing leads to another.
Karen Litzy: 26:12 Right. Or because they don't have the accountability, they don't do them at all.
Steve Anderson: 26:17 Yeah, that's true.
Karen Litzy: 26:18 Right. So I think that's the other part of the coach.
Steve Anderson: 26:22 Coaches will help you, you know, be responsible to help you, or be accountable is probably a better word.
Karen Litzy: 26:32 Yeah, absolutely. Cause I know like I have certainly done continuing education courses and things like that and you learn so much and you're all gung ho. Then a couple of weeks later you're like, what? I haven't been doing everything that I learned at that course or I haven't been as diligent let's say.
Steve Anderson: 26:58 Yeah, exactly. Right. And, I think the other thing that's kind of scary when you start any new thing is that you've probably heard of the J curve. You know, whenever we change behaviors or we try and improve on something, we kind of go in this J curve, which is, if you can imagine what a J looks like, a capital J, you start at a certain level and you dip down into the bottom of the J because you often sometimes get worse before you get better. And so it's that struggling time and that fumbling time and you just can't quite, you know, get it then, then you kind of come up on the other side of the right side of the J and then you reach a higher level. And so some people are unwilling or don't want to get into the bottom, bottom end of the J because it's frustrating. Sometimes you struggle and so, I mean some people would just rather, you know, go with the mediocrity and just keep going solid without the struggle. But sometimes you need to jump off the cliff and then get down into that lower J curve a little bit before you can really improve.
Karen Litzy: 28:09 And I think it's also sometimes if you've had this level of success, let's say the, you know, high level executives or entrepreneurs who have multiple six figure businesses, you know, they have this certain level of success and I think you can get a little complacent and you can think to yourself, well, I am doing well, I'm already successful. What do I need a coach to help me get more? Like I'm there already. I've made it. So what do you say to that kind of comment?
Steve Anderson: 28:41 Well, it just depends on what you want to do. You know, earlier in my career there was this Harvard business review article that was kinda, I used it as my management Bible cause it was, it just resonated with me so much. And the story was about the owner of Johnsonville sausage. This was in the day of Johnsonville sausage was only a Wisconsin company. And people who's constantly knew about it, but no one else knew about it. And he described how he was making ridiculous amount of money. He was really successful. He was just, you know, kinda on the top of everything, but he couldn't leave the factory without people calling them all the time. He was working horrendous hours, you know, all these things were happening. And so on the outside you would look at him and say, wow, he's so successful.
Steve Anderson: 29:37 And then he went through this whole series of changing how he did things. Then in the title of the article is how I let my employees lead. And he grew leaders within the company and they took on the security responsibility and accountability. And so, you know, the end of the story is, is that now Johnsonville sausages, there across the country and probably international, he works less hours, makes more money and is happier and he's ever been. So, you know, I sometimes, as you said earlier, we can't always see what the other side looks like, but we just have to realize that there could be a better way. And then there could be a bigger prize at the end if you’re just willing to go down that road.
Karen Litzy: 30:22 And I don't know many people who would argue against that. I think it's right. I mean that seems like it makes a lot of sense why to have working a little bit smarter, maybe still working hard but at least working smarter and making a better impact on the world, making a better impact with your patients. You know, being able to grow your business or your practice and seeing more patients help more people. So I think that another misconception when it comes to I really need a coach is that the coach is just for you and that no one else is going to benefit from it. Right. But that's not true, is it? And on that note, we're going to take a quick break to hear from our sponsor and be right back.
Karen Litzy: 31:13 Are you interested in a free opportunity to check in with the latest thoughts of other rehab leaders? Well, I've got one for you. There's a new online rehab therapy community designed for the intersection of the clinical and business sides of rehab. It's the rehab therapy operational best practices forum, catchy name, right? It's all about habits and initiatives that juice up your attendance, revenue, workflows, documentation, compliance, efficiency and engagement while allowing your provider teams to keep their eye on the prize. There are patients and outcomes. I personally believe that a better connected rehab therapy profession has the power to help more people jump in, subscribe and join the conversation. Today. You can find the rehab therapy operational best practices forum @ www.nethealth.com/healthy.
Steve Anderson: 32:06 It's certainly not true that your influence and who you work with and who you touch on a daily basis will greatly, you know, benefit from you being better at your job. And a lot of times it comes down to just helping you see, helping you find ways to resonate with what you're doing. I'll give you another personal example. So do you know who Seth Goden is? He's kind of a marketing guru guy. And, so, you know, I was in my CEO position and I'm overwhelmed like everybody else and there's so much to do and whatever. And so people used to always ask me, well, what do you do as a CEO? And I would always hesitate because it was like a kind of, what do I do? I answer emails, I talk on the phone, I go to meetings, I go, boy, is that, how boring does that sound?
Steve Anderson: 33:04 You know? And so I happened to be hearing Seth godin and going at this lecture and he said that you have to find a way to even identify within yourself, what do I do and why do I do it? And he gave out some, some ideas and it really resonated with me and I got excited about. So I went home and I worked at it. And so now people say, when I was a CEO, they'd say, well, what do you do as CEO. And I go, I'm an ambassador for my company. I'm a storyteller and I grow leaders and that sounds a lot better.
Karen Litzy: 33:42 That sounds so much better than I go to meetings and answer emails.
Steve Anderson: 33:48 Exactly. And so you know, so now when I'm doing, I'm sitting there trying to get through my emails. I say, okay, what am I doing? Oh, okay, this email was because I'm being an ambassador for my company. Or this email was cause I'm helping this leader grow. This phone call was for this. And so now those things seem to have more meaning and more purpose. And it just changes my mindset. And so I think that's what a good coach can help you see sometimes.
Karen Litzy: 34:18 Yeah. What a wonderful example. And I often wonder that I would even say to my patients sometimes who are like executives and CEOs, I was like, well, what do you do all day? And they're like, what do you mean? I'm like, you get into work. And then what happens? And it's amazing how many people are like, I dunno, I mean I go to meetings and I answer emails and I'm on the phone quite a bit, like telling me what they're physically doing at their job versus what is the meaning behind the job. And I think that's the distinction that you just made there very well.
Steve Anderson: 34:56 Yeah. And I'll give you another example. On the other end of the spectrum, I talked at a PT school once, gave a lecture and a young man came up to me and said, God, I was really impressed with what you were saying and it was a talk on leadership and I was really impressed with it and it seems like you really know what you're doing. And he goes, could I come and just shadow you for a couple of days? And I said, you mean just my CEO job? And he goes, he goes, yeah, I'd love to just follow you and see what you're doing. Whatever. I said, Oh yeah, you're going to be bored to death. I mean, what am I going to be able to show you? I mean, you know, I'm sitting at a desk, I'm doing that. He says, why? And he wouldn't drop it.
Steve Anderson: 35:37 So I thought, well, what the heck? So here, this a PT student came and shadowed me for a day and a half and he went to meetings with me and he sat there when I was on the phone and he watched me get caught up. I mean, it was just, you know, he just hung out with me. And when he left he said, Oh, this was really great. I'm kind of thinking, God, I hope I didn't bore him to death. And I got an email from him about six years later and he said, Hey, you remember me, I followed you in whatever. And he says, I just wanted you to know that that day and a half set me on my course roots and my career and now I'm doing this and now I'm doing that. And so it had a huge impact on him. It was very gratifying and it made me feel really good, but I had no idea. So through his eyes, he saw things that I, you know, thought was mundane and day to day, but he saw things that he remembered and helped him, you know, find the career position that he wants. So that was a good story.
Karen Litzy: 36:38 Yeah. That's great. Yeah. And again, like you said, it's that external eyes and ears, you know, we often don't see what others see and you never know who's looking. You never know who's listening and you never know who's watching.
Steve Anderson: 36:50 Right.
Karen Litzy: 36:51 So what great examples.
Steve Anderson: 36:56 Yeah. And that's another great point is when you are in a leadership role, people are looking and watching and everything you do and everything you say, matter. And, you shouldn't take it lightly. You shouldn't be afraid of it, but you should realize that you probably have a lot more influence than you realize. And so recognizing that and being aware of that and trying to make that message better, benefits everyone in life.
Karen Litzy: 37:26 Yeah, totally. And now before we kind of wrap things up here, I have a question that I ask everyone and that's knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad right out of physical therapy school? So pretend you're coaching yourself back in the day.
Steve Anderson: 37:52 You know, I told this story earlier because I remember it like it was yesterday and I came out of school. I wanted to be, this good, you know, manual physical therapist as I could possibly be. And so I was doing a lot of extra study and study group work and so on. And I can remember driving home from one of those sessions, I was probably about two or probably two years out of school. And I remember almost becoming overwhelmed with how can I possibly be as good as I want to be, an understand all this information and hone my skills and see the diagnosis and so on, how I was just overwhelmed with it. And, so I look back and I got through it somehow, but I would have loved to have had a coach then or a mentor that said, no, you're doing exactly what you should do.
Steve Anderson: 38:52 You're working on your craft, you're putting in the time and effort and then you just have to go step by step, day by day. As I said earlier, because I would never imagined I would someday be the CEO of a large private practice physical therapy company. It just had never entered my mind at that stage in my career. So instead of being overwhelmed with, you know, this knowledge I have to get in whatever, I just need to start my journey, keep going and keep, keep moving and putting in the time and effort and where I end up in or I evolve into, I may not be able to predict, but I just know, I just know it's going to be something exciting and fun. And as long as I make the right decisions along that journey, I can reach a level I would have never imagined I could reach. And I do see that in new professionals today and they're struggling with that, you know, a few years out of school. And so my advice to them as it would have been to myself is just keep moving forward, step by step. Take some risks, find some things that resonate and excites you and don't be afraid to try them and see where it leads.
Karen Litzy: 40:15 Great advice. And now before we go, let's first talk about your podcast and then where people can find you. So talk about the podcast.
Steve Anderson: 40:27 Okay. Well, I just want to say on this podcast, how inspirational and how helpful you were to me. Because as you probably remember, I thought, well, maybe I should do a podcast and I believe I called you and asked you some questions and I had not a clue how to start it and what to do. And, I really, I commend you and thank you very much for helping me answer some of those early questions and so on. So my podcast is called profiles in leadership and I just try and focus on leaders and then how they lead and just learn something from discussions with each one of them. I've been doing it about a year and a half now, a little bit longer. It's great. I mean, I've gotten some really fun, fun interviews, some inside the professional physical therapy profession and some are outside. I'm doing more outside the profession lately, which is fun. And, again, people ask me, why do you do the podcast? And, I say, because I learned something every time I do one, you know, every time I talk to somebody, I've been around a long time and with my experience, I still learn something every time. So it's like that, that gets me in the jazz and I'm inspired by that. So that's why I keep doing.
Karen Litzy: 41:58 Yeah. And I also heard you say several times that it's fun, so why wouldn't you want to do something that's fun?
Steve Anderson: 42:04 Exactly. And, and you improve. I mean, I heard somebody might've been Joe Rogan who said, you know, if you think I have a good podcast, you should listen to my first few.
Karen Litzy: 42:15 Oh my God.
Steve Anderson: 42:16 I think we all start at a certain level and if you're not improving, then you probably need to get out.
Karen Litzy: 42:23 Yeah, probably
Steve Anderson: 42:26 I'm doing it. I think mine are much better than my first ones were. So, you know, that keeps me going too in the sense that I, you know, we all like to get better. We all like self-mastery. If we're not improving, we're probably not not having fun.
Karen Litzy: 42:42 Yeah. I mean, like I look back at like the first couple of interviews that I did and it was like a straight up boring interview for a job that was not good. It was like, I was not showing my personality. It was very much like, so Steve, tell me about your job and what you do. And it was so, Oh my gosh. Yeah, it was not good. But you know, you got to start, like you said, you got to start somewhere. And I just took courses on public speaking and improv courses in order to help me improve because I knew where my limitations were and what needed to be done. But yeah, I can totally relate to that. The first couple are no good, not good, and it's not because the guests weren't great. It was because of me.
Steve Anderson: 43:33 Well, but look at the risk you took. I mean, to me that's how you reach a higher level of excellence is you're willing to take the risk. You are vulnerable. You were willing to be on camera and on audio and stick your neck out there and, you know, struggle through it a little bit and you improved. And then now you're, you know, you should be very happy with where you're at now because you do a wonderful job. So that's to me what it takes. And if we relate it back to coaching, it's the same thing. It's yeah, I need to take a risk. You need to be vulnerable. You need to realize that, you know, with work time and effort and practice, you're going to get better. And that's what it's all about.
Karen Litzy: 44:19 Absolutely. Very well said. And where can people find you, find more about you and find more about your coaching business?
Steve Anderson: 44:27 Sure. So, my podcast it's on all of the podcast platforms, but, probably the easiest way to find it is through iTunes. You just search for profiles with leadership, with Steve Anderson. I did some as I did with you early on. I was doing the videos. And so, I do have the video gallery. You can search YouTube for profiles in leadership with Steve Anderson and then also all my podcasts and all the videos that I've done are on my coaching website, which is orangedotcoaching.com and that's orange, the word dot coaching.com. And you can see my services there for coaching. And then if you go to click on the media center, that's where the podcast and the videos are stored.
Karen Litzy: 45:18 Perfect. And just so everyone knows, we will have all of that information on the show notes at podcasts.Healthywealthysmart.com. So one click, we'll get to all of Steve's information. So Steve, thanks so much for taking the time out today and coming on the podcast. I appreciate it. I appreciate you. So thanks so much.
Steve Anderson: 45:37 Well, thank you Karen. And again, I just thank you for your early mentorship to me when I was trying to figure this all out and I haven’t forgotten that and I'm very appreciative that you're willing to help me.
Karen Litzy: 45:50 Anytime, anytime. You are quite welcome and everyone else, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Ryan Estis on the show to discuss excellence in business. Ryan Estis has more than 20 years of experience as a top-performing sales professional and leader. As the former chief strategy officer for the McCann Worldgroup advertising agency, he brings a fresh perspective to business events. As a keynote speaker, Ryan is known for his innovative ideas on leading change, improving sales effectiveness and preparing for the future of work.
In this episode, we discuss:
-Three actionable tips to constantly reinvent your business
-How to stay relevant and achieve excellence with changing customer expectations
-Four key practices you should adopt to thrive and avoid stagnation
-Why you need to reframe problems in order to produce lifetime customers
-And so much more!
Resources:
Ryan Estis Website
Ryan Estis Facebook
Ryan Estis LinkedIn
Ryan Estis Twitter
Ryan Estis Instagram
For more information on Ryan:
Ryan Estis has more than 20 years of experience as a top-performing sales professional and leader. As the former chief strategy officer for the McCann Worldgroup advertising agency, he brings a fresh perspective to business events. As a keynote speaker, Ryan is known for his innovative ideas on leading change, improving sales effectiveness and preparing for the future of work. He was recently recognized as one of “the best keynote speakers ever heard” by Meetings & Conventions magazine alongside Tony Robbins, Bill Gates, Colin Powell and Mike Ditka.
Ryan delivers keynote speeches, courses and online learning with an emphasis on actionable content designed to elevate business performance. His curriculum emphasizes emerging trends influencing leadership effectiveness, sales performance and customer experience. Ryan helps participants prepare to thrive in today’s ultra-competitive, hyper-connected business environment.
Ryan supports the world’s leading brands, including AT&T, Motorola, MasterCard, Adobe, MassMutual, the National Basketball Association, the Mayo Clinic, Honeywell, Thomson Reuters, Ernst & Young, Lowes and Prudential.
Ryan and his team publish original research featuring client case studies to expand the live event experience. He is also the author of a popular blog on business performance. His writing has been featured in Inc., Forbes, Entrepreneur, FastCompany, SmartBrief, Business News Network, Crain’s Business, and Yahoo Business.
Read the full transcript below:
Karen Litzy: 00:01 Hi Ryan, welcome to the podcast. I'm excited to have you on. So thank you so much for joining me.
Ryan Estis: 00:07 Thanks Karen. It’s great to be here.
Karen Litzy: 00:09 Yes. And so like I mentioned in the introduction, Ryan was one of the keynote speakers this year at the private practice section annual meeting in Orlando, Florida. And I really loved the keynote, which is why I reached out to you. I took action now like you suggested and we'll get into that as part of my tan plan. We'll get into that a little later. I reached out to you via social media. And so here we are, but I have to say I really enjoyed the keynote and yeah, and it took a really like emotional interesting turn in the middle and I feel like in speaking with other participants that was unexpected and welcomed and really got people to sort of grab onto your words and take it to the end. So well done from a speech blueprint standpoint.
Ryan Estis: 01:06 Well I appreciate it, you know, and I think an experience like that a little more emotional resonance is a good thing because I think that helps. Helps the tan plan, which I know we're going to talk about get a lot of attention. So that's always the goal.
Karen Litzy: 01:20 Yeah, it was great. So thanks so much for that. But now let's let the listeners who weren't at PPS get a little bit more information from you. A little taste of that keynote. And one of the things that you know we were kind of talking about before we went on the air is at the private practice section. There are a lot of small business owners, a lot of entrepreneurs and a lot of my audience are yes, maybe work in healthcare but are also entrepreneurs. And we were talking about kind of customer expectations and how those expectations has changed over maybe the past couple of years. You probably have better research than I do on this, but can you talk a little bit about customer expectations and how they are kind of changing the small business or entrepreneurial landscape?
Ryan Estis: 02:09 Right. Well, customer expectations are skyrocketing. They're changing fast because the world around us is changing so fast. I mean, I'm actually sitting at home right now and you know, when we get off this podcast I can turn to my lap and say, Alexa, paper towels and then an hour paper towels are at my front door. And that experience and experiences like those are elevating my expectations of everything. So as a consumer, I have a whole new set of standards with respect to customization, personalization of efficiency, expertise, sense of urgency and how I spend my time. And for those small business owners and entrepreneurs that are astute, aware of that and have evolving their customer experience to meet customers where they are, the future looks pretty bright.
Karen Litzy: 03:03 And let's say, okay, we'll take me as an example. So I'm a small business owner and I really liked the way my business is running. I'm successful, I've been in business for 10 years. If it ain't broke, why fix it? So what kind of advice would you give to me?
Ryan Estis: 03:23 I'd have some real thoughts about that. I would say if it ain't broke, it's the perfect time to break it because success breeds complacency. And complacency is the ultimate recipe for disruption. And the reality is for so many small businesses and small business owners, they don't change until there's a crisis, or they're experiencing some significant pain. And so, at that threshold, it's too late and you're on the verge of losing market share and getting commoditized, having your margin squeeze. And I know this from personal experience, if you remember from the keynote, my opening story was about exiting the advertising agency I worked for. And the reality of that situation is we had just deep pockets of resistance to change. You know, we wanted to kind of continue to do what we've always done, follow the playbook. And when the world around you changes and the marketplace changes, that's just such a recipe for disruption. And so having lived through that, I vowed personally, I am never going to experience that pain again. So the mindset of a small business owner today has to be continuous reinvention. Change is no longer an event. It's simply a way of existing. If you want to reign, remain relevant, thrive into the future.
Karen Litzy: 04:51 And can you give some examples of maybe what you do with your own business to constantly reinvent? Because I feel like we can say you need to constantly reinvent and I feel listeners out there going, okay, great. Well what does that mean?
Ryan Estis: 05:07 Yeah, yeah. So I'll get real, real specifics. Because here's the reality. If things are going pretty well and like the scenario you outlined, I had my business for 10 years, it's going well and I'm just going to continue to do what I'm doing. I don't see a real need or I have an appetite for change. And when things are going well that's true because change is uncomfortable. But, I've forced myself to get uncomfortable because that's where I'm evolving, stretched and growing. So we'll see a few things that I do. Three things, three very specific actionable tips. I am always in my business conducting what I refer to as three little experiments. I could be experimenting with my marketing on partnership, new software and the goal of the experiment isn't necessarily to have wild success.
Ryan Estis: 06:03 The goal of the experiment is to learn and iterate forwards. So I'm trying new things that I think could help our business. And a part of that is it puts me in a position where I'm expanding my knowledge, acquiring new skills, getting education feedback, and then pantsing the business forward. So I would say some successes iterative, but you want to get out of your comfort zone and into the learning lane. So we have three very specific experiments that we're running in our business right now and there are tasks and we're getting feedback and evolving as a result. So that's one thing that I do. A second thing that I just really encourage or recommend is that in addition to working in your business, like you do, like probably a lot of your listeners do, and I do as a practitioner and a small business owner, you have to make time to work on yourself and on your business.
Ryan Estis: 06:59 So for me, we just came out of a two and a half day meeting that I refer to as our 2020 growth summit. So this is literally shutting down emails, shutting down the phones, two and a half days with my team and some of our partners. There were eight of us attending in a room for two days with a very buttoned up agenda talking about the future of our organization. And you know, we're tearing apart the business and challenging ourselves to think about growth into the future. What are our priorities, budget assessment, looking back, looking forward recommendations, competitive intelligence, I mean all of it. So you know, that type of time kind of out of the business to working on that I think is imperative to having kind of a good solid plan and direction ahead. So that's a second recommendation is make you know, take time out to strategically work on your business.
Ryan Estis: 08:03 Well, the third recommendation I have, and this is something I may have talked about it in the keynote, but I'm a big fan for small business owners of having what I refer to as a personal board of directors. And I have eight people that I've invited formerly this, that on my board of directors. And I invited people that I had a relationship with. I have a lot of trust and respect for their opinion or what they were doing say in their specific area of expertise. And the invitations were fairly informal, but what it's done is it's given me access to these eight people who have competency and skills perhaps to shore up some of my gaps. And I am able at inflection points when facing a critical decision or a juncture or I'm considering making an investment.
Ryan Estis: 08:58 I had a group of people that, you know, I can reach out to and schedule a time with to use as a sounding board. And I think entrepreneurship at times can be very isolating. And you know, you feel you can get to a point where you feel like you're making decisions in a vacuum. And having an advisory board is moonshine option and valuable part of my growth, particularly over the course of the last couple of years. So those are three very kind of tactical things that I think everybody listening to can think about as it relates to their own business.
Karen Litzy: 09:29 And, all of those three examples are things that are pretty doable for everyone. You know, it's not like there are things that are so outrageous. Like when you say three little experiments, you mean small, not like I'm going to restructure my entire business, but you know, you constantly throughout the year are doing this. Do you say I'm gonna do three little experiments a year or is it like every quarter or six months?
Ryan Estis: 10:00 No, these are good questions. I would say I'm always running three experiments simultaneously. So let's say we're working on a marketing project that's a bit of an outlier, an experiment, something we wanted to do, try it. Sponsorship around some of our content branded content. And I'm not sure where this is going to go or if it's realistic. And so what we're testing this, I've reserved a little bit of budget, a little bit of investment, a little bit of capital. We're going to go down this path and then evaluate it. But through this process we'll learn things, we'll uncover things, we'll get customer feedback. We're working with, you know, our marketing partner. And so it's those, they're small tasks that, you know, if there's traction and the evaluation is, yeah, this is beneficial and we could build it then, you know, that we may expand an experiment.
Ryan Estis: 10:57 So, that's the idea. They're small because I'm a big believer in that. Success is iiterative, you know, you want to be doing little things. There’s been a thought about that. It's like the minimum viable effort. There's BJ Fogg, he wrote a book about tiny habits and small changes and his ideas that to create these, he's a professor at Stanford. And his idea is that you create a new habit, you need to simplify the behavior and then make the change so tiny, so little, so ridiculous that it's just something that's easy to do. So no, you don't want to and you want to take calculated risks, you know, not something that's going to jeopardize your core business. So that's when I think of three little experiments and then you build on those things based on your expanded knowledge, experience, exposure, you know, you can start to iterate your business forward.
Karen Litzy: 11:59 Yeah, that makes a lot of sense. So like in my world, in the physical therapy world, for me, I can think of changes that I made over the last year. And we're joking before going on air, like I went into these changes with like white knuckles. Like I did not want to let go of the things that I was doing because like you said, it's very uncomfortable so that it works. So for me in the healthcare world, something that was, it was just simply switching my electronic medical records from one company to another and it was very uncomfortable. But now that I've been doing it for, I don't know, eight months or so or nine months, I think to myself, this is so much better. What was I thinking before? Things are better. My patients are getting reminders that they have appointments, the platform's easy, or I can do it on my phone. I don't need a computer. So you know, that's an example of something small and at least in the healthcare world that you can do. And like you said, I was getting feedback from my patients and they were like, I love this new system. This is great. I love getting these reminders. I love that I can pay through the system. So it worked.
Ryan Estis: 13:14 It works. But I also think it illustrates a very, very relevant point to our conversation that, you know, it's the psychology of change, right? So our brains are wired for safety and survival, not innovation and change, the mechanism in our psychology is trying to keep us safe and alerting us when danger is near. And that's trying to keep us away from these unknown elements. And that was pretty useful in times where there were reptiles running around trying to meet us. But in the modern day society, when you're running a small business, you have to condition yourself to navigate those feelings. So the discomfort, the uncertainty, the trepidation, the anxiousness that you felt upon making this change, that's a sign that you're in the learning lane, that you're expanding, you're growing, you need to kind of learn to welcome a little bit of that tension because that discomfort means you're on the cusp of a breakthrough and you broke through in an area of your business that elevated the client experience that's better for you, that's better for your team. And you just had to navigate that tension inside yourself. And you know what, it's like a muscle cause the next time then you invest in new software or taking intelligent risks or conduct an experiment, you'll recognize that tension of assignment. Yep. I'm in that. I'm in the learning, I call it the learning lane of your comfort zone and into the learning layer. And that's where growth happens.
Karen Litzy: 14:51 And it's not easy, but it's not easy and it's a little scary. But you know, I guess I love the third point you made kind of having a personal board of directors and I guess I do have this without even kind of categorizing it as such, but I do kind of run things by people and it's interesting even when you run things by this group of, let's say you have eight people to shore up your ideas with, what do you do when they come back to you with feedback that doesn't align with what your thoughts are?
Ryan Estis: 14:52 Yeah. So ultimately I would say I'm the decision driver, but if I'm out of my comfort zone or I'm entering unchartered territory, then it's useful to gain some outside perspective. And so I'm taking their advice under advising and helping it shape my decision.
Ryan Estis: 16:04 So if I get feedback or advice or counsel that's counter to what I anticipated and my own opinion, then that means I'm probably going to have to do a better, more thorough job of convincing myself that I was right in the first place. And, then taking that step forward. The other thing about the advisory board, I would just also recommend is I hand selected these people for their particular skill or competency. So I have a technology entrepreneur that's an expert at scaling a business. I have a good friend who owns a research business that's complimentary to mine and he built and scaled that business and sold it. And so he has a lot of expertise that's related to my business. We partner together, but I value the way he ran his business and the organization he'd built.
Ryan Estis: 16:56 I have my business manager who's known me for 20 years and is a good friend. And I also have my life coaches and spiritual advisors. So, my point in kind of sharing some of that context is, you know, I reach out to the people that I think would have relevant context based on the decision I'm navigating. So, if it's a financial decision, I'll probably reach out to my good friend who's worked in finance on wall street for 20 years and say, I'm thinking about borrowing money to do this and what's your perspective and how does this look good? And these are the terms. And so I have kind of carefully vetted these people based on their experience, exposure and the competency and thinking they could bring to support mine, if that makes sense.
Karen Litzy: 17:43 That makes perfect sense. And did you do any sort of like self evaluation to see really where your gaps are, whether conscious or unconscious gaps?
Ryan Estis: 17:54 Yeah, I've gone through coaching programs and have done some assessment work and then I also just recognize, you know, after having been in this business for a decade now, what some of the things that I'm really good at, some of the things that, you know, I'm not strong in. And so I just, I think in this kind of point on the journey, I have some exposure, I have some exposure to that. And some of it's based on my previous experience too. You know, I'm not a finance expert. I've never scaled the business and sold one. And you know, I'm not a technology expert. I've never launched an app. So these are things I'm like, Oh, these are things that, you know, as I move forward and navigate these waters, you know, it'd be good to have people that occasionally can jump in the boat and row with me and that elevates my confidence too.
Karen Litzy: 18:47 Sure, sure. Yeah. And I'm sure it gives you more confidence in your decisions. And you know, I'm thinking of those like brand new entrepreneurs who feel like completely overwhelmed with absolutely everything. What advice would you give to them to kind of really hone in on what their zone of geniuses or greatnesses if you will, and then what may be they need to fill in the gaps?
Ryan Estis: 19:12 Yeah. You know, a new honor, first of all, new entrepreneurship is overwhelming. So the best advice I have is be patient with yourself and be honest with yourself and you know, because everyone talks about entrepreneurship and freelancing and the gig economy. And you know, I guess when I quit my job, people thought I was crazy and I don't know, we weren't, entrepreneurship is so celebrated in our culture today and it's really happened in the last 10 years. You know, we've got magazines like fast company and we're putting, you know, these YouTube millionaires on the cover of ink. And I don't know, I think there's all this pressure to succeed and scale and get and just I would say just remember, focus on the next most important thing.
Ryan Estis: 20:09 Build what you'd want and make and you know, achieve some semblance of success before you move onto the next thing. Focus is so critical for an early stage entrepreneur. It's so easy to get distracted and trying to do seventeens that we try and do 17 things at once. Well, and then you want to be networking. So you're meeting with people in a coffee shop that did it before you and you're just slow down, focus, get the next thing right, be patient, success of build. So that kind of perspective I think is so important.
Karen Litzy: 20:47 Awesome. Thank you for that advice. That was great. I'm trying to take notes as quickly as I can here, but I'm going to have to go back and listen to this again. Now, you know, before you said you were kind of built to survive, you know, our nervous systems are built as human beings for us to survive. But something that you had mentioned in the keynote was, yeah, it's great to survive, but we also need to adapt and thrive. And you had sort of four keys to this breakthrough for poor performance are four keys to really help us adapt and thrive. So, can you kind of go through those for the listener?
Ryan Estis: 21:27 I can. So the first one is very related to kind of where we started, which is about change. And the first one's initiate continuous reinvention. So you want to be an agent of change. You want to look at change in challenge through the lens of opportunity. And you want to be invested in this idea of successes that are rid of them to constantly be conducting experiments. And really I'm going to disrupt myself before the marketplace or competition does it for me. So stay in the learning lane, push yourself, get uncomfortable. That's the first one. The second one is really about customer experience, the idea of brand, the customer experience. We're in the experience and kind of, we touched based on how fast customer expectations are changing. The actionable recommendation around that as audit your own customer experience.
Ryan Estis: 22:20 Look at every customer touch point your app online, offline, and look for opportunities to elevate it and add more value and make the experience better for your customers, meet customers where they are. Then the third one was it's related, but it's really about kind of, you know, the internal operation of your business, which was be a culture champion. I think culture is a catalyst for, you know, employee engagement, discretionary effort and contribution and culture is merely a reflection around how you lead. So think about purpose, vision, values, why are you doing what it is you're doing and what are the people who join you on this journey? Gonna get out of it. And employee experience and customer experience will always be directly correlated. And then the last one was take action. Now you talked about a Tan plan pan is, that's the acronym.
Ryan Estis: 23:16 Take action now. And it's that, you know, great leaders, entrepreneurs, small business owners, they have a healthy action orientation so they don't get paralyzed. They're able to make decisions. The idea that you take in new information and then you immediately take action on those ideas, right? So, just like this, your listening to this podcast, you invest 30 minutes, 45 minutes or reading a new book, it's then taking a pause after you've taken that information in and say, what can I decide and commit to doing and doing differently that's going to create some momentum or advanced my clots. And that's, you know, really successful people they have, they're hungry for information, but then they back it up with action orientation. And those were the four tips.
Karen Litzy: 24:04 Great tips. And I want to go back briefly to where you have branding the customer experience or patient experience in the healthcare world. Often times people use the B word, I call the B word branding to be all encompassing, right? Like you just have to, Oh, you just did your work in your branding, or B, be a better brand. But
Ryan Estis: 24:32 Yeah, that's not really it.
Karen Litzy: 24:34 It's sort of this term, you know?
Ryan Estis: 24:37 Yeah. I have an ad agency background, so I'd probably throw that word out too much. I liked how you call it, the B word that's actually good for me. But let me clarify. So I guess a more specific way to describe what I mean by brand. It's establishing an identity, standards of excellence right away you go to market, tell your story, engage customers, deliver service, follow up and follow through that differentiates you from the competition. And that delivers value or resonates in a compelling way with customers, right? It's how you do things and if that, you know, look every touch point with the customers and opportunity to add value in advance or relationship. And it's just imperative in the experience economy that we're carefully thinking about that and looking for ways to elevate.
Karen Litzy: 25:36 Yeah, and I love the example that you use. Where were you at? A Ritz Carlton or something. Is that where you were? So if you want to like briefly tell that story because I think, you know, when people hear Ritz Carlton, I mean, I know the first thing I think of is expensive, very elevated sense of customer service and is the same thing with like, a St. Regis. And you know, this is what I want to do real quick. I'm going to tell a story about my stay at st Regis and then we can contrast to your stay at a Ritz Carlton, which I would say are on par, right? So I was at a st Regis, I went out, it was like in a very warm part of the country and in the middle of the summer, came back, the air conditioner in the room, not only broke, but flooded the room and like you walked in and it was steamy and it smelled and it was like the carpet was all like squishy with water.
Karen Litzy: 26:46 So we called down and said, Hey, you know, our air conditioner broke, there's water everywhere. And you know this just like one in the morning, I realize it's like the seed team on but still, so the guy knocks on the door with a mop and a bucket and I was like, Oh no buddy, you're going to need more than that. Like this is not good. So we have to call back down. Say, yeah, no, like we can't actually stay in the room. It's really bad. So someone came up, knocked on the door, handed me a key and said, you're in room three 47 and walked away. I was like, boy that wasn't very st Regis of them was it? And then the next morning I went to the front desk and I was like, well maybe cause everybody was like real tired and like I was with my boyfriend at the time. We just wanted acknowledgement and maybe like have breakfast on us, have a drink at the bar. I went back down and said, yeah, my room flooded last night and they just came up and handed us a key and now we're in this room. The girls like, yep. Got it.
Karen Litzy: 27:46 And that was my experience. So I wrote a letter and what the st Regis did is probably more along the lines of your experience at the Ritz Carlton. I wrote a letter, I didn't make a big deal while I was there. Wrote a letter, said what happened to general manager, came back and he said, thank you so much for not ranting and raving and making a big deal of things. Any weekend you want. No blackouts. It's on me. So we took him back and they gave us a whole redo. And now I'm like, I would stay at a st Regis again in a heartbeat. They were fantastic
Ryan Estis: 28:25 There and that's the ultimate lesson for any entrepreneur. It's the last sentence. You just say, cause here, here's the key. And it's similar to my Ritz Carlton experience and their philosophy is that problems are our best opportunities in business to deepen a relationship and that. So it's a real reframing of the problem, opportunity and customer relationship. It's so interesting. The best customer service stories always start out with a problem. My room got flooded, I lost my Ray-Bans in the Bay and was, you know, frustrated. And then some heroes steps in and resolves the problem beyond our wildest expectations. And it deepens our affinity, loyalty and evangelism for that particular brand. And so it's just, it's important to remember, it's never the problem, it's the way it gets resolved that people remember. And that ultimately shapes how they feel about doing business with you and Ritz Carlton leaving keys like PR.
Ryan Estis: 29:38 It's almost celebrated. We have a guest that has a problem. Here's our moment to shine, to be magic, to create that wonderful, memorable feeling. And you know, so often I think in business and small businesses, you know, we get aggravated, Oh, customer's upset. Oh there's a complaint. And just next time that happens, pause and say, how can we turn this problem into an experience that creates a customer for life? And you'll reframe it. And you know, it's just interesting it's when problems come up for me. Now I have some of my, God, there it is. Now we've got a real opera, a magic moment as arrived.
Karen Litzy: 30:16 Yeah.
Ryan Estis: 30:17 How are we going to raise, how are we going to respond?
Karen Litzy: 30:20 Exactly. And, you know, for the listeners who weren't at PPS, and you correct me if I'm wrong, but you were like paddle boarding and the Bay, you lost your sunglasses. And like some guy that worked at the Ritz Carlton went snorkeling down and got them for you and returned them to you. And you were like, what in the hell?
Ryan Estis: 30:40 Yeah. And keep in mind, I never said, Hey, I mean I lost it. It was my fault.
Karen Litzy: 30:47 Yeah.
Ryan Estis: 30:48 And he just overheard me talking about it. I never, you know, I never went and said, Hey, this happened to me, you know, so it was just totally my thing. And the fact that they picked up on that and did what they did. And I was just, you know, I was dumbfounded and the more I researched and unpacked it and learned and actually spent some time with one of the executives at Ritz Carlton that runs a leadership Academy, you learn how based in their culture that is, right. So it's their values, it's their service standards. I mean, one of the great things at Ritz Carlton is that, you know, they have these very simple standards for how they greet and interact with guests. And part of what's great about that is that it creates consistency across all Ritz Carlton properties, right? So there's a way they greet and interact with the guests and they train on that, not what I mean by brand and things standard of excellence that's repeatable, that differentiates them, that resonates with the customer. So it's just a great takeaway from that is do you have standards? You know, you say customer service excellence that may mean something very different to me than it does to you. And that's my point is you don't leave customer experience up to the subjective interpretation of each individual. You standardize it, create protocol around it, process discipline around it so you can deliver a world class experience every single time. That's the idea.
Karen Litzy: 32:20 Yeah. So really get specific.
Ryan Estis: 32:23 Yeah, get specific.
Karen Litzy: 32:25 Yeah. Yeah, that makes perfect sense. All right, so before we wrap things up here, I just have a couple more questions, but first one is, is there anything we missed? Any key takeaways that you want the audience to get?
Ryan Estis: 32:41 You know, I think to just, you know, and this isn't new, but I think really spending some time as a small business owner, looking out, being forward thinking, you know, spending a little time, this is a great time of year to do it. We're coming up on the end of the year and I know it's an exercise I'm going through. I'm asking myself, you know, why am I doing this, first of all, and then what do I really want this to be a few months from now, but even five or 10 years from now? And some of that forward thinking and visioning and purpose, solidification. It helps reconnect me to why I got into this in the first place. Why it still matters to me. And the solidification and the articulation of that can really be beneficial to a culture and connecting your people to it and being able with clarity to say, this is where we're going, this is what we're building and this is why we're doing it. This is the impact that it's having. And I think for your listeners in your industry, some of that work could be, so useful and so, so meaningful. So I would think that's another, you know, Simon Sinek did the great Ted talk. He wrote the book and starts with why. And I think that's true.
Karen Litzy: 33:55 Awesome. Well, thank you for that. And then the last question, I probably should have prefaced this question, but I forgot. So here we go. It's a question that I kind of ask everyone at the end of the interview. And that's knowing where you are now in your business and in your life. What advice would you give to yourself straight out of college?
Ryan Estis: 34:19 Yeah, I would say, relax, have fun and enjoy the ride because it goes by pretty quick and you know, if it's not something that is going to matter five years from now, don't give it more than five minutes of your time and attention. I think for a lot of, you know, achievement oriented, entrepreneurial type a people, which I am one of, we can tend to get perfectionist and stress about the details and kind of, you know, that creates low grade anxiety and overwhelm when things go wrong. And it's just, as I've gotten a little older and wiser, I think just relaxed and letting some of that stuff go and really making sure that, you know, yeah, hard work is great and building something that you care about and are proud of matters, but just really make sure that you're enjoying the moments and the journey your on, you know, while you're moving through it.
Ryan Estis: 35:14 I think that's just so critical. I think we project outward and delay our happiness until, you know, I call it the if when happiness travel, if my business gets to this point, you know that then I'll take a vacation or once I get here, then I'll finally be happy. That's a real, a real miss. And so I let some time go by. I think it's certain phases of early phases, my career and my life where I would have been a little more relaxed about things and that's important.
Karen Litzy: 35:46 Yeah. I know I'm guilty of everything you just said for sure. And now totally guilty. Oh 100% guilty of everything that you just said. And I'm trying to work through that myself. So that's wonderful advice. Now, where can people find you if they want more information and they want to connect with you? They want to hear you speak, all that fun stuff.
Ryan Estis: 36:11 So I would say that the website's a great place. We do a weekly newsletter called prepare for impact. It comes out every Sunday and it's just kind of a couple of actionable tips to help you get ready to be the best version of who you are and the week ahead. And then social media. LinkedIn, I'm pretty active on Instagram. We have a company Facebook page, pretty pretty active YouTube channel. So all of the social properties. But I'd love to connect with any of your listeners. This was a lot of fun.
Karen Litzy: 36:45 Fabulous. Thank you so much for coming on. I really appreciate it. And do you have anything coming up? Anything in the works
Ryan Estis: 36:55 And I do. So, you know, we're working on a book.
Karen Litzy: 37:02 Yes.
Ryan Estis: 37:04 I think we're at the point now that we're at the point now where I think it's actually gonna be a pretty good book and it's about sales, service and leadership. I think it'd be very relevant to the, you know, small business owners and practitioners listening and that'll be out sometime next year. So for anybody listening that's interested in, you know, if they subscribe to the newsletter and stuff, we'll be sure and do promotion on it.
Karen Litzy: 37:32 Awesome. Well, thank you so much for taking the time out and coming on. I appreciate it.
Ryan Estis: 37:36 Yeah. Thanks for having me.
Karen Litzy: 37:38 And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Elaine Lonnemann on the show to discuss the impacts of being diagnosed with degenerative disc disease. Elaine Lonnemann has served the public clinically as a Physical Therapist for over 30 years practicing in a variety of settings in Tennessee, Florida, Kentucky and Indiana. Her early clinical interests in treating patients with low back pain evolved into a clinical academic career with a focus on best practice in orthopaedics, teaching and leadership. She lives in Southern Indiana and is the mother of four boys with her partner and husband Paul Lonnemann who is also a Physical Therapist.
In this episode, we discuss:
-The American Academy of Orthopedic Manual Physical Therapists position on the opioid crisis
-Patient health outcomes following the diagnosis of degenerative disc disease
-The use of Clinical Practice Guidelines for low back pain in physical therapy practice
-Pain science education and the treatment of low back pain
-And so much more!
Resources:
Email: elonnemann@usa.edu
Elaine Lonnemann Twitter
AAOMPT Website
AAOMPT Position Statements
Battie et al. 2019: Degenerative Disc Disease: What is in a Name?
JOSPT CPG: Low back pain
For more information on Elaine:
Dr. Elaine Lonnemann received a BS degree in PT from the University of Louisville in 1989, a MSPT from the University of St. Augustine (1996) and DPT (2004). She is the program director of the transitional Doctor of Physical Therapy program for the University of St. Augustine. She has served in several positions for the University of St. Augustine for Health Sciences since joining in 1998 including teaching in the online and continuing professional education divisions. Her responsibilities include oversight of the transitional DPT program as well as the orthopaedic and manual physical therapy residency and fellowship. She is a board-certified clinical specialist in Orthopedics, Certified Manual Physical Therapist and a Fellow of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). Her clinical experience have been in private practice, home health, outpatient practice, and as Chief PT of outpatient services in a level II trauma center at a university hospital.
Dr. Lonnemann was an associate professor for Bellarmine University in Louisville KY and taught in the first professional program for fifteen years. She has presented nationally and internationally on the topics of spinal thrust manipulation, low back pain guidelines and leadership. She authored textbook chapters in orthopaedic physical therapy and has published in the areas of spine morphology and joint manipulation. She is passionate about leadership, postprofessional physical therapy education, manual physical therapy and integrating pain and movement sciences in the clinical management of clients. She is the current President of AAOMPT and has served two terms as Secretary and Chair of the AAOMPT International Federation of Manual Physical Therapists Educational Standards and International Monitoring Committee, member of the OMPT Description of Advanced Specialty Practice Task Force and committee member and author for the 2018 revision of the Manipulation Education Manual. She received the AAOMPT Mennell Service Award and the 2017 President Joseph and Maureen McGowan Prize for Faculty Development from Bellarmine University which provided the opportunity to study the history of manual therapy at Oxford University.
Read the full transcript below:
Karen Litzy: 00:01 Hello, Dr. Elaine Lonnemann, welcome to the podcast. I'm happy to have you on.
Elaine Lonnemann: 00:06 Thanks. I appreciate being here.
Karen Litzy: 00:08 Okay, so today we're going to be talking about degenerative disc disease. But first I would love for you to talk about what it is, why it exists and what do all those letters in AAOMPT stand for?
Elaine Lonnemann: 00:27 Absolutely. So AAOMPT stands for the American Academy of orthopedic manual physical therapists and it's an organization, it's an association that started in 1991 basically because some individuals felt like we needed a group that could present scholarly works that could meet, have conferences and also test clinicians based on international manual therapy standards. And so that group, several individuals got together and that's how it started in Michigan actually. So that now we have representing 3000 physical therapists.
Karen Litzy: 01:12 That's a lot of therapists. And how long have you been part of the organization?
Elaine Lonnemann: 01:19 I've been a member since actually 1994. So quite a lot of time. I was a resident and fellow in training and became a member of really when it was beginning. So I've been involved as a member and more recently as an officer.
Karen Litzy: 01:37 Awesome. That's great. So now let's talk about AAOMPT position on DDD or degenerative disc disease, which is something that I think is a very commonly diagnosed. I think it makes people nervous when they hear it because they hear the word disease. So can you talk a little bit about degenerative disc disease and the position AAOMPT has on that?
Elaine Lonnemann: 02:03 Yeah, so our position is we just oppose the use of that term. It's commonly used as you said, and it's really used to diagnose an age related condition. And that age-related condition shouldn't be considered a disease. It shouldn't be considered degenerative. So it happens whenever on imaging you see changes in the shape or the size of the disks in the spinal column. So that's how it's identified. And, you know, we know several things that nearly everyone's discs change over time. And the interesting thing about that is that not everyone feels pain even when they have those changes in their discs. So, that's why we oppose it or one of the reasons.
Karen Litzy: 02:52 And you know, like we said, it is so highly diagnosed and when people hear that disease, they think of something that like cancer is a disease or Parkinson's is a disease or a syndrome. But I think it's kind of scary terminology and words matter. So what does AAOMPT feel should be a better descriptor?
Elaine Lonnemann: 03:19 Well, you know, I don't know that we have a descriptor in terms of a substitute, but I think, you know, patients really have the right to accurate healthcare information. And when, like you said, when they are given that diagnosis, you know, not only disease, disease puts a lot of fear in their mind, but degenerative, I mean they start to lose hope because they degenerative just sounds like, you know, they're gone down a pathway, you know, if it is just described as mechanical back pain or radiating back pain, you know, and our healthcare system really looks at trying to find a tissue or a pathoanatomic cause for low back pain. And the research clearly indicates that and has over time that it's very difficult to find a specific cause for low back pain. So we really need to move away from that model.
Elaine Lonnemann: 04:16 And, you know, the other part of that is the patients lose fear, they lose hope. And they also began to believe they can't manage their own pain. So they lose self efficacy. And we know how important that is for our patients. And I think that's the one thing I love about our profession is that we really help patients manage and control their symptoms, their condition, and improve their function. And, whenever they're given that label, it really it can misguide them, you know, because they lose hope. And then they might start choosing, you know, riskier treatment options.
Karen Litzy: 04:53 Surgeries, medications, even less invasive procedures, things like that that maybe may not be necessary. But like you said, if you're the patient getting this diagnosis of degenerative disc disease, it can maybe feel like you're at the end of your rope and you don't have much more to go.
Elaine Lonnemann: 05:16 That's right. And patients need to know that their situation is real, that the findings that they have, because most people are diagnosed after they've had imaging. And so I think it's really important that we emphasize, yes, those findings are real, but this isn't a disease and this can be managed. And you know, the other thing is that oftentimes those imaging findings stay, but their pain goes away after they're treated. So, you know, that helps to give them some hope. I recently had a student who was 26 years old who came up to me and said, you know, I'm really concerned. I went to see a healthcare provider and because I was having some back pain and they diagnosed me with degenerative disc disease, what am I going to do? And then she just went in, almost fell apart because she said, you know, I love to run.
Elaine Lonnemann: 06:06 I don't, you know, I don't know what I should do. Can I continue to exercise? And I'm thinking about getting an epidural injections because I don't want this to progress. And so I had to kind of step back for a minute and say, okay, it just explained to me why you went, you know, tell me about your pain cause you're not going to, she told me, I'm not even in pain now. She said she had had pain for a week and then went in. Because her sister had structural scoliosis, so she was fearful even though that was at 16, she was fearful that she might have a condition that would be a problem. And now she's fearful because she's been labeled as having degenerative disc disease. So, you know, it really took a while to counsel her and you know, to again, affirm these findings are real, there are changes in our discs but these are normal changes that occur with aging and they shouldn't be considered degenerative. The studies indicate that, you know, there's oftentimes when those findings are present, they don't correlate with the exact clinical presentation of the patient. And that's what we want to get. That's the message we want to get up.
Karen Litzy: 07:16 And as physical therapists we can certainly relay that message to our patients. But if the patient hears that from the physician first, it makes it a little bit more difficult. Our job becomes a little bit more difficult because now it makes it seem like we're giving two different diagnoses. Maybe it starts with us as individuals, but how can we as the physical therapist who is maybe seeing this patient after they were given that diagnosis from the doctor communicate to the physicians or you know, cause this is a medical system wide use of terminology and it really needs to change from top to bottom. And I feel like sometimes yeah we're that point of entry but oftentimes where people are coming to see us after they get that diagnosis. So how do we as a profession advocate for this change to the greater health care system?
Elaine Lonnemann: 08:22 Well I think we definitely need to partner with our medical colleagues with APTA and we are already partners but definitely get the word out that you know, this type of diagnosis really does misinformed patients. There is research and AAOMPT has developed a white paper that explains the research related to how this misinformation can potentially guide their treatment or lead them to choose, like you said, riskier treatment options. And you know, one of those, obviously the opioid epidemic is something that we have to think about. And not to say that it's going to lead them directly into that path, but it does. There has been some research that indicates that, you know, the healthcare costs are driven because we aren't following the practice clinical practice guidelines for back pain. So I think the biggest message that needs to come out is we need to follow those clinical practice guidelines.
Elaine Lonnemann: 09:22 And I just heard Tony Toledo, do you have his keynote presentation at the interprofessional collaborative spine conference? And there were physical therapists and physicians and chiropractors all together in a room and you know, it was a great opportunity to meet, you know, as partners with them and you know, what can we do for the greater good of our patients? And I think the biggest, yeah, and he actually presented some of the challenges and what can we do from here forward really to improve this situation. And you know, he was talking to all of this. It wasn't just physical therapists, but one of the things that he did address was the continuity of care. And he said it's really important that patients don't wait, that we get them in early and not that every patient would and I don't want to, I don't, I want to make sure this is clear.
Elaine Lonnemann: 10:12 Not every patient who has low back pain needs to be seen by a healthcare provider, whether it be a physical therapist or other conservative type of clinician. Sometimes that pain will go away, but if it's very intense and if it doesn't go away, then they should seek care and it should be early. So talking about the continuity of care, you know, in terms of who sees the patient first and whoever does it should follow the clinical practice guidelines that recognize, you know, with some time with some activity, with some coaching, a reassurance and a comprehensive medical exam that really does rule out a systemic cause or something more sinister because that's the other thing. Patients are fearful. My 26 year old student was fearful that this was something sinister. So I think that is a really important message to get out that comprehensive physical exam can really help to rule out some of the medical disorders that, you know, are uncommon in low back pain, but that our patients are concerned about.
Elaine Lonnemann: 11:21 So, continuity of care was one thing he mentioned. Oh, and the other thing he mentioned is variation in care. Of course, you know, it's a big problem because you know, whatever healthcare provider you see with low back pain, there's a ton of variation in how the providers performing interventions. So, you know, he highlighted that and I couldn't agree more but one of the things that he mentioned and you know, of course president of the Academy of orthopedic manual therapy, you know, so one would think I'm going to mention manual therapy, but really it's because that is part of the clinic, one of the recommendations of the clinical practice guidelines, is manual therapy for back pain. And again, not every patient needs it, but he mentioned, you know, manipulation, mobilization, those are forms of manual therapy along with exercise. And so I think that following the clinical practice guidelines, trying to reduce our variation in care and also recognizing that, you know, as physical therapists, we need to refer on or we need to know when not to treat and when we do need to treat consistently and follow those guidelines.
Elaine Lonnemann: 12:36 So that's probably a long answer to your question, but as far as the message that needs to get out, I really just think highlighting those things are important.
Karen Litzy: 12:45 No, and I don't think that was a long answer at all. I think that was a very good comprehensive answer. And you know, we're talking about clinical practice guidelines. Where can people find these clinical practice guidelines? I know the orthopedic section of the APTA has clinical practice guidelines on their website. Are there other places where people can search for these guidelines? Because oftentimes we talk about clinical practice guidelines, but people are like, I don't have any idea where to find them. I don't know where to look.
Elaine Lonnemann: 13:21 Well, so that's a good, good point. In terms of looking at websites, you know, I think the orthopedic Academy, their clinical practice guidelines follow the majority of practice guidelines that are out there. The American family practice group also has clinical guidelines. Ciao, published a group of guidelines and they're all fairly consistent. In turn there are some variations and you know, sometimes people ask what, well, why are there, you know, so many variations. And part of it's because the different groups, there might be some bias in those. Just if you break them down and look at the commonalities, you know, again, at least for back pain, I think those are the things that you have to look at. So I know APTA has some links. And now that you mentioned it, we will put links on our website as well to the clinical practice guidelines that are out there. And we'll have a a link to this white paper as well that the Alicia Emerson led that charge along with Gail dial and, and Dan Roan and other Jason's silver. Now other a PTA members amped members that, um, we're working in this area.
Karen Litzy: 14:38 Yeah. Because I think it's, there is a breakdown from, so you graduate with your PT degree, you start working and if you don't keep, you don't know where to look. You're, you're kind of just sort of floating along using maybe what you learned in school, which is great because hopefully you won't kill anybody or do major harm to somebody. But I think when it comes to diving deeper into treatment paradigms, these clinical practice guidelines, people have to be proactive about that. And so knowing where to look and knowing where to find them is great. Um, and I also want to touch back on the variation of care. And when you're talking about variation of care, are you talking between physical therapists themselves or between a PT versus a doctor versus a chiropractor? Uh, manual therapist versus non-manual therapist? I mean I think there is a lot of variation to care and that can also be quite confusing to the patient. So I don't know in that keynote if he sort of touched on what he meant by variation of care.
Elaine Lonnemann: 15:50 Yeah. He met within physical therapists and or within profession and, and really looking at, you know, and all the individuals in the room, many of us are providing very similar [inaudible] at least are able to provide similar treatment options. And so his, his point was that, you know, we really should be looking at more consistent care model following the practice guidelines and not, um, varying to other types of, of treatment approaches that may not have the evidence and, and so variation and care, but also that evidence, um, the care that is supported by the evidence
Karen Litzy: 16:28 of course. And you know, that brings me to, this is going slightly off topic, but, well, no, not really. It's still on topic. It, it reminds me of a, a post that I saw in a Facebook group, a physical therapist, and it was a newer ish grad, maybe out a year or two. And he said something to the effect, I'm paraphrasing. Um, when we advertise to the public about what we do as physical therapists, you know, everyone tends to say, you know, we're evidence-based profession. You said, shouldn't the consumer already know that? And how important is it? Like, don't you just have to do what the patient wants? Because all we're worried about is our job is to make a person feel better. So what does it really matter what you use to get them there? Meaning does it matter if you use something that's evidence-based or not?
Elaine Lonnemann: 17:28 Well, and I think, you know, part of that is patient education and having a relationship with your patient so that they do trust you. So you have, you know, I think they have to be able to trust you and you have to develop that therapeutic Alliance with them too. Help them understand that, you know, these are treatment options and it should be patient centered. You know, we want to be patient centered and we want to help them understand that, that these are the best approaches and it's not a one size fits all. I mean there are some outliers, but the extreme variation that has been shown is the problem. It's not the occasional patient who, well yeah, sure. Maybe that PA it's more patient centered to do a different approach, but there's extreme variation.
Elaine Lonnemann: 18:16 And I think even if we just reduce that by 50%, I think it would have a huge impact on care and the research that's coming out of university of Pittsburgh that I'm not involved with this, so I'm just, I'm just reading and trying to do the same thing, everyone else's. But there's some big research that's coming out to talk about that will speak to, you know, following the guidelines when there is variation of care or if there is a variation of care. Okay. Yeah. What's different?
Karen Litzy: 18:51 Yeah. And I know there was a study that came out a couple of weeks ago that showed that, you know, with different diagnoses, less than half of physical therapists actually follow best evidence to treat.
Elaine Lonnemann: 19:08 Yup. And the thing that you mentioned before too is how do we avoid that? I think as you mentioned, a PTA or being a member of the American physical therapy association really helps. It's made to streamline my direction of understanding so I can go to PT in motion. I can look at, you know, there's a lot of great white papers that they have position statements, you know, on the opioid epidemic. There's just a ton of great resources there. And it was another thing that I would emphasize for clinicians.
Karen Litzy: 19:43 Yeah. Because you know, in the end, you want to treat people using best evidence, you know, and I think it was Jason Silvernail in a comment said something. Again, I'm paraphrasing, but something to the effect of why would I waste my time doing something that I know doesn't have evidence behind it, when I could be spending that time, precious time with our patients. Sometimes you get an hour, sometimes a half an hour, sometimes 15 minutes, right? So why would you waste that precious time on something that you know, doesn't have the evidence behind it when instead you can be doing something that has been shown to help and that goes back to, and then you'll hear the argument against that was like, well, the patient really wanted it. So that's how I'm developing my therapeutic Alliance.
Elaine Lonnemann: 20:39 Yeah. But I would still argue against that.
Karen Litzy: 20:43 And that's where like you said, patient education comes in, you want to explain to the patient, Hey listen, I understand that you like treatment X, Y, Z, but right now we know that treatment ABC is more appropriate for you given where you're at. And explain to them why. And I've done that plenty of times and patients are like, okay, so right.
Elaine Lonnemann: 21:04 And then there's an opportunity to negotiate, you know, let's just try this. If it doesn't work, you know, this seems to be more effective than, and it is more efficient. And like Jason said, why, why would you waste your time and their time? You know? And that's what I tell the patient, I respect your time and this is what we understand and this is what we know at this point and is best care. So, you know, if you're willing to go along with me on this, you know, I think we can try it out. And if it doesn't work, you can fire me. You can find another physical therapist or, you know, I'll find you someone that it works, you know, or the treatment, you know. So yeah, I think you have to be really,
Karen Litzy: 21:45 And I think, like we said in the beginning and going back to degenerative disc disease, words matter, right? And how you explain things matter.
Elaine Lonnemann: 21:55 Yes. Well and Michelle just published a systematic review in spine, she looked at the term degenerative disc disease and the name of the article is what's in a name. And, also found that there's so much variation in what, you know, healthcare providers are calling degenerative disc disease and you know, in summary found that it's just, it's inconclusive and there's not evidence to support this as a disease and there's so much variation in it that they also recommend not using it as a term.
Karen Litzy: 22:37 And so from what we talked about from a sort of 30,000 foot view as to what associations can do to kind of help clean up terminology, this kind of medical terminology and that may, like you said, partnering with our physician colleagues partnering with maybe our chiropractic colleagues to kind of change the narrative. But what can, for all the listeners out there, let's say you're an individual therapist, what can you do to kind of help change the narrative around that term degenerative disc disease? So your patient comes into you, they're fraught with worry, what can you do?
Elaine Lonnemann: 23:19 Okay. You know, I think the biggest thing is to get our patients as our advocates. And so taking the time to educate them about it and say, yes, you know, this is real. Your changes are real. This isn't a disease. And to help them to understand that and then give them the tools, you know, say, Hey, you know, when you go back to your physician or your other provider, whoever referred, or maybe they didn't refer, you know, get the word out to these medical providers, get the word out too, you know, senators, legislators and because they're speaking to them as well and support, you know, this aspect of, you know, whether it's conservative care, you know, and also having pamphlets or educational materials, you know, that really do talk about, you know, if you are referred to a physical therapist first, that there's, I believe it's an 89 point something percent less likelihood for that patient to be prescribed opiates in the following year.
Elaine Lonnemann: 24:23 And that's a huge statistic, you know, and everybody's concerned about the opioid epidemic right now. So, you know, following practice guidelines and physical therapists should be considered, you know, first primary contact providers, then we can do a comprehensive medical exam, we can screen, we know when not to treat, we know when to refer on. And following those guidelines I think is the other part of what I educate my patients about. So I would say, you know, these are the guidelines and having this material. So if you're interested in sharing this with other people and you know, there are certain patients that are more vocal than others and whenever I hit those patients, I really get them and hit them hard and say, you know, help share this information. If you found this valuable, please advocate for not only yourself but for the next person that comes down the road. So they don't have to worry that there are 26 year old now and they have, you know, this label.
Karen Litzy: 25:28 Yeah. He had this quote unquote disease. That is not all right. So is there anything else that from your perspective or for AAOMPT's perspective that we missed that you're like, you know, I really want, whether it be other physical therapists or healthcare providers, even the general public to know.
Elaine Lonnemann: 25:52 You know, I think it's important that I'm clear on this. I'm not saying that imaging isn't useful. Because you know, I've talked to us a little bit on the downside of it, you know, but in the absence of trauma or any other systemic medical concern, imaging studies aren't necessary for, you know, low back pain, a comprehensive medical exam is. So I think that's something that I would like to emphasize, but there are times when imaging is necessary and I don't want to come across as saying that, you know, we're downplaying it all the time because sometimes it certainly is necessary. But I think that, you know, the biggest thing that people don't understand is that these are common age related changes in the spine. They don't correlate with symptoms. You know, that's hard for the patients to understand and providers because we are so focused on finding, you know, some type of pain generating tissue as the cause, you know, so sometimes I'll share stories too with patients and say, you know, because they've now got this disease, they've got imaging, they've got findings and you have to kind of talk them off the ledge to a certain extent.
Elaine Lonnemann: 27:14 And I say, you know, if I had a group of 20 year olds, 120 year olds in a group, and then I have a group of 80 year olds, 180 year olds on, on the other side of the room and none of them have back pain. Now they may, probably 90% of us have back pain at some point in our life. But at this point in this room, none of them have back pain. But then if I sent them all into the MRI or imaging room, then 37% of those 20 year olds would come back with degenerative changes in there. There's fine or changes by positive findings and if you then look at the 80 year old group who then goes in and has the MRI, that number goes up to 96% so that kind of gives them a little bit of a balance. So I guess that's the other thing I would share, you know, just that these findings on imaging don't necessarily have to lead individuals to go down a path for riskier treatment options.
Karen Litzy: 28:15 I think that's a great statistic. And thanks for sharing that because now that's something that if there are any therapists listening, they can kind of use those statistics to say, Hey, listen this is common as you get older. And I think, you know, the downfall that I can see from having this conversation with the patient is then the patient's saying, do you think it's all in my head?
Elaine Lonnemann: 28:40 Right. And that's what I emphasize. Yeah.
Karen Litzy: 28:42 Oh, real. Yeah. That's why I'm glad that you said like, listen, your pain is here. It's real. You're experiencing this. This is not made up. But let's see if we can, like you said, follow these guidelines get you to move, do exercise, feel more comfortable in your body in order to help reduce your symptoms, reduce the pain. Cause I know, I mean when in my early days of explaining things like that to patients, I've had someone say so it's all in my head and I was like, Oh, that is not what I meant. I definitely screwed that up. And with experience you learn, right? You learn how to do that better. You learn how to relate to the patient. And the best thing to do, like you said, is to use stories and to use statistics and to use metaphors and things like that so that people can kind of understand where you're coming from. But yeah, that's the only downfall that I could think of. That devil's advocate here. Right?
Elaine Lonnemann: 29:41 Absolutely. Yeah. And I think as physical therapists we have to kind of get outside of ourselves. Yes, we know that pain is, you know, it may begin in the brain and the synapses and all of that, but do we really have to say that specifically to the patient? Can't we just say, you know, it's a normal, natural physiological response. You've had it, what you have is real and it's impacted by a lot of things. That's a complex issue. But what you have is real. And I have never argued, that was probably some of the best advice I learned in my fellowship training when the patient has pain. And this was way back when before a lot of the pain science research has come out. But when the patient says they have pain is their pain, that is what they have, you don't argue with them about that. You know, regardless of what type of physiological response you're seeing, what they have is real. And so, yeah, I do hear what you're saying about the downside of it. Yeah. They do have physiological changes, but pain is a complex matter.
Karen Litzy: 30:43 Well, thank you for all of that info. And I think that this will definitely give therapists something to think about. It'll give therapists a great way to move forward with treatment. People now know how to access the clinical practice guidelines. And that leads me to the last question for you and that is knowing where you are now in your practice and in your life, what advice would you give to yourself as a new grad, fresh out of physical therapy school?
Elaine Lonnemann: 31:16 I would probably recommend to take more time to reflect on my patients. Not necessarily bringing them home, but to take a little more time to reflect on the things that they said personally related to their care. And also reflect on outcomes to a greater degree.
Karen Litzy: 31:44 Great advice. I always say that I would like to go back to my patients in my early days and just, you're like, I'm sorry.
Karen Litzy: 31:57 I mean, you know, I was doing the best I could with the information at the time. But you know, of course as you gain more knowledge, you gain more experience. You look back on things and you're like, Oh man, I could've done that better. But that is part of that reflection process. So you look back on patients and you reflect and you think, Hmm, you know, maybe I could've done X, Y and Z. So then the next patient comes along and you do better. So I think that's great advice. I love it. And yeah, where can people find more information about AAOMPT and more information about you if they have questions or anything like that?
Elaine Lonnemann: 32:30 Oh, absolutely. So, the AAOMPT website is https://aaompt.org/ and you can certainly email me. I'm happy to answer any questions or talk to you more about, the Academy of orthopedic manual physical therapy, APTA, where to find guidelines, research on low back pain. It's just something I'm very passionate about and always enjoy talking about and working with patients with as well.
Karen Litzy: Awesome. Well thank you so much and thank you for coming on sharing all this info. I appreciate it. Everyone else, thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Eva Norman on the show to discuss her cash based physical therapy business. Eva Norman, PT, DPT, CEEAA is the President and founder of Live Your Life Physical Therapy, LLC, 100% of cash-based business since 2013. It is the first mobile medical wellness practice in the country run by an inter-professional team of physical therapists, occupational therapists, speech language pathologists, personal trainers, acupuncturists, massage therapists, health coaches and dietitians dedicated to optimizing health by transforming lifestyles through innovative wellness, fitness, rehabilitative and preventative services. The company’s success can be attributed to standardizing an approach to develop a life-long client, transforming lifestyles through care collaboration, and mentoring and investing in their employees.
In this episode, we discuss:
-The shocking story behind how Eva was introduced to physical therapy as a teen
-How to attract and maintain patient flow with a mobile cash practice
-The benefits of virtual assistants for the operational side of business
-The importance of maintaining a connection with your network
-And so much more!
Resources:
Live Your Life PT Website
Live Your Life PT Twitter
Live Your Life PT Facebook
Live Your Life PT Instagram
Eva Norman LinkedIn
APTA Private Practice Section
For more information on Eva:
Eva Norman, PT, DPT, CEEAA has been practicing physical therapy for nearly 20 years. She received her B.S., M.S. and Doctor of Physical Therapy degree from Thomas Jefferson University in Philadelphia, PA. Through the years, Dr. Norman has practiced in different practice settings with patients of all ages with various diagnoses. Early on in her career she developed a strong interest in geriatric rehabilitation. To expand her skill set over the years she has taken numerous continuing education courses and also worked in the areas of neurology, orthopedics and cardiopulmonary rehabilitation. In 2013, she became a Certified Exercise Expert for the Aging Adult.
Dr. Norman, an active member of the American Physical Therapy Association since 1994, has served in numerous roles. She is currently serving as the MN Physical Therapy Association’s (MNPTA) Federal Affairs Liaison, MNPTA Delegate, and PT Political Action Committee Trustee Chair. She is a member of the private practice, home health, geriatric, health policy and neurology sections.
In January 2013, Eva founded Live Your Life Physical Therapy, LLC in response to her passionate desire to offer to her clients, patients, and the public, services both in home and the community that could help them to experience health, wellness, and a more active lifestyle throughout their life spans, through the creative applications of preventative and rehabilitative physical therapy, occupational therapy, speech therapy, personal training, acupuncture, massage, health coaching & dietary services.
Read the full transcript below:
Karen Litzy: 00:01 Hi Eva, welcome to the podcast. I'm so excited to talk to you today. As a lot of people may not be familiar with your story quite yet, but those of my listeners who are know that we have a lot to talk about and we could've gone in a million different directions here from advocacy to APTA membership to the PT pac. I mean on and on and on. But what I really want to know, I'm being selfish here, would I really want to talk about is your business, so live your life, physical therapy. It's a really interesting business model, I think. I think and I hope that a lot of physical therapists will trend into your business model at some point. But before we get to that, can you tell us the story behind it? What is the why behind the company?
Eva Norman: 00:57 Yeah, it's quite a long story, Karen. But yeah, that definitely will help you understand why the model is the way it is. So when I was 13 years old, I was involved in a hit and run accident. And actually this was actually the weekend before I was going to go trial. I was headed to nationals or I was trialing for the Olympics and swimming. And so it was pretty life changing. My coach said, don't just go do something fun. And so, ya know, I just don't really have the best balance and obviously hindsight's always 20, 20, I don't know what crops go roller skating with my girlfriend, but I did. And so I was literally going across this crosswalk and the 72 year old man who wasn't wearing his glasses that day and drinking, unfortunately instead of hitting the brakes at the accelerator right at the left side of my body, I'm pretty much fractured all my major bones in my left leg that I honestly referred to myself as road kill, to be honest, for a long time.
Eva Norman: 01:56 And it was very, very traumatic. I was rushed to the hospital where I was told that we needed to amputate within 72 hours. Cause that's all of my ability that we had the femoral artery. There was just, I mean, just a really weak thready pulse. And I come from a family of healthcare professionals. My father's a physician and my mom's a surgical nurse and my team took me home. They told the doctor that they would respectfully disagreed with his conclusion, obviously the diagnostics that had been made and they were going to take me home and have me heal there. So, which is pretty, I know, right. And I just remember being hooked up to morphine and thinking like in shock, of course I'm still in shock, but I trusted my father, but I just remember thinking, okay, how's this going to go?
Eva Norman: 02:47 And I remember the doctor saying, you realize you're leaving the hospital AMA. And my father's like, I perfectly understand that and I work here. So yes. And so they took me home, they converted our living room into a hospital. And, I was going to the hospital for outpatients though. So the one thing my father did ask, the surgeon is to order outpatient physical therapy because at the time, sadly, there wasn't home care for kids. And even today, as we all know, there's very limited. And so I went to outpatients. You're not even going to believe this, but I had anywhere from two to three times a week at non-weightbearing for nearly four months. This was years and years ago. And so, my parents essentially the range of motion through stretching do it, just retrograde massage, acupuncture, and honestly, incredible nutrition.
Eva Norman: 03:49 So during this time, actually I got very depressed. As a matter of fact, I tried to commit suicide during this time. And so it was really dark hours, I'd have to say during my life. And I got really depressed when my father came home to tell us that our insurance had exhausted. And so you can imagine having two to three times a week of therapy for that long period of time. No wonder we reached our annual cut so quickly. And so, my dad asked the hospital if they could see me privately and they said, no, we don't do private pay. And, then my dad was like, well, do you know any other providers in the area that could do this? And they're like, no, we don't know anybody.
Eva Norman: 04:34 So of course my dad literally opens up the yellow pages. Remember back in the day we had yellow pages and just calling anyone and everybody and couldn't find anybody. I mean he researched high and low. They couldn't find anyone outside of where we were from. We're actually from a little town called holiday for Pennsylvania and couldn't find anybody. And so he took the director of the rehab program there at the hospital to breakfast one day. And he asked her if she would consider coming. And the reason is because, you know, people have often asked me like, who is your physical therapist? To be honest, I don't remember. I still don't, it's very foggy. And I've actually looked into this that it was multiple people, but the person I did remember was Jean. So she was the director of the program. I'm not going to share her last name.
Eva Norman: 05:22 Jean, if you're listening to this, hopefully someday you'll listen to this cause God knows you've heard my story before. But she is very modest and she's okay with me calling her Jean. But anyhow, I would love to share her name. I was interviewed and she said now just by first name and I'm like, okay, I want to share that because a lot of people want to know who she is. And so the person that I remember is her, cause I connected with her, she was in PR. She was honestly, my cheerleader walked in always the high fives would always give me hugs and I left. And so my dad took her to breakfast and begged her truly to come over and she said to my dad, you know, you realize I haven't touched a patient for two years.
Eva Norman: 06:04 Like, why would you ask me? I'm like, the last person you would see your daughter, you know, and my dad's like, but she loves you. She's connected with you. And she thinks that physical therapy, you're the person she remembers. And so she just come over, you know, I don't know, just talk to her. I'm just worried. And, of course my dad shared with her about the fact that I was so depressed and so I think that's really what motivated to come over. And I don't really know that she knew what she was getting herself into, but that day was honestly very transformative. And I use that word there because it truly was, she gave me hope that day. I might get emotional here cause it is very emotional for me. But she came in and it's just this holistic approach that she had.
Eva Norman: 06:49 The first thing she saw me, she said it was just this picture of depression. And she came over and gave me a hug and I honestly didn't want to let go. And, she's like, you know, she said to me, she goes, when was the last time you saw your friends? I'm like, it's been months and you know, it's been four months. My mom has me on isolation here. Essentially you're donning gloved right now because my mom's still afraid of infection. And she goes, no, I'm just, yeah. And she turned and looked at my mom's, of course, my parents are sitting there in the room and she said, you know, she needs social interaction. She needs people in her life and you know, is there any way, I mean, her friends could come over and gown and glove like I am.
Eva Norman: 07:27 And it was at that moment, I think the light bulb went off in my mom's head. Like, what have I done? You know? And so my mom, my mom is like, you know, of course she's like, you know what, I'm going to call your best friend's parents today. We'll have them over for dinner. And of course, my mom's solution, everything was always food. So I had this big dinner that she, of course, Christmas staying for. And then the next thing you know, Jean asks me, she's like, your dad tells me you're not doing your schoolwork. And you know, it's all about like, you know, she's like, you love to read. Your dad says you don't even want to read anymore. And I said, Jean it's the concussion. Cause that's something I forgot to mention earlier that I had sustained a concussion.
Eva Norman: 08:04 I'm having a hard time focusing. I'm still seeing double, you know, I'm just having a hard time concentrating and she goes, but you have the TV on. I said, I can listen. I just can't read. I just am having a really hard time with that. And she goes, well have you been doing your exercises? I think she assumed that the PT that I worked with gave you exercises and like no one's ever addressed it. No one's ever assessed it. I don't think anybody even knows that add one, except for the doctor that told me I had one. She goes, Oh my gosh. Then you could just tell by the look of her face. She was just livid. Like, gosh, how are we not addressed that? And she turns to my dad's, she goes books on tape. Remember back in the day we handle, yes. You know, that will be a great solution.
Eva Norman: 08:45 You know, she's like, go. And of course my dad's like, Oh, library down the street, I will get every book imaginable. Great idea. So moving forward. Then the next thing she says, she's like, she's like, now I understand why I haven't been to church and do you actually went to our church? And she's like, I understand your mother doesn't want you leaving this house, literally these four walls. And because she's so afraid that you're going to, you know, obviously end up with an infection. And she said, but you know, I know sister's been calling here a lot and we've been praying for you. Like, I haven't wanted her to come over. And, you know, and it was just an, and I just remember at that moment, I mean, my parents had asked the same question and I finally admitted, I said, you know, I just feel like a failure.
Eva Norman: 09:25 You know, they had just, you know, four months ago, they had this pep rally for me cause I was heading to nationals or I was going to try nationals again. And you know, I was just so happy about that. And I just honestly felt like I failed my town and my failed my school and who had, okay, there's so much time into me, like coming in, rooting me on everywhere, honestly. And, and so and she goes, no one cares about that. All right, let me be happy that your alive. And an amazing family. And she obviously was telling me everything, but you know, obviously I should be thinking, but I mean, that's really what it was, honestly eating away at me. And so, and I said, you know what, and she made me realize that that's just, that's not important.
Eva Norman: 10:07 Right? And she goes, well, would you welcome communion? I mean, is that something important? And I honestly broke down at that moment because, you know, I really thought God had abandoned me. Just for her, just to even offer that. And so I welcomed it and she's like, well, you know, sister and I were going to have dinner tonight, so how about she come over tonight as well? So like I said, that day was just amazing for me. And so just knowing that sister would come over with really miss a lot. And so as you can tell, I mean, just even just with these few little things I have shared, I mean, it was just such a holistic approach. She hasn't even touched me yet, but yet cared about, social, my emotional wellbeing. And so then this next piece she was like, okay, today for therapy we're going to take a shower.
Eva Norman: 10:54 Cause clearly we need one. And so she's asking me about like, where do you shower? I said, well, my mom washes my hair in the sink and then, you know, I sponge bathe in the bathroom, so where's your shower? And I go, well there's one in the basement. Went upstairs, but I can't do steps. And as she goes, why can't you do steps? And I said, well, my leg is just very unstable. And so, it obviously is very painful still. And, and she said, well, why couldn't you go up on your bottom? And I said, well, I don't know how to do that. Can I do that? I remember my dad, like I just remember he was interjecting was like, wait a minute, does this say for her? And she's not allowed to anyway. She's like, absolutely. And of course rolling her eyes again.
Eva Norman: 11:32 How is it, my staff is not addressed this right? So don't we see that a lot in home care? Clinics don't even ask you like how many steps you have or where your bathroom is and so forth. So Jean shows me how to get up there. She has, my mom had her wrapped my leg, literally had my first shower on the second floor, I mean, in four months. Oh my God. And then I get into my bed for the first time in four months. And so now I'm just crying uncontrollably. I'm just so happy. And it truly, I honestly have hope for the first time. And,I remember her really close to me on the bed and she literally grabs me and like my two arms pretty firmly. And she looks at me like really close and she's like, yeah, Eva do you trust me?
Eva Norman: 12:16 I go, Jean, I love you. Like, and I'm sorry and I'm going to get emotional right now. I'm like, of course I trust you. And she said like, why don't we have you back? She's like, well, we're not done yet. We haven't done exercise yet today. But she's like, I will be back. She's like, I want you to know is that you will walk some day. Do you believe me when I say that? Yes, I do. And this was, I mean, of course I've been told by, I mean we had had numerous specialists now, you know, had okay examined me and it was like conclusive apparently according to them. It wasn't scary. Oh, it was. And so that day was the start of a whole new life for me. And, I mean literally eight months later.
Eva Norman: 13:03 Tell them this is the day I was walking with no deficits like in or anything, it really was amazing. He was coming anywhere from two to three times a week. But who did she bring along the way? She brought an OT. She brought a speech therapy because of my concussion, I also ended up with you have ADHD as a result. And I also worked with a dietician to work on my nutrition. I had massage because I had a lot of pain on my leg. Chris, I had mentioned it's an acupuncture earlier. So good luck even today at live your life. I was just thinking that is all said and done. My mom made. So I made two promises, went to my mom. Okay. My mom promised God that if I lived that we would give back. And so from that day, like literally my mom had me volunteering at every PT location, whether it was adult day program, LPP, clinic, you name it.
Eva Norman: 14:06 I was there when I applied to PT school. I had 3,600 hours of volunteer hours. And that was all with my mom. And, then of course today you could see why it means so much to me to give back to them that I love so much and I'm obviously long story how I got into government affairs, but I think that honesty is the best way that I feel like I have to give back. And then, with regards to the promise that I made my father, my father made me promise it some day I would have a business where I could help others in similar situations. So it's very personal to me and obviously it's kinda been like this healthcare ministry in a sense to me. I'm very spiritual but it's just also just become this. Yeah, just something that I'm just so passionate about.
Eva Norman: 14:50 And so I started out, so the company started with just physical therapy initially. It's because I would do what I knew best and what I felt comfortable with. And just so you know, by the way, Jean is still my life helped me get into PT school, had my first clinical with her. And the time I graduated, she has seven like thriving clinics all over Pennsylvania. I mean she's doing as she's teaching the last that she sold her businesses now teaching on a penny towards retirement but still doing amazing. And so now I feel like I'm somewhat following in her footsteps and so like it took a while though cause people always ask, they're like this is somebody that you obviously had this promise to make and cause I was afraid of failure to be honest.
Eva Norman: 15:48 And it sadly took this horrible job to finally take the plunge to be honest. That's usually how it works though, right? And so, I'll never forget the day that then I left that job, which honestly was great day, but my husband said, you know, good for you because this is literally how the company started. And so we go to Buka is you know how they have like the table nets that are just, you know, okay you could with crayons, right. All over and so forth. And we wrote my business plan downstairs just on crayons and stuff. He wrote like generic little business plan but then coming up with the name. Right. So how did we come up with live your life? So I mean we had another sheet, all these words that were meaningful to us, right as a couple.
Eva Norman: 16:35 We had thought of that cause we don't, we talked about the business for so long and Dan was so supportive of this and so, and I remember like, I mean they're literally words live like these words are everywhere, you know, in physical therapy. And I mean there's was just like live, well I remember there's all these different like verses, you know that I envisioned it so forth. And I'm not even kidding you, but I have to share this. Cause people always ask like, how did you finally come up with that? So we're sitting there and you know, there's music always jam and right. And sure enough, Rihanna comes on the side, live your life. And I'm like, and I literally called Paul walk at that moment, he was like business lawyer. I’m like file it right now.
Eva Norman: 17:16 Like file it right now. We're not changing our buys like you know, and so we filed literally that day. So it's just such a great name. As we're putting the business plan together, of course this is something I had thought about for quite some time, but the common thread, cause I had been doing home care now at that point. I'm sorry for how many years I been doing at point 10 years. Yeah. At that point. That was almost seven years ago. January 2013. Yeah, I would say essentially open our door I think. But at that point, what I was most frustrated is with the, the noncommunicable diseases, right. From an unhealthy lifestyle. Such like retention, that diabetes, obesity of your RDCs, you know Karen, stroke, cancer, some of the things that truly, I mean that are honestly draining our healthcare system and we're going bankrupt as a result.
Eva Norman: 18:21 And I'm like, so much of this can be prevented. And I'm so sick of seeing the vicious cycle again and again, repeat patients over and over and over again. I meant seeing them, you know, or it's the pneumonia with the hip fracture on and on and the multiple falls. So it's just this just crazy. I'm like, gosh, we had to do better. And I've always had such a passion for prevention, hence my background where I kind of brought in right. You know, just that holistic approach and just going well beyond just rehab. And so like every patient just prior to this was always going home with some type of what I would call a wellness program. And so I knew I wanted to go in that niche, but I wasn't sure kind of, you know, who to target. Right. And I should start small initially, but you know, I dunno, can I never go small?
Eva Norman: 19:12 What are those things where you just go big or go right, So yeah, let's do the whole spectrum. Since my head said safe and they're like, okay, how about it? Because this all happened to me at 13 we go 13 end of life. Perfect. Let's start there. And it truly is 13 end of life by the way. Still today. So, okay, so that's our target market and then, okay, so who, and what are we going to target? I'm like everything, everything, every noncommunicable diseases, things that we can prevent, those are going to be, those are going to be like their target things. And so of course they started doing research throughout Minnesota to see where, what towns do we target. I mean it was amazing.
Eva Norman: 19:53 I found out that like the city of Minnetonka has the most falls than any other city, which is not far from here. And I found that out by looking at the emergency room statistics, you know, so just started targeting like different cities based on, you know, some of that I'd been doing and done that was out there obviously for anyone to find. And so then I'm like, okay. And of course it was just me initially. Right. And I was thankful that I was doing my, it’s called a certified exercise expert for the aging adults certification around that same time. And, my lab partner happened to be a PT that wanted to go to cash based business. So it was like my first hire. It was great. And so because I quickly knew right away that I needed to have a backup cause I'm like, I'm never going to be going on vacation, you know?
Eva Norman: 20:43 Okay. Right. And how am I going to be able to, you know, continue to grow and he was willing to be that back up who were great by the way. He is now these actually now in Chicago, and doing amazing things with his cash based business but regardless. So we started small, but then I was able to, through those connections and through the certification I was able to identify like all their physical therapists that kind of wanted to start cash based businesses. So targeted them. And then I started teaching at the different universities to connect with other professors, not necessarily wanting to hire students that the professors, because a lot of times they're paying for a part time work. Right. And I thought, yeah, let's target health and wellness professionals. So it was great to kind of, that's how it started and got made.
Eva Norman: 21:36 So by the end of year one we had four PTs, one personal trainer and a dietician. And so, and it's not that I didn't want to, you know, third discipline, it's just that we couldn't find the right people. Right. That one perhaps like to be out in the community. But also that one to go you mentioned kind of area, right? Because it was NC state. I mean that was, you know, almost seven years ago. So back well defining terms in the house delegates.
Eva Norman: 22:12 For OT and speech was difficult, but sure enough, a connecting. Like I said, it's all been through relationships to be honest. Everyone that I have hired, it's literally a friend. I know someone for your mom that will work well with you and I'll see. It's been great. I was just thinking about that as earlier today. Kind of, you know, just start team. We were just thinking, because I'm planning our Christmas party right now. Like, you know, there's eight individuals that have been with me since the beginning. There's 25 of us now, so seven PTs. We have one OT, one speech therapist, five personal trainers or massage therapists, a health coach, a dietician in for admin staff and myself. So 15 of those individuals are employees and 10 are contractors.
Karen Litzy: 23:10 And so if we can just talk, I love the fact that you said you kind of did your research into different towns and tried to see what each one of those towns really needed. So when you are seeing your clients, you had mentioned your cash based, do you take any insurance at all? And so when you’re seeing patients more towards the end of their life, you know, a lot of them are Medicare beneficiaries and we had a little chat about this before we went on the air. So, and this is, I'm sure you get this question a lot. How are you seeing those people?
Eva Norman: 23:45 Absolutely. Thank you for the question. So end of life would be a lot of patients that are receiving hospice care. So when I can think of end of life, unfortunately a lot of the hospice is in the area only. We'll cover two, maybe three visits at the most of physical therapy so that we have great relationships with all the hospice here in the twin cities. So they'll refer us. Cause a lot of times, you know, people are like, I don't want mom in bed. You know, I don't want her last days to be that. She loves to walk. She loves to, you know, go downstairs and spend time with the grandkids or whatever.
Eva Norman: 24:33 So I want you to keep doing that. But I want a professional to help her do that safely. And given her medical, you know, history, you know, her medical complexities, right. Obviously. So, so they hire us. But of course sometimes it's not just physical therapy they may want, sometimes it's just, you know, sometimes they may want a massage because it's just soothing and comforting and so forth. Because they have, a lot of times they have pain and so forth. But sometimes, you know, they'll stop eating and they'll hire even our speech language pathologist to figure out, like, is there something that we could do perhaps to help stimulate the taste buds or give her perhaps mechanical soft diet or something as different type of diet perhaps to help her with eating.
Eva Norman: 25:20 And then sometimes even to our dietician will get hired as well to pick up, how can we get enough calories? We have, and I'm really happy to say this, we have had 15 at this point, 15 clients outlive hospice due to our wellness program. Yeah. Remarkable. And so, Oh, how does it work? Right? Like how do people get into our system and how do we figure out. These are the disciplines that you need it. So, absolutely. So they'll call, they'll call, they'll call 'em. You know, we can call a number. So my admin by the way, are all virtual. They're all virtual assistants.
Eva Norman: 26:06 So I have one person that literally takes the calls. So there is a series of questions that they get asked and we've actually created an algorithm. So based on how their answers are, you are headed, you know, you're obviously recommended certain different services. Now of course my admin isn't clinical so they don't make ultimate decisions, but they can kind of help start that conversation of where, you know, what they're thinking that perhaps they could benefit from. And so I take that algorithm, the results of that, and then I set up a telehealth free consultation. We do 30 minute free consultation because typically, I mean they have some questions and of course because it's cash, they should. And I open that conversation to like as many family members as they want. You'd be amazed. Like I'm, sometimes I have like the whole family because the family's paying this for mom.
Eva Norman: 26:57 Or, you know, the son that's in New York. And then, another cousin that's really involved in Texas or whatever is, you know, is on the phone is on this call. So, that's why we've started to do tele-health, calls. They want to see who I am and obviously want to meet their therapist. And that's like a great opportunity to explain, okay, so according to our algorithm, these are the services that we feel that you would benefit from. So I kind of explain what those services exactly will do for them. And then prior to that conversation, I'm also packaging something for them, you know, depending on what we think would work best for that individual given what I already know about them, I try to package some things so that they know what it's going to cost them.
Eva Norman: 27:43 They don't have to, there's no, we don't have any contracts or commitments they have to make, you know, it's obviously up to them. They can start in whenever they'd like and see us as frequently or not as frequently as they'd like. So it's really up to them. We make our recommendations, but ultimately they make the final decision. And we based that after assessments. Cause a lot of times like I'll give them kind of a ballpark of what I think it could be just based on, you know, other experiences with similar cases, you know, it's really going to come down to really determine what would be best. We always think that way. And then at that point is really when we finalize the numbers as far as what that looks like.
Eva Norman: 28:28 And they obviously will make some times their decision as far as what they want to do. But oftentimes they do want to meet. Like who would be the dietician, just want to see if that's a good fit for mom or dad, et cetera. But it's interesting how it's usually the sons and daughters that are hiring us. And you know, we do 13 to end of life, but I'd say the majority of our clients are over the age of 65 so the majority, but yet we have the full, we do like, I mean actually my youngest right now I do, I do have a 10 year old gymnast right now that's actually a professional gymnast that is trying for Olympics. So injury-free they’re amazing. And our oldest right now is 103 and on hospice, you know, people here in Minnesota live a long time. Amen. I'm going to have a hundred year olds for that matter. We have about 15 clients that are over the age of 90 right now.
Karen Litzy: 29:42 So that's amazing. I mean I really liked this business model and I am a huge proponent of physical therapy being the forefront of wellness care because we're educated for it. We understand co-morbidities, we understand surgical procedures, past medical histories and how best to formulate a good plan of wellness for people. And I really, really feel that, you know, what you're doing in Minnesota is certainly something that can be replicated across the country. I mean, I always tell people like, Eva has a home care business in Minnesota. I mean, it's fricking cold there and there's no way. Like if she could do it, like anybody could do it. Everyone always asks, well, I don't know. I live here. Would I be able to do it? I'm like, let me tell you, yes, yes you can. You absolutely can. It just takes a little bit more work, you know, and it's a different mindset, right? Because you're all of a sudden going from in a clinic where people are just coming in one after the other to now you have to make up your schedule. You have to fill that schedule. It's not as, it's not like, I don't know about your practice, but I know with mine, like I got six new patients in the past week. Week and a half. That's a lot. You know, now in a regular clinic that might be like a day, but when you're going out to people's homes and they're paying you cash, that's a lot of new patients. So how do you guys deal with, you know, your new patient flow?
Eva Norman: 31:09 Absolutely. Great question. And so, I have to tell you this year, this time of year, so it's fall and spring are our busiest times and I'll tell you kind of why. First of all, right now they're getting ready to head South for the winter. So they're trying to get themselves as strong as possible before the holidays because they want to go to Florida, Arizona or Texas don't make sense. And then in the spring it's those that had been sedentary on the couch all winter long and suddenly they come out in the spring and sure enough things are not working the way they hope to right. Because they haven't been moving. So that's where high season. So right now it's if a 10 grit, good question to ask. Cause we do have a waiting list. It's it honestly. But what happens with the waiting list? Cause I don't think that's good customer service.
Eva Norman: 31:58 I ended up out in the fields. And so that's because a lot of times people ask me like, when do you add more PTs? Like when do you decide like you need to hire that next person. So when I get to the point where like three quarters of my week, I'm literally spending in the field, it's time to hire. And even just one week of that is like enough for me to say yes, it's time to hire an as a matter of fact work. We have a full time position right now. And I actually, I'm out now part time, but still I would say, but that's still a lot and I've been consistently that now for a while. So, yeah, we're actually down to final interviews. So I hope to have someone hopefully by next year. But that's kinda how we make that decision.
Eva Norman: 32:43 Before, it used to be like three months consistently, but now I've known that if it stays that busy, especially this time of year, it generally stays the same. Oh, and I haven't really had anyone that I've been able to, like I've had to like, you know, go from full time to part time because essentially once we have them, I keep them busy. And that's one thing too. I should probably share what's also help at this model is that it's kind of a level playing field. There's no, I mean I have the bottom up management style. Like everyone has a voice here and so everyone contributes. Everybody has a project and so perhaps developing a wellness program around what they're passionate about. So we have probably about seven projects going on right now and so just the individuals that not everybody has to do it.
Eva Norman: 33:33 But right now there's seven individuals that are developing programs around one is looking at cancer. One is looking at diabetes right now. One is looking specifically at dementia. One is looking at dementia, the other one's Parkinson's. And then we are looking at cardiac disease. Develop your like a cardiac rehab program for the community. Like for people they can't get to like the actual, you know, hospital for their cardiac rehab. And I think there's one other ends. Oh, concussions one on concussions. Huge. So those are kind of, I think that was seven. Does that sound like seven. But those are currently actively being utilized and we have multiple disciplines working on one project. So like for example, for like the dementia program, we have a personal trainer, we have an acupuncturist and a physical therapist working on that specific program.
Eva Norman: 34:28 And so they meet regularly on their own time, might be doing their own zoom meetings as well and meeting so that's sometimes we'll fill in the gaps when we have ebbs and flows. Cause as we all know in cash base world, it ebbs and flows. So that fills in their gaps. And so they know that they're always going to be full. So when they have downtime, they work on their projects, they'll work on research, they'll meet everybody, also has a mentor that which they're required to meet with regularly. So they might meet with their mentor. And also everybody is required to be a part of the professional association and in their professional association. So that might mean, you know, doing committee work might be on their downtime or you might have been asked to put a presentation together.
Eva Norman: 35:12 So they might be working on that. And you know, well up our time in so many different ways so it stays busy. So I share that because a lot of people say, well, what, what happens when there's downtime? So, but you know, all of that helps the business that leads to employee retention, professional growth in the course of the growth of the company. Which has been really one of the, I'd have to, one of the number one reasons why I think it's led to our success and our growth is because, we do empower them to essentially become these young entrepreneurs, right? And so many of them, you know, want to. So, so lot of times we do lose staff because what happens is they learn how to run their business and they go start their business. But I see that as success.
Eva Norman: 35:57 They don't compete with us. As a matter of fact, they end up taking their own little niche and they refer and we refer back and forth, which is awesome. So, really it is hard though. That's so much time and energy into them and to see them as always are, don't get me wrong, but you know, it's always great when I go to conferences and I see, you know, my young, you know my employees, my young mentees, you know, they're doing amazing things. So it's always, feels great to see that. So, but yeah, so hopefully so back to you. I mean, I'm sorry that's like, but in a lot of different directions there, but, as far as you know, we have one of actually answering your question a little bit more specific.
Eva Norman: 36:43 So we have this waiting list. But like I said, we have a dedicated, it actually monitors our schedules. You know, each professional actually has their own schedule and essentially schedules themselves. But when I say one, like if we see gaps, because they'll put, you know, if they want more patients, obviously you know, they'll put it on their schedules. Like I can take three X week. So she'll monitor that so that she knows of people in as people. And we broke up into four quadrants so for those who don't know cities, we essentially break it up into four quadrants. I'm down a new four 35 w and so we just try to keep people into your graphic areas so they're not driving all over because that's a real pain in the ass right when the snow comes down.
Eva Norman: 37:33 Probably a good hour one way. Although you might be traveling that some days, you know, seriously someday. And it has been pretty bad. Like last winter was horrible. It would take you an hour to drive just 10 miles, which is horrible as well. So, she's great about, you know, in keeping me up to date too. So her and I kind of work together as far as making sure that we keep people busy and so forth. So we might need to be reading perhaps referral sources. Oh, some people were starting, you don't, perhaps numbers are lowering in some people's schedules and so forth. But I mean, generally to be honest, they stay so busy. Yeah, I can't say that we've ever had a point where I had to be worried.
Eva Norman: 38:24 Like I always feel like there's more than enough that we can do and so on the projects too, our business and they get incentivized to bring in business so we bonus them and so forth. So, you know, people are, we really truly work very collaborative and well together to grow the business. As a matter of fact, one thing I should've mentioned earlier with this interprofessional team that we have established kind of, okay, how do we decide when disciplines come in? Like I need to have packaged something together for someone, you know, PT health coach or I'm sorry, PT, dietician. I think I mentioned speech therapist earlier with an hospice patient. So we meet once a week through zoom and we actually have a care conference while we go through some of these cases where we'll problem solve, you know, when can we bring in the next system?
Eva Norman: 39:09 Cause sometimes we don't want to throw everybody all, first of all they're paying cash for that. But also it may not be the best, you know, obviously may not be the best approach. And so we talk through that, you know, as far as who would be best right now, you know, and so forth. Like we just, I have a lady right now that the doctor's recommending like steroid injections for her back, you know, and of course we hear that all the time. And so, okay. So my acupuncturist gets on, she's like, tell her all about me. I'm like, Oh, I already have, you know. And I'm like thinking you might be the next thing because she's ready to like literally go with the steroid injection and possibly an opioid because she is so much pain. But let's have you come in.
Eva Norman: 39:46 And so, you know, we look at you, you know, sometimes one discipline may merge quickly just because of something like that coming up. So, you know, but again, we constantly communicate, we're taking notes, we share kind of even, you know, our notes that we take from care conferences. Sometimes I always say we need to eliminate sometimes let it marinate in the brain to see, okay, well Whoa, would work best perhaps or these patients, sometimes we need to really think that through. And depending on what's going on and perhaps finances to it and also the support or lack of support that they may be having. You know, and I think on, I'm very ethical to like, that's the other thing too, like if we feel that they can get a service covered elsewhere, we will share that with them. And we also try to help them figure out ways that they can get this covered. You know, there's a lot of associations out there. I don't know if you guys are aware that, you know, like for example, for a stroke, the national stroke association, both your local and national, they sometimes will have stipends out there for wellness dollars that you can actually apply for. So Parkinson's has done that stroke muscular dystrophy.
Eva Norman: 40:53 Most of them are multiples, so we'll have them tap into those resources. If you're a veteran, sometimes the VA has, well, you know, dollars set aside for that. We've found, we actually worked with a purple heart recently that was given 30 wellness visits being purple hearts and purple hearts out there. Take note that you might have a great deal with your wellness. And then all set. I'm just thinking there's also been just even private insurance plans too that sometimes have dollars for memberships and so forth. We've been able to negotiate with them to get them to use those dollars for our services. So, which has been great. So a lot of times just picking the phone and asking that question, is this possible? So, and you know, they're, you know, they're frequently trying to reduce costs, right? They don't want them in the hospitals. So they obviously appreciate what we're trying to do.
Karen Litzy: 41:44 That's great advice. I'm really glad that you brought that up. That there are resources out there that we can have our patients, we can help our patients tap into for financial resources. I think that's really important. Good, good, good. Very good. And now you had mentioned earlier that all of your assistants are virtual assistants. Where do you find your virtual assistants? Because I know that's a question that comes up all the time.
Eva Norman: 42:12 So, okay. So my virtual assistants are all, let's see, they're either in school or their moms. And they work out of their homes. And so I know that there's been, I've heard that there's virtual assistants that you can get abroad and so forth and things like that. You know, I actually just recently looked into that and she even had an interview ironically today with a woman in the Philippines, which it could be very cost effective. And I was just thinking more for just, there's just a lot of busy work behind the scenes, you know, of course with many different businesses I could save a lot of time and they're very efficient and I was just surprised like how fast they type and put spreadsheets together or actually can update some of our reports and things and wow.
Eva Norman: 42:57 This I think good. So, I dunno, it was actually, and she's very cost effective. So thinking about and haven't taken the plunge yet, but just like I said, learned about it recently and interviewed her today, but how do I find them? As I mentioned earlier that really works for us has come to me kind of handpicked from friends or they've reached out, you know, and they reached out because they heard about our company. And I have to tell you, even one of them is a previous clients, you know, that, you know, needed a job and you know, and it honestly was just the right time, you know, it was one of those things where it was, it was truly wonderful. She call it the right time because I couldn't believe that day I shouldn't say I was desperate, but I was at the point where like I wasn't finding what I was looking for and she literally, I could check off all the check boxes with her and I trusted her and I knew her. She was a client of mine and no longer a client of mine. So, and I knew she had a really strong work ethic and the hours would work perfect with her schedule. So, it just worked out.
Karen Litzy: 44:04 I think it's great cause I think a lot of physical therapists don't think about using a virtual assistant and it can be an economical way to get stuff done. So I think it's great that, you know, we kind of have that conversation around that virtual assistant and how yes, they can answer your phones or yes they can. Do you know, things like that that you would think that no, it has to be in your clinic, but if you don't have a brick and mortar clinic, then you really have to get creative and that's obviously what you've done at live your life PT. Now, is there anything else that you have found in the building up of this company that you would say to someone, boy, if you have the chance to do this to help your company, I would do it. Does that make sense?
Eva Norman: 44:59 Yes. Ah, goodness. Great question. Yeah, so you know, well, I should take you back to, you know, and also just some. Yeah, it definitely. I would say the one thing that I wish I would have done from the beginning that has helped so much since I started the business. So this would be for the new business owners I'm joining and I have to put in a plug here for the private practice section. I joined the private practice session a year into my business and I wish I had joined them prior to that would've been great cause then I, through that network of individuals, I actually ended up with two tremendous mentors that have helped me so much. When I first started out, I didn't really have a whole lot of money for all, you know, contract develop. I mean I had a lawyer and so forth, but I couldn't afford necessarily to have him generating all these contracts for me week after week after week.
Eva Norman: 46:01 Cause I would just, you know, I ended up meeting a lot of contracts initially but was really great. Is that I found some tremendous mentors. And I'll name them Sandy Norby, Mark Anderson and Tim shell. I thank you. Thank you. Thank you for listening to this podcast. You guys seriously helped me. Tremendous. I mean save me thousands and thousands of dollars, just sharing what you already had. And just getting me going and just also giving me the confidence and I wish I had had that. I mean, I wish I had met them prior to starting the business, you know, cause then it would've been so hard because I think I was trying to reinvent the wheel and little did I know, like there was all these people that could help me, so I can't stress enough doing that. But then now, once I started the business as far as kind of what I would recommend is, you know, the Rolodex that I have.
Eva Norman: 46:59 So one thing that I have to tell you, this phone has 7,000 contacts right now. Yes. I know guys. If you can too. All right. 7,000 and I'm not kidding you. And so I have organized it all beautifully. So I mean, anyone that I need, I literally put a profile together in their context. I labeled them based on her state, they're like their profession and how they can potentially help me. And so that has been huge. So because I mean, I go to so many conferences all over the country. I meet so many people and I'll just do that for PT. I do it for other professions that has been my saving grace. I've been able to find quality staff as a result. I've been introduced to, you know, perhaps, you know, corporations that I wouldn't normally have conversations with thanks to those connections.
Eva Norman: 47:51 And so it's almost like, I mean, that's probably been the easiest marketing that I've had. And so, and it's amazing how I'll call up someone five years after the fact that I met them and they'll just remember just based on the little conversation that I wrote, like a little, you know, the little notes that I had. They're like, Oh yeah, I do remember you. You had that cash based business in Minnesota. How's that going? I'm like, Oh my gosh, you do remember me? And so, it's great cause then we'll jump into the conversation and suddenly we're doing business together. So that has helped a lot. And as a matter of fact, sometimes they become even clients themselves. And so, yeah, developing your Rolodex but really organizing it well so that you don't forget those conversations. Use that notes section and write down what that conversation entailed, how you think that person could help you in the future or today, that kind of thing.
Eva Norman: 48:41 So that has helped. The honest thing I have to say to, you know, I'll put in a little plug cause as far as the marketing, you probably want to know too, you know, we don't do a whole lot. I'd have to say our website is one of the main things. But the other thing is, I joined BNI about five years ago. I don't know if you've heard of it. It's business network. At the time, I was the only physical therapist I've aligned to the United Minnesota, which I was really surprised cause when I read kind of what you know I was doing for other PTs across the country, I thought, well this is really hard to believe. And now of course there are more of, it's interesting how a lot of private practice section members have joined because I've also shared this with others.
Eva Norman: 49:25 And that has also been a great network of individuals kind of outside of my profession, but be able to connect to like other dieticians, other massage therapists and have been able to also, get business that way and just develop those relationships. So I guess what I'm trying to say is don't be afraid to like join like, you know, organizations like that or the rotary club, things like that. Potentially you can develop relationships outside of your usual comfort zone to meet, you know, people out there that can connect you to perhaps people that can afford your business or connect you to those that do. So. Yeah. So I would say that that would be huge. And I wish someone would've told me that like until you know, two years my business that I started.
Karen Litzy: 50:09 I mean what great advice and you know, what's the saying like your net worth is your network or your network makes up your net worth or something to that effect. And, that's essentially what, like you said, developing this Rolodex. I love the tips on adding notes into that. I'm going to remember that cause I don't do that and it's a great idea. A friend of mine that I used to play softball with asked me to join his BNI, which I think he's like doing a presentation in a couple of weeks. I'm going to try and catch it, but all amazing advice. And you know, I wanna thank you for being so open and honest about your story. I did not know any of that and that was very, gosh, I can't believe it if I'm being honest what an amazing journey you've had. And especially like, you'd never know it being as every time I see you at a conference, you're out dancing till two in the morning. So how is this possible?
Eva Norman: 51:18 Oh, he's asked me like where does that come from? I'm like, well there's a story behind it. So yeah, I mean I deeply love it and I owe my life to it. So I mean I really can say that I owe my life to physical therapy.
Karen Litzy: 51:28 Oh, what an amazing story. And the practice is great now. Where can people find more information about you and about the practice?
Eva Norman: 51:37 Absolutely. So our website is a great place. Liveyourlifept.com. But we're also on all the various social media facebook, Twitter, Pinterest, Instagram, LinkedIn, YouTube, well, a lot of different forms of social media. Let me think if anything else. No. And, and our website too, we actually have a weekly blog. And if there's anyone out there, by the way, that wants to be a guest blogger, please reach out to us. We're always looking for people to be a guest blogger for us, so we'd love that.
Karen Litzy: 52:18 Awesome. And, you know, just for everyone listening, if you go to podcast.healthywealthysmart.com under this episode, we'll have all the links to the website and all the various social media handles and things like that. So, one click, we'll get you to live your life PT, to learn a little bit more about the model and hopefully more PTs can kind of step into this world. And now I feel like I have such a better understanding about what you do and so much more appreciation for what you're doing in Minnesota. I think it's great. So thanks so much, Eva, for coming on.
Eva Norman: 52:56 Karen, thanks for having me.
Karen Litzy: 52:57 And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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LIVE from the Annual Private Practice Section Meeting in Orlando, Florida, I welcome Lynn Steffes on the show to discuss physical therapy consulting. Lynn Steffes, PT, DPT is President/Consultant of Steffes & Associates a rehabilitation consulting serviced based in Wisconsin. She provides consulting services to rehab providers nation-wide.
In this episode, we discuss:
-How Lynn’s career evolved from treating clinician to consultant
-Common consultation inquiries and solutions regarding private practice
-Health and wellness advocacy within physical therapy
-The importance of building a strong network of experts within your field
-And so much more!
Resources:
BrainyEX Website
Steffes and Associates Consulting Group
For more information on Lynn:
Lynn Steffes, PT, DPT is President/Consultant of Steffes & Associates a rehabilitation consulting serviced based in Wisconsin. She provides consulting services to rehab providers nation-wide. Ms. Steffes’ is a 1981 graduate of Northwestern University. She is Network Administrator for a group of 50+ private practice clinics where her primary responsibilities include marketing, payer and provider relations and contract management. She currently serves as the state-wide Reimbursement Specialist for the Wisconsin & Florida Physical Therapy Assns.
In addition to her work as consultant, Ms. Steffes works as an adjunct faculty member in the physical therapy program at the University of Wisconsin, LaCrosse Physical Therapy Program, teaching professional referral relations, marketing and peer review. Lynn has addressed private practices, hospital systems, professional associations and therapy networks in forty states regarding Business Aspects of Physical Therapy. Ms. Steffes is active in her profession as a member of the American Physical Therapy Association (APTA) and the Private Practice Section of APTA. She chairs the PPS Task Force for Educational Outreach, is a member of the Impact Editorial Board & the PPS Educational Institute. She is also active in the Wisconsin Chapter of APTA – serving as the Chapter’s Reimbursement Specialist, and on the WI Medicaid Committee.
Read the full transcript below:
Karen Litzy: 00:01 Hey everyone, welcome to the podcast. I am coming to you live from the private practice annual private practice section annual meeting in Orlando, Florida. And I have the distinct honor and privilege to be sitting here with Lynn Steffe's. And I know I have a lot of questions for her and we're going to get to a lot. But first, Lynn, can you just give the listeners a little bit more about where you are now with your business and what you're doing.
Lynn Steffes: So thank you so much for having me, Karen. This is really fun and it's especially fun because it's absolutely gorgeous. So we're sitting outside and we have, I know I'm from Milwaukee and we have six inches of snow on the ground, so I am loving this, but, awesome opportunity to communicate with a lot of PT. So I actually, I feel like I kind of do a variety of things, but I have a singular mission and vision for that, which I do.
Lynn Steffes: 00:53 And it's all really surrounding, the promotion of physical therapy as an important health care provider and service, not only in rehabilitation and healing of people, but actually in lifestyle medicine, being healthy. You have a dentist, you have a doctor, you have maybe an accountant or a massage therapist while you need a PT. And that's kind of me. So I promote physical therapy to all kinds of people. I teach at the university level, which I love. I speak all over the country. So I’ve had the privilege of speaking in 43 States, believe it or not. I do a lot of webinars, I do a lot of consulting and I work with practices as small as a guy where his mom does the billing when she feels like it. And I, by the way, don't recommend that.
Lynn Steffes: 01:43 And then I also work with systems as large as Mayo clinic. So I have kind of a variety. And obviously when you graduated from physical therapy school, you were treating patients. And I know a lot of listeners here that are physical therapists. They graduate from PT school, they're seeing patients. And oftentimes, I know this is the way I felt when I graduated as well. This is what I'm just going to be doing. I'm going to be treating patients until I retire. I didn't have the foresight, I didn't have the knowledge to say, wait, there are other things I can do.
Karen Litzy: So how did you go from treating patients to where you are now and at what point in your career did that shift happen?
Lynn Steffes: 02:26 Wow, I wish I had some big strategic plan to share with you that I had like this vision, but I really didn't. When I graduated, I really did pediatric physical therapy. I graduated and worked for a private practice and I worked as a contract therapist in a school district and then moved on to a rehab facility and then opened outpatient pediatric clinics in a couple States. And I kind of, I love being a therapist. I always say, you know, I could still be a physical therapist if anyone would take me, but it's been awhile. But as I was treating, I was seeing all these opportunities for physical therapy and kind of just, getting more and more experience opening businesses. And it was weird because I actually worked in a private practice and I love treating people and I love managing, I loved, but really everything I was doing, but there was just a lot of it.
Lynn Steffes: 03:20 And I think I started developing a little bit of an entrepreneurial, just like the sense that maybe I want to do some stuff on my own. I actually left the practice and interviewed with someone to become a pool therapist. And it was a PT I knew. And after I got done talking about everything I'd done, she was like, wow, Lynn. She was like, I can definitely sell you as a pool therapist, but I could, I'd love to sell you as a consultant. And I said, really? And she said, yeah. And I said, is there any reason I can't sell myself as a consultant? And she said, absolutely not. And that was kind of like this big aha moment for me. And I actually thought I would just like do a little bit of consulting until I found someplace I wanted to work and then I'd just take a job. I always assumed I wanted a job. And so I started consulting and it kind of became quickly a multiplier. And then I started thinking, well, I gotta look for a job. And I said to my husband, I gotta start looking for a job. And he said, I'm pretty sure you have a job. And it's consulting. And it's so funny because that was a long time ago, over 20 years ago. And I still love it.
Karen Litzy: 04:27 And isn't it amazing that so often it takes that person outside of ourselves, even maybe outside your family or even personal friend group to say, what are you doing? Like you can do this. So what's interesting is you needed that person to give you the push. And now in your work you're giving other people the push.
Lynn Steffes: 04:48 You know, I feel, I do, I feel super excited when I meet clinicians. And some of them are very young and some are also people who are kind of getting to a point in their career where they're looking for something else. I feel super excited when they want to do consulting. Number one. I think there's so much work to be done in, I don't feel like a sense of competition. I'm just like thrilled that people are getting into promoting what we do and being a multiplier. I think of a consultant as a multiplier. I think like if a practice comes to me and they wanted to start, for example, you know, a running program, Oh my God, I've already worked with seven practices that have started running programs. Somebody comes to me and they want to revise their compensation plan. I can, you know, it's like I kind of become a repository for everybody's experience. I would say I'm a kid in a candy store and as I travel I like gather up wonderful people and just a lot of cool stuff that people do.
Karen Litzy: 05:52 And so what would you say are the people coming to you for your work as a consultant? What are the most common things that you are seeing that people are like, Hey, we really need help with this?
Lynn Steffes: 06:04 Well, I feel like everybody needs help with revenue and so anything to do with like marketing promotion, they need help with payer contracting and dealing with third party payers who seem to want to put up roadblocks all the time. And I just have, I have a unique, you know, perspective on that and I've worked with third party payers and I feel like I just am marketing to third party payers. I feel like people come when they look at, you know, how are we going to grow and how are we going to grow in the revenue? And I tap on the shoulder also and go, Hey, yet look at your expenses too. I feel like that's a big thing. I also think compliance, I think we're so burdened and so I try to work with people on what they need to do, but I do it in a different way than a lot of people. I think a lot of people are like into what I call the scary complaints. Like, Oh, you're going to get in trouble. And I do mention that, but I also look at people and I say, you know what, you need to communicate your value in a better way. And if we did that, we'd be in better shape. So that's kind of a variety. Starting cash programs is super fun.
Karen Litzy: 07:16 And do you mean cash programs within a traditional therapy clinics? So for people listening, there are a traditional clinics, I guess we can categorize them as such that are, they take your insurance. So if you call up a clinic and you say, I have blue cross blue shield, do they take it? Yes. Great. So when you say you help with cash programs, is that within a traditional clinic or within like an out of network or do you help establish a cash practice?
Lynn Steffes: 07:45 Both. So I feel like there are people who do, they're excellent young therapists, consultants who have developed cash based programs and who, that's all they really talk about. And so I definitely work with a lot of hybrid practices. So practices that have one foot on the dock where you know, the third party payment environment is and one foot in cash base and they're developing other programs. Sometimes I'm working with people that are all cash. Sometimes I refer them to people that are focused on all cash. I also think like, I think we've kind of only just begun in the services we're providing that would just third party payer covered is so limited for PT and there's so much we can do if we just are willing to collect money.
Karen Litzy: 08:33 And, you know, I think in a traditional therapy setting, I think because physical therapy is always associated with the healthcare system, with the physician, we used to always need a physician referral. So the public's expectation is we take insurance because no one would ever go to a massage therapist, a personal trainer, Pilates or yoga and expect them to be covered by their insurance.
Lynn Steffes: 08:56 I completely agree. But I have this thought. First of all, I'm just going to say out loud and I hope it’s not offending anyone, but I don't like dentists because I just don't like people messing around in my mouth. But I think dentists have figured it out. They have 100%. I feel like physical therapy as a profession has to grow up to be more like the dental profession. I mean, you know, a hundred years ago, dentists, like basically you saw them when you had to have a tooth knocked out and they were kind of that provider of last resort. They, they really were, a last resort kind of provider. And they have evolved being an amazing healthcare provider. They do prevention, they do treatment, they have specialties, they do cosmetics, they do performance. So there's so many things that are parallel, and I don't know about you, but when I go to the dentist, when I walk in and have something done, they tell me, well, this is what your insurance covers and this is not.
Karen Litzy: 09:49 Yeah. And I don't have any dental coverage, but guess what I still do every year I go to the dentist. And PT is, so some of it is the consumer mentality. Like I paid a premium, it should cover PT, I don't doubt that. But a lot of people have dental insurance and they still pay for other things. I think some of it is awesome.
Lynn Steffes: 10:11 It's a mindset shift that we have to have. We have to say this is what your plan covers and these are other services that would benefit you that we recommend. So a lot of times that I'm promoting a program, like for example, the annual PT physical or I'm very interested in lifestyle medicine and brain health and the kind of things people go, well, which insurances cover it? And it's like, okay, that shouldn't be your first question. The first question should be, would this bring value to my patients and my community? And if it does, is there something that's paid that's an inappropriate question but not like who's going to cover in it and if it's not covered.
Lynn Steffes: 10:44 So some of the mentality shift is our own paradigm. So yeah, and I think there does need to be that shift of this is my expertise, this is what I offer looking around in my community. Would they benefit from XYZ program, a program on brain health, which I know, you have, right? So is this something my community would like because it's not about us. We have to be worried about the end user, which is our client, our patient, however you want to, whatever kind of word you want to put for them. But I do think that from a profession wide standpoint, that that needs to shift. And I think if it can shift, I think you're right, you'd be seeing a lot more hybrid practices where yeah, maybe you take insurance, but you have a brain health, you have a vestibular program, you have a wellness program that can happen. And I think that's where, I mean I totally think there is a 100% place for all cash or all third party. But I think we all kind of went in with more of a hybrid idea.
Lynn Steffes: 11:54 We would be able to leverage what insurance pays for our patients. And honestly, a lot of people don't want to do insurance cause they say, well it limits the number of visits. Well guess what? If it limits the number of visits, you still can do cash outside of that. You know what I mean? Like I'm always like, why can't we see that? And so it's interesting that I study like dental marketing and dental operations as a way of just having insight into a different provider even though they're not my favorite healthcare provider. So yeah, I think it's really interesting.
Karen Litzy: 12:28 And what advice would you have for someone listening who maybe wants to start shifting their practice? Going from being a treating physician, from being a treating physical therapist or physician or nurse practitioner or even a dentist. So how could they go from a full time treatment to consulting? Like, do you have to take extra classes? Do you need certifications? Do you, you know, all that kind of real practical stuff.
Lynn Steffes: 13:00 All right. So really good question. Well, I think first it's a self examination of like what are you good at, passionate about, interested in, and a willingness to share. And, you know, when I first became a consultant I thought I had to know everything and I just realized I just have to like know enough and I have to know, I have to ask you questions so that I can learn what you need and then partner with you to create that to happen. So as a consultant, I did go take additional courses. I took courses through the small business administration through our local college. We have a local women's college that has a business and evening business series. I did some of that. I talked to other consultants and actually I find that, you know, sometimes people come to me and they'll say they want to be a consultant and then I'll have a conversation with them and I'm kind of like, Hmm, okay.
Lynn Steffes: 13:48 There's a couple of things you need to do, and you need to listen. I feel like that's hard. I think some people think they just want to tell people what to do, but you kinda gotta listen to what they want and be able to do some diagnostics. I think, getting hands on experience, as much book knowledge and classes as you take in all of that, unless you can relate to somebody's problems and say, yeah, I was kind of bad at that and I learned how to do it. Or, this is where I was and here are the steps. I just feel like that that would be a struggle. So I think getting hands on experience. If you're working in a facility or practice, Hey, volunteer to run a project, get on a committee, take the lead, asked to be involved in interviews, asked to be the marketing person, asked to work with your billing and payment, get involved in the association because I've gotten a ton of contacts and I also, like, I always say it like if I'm the smartest person I talked to all day, that's not good.
Lynn Steffes: 14:48 So I know so many people that are so smart, I feel like I can pick up the phone and call them. So they're multipliers for what I'm able to help people with. I think there are steps in a big thing is hands-on, firsthand experience. Another thing is goal lists. Go take some extra classes, do some reading, but work with experienced people and kind of stick your neck out. I've been consulting for over 20 years and people will call me and say, Hey listen, I got this project, do you do this? And I'm like, you know, yeah, I guess I do, but I haven't done it before but it sounds like fun and if I'm in too deep I just call people.
Karen Litzy: 15:27 Yeah. That's great. So kind of look for those mentors or friends or like you said, colleagues, people in, I mean we're here at PPS, so it might be people at PPS, it might be your neighbor, it might be, I always say to like, don't overlook your family and your friends because there's a wealth of knowledge there as well. I always tend to look out and I'm like, Oh, what about the person right in front of me who knows how to do X, Y, Z, why am I not asking them?
Lynn Steffes: 15:51 Well, it's funny because I was working with a practice that wanted to work with more personal injury attorneys and those kinds of patients. That was something they were interested in doing. And I'm very skilled practitioner in working on spine and cervical issues. I thought, you know, this is a good fit. And he's like, I just don't know how to do it. And so I was like, okay, I know of someone who knows, you know, was an injury attorney who I respected and I just contacted her and I paid her for a couple hours and I interviewed her and spend time with her. Just going through like, what did you want? What's important? All kinds of stuff. What about communications? What is, you know, what would discourage you from using a provider? How do you decide who's a prefered? And it was weird because as soon as the interview was done, it wasn't cheap, but it was so worth it. And she kind of said to me, she goes, you know, I need some good PTs. The more I ask, the more I talked to you, the more I realized like, I know what I need and I don't know if I know who it is. And so it's funny that you know, there are a lot of resources out there.
Karen Litzy: 16:55 Yeah. And so from what I'm hearing is one, don't be shy, can't be shy. Don't be shy too. Don't worry if you don't know everything right now because you can learn it in a short amount of time. And this sounds so crazy coming from me as I'm interviewing you, but I love the idea of interviewing people, but I didn't, I don't know why I never even thought of that before to say why don't really know this, but I know this person does. So let's have a formal interview. Not just like a one or two emails, but really take, like you said, take the time, pay for the time if you need to so that you can really understand what that person needs to help your upcoming client like as you can. I guess you can always do the research so we don't just have to stick to things that we think we know we can expand.
Lynn Steffes: 17:45 Well, and I think as a PT, I remember as a young PT had a patient once that had a child with osteogenesis imperfecta and I'd never seen it before. I was getting a referral for it and I was like, okay, I don't know what I'm doing. So I just like went on the web and look for a PT that treated that. I found someone out at NIH, national Institute of health. I sent her an email and we set up a call and I went through everything. She sent me her protocols. It was like, and I just realized PTs are such incredibly generous people. A lot of people are generous. PTs are exceptionally generous with that. And that kind of taught me like, Hey, don't be afraid to admit you don't know. I have worked with or had exposure to people have worked with consultants who kind of know what all is.
Lynn Steffes: 18:35 And at some level people are like, Oh, we're really excited about them. But it doesn't create long term relationships if you don't say, Hey, that's a good question, let's figure it out. You know? So I don't know. I don't have all the answers, but I sure love the questions. You know, I love that. Love it. That should be like my motto for life. I don't really have any answers, but I love to have lots of answers. But I think what struck me from what you just said, is that we can use our skills as physical therapists. We know how to research, we know how to look up diagnoses and treatments and protocols so we can take those skills and transfer them into consultancy skills. Oh my God. So what I have as a process, when I work with practices, I call differential diagnosis.
Lynn Steffes: 19:27 For your practice. And I basically do diagnostics and then I have a hypothesis and then I write a plan. Then I work on implementing the plan and then we stop and measure and we figure out what's working and what isn't. And of course there are plans just like there are a few, if you treat a lot of knees, you have certain plans you use that usually work. And so over time you kind of accumulate solutions. But I still customize. I think some people like the canned solutions and it probably is more cost effective, but I still like working one on one.
Karen Litzy: I think this is great. Thank you so much. I'm like learning so much here. It seems like your career keeps evolving. Do you have anything coming up that's kind of different than what you're doing?
Lynn Steffes: 20:15 Wow, that's a really good question. First of all, thank you for giving me opportunity to talk about this stuff, but so I have a really big birthday coming next week and I don't need to share the number but it's a pretty big one and a lot of my friends are retiring and I'm always kind of like, what am I going to do next? I'm still, I don't know, I don't know, I just the way I am, but I have been working in the area of brain health for awhile and, and have a signature turnkey brain health program and I have two. I have one thing I want to do with that program and that is to very specifically, instead of just going into the PT market with it, I want to actually start approaching active senior centers and working with their activity people and their exercise and fitness people.
Lynn Steffes: 21:07 Because I think the active senior centers have all the tools. They have all the mechanism, they have this captive audience but they don't connect the dots, which is how cognition and wellness fit. So that's something fun I want to do with brainiacs. And then the other thing is I really want to continue to push lifestyle medicine and PT and I want to connect with other like-minded PTs. There was a young PT that I'm kind of that's just starting out. I want to mentor her. She is very interested in lifestyle medicine and exercise and how it relates specifically to anxiety and depression. I feel like we have so many opportunities we haven't even tried to do. And so this year I came out early to go to lifestyle medicine conference, which was next, which was early. Yeah, it was on the front end. So how perfect. But next year I want to be talking at it.
Karen Litzy: 21:52 Perfect. We'll get that pitch in there and talk at it. That's awesome. And I have one more question that I ask everyone, but before we get to that, if you can talk a little bit more about just the basics of the foundations of the brainiacs program, just because you'd mentioned it and I just want people to understand what that is.
Lynn Steffes: 22:21 Sure. So I have always, you know, as a peds therapist and adult neuro therapists, I've always been into brain neurology and the flexibility and the adaptability and really the plasticity of the human brain. And I've seen back in the day when we didn't think anything could change after childhood, I saw it could. And so I was always kind of like, yeah, we don't know everything. And now we know much more. But unfortunately my parents both passed from Alzheimer's disease. And so when that happens, when you have two parents diagnosed, it kind of scares you. And so I started doing research on brain health and what the literature showed and it's very clear that, you know, prevention, mitigation, and cognitive fitness and health is not just a learning and study and you know, read a book to us to do code. It really is a physiological thing. And exercise probably has the strongest evidence. And so I started a turnkey program and with the basis of it BrainyEx.
Lynn Steffes: 23:24 And prescribed exercise at a certain level of walk around. The block is nice, but it doesn't really do the whole job. And so how to prescribe and train someone to, you know, extra as at a proper level. And then I also added health and wellness education that's evidenced based too, it's nutrition, sleep hygiene, stress management, activity management, socialization. And so PTs, we're constantly doing patient education where we're like perfectly suited to do 100% instead of having people come and sit in a class, I'm like, okay, let's work out and teach. And so it's been pretty fun. I have clinics in 13 States doing it now, which I love.
Karen Litzy: 24:01 Yeah, that's awesome. We'll have a link to that on the website at podcast.healthywealthysmart.com if people want to find out more information because people aren't getting any younger in this country. And so it's really important and you're right, PT's I think are ideally positioned to be the ones to work with that population. So excellent program. Now, the question that I ask everyone, this is the last question. I probably should have prefaced this to you beforehand, but knowing where you are now in your business and in your life, what advice would you give to yourself as a new grad out of PT school?
Lynn Steffes: 24:42 That is such a good question. I honestly, it's weird because I don't think my expectations were high enough as a new grad. I get that. And I think similar to what you said, that everybody graduates from PT school and you kind of think you're going to be a PT and I love being a PT and PT is such an incredible profession, but I never dreamed I would be traveling across the country writing chapters to books, developing my own programs, having an opportunity to speak in front of hundreds of PTs teaching at the university. I never thought of all the possibilities. So I guess as a PT I would say like open your eyes and look not only for what you can do one on one with patients, which is incredibly important, but look for opportunities that multiply our profession. And I think I would've told myself earlier on, like I feel like I started early doing it, but I still think I could have even had the vision earlier and you know, and just ask people for help. I love it when people come to me and say, this is something I want to do. Will you help me? I feel like it's an honor, you know?
Karen Litzy: 25:59 Great, great advice. So great advice for all those students in school and just graduating from PT school or really any programs. So thanks so much. Where can people find you?
Lynn Steffes: 26:09 So I have a website, www.steffesandassociates.com and I also have a website for my brain health program, www.brainyex.com. You can always find me at all the meetings.
Karen Litzy: 26:29 Very true. So Lynn, thank you so much. And just so everyone knows, we'll have links to everything in the show notes for this podcast on the website podcast.healthywealthysmart.com. So Lynn, thank you so much for taking the time out at a PPS and enjoying sitting outside in Orlando before both of us have to go back to our cold places. At least New York doesn't have snow yet.
Lynn Steffes: Yeah, we have snow. Hopefully it'll build. Thank you, Karen. You do a great job of, I think sharing a lot of good information and talking to people who are thought leaders and people who have different ideas. And I think that's pretty important.
Karen Litzy: Thank you so much. And everyone listening, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Shelly Prosko on the show to discuss compassion in healthcare. Shelly is a physiotherapist, yoga therapist, educator and pioneer of PhysioYoga with over 20 years of experience integrating yoga into rehabilitation with a focus on helping people suffering from persistent pain, pelvic health conditions and professional burnout. She guest lectures at yoga and physiotherapy programs, presents at medical and yoga therapy conferences globally, provides mentorship to health providers, and offers onsite and online continuing education courses for yoga and health professionals. Shelly is a Pain Care U Yoga Trainer and maintains a clinical practice in Sylvan Lake, Canada. She is co-editor of the book Yoga and Science in Pain Care: Treating the Person in Pain.
In this episode, we discuss:
-Can compassion be trained?
-The six elements of Halifax’s model of enactive compassion
-Empathic distress, compassion fatigue and burnout among healthcare practitioners
-The five facets of comprehensive compassionate pain care
-And so much more!
Resources:
Shelly Prosko Twitter
Shelly Prosko Instagram
Prosko PhysioYoga Therapy Facebook
Shelly Prosko Youtube
Shelly Prosko Vimeo
Physio Yoga Website
Yoga and Science in Pain Care: Treating the Person in Pain
For more information on Shelly:
Shelly Prosko, PT, C-IAYT, CPI, is a Canadian physiotherapist, yoga therapist, author, speaker and educator dedicated to empowering individuals to create and sustain meaningful lives by teaching and advocating for the integration of yoga into modern healthcare. She is a respected pioneer of PhysioYoga, a combination of physiotherapy and yoga.
Shelly guest lectures at medical colleges, teaches at yoga therapy schools and yoga teacher trainings, speaks internationally at yoga therapy and medical conferences, contributes to academic research, provides mentorship to healthcare professionals and offers onsite and online continuing education courses for yoga and healthcare professionals on topics surrounding chronic pain, pelvic health, compassion and professional burnout. Her courses and retreats are highly sought after and have been well received by many physiotherapists, yoga professionals and other healthcare providers. She is a Pain Care Yoga Trainer and has contributed to book chapters and is co-editor and co-author of the textbook Yoga and Science in Pain Care: Treating the Person in Pain by Singing Dragon Publishers.
Shelly is a University of Saskatchewan graduate and has extensive training in yoga therapy and numerous specialty areas with over 20 years of experience integrating yoga therapy into rehabilitation and wellness care. She considers herself a lifelong student and emphasizes the immense value gained from clinical experience and learning from her patients, the professionals she teaches and the colleagues with which she collaborates. She maintains a clinical practice in Sylvan Lake, Canada and mentors professionals who are interested in pursuing this integrative path.
In addition to her many skills as a healthcare practitioner, Shelly is also an accomplished figure skater and has traveled the world with many professional ice shows. She is passionate about music, dance and spending quality time with family and friends. Shelly believes that meaningful connections, spending time in nature and sharing joy can be powerful contributors to healing and well-being.
Please visit www.physioyoga.ca for more info and resources.
Read the full transcript below:
Karen Litzy: 00:01 Hey Shelly, welcome to the podcast. I am excited to have you on. This is going to be fun today.
Shelly Prosko: 00:07 Thank you for having me. Really excited to talk about this.
Karen Litzy: 00:11 So I spoke to your coauthor Neil a couple of weeks ago, talking about your book, yoga science and yoga and science and pain care, treating the person in pain. And I'm really excited to dig into sort of your writing within this book because you are writing about compassion. So before we get into the nitty gritty, what is compassion? How do you define it?
Shelly Prosko: 00:41 So believe it or not, there actually is not one agreed upon definition. So that's the first thing is some people describe it as a trait. Others say it's more of an emotion. Some people say it's like a motivation or behavior. But the definition that I use in my chapter is the one that is kind of the working definition that the leading compassion researchers use in the Oxford handbook of compassion science. So that's kind of like the compendium, the Bible of all the thought leaders and researchers around compassion. So that definition, the working definition there is basically compassion is first and foremost. You have to be able to recognize that someone is suffering or struggling or in need. And then the second component is then we have to have the motivation to want to do something about it to alleviate or to help. So basically recognizing the suffering with the motivation to relieve and that is not just us and someone else that's also within ourselves. So compassion also includes the self compassion piece and that is I think really important for us to keep in mind.
Karen Litzy: 01:56 Yeah, I was going to say, and would you say that having compassion for yourself allows you to be more compassionate towards others? Do you feel like it's a prerequisite for compassion as a healthcare provider?
Shelly Prosko: 02:13 That's a really good question. From my perspective, I think it helps. The more self-compassion we have, the more compassionate we can be for others. But the research is kind of right now from what I've been reading, actually, I just listened to a recent podcast a couple of days ago and with a couple of the leading researchers. And there still is no really solid evidence that increasing self-compassion translates to increased compassion for others or that increasing compassion for others translates to increased self-compassion. That said, there is some research that shows cultivating self-compassion does seem to help increase compassion for others. So we have a bit of research that says that. And my own personal view would be yes, I don't know if it's a prerequisite, but I have noticed in my own self without making this like a therapy session, I have noticed that I scored quite low on self-compassion and I have traditionally been quite, you know, self critical and hard on myself. But as I've learned more about this stuff and practicing self compassion, what that is and, and exploring it and experiencing it, I feel like I overall am just understanding more of what compassion is. And I feel like maybe I'm, you know, more compassionate. It could be just age and stuff too and experience, but that'd be my answer to that.
Karen Litzy: 03:46 And why is compassion important in the care of people in pain? So how does it benefit me as a healthcare provider to understand compassion? When I'm working with people in pain.
Shelly Prosko: 04:02 Yeah. So I just want to be clear that sometimes people equate, you know, just being compassionate, they just equate that to being kind, you know, and it's just should be common sense and just don't be a jerk. You know, a lot of people just say, well just, it's not that hard. But, you know, there it is a little more nuanced than that. And just going back to your question on, you know, what are some of the benefits if we actually look at the, the deeper layers of compassion and which I can get into a little bit there later, but the components that go into offering compassion and also self compassion towards, you know, yourself. Lot of the research shows, I mean, stuff that we're not probably really surprised at. Like it can increase quality of care for our patients, increase patient outcomes, increase patient satisfaction, increase therapeutic Alliance, and increased patient self care.
Shelly Prosko: 05:04 So I want to just briefly talk about this cause I think it's really important and we don't think about this part of compassion, but there's this one study that I talk about in the book chapter and it was an entire year long. It was in an integrative rehab hospital and it showed there was a hundred women who are living with chronic pain and it showed that it was only once these women actually experienced what it was like to be loved, cared for, to be seen, to be heard. In other words, to have actually to receive compassionate care. Only then could they take active steps towards their own self care, which I think is really important in pain care because so often we talk about how important it is for our patients to play an active role in their pain care. We're always talking about that.
Shelly Prosko: 05:55 The literature says that we're trying to help our patients make healthier choices, et cetera. And now we have some research that says, well, you know what, if we provide this very in depth, nuanced, compassionate care, it looks like people that are patients are then more likely to, you know, better make better choices. And it's neat. Some of the women, what they were saying, things like they felt worthy, they felt loved and yeah, worthy enough to be cared for. And I just think all of that is so fascinating. So those are some of the, you know, the benefits to providing compassionate care, but there's also benefits to us as the healthcare provider. So what some of the research is showing is that it can actually help protect against burnout.
Shelly Prosko: 06:51 We can dive into that a little bit later too in some of the myths, you know, around too much compassion. But, you know and also just overall the positive health outcomes are increased in us as the health care provider and even things like reduced anxiety, depression, even stuff like reduced medical costs and errors and malpractice claims. Like this is just what all the research is saying. But then I think the other part of it that I do want to really highlight is the self compassion piece. So there is benefit for the person in pain to practice self compassion is what some of the research is showing us now and there is also benefit for us as the healthcare provider to practice self compassion. And again some of that for us as a healthcare provider is like reducing burnout, reducing excessive empathy, which they're calling, you know, empathic distress or empathy key things like that.
Shelly Prosko: 07:49 It helping us improve our emotional resiliency and like we said, potentially even increased concern for others, but in the patient, and this is what I thought was so fascinating as of now, I think there's only about five or six studies out there, but they do show that people in pain that either have higher self compassion or some of the studies actually show people in pain. Doing these self compassion practices actually can show reduced pain severity, reduced anger, reduced psychological distress or things like depression, anxiety and even increased pain acceptance. You know, we know there's some benefits. Especially with the ACT, acceptance commitment therapy research, we're starting to see how that's important and, you know, there's even some links to reduce pain catastrophization and rumination and decreased fear avoidance behaviors. And it's just really fascinating. And I think, just the last bit here on that, on that question is increased self-compassion has been shown to reduce our own self criticism and increase our motivation to actually change our behaviors.
Karen Litzy: 09:02 We're just talking today, Nisha mind who's a psychiatrist. And we were just saying, man, how hard it is to change behaviors for human beings. Cause she was talking, she has a dog. And how with a dog, you know, you can change behaviors by motivating them through food. So they have these incentives or incentivize through food. Humans, it's a little bit harder how difficult it is to change behavior in a human being. So now if compassion and practicing self-compassion can help with behavior change, how do we change compassion? I mean, how do we train compassion? Can we train it?
Shelly Prosko: 09:47 Yeah. So the literature says yes, it is trainable and we have quite a bit now and there's different programs and different styles. And I think, you know, there's a lot of different models and I think probably just to make it easiest for us here as I'll talk through this one model that I really like. It's Joan Halifax and she's an anthropologist and a meditation teacher and a few other things. But she has a really nice model of inactive compassion. And what she talks about is, you know how I said the definition of compassion was in recognizing the suffering first and then having the motivation to alleviate it. She actually goes beyond this and she says that definition's a little bit limiting because compassion is actually more of a dynamic emergent process. So it's more of a wisdom that emerges within the context of the environment that we're in, which makes sense.
Shelly Prosko: 10:53 If you know anything about systems theory or emergent theory and you know, so if we're in a room together with our patient, you've got the patient not person in everything, they're dynamic, you know, evolving system right there in that moment. And then there's us, we're also a dynamic, evolving system that we come together in the context of the environment. And that even changes the dynamic or influences. So compassion can emerge from that interaction, from a series of elements that are actually non compassionate in and of themselves. So we can train and these six elements, and again, this is Halifax's model, but we can train these six elements and it saw like you just train one and then you train the other. It's not linear there, you know, it's like I said, an interdependent integrative process. But I think it's just really fascinating because this is something accessible and tangible.
Shelly Prosko: 11:53 And in the book I go obviously into depth and I'll just try to keep this short. But the first element is the attentive domain. So that's just being fully and wholeheartedly a hundred percent present and you can, we can cultivate our focus or concentration ended up and our attention through a whole host of different ways. Whether it's different mindfulness practices or focused concentrative activities. So that's a whole other way to cultivate that. So just by cultivating and practicing the attention is one way to help the process of compassion. And then the second one is the affective domain. So that is being aware of our emotions and we have a lot of research that shows the more aware we are of our emotions, the more aware we can be of others.
Shelly Prosko: 12:52 And then we also have research that shows some interoceptive awareness practices, believe it or not because of the way something with the insular cortex, you know, we don't know if it's that more information is being sent to the insular cortex or it's just changing the way the brain is interpreting this. But when we do enter in an interoceptive awareness practices, it seems that that increases our ability to be more in touch with our own emotions, which is super cool. So an Interoceptive awareness practice might be like a body scan. So you're taking yourself, we're guiding a patient through, you know, a two minute, you know, scan of the body and inside and what are inside physiological state is like, it could be even, you know, a breath awareness practice.
Shelly Prosko: 13:47 And just knowing how that feels inside the body. And then the third element is intention. So in yoga, that of course, you know, that's my framework, how I frame a lot of things. But in yoga, there's a saying, you know, where your intention goes, the energy follows. So, from a science perspective, when you can actually focus and concentrate on something that you really put, have an attention to it that can affect the outcome. So for example, the intention when you're working with someone might be first and foremost my intention is to care for myself first. Secondly, to then care for the person in front of me. And then you may just want to keep that in mind throughout the whole session. And your intention may be something really specific. Like, I am here to serve, you know, when you sort of keep repeating that to yourself, I'm here to serve, I'm here to serve and my intention setting can be super powerful.
Shelly Prosko: 14:54 I don't know if you've done any intention setting before, but you just set an intention. It doesn't even have to be related to our professional career here. Just even personally, you go into a room or a setting where you're feeling like you don't really want to be there, et cetera. Maybe a family Christmas dinner. And if you go in with this intention, okay, I'm just going to focus on, and you could say anything, I just want to be present or I'm just gonna focus on being kind to myself. And you just focused on that one intention. It's like a theme. So that's the third element. So remember, all of these are now together. They start to accumulate into gaining more insight into the person's suffering in front of you, which then can lead us to have a more compassionate response.
Shelly Prosko: 15:40 Then the fourth element is insight. And that's basically just the idea that these first three components together and practice can lead to that deeper insight into what that person is, you know, is really going through. And then the other part to that insight, I just want to add, cause I think it's so fascinating once we start gaining deeper insight into all this stuff, we do start to understand that there's something called therapeutic humility, which is this idea that, you know, we can't control the outcome. So we do the best that we can. We gain as much information as we can. We be the best people we can be and we help the person as much as we can. And then we detach from outcome and we can pay lip service to that and we can all understand that. But when it comes down to it, I think a lot of us are attached.
Shelly Prosko: 16:38 And we're invested in making sure that the outcome is a certain way. So we could talk about that for a long time. But this is huge in part of the compassionate response is this idea to have this insight that we have to have this humility that we're not the almighty savior and we can't control. And then the last two are embodied and engaged. And so the embodied domain is really this idea that we are fully, fully present. So kind of similar to the first one, but this one is more that we are dividing our attention. Meaning we yes, we have to listen fully and be fully present for the person in front of us. But we also have to stay within our body and not detach from what we're experiencing and disassociate. So we have this idea that we can still feel if our breath is tightening or if there's tension in our body and that can give us a lot of information as well.
Shelly Prosko: 17:37 That's really important. So that's part of the compassionate process. And then the last one, the engaged domain that's really compassion in action. So that's your compassionate. And I think for here, this one, I think the biggest take home message for me has been, it's obviously informed by everything I just said. And it's different depending on the context. So there's no, well there's no GoTo, this is the strategy or this is my response or this is what I say, you know, when my friend is struggling and where someone's giving you some bad news and there's no really go to response, you can have some ideas of course, and then some things maybe that aren't, we want to stay away from saying, but it's really important to understand that compassion is this wisdom that emerges in that situation and the engaged part might be not saying anything or not doing anything. It could be just holding space. And so I hope that helps you and the listeners sort of get a deeper appreciation for this process and that we can train it and that it takes time and it can be extremely helpful for both the person in pain.
Karen Litzy: 19:01 Yeah, I think that's great. And thank you so much for going into a little more detail there on that model. I think it makes it a little more concrete for myself and certainly hopefully for the listeners as well. And now I think something that people may misunderstand or misconstrue is the idea of compassion and empathy as being the same. So my question is there a difference between compassion and empathy? And if so, can you kind of give us the similarities or differences there?
Shelly Prosko: 19:39 Yeah. So just like compassion, empathy does not have one agreed upon definition either. So this makes it challenging to talk about this stuff because you know, people have different ideas as to what these things are. So some, you know, of what I've read about empathy, it depends if we're talking about cognitive empathy or emotional empathy, behavioral empathy. So that makes it a bit tricky. But I'm going to stick with the empathy that I find most people resonate with and that is more that the empathy where it's our capacity to be able to share the feelings of another person. So what it's like to be in the other person's shoes, right? To resonate with their experience, even to share that emotional experience. So if we use that definition, then we know we can see that empathy is really more of a competency.
Shelly Prosko: 20:43 It can be a motivating force for compassion. But what the literature shows is that empathy is neither sufficient nor required for compassion. And you think about that for a moment. It makes sense because we can have empathy for someone. So we may emote, be able to, you know, really understand and emotionally share that same experience or share that same feeling because we've had a similar experience. The response may not necessarily be a compassionate one and there's lots of different reasons as to why we would or wouldn't. I go into a little bit of that in the book, but just I think, I hope that makes sense to everybody. How you could still have this empathy but maybe not provide of a very compassionate response. The other part of that is you don't necessarily have to even have empathy in order to provide a compassionate response. And I think that's actually quite hopeful. And you know, cause I think even talking to some of my colleagues who some people may feel that they're not as empathetic or they've been told that they don't have, what you don't understand.
Shelly Prosko: 22:05 And, you know, the good news is you may not be really empathetic or you may not consider yourself an empath, but you can still have a compassionate response. And I think if you go back to the Halifax model of all of those elements, you know, that help us provide a compassionate response. Empathy can be part of that. Like you say, it can be a motivating factor, but not, no, not the only factor in it. Certainly, it could still be lacking. You could still be compassionate.
Karen Litzy: 22:40 That is hopeful for people who may be feel like they're not as empathic as they would like to be. But like you said, that Halifax model is this sort of emergent model by having all of these different inputs go into the system and have, you know, an emergence of compassion from you. So it's not like all of those parts need to be equal.
Shelly Prosko: 23:03 Right? And empathy. Like I said, empathy can be good. Of course. You know, just think of a time when you shared someone's experience feeling, you know, or their experience. You've had a similar experience that may help us give us an idea. But we also have to, I think this is interesting too. We also have to look at the fact that sometimes if we have empathy and we can really share that feeling if we're not careful and if we're not in this more clear kind of state. We may actually start to look at our experience and what we went through and put on someone else, like almost feeling that, well, this is how I felt. So they must feel that too. And there's something that Paul bloom, he's a psychologist at Yale, he calls it empathy arrogance or the arrogance of empathy.
Shelly Prosko: 23:56 And it's just fascinating. Some of his work and you know, this really made sense to me when he talks about the fact that can we truly, truly have empathy, you know, on that deep level of what it means. Because that means that we want really understand and share 100% with that person is going through. And we can't do that really, if you think about it. And it could be, you know, someone may be that we've had a similar experience, or it could be, think of yourself as a healthcare provider. Look at all the patients we have. I'm coming to see us who are very, very different from us. Different things have happened to them, different socio economic status, people who are maybe vulnerable populations marginalized. And if we're in a position of privilege, how can we truly empathize with some of the issues and the things that they're going through that may affect their esteem? So that's kind of a tangent, but I think why I brought that up. I think it's important is because it's just this idea that we can still be really, really compassionate and we can train for these compassionate responses even if maybe we can't fully empathize. So I think that was the point of me bringing that up.
Karen Litzy: 25:22 Yeah. And I think in my mind, it kind of takes a load off of me as the healthcare provider. You know, that you don't have to have experienced what your patient has experienced in order to provide compassionate care in order to have that therapeutic relationship in order to help that patient in some point of their recovery. So I think it takes a little bit of the pressure off of the healthcare provider, which may in turn help us to be better providers. So we don't have that pressure, like you said, that pressure on us for outcomes because perhaps, you know, you don't want to think, well, because I never experienced it that I can't help this person right now, I'm away or I'm not the right person for you, or something like that. So I think it's an important distinction. And now in the book, in your chapter you sort of have this model of comprehensive, compassionate pain care five sort of points to that. So can you speak about that model of compassionate pain care?
Shelly Prosko: 26:42 Yeah, so really just looking at all the different orientations of compassion. So Paul Gilbert, this is based on Paul Gilbert's work, he's another compassion researcher in the UK. And he talks about the orientations which is giving compassion and then obviously we also receive it. And then the third orientation is the self-compassion within us. So the five components that I see when you look at the full comprehensive, compassionate pain care. The first one is of course what we've talked about here, the health care provider providing compassion. And then the second component is the health care practitioner and the person in pain, cultivating or practicing self-compassion. Oh, that's within each of us. And then the third one is also close family and friends, cultivating compassion towards self and others, including the person in pain. And then the fourth is that we want to make sure that the values of the healthcare organization, including its leaders are in line with compassionate care.
Shelly Prosko: 27:54 So this includes a commitment to providing and supporting an environment where compassion can be cultivated by both the healthcare provider and the person who, and I think that's, you know, just really important to include in a comprehensive model here because it's not just about the healthcare provider and the person. And then the very last point is just the community at large. You know, I think it's important to have overall public awareness and understanding, you know, surrounding the importance and the health benefits and practices of compassion. And then of course, that includes the person in pain. So that's a little lofty and I don't have a task force or a plan or not this, you know, right now I'm focusing on those first two and I'm doing a lot of different things and this is going to be my life's work, Karen.
Shelly Prosko: 28:47 Like I really believe in this stuff. And, I think increasing pain literacy and increasing compassion literacy are two things that, you know, I'm in it for the long run and so how that looks on how we increase pain literacy and compassion literacy in, you know, interest in the general public and in healthcare organizations. I mean, that's a huge topic. But, you know, there are some different things that I've been involved and just with, not necessarily with compassion per se, but just increasing pain that I've seen, you know, our health care community and yoga therapy community. So yeah, to me it's got to be comprehensive like that.
Karen Litzy: 29:42 That's the way you're gonna make, I think a worldwide impact, certainly on those living in pain when we know, at least here in the United States, and I think this is probably can kind of be generalized to other parts of the world. But here in the United States, the burden of care for just low back pain and neck pain is number, I think three or four behind heart disease, like diabetes. So we're talking about pain as being one of the largest burden of care in the United States. And I would argue probably across the world. I don't know that it's that much different or there's that much difference from other parts of the world. I don't know what it's like in Canada, but I mean it's a lot of money. It's a lot of time. It's a lot of resources. It's a lot of relationships. It's a lot of people in pain contributing to that burden, behind those big numbers of trillions of dollars. They're individual people. And so if adding something like compassionate pain care can help make even the tiniest dent in that, then I think it's, I don't think it's a lofty goal. I think it's just a goal.
Shelly Prosko: 30:58 Yeah. I'm glad you say that and you put that into perspective, which I appreciate and yeah, and I think that, you know, just overall this compassion what we've been talking about here, like I think it's the foundation of pain care or is this foundation of health care. You know, you can't really argue with that. And, I don't think anybody would argue with that. But what I think we just don't quite understand is that we may have good intentions and we may think that intuitively, yes we are compassionate people, but the research shows that it can be lacking in certain areas of the world and certain regions, healthcare regions. And also there are fears and blocks and resistances to compassion. Like there are actually reasons why we may not offer a compassionate response. And, you know, some of those reasons are the organizational barriers or different social pressures.
Shelly Prosko: 32:05 But some of them may also be certain beliefs that we have that compassion may not be the best response for this person. Maybe we have a deep seated belief that the person needs something different. You know, there's a lot to this, but there are different obstacles. And also just our own health. I didn't really talk about this in here, but you know, we might be overwhelmed by stress in our lives or we may have some unmanaged personal distress and we have research that shows we don't need research to tell us this, I don't think, but we do have research that shows when our own physiological state is not regulated. When we're in a state of flight or stress or a sense of anxiety, things like that. Neuro, biologically we are not set to provide a compassionate response.
Karen Litzy: 32:59 Go figure. Yeah, that makes a lot of sense. All right, what would you love for the listeners to take away from this discussion and then we'll get into where people can find you in the book and all that other stuff, but, what would be your big takeaway when it comes to compassion and care?
Shelly Prosko: 33:25 I think the biggest takeaway that I would like people to understand is that being compassion is not just about being nice or kind or a good person, so that we could still be all those things, but we actually may still be lacking in that compassionate wisdom. So if you can just think of it more than that and that we could, Oh, maybe get a little bit more skilled at developing this compassionate wisdom. And I guess this is more than one takeaway, but that would be the one. And then just knowing that there are these benefits, both the people in pain and also for us as the practitioner for our own health and yes, for burnout and things like that.
Karen Litzy: 34:18 Now where can people find more information about you, what you're doing and where the book is?
Shelly Prosko: 34:24 So my website's probably the easiest, kind of the one stop shop. So it's physioyoga.ca like Canada. And you know, if you want to sign up for my newsletter from there, it's on my blog. And then that keeps you up to date. Cause I do online courses, webinars, onsite courses, lots of videos, YouTube, you know, all kinds of different resources and things. So, and then the social media links are all on my website.
Karen Litzy: 34:54 Yeah. And we'll have all of that to up on the podcast under this episode at podcasts.Healthywealthysmart.com so people can one click and get right to you.
Shelly Prosko: 35:04 Okay. Yeah. And then the book, the co-editors, you've already mentioned Neil Pierson and then Marlisa Sullivan is the other co-editor. And we do have some other authors who are contributing or who have contributed to the book. And you can find that book. I mean it's just Google yoga and science in pain care, treating the person in pain. It's on Amazon, Barnes, Nobles, you know where books are sold.
Karen Litzy: 35:25 I can say I have not read all the chapters, but I have read several of them and I 100% recommend this for healthcare practitioners or not even healthcare practitioners. Really anyone. Because I just find that for me, it's helping me to kind of look inward a little bit more what I'm doing and not doing and what I can improve upon. And a lot of good reminders of pain science and, and things that I can thentalk about with my patients. I think in a way that, that they're understanding and integrating yoga and integrating compassion, integrating breathing and things like that into my treatment. So I'm finding it very helpful from a practice point.
Shelly Prosko: 36:22 Exactly. That's great. Yeah. That was our hope. You know, our hope was that healthcare providers, regardless if they wanted to go deep into, you know, the yoga therapy and bring yoga into their practice or not, you know, we wanted this to be helpful for, you know, people who, you know, just might be informed by some of these teachings. And of course informed by the science and in mind with what the contemporary science is telling us around patients.
Karen Litzy: 37:05 Yeah, exactly. And it's also nice because it's not like, it's not super heavy. It's not like you're like, Ooh, boy, like I need five hours to read two pages. You know what I mean? Cause it's written in simple language, which is very nice versus so you're taking all these studies that are very scientific and able to simplify them and distill it down into something that's very easy to read. And I think that's why it sticks. So well done for you guys on that. You can find the book at any bookseller and we will have links to it on our website. And Shelly, thank you so much for coming on. I mean this is great and hopefully it allows people to at least look into compassion training, at least start incorporating this with clients and with your patients. So thank you so much for coming on. I appreciate it.
Shelly Prosko: 38:02 Thank you. Thanks so much for having me. I'm just so, so, so grateful.
Karen Litzy: 38:06 Yeah. Pleasure, pleasure. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Nicole Stout on the show to discuss cancer rehabilitation and survivorship care. Dr. Nicole L. Stout is a renowned health care researcher, consultant, educator, and advocate. She is research assistant professor in the School of Medicine, Department of Hematology/Oncology at West Virginia University Cancer Institute. Dr. Stout is an internationally recognized expert and leader in the field of cancer rehabilitation and survivorship care.
In this episode, we discuss:
-Functional morbidity in cancer survivors and the role of rehabilitation
-Evidence for rehabilitation and exercise interventions to support individuals with cancer
-Physical therapy clinical, research and education needs to develop survivorship care models
-Why every clinician should be familiar with survivorship care
-And so much more!
Resources:
Nicole Stout Twitter
Nicole Stout LinkedIn
Academy of Oncologic Physical Therapy
2nd International Conference on Physical Therapy in Oncology (ICPTO)
American Congress of Rehabilitation Medicine
American Cancer Society
Nicole Stout Research Gate
Email: nicole.stout@hsc.wvu.edu
For more information on Nicole:
Nicole L. Stout DPT, CLT-LANA, FAPTA
Dr. Nicole L. Stout is a renowned health care researcher, consultant, educator, and advocate. She is research assistant professor in the School of Medicine, Department of Hematology/Oncology at West Virginia University Cancer Institute.
Dr. Stout is an internationally recognized expert and leader in the field of cancer rehabilitation and survivorship care. She has given over 300 lectures nationally and internationally, authored and co-authored over 60 peer-review and invited publications, several book chapters, and is the co-author of the book 100 Questions and Answers about Lymphedema. Her research publications have been foundational in developing the Prospective Surveillance Model for cancer rehabilitation.
Dr. Stout is the recipient of numerous research and publication awards. She has received service awards from the National Institutes of Health Clinical Center, the Navy Surgeon General, and the Oncology Section of the American Physical Therapy Association. She is a Fellow of the American Physical Therapy Association and was recently awarded the 2020 John H. P. Maley Lecture for the American Physical Therapy Association.
She holds appointments on the American Congress of Rehabilitation Medicine’s Cancer Rehabilitation Research and Outcomes Taskforce, the WHO Technical Workgroup for the development of Cancer Rehabilitation guidelines, the American College of Sports Medicine President’s Taskforce on Exercise Oncology, and also chairs the Oncology Specialty Council of the American Board of Physical Therapy Specialties. She is a federal appointee and co-chair of the Veterans Administration Musculoskeletal Rehabilitation Research and Development Service Merit Review Board. Dr. Stout is a past member of the American Physical Therapy Association Board of Directors.
Dr. Stout received her Bachelor of Science degree from Slippery Rock University of Pennsylvania in 1994, a Master of Physical Therapy degree from Chatham University in 1998 and a clinical Doctorate in Physical Therapy from Massachusetts General Hospital Institute of Health Professions in 2013. She has a post graduate certificate in Health Policy from the George Washington University School of Public Health.
Read the full transcript below:
Karen Litzy: 00:01 Hey Dr. Nicole Stout, welcome to the podcast. I am so excited to have you on today. So today we're going to be talking about for all the listeners, cancer, survivorship and morbidity burden among growing populations, probably around the world, certainly in the United States. But Nicole, before we even get to all of those sort of big topics, can you define for the listeners what cancer survivorship is?
Nicole Stout: Yeah, thanks Karen. That's a great question to start off with. And it's a little bit of a Pandora's box right now. So we've historically defined cancer survivors as anyone from the point of their cancer diagnosis, really through the remaining lifespan that that individual has. So we consider a survivor from point of diagnosis and you know, it's sort of different or it's kind of different than what the word expresses.
Nicole Stout: 01:06 The word survivor, I think in some kind of patient means they're done with treatment, they've survived. And you know, we've seen a bit of pushback in the last few years around people who don't necessarily identify with the word survivor. So if we go back to 2006, there was a very important report that the Institute of medicine released called lost in transition from cancer patient to survivor. And this is where the term came from. Basically that IM report was critical because it said, Hey, medical community, you're doing a great job of treating cancer, that disease, but you're doing a terrible job of helping these people transition back to their life when they're done with treatment. They have a lot of functional morbidities, physical, cognitive, sexual, not managing those things. So this term survivorship was put forward. The idea of managing people to become survivors was put forward.
Nicole Stout: 02:05 And what's been very exciting is to see the evolution of emphasis and focus on better managing the human being that goes through the disease treatment in addition to managing the disease. But we've come so far with treatments and in some regard, some people who have advanced cancers for example, will be on cancer treatments for the rest of their life. And you know, I participate in a lot of social media groups and I hear these people say, I'm not a survivor and I'm never going to be one. Eventually I'm going to die from my cancer. I know that. And it's a matter of time. And so they don't identify with the word survivor or survivorship. So, you know, we're sort of moving away from that a bit and we're talking for now without individuals who are living with and beyond cancer. And I like to use that terminology. Even though survivorship is prevalent in the literature and prevalent in, you know, our conversations and in oncology circles is how we describe it. But I think we're trying to be more sensitive to the much, much broader population of individuals who are going through cancer treatments today.
Karen Litzy: 03:19 Yeah. And I liked that phrase, living with and beyond cancer, it seems a little more inclusive to me. Is that why you prefer that phrase?
Nicole Stout: 03:29 I do. I think that encompasses anyone who ever had a cancer type know who is in treatment, who is a, what we call an ed has completed treatment and has no evidence of disease. And it's also those individuals who may be in palliative care, who are progressing towards end of life, who are still being treated or managed in various ways. So I think it is more encompassing and reflective really of the broad, broad scope of this population.
Karen Litzy: 04:04 Yes. Because I think oftentimes, and myself included, people think you either have cancer or you don't. After you've gone through treatment, you don't have it in you're a survivor. So you forget about that population of people, like you said, who have cancers that they'll be in treatment for the rest of their lives.
Nicole Stout: 04:26 Yeah. And that that is actually a growing population with more sophisticated treatment technologies and changes that we've seen around the immunological therapies, the hormonal therapy treatments. Many of these targeted agents as we've come to so call them. And we are seeing individuals live much, much longer with disease, with stable disease, we're able to stabilize it. And so therefore what they would have died from in six months or a year, they're now surviving. I have years on continued temporization treatments. And so how would we describe those individuals? And yeah, let me make sure that the supportive care needs of those people are met and identified and met. It is a very broad population. So I think sometimes we say survivorship and it is not nearly as homogenous as, you know, that group of you either have cancer or you don't. You've been treated and you're finished. Now some people, for some folks that is the case. But for many, there's this very gray area that is the remainder of them.
Karen Litzy: 05:39 Yeah. And I think saying living with cancer treatment or living through cancer treatment and beyond is just a little more sensitive to the person. Like you said, the person behind the cancer. Because oftentimes when you read articles or even whether it's in a scientific journal or mainstream media and you think about cancer, they are always talking in percentages and numbers but not in the person. And so this kind of brings it down to the personal level. Now you mentioned it a couple of times, as we were talking here about different morbidities related to cancer or cancer treatment. So can you talk a little bit about what people undergoing treatments or maybe have completed their treatments might be experiencing?
Nicole Stout: 06:37 Yeah, that's a huge topic. We could spend hours just talking about that. But first of all, just in general, when we say morbidity, we're talking about the complications and the side effects that impact an individual's ability to function. So we're talking about functional morbidity. And the good news, the good news is this. The good news is we have a growing population of individuals who are living with and far beyond their cancer diagnosis. We talk about the population of cancer survivors growing. And you know, we look back to like the 1970s, all types of cancers. We were looking at about somewhere between a 40 and 50% survival rate to five years. So we have, and today we have dramatically driven that number much, much higher when we look across all cancers. That number today is around 70%. But when you drill into some of the more commonly diagnosed cancers like breast and prostate, those survival numbers to five years or even higher, upwards of 90% plus.
Nicole Stout: 07:47 So the good news is more people are being treated and getting to that side of your Mark of survival with no evidence of disease. And that tells us a story that they're more likely to live the rest of their lifespan, but they are living with significant functional morbidity. And so the side effects of cancer treatments are things that we absolutely anticipate. We know that when people go through different types of chemotherapies or mental therapies, radiation therapy, you named the therapy, they are going to be side effects that negatively impact their function. The issue is how severe is the impact? How disabling does it become and does it persist? So multisystem impacts from these interventions. Chemotherapy is a multi, it's a systemic approach to managing disease burden. And unfortunately chemo is not selective. It doesn't go into your body and say, Hey, here's a cancer cell and there's a cancer cell and it wipes out rapidly dividing cells.
Nicole Stout: 08:54 So is the systemic impact to the body. Your immune system is suppressed, you know, your blood counts drop, you become anemic, you become fatigued. Some chemotherapeutic agents cause cardiac complications and cardiotoxicities some chemotherapeutic agents we know are highly neurotoxic and cause peripheral neuropathies. None of these. And there's a spectrum, right, of the severity of that toxicity that people experience. And so some of those are mild, some of those are more severe. That it is the majority of patients going through treatment will experience at least one or more many experience, more than at least one about 60% experience, at least at one or more functional morbidity. And so when I talk about function, I want to say just sort of as a caveat, I always say I talk about Function with a capital F, meaning that it's not just the physical function. You know, I think in physical therapy we think about movement and mobility and gait and balance and you know, activities. But there's cognitive functioning as well. There's sexual functioning, there's being able to assume your psych.
Karen Litzy: 10:10 Yes.
Nicole Stout: 10:10 Social and psychological functioning and all of that, assuming your roles and your daily life. So we have to think very broadly, but when we talk about the morbidity burden, it's very real associated with cancer treatments in the short term. So while people are going through treatment, we expect to see it. But here's the trick. When treatments are done and withdrawal, people do recover to a very high degree. They regain their strength and mobility. But many of them suffer with persistent morbidity. And that disables many from going back to work or resuming their prior roles. And again, those can be across systems. And they can be encompassing of the physical, the cognitive, et cetera.
Karen Litzy: 10:55 And that gives me a lot to think about as a physical therapist. So if I might be seeing a patient too, let's say they have completed their chemotherapy, radiation, whatever their treatment was a year ago as the physical therapist, it sort of behooves me to ask these questions of them. So even though I may have a patient who's recovering from breast cancer that's coming to see me for knee pain, but these are things that if you are the treating healthcare provider, you have to have in your head and kind of ask these questions of them, of those different systems. Right?
Nicole Stout: 11:41 Absolutely. And that's actually a great and very critical point to make for physical therapists. And you know, even more broadly, occupational therapist, speech and language, all of our rehab cohort, you know, you said one year after treatment that the thing about cancer treatments, and I refer to them as the gift that keeps on giving because even though an individual finishes treatments, the treatments are oftentimes not done with them. Radiation therapy is a great example. We see individuals have side effects of radiation therapy in the acute timeframe, of course that we can see for example with chest wall radiation and breast cancer, we can see changes to the lung tissue, the bone and the cardiac function even years beyond the completion of treatment in five years, 10 years. So it behooves us to think about the history of cancer but not just did it have a history of cancer and concerned about recurrence of disease with what I'm seeing in my assessment.
Nicole Stout: 12:41 That's one little piece of it. But the bigger question is, is the impairment that I'm seeing in this patient in front of me somehow related to their cancer treatments? Quite possibly, I would say yes. And if it is, are there things that I need to know about cancer and its treatments so that I can optimally manage this patient? And I would say yes to that as well. It's funny because in, I've been a PT for over 20 years now. I've worked in cancer for the majority of that time. Almost 19 of those 20 plus years have been exclusively cancer. And I still today have physical therapists say to me, I don't really see cancer patients in my practice. And my response to them is they see you every day. They see you everyday. Someone who has had a history of breast cancer with radiation therapy to the chest wall on the left side 10 years ago.
Nicole Stout: 13:38 And you're seeing them as they are deconditioned, they may have dyspnea, they're now having some cardiac complications that can absolutely be related to radiation cardiotoxicity. You're seeing someone's three years out from prostate cancer treatment who is now having some balance deficits and issues, has had a fall at home for example, do a close assessment of their sensation, because they probably have residual peripheral neuropathy directly related to their neurotoxic chemotherapeutic agents. So we know that many of these side effects persist and can cause what we call these late effects, which are the downstream side effects that patients will experience. And a lot of it is musculoskeletal, neurological as well. You know, there are changes that can happen with regard to sensation, cognition, memory, those types of things also can persist for, can come on more substantially later after the completion of treatment.
Nicole Stout: 14:43 So there are functional needs someone's going through treatment, but those needs may be, they may be less, they actually may be more in some folks as they age. Because by the way, there's that pesky thing called aging. I'm done with cancer treatments five years, 10 years later. But you know, you've also aged whole cluster of what are the co-morbidities that we're facing that this individual is facing. You know, what type of lifestyle behaviors are they choosing. So really looking at that from that very encompassing perspective and in the short and the long term, not negating that history of cancer, even though it was, you know, five or seven years ago.
Karen Litzy: 15:26 Yeah. And you know, you kind of answered the question I was going to ask and that's as a physical therapist, why should we care? Well, I think you answered that one very well, but let's talk about the evidence for rehabilitation. And exercise interventions for these individuals with cancer. What does the evidence tell us?
Nicole Stout: 15:43 Yeah. And so when you asked why should we care, not just to alleviate their morbidity and to give a good quality of life and better function, but there are big, big issues that these folks face that caused downstream medical and healthcare utilization than escalate costs, pain medications, imaging, additional hospitalizations. So we should care from an individual perspective. I want my individual patient to be functioning. We should also care from a system and a societal perspective that we can help to alleviate that burden. So the exercise or the evidence, boy, where do I start? The good news is, as I said, multi-system impact for many of the cancer treatment interventions. And that's everything from surgery through hormonal treatments, including everything in between. But the goodness is there is evidence to demonstrate the benefits of rehabilitation intervention for nearly any patient with any disease type across the continuum of cancer care.
Nicole Stout: 16:50 From the point of diagnosis through end of life, there's evidence to support our interventions. And you know, I always say that about cancer oncologist everywhere. Cancer does not discriminate based on body region. It does not discriminate based on system impact. It doesn't discriminate based on race, based on gender. Everybody is at risk for having a cancer diagnosis. Now you know, there are some nuances there that level of risks. So we have to be thinking about that evidence very broadly. And so if we start at the beginning, at the point of diagnosis, there are some populations for whom a prehabilitation exercise intervention is highly recommended. We have seen over the last decade, the idea and concept of prehab is, you know, many times we make a diagnosis for a patient with cancer and it is not emergent to treat them. Now some types, it is some types of leukemias.
Nicole Stout: 17:49 We immediately begin treatment like the sun doesn't set, we treat them. But for a number of populations, there's testing, there's workups that are done. There's lab work, there's imaging and that can take several weeks. And so in populations like lung and colorectal, we had started to see these prehabilitation exercise programs put into place and there's a nice body of literature that has grown and has strengthened demonstrating the benefit of therapeutic exercise, aerobic conditioning, moderate intensity supervised over the course of about two to three weeks. What it does is it prepares them to enter, whether it's surgery or chemotherapy. First it prepares them to enter. They are cancer care continuum in a much better physical performance status. Really the exciting thing in lung cancer with the pre habilitation exercise that we've seen some evidence, the lung cancer population in general, many of them are not in good physical performance status when they're diagnosed.
Nicole Stout: 18:52 And some of them by virtue of that are not candidates for surgery. They're not candidates for the ideal regimen of chemotherapy because of their performance status. And we're starting to see evidence that that prehabilitation exercise intervention can actually convert someone for being a non surgical candidate to the surgical candidate. And that is, that's where we need to really be looking longer term and saying, does the rehab intervention improve survival in that population? The question is not, you know, something that we haven't answered yet but not far from being plausible. So that's evidence sort of from the point of diagnosis. We also have a large body of evidence around that post usually surgery is the first stop for some, for most folks and that perioperative time period. And it just makes sense. You know, the PT, the rehab consults, for especially our head and neck population, we talk about oropharyngeal, laryngeal parasite as we sort of put those into the head and neck population.
Nicole Stout: 19:56 Immediate referral for speech and language pathology should be done in that patient population. Immediate referral for PT or OT console for upper quadrant for cervical mobility, first those things should be standards that should become standards of care. The evidence is building in that regard. And then as patients move through treatment, the chemotherapy, radiation therapy, sometimes chemo, radiotherapy combined, is sometimes the next stop. And around that time period the exercise literature supports intervention during chemotherapy, the conditioning to help to mitigate fatigue, moderate intensity, low intensity exercise for individuals to alleviate distress, anxiety, depression. So exercise prescription is something that we're really starting to see more focused on. The American college of sports medicine just released new guidelines last week, providing some very specific evidence around exercise prescription. So we're getting to the point where we can actually prescribe exercise for targeted impairments that individuals are experiencing during cancer treatments.
Nicole Stout: 21:17 There's strong evidence around fatigue management exercise. To moderate and low intensity for fatigue management. There's strong evidence around lymphedema using exercise to help for women who have, especially in the breast cancer population. There's strong evidence also around using weight bearing exercise to mitigate bone density loss that happens with many of the hormonal agents. So I know I'm sort of picking and choosing out of the air here, but in general, what do people experience when they go through cancer treatments? Debilitating fatigue is probably one of the most prevalent impairments across all cancer types. There's also so deconditioning that comes along with that and you know, that's a starting place for exercise interventions and you know, half the battle I feel with the rehabilitation intervention. And I feel like my role sometimes as the PT on the team, half of the battle is engaging the patient repeatedly in a conversation about enabling them because as they go through treatment, they feel terrible.
Nicole Stout: 22:30 You're sick. They're fragile, they're medically complex, right? Their blood counts drop, okay, let's maybe low. So there's risks and you know, it's sort of like the docs will say things like, well, you know, I guess you can exercise but don't overdo it. And that's almost worse than saying don't exercise. And so sometimes it's just, you know, our role in rehab is so critical during that time period of treatment to see them in a repeated fashion. And by that I don't mean, you know, two, two times a week for the duration of their cancer treatment. But you know, maybe it's a monthly basis, maybe it's every other month, maybe it's every three months as they're going through treatment for those check-ins. Re-assessing how their function has changed. Giving them guidance and support and enabling them.
Karen Litzy: 23:23 Yeah. And it reminds me of some of the work that I do with patients who have chronic pain is that it's not like you said, two times a week for six weeks. It's checking in, it's helping to build their self efficacy so that they can do yeah. And they can do more for themselves.
Nicole Stout: 23:47 And within their own bodies and giving them permission to do it. Cause like you just said, well you can work out but not too hard. Well like, yeah, that saying, well that's confusing and sometimes our patients need permission to feel more confident with their bodies. I had a patient say something to me once and I will never forget it and I use it in all of my talks and it's always sort of at the core in my mind. And she said to me, you know, the medical oncologists, they may have saved my life that you gave me my life back and if I'm going to survive cancer, what is it worth if I can't have my life back, at least to some degree to do things that I love to do. That just really hits at the heart of why rehabilitation is so critical for these individuals.
Nicole Stout: 24:39 Because yeah, that treatments that we have now, I mean, we're detecting cancers earlier. The treatments are so much more sophisticated. Many people will go on and live their full lifespan and die from something else and however, it's not good enough anymore for us to say. He said, I have cancer. You should be happy to be alive. You know, even if you're suffering with pain or lymphedema or conflict fatigue or neuropathies and, or cognitive dysfunctions and you're frustrated because you can't think straight and you don't have good short term memory. It's not good enough for us to say you should just live with those things and be happy to be alive. Not when we have the evidence like we do around rehabilitation interventions. And I mean, I could go on about the evidence. We could get into specific impairments, pelvic floor, for example, returning people to continent.
Nicole Stout: 25:32 Again, that's a place where prehab and then following them through the continuum of care. Makes sense. And you know, we in PT and in rehab has to get out of this episodic care mindset when we're working with patients who have cancer. So that's really where we went and we develop the prospective surveillance model. Way back in the early two thousands when I went to work at the Naval hospital in Charleston, Garvey and Cindy falls there, had developed this protocol for a research study and I went in and this prospective surveillance model said, Hey, we know people going through cancer treatment are gonna experience just awful side effects that are going to negatively impact their function. And if we know that ahead of time, why aren't we using rehab prospectively to help to identify the changes, manage them early when they're less intense and can be managed more conservatively.
Nicole Stout: 26:28 So we ran those studies over the course of the next 10 years and published extensively on this concept of prospective surveillance, which is start with rehab at the point of diagnosis, assess function at baseline, know what's normal, follow that patient then at punctuated intervals, throughout treatment, one month after they start treatment, they're going to have had surgery or they're going to have started treatment. They're going to start to decline. See them at that one month period, reassess baseline and identify clinically meaningful change. Everything might look great and then you say, good, I'll see you in three months. And then we follow them on an every three month basis after that for the first year, every six months, then up to two years and you're only out to buy. And what we found was that I do think that we indeed identified impairments early because for most people it's not if they occur, it's when, when is it going to happen?
Nicole Stout: 27:23 So we're able to identify them early. We can treat them much more conservatively when the impairment is less severe rather than waiting for severe, debilitating fatigue or a big fat swollen leg, and trying to fix or rehabilitate, right? We have to be much more proactive and we have the tools to be able to do that. We have the clinical measurement tools, we have the problem solving skills as rehab providers. What we have got to change is our perspective on an episode of care. This really is a more consultative role for rehabilitation and I think that's great. I think it's a great place for us to think about moving to as a profession. Consultation in that, like you said, sometimes you just see the patient, we tweak a little bit on their program and you coached them a little bit and talk about some of the behaviors they want to move towards and talk about. You're going to get there and you enable need and then I'll see you in three months. But sooner if anything goes wrong, you know?
Karen Litzy: 28:21 And now this brings up to me an interesting question for you. So this, you said back in the early two thousands, this work was done on this, prospective surveillance. So now it is 2019 so you know where I'm going with this, right? So, as rehabilitation professionals, where are we? Are we doing this? Has this been put into mainstream practice? And if not, what do we need to do as the rehabilitation professions?
Nicole Stout: 29:00 Yeah. So my heart is really as a researcher and it takes time. It takes time to do good studies. So that protocol kicked off in 2000. We didn't publish really our first remarkable studies until 2008 so it took us that eight years to enroll enough patients, analyze the data, come up with a full data set. You know, we completed our enrollment, we had the full data set. So in 2008 we published the first article from that prospective surveillance trial and then we published many, many more that the first was lymphedema, we published on shoulder morbidity, we published on fatigue and it was sort of this cascade after that, you know, once we had the data collected. So I'll start by saying it takes a long time to do good quality research. So really I sort of start the clock around 2008 and we've all heard the adage it takes 17 years for something to go from, you know, the research being published to actually implementing it in practice.
Nicole Stout: 30:08 So I looked around at my research, okay, I'm out waiting 17 years. How did the escalate the timeline to get this into practice? And, I encourage individuals who do publish, to think about how you advocate for your research. And so where are we right now as a profession? Well for the first few years it was challenging to get people around their head around this concept of prospective surveillance. We had some uptake in some larger cancer centers who said, this makes sense, let's implement and put a physical therapist in the cancer center, which I think is an ideal situation. It's hard to do though because again, in hospital systems we're in our cost centers and you know, the rehabilitation department, you have to have her referral to PT. I mean, we've got to find ways to overcome all of those barriers.
Nicole Stout: 31:03 So, I would say one moment that was a real catapult for us was in 2010, the American cancer society had identified the evidence around prospective surveillance and they said, do you think that this is ready for sort of an expert review panel? And I said, hell yeah. And so I got to work collaboratively with them and some other colleagues in putting together an expert consensus panel on prospective surveillance. We ended up after a two day symposium look, did the research, worked in groups and teams for about another year and publish 16 articles that came out in a supplement to cancer in 2012. And that I feel like was a bit more of a pivotal moment for us. You know, these research studies were great, but to pull all of that together with a group of experts in a consensus forum and say, this is a model that we need to think about for cancer patients because if we start at the beginning, not just with physical function, but if we start at the beginning with things like assessing someone's cognition, assessing their family status, assessing their financial status, assessing their nutrition status, and we follow them prospectively, all of those things are going to take a negative hit at some point during cancer treatments.
Nicole Stout: 32:21 So I think prospective surveillance lends itself to a much larger cancer supportive care model, which is how I have been describing it. And it is my intent to really focus on how we can study that model and look at better avenues for implementation in this new position that I'm in now at West Virginia university. This is my goal, which is amazing. Now how, so, you know, if we look toward the future and hopefully what you will be able to achieve in your colleagues across the medical spectrum, what are there policies that need to change that will impact the future of cancer survivorship or the future of living with cancer and beyond? Yeah, so the good news to that is there are a lot of things we can impact because we've laid this foundation of the evidence. We have laid this foundation of expert consensus and there's been a lot between that 2012 and today, more and more providers in rehabilitation services are becoming aware and engaging in cancer.
Nicole Stout: 33:36 You know, it's not something we prevalently teach in our curriculum in PT school. Think about how you learned about cancer. You learned about cancer in the negative. You learned all of the contraindications to your modalities and exercise and cancer was always one of them, right? You would say in your practical, okay, ultrasound, great, don't do it over the eyes. Don't do it on a pregnant uterus and cancer. So we find it in the negative for so many years. We have generations of therapists out there who love cancer and negative that never learned about the interventions to help to impact improve someone's function going through cancer treatment. So we're seeing that change and it's changing in how do we know it's changing? Individuals are engaging in cancer rehabilitation networks. We're seeing far more publications. We've published on this. A couple of years ago we did a billion metric analysis of the cancer rehabilitation literature and we've seen this tremendous upswing in the evidence base and an increase in volume.
Nicole Stout: 34:39 We're also seeing more therapists move towards specialty practice and evidence of that is what we have seen culminate in the last year with the first ever deployment of the oncology board specialty certification exam. We had 68 people pass the first exam. So we now have a growing conduct contingency and it will continue to go of therapists who are oncologic clinical specialists, which is fantastic. So we are positioning ourselves, we are moving forward. But when you ask where do we go in the future, I really think of three things. Number one is impacting policy, like you said, second is impacting education. And third really is impacting research. And so I think where do we need to move to in the future? We're starting to see the clinical practitioners really grow. We're starting to see residency programs develop. So from that perspective of the clinical focus, there's evidence, there are pathways that's developing.
Nicole Stout: 35:41 We have to start thinking about how do we embed this better into our curriculum. And this was last January in PTJ, the January issue of physical therapy journal. I coauthored a commentary article with Dr Laura Gillcrest, Dr Caringness and Dr Julie silver and Dr Catherine Alfano. We were all putting forward commentary on a recent national Academy of science, engineering and medicine report about longterm survivorship for cancer. And basically that report said rehabilitation should be utilized throughout the continuum of care, cancer care in order to contribute to that are longterm outcomes. And if that not doing so, not including rehabilitation during cancer treatment is almost negligence based on the breadth and depth of the literature that we have. So that was a pretty strong statement in that workshop document. So those are the types of things. Recommendations from the national academies will help us change policies.
Nicole Stout: 36:48 And by policies, I mean, you know, it's not just how do we get paid for what we do, but also policies around, standards, policies that our accreditation bodies use to designate cancer centers. In fact we are seeing, I think they were just released today, the commission on cancer, which accredits probably 95%, I think it is, of cancer centers around the country. So they're a big gorilla, their standards for an accredited comprehensive cancer center and include a standard for rehabilitation care services. It used to just be a criteria that you had to have a referral source to rehabilitation. But in 2020, the new standards that will come out from the commission on cancer actually has a rehabilitation care service standard. So it's been elevated. That's going to be critical for us because it will require your cancer committee in your hospital to identify policies and procedures for rehabilitation practices in oncology.
Nicole Stout: 37:56 So, you know, this is a place where we've got to start to see uptake in from our rehabilitation directors or administrators in large healthcare systems. The PTA, you know, we were really gonna need to see them start to put forward recommendations. How do we do this to practice? What is the best practice? What are some tools and tool kits that we can rule out. So those things, those policy changes are drivers for us. The education piece, I've spoken to a bit, I think embedding more education into curriculum for the entry level PT. And I think it's critical. You know, we get so bogged down in, well, you know, the capte requirements are, but they are in our curriculum's already too tight and it's a bit of a red herring argument because I see places around the country who have champions for oncology rehab who has put it into the curriculum.
Nicole Stout: 38:51 It just takes someone to understand what is the best practice look like for an educational model and how do we implement it. So places like Oakland university in Michigan, Emory in Atlanta is working right now on elective modules. So there are some real novel ways that these are being incorporated into PT curriculum. And the third area that I think of for the future is research. And you know, as I said, wow, we've seen an explosion in research in the last decade. It's phenomenal. A greater volume. A lot of that has focused on intervention. It's been within some very specific populations like breast and prostate. There is a lot of breast and prostate, understandably. But we need to look at going beyond. We really should be thinking about how do we look at populations with regard to our rehab interventions of cohort studies, large population studies, and we've got to start thinking a little bit beyond end points.
Nicole Stout: 39:54 Like function, function is important, don't get me wrong, it's the core of what we do. But if we improve function through rehab intervention, does it change the downstream utilization of healthcare services? Does it mitigate costs? Do we see them spend less time in the hospital? Did they have less than, do they adhere to their chemotherapy better? Do they have less severe toxicities? Do they have better overall survival? So they've got to think about some different end points and take a bit of a health services research approach. I think in oncology rehabilitation going forward. That's what I would love to see as the future and really at the core, the change in clinical practice so that we are a proactive consultative risk stratifying, triaging, screening, and proactively assessing profession when it comes to dealing with oncology.
Karen Litzy: 40:52 Yeah. And, and you really teed it up for me to ask you this last question here. My question is what advice would you give to your everyday clinician working, whether that be an inpatient or outpatient to allow them to begin to think differently about cancer?
Nicole Stout: 41:19 And that's critical because the fact of the matter is we look at places like Johns Hopkins and university of Penn and MD Anderson and those are like the preeminent cancer centers in the country. The truth of the matter is the majority of people get treated for cancer and community hospitals right down the street from where you live and in outpatient, freestanding oncology clinics. So the likelihood that you're going to see them is very high. So it is important for, as I said, the general therapist. It's also important for specialty practice therapists to improve their knowledge base in cancer. So how do you do that? There are some great resources. I'm always going to point to the APTA oncologic Academy for physical therapy. We're now an Academy. We used to be the section, I still call it the section.
Nicole Stout: 42:13 But we have an Academy for oncologic physical therapy and there are phenomenal resources there. They do continuing education programs. They provide fact sheets. They often have great evidence base that you can access to understand what are the measurement tools they should be using, what are the questions I should be asking someone. I feel there are also some, you know, continuing education courses focused specifically on the general therapist and I teach one of them. So there's my bias opinion and my disclosure there with great seminars, but I tell people that in the beginning of the course, one of the first things I say is my goal is not to spend two days with you to get you to become an expert in cancer rehab. My goal is to change the way you think about every single patient that you see regardless of the diagnosis, regardless of the setting that you are in.
Nicole Stout: 43:05 If they had a history of cancer, what questions do you need to ask? What might you be seeing in your intake that is indicative of side effects of disease treatment, late effects or even metastatic process. The other flip side of that that we haven't talked about and certainly helped me to delve into is that as primary providers, as frontline providers as we are in rehab, right? The direct access. Now, how many of us ask, about screening, cancer screening? How many of us ask questions? How many of us even know what the screening guidelines are for cervical cancer, for breast cancer, for prostate cancer, new screening guidelines for lung cancer. Again, I think that's a great way for physical therapy professionals to brush up in their knowledge base and to start to have these conversations. I'm not going to be the one to order a low dose CT scan for my patient who's at risk for lung cancer, but I might be the person to plant the seed with them and to incite a behavior change if no one else on their medical team has talked to them about it or if they're hesitant about it.
Nicole Stout: 44:12 Colorectal cancer screening as well. So all of those, we should take responsibility to have those conversations. And that is 100% of the patients that we see to ask those questions. So I think we need to sort of self-assess and say, how can I do this? Knowing that we had, we have 17 million individuals in the United States right now that we call cancer survivors. We are expecting that number to double, double by 20, 40 just because of the growing population, first of all. And because of the escalating rates of survivors, because we're treating the disease so much better. So there are going to be far more of them with the aging population and far more needs for us to meet. So yeah, therapists should be asking themselves, what are the resources out there? There are a lot of places now hospitals, health systems do cancer rehabilitation programs.
Nicole Stout: 45:10 They're doing continuing education courses and they're doing conferences as well. So take a look at some of the, I know Mary free bed, rehabilitation center up in Michigan, Brooks rehabilitation hospital down in Jacksonville, Florida, Marion joy, Northwestern. Many of these rehab hospitals are looking at doing one day, two day symposium open, you know, for folks to attend. So many hospitals as well are doing these cancer rehabilitation one day symposium and NYU is doing one next year, university of Miami. There's also an on pitch this because it's fantastic. And the ICPTO, which is the international conference in oncology, physical therapy, physical therapy oncology. I see PTO, it will be in Copenhagen in may of 2020. That's not a terrible place to go. This is the second that we, the second conference that we've done, the first conference we had over 280 participants from over 25 different countries around, well just physical therapists just in oncology.
Nicole Stout: 46:17 It was just amazing. It gave me tingles to be in that room. And so we're hoping to have an even bigger groups. So those are just, you know, again, sort of a snippet of some resources that I can provide. But looking at each of those, I think you can delve deeper into the resources that they have and have them have available within the APTA within the Academy and within some of those other ACRM is another one. The American Congress for rehab medicine has a cancer networking group and that's a beautiful place to go because it is interdisciplinary PT, OT, speech. You have behavioral psychologists, you have interventionalists, you have lifestyle medicine, desire, interest. It's really great. And they have continuous track of cancer rehabilitation content at their conferences. Unfortunately their conferences in early November. So it's coming up quickly, but every year it's in the fall. Next year it will be in Atlanta. So you know, another great place to look for. How do I start to build my knowledge base in this area?
Karen Litzy: 47:30 Yeah, this is great. Thank you so much for all of those resources and we will put as many of those up in the show notes at podcast.healthywealthysmart.com. Quick question on some of those resources. When you were talking about the different screening tools, can you find those screening tools under the APTA's oncologic PT?
Nicole Stout: 47:50 So if you're talking about the Academy for oncologic physical therapy, the hotly debated title. Yes, there are. So screening tools for identifying functional morbidity. Yes. So the course that was the evidence database to guide effectiveness, the edge test scores for oncology has published over 25 systematic reviews and have looked at measurement tools with by disease type within different measurement domains. So for example, you can find how do I measure functional mobility in colorectal cancer? How do I measure best measure lymph edema in head, neck cancer? So it's broken down by disease type and then domain of measurement. So that's there. It's an annotated bibliography on their website. So they give you a nice little simple compendium. But for the larger screening population screening guidelines, many of those are American cancer society and the us health prevention preventive task force. Those are, you know, large scale guidelines that are developed and put forward for screening for disease.
Karen Litzy: 49:02 Yeah, perfect. Perfect. Well that's great. That is a lot of resources for people. So hopefully any rehab professional listening can, if you have no familiarity with any of this information, would you say where's the first place they should go?
Nicole Stout: 49:21 Well, the first place, that's a great question. And I can help you put some seminal articles up there too. I think there are one and the open access articles. Julie silver wrote a fantastic article in 2013, about impairment driven as a rehabilitation. I feel like it's foundational. It's a great starting place for someone to get their head around all of the stuff involved with cancer treatment and the functional morbidity. And then I think the PTs for PTC oncology Academy is a great place. But also if you're an OT or speechie, you can join the Academy of oncology, PT, you can be an affiliate member, you can get access to our journal and our resources.
Karen Litzy: 50:06 Oh, that's cool. Good to know. That's very good to know. And you know, I think as from what I've got out of this conversation, because I am not embedded in with the oncological Academy but what I am have come to realize through this conversation is that regardless of your setting, you may in your career encounter a patient that has had cancer or is going through cancer treatment and regardless of whether you're in sports, PT, orthopedics, neurological pediatrics, odds are you're going to treat someone at some point with a cancer diagnosis present or past. And to understand the basics of how that might affect overall systems is incredibly important regardless of whether you work at Sloan Kettering full time within specifically cancer population or you are the physical therapist for the New York Knicks, you know, you may encounter this population.
Nicole Stout: 51:32 Yeah, that's really a beautiful summary. Karen, I appreciate the way you articulated that because I like to say oncology is everywhere and that's exactly it. It doesn't matter the setting you're in, it doesn't matter what specialty you practice. It doesn't matter geographically where you live. It does not matter, you know, age, gender, et cetera is, it's there, it is everywhere. Multi-system impact across body systems. So I think that's it. And across the lifespan. So I think it's beautifully summed up with that. You just said that, that's how we think about it. Oncologists everywhere. So every patient that you see there is either the risk of them having a cancer diagnosis in the future. So are you talking about the screening guidelines for the chances they'd had a diagnosis in the past and then asking yourself, is that impacting what I'm seeing here in front of me? There's so much we can spend an hour talking about pediatric oncology right now we're talking about red flags, you know, but look around many of the continuing education consortia around the country, med bridge. You know, many of those have a variety of content or are in process of building content for continuing education always look at the references. CSN is a great place to go to get a ton of oncology resources.
Karen Litzy: 53:00 Got it. And that is coming up in February over Valentine's day weekend in Denver, Colorado. So if you're a physical therapist or not, maybe you just want to go and hang out with 13,000 other PTs. You can go to Denver and you look at the oncology track for CSM.
Nicole Stout: 53:20 Definitely bring your sweetheart, make a ski weekend, I guess with the ecology content. Yep, definitely.
Karen Litzy: 53:32 Excellent. All right, so before we wrap it up, I asked the same question to everyone and that's knowing where you are now in your career, in your life. What advice would you give yourself as a new grad out of PT school? So this is the advice you would give to you.
Nicole Stout: 53:48 The advice I would give to me, it's funny. People would say, if you look back, what would you change? And I always say not a damn thing. I guess my advice to myself is what I hold close to my heart and what I convey to others is go for it. Don't be hesitant to take on something new or different because the new and different is what is going to expose you to a pathway you never would have imagined. I never would have imagined coming out of school that I would be doing oncology work. I was worried about in PT school. I didn't know that this career pathway could exist. I didn't know a clinical research pathway was something that I could even pursue. And as the opportunity came up, if I would've been hesitant, if I wouldn't have been interested in taking the risks, so go for it. Don't be afraid to take a risk. And sometimes that means moving to a different city, that might mean taking a pay cut. You know, a lot of times if we chase the things we love, we're not necessarily chasing the money along with it. I think if we chase a big paying salary, sometimes miss things above, so go for it and be open to try and taking those different pathways.
Karen Litzy: 55:02 Yeah, great advice. And now where can people find you if they have questions or they want to talk about oncology physical therapy?
Nicole Stout: 55:12 Oh, you can find me on Twitter, on social media outlet. I really used to try to engage professionally. So it's @NicoleStoutPT. And you know, you can certainly find me there. My Facebook accounts were private. That's where like family and friends stuff. But definitely access and hit me up on Twitter or LinkedIn yet. Another great place. I post a lot of our research articles there. I'm on LinkedIn, so you can certainly connect with me there. Or just email me and always see how many times you can just cold call or cold email. It's some of the most engaging conversations I'll get on the phone with anyone. I will fly anywhere to talk about kids or rehabilitation and you know, some of the best conversations that started with, Hey, I don't want to bother you, but you have some time to talk and I'm happy, you know, to start a conversation via email. So more than happy to engage.
Karen Litzy: 56:09 Perfect. And Nicole, thank you so much for a really great talk and I think that you have given the listeners a lot to think about and also a lot to look up into research and hopefully spark someone out there to, this might be the path I would like to take. So thank you so much.
Nicole Stout: 56:24 Well, I thank you for the opportunity. I'm just grateful for everything that you've done to put PT on such a stage and I'm really excited to have been a part of that, so thank you.
Karen Litzy: Thank you so much. And everyone out there listening, thanks for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Neil Pearson on the show to discuss therapeutic yoga in pain care. Neil Pearson is a physiotherapist, and Clinical Assistant Professor at the University of British Columbia. He is a yoga teacher, a yoga therapist and creator of the Pain Care Yoga training programs for health professionals and yoga therapists.
In this episode, we discuss:
-The components of yoga practice that benefit people with persistent pain
-Yoga therapy as a pain education agent
-The Pancha Maya Kosha Model of yoga and the biopsychosocial model of healthcare
-Yoga and Science in Pain Care: Treating the Person in Pain
-And so much more!
Resources:
Pain Care U Twitter
Pain Care U Facebook
Pain Care U Website
Yoga and Science in Pain Care: Treating the Person in Pain
For more information on Neil:
Neil Pearson, PT, MSc(RHBS), BA-BPHE, C-IAYT, ERYT500
Neil Pearson is a physiotherapist, and Clinical Assistant Professor at University of British Columbia. He is a yoga teacher, a yoga therapist and creator of the Pain Care Yoga training programs for health professionals and yoga therapists. Neil is founding chair of the Physiotherapy Pain Science Division in Canada, recipient of the Canadian Pain Society's Excellence in Interprofessional Pain Education award, faculty in yoga therapist training programs and an author. Neil develops innovative resources, collaborates in research and serves as a mentor for health professionals and yoga practitioners seeking to enhance their therapeutic expertise. He is co-editor of ‘Yoga and Science in Pain Care: Treating the Person in Pain,’ available Aug 2019.
Read the full transcript below:
Karen Litzy: 00:01 Hey Neil, welcome to the podcast. I'm happy to have you on to talk about yoga and science in pain care, which is a title of your new book. And we will talk about the book throughout the podcast, but I'm excited to learn more about yoga and how yoga can work with people in pain. So welcome back to the podcast.
Neil Pearson: 00:24 Thanks so much Karen. I can't remember how long it's been since we've been here but it’s wonderful to be back.
Karen Litzy: 00:29 Yeah, I think it's been awhile. I don't know either, but I think it's been a long time, but I'm excited today to talk about yoga and how yoga can be an agent for people in pain. So as a lot of the listeners know, I had a long history of chronic neck pain, so this is something that really interests me, but I will kind of pass it along to you. So how does yoga help as a pain education agent?
Neil Pearson: 01:00 Okay. So, maybe I'll start at a bit of a different place, but coming to there, so I guess part of my excitement around this, you know, we've got this new textbook out, it's called yoga and science in pain care. And really what it's trying to do is, is teach health care people about yoga and yoga research and how it can help but also some of the research behind that in terms of why it would work. And also it's sort of tried to go the other way as well as to teach yoga people about pain and about the lived experience of pain. So with the textbook, we're trying to hit both sides, right? Because we really see this as being something that needs to be integrated. And I think we sort of hit a really nice time with this because there's such interest in non-pharmacological pain management now.
Neil Pearson: 01:54 Everyone’s starting to recognize that the long-term management of pain or the care of people in pain has lots to do with what the individual does for themselves. Not completely as self-help kind of work, but more as what the person does for themselves under the guidance of people like us as physical therapists and under the guidance of people like the yoga therapists. So that sort of, the sort of broader where this is coming from. And then if we look at sort of how it can help, we can start by looking at some of the research and I guess probably in terms of pain management and pain care the simple thing to do to start with when we say we have now have formal analysis and systematic reviews that show that yoga therapy has been shown to be effective.
Neil Pearson: 02:45 That helping people to have less pain, to improve both perception of ability but also measured function and also improved quality of life. Those three things really are the three keys that people want. When we have ongoing pain, we want to have less pain, better ease of movement, and better quality of life. And the research is showing positive findings there. And it's showing positive findings in quite a varied group. So, there's a lot of research on low back pain. I mean, that's the one that has the most research. So much so that the, you know, the American medical association now has a yoga as one of the suggested treatments for people who have ongoing low back pain. But it also shows benefits for people who have rheumatoid arthritis, osteoarthritis, fibromyalgia, a whiplash associated disorder and a irritable bowel syndrome as well.
Neil Pearson: 03:43 So there's this growing body of evidence saying that when people have these conditions that they can find benefit from them. And of course, like any area of research, we'd have to say, you know, it doesn't say that it's gonna work for everyone. It just says that if you take a lot of people and you give it to them, there will be some benefit with using yogas. The therapy people always want to know, well, is the yoga therapy better than physical therapy or is it better than going to the gym? Is it better for other movement practices? And we don't have that research yet. The effects sizes of some of the research when people are going through using yoga therapy for pain management are higher than the effect sizes of movement on their own and comparable to the effect sizes. You see when you do research looking at cognitive behavioral therapy plus movement therapy for people with chronic pain, which makes a lot of sense because yoga therapy really does cover a lot of the aspects of the person. And so your listeners may be thinking yoga for people with pain. That sounds actually pretty ridiculous because whenever I see pictures of people doing yoga, there's no way that that's what people in pain are going to do,
Karen Litzy: 05:00 Right? Cause they're always in these positions where even if I don't have pain, I think to myself, how in the heck am I supposed to get into that position?
Neil Pearson: 05:10 Well, exactly right. And, and it sort of the other question that often sounds ridiculous to the person who has ongoing pain is like, aren't you listening to me? I told you that movement hurts and you're telling me you want me to move as a way to get better. But movement is the problem. And so it's interesting that the practices of yoga can help people to find new ways to move with more ease. But also, the practice of yoga, we need to recognize really are so vast. We're talking about, if we sort of overviewed yoga, yoga is about learning how to relate to yourself in new ways, how to live in a world in new ways. It is about movement with the postures and it is about doing breathing techniques. And then there are awareness techniques which are akin to mindfulness, but they're a little different.
Neil Pearson: 06:10 And then there are also within yoga there are meditation techniques as well. So it really covers a broad, broad spectrum of interventions. And if we go to the literature again around chronic pain and chronic pain care, we see that mindfulness techniques and meditation are showing positive benefits. Movement is showing positive benefits. Gaining knowledge is showing positive benefits, acceptance, commitment therapy, cognitive behavioral therapy. All these things show benefit for people with chronic pain. And there are aspects of those all within yoga sort of as this package. And the idea would be that we could, with the person who has ongoing pain, the yoga therapist would be able to do an assessment to see how the pain has changed the person or influenced sort of all the aspects of their existence. And then try to find how we could use different techniques of yoga to help.
Neil Pearson: 07:08 So for instance, if a person was, let's take a common example, like the person who has chronic low back pain, but we know that with chronical back pain, often there's anxiety. Often there's grief. Well, there are aspects of yoga that we could use to address the grief or the anxiety. Often when we have ongoing pain, we have the sense of loss of self competence or self efficacy and we could use certain aspects of yoga to address those. Our body tends to get stiff or some muscles, you know, are gripping all the time. And within yoga we can do things to help to release muscles that are gripping or learn how to reengage muscles that seem to be inhibited. And so it's the practice of yoga would be to or yoga therapy would be to go through it and see how this individual is impacted and then see how we could use the different aspects within yoga to put together a plan to address a lot of the changes that are related to ongoing pain.
Karen Litzy: 08:12 Yeah. So I think what you're describing may be a little different than what a lot of, perhaps the listeners are seeing. Meaning yoga is more than just handstands on Instagram and you know, doing these impossible moves and making them look so easy because I think that's what a lot of people associate yoga with. And so what we're talking about here is not just going to a yoga class or not just putting something fun up on Instagram, but the yoga therapist being very intentional in their prescription, the type of yoga therapy they feel this person needs. So it's individualized based on a proper evaluation.
Neil Pearson: 09:02 Oh, exactly. Yeah. Although the one difference in yoga therapy is that yoga therapy is not diagnostic, right? So the yoga therapist isn't a trained health care professional. So what the yoga therapist is doing is it's actually applying yoga, getting the person to do different aspects of yoga, like meditation or awareness or breathing or movements. And then seeing how the person is limited in that and then working with them to find a way so that they can do that particular technique to help them to change ease of movement of life pain.
Karen Litzy: 09:40 Got it. Yeah. And there was, you know, something, we spoke about this a little bit before we went on the air, but there was a sentence within the book, the yoga and science and pain care that I had never heard of this saying before. I mean I'm not immersed in the yoga world, but it's the sentence is expanding our view and even altering our perspective to a Pancha Maya Kosha perspective enhances our understanding that pain physiology is studying the person as much as our biology. So can you talk about that for a little bit because I kind of liked that saying so you could expand on that.
Neil Pearson: 10:25 Yeah. So there's sort of the two parts of it is that that studying physiology is about starting the person, not just the biology, but then there's also this Pancha Maya Kosha which all start with that within healthcare we talked about the bio-psychosocial or bio-psychosocial spiritual model, which is intended to be an integrated view of the person that everything biological is going to affect everything psychological, it's going to affect everything social is going to affect the person who has spiritual manner and it's all working together as an integrated unit. So within yoga, the philosophy and the view of yoga is that there are different aspects of the individual, so the individual is integrated and whole, but we can look at the individual from different aspects to understand them better. And so I'm this pantry, my kosher view looks at the individual from a physical perspective, from a more energetic perspective, being Pancha is one of the things they're talking about, which really is life force.
Neil Pearson: 11:31 And then it really relates a lot to breath as well. But then there's within yoga to SIM Phi, we could say we look at they often call it the lower mind, but it's really getting at the automatic aspects of the human, all that stuff that runs automatically. And then there's above that or you know, I guess above it. There's this other aspect of us that this about us thinking about what we're thinking and it's about us regulating thoughts and emotions and breath and all that stuff. And then the other aspect of us is more the aspect of his that has more to do with spirit and connectedness to the world and everything. And so yoga already looks at the person from that kind of perspective. And with the idea that any change in one aspect of the individual is going to have an effect on the other aspects of the individual.
Neil Pearson: 12:25 So if you have a little back pain, it's going to change the way you breathe. It's going to change the automatic functioning of the body. It's going to change the way you think and emote and it will change your connection with yourself, your community. And that then you'll also have as part of its core belief system is that if a person that had low back pain, you could help the person with low back pain by going through any one of those aspects of the person so that you could help the person by affecting the physical body, by working on breath, by working on the automatic system, by working on thoughts and emotions or community that all those, everything interacts. And so that you could, you know, work at it through any of those aspects of your existence.
Karen Litzy: 13:08 Got it. And as someone who has had chronic neck pain for many years, it is very true that the physical pain certainly affects so much else that is happening in your life. It affects your thoughts, it affects your emotions, it affects your relationships, it affects the way you hold your body, the way you relate to your body, the way you see your body. So now I feel like I have a much better idea as to what that sentence means and how yoga can help the individual relate to all of that and kind of put it all together. Cause sometimes when you're in it, you don't see it. Know what I mean? Like you don't see that you're not relating to your body, you don't see that you're moving differently, you don't see that you're breathing differently, you're clenching, you're holding, you just, you don't realize it because it's just the way you are as a result of the pain.
Neil Pearson: 14:10 It's so true. And I think one of the key things about what you just said is that the experience of pain often disconnects us from awareness of ourself even so much so that we know now from the science side that sometimes when there's ongoing pain that a person will have a hard time actually feeling the non pain sensations of their physical body. So you know, imagine a person with a low back pain and we asked them to take their attention to the rollback and tell us what they feel there. And typically what a person would do is tell us about their back pain. And then of course I get really sort of funny reaction to people when I say, okay, you told me about your pain. What I want you to do is take your attention back there and tell me the non pain sensations you can feel on your low back.
Neil Pearson: 15:02 Which a lot of people, you know, really don't get that. And I say, okay, well you know, just right now take your attention to the feeling of your hands. Your hands are resting. Can you feel your fingers? Can you feel the temperature of your skin in your hands? Can you feel the angle of the knuckles? You probably can feel a whole lot of non pins sensations there and say if you had low back pain, I'd probably say, okay, now take your attention to your upper back, your mid back and notice the non pain sensations. They're just sort of exploring. Scan around. Okay, now what I want you to do is go down to your low back. No, just the pain. Sort of acknowledge it. Now what I'd like you to do is see if you can feel non pain sensations in that same area.
Neil Pearson: 15:41 So maybe you need to try to look under the pain or around it or through it. I feel that and it's amazing that some people will say, you know, I really don't experience anything right now except the pain. All I feel there is pain. I can feel my mid back, I can feel my upper back, but my low back, it's pain. That's all there is. And then other people will say, I can sort of feel it, but it feels like it's murky or muddy or hard to feel. And then, you know, we don't often get it with low back pain, but say what was your hand where the pain was? Well often people when they start to do this say, you know, my hand doesn't feel this right shape or size. It feels like it's too big or it feels like it's too small. It feels distorted.
Neil Pearson: 16:24 And so it's really interesting is that the practices of yoga specifically get people to take their attention to their physical self to try to reconnect to those sensations. And this is always part of yoga, but in Western science we're finally understanding this. It's really only been in the last five or 10 years where we've paid attention to the distortions of body awareness and body image that are common when pain persists. And, of course this becomes really fascinating to me because the next part is, as a research guy, I get stuck in because I know clinically when a person tells me that, that when I get the person start to work on finding those subtle non pains and sensations of their physical body, that when the person starts to be able to feel those sensations, that there's an associated decrease in their pain.
Neil Pearson: 17:20 And then the more the person is able to feel the subtle non-painful sensations of self, the more the pain diminishes. But I can't give you any good scientific explanation for that. You know, we see it clinically, but we can't fully explain it in some sort of, you know, central nervous system or insular cortex or any of those things. We just can't explain it. But to me, that's part of the interesting thing about both the practice of yoga is that it's driven by experience. And yet what the science is now doing is showing is that there's science that says that, you know, the experience of yoga aren't just all in your head. They're actually real measurable changes in the humans biology and physiology.
Karen Litzy: 18:08 Yeah, it's really interesting. And I wonder now you have me wondering, well why do people experience that decrease of pain when they start, you know, looking at the painful areas more than just painful. I mean, are they making changes in the sensory cortex? Is it affecting that idea of smudging that maybe they have a clearer outline of what that body part is now in the brain? And that can lead to changes? I don't know, but it's really an interesting concept.
Neil Pearson: 18:45 Well, and the thing about that too is that as we start to study more our sense of our physiological state, we start to realize that body awareness and aspect of it is, or a big aspect of is happening, sort of outside the sensory cortex. It's happening more in the insular cortex. And so I know in the last year I saw one research study that was saying that they couldn't find any smudging and people who had altered body awareness, but they were looking at the sensory motor cortex and didn't look at the insular cortex. And so it's another area as the research goes on, is maybe that smudging is happening in a different place or that alteration of brain activity is happening in a different place than we thought, but certainly the person that is experiencing it and if the person is experiencing it, we hope we can be able to find, you know, the correlate in the brain activity.
Neil Pearson: 19:45 Of course our, you know, our sciences far beyond or far behind, the experience that the human has, which really gets back to that other aspect of what you're saying is that that statement is when we study physiology, we hope that by studying physiology and pain physiology, that what we start to do is understand the human more rather than, maybe I'll say it this way often when I go to pain society conferences, there's a lot of biochemistry people there and they're talking about their research and at the end of it, they nearly always say, so what the science says is that here's this target for pain care, for pain intervention. And what they're talking about is that, we could give a chemical to the person to target this thing, this gene or this ion channel or whatever it is to change the person's experience of pain. And of course, my question always when I'm there is, so is there anything that the human could do to change that
Karen Litzy: 20:48 Outside of something pharmacological?
Neil Pearson: 20:50 Well, exactly right. And it would make sense if, if we're getting good effects from different treatments. Like yoga therapy that obviously they must be affecting these same biochemical and genetic and epigenetic things within the human. But they're doing them through the person's own, you know, we can say through their own medicine cabinet.
Karen Litzy: 21:13 Right. That medicine cabinet in the brain that David Butler talks about.
Neil Pearson: 21:17 Yeah. Yeah. And I think we can expand it into the human right. Because there's a, you know, especially even with the endorphins, cause there seem to be receptors for those all over the body.
Karen Litzy: 21:29 Or even, you know, up and coming research into the microbiome and things like that. I think is also an interesting study in pain and how can we alter our diets or can we alter what we put in our system to change the pain experience?
Neil Pearson: 21:55 Oh, absolutely. And I think this, you know, when we get to nutrition, the book actually has a chapter on nutrition. And, one of the things that we find one scan clinically is that some people change their diet a lot and really have very little change in their pain or their quality of life. Other people change their diet even just a small amount and get a massive change. And this, once again is part of the thing that is the complexity of pain care is that, we, you know, as an organism, we are a whole bunch of systems together and sometimes you can change one system a little bit and it really, really changes the organism or the person and others times you change that system a ton and you get very, very little change in the human. And that's one scan, part of the trouble of pain care. But part of the advantage of approaches like yoga therapy is because they're sort of okay with that idea is that everyone's fully individual and we don't have everyone should change their diet this way, or everyone should move their back this way, or everyone should, you know, stand this way or, right, right. It's not a linear model at all.
Karen Litzy: 23:11 Yeah. No, definitely not. And then when you think about pain and you think about it as an experience, and if we're going off of all the different inputs that can be put into the body, that can have impact over one's pain experience, and you think of all the different ways you can alter those inputs, all of a sudden treating the person with persistent pain goes way beyond just movement. Right? It goes into all of those myriad of inputs that you have ability to alter, whether that be as the yoga therapist, a physical therapist, or let's not forget the person experiencing the pain themselves.
Neil Pearson: 23:54 Oh, it's so true. Yeah. And with that last comment, you made, the person experiencing pain, the one thing we were really happy that we did within this book was that's her first chapter. So Julietta Belton wrote the first chapter on the lived experience of pain because we wanted to bring it back to, you know, this is why we're doing this work. It's not, you know, it's not that we're all just trying to understand pain. We're trying to help people. But back to movement, one of the things I think is that physical therapists and yoga therapists, anyone who's doing movement therapy, I think one of the really important things that we can do is start to shift our view of movements as though we can use movement for more than helping a person to be flexible, helping the person to be stronger.
Neil Pearson: 24:39 And within yoga therapy, we often do this. We'll say, you know, when you're in this yoga posture, it's not just affecting you on the physical level. It's affecting you on every level. And so we can actually use some of the yoga postures to help with other issues related to pain such as, so I was thinking about, so,one when we do a seated forward bend. So maybe if you have back pain, it's really hard to do it, but you still can get in that kind of position where you're sitting on the floor. Legs were straight or bent in front of you and your trying to reach down towards your knees, your shins, your feet, wherever you get to. The metaphor here is of learning how to let go so you can move forward.
Neil Pearson: 25:29 And so, we can use a lot of the different yoga postures like that is that we're thinking. So here's a person who is stuck, right? The person is, you know, maybe it's letting go of the need to have a definitive diagnosis because a lot of times that happens and sometimes to be able to, we see the person clinically that, you know, when we're in this multidisciplinary pain management setting, we say, you know, it seems to be this, one of the big things that stuck for this person, they're stuck believing that they need that to be able to move forward. And so we can use movement or postures to try to address other issues like that. Or as maybe another one that makes a little bit more, is more clear. Often we feel a sense of fragility when we have especially low back pain, pelvic pain.
Neil Pearson: 26:19 So if we can get you to come into one of the standing warrior postures, when people, the majority of people in a warrior posture, I'm standing with your arms reaching up or out to the sides. There is a sense of strength and stability and connectedness when you do this. And the really nice thing is we could do those postures from a seated position and people still feel that same kind of thing. And so the idea is could we use movement to effect the person on a psycho-emotional level as well? Could we make that out? One of our goals is this person who doesn't feel strong, feels unstable, feels fragile. Could we use movements not just create physical strength, but to address the other changes that are happening to the person? I think so.
Karen Litzy: Yeah. I think so too. And I love that yoga has got that part and I hope that other movement practitioners start to think, well, you don't need yoga to do that.
Neil Pearson: 27:16 Right? You can use any, you know, think of any movement that we do and how it makes us feel. Could we address it that way. And then the one other thing that movement has tried to address in one of the chapters in the book is the idea of using movements or yoga therapy as an educational agent. So I know your listeners all know about explain pain and that wonderful work there. And what we're doing with explained pain really is it starts with a cognitive behavioral therapy, right? We're changing auditions to change their behavior. And so for a lot of the people that we work with, they may not have learned how to learn by sitting and listening or reading a book. They may have learned how to learn by doing. And so one of the things we're playing around with is the idea of when a person has ongoing pain, could we get the person to move in a way that could sort of, when the person moves that way they feel an increased sense of ease or they get some increased movements. And then you use that change from the movement as the educational agent.
Karen Litzy: 28:21 Saying like, look at what your body can do. Yeah, same thing.
Neil Pearson: 28:26 Yeah. Well you can start with, wow, that's awesome. Your pain changed, right? Because that's one of the core messages of explained pain is that right? Changeable. So instead of telling the person that pain is changeable and explaining it to them, if you can get the person to do something and at the end of it, they have less pain or more ease of movement to say, look, it changed. And of course the next step is, and you did it. And so I would then jump into, let's look for all the other things that you could do to actually change this, which is saying to the person your pain is changeable. And you have some influence in it, which is part of what we're trying to do with pain.
Karen Litzy: 29:09 Yup. Yeah. It's like giving them the keys to the car.
Neil Pearson: 29:13 Exactly.
Karen Litzy: 29:13 Right. And having them be in the driver's seat versus feeling like they're the passenger and the pain is in the driver's seat.
Neil Pearson: 29:24 Oh yeah. That's a really great way of saying it. And I think clinically what we want to do is both with people we, you know, we want to find a way to integrate these things, but I really, really believe that there's a lot of the people we work with would understand pain better if we got them to experience it. Experience what we're trying to tell them.
Karen Litzy: 29:47 Yeah. And we know experiential learning for a lot of people is something that sticks.
Neil Pearson: 29:54 Exactly. Yeah. And I think that's the thing is that there were a whole bunch of people that when we explained pain, it changes their cognition, but it immediately they get it, they understand it. It's powerful enough to change their behavior. But then there's other people then some of the research shows this now is that some people have this sort of partial reconceptualization of pain. They understand everything you told them, but they don't apply it to themselves. And so what you're going to need to do at that point is get the person to have the physical experience that matches up with the cognitive experience. And I guess what I'm saying is that what we could do is use the movement practices of yoga or any kind of moving practice for some individuals as the educational agent first and then, I think we need to start to play with that because some people just don't learn well when we talked to them, at least not as well as they do with the physical experience of it.
Karen Litzy: 30:58 Yeah. And I think as the therapist that you can kind of get a sense of this after one or two visits that okay. It seems like they understood, but yet they're not able to apply this to themselves or are they kind of come back to you with the same, I don't want to say the same complaints cause that's not right. But with the same maybe problem solving outlook that they did before when you know, you've kind of spoken about pain and maybe how pain works, let's say from explaining pain and they're still coming back to you with this same idea. The same. I did this so I must have done something wrong. And that's why it hurts because I keep doing this to myself.
Neil Pearson: 31:55 Exactly right. There was something in what you said too that made me think that it's possible that that person coming back, doesn't have the coping strategies that match up with the new information that they learned. So the person's, you know, coped by being saved, being tough and just sucking up and gritting your teeth and pushing through it or coped by fear avoidance. And so we've given them this new information, but the person that hasn't, when the pain worsens, they go back to the coping strategies that don't match up with the new paradigm.
Karen Litzy: 32:29 Right. Yeah. And that was really hard for me to do as well. So what would happen, and I'll give an example of what that means. I think you correct me if I'm wrong, but I used to get a lot of neck pain in my sleep so I'd wake up and kind of feel a pop and then wouldn't be able to move. And what my original coping strategy was hi, I have to call off work today because I need to stay in bed. So I would stay in bed. I used ice, I would use heat but I wouldn't move and that did not do well for me cause like it would help in the short term maybe that day. And then I'd be able to get back into things the next day. But I was still in an awful lot of pain. I mean, maybe I was a nine out of 10 and then I was at seven out of 10 but the seven out of 10 I could function. You know what I mean?
Neil Pearson: 33:24 Yeah, absolutely.
Karen Litzy: 33:25 Until I started going through explain pain and moving more. So now if I wake up and I feel that pain, my first thought is not, Oh, I better lay in bed. It's okay, let me get up, let me start stretching, let me start moving, let me go to the gym and at least get on a bike. And now, because that's sort of my new shift in thinking that maybe the pain will last only one or two days and not forever. Because before it was this high level of pain with a higher spike. And now it's just little to no pain with a spike or a flare up, if you will, a couple times a year. But knowing the moment I feel that, that I get my butt to the gym and I realized that movement is the thing that helps and that I shouldn't be fearful of that. So for me, that was the input into my system that helped and everyone is different of course, but I think that's a real life example of what you just said.
Neil Pearson: 34:27 Yeah. And I think it's great one because what you've said is that what you've found is that you can change the pain and the ease of movement through movements, but also I think what you're saying as well is there's somehow there's a different relationship with your different perspective on it. You're understanding it in a different way.
Karen Litzy: 34:48 Yeah. It's less as this sort of monstrous threat that's going to take over my life for the next couple of weeks, days, months versus now. It's like a little annoyance that I know I have the coping skills and the mechanisms at my disposal that I can make a change for myself versus going to a doctor for a quick fix of a pain medication or something, which is what I used to do.
Neil Pearson: 35:22 Yeah. Well and what I'd say is, well as within yoga and yoga therapy is that a yoga therapy will offer you more on expanding a number of coping strategies or alternatives. We often think of as making people more flexible in their body, but it actually makes us more flexible in how we adapt or modify things when pain persists. So, you know, you wake up in the middle of the night, maybe one of the things is that I'm laying there and actually taking your attention to the pain and exploring the pain. Actually spending some time doing that or the practice of noticing what's happening to your breath. So now or changing your breath or noticing what's happening in your body tension or changing your body tension too. Within yoga there's many, many different ways that you can try to impact things. We often say we want to do practices that have to do with awareness because awareness practices in and of themselves can be a beneficial when we have ongoing pain.
Neil Pearson: 36:28 And then there are other practices that are about regulation. So, you know, getting you to breathe in a certain way or hold your body in a certain way or move your body in a certain way or think a certain way. So with the awareness you can have awareness of your breath or your body or your thoughts or your emotions or your energy or the pain. And the same thing with regulation. You can regulate any of those and start to see what happens when you do either of these things. But then the one other bit you said too was about discernment is what you've learned. You've, you know, you've changed your view of you. You're now when you feel the pain, you can discern more about when the pain is like this, I need to do this. And when the pain’s like this, I need to do this. And, I think that's another positive that people can get or the practices of yoga therapy is that you start to actually understand your pain better, right? Be able to discern different aspects of it or different strategies that you need to do at different times where often when we have chronic pain, it's almost like we lose coping, right?
Karen Litzy: 37:37 Oh, there's no question. You lose everything. You lose all perspective on yourself as a human being, you know? I mean, even as someone like me who is, I was a physical therapist when I first had all of this pain and you just completely, everything I learned as a PT flew out my brain. It was gone because all you want is for the pain not to be there. And the reason you want the pain not to be there is because you want to have a life with more choices and more possibilities. Whereas when people are in pain, their choices are you get up, you go to work and you come home. If you can even make it to work, those are your choices. That's all you have. You know, have kids, maybe it's struggled to take care of your kids or suffer through taking care of X, Y, Z. Right? Versus when you don't have pain, your options are, I can get up, I can go to the gym, but I can go to work or I can go to the gym, meet up with friends, go on vacation, you know, clean my apartment, go play sports. So all of a sudden you have a life of very little choice and possibilities to an opening of your choices and possibilities. And it's just because you don't have that pain anymore.
Neil Pearson: 38:53 Right. And I think that's one of the beauties of the practices that allow us to start to explore are there things that we actually can do for ourselves to try to change this? Or are there things that people can help guide us to be able to do that? Because I think when we're in that huge pain, what we're looking for is, you know, the thing that will just stop it, of course. And you know, we're living in society where the approach mostly is to look externally. And then one of the troubles that people have sometimes when they start to hear about yoga therapy and sort of the self care part is just this idea that it's almost like it's all up to me, right? You're telling me it's all up to me and what we want to say is no, that that doesn't really work well or we want to do is say, what you need is the expertise of a PT or a yoga therapist or an OT who can help to guide you and be there and you know, cheerlead you and coach you and help you through this.
Neil Pearson: 39:53 Because this is really, really hard stuff. You know, learning the techniques of yoga, if people really immerse themselves in it, they'll typically say, this is hard to do. Well, it's way harder to do when you're in pain. Right?
Karen Litzy: 40:09 Right. And you don't want to think like, Oh, I have one more thing I need to do now. I need to do this. I've got all this pain, now I need to do this.
Neil Pearson: 40:17 Yeah, yeah, true.
Karen Litzy: 40:19 But yeah, when you position yourself as the guide, you know, I've been reading this book by Donald Miller called the StoryBrand. And in it he talks about the guide who would be, in this case, the yoga therapists and physical therapists and thinking of them as like the Yoda and the student or the hero, he calls them the hero of the story, which would be our patients would be the heroes of our stories are like the Luke Skywalker's. So they're coming to you for guidance, you're helping them, you're giving them the tools, the confidence, in this case, the movement, the education that they need to go out and be the hero of their lives.
Karen Litzy: 41:00 So it's not like, Oh, one more thing I have to do. If we can reframe that for those people in pain, it's more like let us guide you so that you have so much to do.
Neil Pearson: 41:13 Absolutely. And you know, there's one other piece that I just want to tack on the end because I'm sure you have some people here listening who have ongoing pain is that one of the really difficult things, and I know some, there's been some blogs talking about this recently that has importance is when we work with an individual who has ongoing pain, actually don't know what the outcome is going to be. I think we can be pretty certain that we can help people to be able to move with more ease and to have some less pain and to, you know, get quality of life. But somehow we need to say to people that, you know, when you do these things, you might be the person who says, you know, the pain is mostly gone and I really can do most of what I could do before.
Neil Pearson: 41:56 Or he might be the person who says, well, you know, the pain is better, but it's still there. But what you've been able to do is show me how to get back to allowing my life. You know, the pain is less, but I'd be able to get back. And then there's this other group that will say, you know, it doesn't seem like the pain really is changed at all, but you know, if we've been successful with them, the person will say that, you know, even though the pain is there, you've helped me figure out how to live and have pain. Right. And I think that's one of the struggles that people have when they hear us talking about pain management, is the struggle between you're looking for wanting so much the thing that will stop all the pain. But then not really recognize where maybe recognizing the ideas that for some people that's not the outcome.
Karen Litzy: 42:50 Right. Yeah. And I try and, you know, and that comes, I think as the therapist, I think that comes, that's something that I think experience helps a lot. The experience of the therapist helps a lot because you kind of have a little more confidence to say to the patient, Hey listen, the goal here is to get you doing the things you want to be doing. You may still have pain doing them, but you can do everything you need to do. Would you be okay if you had a small amount of pain and were still able to do everything you want to do? Cause our goal here is not complete elimination of pain or, I mean, yeah, I guess that is the ultimate goal, but being realistic, we have to tell the patient, Hey listen, this may not happen. What if I told you you could do everything you wanted to do and the pain might be there if doesn't really, you're not suffering. It doesn't bother you that much. Would you be okay with that? And that's a hard conversation to have.
Neil Pearson: 43:51 Yeah. Well, you know, in the yoga world is it's somewhat easier because anyone who's a yoga therapist has, I mean that's what we've learned. That's really what yoga says is that we will have pain, we will have suffering in life. And the whole practice of yoga and yoga therapy is to actually learn how to live with it and decrease it. But it's not, you know, it doesn't have the goal of saying there's going to be none.
Karen Litzy: 44:21 Yeah. And I think that that's important. It's important to tell patients. And that's the one thing, this is a total rant on my part, so apologize ahead of time. But you know, when you see websites and they're like eliminate your back pain by reading this free resource, well, that drives me bananas and it drives me crazy as a person who did have chronic pain for many years, you're searching for that thing and if someone puts it out there and then you read it and you're like, my pain is the same, I would be like, screw you. It didn't help my pain. It's like a crappy thing to do to someone because I feel like you're praying on very vulnerable people by doing that. And I think that's why.
Neil Pearson: 45:08 Yeah, I agree all the way. I mean, it's just not truth. It's a marketing stick.
Karen Litzy: 45:14 Right.
Neil Pearson: 45:15 I'm like you, it enrages me. It's hard not to be the police though, right? You want to jump on and say, what are you saying then? And we know that, you know, within our professions, really within all the healing professionals or helping professions, there are people who unfortunately use language like that. Hopefully at some point we will be more compassionate.
Karen Litzy: 45:40 Yes. Yes. I hope so because, Oh man, that is something that just drives me crazy. But I digress. Let's get back to the book. What do you hope people take away from the book after reading it?
Neil Pearson: 46:05 Well, I guess the biggest thing that I want people to take away with is this idea that yoga therapy is something we should consider as a one of the paths when people have ongoing pain. Overall, that's what I want people to do. You know, we don't think that yoga therapy is the answer. But we see it as something that can be integrated within our Western medical world with people with chronic pain and so integrated into that system. But also it allows more access because people usually can get to yoga therapy for less of a cost than they could to medical practitioners. So it's more just to see it as you know, as we've talked about, there's this view of what yoga is. Well, yoga is something different from that. And it actually does make sense as one path to consider when we're working towards recovery when pain persists.
Karen Litzy: 47:01 Absolutely. And now before we end, I have one more question for you. And that's knowing where you are now in your life and in your career. What advice would you give to your younger self?
Neil Pearson: 47:16 Oh, wow. You know, after I graduated as a physical therapist, I spent the first four and a half years working in hospitals and worked, trauma, ICU. And I worked in a neonatal ICU and cardiac care and all these things. And, the thing that if I were to go back to that spot, I would say, Hey, you're doing the right thing. It's funny because a lot of my colleagues were working, you know, we're stepping right into private practices. And by being in that situation, what I not only did I started working as a physical therapist with this umbrella of protection because there were all these other people who are also working with the same patients in the hospital. But I learned such a humanistic view of what I was doing.
Neil Pearson: 48:10 I guess that's because a lot of the stuff we were doing in the hospital had to do with life and death. Now when you're working in a trauma ICU with neonates and so I think you know, cause I know there was a lot of pressure I wanted to work in, you know, sports medicine and in private practice. There was pressure not to be in the hospital. So I guess I'd go back and say you're doing the right thing cause it really helped me to see the person more than the low back or the shoulder or the knee.
Karen Litzy: 48:50 Yeah. You know, I worked in a hospital first as well when I first graduated from PT school.
Neil Pearson: 49:00 There are some advantages to that.
Karen Litzy: 49:04 Yeah. Oh yeah, absolutely. I think it like really increases your empathy and your communication skills. Cause you're like you said you're dealing with pretty sick people. And I wouldn't have traded that for the world. All right, so now where can people find the book?
Neil Pearson: 49:28 Well the books on Amazon. Awesome. So that's probably the easiest place to find it.
Karen Litzy: 49:34 Yes. So we'll put the link in the show notes. So if people want to go to podcast.healthywealthysmart.com, they can just click on this episode and go straight to the book.
Neil Pearson: 49:47 Great. And if people want to learn anything more about the other things that I work on. My website is paincareu.com I'll share that as well with you on there. You can learn about the pain care yoga training that I do and I have a distance professional mentorship that I do for health care professionals as well.
Karen Litzy: 50:11 Nice. That's awesome. And because you're up in Canada, right?
Neil Pearson: 50:16 Yeah, that's right. If you're in Vancouver and you drove East of it four and a half hours over a couple of mountain ranges, I'm in the Okanogan Valley of British Columbia.
Karen Litzy: 50:26 Got it. Kind of. It is so big. Well Neil, thank you so much for coming on. This was a great conversation. I think it's going to give people a lot to think about when they're working with those patients in pain. So thank you so much. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Keats Snideman on the show to discuss the non-traditional path to physical therapy school. Keats Snideman is a results-driven Rehab and fitness professional with over 20 years in the Fitness/Athletic Performance and bodywork industry and most recently the field of physical therapy.
In this episode, we discuss:
-How Keats’ background in health and wellness enhanced his learning in PT school
-The personal and professional pros and cons of being a non-traditional PT student
-The benefits of diversity within a PT cohort
-Time and resource management to avoid burnout
-And so much more!
Resources:
Keats Snideman Twitter
Keats Snideman Instagram
Keats Snideman Facebook
Reality Based Fitness Website
Email: ksnideman@gmail.com
For more information on Keats:
Hello, my name is Keats Snideman and I am a results-driven Rehab and fitness professional with over 20 years in the Fitness/Athletic Performance and bodywork industry and most recently the field of physical therapy. My educational background includes a doctorate in physical therapy from Northern Arizona University (PHX Biomedical campus) and a B.Sc in Kinesiology from Arizona State University. Other certifications and titles held include: Certified Strength & Conditioning Coach (CSCS), Certified Orthopedic Manual Therapist (COMT, through OPTIM Manual Therapy), a Strong First Gyra (SFG) Level 1 Kettlebell instructor, a certified Kettlebell Functional Movement Screen Specialist (CK-FMS), a certified neuromuscular therapist (CNMT), and a licensed massage therapist (LMT) in the state of Arizona.
Read the full transcript below:
Karen Litzy: 00:01 Hi Keats, welcome to the podcast. I'm happy to have you on. So today we're going to be talking about the non traditional path to physical therapy school. And the way we're kind of defining this nontraditional path would be you didn't graduate from high school, go to undergrad and right into physical therapy school. So there was some time off in which you had a completely different career. Well, yeah, a different career and then decided to go into physical therapy school a little later in life. And I use that in quotes when I say that. So what I would love for you to do Keats is can you kind of tell your story to the audience so they get to know you a little bit more?
Keats Snideman: 00:45 Yeah, absolutely. So like a lot of PTs, I have a fitness background, I ran some college track, got into working out and decided to become a personal trainer. This was like mid nineties, so quite, quite a long time ago. And that sort of led me down a little bit into the sort of functional fitness was kind of becoming a thing kind of in the 90s. And people who are beginning to use that word function a lot. I have a twin brother also in the fitness world and we got exposed to a gentleman named Paul Chek. He's the guy who kind of popularized the Swiss ball, the physio ball doing the weight training on it, standing on it, doing all that crazy stuff. This was in like 97 to 99. And Paul Chek was also very rehab oriented, not a physical therapist himself, but started opening my eyes to sort of the world of sort of biomechanics and you know, it's sort of high level physiology, and started reading, you know, more technical sort of physical therapy type books and it really interested me and I was like, wow, there's more there than just being a personal trainer.
Keats Snideman: 02:00 So I sort of made a decision at that point that I wanted to go on and get, I think it was a masters degree. Most of the programs at that time. But then life happens. Got married, had our first child. I had my own business and eventually I went back to school to finish my bachelor's degree at Arizona state university. And really had the idea of going kind of into PT school pretty quickly after that. Had another child, open up a different location for my business. And time just goes by, you know, very, very quickly. And the next thing I knew it was 2012, 13. I was like, if I don't go to school now, I'm never gonna do it. But all the time through that I ended up getting a massage certification or I got in the early two thousands.
Keats Snideman: 02:47 So I started putting my hands on clients who needed it. I started getting some soft tissue clients and basically really trying to find out, you know, what's the best way to use that tool? Cause I wasn't really like a massage person per se. I kind of came into the sort of the manual therapy body work world as more of a fitness person. How could I get somebody out of pain is pretty much the number one thing why people were seeing me so that I could get them more active to get them more mobile, that really fits in to what a lot of physical therapy does. Sort of our modern understanding of pain as it's changing that the therapy is just sort of a, you know, like a brief reset to try to then help, you know, we get that window of opportunity to try to make a change.
Keats Snideman: 03:43 And so that, you know, that finally allowed me to make the decision to go to school because I want to be able to do more than just what a massage therapist can do. And more, you know, I wanted to be able to do, if I want to do a joint mobilization or manipulation like a chiropractor could do, you can't do that as a massage therapist. And so that was the final decision. I closed up my shop, I went back to school, I bit the bullet. It was a very challenging road, but even with the family and everything and I got through it, finished a few years ago and here I am.
Karen Litzy: 04:18 And I mean that's quite a story and we'll get into some of your words of wisdom and advice for other people who might be in the situation where they have a family, they have children, they don't know if they can do this because it is very time consuming. But before we get to that, I would love to know if you could name a couple of your top struggles during PT school that you were obviously able to overcome. Cause you did graduate, you're now a physical therapist. So give us some of your struggles and what you did to help get over them.
Keats Snideman: 04:53 Absolutely. So I would say the first thing that was really, really the hardest for me and my program was at Northern Arizona university. And we were the first class to be sort of accelerated instead of a three year program. It was a two and a half year program. So we didn't get really a lot of breaks. So the coursework I think was condensed a little bit more. And so that meant a little bit higher level of information that we were obtaining. So that first semester was a bit like hazing for me. I've constantly been learning and taking continuing education courses my whole career as a massage therapist, personal trainer, strength coach. But I wasn't quite prepared for the onslaught, sort of the drinking from a fire hose type of thing, if you will, that that first semester did.
Keats Snideman: 05:42 And I end up getting a C I think in pathophysiology, which was, it was like in memorizing a thousand PowerPoint slides and two every two weeks. It was brutal. And that put me in academic probation. You can't get a C in PT school. I mean, are you going to get many of them C B’s and above? And so that was, you know, I was worried, I thought, man, am I gonna flunk out? You know, I just started after all this, you know, what am I going to tell my family? This is terrible, but I got through it. The rest of my grades were actually quite good after that. But if you haven't been sort of in the academic setting for a while, you've really got to kind of give yourself a little bit of an adjustment time and not be so hard on yourself to the expectations for like getting these great grades needs to be tempered because it's intense.
Keats Snideman: 06:35 Obviously you went through it. The amount of information that a physical therapy student will be exposed to is pretty insane. I know medical doctors get a tremendously crazy amount of sort of, you're sort of a general as first, but I think PTs have gotta be some of the broadest sort of scope practitioners out there and me, it was sort of like med school light, you know, a lot of our classes are actually with PAs because we were actually kind of getting sort of the university of Arizona medical curriculum that was given to the PAs at NAU and we were sort of teamed up there with them and some of the occupational therapists as well. So that was my biggest struggle was just the amount of information was just overwhelming. But once I kinda settled in and really focused more on comprehension and learning instead of just getting good grades, I've never been a grade person. I couldn't really care less, unfortunately you need to get good enough grades to pass and then not get kicked out of the program. But I've always been about, I want to understand. So I think if someone who hasn't been in school in awhile, kind of a non traditional student like myself, you've gotta be easy on yourself and you've got to give yourself time to adapt and to adjust to that, just that amazing, wildly overwhelming amount of information that you can get, especially in that first semester, that first year.
Karen Litzy: 08:07 And how did you balance the amount of information, the studying the comprehension. And I liked the fact that you said you're there to learn and comprehend, not just memorize, but that was in PowerPoint slides which I think is great advice for anyone. But how did you balance this with a wife and two kids?
Keats Snideman: 08:27 It wasn't easy. I wouldn't really say that you can, it's not balanced and you know, the family has to be on board. Obviously my kids are a little bit older. My wife obviously she knew how much this meant to me, so she was very supportive. I wasn't able to be as involved with my kids and their sports and stuff. So there's definitely sacrifices. You can't pass PT school. Even if you're just a single younger person who doesn't have any problems, your life will not be balanced if you are in any doctoral program, especially one like physical therapy. So I wouldn't say I really balanced it, but when I had the time and I needed, because you can't just study, study, study, study, you will literally burn yourself out and there comes to a point, kind of like a sponge that's just saturated with water.
Keats Snideman: 09:15 It won't take any more. It just doesn't work. So you have to give yourself little breaks more frequently. And for me, you know, I grew up sort of this ADD never got diagnosed until I was an adult. That's even more important cause I think my executive functioning skills burn out very, very quickly. So I do very well with like the Pomodoro technique where I do like 25 minutes and then take a five minute break or maybe that's 15 minutes, right? Things like that where you do like little mini sprints rather than a marathon of learning. So you give yourself time to get into what's called like a diffuse mode of sort of learning where you have the focus mode, where you're really putting a lot of effort, but then you gotta just walk away, go for a walk, juggle play ping pong. We played a lot of ping pong. If you have a ping pong table and you're like, that really got me through school. I love ping pong. I love it. I have a thing on the table in my house. And just doing something completely different. I'm very much into exercise activities, sprinting, little mini workouts, little mini resets. I feel that helped get me through it. You can't just sit there for hours upon hours and hours. You will just literally just be wasted time.
Karen Litzy: 10:35 Yeah, that is wonderful advice and I think that carries over nicely even when you start working as a therapist as well. Great advice. Now let's talk about some of the positives of going back to school as a nontraditional student.
Keats Snideman: 10:58 Yeah. Well for me, there's a lot of positives because I had already been working with people for so long as a personal trainer, a strength coach and a massage therapist and sort of a hybrid of all those kind of at the same time that I've been dealing with people for so long. And a lot of these young millennials that are just, you know, like you talked about more traditional which is definitely a good way to do it. Don't get me wrong, I kind of wish I had done that, but they don't have sort of the life experience and the ability to deal, I think with a lot of the psychological and more of the interpersonal issues that will come up when you're dealing with people in pain and dealing. Like once you lived a little bit longer, I feel like you just get it a little bit more. A lot of people in PT, at least sort of in traditional outpatient or even acute, they're a little bit older and I feel like you can relate to them a little bit better.
Keats Snideman: 11:51 And it helps me to think about something like soft skills that the professors would talk about and I'd be like, wow, I guess I'm kind of lucky in that respect because I'm older. I kind of already have had to develop those over the years. Those interpersonal communication skills and they would tell, you know, my classmates, these younger sort of millennials that it doesn't really matter what you get. Like, yeah, you got to pass the boards, you gotta pass this, you gotta be smart. But you know, being first in your class, like it doesn't mean you're necessarily gonna be the best therapist. And nobody's going to ask you, Hey, Karen, you know, can you tell me what you got on your NPT boards, et cetera? Oh no, that's too low. I want to work with this person over here.
Keats Snideman: 12:36 Or Hey, what'd you get in your patho though? First? Because it doesn't matter, right? You've got to get through it. You can always, you don't need to memorize everything, just you need to know it enough to pass the test. But the most important thing in physical therapy is your ability to empathize, to be empathetic and to deal with another human being that you're dealing with. And I felt like as an older student that was something I kind of already had. So that was like a big plus I think. And when I'm working with my a little bit older clients and patients, I think that helps. So that's a big plus that you can't really get except through time and going through all those different sort of client and patient interactions over the years that will sort of, you know, cause you have these fits sometimes with clients, they don't work well. You don't always buttheads so you develop a certain amount of grit that I think as a bit of an older student you don't have to develop as much as the newer, younger ones.
Karen Litzy: 13:45 I think that’s a huge positive. I mean experience counts. Experience counts. What other positives did you find even maybe as you were going through the program or looking back on it now?
Keats Snideman: 14:03 Well for me with my background and there were other students in there that were like in their thirties. There was one other guy in his forties, you know, it was like the real grandpa. He, you know, he was a little younger than me. But my background was in fitness and in massage. So I had already kind of educated myself a lot on anatomy and physiology. Since we had this sort of medical curriculum. We spent like six weeks or something on the organs and the guts and I didn't really know that too well, so that was pretty hard. But the rest of this stuff sort of with my background wasn't too hard in terms of it's like I felt like I had already prepared myself for that. Contrary to popular belief, you go to PT school more to learn about differential diagnosis and how to not really hurt somebody, you know, it's more like med school light than it is about, like, I'm going to become sort of a mild personal trainer. Like you don't spend a ton of time on the ins and outs of exercises.
Keats Snideman: 14:57 They sort of say, well you're going to get that in your rotations. So a lot of people who are more non traditional that had come maybe from like insurance or a different world, they didn't have a much of an exercise background as me. They were really looking for that in school and we didn't get that as much. It's not really what it's about. You get that more on your rotation. So I felt like my previous background had made up for that gap that we weren't going to get in school. I had already sort of gone through the sort of the painstaking self studied it just really sort of figure out like you know, which exercises are appropriate for all the different muscle groups and movements and doing sort of like a needs analysis for the sport or the activity.
Keats Snideman: 15:52 Cause that's not really what you're getting in PT school. And I think people don't always understand that they think they're going to learn like everything about exercise. And that's kind of not what it's about. It's more like I keep saying sort of like this being sort of a primary care provider light. You know, and now most States have direct access. So, you know, like taking blood pressures, understanding cardiovascular concerns, understanding pharmacology and like the basics of like protecting, these are real things that are very important that that's what I got out of PT school the most was sort of that thing being sort of, I'm trying marry care provider and the exercise stuff is sort of secondary.
Karen Litzy: 16:40 Yeah. So because you had had this other career before you came into PT school, you were able to kind of be on top of your game I guess. And like you said, you were able to fill in some of those gaps in PT school with what'd you already knew. So that is obviously a huge positive. Any other positives that maybe if someone out there is thinking, Hmm, maybe I want to go into PT school, but I'm like over 40 or I'm over 30 or 35, you know, or I'm married, I have kids. Were there any other positives that maybe not even related to physical therapy but maybe spilled over into your home life or your personal life?
Keats Snideman: 17:19 Well I think it was good for my teenage boys to see that even as an older adult that, you know, the amount of effort they saw, how much I was putting into it, how much it meant to me to just to show them that if you put in the work at any age, like you can still do some pretty cool things. And, you know, you can teach an old dog new tricks. I mean, I think the younger brain learns a little quicker. I don't think there's a lot of debate about that. You can still do it. So for me, I think the positive was it gave me a sense of belief that if I'm really determined that I can find a way. So gave me like a new level of confidence in myself that I have the grit that I have, that I had to take the GRE three times.
Keats Snideman: 18:09 And for those who don't know, that's the graduate record examination that's put on by the people who create the SAT. So it's sort of a SAT for college grads and I hadn't done like high school math, since like 80s and early nineties. So, you know, I did well on those other parts, but I just couldn't remember like basic stuff. I had to get the book. So it gave me sort of a new level of confidence that, you know what, even when things are really tough and you feel like you can't get through, like you can and you know, and you just got to kind of plow through it, like the time will go by anyway. And you just gotta figure it out. How can you work with yourself? To try to, you know, accomplish the goal as challenging as PT school at any age.
Keats Snideman: 18:54 It's challenging but definitely harder if you have a family you've been out of sort of that test taking mode. I used a lot of like some of these other like apps where it sort of makes you keep doing the ones that you're not good at. Cause you do have to memorize some stuff for the test. Let's face it. But if you take the time and you're just, you don't be so hard on yourself, you can get through it, you will get through it.
Karen Litzy: 19:25 Absolutely. And now again, the question I ask everyone on the show is, and I feel like you kind of just answered it, but I'm going to ask the question anyway because maybe you have a different answer, but what advice would you give to yourself, your pre PT self knowing where you are now in your life and in your business and in your work? What advice would you give to your pre physical therapy school self?
Keats Snideman: 19:54 Well I think I was very hard on myself for like initially doing poorly in that first semester especially in that pathophysiology class. But I really thought that I could get through it easier. You know, I just thought like, Oh, this, you know, this is going to be good. I've already sort of learned a lot on my own. I sort of underestimated. So I scheduled my sort of personal training and my sort of my whole clientele in a way that was not realistic. So, you know, working I think is good if you can do it, but giving yourself sort of the permission to say no to certain things that this is an important commitment. And that, you know, not to beat myself up that I'm not earning as much as I could potentially earn by working more because this is an important goal and I need to focus, you need to get it done.
Keats Snideman: 20:56 There'll be plenty of time to work after, but I did work throughout my whole schooling. I was trying to bring in a couple thousand dollars a month, you know, for my own clientele. And I did, but that was about probably about a third of what I had originally sort of thought I could do. So I did have to take out a little more loans than I wanted to, but once I sort of realized that it's okay, that sort of like lowered that stress levels for myself, that just is a huge commitment that I've put on myself that I can do, I could commit to all these different elements. And there's only so much time in a day. Like, you know, there's only so much energy you have, you know, sort of like money in a bank. You don't have the, we call it like units of energy.
Keats Snideman: 21:40 I don't have a hundred units of energy for school and a hundred units of energy for my family and a hundred and some energy for my clients. I have a hundred units total and that's what I sort of figured out. So I would give myself the advice then manage your units, you know, manage your physical and emotional capital because there's only so much and you just have to be realistic. And I just, I was not realistic with myself with what I thought I could do versus the reality. And once I sort of kind of had that sort of come to Jesus moment, I was better cause I was okay with it.
Karen Litzy: 22:13 Well I think that's great advice. So giving yourself permission to prioritize things in your life and doing it all to 100 percent. Excellent advice. Now is there anything else that you wanted to let the listeners know before we sign off about being that nontraditional student in physical therapy school?
Keats Snideman: 22:34 I think we need more non traditional students. I mean I think it only helps the programs. I think if any of my classmates that are listening to this, hopefully they are, they can agree. I think a lot of people appreciated me in the class because I would ask the questions. I find if I didn't, interesting kind of being with sort of this younger generation, it's like they're just programmed and it's kind of like robots that just like get the information, figure out how to you know, memorize it, regurgitate it on a test, move on. And it's more about like passing and getting to the next level than it is about mastery and comprehension and not a lot like questions are asked about things that I thought maybe that the teachers explained that were confusing. So I would ask the questions, I'd be like, well what about this and what about that?
Keats Snideman: 23:32 And because I'd been in the real world for longer. So I think having that older student and maybe some people thought it was a little bit annoying and that's okay. I'm okay. To me, I’m that guy, because I think it was helpful for the betterment of the class. And when you have somebody who's lived a little bit longer, like you just don't care as much. You just, if something's important to ask, it's important. Like you don't have to go, Oh, I'm not going to ask cause I don't want to like offend anybody or you know what I'm saying? So like having those little more seasoned, non traditional students, I think it spices things up a little bit. And I felt that I kind of provided that for my class and it really sort of, it kinda helps sort of broaden the curriculum by bringing in more real life experience of working with people.
Keats Snideman: 24:25 Not that I was a physical therapist, but I was working with people in pain, working with people who had weakness and you know, fitness issues, which is what we do a lot in PT regardless of your setting. So that's my advice is that if you’re really, really passionate about helping people in that domain, that we need more nontraditional, a little bit older students in these programs because it really helps to just sort of broaden the scope because of what we can bring with our experience as everybody else in the class. Everyone has their own experiences. Even, I mean young, middle age, older, it's all good. Like to have a variety instead of just everybody being the same. Like I'm all about diversity and I think we should just embrace more diversity. And like I saw something on the news, I think it was the other week on CBS or something and it was some guy like he was like a car mechanic and he went back to school like in his late fifties and he got his medical degree that just like, I love it. That's stuff just like juices me up and he's bringing all his experience to that program. That must have been really neat for the other students.
Karen Litzy: 25:37 Yeah, I could not agree with you more. And now where can people find you if they want to chat about your experiences or if they have any questions for you?
Keats Snideman: 25:47 Yeah, I'm a pretty Googleable guy. I've got a couple of websites that are sort of in shambles right now, but if you just Google my name, Keats Snideman, I'm on Facebook, I'm on Twitter and Instagram. I think it's a @coachKeats and then I think it's Keith Snideman is what I'm on for Instagram. I'm trying to figure out this whole social media thing. For my own business. I do a combination of PR and work and then just my own, I'm too much of an entrepreneur to work full time for anybody else. But if anybody wants to email me, it's ksnideman@gmail.com. I love helping people who are non traditional to sort of, you know, make the decision. I mean it's not for everybody, but if you're on the fence, I talked to people frequently who sort of find out about me and I would love to talk to you about it.
Karen Litzy: 26:43 Awesome. Absolutely, all of that information will be in the show notes for this episode at podcast.healthywealthysmart.com so that people can one click and get to you in any way possible. Perfect. We'll have it all there. So Keith, thank you so much for taking the time out while you're here in New York, dropping your son off at NYU.
Keats Snideman: 27:01 I know. Crazy. Yeah, it's been a blast. I'm so glad we got to meet up today. I've always wanted to, you know, talk to some other PTs when I come out here and I'm just, yeah, I'm very, very glad that I was able to get on your show. I've been a big time fan of your podcast when I was a student. I'd share it with my fellow classmates. Your doing an amazing job of just getting amazing people and concepts out into the world.
Karen Litzy: 27:26 Well, thank you very much. And, I again, thank you for taking the time today and everyone else have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this week’s episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Cameron Massumi on new graduate engagement within the American Physical Therapy Association. Cameron Massumi, SPT is the president of APTA's Student Assembly Board of Directors.
In this episode, we discuss:
-Cameron’s passion for new graduate engagement within APTA
-Inclusion and diversity within APTA
-How to engage in networking events
-Ways you can get involved within your professional organization
-And so much more!
Resources:
Cameron Massumi Twitter Outcomes Summit: Use the code LITZY for discount
For more information on Cameron:
My name is Cameron Massumi, and I am the President of the Student Assembly Board of Directors. I believe that APTA serves an integral role in ensuring the future of our profession through advocacy, public awareness campaigns, and the sharing of a unified vision. However, there is, unfortunately, a marked decline in membership as students graduate from PT school and become active clinicians. It is my goal to stop this from happening and hopefully bring new graduates back into the APTA. My strong background in sales and marketing as well as my leadership experiences prior to entering PT school will allow me to bring a unique skill set to the Board of Directors. I
will use these skills as well as my connections to ensure membership and engagement increase so our profession can continue to grow and become stronger. My vision is that through my leadership the student assembly can help promote awareness of the profession, increase diversity, and boost member retention. As a profession we need to collaborate, innovate, and strive for excellence. APTA is the best tool to ensure the success of our profession so that we can #MoveForward, so let’s get together and create some real change. After all, we’re #BetterTogether!
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor with healthy, wealthy and smart. I'm here with Cameron Massumi who is currently the APTA student assembly president, all those things, however you prefer to pronounce it. First of all, Cameron thank you so much for coming on. First of all, it is a joy to interview this gentleman before we go into our topic on new grads. Cameron is one of those rare bulls who has massive stamina where he ran twice to become part of the student assembly. And that alone just shows that if you've seen the movie Rudy where he never gives up on his dream, Cameron, you definitely exemplify that. So thank you for being a person with the stamina to run again. And very, very well represent students at large.
Cameron Massumi: 00:49 Oh, thank you for that Jenna. I have to say that I wouldn't say it's a stamina aspect more than it's just perseverance. I think you really learn from your experiences. I did run twice the first time I was unsuccessful. But I'd say that I gained a lot of knowledge from that. You know, you learn a lot about who you are. You really take the time to do some introspection and see what are the areas that you're most passionate about and you find ways to stay motivated and stay involved. I was thankful to the previous board. The students tell me they really helped me find an area in which I could contribute. And so I was a member of the professional advocacy committee and did some work on playing national advocacy centers and then did what I could to stay involved and really kind of figuring out what I would like to work on the next time around when I applied.
Jenna Kantor: 01:41 I love that. I love that. All right. Let's now jump into the new Grad stuff now. Why are we talking about new grads? Cause right now you're currently a student. I actually am a new Grad. I'm experiencing what we are going to be discussing. So why do you specifically have a passion for new grads and have some futuristic plans for that, which we will get into in a bit, but why specifically new grads?
Cameron Massumi: 02:03 Sure. I think the best way to address this is looking at friends and connections that I've made. I think APTA does a phenomenal job of first of all engaging students and finding a platform for them to have their voices heard and for them to be able to network with other individuals. You know, firsthand that we can make some great lasting friendships. But what the APTA I think struggles that a little bit is retaining some of that engagement when it comes to new grads. We have no secret that we have a decline in our member basis as people transition from students to working professionals. There's a positive in that the trend is moving forward as we are retaining more and more. I think early career started years has incentivized the ability for the association to retain members.
Cameron Massumi: 02:51 I think the fact that with our rebranding that we're currently going through as an association, we're finding what matters to its members and really utilizing that to make the association more applicable and more exciting for demonstrating value to members. For me as a person that's about to embark on my own career, transitioning from the role of student to professional it's how do I find a way to stay engaged and how do I find a way to contribute to not only association but my profession. One of the things that most of the feedback that I get from a lot of my friends having graduated is they feel that they're going from a space where they have an existing platform to, you know, share their views and their desires within the profession to one where they don't. So this is a passion project of mine and something that I'm really looking forward to contributing on. And I think APTA's done a commendable job in engaging student voice and looking for collaboration on this. Individually myself, I'm looking at utilizing my state chapter to help with this. But also really pulling students and seeing what we can get collaboratively and seeing where that goes.
Jenna Kantor: 04:17 I love that. So regarding new grads, how do they have a voice right now?
Cameron Massumi: 04:23 Ah, it's interesting question. I think that ultimately it comes down to you finding your voice. You can use social media. It's a very powerful tool. You can use open floors within APTA. We just had our house of delegates and there's plenty of opportunities for members to get involved there. You can become an active member in your delegation. You can seek leadership opportunities within your chapter, within sections, academies or even at national office. I think that there is a plethora of opportunities for people to utilize. But it ultimately, it comes down to you what level of motivation that the individual has.
Jenna Kantor: 05:02 I want to dive a little bit deeper onto the negative specifically for us as new grads and anybody who's listening, not you, you're not a new graduate currently a student. But for being a new Grad, there is definitely a dropoff. There are these opportunities but a lot of it has to do with after five years of experience, doors really do open for getting to apply for some greater leadership positions. And even that when you go, well for me, I specifically experienced this in my state, there is still a level of trust, meaning distrust for me being a new face and energetic face, a creative face, not somebody who's been around to learn the ways of how that specific area wants it to run. So would you mind speaking on that? Where is there a voice for somebody who is still waiting to be trusted?
Cameron Massumi: 05:53 Sure. Tough question. Thank you for that. I'd say a lot of that really just comes down to you as an a association, as a profession or as a whole what we are doing to uplift and support individuals. There was a good bit of discussion at house of delegates and at next about diversity, equity and inclusion and for our student assembly meeting at next conference we had a round table and we invited some key panelists as well as students to share their insight and experiences on the topics. And it's interesting because when it became apparent really quickly is how diversity was highlighted almost exclusively at equity and inclusion. I think that as we try to shine more light to that and looking at what equity really means and inclusion and equity, meaning truly leveling the playing field and supporting people and giving them all the tools they need to have equal opportunities. It's not just saying here go, we're really building up individuals and letting them get to a place where they can create change and they can make their mark. And inclusivity is just ensuring that we're doing that with everybody and we're bringing them to that point.
Jenna Kantor: 07:29 I just want to express my appreciation for this. With the diversity, equity inclusion coming up in these conversations at this conference, at the house of delegates. It's great, although we do not have a game plan at this moment, which is very clear in this conversation. It's good that it's being brought up on the national level, not just at the state level. I definitely personally represent this being a person with a personality that is out of the norm. Now, if I went to musical theater people, I'm in the norm. My personality blends in and actually Cameron, you would stand out. So I do appreciate that it's beyond just the color of your skin. So I appreciate that the equity and inclusion is also being included in this whole picture with the actual definitions to provide the opportunity that people, so desire.
Cameron Massumi: 08:23 So the quote about diversity is being asked to the party and inclusion is being asked to dance. And I think that's a pretty powerful statement if you really break it down and you know, I commend APTA for their effort in or renewed effort in ensuring that we move forward with this as a profession. But it's really interesting. You know I see a very diverse group of people that come to these conferences and in my program back at Virginia, I see a vast diversity within our student population. Inclusion is one of those ones that's a little bit harder to utilize. Because you can't really force somebody to do something. You have to elevate them and promote a way in which they can take that opportunity to really get their voice out there and heard. And, and I think that we're moving in the right direction and it's exciting times and I can't wait to see where it goes.
Jenna Kantor: 09:24 Yeah, yeah, for sure. I think I really liked that you gave that definition. It was worth the wait. It was worth it. So for me, I was just at house of delegates to share a little bit and I'm new. It was my first time at house of delegates. So as a new Grad I went there and I was not voted in as a delegate, an elected delegate. But I was an alternate delegate and with that I was able to attend and sit in the gallery, which is in the very back in order to just listen and learn, which is very valuable during the breaks I am very extroverted.
Jenna Kantor: 10:05 And where for you Cameron, I mean you are present so people want to talk to you. You have that. It's amazing for me. I want to meet people. So I did find regarding specifically inclusion, which is why I wanted to, I was like oh I thought of this. I'm like, oh this'll be a great one with Cameron cause this is where your passion lies. I found myself in the room, you know when you see two people bonding that, oh they know who I am so I'm going to stand on the side and wait until you know you're kind of like smiling awkwardly on the side, you know, so I can get in the conversation and maybe have some bonding time. I think maybe one time, the whole time was it actually successful with me standing on the side because people were so focused in on their individual conversations.
Jenna Kantor: 10:46 So I did not get any networking at all in at house of delegates, which was a shame. And, as you are saying right now about that, inclusion is hard because you can't force anybody. I think what I experienced would be a perfect example of a very, very eager beaver wanting to meet people. Cause that's the thing. You need to meet people. You need to gain that trust and you develop those relationships. And I'm not important enough. That's what I'm assuming where they would go, oh wait, Jenna's here, let's include give eye contact, equal eye contact in the conversation where you can somehow become a part of it even as the new person. So I really like how you're bringing that up, the individual. What are ways that we as the APTA team members where we could start thinking outside of the box outside of our own world to maybe pay attention to when we are actively being exclusionary because of the own world that we live in.
Cameron Massumi: 11:46 Well first I like to say I'm sorry that you were made to feel that way. The House of Delegates is definitely crazy, especially this year when we had over 70 motions to get through. So you have a shorter amount of time and always so much to really get some of those meaty discussions out of the way that can present quite a problem to be able to communicate and network, I guess.
Jenna Kantor: 12:09 Oh, for sure. But these are half hour breaks.
Cameron Massumi: 12:12 Well my suggestion, I mean this really goes down to what are you doing to engage in conversation. You know, I recommend that if it's something that you're passionate about to find alternative means of starting dialogue, you know, it's fine to use the tact where you're kind of standing by respectfully and waiting, but there are other times where it may be more appropriate to interrupt but to you know, find a way to segway into the conversation and say, you know, I was just standing by and I really heard you discussing this. You know, it's actually something that I'm really passionate about. Would you mind if I shared my input? Or you know, maybe ahead of time, reach out and say, Hey, I know I'm a member of your delegation or I am a constituent and this is a passion area of mine I'd love to be involved in discussing this.
Cameron Massumi: 13:10 There's all sorts of different ways that you can approach individuals and it's going to vary based on your personality and the personality of who you're trying to reach out to. So that's where I'd say it took to really start and just find ways to do it. I mean, I'm a very extroverted person. I have no problem really walking up and saying, hey, you know, I would love to engage in some dialogue, but there's other people that are more timid and you just have to find different ways of doing it. I don't think that it is plausible to really expect people to just notice you at all times and be like, Hey, like I see you over there, come on in. And I don't think that that is an issue with inclusivity, more so than the fact that there's just a lot of things going on. So, it's important for people to take more active roles to get involved with things that they're passionate about.
Jenna Kantor: 14:09 This is really helpful. I mean and you make a very good point here Cameron, on just like seeing the real big picture of like the barriers, even though we may be all be in the same room of just the chaos that goes on in the rooms. And this isn't just like one thing. I mean we have these annual wonderful events, CSM, NEXT, we have the national student conclave. We had these other events which are also other opportunities and then of course the local opportunities as well. So for you, what are your future plans that you want to explore with the new grads? Because I remember us talking at Graham sessions, I believe. No, Federal Advocacy Forum. We're like plugging all these places everywhere, by the way, attend all these things at the federal advocacy forum. And you were talking about your passions, some things that you might want to develop one day for new grads. Would you mind starting to go into that?
Cameron Massumi: 15:04 I'm sure I don't have any true plans at this point. All I know is that I feel that the new Grad, early career professionals population is kind of a lost area. And what I mean by that is that there's no formal engagement targeting that group. And that's unfortunate in my mind. So I'd really like to see more active participation engagements available for that demographic. And currently myself, you know, I'm looking to kind of transition from the current role that I'm in and to more of one focused on my local chapter level for a little bit as I also work to you know, further my own practicing career and then really just find a final way to increase involvement and engagement with that population. So there's a good number of early career professionals that I'm friends with that live in my home state. So I would just want to collaborate with them and see what we can get off the ground going.
Jenna Kantor: 16:13 I love that. And for those who don't know, Cameron’s a champ. I cannot express enough how this is somebody you do want to meet. You do want to have in your life in some capacity because of just he is a person who really speaks his truth but really from the heart and has so much love for others and seeing everybody really have the ideal professional career that they so desire. And we had a great bonding moment at federal advocacy forum talking about this and though I have most definitely put you in the hot seat, but for reasons to really help identify that there is and what you just said, there is a gap on the support that's available right now. It's not the APTA is ignoring it, they see it, but it's still there. It's one thing to see it and then figure out exactly how can action be taken. That would be exactly what people need. It's definitely been discussed. So I really appreciate and I'm honestly happy and excited for people in your area to be getting your wisdom and you even just like figuring out what you can do. That's very powerful. So just honestly, thank you for that.
Cameron Massumi: 17:25 Oh, thank you Jenna. I'm just one person, you know, and I'll speak in, like you said, from the heart, and these are just my own thoughts, but I really think that that the heart of it is collaborative efforts. You know, people from various backgrounds are gonna be able to come together and really problem solve a lot. And then as far as APTA goes, I think that they do a terrific job of acknowledging areas for improvement. And they are really actively trying to pursue avenues in which they can rectify some things and improve existing methods. I don't think that they do a bad job by any means with early career professionals, but I just don't think that it's where it needs to. I don't think that where it currently is where it needs to be. But you know, everything's a learning process and as we continue to grow as a profession, things will inevitably improve.
Jenna Kantor: 18:18 Oh, for sure. I was looking at things like that as opportunities. I'm like, oh look, we have more opportunities. And I think, it is really good at looking at things as opportunities and you have to look at it in a positive light. So for anybody who might be listening and being like, ah, you know, waiting for us to say something bad. Like what is it going to, how in this particular conversation right now where we're really trying to reach out and pull in the new Grad audience, like, is it gonna do us any good to sit here and bad mouth or to actually acknowledge what the APTA is doing and how they're regularly acknowledging things. So that way it gives you a rightful reason to hope and believe in an organization that has the power to make a huge difference. They have a huge audience.
Jenna Kantor: 19:02 They have a huge following. Even if right now in June 2019 just for when this goes forward, and time passes, there's one third of the population. There's no denying. Even for nonmembers they have a huge, huge audience. So it is very important. Even if you don't currently believe are not currently a member which join if you're not currently a member, you cannot deny the outreach that they have. So what is very good news? You want to hear that they're talking about it. You want to hear that it's on their mind. You want to hear that they're seeing the opportunities and are trying their best to explore it to the right thing because you know, as soon as they take action on it, they got to stick with it to see if it works, you know, and get that feedback. Well Cameron, thank you so much for coming on here. Thank you for dedicating this time. You've been in meetings this whole time and I was able to fortunately schedule you here at NEXT 2019 and I could not appreciate it enough. Do you have any final words you would like to say? You're like Mic drop to people who are new Grad physical therapists or even soon to be.
Cameron Massumi: 20:14 Thank you Jenna for the opportunity. I think the biggest thing is just be an advocate for the profession and for yourself in whatever capacity that is. The APTA provides a lot of platforms for you to be able to get involved, for you to be able to get your voice out there and heard, support your PAC. You know, that's how we get things done legislatively. How we improve things regulatory too. As an example from a student perspective, you know, lots of lobbying has allowed for legislation to be enacted to help with student loan forgiveness. That's massive. You know, that helps not only students, but early career professionals and we're relieving a lot of their financial burden. Stuff like that is really powerful. Don't underestimate your voice. You have much more volume, your actions and your voice speak volumes and just find a way to get involved.
Jenna Kantor: I love it. Thank you so much.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Michelle Collie on the show to discuss the importance of outcomes and how they can make a difference in your practice. Michelle became the owner of Performance Physical Therapy. Under Michelle’s leadership, Performance has grown to a practice with 13 locations in Rhode Island and Massachusetts and over 200 employees.
In this episode, we discuss:
- What is the definition of outcomes as it relates to physical therapy.
- How to use patient outcomes and business outcomes to drive your business forward
- Using outcomes data to increase your referrals
- A sneak peek into Michelle’s keynote speech at The Outcomes Summit
- And so much more!
Resources:
The Outcomes Summit: Use the discount code LITZY
Performance Physical Therapy
Performance PT on Facebook
Performance PT on Twitter
Performance PT on Instagram
For More on Dr. Collie:
Born and raised on a sheep farm in New Zealand, Dr Michelle Collie spent her childhood years training pet sheep, riding motorbikes, and eating enough lamb to last a lifetime. She earned her bachelor’s degree in Physiotherapy from the University of Otago in 1994 then moved to Rhode Island due to the United States Physical Therapy shortage. In 2003 while pursuing a Master of Science and Doctorate of Physical Therapy from Massachusetts General Hospital’s Institute of Health Care Professionals, Michelle became the owner of Performance Physical Therapy. Under Michelle’s leadership, Performance has grown to a practice with 13 locations in Rhode Island and Massachusetts and over 200 employees.
Michelle is an APTA member and serves as the chair of the private practice PR and Marketing committee. Performance Physical Therapy has received a number of awards over the years for its business success and philanthropy, the highlight being the recipient of the 2014 Jane L Snyder, Private Practice of the Year. She is a board-certified Orthopedic Clinical Specialist
Read the full transcript below:
Karen: 00:00 Hey Michelle, welcome back to the cloud cast. I'm happy to have you back.
Michelle: 00:04 It's great to be here. Karen, thank you for having me.
Karen: 00:07 Of course. So today we're going to talk about outcomes, specifically outcomes within your clinic and with your patients. But I think before we get into the meat of this talk, I would love to hear from you what your definition of outcomes is.
Michelle: 00:24 Well, um, hopefully I'm not quoted by the Webster dictionary or anyone else out there, but for me in my practice is a physical therapist. To me, outcomes of the results that are numbers and they could mean practice management outcomes such as how many patients we see visits in an episode in here. They could be outcomes related to patient satisfaction such as your net promoter score or how many Google reviews did you get. Or they could also be clinical outcomes based on such things as the specific clinical outcomes means, Mitt measures that we use, whether it's related to the Oswestry or a disability scales. So those are just examples of some of the outcomes. But I think outcomes are like the results, tangible numbers of behind them. So you can actually give some, um, objective measures behind what these outcomes are.
Karen: 01:19 Right. And you S uh, I like that you kind of put those outcomes into different categories because when I hear outcomes I just get incredibly overwhelmed and think, well there's, there could be so many. Right? So thanks. No. So now we kind of have a defined how do we measure outcomes within our practice? And maybe you can give some examples of what you guys do, but is there, do you have any standardized ways that you are measuring these different outcomes?
Michelle: 01:50 So again, we can classify it into different ways and I will bring out one, one methodology actually is when it comes to practice management outcomes, that's something you hear often, especially with the benchmarking program that happens through the private practice section. We start looking at outcomes and using numbers to benchmark against each other. And those are things such as, um, how many, how many visits in an episode of care or how much revenue do you gain per patient visit? So these are things that are very much financial and operational defined and how you figure out business wise how well you're doing. So that's one side I'm going to flip to the other side, which I think is much more exciting to talk about for most people and that's actually our clinical outcomes. How good a job or how well are we doing when it comes to treating our patients?
Michelle: 02:47 And there's such a drive now to looking at our outcomes as far as our clinical outcomes and what does that truly mean? Does that mean that my practice or Misa physical therapists get someone better and less visits or at least amount of time or with more intervention or different combination when, how much better do we get someone? So the outcomes to me relate around time, which could also be actual number of visits or encounters and also is how much bitter someone gets. If I'm treating a runner and they, our goal is, Hey, I want to run a marathon in four hours, am I being sucks? Can I get them back to being able to do that? And can I do that just as well as not just the next physical therapist, but other fitness, health care provider, whoever that is. And how can these outcomes?
Michelle: 03:42 So how do measuring outcomes help to drive your practice? So I guess this is a really, what you're counting down to was the why. Why bother doing this? And so yeah, this is getting to the why, which is the most fundamental part is by measuring our outcomes and helps us differentiate. Now when we can differentiate ourselves, it makes it easier to do marketing and that marketing can, it can impact us in different ways. We can use it to market to get more patients. We can use it to negotiate, which is marketing messaging with a payer, whether that's an insurance company or whether someone's paying cash for services that we now have outcomes, which is data to help him messaging and differentiate, here's what I can do or my practice can do. Um, so I think there's many different levels, um, that it relates to, but it's all comes back to marketing and messaging and being able to differentiate and communicate to the consumer and will the payer about what our services can provide.
Michelle: 04:54 And can you give an example of how you, you and your practice might use your outcomes to market and you can choose if you want to market to a payer market to the general public, I'll let you choose. So we've done a whole bunch of things that our practice and hit a lot of success. Um, one is marketing and this is probably the easiest one for people to understand marketing to physicians. So with the data that we have, I can go to a physician [inaudible] physician group and say, Hey, here are end results. If you, when you refer a patient to us, we're going to get them this much theatre and here's what the national benchmarks are. So we're actually proving to you that we're going to get the results that you want and guess what? I can and we're actually gonna do it at least visits and what the national standards are.
Michelle: 05:51 Now I can compare as cells to um, we, I compare as to practice nationally or regionally or even over time. Look, we put these new systems in place or we started try needling or using this new blood flow restrictive therapy or whatever modalities or treatment methodologies we're using and say, because of this, now we're now we have the data to show how much better we're getting patients. And then for us it's actually really helped to Provo provide actually data to referral sources and they can actually say, Oh, so we're going to seam patients to you because you're actually going to provide solutions and get our patients better. It's not just about the fact that Oh, you've got more clinics or you are open on Saturday mornings and no one else is, or you had fancy equipment. I mean these are true differentiators, not just things we can do to make ourselves look better.
Michelle: 06:50 I think that's the big thing. I think, you know, years ago I always used to think that marketing and promoting your practice was just simply about relationships. And if people like you, they'll send you patients and patients like you, they'll come back to see you and all those. Although those things are true too a little bit when you've actually got the data behind you and really meant, helps you tell a story and say, Hey, this is why we should be treating your patients or to the general public. This is why you should be coming to physical therapy to help with your back pain or your ankle sprain or your pelvic health problem or your dizziness. You've got the numbers to show that we will get you better.
Karen: 07:31 Yeah, and I think it's great to use numbers because these are our facts, right? You're not fudging these numbers. This is the actual data that is coming out of your clinic. So I think it's great to be able to then instead of just have the data and say, Oh great, look what we did. But you want to use those outcomes in order to market your clinic.
Michelle: 07:56 Exactly. And I think the other nice side about it as when you're using the data to market, it actually changes the culture within your clinic and within your practice.
Karen: 08:07 That was literally my next question was how did outcomes affect that people working day to day in your practice?
Michelle: 08:13 Yeah, well I think it's really helped to make us practice and every visit make all of our clinicians and their patient care coordinators and our assistance and our exercise specialists realize, yes, we're very concerned about customer service and giving, um, you know, having beautiful clinics and all of these other aspects. But at the end of the day, we need to make sure that every moment we're spending with patients is designed to get them back to be doing the things they want to do in this got a show in the data. Yeah. And I think it's helped to really drive our clinic and the kind of care that we're providing. So it's not just about, Oh, I'll collect the data and now I'm going to get paid more by an insurance company. Or now people are going to come and see us or doctors or refer. It actually drives the culture within a clinic to ensure that you, I always feel like we've got rid of complacency which can sometimes creep and practices. Yeah. And how do,
Karen: 09:14 how do you use this, the outcomes data to kind of align with your vision or the or the mission of your practice? What would you say to other clinicians when it comes to aligning the data with the mission and vision?
Michelle: 09:30 Well, I think that's really a great point you bring up because people often say, well how do you know what to measure and why are you doing this? And I think it always starts with your strategic plan and figuring out, first of all, what is your purpose? Which is like your greater good. Why do you, why you in practice and what's it all about? And then thinking, okay, well then what's their, what's their mission, what are EMV values? And once you figured those things out, then you can challenge yourself and say, well how am I going to prove it and how am I going to measure it? So that when someone says to me, Oh, your purpose is about having a healthy, fulfilling the film happy community, and you're helping your community to be in that way, how are you going to truly measure that?
Michelle: 10:13 That's what you're doing? So I think you have to start with that strategic over powering, look at your vision, your mission, your values and names going on. How am I going to measure that and not the other way round. Mmm. We see like, yes, we're going to look after our community and then we're going to use innovative results given here and now it's like, well, how are we going to prove that? I'm like, the only way you can prove that you're getting results driven, innovative care is by showing the data because otherwise it's just talk [inaudible].
Karen: 10:48 Yeah, yeah. No, that's great. As you're saying this, I'm thinking about my mission for my company and like, Hmm, yeah, okay,
Michelle: 10:59 how am I going to measure this now? And it's not, you're not going to come up with it overnight and there's no perfect way to do it because this is quite a new area for physical therapists or we're only just part of this evolving healthcare environment where payments changing and with payment changes the messaging of how we're promoting what we do, but it is turning into much more a shift away from fee for service and much more to say like we're paying for the outcomes or the experience, not how many visits or how many units of charge per visit or how many visits and an episodic here we should be advocating improving our stamps for our outcomes. Neat. Good. The only way we can do that as some health, pulling out what clinical outcomes and how we're gonna measure those and basic jet.
Karen: 11:50 Yeah. And how do your outcomes from clinic aligned with
Michelle: 11:54 your vision and your mission? Like what is the mission of your clinic and how do you, how do your outcomes revolve around that? The way our mission is about providing innovative, results-driven, physical therapy services for a community. And the way that we measure the outcomes is that our goal is to get, use the hashtag better, faster. So we're all about getting people better, more better, and doing it in the least number of visits we possibly can. Now it's interesting because there's many practices out there, and I'm often challenged by this and this is where I butt heads with media, other people in private practice and like, but we get paid per visit. Why would you want to see people enlist visits? And I've had some really fun heated debates with some colleagues and peers over this Mike. But if we can do it and least visits, isn't that the right thing to do?
Michelle: 12:45 And then doesn't then allow us to advocate and, and, and prove ourselves and our value. And they're like, what? How can you afford to do that? Because you're basically sacrificing money because you're going to do it and least visits. So it's been a fun debate to have because we've had it now for many years. And I think the ties of changing, because I've been now in a position to actually go to payers and insurance companies and actually hit the data and say, look, we are doing at least visits. So let's talk about how we do some cost sharings. Let's talk about different ways to reimburse because we're doing it and at least visits and uncles to go to the outcomes to show that we're getting people just as bitter or more. That's really poor English with that. So I came up here. Yeah, that's okay. We get the gist of it.
Michelle: 13:35 So one of your outcome measures might be how many visits are in an episode of care? So we had the keys that we use, we use visits in an episode of care and the other one we use is the clinical more clinical um, change. So traditionally we've used photo focused on therapeutic outcomes of your system. Um, which has been great because that will, that will differentiate patients based on payer, um, diagnosis, body part, all of these things. So we can say, Hey, for a bag spine or all the Pedic on Euro or upper extremity, here's how, here's the change that we're getting in function and we can actually beat back and compare ourselves to other practices both in our region and nationally as well. You can do, it's an interesting time because now with MIPS and again I realized the assaults and people out there who don't know if MIPS are going to happen and we still don't have a lot of final rules, but again, we're still in with Mets. We're still using different, um, standardized clinical outcome tools that we're all very familiar with and I'm looking at opportunities to benchmark not just against it within their own practices, but between each other's practices as well.
Karen: 14:54 Yeah, I think that's great. I love looking at it that way of, of figuring out your mission and then how are you going to measure it and then taking those measurements and using it for a whole bunch of different things.
Michelle: 15:07 Well, I think that to me that's been the most interesting thing in our practice. It's, we've got this mission and a vision, which is what you have to start with. And your purpose. We've created the tools to measure it well. We've figured out what tools and how to measure it and it's, it's really helped evolve the culture of that practice. It's helped us with how we onboard our staff. It's helped us with how we recruit new people. It's helped us when we take on students. So it's had a big impact on every part of their practice. And, um, rather than just, you know, how just rather than just how we treat a patient, an everything embodied bodied, everything.
Karen: 15:47 That's awesome. And now you had mentioned photo and coming up in October, October 23rd to the 25th, and Knoxville, Tennessee is the outcomes summit. Uh, and you are one of the keynote speakers. So can you give us just a little sneak peek, a little taste of what your keynote speech is going to be about?
Michelle: 16:07 Well, so the keynote speak is all about on marketing with outcomes data, helping people understand the value, um, for outcomes data. When marketing your practice, I'll use my personal story because I think it helps to show that I'm, you know, really at the end of the day, just a little farm girl from a very remote part of the world. And um, so if, if I can use data to Mark it with anybody can, and I also like to talk a lot about the fear because I think there's a lot of fear out there. PTs are often scared. One of my deck data doesn't show what I want it to show.
Karen: 16:44 Right? Then what happens
Michelle: 16:46 then what happens? So yeah, that's like the million dollar question. And then what happens is people run away from fear and then they don't do it and so they're not moving forward. So I definitely had plenty of fears when I first started put up though the date and say what a for not as good as we think we are. Well, I find it interesting that it's really abandoned teach and if you're following what your purpose and your mission is and the results are going to happen because this changes all of the messaging and it impacts your entire culture. But I think it's a journey of how to address the fear of what if my data isn't as good as what I think it can be. Because when it comes to marketing, yeah, I can have beautiful brushers and amazing weird site. I can be open all different hours and think those things are going to differentiate me and they will a little bit.
Michelle: 17:37 But at the end of the day, I do think it comes back to data is the real differentiator and if you want to get serious about marketing and messaging what your practice does, and I think this goes, now I'm going to get on a, and this goes for our app proficiency as a whole and list were privy. At least we're proving that we really are the base caregivers for muscular skeletal and your a muscular disorders and diseases. Then we, you know, we're still lists, we're just not doing a good job, but at the moment like how do we differentiate ourselves from the other healthcare providers and fitness people out there who also say we'll take care of someone's back pain or help them get trained for a five K. so again, we have to, as a profession, as a whole, use that data and be comfortable using it to prove proven value.
Karen: 18:31 I love it and it sounds like it's going to be a great talk. So all of the people who are going to the outcomes, the clinical outcomes summit are in for real treat. Um, so that's awesome. Now, uh, before we, and here I have a one more question and that's what advice would you give to yourself as a new graduate? Fresh out of PT school. So that farm girl from New Zealand, she just graduated from PT school. What advice, knowing where you are now in your life and career, would you give yourself back then?
Michelle: 19:11 Oh my God, it's so much advice I would give. I think it would be about the key advice I would say is that your, we all have fear. We're all nervous of things. Whether it's, Oh, I'm going to make a mistake when I treat a patient or I'm going to have a practice that's not successful, or I'm going to open my mouth and sound like an idiot, but we're all gonna do it in. That's fine. And the only way to conquer those fears is just push through it and just keep, keep moving forward. So I think it would just be letting myself know at that shy Tinder age in my early twenties that, um, all the challenges that I had, just the same of everyone else's. And so yeah, just put on your big girl panties. They would say base the fears and move forward. Sorry.
Karen: 19:57 Great advice. And now where can people find you, whether it be on social media and or your clinic?
Michelle: 20:04 Um, so we have a multi clinic practice based out of Rhode Island with some clinics in Massachusetts as well. So performance ptri.com is our website and all their social media handles all reflect their performance. ptr.com P t@ptri.com. So, um, feel free to check out her website and we are you on Instagram, Facebook, Twitter, all of those, all of those places.
Karen: 20:30 Awesome. Well, Michelle, thank you so much for coming back onto the podcast. I appreciate it. You gave me a lot to think about, so thanks so much. Thanks very much, Karen and everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Stephanie Gray on the show to discuss bone health. Dr. Stephanie Gray, DNP, MS, ARNP, ANP-C, GNP-C, ABAAHP, FAARFM, is a functional medicine provider who helps men and women build sustainable and optimal health and longevity so that they can focus on what matters most to them. She is co-founder of Your Longevity Blueprint nutraceuticals with her husband, Eric. They own the Integrative Health and Hormone Clinic in Hiawatha, Iowa.
In this episode, we discuss:
-What is functional medicine and integrative medicine?
-Hormones that impact your bone density as you age and how to find your deficiencies
-The difference between natural and synthetic hormones
-Your Longevity Blueprint: a guide to mastering each of your body systems
-And so much more!
Resources:
Integrative Health and Hormone Clinic Website
Your Longevity Blueprint Free gift: 10% off using code healthy10
Stephanie Gray Facebook
Integrative Health and Hormone Clinic Facebook
Stephanie Gray Instagram
Your Longevity Blueprint Instagram
Stephanie Gray Twitter
Your Longevity Blueprint Youtube
For more information on Dr. Gray
Stephanie Gray, DNP, MS, ARNP, ANP-C, GNP-C, ABAAHP, FAARFM, is a functional medicine provider who helps men and women build sustainable and optimal health and longevity so that they can focus on what matters most to them! She has been working as a nurse practitioner since 2009. She completed her doctorate focusing on estrogen metabolism from the University of Iowa in 2011. Additionally, she has a Masters in Metabolic Nutritional Medicine from the University of South Florida’s Medical School. Her expertise lies within integrative, anti-aging, and functional medicine. She is arguably one of the midwest's’ most credentialed female healthcare providers combining many certifications and trainings. She completed an Advanced fellowship in Anti-Aging Regenerative and Functional medicine in 2013. She became the first BioTe certified provider in Iowa to administer hormone pellets also in 2013. She is the author of the FNP Mastery App and an Amazon best-selling author of her book Your Longevity Blueprint. She is co-founder of Your Longevity Blueprint nutraceuticals with her husband, Eric. They own the Integrative Health and Hormone Clinic in Hiawatha, Iowa.
Read the full transcript below:
Karen Litzy: 00:01 Hi, Dr. Stephanie Gray. Welcome to the podcast. I'm happy to finally have you on. This is taken forever between the two of our schedules.
Stephanie Gray: 00:09 Thank you for having me on. I'm excited to speak with you today.
Karen Litzy: 00:12 Yeah, I'm very excited. And we had met, Gosh, last year, maybe
Stephanie Gray: 00:17 October.
Karen Litzy: 00:18 Yeah, October of last year. Holy Cow. Yes. Well, I'm very excited to have you on because when we met at unfair advantage and I remember hearing your story and hearing you speak and I thought I need to talk to this woman because I think she's doing some really great work, so I'm happy to have you on and share all about what you're doing. We'll talk about your book, the longevity blueprint in a little bit, but first, can you let the audience know a little bit about your journey from your BS to your MS in nursing to doctorate to all these certifications and how that happened in the why behind it?
Stephanie Gray: 00:58 Sure. Well, maybe the short version is that I was born and raised in the Midwest and I grew up in a very healthy family and I wasn't quite sure what I wanted to do with my life as many people are I’m sure. My parents always took us to see a chiropractor, not a regular doctor. They were self employed, had a really high deductible. So they wanted to keep us healthy and growing up, I wanted to get into medicine. I kind of grew up wanting to be a doctor. I'd play with my doctor Kit, but I didn't necessarily want to prescribe drugs. And so I thought, well maybe I'll go into nursing. Right? So I went through the nursing program at University of Iowa and I love nurses, man, they're so important. We have a shortage, we need more nurses. But I thought I wanted to have more autonomy and more independence and I wanted to still be able to diagnose and treat patients.
Stephanie Gray: 01:43 And so I did continue on to become a nurse practitioner and I ended up going through the master's and then the doctorate program. And I still was a little unsatisfied. I felt like, man, there's gotta be more to life than prescribing medications. Right? Nursing is a more holistic approach in general. And that's why I'm biased to nurse practitioners as primary care providers because I think they do provide a more holistic approach. I wanted some additional trainings so that I could incorporate nutrition, that I would have some credentials behind recommending things other than drugs. So I did also then pursue a master's in metabolic nutritional medicine, which taught me a lot about, you know, using supplements and herbs and whatnot, which I heavily applied in my practice. And then I also did complete the advanced fellowship in anti-aging, regenerative and functional medicine which helped me tremendously. I learned a lot about use of bioidentical hormones as well. And I really just became on fire for integrative and functional medicine and thought, this is it. This is what, especially my community in Iowa needs, because there weren't a lot of providers offering this sort of care. So that's, I guess that's kind of my story.
Karen Litzy: 02:50 Well, that's a great story. I love it. Now you mentioned functional medicine and Integrative Medicine. Can you kind of help us out and talk about what those branches of medicine are?
Stephanie Gray: 03:01 Sure. So integrative medicine combines or integrates conventional medicine with natural, uneven, complimentary forms of medicine. It's not, I'll say functional medicine also really more works to get to the root cause of the problem. That's kind of more of the definition of functional medicine. And I use both in my practice. I use functional medicine to kind of discover the why, but I also use integrative medicine because there is a time and place for medication use. Sometimes patients do need antibiotics or surgery. I've had to partake in them myself. But I want to provide my patients with the best of all worlds combined. So do I think chiropractic is important? Yes. Acupuncture? Yes. Use of supplements. Yes. Medications, all of the above. I think the major difference in the analogy I use with my patients that I did not create a colleague, Patrick, he mentions conventional medicine as being more of the fire department approach. Right? We need conventional medicine. If you have a big bad ugly tumor or whatnot, you need the fire department to put that out to remove it. But conventional medicines tools are drugs and surgery. Functional medicine is a little different. We described that in my practice as being more of like a carpenter approach and that's what I describe in my book. Really helping to repair and rebuild the body, figure out why the fire happened in the first place and try to get to that root cause of the problem, not just provide a bandaid approach.
Karen Litzy: 04:16 Right. And that's a great analogy. Thank you for that. That’s definitely clear. It makes functional and integrative medicine a little bit clearer for everyone. Hopefully. So now I mentioned the book longevity blueprint and again we'll talk about that a little bit later, but there's a chapter in the book, Chapter Four where you discuss the importance of fixing nutritional deficiencies and specifically when it comes to our bones. So as mainly women, we all know as we get older and as we go through menopause, our hormones change and bone density can change along with that. So what nutrients I guess are specifically important for our bones?
Stephanie Gray: 05:09 So I'll discuss several nutrients. So many women think calcium is a number one most important nutrient for their bones. And the truth is that your bones need a lot more than calcium. So vitamin D, magnesium, vitamin K2 and strontium are all nutrients that I recommend to my patients. I mentioned vitamin D in several different chapters of my book and that as many people know, helps your body absorb calcium and phosphorus from the foods you eat. And it helps with bone remodeling. Maybe I don't know how deep we should get into that. Maybe you shouldn't, but without enough magnesium though calcium can also collect in the wrong places in soft tissues and cause arthritis. And so magnesium is just as important as calcium. There have been several studies of women with Osteopenia or osteoporosis showing they're actually not deficient in calcium deficient, they’re deficient in magnesium yet.
Stephanie Gray: 05:58 What's the number one most prescribed supplement? Menopausal woman. Again, it's calcium. I personally have had a kidney stone and they are not fun. So calcium can not only gain weight, it can cause bone spurs, but it can cause kidney stones. It can calcify our arteries. We don't want it getting absorbed in to the wrong places of our body. And that's where vitamin K2 comes in also. So vitaminK is really overlooked nutrient. It's one of the four fat soluble nutrients. So it really helps prevent calcium from accumulating in our vessels. And it can even, some people believe can help remove dangerous calcifications too. We know that low levels of k2 can directly be related to poor bone mineral density. So I like analogy.
Stephanie Gray: 06:45 So here's another analogy on what vitamin K2 really does, and vitamin D. So vitamin D is the doorman that opens the door for calcium to enter the bloodstream. But once it's in the bloodstream, it could go anywhere. So I think if K2 is being that usher that's going to direct the calcium from the lobby, if we think of a hotel or whatnot, directing him to the appropriate seat in our bone matrix. So do we need vitamin D? Yes. Do we need magnesium? Yes. We also need vitaminK2. So there are different sort or different types of vitamin K. So vitaminK is broken down to K1 and K2. So if you are purchasing a supplement, if it just says vitaminK , you don't necessarily know what you're getting.
Stephanie Gray: 07:26 You want to make sure that the label is really differentiating if specifying what is in that product. So vitamin K1 isn't as much needed to be supplemented. It's the deficiency is pretty rare. It's found in leafy Greens. Hopefully you're all getting your leafy Greens. But vitamin K2 comes from very specific foods and also bacterial synthesis. So think of it. Think of yourself as you know, if you don't have a healthy gut, unfortunately your body's not going to be able to convert. K1 to K2 in the gut if you've taken antibiotics, whatnot, if you have a lot of food sensitivities and gut inflammation. And so you really want to think about consuming foods with K2 and possibly supplementing in that as well. So vitamin K2 comes from fermented soybeans, which many of us probably are not consuming and also from the fat milk and organs of grass fed animals.
Stephanie Gray: 08:16 So things like egg yolk, butter, and even liver with why we're coming, we're becoming more vitamin K deficient is that you are where you're what you eat, eat. So if you've heard of what Michael Poland has said, and I think that's really true with K2. So when we removed animals from the pasture, right? If we don't eat animals that are eating greens, they're not getting the K2 themselves and then we're not getting it from our products. So you want to make sure you are eating grass fed animals and think of wild game. Wild game is really what's can usually consuming the ingredients. So try to consume more pheasant, duck rabbit, venison, elk, or wild Turkey. I mean these are things that we don't all have access to, but that would actually help increase our K2 levels. So if you can't get some of those foods into your diet, then you could consider supplementing that.
Stephanie Gray: 09:06 It could literally again consume the fermented soy beans. But MK7 has a pretty long half life, longer than MK4. So I recommend my patients take MK7, MK4 is actually extracted from a tobacco plant, which I don't like either, sometimes will come from fermented soybeans, geranium or chickpea. And the source that we use for our production is chickpea. It has a longer half life, so a single daily dose can provide longer protection. So many of my patients, we're putting on 45 90 or even 180 micrograms of MK7 per day. It's great to incorporate foods that have, you know, consumed grass Greens. You hit the chlorophyll to get the vitamin K and to have a great healthy gut that convert can indicate too, but if you can't, and supplementing with MK7 is what I recommend.
Karen Litzy: 09:56 Yeah. And, just so people know, are you doing blood tests on people to find these levels? I just want to point that out so that people listening are like, well, I'm just going to go buy all this stuff, but you have to go and be evaluated first.
Stephanie Gray: 10:15 Yeah. So in my book in chapter four I talk about, well, every chapter of the book discusses a functional medicine testing option that's available. And chapter four is all about examining micronutrient deficiencies. Which even my patients who eat organic, who grow their own food in their backyard are still nutritionally deficient because our food sources are just not as nutrient dense as they used to be. I mean, the magnesium content in our foods has been on a decline since the 1950s. It keeps going down and down and down, which is very sad. But because of that, we can see that evidenced on a test that we run on our patients. So one of the first tests for my patients with osteoporosis or Penia that we would run is this nutritional analysis, which is looking at vitamin, mineral, amino acid, antioxidant, and even Omega levels. And if you have the access to a functional medicine practitioner, definitely I would recommend getting this test because then you don't have to guess how much magnesium, how much do I need? It's better to really get the test to see what you need.
Karen Litzy: 11:12 Right. Yeah, no, that makes a lot of sense. And I just wanted to point that out to people so that they know. I guess also, are there any dangers of taking these vitamins if you don't need them?
Stephanie Gray: 11:28 So vitaminK to a high dose just can cause blood thinning. So if patients are taking anticoagulants, if they're on medications like Warfarin, you know, Coumadin, then this could potentiate those effects at really high dosages. So if you're listening to this and you want to take some K2, you probably need it. But talk to your doctor or nurse just so that they know so that they can monitor your levels. So that would the biggest, biggest side effects.
Stephanie Gray: 12:04 The last nutrient for bone mineral density that I recommend to my patients is strontium. This was one of the first minerals that I really learned about for bone density. So I heavily used it initially even before I learned about the importance of K2. There have been randomized double blind placebo controlled clinical trials showing that strontium in a dose of about one gram per day could be equally as effective as a lot of the bisphosphonate medications without getting those nasty side effects. But I have seen this be effective in my patients too. Granted, I'm recommending they take minerals, optimize their hormones, reduce their stress, exercise, right? So all of those interventions are going to have an additive effect for improving bone density. But strontium can be very, very helpful for bone density as well.
Karen Litzy: 12:48 Nice. All right, so we have vitamin D, vitaminK2, strontium and magnesium.
Stephanie Gray: 12:56 And then calcium of course calcium. I don't put calcium on the top of the list, but yes.
Karen Litzy: 13:01 But it's there. Okay. All right. Now you mentioned hormones for a quick second there, but is there value in optimizing hormones for bone density?
Stephanie Gray: 13:13 You Bet. So about 25 well, I think it's 27% of women over 50 can have osteoporosis, right? Like a fourth of those patients of that population, which is pretty scary. Yeah. And I'll go 40% have osteopenia. There's also, I'm referencing women over 50 so what's the other common dominator for women over 50 usually you're going through menopause around that declining and this, the danger here is that this can increase risk for fractures. Of course, Osteoporosis Foundation says at 24% of those with hip fractures die within a year. That's, that's terrible. Very cool. So absolutely, I run a hormone clinic and I strongly believe that improving estrogen, progesterone, and even testosterone levels in women can help with bone density. And I can talk a little, I can go into depth with each of those hormones.
Karen Litzy: 14:06 Yeah, I think I would like a little bit more in depth conversation on that and also the difference between synthetic and natural hormones.
Stephanie Gray: 14:15 Sure, sure. So maybe first we'll talk a little bit about estrogen. So estrogen literally helps with a proper bone remodeling process. Progesterone helps promote osteoblastic activity. So osteoblast help build your bones while osteoclast break it down, right? So progesterone is going to help with the bone builders and testosterone has been proven to actually stimulate new bone growth and inhibit or block the osteoclastic that breaking down activity. Progesterone, I've even been heard called one time I heard it called a bone trophic hormone. Like it literally seems to promote bone formation, which is wonderful. So it's one of the first hormones I'll start my patients on even before their menopausal many peri-menopausal or younger are taking progesterone. And when I mentioned testosterone for women, some women kind of look at me sideways like, well I don't want to grow a beard or I don't think I need to.
Stephanie Gray: 15:12 But actually it's extremely important if you even think of how testosterone helps with muscle mass, it can help strengthen the patient also, right? To improve balance, to minimize falls. Testosterone is great for many reasons. In my book I actually mentioned a study. I feel so strongly about how important testosterone can help really because of the study, because I've seen this, testosterone has shown an 8.3% improvement in bone mineral density, which is like unheard of. It's just dramatic. I've had patients who have received hormone replacement therapy, not overnight, but over a year, go from having osteoporosis, Osteopenia to even having normal bone density because after a year, their bones are improving and that is amazing. But conventional medicine, many times putting patients on drugs, we're just hoping that they don't have a decline. We're just hoping that they stabilize, not that they actually build bone density and hormones can really help do that.
Stephanie Gray: 16:08 But in reference to your other question, anytime we talk about hormones, the cancer word is going to come up. So that's where I can differentiate between the synthetics and the naturals. And in my book in chapter six actually show the molecular structure of synthetic hormones like I synthetic progestin and natural progesterone aesthetic is faster on molecule and natural testosterone cause the hormones really need to fit like a key fitting in a key hole, right? And that's what the molecular structure of natural or bioidentical hormones are. I mean, they should fit like a key fitting in and thus caused your side effects. So most of the studies that showed hormones cause cancer were studies like the women's health initiative study, which was done on a lot of women, but they use synthetic horse urine and they use Premarin.
Stephanie Gray: 16:54 That's literally what Premarin stands for, pregnant Mare's urine. So naturally I try to not replicate what was done in that study with my patients. I don't want to use synthetic hormones. I don't want to use oral estrogen either. That means estrogen taken by mouth in a pill form, right? Which is going to have to be cleared through the gut and the liver. So who was trained through, I should say in addition to the fellowship program that I went through was bio t, they're a hormone pellet company. They're the biggest hormone pellet company in the nation who very well trained their providers and their practitioners and they keep us up to date on all the current research and what's happening in Europe as well with hormones. And so they strongly believe that hormone is given an appellate version, which is an actual subcutaneous little implant that we put under the fatty tissue, kind of in the lower back.
Stephanie Gray: 17:44 Upper bottom area is by far the safest. And that's what we're going for with our patients, right? We want to improve on density. We want them feeling better. We want to give them the safest version of the safest dosage. And so pellet therapy specifically is what can improve bone density the most. But again, we're using natural hormones that are plant-based, not synthetic. They should bind to your hormone receptors appropriately. And therefore the risks of, you know, what were shown in the women's health initiative study just can't be compared to what practitioners like myself use. Cause we're using natural hormones, not the synthetics and not by mouth.
Karen Litzy: 18:19 And so what are the side effects or the downside of using these natural hormones versus a synthetic?
Stephanie Gray: 18:26 Sure. So all of us are already making, well we should be making hormones, right? Which when we grow up we go through adolescence, our hormones peak and then in our twenties and thirties and forties and 50s we start seeing this decline. So really if hormones are dosed appropriately, patients shouldn't have side effects. However, if you think of younger women when they're cycling, sometimes before bleeding they may have some fluid retention or a little bit of breast tenderness or whatnot. And sometimes those symptoms can reoccur as we give patients hormones. The goal is that those would be very short lived. They wouldn't last once we refined the dose. But too much of estrogen can definitely cause fluid retention, breast tenderness, potentially some weight gain. Too much testosterone could cause acne, oily skin, hair growth. Too much. Progesterone can make you feel a little tired. Most menopausal women need help sleeping. So they like that effect, kind of calms them down. Or if women are real PMSing they need or have anxiety, they need some progesterone to calm them down. But we don't want to overdose patients. Right? We don't want to get them to high levels of the hormones, but we want to give them high enough levels that will protect their bones, that will help them sleep. Right. That will provide benefit.
Karen Litzy: 19:34 Are there instances of cancer with the natural hormones?
Stephanie Gray: 19:41 So there are always instances of cancer? I can't say definitively that. No, I've never seen it. I'd never had a patient ever have cancer. But from my experience, they're very rare. And Bio T are great to have as a resource because they track all of that. I mean, they're tracking all these hundreds and hundreds of thousands of patients with pellets and they're tracking the rights and if they confidently say the rates are extremely low.
Karen Litzy: 20:07 Well, you know, cause we wanna give the listeners sort of like a balanced view of everything. So we want to give the, you know, as you know, and I'm sure this is the exact questions that your patients probably ask you.
Stephanie Gray: 20:23 Yes.
Karen Litzy: 20:25 Or hopefully that's what they ask you. Let's put it that way, So now talking about these hormones, how would one know if they are low on these hormones?
Stephanie Gray: 20:37 Good question. Really get tested. Does every postmenopause woman with osteoporosis need testosterone? No, I can't say that I'm speaking to what has helped my patients. But the beauty of functional integrated medicine is that we personalize treatment, right? We test hormone levels to see what our patients need and we test them at the beginning of therapy and through the therapy and annually, right. To make sure we're not under or overdosing our patients. So, I recommend that women, even young women, and I should say men too, but we're kind of speaking to women today, get their hormone levels tested in their twenties, thirties, forties. Right? So they can get a baseline. They can track changes. So they start to feel different, start to feel something has gone awry, we can compare to see where their hormones were before. I think that's really important. But basic blood tests can tell you where your hormone levels are.
Stephanie Gray: 21:27 And now that's for postmenopausal women and for men. Now if you're younger, another test that I utilize in my practice is saliva hormone testing. So for younger women whose hormones fluctuate, whose hormones fluctuate on a daily basis, many times I'll have them spit into a tube every couple of days over the course of a month so we can really see what's happening. Maybe they're getting headaches for population or maybe they're getting headaches before bleeding or having pms or whatnot. If we can correlate their labs with their symptoms, then we know exactly what's happening, which hormones fluctuation is triggering that, and then we can intervene appropriately. So that's the beauty of testing and not guessing. Really being able to examine on paper what's happening and match it with what the patient's plan.
Karen Litzy: 22:09 And with osteoporosis or Osteopenia, let's say you are getting tested when you're younger to find out, you know, what are you deficient in vitamin or mineral wise and where are your hormones levels at? Can you through this process help to let's say ward off osteoporosis or Osteopenia even if it's a genetic thing within your family.
Stephanie Gray: 22:40 I guess the easy answer there would be sure. That would be the goal of course. So we want to ward off all chronic disease.
Karen Litzy: 22:47 Yeah, exactly.
Stephanie Gray: 22:49 I'm sure there could be some rare genetic disorder. I'm not aware of that. Maybe, you know, we couldn't influence, but yes, that would absolutely be the goal is intervene soon. Absolutely.
Karen Litzy: 23:03 Got It. And is there anything else when you're seeing patients coming to you with Osteopenia, osteoporosis, anything else that you're looking at or any other treatments that you may suggest? So that if anyone is listening to this, and let's say they are concerned that maybe they have osteoporosis or Osteopenia or they are post-menopausal or reaching that post-menopausal phase and they want to go to their doctor and they want to ask them about these tests, is there anything else aside from what we've already talked about that you would suggest?
Stephanie Gray: 23:37 Oh, all kinds of things. So I'm back to the micronutrient deficiency possibility. Well, especially if that occurs, we're going to be looking at diet with the patient, right? I had a young woman my age who was drinking like six or seven cups of coffee per day. And I said, you know, that's just basically leaching minerals from your bones, right? It's a diuretic. It's essentially robbing you of all important nutrients, even nutrients you're supplementing with. So you still need to examine diet with all of our patients and make sure that we're eating well. Right? And not just drinking tons of carbonated beverages or caffeine or whatnot. So definitely looking at diet is important. Sometimes we do look at heavy metal toxicity with our patients, with these patients specifically. I don't want to say it's rare, but it's much more common and more easy to treat the patients, you know, by fixing the nutritional deficiencies and the hormones.
Stephanie Gray: 24:32 But there are times where it is really important to look at heavy metals as well. And then I definitely always ask my patients about their stress, right? So if they have low hormone levels, that's part of that's natural, right? Your hormones are going to decline as you age, but you're super stressed out. Stress is your body's biggest hormone, hijacker stresses not helping your situation or your bombs. So we do need to think about lifestyle and really getting stressed under control, deep breathing, Yoga, meditation, and then examine if they're doing weight bearing activity as well. Yeah, of course. Needs to start really young, right? You build your phone mineral density in your 20s. So know that needs to start at a very young age. But I do want to make sure my patients are exercising as well.
Karen Litzy: 25:20 Awesome. Well, I think that gives us a really nice holistic view of kind of looking at Osteopenia and osteoporosis from sort of bridging the gap really between that functional medicine and traditional medicine. As a physical therapist, I often get patients referred to me for osteoporosis to do those exactly what you said, those weight bearing exercises, stress reduction, things like that. And so it's good to know that as a physical therapist that we can team up with other healthcare professionals with our patient's wellbeing at the center.
Stephanie Gray: 25:54 Absolutely, I would say that that's also a belief for functional medicine, that we need interdisciplinary care for our patients. You know, I don't have time during my visits to teach patients exercise for strength and balance. We have our own strengths, but we can work together as a team and really have a multidisciplinary approach for our patients, which is going to provide them with better outcomes.
Karen Litzy: 26:17 Yeah, no question. I agree 100%. And now we had mentioned the book a little bit, it's called the longevity blueprint, can you tell the listeners a little bit more about the book and where they can find it?
Stephanie Gray: 26:30 Maybe I'll go off on a little tangent here and just say why I wrote the book first. I think sometimes patients or consumers may think, oh, so-and-so just wrote a book, but she doesn't know because she hasn't experienced such and such or whatnot. And I'm definitely a provider who has gone through my own health challenges, unfortunately. But fortunately I've used them to my advantage to write this book. So I personally, I've struggled with a lot of things. The most challenging really was fast heart rate or a tachnocardic episodes, which, landed me at Mayo Clinic actually, well, firstly to be in the emergency room, but I eventually landed me at Mayo and conventional medicine's approach to my issue was to take a medication to control my heart rate. And although that could have worked and could have helped, I thought I need to figure out what's happening to me.
Stephanie Gray: 27:25 I needed to figure out why my body's gonna ride, right, why my heart is racing like this. And so around the same time, my husband is actually our office manager at our clinic. We have integrated health clinic in Iowa and he said, you know, you should really use this to try to streamline the process as far as what we recommend to our patients. Can you outline all of what we offer? Because sometimes patients would come see a functional medicine practitioner who only offered gut health or only offered hormone health or detoxing or whatnot. And we really offered the whole Shebang. And so he said, why don't we try to create some sort of analogy to outline all of what we can offer patients really to provide them hope. And so I created this blueprint outlining a functional medicine and all the different principles of what we can offer patients with every organ system of the body.
Stephanie Gray: 28:14 And then I kind of laced through my personal story as well as far as what I had to utilize to regain back my health. And so what I'm doing with the book is I'm trying to at least create this analogy between how we maintain our homes and the compare that to our body, right? So with our home, we have, well I have hair in my drain, right? I don't want hair clogging my drain. You probably mow your lawn. If you have a lawn, you probably change the furnace filters on your home right there. Just things you'd have, you know, you have to do to maintain your home. But we don't always know how to maintain our body. We don't know how to rebuild our body if we're sick or build that health period. And so I'm taking a room in each of our homes, right?
Stephanie Gray: 28:55 And I'm comparing that to an organ system in the body. So chapter one is all about gut health because I believe that gut is the most important piece of our health, most important organ system that we have. And I'm comparing that to the foundation of the home. You have to have the strong foundation upon which to build good health. So then I go chapter by chapter. I'm comparing, you know, organ system. So we were talking a lot about chapter four today and chapter six, chapter six I'm comparing the heating and cooling in your home, right? And you don't want to be too cold, you want to be too hot, you have to have a good thermostat there. But I'm comparing that to the endocrine system in the body. And so I try to help patients rebuild their body, rebuild every organ system using functional medicine principles. So I talk about the tests that are important. I talk about the nutrients that are important and offer patients resources as well.
Karen Litzy: 29:42 That's awesome and that's really great for patients. And just so everyone knows, we'll have a link to the book in the show notes over at podcast.healthywealthysmart.com. So if you're interested and you can go over, click a link and it'll take you right to Stephanie's books, you can read more about it and see if it's for you. And now, Stephanie, I ask everyone this question at the end of the podcast and that is knowing where you are now in your life and in your business, what advice would you give to yourself and in your case, since you have a plethora of degrees, let's say right after your bachelor degree, after you graduated with that bachelor's in nursing.
Stephanie Gray: 30:26 Okay, so that's tough. I think what part of what I've learned through my health situation, I had to change my diet and nutrition and what not, but I also had to reduce stress big time. And so I think one I really recommend to all, well everyone but including the youth, I wish I would have as happy I as I am to be where I am and to have the knowledge I have so that I can ultimately help others. My health suffered along the way and so I could have, you know, done this over a longer period of time and instead of jamming it into fewer years, I think the advice to myself would be to physically set time in my calendar to deep breathe. Deep breathing has been extremely important to me to calm my nervous system. I'm obviously a fast talker and I needed to set aside time for my body to just mend and relax, rest and digest. So I think that's what my advice would be to take time for myself. As hard as it would've been, it probably would've been very difficult for me to do yoga. I probably couldn't have sat still, but I needed it. Yeah. That's probably the advice to just slow down, breathe slowly, take time.
Karen Litzy: 31:39 Yeah. And that's great advice and it's advice that I give to a good majority of my patients as well. And so now is there anything else, I know that you had mentioned that you have an offer for listeners. Do you want to share that now?
Stephanie Gray: 31:54 Sure. So if you're hearing about functional medicine for the first time today, I'd highly recommend you check out my book just because I think that it could provide you hope or hope for a loved one. I think many patients are just so dissatisfied, they keep going to the doctor, they keep being told that everything's normal and they know they don't feel normal and they know there are answers out there and there's a good potential that a functional medicine provider could help you. So I would definitely recommend grab a copy of my book, which is loaded with resources but also look for a functional medicine practitioner in your area. So the code on our website that can be used to purchase the book, although it's available at Barnes and noble and Amazon and everywhere books are sold is yourlongevityblueprint.com. So if you use the code healthy10, you can get 10% off order on the book or any of the supplements like vitamin K2 or anything you feel like you need. But after, you know, when you think of a home being built, there's always a contractor overseeing that process. And, that's what the last chapter of my book is about. Finding your contractor to help you personally as a community build your health. The book can help, but you do need a guide. You need a contractor.
Karen Litzy: 33:01 Well thank you so much. This was great. I love learning different ways to kind of keep myself healthy and as I get older and I start, I mean I think I have a little while left, but kind of entering the phase of my life where a lot of this stuff is going to be very pertinent to me. So I thank you for sharing it all.
Stephanie Gray: 33:25 Well, thank you for having me on. I hope this helps many of your viewers
Karen Litzy: 33:28 And I think it will. Thank you so much Stephanie and everyone out there listening. Thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Alex Hutchinson on the show to discuss sports journalism. Alex Hutchinson is National Magazine Award-winning journalist who writes about the science of endurance for Runner’s World and Outside, and frequently contributes to other publications such as the New York Times and the New Yorker. A former long-distance runner for the Canadian national team, he holds a master’s in journalism from Columbia and a Ph.D. in physics from Cambridge, and he did his post-doctoral research with the National Security Agency.
In this episode, we discuss:
-How to disseminate findings from complex research studies to a layman audience
-Attention grabbing headlines that commit to a point of view
-Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance
-What Alex is looking forward to from the Third World Congress of Sports Physical Therapy
-And so much more!
Resources:
Third World Congress of Sports Physical Therapy
Alex Hutchinson Twitter
Endure
Range
Alex Hutchinson Website
For more information on Alex:
I’m an author and journalist in Toronto. My primary focus these days is the science of endurance and fitness, which I cover for Outside (where I’m a contributing editor and write the Sweat Science column), The Globe and Mail (where I write the Jockology column), and Canadian Running magazine. I’ve also covered technology for Popular Mechanics (where I earned a National Magazine Award for my energy reporting) and adventure travel for the New York Times, and was a Runner’s World columnist from 2012 to 2017.
My latest book, published in February 2018, is an exploration of the science (and mysteries) of endurance. It’s called ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance. Before that, I wrote a practical guide to the science of fitness, called Which Comes First, Cardio or Weights? Fitness Myths, Training Truths, and Other Surprising Discoveries from the Science of Exercise, which was published in 2011. I also wrote Big Ideas: 100 Modern Inventions That Have Transformed Our World, in 2009.
I actually started out as a physicist, with a Ph.D. from the University of Cambridge then a few years as a postdoctoral researcher with the U.S. National Security Agency, working on quantum computing and nanomechanics. During that time, I competed as a middle- and long-distance runner for the Canadian national team, mostly as a miler but also dabbling in cross-country and even a bit of mountain running. I still run most days, enjoy the rigors of hard training, and occasionally race. But I hate to think how I’d do on an undergraduate physics exam.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody. Welcome to the Third World Congress of sports physical therapy Facebook page. And I am your host, Karen Litzy. And we have been doing several of these interviews over the past couple of months in support of the Third World Congress of sports physical therapy. And today we have writer, journalist, author, athlete, Alex Hutchinson who is part of the Third World Congress. He's going to be a part of an informal Q and A and also doing a talk with Greg Lehman, who's already been on. So Alex, welcome to Facebook live.
Alex Hutchinson: 00:37 Thanks very much, Karen. It's great to be here.
Karen Litzy: 00:39 All right, so for those people who maybe aren't as familiar with you, can you tell us a little bit more about yourself?
Alex Hutchinson: 00:46 Yeah, I mean, I guess when people ask what I do, I say I'm a freelance journalist, but if you kind of drill down a little bit, my subspecialty is like, I'm a sports science journalist or even an endurance sports science journalist, which isn't really a job, but it's effectively what I do. So I write for, for outside magazine and a few other places. There's Canadian running magazine and a newspaper in Canada called the globe and Mail, but mainly outside magazine about the science of Endurance sports, sports more generally, adventure, fitness, health, all those sorts of things. A fairly, fairly broad stuff that interests me, I try and look at the science angle of it. And so that means talking to a lot of athletes and sometimes I talk to coaches, but mostly I talk to researchers who are trying to use, you know, research studies, peer reviewed, you know, placebo-controlled, blinded studies to answer questions that a lot of us have when we exercise, you know, what workout should I do or how should I refuel or these sorts of things.
Karen Litzy: 01:48 Alright, so you're taking, which I think is great. You're taking the research and you're able to disseminate that out into, if you will, the layman's audience.
Alex Hutchinson: 01:57 Yeah, that's the goal. Yeah. And, it's interesting cause I come from a running background. I was a competitive runner. And I was a, a guy interested in science, but there wasn't no, when I was competing in the sort of nineties and early two thousands, it to me at least, it seemed, it wasn't very easy, I didn't even know that there were, you know, thousands of researchers around the world trying to answer these sorts of questions. And I think for me it was in the middle two thousands I started seeing some columns in the New York Times from Gina Kolata. And then from Gretchen Reynolds. Gina Kolata had a column called personal best where she was like looking into the myth that lactic acid causes fatigue. And this was maybe around 2005 and I was like, Holy Mackerel.
Alex Hutchinson: 02:37 And she was interviewing scientists who are asking these questions. And I thought there are scientists who care about lactic acid so that kind of started me on the path of thinking that, realizing there's a body of research out there that wasn't reaching interested lay people like myself. So I started pursuing that. And I think today there's a lot more. Like there were a lot of avenues through which exercise science reaches the lay people. I feel like I'm one of those channels, but it's definitely, there's a lot more options for people now, including directly from scientists themselves in places like Twitter.
Karen Litzy: 03:13 Exactly. And I think that's where I, you know, in the late nineties, mid two thousands, social media certainly wasn't as robust as it is now. And now you have scientists and researchers being encouraged to get onto these platforms and disseminate some of their information, whether it be through tweets or infographics, podcasts, Facebook lives, things like this. So I think the leap from relatively nothing, you know, meaning researchers kind of doing their research but not having perhaps the means to get it out to a wider audience outside of a journal that not every lay person who reads, you know, having such great avenues to disseminate this information. Do you feel like it's made a difference in the general public?
Alex Hutchinson: 04:00 I think it has. It's hard to really evaluate this stuff, but my sense is there's a higher level of literacy or sort of awareness of issues, you know, things like how to fuel that's maybe not just drawn from, I heard it from a guy at the gym or I heard it from my coach who heard it from his coach who is taught by, you know, some guy in 1830 that this is how it works. I mean, I would almost say that we've gone from a place of scarcity to a place of excess that now it's not like you can't find information. Now there's these fire hoses of information just drenching you with 20 different theories. All of which seemed to be supported by scientists about how you should eat, how you should exercise, how you should move, and all these sorts of things.
Alex Hutchinson: 04:45 So I started writing about sports science, let's say 15 years ago or a little less than that. And at that point it was like, let's get the information out there. People don't realize that there's information now. It's like there's all this information, let's curate the information. Let's try and provide people with some judgements about what's reliable and what's not. Why we think that some sources of information are better than others. How each person can evaluate for themselves, whether this is trustworthy. You know, and this is obviously not an easy or there's not like one answer to this study's right and this study's wrong, but, yeah, I feel like my role has shifted a little bit from get the information out there to, okay, maybe I can be a trustworthy source of curation where I'm giving people the information, not necessarily telling them what to think, but saying, here's the evidence. Now you may choose to think this evidence isn't convincing enough for you to switch to the, you know, the Aldana Diet or you may not, but here's, here's what the evidence says it exists.
Karen Litzy: 05:45 Yeah, and that's a great lead into my next question is when we look at quote unquote fake news and we can categorize that as misinformation or disinformation. So misinformation being like you're putting something out there and you think it's good, but you just don't know that the information is bad versus disinformation, which is, I guess we can categorize more as propaganda. So you know, the information's not correct, but you're pushing it out there anyway. So I think it's important to me. Both of those are fake news, but it's important to make that distinction. So as a journalist, how do you navigate this and how important is it for you to get that right?
Alex Hutchinson: 06:27 Yeah, yeah, yeah. Well, getting it right is important to me and I'm glad you made that distinction because I think that's an important one because you know, fake news in the politicized sense is another way of saying propaganda. And I think that's mostly not what we're dealing with in the exercise or the health space. I mean there, there is actually, I mean, you know, let me take that back a little bit there. There are people who are just selling things to make money who are just, they don't really care whether it's true. They're putting steroids into their stimulants, into their strength supplements because they just want people to feel a boost and they're just flat out lying so those people are bad and they're also not that hard to spot if truth be told, if you're critical, what's tougher is the, you know, what you call misinformation rather than disinformation, which is people honestly believe this.
Alex Hutchinson: 07:20 Like, I tried this diet, it works for me, and therefore everyone should be doing it. And I read this study that shows that people who do this diet, you know, increase their levels of some inflammatory marker and that proves, that confirms my belief. And therefore I'm going to become an evangelist for this. And I'm going to say that everyone who disagrees with me has been paid off by big industry and blah, blah, blah. And sometimes it's not quite that. I mean, I'm caricaturing it, but people don't have strong beliefs that don't have as strong beliefs about, you know, controversies in particle physics cause we don't have personal experience in particle physics when you're talking about health and exercise and eating and things like that. We all have our, we have our experiences. And so we map that on top of whatever evidence we're experiencing, and I include myself in this, you know, my experiences play into what science, scientific research finds plausible.
Alex Hutchinson: 08:12 So that creates a different dynamic. So to answer your actual question, how do I navigate this? Imperfectly like every other human, but my goal in what I write, what I try and do is if I'm writing about a study, this article from my perspective as the one in which I'm able to serve, take the key graph from that study, cut and paste it into my article and then describe what the study was. Here's what they did, here's what they found.
Alex Hutchinson: 08:46 I'll take it a step further than that because my role is to interpret. I'll say, here's what I think this means, but I want to make sure I can give enough information to someone who doesn't think that's what it means is also can also see, well that's what the evidence was. And it's like, well no, I don't agree that that should change my behavior or whatever, but I'm giving them, I want to give people enough information so they understand what the study did and what it found. And then the meaning, if I've given people enough information, they don't have to rely on me telling them that this is what it means even though I am going to tell them what I think it means.
Karen Litzy: 09:16 If you were to give tips to let's say the layman person, say it's like my mom or you know, your friend who knows nothing about science, he doesn't have a phd in physics, and we'll get back to that with you in a second. But what tips can you give to the lay person on how to spot this misinformation, because the thing is when you look at a lot of articles, they're always citing this study, that study, this study.
Alex Hutchinson: 09:47 Yeah. It used to be like, show me the peer reviewed evidence. But yeah, I've slowly realized, you know, and understood that there is a peer reviewed study for everything. And you know, 10 years ago I used to get, I'd see a study saying, you know, hey the, you know, the fruit of this plant, if you take it's going to increase your endurance by 2%. It's like, well if they have a placebo controlled, double blinded study published in a peer reviewed journal, it must be true. I'll write about it. And then, you know, I never did hear about that extractive of such and such a plant. Again, like no one, it never turned out to be a thing. And I sort of finally understand, you know, started to understood the bigger systemic problems, which is that if you have, you know, thousands of Grad students across the country looking for a master's thesis that can be done in six months or an experiment, they can be done in six months.
Alex Hutchinson: 10:33 They're testing all sorts of things. And if it's not interesting, they don't publish it. And if it happens by chance to produce a positive result, then they publish it in a journal. So we get this sort of, there's always public positive studies about everything. What I was saying, which is that just the mere presence of a study isn't enough. So there is no simple template. But I would say there are some guidelines like follow the money. If someone's trying to sell you something, it’s obvious, but it's surprising what a good rule of thumb that is. And it's why we see so much information about pills and technology.
Alex Hutchinson: 11:20 And so little information about, you know, another study showing that sleep is good for you, getting some exercise is good for you because it's very hard to monetize that. And so there's lessons. I don't mean to sound like a patsy or like someone who's, you know, pump promoting my own way of seeing things. But I think there are some sources that are more sort of authoritative than others. And frankly, the mainstream media still does a pretty good job relative to the average blog. Now there are some great blogs out there and you know, and I will say, I started out in this, I set up my own blog on wordpress and I blogged there for five years, just analyzing studies. And then runner's world asked me to bring the blog onto their site and then it got moved outside.
Alex Hutchinson: 12:08 So it's not that there aren't good blogs and you can maybe get a sense of what people's agendas are and what their backgrounds are. But, you know, if I knew that, I know in this highly politicized world, I know that this may be a controversial thing to say, but if I see something in New York Times, I'm more likely to believe it than if I see it on, you know, Joe's whole health blog and I read the New York Times and I get frustrated frequently and I say that now they're getting this wrong. And this is not a full picture of this. Nobody's perfect. But I think that people with credentials and getting through some of those gatekeepers is one way of filtering out some of the absolute crap that you see out there.
Karen Litzy: 12:53 Perfect. Yeah, I think those are very easy tips that people can kind of follow. So sort of follow the money, see who's commissioned said RCT, systematic review. And, oftentimes, especially on blogs, it can be a little tricky because some of them may write a blog and be like, oh, this is really good. But then when you look down, it's like the blog is sponsored by so-and-so,
Alex Hutchinson: 13:18 And that's the reputable people who are acknowledging who's sponsoring them. Then there's the people who are getting free gear, free product or money straight up, but they're not, you know, like there's levels of influence and the people who are disclosing that at least they're disclosing it. But nonetheless, it's, you know, one of the things that I think people often kind of misjudge is when, when someone says that follow, you know, follow the money and the financial influences, finances can influence someone. That doesn't mean that the people who are passing on this message or corrupted or that it's disinformation as you would say that they're deliberately, yeah. I mean, lots of researchers who I really highly respect do excellent research funded by industry. And I think that there's any important information that comes from that research, but I also think that the questions that get asked in industry funded research are different than the questions that you might ask if you just had you know, a free pot of money that wasn't tied to any strings.
Alex Hutchinson: 14:16 If you want to, you know, not to pick on anybody, but if you want to know which proteins are best for building strength and if the dairy industry is going to fund a whole bunch of studies on dairy protein, then you're going to have this excellent body of research that shows that dairy protein is good for building muscle. That doesn't mean it's wrong, it just means that we haven't studied what, you know, vegetable proteins or other forms of meat. There's been less emphasis on those proteins so you get a distorted view of what's good or bad without anybody doing anything wrong. It's just that money does influence the way we ask questions and the answers we get.
Karen Litzy: 14:53 Great. Thank you. Now I had just mentioned about having a phd in physics. That is obviously not me. How did you end up doing your phd in physics and how does this help you when it comes to writing your articles or writing these reviews of RCTs or systematic reviews?
Alex Hutchinson: 15:14 Well, I should first say that if anyone's interested in becoming a science journalist, I wouldn't necessarily recommend doing a phd in physics. It's not the linear path or you know, the path of least resistance. I honestly didn't know what I wanted to do when I grew up. Some advice I got, which I think was good advice to some extent was, you know, if you don't know what you want to do, do something hard because at least you'll prove to people that you can, you know, solve problems and there'll be some transferability of that training. And I think that was true to some extent. And I, you know, so I did physics in Undergrad. I still didn't know what the heck I wanted to do. And I had an opportunity to go do a phd in England, which seemed like a big adventure.
Alex Hutchinson: 15:50 So I went and did a phd there, PhDs there are actually a lot shorter than they are in North America. It's just over three years for my phd. So it wasn't, it wasn't like this sort of, you know, spent my entire twenties on this. Physics was fun, but it just, I could see that the other people in my lab were more passionate about it than I was, that they were, they were just interested. They were passionate about it. And I thought, man, I want to, I want to find something that I'm passionate about. So I ended up in my late twenties saying, okay, well it's been a slice, but I'm going to try something else. And, you know, fortunately I guessed right. And journalism turned out to be fun. Fun for me. I don't write, you know, especially these days if I'm writing about exercise and it's not like I need to know Newton's laws or anything like that or you know, apply the principle of general relativity to exercise.
Alex Hutchinson: 16:35 So there's not a lot of like direct pay off. But I would say that having a scientific training has helped me be willing to speak to scientists and not be intimidated by paper. You know, Journal articles that look very complex and you know, I have the confidence to know that, okay, I don't have a clue what this journal article is saying, but I know if I slow down, if I read it a few times and if I call it the scientist and say, can you explain this to me? I'm not worried. Well, I mean, I don't like looking stupid, but I'm over the idea is like, it's okay. I can call up the scientist. I know enough about scientific papers to know that probably the guy in the office next door to whoever wrote this paper doesn't understand this paper. You know, science is very specialized and so it's okay to just say, explain to me, explain it to me again. Okay. This time, pretend I'm, you know, your 90 year old grandfather and explain it again. And so that allows me, or has helped me write about areas even when I'm not familiar with them and not be intimidated by numbers and graphs and things like that.
Karen Litzy: 17:36 All right. And I would also imagine that going through Phd training yourself, you understand how articles are written, you kind of can look at the design, and you can look at the methods and have a little bit more, I guess confidence in how this study was maybe put together. Versus no training at all.
Alex Hutchinson: 18:03 You've seen how the sausage is made and so you understand the compromise that get made. I will say that it was surprising to me how different the physics processes to the sort of the sports science world in terms of just the factors that are there that are relevant in physics. You’re never dealing with people. And with the sample recruitment and things like that. An Electron is an electron, you know, for the most part. You know, and this is an important to understand is physics aside by looking a lot of studies, I started to see the patterns and started to understand what the functions were, started to understand how to read a paper relatively quickly. How did you know it? For me to find stories, I ended up looking at a lot of journal articles and I can't read every one of them in depth in order to find the ones I wanna write about.
Alex Hutchinson: 18:52 So I have to find ways of, you know, everyone knows you. Yeah, you can read the abstract, but you're not going to get the full picture. You know, you start to learn just by experience, by doing it. That, okay, if I read the introduction, that's where the first three paragraphs are where they're going to give me the context. Because often a study seems very specific and you're like, I don't know what you're talking about. And then they'll give two paragraphs where they're just like, since the 1950s, scientists have been wondering about x, Y, and zed. And then you can go to the conclusions and then, you know, depending on how deep you want to get, you understand where, which part of every paper is written with a specific format and you can figure out where to go with a little experience. And it doesn't require a physics phd or it requires just getting, getting familiar with that particular, you know, subject area.
Karen Litzy: 19:35 Nice. And now, you know, we talked earlier about how, you know, information from researchers went from like a little drip to a fire hose and as far as getting information out to the general public, so because there is so much information available, how do you approach designing your article titles and headlines to ensure you grab attention for the reader. So I think that's a great question directed at the researchers who are maybe thinking of doing a press release or things like that to help promote their article.
Alex Hutchinson: 20:10 Yeah. This is a really interesting question. This isn't one where my thinking has shifted over the last, let's say, decade. So I started out, you know, in print journalism, writing for newspapers and magazines. I still do that, but one of the things in from when you're writing for a newspaper magazine is you don't have control over your headlines. You write the article, the editor writes the headline. And so my experience in that world was always one of frustration being like, I wrote this very carefully nuanced, balanced article. And then the headline is, you know, do this and you'll live till you're a hundred or whatever. It's like, no, that's not what I was saying. It's terrible. And so I got into this sort of reflects of habit you know, just apologizing for the headlines. Like, Oh, you know, when I talked to researchers, I'm so sorry about the headline.
Alex Hutchinson: 20:59 You know, I'm very sophisticated, but you know, that this silly editor wrote the headline and a couple of things help to sort of shift my views a little bit on that. One is the shift to online meant that newspapers and journalists now have a very, very clear idea of who clicks on what. So you understand what it is that gets people's attention. And the second thing is that, you know, when I started my own blog, and then even now, when I blog, I don't have full control of my headlines, but when I was on wordpress, I wrote my own headlines. And when I now as a blogger, I suggest headlines. And so I don't have control, but I am given more input than I used to be on how this article should be conveyed.
Alex Hutchinson: 21:40 And one thing that's really clear is that, what people say they want and what people will do is different. And so I remember looking at when the global mail is the Big News newspaper in Canada. I remember when it first started showing its top 10 most clicked articles. You know, in the transition to digital on its website. And of course, everyone says, I hate clickbait. I want to have sophisticated, nuanced conversations. And then the top 10 articles clicked would all be something to do with Brittany Spears or whatever. You know, this was 10 years ago. And it's like, so people click on, people do respond to clickbait and click bait it's bad. But you know, I sometimes I want like sometimes give talks to scientists about science communication and I'll give some contrast between here's the journal article, you know, here's my headline and the journal article will be something that's so careful that you're not even, it definitely doesn't tell you what the article's going to say.
Alex Hutchinson: 22:36 You're not even entirely sure what the subject is. You know, like an investigation of factors contributing to potentially mitigating the effects of certain exercise modalities. And you're like, I don't know. I don't know what that's about. No one clicks on it. And so it's like that sort of, if a tree falls in the forest, if you write a perfectly balanced nuanced article and nobody reads it, have you actually contributed to science communication? And so one of the things that I found in with headlines that I'd complain about is I would complain about a headline that someone had written for my article and then, and I try to think why am I complaining about this? And it's like, well it's sort of coming out and saying what I was hinting at, I was hinting at, I didn't want to come out and say, you know, overweight people should exercise more or whatever.
Alex Hutchinson: 23:22 Cause that's horrible. No one would say that. But if you sort of read what the evidence that I was shaping my article to be, it'd be like, if you're not getting results from your exercise, maybe you're just not exercising hard enough. I was like, well maybe I need to own the messages. You know, if the headlines to me seems objectionable, maybe it's my article is objectionable and I've tiptoed around it, but I need to think carefully. And if someone reads my article, you know, an intelligent person reads my article and says this in sum it up in seven words, this is what it is, then I need to maybe be comfortable with having that as the headline, even if it's an oversimplification, because the headline is never going to convey everything, all the nuances. There's always caveats, there's always subtleties.
Alex Hutchinson: 24:04 You can't convey those in seven words. That's what the article is for. So I've become much more of a defender, not of clickbait, not of like leading people in with misleading things. But if ultimately the bottom line of your article is whether it's a academic article or a press article is, you know, this kind of weight workout doesn't work and you should be okay with a headline that says that. And yes, people will say, but you forgot this. And then you can say, well, no, that's in the article, but I can't convey all the caveats in the headline. So anyway, that's my, that's my sort of halfhearted defense of attention grabbing headlines in a way.
Karen Litzy: 24:37 Yeah. And if you don't have the attention grabbing headline, like you said, then people aren't going to want to dive into the article. So I was, you know, looking up some of the headlines from outsideonline.com and the first one that pops up is how heat therapy could boost your performance. And you read that and you're like I would want to find out what that means.
Alex Hutchinson: 25:02 And they put some weasel words in there. It's not like heat therapy will change your life. It's how it could boost your performance. And so, and I'm there, it's interesting, I've got conversations with my editor and they, you know, they don't like question headlines. They don't want to be as like, is this the next, you know, a miracle drugs? And then it turns out the answer is no. It's like they feel that's deceptive to the reader. They want declarative headlines that say something. It’s an interesting balance but outside has been, they've had some headlines which were a little, you know, there was one a while ago about trail maintenance and it was like the headline was trail runners are lazy parasites or something like that. And that was basically, that was what the article said. It was an opinion piece by a mountain biker. They got a ton of flack for that and they got a bunch of people who are very, very, you know, I'm never gonna read outside again. It's like, dude, relax. But I understand, but I understand, you know, cause it is a balance there. They want to be noticed and I want my articles to be noticed, but I don't want to do it in a deceptive way.
Karen Litzy: 26:07 Yeah. And I think that headline, how heat therapy could boost. It's the could.
Alex Hutchinson: 26:12 Exactly the weasel word that it's like, it's, I'm not saying it will, but there's certainly some evidence that I described in the article, but it's possible this is something that people are paying or researching and that athletes are trying, so it's, you know, check it out if you're interested.
Karen Litzy: 26:25 Yeah, I mean, I think it's hard to write those attention grabbing headlines because like you said, you can have the best article giving great information, but if it's not enough in the headline for the average person to say, hmm, Nah, Nah, nevermind, or Ooh, I really want to read this now the, I think when you're talking about an online publication, like you said, you now have a very good idea as to who is reading by going into the analytics of your website. So I think that must make it a little bit easier, particularly on things that they're going to catch attention.
Alex Hutchinson: 26:59 And so since I'm working for outside, I don't have access to their analytics though. I can ask them what my top articles were or whatever. And I actually am careful not to ask too much because I think there's a risk of you start writing to the algorithm. I start with, you know, you're like, oh, so if people like clicking on this, I'm going to write another article that has a very similar headlines. So, when I had my wordpress site, I had much more direct access to the analytics and it's a bit of a path to, it forces you to start asking yourself, what am I writing for? Am I writing to try and get the most clicks possible or to do the best article possible? So I actually tell him when I talked to my editor, I'm like I don't want too much information.
Alex Hutchinson: 27:43 I want to know. Sometimes I kind of want to get a sense of what people are reacting to and what aren't. And I can see it on Twitter, which things get more response. But I don't want that to be foremost in my mind because otherwise you end up writing you know, if not clickbait headlines, you write clickbait stories, you know, cause you do get the most attention. Yeah. So I try not to follow it too much and let someone else do that worrying for me.
Karen Litzy: 28:09 Yeah. So instead, I think that's a great tip for anyone who is putting out content and who's disseminating content, whether it be a blog or a podcast, that you want to kind of stay true to the story and not try and manipulate the story. Whether that be consciously or maybe sometimes subconsciously manipulating the story to fit who you think the person who's going to be digesting that information wants.
Alex Hutchinson: 28:34 Yeah. And I know that happens to me subconsciously. You know, it's unavoidable. You're thinking, well, if I write it this way, I bet more people are going to be interested, it happens a little bit, but you want to be aware of it. And especially, I guess if you're, let's say you're someone who's, you know, starting a blog or starting some form of podcast or whatever it is, clicks aren't the only relevant metric and you can get a lot of people to click on something, but if they're left feeling that it wasn't all that great, then you're not gonna, you know, it's better to have half as many people all read something and think that was really substantive and thoughtful and useful than to get a bunch of clicks. But no one had any particular desire to come back to your site.
Karen Litzy: 29:15 Like you don't want to leave people feeling unfulfilled. Yeah, yeah, yeah. Not Good. Well great information for both the researchers and for clinicians who are maybe trying to get some of that research out there. So great tips. Now, we talked a little bit about this before we went on air, but in 2018 you've published your book, endure mind body and the curiously elastic limits of human performance. So talk a little bit about the book, if you will, and what inspired you to write it?
Alex Hutchinson: 29:50 Sure. The book is basically, it tries to answer the question, what defines our limits. Like when you push as hard as you can, whether you know you're on the treadmill or out for a run or in, in other contexts, what defines that moment when you're like, ah, I can't maintain, I have to slow down. I have to stop. I have reached my absolute limit. And it's a direct, you know, it's easy to understand where the book came from. I was a runner and so every race I ran, I was like, why didn't I run faster? Like I'm still alive. I crossed the finish line. I've got energy left. Why didn't I, why surely I could have run a little bit faster. And so basically I, you know, I started out with an understanding of a basic understanding of exercise physiology.
Alex Hutchinson: 30:32 And, you know, 15 years ago I thought if I can learn more about VO2 Max and lactate threshold and all these sorts of things, I'll understand the nature of limits and maybe what I could have done to push them back. And about 10 years ago, I started to realize that there was this whole bunch of research on the brain's role in limits. And there've been a whole bunch of different theories and actually some very vigorous arguments about this idea. But this idea that when you reach your limits is not that your legs can't go anymore. It's that in a sense, your brain thinks you shouldn't go anymore than that. Your limits are self-protective rather than reflecting that you're actually out of gas, like a car runs out of gas. And so then I thought I was gonna write a book about how your brain limits you.
Alex Hutchinson: 31:12 And in the end, as you can probably guess, it ended up being a sort of combination of these sorts of things. Like there's the brain, there's the body, they interact in different ways, in different contexts. So I ended up exploring like, you know, we were talking about this before, what is it that limits you when you're free diving? If you're trying to hold your breath for as long as possible, is it that you run out of oxygen after a minute and then how come some people hold their breaths for 11 minutes? And how does that translate to mountain climbing or to running or to riding a bike or to being in a really hot environment or all these sorts of things. So that is what the book is about is, is where are your limits? And the final simple answer is, man, it's complicated and you have to read the whole book.
Karen Litzy: 31:51 Yeah. And we were talking beforehand and I said, I listened to the book as I was, you know, commuting around New York City, which one it would got me really motivated and to want to learn more. And then it also, I'm like, man, I am lazy. There are so many different parts of the book from the breath holding, like we were talking about. And things that I was always interested me are altitude trainings and the how that makes a difference, whether you're training up in the mountains or sea level or in those kind of altitude chambers. Which is wild stuff. And is that, I don't know, is that why people break more records now versus where they were before? Is it a result of the training? Is it, and then, like you said, the brain is involved and so are you just by pushing the limits of yourself physically, but then does the brain adapt to that and say, okay, well we did this, so I'm pretty sure, and we lived, so can we do it again?
Alex Hutchinson: 33:08 And that's actually a pretty good segway to the World Congress of sports therapy. Because the session that I'm talking about it that I'm talking with Greg Leyman is on pain. And, one of the things that I find a topic that I find really interesting is pain tolerance. Do we learn to tolerate more. And so, you know, one of the classic questions that people argue about on long runs is like who suffers more during a marathon, you know, a two and a half hour marathoner or a three and a half hour marathoner. It's like, one school of thought is like, well, it's a three and a half hour marathoner is out there pushing to the same degree as the two and a half hour marathoner, but is out there for longer for almost 50% longer so that that person is suffering longer.
Alex Hutchinson: 33:56 And the counter point, which sounds a little bit maybe elitist or something to say on average, the two and a half marathoner has learned two and half hour marathoner has learned to suffer more as his learning to push closer to his or her limits. Now that's a total generalization because it's not really about how fast you are. It's about how well you've trained, how long you've trained. So there are four marathoners who are pushing absolutely as hard as any two and half hour marathoner. And there are some very lucky two and a half hour marathoners who aren't pushing particularly hard because they were capable of doing it, you know, at two 20 marathon or something. But the general point that I would make and that I think that the reason that I think the research makes is that one of the things that happens when you train, so we all know that you go for that first run and it feels terrible, Eh, you feel like you're gonna die when you keep training, all sorts of changes happen.
Alex Hutchinson: 34:52 Your heart gets stronger. You build new Capillaries, your muscles get stronger. Of course, that's super important. It's dominant. But I think another factor that's on pretend times under appreciated is you learned to tolerate discomfort. You learn to suffer. You learn that feeling when your lungs are bursting and you're panting and your legs are burning, that doesn't mean you're gonna die. It just means you can't sustain that forever, but you can sustain it for a little bit longer. You can choose to keep holding your finger in that candle flame for a little longer. And there's actually quite a bit of evidence showing that as training progresses, you learn not just in the context of whatever exercise you're doing, but in the context of totally unrelated pain challenges like dipping your hand in an ice bucket or having a blood pressure cuff squeezed around your arm.
Alex Hutchinson: 35:35 You learn to tolerate more pain by going through the process of training. And I think it's an interesting area of, I think it tells us something interesting about physical limits cause it tells us that part of the process of pushing back physical limits is pushing back mental limits. But it also tells us something about how we cope with pain and why. For example, why exercise training might be helpful for people dealing with chronic pain, for example, that it's not just endorphins block the pain, it's that you learn psychological coping strategies for reframing the pain and for dealing with it.
Karen Litzy: 36:10 Yeah. As a quick example, two and a half weeks ago, I tore my calf muscle the medial gastric tear, nothing crazy. It was a small tear and it happens to middle age people. Normally the ultimate insult or worse, at any rate, you know, very painful. I was on crutches for a week. I had to use a cane for a little while, but I was being so protective around it. And then I read, I got a great email from NOI group from David Butler and they were talking about kind of babying your injury and trying to take a step back and looking at it, looking at the bigger picture. And I thought to myself, well, this was the perfect time to actually get this email because I was like afraid to put my heel down. I was afraid to kind of go into Dorsiflexion and once I saw that, I was like, oh, for God's sakes. And that moment I was able to kind of put the heel down to do a little stretching. And, so it wasn't that all of a sudden my physicality changed so much, but it was, I felt from a brain perspective, from a mental perspective that I could push my limits more than I was without injuring.
Alex Hutchinson: 37:35 Absolutely. And it's all a question of how we have the mistaken assumption that pain is some objective thing that there's, you know, you have it damaged somewhere and that's giving you a seven out of 10 pain. But it's all about how you frame it and if you were interpreting that pain as a sign that you weren't fully healed and therefore you're going to delay your recovery, if you're feeling that pain, then you're going to shy away from it. And if you're just interpreting it, if you read that email and it reframes it as this pain is a part of healing, it's a part of the process of, and it's like, oh well I can tolerate that. If it's not doing damage, then I don't mind the pain and all of a sudden it's become something that's a signal rather than a sort of terrible, it's just information.
Karen Litzy: 38:15 Yeah. Information versus danger, danger, danger. I just reflected on that and thought, yeah, this is pain. It's being protected at the moment. It doesn't mean I'm going to go run a marathon given my injury but it certainly means I can put my heel down and start equalizing my gait pattern and things like that. And so it's been a real learning experience to say the least. And the other thing I wanted to touch on was that idea of pain and suffering. And I know this can probably be out for debate, but that because you have pain, does it mean you're suffering? So if you have a two hour 30 versus a three hour 30 or whatever, the person who runs it in six hours, right? Because you have pain, are you suffering through it or are you just moving through the pain without the suffering attached to it? And I don't know the answer to that, but I think it opens up to an interesting, to a wider discussion on does pain equals suffering?
Alex Hutchinson: 39:20 Now we're getting philosophical, but I think it's an interesting one cause I mean I've heard a number of sports scientists make the argument that one of the sort of underappreciated keys for success in endurance sports is basically benign masochism that on some level you kind of enjoy pushing yourself into discomfort. And I think there's some truth to that. And I think it's an entirely open question. Like are people just born, some people just born liking to hurt or is it something in their upbringing? Moving outside of a competitive context and just talking about health, it's like what a gift it is to enjoy going out and pushing your body in some way because that makes it easy to exercise. And so I think one, you know, this is changing topic a little bit, but one of the big challenges in the sort of health information space is that a large fraction of the people who write about it are people like me who come from a sports background that on some level enjoy, I go out and do interval workouts.
Alex Hutchinson: 40:16 Not because I'm worried about my insulin, but because I like it. I like pushing, finding out where my limits are on being on that red line. And so when I'm like, come on, just go out and do the workout, then others and some people find it very, very, very unpleasant to be near that line. And so I think we have to be respectful of differences in outlook. But I also think that’s what the evidence shows is you can learn to, you know, like fine line or whatever. You can learn to appreciate some of what seems bitter initially. And if you can then it totally changes then that pain is no longer suffering. Then it’s the pain of like eating an old cheese or whatever. It's like oh that's a rich flavor of pain I'm getting today in my workout as opposed to this sucks and I want to stop.
Karen Litzy: 41:06 Yeah. So again, I guess it goes back to is there danger, is there not danger? And if he can reach that point of feeling pain or discomfort or whatever within your workouts and then you make it through the workout and you're like, I can't believe I did that. And all of a sudden next time it's easier. You pushed the bar. Yeah. You've pushed them further to the peak a little bit. So I think it's fun when that happens.
Alex Hutchinson: 41:35 And I think it's important what you said, a understanding the difference between pain as a danger signal. Cause I mean as an endurance athlete I may glorify the pushing through the pain. Well that's stupid if you have Shin splints or you know, if you have Achilles tendon problems or whatever. Yeah. You have to understand that some pain really is a signal to stop or at least to understand where that pain is coming from and to do something to address it. There are different contexts in which it's appropriate or inappropriate to push through pain.
Karen Litzy: 42:03 Yeah. And I would assume for everyone watching or listening, if you go to the Third World Congress of sports physical therapy, there will be discussion on those topics. Given the list of people there, there will be discussions on those topics. There are panels on those topics.
Alex Hutchinson: 42:22 Yeah, I was gonna say, like Greg and I are talking about pain, but looking at the list of speakers, there's a bunch of people who have expertise in this understanding of the different forms of pain, trying to find that line, understanding the brain's role in creating what feels like physical pain. So I think there's gonna be a ton of great discussion on that.
Karen Litzy: 42:39 Yeah. All right, so we're going to start wrapping things up. So if you could recommend one must read book or article aside from your own which would it be?
Alex Hutchinson: 42:50 I'll go with my present bias, which is so, you know, casting my mind all the way back over the past like two months or whatever. The book that I've been most interested in lately is a book called range. I think the subtitle is why generalists triumphant a specialist world by David Epstein. So David Epstein, his previous book was like six years ago, he wrote the sports gene, which I consider basically the best sports spine science book that I've read. And so it was kind of what I modeled my book endure on, but his most recent book just came out a couple months ago at the end of May. And it's a broader look at this whole role of expertise and practice, a sort of counterpoint to the idea that you need 10,000 hours of practice if you want to be any good at anything.
Alex Hutchinson: 43:33 So as soon as you're out of the crib, you should be practicing your jump shot or whatever it is. And instead, marshaling the arguments that actually having breadth of experience, is good for a variety of reasons, including that you have a better chance of finding a good match for your talents. So for someone like me had, I just had too much quote unquote grit and decided that I needed to stick with physics cause that's what I started with. And I'm not a quitter. I’d be a physicist and I might be an okay physicist, but I'm positive that I wouldn't be as happy as I am now having been willing to sort of switch career tracks. And so it has a lot of sort of relevance for personal development, for parenting and for understanding expertise also in a sports realm as well. So range by David epstein is my pick on that front.
Karen Litzy: 44:22 Great. And we already spoke about what you're going to be talking about at the Sports congress, but are there any things that you're particularly looking forward to?
Alex Hutchinson: 44:29 Yeah, there's a whole bunch of speakers, but I guess the one that caught my eye that I would definitely not sleep through is, I saw that Keith Barr is speaking on a panel and that over the last three, four years, maybe, maybe more than that, I've just been really blown away by the work that he's been doing on understanding the differences between what it takes to train for, you know, your strength, your muscles or your heart versus what it takes to train tendons and ligaments. And so I'm really looking forward to seeing what the latest updates are from his lab and from his results.
Karen Litzy: 45:04 Yeah. He gave the opening talk at Sports Congress, not 2019 but 2018. And he was just so good. I mean, I was just trying to live tweet and take some notes. I'm really looking forward to that as well. I feel great. Yeah, absolutely. All right, so is there anything that we missed? Anything that you want the viewers or listeners to know? Oh wait, where can they get your book from?
Alex Hutchinson: 45:35 Fine booksellers everywhere. I mean include Amazon but it's definitely put it in a plug for your local independent bookstore. It should be, it should be available anywhere. And if you can find my latest stuff on Twitter @sweatscience, all one word and there might be a link to the book that there, but yeah, really, if you Google Hutchinson and endure for any bookseller, they should be able to get a copy of it.
Karen Litzy: 45:59 Perfect. And anything we missed? Anything that we want to hit on that maybe we didn't get to? I feel like we got a good amount.
Alex Hutchinson: 46:06 I think we covered some good basis. I guess the only thing is, you know, for anyone listening, I hope I'll see you in Vancouver and cause I think there's all of these things are ongoing discussions and there's lots more to learn. So I'm looking forward to the conference
Karen Litzy: 46:20 As am I. Everyone. Thanks so much for tuning in. Thanks so much for listening again, the third world congress of sports physical therapy will take place in Vancouver, Canada, British Columbia, October 4th through the fifth of 2019 and so we hope to see you all there.
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On this week’s episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Lynn Rivers on Robert’s Rules. Dr. Rivers is currently the Speaker of the Assembly for the New York Physical Therapy Association (NYPTA) and sits on the Board of Directors for the NYPTA. She strives to facilitate the active engagement of the students in becoming advocates for the patients/clients they will serve and their profession.
In this episode, we discuss:
-What are Robert’s Rules and how debate is conducted at the House of Delegates
-Different ways to collect votes from the delegates
-Point of Order, Point of Inquiry and Point of Information
-Can a guest speak during a meeting?
-And so much more!
Resources:
Email: riversl@dyc.edu
Robert's Rules for Dummies
For more information on Lynn:
Dr. Lynn Rivers has 25 years experience as a clinician and 20 years as an educator in higher education. Her clinical experience has focused on adults with neurological disorders and traumatic injuries such as head injury and spinal cord injury while working in a Level I Trauma Center. Before becoming chairperson of the department in 2001, Dr. Rivers was Director of Clinical Education for the physical therapy program. Dr. Rivers is currently the Speaker of the Assembly for the New York Physical Therapy Association (NYPTA)and sits on the Board of Directors for the NYPTA. She strives to facilitate the active engagement of the students in becoming advocates for the patients/clients they will serve and their profession.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello and good morning. This is Jenna Kantor. I'm here with healthy, wealthy and smart and I get to interview Lynn Rivers who knows so much about Roberts rules. Okay. Robert's rules. You know I'm going to actually hand over the mic because I can already imagine me describing it and Lynn going, well not exactly. So would you mind first just defining what Robert's rules is and where it is in applied within the APTA?
Lynn Rivers: 00:26 Sure. Well Good Morning Jen. Thanks for the opportunity. Thank you for the opportunity to be able to share just about 28 years that I have sort of gotten myself involved and love Robert's rules of order. So what is Robert's rules of order? It goes back hundreds and hundreds of years. It is the philosophy and the construct of how do organizations, any organization, whether it's a small church board or it's Congress or its parliament in England, how does a civil society with lots of divergent opinions, how do we conduct our business so that there are two principles that are met and the two principles are that the will of the majority will rule, but we must protect the rights of the minority. So it is for the voices of everyone in whatever society, whatever group, whatever meeting that every opinion gets heard and heard with respect. And that there is civility so that when very strong, strong opinions can equally be heard, both sides of the debate can be heard.
Lynn Rivers: 01:41 But there is civility and respect. And then when the decision is reached that the minority will agree that the will of the majority will rule. So that those are the two principles. So then the rules, holy smokes, there's, you know, I'm sure if people have looked into it, the 11th edition is 800 pages long and there are so many minutia rules. But the bottom line is that the rules guide how people make decisions about what gets heard and how we make choices. So there are just the word motions is a tenant of Robert's rules of orders. So what is a motion? A motion is just an ask. It is an idea that someone has, that they want the society, the group, the organization to do. I want to ask that we pursue buying a piece of property or I want my APTA to look into this or work on this legislation, create a document for us to help us write.
Lynn Rivers: 02:56 It's an ask and then there's a way to make the ask. And so they give guidelines on how you make the ask. And then there are rules of then how do people debate. So you have to write out your ask. It becomes a motion. And then it's agreed during the meeting. It will be, they call it lay it on the table, but it just means say it right. Make the ask for the whole body to hear. And then there is the leader of the meeting who is neutral and just trying to facilitate the discussion and they have different titles. Then everyone respectfully just raises their hand or makes a motion. They have to be recognized to speak. And then when you speak to the motion there are just rules of civility meeting respect that you aren't shouting that you are just speaking to the facilitator of the meeting and you are making your case but you tend not to speak only about the motion, not who made the motion and don't speak ill of any other opinion. You just state your own opinion and the debate goes back and forth and then there's a vote.
Jenna Kantor: 04:16 Actually could we go on this a little bit more with the ask, cause there's some things in this that I think is so fantastic with the civility that you are discussing and you guys, anybody listening, all you new grads, anybody who hasn't done house of delegates or been to any of these type of meetings before. You know how easy it is for things to get heated when it should, when it's a touchy subject. And of course within physical therapy we're extremely passionate about what we do. So those issues can get personal very easily. So would you mind going into the process of who is actually getting the eye contact, when you are standing up to speak about something and say it might be something you are quite passionate about, you have a written out exactly what you want to say. Who do you make eye contact with? And how do you address or refer to somebody who may have spoken before? Would you mind giving an example of that so people can get a better idea of how important and valuable it is to keep this going?
Lynn Rivers: 05:18 Be Glad to Jenna. So I'm just going to think back to the most recent house. The American Physical Therapy Association taking a stance against firearm violence. And there are some very passionate opinions in the room. So what will happen is in order to not hurt feelings or offend anyone, what happens is that the individual who wants to now speak passionately against the APTA taking any kind of social stance, they make direct eye contact, the room is full of 400 people, face forward. You're looking directly at the speaker of the house, which is the title of the individual who's standing up in the front, who has recognized you to speak and you say, Madam Speaker, I would like to speak vehemently against this. I respectfully disagree with the previous speaker from Oregon who made this claim.
Lynn Rivers: 06:22 And I disagree with that. So you don't say, I think Henry is an idiot. You say, I respectfully disagree and you speak about people in the third person and it's amazing how that sort of takes the emotion out. You can be emotional, you can feel passionate about your stance and you could be angry about the thought of an action being taken, but you are looking at the neutral speaker of the assembly and you are referring only in the third person to previous speakers or to a speaker from another state. And it is amazing how that can really deescalate the emotion.
Jenna Kantor: 07:08 And then for such a very important debate and which I'd like to say that, you know, it's nice that there's an opportunity for every single motion to be debated on. So whether or not you think it's important, it still doesn't obliterate the opportunity for other people to debate on that, which I think is wonderful as well. But of course these things can go on forever. So how is it handled to end, you know, as a group cause you have a group of 400 people you know, for us at the house of delegates. So how is it handled, you know, to rightfully decide when it's appropriate to stop the discussion and move on to a vote?
Lynn Rivers: 07:48 Yes. So again, what happens is, you know, people have raised their hand or we do it electronically now in the house of delegates with a blackberry, you can put yourself what they call in the queue. So you're in line to speak. And so the speaker will monitor and you must indicate to the speaker whether you're speaking for or against it. So they try to balance debate. And at times after a bit of discussion, the speaker will say, at this time there appears to be no one who is in line or in the queue to speak. Are you ready for the vote? Other times, the speaker that we do have an opportunity and in Robert's rules there is a motion it to what is called call the previous question. And all that means is that person has put a motion to say, I think I've heard enough.
Lynn Rivers: 08:38 I have heard both sides of the debate. I am ready to vote. And so then if the speaker of the house, the leader of the meeting, observes that there are many people who think it's time to vote, then he or she will ask the body, that group at the meeting, are you ready for the vote? And if there's no objection, then you move to the vote. So it can either be everyone has stopped talking or there has been a lot of balanced debate hearing both sides of the story and enough people have spoken that the group feels they can make a vote.
Jenna Kantor: 09:16 I also saw in the meeting, and we're not gonna hit all 800 pages of the book, but I'm just pointing out some interesting things. Sometimes the voting switched between standing between saying Aye and then also the electronic vote via the device. So how does, in this case, the speaker of the house who was running the meeting, how does the speaker of the house decide which way to do the vote?
Lynn Rivers: 09:43 Yeah, so certainly, what happens is each organization has also something that's called the standing rules. So we use set rules at the beginning of the meeting. And one of the key rules you decide is how much agreement does there have to be in order to pass that motion to say it's going to go. So for normal business, the actions of the house, we agree in the house of delegates, a simple majority, so just over 50%, 51% of the group. So the default or easiest for 404 was our voting strength yesterday, that the speaker starts with a voice vote. All those in favor say Aye. So she listens to the volume of the ayes compared to the volume of the no’s. And many times it's very clear if 300 people say Aye and 100 say no, then it's pretty clear by voice.
Lynn Rivers: 10:42 And that's the simplest and quickest. If it's still a vote for simple majority and she couldn't tell by the voices, then we have to use the electronic voting. Within that everybody has their clicker and they vote Yay or nay and it comes up. The standing vote is typically done when there is a vote that is more precious than just a normal business action. It's any vote that is going to hurt the rights of members. And I'll give the example then if you need to know, if two thirds of the people agree, many times the speaker will do a standing vote because that is much easier to see two thirds clear by standing. And that is when there is an objection to calling the question, meaning stopping debate. And because that is a right of the minority to continue to be heard, that is when the speaker calls for a standing vote. And then there was one time, even in the standing vote, she was not 100% sure it was two thirds. So she had us sit back down and do the clickers.
Jenna Kantor: 12:05 This is great. So, you know, it's so funny, earlier you mentioned the word Henry and now I'm thinking of the Henry Bar, the candy. And I'm like, oh my gosh, what do these conferences do to me? I'm like, I need sugar all the time to like stay awake. Can we get into some of the language, just the intro that people say when they say parliamentary inquiry, like why do we say that instead of something else? Does it make it more efficient?
Lynn Rivers: 12:35 So again, there is a protocol to how one introduces a motion. And one of the first again for civility is whenever you are recognized to speak, you start by introducing yourself so speakers know who you are. We also ask them to state what component they are from, component or state. So I'm Lynn Rivers from New York would be how I would start. And you must be recognized in order to speak. There are three instances, and someone can shout out and not wait to be recognized. Point of order, point of inquiry and point of information, point of order. They there is shouted out and you are allowed to shout it out if you believe what is happening right now is not following Robert's rules of order. We are not doing it correctly and we believe that we have to ask the speaker that.
Lynn Rivers: 13:45 So if someone shouts out point of order, all debate stops immediately and the speaker says state your point and that person comes up to the mic and says speaker, I believe it is not in order for this motion to be heard. And there is a reason why we did not have due notice before this motion came. I don't think it's right that we are hearing it and then they would confer and decide whether that member is correct or the speaker rules. No, I do believe it's in order point and I'm sorry I misspoke. Point of inquiry or point of information are very similar. There is no real difference between that. A point of inquiry is sometimes said because people are really wanting data and facts, point of information. People tend to say they just have a question. They don't really understand why the makers of the motion wrote it this way. They don't really understand the intent of the motion. So they are asking a question to better understand the motion point of is just a little more precise if they want to. If someone wants to ask someone else other than the maker of the motions, they understand the motion but their point of inquiry is we'd like to hear from legal counsel is what the maker of the motion asking us to do. Is that legal in all 50 states? So then the speaker will say, is there an objection? Does anyone object to legal counsel addressing the body and answering this person's inquiry?
Jenna Kantor: 15:16 Yes. That honestly makes more sense for me. Now listening to that because there was a motion on creating a virtual historical museum and there was a lot of point of inquiries to the board to find out how much work would this be putting on them. Would this be possible for them to take on? And also what would the game plan, where would the financial resources come from? What would we be taking away from? So that makes even more sense. And it's also respectful way to be like, it's just clarification. It's not going to be an attack. We just have a question to like know what this means. And of course, it's pointed in a very professional way of just saying, we really just need to know to get the full picture on if this is a good thing to vote on. So, I'm getting some massive light bulbs here right now. And then I think I want to finish with one more or the Lord knows we could go on forever with Robert's rules. And, honestly, if I really do recommend, yes, it's an 800 page book, but if you're interested in it, read it. Why not?
Lynn Rivers: 16:30 Well, and I'm going to say the caveat. Please don't start with that book because you will run away screaming, but please know, and you can just Google it. Robert's rules for dummies is one version. There are about four levels of books. There's Robert's rules simplified, right? So Google Robert's rules and look at the different books and start with the first one and then move up to the next one. That gets a little deeper into it. If you really think you want to fully understand it, you want to join be a member of the national parliamentarian society. That's when you buy the 11th edition of Robert's rules. Nearly revised. Yes.
Jenna Kantor: 17:17 Awesome. Thank you so much. And See, this is a perfect example. Why bring the expert on to help? Correct me as I'm going, why don't we just do this? You're like, Whoa, whoa, Whoa, whoa, Whoa, whoa. Well, thank you for helping prevent people from walking away and pulling their hair out. Trying to read it going, oh, I give up. So that's good. I love those dummy books. Those are amazing,
Lynn Rivers: 17:36 I guess. But I just want to say the dummy books are not always helpful. Right. But I can assure you for Roberts rules, that book is a great start. If you just want to be able to be a voice at a meeting, not necessarily run one yet. You know, you just want, you want to write a motion, you want to get up and state your opinion and don't want to look foolish. Start with Robert's rules of order for dummies.
Jenna Kantor: 18:03 Love it. Love it. Oh, I've been forgetting what my last, Oh yes. So for those who don't know, so at the house of delegates, I'm not sure if this is elsewhere, so you can definitely clarify this, Lynn. So at that house, all the people who are elected delegates sit in, I want to say an organized clump with their states and everything. But then there can be guests attending the event and they are sitting in the gallery in the back. And these are, it's separated in the back of the room. Is it true that they can come up and say point of order or speak to a motion or ask a question and so on and following Robert's rules and when or how, if that is appropriate? Is it appropriate?
Lynn Rivers: 18:49 Yeah, no, that's a good question. And the short answer is no. A guest in the gallery does not have the right to state point of order. Point of inquiry, they cannot shut out. But with the permission of the group permission has to be asked, can a guest speak? So guests can be invited to speak. A guest in the gallery can ask a member of the group to request permission for them to speak. So, so there's two things. There may be a member in the audience that knows there's a lawyer in the audience or in the gallery and they may initiate the request, but the lawyer may be sitting there antsy thinking, I have something to contribute. There are guests in the gallery. They are allowed to walk up to a member and say, would you ask the speaker of the House to request permission for me to speak? Because I have something to say. And almost always the body would say yes. If someone really wants to speak. I've never seen a guest be denied, but there must be permission given.
Jenna Kantor: 20:07 Thank you. That's very helpful. Well, me as a performer first I see this mic sitting in front of us that's clearly not pointing to the people. You know, anybody sitting in amongst the delegates. And I remember staring and going, I mean, do they want us to sing? What is this opportunity? This mic Beholdeth on us? So no, they give them one for clarifying. But thank you Lynn, thank you so much for coming on and clarifying. Just even giving people a little glimpse of what Robert's rules is and just really learning how valuable it is. I think this will be such a good thing for so many, even experienced physical therapists to really know more of and understand what goes on behind the scenes and why we are following such rules. I'm new to this, but honestly, I really do believe in them because it is not easy to have these hard discussions in a nice manner.
Jenna Kantor: 21:01 You don't want to leave pissed off. You want to leave like, okay, that was fair. That was a discussion. I can see why we might be moving a little slowly on this matter or why we might move quickly on this matter. It was eye opening in a very positive way. So I was wondering, Lynn, if people wanted to reach out to you or find you to learn more or maybe even get more guidance if they start finding themselves passionate about getting much more involved in this whole parliamentary process, how could they find you?
Lynn Rivers: 21:31 Thanks Jenna. Well, I'm in Buffalo, New York at D’Youville College and I am happy to share my email. It is riversl@dyc.edu.
Jenna Kantor: 21:48 Thank you so much for coming on.
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LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Emma Stokes on the show to discuss leadership. Dr. Emma Stokes BSc (Physio), MSc (research), MSc Mgmt, Phd is the president of World Confederation of Physical Therapy.
In this episode, we discuss:
-Dr. Stokes’ journey to becoming the President of the WCPT
-Takeaways from the World Confederation for Physical Therapy Congress
-Constructive feedback and the 360 review
-How to grow your professional network and the two up, two down and two sideways rule
-And so much more!
Resources:
Third World Congress of Sports Physical Therapy
Emma Stokes Twitter
World Confederation for Physical Therapy Website
WCPT Facebook
WCPT Twitter
WCPT Instagram
For more information on Emma:
Emma is the head of the newly established Department of Physiotherapy & Rehabilitation Science at Qatar University. She has worked in education for almost 25 years and is on leave from Trinity College Dublin where she is an associate professor and Fellow. Her research and teaching focus on professional practice issues for the profession. She has taught and lectured in over 40 countries around the world. In 2015, she was elected to serve as President of the World Confederation for Physical Therapy. She was re-elected for a further four years in 2019. She has experience as a member and chair of boards in Ireland and internationally in a diversity of settings including education, health, research and regulation.
Read the full transcript below:
Karen Litzy: 00:01 Hey everybody, welcome to another interview for the Third World Congress on sports physical therapy, which is happening in Vancouver October 4th and fifth of 2019 and we've been interviewing a lot of the speakers and today we're really excited and honored to have Dr. Emma Stokes who will be in Vancouver with us. So Dr. Stokes, thank you so much for coming on.
Emma Stokes: 00:29 Oh, thank you so much for the opportunity to chat with you again, Karen. It's always a pleasure.
Karen Litzy: 00:34 I know, I know I just saw you in Switzerland and we'll talk about that in a little bit, but before we get into all of that, just in case, there are some people who are maybe not familiar with you, which may be, there are, I don't know, but can you tell us a little bit more about yourself?
Emma Stokes: 00:55 Yes, of course. Well, I'm an Irish physiotherapist and I'm sitting in Trinity College in Dublin, where I have the privilege of spending a lot of my professional life. So I qualified as a physiotherapist in 1990 and let's just fast forward to eight years after I qualified, I went to my first international meeting and you know, I tell this story wherever I go in the world, which is, you know, I went to that meeting and I came home. And in that moment, in those days I really recognized that I wanted to be part of the international physiotherapy community. You know, a lot of people ask me that question. They say, well, you know, how do we become part of that? And you know, honestly then I didn't know what that meant or looked like or felt like or anything like that. But as I tell the story and we can come back to this later on, you know, I decided I was going to make myself indispensable.
Emma Stokes: 01:45 So I volunteered for every conceivable opportunity that arose, including within the ISCP, which is the Irish side of charter physiotherapists. And in 2015 I was elected to serve as the president of WCPT the world confederation for physical therapy, the global physiotherapy organization of which the IFSPT, which is the International Federation of Sports Physical Therapy, is a subgroup of which the Canadian physiotherapy association is a member organization. And of course of which sports physiotherapy at Canada is a division of the CPA. So we're all connected in this big family and I got to serve as the president for four years. And then last year I decided that I would seek a second term as the president of WCPT. And there was an election in May and I was reelected, here I am, I'm very, very happy to am honored to be serving a second term as president of WCPT. And it's been a long journey and I'm happy to answer any specific questions about that as I always am. Because you know, I think not because I want to talk about myself, but because I think sometimes people look at you and they say, how'd you get there? And I'm happy to share that journey because I think that's a really important question. When you see someone in a position that you want to be in, then you need ask them how do they get there?
Karen Litzy: 03:01 Yeah. So let's talk about that. So you volunteered for everything and anything you could get your hands on it sounds like, and I'm sure that helped get your foot in the door and, open things, a crack here and there. So when did you first decide to be an elected official?
Emma Stokes: 03:23 I think physiotherapists are nervous about the volunteering thing and the idea that, oh gosh, it would be terrible to volunteer if you had an end game and you know, 30 odd years ago to be 30 years since I graduated next year as a PT, you know, I don't think we had the whole, I don't know the word networking even existed in the way it does now, but I loved getting involved and things. So I was very involved with the Harriers and athletics club here and lives in trinity and I reckon I spent more time with them than I did and my physiotherapy program. I just loved getting involved and you know, when you're a junior physiotherapist or in your, the early stages of your career in the day job, you know, and you'd know this Karen, right?
Emma Stokes: 04:08 You don't always have the opportunity to do the things that you want to do because you're maybe limited sometimes in the organization that you're working in. And in fairness, I worked in St James's Hospital in Dublin and there were no limitations placed on me when I started to get momentum, but it took me a few years to get some momentum. So I became a member of the Irish society and I went to a meeting. They needed a member on a committee and that's where it started. And you know, I was on a committee and then I was on another committee and then in 1996 when I was working in trinity, one of my friends whose office was across the Carto said to me, we're stuck for someone on the international affairs committee. Would you volunteer? And I think I suggest more because I was sort of trying to help her out.
Emma Stokes: 04:51 Than I wanted to necessarily do international affairs. And then, you know, it started, I just, I knew then the global physiotherapy was where my, I think maybe I was struggling to find my place in the Irish physiotherapy world or maybe the clinical physiotherapy world rather than the Irish. You see that everywhere, the clinical physiotherapy world. And so when I started to do some international work, so I got involved with my first international research consortium and I started to volunteer and so the first international meeting that I went to was 20 years ago. In 1999 and no one paid me to get there. I paid for myself to get there. I was presenting some of my phd research and I had gotten to know, Brenda Meyers, I'd met her once or twice and I emailed her, I said to her, look, I'm here.
Emma Stokes: 05:42 Do you need to volunteer? And I was a teller at the general meeting of WCPT I helped count votes. Now you might not think that that's super important which it is. In the governance meeting of WCPT, I counted the votes in 1999 and then clearly I could count and I stayed involved with European level. And in 2003 the meeting was in Barcelona and I asked you about some time, the Irish societies delegation. But I was there with some of my phd students at that stage and some of my own research. And I went to the general meeting and Brenda said to me, well you would you like to be the chair of the credentialing committee? And that's what I did. So in that, that was the time when you presented your credentials in within paper, you brought your paperwork to the meeting and there was something really elegant about that process. And now we do it electronically and it's a little different. And plus I got to meet the presidents of every member organization and WCPT at that meeting. And then I finally got elected to actually the board of WCPT in 2006 and that was a chance I didn't expect to get elected. I was only running to signal my interest for four years later. But I got elected and I guess the rest is history.
Karen Litzy: 07:01 Great. And I think the big moral of the story here is that no one's an overnight success. It's not like you one day said, I'm going to run for president of WCPT and got elected, you have to put the time in and pound the pavement, if you will, in order to kind of work your way up. And I think in the days now of social media and everything happening, having to happen immediately. Yeah, it's hard. So what advice would you give to someone who maybe doesn't have the patience these days to put the work in?
Emma Stokes: 07:35 Yeah. So first of all, I think you have to enjoy the journey. So, you know, I never knew it was a journey in many ways. I guess at some point I knew it was a journey. And I think one of the things, because I've done a lot of reading around leadership and, I think what I've been fascinated about is this notion that just because you try once for perhaps an elected position and you're not elected doesn't mean that you walk away. So that in 2006 now, I don't know would I have walked away. I don't know that I did because I actually think I would've because I think what happened was in 2006 I had no expectation of being elected. But my plan then was to say, look, I'm interested. I know that's going to be another four years before I'm elected.
Emma Stokes: 08:26 Or I could be elected. And I don't mind if I'm not elected this time. So I was elected and that was pretty amazing. And interestingly in 2011 and it was suggested to me by a number of people that I should run for president. And I decided not to because I wasn't ready now cause that's another conversation which is about when are we ever ready. But I think I'm very objective about my abilities. And so I had sort of decided that I didn't feel ready in 2011 to be elected as the president but by 2015 given what I had done between 2011 and 2015 I knew that I had the experience, I had the capabilities to be a very effective president from the point of view, I think at least I felt I had given the organization the best shot in terms of the experience that I had gathered.
Emma Stokes: 09:33 So I had done a graduate business degree. I had done a lot of governance courses. I had been the chair of the board of charity and I just felt, I suppose I felt from a self efficacy perspective and we talked about this, about our patients all the time. I felt confident going in that not withstanding what needed to be done, I was confident that I was able to definitely demonstrate that I had the experience to be the chair of the board of a charity based in the United Kingdom, which is what WCPT is from a governance perspective. But also that I felt that I had enough experience to at least give a fairly good shot of being the president of the global organization. And there are two quite distinct parts of the road.
Karen Litzy: 10:21 Well, and that leads me to my next question is as president of WCPT and for maybe the people listening, if maybe one day that's on their list, can you give a quick rundown of the roles and responsibilities of that position?
Emma Stokes: 10:35 Yes. And Look, you know, I think let's just use the sort of a nice kind of balanced scorecard approach to this. So to me, when I ran, when I sought to be elected as president in 2015, I said I would look in, I would look out, I will look to the future. And then I had a little small part of the balance scorecard, which is you know, that quadrant system which was about inspiring. And in a way they map onto the two I think quite distinct aspects of the presidency, which is that you are the chair of the board of an organization and a company that's based in the United Kingdom and that brings governance, legal, fiduciary responsibilities. But you were also the president of a global organization. You are the leader in some ways the first among equals. But nevertheless you are in a leadership role.
Emma Stokes: 11:21 And my perspective on that is my job is to bring people together in the global community and that's whether it's the physiotherapy part of the global community or the wider collaborative part of the global health rehabilitation community. So looking in was about ensuring that the organization with working with the board and staff and our volunteers was its best version of itself. Looking out was to start looking at who we working with internationally and what are the international organizations that we're working with. Looking into the future is about leadership. It's about creating the next generation of leaders in physiotherapy. And then the other space was about inspiring. And I suppose for me in the four years, I'm sharing something with you that I have probably not shared with very many people. So in my narrative and the work that I do with an amazing coach is around how do you walk with the dreamers and I've given a few talks that talk about what with dreamers, but it's about that idea of how do you inspire people to do something different, to get involved, to be involved in a different way, to just grow.
Emma Stokes: 12:30 I guess just to enable us to sort of amplify everything that we do. And I suppose for me that's very, very, it's an intangible, right? It's that sense of how do you measure that when it's very hard to measure it? Right? And you know, now in the next four years, that hasn't changed. So we're still looking. So I believe we need to still look in, we need to still look out. We just need to look out in a bigger, better way. We need to look to the future. And I feel that commitment from me over the next few years is really important in terms of what are we talking about in terms of sustainability, the next generation of leaders, the future of organizations that are just in their beginning part of the journey. And My blog, which just was posted yesterday, is about, I suppose that other quadrant, now I'm talking about the moon landing projects.
Emma Stokes: 13:21 So it's 50 years since, you know, since the first Americans landed on the moon. But I think that 1961 speech that JFK gave about this idea of what, asking ourselves the question about what we should be doing, not because it's easy, but because it's hard to me, you know I’ve got four years, you know, I'll be president for four years and then I go on and I just do a different part of my life. So if I had one thing that I want to do, it's about, we could be asking ourselves the question as an organization and as a community. What should we do because it's hard. What should we do, because it's right. And, we have to ask ourselves the hard questions. And those things are nuanced and they're just this dissonance in them and they're not easy and they're not going to be done in the four years.
Emma Stokes: 14:14 So what are the big projects, what does that decade going to look like? And if you look at who they have two big projects that are focused on 2020, 30, which is, you know, it's almost a decade away. And I think we as a global community and as a global organization needs to be thinking about what are we doing to help answer those questions. So I guess, yeah, does that answer the question?
Karen Litzy: 14:52 That's the role and responsibilities in a very large nutshell, a balanced score card and nice framework. Cool. Yeah. No, that's great. Thank you for sharing all of that. And you know, I did feel that sense of global community and working together and learning and open-mindedness, I guess would be a good way to describe the WCPT meeting in Geneva, which was a couple of months ago. I definitely did feel that global community. And I think, you know, social media has its pros and cons and we can talk about that forever. But one of the pros is that it does certainly bring people together from all parts of the globe. And so I really felt, a lot of comradery and felt like I quote unquote, Knew people even who live in Africa or they're in Nepal or Europe or even just across the United States. I really enjoyed WCPT. I thought that there were some, I mean obviously I didn't go to every session cause it's impossible. Well I went to some really great sessions that did bring up some uncomfortable questions and kind of pushed my boundaries a little bit. So I really enjoyed that. But what were your biggest takeaways? Obviously, again, not that you could be in everything everywhere all the time, but what were a couple of maybe maybe two of your biggest takeaways if you can whittle it down?
Emma Stokes: 16:34 Oh Gosh. Two really, okay. But let's, let's start with the opening ceremony. So you know, it, the opening ceremony to the board. So we work with the board and the staff work really closely together around that type of event. So the board does not get involved in, you know, what color is the curtain, but we do make a decision about the venue because the venue has a cost implication. So, you know, so do we go for a big room where everyone is together or do we go for a smaller room where there's some breakout sessions? And I think what was really interesting was we had a series of conversations around that and we finally resolved in them, I guess April, of the year before the congress. So April, 2018 but the decision was, nope, we are going into a big space where everyone is together on it. And it meant that, and you will recall this, it meant that everyone had to walk.
Emma Stokes: 17:29 It was a short walk from the venue of the opening ceremony to the welcome reception and not happening. It wasn't raining so, and so I don't know that anyone ever understood the amount of forwards and backwards and trade offs on cost and logistics and the walk and everything like that. But, when we made that decision, the decision was, we are a global organization and our strategic imperative is that we are a community where every physiotherapist feels connected to the engaged. Therefore, when we have an opening ceremony, everyone is in the room. And to me that probably has been one of the most powerful memories of my WCPT life is that moment when everyone is in the room and I have experienced it in the audience, but boy experiencing it on the stage, looking out that audience is, you know, I'm never gonna forget that, that that's a memory that I'm gonna have for the rest of my life was that I never imagined, I forgot.
Emma Stokes: 18:31 I didn't think that it would in my mind, you know, we're all gonna walk along. It's gonna be 15 minutes. I dunno if you remember this, but it was that snake of people. And it was perfect because you had international physiotherapists rambling on, and they had to walk slowly, right? Because it was enforced because we weren't going anywhere in a hurry when there was, you know, 4,000 as we wove our way along to the opening center to the welcome reception. And to me, I think it was a visual and a physical and representation of who we are, which is that community of people that are connected better because we are connected. So that to me was, it can only go downhill from there.
Emma Stokes: 19:29 Right. Cause I was just like, it was fabulous. So in terms of specific content, and I completely love the diversity and inclusion session, and I think that was, you know, that was a focused symposium. It was peer reviewed. It was submitted. It was an amazing team of fabulous physiotherapists from all over the world and a stellar audience. And to me that was, you know, that was both literally and symbolically immensely powerful in terms of what it is that we're doing as a community. And in the closing ceremony I said, you know, I felt that the three themes that came together were diversity, inclusion and humanity. And that's not to take away from the content, the science, the practice content, the clinical content. I'm not taking away from that, but I think what we've started to do is bring us up.
Emma Stokes: 20:20 We have started to lift our eyes as a global community. And now more than ever, we need to do that because of the stuff that is happening in all worlds. So, you know, we just need to raise the level of our conversation. Of course everyone needs science and they need evidence informed clinical practice, we need humanity in our conversations. And if we're not doing it as a global community, then I don't know who else should be doing this. And to me, the diversity and inclusion session was babied us. We had an amazing session on education talking about the education framework policy piece. But you know what I think really emerged from the congress was on a big shout out to anyone in education is we need to revive our educators network. We need a global community of educators that are having conversations with one another.
Emma Stokes: 21:21 We need to do it. Whatever we can do. I think the other session that that I loved was the advanced practice one because that's a big conversation and it's a big conversation that spans not just high income countries but low, low middle income countries. It's it, you know, if we look to ensuring that we'd have universal health coverage, then you know, the World Health Organization is talking about this billion level of health workforce shortage and we are a solution. We're a solution in so many ways and we need to start having those conversations around how are we the solution. And one of the ways that we are solution is around advanced practice. And then I guess the other one that I just loved, and I'm really sorry that so many people were actually turned away from the door with us doing this. And we went on, we would talk about this was the one that starts to take that editorial from editorial to action.
Emma Stokes: 22:13 Then you know, the stellar mines that were involved in that. You know, so Peter O'Sullivan and Jeremy Lewis spoke the editorial, you know, Karim, who was the editor was going to facilitate that session but couldn't because he had other commitments. But he was at Congress, which was amazing. So what we had was we had to have the insurance. We had the physicians, we have physiotherapists from the low middle income countries in that room. And I think what's brilliant is, but you know, there's a, you know, I wouldn't, I'd love to suggest that I was writing it, but I'm not, I'm just, you know, I'm sort of sitting you know, I'm there in the background saying, Hey, look, the bread lines are out there.
Emma Stokes: 23:01 You do your work. So we're going to have a nice, I hope, a nice publication around that. But, this is one of the moon landing projects, right? If we want to have this paradigm shift, what does WCPT need to be doing in terms of what does the global community need to be doing? But what can we facilitate around this? This is another moon landing project. What does that look like? You know, how do we change the way and we ensure that the delivery of rehabilitation and physiotherapy is the best version of itself.
Karen Litzy: 23:46 It was a definitely a very popular session. Peter O'Sullivan was like, I'm sorry, I didn't know it was going to be that many people there. But it looked really great. I was watching from, I was going to another session, to see my friend, Christina present her research, but it was good to follow along with all of the tweets in the social media from there. And I was interacting and after Boris was like, so what did you think? Did you like the session? I was like, I wasn't in it. And he was like, what? But I thought you were there cause you were tweeting. I'm like, well I can keep up.
Emma Stokes: 24:20 Yeah, yeah. And you know, I think one of the things that, so we are, we are a learning journey, you know, and there was a tradeoff, right? So, yeah, I think Peter and Jeremy were really keen to get a very, very interactive session because there was data that needed to be developed from this, you know, so the data being gathered as a result within this session, which is a very interactive, you know, session. And I think that's really important. You go for a smaller room with very interactive session of course, or you go for a big space with 500 people in it and close, you lose a granularity in terms of detail. Plus the editorial was only published in June, you know, less than a year before the meeting.
Emma Stokes: 25:18 The other thing, right, you're not planning for years cause I mean it wasn't four years. And so that's where you're trying to do the responsiveness piece, which is, you know, a hot editorial, which was big on big ideas, you know, so, you know, the conversation then well it's of course that's the choice of the editorial, which is big ideas. Now let's just talk about enactment. What does that look like in term, well, A, can it work beyond high income countries, but B, what does it look like in terms of the next steps? So it is, so, you know, I acknowledge that was a big challenge and there was a lot of people who were very disappointed, but it wasn't a keynote session. It was around from editorial to acting what needed to be a granular session. We should talk about, you know, how do we keep that conversation going? And that's where I think things at the meeting that the conference in Vancouver a year later then congress the year after that starts to allow us to start a plan for those conversations to move forward.
Karen Litzy: 26:20 Yeah. Yeah. And I think that's a good thing to hopefully bring to, Vancouver and allow people to see, well, what did come out of that WCPT and then how can we expand on that. Excellent. Good. Okay. So let's shift gears quickly. And you kind of alluded to your research earlier and that you were started your research in the 90s. And I know that a lot of your research centers around leadership. So can you talk a little bit about your research, number one and then number two, how does that research kind of guide you in your day to day function within your job?
Emma Stokes: 27:24 Yeah, initially my research was very clinically based research. And then in 2010 I made a decision. So first one, let's put it out there I'm not a researcher, right? So I'm not going to be anyone ever with a high heat index. That does not give me joy in my life. My joy is around amplifying other people's research, which is why, you know, my joy is around saying that editorial was amazing. Now let's see how we can get it to the next steps. But nevertheless, I am an academic and therefore it's really important that my research informs my teaching. You know, we are resected at institutions both here in Trinity, but also where I'm working now at counter university. And so it's really important that when we teach, we
Emma Stokes: 27:56 are teaching, our research informs our teaching. So in 2010 I had an amazing opportunity to take a sabbatical. I finished my graduate business degree. I'd suddenly discovered that you can actually learn about leadership. And I had suddenly thought, hey, you know what? Let's look the what's happening in physiotherapy research and leadership. Answer nothing at all. And, you know, then you ask yourself the question, well that's fine. You know, do we need to be doing research in leadership physiotherapy? And the answer is actually, interestingly we do because we know obviously more and more about leadership is that leadership is context specific. So it's very contextually informed. It's also very contingent around, you know, what you do on a day to day basis. But increasingly the conversation around leadership and healthcare is leadership is not a role.
Emma Stokes: 28:45 It's a mindset, right? You lead from the edges. A loy about transformational leadership? It's moving from the transactional nature to the transformational. And so that's what I was doing. If you think about it, my practice in Physiotherapy was around, you know, working with organizations in either leadership roles or being part of other people who were leading projects and you know, being in the followership role or the participant road. And so I made probably, what's a career changing decision, which is that I actually stopped doing physical research. I said, okay, my research was around professional practice issues. I will research what I practice and my practices is physiotherapy. So I worked on that year with Tracy Barry around direct access and we did it globally. We're now looking at sort of processing the results of, you know, a really interesting survey around advanced practice and the building survey around that.
Emma Stokes: 29:38 And you know, so now I'm not that, I'm not the doer, I'm the person that’s part of a team and the next generation of fantastic researchers are doing the research. So I want to give a big shout out to Andrews Tollway is doing amazing work on the advanced practice survey and also Emer Maganon, who was done, you know, she was my phd student on my post-talk and she's done a huge amount of research around leadership. And I've had the privilege of being along for the ride, which is fabulous. And that's what you get to do as a phd supervisors. So that's wonderful. And so the research has been around leadership, physiotherapy. We've worked around with the global community around some of the research that's happening and there's very little in physiotherapy and that's a shame. But actually what's interesting is there's more and more and that's good. And there's a huge Canon of research around leadership in nursing and for doctors, their providence is different. And so I don't think we should underestimate doing a lot of really good research around understanding the physiotherapy perspective and understanding and enacting leadership because I think that helps us start to understand where we might have some weaknesses or some behaviors where we're reluctant to get involved. And I suppose that for me is around how do we have those conversations, both from a research perspective but also from a day to day practice perspective.
Karen Litzy: 30:59 Right. And then you kind of answered the question of how does it affect your day to day leadership abilities. And I think you just answered that because you're finding your weaknesses as a whole within the profession and I'm sure that can make you a little more introspective to see if you're either contributing to those or hoping to overcome them.
Emma Stokes: 31:18 Yeah, absolutely. You know, I think you're absolutely right. I did a really interesting thing of just before I finished my first term as president, and I don't know if that, if you've done this or if anyone has, but I did it at 360.
Emma Stokes: 31:32 So I had 11 people do the leadership practices inventory. So I did this and then 11 observers did this and then four people did in depth interviews. Oh, let me tell ya, so first of all, I'm indebted to the 11 people who participated and who gave up their time to do the Leadership Practices inventory about me, but also the four people who did in-depth interviews and they were, you know, so there were people within and external to the global physiotherapy community and Oh gee, that was interesting. You know, that was a, I learned a lot about myself, you know, and you know, and interesting I’ve done a reflection beforehand, sort of predicting what they might say and there were no surprises. There was a lot of reinforcements and you know, so I obviously, you know, you do the thing right, the 80 20 thing, which is they focused on the 20% of stuff that you're not best at.
Emma Stokes: 32:27 And of course I had focused on that. So there was no surprises. But nevertheless it is saluatory to hear people say it about you and you know, and so on a cross, you know, so this wasn't, or three people, this was 11 people saying similar things about me and I've just spent two weeks with my family, Eh, like way more time with my family that I'm spending a long time. And I'm like, Oh yeah, I see where that comes from. Oh, how interesting. So I've done a 360 with my colleagues and I've spent two weeks with my family and yeah. Yeah, you know, I get it a lot of your niece that is seven and nine. They're saying, I think we should buy a to do list notebook. And I'm like, what do you think? I need one.
Emma Stokes: 33:09 Oh, yeah, you definitely need to do this, that book. I'm like, okay. All right. So there's seven and nine and they're seeing that list already, you know? So it's fascinating. So I think you get, I think for me it's about where did the data points come from? I'm ensuring that you get them from people who will tell you the truth in a trusting, positive way. And so I do the research and then I do the granular stuff, which is hard, but yeah. But you have to do it if you are committed to being the best version of yourself in the service of the role that you're in.
Karen Litzy: 33:47 Yeah, yeah. And in the service of others.
Emma Stokes: 33:50 Yeah. Am I going to get any better? I'm not sure. Am I any more patient? Am I better at listening? Am I going to be any better as I'm pressing the pause button? I don't know, but I'm going to try. Maybe try anyway.
Karen Litzy: 34:08 You know, I think the good thing is that you're now aware of some of these and I don't think they're faults. But you're aware of that side of your personality.
Emma Stokes: 34:22 Yeah. And I think maybe it's not that I wasn't aware of it, it's more that it was reinforced about the impact that it has on people. If you'd ask me, honestly, did I find out anything with the 360 that I didn't know about myself? The answer is no. But has it made me face up to it and acknowledge its impact on others? Yes. And am I taking responsibility for trying to be a better version of myself. Yeah, sure I am. Cause you don't do this without taking it on to the next phase of the journey. Right?
Karen Litzy: 34:54 Yeah. You don't just read it and say, okay. Yup. Nope. Yeah. Great. Cool. Well thank you for that. I'm going to look into that. So, you know, we're talking about WCPT and all of these international organizations and you do a lot of traveling and meeting all the different people. So you have a very wide network. So what are your top tips for physio therapists who are trying to build their professional network?
Emma Stokes: 35:28 Two Up, two down, two sideways. And we've talked about this before, I think, which this is not my rule. I got it from, and a really good friend of mine who got it from someone else, a colleague of his, and the idea that networking is really natural to some people. Like they just, they're good at, right? Yes. But for a lot of people it's not. So, so I think the first thing is that you do two up two down two sideways route. And I think what's really interesting is when you say it out loud, you can start to use it. And in that way. So, and two up, two down, two sideways is, and so you're at a meeting and you want to be two people who are ahead of you in their journey.
Emma Stokes: 36:09 So, you get ready, you identify them in advance or you don't, you just happened to meet them. But, for a lot of people it's about working and saying, okay, these are two people that I want to meet. And you're prepared and you don't randomly want to bump into them, but you have an ask of them maybe or not. Maybe you just want to connect with them because you admire the work that they'd done. And two sideways is two people that you want to connect with who are your peers, right? So two people that you've met on Twitter that you say, okay, I want to meet that person in person, I want to see that person. And then two down or two people who are ahead of you, the behind you in the journey. So students and you know, phd student, you know, so if you're a little ahead of them in the journey, who are they?
Emma Stokes: 36:53 You know, and you know, who can you help along the way? So it's really interesting is I think it's a great rule. So you're at a meeting, who are your two up, two down, two sideways. I love it. And really interesting is if you know the rule and the person you're talking to knows the rule, it's great fun. So I was at a meeting where a physiotherapist came up to me and said, have you done your two down? So I had talked about this in the next year, a few months before rounds, and he'd come up and he said, have you done your two down yet? I'm like, sorry. He said, have you done your two down? I said, no, I haven't. He said, can I be one of them? Oh, that's so cool. And I said sure you can how can I help you? And so we ended up having a conversation and I was able to do some stuff for him that was fantastic.
Emma Stokes: 37:38 And I thought, hey, you know, that's great. So, I think it's fantastic. So plan for your two up two down two sideways or be ready for your two up two down two sideways. And you know, I still do that. I mean I still think about hooking you. Who are the two people in the world that are going to be helpful for WCPT, who do I need to interact with, you know, and I don't necessarily always know who they are now, but it's in that moment I'm like, okay, I've got my card ready, let me tell you who I am. Do you think I could connect with you about this conversation or this presentation that you made? And so the other thing then is about looking around the room. And I think this is both as someone who wants to network, but also someone who's potentially in a situation where you could open circle.
Emma Stokes: 38:24 So it's about physically looking through was a great piece of advice that I got. When circles are closed. So if it's me and one of the person I'm wearing a huddle, that's very hard for someone to come into. And sometimes that's okay because sometimes you are having a meeting and you don't necessarily, you need to have a conversation. But also sometimes it's about how do we keep that circle open to welcome someone in or if you see someone on the periphery to bring them in. Yep. So, so it's about the physicality of the space so that, you know, so sometimes it's about being polite and saying, look, oh, are you having a meeting? Or if sometimes people are having meetings, right? They are genuinely saying, look, we're actually having a conversation. But sometimes it's about looking around the room where you see the open spaces and coming in and saying, oh, hello, I'm so and so knowing that that that circle is open to have someone come in. Yeah. But also I think as people who are in spaces, recognizing if you see someone out of the corner of your eye might be hovering, have the generosity
Emma Stokes: 39:29 to bring them in and say, oh, hey, did you want to join us? Well, and sometimes, so for me, a lot of the time what I do is I bring someone in because I know they want to connect with someone and I say, okay, you guys are connected. I'm going to go and I'm going to move on.
Karen Litzy: 39:44 Yeah. I feel like Karim Khan is the king of that, by the way. Oh yeah, absolutely. Absolutely. Yeah. Oh, did you want me to come with me? This is exactly, yeah, exactly. Absolutely. He is the king of connecting people like that at different conferences. He's done that for me so many times and I don't know how. I'm always like, what can I do for this man? Because I feel like he's done so much and he's so good. And I love the two up, two down, two sideways. I'm going to remember that when I go to Vancouver. It's a great room. You know, and maybe we need to produce a little card to up to that, like a dance card. Oh that's a good idea. Maybe we can do that for sports congress. Oh I'm definitely doing that. Oh that's such a good idea.
Emma Stokes: 40:37 And then maybe one of the sponsors or one of the, you know, cause they could have a little piece of the sponsorship piece at the back.
Karen Litzy: Yeah, absolutely. Well I know that, you know, Chris is listening in on this, so I'm trying to shout out to a sponsor. And then if you really want people to kind of get into it, you can kind of fill it out with the person's name and then handed in and win a prize at the end. And I love the bringing someone in and when we were in Switzerland, Christina Lee that I was with and you know, we had met in Copenhagen at Sports Congress and decided that it all stayed together at WCPT and you know, you're just walking around and she gave me a compliment that no one's ever given me before, but it's might've been one of the best compliments I've ever received.
Karen Litzy: 41:52 And she's like, you know, you are so good at making sure people are involved in conversations. Like you're so good at bringing people in and you're so good if someone's not saying anything of, you know, making sure there's space for them. She's like, that is, she's like I'm learning from that.
Emma Stokes: 42:10 That's fantastic. And it is a great gift of yours because you are so present in the moment when we're having conversations. So you're very sensitized I think to the people in the room or the space that we're in. So you do connect people in a way that is fantastic and it's a huge gift. And I think the fact that you don't even know is that you're doing it means that's a great gift for you. Yeah, I think sometimes, and that's, you know, that is wonderful. So you have, you know, you've internalized that it's probably just a natural part of who you are. And I think for other people it might not be intuitive, but it's a great thing to remember. The other thing to remember is the 20 second rule or the two minute rule, but we have the rule, which is, you know, we meet people all over the world. Some people meet people around the world. You're never necessarily going to remember everyone's name. So I have a rule, which is if I'm standing chatting to someone and the person I'm with who knows me, we haven't been introduced within 30 seconds. The cue is introduce yourself because either A I’ve forgotten cause I'm so taken up in the conversation. It's not beyond the bounds belief, you know, happens very regularly. Or secondly, I've had that moment where I'm suddenly thinking,
Emma Stokes: 43:28 I don't know that I remember this person's name or I'm not sure enough that I remember their full name.
Emma Stokes: 43:35 So just introduce yourself, so if you're with me and we're in a conversation, you would always do it right. You'll say, Oh hey, I'm Karen, she's introduced me. That's fine. But, but it's also, it's a very polite way of getting over that moment of she's forgotten. She's taken up with a conversation or she hasn't done it because she's only thinking I'm having a panic. I remember exactly where I met the person. Yeah. I remember their name. And you know, sometimes I put my hand on them. But I can usually remember exactly where I've met the person.
Karen Litzy: 44:11 Yeah. I'm good at faces. And sometimes like if I'm with some, like a friend of mine and I see someone, I'm like, oh my gosh, I know this person, I know this about them, this about them. But I don't know their names. So when we go up, we'll start chatting and then I want you to introduce and then I want you to introduce yourself. So I'll prep this, the person I'm with, I'm like, I might know their backstory, I've read them know, but I can't think of their name.
Emma Stokes: 44:32 So you know, do the 30 second rule, which is when you're with a friend who hasn't introduced, you just introduce yourself.
Karen Litzy: 44:38 Perfect. All right, so let's talk about Third World Congress. What are you going to be speaking on?
Emma Stokes: 44:45 Well there you go, on leadership and you know, you know, how fabulous is that? I'm so excited about being there, you know, I'm just, I'm so honored to be invited because I was invited a couple of years ago and, you know, I wasn't necessarily going to be the president of WCPT again. Right. So, and I said to them, you know, what's really nice that you've invited me but you know what, it's great. We just invite you anyway because we want you to talk about leadership. And he would have been the president and that's great. So, I'm thrilled that I was invited to be that. I'm super excited about that. I'm back as the president of the world physiotherapy and, you know, I just, I guess, you know, I love the sports physiotherapy world.
Emma Stokes: 45:27 You know, I've never practiced as a sports physiotherapist and it's not my field of expertise, but I have learned so much simply by sitting in the rooms of amazing congresses. And I've learned so much that just simply by Osmosis, that every now and then I say something and I think I sound like I know what I'm talking about. Actually. I'm fairly confident that I do, but how do I know? And then I realize, okay, what I've sat through five keynotes lectures from the stellar people in the field. And it's not that I'm an expert, but I can actually at least point people to the references. So, you know, I think there is so much to be gained from a global community of practice and knowledge coming together and you know, the sports physiotherapy world is incredible and I am so excited and Vancouver is beautiful and the Canadian physiotherapy is fabulous, So bring it on.
Karen Litzy: 46:26 Awesome. Well I know, I am excited to go in to learn and you know, there's breakout sessions. I don't know which one to go to because they all sound really great. I don't know what you think, but I think they all sound like it's an amazing program.
Emma Stokes: 46:40 Absolutely. It's fantastic. And I think, you know, you know, I get the joy. So I suppose my joy is my privilege and my joy is that I get to dip in and out of so many sessions. And because you know, in a way I am taking different lessons away from Congress. It's like this. So I'm taking away the thought leadership lessons I watched, you know, I want to sit in on the leadership stuff, I want to sit on the policy stuff. But you know, if you're practicing day to day working with people in the sports world, there the richness of the programming is like, where do you start to choose, you know, how do you decide what you're going to go to, to take away, to inform your day to day practice?
Karen Litzy: 47:18 Agreed. I think it's going to be great. And again, just for people listening, you're obviously on the Facebook page, so hopefully you can see the banner on top that says October 4th and in Vancouver the Third World Congress of sports physical therapy. But I guess this is going to be on my podcast as well. So Emma, where can people find out more about you?
Emma Stokes: 47:40 Oh, so, well, like they want to find any more out, more about us I think actually look at, so WCPT.org is our websites. Have a look at the website because we are going through a major both rebranding, you know, redesign of the website. So it's going to look super different. I think we're going to have some interesting information about our rebranding by October and about the rebranding of the product. You know, the kind of, the idea of what do we call ourselves as a global community and started to merge the space. I'm committing to blogging once a month, which I've failed dismally at, but I am now committing, so just put the first blog out there and yeah, so follow us on social media, like Facebook, Twitter, Instagram, and then look at our webpage but also look at our subgroups obviously because, the world sports congress is being co hosted by the Canadian Division of sports PT and the International Federation sports physical therapy and that's the WCPT subgroups. So all joined up. So yeah, look at the website and I see the early bird is opened on until the end of August for Congress in Vancouver in October.
Karen Litzy: 48:55 Yes. Awesome. Well, thank you so much for taking the time out and coming onto as a pleasure.
Emma Stokes: 49:00 It's my pleasure as always, and thank you for the opportunity and I will see you in Vancouver.
Karen Litzy: 49:04 I will see you then. Thanks everybody. Have a great day.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dan White on the show to discuss evidence-based practice. Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy. Dr. White’s research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after Total Joint Replacement.
In this episode, we discuss:
-What is implementation science?
-Evidence Based Practice and how to use Clinical Practice Guidelines
-The latest research findings from the Physical Activity Lab at the University of Delaware
-Limitations of physical therapy branding and how we can step into the physical activity space
-And so much more!
Resources:
Email: dkw@udel.edu
Academy of Orthopedic Physical Therapy
University of Delaware Physical Activity Lab
Published CPGs
For more information on Dan:
Dr. Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy. Dr. White received his Bachelor’s degree in Health Sciences, M.S. in Physical Therapy, and Sc.D. in Rehabilitation Sciences, all from Boston University. He completed a post-doctoral fellow at the Boston University School of Public Health and earned a Masters in Science in Epidemiology from the BU School of Public Health 2013.
Dr. White’s research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after Total Joint Replacement. Dr. White is an Associate Editor for Arthritis Care and Research, and an active member in the American Physical Therapy Association. His research is funded by the National Institutes of Health, and the Rheumatology Research Foundation. Dr. White can be reached at dkw@udel.edu
Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy. Dan’s research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after joint replacement. His research uses large existing datasets to answer questions related to physical functioning and physical activity. As well, he is also conducting clinical trials to lead ways to better promote and increase physical activity in people with knee osteoarthritis and after joint replacement. Dan is an Associate Editor for Arthritis Care and Research, and an active member in the American Physical Therapy Association, the American College of Rheumatology, and OARSI.
Read the full transcript below:
Karen Litzy: 00:01 Hey Dan, welcome to the podcast. I'm happy to have you on.
Dan White: 00:05 Thanks. Great to be here.
Karen Litzy: 00:07 And now today we're going to be talking amongst other things, implementation science. So before we go any further, can you give a definition of what implementation science is?
Dan White: 00:19 Absolutely. So implementation science, that definition is the scientific study of methods to promote the systematic uptake of research findings and other evidence based practice into routine practice and hence to improve the quality and effectiveness of health services. So essentially it is bridging the gap between science and practice, and it is taking things that we find in laboratories and in clinical studies and literally implementing them into real world, clinics where most physical therapists work.
Karen Litzy: 01:00 Right. So then my other question was why should the average PT care, which I think you just explained that, so we need to care about implementation science because this is how we're getting what researchers do in the lab to our real world situations and our real patients.
Dan White: 01:16 Yeah. I think practicing as a physical therapist, you know, you can look around and a lot of people do a lot of different things and a lot of things seem to work. Snd I think, if we want a game changer in our practice, that is going to come from a systematically studying people and understanding what are the underlying critical ingredients of our practice that really work and the best thing we have made up today to answer that sort of question of, you know, what is it that really works our clinical practice guidelines that is the, essentially the best body of evidence that has been reviewed by a panel and vetted and made to be digested by the everyday clinician. And implementing these clinical practice guidelines are really the key element that is going to lead to a game changing opportunity for us as a profession.
Karen Litzy: 02:34 And when you talk about clinical practice guidelines, I know sometimes people think that you're doing sort of it's cookie cutter and what do I need to follow a cookie cutter recipe for because all of my patients are different. So can you speak to that?
Dan White: 02:52 Yeah, no that is a great point. So on the one hand, there is definitely an art to physical therapy and the clinical practice guidelines and evidence based practice is by no means trying to take that away. It's evidenced based practice in general is not cookbook medicine. It is combining the three things and one is what the evidence says, but two it also combines what the therapist's experiences are and then finally it's what patient's preferences and what their feelings are on the whole thing. And it's a combination of all three. It is literally the definition of evidence based practice and these clinical practice guidelines are definitely consistent with that EBP models. So they are not directions or they're not instructions, they're guidelines. They're ways of helping people make informed decisions. And at a minimum, if you consider yourself an expert clinician and knowing what the clinical practice guidelines are, is a big leg up. And definitely key to helping our profession. It doesn't necessarily mean you ascribe them to every single patient. No, that's not what evidence based practices, but being aware of them is by definition, in my opinion, being a good clinician.
Karen Litzy: 08:02 So can you give us an example of one of these clinical practice guidelines?
Dan White: 08:21 Sure, absolutely. So one of the common patient populations that people treat is low back pain. And Tony Toledo and his colleagues at the University of Pittsburgh and elsewhere developed a clinical practice guidelines for low back pain, and published this and JOSPT in 2012, their paper described that the purposes of these CPGs, our first to what EBP is for a physical therapy practice. And then also to classify and define common musculoskeletal conditions from this classification criteria specific interventions are devised. So for an example, so I don't treat low back pain. This is not my area. So just forgive me for giving a guess here.
Dan White: 09:32 One example, is a lumbosacral segmental somatic dysfunction. And this is associated with the ICF diagnosis of acute low back pain with mobility deficits. And, Tony goes on to saying that there's, certain clinical findings with this, including acute low back pain, a buttock or thigh pain restricted lumbar range of motion and lower back pain and lower extremity related symptoms with provocation. And then from that, there are specific interventions that I'm not going to get into that is unique from a different classification. So a different classification, a low back pain is sub acute, low back pain with mobility deficits, which is basically not acute but subacute patient and the symptoms are produced with ingrained spinal motions and there's a presence of a thoracic lumbar pelvic girdle mobility deficits.
Dan White: 10:41 And then he goes on and there's these different classification criteria from which there are very specific interventions you're supposed to do. So it's classification and then intervention based on that. And essentially, that is in an ideal world of what a CPG should do. However you’re always gonna have the patient that really doesn't fit into one or the other. Let's have somebody who is not quite acute, but they're not quite subacute. So what do you do? And I think being able to first even make that distinction, you have to be aware of the clinical practice guidelines. So knowing that, okay maybe it's going to be a combination of these two interventions because of this person doesn't fit into either one, but see how that approach is already a leg up from not knowing what CPGs are to begin with and what our common classifications is. Does that make sense?
Karen Litzy: 11:38 Yeah, that makes a lot of sense. Thanks so much for using that as a really great example for people. And when you're talking about different CPGs, I know that the Academy of Orthopedics, which used to be the orthopedic section of the American physical therapy association, they have all these different names now. It's just made it all so, so much more confusing. But now obviously big proponents of the clinical practice guidelines, but if I wanted to find the average clinician and I want to find some of these guidelines, where do I go? How do I find them?
Dan White: 12:14 Sure. So all the published clinical practice guidelines for orthopedics are on the Academy of Orthopedic Physical Therapy’s main webpage, which is Orthopt.org. There's a banner that says CPGs and you just click on that and you can get right to all the published CPGs.
Karen Litzy: 12:41 Awesome. And we'll have a link to that in the show notes at podcasts.Healthywealthysmart.com under this episode so that if people need it one click and we'll take you right there. So there's no excuse to not know these CPGs after listening to this podcast then because we're going to make it really easy for you. And now you just gave us a good example of how CPGs can work in clinical practice. Are there times where maybe they don't work so well or is there a downside I guess is what I'm trying to say?
Dan White: 13:16 Yeah. I mean, again, going back to your original question of, you know, is this cookie cutter medicine and it's not and again, since EBP is a combination of patient preference, the provider know how, and what the evidence is. I mean, there's going to be situations where, you know, a situation's weighted much more towards a patient's preference. Like they don't want you to do manipulation or maybe they want something specific and you're like, well, that's really not called for in this case. And so you don't do the intervention that's prescribed or that the CPG recommends. And that's okay. We're not here to tell people, to command them what to do. They're coming to us for help. And, patient preference is a large part of evidence based practice. I think that’s the best example I can think of.
Karen Litzy: 14:16 Yeah. And, and I think another, if you're looking at your clinical experience as one of the legs of that stool, if you will, and the patient doesn't have a preference yet, you're sensing as a clinician that there's some trepidation on the patient's part. There's some fear if you were to, like you said, we'll take a manipulation as an example, then using your provider know how you would say, you know, this is not the right time or place for this. And so I think you've got all of that in. So the CPGs is not a cookie cutter oath just because A B C is present you have to do treatment B or treatment a or B. But instead it's giving you a way to maybe differentially diagnose and a way to, you know, be able to maybe give your patient an explanation as to what's going on and then use your judgment, use the patient preference and the evidence to then guide your treatment.
Dan White: 15:21 Yeah, exactly. It's just like, you know, when you just meet somebody, you try to figure out who they are, right. And you try to figure out what kind of personality they are. And there's some sort of structure or rubric people use. Like let's say there's introverts and extroverts, is this person an introvert or extrovert in the CPG the first thing that it does is provide you a framework of saying, well, what kind of types of people are there with this type of pathology? How are they a type of person that has, I don't know, this type of this type of disorder or this type or another type of disorder. And from that diagnosis of providing a classification, you can, there are clear treatments associated, with that so back to the party analogy, you know, if you're dealing with an introvert, you know, you, you know that they're not going to be super bubbly and all over.
Dan White: 16:10 You have to kind of bring things out of them and maybe take it easy and you know, take it on the slow road. Versus if someone's an extrovert, maybe are going to be doing all the talking. And, you can just be an active listener and be very interested in what they're saying, because they're the extrovert and perhaps, you know, that that's Kinda how it goes. And the CPGs is essentially just it is in the party analogy, a way of just navigating through our clinical practice, to provide best care. And, you know, I think another, medical example that really, stays fresh in my mind is a sort of lifesaving approaches to acute MIs. And, it wasn't the sort of protocol for or clinical practice guidelines for myocardial infarction, weren't developed, when necessarily, right after science discovered that, you know, look, if you do x, Y and z can actually save someone's life.
Dan White: 17:20 It kinda came much, much later. And it wasn't until, the university hospital in Chicago, implemented these sort of CPGs for lifesaving approaches to MI that the death rate for acute MI’s went way down. And all the medical residents followed, this CPG for treating acute MIs. And, that systematic approach is what made care better. Obviously in physical therapy we're not talking about life or death, but these CPGs have been vetted and are an approach that is systematically used, will produce a better outcomes. So yes, it's, you know, EBP, I'm not changing my story here. EBP is obviously patient preference, provider experience as well as the evidence, but when applied systematically, which means you'd be at minimum aware of what the CPGs are, they should produce better outcomes system wide.
Karen Litzy: 18:27 Yeah. And thank you. I love the party analogy and comparing it to that medical example really kind of makes the CPGs a little bit clearer and hopefully people will now not look at them as some sort of cookie cutter program, but instead, as a way to help inform you of your practice, which I think is, yeah, I think it's great. And now, all right, so let's move on from CPGs. Let's talk about, I'm kind of interested in what you're doing next. So you are the director of the physical activity lab at the University of Delaware. So let us in on some of the things that you guys are working on. If you can, you know, I understand you can't say everything, but what are some things that you're working on that you feel like will be part of future implementation science for the average physical therapists treating patients like myself?
Dan White: 19:23 Yeah. Thank you for the opportunity. You know my whole goal is just to get patients better. And, I worked in inpatient, acute, acute Rehab for several years. And I always wondered, you know, after I got people independent with bed mobility, transfers and ambulation, you know, would they actually take those, you know, new found independence, and actually resume their daily activities and be active in the home. And that led me to really thinking a lot about this notion of physical activity or, you know, how much do people do. And so, in the area I study, it's osteoarthritis and osteoarthritis is a serious disease that is associated with higher rates of mortality.
Dan White: 20:21 And only definitive treatment for osteoarthritis is a total knee replacement. Now, after total knee replacement, people do great with improving their pain, and increasing their function. But there's many systematic studies that show in terms of physical activity, people aren't doing more, they're doing just as little as they did before. And I think that's a real missed opportunity for physical therapists. And I think there's a great opportunity to talk about, you know, being more active and helping patients and it really doesn't take that much. It's just a, hey, so, you know, how much are you doing every day? With smart phones and the use of fitbits, counting steps per day is actually an incredibly effective, a way to increase or one to see where people are at in terms of physical activity and to increase how much activity people are doing.
Dan White: 21:19 So just like if you're trying to, you know, lose weight, you usually have a scale and you want to see how much you know, where you're at and what progress you've made. Using a pedometer or using a fitbit monitor to count your steps is an analogy and analogous way of doing the exact same thing. So at the University of Delaware, we are studying what are the best ways, physical therapists and practical ways physical therapists can increase activity in people with knee replacement. And what we've done is we recently published a study that basically found that, it's very feasible to talk about physical activity and do a really quick intervention for people after knee replacement by simply giving them a fitbit monitor. And seeing how many steps per day they're walking, and then increasing that number of steps today.
Dan White: 22:19 Our target goal of 6,000 steps per day in a study we did several years ago, we found people with knee osteoarthritis who want at least 6,000 steps per day we're much less likely to develop financial limitation than people who walked less than 6,000. So that's where we use the 6,000 steps per day. That's where we have the goal set up. And, since there is a health outcome associated with 6,000 steps that's our goal. And we see where people are walking and then we start to increase their steps by five to 10% per week. So if you're walking 2000 steps, we increase it by 100 to 200 steps per day more.
Dan White: 23:25 And then the next week we see where they're at and we increase it again by another five to 10%. And what we found, doing this intervention and physical therapy is that a one year after discharge from physical therapy. So they've had no physical therapy and no intervention. People pretty much maintain the gains they made in physical activity and their gains are pretty substantial. There was a high percentage of people that met the 6,000 steps per day goal, and maintain that one year out in a preliminary study. And we are currently collecting more data to look at a larger sample to have a little more robust results. In talking with the theme of Implementation Science, what our next step is to do is to implement this intervention in real world physical therapy clinics.
Dan White: 24:24 We recognize, you know, at the University of Delaware, we have a fantastic physical therapy clinic. But you know, our clinicians, and the type of people, patients that come here don't represent a cross section of the entire country. We want to see whether this intervention will work in real world clinics. And we've partnered, with a clinic in Lancaster, PA called hearts physical therapy. And we're looking at developing a implementation of our intervention at that clinic, to see, you know, what's the uptake with clinicians, what are the barriers, what are the uptake with patients, where the barriers and how can we make this evidence based practice approach actually work.
Karen Litzy: 25:13 Yeah. And you know, as you're saying that I'm thinking, well, hmm, does it matter like these people know that they're in a study. So is that their incentive to, you know, continue on with getting these 6,000 plus steps in a day because you know, we all want to show the teacher that we're good at what we do. Yeah. Right. And then the question is that enough? Like you said, you followed them for a year to really make that a lifestyle change and maybe after a year it is.
Dan White: 25:43 Yup. No, those are good questions. So in terms of sort of in terms of like a Hawthorne effect or where you were, you know, you're just doing this because you know you're in this study. First we do have a control group that wears the Monitor. And they did not have the intervention, but we are monitoring their physical activity and know it and the intervention group, in our previously published study, in arthritis care and research, that the intervention group still is walking almost double of what the control group does a one year out. So that's, you know, that's notable.
Karen Litzy: 26:36 Oh, one year is a long time and at that point, do you feel like it has shifted to a lifestyle change?
Dan White: 26:47 Yes and that's the encouraging part. Like one year out that's a pretty good outcome, for not having any contact with, you know, well not having your original physical therapy for you. And, that's incredibly encouraging for a longterm outcome and actually thinking that there might be large behavioral change. Another interesting thing with our preliminary studies that we looked at adherence or the fidelity of a treatment in the physical therapy clinic. And what that means is how often did physical therapists tell the patient about, you know, ask them about their step goals and ask them about you know, how they're doing. And it actually wasn't that great. It was around 50%. So, it wasn't that this intervention was, you know, so well taken, in my mind, it was more that the patients really grabbed onto this and saw that, you know, look, this monitor tells me exactly where I'm at. And in qualitative studies we've done, or interviews we've done after the intervention, the patients, by and large, they say, look, I know where I'm at, that this monitor tells me, and I know when I have a good day and I know I have a bad day and what I need to do to make a difference between the two.
Karen Litzy: 28:05 That's great. And if you can get that from the monitor or the fitbit or the pedometer or whatever it is that you're using, then I think that's a huge win, not just for mobility, which obviously we know we need as we get older and especially after knee replacements, but for a whole host of other health reasons as well.
Dan White: 28:27 Yup. Yup. Exactly that. I was just lecturing yesterday to newly-minted rheumatology fellows at u Penn in Philly. And talking about physical activity first, it was interesting to know that none of them knew what the physical activity guidelines are, which maybe, you know, most people don't know what they are, but it's a 150 minutes of moderate intensity activity per week or 75 minutes a week of vigorous intensity. And the reason why these guidelines are so important is that the benefits of health of being physically active are far reaching. They range from not only improved strength and flexibility, but you also have cardiovascular benefits. You have a mental health benefits. There's less the chance of depression, there's less chance of weight gain.
Dan White: 29:28 There are a lot of far reaching effects even so that the American College of Sports Medicine Jokes that if you could put the benefits of exercise into a pill, you'd have a blockbuster pill. I mean, it’s definitely a huge benefit to be active. And then the second thing is that, you know, for physical therapists, you know, is that something we should address? I mean, that could be something that, yes, typically, yeah. Typically therapists you think with a patient comes in, you know, they have their complaints and, you know, let's talk about, you know, reducing your pain and increasing your range and then getting you back to, you know, where you were at. But our recently published study in physical therapy actually surveyed patients and said, you know, what do you feel physical therapists should talk about?
Dan White: 30:24 And they were asked a range of things including weight and Diet and physical activity. And by and large, it was 90 plus percent of patients said, I want my physical therapist to talk about this collectivity. That is what they're there for. You know, that that is a major reason I am here and I want them to ask me about it and to counsel me on it. So I think that's something we should, you know, to embrace and understand, you know, what our guidelines are this 150 minutes a week, understand that. And understand, you know, what our steps per day, what are sort of major benchmarks for steps today. You know, we oftentimes say 10,000, but you know, we found earlier that 6,000 for people, you know, osteoarthritis is a meaningful benchmark.
Dan White: 31:15 And then, the last thing I'll say about the physical activity thing is that, American College of sports medicine and the physical activity guidelines from the Department of Health and Human Services, you know, their major recommendation and before the timeline is that it's the saying that some is good but more, it's better that there is a dose response relationship between how much activity people do and their health benefits. So even getting somebody who is completely sedentary to doing at least walking for five to 10 minutes a day, can have a huge change in their health outlook and risk for future poor health outcomes. So, that is a major thing that, you know, PTs need to keep in mind is if I can get this person who I know is sedentary just to do something in adopt that I think is huge win for this patient.
Karen Litzy: 32:12 Yeah. And, I think that the physical therapy profession needs to really step up and be the people to step into this space. I mean, this is what we do. This is our space. You know, we should be grabbing those patients who maybe have knee OA, but don't need a knee replacement yet. We should be stepping in. That's our jobs. That's what we should be doing. We should be working with obese or sedentary people of any age before they have to come and see us for an injury.
Dan White: 32:46 Yup. Yup. Exactly. My doctoral student Meredith Christianson who worked with Gillian Hawker at the University of Toronto to do this qualitative study on primary care physicians. And essentially the question was why don't primary care physicians recommend exercise and physical activity to patients with knee osteoarthritis. Although despite the fact that every single clinical practice guideline recommends, you know, exercise by and large, the primary care physicians or that we're saying, well, we don't know what to recommend. We're not the experts. And, they would like to refer their patients to PT, but it's not reimbursed up in Canada. So, you know, I think this further underscores the notion that as physical therapists, we should own the physical activity sphere. We should be the ones that people think of, like, you know, well, I want to be active but I have some problems. What do I do? Go see a physical therapist. You are highly educated individuals who know more about biomechanics, more about kinesiology than anybody else in the clinical sphere. And we are the best place to make exercise and physical activity recommendations to people of all types, more so than any other health provider.
Karen Litzy: 34:13 Yes. I couldn't agree more. I could not agree more with that. And, in my opinion, and my hope is that physical therapy really starts to move toward that in the very, very near future because boy could we make a big impact in the lives of people around the world if we're that sort of first line of defense, if you will. And isn't it amazing that like, I love that you brought up this not covered by insurance, but people will go and pay for a trainer or a massage therapist, not knocking any of those professions at all because I think they're all very valuable. But people will pay for that and not say, well, can you turn it into my insurance? And then when it comes to physical therapy where, you know we know all this stuff, we have the guidelines, we have the clinical prediction rules. We have the education and it's just not something that people are willing to put money down for.
Dan White: 35:27 Yeah, I think there's two things. One I think people will pay if they see value in it. And yes, I think that it's not that we don't have value, but I don't think we're marketing ourselves well as specifically to the larger community. Going back to the implementation science, Workshop Implementation Science Conference and workshop in Providence, Rhode Island this past march and the president of the APTA came and spoke there and he said that, you know, for us as physical therapists, we're really lacking in the sales and marketing sphere. And one of the reasons why is because, well, one of the things is we all call ourselves physical therapists. But what that means is very different depending on where you work.
Dan White: 36:33 So for instance, you know, a patient is going to have an eye, a view of what a physical therapist is. In this context. So if they see a physical therapist working in a school, well they'll think all PTs work in a school, and in acute care after a major MI then they think they only worked at acute care, but you know, marketing that we actually are versed in many areas is a challenge we have. And I don't know if that means we start to call ourselves a sports specialist or you know, cardiac specialists or what, but, you know, something along the lines of marketing our idea or marketing our expertise better is a key area of need. And then the second thing is, you know, I think it's okay to ask people to pay for things.
Dan White: 37:24 In knee osteoarthritis as people will pay five to $10,000 for stem cells or PRP injections, and, you know, the evidence behind that is, well, let's say it politely, much lower than what the evidence is for exercise is. And, it's just incredible that, you know, if someone's gonna lay down that sort of cash, you know, I think there is a definite market out there for services that are viewed as valuable and having a physical activity or exercise prescription that's tailored to, you know, individual needs, you know, is a clear area of opportunity for our profession, for people with chronic diseases. And, you know, I think a space that we should definitely pick up.
Karen Litzy: 38:16 Yeah, there's no question I could not have said it better myself. And I think I'm going to make nice quote on that because you're absolutely right. And now before we wrap things up here, it's the same question I ask everyone, and that is knowing where you are now in your life and in your career, what advice would you give to yourself fresh out of school?
Dan White: 38:54 Yeah, that's a good question. The advice I'd give myself is, just do your best to make your patients better. I think that's all it is. And you know, at the University of Delaware, we have people here that work in very different outputs. So we have our clinical faculty that are working, doing a bulk of the teaching for the students. And then we have research faculty or tenure track that teach the PT students, but all have our own research lines. And then we have clinicians that are working in the clinic so very different outputs. But our goal is all unified and that is just to help patients get better. That, you know, and from the clinical side, we are focused on excellence in research or excellence in teaching students the best and latest up to date things and the most effective ways to teaching them.
Dan White: 40:05 So they remember not only to pass the test, but to have successful careers. And then from a research perspective, we're trying to look for, you know, what are game changing discoveries to help treat people and help them get better. And then the clinicians are implementing that on a daily basis at the University of Delaware. And you know, again, what makes us, I think, what I think of as a prideful point is that we're all aligned in our goals with trying to get people better. And so that's something that I guess, you know, I've always ascribed to as both a therapist, as a doctoral student and now as a clinical scientist is trying to, you know, my major goal is just to help people get better.
Karen Litzy: 40:54 That's a wonderful answer. Thank you so much. And where can people get in touch with you if they have questions?
Dan White: 40:59 My email address is dkw@udel.edu. Feel free to email me anytime.
Karen Litzy: 41:16 Awesome. Well, thank you so much. Thanks for breaking down the clinical practice guidelines and implementation science, and I love the stuff you're doing in your lab, so thanks for sharing.
Dan White: 41:25 Great. Thanks so much for having me
Karen Litzy: 41:27 And everyone else, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Kathy Mairella on how to get elected to the House of Delegates and other APTA positions. Dr. Mairella is Assistant Professor and Director of Clinical Education at Rutgers University. Dr. Mairella has served in a number of leadership positions, including service on the American Physical Therapy Association Board of Directors, and terms as president and chief delegate of the American Physical Therapy Association of New Jersey.
In this episode, we discuss:
-How to make yourself known to the Nominating Committee as a potential candidate
-Referencing the candidate’s manual and seeking guidance from your campaign manager
-Candidate interviews and Kathy’s experience with election day
-The continual pursuit for leadership experience
-And so much more!
Resources:
APTA Engage Website
Kathy Mairella Twitter
For more information on Kathy:
Kathleen K Mairella, PT DPT MA, received a Baccalaureate degree in Physical Therapy from Boston University, and a Master of Arts in Motor Learning from Columbia University. She received a Doctor of Physical Therapy degree from the MGH Institute. Dr. Mairella is Assistant Professor and Director of Clinical Education. She teaches Professional Development I, and Health Care Delivery I and II. Her professional interests include health policy, professional leadership, and clinical education. She has presented on these topics on the national and state level. Dr. Mairella has served in a number of leadership positions, including service on the American Physical Therapy Association Board of Directors, and terms as president and chief delegate of the American Physical Therapy Association of New Jersey.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor with healthy, wealthy and smart. And I'm here with Kathy Mairella and we are at the house of delegates and going to talk about the process, the election process for people who are running for positions within the APTA. And I know nothing. So first of all, Kathy, thank you so much for coming on.
Kathy Mairella: Thanks. This is fun. I'm looking for to talking about this.
Jenna Kantor: So for those who haven't listened to any of the interviews that I've done before that were kind of similar, I am totally beginner and I'm just going to be asking step-by-step and learning with you the listener about this process. So let's start from the very beginning. And honestly, I don't even know what that is. So Kathy, would you start, how does it just even start in the first place? Is it a piece of paper you signed? Do you raise your hand in a meeting? Like how do you get the opportunity to run for a position within the APTA?
Kathy Mairella: 00:49 So that's a great question. So many, many of the leaders who run for positions at the APTA level started the component level and they often, it means state component mainstay or it can be an academy section as well. Those are also components. So every state has a chapter and then your sections are also considered components. So most candidates who run at the national level have had some level of leadership experience at the component level. And so you start there simply by showing up and getting involved in different activities. Usually if you have a leadership interest, somebody will notice and give you some direction and it helps to get that direction if you ask for it. If you're doing some work on a committee level or a task force level, you can ask the people who are more engaged.
Kathy Mairella: 01:55 How did you do this? How did you get started? I started as a New Jersey component leader. I started as a secretary and moved through vice president and president and then to chief delegate. And so I got to know people on the national level through my work as a chapter president and as a chief delegate because that's where you come to a national meeting and you start to connect with people beyond your component. You start to meet people who are either other delegates or serving on the national level. And you develop connections, you develop relationships. When I went to my first delegates, I looked at the candidates who ran and I thought I would never in a million years do that, but I was a delegate and I watched and then people came to me and said, we think you have some leadership, would you be in check?
Kathy Mairella: 03:00 And I was totally floored. I did not expect that at all. In fact, I was a member of APTA's nominating committee. So nominating committee members are elected to slate the candidates who run and they start years ahead of time identifying those who are interested. And so I was approached and I thought, not really, no, I don't think I really want to do that, but it gave me the idea of perhaps in the future serving at a national level.
Jenna Kantor: I want to pause you just very briefly. Would you mind saying what a delegate is for those who don't know what that means?
Kathy Mairella: Sure, absolutely. So each state chapter elect delegates who go to the house of delegates to vote on motions which are ideas, ideas for action. Really the house of delegates is considered a representative body, just like Congress as a representative body. So you are elected by your state or there are also section delegates, but you're elected to represent them in the house of delegates.
Kathy Mairella: 04:21 And the house of delegates has about 402 delegates. And so the states with larger membership have more delegates, states with smaller memberships have at least two. They will never have fewer than two. So they call that apportionment.
Jenna Kantor: So you're bringing up the delegates cause they're the people who vote for you. So it’s important to be introduced to them because it can help your candidacy if you should run.
Kathy Mairella: Correct. And when you decide you want to run, it's important to get a sense from people. Is this a good idea? You don't want to put in all the work and then not be successful. So you really do start to observe people who have been elected or people who are doing work within the association that inspires you, that interests you and you know, you can observe them, you can ask them questions.
Kathy Mairella: 05:24 You can start to connect with people. And then running for offices really a matter of experience. But it's also a matter of timing. We all have work life integration and we figure out the timing that works best for us. And in my case, I had three growing children. I knew I wanted to serve at a point where they were a little bit more independent. So that determined my time frame. So again, I had been a chapter president, a chief delegate, and then at the end of the time I was a chief delegate. My youngest child was graduating from high school and I thought, okay, this is the time for me to start pursuing that. So, I would observe then you need to know what the positions are. You need to know.
Jenna Kantor: So just to run for say, secretary or President or director, you need to know what it means that you would need to know what to do.
Kathy Mairella: 06:29 Correct. So, the board of directors at the APTA level is 15 members. You have nine directors and then you have house officers, speaker and vice speakers. So those are two board positions that actually run the house of delegates. And then you have president, vice president, secretary and treasurer. So you would need to know, you know, kind of the roles and responsibilities of each of those. And you can also run for the nominating committee, which I mentioned earlier. So those are the people who are elected by the delegates to determine who the candidates are each year. So, you know, you run through a process that starts immediately after each house of delegates. So we literally just finished the house of delegates today on June 12th, and the next cycle starts for the 2020 election today. And it starts by forms that are available on the APTA website that any member can complete.
Kathy Mairella: 07:34 They don't need to be done. You don't need to be a delegate. You don't need to be a leader. You can go on the APTA website and you can put in what's called an NC1 form, which stands for nominating committee one form. And you put that in and as an individual and you recommend someone that the nominating committee should contact as a possible lead for them to slate for office and you can you choose, I think this person would be a great secretary. I think this person would be a great treasurer. And you put in the recommendations for the offices that are up for election in the following year and the nominating committee collects all of that information. They also keep an ongoing spreadsheet of people who have expressed interests cause sometimes people will say, yes, I'd like to do this in the future, on completing a residency now and I'm getting married the year after that and I'd like to practice for three to five years and then maybe I'll be ready.
Kathy Mairella: 08:47 They start to keep that spreadsheet and they turn that over every year from nominating committee to nominating committee so that they have a database of potential candidates.
Jenna Kantor: I have a question. I have a question about that. I'm definitely a person who wants to work on the board one day. Definitely a dream of mine. And what if I'm in a position where I don't have somebody saying, Oh, I submitted for you. Like what if you don't have something like that? Does that look low upon yourself? I would love to know that perspective.
Kathy Mairella: Sure. So the volume of those NC1 forms really doesn't make a difference. It's important to have a few people say, yeah, it would be nice for nominating committee to talk to that person. You're not committing to anything. It simply gives your information to the nominating committee as someone that they should talk to and it just gets you in kind of in the system.
Kathy Mairella: 09:47 So, I think for anyone who is interested, you can contact someone on the nominating committee directly. Their list of names and contact information is on the website. And usually they’re assigned to a region. So who's ever assigned, you know, if you're from New York, from the northeast, you know, you can directly contact, you don't have to have NC1 forms until you're actually ready to run for office. So once you decide you are ready to run for office, it usually is a good idea to ask a few people. Would you be willing to put in an NC1 form for me? And talk to people kind of before you’re ready, you know, do you think this is a good idea? Cause as I said earlier, you don't want to put in all the work and then find out that you're not successful.
Kathy Mairella: 10:35 You're spending this time looking at your leadership skills. Learning about leadership. Always growing, always growing. There are some resources. APTA has opened, a new platform called APTA engage. And they are in the process of transferring some of their leadership development resources to that place. When I was on the APTA board, I chaired the leadership development committee and we came up with some core competencies of leadership. So, they were self function, which is how an organization works people, which is managing people's skills and visions. So knowing how to be visionary. And so I would recommend that you would look at all of those areas and they're always, they're not linear. It's not as if you develop self first and then people and then they're cyclical. Right? So you can be, you know, you can work on all of those things and constantly come back to developing yourself as a leader.
Kathy Mairella: 11:43 You're always developing yourself no matter how experienced you are. So the nominating committee, these NC1 forms are available between now, which is June and November. Usually it's around November 1st they close and then the nominating committee takes those forms. They look at who the possible people are that might be good to be slated for these positions and they actually reach out to these people. They interview people, to figure out who should be slated for this next year's offices. And they come up with a slate and what they decide how many candidates to slate. So usually if it's an officer position, president, vice president, secretary, they try to slate two people because there's one position. And for director there's usually three positions. They try to slate six individuals for those three. So two for each position is the goal. And that's what they would consider a full slate. And sometimes that's a challenge to get a full slate to get people to commit to run and you have to consent to run. They will call you to say, do you consent? They don't just put people's name on a list.
Jenna Kantor: 13:15 So for you, you went through this whole process yourself and several times. Oh my gosh, this is for those who do not know, Kathy, she has the stamina of wonder woman just doing the whole process. So you knew you were going to run. Is there a meeting to teach you about principles or how are you trained for what is to come.
Kathy Mairella: And that's a really great question. So the nominating committee members are mentors or guides for you. They're not your advocates because they remain neutral in the election process. But they will assist you with some resources. But then APTA staff who work in the governance department become your assistants as well with the process. There is a candidate manual that contains much of the information and that's available to anybody. You don't have to wait until you're a candidate.
Kathy Mairella: 14:16 Any member can go on the website and locate the candidate manual and read lots and lots of information about this whole process. And it really describes the nominations process, the candidacy process, and the elections process. So once the nominations process ends, the candidacy process begins and the nominated committee publishes the slate and the slate goes up on the website. And that's when people find out, it's usually early in December. They usually find out these are the people who are on the slate and then the campaigning begins. And as candidates, you are given a question to answer that goes in written form that goes on the website, on your candidate page. You also have to have your CV that gets posted there and that becomes available to the delegates and to the members to look at who are these people.
Kathy Mairella: 15:21 And that's how you get information. The CSM meeting in February is usually the first live appearance of the candidates. When delegates start to pay attention to who are these people who are slated? And so the candidates pick a campaign manager and your campaign manager is the person who helps you. They are your advocate. They are the ones who help you navigate the candidacy and election process.
Jenna Kantor: I love that you guys do that.
Kathy Mairella: Yeah, and I actually I served as a campaign manager last year and I loved it. It was really a lot of fun. I really enjoyed that. So usually you want your campaign manager to somebody who does understand this whole process and who can again be your advocate, you know, let you know if your hair is straight and you know what you know, look at the things that you're writing and give you feedback and be sort of your sounding board when you have questions on strategy and who should I be talking to and here's what I'm hearing and how do you think I should handle it?
Kathy Mairella: 16:38 That's your campaign manager's job. Because they have the job of being your advocates. Do you show up at CSM, you go through the process of contacting people, you know, asking them for your support, putting together your platform. Why are you doing this? Why should somebody vote for you? You have to have a pretty clear picture of why, if you're going to convince people, you know, to vote for you, it's politics. It's absolutely politics. And the thing about elections is that not everybody can win. You have to understand that the delegates vote for a variety of reasons. It's not always personal. If you are not the one who is elected. And there are multiple reasons why delegates will look across the slate at everyone that they're electing. They will be looking at the balance, they'll be looking at geographical balance.
Kathy Mairella: 17:43 They'll be looking at age, they'll be looking at male versus female. So they're looking at all of those things for a mix. Again, because your board is a team of 15.
Jenna Kantor: I would love for you to go into now the day off, so the day off. So, for those who don't know, at the house of delegates, it begins of course with a bunch of meetings, but the real star time where people are coming together for delegates to start voting on things are the interviews for these candidates. So if you wouldn't mind talking about that experience.
Kathy Mairella: Sure. And candidate interviews are identified by potential candidates as being one of the biggest barriers to serving because many members find the idea of doing these candidate interviews to be really intimidating.
Kathy Mairella: 18:42 The candidates at this point get at least one of their questions in advance. So you work on that and get it, you get that one prepared. So I ran this year for the office of Secretary. And so there are 20 minutes allotted for your interview. You get a two minute opening and you get a one minute closing and then the other 17 minutes you are interviewed by delegates to the house. They're divided into four groups. And so you how you do this four times, so you do 20 minutes, four times with a break in between each. And really, the delegates can ask you almost anything. And there's a standardized rotation and about who gets to ask the actual questions. So again, because I've done this a number of times, I actually enjoy the experience. The first time I did it, I found it to be, you know, completely intimidating and scary.
Kathy Mairella: 19:39 Because it's been identified as a barrier, there's been a lot of discussion about how else can delegates get information about candidates besides these interviews. You know, when you’re a board member, you're not necessarily a performer. You know, it's not necessarily about being a good person who answers questions well on your feet, but yet that's how you are being evaluated based on, you know, on these interviews. There's a lot of behind the scenes leadership roles. So this process I think does favor those who interview well for lack of a better term. And again, it scares a lot of people.
Jenna Kantor: I get that. I get that. I was wondering for the last question now. So you've done all these interviews, who you finally get to go eat, drink, try to take a nap cause then you're waiting for the votes. So the votes go through. What's that experience? And so the last question, what's the experience of getting the votes and how it ends?
Kathy Mairella: 20:36 This is a great question. I had to explain it to my husband the other day. So, the actual election takes place in the house of delegates and the delegates use a ARS device for electronic voting. So it is anonymous. And so they vote for each office and then ARS system tabulates the results. As that's happening, the candidates are asked to go with their campaign managers to a special room and you are handed in your hand an envelope with the results. So you get, as a candidate, you get the results before they're publicly known, which is very much a kindness. So you're not like sitting in the house of delegates getting the results at the same time that everyone else is. So you have some privacy around getting the results. You get that envelope, you either stay in the room, you go somewhere else with your campaign manager, and then you open the envelope and there you see the entire slate with the vote tally and how many each candidate and who you know, who is elected and who's not.
Jenna Kantor: 21:57 And for anybody listening of course there can be mixed opinions on how this is run at seeing the tallies, seeing the numbers. I've honestly heard the ying and the Yang version of that, but overall this is the process. So I'm not doing this interview to add on all those opinions. This is just for just that blanket, like this is how the candidacy people running for the APTA. This is how it's run. This is how it works. Of course. Thank you so much Kathy. You just gave all these references for people, for them to look up and find out more details on their own if they really want to see details by details. That's amazing that there's a packet of book you said. The candidate manual. That's amazing. But thank you so much, Kathy, for coming on. This is a pleasure and I cannot wait for people to learn this information though.
Kathy Mairella: I think it's really important that this information is shared. I think it's really important that members and potential members know how their leaders are elected and how they can get involved.
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On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Sneha Gazi and Maria Muto on Physical Therapy International Service. Dr. Sneha Gazi is a physical therapist based in Manhattan who specializes in orthopedics and pelvic health. Sneha’s desire to bring her skills beyond her immediate reach drove her to start PTIS in the hopes of bringing PT services to underserved populations. Dr. Maria Muto is a physical therapist based in Manhattan who specializes in orthopedics.
In this episode, we discuss:
-How Sneha and Maria started Physical Therapy International Service as students
-The logistics around organizing a volunteer event abroad
-Roadblocks Sneha and Maria encountered along the way
-Advice for those interested in following in Sneha and Maria’s footsteps
-And so much more!
Resources:
#PTIS #PTInternationalService #CerveraDelMaestre #Spain
PT International Service Website
Email: pt.internationalservice@gmail.com
For more information on Sneha:
Dr. Sneha Gazi, DPT earned her Doctorate of Physical Therapy from Columbia University with a focus on orthopedics and pediatrics. She holds a BA in Honors Developmental Psychology from New York University where she completed a Concentration in Dance and published a scientific article on infant motor learning and development.
Dr. Gazi worked at clinical rotations in both outpatient orthopedic practices and acute care hospitals, gaining knowledge on high-level manual therapies and evidence based exercises to help her patients return to the activities they loved. She’s treated pelvic pain in pre/post-partum women, rugby players in New Zealand’s sports training facility and helped many NY’s Broadway and Off-Broadway dancers, actors, vocalists, and instrumentalists to get back on stage.
She combines her knowledge of how to rehabilitate lower back pain, neck pain, TMJ dysfunction, sports and dance injuries along with a compassionate energy. Sneha is also a certified yoga instructor and professional Indian classical dancer. She integrates yoga asanas, breathing techniques, guided mediation, and mindfulness exercises into her treatment sessions to enhance her patient’s recovery process. Sneha has a strong passion for service overseas and pioneered the first ever Physical Therapy International Service trip to Spain with Dr. Maria Muto.
For more information on Maria:
Dr. Maria Muto is a physical therapist based in Manhattan who specializes in orthopedics. Maria received her Doctorate of Physical Therapy at Columbia University where she began to analyze runner's running mechanics. In recent years, Maria has worked with the athletic population as a personal trainer. She hopes in the near future to obtain her certified strength and conditioning specialist certification (CSCS) to practice both training and rehab with high level athletes. As a physical therapist, Maria’s treatment approach is team-based between her and her patients. She believes that getting to know and involve her patients as much as possible within his or her care is the best way to optimize function and maximize movement mechanics for a true recovery. This belief of involving patients within his or her care at this level persuaded Maria to expand herself to this world and discover how to truly connect with others of varying conditions, cultures and fortunes. Maria has now practiced in Italy and Spain. Overall, Maria is excited and eager to continue to learn more about the world and her profession by these experiences.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:04 Hello. This is Jenna Kantor. I am partnering as a host with healthy, wealthy and smart. And today I get to interview Sneha Gazi and Maria Muto. And they are the creators of physical therapy international service, which is PTIS, where they led the first ever international service trip in Spain, which is incredible. So I'm extremely excited to be interviewing these two. One they're good friends of mine, two their big goal getters. Literally this wasn't any teacher or any mentor telling them to create this service trip. This is something they just found a real hardcore desire to create from scratch. So this podcast is extremely valuable because they are going to be sharing exactly how they did it, maybe a little bit of obstacles, and then hopefully put a fire in your flame if you're considering doing something like this yourself. So the topic for today is very simple. It's just creating a service trip. All right, so first Sneha, would you just mind just saying hello one more time so people can really hear your voice. And Maria, would you do the same? Perfect. Alright, so first question, why did you decide to create a service trip?
Sneha Gazi: 01:31 So we had multiple reasons to create a service trip, but two of the main reasons were, one, we wanted to provide physical therapy services to a group of people in a different country who didn't have that opportunity already. So we chose a small town in Spain. They have no physical therapy services in that town and the closest medical services they have to travel quite far to obtain even basic medical services. So physical therapy is sort of a luxury treatment for them in that town. And these are also people who work high levels of labor, their agriculture workers, they do a lot of physical demanding work, so they end up having a lot of physical stressors. So, that's one main reason we wanted to provide a service to people who didn't have it. And then the second reason, our main reason to join with two folds.
Sneha Gazi: 02:23 The second one was to provide an opportunity for students to learn in a different setting. So this provides cultural awareness. This provides an opportunity for students to bring things outside of a classroom setting, even outside of a clinical affiliation setting where they have, you know, very structured environment into sort of the blue and an environment where they won't have a chance to, you know, readily look something up on the Internet, but they have to think on their toes. They have to know how to modify a treatment. They have a licensed physical therapist there to guide them throughout to make sure everything is safe and everything is moving forward very well for the patient to have the patients' interests in mind. But it's to provide these students an opportunity where they're kind of thrown out of their comfort zone.
Jenna Kantor: 03:05 That's excellent. So, okay, you started from scratch. How did you guys fundraise for this trip?
Maria Muto: 03:14 Yeah, so we had three separate events. These were a happy hour events, that we advertised to people that we knew in the local area to come hang out with us downtown, come out and support this service trip. We had great turnout the first two times. It was so much fun to just gather with these people to help promote this amazing trip. Super supportive. It was a true gift, honestly. So, you know, we hope to continue doing this.
Jenna Kantor: 03:49 That's great. Yeah. Sounds so simple that you guys were just able to create these social nights and you're able to just make money from that. Was it difficult just to follow up a little bit more money? Yeah. So was it difficult putting together these fundraising events or was it rather simple?
Maria Muto: 04:04 Well, the simple fact that we are housed in Manhattan kind of make it easy because there's so many opportunities to go out and explore the city. So, you know, between Sneha and I, and a third member, we kind of were just thinking about, you know, where do we want to be? Thinking about the audience that we were targeting, like young 20s, let's think about the area and location. So we did our research, we contacted, the coordinators of these local areas that we were interested in and things, you know, led to another. And we were talking about deals and we got really great offers and apparently our audience loved it too. So, it wasn't really that difficult. You just have to kind of reach out and speak to the right person.
Jenna Kantor: 04:50 That's great. I like how you say it. It almost sounds like boom, Bada Bang. It happens.
Maria Muto: 04:56 New York is a land of opportunities so it is put yourself out there and you never know what you're going to get.
Jenna Kantor: 05:03 Yeah. So we learned right here, moved to New York is a good suggestion. Did you choose a location then for your actual service trip? Sneha you start to go into this a little bit saying all the benefits of Spain, but I'm sure you must have explored other locations as well. So would you mind telling me that journey?
Sneha Gazi: 05:24 So, I actually had the wonderful opportunity before joining PT school to do a Yoga Shiatsu program where I got my yoga teacher certification in this very town. So the way I found that was I just looked up yoga teacher certifications in Europe because that's where I wanted to do it. And I know a little bit of Spanish. So I knew that that would be a little bit easier for me to mingle in with the folks in the town and have a good time and get to know different cultures. So I chose Spain, I ended up going there, made some amazing connections, you know, the smaller the town, the lovelier the people in a lot of ways. Everyone is so humble in that town. Everyone is so open and warm and you know, willing to let you into their homes and their town in their community, which is already so small to begin with.
Sneha Gazi: 06:11 So I made some really good friends there and when I was thinking about places, Maria and I were discussing, that was one of our many options. And it also was the one that flew the quickest for us because of that connection that I already had there. So it wasn't easy to do the communication and you know, do the long distance back and forth, emails, thousands of emails, thousands of things to coordinate. But at the end of the day, that was the best route for us to go to because I already had been there before and I had known that it was a safe place. The people were wonderful and I knew that this would benefit both the town in the students and the licensed therapists who are coming along with it to make it a safe working environment and a safe learning environments. And that's why we chose that.
Jenna Kantor: 06:52 Yeah. Yeah. That's great. Oh so good that you knew that it was a safe area to cause I know for people traveling overseas that would be a concern. So having that background with Yoga, by the way, power to you being a physical therapist and knowing yoga. Wow, that's definitely given you a leg up for sure. But being able to have that experience before that, that's great. What a great way, how your life and kind of led you to creating something more in this area that you fell in love with through yoga.
Jenna Kantor: 07:53 So we talked a little bit about fundraising. Now my mind's going to how much would this cost if I was a student now I wanted to participate. How much did it cost for a student to go and be part of this service trip?
Maria Muto: 08:17 So, because this was the first event, we kind of hope that the next following will be similar into what the expenses were for this one. But you know, as a student, finances can be very difficult. So, you know, trying to keep that within our minds. We calculated a fair of 450 euros, that would be per students. So kind of just thinking of the numbers, we were, you know, that's why we had those three fundraising events to try to cover for those costs. So, you know, we were planning accordingly. We did tell the students, which we have three students with us and two licensed PTs, we did tell them that their airfare would be on them. Because we wouldn't be able to cover that. Hopefully as we grow as an organization, we will be able to, you know, create larger fundraising events and have, you know, even more money to, you know, help us move this opportunity along and help you know, out the students, or whoever's participating more. But for the first time, that was pretty much what we had the students pay. So, you know, we'll see what happens in the future. But, it wasn't really that expensive. When you look at a larger scale of what it actually could potentially be per person.
Sneha Gazi: 09:46 We have to say what the fundraising money went to. So we have to say that we covered the entire cost for the licensed therapists. 450 euros for two people.
Maria Muto: 09:56 The 450 was covered like we provided coverage for the PTs and then everything, the airfares and all that stuff was on their own.
Jenna Kantor: 10:17 Selecting students and selecting mentors, I feel like this is almost like a raffle, you know, like who gets it? How did you do this? Was there some sort of like people wrote in letters and mentors. I mean, you were students at this time. So how many professionals did you know at this point to be able to pull in the ideal people to guide you over in Spain?
Sneha Gazi: 10:40 Yeah, so the licensed PTs who came on this trip, the way we approached that was we emailed, texted, Facebook message called, kind of in any way, a form of communication to every license PT that we knew and our contacts list, and then ask our friends to give us more context. We had many people show interest, but we knew that we were asking a lot from them because they weren't getting paid to go on the trip. All we were able to do was completely cover they're living, food, transportation in Spain, which was the 450 euros that Maria mentioned, but we weren't going to be able to cover their airfare. So what these therapists had to do, and we are forever grateful for you, Patty and Michelle for doing this. They actually took off of work and paid their airfare to come to be a part of this trip.
Sneha Gazi: 11:32 And the two therapists who came in were the ones who were able to give us a commitment as soon as, and we knew that everybody who we reached out to was a reliable, intelligent and wonderful therapist who we knew would be an amazing form of guidance for the students and for ourselves because we were students while we went on the trip. So we knew whoever came in and whoever signed our contract and said they were on board. And you know, there were many who are very enthusiastic about this. But whoever came in first were those. And then in terms of the students, we reached out to several schools. We did not want this to be a school trip. You know, never really was a school trip. This is an independent project. So we reached out to several schools outside of our own school.
Sneha Gazi: 12:18 Maria and I go to the same school but reached out to other students to make sure that we get a diverse group of people so we can learn from other schools as well. And we wanted everything to be a sort of from different pockets of the states. So we were able to get three students from three different schools who joined in. A lot of people sent in their applications and we sort of chose based on, you know, their essay of why they wanted to do it and sort of their background on the classes that they had taken just to make sure that we had a diverse group of people but single minded in terms of what we wanted to accomplish, which was service and learning because it's physical therapy international service trip. So yeah, that's how we chose everyone. And you know, that was initially we thought that this was a struggle but we found very quickly moving forward that that was the least of our worries. It was easy to get those.
Jenna Kantor: Oh that's so good to hear. Cause I mean putting everything together from scratch is already enough on its own. So that's great that that ended up being a smooth journey for you both. Now, what was your biggest obstacle, because I'm sure you've had many obstacles as you were putting this together, but what would you say is your biggest obstacle that you encountered and how did you overcome it?
Maria Muto: 13:30 I'm really glad that you were asking that question now. Just because the last thing that you said kind of segways into my response in that starting from scratch is pretty difficult. So as students, you know, we're trying to think of who do we know, what do we know, where do you know we want to go and how do we want to do this ourselves? You know, as very ambitious PT students, we really tried to, you know, Gung Ho and take sail what this in which we did. But that wasn't really easy to do because of who we are as just students. And with the experience that we had at that given time, which, you know, was a decent amount of experience and, you know, led us to having this project follow through. But I think, you know, we just had to kind of keep on rolling, keep on thinking, make sure that, you know, we had all of our grounds covered. You know, just having the trust in the people that we selected and which we did. So I think that that was hard to kind of try to really piece everything together. But you know, we just kept on powering through. We just really wanted to make this work and we're so thankful that it did.
Jenna Kantor: 14:52 We're up to the last question and this is just getting words of wisdom from each of you. What words of wisdom do you have for someone who's listening to this and goes, that's it. I want to plan a service trip now. What do you have to say to that person?
Sneha Gazi: 15:20 So there are many, many things that go into planning this trip. I'm going to tell you that it ends up being sort of a part time job, especially towards when you get to the end of the race, when you're putting everything together. It took over a year and a half of preparation. We had many obstacles along the way like Maria had mentioned, but even through that, it did take quite a bit of time to put everything together. So I would say number one is make sure that you have a contact in the location that you want to do your service in A to make sure that this place is a safe learning environment and a safe working environment. And secondly, to make sure that logistically that you have a point person to get information from, to coordinate the patient's there to coordinate the simple things.
Sneha Gazi: 16:10 And we had a wonderful lady Alaina, who did all of this for us while we were there and Kudos to her because if it wasn't for her, we wouldn't have been able to do this trip. But she was a local who volunteered her time to put together plints, towels, pillows, sheets, dividers, coordinate the schedule of the patients, get together the schools when we did our educational workshops to coordinate the location, the projector, everything. So I would definitely say you need somebody like that in this location. If you are not yourself able to travel back and forth throughout the year or however long it takes for you to plan it, to get there, you need to have somebody there. And the second thing is to make sure that you know how the money is going to play out from the beginning.
Sneha Gazi: 16:56 So making sure you're very transparent with how much is food, how much is transportation, and how much is living costs, how much your supplies, and then devise a plan of how you're going to make this feasible. Like Maria and I had planned before we even got the location, we already started fundraising because we knew this was going to be expensive. So we put together the fundraisers, you know, three months before we even nailed the location down. So I would definitely say, make sure that you have a plan financially to get everything together and make sure that the place is a good place to be in and you will do wonders if you just have those two solid.
Maria Muto: 17:51 So everything that they have said totally feel the exact same way. Wonderful, wonderful advice. But I think when you go abroad into another country, be very accepting and welcoming to the new culture that you're in. Embrace where you are, feel it, feed it, do everything that you can. Because at least from my experience, these people are so welcoming and just want to know about you as a person. They're very intrigued that you're American and there's so many other ways that you communicate with people other than just words. But I would advise for you to study up on the language in which that you're going to be treating in because it makes it a little bit easier. But there are other ways to, you know, understand people if you have that language barrier, but for sure, really tried to, you know, embrace the culture that you're in. And I think that would really make the experience even more fulfilling.
Jenna Kantor: 18:36 That's great. I actually just thought of something, I'm wondering what Spanish phrase did you use the most there?
Maria Muto: 18:46 Because I was speaking so broken Spanish, like I was actually speaking more Italian. I think I would say like siéntese, por favor. Hola. Or Ciao. Aquí. Dolor.
Sneha Gazi: 19:05 I think I used boca arriba the most, which is face up. It literally means upwards. Oh yeah. But it means supine. And I had to say, I had to tell people, can you lay flat or lay on your back? And it was very difficult for people to understand this. So one of my patients who spoke broken English was like Boca arriba.
Jenna Kantor: For anyone who was interested in starting a service trip. Please reach out to Sneha and Maria. They are huge Go getters. I really, really appreciate you guys coming on here. This is extremely valuable. Thank you so much.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Evert Verhagen on the show to discuss qualitative research and how the outcomes can be useful for clinical sports practice. Evert Verhagen is a human movement scientist and epidemiologist. He holds a University Research Chair as a full professor at the Department of Public and Occupational Health of the VU University Medical Center and the Amsterdam Movement Science Research Institute. He chairs the department's research theme 'Sports, Lifestyle and Health', is the director of the Amsterdam Collaboration on Health and Safety in Sports (one of the 11 IOC research centers), and co-director of the Amsterdam Institute of Sports Sciences (AISS).
In this episode, we discuss:
-The difference between qualitative and quantitative research
-How qualitative research influences sports medicine and injury prevention research and clinical practice
-How to design a qualitative research study and control for biases
-What is in store for the future of qualitative research in sports medicine
-And so much more!
Resources:
Evert Verhagen Twitter
Email: e.verhagen@amsterdamumc.nl
Sports Lifestyle and Health Research Website
IOC World Conference Prevention of Injury and Illness in Sport
For more information on Evert:
Evert Verhagen is a human movement scientist and epidemiologist. He holds a University Research Chair as a full professor at the Department of Public and Occupational Health of the VU University Medical Center and the Amsterdam Movement Science Research Institute. He chairs the department's research theme 'Sports, Lifestyle and Health', is the director of the Amsterdam Collaboration on Health and Safety in Sports (one of the 11 IOC research centers), and co-director of the Amsterdam Institute of Sports Sciences (AISS). His research revolves around the prevention of sports and physical activity related injuries; including monitoring, cost-effectiveness and implementation issues. He supervises several (inter-)national PhDs and post-docs on these topics, and has (co-)authored over 200 peer-reviewed publications around these topics.
Read the full transcript below:
Karen Litzy: 00:00 Hi Evert. Welcome to the podcast. I'm so happy to have you on.
Evert Verhagen: 00:04 Yeah, thank you very much. I'm really happy to be here as well.
Karen Litzy: 00:08 All right, so today we're going to be talking about qualitative research in mainly sports medicine. But before we even start, can you give the listeners the definitions and perhaps the difference between quantitative research and qualitative research?
Evert Verhagen: 00:30 Sure. I think that is a really valid question to start with. I believe most people are familiar with quantitative research. It is what we do like in the word already, quantification of a problem by counting, by having numerical data or data that we can transform into statistics. And then we can quantify attitudes, opinions, define variables. And we can generalize that across the whole group of our population. So we can generate averages in given populations and we can compare averages between populations. Qualitative research on the other hand, doesn't go by numbers, it's more exploratory. And we try to get an understanding of reasons, opinions, motivations and instead of quantifying a problem. So, giving a number to it, giving a magnitude to it, we get insight into the problem and it helps us to develop new ideas and our policies. And that can be a precursor to do a bigger quantitative study in which you have an idea of where to look and where you would like to quantify and get some more thought. But you can also do it afterwards, where you have a quantifiable outcome and you want to understand better what that outcome actually means and what it means to your population and in the population. I think that is in essence the big difference.
Karen Litzy: 02:06 Yeah. Thank you for that. And, now you have had over 200 peer reviewed articles in different journals and you yourself had done a lot of quantitative research. So why the shift now for you into more qualitative research?
Evert Verhagen: 02:22 Oh, it's not the first time I get asked that question. I'm a trained quantitative research. I'm an epidemiologist. I'm a human movement scientist. So I kind of live and swear by numbers. If I can't measure it for me, it shouldn't count that many people think. Now, I learned that through the years, if you can count it, it still doesn't mean anything. It still needs to have a meaning. So a difference between two groups in a trial, it just gives you the difference between the groups in a trial. It doesn't tell you how the individuals within that trial actually experienced it. The same with trying to get your head around an injury problems so you can capture an injury problem in incidences in prevalences, in severity, in numbers of days, lost availability during games. But what does it actually mean for the individual athlete?
Evert Verhagen: 03:23 What does it mean for the patient? And the same maybe with treatment outcomes, rehabilitation outcomes. It's nice to know that, you know, you reach a certain degree of range of motion after rehabilitation or reduced level of pain on a visual analog scale. But what is actually the opinion of, of that patient, does that actually align with what you can measure? And if not, where does the different come from? And if you do, it kind of shows you that you’re in the right direction. And over the years I learned that quantitative research can only help so much in solving the bigger issues we have where it concerns, prevention targets for presumed prevention. It stops at your number and then you need to do something with it. And the only way to do something with this, it's to understand where it comes from and also to understand what it means. That's where my interest kind of started.
Karen Litzy: 04:23 Yeah. And that makes a lot of sense coming from myself from the clinical side of things. And I'll use the VAS scale when you're looking at pain as let's say one of those quantitative points. And I think this is a good example. Looking at the VAS scale, a four or five for me is a very different experience for someone else with the four or five out of 10 pain. Right? And so just looking at that number from quantitative research saying, well, this proves that this treatment, whatever it may be reduced pain by, I don't know, four points on the vas scale. Well, okay, that's great, but then what does that mean for the individual person and that you're just moving it because qualitative someone's opinion. This is an opinion of what my pain is and then we take it to quantitative data, but then it doesn't say how that patient is living with that pain. The pain has decreased, but I still can't walk to the store. I still can't play with my kids. So what does it mean?
Evert Verhagen: 05:27 Exactly. I think that what you just said that is purely qualitative talks about what does it mean, what impact does it have as one little, one little thing I would like to specify is that a VAS scale in essence, which is a subjective outcome measure, is still a quantifiable objective measure. It's not qualitative and that is something I run into every now and then in a discussion where people seem to think that a subjective outcome on a scale or a subjective outcome measure in a survey is qualitative. It is not you have to look behind those measures. So why does someone report a reduction from eight to four on a visual analog scale? That is what we're looking at and you're completely right from eight to four in someone who has a seating job for instance. Mostly behind the computer means something completely different than someone who moves from eight to four who has a really active job and we have four is still really limiting for them.
Evert Verhagen: 06:35 We may go to athletes, for instance, a pain of four today in preseason maybe or at the end of season when there's no big competitions around, I'm okay, I can skip the training, but a pain of four during competition when has a big game coming up? You probably will suck it up. And even though the pain level is the same, your experience and the burden it gives you is completely different. And those are the things we do work capturing in numbers. And those are the things that make the big difference for the individuals we do our research pool and our target population.
Karen Litzy: 07:14 Yeah. And that actually leads nicely into the next thing I wanted to talk about and that's, how does qualitative research manifest itself in sports medicine or injury prevention?
Evert Verhagen: 07:25 From the research perspective you mean? Or the practical perspective?
Karen Litzy: 07:28 Let's take research perspective first.
Evert Verhagen: 07:31 On a research perspective, I think it adds a new layer of information to what we already know. And you can think that in multiple ways. It gives you direction to where you would like to go with future research because you understand better your population, you understand their needs, their wishes, their opinions, their fears. You understand, their foci and based on that you can have more targeted either interventions or more targeted outcome measures to chart a problem or to monitor a problem. So it will guide quantitative research in that sense, which I would say is also really interesting in regards to machine learning and the complexity theories that are out there. We can't measure everything but if we get a sense already based on the public, the population where we should focus on it will gives direction to those novel technologies where we do data mining and all that.
Evert Verhagen: 08:38 Also on the other hand, if we do interventions or if we do objective measures of what we try to assess in research, we need to find a way to translate that to the population. Research of course it is about putting it in a nice article and publish it in a high impact journal if at all possible. But in the end, and I'm speaking for myself here, I do research because I want to help people, I do research because I have a general question that I feel is valid to ask in relation to an issue or problem I see in athletes. So I want that number to come for athletes as well. And in order to do so, I need to talk to them and get their opinions about how they feel about this number, how they feel they can use it, how they feel they may not be able to use it.
Evert Verhagen: 09:38 And based on that I can develop my next steps and I understand better what I did right, what I did wrong. I understand better what it means actually because I have my own opinion. And that's why I think qualitative and quantitative are synergetic to each other. Let me give you a clear example, which may be a bridge also to more the practical side of it. Maybe that's injury definition. If I ask athletes or students and fellow researchers how they would define an injury. Usually they come with the technical definitions. We also have in our manuscripts, like it is tissue damage. It leads to pain. That pain may lead to a diminished performance, maybe a limited availability, which is all fine. And if you ask athletes like, when are you injured? The elite athletes will say, well, pain is actually part of the game.
Evert Verhagen: 10:34 I always have pain. I'm used to that and I know how to deal with that. And I will not think this pain is a problem unless my performance is limited, which is already a little bit of a different injury definition. So the problems we see and we have in terms of pain and availability may not even be the problems they perceive to be problems. So we solving maybe something they don't even see to be an issue. Now if you translate the same thing to maybe recreational athletes or novus athletes, people who sit on the couch and say, okay, let's be a bit more active. They're not used to pain, they're not used to how their body reacts to physical activity. So we think they have more injuries, but maybe their perception of injuries is simply different from the perception of injuries we see in most of the papers we read. And I think there's a clear clinical message there is that, perspective, context, experience of the patients you have in front of you determines their perception of the issue they have. But it also determines for you as a clinician what you need to do and how you need to approach that. Because the numbers you see in the quantifiable manuscript that's all based on averages and not on that one single person in front you. And this is where qualitative research can help a lot to understand that.
Karen Litzy: 11:59 Yeah, and that makes a lot of sense to me. And as a clinician, I think sometimes we can get caught up in the quantitative data and those numbers and lose sight of the person in front of us. Meaning sometimes we may say, and I see this on social media threads and things like that, which I'm sure you've seen as well. Well this is the study and this is what the study says. This is what you should be doing with your patient. Yeah. Well, there are a lot of nuances to that because like you said, you're talking about averages and not the person in front of you. And, I love the example you gave. What is an injury and what does that mean to different stakeholders within, let's say, injury prevention realm if we will. So the athlete versus the average person versus the clinician?
Karen Litzy: 12:56 Well we have three different definitions of what an injury is. So how can we fill those gaps to be a little bit closer? I mean I can say, let's say I'm the average person who's working out. I know I am not anywhere near a professional athlete, but the problem is, and you alluded to it a little bit, is that when people have an injury, they read about an athlete that has an injury and they say, well, this athlete had the injury and they were back at their sport in four weeks. How come I have to wait four months? And I think that's a big disconnect. And maybe that's where getting some better qualitative research and around these definitions can actually help with the perception of what an injury is across the board.
Evert Verhagen: 13:49 Yeah, it's sort of framing but it's framing from both sides. It's framing for the patient so you can even better, why it takes for them four months instead of four weeks. Right. And usually in all honesty, by the time a professional athlete is already back training again, a recreational athlete maybe hasn't even seen a therapist. How then can you take a protocol or a guideline based on evidence that shows that on average after four to six weeks you need to be at a certain stage in the rehabilitation phase where that one single person in front of you as already been looking three weeks for a proper therapist to treat the injury and then they come in and they've seen this evidence like you said, but then you would like to know a bit better where they come from, what their context is and what they need to do, which is not shown in evidence is also not what the patient thinks about.
Evert Verhagen: 14:55 So having some knowledge about such perceptions and where they come from and what they mean I think can really help to support you in your clinical practice to use the evidence to a better extent. You know, in some of the issues we have in objective quantifiable research also apply here. I would say there is, for instance the discussion started a couple of years ago about we should screen or not to predicting injury actually to see if someone's at an increased risk. And one of the main arguments in there is, well basically what we're doing is we create two normal distributions and normal distribution is the Garcian curve where we think most of the population is in the middle and we have a few outliers and that is nicely distributed. So we have a normal population with our risk factor and a normal population without a risk factor. And if you know, the averages don't overlap too much, then Oh, we have a significant difference. But that negates the outliers on the top side and on the bottom side of both. And then you talk about an average, but there's even an equal amount of people who are in that overlapping phase that we still give the average treatment. And if we understand better why these people are on the outskirts and why are they in a position, we can actually make that evidence for them work. Because we can model it to their specific situation.
Karen Litzy: 16:31 Got It. So that qualitative research, like you said, can help to guide quantitative research, which can then help to guide actual treatment practices for the average clinician. In a very simplified, overly simplified nutshell. So yeah, very, very, very oversimplified of nutshell there. Can you give us an example of what a qualitative research project may look like? Can you give an example of what that looks like in it's sort of set up phase and then throughout the project.
Evert Verhagen: 17:19 Okay. Well in essence, it looks a little bit simpler because for quantitative researching in big groups of people, because of those averages for qualitative research, you need smaller groups. One issue though is in case of how our specific needs, we would like to have groups that are quite specific. So if we have a group of elite athletes combined to recreational athletes and we want know perceptions about injury, like we were already talking about. That doesn't work because we get too many deviating perceptions in there. So you need to, you need to frame your research question correctly there. And the essence here is that you start doing your interviews until you reached so called saturation. So you do interviews, you get answers, and your next interview will give you a deeper understanding. You get different answers, you get more answers, you can ask a bit further.
Evert Verhagen: 18:18 But at a certain point of time, you start hearing the same thing. So you don't add any new information. That's when you're done. And now, depending on your group or your specific focus, that can happen between eight to 15 interviews. So in that sense, it sounds really easy. Then what do you need to do is you need to type those interviews out. So you need to transcribe them. And then the analysis start. And for most people, this is boring, but this is actually where for qualitative researchers me as I'm a changed person. I like that too, because you start to go, so you start to read through the interviews and you start to look for clues of what people say and what it might mean. Now as we need statistics, there are several philosophies you can follow. The different philosophies make a big difference. The same as in qualitative research, but that on the side.
Karen Litzy: 19:21 So you go through this series of interview questions and you keep narrowing those questions down until you reach a saturation point and then you can start the analysis. And so then my next question was what set of statistics do you use to analyze qualitative research? And this might be a stupid question.
Evert Verhagen: 19:44 No, no, no, no, no. We don't use statistics. And that's not a stupid question because, you know, there's very few ways in qualitative research and arguably the most simple way to go is this so-called thematic analysis. So you do your analysis and you start to find themes in the interviews by coding. So you have overarching themes and within these overarching themes, you find sub themes, and you just report those themes. And that is really interesting because, for instance, if you're looking for barriers towards implementation of an injury prevention measure, you can say, okay, these are named barriers and these barriers can be categorized as time as disinterest or as non belief in the effectiveness. And then within those main categories you can have sub categories of where that comes from. That's I would say one of the simplest versions of how we can use qualitative research.
Evert Verhagen: 20:46 Or you can also make it more intricate. You can build models, you can validate models. And for each of those research questions you have, you require a little bit of a different approach thematic analysis is easy. You just sit down, you have just semi structured interview, you ask people, about opinion, about a certain topic, they give you an answer and then basically you say, okay, can you give me an example of that? Can you explain that a little bit further than what you already know, the topics you're interested in. So you want to talk about barriers or facilitators so you can focus on that. You can also go open minded where you say, okay, I just want to know how elite athletes perceive an injury. So you need a different kind of approach of first you need, you would like to make them feel comfortable that they can talk about it, that it's a safe environment.
Evert Verhagen: 21:42 You would like to ask them about their previous injuries. So you get a sense of which of those had a high impact. Then you can dive a little bit deeper into, so what did it mean for you? How did you feel, what were the consequences of it personally, how did you recover? Did it take longer or shorter than expected? So you kind of, you kind of follow a story and that story unfolds itself. And if you do it really open, then you can do one interview. It gives you a direction and your thoughts and based on that direction in your thoughts, you look for your next participant and you continue where you were with your previous and then a bigger story unfolds. And that takes a bit more time because you do it by interview. But it's a lot more deep and rich information. But it all starts with the research question I would say. And it's different types of research questions that we have in quantitative research. It's not to compare this to compare that, it's not how big is this problem, but it's really diving into beliefs. It's diving into opinion, diving into reasons. And that can be because of something you did, but that can also be to understand better what's going on in the minds of people.
Karen Litzy: 23:17 As the interviewer within these studies, how do you control for that interviewers biases? So you know, the leading question. So let's say you're doing this long form where you interview someone, you get really in depth, they give you their answers, you go onto the next person. How do you not then guide that next person to kind of be like what the first person said and then the third person, like the first and second person. So how do you control for like leading as an interviewer you can lead the direction of that interview really in any way you want.
Evert Verhagen: 23:52 Exactly. But isn't that the same in quantitative research? The way you're framing the question, you can already guide people towards answering questions. A really good example I encountered like last year in a project where the premise was that, there was a funding scheme and the premise was that projects that were driven by questions from practice would have a preference. So they asked in a particular sport and a particular association, two older members. Do you think injury prevention is important? That was the first question in a survey. Of course, everybody says yes. Then the second question was if you think it is important, do you feel that an app on an iPhone would be helpful? Yes or no? Of course. Many people say yes. So their conclusion was okay, 80% wants injury prevention and 80% want that in an app on an iPhone.
Evert Verhagen: 24:51 So we should have a lot of money to develop such an app was well a disaster. Because they finally developed it and they kind of scoped already with the public what they had of an idea. Instead of really have something driven by the audience. And so I think by in that sense, it's not only applicable to qualitative research. Subjectivity maybe is because you as an interview, have an understanding most of the time on what the topic you're interested in. And that's why in qualitative research. You also see a little paragraph on reflection where the interviewer or the authors explain what their background is, where they come from. And of course it's really hard to take that out of the interviews. It's practice and it takes a lot of self control. You can tell you that and it's not always possible. So that's why you need to be frank upfront that you are a physical therapist and that you ask questions about physical therapy guidance or physical therapy conduct.
Evert Verhagen: 25:58 And of course you have an opinion about them. And also of course it is the connection between interview or an interviewee that is important. If you interview someone who thinks you are a prick, you will not get much, much out of it. But if you have a good connection with someone and you really are empathetic, then they will open up. But that requires experience I would say. We do have some tricks in the analysis to reduce that. Two main tricks that may be of interest to say is we call that triangulation where you're not only interview patients but you also interview other stakeholders on similar topics and tried to find connections and similarities between answers. Because if three people from different perspectives say the same thing, that must be something that really counts, right? So it's not one thing and it's not just one person interpreting. That's one. And the other one is you can do is multiple coders. So you have one interviewer and you need to code the interviews. But you can do that with two people separately. Much like we do with systematic reviews where you check for the quality of papers. We have two independent reviews and then we compare notes. We can do the same here too. So you take a bit of that subjectivity out and that preoccupation out.
Karen Litzy: 27:21 Yeah. Great. Thank you for that. And now where do you see the future of qualitative research moving?
Evert Verhagen: 27:29 Hmm, that's an interesting one. For how a specific field I would say it as a lot of ground we have to cover. We're getting there. There's a lot of interest in it at the moment. There is more and more papers being published at the moment. One of the, not issues, but one of the fears I have is that most of these papers still get published in not the mainstream sports medicine literature that is being read by the clinicians even though the messages are supposed to be targeted to the clinicians or the therapists. So we need to find ways to grasp that clinical message in such a way that it doesn't become this lengthy qualitative research paper and it will become a succinct, easy to read paper with a clinical message though with a constructive, strong methodology. We've been battling with that for a couple of years now I would say. And, I just got the word this morning from one of our PhDs that she got a full qualitative study accepted in British journal of sports medicine. That's nice because that was a journal that said one and a half, two years ago. We're not interested in qualitative research. I think that whole movement is gaining ground and we're finding ways to communicate our messages that it really is helpful for clinicians and it's readable by those journals, which I think are a few big steps we have taken.
Karen Litzy: 29:13 Yeah, I would say they're very huge steps because if the research is there but no one's reading it and no one's talking about it, where is it going? It doesn't make the research any less meaningful, but it doesn't make it applicable if no one's reading it cause no one can apply it to their populations.
Evert Verhagen: 29:33 Hmm. But you know, the true theory is it's still quite difficult because if you want to write a manuscript that has the full qualitative methods and traditional version of the outcomes, in my opinion and probably people will be mad when I say that, it's kind of dry to read. It's not really interesting to read. So if you juice that a little bit so it becomes interesting and more concise and easy to digest for the more clinical oriented reader you lose a lot of information that for qualitative reader is required to assess the validity and the reliability of what you did. So we're kind of in the middle. We need to have suppression of information in there, in such a paper for the knowing reader that we did right. But it also need to be dumbed down to such an extent that for the unknowing reader, it's understandable and they see the method and understand the clinical meaningfulness of the message. And that is still a bit finding the balance. And I think that is one of the main challenges to do.
Karen Litzy: 30:51 I will say that as the clinician, I very much appreciate your trying to kind of find that sweet spot between the dryness of what may be some people would think qualitative research write up would be to this applicable like you said, more juiced up version that a clinician can take and digest very easily. I think there is a space for that for sure. And I look forward to I guess more progress on that end. So it sounds like you're getting there but that there is maybe more work to be done, but I am sure there's always more work to be done, but you know, I think if you can find a way to blend those and make it digestible and allow clinicians to take this information very readily to their patient populations, then in the end, like you said, you got into research to help people. Clinicians are there to help people. So in the end it's hopefully this blending of research and clinical care that's there for one reason and to benefit the person in front of us.
Evert Verhagen: 32:14 I believe so, yeah. I believe we can achieve that. I don't think we are there yet still finding a direction. But in all honesty, if you look at most journals 10, 15 years ago, even quantitative research, it was sort of dry, straightforward academic language as well. And we have made big grounds there and I think we can draw on those experiences and that expertise that has been created there. And our field of sports medicine has been in the forefront, I would say. There are some journals who really, really do that really well. And it has helped us to get this topic on the attention. One other sign that is gaining the attention I feel it deserves is for the last two additions we tried to get it on the program of the IOC prevention conference and this year for the first time we got a dedicated symposium on qualitative research in sports injury prevention on the program. So that already shows that in the wealth of proposals they can choose from ours stood out and the topic is found interesting at such a platform. So it's now up for us to grab this opportunity and make it count.
Karen Litzy: 33:41 Yes, it's up to you to deliver on in that focus symposium. And just so people listening we will have a link to this, but that's the IOC, the International Olympic Committees Injury Prevention Conference, which is march of 2020 in Monaco. I don't have the exact dates, but I know it's march. I think it's like the 14th and around there. Maybe. I'm not a hundred percent sure. I think it's around there. But we'll have a link to it in the show notes at podcast.Healthywealthysmart.com if people want to check that out as well. So now if you could leave the listeners with let's say a highlight of the talk or a highlight in your opinion of the importance of qualitative research, what would that be?
Evert Verhagen: 34:33 My highlight would be that qualitative research gives deeper understanding and deeper meaning to the quantitative evidence we have to use in daily practice.
Karen Litzy: 34:47 Perfect. And one more question. I probably should have told you this ahead of time, but I forgot. So I'm going to surprise you with it, but it’s the question I ask everyone, and that is knowing where you are now in your life and in your career, what advice would you give to yourself, let's say straight out of your graduate program, let's do that. So maybe even before PhDs happened. So what advice would you give to yourself?
Evert Verhagen: 35:22 I would give the advice to just follow your heart and follow wherever your thoughts lead you, don't plan ahead.
Karen Litzy: 35:36 That is great advice and so difficult to do. I'm a planner. That is so hard to do, but I agree it's great advice.
Evert Verhagen: 35:46 I plan next week but I don't plan two years ahead. So it hasn't disappointed me.
Karen Litzy: 35:53 It's worked well. That's excellent. Well thank you so much for coming on. Where can people find you if they have extra questions?
Evert Verhagen: 36:05 I'm sure you will share my email address.
Karen Litzy: 36:08 I can if you want, or social media.
Evert Verhagen: 36:15 Twitter account, just drop me a line there or private message.
Karen Litzy: 36:19 Perfect.
Evert Verhagen: 36:20 I have a website we should probably post as well. And most of the work we do also in qualitative research will be posted there once it's published.
Karen Litzy: 36:32 Perfect. Perfect. So we will have all of those links for all the listeners. So thank you so much for coming on and sharing all this great information with us. I really appreciate it. And everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Brenda Walding on the show to discuss Whole-Hearted Living. Dr. Brenda Walding is a Women’s Holistic Wellness Expert & Coach, Doctor of Physical Therapy, Functional Diagnostic Nutrition Practitioner and HeartMath certified coach. Brenda specializes in supporting women health/wellness professionals in overcoming burnout and health challenges in order to truly thrive and give their gifts to the world.
In this episode, we discuss:
-Brenda’s incredible story of illness and recovery
-The 9 Essentials to Whole-Hearted Healing
-The importance of the biopsychosocial model in healthcare
-And so much more!
Resources:
Sick of Being Sick: The Woman's Holistic Guide to Conquering Chronic Illness
Brenda Walding Website and a Free Gift: Dr. Walding is offering a complimentary 45-minute consult for any woman dealing with burnout or health challenges that has a deep desire to THRIVE. Schedule your consult and see how she may be able to support you in creating a life you love.
Brenda Walding Instagram
Brenda Walding Facebook
Email: risetoradiance@gmail.com
Heart Math Website
Women in Physical Therapy Summit 2019
Outcomes Summit: use the discount code LITZY
For more information on Brenda:
Dr. Brenda Walding is a Women’s Holistic Wellness Expert & Coach, Doctor of Physical Therapy, Functional Diagnostic Nutrition Practitioner and HeartMath certified coach. Brenda specializes in supporting women health/wellness professionals in overcoming burnout and health challenges in order to truly thrive and give their gifts to the world.
She currently resides outside of Austin, Texas on the beautiful Lake Travis with her husband and dog. Brenda loves spending time in nature, connecting with her family and friends, dancing, facilitating women's circles, and learning about holistic wellness.
Read the full transcript below:
Karen Litzy: 00:01 Hey Brenda, welcome to the podcast. I'm happy to have you on.
Brenda Walding: 00:06 Oh, thank you so much for having me, Karen. I'm excited to be here today.
Karen Litzy: 00:11 And like I said in the intro you are a recently published author of the book sick of being sick, the women's holistic guide to conquering chronic illness. So without giving away the entire book, can you give the listeners a little bit more about your background and your story of illness and where you are and how that led you to where you are today?
Brenda Walding: 00:36 Yeah, sure. I'd love to. You know, it's really, I'll give you do my best to give you the cliff notes. It's spans the time period of over a decade. So really I grew up seemingly really healthy and vibrant. I was a collegiate athlete. I played soccer at TCU in Fort Worth. And then I went on to physical therapy school to get my doctorate in physical therapy. And then after that moved to Austin, Texas with my now husband. And during that time we passed our licensure exam, got new jobs, moved to a new city, got engaged, got married, and then after this whirlwind of all these major life events, my health started to rapidly decline. And you know, I was in a busy physical therapy practice and seeing a lot of patients, and you know, all of a sudden I'm just getting weaker and more tired and getting sick more frequently.
Brenda Walding: 01:35 And then it got to where I could hardly even get up and down the stairs. I was experiencing chronic fatigue and experiencing, I broke out into these rashes that literally covered my entire body for two and a half years. No one could really figure out what was going on and I just kept getting more and more sick and I was seeing specialists all over trying to figure out what was wrong with me at this time I didn't really know much about natural health nutrition, holistic wellness. I was just kind of in the conventional medical model, taking the steroids and the pills and you know, my blood work had come back pretty normal, so they couldn't really figure out what was wrong. But literally I had oozy itchy rashes, like covering my entire body where I had to pack my body full of ice in the evening to fall asleep and eventually developed in a systemic infection that led me to going on disability from my job as a physical therapist.
Brenda Walding: 02:40 And granted, this is, you know, I am in my late twenties, not even 30 yet, so very young. And you know, I got to the point where I thought like doctors kept giving me antibiotics and they were worried that the infection would get into my bloodstream and I thought I was dying. I was really, really at that point of like, okay, I think this is it. And by the grace of God, I had, I took four rounds of antibiotics and a month and a half, kept being sectioned, kept coming back, had pus all in my mouth and throat, couldn't swallow, couldn't hardly eat. So this was a pretty intense experience. And I found this article I was looking, researching and found this article called natural solutions to drug resistant infections. And it caught my eye and I thought maybe I have a drug resistant infection. And it talked about wild Mediterranean, Oregano oil and how it was, you know, healing people with malaria and different, you know, chronic.
Brenda Walding: 03:45 Very, very severe illnesses. So I thought I would try it. It's like $20 and I know bought it online and in, within a few days the infection went away. And for the first time in years I got some relief from the pain and itching on my skin. And so that really was the portal to opening me up to natural healing. And I thought, what is it? What do I not know? What else do I not know, you know, about this? And so that really became this entry point into studying natural healing and nutrition. And I started seeing more alternative and holistic type practitioners. And that over time started to gradually heal. I started to get some answers. I was full of toxins. Had lots of infections and a poor ability to really clear toxins from my system. So I started to get more answers, started to change my diet, slow down my life a little bit, you know, as that type a over achieving, you know, hardcore athlete and academic.
Brenda Walding: 04:54 And I realized that also was part of the puzzle here ever learning to slow down and then, you know, so for eight years I really focused on healing my body. Like it was a full time job. I was able to go back to physical therapy after a while and start working again. But it really opened up my passion into natural healing and started a nutrition lifestyle company with my husband and helping people heal their bodies through nutrition and lifestyle changes. And you know, it was a slow and gradual process and I started, you know, getting better gradually and then almost to the point where I felt okay, I think I'm almost ready to, you know, start a family. I had a few lingering symptoms but I was like, you know, I'm doing pretty well. Got my strength back. This is eight years later. And then I was diagnosed with breast cancer.
Brenda Walding: 05:51 And so this was a few years ago. So this was like, what am I missing? What am I not getting? Cause I was really, you know, dialed in my diet lifestyle. I started meditating. I was really, you know, spent hundreds of thousands of dollars on healers and treatments, natural remedies. You couldn't find somebody more committed to their healing. And it was like a full time job. And I wasn't really living, I was just trying to get better and feel better. And then the cancer diagnosis came and so I had to step back and go, what am I not getting? And I really, you know, I share this in my book. I had to step back and I was in, this is actually, I found the mass in my breasts right before this, we had planned this epic trip to Italy where we were going to start our family.
Brenda Walding: 06:50 So it was this tragic, you know, oh my gosh, you know, why is this happening to me? And then, yeah. And so, you know, in the middle of the night at 3:00 AM I'm, you know, tears coming down my face going like, God, what do you want me to do? Because I knew that conventional chemotherapy and radiation was not going to be my path. I just didn't know what I was going to do. And you know, I heard this, I call it the divine whisper that said, if you're going to survive, you're going to have to learn to listen to your heart. And I just felt this immediate peace. And then I started to kind of panic because I thought, I don't know how to do that. I really don't know how. I don't know, like maybe like so many of the listeners and people and my clients that I work with, we're really stuck in our heads so much of the time.
Brenda Walding: 07:42 And, you know, my immediate reaction to a challenge would be to research it, to try to figure it out, to strategize. And this was like, no, no, Brenda, it's time for you to really go within and listen and allow your heart to guide you. And, so I knew there was a level of emotional and spiritual, you know, healing too that needed to take place. And so I committed at that point to learn to listen to my heart. And over the next few years I had a pretty interesting and incredible journey through healing, holistically and wholeheartedly I should say from cancer. And it really became the catalyst for me to live in even more extraordinary life. Now I can say that I can access joy and just living a life of purpose and wholeheartedness that I'd never experienced before cancer. And so now that's really why I'm, you know, I kinda quit physical therapy and I'm focusing on helping women, especially women, wellness professionals, to truly heal and thrive so that they can give their gifts fully to the world. So that's kind of my story in a nutshell.
Karen Litzy: 08:56 And are you now cancer free?
Brenda Walding: 09:01 Yes. So I'm doing great. And yeah I'm doing awesome. And that's really where my focus is now, is helping women to heal and thrive and connect more fully to their hearts.
Karen Litzy: 09:15 And quick question on, you know, so you're diagnosed with cancer, you did not do traditional cancer treatments.
Brenda Walding: 09:24 I did sort of a mix. I didn't do traditional chemotherapy and radiation, but I did do surgery. So I went to a couple of different clinics in the United States that focus on holistic and alternative cancer treatments. And so I did. It was a pretty wild ride. So we spent our entire life savings and did this treatment but then I also had a mastectomy.
Karen Litzy: 09:56 Okay. I guess sort of a combination. Yeah. Cause I just don't want to give the listeners the impression that you don't have to go through traditional medicine when you have a very serious diagnosis as cancer and that, you know, sometimes that is the route that one needs to take. And like you said, combining it with other holistic treatments I think is perfectly reasonable. But I don't want people to think that we're saying no shun traditional treatments.
Brenda Walding: 10:27 Exactly. And you know, for me, this is what I do. What I do know to be true is that, you know, a decision made out of fear is never the highest best choice. So when I work with women, where you're working with people on their healing journey is like learning how to really access the heart to be able to tune in to that guidance to make decisions. So yes, you get the tests and get the information from doctors and healers and then trust your own heart to lead and guide you down that path. And that might look like conventional therapy for some people and that might look like alternative therapy for others. And that might look like a combination. So it's really, you know, definitely not shunning conventional medicine. But I knew for me in my heart that in this particular moment, you know, chemotherapy and radiation wasn't going to be my choice, that I was going to do a combination. And it really does differ for each person. And that's the thing is, you know, oftentimes we get scared into, you know, doing things because someone else tells us that we have to do this and we have to do that. And you know, my recommendation is to take the information but also really listen within and let your heart guide your journey as well.
Karen Litzy: 11:42 Right. Yeah. Yeah. And I think in combination with your physicians and other practitioners that you're working with as well.
Brenda Walding: 11:53 Yes. It's important to have an amazing support team.
Karen Litzy: 11:54 Yeah, I just don't want people to think that we're saying, no, don't, don't listen to your doctors, because that would be really irresponsible. But yes, you have to, and it's like what we say within physical therapy as well as you as the practitioner and wanting to give the patient all the available information and guidance that you have and then along with the patient, you make those decisions on what is best. And I think that that is what every healthcare practitioner strives to do and strives to educate patients as best as they can. Give them the knowledge, give them the odds, give them pros and cons and then along with the patient and their support team and physicians and nurses and whoever else you have working with you kind of make that decision on what is best for you. And, those decisions aren't always easy.
Brenda Walding: 13:01 No. Yeah. And Yeah, work with people, you know, work with people on your support team that you feel good about. That you feel supports you fully and is in alignment with your values. You know, I definitely navigating this path, you know, I definitely had practitioners that, you know, were trying to force me into something or I just had a gut feeling that didn't feel good. And so to really follow that and find, you know, doctors that are really on board with you and are listening to what you desires are. Because they exist, they exist for sure.
Karen Litzy: 13:31 Yes, of course. Of course. Okay. So you've obviously gone through a lot, over a full decade plus it sounds like, of your life. So let's talk about kind of what you're doing now and how you're helping other, like you said, mainly women kind of navigate through a healing process.
Brenda Walding: 14:00 Yeah. So like Karen mentioned earlier, that I felt really called to write a book. And so this book really is my love letter to all women and it's applicable to men as well. But you know, it's really all the information I wish I would have had 10 years ago to really truly to heal and to really thrive. Cause it's, I spent eight years really focusing on the physical aspect of healing. And I think that's where we're naturally inclined to as sort of these physical beings is that we're like, okay, nutrition, lifestyle, medication, you know, the various things, focusing on our physical body. But, what I've come to find out that, you know, really looking at ourself holistically, taking into account our mental and emotional and spiritual bodies, so to speak and healing on those levels are equally as important as the physical.
Brenda Walding: 15:00 And then this sort of heart centered approach of really learning to get out of the head and allowing the heart to lead. So that is where I call it, like this whole hearted healing or this whole hearted living approach. And so that's what I share in my book along with my story. And, I did research on, you know, what, who are these men and women that were not only healing from catastrophic illness but that were really thriving and using that illness as an opportunity to create an even more extraordinary life and what did they all have in common? And so that's really how I, you know, navigated my journey. And also, you know, taking that research into consideration really came up with these nine wholehearted healing essentials. And I share that in my book. And that's really sort of the framework I use when I work one on one coaching with women.
Brenda Walding: 15:55 And then I also do, you know, create a curated experiences, a women's circles and workshops and things to help women to have an experience of some of these things. So that's kind of what I'm up to now.
Karen Litzy: And can you share with us what your wholehearted healing 9 essentials are?
Brenda Walding: Yeah, I'd love to. So the first one is taking responsibility for your health and your life. And that really, it just, it kinda comes down to so many of us, we kind of rely on other people, maybe it's even relying on a doctor or relying on, you know, other people to tell us what to do or to have authority over our life and our health. And this really is just taking your life and your health in your own hands, stepping away from that victim mentality and really taking ownership of everything that's ever happened in your life and taking responsibility for you right now so that you can be in the driver's seat of your life and what happens moving forward.
Brenda Walding: 17:06 And so the number two is creating a vision. And this is really, I have a mentor that I said, it's better to be pulled by your vision than pushed by your problems. And so there's a lot of research that has come out in the realm of quantum physics and the power of imagination of using our mind and elevated emotional states to actually change to affect us on the level of our DNA. And so I really got fascinated with the work of, you know, like Dr Joe Dispenza and Greg Braden, and really tapping and honing in the power of imagination and vision when it comes to healing. So that is something I really work with, with people to do is like what is it that we want to create and when we tune into that and imagine and tap into that elevated emotional state, that really helps to begin to pull that event towards us, whether that's healing or creating more of what we want in our life.
Brenda Walding: 18:12 And number three is thoughts and beliefs. So just learning to manage our mind and harness the power of our thinking mind to create healing and really looking at beliefs because our beliefs are our underlying beliefs can be something that is really in alignment with our vision and what we want to create. Or it can be subtly sabotaging if we don't really believe we're worthy of healing or we have beliefs that are contrary to what it is that we really want. So that's a piece I think often a lot of people overlook. And number three is feel your feelings. And so that is sort of tapping into that emotional part of healing, which I feel like there's a lot of energy that we deplete in waste because we are dealing with a low to moderate level of anxiety and stress a lot of the times.
Brenda Walding: 19:12 And that has a really huge impact on our physiology. So there's that whole element, it can dive into that more. But that's number four. Number five is nutrition. So really looking at what we're putting into our bodies, the quality of food, but not just what we eat, but how well we're able to digest and absorb and assimilate that food. Number six is live to thrive. And so in this essential, I really dive into lifestyle factors. So this is where exercise and movement and connecting with nature and getting sunshine and play and you know, these different how we go about living our life on a day to day. And then the next one is connection and relationships. So really looking at the quality of our relationships and, you know, found that in our relationships.
Brenda Walding: 20:17 That's where a lot of people can experience a lot of emotional drain. And we know that how our emotional state, you know, negative quote unquote depleting emotions affect our physiology. So really looking at the quality of our relationships and this piece around authentic connection. And I love this topic because this was actually a huge blind spot for me in my own life, is really learning what true connection really was, which is, you know, the ability to be, this sense of being, feeling connected energetically and being able to be seen, heard and valued and deriving strength and sustenance from the relationship. And, you know, there's so much research on the impact of chronic loneliness, you know, we're so disconnected. We're connected very much with technology, but there's so much loneliness. I think it was one study was talking about how chronic loneliness is equivalent to smoking, like several cigarettes a day.
Brenda Walding: 21:25 And the impact that has over time on our body of not being connected with one another in a deep and meaningful way. So that is a really incredible piece to look at. And then we have self love and self care, so love yourself and that really can encompass a lot of different things and can be an even bigger conversation. But really I found underneath it all is really healing and thriving is about all about truly falling in love with who you are and loving your life. And how does one do that? And then finally trust and surrender. So I found that, you know, of all the people that I researched, they all spoke about elements of really having this higher power that they were trusting, trusting, you know, source God, trusting within themselves, you know, and surrendering the outcome really learning to trust and as a power bigger and greater than them to guide them on their path. And so that is the last one is learning to trust and surrender.
Karen Litzy: 22:36 I mean, that's a lot.
Brenda Walding: 22:38 Yeah!
Karen Litzy: 22:40 That's a lot. But if you think about it and break those down, that's as human beings kind of what we need. So it seems like, oh my gosh, this is so daunting. This is so much work. This is going to be work. But if you take each one individually and break them down, I mean, it's pretty simple. It's what we all need to be happy and healthy and live our lives. So I get it. I'm on board.
Brenda Walding: 23:04 Yeah, exactly. And you know, like I said, they intention really was to create this holistic healing living roadmap. So it's like these are, I wanted to like, I've got this, all of this information downloaded and experienced in my life over the decade and I got the little bits of information here. Oh, you need to learn about nutrition. Oh, okay, great. I will focus on that for many years. Oh, okay. I need to understand how my emotions impact my health. Okay. You know? And so I got these little, these, this information and different from different books or different teachers. Then I realized like, oh, really, it's really about it. All of these things. And they're all important to really living your best and most full life. And it takes all of those things to some capacity to really, really live and thrive. And it doesn't, you know, like you said, you know, you don't dive in and try to do them all at once, right, yeah, you focus on one thing and you began to implement that.
Brenda Walding: 24:08 And that's why coaching is really amazing. It's like I had so many coaches and mentors and teachers that helped me begin to integrate all of these pieces. And so it's helpful too. Yes, my book is a good resource, but it's also helpful to have, you know, someone that can see your blind spots and can see, oh, hey, you know, let's dive into, you know, there's this emotional piece that you have held on to all these emotions from the past and that's taking up a lot of energy and negatively affecting your body. But I didn't really see that. And so let's work through that together. So there's a lot of things that can be helped when you have someone to help you move through some of these things together.
Karen Litzy: 24:52 Sure. And how has your training as a physical therapist, how does that play into the role that you're doing now with coaching? Because I know there are a lot of physical therapists who might be looking for nonclinical roles or nontraditional roles. So how has your training helped prepare you for what you're doing now?
Brenda Walding: 25:09 How has my physical therapy training help me in what I’m doing now? Well, I think, well, and you know, I actually had the really beautiful experience recently of going back and doing some physical therapy part time. And so I've been able to kind of go from both directions. See the difference, how my training up until this point with all of this work has made me and even different, physical therapists how I interact. So from that perspective, I can, and I think there's a lot of value for physical therapists and any healers or practitioners to interact and address the patient or the client from this holistic perspective. Knowing that coming in this person with chronic pain or this, you know, ailment has, there's many pieces. Generally speaking, generally speaking, especially if it's a chronic issue and that it's more than just the physical aspect, oftentimes that there's an emotional piece and that there is a mental piece perhaps. And so being able to relate to that person in their wholeness can help me be a better overall practitioner to be able to offer some insights or how to relate to that person and help them, you know, experience a greater outcome.
Karen Litzy: 26:37 Yeah, absolutely. And you know, it's that shift from a strictly biomedical to a biopsychosocial framework of treatment, which we talk about all the time on this podcast. I'm sure people are sick and tired of me saying it, but that is the way things should be in healthcare. So I will keep saying it many, many times. Now before we finish up, is there anything that maybe we didn't touch on that you're like, oh wait, I really want the listeners to know that.
Brenda Walding: 27:10 I think really a piece that I think is really helpful, especially for practitioners and you know, I don't know much if we'll have time to go into this, but this, I am a heart math certified coach and really we look a lot about energy management. And so we waste a lot of energy in the domain of emotions and repetitive negative and repetitive thoughts. And that affects our physical abilities and our physiology. And so really learning to manage our energy. And we do that through being able to get into a coherent state. So getting our heart, mind and emotion and energetic alignment through slowing down the breath and experiencing elevated emotional states like love and gratitude and can actually get the heart into a smooth coherent rhythm, which impacts the way that the rest of the body feels and how it can heal. And so I think if we learn some techniques, as practitioners to help manage energy we can improve outcomes for our patients and our clients. So this is sort of that combining of going beyond the physical and that heart math has some really incredible tools so that you can check them out heartmath.org I think it's a really great tool for a lot of practitioners. I just wanted to throw that out. Yeah. So I think that, yeah, that's helped me a lot in my own coaching on and with physical therapy.
Karen Litzy: 28:48 Great. And we'll have all of that info at the show notes over at podcast.healthywealthysmart.com. So if people want to learn more about heartmap.org they can just go click on it and you're there. So thank you for sharing that. And now the one question I ask everyone is, knowing where you are now in your life and in your career, what advice would you give to yourself as a new Grad right out of PT school?
Brenda Walding: 29:16 Right out of PT School? So I would definitely, I wish I would know now is really learning how to listen and lead from my heart. I feel like I got myself into a position where I was burned out running ragged, just trying to do the best I can as a new Grad. And I've missed a lot of the cues, you know, internally of Hey, slow down. These other aspects of your life are important to you. And you know, I think that was really the catalyst for me to start to get burnt out and sick. And so really to slow down and really listen to my heart is what I would tell myself.
Karen Litzy: 29:42 Great Advice. And burnout is real. This year at the women in PT Summit in Portland, we have a whole panel on burnout. I'm really looking forward to listening to, cause I am not part of this panel. I'm not part of the creation of it. It was sort of pitched to us and I'm really excited to hear what the women on that panel have to say. Cause it's a thing and I think it's happening more and more with the newer grads because they're trying to work more and more. They've got student debt out the yes. What? Um, so I feel like it's a real thing, you know, and like you said, just to take a moment to slow down and focus on other parts of your life is, is something that that can help. So thank you for that. And now where can people find you if they have questions? Where can they get your book?
Brenda Walding: 30:49 Yes. So you can find me. I'm in the process of creating, readjusting my website. So right now you can really connect with me by emailing me at risetoradiance@gmail.com. And then I'd also love if any of this resonated with you, if you're a woman that is dealing with burnout, exhaust exhaustion. I love working with wellness professionals. If you're interested in some of these heart math tools that I use, I'd love to hop on the phone and I'm happy to offer your listeners a complimentary 45 minute consult.
Karen Litzy: 31:32 Oh, that's awesome.
Brenda Walding: 31:34 Yeah. So if you'd like to take advantage of that and you can go to www.Brendawalding.com and that is my calendar link. And so you would just set up a time to chat with me. Okay. And I love hearing your stories and hearing where you're at and what you need most support with. So happy to do that. And then my book is coming out in hard copy at the end of this year, but you can find it on Amazon.
Karen Litzy: 32:02 Perfect. And you'll give me all the links. I'll put all the links up on the podcast website under this episode so that way people can get to you, they can chat with you. And thank you so much for offering a session for everyone. That's so nice.
Brenda Walding: 32:21 Yes. Awesome. I look forward to connecting with some of you.
Karen Litzy: 32:24 Great. And, again, Brenda, thank you for coming on and sharing your really incredible story. And we are all very happy that you are today healthy and happy and moving forward. So thank you so much.
Brenda Walding: 32:39 Oh, thank you, Karen. I enjoyed it. I enjoyed being here, so thank you for the opportunity.
Karen Litzy: 32:44 And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE from the NEXT Conference in Chicago, Jenna Kantor guests hosts and interviews the teams from the Oxford Debate which covered the question: Is Social Media Hazardous? The Pro team consisted of Karen Litzy, Jimmy McKay and Jarod Hall. The con team consisted of Ben Fung, Jodi Pfeiffer and Rich Severin.
In this episode, we discuss:
-How each of the debaters prepared and crafted their arguments
-Bias and how to research a question openly
-The importance of respectful debate on controversial subjects
-And so much more!
Resources:
Jimmy McKay Twitter
Rich Severin Twitter
Ben Fung Twitter
Jarod Hall Twitter
Karen Litzy Twitter
Outcomes Summit: Use the discount code LITZY
For more information on Jimmy:
Dr. Jimmy McKay, PT, DPT is the Director of Communications for Fox Rehabilitation and the host of five podcasts in the category of Science & Medicine. (PT Pintcast, NPTE Studycast, FOXcast PT, FOXcast OT & FOXcast SLP.)
He got his degree in Physical Therapy from the Marymount University DPT program and a degree in Journalism and Mass Communication from St. Bonaventure University. He was the Program Director & Afternoon Drive host on the 50,000 watt Rock Radio Station, 97.9X (WBSX-FM).
He has presented at State and National Conferences. Hosted the Foundation for Physical Therapy research fundraising gala from 2017-2019 and was the captain of the victorious team in the Oxford Debate at the 2019 NEXT Conference.
Favorite beer: Flying Dog – Raging Bitch
For more information on Rich:
Dr. Rich Severin, PT, DPT is a physical therapist and ABPTS certified cardiovascular and pulmonary specialist. He completed his cardiopulmonary residency at the William S Middleton VA Medical Center/University of Wisconsin-Madison which he then followed up with an orthopedic residency at the University of Illinois at Chicago (UIC). Currently he is working on a PhD in Rehab Science at UIC with a focus in cardiovascular physiology. In addition to research, teaching and clinical practice regarding patients with cardiopulmonary diseases, Dr. Severin has a strong interest in developing clinical practice tools for risk assessments for physical therapists in a variety of practice settings. He is an active member within the APTA and serves on the social media committee and Heart Failure Clinical Practice guideline development team for the cardiopulmonary section.
For more information on Karen:
Dr. Karen Litzy, PT, DPT is a licensed physical therapist, speaker, owner of Karen Litzy Physical Therapy, host of the podcast Healthy Wealthy & Smart and creator of the Women in Physical Therapy Summit.
Through her work as a physical therapist she has helped thousands of people overcome painful conditions, recover from surgery and return to their lives with family and friends.
She has been a featured speaker at national and international events including the International Olympic Committee Injury Prevention Conference in Monaco, the Sri Lanka Sports and Exercise Medicine Conference, and various American Physical Therapy Association conferences.
For more information on Jodie:
Jodi Pfeiffer, PTA, practices in Alaska, where she also serves on the Alaska Chapter Board of Directors.
For more information on Jarod:
Jarod Hall, PT, DPT, OCS, CSCS is a physical therapist in Fort Worth, TX. His clinical focus is orthopedics with an emphasis on therapeutic neuroscience education and purposeful implementation of foundational principles of progressive exercise in the management of both chronic pain and athletic injuries.
For more information on Ben:
Dr. Ben Fung , PT, DPT, MBA is a Physical Therapist turned Digital Media Producer & Keynote Speaker. While his professional focus is in marketing, branding, and strategic change, his passion is in mentoring & inspiring success through a mindset of growth & connectivity for the millennial age.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. Super excited to be talking here because I am at the NEXT Conference in 2019 in Chicago, Illinois. And there was an awesome debate an Oxford debate and I'm with almost all the team members. So that being said, I want to just interview you guys on your process, especially because everyone here is either extremely present on social media or uses social media. So it's funny that we had these two opposing teams really fighting different arguments here where everyone pretty much is on the same page that we all use social media. It's great for business. There's no denying. So as I ask my questions, would you guys say your name because people aren't going to necessarily, well maybe for some recognize your voice and also say what team you were on, whether it was team hazardous, which was correct me, Jimmy, which was the pro argument. The pro argument was saying that social media is hazardous and then the Con team was team Blues Brothers, which I've learned from Ben Fung it would have been the star wars theme except it had already been used in the past and they needed to be original. So that being said, I want to start off with #teamhazardous. What was your individual processes with finding your arguments since each of you are very present on social media?
Jimmy McKay: 01:39 Jimmy McKay team #hazardous. I think first of all, this was a very difficult argument for our opponents because, well, first of all, we didn't get to pick which sides. A lot of people think that we've vied for the sides. We were literally just asked if we wanted to do the Oxford debate and then been given a side and given a team. So I want to make that very clear. I think they did a great job. I was keeping track of all the points that I would've hit if I were on that side, I thought that was the uphill battle. Because people, when they found out we were pro social media it was like, oh, you don't like social media. But if you read the prompts for a debate very closely, it's like, is it hazardous?
Jimmy McKay: 02:18 Not is it good or bad? Right? So we agreed like all the things that the con side said, we agree with it's fantastic. It should be utilized. But just like PT why do we take the NPTE for example? Because if improperly used physical therapy could be hazardous. So that's why we take a test that makes sure that we're a safe practitioner of physical therapy. So, my thought process was I went on social media and wanted to grab all the kits, right? Like emojis and gifs and videos and Beyonce doing dances because that's what people resonate with. But then focus on the things where I think it falls short. Everything falls short, right? There's no Shangri-la and social media is no different. So just focus on the issues that stood out, right.
Jimmy McKay: 03:01 So all I had to do is can I just ask, what do you love about social media? Like what irks you, you know, what are things that you wish were better? And as you heard from tonight, I think in past Oxford debates, sometimes it was hard to get four or five speakers to ask questions. And I think they had to cut them off because everybody, it resonates with everybody and it's super personal, right? I mean, what was the stat? How many people, I mean minutes that people spend a day, 140, 116 minutes a day
Jimmy McKay: 03:29 It's probably hard, so it's super personal for people but I think again, the argument from the other side was just is really hard. I mean, I think you guys were put in a corner. But here's the funny part. Like you defended it, I think you defended that corner pretty well. So that was my process.
Karen Litzy: 03:50 Hi, Karen. Let's see, #teamhazardous and yes, this is also my podcast, so that's, yeah.
Karen Litzy: 04:00 So my process was pretty easy because I had just spoken about social media and informatics at WCPT in Geneva. So I was able to use a lot of that research and a lot of that information to inform this debate. And what I wanted to stick to was, I wanted to stick to the idea of fake news, the idea of misinformation versus disinformtion because there are different and how each one of those are hazardous. And then the other point I made was that it's not individual people, it's not individual groups, it's not even an individual platform. But if put all together, all of the platforms add in misinformation and disinformation, add in people who don't know the difference between something that's factual and not. So if you put it all together, then that's pretty hazardous. But the parts in and of itself maybe aren't. And then lastly that social media is a tool we need to really learn how to use it as a profession because it's not going anywhere as the team concept. It's not going anywhere. So the best way that we can reach the people we need to reach is by using it properly and by making sure that we use it with integrity and honesty and good faith.
Jodi Pfeiffer: 05:22 Hi, I'm Jodie Pfeiffer. I was for the con team blues brothers. I got to be the lead off person as well. So I really just kind of wanted to set the tone. It was a hard argument. Everybody uses it. I would like to think most people try and use it well we know this isn't always the case and it is a really useful tool for our association and for our profession. But there are times when it is not, we were trying to just, I was trying to set the stage for my other team members to give them things to work off of, give everybody a little introduction of the direction we were going. And I also tried to play off of our opponents a little bit as well because you know, really their argument that they made so well kind of proved both sides, how good it is and the hazards. So yeah, that was the direction that I went.
Jarod Hall: 06:20 This is Jarod Hall. I was on the pro team #teamhazardous and I remember when I was asked to be on the Oxford debate panel, the same day I was scrolling through social media of course, and I saw Rich Severin on Facebook saying, Hey, look, I was selected to be for the Oxford debate. And I thought, man, he's super well-spoken. This dude knows his stuff. He's going to come in strong. And then like I checked my email an hour or two later and I had been asked as well and I was pretty floored. I didn't know what to say. And they're like, do you want to do this Oxford debate and what side do you want to be on? And of course I said, I'm super active on social media. It's been helpful for me to find mentors and it's really positively influenced my career. I want to be on the side that's pro social media. And they said, cool, you're on the opposite side.
Jarod Hall: 07:21 And I thought to myself, oh, ouch. Okay, I need to look at this subjectively. You know, I need to, I need to step back away from the situation and look at ways that either I myself have been hazardous on social media or things that I've seen that were hard for me to deal with on social media. And, when Karen and Jimmy and I were strategizing, you know we kinda came up with a couple of different points. We wanted to 8 mile, you guys, we wanted to 8 mile the other team and kind of take the bullets out of your gun. We wanted to address the points that we knew you would address. And Karen did a really awesome job of that because we knew you guys were gonna come with such a strong argument and so much fire that we had to play a little bit of defense on the offense.
Jarod Hall: 08:07 And Karen got everybody hyped up and then our strategy was maybe, go the opposite way in the middle with me and maybe bring a little bit of the emotional component the other side of emotions and have people reflect on what does it feel like to feel not good enough? What does it feel like to see everybody else's highlight reel on social media when in reality, you're doing the day in the day out, the hard grudge, the hard trudge, you're putting in so much hard work and all you see is everybody's positive stuff around you. And it can, it can be a really defeating feeling sometimes. So we wanted to emphasize, you know, a lot of the articles that have been coming out across the profession about burnout and how that could potentially be hazardous. And you know, obviously we're all in favor of the appropriate usage of social media and when done the right way.
Jarod Hall: 08:55 But to take the pro side of this argument, we had to reflect on how could this really actually pose a hazard to us both personally and professionally. And, you know, I think that that's one of the things that directed our approach. And it was a hard thing to do to take the opposite side of, you know, how I position myself. But, all of my own errors on social media were really good talking points and learning points to drive home the discussion. And, you know, we just knew that the other team was going to have such a strong argument. We knew that it's really hard to ignore the fact that social media has connected us. It has allowed me to meet everybody sitting at the table with. It's allowed me to have learning opportunities and mentorship and it's allowed me to have business opportunities that I wouldn't have had otherwise. So we knew that the argument was just, it was going to be tough to beat. And, you know, I think that the crowd just resonated with everything that was said from both teams. And at the end of the day we were able to shed light from both sides on a really difficult topic and have people, you know, reflect on it and really have some critical thought.
Ben Fung: 10:10 Ben Fung here. I was a part of the con team. So that was so difficult. Pro Con. So I mean like it was interesting. I had a very similar experience when they asked me to be on the Oxford Debate. They're like, hey, you know, we'd like you to captain the team. I was like, okay, great. What am I debating? Or like, then when they would actually did tell me, they're like, oh, it's about social media. I was like, okay, yes, I'll do it. And then they're like, okay, you're on the con team. And so immediately I thought like, Oh, I have your job. Like I have the team, you know, #Hazardteam, I needed to somehow slam on what much of my success had been attributed to, you know, and I was like, okay, that'll be a tough job.
Ben Fung: 11:01 Right. And then what's interesting is that, you know, then they sent me the prompt and I was like, oh no, no, no, I'm against the against statement. So I'm pro social media and, you know, then the other side I can promote this. And it was actually only in retrospect that I was like, oh, it can be an uphill battle. But then I decided just personally not to think about it from that perspective, from my, you know, debating approach cause we're trying to present, you know, we're trying to present a point, more importantly, just engage the audience, you know, because, the Oxford Debate in the past, for the most part it's been really positive and entertaining. But then in some past years have gotten a little too intense I think for the audience and some afterthoughts.
Ben Fung: 11:40 So I just wanted to make sure that the thumping in the background stops, but also that you know, people were engaged, entertained, you know, that generally said some critical thought. You know, like those might've come into this being maybe a con member goes over to pro and vice versa. But really, you know, it was just really, really fun. You know, as people, I was like, you know, I know all these folks, it's going to be so much fun. And you know, if we can bring even like an ounce of the kind of energy that I know we all have and put it together, that stage is just going to be vibrant. So, you know, from what I can tell, that's what happened. And, you know, I'm very pleased regardless of who won, but congrats you guys though. You guys did a great job.
Rich Severin: 12:32 And this is Rich Severin, was on the con team, which is again this incredibly difficult to kind of, yeah, team blues brothers. That's a better way to go about it. Everyone's said it, you know, this was, it's a difficult topic. You know, I asked like, who were, you know, were on the other teams, you know, realizing that, you know, we're going against some of the people who have, you know, some of the largest profiles in PT, social media and Karen and Jimmy and like, they have a really tough task here. I'm interested to see how they're going to go about this. Cause it's like, I even, I was like, man, I'm kind of glad I met on that side, but I don't know if I could somehow think of a tweet quoting me and like saying, ‘PTs social media is hazardous’ or whatever.
Rich Severin: 13:12 But anyway, realistically the Oxford debate, you know, it's to present a topic that's challenging, that's facing the profession and dissected and debated. And that's kind of the beauty in having fun. And I think everyone there had fun. I had a lot of fun. And it was just, it was just good. And I think, you know, the pro team, or #hazardousteam, you know, they did a really good job. It's not an easy topic to debate because again, social media is kind of a tool in a lot of the problems are kind of the human nature in a certain stance on a platform. But, you know, addressing the issues of burnout, addressing the issues that people wasting time, fake news, misinformation, you know, those were our, you know, those were all good things, but you kind of brought to light throughout that debate.
Rich Severin: 14:04 And I think our group, you know, came across with obviously with a good argument, but, you know, Karen came on the short and a little bit today. But, you know, it was a great spirit's good spirited debate. It's a lot of fun. It's a great time and having these conversations about tough issues, having to kind of take some time for introspection and looking through things was enjoyable. And enjoying hearing other people kind of, you know, doing the same. You guys definitely did like, I think put a lot of time into researching and discussing topics cause it's a serious issue, you know, our younger populations growing up using social media in middle school, you know, and it will, you know, the topic I thought you guys would get into was like the bullying and esteem issues that are happening and the mental health issues, anxiety, depression, it's linked to social media, you know, and whether or not that's the cause or it's a vehicle for that outcome.
Rich Severin: 15:03 So like, you know, I do agree with the safe #safesocial, right. Like you know, and it kind of led to like kind of on our side too. It’s a tool and how you use it, it's kind of really an issue and I think you guys brought a really, really good light to that issue. So yeah, I was like, it's a great spirited debate and the crowd had fun. I mean dressing up as the blues brothers in Chicago, right? I mean, so, so much fun.
Jenna Kantor: 15:28 Thank you so much. Now, I just want to leave it. Not Everybody needs to answer this, but I would like if anybody would like to do a little last words in regards to this debate, whether it be some sort of wisdom on doing an Oxford debate in general or pretty much what rich started to do on when he was just last talking in regards to social media being hazardous or not so hazardous. Would anyone here like to add onto that as a little like last mic drop, which is your outlet.
Rich Severin: 15:54 I think we've hashed out the debate on both sides pretty well. Which I think, again, it's the spirit of the debate is they present both sides. And that's kind of where I'm getting yeah. Is that we need to have more of these kind of conversations and discussions. And you know, to me it's almost kind of a shame that this is the only really time in our profession. Like, you know, at a high level where we have these discussions where both sides do their due diligence and say, like, legitimately argue, like, you know, and like arguing is not a bad thing. Right? Debate is not a bad thing if it's done well done amongst colleagues and friends and with mutual respect and we need to have more of that.
Rich Severin: 16:39 Social media is not necessarily a bad thing, but arguments necessarily a bad thing, but it's how you go about doing it. So, you know, I would encourage the profession to have more of these outside of just the Oxford debates. Well, when it was the women's health section, they did one on dry needling a couple of years ago and that was awesome. And I'd really encourage and support that again, you know, so that's my little, I don't know if it's a mic drop or not, but we need to debate more and do it well.
Karen Litzy: 17:29 Rich, I totally agree with that. And this is the thing, we were able to do that because we were in front of each other and we knew that there is no malicious intent behind it. We can hear each other. We know that we're smiling at each other, we're clapping for each other and we're kind of building each other up. And I think that's where when you have debates on social media, as Jarod attests to and Rich, sometimes those spiral into something that's really not great. And so I think to have these kinds of discussions in person with our colleagues and it's good modeling for the next generation. And it just, I think, you know, social media has a lot of great upside to it. There's no question, but there is nothing that beats in person interactions.
Karen Litzy: 18:20 And I think that that's what we need more of and I do see that pendulum shifting and you do see more in-person things happening now. But I agree. I also thought it was like a lot of fun and I was really, really nervous to do it and super scared to get up on stage and do all of this. But then once it started, it was a lot of fun.
Jenna Kantor: Thank you so much you guys for taking this time, especially after, literally right after the debate. It is an absolute pleasure to have each of you on here.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Andrew Tarvin on the show to discuss humor in the workplace. Andrew Tarvin is the world's first humor engineer, teaching people how to get better results while having more fun. Combining his background as a project manager at Procter & Gamble with his experience as a stand-up comedian, he reverse-engineers the skill of humor in a way that is practical, actionable, and gets results in the workplace.
In this episode, we discuss:
-How to construct humor and learn the skill of humor
-The benefits of humor for the individual and the organization
-Types of humor that are appropriate for the workplace
-The importance of the “Yes, and” mindset
-And so much more!
Resources:
Andrew Tarvin Website
Andrew Tarvin Twitter
Andrew Tarvin Facebook
Andrew Tarvin LinkedIn
The Skill of Humor TedX Video
Humor That Works Website
For more information on Andrew:
Andrew Tarvin is the world's first humor engineer, teaching people how to get better results while having more fun. Combining his background as a project manager at Procter & Gamble with his experience as a stand-up comedian, he reverse-engineers the skill of humor in a way that is practical, actionable, and gets results in the workplace. Through his company, Humor That Works, Drew has worked with more than 35,000 people at over 250 organizations, including Microsoft, the FBI, and the International Association of Canine Professionals. He is a bestselling author; has been featured in The Wall Street Journal, Forbes, and Fast Company; and his TEDx talk has been viewed more than four million times. He loves the color orange, is obsessed with chocolate, and can solve a Rubiks Cube (but it takes like 7 minutes).
For more information, please visit, www.drewtarvin.com and connect with Drew (@drewtarvin) on Twitter, Facebook, Instagram, YouTube & LinkedIn.
Humor That Works is available on Amazon and wherever fine (and funny) books are sold.
Read the full transcript below:
Karen Litzy: 00:01 Hi Andrew, welcome to the podcast. I am happy to have you on. And now today we're going to be talking about humor and why humor is important in the workplace and in life. So the first question I have is you say humor is a skill, so how is it a skill and can that really be learned by anyone?
Andrew Tarvin: 00:28 I think a lot of people have this question or this belief, like, you know, humor is just an innate ability, right? You're either funny or you're not. I will say that I've done over a thousand shows as a standup comedian and spoken word artist, storyteller, et cetera. I have spoken or performed in all 50 states and 25 countries and on one planet. This one. But when I went to my high school reunion and people found out that I did comedy, they're like, but you're not funny. And that's because, you know, growing up I was never the life of the party or the class clown. My senior year. I was voted teacher's pet. So much more of an academic, much more quiet. You know, I'm a very much an introvert. And then I started doing Improv and standup in college and admittedly was terrible when I first started out.
Andrew Tarvin: 01:22 Like we often are in a new skill that we try, but with practice and repetition I got better. And so I realized that, you know, really there there's an art and science to humor. And so what we do with our organization, with humor that works is we teach people the science. So we teach things like comedic structure, things like a comic triple things like timing and understanding how to like position things in different, you know, strategies that humorous use between say association or incongruity or a story, et cetera. All of this kind of science stuff that's easy to, you know, this conceptually you can learn and then there's an art, there is an art piece to it, right? There is, you know, some of that comes from your own perspective, the thing that you like and that you improve with practice and repetition. And so what we say is, you know, with the skill of humor, we can help to teach anyone to be funnier not necessarily, you know, across the board. Funny. It's not like, you know, you can magically teach someone to be so funny, they're going to magically have a Netflix comedy special, but you can learn certain things that are gonna take whatever your base level, you know, ability to use humor is now and take it up to the next level.
Karen Litzy: 02:30 Okay. So let's break this down a little bit because I know the listeners love to get these little nuggets of knowledge that we can start applying today in our life and in our workplace. So you said that with your company that you can teach people what is comic structure and timing. So can you first tell me, cause I don't even know the answer to this question, but what is comic structure?
Andrew Tarvin: 02:55 Yeah. So there's certain things that, you know, there's certain ways that you can structure a sentence or a joke that make it more effective. So, one of the big things is, is learning to put the funny part of the punch line of something at the end. So a great example of this is, I think it's a George Burns quote that says, ‘happiness is having a caring, a close, tight knit family in another city’ right? Which I think is a pretty funny, you know, a humorous line. That line doesn't work if you say, ‘happiness is having a family in another sitting who is in another city who is carrying and close and tight knit, right? So you put the funny part, the unexpected, the surprise piece at the end, right? So that's just a simple structure thing. It's kind of the structure of set up and punchline another example of that is something called a comic triple.
Andrew Tarvin: 03:52 And so a comic triple is anytime when you have a list of three things, the third item is something unexpected. So, for example, when I give my, you know, when I'm talking about some of the clients that we've worked with, we'll say, you know, we've worked with organizations such as Microsoft. The FBI and the International Association of Canine Professionals. And so that last one is just something different, something unexpected where it's like, okay, Microsoft, okay. Corporate FBI, all that's kind of interesting. They seem serious. That's kind of cool. International Association of Canine Professionals. What does that mean? Right? So it, and again, we put that at the end. So simple things like structure or things that you know, kind of anyone can learn. And that's a starting point. The other thing that's kind of important to understand, maybe not necessarily specifically about comedic structure, but about the skill of humor, is that humor is more broad than comedy.
Andrew Tarvin: 04:46 So a lot of times when we think of humor, we do think of comedy. We think of funny, we think of laughter, we think of jokes. But humor is defined as a comic absurd or Incongruence, quality causing amusement. So it could be a joke or it could be just something a little bit silly or something a little bit different that you do that doesn't necessarily make someone laugh, but maybe it makes them smile. And that broader definition means that, you know, maybe you're not a great joke teller, but maybe you're good at telling stories or maybe you're not going to storytellings or jokes, but you're really good at drawing interesting visuals that will get people to pay attention. Right? So that's, that's part of what we mean by this skill.
Karen Litzy: And what about timing? How do you teach timing?
Andrew Tarvin: 05:33 It can be a tough one to do, but that's, that's where the practice and repetition comes from because even as standup Comedians, like, you know, Seinfeld or, Ellen or that kind of thing, when they're doing new special, when they're going to new materials, they have to get it in front of people to see, okay, where do people actually laugh and how long of a pause should it have. Cause sometimes the difference between getting a big laugh and no laugh at all is how long you pause or how long you allow someone to get something. So, one example within timing is a lot of times when people are first starting out with humor, they'll say something that's actually pretty funny. And they'll leave a brief pause and then they'll start talking again right away. And this is something called stepping on your laughter is if someone starts to kind of laugh, but then you start talking again, people will stop laughing, they'll shut down the laughter response because they want to hear what you say next.
Andrew Tarvin: 06:25 And so sometimes one of the hardest parts is a brand new comedian to learn. And sometimes you have to be quiet a little bit longer because it takes the audience a second to actually get the joke to then process that it is a joke process that it is funny and then start to laugh. And that, you know, you need to be comfortable kind of in that short silence to allow them to then laugh and then also to not talk while they're laughing so that, they kind of finish that laughter out as opposed to stopping at short.
Karen Litzy: 06:50 And I would imagine if you're up on stage and your, you know, telling the story or joke that time from the end of you finishing your sentence to a little, maybe pause to laughter building must feel like it's an hour.
Andrew Tarvin: 07:10 Yeah. It can feel like a really, really long time, especially as you've, if you do a certain joke over and over again or one that you know, that works because as you went, you think about it and like, oh, that's funny. I want to share that you've already thought about and processed why it's funny. And so you're like, oh, if they don't get it immediately, they must not think it's funny and it's they've never heard that construction of those ideas together before. So for example, I love puns and wordplay and I recently tweeted out, you know, that I'm a pale person. The only time I get Tan is when I do trigonometry.
Andrew Tarvin: 07:47 And that joke, particularly when said verbally is it's talking about get Tan. So Tan being short for Tangent. Exactly. So the only time I get there is, you know, it takes a while. It takes a moment for people to be like, wait, why is that funny? Is that a joke? That doesn't, you know, what is what is, you know, that has to do with trigonometry. Oh wait, 10 to there was like cos sign and tan like, yeah. So it takes time for that to happen and you have to get comfortable kind of in that silence. The other thing to, to recognize though is that that's true specifically of, kind of planned humor. Things like conversational humor. They don't necessarily, one you may not have, it might not be a preplan thing, but even conversational humor, something that can be learned and something that can be practiced through, you know, drawing on some principles from improvisation.
Karen Litzy: 08:40 Right. So now I actually took a number of Improv classes to help me with the podcast to help me, like you said, just carry out a better conversation and to yes. And, and all of that. So can you a little bit about improvisation and how that can help with general conversations, especially let's say at work.
Andrew Tarvin: 09:05 Yeah. So, you kind of mentioned the fundamental mindset of improvisation. The key that really helps with a lot of that in that is the mentality of yes and, where yes. And is really about kind of taking whatever was offered and building off of it. And so that can be fantastic for conversations. In fact, if you're ever in a conversation and you don't know what to say next, you can just simply yes. And the last thing that was said, so like you can even take, you know, the stereotypical small talk example of, how, how about this weather, right? So I'm in New York. It's sunny, it's 85 degrees. Someone asked me, how about this weather, if I'm say at a networking event, right. Or say one-on-one with a client, how about this weather, I can be like, yes, it is, it's beautiful out. It's, it's sunny out now. You know, if you weren't at this meeting, if we weren't interacting right now, how would you be out enjoying, you know, 90 degree weather? Right. And then so that gives him a chance to be like, oh well, you know, I'd go swimming because it's hot out or I'd stay indoors because it's too hot. Or I'd go out on the bike, you know? And that turns a conversation that was about weather into something more interesting about like in getting to know that person in terms of things like their hobby.
Karen Litzy: 10:16 That's great. I love that because that networking and going to those kinds of events is always so daunting. And especially as an entrepreneur or a small business owner, you kind of have to do those things.
Andrew Tarvin: 10:30 70% of jobs are found through networking and, and to your point, entrepreneurs, I'd say it's a way that a lot of people drum up business. And I learned that pretty early on as an introvert, you know, going to networking meetings, like you said, is daunting. It's a little bit awkward. And so for me, I developed a three step process for being able to network with people. And that yes, and piece is the third step is how you continue the conversation is just to continue to build off of what was said.
Karen Litzy: Nice. What is step one?
Andrew Tarvin: Step one is to ask interesting questions. And so, you know, if we think about Dale Carnegie and how to win friends and influence people, you know, great quintessential business book, he said that you will get, you'll make more friends and a month by getting people interested, by being interested in other people than you will in an entire year in trying to get people interested in you.
Andrew Tarvin: 11:24 And so what that translates into is basically getting other people to talk and then shutting up and then listening to them. And you know, if we go to a networking event and we have the same kind of boring questions, the same, you know, what do you do type questions and at least the same boring answers. And that's not distinguishable. That doesn't stand out to anyone. And so instead of you, if you ask more interesting questions, so simple questions, you know, what's the coolest thing that you've worked on in the last three months? That a lot of times people, you will end up answering the question of what do you do, right? They'll say, oh, when I was working at blank. But it gets him to think a little bit differently. It gives him a more interesting response and you can actually kind of connect a little bit closer.
Andrew Tarvin: 12:11 And that's an example of something that's a little bit in congruent. So maybe it's not laugh out loud funny, but it is something a little bit different that maybe gets people to smile a little bit more or at least thinking a little bit differently. So that's step one is to ask interesting questions. The second step is to tell a compelling stories. So when someone asks you a question, right? Sometimes we hear this advice of like, Oh, you've got to ask people questions. That's how you build rapport. But if all you ever do is ask them questions and never answer anything that they say, it starts to feel like a weird interrogation. Or like why is this person being so closed off? And so when someone asks you a question rather than just giving a yes or no answer, you can give a little bit of a story or a little bit of a background.
Andrew Tarvin: 12:54 So if they're asking, you know, why did you get into healthcare? Why did you get into physical therapy? Or why didn't, you know? Rather than just being like, oh, it was fun. Like, you know, oh, growing up I always felt like this, or I was an app. Like just giving that background allows people to connect with those ideas and maybe they don't connect with physical therapy. But if you're like, oh, well growing up when I used to play soccer, I felt like this. And then on to the next thing, people are like, oh, I played soccer as well, and now you've created a connecting point with this person through a shared interest or a shared commonality.
Karen Litzy: 13:25 That's great. Thank you. Those are great tips. And finally finishing up, like you said, using the yes and to continue that conversation is great. Now since you brought up health care and physical therapy, a lot of the audience, are in those professions. So sometimes humor in that workplace can be a little difficult cause there are times where we have to be pretty serious. So can you kind of talk a little bit about how using humor at work can even work when we have to, you know, sometimes give bad news?
Andrew Tarvin: 14:01 I think your is a great point and this is something I think for, for all professions to, to recognize with humor is that it's simply another tool in the tool belt in the sense that it's not something that you're going to use all the time. 100, you know, 24, seven and everything that you do. It's, it's true that there are times that humor may be inappropriate. And, one of the ways that we can avoid inappropriate humor is by following what we call a humor map. And the map stands for your medium, your audience, and your purpose. So your medium is how are you going to execute that humor? Is it an email? Is it in a one on one consultation or conversation? Is it in a phone call? Is it in a presentation to a bunch of people? Because that medium impacts the message, right?
Andrew Tarvin: 14:47 The second piece is the audience and who you know, who is the, what do they know? What do they need and what do they expect? Because when you're using humor and say communication, you probably are, you do want to deliver on what that person needs while doing it. Maybe in a way they don't just 100% expect by adding a little bit of something different can add be that humor component. The other thing is also understanding your relationship with that person because you know something that you, if you have a client that you're meeting for the very first time, that's going to be very different than the humor that you might use with the client that you've been working with for 15 years, right? You've got to know each other a little bit better. And then the final piece is the purpose. Why are you using humor?
Andrew Tarvin: 15:27 And this is the most important one. This is why as an engineer, I like it because humor can be effective in using or achieving certain goals. So you could use humor as a way to get people to pay attention. Or maybe you use humor as a way to build a relationship with someone to build rapport, right? If you're meeting a client or if you're just now starting to work with someone, you can find a way for you to both laugh together. You kind of show that where you're standing on the same side and then after you've built that rapport, then if you have to get more serious news, that's, that might be when you become a little bit more serious or a little bit more somber or whatever. Right? So again, it's just recognizing that it is, it's a tool. It helps us achieve certain goals and that when we have those as goals, it might be the appropriate tool to use.
Karen Litzy: 16:10 Great. I love it. And I like that acronym of the humor map. That's really easy to remember. Now let's talk about, we're talking about humor, right? There's maybe good humor, bad humor. What is the type of humor one should kind of stay away from in the workplace?
Andrew Tarvin: 16:34 I think that's a great question. So to give it a little bit of additional context, a psychologist Rod A Martin defined four styles of humor. He said in general, humor kind of falls into these four buckets. The first bucket is affiliative humor and this is positive inclusive humor. This is to me, I think of like Ellen Degenerous, like her style of humor, her TV show, it's very positive, upbeat. Everyone is included. There is no target, if not aggressive. It's not calling anyone out. It seems like team building events in the corporate world or activities that you may be doing with your clients or your patients, right as positive and inclusive, everyone is included. The second style is self enhancing humor. And this is a humor where the target is kind of yourself, but it's positive in nature. To me it's kind of best summed up by, there's a great Kurt Vonnegut quote that says laughter and tears are both responses to frustration.
Andrew Tarvin: 17:33 I myself prefer to laugh because there's less cleaning up to do afterwards, right? It's that idea of like when we're thinking about the challenges or the hardships that we have to go through day to day, it's finding the humor in them so that you laugh about them instead of cry about them. So that's another great form of humor and that's, that's kind of like, you know, finding ways to make your own work more fun. It's, you know, listening to music when you have to go through email or you know, rocking out to a song and you're in the car on the way home, or you know, these small examples of things that are just improving your life day to day. A third style is self-defeating. Humor, self-defeating humor as a negative form of humor where the target is yourself. And so this is, you know, Rodney Dangerfield.
Andrew Tarvin: 18:15 I get no respect. That's kind of poking fun at yourself. And this can be a great form of humor when used one in a high status position. So if you are a presenter that sometimes adds a little bit of status to it, or if you're the boss or the CEO as a way to reduce status. Differentials can be very good. And it's best used when sparingly. So like you don't want to use it as every single joke that you do, but every now and then on occasion, and that can be a good form in many ways. But if it's used too much since people started to think like, oh, this person isn't confident or they're not actually good at what they do, or you know, they're throwing a pity party and I don't know if I laugh or not. So there's some limitations to that one.
Andrew Tarvin: 18:55 And then finally there is aggressive humor and aggressive humor is a negative form of humor where the target is someone else. You're doing it to try to manipulate them or try to make fun of them or that kind of thing. And so that tends to, to not be appropriate in the workplace. It includes things like sarcasm and satire, which can be okay in a group setting where you're all very comfortable with you, with each other, and it can be a very good form of Catharsis. So I know a lot of like say doctors, surgeons, we do some work with emergency first responders. They sometimes have a dark sense of humor as a group, because it, you know, serves as Catharsis. They see so many stressful, so many crazy things that they need some outlet to relieve that stress. And so that type of humor can be helpful there. But again, only when it's a very close knit group, when the relationships are kind of already formed and you know that it's going to be seen as catharsis and not seen as aggressive.
Karen Litzy: 19:52 Yeah. And I think we've all been in those situations where you're just sitting there and it's like awkward. Like this did not fall the way that the person intended it to.
Andrew Tarvin: 20:03 Yeah. And that's why, you know, if you stick to the other three forms a lot more, you're going to be, it's gonna be a lot better. And, and that's the other differences, again, we're not trying to teach people how to use humor to become stand up comedians. Cause yes, absolutely tons of comedians or kinds of comedy shows, you'll see a lot of sarcasm, a lot of satire, a lot of aggressive humor. But that's not our goal. Our goal is using humor so that we get better results.
Karen Litzy: 20:29 And so that was my next question. You just led me right into it. So let's talk about results. What kind of benefits can, let's say myself as an entrepreneur or within an organization, get from humor at work
Andrew Tarvin: 20:44 It's great question. And as individuals, there are 30 benefits at least that we found. 30 plus benefits from using humor in the workplace that are all backed by research case studies and real world examples. And so they range from ways to improve your communication skill as a way to, you know, for example, do you use a little bit of incongruity, get people to pay attention a little bit more cause they're like, oh that person just made me laugh. That's a little bit different than what I was expecting. Now I'm listening and paying attention, to helping with creativity and backed in one study they found that kids to watch a 30 minute comedy video before trying to solve a problem. They were nearly four times more likely to solve that problem in kids. You watched either a math video or no video at all.
Andrew Tarvin: 21:28 So we can use humor as a way to kind of just warm up the brain to be able to think about things a little bit differently. Give ourselves a different perspective. We can use it for things like relieving stress so we know that, you know, stress by itself is not a bad thing, right? As a physical therapist, you know that you have to stress muscles to some extent in order to get them to grow. That's what we're doing when we're working out is we're breaking down muscles, but then they grow when we rest and we feed them and the body, our capacity for being able to do work is the same thing. We can stress, you know, we needed a little bit of stress to sometimes get to that next level in terms of productivity. But if we never relieved that stress, that's when we see an increase in blood pressure and increase in muscle tension, a decrease in the immune system. Well humor can help counteract those things. When we take a break to actually laugh, we increase oxygen flow through our body, we relax our muscles and we boost our immune system as well. So we can use it for things like that as well.
Karen Litzy: 22:25 Well they are all really great benefits especially to use at work. And now these are, like I said, these are all great benefits. So why is this not being implemented more? Why aren't more people quote unquote funny at work? And I know that's not the right term, but I think that's what people think. Right?
Andrew Tarvin: 22:46 Right. Yeah. And what we say kind of with humor in the workplace as a goal isn't necessarily to be, to make the workplace funny, but it is to make things a little bit more fun. And you ask a very, I think, important question to say, okay, why don't people use humor more? And we wanted to do the answer to that. So we ran a study through our site and we found that the number one reason why people didn't use humor in the workplace as they said that they didn't think that their boss or coworkers would approve.
Karen Litzy: 23:12 Interesting. I can see that. Yeah, I can totally see that.
Andrew Tarvin: 23:15 Right? Yeah. Cause if you work in a culture and no one's really laughing or smiling all that much, then you're kind of like, oh, I guess it's not welcome. I guess it's not what we do here. It's a, you know, quote unquote serious workplace. And the reality is that 98% of CEOs preferred job can edge with a sense of humor and 81% of employees at a fun workplace would make them more productive. So I think people actually want it. It's just that we're still stuck sometimes in this old mentality that work has to feel like work and we don't that well, we're human beings. And humor is an effective way to reach human beings. And so if we want to be more effective in what we do, we have this tool that we can use. And I think specifically for entrepreneurs and leaders of others or team leads and stuff, that's an important thing to recognize is that if you're the leader of a team or an organization and people don't constantly laugh or people don't kind of have that sense of humor, it doesn't seem like you might be part of the reason why.
Andrew Tarvin: 24:12 And it's probably not intentional, right? You probably like haven't gone out to be like, all right, let me squash any remote mode of fun. That happens every single day. But if you don't use it yourself as a leader, if you don't encourage it, if you never laugh or smile in the workplace, if you never kind of express some humor or share a little bit more about yourself, people will kind of take whatever the leader does and say, this must be how we have to act.
Karen Litzy: 24:36 I mean things trickled down from the top. There's no question. It makes me, as you were saying that the thing that came to my mind was the movie the Devil Wears Prada and Meryl Streep's character who was just, I don't think she cracked a smile except like the very end of the film. And you can just sense the tension among everyone that worked below her.
Andrew Tarvin: 25:02 Exactly. And I think we, I think we need more, we need more metaphors to the movie devil wears Prada. So I'm happy that we've gotten there for this. But I think you're exactly right. How the managers behave does tend to set the tone. And, but with that being said, one of the things that, you know, I'm a big believer in is that, you are responsible for your own happiness. And so even if you do work for an organization or you do work for a manager or a leader who doesn't really use humor, I think that it's still up to you. You choose how you do your work every single day. And, and it's not really the responsibility of your manager, your coworkers, or your patients or clients or customers to make sure that you're having fun, right? That's an individual choice that you make. And hopefully they don't detract from that. But even at a minimum, like they can't control how you think. Right. One of the things that I like to do when getting bored and emails that I'll start to read each of the emails in a different accent in my head. And this is something kind of fun, something a little bit different to do and no one can stop me from doing that, right? No manager could come up and be like, hey, you're reading emails in the accent in your head. Stop it.
Karen Litzy: 26:10 Yeah, totally. And so when you go into these companies, you go into Microsoft or in working with the government, how do you enter into those situations to kind of explain to them that using humor in the workplace is important? Because I would have to think you have had to encounter some hard nuts to crack.
Andrew Tarvin: 26:38 Yeah, absolutely. And in conveying the value of humor is a little bit of a challenge. You know, no one really thinks of humor as a bad thing. They typically don't think of it as kind of a nice to have. But to me it's a must have. If you just look at kind of the statistics, if you look at the numbers, you know, 83% of Americans are stressed out at work, 55% are unsatisfied with their jobs and 47% struggle to stay happy leads to 70% of the workforce being disengaged. And then Gallup has estimated that's a cost on the US economy of about $500 billion lost, you can do the math of that. That's, you know, you take the number of employees and all that. It's an average of about $4,638.
Andrew Tarvin: 27:29 And lost productivity. And so then when you're starting to talk with people, so if you're talking with Microsoft or other organizations and saying, Hey, if you know 70% of your workforce is disengaged and each one costs you $4,700, now they start to see like, oh, okay, there's numerical losses here. Because if you look at the benefits of using humor, we talked about some on the individual level, when an organization uses humor, you see an increase and you one create a more positive workplace culture. You see an increase in employee engagement, you see an increase and company loyalty, see a decrease in turnover. And on a lot of organizations, you also see an increase in overall profit. And so when I'm talking with the organizations, it's talking about the business benefit of it. It's recognizing that, you know, well, as a gross simplification of it, I have a dumb question for you.
Andrew Tarvin: 28:22 But it's still wants you to kind of answer it, but, would you rather do something that is fun or not fun? Fun, right? Yeah. You'd rather do something fun. So if you were to make your work a little bit more fun, probably stands to reason that you might be a little bit more engaged in it. Or if you were to make your kind of conversations with your patients or your clients a little bit more fun, you might see that they might be a little bit more willing to actually want to go to them or pay attention in them. So that's a big part of when you consistently use humor, that's when people are like, oh they actually look forward to that meeting. They maybe know that it's going to be hard or they know that, you know they're going to have to do some work, but they're like, at least it's not going to be terribly boring.
Andrew Tarvin: 29:10 At least it's not going to be awful and that's that fun component. And so that's kind of the higher level. And then we have a bunch of studies and a bunch of background kind of back all those things up. But that's been the messaging is like, this is again, it's not about let's all hold hands, Kumbaya. You know, we should all enjoy our work just because we're happy. Go lucky. It's more of here's a strategic use of a tool that will get you better results. And here's all the research that says that it has done that.
Karen Litzy: 29:42 And when, when we're talking about humor in the workplace, it doesn't mean like your boss coming out and doing a standup bit every morning.
Andrew Tarvin: 29:47 Exactly. Yeah. Right. It's more about making it a little bit more fun. It's more about bringing the your humanness to work. Right. And this is one of the things that I'll share with my corporate audiences, you know, I'll say to an entire room full of people is I'll be like, you know what my guess is that many of you, and this is probably true of your listeners as well, many of you are likable people at home, right? And then they go into the workplace and something changes right? At home. They laugh with their friends, they smile, they make jokes, say, are conversational, et cetera. Maybe a little bit silly, you know, maybe they sing in the shower, they dance in the kitchen, whatever. And then they go into the workplace and something changes. They put on a work face and they feel like they have to be like a robot with no emotions or anything like that. And that's not effective for the way that we work today. Maybe that made sense, the industrial revolution, whereas all about efficiency and the most widgets that you could produce. But now when humor, interactions are important now when your emotions impact your ability to be, say, creative or productive, we have to manage the human experience. And humor is just one effective way to do that.
Karen Litzy: 31:00 And so if I'm hearing you correctly, when we're talking about bringing humor into the workplace, it's really about being kind of open and trying to be a little bit more yourself and perhaps letting your guard down a little bit to allow yourself to be present and to, like you said, be funny or to not be so serious all the time. Or to, you know, have more conversations where you're injecting your personality. Because I do think most people have funny things to say in conversation. We're not all like Debbie downers. Yeah, I'm green. And so is that kind of what you're teaching when you're going in and talking about humor outside of, you know, how you talked in the beginning about timing and about the comic triple and having those unexpected things at the end of your sentences or punchlines if you will. So you're kind of teaching these tools, but in the end, as the worker or as the company, it's sort about changing the culture.
Andrew Tarvin: 32:10 It is. Yeah. I think that's a great articulation of it. So in the book we had a book that just recently came out and it's called humor that works with missing scale for success and happiness at work. And, you know, we talk about 10 humor strategies for using humor in the workplace across five different kind of key skills at work. And so if you want to use humor to improve your productivity, you know, you can gamify your work or play your work and here are the steps how to do that. Or if you want to use humor and connecting with people here as a way to, you know, kind of a three step process we mentioned earlier about and that's a way to build empathy with someone. But at the end of the day, the bonus strategy and I think kind of what articulates what you're talking about is the biggest thing that we encourage.
Andrew Tarvin: 32:52 The biggest takeaway, and I would say the same is true of your podcast listeners, is to simply think one smile per hour. You know, what's one thing that you can do each hour of the day that brings a smile either to your face or the face of someone else. And so that could mean, hey, if you like telling jokes and you want to learn more of them and you have that, you know, like you like that witty kind of feeling great, do that. If instead you're about to, you know, get in traffic and you know, like how can I bring a smile to my own face? Like, Oh, well let me maybe listen to a comedy podcast on my way home from work so that I laugh and show up more present for my family when I get there. These are all just small choices. And to your point, I think everyone, everyone has a sense of humor.
Andrew Tarvin: 33:35 I think it might be a very specific sense of humor and sometimes you don't always see it, but I think everyone has one. And so it's like, okay, how can you leverage your sense of humor to bring that smile to the workplace? And the other thing is directing that you don't always have to be the creator of humor. Instead, you can be kind of the conduit of it or the shepherd of it where you know, you don't have to be the one that makes a funny joke. Maybe you find one online and you added as a pss or the end of a long email. Or you find images online using a creative Commons license and have that in your presentation as opposed to having a bunch of slides with just full of text. Maybe you watch a Tedx talk that you think is really, really good that you really like and you like, you share that with people to say, Hey, you know, let's try to incorporate this type of thing a little bit more. So you don't always have to be the creator of it, but you can be that source of it, that shepard of it.
Karen Litzy: 34:24 Yeah. Great Advice. Thank you so much. That really helps to kind of break it down in my mind. And I would assume in the listeners minds as well. And you know, before I have one more question that I ask everyone, but before I do that, you had mentioned Tedx and I do want to mention that you had a great tedx talk that's been viewed millions of times. I watched it, I loved it. Where can people find that talk?
Andrew Tarvin: 34:48 Ah, yes. So they can find it. If they just Google my name, Andrew Tarvin, Tedx, it'll show up. Or they Google a skill of humor. Tedx, it's on the official, you know, Tedx Youtube Channel. If you just Google my name, it's one of the first things that comes up and you can getting near your, a fantastic story about my grandmother and we go in and talk. It's funny, it goes into a little bit of that deeper dive of the scale of humor and for me at a, yeah, that can be a great starting point for people. And I know plenty of people have used that as a thing that they share out where they're like, hey, you know, I want to incorporate more humor into the workplace. People don't necessarily know why. So let me send this out to my team and say, Hey, this was a funny talk that I really like. Maybe it should encourage us to have a little bit more fun in what we do.
Karen Litzy: 35:31 Yeah, I really enjoyed it. It was a great talk and it was funny in that bit with your grandmother is classic Classic Grandma classic grandma's stuff. So everyone listening, definitely check out the TEDX. It's really great. And like I said, before I finish, I usually like to ask everyone the same question. And that's knowing where you are now in your life and your career. What advice would you give to yourself as a new Grad?
Andrew Tarvin: 36:00 As a brand new Grad. Two things kind of come to mind. The first, is more tactical and I would say do stand up comedy earlier, frequently. Just because one, I love stand up. I love doing stand up. It's I think one of the hardest forms of public speaking you will ever do.
Karen Litzy: 36:22 Yeah. I would never be able to do it. I give you all the credit in the world.
Andrew Tarvin: 36:26 Well, one, you absolutely could do it if I could do it. Anyone. But it is intimidating, but it's made me much, much better as a speaker. In fact, that I think the reason that the Tedx talk has been successful is because I did a lot of stand up before it to work on it, to practice it, to try jokes. And it's where I've refined, you know, my sense and my skill of humorous, I'd say do that, you know, first. And then I think the other thing would be get more clear on the articulating the value of humor. It took me a while Kinda to your point, you know, why do companies hire this? At first I was like, no, humor is just a brilliant idea. Shouldn't everyone see that? And the reality is that no one cares about humor and the workplace, like in terms of they never think of it as something that they need. And, and they know that they need communication training or leadership training or they know that they need to improve morale or they know that they need to help people relieve stress. It just turns out that humor can be the tool to do a lot of those things. So getting more clear on how humor can be beneficial, I think would've helped my personal career a little bit more and would've gotten me out to sharing this message with more people sooner.
Karen Litzy: 37:32 Great. I love it. And I don't know that I would ever do standup. But you're making me consider it. Like even when I took, even when I took improv classes, I had like an Improv teacher come to my apartment cause I was too nervous to go to a class because I didn't want to screw up.
Andrew Tarvin: 37:51 Yeah. But here's the thing though is you just rock this, this podcast and plenty of other ones in the future. That's all Improv as well.
Karen Litzy: 37:58 I know that's why I took the class, but I don't know. There's something about being, I dunno, it's a fear. I should probably, I'm working on my public speaking. I've been working on that for the past year. But yeah, I think taking an Improv class in front of actual people and with other actual people would probably only benefit me. But it's just so darn scary.
Andrew Tarvin: 38:21 It is. That's why you have to, you have to leverage that one light, that one evening that you like, have that like, you know what, I should do it. And then you sign up real quick and then force yourself to like go and there were only reason why I say that is is because I'm a big believer. Improv is fundamentally changed my life because as I mentioned I am very, very much was an introvert and everything growing up and that's how I kind of got into this and so I'm a strong believer that anyone listening, you know if they have the capacity, if they have any slight interest in it, I think should take an Improv class because it teaches you life skills. In fact, one of the most popular blog posts that we have on our website is 10 life lessons from Improv. So much application. It teaches you the human skills to interact with other people on ways to be more present, to think on your feet, to be able to react quickly, to build your communication skills and your confidence. Like there's tremendous number of benefits and once you get used to it, it's so much fun to do.
Karen Litzy: 39:19 All right, I'll think about it next time UCB has like a one on one class. Granted that's upright citizens brigade for those who aren't, I guess in New York. They may not know that. If I can make the cut cause those classes fill up in about five minutes. But maybe I will do it this time. We'll, we will see. And now you mentioned your blog. Where can people find you?
Andrew Tarvin: 39:42 Yeah, so if they're interested more in the human in the workplace, if they go to humorthatworks.com we have a bunch of, you know, blog posts out there about different topics on humor. There's a free newsletter to sign up to. There's a link to our new book that has a lot of resources there as well. I information about our workshops and coaching and all that kind of stuff. And they want to connect with me directly. They can find me @drewtarvin on all social media. So whether that's Linkedin, Instagram, Facebook, Twitter, a recently discovered, I still have a myspace page. So if my space is your jam, then you can connect with me there as well.
Karen Litzy: 40:23 That's amazing. Well thank you so much, Andrew, for coming on and sharing all of this great information on how to use humor in the workplace. So thank you so much.
Andrew Tarvin: 40:35 All right, sounds great. Well, thank you so much for having me, and hopefully this was valuable for the listeners.
Karen Litzy: 40:41 I'm sure it was. And everyone out there listening, thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
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On this week’s episode of the Healthy, Wealthy and Smart Podcast, I welcome Leda McDaniel on the show to share her experience with persistent pain. Leda McDaniel is a Physical Therapist in Atlanta, GA. As a physical therapy student, Leda published a book that chronicled aspects of her three-year battle with chronic knee pain and ultimately led her down a path of discovery on her way to healing with a holistic approach.
In this episode, we discuss:
-Leda’s experiences with Complex Regional Pain Syndrome (CRPS) and how it impacted her life
-Pain neuroscience education and a holistic approach to treatment for CRPS
-How Leda’s approach to patient care has shifted to a biopsychosocial framework
-The importance of listening to the patient’s story and being a voice of hope
-And so much more!
Resources:
Sapiens Moves Website
Email: LedaMcDaniel1@gmail.com
Painful Yarns Book
Moments from a Year of Healing: A Book of Memories and Essays
Leda McDaniel Facebook
Sapiens Moves Instagram
The Outcomes Summit: use code LITZY
For more information on Leda:
Leda McDaniel is a Physical Therapist in Atlanta, GA. She earned her Doctorate of Physical Therapy from Ohio University and holds a B.A. in psychology from Trinity University, in San Antonio, Texas where she also played Basketball and ran Track and Cross Country for the NCAA Division III School. As a physical therapy student, Leda published a book that chronicled aspects of her three-year battle with chronic knee pain and ultimately led her down a path of discovery on her way to healing with a holistic approach. It was this experience that motivated her to become a physical therapist in order to help others recover from chronic pain.
Her book is entitled: “Moments From a Year of Healing: A Book of Memories and Essays” and can be found on Amazon:
https://www.amazon.com/dp/B07CWGH7X6/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1525656733&sr=1-1&keywords=moments+from+a+year+of+healing
Leda’s Professional Blog:
https://sapiensmoves.wordpress.com/
Read the full transcript below:
Karen Litzy: 00:01 Hi Leda welcome to the podcast. I'm happy to have you on and a big congratulations to you for being a new physical therapy graduate. So welcome to the field. And you know, longtime listeners of this podcast will know that I often have people on the podcast who have struggled through persistent pain, who maybe are still having persistent pain issues and you are one of those people. So what I would love for you to do is just let the audience know who you are and tell your story and then we'll take it from there. So I will throw it over to you.
Leda McDaniel: Thank you. Yeah, so I just recently graduated from physical therapy school and I’m entering my clinical practice as a physical therapist. So I'm in Atlanta, Georgia and I'll be starting residency at Emory university for Orthopedic Physical Therapy in August.
Leda McDaniel: 01:03 So I'm really excited about that. A little bit about what got me into this field and interested in being a physical therapist. I had an ACL injury that I suffered in my mid twenties, tore my ACL playing soccer and then I had surgery, reconstructive surgery, to repair that ACL. And the recovery from the surgery didn't quite go as planned, so I had had a prior ACL surgery, so it kind of knew what to expect. What's this time it was not quite so good and it was a little bit different and challenging in that the physical therapist I was working with kept pushing me to strengthen my muscles and try to get my range of motion back and all those things that I was familiar with, but I knew it wasn't really responding as you might expect it would after surgery. So I had this chronic pain and inflammation that developed over the next six months to a year.
Leda McDaniel: 02:04 And both my physical therapist that I was working with at the time, and then, a handful of orthopedic doctors, including the surgeon who did the surgery, they were a little bit puzzled as to what was going on because I had a repeat MRI. They couldn't find any structural issues. At the time I was really focused on that idea of well I still have pain, what is wrong structurally? And I just had this feeling that something is wrong. It didn’t feel right. It was always painful and it was always swollen and I really couldn't it over the hump to the extent that I was even limping when I was walking about a year after surgery. So I continued to try to rehab and over the next additional year and two years out of ACL surgery I had a second surgery.
Leda McDaniel: 03:00 The idea that they clean out some of the scar tissue in there. It's the joint capsule is scarred up a little bit and try to get things work in a little bit better or feeling a little better after that surgery. Again, that kind of made my situation worse and I developed this mirror pain cause I knew I was hypersensitive at that point and had after that diagnosis of complex regional pain syndrome and just really severe nerve pain to the extent that not only was it painful to walk, but I really couldn't walk and I couldn't put pressure on that knee. I couldn't touch the knee without it being painful. And kind of just spiraled into it's really bad situation where I was pretty disabled. I wasn't able to work at the time. And in that time period had gone back to school for physical therapy because I'm flattered by this injury and wanting to help other people regain their health.
Leda McDaniel: 03:59 I had some really excellent physical therapists along the way who really try their best to work with me even though things weren't going in an ideal direction. So, anyway, so I had to take time off school. I couldn't work. All of this really pursuing or being fixated on this idea of what structure is injured. And it really, the course of my injury and health didn't really change until my perspective or kind of switched my focus to more of a treating pain based on what were currently understanding is more of a progressive approach to chronic pain, which is pain neuroscience education where we're understanding that there are many components to pain not just structural ones and a lot of these inputs can contribute to these situations where you have this over sensitivity or hypersensitivity.
Leda McDaniel: 05:05 And that's kind of the place I found myself in. So I really started to self treat based on some of those principles and try to reduce the sensitivity that built up within my nervous system. And over the course of about a year, I was able to turn things around and get back to the point where I was walking. I was back to school, working, functioning in society like I wanted to and my pain levels were significantly decreased. And gradually, gradually got to the point where I was pain free.
Karen Litzy: And can you talk about what specifically you did during this time in order to treat the pain? Obviously not treat the structural issues, but to treat the pain just so the listeners have an idea of what you did.
Leda McDaniel: Sure, absolutely. So it's not a quick fix approach by any means, and it's not a singular approach by any means.
Leda McDaniel: 06:08 So I really had the perspective of creating as many positive inputs to my life as possible. And I was really diligent about addressing all the different components as we know, pain really has this bio, psycho social, construct. And so I really wanted to have positive inputs physically, mentally, and emotionally and socially. So physically, I was eating a really nutrient dense diet, so lots of full foods, real foods, fruits, vegetables, bone broths, collagen stocks, things like that. So really preparing foods from scratch and eating a lot of nutrient dense foods. I was meditating to decrease my sympathetic activation or over sensitivity work on the mental component. I was doing a psychological therapy at the time. So cognitive behavioral therapy to try to just that psychological component. I was using visualization to try to incorporate the lowest level input that I could to that system and really start preparing for movement in a joint that couldn't really take movement in the beginning, but trying to retrain my brain to prime it for the movements I want it to be able to do.
Leda McDaniel: 07:42 So I did a lot of visualization on walking, moving my knee. When I got a little bit better, I would visualize myself doing higher level athletic activities such as running or jumping or those sorts of things.
Karen Litzy: 09:44 So over the year plus time that you started incorporating all of these different kinds of inputs into your system, did you start doing everything all at once or did you sort of slowly pepper things in?
Leda McDaniel: Yeah, so there was definitely kind of a gradual addition of different components. As I learned more, I was trying to incorporate different types of movement to try to make a difference. So, for example, I'd started a mindfulness based stress reduction meditation course online. That was free. Because I had found out about that and that helped quite a bit. But I gradually added other things in. And one of the things I wanted to mention as well is I was doing, it's hard to mention every single treatment I was doing cause I was really trying to address all these little pieces and I think addressing all those little things really made the difference to turn the tide.
Leda McDaniel: 11:07 So one of the other important things that I was doing not overly relying on but definitely helped me get out of the most acute and serious pain so that my nervous system could reorganize was pharmacological treatment. So I was taking so medications to get me out of pain. And I think that as an adjunct treatment to the other things I was doing, it was actually really important. So you have these periods of not being in such severe pain that I had the ability to you some of these other treatments.
Karen Litzy: Yeah, and I mean I don't think that there's anything wrong with pharmacological interventions, especially for people with CRPS. I mean this is really painful and I think that you're right, you kind of need the medications as a bit of a reprieve for your systems so that you can get to all this other stuff.
Karen Litzy: 12:08 Now the question is, is are you now on the same medications that you were on in the sort of height of this pain process?
Leda McDaniel: I am not. So I was pretty resistant to taking medication in the beginning. And I really used it for the smallest duration that I could to get me out of that really severe pain. Once I was on my way with this combination of lifestyle factors and I'd really seen the pain decrease to the extent that I could walk without being in pain, or I could touch my knee without having a severe pain reaction, I really started to taper off these medications with the guidance of the prescribing physician.
Karen Litzy: Right. So I think for listeners is just important to remember that if you have pain, we're not saying do all of this other stuff and don't go a pharmacological route because sometimes that's necessary, but you have to make sure that you go that pharmacological route with your physician and that when you're ready to kind of taper down that you do that also under the guidance of your physician.
Leda McDaniel: 13:31 Absolutely. That's a great point. I think also it's important to mention that, and this has been mentioned by others in the field that are doing this work, really trying to get patients to take an active role in their treatment. So just taking medication but not doing these other active components such as meditation, the prescribed loading if that's appropriate. And really addressing lifestyle factors and taking ownership of those in addition to these more passive treatments I think is really important.
Karen Litzy: Yeah, and I think when you're talking about people with persistent pain issues like CRPS, you kind of, I think it's okay to have that combination of active and passive treatments. But yes, the patient has to know that they're not coming to the healthcare practitioner to be fixed, but instead they're coming to be guided and that they need to, like you said, take an active role because all of this, you know, nutrient dense diet, meditation, psychological therapy, visualization, progressive loading, exposure training.
Karen Litzy: 14:49 So exposure to movement, exposure to activities that maybe you have fear avoidance behaviors around. All of this requires active work from the patient, active work from you. Right? And if you're not doing that as the patient, I think that you’re not giving yourself an advantage. Would you agree?
Leda McDaniel: Yeah, absolutely. Well said, Karen.
Karen Litzy: Yeah. And so let's talk about timeframe here. So obviously changing your diet. We know that diet does have a huge ramifications to overall health, the psychological training, the meditation, the gradual loading, exercise, movement, visualization. This all takes time. So people will probably be thinking how many hours a day were you working on this stuff?
Leda McDaniel: Well, for better or worse, I wasn't able to work or go to school at the time. And so really regaining my health over this year period, I actually deferred a year from physical therapy school.
Leda McDaniel: 16:00 I had started and completed my first semester, but then wasn't able to continue sequentially, but my program allowed me to defer a year. So for that year my fulltime job was getting back to health and I really took that seriously as a full time job. So, a majority of my time was spent trying to create these positive inputs. I was doing a lot of reading and trying to learn as much as I could about pain and physical therapy related things, because that's developed into one of my passions and I really felt like it was important to maintain this engagement in intellectual pursuits as well, so that I could have some connection and some purpose to my future, even though I wasn't actively in school at the time or actively working at the time. So really to answer your question I was working on this pretty diligently.
Karen Litzy: And what was, and maybe you didn't have one, I don't know, but did you have this sort of Aha moment at any point? So from the first surgery to where you are now, can you say there was one point where you reached this crescendo and then things started to fall in place?
Leda McDaniel: 17:24 Yeah. Thinking back, I think, I can't pinpoint a specific time point that I would say generally it was about the time when I was forced to take a break from school. So it was almost at the lowest point where I wasn't able to walk on my leg, wasn't able to touch my knee because a sensitivity pain had gotten so bad that it really taken me out of a normal functioning, productive life. And somewhere around that point I was researching and reading as much as I could on my own. And I really stumbled upon this pain neuroscience education approach and some of the work of Lorimer Moseley and Butler and Lowe. And this idea that the pain that I was experiencing didn't necessarily have a structural cause. And to me that was the time period when I really changed my approach from this fixation on trying to find a healthcare practitioner who would tell me what is structurally wrong and how can we fix it to an approach of my nervous system.
Leda McDaniel: 18:42 My brain is just creating this maladaptive signaling, maladaptive pain response and I really need to target my nervous system sensitivity versus trying to pinpoint what is wrong structurally for me, that seems like the turning point, where I was able to really start making gains and gradually progressed back to health.
Karen Litzy: Yeah. So it was kind of the light bulb went off and you said to yourself, I think there's another way. And was there any one piece of reading book article that you can say, you know something, this really helped me to understand what's going on?
Leda McDaniel: 19:30 Yeah. I think as somebody who's interested in health at the time, but you didn't have a great grasp on some of the biology and physiology surrounding pain systems and the nervous system one book that really helped me understand these things and I would recommend to clinicians and patients who are wanting kind of an easy buy in to these sorts of principles is Lorimer Mosley's book painful yarns. He tell stories to communicate these principles of how pain systems work in our bodies. And really does a lovely job making these principles accessible to people who might not have the scientific background to understand because pain is complex. These systems are complex. But listening to these stories, I think it makes it really understandable.
Karen Litzy: Yeah. A little bit more digestible for folks. I often tell my patients to get that book because it really is a patient forward book because of the stories and the metaphor that he uses throughout the book to make you say, Huh, okay.
Karen Litzy: 20:51 I think I'm starting to understand this a little bit. Because for the average person, maybe they don't need to get too into the weeds as to the chemical reactions happening in the brain and within the body in the spinal cord and why these persistent pain issues can arise and kind of take hold in the body. But we certainly can give patients stories and metaphors to help them have a better understanding of maybe what's happening and to decrease the fear around what's happening within their bodies. And I think painful yarns does a great job at that.
Karen Litzy: And all right, so you are diagnosed with CRPS you dive in, you start treating yourself. Were you still seeing a physical therapist over this year? Or were you really just at this point working on all of the components you mentioned above on your own?
Leda McDaniel: 21:51 I had actually stopped seeing a physical therapist because as I was learning more, I was seeking a clinician who had some of these approaches in their toolbox. For example, the graded motor imagery. And I really unfortunately couldn't find one in my geographic area. And so I was actually doing these treatments, kind of self treating at that time, hoping that eventually I could work with a PT for some of the loading components. But knowing that at that point I just couldn't tolerate the exercise based physical therapy.
Karen Litzy: Right. And now were you ambulatory at this time? Were you using an assistive device were you in a wheelchair. How were you getting around?
Leda McDaniel: So after that second surgery I was using crutches for about nine or 10 months. And really non weight bearing. I couldn't put weight on my leg so I didn't go to a wheelchair.
Leda McDaniel: 22:55 Partly probably out of stubbornness. But yeah, I was using an axillary crutches to get around everywhere.
Karen Litzy: Okay. Well that is not easy as we've all had patients who've been on crutches for like six to eight weeks and they seem to just be completely spent. I can't even imagine for 10 months. But I mean good on you for keeping up and I'm assuming you started seeing progress, which is why you kept with all of this stuff. Right? So how long into this year and a half or a year plus did you start to see changes within your pain?
Leda McDaniel: I would say probably within, it took probably three, four months of diligently committing to these practices before I really saw some noticeable change. Which was really hard. But at the same time I think is an important thing to communicate where these changes and the sensitivity that's been built up in your nervous system, it does take time.
Leda McDaniel: 24:10 It does take some patience and some persistence and I would really encourage patients and clinicians alike to have this longterm perspective of if we can introduce these positive things just to kind of have trust and just kind of have faith that they're going to make a difference, that they are making a difference on some level, but that noticeable changes might take awhile to manifest.
Karen Litzy: Yeah, I agree. I think it is very important when you have patients with persistent pain to be very honest with them and make sure that you're giving them some realistic timelines. Because let's face it, we're human beings and we get frustrated, right? We want things to happen sooner rather than later. Especially when you're in pain and especially if you're suffering. I mean you just can't imagine doing this for another month or week or even day for some people. But I think being honest and giving realistic feedback is very important because that also helps you to mitigate your expectations, which is important, especially when you have such a serious pain complications as CRPS. And now, how has this experience influenced the way you will now treat as a physical therapist?
Leda McDaniel: 25:48 I think ultimately while there are a lot of things that I think it adds to my ability to treat patients as a clinician, maybe the first thing is to have a little bit more empathy and compassion for what these patients are going through. Having had this experience, I think I understand what the chronic pain journey and struggle looks like, but also what it feels like to be in that. And I think it helps me relate with my patients a little bit better. So that I'm not just talking at them, but I'm really able to kind of imagine what impact it's having on their life and to try to communicate accordingly and really, really develop some good therapeutic alliance with these patients. I think the other thing that it allows me to do as a clinician is kind of as we were talking about, have a little bit more patience and approach these patients in a little him more of a calm manner.
Leda McDaniel: 27:01 I think in realizing that it's going to take time to see changes, but that doesn't mean that it's not worthwhile to work with these individuals on improving their function but also on improving their pain. And really promoting this expectation that recovery from pain is possible or could be possible, but that's more of a longterm goal for these individuals than some of the patients that we work with who are in an acute injury or an acute pain situation.
Karen Litzy: Yeah. So it's really providing hope to the patient, allowing them to even visualize themselves pain free. Cause oftentimes if you're years into a painful experience, sometimes you can't even picture your life without it. So I think it's really important to give that hope to patients. And another thing that you had mentioned in some of the pre-podcast writing is that allowing the patients to tell their stories.
Karen Litzy: 28:16 So just like today having you tell the story, it can be very powerful way for you to continue with your recovery and for others to learn from. So as clinicians, we have to allow these patients to tell their story and also noting that that story may not all come out at one visit.
Leda McDaniel: Yeah, good point. I think there's just like in any physical therapy session or clinician patient relationship, depending on the personality of the patient and the clinician, there's just a natural unfolding of developing trust and developing an ability to communicate between the two people where you really can't force that story out of the patient and you really can't force that trust or rapport but I think as you're intentional about listening to your patients and understanding where they're coming from and how their injury is affecting their life, personally I think over the course of a few treatments or however long it takes to naturally work itself out, you really can develop a close alliance and improve your ability to the effect that patients' health in a positive way and garner some positive outcomes from your treatments.
Karen Litzy: 29:48 Yeah. And I think the other thing that's important to mention is sometimes patients aren't ever pain free. And that's okay. Sometimes patients aren't pain free, but they're doing all the things in their life they want to do. You know, they're working towards the things they want to do. Or maybe they went from taking four pain pills a day to a half of one a day. So they may still have pain. And I think as physical therapists, it's sometimes a little difficult because we want to fix people, right? We want to make people 100% healthy, but it's okay if the patient continues to have some level of pain that they're coping and they're living the life that they want to live. So I think as new graduates, if I could give a little piece of advice to all of you guys, it's to not take on your patients outcomes as your own, but to really, like you said, have empathy, sympathy, step into their shoes and understand that hey, maybe they're not pain free, but they can do everything they want to do. And that's okay. They can live with that.
Leda McDaniel: 31:00 Yeah, that's a great point. There are different markers or ways that we can see positive change in physical therapy and decreasing pain is one, but improvements in function are another one and absolutely mentioning if we can reduce medication use that can have positive implications of a person's experience and their overall health as well. So I think all of those things are great. Great things to think about.
Karen Litzy: Yeah, absolutely. And now, you know, is there anything that we missed? Anything and we're going to, I'm going to get to your book in a second, but is there anything that we missed about your story? Any piece of advice that you know, maybe you would like to give to clinicians as someone who's gone through it?
Leda McDaniel: 31:52 I think the first thing that comes to mind is as clinicians, sometimes faced with individuals with longer lasting pain or sometimes pain that doesn't quite match a structural issue or a clear PT diagnosis or medical diagnosis. Sometimes the inclination is to get uncomfortable and maybe distrust the patient or the cognitive dissonance that you're feeling into more of a situation. What I would really ask you as clinicians to first off, no matter what, no matter how uncomfortable this makes you or how puzzled you might be as far as what's going on, I would just ask that you really trust what your patient's telling you. Trust their story, trust their experience. And if it takes a few visits to kind of reconcile what they're communicating with, maybe what is going on, whether it's a sensitization or a longer lasting pain that's manifesting in some other way, I would really ask that you treat them as if what they're telling you is the absolute truth.
Leda McDaniel: 33:19 And give that a chance to really play out before making assumptions about a malingering or a psychological primary component to what they're telling you. I think in a lot of cases that's too soon of an attribution from clinicians who are uncertain about what's going on.
Karen Litzy: Excellent advice. And you know, at the end of each podcast I usually ask someone, hey, what advice would you give to yourself as a new graduate right out of PT School? But since you literally are a new graduate right out of PT School, it doesn't seem like the right question to ask. But what I will ask is this, knowing where you are now in your recovery and in your life, what advice would you give to yourself during the height of your pain experience? So if you could go back in time knowing where you are now, what advice would you give to yourself then?
Leda McDaniel: Oh yeah, that is a great question. I think what I would tell myself is, and I did this a little bit, but I think I would try to encourage myself further, is to keep an open mind about what is possible for your improvements in health and for the body's ability to really heal and recover given the appropriate inputs.
Karen Litzy: 35:01 Excellent advice. Thank you so much. And now if people wanted to know more about your story and dig a little bit deeper into your year of healing, they could read your book Moments from a Year of Healing a book of memoirs and essays. And where can people find that?
Leda McDaniel: Yes, so my book is available online. It's available from Amazon, both in a print paperback version and also as an Ebook, supported by kindle. So they can search for the title of the book, Moments from a year of healing, a book of memories and essays or search for my name as the author. And I believe either way they should be able to access that.
Karen Litzy: Awesome. And what if people have questions for you? Are they want to talk to you a little bit more? Where can they find you?
Leda McDaniel: Sure. My email is LedaMcDaniel1@gmail.com and I'm happy to open conversations and really talk to patients or clinicians who are wanting additional resources or just wanting to hear more about my story. Yeah, I think that would be great.
Karen Litzy: Well, thank you so much for coming on and sharing your story. And again, congratulations on being a new physical therapist. Good luck in your orthopedic residency at Emery. And I am very certain that any patient that works with you will be very lucky to have you. So thank you so much for being on the program. Everyone listening. Thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
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LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Christian Barton on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada. Dr Christian Barton is a physiotherapist who graduated with first class Honours from Charles Sturt University in 2005, and completed his PhD focusing on Patellofemoral Pain, Biomechanics and Foot Orthoses in 2010. Dr Barton’s broad research disciplines are biomechanics, running-related injury, knee pathology, tendinopathy, and rehabilitation, with a particular focus on research translation. Dr Barton has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals, and he is an Associate Editor for the British Journal of Sports Medicine.
In this episode, we discuss:
-The inspiration behind TREK Education
-Different mediums that facilitate knowledge translation from researchers to clinicians and patients
-Common misconceptions around running and injury prevention
-The good and bad surrounding social media and knowledge translation
-And so much more!
Resources:
Third World Congress of Sports Physical Therapy
Christian Barton Twitter
La Trobe University Sport and Exercise Medicine Research Blog
Switch
TREK Facebook Group
Made to Stick
TREK Education Website
For more information on Christian:
Dr. Christian Barton, APAM, is both a researcher and clinician treating sports and musculoskeletal patients in Melbourne. He is a postdoctoral research fellow and the Communications Manager at the La Trobe Sport and Exercise Medicine Research Centre. Christian’s research is focussed on the knee, running injuries and knowledge translation including the use of digital technologies. He has written and contributed to a multitude of peer-reviewed publications and is a regular invited speaker both in Australia and internationally. He also runs courses on patellofermoral pain and running injury management in Australia, the United Kingdom and Scandinavia. He is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, and a guest lecturer at La Trobe University and the University of Melbourne.
Christian is currently studying a Master of Communication, focussing on journalism innovation. He is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine, as well as Associate Editor at Physical Therapy in Sport.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody, welcome to our live broadcast. I'm just going to take a look quickly on my phone to make sure that we are in fact live, which I think we are. Yes. Great. All right, so we're live, which is awesome. All right, so thanks to people who are already on and thank you to my guest, Christian Barton, coming all the way in from Australia. So it is my times as you're watching this. It's 9:30 New York time. So Christian, what time is it in Australia right now?
Christian Barton: 00:37 11:30 in the morning. That's quite a nice time to do this.
Karen Litzy: 00:43 Yeah. So we're doing this over two different days, so Tuesday for me and Wednesday for you. So crazy. But anyway, thanks for taking the time out to come on to chat with us. So for all the people who are on right now and for as we go through, if you have questions, you can type them in the comments, we can see them and we'll be able to address them as we go along. But before we get started, Christian, what I would love for you to do is just to tell the viewers and the listeners a little bit more about you and how you got to where you are now.
Christian Barton: 01:18 Yeah, sure. So I'm a physiotherapist by background have been for nearly 15 years now. So it's getting on. I've always had an interest in research and clinical practice and continuing to try and juggle the two. And that probably started from the very beginning. I finished my undergrad course and well tried to find a position to do some research assistant work on clinical trials and things like that. And quickly my mentors taught me to do your PhD and actually started that about a year and a half out. And so I did that quite early in my career and probably since then I've been probably a mix of half, half clinic and research. So along the way, probably as I've gone through more recently doing more and more research because it gets harder to keep the research, you can do bigger picture things, which is something I've become really passionate about and I'll talk more about later.
Christian Barton: 02:05 And so currently I work three main roles. One is my own clinic in Melbourne, which is a sports and an injury clinic. And we work one day a week there and then also work at the Trobe university three days a week. And my main research focus areas around there it's translation and implementation. And then the past couple of years have been doing one day a week with a surgical group. So the Department of Surgery, it's in Newton's hospital in Melbourne and there big project or area of research is around preventing inappropriate surgery. So that aligns very well with what I do of trying to optimize what we do as therapists to prevent unnecessary or inappropriate surgery as we go along.
Karen Litzy: 02:44 Yes. Fantastic. Busy weeks. You have busy weeks.
Christian Barton: 02:48 Yeah, I work alongside the three kids at home and yet it's not, not the easiest to juggle at times, but it's certainly all things that I enjoy.
Karen Litzy: 02:55 Yeah, that's amazing. And every time all the interviews ever had with all of the speakers who are coming to Vancouver in October, all do so much. But we didn't do one time is just have an interview on how you manage your time. But that's for another interview. But I think people would really enjoy that. So now let's talk a little bit more about physiotherapy. So why this field?
Christian Barton: 03:23 Yeah, I think as a kid I was always active, playing a lot of sports and had a few injuries myself. And I think I always valued the physios guidance about getting back from some of those injuries. So that got me interested in the field and then you go to university, you actually realize physio has a lot more than just train sports injuries. And you need to have to think about pulmonary rehab and cardiac rehab and you're electrical physio. There's a whole range in spectrum that we through. But I think pretty quickly when I come out I would want it to go back to musculoskeletal and sports. And so we went back down that path. And I think what I enjoy about being a physio therapist is just keeping people active. That's your more sedentary person, where you're trying to motivate them through lifestyle changes to get active and manage their persistent knee pain or back pain or whether it's a really elite sports person. I really enjoy trying to get people to achieve their physical activity goals essentially is what I'm enjoying.
Karen Litzy: 04:18 Awesome. And now I can see more and more people joining you. Again, if you're joining, please write like where you’re watching from and if you have any questions, put them in the comments because we'll be talked with, you know, so now let's, you had mentioned this earlier, talking about kind of what you do, part of what you do and you're involved in several knowledge translation initiatives. One of them being the trek group, which I remember I guess it was last year after sports congress and we all changed our social media to the trek elephants logo, which was really great. So this is a nonprofit initiative created to enhance knowledge translation to healthcare professionals, but also to patients and general public. So can you tell us a little bit more about trek and how it all started?
Christian Barton: 05:13 Yeah, sure. Also I think my research journeys being quite interesting. When I first started off doing research, I was in a gait clinic doing biomechanics research and I've always found that side of our practice really interesting. And you do this real integral research and you spend a long time for assessing data and finally end up with maybe a couple of things that you can share in the community and they share them. And then I started doing more clinical based research and trials. Firstly looking at biomechanics and then did you that exercise interventions. Very early on I actually worked on a lot of systematic reviews and my passion for doing that was, well we have all this great body of research, we need to bring it together so we can disseminate a little bit better. And then I actually did a project in London where it was actually looking at clinical reasoning of physical therapists and how they integrate evidence into their practice.
Christian Barton: 05:59 And what I discovered really quickly is not only were people not using evidence based practice all that often when I actually talked to them about patellofemoral pain, which I'd spent the best part of seven or eight years researching, they've never read any of my papers, never read any of my research. And so it sort of made me reflect a little bit and go, well, why am I doing all this research? And it's not actually being translated into practice. And so I started to have a bit of a flipping all I did and instead of spending time in the lab alongside doing clinical trials, I started to focus a bit more time on actually getting information out there. And so have a good friend of mine, Michael Ratliffe who's based in Denmark and we often catch up and catch up at conferences.
Christian Barton: 06:40 And actually one of the first times we spent a lot of time together was when I went to a Danish conference a number of years ago. It was actually after that conference, I was sitting down both quite frustrated, having a couple of Belgium beers talking about this problem and the acronym trek come up with just on a random occurrence sitting his kitchen table. I still remember it. It was like, how do we do this? We'd probably need to brand it with already and get people behind a movement and something happening. So trek stands for translating research evidence and knowledge. So it fits really nicely with that. It actually has more meetings in that. And if you look at English language for trek, it means a long and arduous journey, which I think an old translation very much use when you try and actually make change. And then it also fits with
Christian Barton: 07:22 probably one of my favorite books I've ever read, which is called switch, which is how to make change when change is hard. I highly recommend people read this book. It changed my life. And it's a really simple analogy. You have a rider sitting on an elephant and you need to get to a destination. So there's three main parts to that. The rider needs to know where to go. The elephant needs to be motivated because it doesn't matter if the writer tells them how often to go. It's not going to go anywhere to be big beast. Right?
Christian Barton: 07:48 We also need an appropriate pathway to get there. So if you picture yourself as an elephant rider on an elephant and an elephant in the middle of the jungle, we want to get to the beach. There's no path to get to the beach and it doesn't matter, you're not going to get there. So the concept of trek is that we have clinicians, we have patients searching for health information who are all motivated to learn more and to do better. They don't really know where to find that information and they certainly don’t know appropriate path to get there. So the idea of trek is to try and improve that. So that sort of started as an idea about how we do this. And then we've, I guess talking and trying to work with lots of people. It's been set up as a not for profit.
Christian Barton: 08:25 So it's not meant to be owned by anyone. No one's meant to profit from it. It's trying to bring everyone together and break down the silos of competition between universities because universities don't like to talk to each other and help each other because they're in competition for the same grants and that they might be buried. The knowledge translation. So it's been really important to me from the beginning that yes, we'll try here where I work supports it. But it's not meant to be owned by the tribe. It's not meant to be by myself. It's meant to be everyone seeing. And it comes from a socialist I guess, concept called connective action where we actually, it's basically a meeting which we connect people with the same ideas. And then I did a communications degree and was focusing on journalism and multimedia and social media and writing a whole bunch of stuff around that.
Christian Barton: 09:10 And I thought, well, this is a nice platform to use. I think about not just mainstream media, but also social media or whatever people turn. And then our favorite thing, doctor Google, where most people turn to health information. And when you start looking at doctor Google, it's a pretty broken system with a lot of misinformation. And so the concept and my hope is that in time, this trek movement or trek concept could maybe be something that we can't take over with Dr Google, but we can certainly contribute to the information that people find on doctor Google. And so it's getting people around the world to contribute information but create it in an engaging format that will actually get people to rate it and use it. We know there's lots of barriers to reading research for clinicians, understanding your research their reading, but also it's time.
Christian Barton: 09:53 And if you can consume the same information sitting on a train, listening to a podcast or looking at a brief video or infographic that maybe gives you the key information from some research and you can trust that source, that it's not biased, it doesn't have an agenda, then that means you can be confident that you can bring that into clinical practice. And for a consumer or a patient that gets that information, they can maybe make health decisions based on that as well. So that was kind of the origins of the project and it's still growing and developing. A lot of people were helped along the way and hopefully we'll get more as well.
Karen Litzy: 10:24 And what has been, so this sort of launched last year, right? Like officially launched. So what metrics have you found from launching last year to where you are now?
Christian Barton: 10:39 Yeah, so what I did is actually was lucky enough to get a small grant from the Australian physio association to build a platform to improve physiotherapists knowledge of exercise prescription. And so we did a study last year where we basically built a website, which is exercise.trekeducation.org and before we gave access to everybody, we made them do a test, which is about 20 minutes. And so I have this great data for grants. It's linked with your physios. You've still need to sit down and write up and we see big variations of knowledge of exercise prescription. And we kind of expected, our hope was that we could then test the evaluate, right? This website helped to improve people's knowledge. Now out of 1,600, I think about a hundred filled in that follow up survey or questionnaire rate. But it was at least as the grant gave us the funding to build a platform.
Christian Barton: 11:26 And it's a multisite platform. So since this time we've built a website now for many patellofemoral pain, which is a big area of mine for clinicians. We've actually just finishing up a low back pain site and a knee osteoarthritis sites. So by the time the conference is around, we will have launched them and be available and working with some other researchers to make a shoulder side. So think of all the big musculoskeletal conditions with variables. And we've also been developing platforms, consumer patients as well. And so we have one which a PhD student in new idea, Olivia or Silva has been working with me for the last two years and we did a super little trial looking to see how beneficial that might be by itself. And then in conjunction with physiotherapy intervention. And certainly the website by itself is incredibly helpful for improving patient's knowledge and self management strategies, their confidence in doing things.
Christian Barton: 12:17 And it seems to lead to reasonable clinical outcomes as well by itself, but probably better outcomes if we combine it with physio. And we haven't done what to evaluation yet, but we're hoping that we can start to do that more and more as we go along. And most importantly, just have some quality resources that are free. You don't have to pay for it, just there, you can use them. And it's been nice to see the exercise site. And certainly the one with the value at the moment. There's plans to do this as well, but they've been embedded into teaching curriculum as well, which has been really good. So University here at La Trobe is using them, but other universities around the world have also used bits and pieces of content and that's the idea of it is to write and use it all way pointless multiple people around the world creating the same content when we could work, maybe be better together.
Karen Litzy: 13:06 No, that makes a lot of sense. And now you're sort of like you said in the beginning, sort of doing a little bit of both your research and clinician. So why are we, in your opinion, why is it so important to bridge that gap between research and clinical practice?
Christian Barton: 13:23 Yeah, I think from, if I put not my research hat that my clinician hat on and I think about our physiotherapy profession, I think we have some amazing physios around. We do really, really good job. We have others who are very good physios that are working really hard to continue to improve knowledge. We have a lot of practice that I would also consider as pretty low value care and sometimes iatrogenic care where actually maybe delivering health education and information is actually detrimental to the patient. And so I think collectively we need to work really hard to establish our brand better and better because we can do better. And a big part of that is actually making sure that what we do know to be beneficial for patients all around the world is actually disseminated into the hands of people who can use it. And that's a big part of that is physios and other health professionals. So that's the big passion for trying to change it. And I see in my clinic second and third opinions and sometimes it's just the patient hasn't been motivated, haven't done the things that I need to do that have actually been given really good guidance. But equally we see cases where they've seen multiple health professionals and just the treatments and information being given is just not aligned with what we know of contemporary knowledge around evidence about what should help that person
Karen Litzy: 14:36 As physio therapists, what do you think we're doing really well and were doing right and what do you think we need a little bit of hopefully they’re not doing wrong. But what they just need a little boost.
Christian Barton: 14:57 Yeah, it's a good good question. I think in the most part physio practice and physical therapy practice is moving towards more active management and there's lots of debates on Twitter and social media and people argue about the value or lack of value, whichever side to sit on about manual therapy and things like that. But I think overall we are moving to more active management approaches. We are moving more towards managing the pain science side of things and educating patients better about that. And I think that's probably what we're not doing very well is building that brand of what we deliver. And as a couple of hours to that one is I guess getting collective way across the board that we're all on the same page and delivering similar high value interventions. And what that means is some patients will go to see for therapists or physiotherapists, then they maybe get delivered a lot of electrotherapy or something else and they don't get better in a long time. And then they go back to their doctor or their surgeon and say, oh, I did PT, I did physio. It didn't help.
Karen Litzy: 15:54 Yeah, yeah. Failed PT.
Christian Barton: 15:57 It failed. And I think that's something that drives me a little crazy is you don’t fail that profession, you fail an intervention. It's a lot of inappropriate surgeries and other treatments. I think collectively we need to be more on the same page, but that's something the knowledge translation probably helps with a lot. The other part that I think we do very, very poorly and actually worked with Rob Brightly, he's going to be presenting the conference and that is collecting outcome measures. So we don't actually measure what we do very well. We occasionally measured them and this is the same around the world for compensable patients because we're forced to. But if you were to audit most people's clinical practice and say, can you show me that what you do is truly valuable, it's worth something.
Christian Barton: 16:48 Most physio practices won't be able to. And I reflect on myself and I can't do this very well. So we need to get better at measuring the value of what we do. So we can take that information to funders and say, hey, we are actually worth something in what we do is worth something. And so I think that's a cultural thing and it's a systems thing and I think it's something we collectively maybe need to work pretty hard to, to try and change. And certainly locally I'm trying to work with the Australian physio association here and it started to come up with some processes that you can, we might do that and knowledge translation. One of the projects I've enjoyed the most here in Australia is a program called GLA:D. I'm going to talk to Ewa recently and that will be certainly discussed at the conference in the biggest strengths of GLA:D isn't it aligns with clinical practice guidelines.
Christian Barton: 17:34 That's education and exercise. So I'll bring that standard up across the board. So first to trust that when they send someone to the program they will get exercise with education and it also raises the outcomes related to that as well. So it can turn around and we have some great data in Australia which were yet to publish, but it certainly shows from now data that not only does pain improve, which is something that may or may not be the most often, but also changes things like medication and also changes things like surgical intention. So people may believe I need surgery or going down the line to surgery. Am I saying certainly in Australia that less people are desiring that. But we look at that in GLA:D that's great here. But the rest of physio practice so you have nothing to contemplate. Suddenly we need to work. You don't run out.
Karen Litzy: 18:19 Yeah. And I know the APTA here in the United States does have an outcomes registry that they started I think maybe a couple of years ago, maybe two years ago is starting to collect that data so that we can take it at least here in the US to insurance companies to show that what we do is valuable and that what we do should be reimbursed.
Christian Barton: 18:42 Do people contribute to it, do the people actually give data?
Karen Litzy: 18:51 I don't know the answer to that question cause it is voluntary. So I don't know the answer to that question at the moment. But I would assume some people do, but do the 300,000 physical therapists that work in the United States? No, but hopefully it's something that will grow over maybe the next, I mean it's slow. Right? So it may take like a decade plus to kind of, if we're being realistic. Right? If someone were to audit my books so to speak, I dunno. I can certainly show that. I don't know. I don't know. That's something I need to get better at, so I'm calling myself out, I guess. And it's something that I certainly need to do better at myself.
Karen Litzy: 19:52 So let's talk about your experience as a researcher. So we'll move from kind of the clinical dissemination to do you have any tips for, let's say, new and upcoming researchers or even physio therapy students who maybe want to go into the research track to kind of help maximize their potential for reach and for knowledge dissemination? So, you are the researcher, you're doing great work and then what? It doesn't get to where it needs to go. So what tips would you give to people to help with that dissemination?
Christian Barton: 20:37 Yeah, sure. So we put together a paper, which was just recently published in BJSM, trying to remember the exact title, but it's time. I think it's something along the lines of it's time for a place, publish or perish. We've got vanished. Yeah. So we have this in research that if you don't publish your work, then obviously there's no record of you doing it. But also you can't give credibility to your work in peer review processes. Very important to doing that. When we go for job promotions and we got the scholarship, for example, to do a PhD or whatever it might be, they're a competitive process and people look at metrics and one of the key metrics is really simple is how many papers have you published? What journals are they publishing? So it's really hard to get away from that. But ultimately, as we've discussed, that doesn't put the knowledge into the end users hands.
Christian Barton: 21:23 And what happens is we end up with commercial companies selling pharmaceuticals and nutraceuticals and surgical interventions. That can be, I guess maximize money. And even pay teams event and for that matter. And so therefore the researchers, good knowledge doesn't get there. And maybe in health information that if news information gets cut through to clinicians and to patients, so you simply have to allocate some time to do it and you have to be quite aware and understanding that that might mean that you take a little bit of a heat on your academic gap or from a publication perspective because when they have so much time in the day. So that's a thing. It's just having that expectation that you can't do it all. That's really important. Spending some time on it. But in saying that it's not a ton of extra time to, after you publish a great RCT that was part of a PhD or whatever it might be, to spend some time with your media team at the university, put out a press release about that RCT and what the implications might be, which there may be ways from a radio interview or getting picked up in papers.
Christian Barton: 22:27 And so that's not a lot of extra work on top of maybe two or three years of the study even. Right. I think linking in with me, your teams at different universities is a really good starting point if you can. Then we have the social media world, and the social media world as a challenging one because there's a lot of strong and loud voices on there. Some of them are good, strong amount, Sometimes there's misinformation from those strong loud voices. And so you're going into competition for the microphone essentially on social media to do that. And you can get on and you can have debates and arguments and discussions and conversations about your research that you've done. But ultimately the people who disseminating, interpret that are the ones with the loudest voice and that's kind of, you can lose your information, which is a bit of a frustrating thing.
Christian Barton: 23:12 So yeah, so people get very frustrated about that when they've spent two or three years doing some research and then it gets misinterpreted by someone on social media who's got the microphone. So there's a few options around that. I think one of them is either creating a skill yourself or working with someone who has the skills to create knowledge translation resources. So we know from research that we've done and certainly evaluation of this is that the general consumer and that consumer can be the coalition or it can be the patient won't engage with your article, but they are likely to engage with your article but they are likely to engage with an infographic or an animation video. And so spending some time and effort on creating those types of resources to summarize your research findings is probably time and money well spent. So I'd strongly encourage people to price some emphasis on that.
Christian Barton: 24:04 And then you've got an asset on social media, and if you already have a big following on social media, you have to be the one that shares that asset because you've created the asset. So you've controlled the narrative of what goes into that asset and the key messages. You can then leverage the people. We do have a market friend and hopefully they can then share for you, et Cetera. We help with so you can spend your time arguing with the people, misinterpreting your work on Twitter or you can spend your time maybe creating some of resources. And I guess the concept of trek is to try and create resources with those types of things can be embedded into a web page. So if you've done research on my back pain and it's game changing research, then those knowledge translation resources can be put onto a platform on trek.
Karen Litzy: 24:50 Yeah. Great Advice. Anything else? So we've got getting to know the media team at your university to release a press release, which is huge because that can lead to other opportunities. And knowing how to either get your original research onto an infographic or an info video or a podcast, and then use that as your vehicle via social media, attaching that to some social media influencers, if you will in order to kind of get that out there. But I definitely think that's much better advice than banging your head against the wall and arguing with loud voices.
Christian Barton: 25:34 Yeah, exactly. Probably the other advice, if you go back a step in terms of designing search, it's probably really important and this hasn't been done well, but you engage the end user from the beginning. So going back a step and when you're designing your clinical trial, no good designing an intervention that no patient is going to engage or to use. So you might design an exercise program that you think is amazing and it's fantastic, but actually when the patients in the trial do it because they in a clinical trial, but then you go into the real world, It's too challenging for them to do. It's just too difficult. And therefore you're going to get criticized for your intervention that isn't clinically applicable. You want to cop that criticism in that design phase and people say, this is not clinically applicable. This won't work. Because then you've got time to redevelop on it and evaluating it and then realizing it won't cut through. So that's, yeah, I will probably important thing to think about. So when we talk about engaging the end user, particularly patients as the end user, but also clinicians as well, and getting their input because they're all going to be the ones delivering yet. And just to some extent, funders, they're a little harder to talk to.
Karen Litzy: 26:45 Yeah. Yeah. A little bit easier to get in with the patients or your fellow colleagues, hopefully. And now earlier you had mentioned that you have done research into topics such as patellofemoral pain. We also know that you do research in running injuries, obviously knowledge translation. So let's talk about kind of some common misconceptions around, we'll take running injury prevention and management, right. Cause these misconceptions come about because of poor dissemination of information I think is one aspect of it. So what would you say are some common misconceptions around running and injury prevention?
Christian Barton: 27:32 Yeah. So we can go into lots of areas here.
Karen Litzy: 27:35 No, it’s a lot of branches.
Christian Barton: 27:37 Yeah. So let's stick to running because it's a popular thing again. Everyone likes to manage runners and treat runners and not a lot of people like to run themselves. We actually put an infographic series out on our trek website. So James Alexander who is a master student environment moment putting together a series and we have the graphics and there's a few key ones for running injury prevention. One being stretching helps. And so that's something that has long been ingrained in people's beliefs that why you’re getting injured is that you haven’t stretched enough then stretching doesn't actually help us prevent injury. So it's not that it's a bad thing necessarily, although there is some evidence that stretching might impair muscle function, might actually reduce your ability to have muscle function but certainly it doesn't prevent injury.
Christian Barton: 28:31 So focusing on that as the problem is probably not the answer. Footwear often gets blamed for injuries, prevention and also as though the key focus. Now typically most of the times if you changed before where yes, it could definitely cause the injury drastic change, but a lot of times it's not the fault of a footwear. Someone buys a new pair of shoes, but they also decide they want to get fit and lose weight at the same time. And they go out and they overload and they train too much.
Karen Litzy: 29:01 Yeah. So those things kind of do overlap cause you get motivated, you go out and buy the new shoes and then you blame the shoes and not so much the amount of load that you just put through your body that you haven't put through your body in months or years.
Christian Barton: 29:14 Exactly. This is not the shoes that are important because they will moderate where the loads go can to some extent. But I think we get very obsessed and part of that comes back to who controls information that gets out there. And it's shoe companies, right? They sell shoes. There's all these motion control technology that shock absorption technologies. And so that's a big marketing campaign and that changes what people buy. And what I will say, it's a big problem. People have that answer. And then we have big pushes about minimalist shoes and they're the answer to everything. And in reality it's probably going to be very variable across different people in it. People with running shoes, all their life will be taken into women's shoe. That's a big change. So that will probably injure them. So yeah, might help. They need, they might get some acuities buying.
Christian Barton: 29:59 It might help their heel pain or forefoot stress fracture. So again, just that big emphasis on footwear and often because it's a commercial and marketable thing is offering the way what happens? I always love the example of Australia by a guy called cliff young. So some people are watching may know him, but those who don't, he actually run the first ever Sydney to Melbourne ultra marathon. So that's 800 kilometers or so. And one of our quite a few hours now, cause John did most of his training in numbers. He used to run two or three hours on his farm every day chasing sheep in Gum boots. So Wellington boots, clearly he didn't have any significant injuries. Right. And I have some great footage that I take when I teach my running course. That's some great footage of me doing that. And that's not to say everyone should go out and run in gumboots.
Christian Barton: 30:46 But certainly for him he was doing it his whole life. So he's adapted to doing that. And if you're adapted to doing something, don’t change it, right? Maybe maybe you might modify footwear to reduce the weight because that we know that helps with performance, but beyond that we don't really have a lot of good evidence that changes footwear will help with injury or performance or anything like that. So my philosophy mostly before where it ain't broke, don't fix it. But there are some nuances around some biomechanical considerations depending on what you want to try and change. But that's probably a couple of the key points of stretching and in footwear and the importance we place on them. I think it's probably more important to get our training loads right. And probably also thinking about, and these are my biases and there's not strong science on this, but doing a resistance training program might be more beneficial for preventing injury. We could do more loading with our muscles and tissues without that impact. And so that's possibly beneficial. And we do see some evidence that may be doing a resistance training program helps with performance as well. And most people get down because they're trying to run personal best times or beat their friends or whatever it might be. So rather than smashing yourself more and more on the training track, maybe get in the gym and do some resistance training would be my advice.
Karen Litzy: 31:57 Great. All right. Now, we're gonna shift gears just a little bit here. So the next question is what is or are the most common question or questions, I'll put an s on there that you get asked. And this could be by researchers, clinicians, patients, maybe you've got one for each. I don't know. What are the most common questions you get asked?
Christian Barton: 32:28 Yeah, so I'll start with researchers. So academics, you sort of touched on this a little bit before, but it's often around how to dedicate time and make knowledge translation, but not just that. So creating the resources we've talked about before, but how to navigate media or platforms like Twitter, like you get on Twitter and someone's attacking your research and let me see, interpret it. Or you get on Twitter and you put something out there and someone gets offended and that's a problem as well. And so it's actually, it's very difficult on social media because when you're typing things and writing things in, emotion gets taken out of things and people interpret emotions. So you might write something that has really no emotion attached to it, just a simple statement, right? But someone who thinks that you might be attacking them, we'll take that as an attack and then that creates a problem.
Christian Barton: 33:19 All the time. And I know that I offend people at times because they tell me that I've offended them and that's what I really appreciate it at least it gives me a chance to reassure and go look. It's not meant to be offensive when used social media is a positive way of translating knowledge and then other people probably get offended and just don't talk to me anymore. Yeah, I think I've been blocked a couple of times.
Christian Barton: 33:51 So my advice usually to people about Twitter is I think it's immediate that you can get a really good understanding about how part of the world is thinking. It's only a small part of the world. And then I think it's important to understand that that's the case. You're only getting a snapshot of some people and often it's people who have louder voices and want to go on talking, but it does give you some insight into that. And I think for me that frame some of my research questions and maybe modify as and move it and helps me narrow it down. It gives me a media where I can use assets that we've created to put them in hands of people who will disseminate them. So I think that's really, so sharing a good infographic or podcasts or video on that platform is one of the influential people there who hopefully then share your message. So I think it's important to have some presence there for that reason, but don't get emotional about it. If you feel like you're engaging in a circular conversation, you probably are engaging in circular conversation. You just stop, don’t keep going.
Karen Litzy: 34:48 Pull yourself out of it. Like I think often times what I see in those circular conversations is like somebody, it just seems like one of the parties within that conversation wants to win more than the other one. Or are they both really, really want to win. And so it's just like, I'm going to get the last word. No, you're going to know I am. No, I am. It goes back and forth and you just like,
Christian Barton: 35:14 My advice in those situations, for someone who feels like they're in a circle of conversation, they're beating your head against the brick wall. Just step back for a little bit and just think why is this happening? Why is what I believe or what I think not being interpreted the same way. Right. And it might be that actually you discover your own biases and it might be that. And that's a good reflective thing. It's ok to change you mind and beliefs. That's a good thing. That's a positive thing. Or it might be that actually you don't have as much supporting evidence for what you believe in. And maybe that's because you need to do some better quality research to test your biases and maybe you discovered that actually you were wrong, or maybe you test your biases properly and you discover I was on the right track, so that's good. Yeah. You usually have to prove myself wrong more than I proved myself. Right. That's a good thing. Yeah. Or actually worse what's happening, it comes back to that communications is you're not disseminating your messages very well. So you're actually not providing an adequate messenger. You can sit back and think about that and don’t keep argue with that person. You think about some strategies to disseminate and put together a podcast or a video, or write a blog about the topic that has really good details where you've got more than a couple of hundred characters.
Karen Litzy: 36:30 Yeah, that is really useful. So, and sometimes in these kind of conversations, if you will, sometimes you can also just take the person and send them a direct message where you can write a novel if you want to do as a direct message. And I find that when you do that and you kind of can explain yourself a little bit better, it helps to kind of foster better communication and a better conversation. And oftentimes when it's in private, people are different.
Christian Barton: 37:07 Yeah, that's great. And, taking the conversation off the social media platform is often a really good strategy too. Navigate and get over those miscommunications that can happen. Yeah.
Karen Litzy: 37:17 Yeah, I've done that before.
Christian Barton: 37:20 That's really spread enemies. Right. And then probably the other advice I'll give to people when I've actually put a tweet about this I think earlier this year or late last year. It's just, I'll refer to them as trolls and I'll call them trolls in until they show their face. People who are on there who don't have a public face. So it's social media. So for me you should have the transparent profile and the reasons for that is you want to know where people come from and where their beliefs come from so you can understand their point of view. And if you can understand that point of view, it makes it a little bit easier to have discussions with. But there's probably people on Twitter who just set up their identify profiles just to kind of attack and stir the pot and it's just not worth engaging with those people's I used to try and have their fun with them and make a few jokes and I've done that a few times. If you'd be probably saying that like, so that's also a time wasting. So it's kind of entertaining, but it's also time wasting as well. So I think when you identify, communicates, asking you persistent questions and almost feels like you're having circular conversations just block that person. There's no, you don't know what their alterior motive is. You don't know what their conflicts of interest are. You don't know where they're coming from.
Karen Litzy: 38:28 Well, you don't even know who they are.
Christian Barton: 38:31 Exactly. And so I don't think we should engage with those people. That's my first way. Most people won't like hearing that and they just keep creating new profiles. Right. Well that's okay. I never used to block anyone until six months ago, are quite a few people in racing time for that very reason. In short, if you get it, get into social media and you kind of, so you can learn from it and focus more on giving some quality content and having meaningful discussions rather than arguing. Yeah.
Karen Litzy: 39:01 Yeah. That's sort the idea of social media, especially when you're a professional, you want to be a professional because you're a professional and so, and the point of social media is to be social.
Christian Barton: 39:20 Yep. I like that.
Karen Litzy: 39:21 You know, it's not to go on there and be antisocial and argumentative. You're there to be socially it's fine to debate. It's fine to disagree. But some of the things that people hear this all the time that you see on social media, you would never see that kind of an argument with people face to face. It just wouldn't happen. You know? So you have to remember to keep this social in the social media and not be like a maniac.
Christian Barton: 39:52 I like that phrase. Keep the social in social media.
Karen Litzy: 39:54 Yeah. So if you could recommend one must read book or article, what would it be?
Christian Barton: 40:02 Yeah, so I mentioned earlier about with the trek origins and the concept around that. So switch is probably my book. I think it's influenced my life the most from many respects. I think I gave a really brief, probably poor synopsis of it. It is the elephant, the rider and getting to the destination. But it just changes the way you think. And when you're trying to make a change, it gives you nice, simple way for you where your barriers are. So is it people don't know what they need to do? Is it about the emotion and motivation? There's lots of great analogies that examples within that that I think will kind of really inspire you to think about the rest of your work. Not just research it, it's not just clinical practice but how to change relationships with different people and things like that. So I think it's a really good book to read. I'll give you a second one as well. John Rockwood. Yeah, no, he's translation and dissemination is a book called made to stick and that's basically made to stick. So it's around how to make your messages stick. So that's a really nice book as well. So if you're trying to communicate more clearly, that will hopefully give you plenty of ideas and concepts to look out for. That'd be my to go or recommendations.
Karen Litzy: 41:12 Perfect. All right, now let's get to the conference. It is October 4th and fifth in Vancouver of this year, October 4th and fifth of this year. And can you give us a little bit of a sneak peek about what you'll be speaking about at the Third World Congress?
Christian Barton: 41:32 Yeah, sure. So we've got a couple of presentations. One is actually in the session review, which I'm really looking forward to discussing with yourself and all around knowledge translation. And one of the things I want to talk about in that is how healthcare disinformation develops and spreads? Cause I think it's important we understand the mechanisms of that. And that also allows us an opportunity to understand how we can spread good information because we understand how, how can this disinformation grows and spreads. And hopefully that gives us some insight into how we can grow and spread the good quality information. And so we'll go through some of that and break down some of the things we've talked about around using I guess digital assets for knowledge translation in. One of the things I've actually really looking forward to talking a little bit more about is some of the outcomes from the research we've been doing, particularly around patients and finding them and what we can achieve through a good quality website.
Christian Barton: 42:23 So we have a review at the moment, which is under peer review looking at patellofemoral literature and it doesn't just do a systematic review of patient education. It also looks at online information sources. Basically when we look at all of those is the vast majority of conflicts of interest, often financial conflicts of interest. There's a lot of missing information on there. And so for the person navigating that, that's really challenging for them. And we've done a lot of qualitative work with people with the patellofemoral pain. And then part of the new ways work I talked about before, we actually did reasonably if we needed to clinical trial where for a period of that trial all they had was a website that we developed for them. And we put multimedia and engaging resources with quality information and accurate information, simple exercise program that they could do.
Christian Barton: 43:12 And so we're still pouring through the results and we'll have it done before the conference and I can see from the preliminary stuff was actually do really well by themselves with quality information. And certainly that then makes your life easier as a physio cause you don't have to fill in as many gaps. I can focus on adequate exercise prescription or clarifying some information and things like that. So it makes us more efficient. So yeah, really looking forward to talking about that in our session. And then the second session I'll be talking on is around exercise prescription and I think the title is beyond three sets of 10. And so I mentioned at the beginning my research started in the biomechanics lab and I used to think biomechanics, were the be all end all and I've probably changed my opinion on that over the years and very subtly, very slowly and I still think biomechanics matter, and exercise prescription around that can be important, but equally education alongside your exercise prescription to address things like Kinesiophobia and pain related fear or something that we find is a really important factor in managing people’s pain.
Christian Barton: 44:19 So yeah, a huge barrier to actually getting engagement, but even getting, they might do exercise but they won't get as much out of it if you haven't tackled those fears and beliefs. We'll talk some of the research we've done in that space recently around how that can guide exercise prescription and some processes around that. And then I've had some fun almost on the other end of the spectrum where we've actually just got people in the gym and focus more on physiological responses and we just smashed it in with strength and power. And one in physical therapy in sport, which is just a feasibility study. Probably 10 people, people who we just put through a resistance training program of strength and power and the reason we did this study is when you look at all the patellofemoral literature, no one has done a program of adequate intensity of progression and duration.
Christian Barton: 45:10 You would actually see any meaningful changes in strength and power despite the fact that a lot of them say that they do strength from your title when you actually look at their protocols are not true strength protocols. So we decided to just put great people through this program and just smashed them in to do. And they did better than I thought they would do. I was actually surprised. And so we'll talk about some of the findings and implications of that and how to put that into your clinical practice. And I think the whole idea for me is we have these programs that physios focus on around motor control and they often low dose exercise. Don't know what the education part alongside that done very well around pain, weighted fear and even exercises to tackle that. And simple great exposure. But equally we don't get the end stage stuff done very well. Actual really good progressive resistance training. Yeah. I think we get the middle part done well, but we kind of miss those two elements that's trying to bring all that together. So I'm looking forward to that where it’s not just three sets of 10 of hip abduction and knee extensions.
Karen Litzy: 46:11 Yeah, no, that sounds great. And, and I know that anyway, they'll probably be a lively discussion around that topic. I know here in the US, if people are using their insurance, they're often cut off before we would ever even remotely get that. Let's get you in the gym and really do it, you know, let's really kind of work and like you said, like smash it out, get them stronger, get them confidence and, and it's unfortunate, but that's the system that we have to play in and yeah.
Christian Barton: 46:44 Well, we can put a link up to the paper on the Facebook group. It’s actually open access at the moment? It's appendix of all the exercises. I think they're really simple exercises which was kind of cool about. So we just, we really just pushed it straight away and we only went for 12 weeks. And that was purely from a feasibility perspective of yeah, it just costs money to do these projects over a long period of time. Yeah. But my bargain is that if we kept going and with the clinical hat on, they continue to improve, at least in terms of function. A whole different kettle of fish, but they can do more exercises, more progressive. We make it, the more they can do and wherever their pain usually reduces. But wherever it gets to the point where they're happy or not, at the conference we'll talk about that.
Karen Litzy: 47:29 Yeah. Sounds great. I look forward to it. And are there any presentations at the conference that you're particularly looking forward to?
Christian Barton: 47:38 Yeah. So I think, and not just because I'm talking to you now, but looking forward to our presentation, not just from me talking but also hearing from yourself and rod and I, I think one of the things I've appreciated about knowledge translation and using social media experts, there's no person in the world that knows everything you guys had it through. Then over the years I've actually learned quite a bit from yourself with the podcasts and stuff you do and really enjoy some of yours. And I think I like the process and approach you've taken and I think you've been quite inspirational about how you can actually find a model where you can spend time doing it, which is really cool. I'm so looking forward to hearing more about that and maybe you have some good tips for me, but also Rob Whitely presenting in the same session.
Christian Barton: 48:22 I really like the way rob thinks, he thinks very differently to most people. He's got my favorite Twitter profile picture that I've seen so enough. Those are not from Australia where I quite understand it, but there's a picture of a kid with his head down looking asleep. We've got ex Prime Minister Tony Abbott talking at the same time. So it's quite a funny picture. But he's, yeah, he's a bit eccentric, but also very clever for instance. The whole conference is really good with lots of, I think clinically focused presentations because everyone presenting going through it has a really strong clinical focus here in what they do. I think that's a real strength of it. The Saturday morning there'll be a couple of really good workshops I was looking at it yesterday and trying to work out knowing that you would ask this question where I want to go.
Christian Barton: 49:13 And you've got that and it's allowing presentation with Ewa Roos, Christine, both of which have a huge respect for and I’ve learned a ton about exercise. And so I'm looking to that and saying what other things I could learn from my clinical practice. But at the same time, talk to you about upper limb, the same stuff. Now I see a few cases in shoulders. I don't see as many as Rollin, so it'd be great to learn some things from them, but also I liked to take knowledge from other areas and see how I can apply that to lower limb in my research and yeah. One interesting to do that, but I reckon I'm going to have an apology to those guys for saying that I won’t be able to make both. I'll have to make sure I send someone along.
Karen Litzy: 49:55 It’s going to be hard to choose, but you know, you'd take someone over, you have to divide and conquer. Exactly. You know, can you send someone with that? Yep. Need a team. Yeah, yeah, yeah. Over a beer or wine
Karen Litzy: 50:32 No, for me, like a small little glass of beer. That's right. Yeah. Thanks. Yeah, that's true. That's true. And you know, look at sports congress. This past year I did not have the flu. So drinking those like small little ones kept me awake.
Christian Barton: 50:49 Good, good, good.
Karen Litzy: 50:51 I found like this sweet spot. Well Christian, thanks so much for coming on and giving your time. Thanks everyone for coming on and listening. And Christian, where can people get in touch with you? Where can they find you? They have questions or they want to give you some unsolicited feedback or arguing.
Christian Barton: 51:26 Very happy, very happy with any feedback or questions. Probably easiest way to engage is probably on Twitter. So do you use Twitter a little bit for that? We also have a Facebook group for the trek exercise group. So if you look that up, I might put a link to that as well. So it's trek exercise group. And so that's not a bad medium to kind of start to engage with the trek initiative. And we'll actually use that to launch the back pain and also arthritis websites and I can put some links on there to the top from a website which we set up. And actually the other thing on that note, and I might put this on the Facebook page here as we have a course for anyone who's interested, it's a free online course learning how to critique randomized controlled trials.
Christian Barton: 52:14 So basically it takes you through some modules about how you go back to taking them. Before that we kind of get your knowledge and confidence on your capacity to do that. Do the course and then you could take a few articles and then at the end of it there's a followup test to see how you go. There are actually some prizes as well. So at this point in time we've had I think over a hundred people sign up to this. But only around about 20 finished. Yeah, there are two $500 prize as far as with Australian dollar prize. So at the moment those 20 people will have finished it or, and we've a one in 10 chance we'd pop your dollars. Say I would suggest that you jump on board and have it for learning, but chances to win a prize
Karen Litzy: 52:51 This is 500 Australian dollars or US dollars.
Christian Barton: 52:56 It’s about $350 US. So it's not as lucrative. It's not a small amount. So this is actually part of the, the trek project in collaboration at the University of Melbourne who established this. And so that's the sort of stuff that we're trying to do with trek is to put these types of resources out there and Yep. So hopefully we can get a few people on board back.
Karen Litzy: 53:21 Yeah. So you will try and put all the links. I'll find the links to books and everything that you had mentioned. Switch and make a stick and trek and we'll put them all in the comments here under this video. So that way people can click to them, and join the trek group and figure out how to get in touch with if you have any questions. So everyone, thanks for listening, Christian. Thank you so much. This was great, and I look forward to seeing you in Vancouver.
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On this week’s episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr.Tami Struessel and Colleen Rapp on the show to discuss holistic physical therapy. Tami is an Assistant Professor in the Doctor of Physical Therapy Program at the University of Colorado Anschutz Medical Campus and treats patients in an outpatient clinic. Colleen Rapp has worked as a journeyman and press operator at The Denver Post for more than 30 years. Decades of physically demanding work plagued Colleen with back and shoulder injuries as well as significant chronic pain, ultimately requiring surgery. In 2014, she turned to physical therapist and University of Colorado faculty member Tami Struessel, PT, DPT, OCS, MTC for care.
In this episode, we discuss:
-The key elements that allowed Tami and Colleen to develop a strong therapeutic alliance
-The importance of a holistic treatment approach to physical therapy care
-How Tami’s treatment approaches have shifted to be more patient centered
-How physical therapy has changed all aspects of Colleen’s life
-And so much more!
Resources:
Colleen Rapp Twitter
Colleen Rapp Facebook
Physio Pro Website
University of Colorado Tami Struessel
Clinical Outcomes Summit: use the discount LITZY
Benefit Concert for CU PT Scholarship
More information on CU Giving Scholarship Program
For more information on Tami:
Tami began with Physio pro in 2018, and enjoys working with patients after all types of injuries and surgeries. She is an Assistant Professor in the Doctor of Physical Therapy Program at the University of Colorado Anschutz Medical Campus, and has been awarded Bachelor’s, Master’s and Doctoral degrees in Physical Therapy. Clinically, she has been recognized since 2003 as an Orthopedic Clinical Specialist (OCS) through the American Board of Physical Therapy Specialists and since 1999 as a Certified Manual Therapist (MTC) through the University of St. Augustine. She is a past recipient of the American Physical Therapy Association-Colorado Chapter Physical Therapist of the Year, and teaches, and researches in the areas of clinical reasoning, orthopedic physical therapy practice, and practice management. She is a member and past president of the Colorado State Physical Therapy Board through the Colorado Department of Regulatory Agencies (DORA).
Outside of work, she spends as much time with her family in the mountains as possible, enjoying cycling, hiking, skiing, snowshoeing and mountain music festivals. She has 2 adorable dogs, Daisy a boxer/great dane mix, and retired seeing eye dog Donovan, a yellow lab.
For more information on Colleen:
Life-Changing Experience with Physical Therapist Inspires Patient to Give Back
Colleen Rapp has worked as a journeyman and press operator at The Denver Post for more than 30 years. Colleen noted, “I'm very proud to be a woman working in a ‘man's world’ where the work is difficult, but rewarding.”
Decades of physically demanding work plagued her with back and shoulder injuries as well as significant chronic pain, ultimately requiring surgery. In 2014, she turned to physical therapist and University of Colorado faculty member Tami Struessel, PT, DPT, OCS, MTC for care.
After being introduced to and working with Tami at Physio Pro Physical Therapy in Denver, Colleen’s outlook on maintaining a healthy lifestyle began to shift. Colleen reflected, “Life-changing care, to me, is defined as care that influences great changes in self.” From the beginning, Tami approached Colleen’s treatment from the whole-person perspective. “In addition to my treatment, Tami showed me online anatomy classes so I could learn muscle groups and have a better understanding of my body,” she said. Additionally, Tami introduced her to things like a calming application, in efforts to reduce stress.
Tami said, “Colleen is one of those patients who truly embraces the idea of becoming stronger and healthier, and is a huge believer in physical therapy.”
“For years, I viewed my work as my exercise,” she said. Through the help of Tami, Colleen lost 30 pounds, has better eating habits and consistently exercises 5-6 days a week. “Tami has taught me the concept of working smarter, not harder,” said Colleen.
“I feel like a whole new person thanks to my care, and it has led to a newfound appreciation for exercise and for keeping my body strong,” Colleen added. “Tami really wants to see her patients succeed, it matters to her.”
Admittedly, Colleen wasn’t fully aware of physical therapy and its importance when she was first referred. From learning movement, stability and range of motion among other things, she realized there were many elements of physical therapy beyond what she initially thought. “I realized that physical therapy was the most important thing in between the points of injury and health,” she said. While every day presents challenges to stay on a good path of nutrition, exercise and the willingness to strengthen her physical fitness, Colleen is greatly appreciative of Tami’s influence and care in her life.
“Through her hard work, Colleen has transformed herself into a much healthier and more resilient person,” said Tami. “To me, that is what being a physical therapist is all about!”
Colleen’s experience and Tami’s impact was so life-changing that Colleen felt inclined to give back. With Tami being a Professor for the CU Physical Therapy Program, Colleen felt the best way to honor her was to support funding for student scholarships. Colleen initiated a fundraising campaign for the Physical Therapy Student Scholarship Endowment, supporting future leaders in physical therapy. “I not only personally donated, but I’ve run multiple online auctions where I have sold sports and music memorabilia,” she said. Colleen is not only motivated to improve herself and her quality of life, but ensuring the availability of funds to help the next generation of physical therapists impact their own patients.
CU Program Director Margaret Schenkman, PT, PhD, FAPTA has led the charge behind student scholarships since the inception of the CU PT Scholarship & Endowment Board in 2012. Colleen noted, “Margaret supported my efforts to give back and help the students. She reached out to me with so much kindness.”
“I know that my efforts will impact a student’s life just like Dr. Struessel has impacted mine,” added Colleen. “She’s far more than my physical therapist.”
Read the full transcript below:
Karen Litzy: 00:01 Hi Tami and Colleen, welcome to the podcast. I'm so excited to have both of you on. As I said before we went on the air, this is a first time I've had a physical therapist and a patient on at the same time. So I'm excited for the listeners to learn from both of you. So welcome. Welcome to the podcast. All right, so Colleen, let's start with you. So, why did you seek out a physical therapist?
Colleen Rapp: 00:32 Well I was working and I hurt my back and I went to a doctor and basically he had me go to physical therapy, which I had gone before maybe like a couple of weeks. So I wasn't really familiar with physical therapy, but I had hurt my back really bad. So I knew it was going to be a long road and I was kind of nervous at first. And so he recommended me to go to low high physical therapy. And that's where I met Tami.
Karen Litzy: 01:02 And so I know you said you didn't know a lot about physical therapy, but once you were referred to physical therapy, did you look anything up? Did you have any expectations?
Colleen Rapp: 01:13 I really didn't have many expectations because I'm working with a lot of people that have gotten hurt in my job, I'm a pressman of the Denver Post. It wasn't a very good report from the people because they just didn't get a lot out of it. So it was kinda like, oh, I'm going to physical therapy, what a drag. And that's kind of what I was looking at. So I didn't really know a lot about it, so I just kind of walked in there and had to go basically.
Karen Litzy: 01:45 Okay. And so Tami, let's talk about kind of that first visit. Did you know any of this before Colleen came in to see you or did she say, Oh, I'm just here because the doctor told me to.
Tami Struessel: 01:57 Well, this particular clinic, sees a fair number of people who are press operators at the Denver Post where where Colleen works. And, so I had seen, you know, a few people here and there. So I knew a little bit about the job. I knew it was a pretty physical job that they had a fairly high injury rate. I evaluated her and, you know, found out that she had had a long a history of being very healthy in her job until she hurt her back and that she was, you know, she was in a lot of pain and I'm having a really hard time getting back to work. And so that's where we started.
Karen Litzy: 02:45 And it's kind of look at this as like a mini case study right now. Right. So Colleen she comes in with low back pain, injured at work calling. Were you unable to work at the time?
Colleen Rapp: 03:01 Yes, I was taking off work. I could barely walk. So I was taking off work. I couldn't even go down to modified duty. I was at home.
Karen Litzy: 03:10 Okay. So Tami kind of walk us through your evaluation, meaning when she came in, what kind of questions did you ask for this subjective? And then what did you look at for the objective part of the eval?
Tami Struessel: 03:36 She'd had a long history of working in a very physical job and the vast majority of people that do the job or are men and that she had been very successful and really loved her job and worked hard at it and was very proud of it. And I think she's still very proud of it.
Tami Struessel: 03:58 And I think I asked probably fairly typical questions about the mechanism of injury, how she was injured and you know, what kinds of, you know, what kinds of things she was not able to do and what kinds of things she could still do. And then did a full lumbar and hip examination, which I always do. You know, kind of head to toe but focused on those areas.
Karen Litzy: 04:31 After that evaluation, Colleen, what did you feel after that first visit when you left? Did you feel like, oh I think I'm in good hands here? Or were you like, oh maybe this might work but I'm not sure.
Colleen Rapp: 04:46 No, I definitely at first knew I was in good hands with the way Tami treated me when I came in. I think she knew I was a little nervous and so she kind of, you know, kind of joked with me and she kind of liked explained things to me and then she examined me. But through the examination it was very comfortable. So I was like, oh okay, this isn't so bad. You know, you have to feel comfortable at first and get that report and then you're just not like shaking going, oh my gosh, where am I at? And so I think after like 20 minutes of that and just talking to her, cause the first session was an hour and after her examination she sat with me for about like 10 minutes and explained everything to me about, not exactly what was wrong with me because she doesn't really believe in that she believes in, you know, the fact that I need to know to listen and not concentrate on that. So she kind of just explained to me about, that we were going to work together. I was going to see her twice a week in that we were just going to get me better and get me stronger and made me feel really comfortable. And that was the first step of like just being a good experience.
Karen Litzy: 06:03 And you know, before we went on the air, I've talked about this idea of a therapeutic relationship. And I think Colleen, you just really described a really great first step in achieving a therapeutic relationship. So Tami, did you have a sense when Colleen left that A she is going to be coming back and B she was probably going to be pretty invested in this.
Tami Struessel: 06:36 I mean, I guess there's always a possibility that you don't connect with people and that they, you know, they choose not to come back. But I didn't get that sense from her. I think, from the very beginning she was very interested and I think because she does like her job a lot and, really wanted to get back to it. Just in general she was invested and I think one of the things she talked about is, as most people do, to know the thing that was wrong with her back. And I'm pretty averse to the, you know, biological approach model and explaining all of the anatomy and everything.
Tami Struessel: 07:27 Because I've been doing this now for 28 years, so, I used to do a lot of that. And I realize now that that's just not healthy. And she, she actually, you know, she embraced that. And she already said that that clearly is kind of a core principle for me that, you know, I'm not gonna, I'm not gonna, you know, get that model out and say, here's the thing that's wrong with your back. And, you know, unfortunately sometimes, you know, depending on who she's talked to, whether that's coworkers or that's the nurse at work or that's one of the workers comp physicians or something like that. I think she got a little bit of that. And I tried to divert away from that mindset and that she's really been very receptive. She doesn't ask me very much anymore exactly what you know about my disk or about my, you know, I mean, we talked a little bit about your SI joint but we try not to focus too much on it.
Karen Litzy: 08:32 Right. And so Colleen from a patient standpoint, what Tami was saying, is it just for your clarity, so a lot in the physical therapy world, we used to rely on the sort of biomedical model where you know there is an issue with the tissue A plus B equals C. So this hurts and this tissue is quote damaged. This is why you have pain. Now pain, we know is much more complex and we use what's called a bio psycho social model of care, which is, yes there is the bio part is still in there, but we also want to take into consideration that there are psychological aspects to pain and social aspects to pain. So Colleen, my question for you is, did you feel like not focusing solely on the biomedical part of it or just on the tissue part of it was helpful for you in your recovery?
Colleen Rapp: 09:34 Yes, because it made me realize that I needed to just work and get better instead of like, oh, this is what happened to me, this is what I have and if I knew, I think I probably would have been scared, you know, or like, Oh, poor me or this or that. And I didn't want to get into that, that view point. I wanted to kind of just say, okay, all right, I got somebody that just basically let's do this. Let's get working, let’s get me back to work. I'll work with you. You work with me, I'll teach you things and do the best for me. And I needed to listen and I needed to do those things. And that attitude gave me the will to do that and not focus on the other stuff. And that helped. It really did. If you get your mind focusing on what is wrong it doesn't really help. You got to kind of move on and try to do the things you need to do to get better.
Karen Litzy: 10:32 Yeah. I think that's great advice for anyone. Instead of dwelling on what's wrong, let's start dwelling on what's right and what you can do to improve your function and to improve your life. Two very, very different ways of looking at things. And from a patient standpoint. I think that's great to hear. Now, Tami, you were saying before we went on that, okay, the back thing was a couple of years ago, but then there were also some other things. So Colleen is a bit of a repeat offender, no offense Colleen. But again, I think that shows the strength of the relationship. And now I don't know what the laws are in Colorado, but do you have direct access there?
Tami Struessel: Yeah, we have a 100% direct access.
Karen Litzy: Lucky. So, Colleen, when you were injured, let's say subsequently after the back, you had gone to see Tami for other things. Did you know just to go straight to her or do you still have to go through a system?
Colleen Rapp: 11:32 When I went I hurt my shoulder, I basically asked my doctor if I could see her and I told my doctor that I was comfortable with her and the success that I had with her, with my serious back injury and that I really felt comfortable with her and he was okay with that.
Tami Struessel: 11:54 These were work related injuries. So there's always going be a claims process and a physician, now take a little bit of a step back after we finished treatment related to her back. We did do some training sessions to really get her beyond, you know, kind of basic back to work and those kinds of things and work a lot on fitness and exercise and those kinds of things, which was fairly new for her. I mean, not that she didn't exercise before, but I think she can probably talk about like what her fitness routine was like.
Colleen Rapp: 12:43 Okay. So I think that the most important thing that we're kidding here and I have to kind of come on and for 33 years I worked at the post and I'd never really had an injury and like little things until like five years ago when I hurt my back and that it just seemed like, the last few years with the, you know, staff decrease in everything, we might work a little bit harder or faster and stuff. And I think things have gotten a little bit to where I had had like three injuries and so that's really cool cause Tami actually working with her has reminded me to always make sure that I work smarter than harder and got me back to where no matter what my position is, my work or my life or anything, I always have to be smart and I always have to take care of myself first and you know, be careful what I do and think about what I do. Cause it's the job I do is very dangerous and it is really scary. And, this whole PT thing is really important because it did change everything that I do at my job and it has made it so much safer for me.
Karen Litzy: 14:04 So Colleen, I'm going to ask out of pure ignorance here, what exactly does your job entail?
Colleen Rapp: 14:21 I actually worked on a five story press. Like on TV where the paper's coming on a conveyor and yeah that's what I worked on. They're a little bit more fancier but they're a little bit bigger. Now there are about five stories high. They're really long. I'm really not sure how long they are, but I do like 600 steps a day. I lift 50 pounds, I push a 1500 pound rolls. I do a lot of climbing. I do a lot of everything. It's eight hours, 10 hours, sometimes 12 hours of just physical work.
Karen Litzy: 14:56 Okay. Wow. So that's a lot. So now Tami, as Colleen is coming to you for various injuries. You obviously have this in mind. So my question for you, and this might be some good advice for other physical therapists who might be listening, is how did you take into account her job and the requirements of her job when it came to exercise prescription and things like that. And then, and now I understand why you moved onto the fitness part of things because you know, you hear a lot like, well, insurance cut me off so all we could do or just these little exercises or I only saw the patient for six weeks when in reality, we know they need a lot more to stay healthy and to not reinjure themselves. So what advice would you have for therapists who need to take into account the person's very physical job?
Tami Struessel: 16:02 Yeah, so I think there's probably two components of that. So, one is definitely, the work itself and, you know, if I was having her do basic, you know, transverse abdominal contractions and, and those kinds of things, it was just never going to be, you know, to a point where she was able to, you know, get strong enough to actually physically do her job before. And I knew she was able to do it before so she would be able to. So there was definitely, I believe in Colleen could tell you this. I believe in hard exercise. I think sometimes we don't push people enough and some of it does have to do with, there's times where we have a very short, you know, we see somebody for three weeks and, you know, how much can you do from a fitness standpoint.
Tami Struessel: 16:55 But we were lucky. We got to see Colleen for longer. And so I had her work hard, as far as kind of general exercise and fitness and getting stronger. There was a time in my career where I would go out and visit the patient and see what their job was and those days are mostly gone, honestly. We get video, you know, off of people's phones. And so I had a pretty good idea of what the work was. But, several times Colleen, brought in, you know, we've talked about it and she's brought in video of, you know, the types of work that she needs to do. And then we would go through things like, you know, so what of your job duties do you think is the hardest or most trickiest? Because she would have to get into like, you know, awkward positions or I think I remember trying to work with her on like what her foot position was or something. She's like, you realize I'm standing on this little bitty platform that I can't really move off of. And I was like, oh, well maybe we need to re rethink that. So I don't know if Colleen you want to talk more about that asset
Colleen Rapp: 18:10 There’s sometimes where like I'm standing on a platform and there's like a drop on either side of me and I have to reach up and lift up probably about a 45 pounds piece of press. It's called a bar and turn it around and position it in a different way without falling. And it's really crazy because on this precept, the press, there's an air connection to it. So once you take it off where it goes, it pulls you back. And so you have to be pretty strong and you have to be pretty smart or you know, you're in trouble. You can drop it, break your toe or something. So I think we worked on that and that was the most important thing that I think while we're on the subject is the greatest thing about Tami was, is that she saw that I needed to stay strong. When you injure yourself, I think that you have to learn that it's not over.
Colleen Rapp: 19:11 As soon as you walk out at therapy, you have to stay strong. You have to keep on doing your job and you have to do the things that are going to make you able to do that and not keep getting hurt. So would this keep working together? I learned all kinds of stuff. I learned how to, you know, just talking with her, she would say, well, can't you move the press down a little bit so you're not, your arms aren't up so high or can you just position yourself or can you not twist? Then, it just all made sense to me and I always say that you can walk up some stairs and you come up really fast. This for example, but if you walk up the stairs right, sounds weird. But if you walk them up right, you can do a whole bunch of them and you're not hurting yourself. But if you don't do things right, the repetition does wear on you. So my period of time with Tami and learning all these things and doing the things that I needed to learn just totally, it was life changing for me.
Karen Litzy: 20:12 That's amazing. Tami what a great job. And if I can go back to kind of just reiterate what you had said before. So when you're working with someone who may be has a complicated job situation, not everyone sits at a desk for, you know, eight to 10 hours a day. Not everyone does that. I love the advice of asking the patients to take video of what they need to do. And then the question that you asked, well what are the things that you know are most problematic for you? What are the trickiest things you need to do at your job? Because if you can get the things that are the hardest things to do, I would imagine that working on those and getting some confidence and to be able to do those really difficult parts of the job, then you can get down to like some of the easier work after.
Tami Struessel: 21:04 Definitely. Yeah. I mean, and some things are not modifiable. I mean, when you're a large piece of equipment. But what I found with Colleen is she was so familiar with the job and what she had to do that, you know, both we could work together to find alternative ways or alternative positions. I'm like, is there any way you could step up or, you know, do something so that you're not reaching so high or, you know, whatever. And many times she was like, Oh, actually, I've never really thought about doing it that way. I'll try. And, often she was successful with that. And the other aspect was that she had such seniority that she is able to, she has such seniority that she's able to bid on shifts that are a little bit healthier for her in general now. We can talk about things like sleep and diet and stress reduction and weight loss and all these things are a result of her really embracing the idea of, you know, she wanted to continue to work. She knew that she wasn't probably going to be able to, if she didn't really change her lifestyle. And to her credit, she absolutely did. And I repeatedly tell her she's the one that put in the hard work cause I can do all of these same things with somebody else and if they don't take it seriously and they don't really embrace it, then it doesn't matter.
Colleen Rapp: 22:42 I think that that's the greatest thing about this is Tami taught me it’s not the exercise it's eating well, nutrition, losing weight, sleeping good, using your environment. I was hiking today and I was thinking about, you know, about what the most important thing about, you know, physical therapy and everything was, and I always think that some people that are really working out and stuff, they have to use weights and they have to do things and they think they're so strong and they still do things wrong. And I was hiking and I was like, I use my environment to make myself better every day because of Tami care. By the way, I walked, at work, the way I move and the way I eat, the way I sleep, the way I think because actually, injuries and especially a couple injuries, you know, I just got out of one injury and got hurt again and that was totally mentally hard on me and all this connects to the patient and that's what a patient goes through.
Colleen Rapp: 23:58 So when you can correlate all this in your life as a whole body and like Tami teaches, it's amazing. It is. I truly believe that physical therapy is the most important thing between the point of injury and health. And if you keep on going, I'm going to be walking when I'm 62 and I want to be doing a whole bunch of things and it has just changed my life.
Karen Litzy: 24:23 I think this is such a great example, Tami, of being a physical therapist, treating at the top of your license and really, really incorporating lifestyle change into your practice. You know, it sounds to me like you're more than I see someone for a bout a therapy they're discharged, Versus giving them a lot of skills and tools to not just take care of that bum knee or the painful shoulder, low back pain, but rather let's look at this person as a whole. Let's take a holistic view of this person. So you know, you said you've been
Karen Litzy: 25:23 practicing for 28 years. I've been practicing for like 20, so I can certainly attest that my views have completely changed from when I first started. So I'm not going to assume that yours have or haven't, but if they have changed, where was it in your career where you feel like you had a major shift? Like I can say I know exactly when I had sort of this major shift in treatment paradigm. Did you have that major shift or was it just as more research came out, you just started incorporating all of this? Or were you doing it from the beginning.
Tami Struessel: 26:03 I would say that I don't know that I had a shift. I'm fortunate enough to teach at the University of Colorado and so I'm around really smart people all the time and I don't want to minimize how that is so important including people that practice in all different areas. And so I've learned a lot from, you know, from our neuro folks, from our cardiopulm folks, from other, you know, musculoskeletal people. I guess, you know, there was a shift at some point, and I don't even remember, I think I might've gone to a course where the emphasis is like, you know, your orthopedic people have neurological systems. I would say that's probably, if I had to have a point of shifting that was like, oh, of course, you know, if I'm not addressing that, then, you know, then I'm missing the boat.
Tami Struessel: 27:06 That was a while ago. But, I would say from a language standpoint, you know, therapeutic neuroscience education and motivational interviewing and some of the things that, you know, I think probably took the first of those about maybe four or five years ago. So, I was never a big, well, I can't say never, but I think I figured out that, you know, just pulling out the spine model and scaring people to death was probably not a good idea a long time ago. But I do think that that, you know, I think we all have learned that probably some of the language that we use is not helpful. I don’t know if I had a Aha moment or it's just, I think I've always been very open and from my first outpatient job, I remember I did inpatient for a couple of years and then, I worked at a clinic where the people had continuing education lists that were just enormous and that had a big impact on me. I specifically remember thinking, you know, wow, these people really are invested in learning and learning from each other as well. I think that was instilled in me very, very early in my career and it's continued with me. I have a pretty long continuing education list because I've, you know, been able to glean something from every single thing that I've gone to.
Karen Litzy: 28:40 Yeah. That's amazing. And Colleen, as the patient, do you get a sense of that, this sort of lifelong learner in Tami?
Colleen Rapp: Oh, yeah. I think Tami inspires me. I mean, I kind of look at her like, who else could you be in your profession? I meen, you teach, you practice, you govern, you everything, you know, I mean it's so inspirational. I have to tell you one thing that she did for me that was kind of relative for this. Not only did she teach me about my health and help me see my things, I kind of like, I'm in a world where the press room so I'm not like very, I'm educated, I'm smart, but I'm smart and the things that I know, and she introduced me to classes online where I could learn about anatomy. And so I took them and it was amazing. She taught me how to be a better person in a whole bunch of ways and being able to go into a doctor's office and know what my quads were and kind of explain things a little bit more and understand what we were doing and what was firing and actually all the way around. It's really incredible. So yeah, I think very highly of her. I think that she totally is a true inspiration. And a gift for her profession.
Karen Litzy: 30:12 Sounds that way to me. That's for sure. And it also sounds that, you know, from the patient's standpoint, and I think this is so important, it's something that we hear so much about is that through education she was able to empower you to take control of your own health. You were partners in your care versus her just telling you what to do. And you did it without knowing why or what behind it. And, like you said, really inspired you to reach for more. And if every physical therapist can do that with every patient, then I think that would be such a boon to the profession.
Colleen Rapp: 30:52 Oh, definitely. It would, it would kind of, yeah. I mean, you guys, you guys are really important and you guys change lives, but you know, it's hard because not everybody's accessible to that. So, but in this story, I was and it's changed me. I've lost like I think, tell me what, like 35-40 pounds and I exercise like, yeah, like three or four times a week. And I'm just overall a better person. And, it's just a wonderful thing. I'm very, and as, you know, it's in me now and it's not just physical therapy. It's life. It brought life back in me. I can say it that way.
Tami Struessel: 31:44 You already said, well, you know, I was hiking today and, you know, I mean we're fortunate enough to live in one of the most beautiful places on earth. Colleen has taken full advantage of that. You know, I think there was a time where she would come home from work and was tired and he wouldn't do a whole lot. And now she's really, she's really a drank the Koolaid of being an active person. I think she exercises, but she's also just a more active person in general and thinks about activity and exercise differently. And, she embraces that and embraces making some lifestyle changes that has made all the difference.
Karen Litzy: 32:36 And you know, before we kind of wrap up here, I just have one more question for each of you. They're going to be slightly different, but Colleen, I'll start with you and you've kind of, I think might've already answered this question sort of throughout, but as a patient, how has physical therapy changed your life? And part two of that, what advice would you give to someone who's on the fence about physical therapy?
Colleen Rapp: 33:10 I think physical therapy changed my life because I've learned that the most important thing is mobility and stability and so movement. I was always thought that to be a strong person, I had to go out and, you know, get a trainer and do 50 pushups and 30 squats and walk home, couldn't breathe, you know, and what I learned through physical therapy is that the exercises that you get are, are really important to learn how to balance. The simplest things can impact you in a certain way. And the other thing is that I had to embrace it because if I embraced it and learned how to do the things Tami taught me, not on any of the exercises, but if my leg hurt and how to take my leg, or I said, or something I could achieve to be better and to stay better and not be a person that was going to a year from now say, oh my shoulder still hurts or my back still hurts.
Colleen Rapp: 34:20 And that's what I worked every day for is finally instead of, you know, I finally found something that like physical therapy that just had an impact to me. And it's very important and it's very important if you do those things, you'll be successful. And that's the way I believe. I think that to tell somebody is to give it a chance. Because I work with so many people that don't, they automatically say, I want to have surgery, I don't want to go to physical therapy. And, I think you get into that stuff where they just assume that it's a waste of time. But I think if you would just give it a chance and just see and, and give it, you know, give it a try and listen, I think you'll learn that it's gonna Change Your Life. Like it did mine.
Karen Litzy: 35:11 Incredible. And Tami, this is a question that I ask a lot of my physical therapy colleagues that come on the program and that's given what you know now where you are in your life and your career, what advice would you give to yourself as a new Grad right out of PT School?
Tami Struessel: 35:38 Wow. That seems like a long time ago. You know what I think, it might be similar and actually I give this advice to my new grads that I teach. And that is that first of all that your first job or two is so formative and so select wisely, you know, look for places where you have a sense that the culture is good, that there is a lifelong learning mindset. I want to be sure that my patients that have come to see me, if I'm on vacation for a week, then they can go to somebody else and I know that they're going to get really good care. And then just that lifelong learning for yourself. You know, if you get stagnant and, you know, kind of bored, maybe you need to kind of figure out what you might be able to do to kind of spark that again.
Tami Struessel: 36:45 There was a time where I decided that I wanted to pursue teaching and I really sought out that opportunity and that's been extremely enriching for me as well. So I'm really fortunate there, but I also don't want to, you know, teach and not treat patients. As long as my body can hold up. I want to, I want to keep doing that because it gives me all kinds of great stories for a class. And it’s also fun. I think I was born to be a physical therapist, so, I know I made the right choice a long time ago and it still is really a terrific profession.
Karen Litzy: 37:32 Amazing. And Colleen, can you tell us a little bit more about your student scholarship fund and what you have coming up?
Colleen Rapp: Well, Tami changed my life so much that I wanted to do something in return. And so I found out this scholarship fund at her school didn't get a lot of funding, so I worked like a year and sold, sports memorabilia and I basically sold concert tickets and all kinds of stuff and I put all the proceeds for a year to the fund. And so the year was up and I kind of wanted to do something. I was like, well, this was really good. I want to do something like really crazy fun, you know, go out with, you know, happy, you know. So I decided to arrange a concert on September 5th, and it's going to have a pretty good artist in Denver. Her name is Hazel Miller and all the proceeds will go to the scholarship fund. They will be donated. So I'm kind of excited about it.
Karen Litzy: 38:37 That's incredible. And what a great way to kind of pay it forward. And then just to be clear, this is a scholarship fund at the University of Colorado.
Tami Struessel: 38:48 The doctor physical therapy, specific student scholarship fund.
Karen Litzy: 38:54 Awesome. Well, I mean, Colleen, what a great way to give back to the profession and to the future of the profession. So, and I'm sure those at the University of Colorado are very thankful for all of your help and enthusiasm in getting the word out about physical therapy. I know. I am. So Colleen, thank you for coming on and sharing your story. And Tami, thank you for coming on and sharing your story. In the way that you've worked with Colleen, and I think that you're giving a lot of therapists, especially newer grads or students, a nice glimpse into really how we can move beyond just take an injury and rehab it to take an injury and change a lifestyle.
Tami Struessel: 39:42 Yeah. Thank you so much, Karen. That's what I'm practicing at the top of your license, as you said before, you know that’s where you can really feel good every day about inspiring people and getting people to make lifestyle changes, like Colleen made, so that they can be a better, stronger, more resilient person. That's what it's all about.
Karen Litzy: 40:08 Amazing. Well, thank you both ladies, for coming onto the podcast today and to everyone listening, thank you so much. Have a great couple of days and stay healthy, wealthy, and smart.
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LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Lars Engebretsen on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada. Lars Engebretsen is a professor and consultant at the Orthopedic Clinic, University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center.
In this episode, we discuss:
-Dr. Engebretsen’s career shift from being reactive to proactive in injury treatment
-The importance of a team approach for injury prevention in sport
-Programs that focus on translating injury prevention research to coaches and trainers
-How to develop your research portfolio
-What Dr. Engebretsen is looking forward to at the Third World Congress of Sports Physical Therapy
-And so much more!
Resources:
Third World Congress of Sports Physical Therapy
Oslo Sports Trauma Research Center
Lars Engebretsen Twitter
For more information on Lars:
Dr. Lars Engebretsen is a professor and consultant at the Orthopedic Clinic, University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center.
He is also a consultant and former Chief Doctor for the Norwegian Federation of Sports, and headed the medical service at the Norwegian Olympic Center until the autumn of 2011. In 2007 he was appointed Head of Science and Research for the International Olympic Comittee (IOC).
Lars Engebretsen is a specialist in Orthopaedic and general surgery and authorized as Sports Medicine Physician (Idrettslege NIMF) by the Norwegian Society of Sports Medicine. He serves as chief team physician for the Norwegian Olympic teams.
The main area of research is resurfacing techniques of cartilage injuries, combined and complex knee ligament injuries and prevention techniques of sports injuries. He is currently the President of ESSKA (European Society of Sports Traumatology, Knee Surgery and Arthroscopy).
He is the Associate editor and Editor in chief for the new IOC-BJSM journal: Injury Prevention and Health Protection. In addition, he serves on several major sports journal editorial boards and has published more than 200 papers and book chapters.
Read the full transcript below:
Karen Litzy: 00:01 Hey everybody, welcome. Happy Saturday to everyone. For those of you who are on the Facebook page right now, welcome. I'm just going to check and make sure it's on. Yes. So we are live, which is awesome. As you know, we've been doing live interviews with speakers from the Third World Congress of sports physical therapy. And for those of you who, if you're on this page, I hope you know when it's going to be, but it's October 4th and fifth in Vancouver, Canada. And today I have the distinct pleasure and honor to be talking with Professor Lars Engebresten. So, professor, welcome. Thank you so much. And as we said before, I've been practicing that name for at least a week, so. All right. Chris Napier, welcome. We said welcome, to you, thanks Chris for being on. It's a little bit early. They're over in Vancouver. So professor, before we get started, can you please tell the audience and tell us a little bit more about you, your career trajectory, and what you're up to?
Lars Engebresten: 01:17 Yeah, I'm a professor at the University of Oslo Department of Orthopedic Surgery. And then I work, at the Olympic Center of Norway getting gold medals for Norway. And then I do work at the Olso sport Trauma Research Center, which I run together with Rollbar. And then I am a professor at the medical school and I work every other week for a couple of days in the Olympic national committee. So I have a very good combination or clinical practice. I still operate and I see patients quite a bit every week and research. I have many PhDs working on projects that I would say coordinated by myself.
Karen Litzy: 02:02 That's an amazing amount of work to do. It's like five jobs all rolled into one and I'm sure, although this is not what we're going to be talking about today, but maybe another time we'll have you talk about your time management skills. I mean, how you get all of that done because that's an amazing amount of work to fit in. But let's dive right into, since you just mentioned that you're still doing clinical work and research, so how being that clinician scientist, how important is that to merge your clinical work with your research work?
Lars Engebresten: 02:38 Well, you know, I think I found out very early in my career in orthopedics how important researchers, I was actually, you could tell this story I was doing in clinic as a resident, up in Trondheim where I did my residency and next door to me was one of the professors. And I had many patients with anterior knee pain. And I would ask him, what do you actually do with those patients? Cause they now see him a little bit strange now on them and then suddenly I operate and all that. So I said, yeah, what kind of operation do you actually do? And then it sounded, you see, I do a Mickey operation, like, elevating the tibial tubercle to reduce the load on the Patella site. And I said, oh, that's strange. How are they doing? And he said, oh, they all do very well.
Lars Engebresten: 03:35 And then I actually looked up 50 of those patients. I am in the hospital and then sure enough about one third did pretty well. One third was about the same and one third was much worse. Then I realized, you know, you can't really trust the old professors. You have to in the areas where there are some doubts here and there and what to do, you have to do research in those areas there. There's no way you can be a clinician in your university clinic without, doing that kind of research. So since that time, which was a long, long time ago, I've actually been doing all kinds. So both clinical and basic science research
Karen Litzy: 04:18 How does one inform the other? So how does clinical inform research and research informed clinical for you?
Lars Engebresten: 04:28 Well, for me it's been like a, you know, I see patients, I follow a various teams. I'd done all kinds of soccer teams, handball teams, ice hockey teams and so forth. I see the issues, what kind of problems do patients have. And I see what we have to, give them in the form of various therapies or various surgeries. And I realized that we aren't really perfect. That there is a lot of research that remains to be done actually. So that's a general in general speaking the way, I've found out that this is something I have to do. And, when I was young I was doing all kinds of sports myself. And I also realized that, you know, when you got the injured really, we really didn't have that much of a argument for getting people back. And that was a long, long time ago. And now we're better, we aren't getting better, but, we still have a way to go. So the last, I would say, 30 years I've been working on the three different research areas. So I've been working on a cartilage issues, a ligament issues, and then later on the prevention of injuries issues.
Karen Litzy: 05:48 And you know, since you mentioned the injury prevention issues, let's dive right into that now. So, you've been involved in conducting a number of studies regarding, sports injury prevention. So what would you say are some of the common misconceptions around injury prevention?
Lars Engebresten: 06:10 Right. It's very difficult to get people really interested in that area because, you know, it doesn't really pay much on an individual basis. It does pay back to society because you get less injuries by doing it, but to the individual doctor or Physio, it is a difficult because of the payment schedule in these cases. In my case it was actually more specific at what made me change my attitude to this. So I was doing, all kinds of basic science and also can you go studies in the ligaments and tendons and then, you'll see them and they are very good. They were supposed to win the gold medal. Actually in Sydney. The star player had an ACL eight months at a time. And, which was a major issue of course.
Lars Engebresten: 07:17 And we operated on her and the most successful and she came back, Nora did not win the gold medal. Olympian bronze medal and she didn't really perform the way she was supposed to. And I realized then actually, that, you know, what we were doing was not really that great. I realized that she was on track for getting osteoarthritis pretty early after the surgery. And I realized, Oh, all my efforts in the, you know, ligament, design and, new ways of doing the surgery and stuff wasn't that great because I thought, you know, I should spend more time on how can I prevent these types of injuries at the same time as I treat them later on. But I kind of refocused towards prevention all these injuries after that incident.
Karen Litzy: 08:25 So getting back to this injury prevention, so based on our current knowledge of injury prevention in sports, what would be your recommendation or go to strategy intervention for injury prevention? So for example, is it exercise? Is it load management? Is it education?
Lars Engebresten: 09:05 The most important thing is to look upon this as a team effort. There's no way you as one person, I would be able to make a huge difference in this area because prevention is all the aspects that you mentioned. And therefore, you know, in our case, you know, also sports trauma research center, we are a quite a few people working in this field and there's no way that not one of us could make a big difference. Yeah. It's all about the team effort. Because you have to do research, just figure out whether your program is working. Secondly, you have to make people do it. And third, you have to look at results of it. And that really demands a manpower, budgets, long term studies in this area.
Lars Engebresten: 10:13 We’ve done a lot on randomized control studies showing the effect of these programs, but we still don't have perfect compliance, you know. What we have found out lately is that, we are changing our approach and it can be towards instead of travel around I get a mixture of some of this to athletes and stuff. We actually tried to teach the coaches in Norway anyway. The coach educational programs are now filming this prevention programs we have. So it's all about, I think parents and coaches, then the doctor or the physio doing it. So we have to be able to relate all the knowledge we have and to be able to implement it. And that is the biggest challenge at the moment.
Karen Litzy: 11:17 Yeah, that makes a lot of sense. Changing people's behaviors is not easy.
Lars Engebresten: 11:25 It's not, but you know, at least where I live and I'm sure also in the US, we have been able to stop people from smoking. Very, very few smokers left here. So we should be able to, you know, instigate the system where, if you are young and you're doing a sport, part of your sport is the prevention part.
Karen Litzy: 11:50 Yeah. And, and I think that that's great example that yes. Smoking, when I first moved to New York City, so many people smoke. Now it's a rarity mainly because of good outreach campaigns, via media and things like that. And sometimes they think that's where, injury prevention and sports injury prevention is just not getting its fair air time, I guess. Right. So when you look at mainstream media and news and things like that, they focus on the injury. So the professional player who gets injured or the collegiate player that gets injured, this is the injury. This is the surgery versus look at all the people who haven't gotten injured and why is that?
Lars Engebresten: 12:33 Hmm. Yeah. You know, there are some good examples. For example, hamstring injuries, we have a pretty good way of reducing and reducing those by maybe as much as 75%. And even in the premier league in England, the best, very best teams, you don't really do those exercises. And it's really, really crazy cause the number one injury, keeping people out of premier league soccer is actually hamstrings, it's a very strange thing that I've not able to, and I think that's all about, you know, the coaches being involved and understanding how important is this.
Karen Litzy: 13:15 Yeah. And are you doing things in Norway? I know you said that now you're getting more coaches to come to lectures and things like that. So if there are people listening from other parts of the world, what sort of system are you using to get those coaches in?
Lars Engebresten: 13:32 Well, there, you know, almost every country has some sort of cultures of education and it's like level one, two and three and so forth. And, now we have introduced international programs, you know, all those levels. That’s part of some sort of daily education is about prevention. And I think that's I must add a key in this area. We have shown that we are able to reduce the number of serious knee injuries for example by more than 50% in some sports that are really prone to those type of injuries. Team handball is a very good example. Basketball could be another one. So I think that education day is very, very important. But as I said, we are trying out new ways of getting compliance improved cause that's still an issue.
Karen Litzy: 14:30 You can have a great injury prevention program but if nobody does it.
Lars Engebresten: 14:36 Hmm. I know, you know what we are trying to do is to teach the parents. If you have a daughter, 12, 13, and 14 year old and if she plays soccer or team handball, the chance of having a serious knee injuries are very high and you can really take out insurance by doing a these kinds of exercises at the same time that you are training. So maybe spend 10, 15 minutes, three times a week on this that would be able to reduce the percentage risk for having an injury like that.
Karen Litzy: 15:13 Yeah, I mean from the standpoint of the clinician and the researcher just makes so much sense. We just have to get the coaches and the players and the parents and team organizations in schools and things like that on board. And I would assume that takes time and some effort and the incentives.
Lars Engebresten: 15:35 I think that in the US you have all the sports in schools, right? Whereas in the rest of the world, for the most part the sports are outside schools and community teams and stuff like that where it is a little bit more difficult to get this through. So there should be good chances in the US and Canada as well.
Karen Litzy: 16:01 Alright, well hopefully people listening to this will kind of take this to heart and go to their local high schools and middle schools and try and educate those coaches and parents. All right. Now you already touched upon this I think a particular patient case that you personally treated that caused you to reevaluate your whole treatment paradigms. And I feel like you touched upon that a little bit already. Do you want to expand on that at all?
Lars Engebresten: 16:31 Yeah, in a sense that, for me personally, it really changed me from, you know, doing surgery four times a week, four days a week, to spending more work in the research lab, trying to design exercises to help in preventing these kind of injuries. We have done a lot of work on looking at why are they happening and how are they happening. And our team here in Oslo has relatively good knowledge in this area and that has helped us in designing programs. It's taken a long time and takes your way from the OR and into a different environment and that has really put the major change in my medical activities.
Karen Litzy: 17:24 And are you happy with that change?
Lars Engebresten: 17:30 I am, I'm going to a meeting, for example now in a couple of weeks and I'm preparing for it in Pittsburgh on the ACL, various kinds of injuries. And that just tells you here all these, experts from around the world. They still attending as still the same question comes up. And again, there hasn't been a huge development, I would say, when it comes to serious knee injuries in the results of the treatment we have. So there, you know, the area that I'm interested in, this prevention area probably have still a lot to contribute to the field because you would, the surgeons haven't really caught on, at least not on the measure where of them. I would say in this, even though if you guys have done it, the physios have done it. The big story is still lagging behind a little bit.
Karen Litzy: 18:36 Yeah. And it's to me, what it sounds like I'm hearing from you, is it sort of forces you to be instead of a reactive doctor, a more proactive physician.
Lars Engebresten: 18:47 Absolutely. That's a good point. That's a difficult change.
Karen Litzy: 18:54 Yeah. Especially because you had a lot of training, but it's still, I mean, it's still all medicine and in the end it's helping the patient, which is the most important thing. That's why we do what we do. Right. As we said in the beginning, you're also a researcher. You have an impressive publication record, hundreds of peer reviewed articles. So if you kind of take a look back at all of those articles that you published, which one of your research projects or papers is most meaningful to you? So maybe it doesn't have the highest altmetrics score, but which one to you is like most meaningful?
Lars Engebresten: 19:40 For me that's very difficult to say actually because you know, not because I have some many, but more so because I have various fields and I've been very heavily involved in, there were some really important ones in a mechanism and I was working in the lab and then taken lab or to the OR. But I think that, overall the most important one is probably the one we did on, prevention of ACL injuries and team handball and follow, this for 10 years. I mean, you could see, you know, when we went in there actively and we were able to reduce number injuries and then we kind of stepped out and let the players do themselves, ramp back up, all the injuries. And then we really, reinforced our efforts and all of a sudden we were able to really reduced the number of injuries again and just shows us that if you really, put your mind to it, you can really achieve something. So that's probably the most important paper to come up with. Then again, you know, this is all about a team, a group, a team thing. It's not something I've done myself. Yeah. I've been part of the whole team, so really that's probably the most important.
Karen Litzy: 21:00 Nice. And then what advice would you have for young researchers who are trying to develop their publication portfolio?
Lars Engebresten: 21:10 Yeah, I keep telling my coworkers in the hospital, that's not the university that although it is great to have patients and to treat them and see that they're doing fine. Still if you've been doing that for 10 years, you kind of get bored after a while if you don't really progress and develop yourself. So you have to be able to do some sort of research during your clinical work as well. I'm really trying to tell them some examples here and there, why I did this and that. And then it is absolutely possible to combine a missing clinical practice with some sort of research at least if you're able to work as a team. So you still as you know, have other orthopedic surgeons or in my case physios and trainers that you work with, which will enable you to do much more then you can do only by yourself. I think their whole, the most important advice is to, you know, if you look at your 10 last patients and you see and you really look, take a close look at them, then you realize that, you know, there are many things you don't really know. So there many things that needs to be researched. I had one young person come up to me a while ago saying that he was discouraged because there's nothing more left to research. That’s all wrong.
Karen Litzy: 22:51 Yeah, everything's been done?
Lars Engebresten: 22:54 Everything has been done and you know, that is absolutely wrong there's so much left to do. So there's work for everyone.
Karen Litzy: 23:07 Yeah, I would think there would be. And now let's talk about what you're going to be speaking about at the Third World Congress on Sports physical therapy. So can you give us a little sneak peek as to what you're going to be speaking about?
Lars Engebresten: 23:20 Yeah, I see from the program that I'm going to talk about ACL or ligament injuries and a surgical treatment versus non surgical treatment. And that's something that we have been working on for awhile in Norway and also with other groups, where we have lots of research have been showing that in Norway we actually do about 50% of our ACL patients are having ACL surgery. The reason is that, you know, people that are not doing pivoting activities or pivoting sports they are completely able to continue what they're doing without having a reconstruction, things like that. The key there is of course, range of motion proprioception and strengths. And, if you are able to do that, then you can do well without having an ACL reconstruction. And even if you have an ACL reconstruction, if you don't do those kind of rehab are, you'll never be successful. That's probably what I would be talking about and some of the results we have from our area in the room.
Karen Litzy: 24:39 Sounds great. I look forward to it. And I think it is amazing that it's only 50% of people in Norway. I feel like in the US it's much higher. You probably know the figures better than I do. But just from an anecdotal standpoint, it seems like the moment someone has an ACL tear, they're having surgery regardless.
Lars Engebresten: 24:57 Yeah. I'll let you know. The point is nobody knows that in the US because you don't really, you know, how the numbers on people and not having a ACL injuries. It's very interesting because I been working with China actually on developing an ACL program for them. And you know, they have thousands of ACL injuries, but I have no clue on how many actually, because I think they have mostly injuries and China is not really being operated on, at least not until now. But you are right in your part of the world. If you have an ACL injury, you will be operated on automatically almost. And the same goes for central southern Europe. It's the same thing. And in Scandinavia, Sweden, Finland, Denmark, Norway. We're trending to operate only on the ones with the pivoting work and the rest we don't do so in Norway we have about 4,000 ACLs a year. You know, 2000 see surgery.
Karen Litzy: 26:14 Right. We'll see what happens as time goes on and people start to realize that maybe there are some other options. But I'm definitely looking forward to that talk in Vancouver. And are there any talks that you're looking forward to or people that you're looking forward to seeing?
Lars Engebresten: 26:32 Yeah, you know, I look forward to see some of the PT work on the new ways of getting people proprioceptively sound new ways, testing people for it, in sport, things like that. That is really something that interests me.
Karen Litzy: 26:50 Well, I have to say, I want to thank you so much for taking time out today. Is there anything we didn't cover that you have like a burning desire to talk about before we end?
Lars Engebresten: 27:00 No. I look forward to come to Vancouver. It's a wonderful city. I was there during the Olympic Games in Vancouver, and Whistler and also down in Vancouver and it was a beautiful area.
Karen Litzy: 27:16 Yeah, me too. The only time I've been to Vancouver was when I went to whistler to ski. I was only in Vancouver for as long as it took me to get off the plane, get into a car and drive up to whistler. So I'm definitely looking forward to spending a little more time there. But thank you, professor so much for taking the time out and speaking to everyone and Chris and everyone else that's watching. And Mario gave a thumbs up. Mario Bozenie, thanks so much for tuning in and hopefully we will see you all in Vancouver October 4th and fifth so thanks so much.
Lars Engebresten: 27:50 Thank you.
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On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Tamara Rial on hypopressive exercise. Tamara Rial is the creator and co-founder of Low Pressure Fitness which is an exercise training program based on hypopressive, myofascial & neurodynamic techniques.
In this episode, we discuss:
-What are hypopressive exercises?
-Patient populations that would benefit from hypopressive exercises
-The latest research on the mechanisms and effects of hypopressive exercise
-Common criticisms of hypopressive exercise
-And so much more!
Resources:
Shannon Sepulveda Website
Shannon Sepulveda Facebook
Tamara Rial Website
Herman and Wallace Website
Pelvic Guru Website
Tamara Rial Instagram
Hypopressive Guru Instagram
Email: rialtamara@gmail.com
The Outcomes Summit:Use the discount code LITZY
For more information on Tamara:
Tamara Rial earned dual bachelor degrees in exercise science and physical education, a masters degree in exercise science and a doctorate with international distinction from the University of Vigo (Spain). Her dissertation focused on the effects of hypopressive exercise on women’s health. She is also a certified specialist in special populations (CSPS).
She is the creator and co-founder of Low Pressure Fitness which is an exercise training program based on hypopressive, myofascial & neurodynamic techniques. In 2016, this program was awarded the best exercise program by AGAXEDE, a leading sports management association in Galicia, Spain. Dr. Rial is the creative director and professional educator for Low Pressure Fitness. At present, over 2000 health and fitness professionals from around the world are certified Low Pressure Fitness trainers.
Dr. Rial is a professor of pelvic floor rehabilitation in the masters Degree at Fundació Universitaria del Bages in Barcelona, Spain. She is the author of several scientific articles and books about hypopressive exercise. She has also published numerous articles and videos about pelvic floor fitness, hypopressive exercise and women’s health. She is an internationally recognized speaker and has presented at conferences throughout Argentina, Canada, Mexico, Portugal and Spain. As an established researcher and practitioner, she continues to collaborate with colleagues at universities and health care settings to explore the effects of hypopressive exercise on health and wellbeing.
She lives with her husband and two dogs in the United States and Spain. Dr. Rial is available for consulting, speaking and freelance writing in Spanish, Galician, English and Portugues.
For more information on Shannon:
Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.
Read the full transcript below:
Shannon Sepulveda: 00:00 Hello and welcome to the healthy wealthy and smart podcast. I'm your guest host Shannon Sepulveda and I am here with Tamara Rial. Hi Tamara. Can you tell us a bit about who you are and what you do?
Tamara Rial: Well, we're going to introduce a little bit how we met because Shannon came to our hypopressive course that we hosted in Portland with Bobby Grew, right. So I like to call myself a hypopressive expert. I been studying and practicing and teaching this technique for over 10 years and I did my PhD based on hypopressive and its effect on urinary incontinence. And then I began teaching this technique to professionals as also to practitioners. And well, I happened to live in Spain also almost all my life and they do my work there. And also I have been a professor in the University of Vigo in Spain.
Tamara Rial: 01:13 But two years ago I came to United States because I married my husband who happens to be American and we moved into New Jersey and that's where I currently live.
Shannon Sepulveda: Well, can you tell us a bit about what hypopressives are and what low pressure fitness is because I would assume the majority of the audience has no idea what that is. I think some of us pelvic health PTs know and some other people in the world, but it's all the rage in Spain. So tell us about what it is.
Tamara Rial: Yeah, I understand because there's this word hypopressive and some people kind of listen to this word for the first time. So if we look at the etymology of hyper pressure, really what it means, a hypo pressive, it's Hypo. Less pressure pressure of course. So it's an exercise that reduces pressure.
Tamara Rial: 02:16 It's specifically a intraabdominal pressure intrabdominal pressure and intrathoracic pressure. So normally we call the hyper pressive exercise as a form of exercising with different postural cues and different poses throughout and a specific mechanism of breathing. And the general name of these exercises was named after that reduction in pressure that we have observed after doing these poses, combined with this specific hypopressive breathing technique. So yes, I know that sometimes it’s quite hard to understand, but they name and especially in some countries are for those people who are not familiar with it pelvic PT area. But, it will be the name given to a form of exercise.
Shannon Sepulveda: So can you talk a bit about what you mean by poses and then what you mean about the breathing technique?
Tamara Rial: Well hypopressive exercises are also known as the hypopressive technique as I said, as a form of exercise that is mainly postural and breathing driven.
Tamara Rial: 03:42 So I also like to say that it's a mind body kind of technique because it is based on low intensity poses that can resemble a little bit of the kind of poses we were doing pilates exercise or when in Yoga many yoga instructors will find that many of those poses and breathing techniques are very similar of the ones they also practice. So the postural technique of hypopressive is basically one that aims to do a postural correction, a postural correction in a more body awareness. Like how is our spine, how do we activate our pelvic girdle, how do we activate our pelvic, abdominal muscles or shoulder girdle? So we would focus a lot of body awareness as I said, and on posture reeducation, making the person aware of how they stabilize their spine, how they stabilize their body.
Tamara Rial: 04:54 And from there we would progress the exercise from a more static poses. And then from there going to a dynamic postural position, and then the breathing exercise is mainly the technique made up of lateral costal breathing that is also practicing in pilates and also by a form of exercise that is also called the Ooda bandha technique. So this is a Pranayama, yoga Pranayama that we use in hypopressive and we call it the hypopressive breathing. So it's a very noticeable and visible technique. But you, because when you practice it, you see how they add them in draws in and the thorax expands and sometimes people confuse it with a hollowing, abdominal vacuum hollowing. Because when you're doing abdominal hollowing, you see how they belly button draws in and there is actual a little scoop in your abdomen, right?
Tamara Rial: 06:10 But really when you're doing abdominal back q or a do the Anna Vanda or hypopressive breathing technique, what is happening is that you're actually opening your rib cage throughout a breath holding maneuvers. So that means you expel all the air or you expel the current volume of air you have in your lungs. And then after that you open your rib cage. And that will lead to a observable and very noticeable draw in of your abdomen. It is going to be even more noticeable that the actual abdominal Holloway maneuver. Why? Because their rib cage opens and lifts and that's gonna draw in the abdomen and in and create this vacuum that we call in yoga with the Yana Veranda, which is a Prana Yama. They are yoga teachers in some practitioners may be also aware of. And the combination of this type of breathing in a sequence with different poses that they instruct are not normally a progressive. The person through these form of exercise, the low pressure fitness technique.
Shannon Sepulveda: 07:31 That's awesome. So let's talk about who can benefit from this form of exercise because I think that it's become really popular in the pelvic organ prolapse community and the urinary incontinence community. But then we also had a bodybuilder in our class because she needs to learn these poses for her bodybuilding. And we also learned about other types of athletes in particular in Spain that use this technique to help with their sport. So could you talk about like who can benefit from this?
Tamara Rial: 08:03 Right. That's a great question. Well, hypopressives at the beginning where as you a correctly said, we're especially aimed for the post natal woman. And so specially after giving birth woman began to have some urinary incontinence and many women develop some type of prolapse and also they want to rehab there mommy tummy. So the application of this type of exercises that reduce their waistline and also reduce pressure, especially at the first weeks after giving birth where especially in France and in Belgium, the exercise that they were doing and performing and in France and in Spain, these exercise became to get a more popular and I think almost all a postnatal woman do this kind of routine and pelvic floor physical therapist and also midwives and duolas recommending and teach this kind of exercises in the postnatal phase.
Tamara Rial: 09:18 So that's why I think it got very popular. But it's true that many other people and at the beginning I wasn't very aware of it because I also began focusing a lot in urinary incontinence because I thought that we're dealing with pressure, right? So this thought of I want to reduce pressure so it will benefit those women or those people who have some type of issue related with increase or dynamic pressure. So the one that always can come to mind or what stress urinary incontinence and pelvic organ prolapse. But there are other pressure issues that can go that people can deal around. And in the woman's health community we are very aware of constipation because it could also lead to constipation in the way we breathe and we push when we go to the bathroom can also lead to some symptoms.
Tamara Rial: 10:23 So we've seen that people who a incorporate hypopressive breathing and also hypopressive technique from a regular basics and have constipation issues can benefit. And also there has been some research done on pelvic who suffer nonspecific, lower back pain and who have shown good results doing a basic series of exercises because many people ask what are the exercises? Are they're doing a lot of a complex exercise or are they doing dynamic? No, the basic routine. For example, in the course we learned the basic normal static exercises and in the easiest vacuum, that means a vacuum that is performed with a low breathe breath holdings only between 6-10 seconds. And also very easy poses that almost anybody can do in a standing position in a sitting and a kneeling. So really you don't have to be at gym to perform it and even our elderly in our and people with any type of a movement issues or even people who are in wheelchairs can also perform it because really the exercise is very easy.
Tamara Rial: 11:52 It's basically controlling your breathing and control your pose. So it's specifically, we began to see that not only the woman's health, a community could benefit from hypopressive, but also people suffering, as I said, with a constipation, low back pain. And then there has been an increasing application of this type of training from an aesthetic point of view. Why? Because doing this type of exercise, the transverse abdominis muscle gets quite activated and when you see the abdominal vacuum maneuver, you can see that really the transverse and all the abdominal muscles have this corset effect. There's a visible waistline reduction so that waistline reduction is visible during the exercise. But after two or three months of continuous practice, that means doing two or three sessions of 30 minutes over a period of three months. You can observe a statistical reduction.
Tamara Rial: 13:07 Yeah, significant statistical reduction in waistline, we're talking about between two centimeters of average or 2.5 between 3.5 right? So that will be the average waistline reduction. So for people who really want to reduce their waistline because they want to look better or they're doing a competition for bodybuilding for example, they are really want to find exercise that can achieve a waistline reduction without only thinking. Of course we all have to think about our food intake and our caloric expenditure. But when all those variables are taken into account and you also want to want to work on your natural corset that means your abdominal muscles. We all know that we have to train our core, but we can train our core in different ways. And one way that we have seen that also can be an alternative to normal or traditional core training methods is also the stomach vacuum or the abdominal vacuum or the hypopressive technique.
Tamara Rial: 14:27 In fact, it's funny to observe that in the body building community they have a pose that they execute. That is called the stomach vacuum pose. And this stomach vacuum pose was a popularized by Arnold Schwarzenegger in 1970. There are many, there are some pictures of him that if you go to the Internet and you put an Internet Stomach vacuum pose, you can really see how he had a pose I think he's the king of the stomach vacuum pose. And he really popularized it because when he would go on stage, he will want to show his serratus. So a way to show the great development or the mass development of his serratus would be going into a big rib cage expansion, lifting his arms behind his head and just pulling in his stomach throughout this abdominal vacuum technique that is really hypopressives.
Tamara Rial: 15:29 So he even wrote in his bodybuilding, he wrote that he usually trained this technique to achieve a waistline reduction. And if you see his body, it was amazing. He really had a very thin waistline and a big thorax. And now bodybuilder nowadays they're there. Well at least what they are seen as they're getting, they're having trouble in and getting a great lat spread and a great big thorax and in comparison have a very, very thin waistline. So that's why now we're recovering a little bit. This knowledge that he brought us in the 70’s it seemed that now more bodybuilders are being aware of doing this type of a stomach vacuum exercises. And even in Spain, the Federation of bodybuilding has a included the stomach vacuum pose again as compulsory for the male competition, which is kind of cool.
Tamara Rial: 16:34 And that's why I think it was two years ago. And we begin to see a great demand of body builders to come to our classes to learn, only from aesthetic purpose is to learn the technique because it's not easy. It's not easy to be onstage, hold your breath, be smiling, and at the same time hold your breath for 10 seconds when you're already very tired and open, open your ribs and show that stomach vacuum so you really have to train it. And in our bodybuilders, that came to the course. She is amazing. Of course she was absolutely gorgeous, but she wanted to work a little bit more on her stomach vacuum pose.
Shannon Sepulveda: 17:20 Yeah, yeah, yeah. She told me that, that maybe the difference, like it like she's like, I need to learn this. And I was like, wow, that's, I didn't even think about that. And then when you showed us the pictures of Arnold Schwarzenegger I was like, oh yeah. I mean I remember seeing them as a kid, but I was like, oh, it totally is a stomach vacuum. And so I think it's really fun when you have all of people from different
Shannon Sepulveda: 17:50 backgrounds in the courses because it's just fun to talk to them and pick their brains and see like why they're here. So I thought that was, that was really cool.
Tamara Rial: And how different people from different areas, from fitness professionals for women's health, from even massage therapists, it can have a common link. There was also the course, we had a several yoga instructors because I guess it also makes sense to incorporate a technique that has so much in common with already yoga.
Shannon Sepulveda: Yeah. Can you tell us a bit about your research and your education and your PhD work?
Tamara Rial: Okay. Yes. So as I said I was Spanish and I think some of our listeners have noticed that I have a little accent. Well say. I've grew up in Spain. I did my education, all of it over there.
Tamara Rial: 18:54 I also did a semester in the University of Porto, part of my PhD and they laboratory of CNN, Tropo Matree with the professor. But my main focus was always a pilates, and some type of mind exercise. Mind body exercises a woman's health. So I began to get interested in this because I've seen at least in his Spain, it wasn't a woman's health wasn't a topic that was taught so much in the physical education and fitness community. We were talking about the benefits of exercise for health, but we were looking so much of the benefits of exercise also for Woman's health and how some type of techniques and pelvic floor muscle training could also benefit a lot. Mainly females and males who have some type of dysfunction.
Tamara Rial: 20:00 And we really had to bring this knowledge into the physical education to the exercise science community and into the gyms. And I also think into the woman's community because sometimes there's that, well I really think there's this feel like great taboo talking about women's health issues. So maybe it will be easier if we begin to talk about it in a easy way from the gyms and bring this topic into the fitness instructors. So they would bring more awareness and also the coaches into the sports community and that way make aware to our woman and our males that there is option to, and there's options to take care of your pelvic floor and your health with exercising correct movements and how just by breathing you can affect immensely your pelvic floor health because we are not aware of how we breath, how we are standing now.
Tamara Rial: 21:06 Now our listeners they’re maybe they're sitting in the car they're walking, but are we taking our time? Are we looking in was and are we feeling our brand that we fit in our body? So all those things I thought we, I had to bring it into the fitness community. And that's why I really wanted to focus on how some type of mind body techniques could impact urinary incontinence. And at that time hypothesis was not a very famous thing in Spain. I think it was not famous. Nothing. Maybe some pelvic floor PTs who had been taught in France. Know a little bit about it, but really it wasn't a big thing. So I learned about it from Marcel Frey, who was one of the main people and teachers who begin to get interested in this topic. So I thought, why don't I do a research study on this on urinary incontinence?
Tamara Rial: 22:12 And I remember at the beginning it was hard because imagine telling your doctoral advisor that you want to do a study on woman that's kind of, okay, I'm focusing on women and then say I want to focus urinary incontinence. So I'm getting more specific. And then I say, I'm going to assess the effects of hypopressive exercise. When I said this word, he was like, what is this? And we went into the literature and there was nothing in the literature, nothing at that time. And right now there's still nothing. Okay. But at that time there was negative and it was kind of hard because what is the basis? There is almost no basis. And I know, I know I took a risk, but I began to apply it on myself and I begin to apply on some practitioners and I saw results very quickly and they were telling me even after three sessions that they already were feeling a decrease in their ordinary symptoms and they were, I was even shocked because I like time.
Tamara Rial: 23:25 I didn't believe it. I was still one, I was one of the skeptic that's a little bit the reason why I said I want to study this to prove it's not working, but when people begin to already tell me, you know, I feel great and I begin to see how women were enthusiastic about it. I said, okay. I really had to give it a chance and that's how I got paid. I'm really passionate now about it and people say, you're very passionate. Why? I think that people who I work with made me passionate because whenever I see that somebody can benefit from what I'm teaching, that makes me happy. And that makes me really think that maybe I'm, if I'm making somebody better, I'm helping in some sort of way, I think that's how I've been driven to keep on in this path.
Tamara Rial: 24:19 And also because I want it to make it more on evidence based or a technique that would have more support. Because at the beginning I would hear people say, hypopressives does this, or hypopressives does this, but there was no, there was no basis behind that. Even sometimes the physiological description of the exercise was wrong and people were very assertive. Like people would say, it does this to the body or you can achieve this, whatever. But what is the research like? What is the, what is the, even the physiological mechanism, which explains that. And, and there was very contradictory explanations in the literature because I guess nobody has really wanted dive into it and study to show that maybe it's correct or not as correct because I even at the beginning thought that maybe intraabdominal pressure doesn't increase or maybe decrease.
Tamara Rial: 25:29 We still don't know. We still don't know what has happened at the thoracic level so we cannot just assume things if you really don't study it. I think that was the big mistake with hypopressives. People got excited and they began to say, there's no thing called hypopressives. It's fantastic and blah blah blah, but you cannot put something out in the market and say it is great without really having to first apply it with real people as it in a clinical way and then begin to do some short term studies or some physiological studies. That means, for example, if you argue that there is a decrease in pelvic pressure, you have to assess it. You cannot say it without even assessing, maybe not 200 people, but at least a group of people. And then from there, which we would have to see if there is some type of chronic effects.
Tamara Rial: 26:39 We still don't have a research that really shows many claims that people say. So those are lacking in the literature. So we always have to be cautious and see, you know, we don't know. We don't know. People are getting some good benefits and they're claiming that they're feeling better. For example, they're feeling more posture rehabilitation or they feel there breathing capacity has increased. But that's anecdotal evidence and we have to prove that with more randomized trials. Right. So, that's a little bit how I started and I got interested in it and I'm still working with it and teaching. I came to United States and I did my first courses through Herman and Wallace, pelvic rehabilitation institute, and also through pelvic guru that we're the first people who trusted me in United States.
Tamara Rial: 27:52 And they led their hand and they began also to hear from some pelvic floor practitioners who in United States who were already working with this. And I guess there was a little bit of spread of the word and that's why I think in the United States some people began to get interested in it and now let's just see how it works and hopefully more universities can open new lines of research on this topic because I think women's health and pelvic health, although if we focus a lot on urinary incontinence in pelvic organ, there are many other issue that have not been so much address like a hypertonicity, a topic for dysfunctions, pelvic pain. So there is still a lot of research that we can do. And I think also the area of alternative movement exercises, for example, Yoga and even pilates, there should be more, more interested in it because our woman and our people, our population, we need to move, we need to do exercise.
Tamara Rial: 29:13 And we really, when there is a public condition, many women are afraid of moving and doing exercise. And I don't think it's good to tell a woman or to tell a postnatal mom, you know, you have to be careful, don't lift weights or don't do this exercise or don't do curl ups. So are I feel that sometimes we're frightening too much are woman and there and instead of going to the gym or maybe sometimes you can have a leakage and you say, Oh, I'm a little embarrassed because I'm leaking during my crossfit activity, but I love going to crossfit. So maybe I can also compliment my activity with other more pelvic floor friendly programs or with some programs that kind of counterbalance that high intensity activity. I kind of, I sometimes say that a low pressure of hypopressives are the best friends of high impact activities because we have the metabolic benefits of a high intensity interval training, which has a great background of research that shows that is one of the best type of training for many metabolic conditions for our cardiovascular health. So we want people and we need people to be doing their physical exercise. And on that note, we're going to take a quick break to hear from our sponsor and we'll be right back.
Shannon Sepulveda: 31:36 Okay, so we learned about some awesome new research in the course. So can you share that with us?
Tamara Rial: Yes. Well, we still didn't know until some weeks ago what was happening in the diaphragm. Because it's true that when you do the abdominal breathing maneuver, the hypopressives maneuver, you're actually opening your rib cage in, you're holding your breath. So it was hypothesized that because you're using your inspiratory muscles to hold and expand your rib cage, that diaphragm what is happening it raises up, right? So imagine when you breathe in your diaphragm goes down, contracts and lowers the position and also the pelvic floor because the movement of the breathing and the synergy or the diaphrgm the pelvic floor diaphragm is synergistically, right? So then when you exhale, the diaphragm raises up and also the pelvic floor contracts and raises.
Tamara Rial: 32:38 So when you're doing this hypopressive maneuver, what has happened is they're opening your rib cage in your allowing to your Diaphragm to raise up a little bit more. So that means that it achieves a little bit of higher position than when you're only exhaling because it's kind of a stretch of the diaphragm. But the question was, well, but what happens? Because we have some studies that have shown through ultrasounds and MRIs that when you're doing this hypopressive breathing, there is a pelvic lift, right? There's a raise of the pelvic floor and also the bladder and the uterus. So this is something you can actually see. And in the course we also see it in ultrasound measurements, but it's difficult to have an ultrasound measurement of the diaphragm and also it's difficult to see the pressure in your esophagus or in your abdomen.
Tamara Rial: 33:40 Because that would have to be through a more difficult assessment that normally in the pelvic settings we don't have have. So normally if we want to assess in a pelvic floor or physical therapist setting the pressure, we can use intrarectal devices or intra vaginal devices. And that way when we're doing different types of maneuvers, we can assess what's happening, right? So when you're doing the maneuver, what happens with hypopressive is there's going to be a decrease of intrarectal pressure intracolon and also vagina, right? If you performing the exercise with the correct form, and I always like to say and this and make it a specific, that it's not something that you can achieve the first day of practice. You have to know how to correctly perform the technique as well as we teach how to correctly perform up pelvic floor muscle contraction to enable the pelvic floor muscle to really lift and contract and not to, for example, Bulge.
Tamara Rial: 34:51 That can happen if the technique is not correctly performed or if they breathing phase doesn't accompany the contraction. So in the same way, when we're doing a hypopressive maneuver, what would happen is that we would exhale first and then after that exhalation we would hold their breath and we would only perform a voluntary muscle contraction of our rib cage muscles. So the question is the diaphragm what happens is a very relaxed is a very contracted, is it not? So Trista sin, which is my colleague and one of my friends who have, I been working also very closely and she teaches courses over there in Canada, she actually flew to Vancouver because there's a research group there who's going to access actually with the group of people who are going to do hypopressives and I can't recall right now his name, but he's a phd candidate who is a looking forward to do his phd on the effects of a hypopressive technique on the EMG activation of the diaphragm and also into the pressure management, intrathoracic pressure.
Tamara Rial: 36:29 So we won't call it the pilot testing and because Trista is a very good practitioner, she already knows how to do the technique and I know that not everybody wants to introduce a catheter, it's not one of those research that a everybody would want to do. So she did it. And, we have the preliminary results that I can, I can read you some of them. And she also did different poses. So she did the analysis in the standing pose, which was more easier to assess also in kneeling. Because you don't have to move your face or you're not on a board where sometimes you can change the position of the catheter.
Tamara Rial: 37:32 Yeah. And, also supine was an easy pose. So that's the assessment and there actually was electromyographic activity shown in the diaphragm from which would make sense because the diaphragm cannot relax. So there's a quite of lengthen in an activity going on even if you're doing the breath holding maneuver. So I guess that when they results on the group, they're going to test on the trial. We will get to know more of really what happens, not when you're doing actually that technique, but what would happen, what chronic effects would have your intercostal, your breathing muscles. And also your Diaphragm from when you're doing this kind of vacuum technique and also what happens into the pressures. So we would be able to show that there is a reduction, the reduction of thoracic pressure and intrabdominal pressure, which is kind of cool.
Tamara Rial: 38:40 It's pretty cool because at least now you can say that it makes sense to call it hypopressives. So, well, that's the thing. And also when you're doing hypopressives, the thing is that you're lifting your rib cage and you're using your breathing muscles. So for example, they, SCM muscle increases his electromyographic activity because it's all it has, it enables their rib cage to lift, right? So whenever you're doing a hypopressive, you will really actually see the lift of the rib cage and also the widening of your intercostal rib cages. All the rib cage actually open. So also this serratus is a muscle that is also going to increase as is electromyographic activity. Right. And there has been another group from Brazil that actually did not a chronic study, but they did an acute study that they assessed the electromyographic activity of the abdominal muscles, so transverse, Oblique and internal oblique.
Tamara Rial: 40:01 They did it through superficial electromyographic activity and it was with some female practitioners. They were healthy. There were no pelvic floor dysfunction. Just testing when you're doing the vacuum, what actually happens in the core muscles because some people think that when you're doing a hypopressive, maybe there's a high electromyographic activity, but really you're not doing an active contraction. For example, if you do a a crunch exercise or you actually contract forcefully your abdomen, you will have a very high electromyographic activity, but because what you're doing is just having a stabilizing pose that makes your spine grow and you're actually doing a low intensity postural activity and you're opening your rib cage in your muscles. There's not going to be such a high activity. There is an increase of activity but not so much on the rectus abdominis and the external oblique as much as there is in the transfers and in the obliques. So that's why it's especially indicated for people who need a rehabilitation of their deep inner unit and not so much of the outer unit. So especially in the first rehab phases for example, for those with lumbar pain and want to achieve
Tamara Rial: 41:34 a greater mind body connection of your deep core muscles or we want to a connect that transverse and the pelvic floor. This could be a technique that we could use for example. So especially more indicated for our deep system. And then from there we can build on a more dynamic exercise that will recruit the larger muscles and the larger dynamic muscles.
Shannon Sepulveda: Cool. That's awesome. Thank you so much for that explanation of the new cutting edge research. I think that's awesome. In my experience, it seems like there's a little bit of controversy surrounding hypopressives and low pressure fitness where some women's health people are like, yes. And some women's health People are like, no. And in my opinion, not that it means anything, but my opinion about something like this is if it works for somebody and there's no harm in it, then why then what's the problem?
Shannon Sepulveda: 42:41 Because it's not like we're causing any harm with any of this. And so if it's a tool in your toolbox and it works for certain women, what's the harm? Yeah. Because really there is none. And so why not try it? But I just wanted to get your thoughts on, you know, what's going on in the, I mean, I feel like hypopressives are so hot right now. It's Kinda like diastasis is just so hot right now and it's the new buzz word I think in women's health, physical therapy. So, but there's been, you know, people are like, if people don't, I don't really know. But what's your take on all of that?
Tamara Rial: There has actually been all a lot of controversy and even a lot of controversy in the scientific literature because I think it was last year there has been a discussion paper published by Carrie Bowen, a researcher from Spain, on hypopressives saying that there wasn't enough evidence to support that hyporessives could be an alternative exercise for women with pelvic organ prolapse.
Tamara Rial: 43:54 So they based their discussion paper and their results on the articles that our group has published it on this topic. So I wrote a letter to the editor and it was published on the British journalist sports medicine blog. It's available and they had also a reply. So it's kind of funny when you get to have these replies. So there has been a lot of controversy even in this field because as I said before, it's true that there has not been a lot of research and there are studies that have been publishing from the Brazilian groups. They have done some studies on woman with prolapse. We can find a on pub med with the word hypopressive but my argument and my counter argument in the letter and the response to the letter to the editor that is available as you said in British Journal of sports medicine, you can read it is that the thing is when we are applying a technique and especially a technique as hypopressives, that is first difficult to teach, difficult to a specially properly perform if there's not a good instruction and supervision.
Tamara Rial: 45:25 That means that first we have to assess if the person is correctly performing the exercise as well as anything as well as pelvic floor muscle training. We will teach first how to do a optimal pelvic floor muscle contraction before beginning the trial. We have to perform or assure that the person who is really doing that vacuum is actually doing a vacuum and if the form is correct that means does that person do a vacuum that is really lowering the pressure. Is that person really in the correct positioning or does that person need a little bit more of supervision of somebody who really knows how to correct and see if the pose is correct? Is the breathing so in the description and they papers and you can read the paper. They don't describe the exercise as a form of different postural exercises.
Tamara Rial: 46:25 They only described that they performed on a technique where there is an abdominal contraction a transverse abdominal contraction. But that is that you don't really know. They have been doing the whole series of exercise as this has been described in the literature because hyporpressives are currently describe the technique as a postural base and a breathing base. So that was my critique that you're basing your argument on the low number of research that is still available and on research that doesn't describe quite maybe let's use the word accurately as all their manuals and other professionals and other also because we can see other research common from other groups that are already doing and describing the technique. And this happens a lot in exercise science and physical therapy. Whenever we're using exercise that involve a lot of supervision and technical instructions, we have to be very clear and describing that technique.
Tamara Rial: 47:37 That means how many repetitions did you do, how many rest breaks, how many seconds did you rest between exercise and exercise? Because we know that changing one little variable can change the whole exercise. And, even when it comes to breathing exercise, we have to very accurate accurately describe the time that means, for example, you're breathing in how many seconds you're breathing out, what way you're really now doing a four, six inhalation, or you're breathing out doing a a more relaxed maneuver. Are you for example, doing a more intercostal breathing? Or are you doing a more diaphragmatic breathing using, you know, there's so many different aspects that if we really don't describe how is that technique, it's gonna be more difficult to replicate that and more. And it's going to create even more controversy between the readers or the listeners because we really don't know what the technique is about.
Tamara Rial: 48:49 And many times we see a video on youtube. This is the worst thing to learn from youtube. I know that we all go to youtube many of our listeners are now, many people that are doing it, but you can see the person do the exercise. But how did you know if you're really doing what that person is doing it maybe you are contracting or you're trying to pull your shoulder up or it's Kinda hard and I would never I love watching those youtube videos and there are some yoga professionals that do amazing exercises, but it will be very hard for me to know if I'm doing the exercise correct if I don't have somebody that is telling me I think, I think you're doing the pose or even when I'm instructing pelvic floor muscle training, we really have to have somebody that is supervising that technique and giving us advice to progress in the technique.
Tamara Rial: 49:56 So I think this has been the first controversy, the lack of research and the claims of some Gurus and like they is the best exercise for the pelvic floor. Well that's a huge claim. You can never do the say that and, or some people will have, I have also claim a hypopressives if you do hypopressive's is much better than Kegal Well, no, no, no, you can never have those because that's going to go against you and, and that's why maybe I think there has been such a bad reputation and also because maybe there has been a lot of marketing towards that waistline reduction. So if people say you're selling it as a tool that is only aesthetic, but it kind of sounds like a selling thing, right? Where we want to sell a product only because it Kinda is new, but why, what is it, how is it an other profession?
Tamara Rial: 51:07 Is it professionally driven, technique driven, and that has been the big, I think, huge controversy in the literature and also between practitioners. Right. And I think also another controversy that I see from my point of view is, is that one of people trying to learn, learn it from professionals who learn it from youtube. If I'm not sure about it and I would rather not do it or if you really want to practice it. I always advise people even to exercise under the guidance of professionals and I know that sometimes hiring up a personal training or higher, you know, going to a physical therapist once in awhile people can say it's a waste of time. I think I'm good on my own. But no, even, even us as professionals, we should be instructed on the care of over there people because the eye of a professional is better than your own eyes and we need that supervision.
Tamara Rial: 52:20 We need to a planification and we also need an assessment. So maybe when you're under the guidance of a pelvic floor physical therapist or a instructor, they would assess you and say, you know, maybe we should do other exercise or we should begin with this. But then progressed to other phases and talking about progression, the idea that hypopressives would be like the magic pill. No, I don't. I think that that's a very wrong message to tell our people because there's nothing that is magic pill there. It's a tool in your toolbox. So it can be something that you can do to help you in some part of your life, but then you're going to progress and then you're going to do more things. Because for example, hypopressive is a good maybe reputative tool kind of. Yeah, kind of reputation tool.
Tamara Rial: 53:20 But I won't think that I'm going to get better improvements in my cardiovascular health doing hypopressives, for example, I'm not going to lose weight doing hypopressives it's not an aerobic driven kind of tool. So if you're beginning to sell a technique as something that is the best for everything, or maybe that thing of a reduces waists. So people say it's because it's because you're losing weight. No, no, no, it's maybe because you're getting a better posture so then you don't have such a bulge in your abdomen. We all know it. Right? If you have bad posture, your abdomen is going to bulge more so by again having a better posture or by having a better breathing habit, you're going to help you to have a better abdominal appearance. Right. And then if you tone your inner unit, that will also help, but we will never, never achieve a waistline reduction or a better appearance without a loss of weight because you almost don't use a lot of energy.
Tamara Rial: 54:33 In fact the heart rate will even decrease a little so, so not not increase. Interesting. So we still have to do cardiovascular work. We can then counterbalance our running.
Shannon Sepulveda: I know. I was like I love to run and I was like okay, 20 minutes a day, 10 or 20 minutes a day. Like I can do this. And it actually felt really good because I'm so tight for running and I just like them. Then it was actually pretty awesome doing it in the class.
Tamara Rial: Yeah. And many, many people who perform running or other type of high intensity activities or aerobic cardiovascular training, they use what he'd do this training, they could operate it after. So as a way of cool down. Yeah. So it's a set of doing other type of exercise or we can incorporate it into our cooling down or even our stretching because many poses are like our stretching houses lying on the floor, stretching and our arms stretching our legs.
Tamara Rial: 55:41 So we just incorporate it and it's 10 minutes. You don't need much, you really don't need much. 10 minutes for those that need other 15 maybe 50 minutes and, and I think everybody can find 15 minutes in their day to have sum up some sort of mind, body practice. We really need it nowadays with so much going on. Social media.
Shannon Sepulveda: Yeah. Well, it actually, it was interesting, I was thinking about why it felt so good and why say I would stick to something like that instead of yoga. I've tried yoga before and I wasn't too into it. I think it's because never in my life have I stretched that area. Like it's so hard to stretch your thoracic area, right? Like I couldn't, there's no way. Or like even my rectus, right, your front abdominal muscles. Like it's, unless, I mean you could do up dog to stretch, but it's really hard to lengthen and stretch all of that. So it was like the first time in my life where like those muscles stretch and it feel really good.
Tamara Rial: 56:39 Because we're stretching from the inside. You've seen our breath instead of pressing it down, we're pulling it inwards. So that's why maybe this sensation is different. I think also the concentration on the breathing in that now it gives you a kind of mindful sensation. So for many people, they only do it as a mindful practice. They're pressing because they're so focused in on their breathing. It takes you out of your daily worries.
Shannon Sepulveda: I think that's what I found too because it gave me something to like focus on, like I had an objective so I wasn't thinking about anything else because it's hard to do. And so it's also like a new challenge.
Tamara Rial: Yes. Yeah. So it was really great. And to challenge your breath Holding and to only think as well as we count, we always tell people sometimes when they're breathing to count breath up to one, two, three.
Tamara Rial: 57:41 So whenever you're counting, you're mindful in your present. And also we're gonna add they've beneficial effects of having us slow paced breathing. That's to add down train our nervous system. So we're also going to help us if we want to just do a mindful or a relaxation kind of technique.
Shannon Sepulveda: Well thank you so much for coming on the podcast. And so where can we find you? Email social media courses and you teach people like where can people find you if that.
Tamara Rial: Thank you. My name is Tamara Rial So my website is tamararial.com but I'm very active in Instagram, so you can find me as Dr.tamararial and I also have another, another Instagram account that is a specific only, only for hypopressive that is called hypopressiveguru because I also teach other women's health programs, not only hypopressives.
Tamara Rial: 58:53 So I focus also on the female athlete. Pelvic friendly exercises, so, so you can see all my programs and courses on my website, although in my social media, especially on Instagram and know the courses I'm hosting in United States are throughout Herman and Wallance and also pelvic guru. So if we'd go to the websites we would see their announce all the hypopressive or low pressure courses. And I think contact email is rialtamara@gmail.com.
Shannon Sepulveda: Great. Well thank you so much. We really appreciate it.
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LIVE from the APTA NEXT Conference in Chicago, I welcome Duane Scotti on the show to discuss gymnastics medicine. Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.
In this episode, we discuss:
-The most common injuries in the youth gymnastic population
-Differential diagnosis for low back pain
-Key features of a rehabilitation program following an ankle sprain
-How to enhance communication between athlete, coach and clinician
-And so much more!
Resources:
Duane Scotti Twitter
Duane Scotti Instagram
Spark Physical Therapy Facebook
Spark Physical Therapy Website
For more information on Duane:
Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.
Duane is currently the founder of Spark Physical Therapy, providing prehab, rehab, and performance optimization services either onsite or in the comfort of your home within the Cheshire/Wallingford CT region. He also is a clinical assistant professor in the Department of Physical Therapy at Quinnipiac University responsible for coordinating and teaching musculoskeletal examination, intervention, and advanced manual therapy within the orthopedic curriculum.
Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation, dance medicine, gymnastics medicine, and rehabilitation for runners.
Duane has been in clinical practice working with orthopedic, sports, and performing arts populations since 2003. He has strong clinical and research agendas in screening, injury prevention, and rehabilitation for runners, dancers, and gymnasts. Duane uses an integrative model of manual therapy including manipulation, mobilization, and soft tissue treatment including dry needling and the Graston technique for the management of musculoskeletal dysfunction. Duane is a physical therapy advocate and is actively engaged with the American Physical Therapy Association and serves as Vice President of the Connecticut Physical Therapy Association.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody. Welcome back to the podcast. I'm coming to you live from Chicago, Illinois at the APTA Next conference. And I have the great pleasure to welcome back to the podcast. Dr. Duane Scotti physical therapists. And today we're going to be talking about gymnastics medicine. So Duane, welcome back.
Duane Scotti: 00:19 Thanks for having me Karen. It's good to be back
Karen Litzy: 00:21 And I have to tell you, gymnastics is something near and dear to my heart. I was a gymnast for many, many years as a child. And luckily I didn't have any major injuries, but what we're going to be talking about today are kind of the most common injuries you might see in a gymnast. And this is something that Duane is so passionate about. These are the people he sees. So if you're a physical therapist out there, and maybe you have the off chance that you might see one of these young athletes, I think this'll be really helpful for you to give us your insight. So Duane, tell us what are the three most common injuries one might see in a gymnast?
Duane Scotti: 01:02 Well, I think first off is I definitely do have a passion for this area. Like you state because I have a daughter who's a gymnast. So that is one of the things that I kind of in my career from a clinical standpoint, kind of focused a little bit more in this area is spinning off of like dance medicine and got into the realm of helping gymnasts out because I did see there was a need in the local club in our region. So in terms of the most common injuries I would say, you know, definitely low back pain, in gymnasts and specifically extension based low back pain. So because of all of the kind of back bends you think about, they do like bridges, back walkovers, back handsprings all of those, especially in the young developing gymnast. So usually the smaller ones like the level fours and fives, they're doing a lot of those skills. A lot of times you'll tend to see that occur as well as a lot of the compressive loads that happen especially during your floor passes in gymnastics, there's a lot of compressive loads as well as shear loads that get transmitted to the spine.
Karen Litzy: 02:11 And can you kind of briefly tell us what exactly you mean by when you say a compressive load and can you give an example of when a compressive load might happen and a shear load? Same thing.
Duane Scotti: 02:23 So it's really the compressive load is if you think of landing, right, so you're landing, your body weight is coming down. So we know that actually landing, you know, there are some studies that look at between 12 to 17% of your body weight is actually, or times your body weight is actually being loaded through the spine. So that's that compressive load as opposed to like a shear load, which would be something like if you think of doing that back bend or that bridge where you're getting one bone kind of shearing on the other. And in the young developing gymnast who is still growing, that can be problematic. And then that's where we start see things such as stress fractures. So that's kind of really the most you know, important thing. And the thing that I tried to intervene and educate because a lot of times most gymnasts have the perception that maybe back pain is normal with gymnastics due to the training and it's going to happen. But being a young gymnast with their bones developing, if they develop that stress fracture that could be detrimental to their long-term health if it goes undiagnosed.
Karen Litzy: 03:28 Oh that was my next question. So let's talk about differential diagnosis of that stress fracture. Cause I think that's really important to think about. And I would imagine that a lot of therapists aren't thinking stress fracture when they're thinking of a young girl or a young boy. Most of the time we think stress fractures in our older adults with osteoporosis, osteopenia. So how do you differentially diagnosed that stress fracture from other causes of back pain?
Duane Scotti: 03:59 Yeah, so the stress fractures are, they call spondylolysis and it is really diagnosed based upon the history. So kind of taking a report, is that something that typically it can occur acutely from like a specific landing where they felt an acute kind of sudden onset of back pain, but usually it is something that's developing over time and it's not getting better with rest and it continues to get worse over time. And then there are some things on the physical exam that we can evaluate whether they have pain usually commonly with extension. So they're, you know, doing a standing extension test or a stork test standing on one leg, bending back. You can look at the irritability based upon if they have pain with that or if they don't have pain with like a press up on their stomach, then I feel pretty confident that this person doesn't have a stress fracture, that it is more muscular.
Duane Scotti: 04:50 But you always have to kind of make sure and rule that out and then looking at confirming that. So you, you know, you send them to a specialist, a spine specialist. It's not going to show up on x-ray unless it's chronic by that point that they'll see the callus formation on x-ray. But it's really an MRI or a bone scan. And a lot of times, you know, if it is kind of consistent with the history, then even the specialist may not even recommend an MRI just because it's sometimes not necessary. So sometimes it just requires that kind of protection phase and avoiding the extension based activities. And then that allows that to heal.
Karen Litzy: 05:26 And how long is that protection phase?
Duane Scotti: 05:29 So it's around, you know, everyone's different but around six weeks. So that's the most common timeframe you'll see. And there are some that recommend bracing. So they call that like the, the Boston braces, the Bob braces where they will brace them. So that athlete is actually preventing any back bending at all. So they're not going into any extension and forces them. So it's a hard kind of turtle shell brace. And they'll wear that for six weeks to really make sure that it heals up. Cause some of these young kids don't even realize and they don't understand the severity of it. I actually just had a girl recently who, you know, tried not bracing at first and then wasn't getting better and now she's braced and it will allow things to heal.
Karen Litzy: 06:10 Mm, Nice. And my next question was actually going to be how do you communicate this to a young boy, a young girl, young gymnast, that it is of utmost importance to not move into these motions. And then I'm sure you're reinforcing that with parents, guardians, coaches, etc. So talk to us a little bit about the communication that needs to happen around this. A child with a stress fracture.
Duane Scotti: 06:38 So I'm lucky in the fact that I'm on site, so I have these relationships with the coaches already. So I'm seeing a lot of the gymnast actually within the gym and I have those relationships with the coaches as well as with the patients. I see the parents are always there during the evaluation. After every visit, I'm always communicating, you know, even if they're not there for the visit, we do the visits in the gym and then I communicate all my findings on each day with them. That being said, it gets challenging, especially during competition season. So this is where the difficulty comes in. And I think it is a very important role we play as healthcare providers where sometimes we have to be the bad guys because we're looking out for their health. So I had a girl this year before regionals, it was, you know, big competition for her and we have to make that decision and there are tough decisions and if things are sounding and going down that route that you think stress fracture, then it's like you have to take care of your long-term health.
Duane Scotti: 07:36 And it's, you know, one of the hardest conversations, honestly, I've had, I go, you know, home at night thinking about these decisions. I have these long conversations with their parents and, but in the, you know, in the long run, when I reflect back, I'm like, okay, this was the right decision because you know, I don't want this, you know, female to have persistent low back pain for the rest of her life and she wants to have kids one day and grandkids and be able to move later in life. So you know, you want to make sure that you're thinking for their long term health.
Karen Litzy: 08:04 Yeah, I think that's very well said. And you know, I used to work at the lion king in New York and I remember it was like their last performance at the new Amsterdam theater before they moved to the Minskoff. And one of the young simbas was limping around, limping around. So they brought him in and he was not fit to dance that day. And so I had to make the professional decision to call in stage management, call parents, call tutors, call everyone around this huge production of he can't go out and dance because I'm looking out for the longterm house. So it is a lot of tears, which I'm sure you can attest to, but you're right, it's being a good health care professional. It's not about just that moment. It's looking out for these young kids.
Duane Scotti: 08:53 And you know, I definitely pride myself on, you know, getting the recovery for injuries as quick as possible so they can get back out there doing what they love, being able to compete. So when something like that happens, you know, you almost feel like, oh, was I a failure or in, you know, but you have to think about the bigger picture and their long-term health versus that short term gain.
Karen Litzy: 09:14 Yeah. That's when you take yourself out of it, right. As the therapist, as we should all be doing, we check our ego at the door. It is not us. Sometimes things happen. Timing sometimes sucks and we have to make decisions based on what's in front of us. And I think if you're making what you feel is the best decision at the time for the health of that patient, then it's the right decision. And all right, so outside of stress fractures in the low back, what are there other common types of low back pain? Is it muscular and mechanical, low back pain. And what do you then do for those gymnasts?
Duane Scotti: 09:54 So very good. Mainly there's not a huge amount of mechanical low back pain that I tend to see when we think of disk related low back pain, sometimes some facet joint. But these kids are a lot younger so it is usually muscular in nature. I kind of see that common pattern, but it is usually due to an underlying instability in the lumbar spine. But honestly more importantly that I'm seeing is the contributing factors. So specifically looking at hip flexibility, so limited hip flexibility specifically the hip flexors, is going to cause more lumbar extension as well as kind of a weakness or inactivation of the glutes. So these girls are doing these leaps and they're doing these movements where they are extending their hip but they're really not turning on their glutes and their using, you know, if they do have flexibility issues. So I found, you know, addressing those issues. Number one from a treatment standpoint is going to be helpful in the long run, but also for Prehab standpoint. So in prevention. And that's what I kind of do in the gym with all these girls is take them through a full screening help to identify those risk factors and then get them on plans to address the soft tissue care because they are doing a lot of strength and conditioning their front of their hips get really tight and that causes that excessive shearing in the lumbar spine.
Karen Litzy: 11:13 Great. So I think for me a big take home here is when you're looking at these young kids, you're not, they're not just tiny adults and so we're not necessarily looking for disc issues, but rather we really need to look above and below to kind of see, well is the back pain, this muscular back pain a result of compensation from other parts? Right?
Duane Scotti: 11:36 Absolutely. Yes, definitely. And then even the core stability aspects of most of these gymnasts, like super strong, but sometimes there's still these little muscle imbalances that you can find with like a good examination that they're not using the muscles you think they're utilizing. And a lot of, you know, even physicians and you know, these athletes will go to a, you know, a pediatrician or primary care provider or an Ortho and then you're like, oh well there look at them. They're Jacked, you know, like you've seen gymnasts there, Jacked, like really, really good conditions. Yeah. So they, they're like, oh, there's no way they could be weak. But no, like when you actually watch them move and you watch their movement patterns, then you pick up on some of these weaknesses and then you know, having them get into, when they're doing their extra, it's like, okay, well where are you feeling this and this. I go, if they're not feeling they're glutes at all. They're like all of their feelings and their hamstrings. So I find a lot of that they're kind of using your hamstrings to extend their hip joint and not using their glute. So you kind of work on correcting some of those kinds of muscle imbalances.
Karen Litzy: 12:34 Perfect. All right, so let's move off of low back pain. What's another common injury that you see in your gymnasts?
Duane Scotti: 12:44 So definitely you know, the most in terms of the research is ankle and foot are kind of the most common region or you know, area to be injured. And most of that is due to traumatic ankle sprains. So they get their classic inversion ankle sprain while they're beam landing from a pass on the floor, dismount off bars, everything vault like you name it, you know, an ankle sprain can happen. And it usually happens in practice. Not so much in competition. We know that the majority of gymnastics related injuries happen during practice. So I do see a lot of ankle sprains. I do a lot of triaging, especially because I'm onsite. So I need to make that clinical decision on, you know, do we send them out for a radiograph? So utilize the Ottawa ankle rules, and seeing, you know, if they can't put weight on it, then they're definitely getting a radiograph. If they're having pain and they have that bony tenderness, then sending them out for a radiograph. And again, this is where I see us as physical therapists being able to make an impact in our communities in being that point person and make that decision so the athlete goes to the proper place versus just putting ice on it and then going home. And then, you know, so I've been able to kind of streamline that process for a lot of the athletes that I see.
Karen Litzy: 13:56 Fabulous. And I don't think we need to go into the ins and outs of ankle sprain rehab. But have you found amongst this population, what is one thing you can tell another therapist if you do nothing else to rehab these gymnasts after ankle sprain, you must, must, must include this in your program.
Duane Scotti: 14:20 Can I say two things? So first is one thing that I see overlooked a lot is mobility issues. So a lot of people have the assumption that you sprained your ankle, you have a loose ankle and we need just stabilization, stabilization. And that is important. Don't get me wrong. And kind of proper stabilization going from your balance activities proprioception to plyometrics. Definitely necessary need to do the plyometric training with your gymnast before you release them to do gymnastics training. But also checking for mobility issues, specifically lack of Dorsiflexion during like a weight bearing dorsiflexion test. And I've seen that where there's, you know, asymmetries on both sides and that's going to be important because when these gymnast land from their floor passes a lot of them, sometimes land short and if they land short, that requires more Dorsi flexion motion. So that can in turn cause you know more limitations of Dorsiflexion, anterior ankle pain. So you really want to make sure you normalize the joint mechanics and the talocrural joint and do your manipulation mobilization techniques to kind of restore that. So that's one thing. And then, especially if someone's been immobilized. So if there are mobilized in the walking boot or in an air cast, a lot of times you'll find stiffness in those joints as well as the distal tibiofibular joint.
Karen Litzy: 15:35 Perfect. Thank you. That is great. I would have thought your firsthand, so we would have been propioception exercises, which are important, but I'm glad that you brought up the mobility stuff. Great. All right, let's talk about one more common injury that you see in this population.
Duane Scotti: 15:51 So this is more your kind of growth plate injuries. So the kind of growing gymnast as they're growing, they go through that growth spurt. So commonly in the younger gymnasts, so like the nine 10 year olds, you're going to see like the Seavers, so they're going to have heel pain. The calcaneal apophysis and then as they get a little older, usually around 12 ish, you're going to start to see knee pain. So whether or not it's Sinding-Larsen-Johansson Syndrome, which is the inferior pole of the Patella or the more common one that everyone knows about osgood schlatters which is at the tibial tubercle. So you will tend to see these kind of growing pains if you will. The big thing is to educate the parents, the gymnast, and there are things that they could be doing at this time.
Duane Scotti: 16:38 They don't just need to train through pain and usually it relates to soft tissue flexibility. So for Seavers, it's really the calf, the Achilles, make sure they're on a good mobility flexibility program for those structures. And then for the knee, a lot of rectus tightness I tend to see, so working on some of the flexibility mobility during this time period and watching load management, so maybe not doing their rigorous training and if they're going through that kind of gross spurt and they have some pain and now let's say like summer conditioning starting, then they might need, be able to kind of do a modified practice, especially when it comes to the jumping and the plyometric training. So they're not doing because we know that's what really caused it. And that's why the incidence is so high in gymnast is because they're going through this rapid growing and they do a lot of jumping, a lot of contraction of the Achilles and contraction of the quads. So that's why you tend to see pains in both the ankle and the knee area.
Karen Litzy: 17:35 Perfect. Yeah, I had a patient a couple of months ago Seavers disease, she was nine and she was a gymnast. And what was really interesting is I would have her, because I needed to see how she jumped and how she landed. And I don't know if this contributed to it or not. In my line of thinking, I felt like maybe it did, but when she landed she tended to land in a very valgus position of her knees. And I don't know, can that, so looking at the biomechanics of the landing, can that help in the treatment of Seavers disease? Cause then we kind of worked on that so that she wasn't landing in quite such a valgus position. So that in my line of thinking was that if we can help to normalize her landing a little bit more, that she’d be able to more effectively use her calf muscle in order to land instead of being at this very sort of sharp valgus angle.
Duane Scotti: 18:33 Yes. I think that's definitely important. And then even I guess going one step further than that is looking sagittal plane and with ankle Dorsi flexion. So if they're limited there because their Achilles is tight and their gastric is tight, I see that even more so. But maybe like you said, if even if they're weak hip muscles, so your abductors external rotators are weak and they're going into that dynamic Valgus, you know, could that be a contributing factor to different mechanics going down at the ankle? Possibly.
Karen Litzy: Interesting. Yeah. There's so much to think about with these gymnast's that you would not think about in your ordinary population.
Duane Scotti: Right, right. No, absolutely. And it is as you said that they have such high levels of training, you know, the girls I see, you know, once they get up to level six and above, they're in the gym for 24, you know, 25 hours a week.
Duane Scotti: 19:21 So it's a lot of training. The only get like two weeks off a year. So it's like at the end of the season befor summer starts and then before a fall starts. So it's a lot of training, a lot of wear and tear on their bodies. And that's why it's so important to be able to pick up on, you know, contributing factors. Cause every gymnast is different too. So someone's going to have maybe a tightness in the front of their hips. Someone's gonna have some tight calves, so I'm just going to have maybe week shoulder muscles and they're starting to get shoulder pain with bars or tight lats. So that's a common thing where they're limited with overhead mobility with reaching. So you kind of need to identify what each one does. And that's what I like to do is to get them on like a customized kind of program and it's like, okay, here are your like top five exercises you should be doing before practice every single day.
Duane Scotti: 20:03 So as opposed to just like chatting with your friends, like, let's prime the body, let's get, you know, warmed up. If it's rolling the front of your hips, doing some glute activation exercises, make sure they're turned on before practice starts. That's what they need to be doing.
Karen Litzy: And you know, I was just going to ask you, what advice would you give to, let's say, any physical therapists out there listening to healthcare practitioner who maybe doesn't have the amount of experience you have with the gymnastic population, but like I said, maybe they've got a gymnast coming in and I feel like you just kinda answered that. Do you want to add anything to it? What advice you would give to that PT?
Duane Scotti: 20:48 Don't be afraid to reach out and talk with the coaches. I think a lot of the gymnastics world and culture, I tend to see a little bit of kind of medical professionals on one side, coaches on the other. The coaches think that the medical professionals don't understand their sport and vice versa. The medical professionals think that the sport is just bad for them and they shouldn't be doing it almost that it's too much and it's not good for their bodies. So I think we need to kind of meet in the middle and actually communicate and have these conversations and you know, try to meet in the middle. And that's what I tend to do with the coaches and cause they, I could see where their mindset is. And I, you know, with my years of experience coming from the kind of clinical mindset and injury side, and I've shifted a little bit in some of my thought processes as well. Being able to actually be on site and see some of the training that they do and to see some of the practices.
Duane Scotti: 21:32 So just don't be afraid to communicate and I guess reach across the aisle and be able to say, okay, this is what I'm finding, and even just letting them know that, hey, this is pretty irritable right now, but it's a minor problem, but if she can do a modified practice today and tomorrow and then she has off on Sunday, that will give her three days of this kind of protected rest phase and the next week she'll be able to do full practices to have you kind of frame it like that. Then the coaches are like, okay, I could, I could deal with that. Versus the coaches being like, no, they can't modify practice right now. We have a competition in two weeks. But if you've kind of framed it that way and say like, Hey, if we just allow these couple of days and then next week they're going to be able to have full practice without limiting themselves at all, then they're more likely to kind of go with your recommendations versus, you know, everyone being on kind of different sides.
Karen Litzy: 22:20 Perfect. I think that's great advice. Communication is vital and everything we do with our patients from all the different stakeholders that are involved to the patient themselves, to parents and caregivers and to each other. So I think that's great advice. Thank you so much. And I have one last question for you and it's the one that I ask everyone and that's knowing where you are now in your life and in your practice. What advice would you give to yourself as a new Grad right out of physical therapy school?
Duane Scotti: 22:51 So this is a tough question because I hear this all the time because I listened to all your podcasts and you would think I would have the answer right off the top of my head. But I would probably say, there's a couple things is one, just not be afraid to fail. Failure is good because we learn from that and then don't abandon certain techniques or philosophies early on if you're not getting it right. Continue to learn and grow, evolve. And that's how we all get better in what we do.
Karen Litzy: 23:22 I think that's wonderful advice. That's perfect. Resonates with me. Very much so. Thank you, Duane, for coming back on the podcast again and educating us all around gymnastics medicine, so thank you.
Duane Scotti: 23:32 Awesome. Thank you for having me. This has been great.
Karen Litzy: 23:35 My pleasure. And everyone out there listening. Thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Megan Sliski and James Nowak on the New York Physical Therapy Association Student Special Interest Group. Megan is the NYPTA SSIG President, National Student Conclave Project Committee Chair and NYPTA Central District Conclave Committee Chair. James is the NYPTA SSIG Vice President.
In this episode, we discuss:
-The roles and responsibilities of the President and Vice President of the NYPTA SSIG
-A few of the highlights and accomplishments of the SSIG this term
-What Megan and James look forward to in their future leadership roles
-And so much more!
Resources:
NYPTA SSIG Website
Megan Sliski Twitter
James Nowak Twitter
For more information on Megan:
Favorite PT Resource: PT Now
School: Utica College: DPT 2020; Utica College: Health Studies, Healthcare Ethics
“I’m excited to see the team grow & work together to create opportunities for DPT/PTA students around New York.”
For more information on James:
Favorite PT Resource: New Grad PT
School: Utica College: DPT 2021; Utica College: Health Studies
“I’m so excited to be a part of a growing team that has the opportunity to truly enhance the student physical therapy experience in New York State.”
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor here with healthy, wealthy and smart. And I'm here to interview Megan Sliski and James Nowak. First of all, thank you so much for coming on and agreeing to speak about drum roll please. The student's special interest group. You're here in New York and you two are a power duo and Megan here is the president and James is the vice president and you're halfway through now. Is that where you're at? About halfway through. So I would love for those who don't know, when people say, what does this SSIG do? That’s the student special interest group. Could you start from the elections? Don't worry about taking me through the whole year. I'll ask you questions as we go through. So you got elected. What happens next? I'm going to hand it to Megan and then when you need help you can pass it over to James.
Megan Sliski: 00:57 So when we first got elected, Jenna, a lot of it was just trying to figure out what the dynamic of the new team was going to be and how we were going to encompass the goals of the SSIG into the individuals that we were introducing into the SSIG. And so the beginning of the term involved a lot of transitioning and a lot of, of trying to make sense of, you know, what we were going to do and how we were going to progress forward. And the SSIG being just only in its infancy, only two years old at this point. You know, we had a lot to consider. We had to, to figure out, you know, what had worked the previous year, what hadn't worked, how are we going to move forward? How are we going to make this organization successful? How are we going to pair with the NYPTA and, and really make this an organization that was going to succeed.
Megan Sliski: 01:44 And so at the beginning we really focused on trying to get to know each officer individually as well as trying to get to know the positions individually. And so the nominating committee chair from last year did a wonderful job slating candidates. And we were very fortunate that the candidates that we had were so wonderful and that all of the individuals who are elected were just so great for their positions. And you know, we're really lucky for that. And so what we did was move forward. We got to know the individuals on an individual basis and we figured out how we were going to make the organization work for us. That being said, you know, there were times where there were hurdles, but when aren't there hurdles will a new organization, especially when the organizations only in it’s second year. And we were fortunate enough that, you know, James and I actually go to the same school.
Megan Sliski: 02:32 And so we were able to meet almost weekly to talk about some of the challenges we were having in some of the successes and how we were going to make sure that the successes continued. But at the same time, how are we going to approach the challenges that we were having? Again, with it being a new organization. And I happen to think that we're very lucky that James and I went to the same school because in the second year of this organization, we were able to work through some things that were a bit challenging that we hadn't maybe thought about before, that maybe weren't issues the year before. And I think that we've been very lucky so far with the caliber of people that we've had and the team that we've had. And I think that the rest of the year it's going to be so wonderful. I love that.
Jenna Kantor: So, James, for you, when you got elected, what happened? Was there a meeting? Was there, I mean, you already knew Megan, I'm assuming. I would love to know.
James Nowak: 03:26 It's actually a really funny story. So I'm wrapping up in my first year of DPT school and I remember, It's the fall with heavy musculoskeletal stuff. And then this girl by the name of Megan comes in and does a little introduction on this state organization, state student special interest group called the NYPTA SSIG. And immediately within, probably within a couple of minutes of her presenting it, I said, oh my God, this like, like this is for me, this is what I want to be a part of. And at the time, I probably saw Megan around a little bit, but I had never talked to her. And I gathered up the courage and I introduced myself and I said, you know, this right here is something I want to be a part of.
James Nowak: 04:13 I want to make a difference, not only at my school, but on the state level I want to interact with students and professionals both throughout the state, you know. And so I said, I went up to her and I said, how do I get involved? And then she kind of talked me through the election process and how that was gonna be coming up. She did a little presentation right before elections ran. And so from there I decided to apply. And thankfully I got slated. Luckily, luckily enough, I got elected as the vice president. And I was very, very thankful for that. And I think my process after that really my first initial thought was, okay, so now I'm a part of the state organizations, such a phenomenal opportunity. I wanna be able to work with students throughout the state.
James Nowak: 04:58 I'm here in central New York. You know, if you think of a map of New York state, you put a dot right in the middle. That's where I am. And I'm going to get to work with people who are all the way down south in the city and all the way up towards Canada. And getting to being able to really get the wealth of knowledge and experience from them. It was very exciting to me. I hadn't had the opportunity to interact with the students yet. So I think my first thing was really getting to know my team, you know, getting to know the people who were elected. So initially it was phone calls, just to get to know them. Eventually as the year turned to the start of our term.
James Nowak: 05:41 We had a nice transitional meeting, so we had a transitional meaning from our board from the previous year and the people who are elected for this year that we're currently in. And that it wasn't just a phone call on the phone, it was face to face through the computer. Really, it's almost like Skype, but they use, it's a platform called goto meetings that we use. And I got to see the past president of the SSIG and I got to see all the people that I was working with throughout the year and it was such a unique opportunity to be able to interact on that level. Even though I'm sitting in my apartment in Utica, New York, I got to talk with students who were from, you know, places like Columbia all the way down in the city. And that was such a unique opportunity.
Jenna Kantor: 06:25 I love that. So for you, James, what have you been doing? Cause you look over all the regional reps. So for those who don't know, I was part of the SSIG, so I'll educate you guys on this. So there are regions within New York in which there is a student that represents several schools and we'll handle the communications with several schools because New York is huge and we have a lot of schools here. So when you're working with the regional reps, how often do you meet and how do you run those meetings?
James Nowak: 07:00 So I think that's a great question Jenna. As of right now, we try and meet on a monthly basis. And with that being said, coming up towards our midterm here where, you know, something we really put at the forefront is getting immediate feedback on things and we're going to get feedback from students and see is that something that's working? Is this something that's not working? You know? So that's something we're going to see. But as of right now, that's kinda how we do things and enables us to really, on a monthly basis be able to say, okay, so these are the things we're working on. How can we contribute? How can the representatives throughout the state really add various ideas to your advocacy dinner? Let's say for example, that you're planning, you know, how can we bolster this? How can we support you to make this a reality?
Jenna Kantor: 08:11 I love that. I love that. So they're not thrown to the wolves. Megan, for you, we went a little bit backwards because I jumped to the interactions with the regional reps. You're working with the board. So I always forget because there's the main board and then there's the extension people. What are the terms? The advisors and the advisory panel. I should know this because I was on the advisory panel but, but so in these meetings with the advocacy chair, somebody who's in charge of volunteering and somebody who's in charge of events. What do you guys discuss or what even did you guys discuss and how was it passed along to James to be passed along to the regional reps? I mean just throwing out 5 million ideas.
Megan Sliski: 08:56 So I think that that was something that was a challenge last year. We were trying to work through how do we communicate from the executive board and advisory panel to the Board of Representatives. And that's something that James and I did not take very lightly this year. We worked very hard to figure out how we were going to communicate with the board representatives. The Board of Representatives and the liaisons are our main contact with the schools. And without them, our structure falls apart. We need them, we need the communication with them. They need to know what's going on. And so the way that we worked through this was yes, we had our executive board meetings where the executive board talked with the advisory panel and we figured out the plans for everything and we figured out, you know, what we were going to do for the rest of the term or even for just the upcoming months.
Megan Sliski: 09:53 Not even extending until the end of the term and just focusing on the now. So we would talk through that. But what we added this year, Jenna, that I think you'd be very happy to hear is that the board of Representatives were invited to every single executive board meeting. And so not only do they know what's going on at the executive board meetings, they have active voices in what's going on at the executive board meetings. So the board of reps have become this voice for us, the voice of we know what's going on in this region, we understand our schools, we can give you the information that you need to help the SSIG be successful right now in these regions, in these schools. And I think that that was what was crucial and that's what we added in, that's really been beneficial to our organization is that we've been able to encompass all of our officers and we've been able to involve all of those officers in the decisions and we've been able to hear all the different perspectives and I think that's been great.
Jenna Kantor: 10:55 How did you narrow down exactly what you were going to be doing this year, Aka advocacy dinners or even conclaves?
Megan Sliski: We haven't actually, we haven't narrowed that down and I think that maybe that's one of our strengths is that we're trying to figure things out as we go. I talked earlier in the podcast about how this organization is in its infancy and how we don't actually know exactly where it's going. And I think maybe that's the best part of this organization right now is that we don't know. You know, so we've thrown off ideas, we've talked, we figured out what everyone's strengths are. We figured out where we can go with the ideas that we have. And from that we've decided that, you know, we have a very strong advocacy chair who's really great at working with the student assembly and working with you as the past advocacy chair.
Megan Sliski: 11:47 She's had wonderful mentorships. Which I can say for a lot of our officers, actually all of our officers, they've had wonderful mentorship to be able to guide them to what we've done now. I think that talking about the strength and talking about, you know, what succeeded last year, you know, what we can do better from last year. We had such a strong board last year and they left us with such monumentous advice and you guys were so wonderful in guiding us to where we needed to be for the next year. And we've taken that and we've run with it, you know, and everyday we may not have the answer to what we're doing tomorrow, but I think that right now the plans that we have in place are wonderful and I think they're great for enhancing the student experience.
Megan Sliski: 12:36 And I think that as the term continues, we're just going to keep coming up with more ideas and we're just going to be able to keep invigorating students to be able to get involved with the special interest group. And personally, that's what I love about it. I think that every day we just grow more and more as an organization and I love that.
Jenna Kantor: So what have you guys accomplished this year so far? You share some and you share some split the mic.
Megan Sliski: So I’ll start. I don't want to sell so much of James’ thunder, but I think so far one of the wonderful things that we've come up with is that we've voted in the establishment of an advocacy task force. And we've also voted in the establishment of a service task force.
Megan Sliski: 13:21 The advocacy task force is going to promote legislation nationally and statewide to help students become more informed on the issues that really pertain to us as physical therapists and physical therapist assistants. And the service committee, the service Task Force, I'm sorry I should use the right language, is going to really focus on helping our service chair with implementing a really great day of service project. Something that we really hold to high standards in New York state. And I am so excited to see what they accomplish. So I'll give the mic to James and I’ll let him talk about more of our successes.
James Nowak: 13:55 Well, without further ado, so I think really two things stand out to me early on. One first is it's really a continuation of last year and it's really implementing the advocacy dinners. We've really tried to put a focus on students networking not only with themselves but with professionals as well too, to really advocate for our profession out always. PTs with PTAs as well with one common goal of, educating folks, educating just our regular public along with educating our legislators. You know, that's put a focus on is initially, you know, extending that to things such as lobby day. And really just letting students know that, hey, this is something, you know, your classroom education has relied on. It's very important, but you also should be concerned about some of the legislative issues that are going on cause it's really going to impact your future.
James Nowak: 14:48 So we've already had a couple of advocacy dinners. We've had some standout speakers such as former NYPTA president, Dr. Patrick VanBeveren. He gave a phenomenal presentation at Utica College. And really I want to say with that is a huge shout out, not only to our advocacy chair Liping Li for, for really making these things happen, but also, our regional representatives, down to the liaisons at each individual school. Really Planning and being our boots on the ground. We're making these things happen. They did a phenomenal job. And I would say our second accomplishment of this year, which I really feel strongly about is connecting with the NYPTA and specifically the NYPTA districts. Something we've really made a push for is to start to really try in and promote similar events, you know, and get students involved in mingling with the professionals in their various regions. We had our regional representatives actually reach out to the district chairs and the NYPTA and really trying to foster that relationship. So then you know, in the future we have that great connection with professionals who are in the field, and that will really provide students with phenomenal networking opportunities that they might not be able to get at their individual programs, but they can receive that from us.
Jenna Kantor: 16:16 I freaking love that. Okay. So I am going to move you both forward into the future. The future of when your term ends. What are you going to miss most?
Megan Sliski: 16:36 I think what I'm going to miss the most is being able to inspire the students in New York from my leadership position as the president. I'm going to miss talking with them on a weekly basis and you know, hearing their thoughts and hearing their opinions on how we're going to better things for the physical therapy profession in New York state. But I say I'm going to miss that. Although I have a feeling that those relationships aren't going anywhere and I have a feeling that knowing myself, I'm still going to be reaching out and talking to all of those individuals I think I’m going to miss inspiring the team. I think I'm going to miss the SSIG. This being my second year involved I think the SSIG has really given me an opportunity to grow and I think it's helped me realize who I am as a person and who I want to be as a professional. And although I'm eternally grateful to the SSIG for what it's given me in my role as a graduate student, I'm gonna miss that. I think I'm gonna Really Miss Interacting with the people that I've met, but I also know that that's not the end of what I plan to do. And although it'll be a little bit of a bittersweet ending, I'm excited for what comes after the SSIG for me.
James Nowak: 17:58 Just got to wipe away my tears after that one. I don’t know how I’m going to follow that. What I think really going off what Megan was saying, our organization, one of the things were really true is we try and do is deliver the experiences to students throughout the state. And that I think I would miss a lot is hearing feedback from schools saying, did you know, did you like this? You know, and stuff like that. And really being able to implement things that, you know, and give students the experiences that they might not be necessarily getting in the classroom directly. But I think just Kinda like what Megan was saying, working with the team, you know, when you're in an organization like this and you're able to network with students throughout the state, you really do build close bonds, you know, and there's something about that atmosphere of, you know, coming together, collaborating, sort of to deliver those experiences and really make a difference. You know, what we're doing here is we are inspiring and we are educating the future professionals of our field and to really be at the forefront of that is something that I think I'd miss greatly.
Megan Sliski: 19:09 I want to comment James on what you just said. So I happen to think that our dynamic duo of leading a team isn't quite over yet. And so our sounding all somber here and sad about leaving, I have a feeling that James and I are going to continue our little teamwork and leading teams and things are just going to get a little bit better. So look out for the dynamic duo.
Jenna Kantor: I love it. Well, thank you so much dynamic duo for coming on. Take care everyone. Thanks for tuning in.
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LIVE from Graham Sessions 2019 in Austin, Texas, Jenna Kantor guests hosts and interviews Lisa VanHoose, Monique Caruth and Kitiboni Adderley on their reflections from the conference.
In this episode, we discuss:
-The question that brought to light an uncomfortable conversation
-How individuals with different backgrounds can have different perspectives
-How the physical therapy profession can grow in their inclusion and diversity efforts
-And so much more!
Resources:
Lisa VanHoose Twitter
Monique Caruth Twitter
Fyzio 4 You Website
Kitiboni Adderley Twitter
Handling Your Health Wellness and Rehab Website
The Outcomes Summit: use the discount code LITZY
For more information on Lisa:
Lisa VanHoose, PhD, MPH, PT, CLT, CES, CKTP has practiced oncologic physical therapy since 1996. She serves as an Assistant Professor in the Physical Therapy Department at University of Central Arkansas. As a NIH and industry funded researcher, Dr. VanHoose investigates the effectiveness of various physical therapy interventions and socioecological models of secondary lymphedema. Dr. VanHoose served as the 2012-2016 President of the Oncology Section of the American Physical Therapy Association.
For more information on Monique:
Dr. Monique J. Caruth, DPT, is a three-time graduate of Howard University in Washington D.C. and has been a licensed and practicing physiotherapist in the state of Maryland for 10 years. She has worked in multiple settings such as acute hospital care, skilled nursing facilities, outpatient rehabilitation and home-health. She maintains membership with the American Physical Therapy Association, she is a member of the Public Relations Committee of the Home Health Section of the APTA and is the current Southern District Chair of the Maryland APTA Board Of Directors.
For more information on Kitiboni:
Kitiboni (Kiti) Adderley is the Owner & Senior Physical Therapist of Handling Your Health Wellness & Rehab. Kiti graduated from the University of the West Indies School of Physical Therapy, Jamaica, in 2000 and obtained her Doctorate of Physical Therapy from Utica College, Utica, New York, in 2017. Over the last 10 years, Kiti has been involved in an intensive study and mentorship of Oncology Rehabilitation and more specifically, Breast Cancer Rehab where her focus has been on limiting the side effects of cancer treatment including lymphedema, and improving the quality of life of cancer survivors. She has been a Certified Lymphedema Therapist since 2004. She is also a Certified Mastectomy Breast Prosthesis and Bra Fitter and Custom Compression Garment Fitter.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly YouTube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. And here I am at the Graham sessions in 2019 here. Where are we? We're in Austin, Texas. Yes, I'm with at least. And we're at the Driscoll. Yes. At the Driscoll. Yes. I'm here with Kiti Adderley, Monique Caruth and Lisa VanHoose. Thank you so much for being here, you guys. So I have decided I want to really talk about what went on today, what went on today in Graham sessions where we were not necessarily hurt as individuals. And I would like to really hit on this point. So actually Lisa, I'm going to start by handing the mic to you because you did go up and you spoke on a point. So I would love for you to talk about that. And then Monique, definitely please share afterwards and then I would love for you to share your insight on that as well. All right, here we go. Awesome.
Lisa VanHoose: 00:52 So first of all, thank you so much for giving us this opportunity just to kind of reflect on today's activities. And so, I did ask a question this morning about the differences in the response to the opioid crisis versus the crack cocaine crisis. And I was asking one of our speakers who is quite knowledgeable in healthcare systems to get his perspective on that. And he basically said, that's not really my area. Right. And then gave a very generic answer and as I said earlier to people, I'm totally okay with you saying you don't know. But I think you also have to make sure that that person that you're speaking to knows that I still value your question and maybe even give some ideas of maybe who to talk to and this person would have had those resources. But, I guess it was quite evident to a lot of people in the room that they felt like I had been blown off.
Lisa VanHoose: 01:48 So yes. So that was an interesting happenings today.
Jenna Kantor: And actually bouncing off that, would you mind sharing how this has actually been a common occurrence for you? You kind of said like you've dealt with something like this before. Would you mind educating the listeners about your history and how this has happened in your past?
Lisa VanHoose: I think, anytime, you know, not just within the PT profession but also just in society as general when we need to have conversations about the effects of racism. Both at a personal and systemic level, it's an uncomfortable conversation. And so I find that people try to bail out or they try to ignore the question or they blow the question off and ultimately it's just, we're not willing to have those crucial conversations and I think they almost try to minimize it. Right.
Lisa VanHoose: 02:41 And I don't know if that comes from a place of, they're uncomfortable with the conversation or maybe they just feel like the conversations not worth their time. But, I can just tell you as just a African American woman in the US, this is a common occurrence. As an African American PT, I will admit it happens a lot within the profession. But I do think that there are those like you and like Karen and others that are willing to kind of move into that space because that's the only way we're going to make it better.
Jenna Kantor: Thank you. Thank you for giving me that insight. Especially so because people don't see us right now, so, so they can really get a fuller picture of it. And now, Monique, would you mind sharing when you went up and spoke, how that experience was for you, what you were talking about and how you felt the issue that you are bringing up was acknowledged?
Monique Caruth: 03:37 Well, as Lisa said, we're kind of used to talking and it going through one ear and out the next day and our issues not really being addressed. I think it comes from a point where a lot of Caucasians think that if you try to bring it up, they would be blamed for what was done 400 years ago, 300 years ago. So it comes from a place of guilt. They don't want to be seen as they have an advantage. And I think as blacks we had a role to play in it by saying, oh, you’re white and you’re privileged. So you had an advantage, which structurally there is an advantage. There is structural advantages as I was discussing with Lisa and Kiti last night that as an immigrant, even though I'm black, they're more benefits that I've received being here than someone who was born maybe in Washington DC or inner city Chicago or maybe even, Flint, Michigan.
Monique Caruth: 04:51 I can drink clean water, I can open my tap and drink. What I don't have to worry about, you know, drinking led or anything like that. I can leave home with my windows open, my doors open and feel safe that my neighbors will be looking out for me and stuff that I can walk my neighborhood. So there are privileged even though I'm black, that some people that can afford and would I be ashamed of being in that position? No, acknowledge it. And even with an all black community, there are a lot of us, we may not have been born in a world of wealth. I wasn't, my parents sacrificed a lot to get me where I am today, but not because I have somewhat made it means that I have to ignore the other people that have struggled.
Monique Caruth: 05:43 And this is a problem that I'm noticing in a lot of black communities, like when someone makes it or they become successful, Aka Ben Carson, Dr Ben Carson, we feel that if I can make it, why can't you? And because some of those people were not afforded the same privileges that you were afforded, and it's kinda not fair to make that statement that if I made it. So can you, and you can't tell people that you worked your butt off and pull yourself up by your bootstraps when you were afforded welfare stuff. Your, you know, your mom benefited from stuff. I was afforded scholarship so that I don't have to have $200,000 in debt. So I could afford to purchase a home after I graduated and all that stuff because I was not in debt.
Monique Caruth: 06:47 And a lot of people do not have that luxury. So I can tell people if I can do it, you can do it too. I have to try to find ways to address their concerns and see how I can better help them to move forward and live better. And the problem within our profession is that many in leadership, even though they see themselves as making it, they don't want to have acknowledge that not everyone comes from the same place. It's not a level playing field. And they try to dismiss those by saying, Oh, if I can make it, everybody else can as well.
Jenna Kantor: Thank you. Well said. Well said. Kiti. would you mind sharing in light of what everybody said, some of your thoughts on this matter?
Kitiboni Adderley: 07:30 While it was interesting to watch the conversation, listen to the conversation today. I have a unique perspective in that I don't practice in the United States. I don't live in United States, but I frequently here taking part in education, but also watching the growth and development of the physical therapy profession. So I'm from The Bahamas and it's predominantly African descent population. Right? And so some of the issues that people of color in the United States deal with, we don't really deal with those in terms of that limitations and privileges. And you know, it's more of a socioeconomic for us. And once you can afford it, then you go and do. And, and I think we're pretty fortunate if we talk about while across the board that most people can afford some form of education and get it.
Kitiboni Adderley: 08:30 So I'm in a unique position because I look African American, it was, I don't open my mouth. You don't know. And so I'm privy to some conversations on both sides of the role, you know, and if people are probably, so what do you think about this and how do you feel about that and how does it bother you? And you know, so while I'm not the typical African American and they see them start to take a step back and it sort of gives you the understanding that they don't truly understand that every person of color does not have the same story. And so you can approach us expecting us to have the same story. Right? Cause your three x three women of color here, one's born and bred African American ones born and bred Trinidad and transplanted United States and one's born and bred, still working in The Bahamas and the Caribbean.
Kitiboni Adderley: 09:17 Good. So we all have different perspectives that we all come from different backgrounds and different experiences. But it was interesting and when Lisa asked a question and you know like, you know, people say you will, you know you need to bring it up if we don't talk about these things enough. And it's almost like, okay, you bring up the conversation. So the balls in play, it's tossed from one play at an accident and be like, Oh shit, we can handle, listen to bar this draft again. And so the conversation shuts down and you're like, but you didn't answer the question and you're like, you know, well, yeah, okay, well we'll throw the ball up in the air. And at another time, and I think this is where the frustration comes in for people of color that live in United States because you want us to have these conversations were given quote unquote, the opportunity to ask questions or have these discussions and the discussions come up and at the end of it it's like, okay, we just gave you the opportunity to discuss where do we go from here?
Kitiboni Adderley: 10:14 What's done, what's the recourse, what's our next step? What's our plan of action? And when we talk about inclusion and diversity, if you're not going to take it to the next step, if you're not going to have a call to action, then what's the point? And this is why probably people of color don't come back out again because what's it's a bit, it's a bit annoying. It's like frustration because you stand there, you're waiting for a response. And I was like, oh, well, you know, this isn’t my field and I appreciate the honesty, but then let’s address this at some point we have to address this. So do we need another meeting just to address this? Do we have to have, you know, just, let's pick the topic and work on it. So like I said, it was a very unique perspective.
Kitiboni Adderley: 10:57 I sort of like watching the response of the other people in the room and see how they respond to it, but the conversation needs to keep going for those of us who can tolerate it or have the patience to deal with it at this given time. And, it was a great experience. It was a good experience.
Jenna Kantor: I love it. So I would have just one more question for each of you and it's what would you recommend we do as a profession, both individually and as a collective in order to grow in this manner?
Monique Caruth: 11:37 Well, piggy backing off of what Kiti mentioned, I was sort of blown away too when he said that that's not his field because he's a reporter, he does documentary stuff all you was asking was one opinion you want asking for, you know, an analysis or anything. It was just an opinion and he refused to give that. And his excuse was, I don't know much about it and what was, it wasn't surprising but no one else in the crowd said well we then address her concern and immediately he was, she didn't put it in a way that made it seem or the crack epidemic was black and the opioid crisis as white. He was the one who drew it up cause I was actually praising her for how skillfully she worded it. I'm learning a lot of tack from obviously Lisa I'm not that tactful and my family tells me I need to be tactful, but it's that no one else said, okay, let's discuss it.
Monique Caruth: 12:51 Really. Why, why is APTA making such a big push choose PT. Now. Versus in the 80s when the crack and the crack epidemic was destroying an entire city because DC was known for being chocolate city on the crack epidemic, wiped it out and it got judge all. Alright, it rebuilt it. But now again, it's trying to find like I went to Howard University, you know, I could walk around shore Howard and I'm like, am I in Georgetown? Because you don't recognize, you know, the people live in that. It has driven out a lot of blacks that were living in drug pocket. You know, it's now predominantly, young white lobbyist living in the area. So if we don't have the support of our colleagues, how can we address inclusion? How can we address equity if they're not willing to put themselves out there to say, Hey Lisa, I got your back.
Monique Caruth: 14:05 We need to talk about this. We need to discuss it. Let's have a discussion. Your question was not answered. It wasn't even to say that it was acknowledged with a dignified response because we're spending millions of dollars under choose PT campaign. Why is it because the surgeon general is saying, oh there needs to be another alternative because Congress is trying to pass bills to lower the opioid crisis. Why? If you asking people to choose PT what makes it different? Okay. Even with the Medicaid population, the majority of people who receive Medicaid are black and brown. Are we fighting to get make that people have medicaid coverage or other stuff. Or are we fighting running down Cigna and blue cross blue shield and Humana and all those other types of insurances? Because we think the money is in these insurances. When they could dictate whatever they want, then you could provide a service and say you're providing quality service.
Monique Caruth: 15:14 But if they say, oh, we're just gonna reimburse you $60 we are getting $60 and people on our income. So people complain on Twitter and on social media about, you know, insurance stuff. But if I see a medicaid patient in Maryland, I am guaranteed $89 and that person has the treatment. They’re being seen, they're getting better. It's guaranteed money. But a lot of people don't want to treat the Medicaid population because they think they're getting blacks or Hispanics. And I hear complaints like I don't really want to treat that population because we are going to have no shows and cancellations and all that stuff, which is bs. It's excuses. And we have to do better as a profession to acknowledge or biases and work on ways to help work with the population that we serve. Because let's face it, America is not going to remain white? It's gonna get mixed. We're going to have some more chocolate chips in the cookies. Okay. All right. It's going to be more than two chocolate chips in the whole cookie next time.
Jenna Kantor: 16:33 Before I pass it to you, Kiti, I really like where you're going with this, Monique, and I think it's important to acknowledge why, which I didn't at the beginning. Why, why, why we're tapping on this one incident and really diving in and it's because what I learned today from my friends is that this is a common occurrence in the physical therapy industry. It's not just it and it's not just within our industry. It's what you guys deal with regularly. And if we are talking about our patients providing better patient care, we need to really, really be fully honest with where we are at. Even as they are speaking, I'm constantly asking myself, what are my things that I'm holding within me where I'm making assumptions about individuals? There's always room for growth. So please as you continue to listen to Kiti speak next, just keep letting this be an opportunity to reflect and grow.
Kitiboni Adderley: 17:50 Okay, so I recognize that incident was uncomfortable. It was an uncomfortable conversation to have and it's okay to have uncomfortable conversations. As physical therapists, we have uncomfortable conversations with our patients all the time. We have uncomfortable conversations with our colleagues and we have to call them out on some mal action or when they call us out on something that need to do. And because the conversation is uncomfortable, it doesn't mean that we don't have it. We probably need to talk about it more. And so if there's anything that I want to say, I think we need to have more of these conversations and have them until they no longer become uncomfortable until we could actually sit down with, well no, I shouldn't say anybody but, but the people of influence, cause this is what it's really about. We were sitting with very influential people today and all of us there, I'm sure where people of influence and you know, this is what we need, this is what we need to use. And don't be afraid to have the conversation. As uncomfortable as it may make you feel. Why are we having this conversation? We want inclusion, we want diversity, we want a better profession. And those are the goals of the conversation. We shouldn't shy away from it.
Jenna Kantor: Thank you. I'm gonna hand this over to Lisa for one last one last thing.
Lisa VanHoose: 18:43 So I just want to talk about the fact that part of the conversation was this dodging right? Of a need to kind of have this very authentic and deep conversation. The other part of today's events that I'm still processing is this conversation about the need for changed to be incremental, right? Comfortable. And for those of us that are marginalized to understand that the majority feels like there has been significant change and that was communicated to me in some side conversations and I was challenged by one person that was like, well, I think you have this bias and you're not recognizing the change that has occurred and how that this is awesome that we're even in a place to have this, that we're having this conversation today.
Lisa VanHoose: 19:46 You know, that you need to acknowledge that success that we've made. And so I do agree that, you know, what all work is good work and I will applaud you for what has been done today. But I also would say to people who feel that way, step back and say, okay, if the PT profession has not really changed as demographics in the last 30 years, and if you were an African American and Hispanic and Asian American, an Asian Pacific islander or someone of multiracial descent would you be okay with that? Saying that, you know what, I started applying to PT school when I was in my twenties and I'm finally maybe gonna get in my fifties and sixties. How would that feel? Right? That wasted life because you're waiting on this incremental change. And I think if we could just be empathetic and put ourselves in the other person's shoes and say, would I be okay with waiting 30 years for a change?
Lisa VanHoose: 20:53 Would I be all right with that? But I often feel like when it is not your tribe that has to wait, you okay with telling somebody else to wait? Right? And so, I want to read this quote from Martin Luther King and it was from the letters from Barringham where he criticized white moderates and he said that a white moderate is someone who constantly says to you, I agree with your goal, with the goal that you seek, but I cannot agree with your methods of direct action. Who believes that he can set the time table for another man's freedom. Such a person according to King is someone who lives by a mythical concept of time and is constantly advising the Negro to wait for a more convenient season. And that's how I felt like today's conversation from some, not all was going. King also talked about the fact that that shallow understanding from people of goodwill is more frustrating than the absolute misunderstanding from people of ill will. Luke warm acceptance is much more bewildering than outright rejection. And I say that all the time because I would prefer that you be very honest with me and say, I don't really care about diversity and inclusion, but don't act like you're my ally. But then when it's time to have a hard conversation, you say, I can't do that. I'm like, choose a side, pick a side. There is no Switzerland. There is no inbetween.
Jenna Kantor: 22:25 Thank you so much you guys. I'm so grateful to be having this conversation to finish it with a great Martin Luther King quote, which is absolutely incredible. I'm just full of gratitude, so thank you. I'm really looking forward to this coming out and people getting to share this joy of learning and growth that you have just shared with me right now.
Lisa VanHoose: And thank you for being an ally. We really appreciate that. So we're not, I just want people to know, we're not saying that the African American or the immigrant experience is different from the Caucasian experience. I think we all have this commonality of being othered at one time or another, but yes, with being a white female LGBTQ, I think the complexities of who we are as a human, there's always going to be a time where you're an n of one or maybe of two and you get that feeling that, Ooh, am I supposed to be here? But I think what we're talking about is being empathetic and if we're going to talk about being physical therapists, being practitioners and compassionate, and we're going to provide this patient centered care, how can you tell me you're going to provide patient centered care when you can't even have a conversation with me as a colleague, right. When you can't even see me. So I just want the audience to know, that we're not coming from a place of being victims were coming from a place of really wanting to have collaborative conversations.
Monique Caruth: 23:59 I like to view my colleagues as family members. There are times, as much as I love my family, my mom and my dad and my sisters and my brothers in law, there are times we will sit and have some of the most uncomfortable conversations, but at the end of it it’s out of love. It's all for us to grow as a family. And Yeah, you may not talk to the person for like a day or two, but you're like, shit, you know, that's my sister, that's my brother in law. You know, I have to love him. But you know, you try to hear their perspective, you try to make sure they hear your perspective and you come out on common ground so that the family can grow. And we don't treat this profession as a family, the ones who are marginalized are treated as step children.
Monique Caruth: 24:57 And that's a bad thing because stepchildren usually revolt. And when they revolt, the ones who are comfortable with incremental change and are afraid of chasing the shiny new object. Because when I heard that comment today, I felt like the shiny new object was diversity, equity and inclusion that people were trying to avoid without saying it outright. And, someone who feels like they have been marginalized. It was like a low blow. So I, for one, appreciate people like you, Ann Wendel, Jerry Durham, Karen Litzy, and stuff. Who Have Sean Hagy and others, Dee Conetti, Sherry Teague reached out to us and say, how can we help? And you need people like that to be on your side. Martin Luther King needed white people. Okay. Rosa parks needed white people. Harriet Tubman needed white people to get where they're, even Mohammed Ali needed white people to be as successful as he is. We all need each other. If we are saying championing better together, how can you be better together if you're not willing to hear the reasons why you feel marginalized or victimized, it's not going to work. Stop turning around slogans or bumper stickers and start working on fixing the broken system that we have. That's all I'm asking for and we got to start working as a family, as uncomfortable as it may be. All right, we'll get over it and you're going to like and appreciate each other for it later on.
Jenna Kantor: 26:44 Thank you guys for tuning in everyone, take care.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Greg Lehman on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada. Greg is a physiotherapist, chiropractor and strength and conditioning specialist treating musculoskeletal disorders within a biopsychosocial model. He currently teaches two 2-day continuing education courses to health and fitness professionals throughout the world. Reconciling Biomechanics with Pain Science and Running Resiliency have been taught more than 60 times in more than 40 locations worldwide.
In this episode, we discuss:
-Common misconceptions surrounding the source of pain
-Do biomechanics matter?
-Promoting movement optimism in your treatment framework
-What Greg is looking forward to at the Third World Congress of Sports Physical Therapy
-And so much more!
Resources:
Greg Lehman Website
Greg Lehman Twitter
Third World Congress of Sports Physical Therapy
David Butler Sensitive Nervous System
Alex Hutchinson Endure
For more information on Greg:
Prior to my clinical career I was fortunate enough to receive a Natural Sciences and Engineering Research Council MSc graduate scholarship that permitted me to be one of only two yearly students to train with Professor Stuart McGill in his Occupational Biomechanics Laboratory subsequently publishing more than 20 peer reviewed papers in the manual therapy and exercise biomechanics field. I was an assistant professor at the Canadian Memorial Chiropractic College teaching a graduate level course in Spine Biomechanics and Instrumentation as well conducting more than 20 research experiments while supervising more than 50 students. I have lectured on a number of topics on reconciling treatment biomechanics with pain science, running injuries, golf biomechanics, occupational low back injuries and therapeutic neuroscience.
While I have a strong biomechanics background I was introduced to the field of neuroscience and the importance of psychosocial risk factors in pain and injury management almost two decades ago. I believe successful injury management and prevention can use simple techniques that still address the multifactorial and complex nature of musculoskeletal disorders. I am active on social media and consider the discussion and dissemination of knowledge an important component of responsible practice. Further in depth bio and history of my education, works and publications.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody, welcome to the live interview tonight with Doctor Greg Lehman. And we have a lot to cover tonight. So for everyone that is on watching, oh good. And we're on. Awesome. Just wanted to make sure, for everyone that's on watching and kind of throughout the interview, if you have any comments or you have any questions or you want to put Greg on the spot, feel free to do so. We can see your comments as they come up. Greg, if you can't see them, just know I'll kind of let you know. But one thing we do want to know is if you're watching, say hi and let us know where you're watching from. And that way when you start asking questions, at least I'll have a better, kind of know who you are a little bit. Now before we get to the meat of the interview, I just want to remind everyone that if you are watching this, this is not on my page and it's not on Greg's page, but instead we are on the Facebook page for the Third World Congress in Sports Physical Therapy and that is going to be taking place on October 4th and fifth in Vancouver, Canada.
Karen Litzy: 01:20 So hopefully we're going to be doing more of these throughout the year talking to a lot of the presenters and Greg is one of the presenters at the congress. So that's why he's here.
Greg Lehman: 01:31 Not just me every time
Karen Litzy: 01:35 Although I have to say, I bet people would really enjoy that.
Greg Lehman: 01:39 Yeah, I'll fill in for whatever speaker it is and I'll just learn their stuff and then pretend like I know
Karen Litzy: 01:46 Okay. So I'd like to see you fill in for Sarah Haag.
Greg Lehman: 01:50 Done. I’ll shake my pelvis.
Karen Litzy: 01:53 Pelvic health and stuff like that. That would be amazing. I would actually wouldn't mind seeing that. Now before we get started, Greg, can you talk a little bit more about yourself, just kind of give the listeners, the viewers here a little bit more of a background on you so that they know where you're coming from, if they are in fact not familiar with you.
Greg Lehman: 02:13 Okay. Well, leading into that, I'm a generalist. I'm not a specialist. I have a background in kinesiology and then a master's in spine biomechanics and I was really into spine biomechanics for a long time. But you know, I became not, sorry, I was going to say dissolutioned. That's a little too strong. I've always been skeptical, skeptical of everything that I've known, and that's probably why I got accepted to my master's in biomechanics because they liked the questions I asked. And then my research there was in mainly exercise, like EMG and manual therapy, what manual therapy does. And I was pretty lucky because I was with Stuart McGill and two chiros named Kim Ross and Dave Breznik, who I always have to mention. And I should give a big shout out to Stu because he took on Kim Ross Dave Breznik who were chiros at the time and they did like amazing research that challenged so much of what we know about, you know, spine manipulation.
Greg Lehman: 03:19 And they also challenged me to think about what I thought about low back pain at the time. So my master's was really helpful for me because it challenged so much of what I thought. And so that's when I was first introduced to the bio psycho social, not actually first, cause I used to read John Sarno when I was like 19 years old. I was a bit of a nerd when I was a kid. But definitely the occupational biomechanics at Waterloo, even though they love biomechanics, even back then they knew that psychosocial factors were important for your pain and injury. And then I went to chiro school, actually I went to, that's like in quotes. I like was registered, but I didn't go to class, but I had a research program and they were awesome. They funded me to do more biomechanical research. Then I was in practice for a long time and then I went back to physio school and then I was in practice for a long time and didn't do a lot of research. And then I just started teaching with John Sarno who's running the conference with the running clinic and they were great. And at the same time I also started teaching my course which is about biomechanics and pain science. How do we like bring them together? And you've hosted me.
Karen Litzy: 04:38 I've taken that course. Yes.
Greg Lehman: 04:41 For you is like an echo chamber. Just it was confirmation bias. Yeah, yeah, yeah. We know this shit, Greg. But thanks for confirming what I already know. And my course does that a lot, which I don't mind. So that's me. There you go. That was fun.
Karen Litzy: 04:56 Excellent. Very good. And, you know, just as a side note that I spoke to John Sarno a couple of years, like when I was in the middle of like all my neck pain, I reached out to him via email and he said, you need to call me.
Greg Lehman: 05:11 Oh, interesting.
Karen Litzy: 05:12 So I called him and I spoke to him. I never saw him but I spoke to him and he was like, you're a young chickadee. I was like, what? And like crying and all this neck pain. I'm like, who is this guy? And he said, well, just get my book. Read it. If it doesn't work, come in and see me.
Greg Lehman: 05:30 Yeah, that's funny. I had a patient, he was very famous, very rich, and he bought like a hundred of his books and gave them out to his friends. He thought it was amazing. Sarno was interesting because and this happens, this is the issue with biomechanics sometimes is he had physios working with him for a long time and then he realized that doing physical medicine conflicted with the message he was giving about where pain came from, meaning like predominantly emotional, I'm probably bastardizing my sense in a long time since I thought about them. And so, which is funny that he had the problem that I had for a long time and so many of us do where we think it's bio-psychosocial, but often our biomechanical ideas will conflict with their psychosocial. So we have to be careful in how we navigate all the multidimensional nature of pain.
Karen Litzy: 06:26 I think that's the important part is that it's multidimensional and that you can't have that pendulum swing too far in either direction. And you know, now that we're on the topic of pain, let's go in a little bit deeper, so what would you say are the biggest misconceptions or common misconceptions around pain and it's, I'll put this in quotes, sources, quote unquote sources.
Greg Lehman: 06:53 Yeah. The biggest one. And I really like to focus on this because it helps me in practice, it's this idea that, and I like this cause it's how our practice is that we don't always need to fix people, right? And I kind of mean, I don't just mean that in the biomechanical way. And I would have meant that in the biomechanical way five years ago where I would have said, well, you don't have to fix that posture. You don't have to fix that strength or that weakness or we don't fix strength. We're gonna have to fix that weakness or tightness. And I believe that although I do think strength and weakness and range of motion can be relevant sometimes, but I also don't think we need to always fix catastrophizing and depression and anxiety and worry, and so that criticism goes both ways.
Greg Lehman: 07:53 It started out for biomechanical with me, but I would also say psycho social and we see that in the literature where people recover and they still have these, you know, mediators of disability and pain. It could be high catastrophizing but they still do really well because maybe they built up their self efficacy and they got a little bit of control and they were able to do something and something to control their pain or do something that they loved or they had some sort of hope. And so that's the biggest one, that idea of like fixing and if you want to be more technical or mechanical, it's the same idea. Like I don't think you have to get rid of nociception. So like your tissue irritation stuff, you can have shit going on in the tissues, but it's how you kind of respond to that stuff. That’s exciting.
Karen Litzy: 08:45 Well why would want to get rid of nociception.
Greg Lehman: 08:49 Yeah. Well I mean I don't, well I know what you mean. Like, we don't, you don't want to, cause when you sit down you want to get an ass ulcer. Right. You definitely want to move around. So, but that now we get into crazy stuff with that.
Karen Litzy: 09:03 Well do you mean the sensitivity around it?
Greg Lehman: 09:05 Yeah, it'd be like you definitely don't want like a raging disc herniation that's pressing on a nerve root and you have chemical inflammation, things like that. It’s worthwhile getting rid of. But you know, other things, you know, you can have tendinosis and a muscle strain and it can definitely hurt. But it's the idea that sometimes maybe what our rehab does is helps us cope with those, with those things, right? That's at a peripheral level and more central level. You can have anxiety and worry and those might magnify your pain response, but you can also cope with them as well. And so I love that message because I think it's just positive. Like people think I'm so messed up, I got scoliosis, I'll never got pain. And I'm like, dude, like it might contribute. I don't think the research actually supports that. Perhaps. Perhaps it does, but you can have that and still be doing awesome.
Karen Litzy: 10:00 Right. So just cause you have chronic, let's say persistent pain or you've had pain for x amount of time, it doesn't mean that that should be the thing that defines what you do or defines whether you're happy or sad or anxious but that it's a part of your life that perhaps you can cope with or like in my case I had many years of chronic pain. Now I have pain every once in awhile. But there are times where it's more severe than I would like it to be. And there are times when I want to fix it or I need to fix it. And then there are other times where I feel like I can cope with it and it's not horrible.
Karen Litzy: 10:45 I think it's context dependent. So like I had pain last year, like pretty severe for like a week or so, and I knew that in another couple of days I had to get on a flight to go to Sri Lanka. And so I needed it. So what I did for myself was I decided to get medication to help bring those pain levels down and that's what I needed at the time. But I felt so guilty about it. I would like say is this the bio psycho social way? Is this the way I should be handling this?
Greg Lehman: 11:20 I would think so. I’m going to mansplain you for a second. Cause I'm guessing that you knew that this was just a flare it was going to go away and that you've managed it before, but you're just giving yourself a break for a few days. Yeah. I don't think there's anything wrong with taking Tylenol for a few days. I've talked off topic, but it's how you do manual therapy, I don't do a lot of manual therapy, but I don't begrudge people that do. And it's, especially at an athlete level, I brought this up with some of the people who are going to be at the congress and I'm like, I find it ironic that all of us who teach a running course, none of us really teach manual therapy at our running courses and no one would ever say that manual therapy is a strongly evidence based, you know, modality for running injury.
Greg Lehman: 12:16 It's not, we would all talk about load management and exercise and blah, blah, blah, blah, blah, all of these things. Yet when you're a physio or a chiro training like elite athletes and you're working with them the day before their competition, what are you doing? You're probably doing some manual therapy. And so I just found that ironic that we do that, that when we're traveling with the team, I don't travel with teams, but I do have athletes come to see me the day before an event or I've been working with them for months and here I am doing what people would call low value care. But I'm like, no, sometimes it's a bandaid, but sometimes bandaids help and that's the only solution. Well, the solution that works then.
Karen Litzy: 13:08 Well again, it's context dependent, right? So if, and I saw this conversation on Twitter about, you know, what are we doing race day and race day yeah you probably are doing some sort of manual therapy.
Greg Lehman: 13:30 You’re treating that little niggle and this things tight and sore and you treat and people feel better. And if fatigue is psychobiological, which it is, then our intervention is probably psychobiological and it could certainly be more psycho based. Yeah.
Karen Litzy: 13:48 Right, right. It’s still real. And you know, in the context of athletes and being, this is the Third World Congress in Sports Physical Therapy. So there'll be a lot of, we can assume, I don't know, physios there that probably work with an athletic population. And so I think it's important to bring that up. All right. I digress.
Greg Lehman: 14:14 I did, you were the professional.
Karen Litzy: 14:20 So one common misconception is that we don't have to fix everything and not just the biological part, but the psychosocial part as well. Is there any other, maybe one other common misconception around pain and its sources that you hear a lot or you see a lot?
Greg Lehman: 14:40 I mean if I had to say anything, it's like it's the relationship between bio motor abilities, which would be like strength and flexibility and pain. I think that it’s over sold. You know, I don't think posture is relevant. I don't think strength or motor control is irrelevant. I just think it gets over done in that, that to me is that kinesio pathological model, which I have a big issue with, which would be like your knee goes into Valgus, you're going to pay for it later and you're going to get knee pain or hip pain. And, I'm like, well if your knee hurts and it goes into Valgus it's certainly a reasonable option to avoid that for a little bit. And then you might recover cause it's an avoidance strategy and build yourself back up and you'll do great. But I think what often happens is we then say, well, you went into valgus and it hurt, therefore valgus is inherently wrong and we need to make rules for everyone on how they should function. I hardly saw you when we were in Denver together, but I gave that whole, I forgot about that. We just saw each other, sorry, I was with Betty the whole time. I couldn't hang out with you guys. And so that I gave that example of limping, like when you sprain your ankle.
Karen Litzy: 16:06 That example was great.
Greg Lehman: 16:08 Yeah. You sprained your ankle and it feels better to limp. That's totally reasonable. But no one would then conclude that we all should be limping. That that's the right way to move. When I see like people I really respect, like Shirley Sahrmann or Jill Cook who will, you know, say avoid hip abduction, right? It's so horrible on the tendon, on the outside of the hip or is so bad on the knee. And I'm like, yeah, it's reasonable for symptom modification but I don't want to make a general rule and that happens too much and then we're too quick to be like, well just cause someone got better with exercises that try to change those movement patterns. That doesn't mean that's why that treatment was successful. Often those rehab programs that try to change movement patterns are like amazingly comprehensive and excellent rehab programs. And then you have like awesome therapists like you know, Stuart McGill or Shirley Sahrmann who just like build in this graded self efficacy and pump them up and they tell them you can do whatever you like. Let's just change your movement patterns and start doing this stuff you love again, may have nothing to do with the movements. It's just like the person was like, wow, I'm awesome, you're awesome. Let's do it.
Karen Litzy: 17:26 I think you can’t sort of parcel out one part of that complete treatment program and say this is the thing that worked. This is why this worked. I mean, you can't do that. I think that's impossible.
Greg Lehman: 17:37 No. And it's certainly the same with the people who I really love, like Peter O'Sullivan and that whole group when they help people, like I don't really agree. I'm such a jerk. I don't always agree with their mechanisms because when I see Pete treat, he's just so confident. It's like, you can do this, you can do this and bend over and do this and do this. And like, and I would never practice that way. I just couldn't pull it off. But I can imagine how much he helps people. That's actually why I really respect him. What he does really well. When he tests RCTs, he doesn't test himself. He trains people and other people do it. So, I actually shouldn't, I'm not knocking his research. I can't get to his style because he's so confident. It's absolutely really honorable what he does where he's like, I'm not going to be the dude that's in the RCT and train people and then we'll do the studies on them, which is just, that's nice science.
Karen Litzy: 18:34 Yeah, for sure. And all of those people you mentioned also have great reputations. People are referred to them when nothing else works. And so as the patient, you're like, well I know this person's the expert.
Karen Litzy: 18:49 Right. So I think in the patient mind they're thinking, if anyone can fix me, yeah, it's going to be this person. And I think that that also plays into it.
Greg Lehman: 19:00 I just opened my own little clinic out of my house. We have like a little gym. It used to be a workshop and now it's a clinic gym and I have nothing on the walls. And I'm like, how can I placebo the hell out of this? So that's my answer. I like art. I want to put up like, no, I should put up like placebo shit. Like what was like going to make me look amazing?
Karen Litzy: 19:25 Yeah. Well you can put up like awards you've gotten put up your degrees. People will be like, look at how many degrees he has. Look at all of his qualifications. He must be amazing.
Greg Lehman: 19:37 Yeah. Maybe, I don't know.
Karen Litzy: 19:41 You see that a lot in the US like when you walk into an office, the degrees and the licenses and certifications, right?
Greg Lehman: 19:46 All that weekend certifications, all that nonsense. After I teach, I always tell everyone, like, whenever you want me to write on your certificate, I will write levels six fascial blaster done, master Fascia blaster. I don't care. It's all bullshit.
Karen Litzy: 20:03 Biomechanics. Does it matter?
Greg Lehman: 20:07 Since the sport conference let's start. They definitely matter for performance. We got to listen to our coaches and the physios. But biomechanics and technique matter for performance. So if you want to tell someone to sit up straight, yeah, it's totally reasonable to do that if you're thinking how they're going to function 30 years from now. So that's great advice. And then, it's like a question of when they matter after that. And so I kind of Parse it into a few different areas of when they matter. The big one for me is like what's more important, is it's not how you move, it's that you're prepared to do what you're doing. So make the mechanics and the loads on the person matter.
Greg Lehman: 20:59 But it's the movement preparation. So my pithy expression is preparation trumps quality, right? Something like that. And then the other way or the other area where they matter is this symptom modifications. So if it hurts to do something, like if you're a runner and your knees hurt and you heel strike and you have a long stride, it's totally reasonable to shorten your stride, maybe changed your foot strike, although that's debatable, but it could serve it is certainly is an option. And if it feels better, keep running like that. So the mechanics there help but it doesn't prove, you know, the thesis that there's a right way of running. It's just that you're running differently cause another run or you're going to be like stop forefoot striking and actually lengthen your stride. I've done that plenty of times. So you're just symptom modifying.
Greg Lehman: 21:45 So mechanics help a ton for symptom modification. And then you know there's probably under high high loads, there's probably better ways for your tissue to tolerate strain. You know, like if you're landing and cutting you can go into valgus but you probably don't want to go into Valgus if your knee's not flexed. Right. So high loads where the tissue gets overloaded matters. And then after that with that principal there, it gets more difficult because you start thinking of the spine and you're like, okay, is there a better way for the spine to tolerate loads? And that's where we have been debating biomechanical principles here because certainly the bio does drive nociception sometimes. And so those are the big areas for me where biomechanics matters. Sorry I went over that fast.
Karen Litzy: 22:39 I think that makes perfect sense. And I mean, I don't know if you saw this since you are probably more into tumbling and gymnastics than I am. I haven't seen this yet. But did you see yesterday a gymnast broke both of her legs or something.
Greg Lehman: 23:01 I saw that by accident. I won't see it again.
Karen Litzy: 23:02 But I don't know what happened there.
Greg Lehman: 23:07 I think it may have been in a double Arabian or a double front tack and she landed and then hyper extended. And what freaked me out a little, only saw it once and I'm not gonna see it again, is I don't think she landed with straight knees. They were like bent and then they went into extension like, which freaks me out because my daughter's learning front and I'm doing them with her front tuck step outs, and you kind of land on that one leg and it's straight ish. And I was worried of extending.
Karen Litzy: 23:46 Yeah. I mean I haven't seen the footage of that, so I was just wondering if that would be a time when biomechanics mattered or just an accident.
Greg Lehman: 23:55 It certainly did. But here's the problem with all the biomechanics mattering stuff, is it the mechanics mattered and caused the injury. It's just whether you can prevent it. Yeah. It's like so many ACLs. Someone might cut 10,000 times with their knee in valgus. Well, that's proof of principle, that they're safe and then they do it one way that's slightly different and then they tear their ACL. But it doesn't mean that the way they were doing it before was unsafe because they could have had less valgus pattern before and then they could have done that too. Like, yeah, I don't know. It's difficult.
Karen Litzy: 24:34 Yeah, and I think when you're talking about injury prevention, I mean that's a whole other conversation. But I think that so many factors go into that as well. It's sleep, it's nutrition. It's what did you do the day before or was the beginning of the game, the end of the game? Are you fatigued? Are you not? I mean, so much can go into that. So yeah, you can cut 10,000 times and one time you have an injury. It doesn't mean that the way you did it was incorrect. It doesn't mean that the preparation leading up to it, it could have been that day. It could have been what you did the night before. I mean, so many factors and elements that go into something, some sort of accident or injury like that, which is why injury prevention programs are difficult.
Greg Lehman: 25:25 Yeah. And, and we see them running, you know, like we've been saying the same thing for years. So you don't have training errors, which just means don't do too much too soon. And then you try to nail it down in the research and you say, well, what's too much and what's too soon? And then there's no real good research on that, right? Because there's so many different variables that influence that. So my joke tonight, we're arguing not we were talking on Twitter about this. I'm like, well, we can probably all agree when it's like just looks ridiculously like too much too soon. And that's the pornography test, right? Which is your old Supreme Court justice is either pornography or obscenity and they're like, I can't define pornography, but I know when I see it. And so when a movement pattern or a training load is pornographic than maybe you avoid it or depending on your personality.
Karen Litzy: 26:17 Right. Well, you mean it just gets a point where it's so obscene.
Greg Lehman: 26:20 It's so obscene. You say, ah, that's probably some of them. But it has to be that and who knows? That's the worst part is there's probably people who can handle that obscenity. And I stopped this analogy because I dunno, they're built for it. They prepared to handle.
Karen Litzy: 26:41 All right. Let's talk about being a movement optimist. Yes. So for those of people watching and listening that aren't familiar with this, can you talk about it a little bit more and how this came about?
Greg Lehman: 27:02 Well, I mean, I have already, I've already said all the good stuff I've run out of material.
Karen Litzy: 27:08 I can't, I can't even believe for a second. That's true. You're not like your greatest hits album.
Greg Lehman: 27:18 I was in Denmark and they gave me this little bobble head that you've pressed the top of and the whole thing like bounces. And it's funny, I was in Scandinavia three or four years ago and they gave me the same thing. It's like this thing that I would get there, but it's called a hop to mist. I loved it. My kids have it anyways, so what it means is like we need to stop vilifying like certain movements. You know, like when you look at someone's skateboarding, their knees are going to cave in and it's amazing and it's a successful movement pattern. If you rock climb and you were just at a birthday party.
Karen Litzy: 28:01 I was at a rock climbing birthday party yesterday for my 10 year old niece.
Greg Lehman: 28:05 Well, I doubt they were doing it, but there's something called a drop knee, which is what I do on a climb is, is you can do it. I'm not doing it. You put your foot up behind you almost and drop your knee down into valgus and then stand up on that and you go into that.
Karen Litzy: 28:24 There are actually some more like real climbers there and they were doing that. There are a couple of people doing that move. Cause I remember my friend that I was with was like, oh my God, look at that person's knee. How is she doing that?
Greg Lehman: 28:37 Yeah. And so Alex Honnold is a famous rock climber. They just won the Oscar for Free Solo Yosemite without a rope. But I have sometimes he's in another documentary about Yosemite. I've filmed it when he's in it because he sits like me. He's like super hunched forward with the super forward head posture. And here he is climbing, you know, these massive granite walls and that's a movement optimists, it says you can do all these weird funny things with your body and still be fantastic. You can be a paralympian where you're missing a limb than have induced, you know, assymmetry that you can have scoliosis and make it to the Olympics. You can have scoliosis and lift five times your body weight. And so that's the optimism. It's this revolt a bit against the kinesio pathological model, which to me is certainly has value.
Greg Lehman: 29:39 It's certainly has treatment efficacy because I like the treatments that are associated with it, but the fundamental ideas behind it that there's like bad ways to move or better ways to move for injury and pain, that's what I would challenge. I'd be like, let's be more optimistic about how we move, you know, we don't have to always fix these things right now is go and anytime someone like me talks and says to people, all you can move this way, you always want to look for exceptions, right? When you're in practice, like, when should I, you know, disregard what I think, like when you know, when is how someone moves. Like when is that important? You know that and that'll help him be a better clinician. I think. I always challenge challenging whatever you think is true. It makes it difficult.
Karen Litzy: 30:40 Yeah. But I think having that as a clinician, having that sense of doubt is not a bad thing.
Greg Lehman: 30:48 Yeah. I mean, I'm going to want to agree with you. Sorry. It was like, why am I listening to this guy? It's like, but then there's those clinicians that get people better by sheer force of personality. They have that utmost belief in what they do, even when they may be full of shit. And so that's how it was hard.
Karen Litzy: 31:16 I have a great example of that, I'm not going to go into it right now.
Greg Lehman: 31:25 Now you also have to wake up in the morning and be happy with yourself, so.
Karen Litzy: 31:29 This'll be an easy one for you. What is the most common question you get asked by other physio therapists? If you could say whether it's maybe they private message you or at your courses or lectures. What is the most common question that other physios or healthcare providers ask you?
Greg Lehman: 31:59 Oh, that's funny. I didn't read this one before, but a few things. But usually it's like what's the paper that you mentioned? And then I have to like come up with a name and I usually know it, but the bigger one is this is what I do with people. This is not what you talked about, but tell me why it's helping them. That's, what I get a lot, they want validation and then they want to like, you know, tell me their theories of things, but really tell me they want me to tell them why it's great. It's like what the mechanism is.
Karen Litzy: 32:47 That's why it's okay. Looking for just your confirmation.
Greg Lehman: 32:54 Confirmation and then like, and then trying to like find out why it works. Like they want me to do the research behind it, I'm going to go. Okay. So what do you say? I mean it depends. Like I probably do like the motivational interviewing thing where I roll a bit with towards distance and I just probably, it's pretty bad, but I probably just read say are actually depends if I've met them before, I'll just talk about the general things that help pain and I'll say maybe it's working this way, but I don't, that's all I do if I think they're totally off base. I don't think I ever really say that. I don't know if I've ever done that.
Karen Litzy: 33:49 Now, and you kind of alluded to this in your answer there, but if you could recommend one must read book or article, what would it be? And if you want to say one book and one article, but just one.
Greg Lehman: 34:06 Yeah. You know what I'd go old sounds funny saying old school, but I would read David Butler's the sensitive nervous system. So good. Yeah, it is. Cause it's not only good in like a pain, but if when you read that he's just throwing out little ideas all the time. Like it would be nice for me to reread and just pull out his anecdotes and like little things that he says to do because there's things that I do and I thought, oh, this is kind of neat. And I thought I'd discovered them myself. I thought I'd, you know, you know, found it myself and then I'm realizing here at, he said it 20 years ago or something like that. Yeah, yeah, yeah. That, and then like his former partner would been Louie Gifford and I've only read parts of his books, but I've read some of his other writings and I like his stuff too. But David Butler's the central nervous system, which is just, and it's what, 15 years old, but it's still plenty accurate.
Karen Litzy: 35:07 Yeah. Yeah. And for people who are listening or watching, I can plug that into the comment section, when this is done. All right, so let's move on to the conference. October 4th and fifth in Vancouver, the Third World Congress is sports physical therapy. So can you give us a little bit of a glimpse into what you're going to be talking about?
Greg Lehman: 35:32 Not really. I am talking with Alex Hutchinson who's kind of a friend of mine here in Toronto, like the same kind of know those same people.
Karen Litzy: 35:46 You run in the same crowd.
Greg Lehman: 35:53 Like, you know, like we rock climb together. We've been to some similar weddings. I've known Alex for awhile and I love his stuff and I always pump up his stuff in my courses. That's what's funny. And then when they put him with me, I was like, this is awesome. Because I always talk about the psychobiological model of fatigue, which is that fatigue is kind of a nice analog for pain. That it's not just purely physiology, that there's a psychology component to fatigue. And I'm like, Whoa, we should talk about this because look how this area of function relates to pain. But so we're talking together on like this massive nebulous talk topic of pain science and athletes.
Karen Litzy: 36:44 Yeah. Yeah. That's a heavy one. I listening to his book Endure right now.
Greg Lehman: 36:48 Yeah. See I like the breath holding stuff in there.
Karen Litzy: 36:55 That's the chapter I'm on now, which I can't even fathom.
Greg Lehman: 37:13 So go, go online and find David Blaine's breath holding stuff. He needs to have the breath holding record. He did. But he could also do like eight minutes without that. I used to hold my breath in church all the time to pass the time. But breath holdings interesting because if you just hold your breath right now, you might make it 30 seconds, but you can train yourself to make it for four minutes. And so within like a few days if not an hour. So it means your physiological reaction to try to breathe is way over cooked. And that often happens with persistent pain. We do this protective response. So I've been talking about breath holding for years and then Alex's book came out and I'm like perfect. Now I can refer people to that way better down. But so like finding analogs between weird things about pain and then interesting things about performance or breath holding is really nice.
Greg Lehman: 38:04 So we've been talking, we were probably going to go rock climbing and then we're going to try to maybe come up with something that parallels each other. I will probably, I'm guessing talk about like how we, I like doing something really practical, like instead of saying this, which might have a negative connotation to some patients, like set them up to have some, you know, less than good expectations say this instead. So, you know, like the diet stuff, don't eat this, eat this. Well it would be the same idea with explaining common running injuries. Which we'll probably talk about, cause Alex’s a runner and I'm a slow runner. So mine will probably be something like that. Just met her way to phrase things. And because everyone always says to me like, okay, well what the hell do I do then if I don't tell them that they have SI joint pain cause it's out of place than what the hell do I say? No, no, not yet. Yeah, I think. And then that's really fun and it's a nice end. We'll have time to talk about it too because there'll be a lot of wisdom in the room and hopefully we'll maybe pull that out.
Karen Litzy: 39:22 Yeah, that sounds great. And I really appreciate those kinds of conversations because then I know that I can kind of take that and use that with my patient population on Monday. Or Tuesday, whatever day. But you know, the next day in clinic.
Greg Lehman: 39:38 That's the idea. I don't want to hammer people with research. I know I won't do that. That's for sure. That's easy. I could do that. And it'll be entertaining by your life. Go. Well I got some more research, but it'll probably be more practical. Right. And we're real, more practical story.
Karen Litzy: 39:52 Nice. And I look forward to, you know, the two of you speaking together, I think we'll be entertaining and educational and I look forward to that kind of play that you guys will most likely have off of each other. I’m reading his book and you brought the bread holding, which is exactly where I am. And it reminded like in the breath holding chapter, you know, he said like the people who had like, who broke these records or who could really hold their breath the longest are the people who knew that someone was there to pull them up if they needed it. Yeah. And so when I think about that as it compares to pain, like especially persistent pain, I wonder if you knew like you had an out, would that pain still be as persistent? So that's what got me thinking listening to this chapter was like, hmm, if you knew your pain had a safety net, how would that change your view of your pain?
Greg Lehman: 41:03 Oh, that's interesting. No, and I think what you're talking about has actually more ramifications for the negative aspects, right? Because most people think, oh, this will pass, but there's some that think that this won't pass. And Yeah. And that's why there is no optimism. And that's of building that where, there's no reason for them to think that it will change. And that's kind of what we have to do is build that model that there's a possibility for change.
Karen Litzy: 41:35 Yeah. And before we're going to wrap things up in a second, but Kate Pratt said, well, I find one of the greatest sources of misinformation to patients about pain and biomechanics is their MD/ortho. As PTs we hopefully consistently educate our patients. Do you think it's possible to educate MD’s or orthos regarding pain and how would you begin to approach such a scenario? So I think she means as the individual clinician with, you know, the referring physician or the physician who's seeing that patient.
Greg Lehman: 42:11 Yeah. I mean in general, I think that's a problem across the board of all professions. How we change our colleagues, view the docs, like our colleagues. And I'm not really sure cause you would assume that has to happen at a school level, right at the training there and at a conference level. So it's really conferences in schools who are open to, you know, providing the different messages there. But I would say, and we've talked a lot about this is when you do have patients who have these beliefs from their doctors or other healthcare providers, which is super common, there are routes that you can, you know, still address those beliefs without throwing the doctor under the bus and that’s what you have to figure out. So often it's more like acknowledging yeah, that's, you know, you have hip pain because he has OA or something you can say that's part of it.
Greg Lehman: 43:15 This is the my optimism approach. Yeah. The hip OA is part of your hip pain, but you can still do great even though you have those changes on the scan. And that often really helps, especially with when physios and like we're navigating referral sources. And it's so funny that you bring, I just got, I just like 10 minutes ago before we started, I got a referral from a sport MD who was in the course. I taught with JFS school. On running five years ago and said, are you seeing patients? And like it was so funny that she was in the course because you don't normally see MDs. Yeah. You know, taking courses with the PTs. Great to do that. And so that's how we have to change. You use it somehow get into that educational system.
Karen Litzy: 44:01 Yeah, I agree. And from a one on one. I think it's difficult. I mean
Karen Litzy: 44:11 What I've done once that worked with the referring physician was, you know, I said, hey, you know, we're doing this, this, this and this, but I found this article, do you want to take a look and let me know what you think? Cause I'm thinking of incorporating it. And it was like an, I don't know, I think it was an article, Moseley or Peter O'sullivan. And so I sent them that and then he was like, oh yeah, that's really interesting. Yeah, definitely start doing that. So that's a way you can kind of maybe start.
Greg Lehman: 44:44 Yeah. O he or she just rolled with your resistance maybe. No, I totally agree. Yeah. I think we're good.
Karen Litzy: 45:00 It's so hard, but it's a way to be diplomatic. It's a way to say, you know, I don't know.
Greg Lehman: 45:08 I really liked that you just sold a good treatment plan and then you gave them other research behind it. That's nice. Yeah. That's probably better than saying you're an idiot.
Karen Litzy: 45:20 Yeah. Well, yeah. But I mean I also find that like I had one doctor that came back to him and he's also a good friend of mine. He was like, that's really interesting. Like we need to talk more about it. Oh, that's cool. Which is awesome, you know? But he's also a friend began, you know, we played softball together. So it's like the different opinions.
Karen Litzy: 46:01 Chris Johnson said to say thanks for carving out the time you need to stop picking your eye. Always exercise diplomacy and avoid creating a disconnect. It doesn't accomplish anything. And that's in regards to Kate's question that we just tried to answer. Like I'm bringing a course to New York City and we're going to have like a free two hour preview of it and just invite doctors.
Greg Lehman: 46:44 Wow.
Karen Litzy: 46:45 That's, you know, one way to do it if you want to get them involved in the educational process with Physios, which I think is great.
Greg Lehman: 46:52 One of my best course ever in Toronto here was, we had three physiatrists that came and they were fantastic. That's awesome. Go into this stuff. It was a bit, some of it seemed a bit new, but they're open and like, and then the email to everyone after and they share their experiences. I love when you have multi disciplinary people at the course. There are some, I mean I'm not throwing MDs under the bus. They certainly, it's so hard. I have a friend who was an MD and he's like the best motivational interviewer. He was so good. Like he knew this thing is that as patients had to do, but you know, in Canada you only have eight minutes with them. Yeah. And there or whatever. Anyways, so I'm off topic.
Karen Litzy: 47:42 So let's wrap things up here. Are there any presentations you're looking forward to seeing at the conference?
Greg Lehman: 47:48 Rob Whiteley. Yeah. I really like is like career and that the stuff he's done and what he's doing there, you know. I'm a socialist I like exercise for everybody and I like the name to change things. But I have trouble like arguing with exercise. It's amazing. It's jam packed like there, there's so many. So that's one of the reasons I wanted to go cause you know, I would have, it'd be nice to go to that conference as well.
Karen Litzy: 49:22 Well, I am looking forward to your talk with Alex. I will obviously finish his book within the next week, so that's very exciting. And I've already taken your class and read your free resource. So I feel like I'm like ready for it.
Greg Lehman: 49:39 I'll bring something new.
Karen Litzy: 49:42 I'll come armed with lots of questions. All right. So before we hop off, where can people find you?
Greg Lehman: 49:49 Just my website I guess, which is Greglehman.ca. Which I hardly do anything on and then Twitter, same thing. Twitter is my favorite. I like the discussions on Twitter, even cultivate them, trying to keep them polite and nice and you know. So Facebook, Nah, it's for the trolls.
Karen Litzy: 50:15 I think. Yeah, I guess it depends anyway. Again, a whole other conversation. Yes.
Greg Lehman: 50:21 No, I'm doing a big thing on Facebook right now. I shouldn't say that.
Greg Lehman: 50:29 Yeah. Cause we have like a podcast with me and Oh, I have a podcast, I guess. Never. It's, well it's Adam, it's Meakins podcast, but I'm the cohost so I guess is mine. I don't know. When do you get part of that? I've done three with them. I'm just baggage. I'm a carry on.
Karen Litzy: 50:52 Yeah. I think, I think you need, you need a little bit more. I don't think that three really qualifies as like a permanent cohost.
Greg Lehman: 51:01 Oh yeah, yeah. I don't think I want that.
Karen Litzy: 51:03 No, no, no. You're still like a guest cohost, give it a couple more and then I think you're in.
Greg Lehman: 51:08 Okay. Well we're doing like a thing on neurodynamics like their dynamic techniques. And so I wanted to poll people and see what people thought. You know, I was curious what people thought, what the hell we were doing when we do them for that.
Karen Litzy: 51:27 I use them, I use them. And oftentimes in people who are a little fearful of movement.
Greg Lehman: 51:33 Yeah. So what does that tell you what you're doing? Or you really like manipulating the nerve to, you know, feed them more oxygen or something. Getting someone moving again?
Karen Litzy: 51:45 I think you're getting someone moving again, I think you're taking them to a place where they can stay within a relative comfort zone and you can kind of see, I think what I use it is because you can see some changes pretty quickly. And so I think patients then get a little more confident that they can move because they can see those changes pretty quickly. So that's why I like to use them is to give people some hope.
Greg Lehman: 52:15 It’s a modification.
Karen Litzy: 52:18 So that's why I use them, but I use them quite a bit just because I think, I think that they work very well. The only time I don't use them was really with like one person who said I was doing all these nerve glides and now it made my arm so much worse.
Greg Lehman: 52:37 It's like everything.
Karen Litzy: 52:38 You know, but I don't know how many, what they were doing, why they were doing them, what explanation they were given. I have no idea that I just sort of held off for a little bit and had the move a different way. But yeah. So that's why I use them.
Karen Litzy: 52:59 So if no one else has any questions. So Agnes said that she'll play softball with me in Vancouver.
Greg Lehman: 53:08 Tell her I’m going trampolining and rock climbing.
Karen Litzy: 53:15 I would go trampolining but I really just like bungee trampoline.
Greg Lehman: 53:19 Let's do stuff.
Karen Litzy: 53:20 Well you're attached to a bungee and then you obviously go down and then you can go up and flip like two, three times in the air and come back down again. You can't twist, but I did do a double layout. Yeah, it was pretty cool. But yeah, I would definitely play softball. I will bring my glove and I can do some trampolining. I wouldn't have done it 10 years ago or five years ago because of my neck, but now I can do it. Yeah, totally can.
Karen Litzy: 54:14 Just so people know when Greg and I were at the align conference a couple of weeks ago in Denver, Colorado and he had his daughter Betty with him cause it was her birthday weekend and she was his personal photographer just so that it made him look better than everyone else because he had personal Paparazzi. And she was just super adorable and doing back walkovers and she probably would've done a lot more, but we were at a conference on the first day.
Karen Litzy: 55:21 She was very sweet and that's who we're talking about. All right. And I’m going to edit all of this out before I put it out on a podcast. Thank you everyone so much for listening and sorry for rambling at the end. If no one else has any questions, I just want to thank you all for listening and make sure you go and click on the link on this Facebook page. Should take you to the website for the Third World Conference in sports physical therapy. Again, it's October 4th and fifth, and Vancouver. Greg is speaking with Alex Hutchinson and I think that's going to be a highlight of the conference. You don't want to miss it. So Greg, thanks so much for hopping on the call and sorry for the technical difficulties. Thank you so much and we'll try and put all the information that we spoke about in the comments section here. So thanks everybody. And Greg, thanks again.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Kelly Duggan on the show to discuss her hybrid physical therapy business model. Kelly is the creator and owner of Physical Therapy U, a successful insurance based PT clinic in Bridgewater Massachusetts. PTU is focused on changing the healthcare experience for their community with a focus on youth athletes.
In this episode, we discuss:
-How Kelly’s hybrid practice has married quality patient care with financial freedom
-Marketing strategies that have exponentially grown Kelly’s practice
-Top key performance indicators Kelly tracks to ensure her clinic meets its mission
-Why your life vision should align with your daily life
-And so much more!
Resources:
PTU Clinic Instagram
PTU Clinic Website
PTU Clinic Facebook
Strive Labs
Email: PTUclinic@gmail.com
For more information on Kelly:
Kelly J. Duggan is a physical therapist with over a decade of experience in both inpatient and outpatient settings. Kelly is the creator and owner of Physical Therapy U, a successful insurance based PT clinic in Bridgewater Massachusetts. PTU is focused on changing the healthcare experience for their community with a focus on youth athletes. Physical Therapy U is a hybrid clinic offering PT, massage and sports/fitness trainings. Kelly uses this hybrid approach to combat the typical decline in revenue that most insurance based outpatient clinics (that aren’t tied to a hospital) experience over time.
Kelly is also a proud wife and mom of her three young children. Kelly has worked hard to show that although the timing doesn’t feel “perfect”, you can open a clinic at any time of life. Physical Therapy U was created during the 3 months after her third child’s birth, while she also had her 1.5 year old and 3 year old home with her. Kelly encourages others to go after their dreams and although being in the spotlight causes significant anxiety, she continues to push herself forward so that others can see what is possible.
In just three short years Kelly has successfully tripled her small business from a 1200SF space to a 4500SF space without the need of tripling her patient visits. Kelly enjoys sharing her highs and lows with others so that they can learn the best techniques even faster than she did.
Physical Therapy U continues to grow and evolve and Kelly welcomes any and all advice for the future success of her business.
Read the full transcript below:
Karen Litzy: 00:01 Hey Kelly, welcome to the podcast. I'm happy to have you on. Welcome.
Kelly Duggan: 00:06 Thank you so much for having me. Excited to be here.
Karen Litzy: 00:09 And today we're going to talk about your business, the growth of your business. I would say the very fast growth of your business over the past three years. So PTU opened its doors three years ago. It was you and your sister working 10 hours a week. And now let's fast forward to three years. You have 17 employees, four PTs, one PTA. I mean that's a huge growth in three years. So I'm really excited for you to come on and let the listeners know how you did it. So let's first talk about how you started. So take it away.
Kelly Duggan: 00:49 Yeah. So how we started, I was actually nine months pregnant and trying to decide which direction I was going to go with things. I had always been an employee that worked like around 30 hours a week and I would have one day off with my other kids. And when we got pregnant with our third, we realized that financially that was not going to be an option anymore. I needed to work full time. So I started looking at different options to do that, who I would work for, what I would want to do. I've always really enjoyed, the program development and the marketing aspect of physical therapy. For me, you know, I've always needed a creative outlet and that was kind of my outlet in physical therapy. But where I was and kind of what I was looking into, that wasn't going to be an option.
Kelly Duggan: 01:43 So it kept getting thrown around. Like what about your own place? What about your own place? And so finally, as the pregnancy progressed, I sort of started looking into it. So what do you, what do you do when you first start looking into stuff? You start googling it. So that's where this all came from, is kind of a few Google searches of like, how's this going to work? And, what I did at the time, was reached out to a few other people that were in my situation, parents of multiple kids that own their own practice to see because for me, that was the big hangup of, you know, this is going to take a lot of time away from my family. Am I going to be okay with that? And how, you know, how is that gonna work with my family and work with myself or my kids in the future.
Kelly Duggan: 02:31 So I reached out to a few other moms of multiple kids who had opened their own practices. And, you know, I got some feedback that I liked. I got some feedback that I didn't like and, you know, I kind of just hung on to the words of advice from the people that said, go for it. And Yeah, I think my son was like one month old when we finally committed and I said, you know what, I'm just going to do this. And I think, and I always laugh about this, but I think that I was so massively pregnant and then postpartum that my husband was just like, yeah, whatever you want to do, whatever that sounds great. Whatever we have to do, we'll find the money and just kind of like on board. So yeah, we started out really small.
Kelly Duggan: 03:20 I found a clinic that allowed me to do a one year lease because for me, I was just preparing for, well, if it doesn't go well, what are my options? I'll always have my license. So, you know, where could I work if this doesn't go well and it doesn't build and it doesn't grow, like I want it to grow. So I found a clinic that did a one year lease. I looked at all the bare minimums of what do I need to make at the bare minimum. And I just laid it all out. You know, I always say I'm not a huge numbers person, but I think owning your own practice turns you into one. So now I'm like all about the numbers and that's, you know, my mom took this photo of me sitting at my laptop.
Kelly Duggan: 04:05 Like, I dunno what I was doing either making the website or trying to crunch the numbers and I've got a coffee in one hand, one hands on the mouse and somehow I'm like balancing my newborn like on me. And it was just like very kind of how my life was at that moment. And for me it was if I want to do what I'm really passionate about in PT, which is marketing program development in sports, then I have to create it myself because it's not there. The option is not there for me. So it's just figuring out what I had to do to do it myself.
Karen Litzy: 04:58 And I mean to do this massively pregnant and then with a newborn, I mean that is ballsy. Like that is no joke. I mean, I don't have children, so I don't know what those first months are like, but I mean, and this was your third. It's not like it was your first, you had two other children. I mean what a leap.
Kelly Duggan: It was. And again, it was just kind of like, all right, it's go big or go home. Like if we're going to do this and I'm very much a determined person. If something is not there that I want, I'm going to create it or make it or somehow make it happen. And this was an opportunity for more time with my family in the long run. So in order for me to have more autonomy in the long run, it had to be done and it had to be created and it was, you know, it was for me and it was for my family and it was kind of like that, you know, you see like the parent lift a car off their kid, you hear those stories of was that sort of situation, it was like, okay, here’s this person with no business background, who hates numbers.
Kelly Duggan: 06:01 Who is going to like create this massive thing because I have to, that was the option, so it had to be done, you know?
Karen Litzy: Yeah. And so that's when you started three years ago. So let's fast forward now to today where like I said earlier, 17 employees four PTs, one PTA. So can you break down for the listeners how you did that because that is massive growth and Kudos to you.
Kelly Duggan: Thank you, so it's funny because I didn't plan it that way. It's not like I was like, you know what, my three year plan is this and my five year plan, 10 year plan says this again, I was very naive going into it. So I thought this is my plan and this is where I'll be, you know, three years from now if it's successful, I'll just stay in that same location.
Kelly Duggan: 07:00 So we opened our doors in May and in September I looked at my sister, I'm like, well, this isn't going to work. You know, we were in a 1200 square foot space, you know, it took about a month and a half, but we went from no patients to I had a full schedule and I was prepared on the opposite end of that. Like I was prepared for all right, maybe I'll have three days or whatever it is. But we scaled really quickly. So starting in September, I started looking for additional staff and it took me until January to actually hire someone. So I would say anybody that's kind of in this position is just make sure you're preparing ahead of time for if it does go well. Cause I did not. And so I hired someone in January and then I hired my second person in February and that's when I said, okay, I'm not even gonna make it to a year in this location.
Kelly Duggan: 07:56 Like we need to expand. So it was probably March so not even one year in where I started looking into what is this location need to look like in order for it to be a success because the demand was there and I didn't want to not provide the same service for more people. Like, you know, you see clinics that ended up getting stacked in their booking. People on top of the next person is just crazy and busy. And I didn't want to do that. I wanted to still be able to provide the same level of service just for more people. So that meant expanding. So I started looking at additional locations and how that was going to work and started hiring and scaling is the big word that we used, but we scaled up from March when I started looking to the following March when we moved into our new location.
Kelly Duggan: 08:57 It was just kind of a slow scale and I was lucky enough to find a team of people that understood the importance of where we were going. And they were willing to adjust their hours as needed, but also work anywhere between like 28 and 40 hours as needed as we scaled. So for me, you know, I don't like to use the term, I was lucky because I busted my ass for everything that I've done. But in the sense of hiring people, in a kind of a team and a family that understood the importance of that, I was lucky. I mean these, these people kind of worked as hard as I did to get us to where we need to be. So that was good because you don't always find that in employees, you know?
Karen Litzy: 09:44 Yeah. For sure. And now let's back up for a second. How did you go from zero patients to a full schedule? Cause that's what everybody wants to know. How do I get more patients on my schedule? How do we let people know we’re here and we’re ready to help?
Kelly Duggan: 10:03 So. MMM. Yeah, you know, I hustled basically. So in whatever that term means to you, you know, like the older generation are horrified by the use of that term. But, I worked really, really hard. And I just networked and got my face everywhere. And you know, it, I think we've talked about this before, but I feel really uncomfortable when I'm talking in group settings or in front of people
Karen Litzy: 10:34 I know, but I don't get it.
Kelly Duggan: 10:38 Thank you. The Facebook lives, but again, it was there was a need to do, I knew that if I wanted to grow my practice, people had to know who I was. And I had to be seen as kind of an authority in the PT World, in my community. So in order to do that, you have to put yourself in front of people. So I was putting myself in networking groups, putting myself in business associations, talking, volunteering to talk, I'm doing all these live videos and posting it to different groups and doing all these things that are way outside of my comfort zone because I knew that people had to recognize me and my brand as, you know, as healers. So, on top of that we did like a lot of online marketing or I always say we, but I did a ton of online marketing.
Kelly Duggan: 11:29 As well as, I did some print ads, not a lot because they're so expensive. But what I did do, which I tell everyone to do, cause it's such a good idea, is I think it's everyday direct mailers is what it's called for the post office where you can either create a postcard or a letter and you can map out on the US Postal Service website, who you want to get your letter. And so within like a three mile radius of my clinic, I sent out a postcard, which one side had who we were and what we did and the services we offered. And then on the other side I did a baseball schedule. Right. Or you do a football schedule or basketball or whatever. Because for me, like when I get mail, if it's junk, I throw it out unless it has a sports schedule on it.
Kelly Duggan: 12:24 And then it's on my fridge. And then I don't even know who these people are and they're on my fridge, the entire sports schedule because it's the sports schedule. So I put it up there. So to put the sports schedule or whatever that is, you know, in your community, it goes right on people's fridges. And then every day they were opening the fridge and they see your logo and they see whatever it is you put on there. And that helped. And I did have a lot of patients that came to me because they got the flyers and they're like, oh yeah, you're on my fridge.
Karen Litzy: Yeah, because don't they say it takes like x amount of touch points before some of them will decide to pull the trigger and make a purchase.
Kelly Duggan: So I did a ton of marketing, you know, and even, you know, the patients that we did have asking them, but I don't want to use this as like a copout as to why we scaled so quickly.
Kelly Duggan: 13:16 But you know, I also take insurance, so that obviously is a lot easier than convincing people, you know, over your cash rate. But in the beginning I wasn't contracted with every insurance, so I was actually seeing, you know, a handful of patients that were paying my out of pocket rates because I wasn't contracted with their insurance yet. So that was kind of cool.
Karen Litzy: Yeah. So you had a little bit of a hybrid in the beginning and then, and now, do you take all insurances in your area or just a couple?
Kelly Duggan: I take most insurances there. Again, from the business side of things, there are a couple of insurances that financially, we wouldn't just lose money, but I'd lose like a lot of money. So we can't take every insurance, but we do take most and then we do offer our cash rate or a prompt pay rate if people don't want to use their insurance or some people don't even want to use their insurance benefit.
Kelly Duggan: 14:21 So, even though they have an insurance that we would contract with, they choose to still pay us a cash rate and then you know, we have additional services since moving into our larger location that cause again, PT insurance, it doesn't, unless your really savvy is the word I'll use, it doesn't make good money. We basically we paid the bills and that's how we get by. But if we want to make additional incomes of that, you know, my employees can get raises and we can buy new fun equipment. We had to take on all these additional ancillary services in the new location.
Karen Litzy: 15:02 Okay. So what are these ancillary services? Because this is something that I think we really want to touch upon because listen, not everyone has a cash based service. I would say the majority of people by and large do not. Yeah. And that most physical therapy offices around this country take insurance. And like you said, sometimes the insurance does not reimburse a lot. I know New York state, it's very, very low. So what ancillary services have you added? So again, kind of make that hybrid practice.
Kelly Duggan: 15:40 Yeah. So in our previous location, which was really small, what we did, and it was a much smaller scale, but we would hold classes every now and then, so we'd have, you know, a yoga class or a strength and conditioning class or something so every now and then we could get a little bump of money, in our new location, which is 4,500 square feet. We're able to add in a lot more.
Kelly Duggan: 16:10 So we're looking to make it a little more consistent, but we've had yoga. I hired, so I didn't like rent out, but I hired two massage therapists, and they work on kind of like a per diem rate. So they're not there all the time, but you know, when they have clients. So we've built up and that's really been a huge compliment to our physical therapy services, not only for our patients, but for our therapists in kind of taking the load off of not having to do as much manual because if people are getting massages with it, it just helps that much more and then people are carrying over better. And, so that's been a benefit all around financially and for our patients. And for our therapists. We hired massage therapists.
Kelly Duggan: 17:11 I had massage therapists and I have a program that we call the elevation programs so that, we all know that insurance doesn't cover everything, right for physical therapy. They don't really cover the sport based stuff or transitioning someone back to crossfit or whatever it is. It's not always covered within their plan. And then, you know, there also insurances that cut you off after 60 visits or at 90 days. So what we did was kind of bridged the gap between physical therapy and a patient's return to sport or return to their full activity. So we created something called like an elevation plan where people can purchase it on a monthly basis, you know, similar to how you would purchase a gym membership. And the elevation plans include, you know, PT visits, massages and an exercise prescription by a personal trainer, which one of our rehab aids is a personal trainer.
Kelly Duggan: 18:21 So we utilize her and kind of kick people off with this really great program. And it's really meant to be a transitional program. So people will do it for a month or two, and then they have the confidence in order to get back to sport or gym or whatever it is they wanted to do. And maybe they're like getting back to, but maybe they're starting it for the first time. So we have yoga, we have the elevation plan, we have massage, and we do like sport performance clinics. So, you know, sometimes we do two hour ones. We just had a dance one for our dancers. Sometimes we do, you know, like a six week program for our youth athletes. We really focused on, at the new location, kind of like, my big thing was, okay, you know, I love to work with athletes.
Kelly Duggan: 19:15 I think it's an underserved population. The youth athlete, I think we get lost in the shuffle. So that was for us kind of a big part of what we're trying to do with PTU. So we have all these programs for our youth, for flexibility, coordination, the things that the coaches can't necessarily allocate time for in their practices. We again, are just trying to bridge the gap and support where there is a need. So we created all these programs. So all of that is additional money that helps to run our insurance based practice.
Karen Litzy: 19:54 Right. Fabulous. And I love the sports performance for our kids because you're right, that is not something that is widely used. You know, kids they go to their practice, they do their sport, and then that's it. And I mean, I see a lot of kids in my practice having very adult injuries, ACL injuries, you know, knee pain, a torn labrum. So things like that. So I think what a great idea. And then that's also great for your marketing. Right?
Karen Litzy: 20:37 It’s also great for your marketing because then you have the kids coming in, the parents know you’re there. So if something happens to anyone in the family, they're going to come to you because they already know you, like you and trust you.
Kelly Duggan: 20:53 Yeah, absolutely. I think, you know, with having like kind of the youth athlete as your main population, you know, they can't drive themselves. So someone has to bring them, whether it's a parent or an aunt or you know, and then they're exposed to your facility and exposed to what you do. And, I think once they see that you're providing something different, that's of quality and the services, the customer service there, it just spreads like wildfire.
Karen Litzy: 21:28 Yeah. Fabulous. And now so we spoke about what you did to get patients in the beginning, how you've expanded and how you've expanded so quickly, which is all awesome. Now can you tell us, were there any mistakes, any pitfalls along the way that you can share?
Kelly Duggan: 21:50 I mean, there's always, pitfalls. I'm trying to think of something.
Karen Litzy: 22:00 Yeah. Like if there's something that you're like, oh man, if only I knew I would not have done it this way.
Kelly Duggan: 22:10 Yeah. Well, you know, a lot of pitfalls that were kind of, if I had known I probably would have done differently. The billing aspect of things in the beginning we outsourced, which was fine because again, it wasn't like I was learning so much at the time anyways. It's not like I could learn another skill of the billing side of things. So I outsourced. But we lost a lot of money in outsourcing. And I think not only did we lose a lot of money, but I think there was a lot of opportunity for me to have learned more about why we bill and what we bill and that aspect of things that I just wasn't paying attention to for the first year and a half. I was just kind of filling out and assuming that everything was fine and coming back on in it and it was fine.
Kelly Duggan: 23:10 It was just once we decided to take on billing and hire someone, the learning curve there of what we're billing, how much we're billing, why we're billing it, what we get paid. I learned a lot in those first like six months of bringing on billing that in hindsight probably should have just figured out like how I could have done that earlier on. Because once we took it on and we started learning more about what you know, actually pays and what doesn't pay, we were able to make some adjustments in what we do to make more money through insurance. So that was definitely kind of a big eyeopener for me switching from outsourcing billing to taking it on.
Karen Litzy: 24:01 Great. Yeah. Know your billing know where your money's coming from, where it's going and why some things are being paid and others are not. And I mean the list can go on and on. Right,
Karen Litzy: 24:14 That's great advice for people who are wanting to start their own practice, especially in an insurance based practice.
Kelly Duggan: 24:24 Yeah. And a lot of those outsourcing companies, they will train you, you know, that's an option. I just kept saying, Eh, I'm like, like this one more thing I don't need to know. And it was like once I learned it, I'm like, wait, what was I doing? Why did I not want to know any of this is so important. Making more money.
Karen Litzy: 24:42 Right. And now what are the things that you look at now? So in business, you know, we talk about key performance indicators. So what are let's say for you and your business, what are the three most important KPIs that you look at?
Kelly Duggan: 25:08 Yeah, we look at cost per visit. So obviously you're looking at what you make per visit cause that's important for me. I'm looking at cost per visit and obviously I want that to be lower than what we make per visit because my overhead is so high, our cost per visit is a bit higher. Which is why in going to the new location and tripling in size. It's funny cause a lot of like insurance based PT clinic owners were like, no, like that doesn't like, you can't do that, it's not gonna work. Insurance doesn't pay enough money for that model to work. That's why people don't do it. And I just kept going back to like, yeah, but it's a service to our patients. It's exactly what they need and somehow we're gonna figure out how to make it work because it's what people want and it's going to just provide so much for them.
Kelly Duggan: 26:12 So a huge one for me is cost per visit cause it's high. But we want it to be below what we make per visit. So I'm looking at cost per visit and then I'm looking at how can I make that lower? I pay attention a lot to like how many elevation plans were selling in a month, how many massages we're selling in a month. Because again, that is going to bring down that cost per visit for me so I focus a lot on there. I used to focus on, you know, the average amount of visits we were getting out of people. But over time it's been similar over time, so it's not like I'm like, you know, worried about it. But there are certain key performance indicators that I don't know how I want to say this without sounding like, I don't want my therapist to be aware that all right we need every patient to have 12 visits because that's what we need financially.
Kelly Duggan: 27:26 You know, you don't want someone's treatment to be affected by the bottom line. So I track it, but that's not something I share with my employees or even try and like, oh, we got to get that to, you know, 13 visits or 14 visits because I mean, it's a wonderful thing if you can get somebody better within four visits or six visits, cause then they're gonna, you know, talk about, Oh my God, I felt better in six visits. So you don't want to focus on those numbers. So I think, you know, you do see that number of listed a lot when people are talking about key performance indicators and how many visits you're getting out of your plan of care. But I think going into it and focusing on that number is not a good thing for us as PTs.
Karen Litzy: 28:15 Right. Yeah. And, also it then puts these perhaps unrealistic what's the word? When they have to meet a quota, is that a thing? Like PTs have to meet a quota or something like that? Yeah, some clinics. It incentivizes the wrong thing, right? I think what you're doing is you're incentivizing patient care. Versus incentivizing patient visits. Those are two very different things. More visits doesn't equate better care. It just equates more visits.
Kelly Duggan: 28:59 Yup. Exactly. Exactly. And we've talked a lot about in talking to my coworkers and stuff of, all right, well, what do we have to do? How many visits do we need to do? And how many massage appointments do we need? How many elevation plans do we need so that we continue to deliver the level of care that we're delivering. I don't want to change my business model to seeing a patient every half hour, or, you know, forcing that sort of way to hit our bottom line. I'd rather have it, well, you know, can we get more people in? Can we do performance clinic? Can we, you know, add in yoga again, like how can we add additional services? Because you hate to really like turn into a mill to hit your numbers, you know? So for us, we need to encourage more people to, you know, sign up for massage or maybe we need another deal because we're getting close to that number of we're not gonna, you know, make our minimum requirements and we don't want to change our model. We don't want to change the level of care we're able to provide to people. So I think that therapists knowing that they are getting so much better with like, mmm, you know, wanting to do these additional programs and wanting our patients to do these additional programs. So it's been good in that sense. You know, and I've heard from other business owners and other PTs that they’ll get a bonus if they hit their productivity.
Karen Litzy: 30:42 That's terrible.
Kelly Duggan: 30:46 That’s not what we want to do at all. You know, it's like, it's just, again, it's the quality of care and it's then the PTs just thinking about their numbers and not, am I getting people better?
Karen Litzy: 30:58 Exactly. And then, you have PTs saying, oh, I can work through lunch or I'll stay later, or I'll come in earlier because they're just so focused. I mean, let's be honest, a lot of PTs are type A, right, so focused on hitting this arbitrary number to get a bonus. Right? So let's say they get $1,000 bonus. Well, right, that thousand dollar bonus down to all the times coming in early and lunches that you worked through, guess what, that thousand dollar, $2,000 bonus that it doesn't equate to what you're making per hour. Right. And then it just, I think it's a great way to burn out your therapists. And I'm not sure, is the care better? Is it not better? I don't know that I can't say, but I think it's, like we said, just incentivizing the wrong thing. So glad you brought that up. Is there any other big KPI that you look at regularly and that forces you to maybe change the way your business is being run?
Kelly Duggan: 32:17 Not really. I mean, I look at a lot of stuff just to monitor for myself. You know, I look at average codes for treatment, you know, and are we in line with the national average. You know, how can we make that in line with the national average while still providing the quality care that we're providing. I mean there's nothing that I, again, it's a lot of stuff that I look at kind of the behind the scenes stuff, but nothing that I would want my therapist too be concerned with I guess.
Karen Litzy: 32:59 Yeah. And what about cancellations? No shows? Yeah. It's always one that everybody always touted as being one, but I dunno.
Kelly Duggan: 33:10 We track that and if it starts to get higher than like, you know, a certain number, we were like, okay, what's happening? But we have things in place that, kind of limit the amount of cancels and no shows. You know, we do our reminder calls. We, you know, people that are dropping off, patients that drop off. We use like an automated email system we use. We're integrated with strive, so we use strive, but I know some people use infusion soft.
Karen Litzy: 33:45 Infusion soft is very expensive.
Kelly Duggan: 33:48 Yeah. I love strive. It's really user friendly. And the customer service has been awesome and you don't have to like build your own sort of stuff. It's, you know, you create your own content and all of that, but you don't have to like be a computer genius to use it.
Karen Litzy: 34:12 And is that strive labs through web PT?
Kelly Duggan: 34:16 We were using them before they were integrated with web PT and they do work with, you know, if you don't use webPT, I believe, you know, but I do use webPT.
Karen Litzy: 34:28 Cool. Very cool. And so we talked about where you came from, where you're at, what you're looking at, how you're growing. So now where do you see yourself going in the next three years?
Kelly Duggan: 34:43 Yeah, so, you know, I’m always thinking about that. But you know, one of my biggest struggles I would say right now is because we're so busy as just like, how do I get through the day? How do I get through the day? And I would say a couple of weeks ago, I'm like, what am I doing? Like all of my energy is focused on how am I getting through today and this week? And I'm not thinking of kind of the long term. And every time we have either a student or someone interviewed, they're like, what's the longterm plan for PTU? I'm like, well, you know, I don't really know.You know, people ask, because for me it was, I opened PTU because I wanted that creative outlet. You know, I wanted to support our athletes, but I wanted autonomy and I wanted time with my family. And I'm starting to get that so I don't want to, you know, it's not in the cards for the next three years to expand to another location.
Kelly Duggan: 35:42 It's just to get this PTU central location successful in the insurance world. And, you know, I'd like to be able to give everybody raises. And all of that. So I want the next three years is figuring out how do we make this insurance hybrid model, successful so that we can, you know, give people raises and continue to treat at the level that we're treating. And you know, so that I can get the time that I wanted with my family. And then if we're able to do all of that in three to five years, maybe, you know, I've talked about adding on a second location, but I don't even want to think about it because I'm, again, like you mentioned, a lot of PTs are type A, I'm so type a that if I decide that I want to have a second location, I can't say, well, I'm going to do it in five years.
Kelly Duggan: 36:39 Like it'll be here in six months. Like that's just how like I work. So I just, I want to keep putting that off. And for right now it's just PTU. It's our central location. I want it to be, you know, successful. And when I say successful, you know, I don't want to sugar coat it. I want it to be lucrative. I want it to be a business that makes money.
Karen Litzy: Of course you got, why wouldn't you and what other business world outside of like PT, the healing world do people say I really hope it's successful. Like of course yeah I still want to make money though. Yeah! That's why you started your own business for some freedom, for stability to be with your family, to help the people in your community and to make money. You didn't start a business to not make money.
Karen Litzy: 37:32 He didn't start a non for profit, which is a totally different world. So like if you opened up a clothing store, you wouldn't be like, man I just, I just hope I can make money one day.
Kelly Duggan: Yeah. It's funny cause it's the PT struggle, you know, it's like I want to support my patients. But you know, you have to put on that business owner hat and be like, well we need to make money to support our patients.
Karen Litzy: So that's right. It's your responsibility to make money so that you can be present in your neighborhood and that you can be present in your community and help people. Because if you didn't make any money, you'd have to close your doors and all those people who depend on you, what do they do then?
Kelly Duggan: Yeah, exactly. So in three years, you know, I want, you know, hopefully two more PTs is like the goal, you know, and I'd like to have that within the next year. And I want one of those PTs to take over the performance side of things because I feel like that's one area that we can continue to grow and we could have, you know, we could constantly be hosting some sort of sport related supportive group or clinic or camp or whatever. But I don't have time to plan all that. So I want to hire, I want one of my PTs to kind of take over the performance side of things.
Karen Litzy: 38:49 Very smart. Well, it sounds like you have a good plan in place and I love the fact that you said, you know, I just want to make this into a well oiled machine. This is what I want. And that's amazing because not everything, like you said, not everything has to be scaled to infinity. I mean, knowing where you are in life and knowing what you want and knowing how you want to live your life and if you can achieve that
Karen Litzy: 39:20 Achieve those goals within the parameters that you have. It just has to be, like you said, little tweaks here and there. I think that's amazing. So congratulations on such a huge, huge change in three years.
Kelly Duggan: 39:34 Thank you. Thank you. And I want to actually bring that up. I want to say something to that because, I think again, PTs as kind of type A, and especially PTs coming out of school, we are so on this really, really like fast train of trying to be successful and achieve our goals. And, for PTs a lot of people are so focused on their career and their career ladder in their career growth. And I just want to say a reminder to people to kind of pull yourself away from that for a second and just think like, what do I want out of my life? What are my life goals, right? Is it that I want to travel more? Is it that I want to have a lot of money?
Kelly Duggan: 40:25 Is it that I want more time with my family? Whatever it is for you. Think about that for, you know, a few minutes and then think about, okay, so how does PT fit into that? And not the opposite way of like, let me like reach the top of this career ladder and then like, well, is PT my life? Or like where am I now? So just pull yourself away from that and think of, you know, like for me it was and it might take a life event for you to figure out that. Like for me it was having my third kid and like, wait a minute, what the hell am I doing here? And it was okay, I want more time with my family. How do I do that? How does PT fit into that? And I just want to encourage more people to do that. Cause I think as type a people, we get so obsessed with climbing this kind of career ladder that, you know, we can get lost in it.
Karen Litzy: 41:19 And great advice. And I am in this, speaker's group, which is really a bit of an entrepreneurial group as well. And the woman who runs it Trisha Brook, at one of our first sessions, she had us write out kind of what do you want your legacy to be? And that's if you think about that you're doing exactly what you just said. You know, you're putting forth what do you want your legacy in this world to be? Right? And it sounds like for you it was too, you know, be with your family to have an influence over your children and to have that be such a great legacy. Have your children, your family, be your legacy, have the community that you're in, be your legacy. But what I didn’t hear from you, and correct me if I'm wrong, but what I didn't hear from you is for PTU to be your legacy.
Karen Litzy: 42:21 Right. It was, I want to make a change in my community and my family and that's the legacy. PTU is part of the way I do that. But it's not everything. Excellent advice. And now I feel like I'm going to ask you this last question, but you might have just answered it. But the question is, given where you are now life, career, what advice would you give yourself as a new grad out of PT School?
Kelly Duggan: 42:57 That's it. Don't fall for the trap.
Kelly Duggan: 43:12 Don’t fall for the kind of trap of just trying to, you know what, nevermind, I wouldn't say that. Because I feel like all of that got me to where I am right now. You know, the struggle of how do I get high around the career ladder and how do I do all of this. And, so I guess what would I say to myself straight out of PT School is take jobs that you have fun at. If it's not fun at the end of the day, if you didn't laugh, if you didn't enjoy yourself, get out of that situation sooner than later. I think I held on to certain things knowing that they were good for my career and I should have let go of them sooner.
Karen Litzy: 44:08 Excellent advice. Couldn't agree more. And now where can people find you and the clinic if they want more info or they want to talk shop with you.
Kelly Duggan: 44:17 So I'm on my website is PTUclinic.com. The email is PTUclinic@gmail.com. I'm on Facebook, I'm on Linkedin. I'm not on there too often, but I'm on Facebook pretty regularly and my clinic is on Instagram. So any of those realms reach out if it's something that you're thinking of doing. I love talking with people that are thinking about opening their own clinic. I love to just encourage it, I think, you know, if it's something that you want to do then to go out and do it and yeah, reach out to me. I'd love to be of any help if that's what you're looking for.
Karen Litzy: 44:57 Awesome. Well thank you so much, Kelly, for coming on and sharing your entrepreneurial journey. I think you gave a lot of people a lot of help today, so thank you so much.
Kelly Duggan: 45:07 Thank you so much for having me. Really appreciate the opportunity to talk about it and I hope we encourage some people today.
Karen Litzy: 45:15 Yeah, I hope so too. Thanks so much. And everyone out there listening. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Megan Rigby on the show to discuss how she found success with her online nutrition and fitness consulting. Dr. Megan Rigby is a doctorate prepared pediatric GI Nurse Practitioner, IFBB Figure Pro, blogger, macro lover and online coach. She is on a mission to help others become fit, healthy and happy.
In this episode, we discuss:
-How Megan started her side hustle and when she decided it was time to leave her corporate job
-The pro’s and con’s of being an online entrepreneur
-The importance of vulnerability and integrity on social media
-And so much more!
Resources:
Macro Mini Website
Macro Mini Instagram
Megan Rigby Twitter
Macro Mini Facebook
Macro Mini You Tube
For more information on Megan:
Megan Rigby is a Doctorate-prepared GI Nurse Practitioner, Certified Nutrition Consultant, IFBB Figure Pro, and Owner of MacroMINI. She is passionate about educating others through her coaching, as well as publicly speaking on topics surrounding food, fitness & healthy mindset. Megan has helped hundreds of people experience great physical and overall lifestyle changes. She is on a mission to empower others to become healthier, happier versions of themselves while still enjoying food as one of life’s simple pleasures. In 2018, Megan left a corporate position as a Digestive Nurse Practitioner to open her own coaching business & has made over 400k+ within her first year. Megan has been featured in Oxygen & Strong magazines as a content creator, along with appearances on News Channel 12. She has been recognized as a top industry leader within her community.
Read the full transcript below:
Karen Litzy: 00:01 Hi Doctor Megan Rigby, welcome to the podcast. I am happy to have you on.
Megan Rigby: 00:06 Thank you so much for having me. I'm excited to do this with you today.
Karen Litzy: 00:10 Yeah. And so what we're gonna do is we're going to talk about your sort of entrepreneurial journey, your business story, because, as I said in the intro for you, you are a doctorate prepared GI nurse practitioner and a nutritional consultant and a whole bunch of other stuff. But, something that I think the listeners of this podcast can relate to is there's a lot of healthcare workers, things like that who are listening to this podcast who maybe have started their careers in a hospital and clinic, but maybe you want something a little bit more. So I would love for you to kind of share your story of how you made that transition from, I love that you say you were like a corporate girl in a hospital or clinic, but when you're in healthcare, that's kind of the equivalent. So go ahead and tell us your story. How'd you do it?
Megan Rigby: 01:03 I never planned on being an entrepreneur having my own business. That's just not something I ever saw in my future. My Grad program, I had focused on family and childhood obesity. It was my dissertation. I love health and nutrition. I think it's the preventative to a lot of health care. So I always tried to teach all my clients that, but I started to get frustrated a few years in just because working for corporate, you're kind of inside a box. And I think there's a time and place for complimentary medicine and modern medicine and sometimes that can be hard when you're working for a hospital. And so I started having more and more people talking to me on the side about health and nutrition and fitness and people would just start asking, Hey, can you give me an advice? Give me tips and I'll pay you. And so slowly I started doing nutrition plans and education on the side.
Megan Rigby: 02:05 And over time I was able to build it into an online business. I realized that my limitations that I have within the clinic are able to actually be kind of removed online. I get to spend more time with my clients, educate them, and truly provide a service that's unique to them. So with time it took probably, I mean two years I was doing a lot of my own online stuff, while working full time in clinic. And then I gradually dropped down to more of a part time position once I started picking up online. And then within the two years I was actually able to make more than what I was making clinic with the online business and I transitioned over and I left September 2018 and now I run my own company doing health, fitness and nutrition.
Karen Litzy: 02:57 And I would imagine that there are pros and cons to this. So I'm just going to name one pro and one con. Right. So the pro, obviously you can probably help more people with online programs. Con would be, do you miss having that person sitting in front of you?
Megan Rigby: 03:16 I do. I missed that. But the beautiful thing about online is you can still do zoom calls face to face. So there is still that where you can talk to them. So almost like a telehealth. I would say one of my biggest cons is when I used to leave the clinic, it was kind of like my work was done. Like my charts were done, I was done seeing patients. Now, I feel like I'm on a lot more so my day doesn't end nine to five. I work a lot more around the clock. I feel like, and that's something I'm still trying to work on as a new entrepreneur.
Karen Litzy: 03:50 Yes. And that is absolutely true. I think a lot of people when they think I'll just start my own practice, they think you can leave it at the door when you leave, but you cannot. You're always doing something. I mean, there are times like last night it was midnight and I'm working.
Megan Rigby: 04:09 Yes. It never goes away because it's now your business, you're responsible for everyone you're taking care of and you're responsible for bringing more clients in. And so definitely you work, I think a lot more being an entrepreneur, but at the same time you have more freedom, which is nice.
Karen Litzy: 04:26 Yes. You have a little more flexibility, you have a little more freedom. So there's pros and cons to all of this. But let's start, how, if you can get even a little more granular into your kind of transition from hospital to on your own. So my first question is how did you have this conversation with your employer? That's a question I get asked all the time.
Megan Rigby: 04:51 Yeah. So I think you have to just be honest about it. And that was something that they knew that I loved the nutrition aspect of things. I love being able to teach and spend more time. So when I went down to part time, you know, I let them know that I was, you know, on my side I was, you know, just educating and teaching people about nutrition and health. And that was not going to interfere with my job. And I think that's the biggest thing. If you can, you know, let them know, reassure them that you're not letting it interfere with your work and how you come in every day and interact with your patients there that you know, helps them as well, as well as not ever taking any of the businesses patients.
Karen Litzy: 05:37 Of course I think we say that of course, but maybe people do. I don't know.
Megan Rigby: 05:46 Yeah. And that was something where it's kind of drawing, you know, a line in the sand and making sure that both of the jobs stayed away from each other and they never came together. And I think that's something that a lot of people have to remember. Like I would love to have been able to work at work, but you can't do that. I mean, I came home at night and I saw my clients from online at night and there was no crossing that during the day at all when I was clocked in and I was being a nurse practitioner in the clinic.
Karen Litzy: 06:13 Yeah. And I think that's great advice. And it's just dry and clear boundaries for yourself and also being respectful of your employers.
Megan Rigby: 06:21 Yeah. Because in the end, if you decide to go back to clinic, you need recommendations and burning bridges is not something you want to do because who knows? I mean the venture that we have or I have, it may, may die down one day and I do need to go back to the clinic. So I never want to slam that door shut because it provided me so many opportunities.
Karen Litzy: 06:42 Absolutely. And I remember when I left the physical therapy clinic I was working at, it was really hard to do because I really loved working there. But they now refer patients to me and I refer patients to them. Right. So it's like you don't want to burn those bridges because guess what, they can help you and you can help them. And I think you want to really make this a win, win for everyone. So you have this conversation with your employer, they're understanding, you go down to part time for you, what was, if you can describe kind of the hours worked in clinics or are you down to like 20 hours a week or less and obviously we know you're working then on the online part, but what was the breakdown for us?
Megan Rigby: 07:33 They let me go to three and a half days a week, which was nice. And so that was considered more of a part time position there. So I worked Monday, Tuesday, Wednesday, and then half day Thursday and I was off Fridays. So I would make sure that all my check ins and my main communication with my clients would be on the weekends. That works best for me. So Thursdays I would do all of my prep when I got off work. And then Friday, Saturday, Sunday, those were my days that I was really able to devote to the actual online business and evenings whenever I, you know, was able to after work I would come in home and I would do what I needed to do. But otherwise it was an 8:30 to 4:30 Monday through Thursday, half day.
Karen Litzy: 08:21 And since going completely on your own, do you give yourself a schedule? Because it must be difficult, right?
Megan Rigby: 08:28 I'm still close the computer when there's still work to be done and I always want to make sure that everyone is getting the, you know, service and communication that they deserve. And I think that just comes from being a healthcare professional that you know, you want as much time devoted to each and every client. And so it can be hard to kind of turn that off and feel like you still have unanswered questions or things going on.
Karen Litzy: 08:59 Yeah, there's no question. And again, that's where kind of setting boundaries for yourself comes in handy or making sure that you know, you have scheduled times that you're working even with the online clients and that they know that. Not that they're taking advantage because I don't think they are, but if you allow yourself to be available 24 seven then guess what, people will take you up on that offer.
Megan Rigby: 09:27 Yeah. So it is, it's creating boundaries too. And that's what I have learned. It's been hard, but yeah, working, you know, maybe nine to like four and allowing lunch in there, is something that I'm striving to be more consistent with. But it is nice because if you have appointments, you know, you can schedule those in and that's where the flexibility has been really good. But also drawing the line of when you kind of cut it off at night.
Karen Litzy: 09:52 Yeah, absolutely. And now how do you advertise? How do you market yourself?
Megan Rigby: 09:56 So social media is kind of where it's all at, as exhausting as it can be. I have, you know, my page and that's where a lot of people find me word of mouth has been the biggest thing and I value that the most. I think if people can refer other people to me because they've had great experiences and outcomes, that's where I've actually gotten a lot of my clients. I don't really do a lot of paid advertisement or anything right now. Like I said, it's just word of mouth and then making sure people who do follow me or start following me understand, you know, where I'm coming from and really being open and vulnerable on social media so everyone kind of knows who I am and there's no hiding.
Karen Litzy: 10:44 And what advice do you have for the listeners on how to be vulnerable? Because that's hard.
Megan Rigby: 10:50 It is really hard. I think it's just to be true to you and stand by what you believe in and how you practice. And provide honest, you know, education, advice and share yourself I think with people has been the hardest thing because a lot of people will look up to healthcare professionals, you know, and think that there may be on a pedestal or something. And I think making yourself relatable is the most important thing because we're all humans and so we all have struggles as well. And I think putting those out there so people can relate to you is going to bring more clients in and more, you know, followers as well.
Karen Litzy: 11:30 Okay. So how do you make yourself more relatable? Because isn't social media is supposed to be like, it's your highlight reel. We don’t want to show people that we have any problems. Right.
Megan Rigby: 11:40 With me, it's a pretty easy with the nutrition and the fitness and health because I think, you know, as a female we struggle with appearance. We struggle with, you know, day to day eating healthy, making the right choices, preparing food for our family. So I can relate to a lot of that. You know, I've had my own insecurities and I'm not perfect every day with how I eat. There are days that I want to go to dairy queen and have a blizzard. So I'm able to really relate to people in that spectrum and then talking about, you know, different health issues that so many of us women struggle with and it can affect how we lose weight and really making sure that we stay on top of those. So whenever I talk about something, I try to draw in my past experiences with it and I think that usually helps a lot.
Karen Litzy: 12:28 Yeah. I think that's really good advice. And what would you tell people who maybe have these great stories and we know this is what you should do to kind of get people to get to know you, like you and then eventually right purchase from you. Right. What if you're scared to put yourself out there? Like how do you overcome that fear?
Megan Rigby: 12:53 I think you have to jump in with both feet. Like if you are truly passionate about starting a business, that's vulnerable in itself and then putting yourself out there on social media. Like you just have to realize that people are gonna love you or hate you. And as awful as that sounds, it's the truth. I mean, people are going to be drawn to you. So just jumping in and sharing it, whether it's just the writing at first. I know a lot of people are camera shy, so sometimes they say like blogging at first is really good. Or just sharing it on your Instagram through words, before going into any of the videos or anything like that. Even you know what sharing with your family sometimes too because you can be vulnerable with them and getting feedback sometimes can be a little bit comforting if you're not ready to just jump.
Karen Litzy: 13:40 Yeah, I think that's great advice kind of sharing with friends and family are sharing within a trusted circle.
Megan Rigby: 13:47 Before it's scary. You're going to get judged. That's human nature I feel like so people will judge, but people also will be able to relate to what they hear from you. And those are the people you want following you and interacting with you.
Karen Litzy: 14:05 Yeah. And do you have any sort of memorable comments or notes or things that people have sent to you that have stood out because you've been a little bit more open?
Megan Rigby: 14:17 Yeah. So when I do stories I try to talk about topics that have affected me recently. I usually always try to keep things kind of close to my heart. And so when people message me and say, oh my gosh, I needed this today. It's been such a struggle, like it, it's so nice to know someone else's out there going through it with me or I appreciate the advice. So those things always help to kind of reaffirm like there are people listening and what I am saying is holding others. So, you know, it makes me want to keep doing that more and more.
Karen Litzy: 14:52 Yeah. I love getting those notes. I think it's so cool. And I always think to myself, Gosh, you never know who's watching, sitting, listening. You just don't know.
Megan Rigby: 15:01 Cause you're always impacting someone. There's always someone out there watching and listening. Like she said, you never know. So if it's something you're passionate about, something you love and you want to be heard, then it's worth sharing.
Karen Litzy: 15:15 Absolutely. I agree. 100%. We’ve been talking that you're in that nutrition, fitness realm, very crowded field. Every time you turn, everywhere you look, someone is talking about nutrition, whether that be good or bad evidence based or not. It's out there. So what advice do you have to stand out amongst all this competition? Because I'm sure it can be applied to almost any industry.
Megan Rigby: 15:49 It can. I always say be true to you. So whatever you believe, stay with that. It's so easy to get into the comparison game of you know, what they're doing or you know, this is the new trend, but you have to do your own research. You have to believe in what you believe in and talk about that. I think that's the most important. So many people in the fitness industry just jump from one trend to another. And so it's whatever the hottest topic is. And I think when it comes to, you know, this industry, you have to really stay true to the basics and what is science saying and what you believe in. Because if people hear it consistently and they can expect the same thing from you, which is the honest truth in what you believe in, they will trust you. It's the people who kind of jump all around that, you know, you kind of start to say, Hey, wait, last week you were talking about this. And that was the best thing there was. So that's what I found is people, they expect the consistency from me and they know that I believe in what I'm talking about.
Karen Litzy: 16:52 Yeah. So not jumping on the bandwagon every time something comes out, but rather look at it critically.
Megan Rigby: 17:00 And not comparing yourself. I think that derails a lot of us is when we start to look at what other people are doing in the same field and we feel like we need to mimic that or we need to jump on that. And that can be very distracting too.
Karen Litzy: 17:20 But it's so hard.
Megan Rigby: 17:24 It is so hard. I do my best actually not to follow a lot of people in my industry. I'll follow the people who I think provide me motivation, but if there's anyone who evokes jealousy, or you know, kind of gets under my skin, I figure that's negative, you know, vibes and I don't need that. So I really tried to just stay with the people who motivate me the most. I think social media should be a positive outlet. And it's so easy to make it negative. And I really tried to avoid that.
Karen Litzy: 17:58 Yes. As a matter of fact, I'm part of a Oxford debate in a couple of weeks at a physical therapy conference. And so the debate topic is social media and it is, we believe that social media can be hazardous to the profession of physical therapy. And you know, people will argue in favor of that and against that and that can easily go either way. But in the end it's a tool. It is a tool and it's not the tool, but it's the user.
Megan Rigby: 18:36 It is. It's how we allow ourselves to use social media. No, I agree. I'm curious to hear how that goes. So I hope you will talk about that.
Karen Litzy: 18:48 I will talk about that. I'm curious to see how it goes to, I hope it goes well. I'm a little nervous about it, but I think it's supposed to be this like fun debate, like lively, fun and funny. But you still want to win the debate of course. So we'll see what happens. So is there anything else about kind of your entrepreneurial journey that you really want people to learn from?
Megan Rigby: 19:13 I think starting small, and a lot of people when they tried to start a business feel like they have to dump a ton of money into it. And I've learned that you don't, with starting small and using the skills that you have, you're actually able to start a business that may, you know, not be as profitable as you want in the beginning with time you can reinvest that money you make back into it without taking up such a huge loan in the beginning, especially when it comes to the online type of business. I think there's so much that we can do on our own before we have to really start spending money. And I think that's something that, you know, a lot of new entrepreneurs who are wanting to go the online business, just have to remember that it doesn't take a ton of money to get up and going and get clients. It just takes, you know, the passion and the time and the knowledge.
Karen Litzy: 20:09 Yeah, absolutely. And I have one more question for you. The question that I ask everyone and that is knowing where you are now in your life and in your business, what advice would you give yourself, not to someone else, but what advice would you give to yourself at like the day you graduated and we'll say with your doctorate, why not? Because you’ve got like advanced degrees here. So let's go with the doctorate. What advice would you give to that gal?
Megan Rigby: 20:40 Okay. My advice would be to not change anything, to enjoy the ride and kind of allow it to take you where it's going to take you. Because there are times that I wondered, you know, why was I where I was and what I was doing and it all led me here. So I think the biggest thing is enjoy the ride. So often we keep wishing the years away and if only I was here, if only I was there. But every step and every moment you have is leading you to where you really need to be.
Karen Litzy: 21:09 Very nice. It's like that sounded like from Game of Thrones and that's not a spoiler or anything for anyone listening. If you haven't seen the finale, it's not a spoiler, but that was very Bran like of you, it was great. Now where can people find you if they want to get in touch with you, if they want to work with you, they want to follow you. Where can they go?
Megan Rigby: 21:36 Yeah. So on Instagram, I'm macro_mini. And then why a website is www.themacromini.com.
Karen Litzy: 21:47 Awesome. And just so in case you know, you don't have a pen and paper and you're not taking notes right now, like I am, you can go to podcast.healthywealthysmart.com. We'll have all the links, one click will take you right to all of Megan's info so that you can get to know her, like her, trust her, and work with her. So Megan, thank you so much for coming on and sharing your journey. I think it will give a lot of people in health care a bit of a boost, maybe a little kick in the butt too, and the confidence to go out and kind of do what you're doing.
Megan Rigby: 22:23 Thank you. I appreciate that. And thank you so much for having me on.
Karen Litzy: 22:26 Yeah, my pleasure. This is a great conversation and everyone who's out there listening, thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Christina Le on the show to discuss youth kinesiophobia following knee injury in sport. Christina Le is a PhD candidate in Rehabilitation Sciences in the Faculty of Rehabilitation Medicine at the University of Alberta in Edmonton, Canada.
In this episode, we discuss:
-What is kinesiophobia?
-Preliminary results from the University of Alberta research team focused on prevention of early onset osteoarthritis
-Why clinicians should address kinesiophobia early and often in rehabilitation to minimize poor long-term health outcomes
-And so much more!
Resources:
Christina Le Twitter
World Congress of Sports Physical Therapy 2019
Tampa Scale for Kinesiophobia
For more information on Christina:
Christina Le is a PhD candidate in Rehabilitation Sciences in the Faculty of Rehabilitation Medicine at the University of Alberta in Edmonton, Canada. As a clinician, she frequently treated athletes with anterior cruciate ligament (ACL) injuries. This experience has motivated her to pursue research to better understand health-related quality of life (HRQOL) following a sport-related knee injury in active youth. Her research include identifying what factors impact youth HRQOL during rehabilitation and developing strategies to improve long-term HRQOL.
Christina continues to work part-time as a physiotherapist at the Glen Sather Sports Medicine Clinic. She treats patients on weekends, participates in multidisciplinary clinics with sport medicine physicians and orthopedic surgeons, and teaches an ACL rehabilitation group class called the Functional Agility and Strength Training (FAST) Program. Find her on Twitter as @yegphysio or online at www.yegphysiotherapy.com.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody. Welcome back to the podcast. I am coming to you live from Geneva, Switzerland at the WCPT meeting and right now I have the distinct pleasure of sitting across a table from Christina Lee. She is a PhD candidate at the University of Alberta and she's also a physio therapist. So Christina, welcome to the podcast. And today Christina did a wonderful platform presentation on Kinesiophobia after knee injury and we're going to definitely get to her study on that. But before we do, Christina, can you tell the listeners what is kinesiophobia?
Christina Le: So kinesiophobia is taken from the chronic low back pain literature and has been applied in our knee injury population as well. And it's an excessive and irrational fear of movement due to feeling vulnerable to pain or reinjury.
Karen Litzy: And so now let's get to your study. So what I'll have you do first is maybe tell us why you thought this was an important thing to look at.
Christina Le: 01:02 Yeah. So I think after knee injuries in sport, knee injuries in particular, and we're looking more at our youth, we know that there are a ton of different consequences that happen after knee injuries and they spend the physical, psychological and social domains of health. And this is just one that hasn't been studied to great length in our youth athletes in particular. And it's something that I think can contribute to poor long term health outcomes because it's the most common reason for kids quitting sport after they get injured. It's related to physical activity. So it's something that maybe we can manage a little bit better as clinicians and moving forward to help out with better long term outcomes.
Karen Litzy: Right. And that sort of lack of return to activity, lack of return to sport can, like you said, have long term outcomes. So we know that inactivity can lead to obesity and childhood diabetes and a lot of downstream consequences.
Christina Le: 01:58 Yeah, exactly. Posttraumatic osteoarthritis is probably one that’s stuck in my head right now. Just coming from the International World Congress as well. And we know that that can affect almost up to half of our youth injuries that have a knee injury as well.
Karen Litzy: All right. So let's break down the study for us. So I will just have you kind of take it away and talk about the study now that we know the why behind it. Go ahead.
Christina Le: Yeah, so we are currently running an ongoing prospective cohort study at the University of Alberta. It's a part of the prevention of early onset of osteoarthritis research group, I guess that was initiated out of the University of Calgary. And we're looking at youth athletes aged 11 to 19 who have sustained a sport related knee injury. So tibial femoral Patella femoral injury within the last three months. They had to have seen a physio therapist, a doctor or some sort of medical professional and had to have missed at least one session or one game from their sport to be considered injured.
Christina Le: 03:02 And then we're comparing them to age, sex and sport match controls. I'd say kind of 75% maybe through our study right now. And so this study that I presented on today is just a preliminary analysis of what our baseline data was. And what we were looking at was self reported kinesiophobia. So using the Tampa scale for Kinesiophobia and its influence on bilateral knee strength, using isokinetic dynamometer and triple single leg hop and Y balance test.
Karen Litzy: Okay. So those were all of the things that you are looking at, that's the data you are collecting? All right. Before we go on, I think most people know what a single leg three hop test is and the Tampa kinesio phobia scale you can look up, but can you talk about what the Y balance test is really quick just so people have a frame of reference as to what you're doing?
Christina Le: 03:53 Yeah, sure. So the Y balance test is we ask our participants to stand on one leg, hands on hips, so they can't use their upper extremity to help out with their balance. They're reaching as far anteriorly as they can while standing on one leg. And then they also do a posterior lateral and a posterior medial reach as well. We do three trials and we take the average of the three direction reaches. So one point they're planted on the injured or the index side and then the other time they're on the other side.
Karen Litzy: Perfect. All right. So continue. Now we know what you're measuring. We know who you're measuring. So now let's talk about how?
Christina Le: 04:41 So we are looking at our mean within paired differences. So we take our injured scores, we subtract them from our uninjured scores in terms of study groups, and then we're just looking at the differences between the two groups on all those variables listed. And then we're also running a logistic regression model that's accounting for our match design. So it means that we are looking at the odds of scoring higher than 37 on the TSK. And we're looking at if there's a difference between our injured in uninjured groups in scoring higher or lower than that 37 and the 37 is based off of chronic low back pain literature where a study dichotomize their participants based on high fear responders are low fear responders based on that TSK score.
Karen Litzy: Right. And just so people know, the lower your score on the TSK, the less kinesiophobia you have and the higher score, the more kinesiophobia you are experiencing.
Christina Le: 05:39 Yeah, exactly. So I always say TSK is like a golf score. So higher scores worse lower scores better. And then we're also running separate multivariable linear regressions as well. So effectively looking at the Association of TSK on strength or triple single leg hop or Y balance.
Karen Litzy: Okay. And what did you find with that analysis?
Christina Le: So what we found was with our mean within pair differences, so when we're looking at our injured versus uninjured groups, just based on these variables alone, that the injury group scored on average about eight points higher on the TSK than the uninjured, which means that they are reporting greater kinesiophobia or higher kinesiophobia as you said. And they're also scoring lower on strength, which isn't maybe the most surprising finding considering they've just been injured. So we're testing them on a median of six weeks after injury.
Christina Le: 06:39 With our odds ratio where we found that the odds of scoring higher than 37 on the TSK was about 10 times greater for the injured group than the uninjured groups, which again, just means that they're more likely to be kind of in that high fear responders group. And then with our multivariable regression, we found that there is an association between our TSK scores and our knee extension strength bilaterally and actually flexion strength bilaterally as well. The differences or the relationship strength itself isn't the strongest. So if we have a one unit increase in our knee extension strength on our injured side for example, it just corresponded to a 0.1 decrease in the Tampa scale for Kinesiophobia, which is a minor change.
Christina Le: 07:40 It's probably not something that we can detect in all honesty or that's clinically relevant, but just tells us that there is some sort of association between Kinesiophobia and strength.
Karen Litzy: Got It. And so we know the results of your findings. What are your recommendations? What conclusions did you come to as a result of this study?
Christina Le: Yeah, so I think the two big take home messages is that kinesiophobia is present as early as the three months leading up to or after an injury. I think as clinicians we generally tend to look at this closer to the return to sport end of the spectrum of Rehab. But it's something that might be early, as our present, as early as three months. So we should be dealing with it as early as three months. And that it's potentially something that might affect both sides of the body as well.
Christina Le: 08:28 So if you've had a right knee injury, doesn't mean that you don't necessarily have kinesiophobia on that left knee as well. So it's just trying to get clinicians to think maybe a little bit more bigger picture here and that I think ultimately if we can address kinesiophobia early after an injury, then potentially we can set people up for more physically active lifestyles, that sort of thing. And then hopefully help out with that reduction of those poor long term negative health consequences.
Karen Litzy: And so as a practicing clinician, so let's say I am seeing a, just making this up off the top of my head this is not a patient I have I swear, I am seeing a 16 year old boy who plays Lacrosse and let's say he will use a term sprained his knee, maybe let's just say it's an ACL strain or sprain.
Karen Litzy: 09:22 So not a tear doesn't need surgery. So they're coming to me, should I be using the Tampa scale on the first visit that I see this person? Or do you wait for a little bit further down the line?
Christina Le: I don't think it hurts to be using that right away. I think that what these individuals with knee injuries or any MSK injury, realistically they might be fearful of different things at different times in their rehab. And I think picking that up early on might be able to detect that, oh, maybe he's scared of going downstairs or something like that. Whereas later stage Rehab, maybe it means that he's a little bit more fearful of changing directions with contact around. I don't think it hurts to necessarily use that Tsk early by any means.
Karen Litzy: 10:13 Okay, great. So that's a nice take home for the clinicians listening that hey, this is easy. It's simple, it's free. You can get it online and just have your patient fill it out and it’s easy to score. We just heard if you're over 37, maybe that's something to worry about. The lower the number, the less kinesiophobia. So it's something that we can easily incorporate as clinicians with youth knee injuries. Can this be extrapolated to other injuries outside the knee and let's say the back?
Christina Le: So the tricky part with the TSK is that it actually hasn't been validated for knee injuries yet. So it's hard to say is this something that we can use in other areas? I'd really think that there is a need to validate this tool or if it's not, then to generate a tool specifically for knee injuries.
Christina Le: 10:59 Cause I think it's something that we discuss a lot as researchers, as clinicians with our patients. So for now I guess it's the best tool that we have but it doesn't mean that it's necessarily the right tool yet.
Karen Litzy: Yeah. Well something to add to your list. Get Jackie Whittaker and get your team together. And that's another study you can do because you have the time. Right?
Christina Le: Totally. Really hoping to bring on Doctor Johanna Krista at some points on this topic as well. So I think she's a good one to look at if you're curious about the kinesiophobia stuff in our knee injured population as well.
Karen Litzy: Awesome. And then because you said you're about 75% through the study of preliminary data. Where do you see this going?
Christina Le: So in the grand scheme of things for my own PhD, I'm going to be using this data to look at more health related quality of life in our young adults and our young athletes with sport related knee injury.
Christina Le: 11:55 I'm a big proponents of kind of that bigger picture. So again, I think as clinicians, we're really honed in on the whole return to sport thing as are our indicator of successful recovery. And looking at the literature, we know that only 66% of people return to their pre injury sport at the pre-injury level. And we don't really have great numbers for anything past probably two or three years either in terms of sport participation. So are we may be selling our patients short if we're only focused on that one thing as recovery versus again, kind of thinking bigger picture. Can we set them up in terms of physical health, psychological health, in terms of Kinesiophobia specifically, social health as well, so that they are able to maintain these healthy, active lifestyles, avoid osteoarthritis, avoid obesity, all that kind of stuff.
Karen Litzy: 12:47 Awesome. Well it sounds like you have big plans and I think it's only going to help clinicians and help the young athletes and young adults and teenagers and tweens that we treat on a regular basis. So thank you for your work. And now I have one more question. I probably should have told you this ahead of time, but I didn't cause I forgot. But the question is knowing where you are now in your career and in your life, what advice would you give to yourself as a new Grad out of physio school?
Christina Le: I would've said seek mentorship early and often. I think it took me a long and windy road to kind of get where I am and in all honesty, that's probably made me who I am now as well.
Christina Le: 13:32 But I think it would've been great to have maybe a little bit early on into my career as a new Grad, a little bit more mentorships with somebody or some people to kind of cling on to more or less to have a little bit of guidance in terms of what I should be doing, where I should be focusing my efforts on and spending my energy on.
Karen Litzy: Awesome, great advice. Now, where can people find you?
Christina Le: I am a on Twitter, I'm @YegPhysio, Yeg is the airport code for Edmonton, Canada. So that's why I'm that. And that's pretty much the only thing I'm active on in tems of social media for professional stuff. So, yeah.
Karen Litzy: Perfect. Well, thank you so much for taking some time out of your schedule here at WCPT to come on the podcast.
Christina Le: 14:17 Thank you so much. I'm going to throw a quick plug in for the world sports physiotherapy Congress in October in 2019 I'm hoping that all of you guys are going to be there cause we are going to be there. So you should have a lot of fun of you'll come.
Karen Litzy: Yes. And it's in Vancouver in and around that first weekend of October. Yes, the lineup looks fantastic and even if you don't work with a sports specific population, you can take all of this information and you can pair it down or you can pair it up to the population that you're seeing because it's all about concepts. It's not necessarily sports specific.
Christina Le: Yeah, exactly. I think it's something that's going to be useful for every MSK general practitioner out there. Whether again, yeah, you're in sport or not so highly, highly recommended. Yeah, you guys should all come out and hang out.
Karen Litzy: Yes, absolutely. We will both be there and I'm definitely looking forward to it. So, Christina, thank you again and everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Daniel Board on the show to discuss torture-survivors’ experiences of healthcare services for pain. Daniel Board is a Specialist Pain Physiotherapist working in a pain management clinic at Chelsea and Westminster Hospital in London, UK. Clinically, he helps people with a variety of persistent pain conditions and has a special interest in refugee healthcare.
In this episode, we discuss:
-Torture-survivors' experiences of healthcare services for pain
-The importance of the patient-clinician relationship and communication skills
-How to avoid burnout when servicing this patient population
-And so much more!
Resources:
Daniel Board Twitter
Chelsea and Westminster Hospital
For more information on Daniel:
Daniel Board is a Specialist Pain Physiotherapist working in a pain management clinic at Chelsea and Westminster Hospital in London, UK. Clinically, he helps people with a variety of persistent pain conditions and has a special interest in refugee healthcare. Daniel is also an early career researcher and recently conducted a qualitative study investigating torture-survivors’ experiences of healthcare services for pain.
Read the full transcript below:
Karen Litzy: 00:01 Hey everybody, I am coming to you live from WCPT in Geneva, Switzerland. And I have the pleasure today of interviewing Daniel Board. Daniel's a physio therapist in the United Kingdom and he specializes in persistent pain. So Daniel, welcome to the podcast. And today you had a really interesting platform. So I want you to kind of give the listeners a little insight into what your platform was, because like I said, you are specializing in persistent pain, but you really have a very unique perspective.
Daniel Board: 00:35 Yeah. So my background is in working with people with persistent pain problems. And part of that is that I'm lucky enough to work in a specialist clinic for torture survivors at Chelsea and Westminster Hospital in the UK. The platform presentation I did today was presenting the findings of a research study that we did last year, looking at the experience of persistent pain in survivors of torture survivors are kind of an underrecognized group. They have a variety of psychological, physical, and social, kind of consequences and burden as a result of torture. For example, persistent pain rates succeed. 80% inspires of torture. Rates of PTSD and depression exceed 30%. Issues aren't just standalone. Many certainly the torture survivors that we encounter are living in a country of excile and there are also lots of problems associated with that, such as seeking asylum, lack of social support, and also obviously the language barriers, and kind of what they're not necessarily knowing what their rights are with regard to accessing services within the UK. So that's the population.
Karen Litzy: 01:49 And what did your study specifically look at that you presented today?
Daniel Board: 01:54 So what we looked at from the evidence base is very limited. There was a Cochrane review last year that looked at interventions for managing pain in torture survivors and they find that there was no evidence to refute or support any intervention currently for managing persistent pain. Clinically, we see, as I said, quite a complex population and typically outcomes from treatment aren't great. We also find it quite difficult to engage them within our services. We have high sort of failed attendance rates and that really affects their ability to access and benefit from healthcare. So the study that we looked at or the study that we did was a study looking at what's torture survivors experiences of pain services in the UK is like so often, torture survivors that generally the first place they'd go to is that GP with a pain problem.
Daniel Board: 02:48 But they would also, the participants in our study, had seen GPs, they'd seen physiotherapist, pharmacist, they'd been referred to trauma orthopedics, cardiology, rheumatology, and that in itself posed a number of issues. So one of the first things we find was actually there was a big confusion over or a lot of confusion from the survivors of torture perspective over what their diagnosis was. So because they'd seen lots of different health care professionals, they're often confused. So for example, one of the quotes in our study was, ‘One says you have fibromyalgia, one said you had PTSD and another one said a slipped disc.’ So all of these things, they don't necessarily mean a lot to the patient and it can often leave them confused. So it was the first thing that we found.
Karen Litzy: 03:34 And with the finding like that and like the confusion of the patient, is that a reason that may be why they're not seeking out physical therapy or maybe why they drop off?
Daniel Board: 03:46 I think to be honest, I think there's a number of reasons why they might not engage very well. I think there's a couple of issues with diagnosis and let's maybe start with that. One of the things we noticed in the study was a really overly biomedical approach to diagnosing and treating pain, which isn't isolated to torture survivors. It's widespread, but certainly with this group that was relevant. So participants receiving diagnoses like degenerative disc disease or disc derangement. These were things that were noted in our study. And even if they didn't fit necessarily with the participants picture of pain, so they might have had widespread pain or pain that didn't fit that specific diagnoses. That does a couple of things. First of all, providing a diagnosis, which doesn't necessarily fit the clinical picture.
Daniel Board: 04:38 It takes away, I think, ownership of being able to do anything about it. So by saying you've got disk to arrangement that's going to instill fear, that's going to take away any kind of ability that they might perceive they have to change that situation. So that was one of the things with diagnosis. The other important thing we find was that there was a distinct lack of recognition of torture experience when diagnosing pain. So if torture was recognized often it was done. So the word that came up quite a lot in the study was that participants had a biopsychosocial overlay, which in itself is a pretty ambiguous term. And there was a real lack of recognition of the affective and cognitive components of a pain experience and how torture experience might influence that within a pain experience. So I think that would affect how do they engage with services because I think it takes away some of the ownership by providing that kind of diagnosis.
Daniel Board: 05:31 I think the other thing is that it's not as simple as there's not one thing that is the problem with us engaging this population. Rates of PTSD and depression are very high our participants said that they struggled to engage with services often because they either lacked motivation to get to the hospital or they were in too much pain to complete that physiotherapy exercises, for example. So those were a couple of things. And I think there's also one of the things that we find one of the problems that we think then as a finding from the study was that there seems to be not necessarily a dualistic on the part of the clinicians. I think that's probably a little bit outdated given what we know about current pain understandings.
Daniel Board: 06:18 But I think there still is that perhaps a dualistic tendency in the organization of services, particularly in the UK. And I'm sure it applies to other countries as well, that if you have a physical problem, you go and see the physical services. If you have a mental health problem, you go and see the mental health part services. And I think that leaves populations like torture survivors who present with a really complex mix of all of these factors in quite a precarious position. So for example, they might come to a pain service, I'll see a physio, and they might say, Oh, you look like you're really struggling with PTSD. Let's get you some help with that and then come back and see me. So then they'll get referred to a psychological service, but they might struggle to engage with the psychological service because of the pain that they're in. So it just seems to be, I think the service provision we have at the moment isn't well suited to this population.
Karen Litzy: 07:07 And so is this population, they're not being treated collectively. So if they're going to see, let's say you for pain, they'll see you and then if they're referred to psychologists or psychiatrists, they stopped seeing you and go see a psychiatrist or psychologist. It's not happening at the same time.
Daniel Board: 07:28 So at the moment, no, not in the general health services. I think the key thing with any care and specifically with this population is it is very individualized, each of their particular problems or the things that are affecting the very individualized. So, for example, we might have someone who gets referred to the pain clinic I work at and they might really be struggling with their mental health. They might be really struggling with PTSD, having regular flashbacks. And what we try and do is assess the weight of the various physical, psychological and social components and help them kind of almost line it up. As in what do you think is the most important thing to get sorted first? Do you think you'll be able to engage with the pain service?
Daniel Board: 08:13 You've actually got all this other really difficult stuff going on. So for those people we might say go and engage with a community mental health team, get some help with the PTSD and then come back. But that being said, I think that doesn't mean that people who are undergoing sort of significant psychological distress can't engage with pain services. So what we've started to do, we've just set up, a specific exercise class for this group of people, which is psychologically supported. So myself and one of my psychology colleagues, we've kind of paired the approach right down to keep it simple and actually you say kind of we understand you're really struggling with your pain problem. We can try and help you or try and help it impact you less. So actually setting some goals with you. We use the patient specific functional scales are really nice outcome measure if keep going, what do you want to do? I'm really struggling to bend over. I can't play with my kids. I can't climb stairs. Okay, great. Let's see if we can start doing that. And I think well slightly off on a tangent. Pain education is a really important part of that. But I think sometimes it gets lost in translation particularly.
Karen Litzy: 09:23 Yeah. I was just going to ask if it is a language barrier talking about pain education, we know that we can simplify it. Not Dumb it down but we can simplify it. But if there is this language barrier that Gosh, that must make it so much harder.
Daniel Board: 09:35 It is really, really difficult and there is some really nice work being done. The evidence base is limited, but there is some really nice work being done. April Gamble, who is a researcher who I've met here with the conference has done some really nice work looking at pain education in groups within their cultural setting and has come up with a variety of different tools that can be a cultural accessible tools that can be used. So she's definitely a person, a good person to speak to you. I think what we try and do in the clinic is find one very simple metaphor that we can use with patients. So I'll talk a lot about the volume on your nervous system being really high or I don't know, when you're assessing you find something that works for them and then when we're doing stuff in Vivo, kind of let's do some exercises, what's showing up for you?
Daniel Board: 10:23 Kind of what thoughts are coming in your head, how that might be a barrier and that's where the psychologist is really helpful. But then looking at reassurance, lots of reassurance and actually, okay, you're not damaging yourself. It's just a volume knob on high and I will mimic turning up a volume knob about a million times a day, I think with my patients. And yeah, it seems to work well for a group. But again, we can't be prescriptive and actually it doesn't work with everyone and we still need to look at other ways of engaging that group that it's not necessarily working for.
Karen Litzy: 10:55 Yeah, great thoughts. Thank you. And anything else? Did we miss anything else from the study?
Daniel Board: 11:04 So they key things, I'll summarize them cause I can remember them cause we just talked about them. I guess the key things were that there was a distinct lack of recognition of torture experience when diagnosing and treating pain. There was something which we haven't overly covered, which was that the patient clinician relationship.
Karen Litzy: 11:23 We're going to touch on that in a second. That was my next question, but go ahead.
Daniel Board: 11:27 We'll hold that one. And then the last thing was the current organization of health care services and how that's not necessarily conducive to such a complex population.
Karen Litzy: 11:36 My next question, if you didn't bring it up, was going to be how do you as the therapist, how are you able to connect number one and number two, is there a burnout rate for the therapist, working with people in this population? Because if you're an empath, let's say someone who's very, very empathetic, I would think this would be a really tough group to work with until you kind of get your bearings with them. So can you kind of touch upon that?
Daniel Board: 12:08 Absolutely. Starting with your question about the patient kind of clinician relationship and how you foster a kind of a good therapeutic relationship. I think you can probably over complicate it a little bit. I think from a therapist perspective, I think one of the key things that we have as physiotherapists is we're very good at talking to people and we're very good at helping people kind of be open. And I think actually what physios in the clinic, when we spend time with people, we're often the first sort of people that they might have told about that specific problem. I think we're really lucky. I'm really lucky that I'm able to work with psychologists, so if there's anything that is really significant that they're on hand and they can help me.
Daniel Board: 12:53 But I think as Physios, certainly when I was not working in pain, I think we look at mental health as a bit of a Pandora's box. And I think there is a fear amongst some therapists of going, well, I don't know. I don't want to ask the question about your mental health or how your depression is, or whether you've been taught, for example, because I don't know what I'm going to do with that information afterwards. So if I get an impression of you being a low mood and then you tell me that you've got some suicidal thoughts, I've got to act on that. And that's scary. So I think personally myself, I used to be perhaps that way inclined. But actually I think as I said, we're very good at talking.
Daniel Board: 13:31 A lot of what we do is talking as a profession. And I think actually just having a really good listening ear to someone, being able to say the things that come naturally to you with patients. So I'm not acting in shock at someone's telling you what's happened to them or avoiding questions about things that might be difficult and then dealing with whatever it is that comes up and that probably will have an element of you knowing what your support processes are within your service. So we have a really good pathway for suicidal ideation, for example. I think that patient clinician relationship is really, really important. And I think we as therapists, we've got really good chance to just be open and talk to patients. In the same sentence though, not with all survivors specifically. One of the things in the study was that actually some people really wanted to tell you about their experience and some people didn't. Some people were really avoidant of it. And I think it's just being careful that you're not overstepping. Just being kind of a really sensitive approach is important.
Karen Litzy: 14:31 So the other question was, as the therapist, how do you protect yourself from burnout, from feeling just so empathetic towards these people that you're taking it home with you at the end of the day?
Daniel Board: 14:46 I guess there's a couple of things. I'm very lucky as I said that I work with a really good team of Physio, psychologist, doctors, nurses, and I would feel very comfortable being able to say or talk about anything that I was worried at with them. I think, sadly you do get a bit used to those conversations at times. I think they do affect you less. But inevitably you're going to hear stuff, which is, which is horrendous. And I think the key thing in the same way that you would do with any other kind of mental health is not keeping it bottled up and actually if you need support, being able to talk about it, with your colleagues to get some support if you felt that that was needed.
Karen Litzy: 15:23 Yeah. No, that's fair. That's fair. Well, I mean, I have to say I think it's a wonderful service that you're providing for this group. It's not easy. I have never worked with that population so I can't put myself in your shoes. But I admire it greatly because these are truly marginalized group of people who really need the care. So congratulations to you and your clinic on doing this.
Daniel Board: 15:50 Thank you. I think this population encounters physios every day, I think we're just lucky that we've got a service, which is nicely set up to help the people.
Karen Litzy: 16:00 Yeah. All right. So I have one last question before we finish. Well two actually, but we'll start with one and it's a question that I ask everyone. So knowing where you are now in your career and in your life, what advice would you give to yourself as a new Grad straight out of physio school?
Daniel Board: 16:19 Very, very good question. As a new Grad, I'm going to say is probably the key thing is say yes to everything. Opportunities. A good physio colleague of mine, Dave Reese when I was applying to do the masters of research we did last year, I was unsure. I kind of had that imposter syndrome and I think we often feel that, and he said a really good, a good thing, just lean in. So any of those kinds of experiences, which might seem scary, like presenting at a conference or being interviewed for a podcast or whatever it might be in your professional life, whether that be clinical research, I think, yeah, just take any opportunity to develop and learn from people that perhaps know more than you.
Karen Litzy: 16:59 Great Advice. And then lastly, where can people find you if they have questions they want to follow you on social media, where can they find you?
Daniel Board: 17:05 I'm relatively active on Twitter and my Twitter name is @BoardDan that's probably the easiest way to get me as well.
Karen Litzy: 17:14 Perfect. And just so all the listeners know, we'll have links to your clinic and links to everything at podcasts.healthywealthysmart.com. So you can go over there one click and it'll take you to anything if you want more information. So, Dan, thank you so much for taking time out of your day at WCPT. And everyone, thanks for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Efosa Guobadia on the show to discuss entrepreneurship in physical therapy. Efosa L. Guobadia, PT, DPT, is the founder of the integrated wellness company FFITT Health; President and CEO of Move Together, a 501(c)3 for purpose organization dedicated to improving access to quality rehab medicine around the corner and around the world; Co-Founder of the initiative Global PT Day of Service, which has spanned 60 countries since its inception; Founder of the informational website PT Haven; and also developed and led the international volunteer program ATI MissionWorks for ATI Physical Therapy.
In this episode, we discuss:
-Efosa’s entrepreneurship in underserved communities
-How to approach roadblocks and tackle them head on
-Three qualities of inspiring leaders in the entrepreneurial space
-Exciting ways you can get involved with service through PT Day of Service
-And so much more!
Resources:
Move Together Website
@efosaguobadia
@ptdayofservice
@ffitthealth
Move Together Instagram
PT Day of Service Website
PT Haven Website
efosa@movetogether.org
For more information on Efosa:
Efosa L. Guobadia, PT, DPT, is the founder of the integrated wellness company FFITT Health; President and CEO of Move Together, a 501(c)3 for purpose organization dedicated to improving access to quality rehab medicine around the corner and around the world; Co-Founder of the initiative Global PT Day of Service, which has spanned 60 countries since its inception; Founder of the informational website PT Haven; and also developed and led the international volunteer program ATI MissionWorks for ATI Physical Therapy. In 2017, he contributed a chapter on sustainability as well as the closing afterword for the book ‘Why Global Health Matters”, edited by Dr. Chris E. Stout, and with a foreword by Nobel Laureate Jody Williams. He received his BS in Kinesiology from the University of Massachusetts in 2007 and his Doctorate of Physical Therapy from the University of Scranton in 2010. He is recipient of the 2017 Distinguished Young Alumni Award given by the University of Massachusetts/Amherst School of Public Health and Health Sciences and is a 2018 American Physical Therapy Association Social Impact Award Recipient. He is currently based out of Guatemala City, Guatemala.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody, I'm coming to you live from the WCPT conference in Geneva, Switzerland. And I have the distinct pleasure of sitting next to Dr Efosa Guobadia who is a physical therapist from the United States now based in Guatemala. And he has also the cofounder of PT Day of service and move together, which we will talk about during this interview. But first, what I'd really love to talk about Efosa is you were on a panel today about entrepreneurship and physio therapy. So can you give us the highlights?
Efosa Guobadia: 00:34 Yes. Well, Karen Litzy is such a high pleasure to share time with you. The only time I get a chance to hang out with you, you put a smile on my face. I love the energy and all that. So yes, the panel is about entrepreneurship. So one of the things that I certainly talk about, I said entrepreneurship is a mindset, you know, it's about bringing the vision and the vision of your heart and the idea in your mind into actuation, you know? And with that being said what I also said, I think everybody has, it has the potentiality and the capacity to be entrepreneurial or you sometimes talk about product market fit or passion market fit and where does your passion, your idea slash your product meet the market. You know, and I think that's also very important. A friend of mine recently we're having a concept about what's an entrepreneur? He says an entrepreneur is the intersection of your idea, fundamental value and the wants, desires, desires and the understanding of the client and consumer. And that sweet spot is so important. If it's just about your ideas, you may be a starving artist, you know, but if it's a too much about the client, you know, you may be selling out a little bit. So find that great amalgam and that sweet spot and I think that's very important.
Karen Litzy: 01:37 Yeah. Thank you for bringing that up. I think that's great. I usually tell people when they're like, not sure if this idea can actually turn into a business. And I'll always tell people like, make a list. Like, what are you good at? What are you really passionate about? And what would someone be willing to pay you for? And if you can find that sweet spot, and again, it's like you just said, it's your passion where it intersects with what the consumer needs or what the consumer doesn't know they need yet. And that's where entrepreneurism really comes into, I think, a great place for the person. So let's talk about what you're doing as an entrepreneur.
Efosa Guobadia: 02:16 I love that so much. And I agree. To piggyback on what you just said, Karen, it's about fundamental value. And I think this is true in any industry. So whatever this thing, this fundamental value, your product service, after a person comes into contact with it, are they better off? And then well, we can talk about marketing or this or that, but that should be the first thing that you curate. So that's very foundational. I'm living a pretty interesting existence right now Karen Litzy so this past November in 2018, I actually decided to move to Guatemala and now I'm doing two different things. So I feel a part of my bandwidth is for the global health sector. You know co founding, you know I lead the organization move together and our mission there is to increase access to quality rehab medicine around the corner and around the world.
Efosa Guobadia: 02:56 I've been going to Guatemala now for the last seven years I've been doing this global health work for the last seven years. I moved together under that umbrella. We've been doing some pretty interesting work there for the last three years of amazing partners on the ground and amazing participants and volunteers that have joined us from the US and other places around the world. We help to build the development of rehab clinics in underserved communities. And the keyword there, this is the keystone where there's the operization, the local PTs and students on the ground. They run these clinics that we co set up throughout the year and on the ideas that it thrives uder them and we are glad to say it has been so. And then we have other programs under them, the nonprofit move together, PT day of service, which you mentioned, we have a program called that pro bono incubator and that's US based in which we dispense funds to pro bono projects in clinics in the US over the last two years we just spent $20,000 to a 11 different projects and a mentorship and resource to many more than that as well.
Efosa Guobadia: 03:53 So that's been pretty fun. So that's one part of my existence. The other part of my existence is entrepreneurial. This past I officially opened this March, but I did some ramp up work to it this past march. I opened up a clinic in Guatemala City and it looks at three verticals. It looks at mobility, which is Rehab. And I do some movement analysis with the movement three d camera. We do look at nutrition. I'm hiring some nutritionists to look at because nutrition is important for a few reasons, right? For pain. It's relationship with inflammation and with energy and a certainly with weight management, weight management is predicated on nutrition. I think above all cardio and then lean muscle mass. So it's looking at it through that portal has been important. And the third vertical has been mindset that, you know, a routine and breathing and sleeping and all that good stuff. So creating a team that helps me do those things in an ecosystem systematic way has been fun. You know, the early part of it has been mobility and people have been responding so very well to it in Guatemala. They're telling me now I can't leave, but you know, some of my clients and it's been fun.
Karen Litzy: 04:56 Awesome. And now, you know, your version of entrepreneurship is let's say different than maybe some traditional entrepreneurship where you're setting up shop in a very developed country and it's certainly different than what I do as an entrepreneur. I think from a practical standpoint, different, but I think from a fundamental standpoint and where our mindsets are and what we're trying to do for our clientele, it's pretty similar. Would you agree?
Efosa Guobadia: 05:23 A hundred percent fundamental value around the world. Its fundamental value in each industry needs to know their fundamental value. Let's say for us, our fundamental values as healers is help people move better so they can live better. That exists and is needed anywhere in the world. So again, know fundamental value, build the architecture and fit it to the market into the behavior and the knowledge and the awareness of your customers or customers to be and that's how you make it make sense wherever you go.
Karen Litzy: 05:47 And for maybe listeners out there who would like to replicate what you're doing in an underserved area or in an underserved country, what were some of the biggest roadblocks you experienced in the beginning that you would like to advise people on? Maybe how to avoid or at least how to minimize?
Efosa Guobadia: 06:07 Oh, interesting. I think it's so important to identify roadblocks and barriers. I sometimes say this with my clients now you need to know the dragon and sort of delineate the dragon so you could slay it. You know, so it's the transcend another general thought. Anytime Challenging things happen. I cheer this in the panel as well. It's information, you know, it's that when a situation happens, good or maybe not good to the way you want it to happen, it's situation. What's good about situations, it leads to solutions. So once you figure out how to handle something, now you have this tool of this extra solution. Now you can play defense and prevent that from happening again. Or if it does happen, you can handle a quicker, and actually turn it into a good, et Cetera, et cetera. So that mindset, that paradigm shift, the mindset.
Efosa Guobadia: 06:50 If you're an entrepreneur of how do you engage with things that don't necessarily happen the way that you want to have it on the, for me and some of my experiences, every country has its own things. And one thing is you go through the legal process is setting up your business. What I just had to learn is a little bit different from the US so tagging in this is a truth for all entrepreneurs and all projects, you know, identify and tag and the right people who could best help you with what you need to do. And then that saves time and that maximize your efficiency as well as your effectiveness.
Karen Litzy: 07:18 Yeah. So when you kind of hit those roadblocks, I love the way of reframing it as not a, Oh my gosh, I'm so stupid. Or how did I not see this coming? Oh great, now I'm sunk and I'm going to go sulk into a corner. But instead you're saying to reframe it as, well, here's this roadblock, but guess what? Now we have a system in place to avoid this from happening again. So being very intentional about how you're thinking of roadblocks or I don't want to say failures or things like that in your business, but being intentional so it doesn't happen again, and then you can go out and help others do the same.
Efosa Guobadia: 07:54 You said that perfectly. Nothing to add to that.
Karen Litzy: 07:55 Okay. All right. So let's talk a little bit more about entrepreneurship, specifically leadership. So if you're an entrepreneur, you're a leader, right? You're either leading yourself, you're leading others. So what do you feel like are qualities of, let's say leadership within the entrepreneurial space?
Efosa Guobadia: 08:15 Yeah, I can say a few of both. They overlap and they're interrelated like you're saying. But on the leadership front, I think, there's three things that are important. You know, maybe I'll break it down to three C’s. So one C is courage, the second c is compassion, and the third C is credibility. So I'm gonna explain what I mean by those. But first of all, with those three things, you start with yourself. You need to serve yourself. You need to lead yourself first, before you can think about leading people. So on the coverage piece that then set on your heart or the things that you believe in, do you pursue them or do you stand up for them? And the micro moments and the macro moments. And it's like a muscle you have to cultivate and you’ve got to work it out. You know?
Efosa Guobadia: 08:51 So expressing when things are more macro and big and where things are really intense. You've had this muscle, I'm going to be strong, I'm going to be courageous. I'm going to be dictated and guided by what I see is right and righteous. So courage is important. The other part is credibility. Again, starting with yourself. Do you do the things that you set that you intend to do we get the to do list. Have you written out 20 things consistently for the last month. I've only got three things done. You're telling your conscious and your subconscious, you can't trust what you write down. So start there. Create credibility and trust with yourself and then it’s metaphysical it transmits to your team, you know, you can't really have credibility with others without having credibility with yourself. And then caring and compassion. You know, one of the most important words in my life, caring, you know, caring about yourself, being compassionate about yourself.
Efosa Guobadia: 09:33 To be able to do that with your team. You need to be able to do it yourself. There's one politician and I heard say it as a couple of years ago, the best thing a leader could do for his team, his or her team is to care about them. You know how you do that by actually caring about them, you know, so actually care about yourself to take care by yourself, actually care about your team, to care about your team, on the entrepreneurial realm. A lot overlaps with say consider our focus decision making capabilities. And I will also say reasoning, you know, able to multidimensional think a lot of entrepreneurism is problem solving and thinking ahead and thinking what's coming down the pike. So that's the critical reason. A lot of the decision making, whether you've got to make quick decisions or deep decisions.
Efosa Guobadia: 10:14 What's your prototype, what’s your paradigm, how do you handle that? How do you stay calm under pressure? Maybe that goes to a curse a little bit. And then in focus, you read all the greats, you know, whether it was old school philosophy or current CEO's, one of the most important things that they talk about is the ability to focus on your task at hand and to chop wood on your task at hand as their old quote. I forget who said it now, the way you do anything is the way you do everything. So for me to close on this, I enjoy doing dishes. I don't do it that much, but when I do dishes, I'm locked in. I've tried to clean it as best as I can and I know that it's going to transmit to my clinical treating and my leadership or building your footing. So those would be some thoughts there.
Karen Litzy: 10:56 Yeah. And I loved the compassion I had a woman on a couple of weeks ago who talked about having compassion for yourself and forgiveness for yourself and how can you even make a decision if you can't even give yourself compassion? So, those qualities of leadership, courage, caring and compassion, and credibility. Yeah. So if you can't give that to yourself, then how can you give it to your business and be a successful entrepreneur? And courage by the way, this year was my word of the year on my vision board. So when you said that, I perked up and said, oh, courage. Yes. So that's something that I'm working with and I've been in business for a while. So I think another thing for everyone out there who's an entrepreneur or wants to be an entrepreneur is it's not like, oh, I have courage one day and then that's it. It is for ever, you are forever working on it. At least that's my view.
Efosa Guobadia: 11:56 I agree. Excuse me. I agree. It's a muscle and it's not this goal to achieve and that you're good at. It's an attention and intention really has to do a behavior and courage and you’ve got to be smiling in this world. It's so much about courage is a call to adventure. What is it in your heart, what do you feel pulled to and are you willing to answer that call and say, heed that call. Even if it's a small step, even if it's a big step, even as a small step that leads a big step. If you do, if you heed the call, if you go for it, if you stand up for the things that you believe in, you will live a life in full. You know? And it’ss be a certainly an interesting one.
Karen Litzy: 12:32 Wonderful. I have nothing to add to that. Now before we went live you were talking about how it's such an exciting time in physical therapy and we're here at WCPT with 4,500 people from around the world. And I have to say it is exciting. So what is your version of now is an exciting time for physical therapy?
Efosa Guobadia: 12:51 It's a combination of things. You know, there's so many exciting and interesting people doing exciting and interesting things you with your cash based practice you with this podcast. So many other people. The prehab guys, you know, I don't even know those guys, but I admire them from Afar, how they're growing, how they're fitting something in the market, how they're influencing and inspiring clinicians and clients have like so many others. So many exciting people doing exciting things. So that's one variable too with technology. You know, technology is allowing us to do a multiplication of things that we couldn't do six months ago, 12 months ago, and then certainly two, three, four, five years ago. So understanding where the tech is now or where the tech might go, it's a variable that leads to a multiplication. And then the consumer that, you know, they're more intentional with where they spend their time or where they spend their dollars, how they engage with health and health care and all that good stuff.
Efosa Guobadia: 13:39 So they're becoming more of a partner. That's how I treat my clients and my consumer, my patients as a collaborator in the journey. So you play with those different variables of technology ideas of different people, a consumer that's wanting to be healthier and then wanting to be fit. And intentional in that healthiness in that fitness, we're at this place really where anything is possible and everything can change. And I think in the next 10 years Karen the next 10 years, we're going to see an evolution slash revolution of efforts and actuations within our profession. And certainly the other step is how we collaborate with other verticals and other industries and other professions as well because not just about what we could do alone by what we could do is by what we could do together.
Karen Litzy: 14:21 And on that, that is just the perfect segway because the next thing I want to talk about is move together and PT day of service. So let's give a plug to both of these, well move together, the parent organization of PT day of service. So let's talk about that a little bit so that the listeners know what the heck you're doing.
Efosa Guobadia: 14:42 Yeah, sounds good. So move together is a 501©3 that I cofounded in 2016. And the way we define mission is that we measure everything that we do and say by. So the mission for the organization is to increase access to quality rehab medicine around the corner around the world and access being the keystone word and the keystone structure cause with access that we've seen in some of the places that we've been to, the place doesn't exist for people to go to or the place does exist. They don't have the means to go there of it does exist. They have the means that placement, I have the things that that community member that community needs. So it was a multidimensional challenge, so it needs a multidimensional approach. So that's been pretty exciting.
Efosa Guobadia: 15:18 I smell inside and out every time I think about our vision first. But the way we defined vision, vision is Simon Sinek talks about this a lot. Do you need to be able to see it? You know, that's why we call it a vision. And then when I think about it, I think about it as a guiding light or the northern star that's shining the way forward. I also think about it as the horizon. There's always going to be necessary distance between your horizon. That's the definition of horizon and so it becomes this pursuit and then you're pursuing the doing of good and doing and what your vision is, which I'll share in a moment, but also how you enjoy the journey. You're able to turn around and look at the shore, see how far along you've gone and also set up beacons and objectives along the way to measure your progress.
Efosa Guobadia: 15:58 Our vision for the organization is a clinic in every community and a sense of community in every clinic, a clinic in every community speaks to the horizontality of where we want to go, the geographical breadth of where I want to go. Community in every clinic speaks of punctuating depth and the verticality of what we do and the places that we do go. So a clinic in every community and community in every clinic. And that really drives what we do. We have three pillars in our organization, one that looks at increasing the quality and quantity of clinics. We do that. We have a program, PBI in the US and other clinic development program around the world or work with municipalities and mayors. And, and our community leaders to build development operationalized clinics. We have a second pillar called empower local clinicians. You know, not just a going and leaving going and leaving something behind and power and local capacity.
Efosa Guobadia: 16:42 Mike Landry talks about that term about local capacity. So most of our projects abroad we usually teach, you know, and learn and do labs things of that nature and we partner with other kinds of organizations to start doing it more in an architectural way for sustainable change. And then the third pillar, which ties into PT day of service is catalyzing servant leadership. What we've seen about our profession, certainly beyond our profession, PTs and PTAs and students, they like to serve we are a profession of heart and compassion. You know, so many people have been doing so many good things already, but for many people they don't know where to start, you know, so how can we create this junction of Bi directionality where people can be fulfilled while fulfilling other's? We see path for academic leadership and association leadership and corporate leadership and those are great.
Efosa Guobadia: 17:25 It was very important for us as an organisation. Josh and I, we talk about this a good amount is creating a path for servant leadership. You know, so we have two programs right now in that pillar program. We're very excited about anybody listening that is interested in our mission and vision. This would be a good portal to join, call the catalyst club and it’s all family for the organization. It's a critical mass to volunteer team that's going to help us fulfill the vision and pursue the vision. And then of course we have PT Day of service. Just an amazing program, really driven by amazing, amazing team which Karen, we love you so much for being on our team since really the beginning and then amazing people around the world participate in a PT day of service when we challenged students, clinicians to do an act of service on the same day and around the world.
Efosa Guobadia: 18:07 Year one we had 28 countries participate. Year two we had 42 countries participate. Year three we had 55 in year four we have 56 give or take, we're in year five which the big year for us and we're very excited and we’re looking to grow not just for the sake of numbers but to grow in the sake of service and showing that service can grow at the end of the day. What that program is about PT Day of service. It's about local service for a global effect and a global impact in your backyard in multiple places.
Karen Litzy: 18:35 Yeah. So this year it's October 13th and if you want more information you can go to PTDayofservice.com or move together.org
Karen Litzy: 19:01 And we'll have all of the links to everything, under this podcast at podcast.Healthywealthysmart.com. So one link can take you everywhere. So Efosa before we finish, I have one last question. I cannot wait to hear your answer. I'm like super psyched about this as a question I ask everyone and it's knowing where you are now in your life and your career, what advice would you give to yourself as a new Grad fresh out of the University of Scranton, right?
Efosa Guobadia: 19:27 So were you saying I'm having a conversation with a 24 year old, Efosa that guy was interesting. I wish I could have a conversation with that guy. So what I will say, I'm actually gonna say, he's gonna be interesting. So are you asking me to look back and what advice I would give that person will be to actually look ahead. So there's an exercise that I do sometimes called futuristic retrospection. I came with this term several years ago. And what the exercise you actually do is visualize yourself as an older person and this is similar to other activities but futuristic retrospection, it goes to visualize yourself as an older person. So 24 year old me is talking to 90 year old me, maybe I'm hanging out in pajamas, you know, and a cat is just doing whatever I'm doing.
Efosa Guobadia: 20:10 And in that conversation I would tell my 24 year old self do this. In that conversation, ask your older version of yourself, what do you wish you did? What do you wish you did at 24, 25, as soon as you graduated, what do you wish you did? Where do you wish you were at? Who do you wish you where? et Cetera, et cetera. And then, certainly you have to extrapolate what you think that answer might be. And then whatever that answer is, you've got to let it guide you. You know, there's an article I read at slate a couple of years ago that said, when we think about an older version of ourselves, the same part of our brain lights up as if we're thinking about a stranger, at least in the Western world, right? When we think about an older version of ourself, the same part of our brain lights up as we're thinking about a stranger.
Efosa Guobadia: 20:47 So this exercise allows you to get feedback and thoughts from your subconscious. The person who really knows you the best, and it's pretty powerful. Jeff Bezos, he utilizes something similar called the regret minimization framework. You know, think about an older version of yourself and what then do you think you regret not doing, you know, and then to make sure you do that. And then the other thing at least the character Togo has this quote, we're presented with insurmountable opportunities. So there's a never ended amount of opportunities in the world, you know. So with that being said, it becomes about being essential with your time. You know, people going to ask you to do things, you know, which is good, which is fun. And the better you are at things hopefully the more that you’re going to get asked. The honor is the ask, you don't have to say yes sir. So be essential about what you're doing so there’s this balance of knowing your measures, knowing your markers. Know you're vision and let that guy that didn't create or the things you accept and you multiply that by being adventurous as well. You know, trying things, finding that sweet spot will allow you to maximize yourself. Your time. 24 year old, they feel similar.
Karen Litzy: 21:54 Wonderful Advice. Thank you so much. Where can people find you if they want to ask you questions or find out more about you? Where are you on social media and all that kind of fun stuff?
Efosa Guobadia: 22:03 All my handles on social media or my first name followed by my last name, @EfosaGuobadia. I do a lot of mentorship talks with folks that are certainly a lot of folks, new professional folks, students and all that good stuff. I take much joy in that and is very conversational. A lot of the answers are within you and I guide you to some thoughts. So somebody is interested in that, shoot me an email and we'll find a time in the schedules, they can shoot me an email address. That's my first name, efosa@movetogether.org and you know, so whether it's email or whether we do a 30 or 45 minute talk, that's one of the ways I enjoy serving. So, be intentional reaching out cause I mean that.
Karen Litzy: 22:46 Well, and for all those of you listening, take advantage of that because to have Efosa mentor you or just talk to you about anything, you will walk away knowing more and feeling I don't know better about yourself somehow. I don't know how that's even possible, but that's the sense that you get after speaking with him, you're going to walk away with value. So take advantage of that. So folks, so thanks so much for coming on and taking time out of WCPT.
Efosa Guobadia: 23:15 Karen, thanks so much. I think this may be the third time between Josh and I are hanging out with you, we have so much love for you, I thank you so awesome. Thank you for this, another way for you to serve this information.
Karen Litzy: 23:26 Thank you. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Ryan J. Lingor, MD and Michelle Cummings, PA on the show to discuss HSS Ortho Injury Care. Dr. Lingor serves as an Assistant Attending Physician at Hospital of Special Surgery, faculty at Weill Cornell Medical College, Medical Director for HSS Ortho Injury Care, and Team Physician for the New York Rangers. Michelle is a physician’s assistant who enjoys helping patients get back to their active lifestyles while also providing them with a thorough understanding of their orthopedic diagnosis.
In this episode, we discuss:
-The unique offerings of HSS Ortho Injury Care
-Expanding patient’s access to quick and affordable medical care with the HSS Ortho Injury Care business model
-How to market your services and gain trust with your community
-And so much more!
Resources:
HSS Ortho Injury Care
For more information on Dr. Lingor:
Dr. Lingor serves as an Assistant Attending Physician at Hospital of Special Surgery, faculty at Weill Cornell Medical College, Medical Director for HSS Ortho Injury Care, and Team Physician for the New York Rangers.
Upon graduating from St. John's University in Minnesota, Dr. Lingor obtained certifications as a Registered Dietitian, Certified Athletic Trainer, and Strength and Conditioning Specialist. He went on to complete athletic training internships with the New England Patriots and Miami Dolphins and was named Head Athletic Trainer of NFL-Europe's Hamburg Sea Devils.
Dr. Lingor graduated from medical school at Loyola University Stritch School of Medicine and completed his residency in family medicine at Illinois Masonic in Chicago and his sports medicine fellowship at the University of Notre Dame. He is board certified in family medicine and obesity medicine with a subspecialty in sports medicine. His previous experience includes working as an Assistant Team Physician for the New York Jets as well several local high schools and colleges.
Having professional passions in weight management and comprehensive sports medicine, Dr. Lingor utilizes his background in nutrition, athletic training, and strength and exercise training to provide a comprehensive, personalized approach to help his patients achieve their health and performance goals.
At HSS, Dr. Lingor utilizes musculoskeletal ultrasound for diagnostic and therapeutic purposes, performs and conducts research on biological treatments for chronic tendon problems, provides comprehensive concussion management, and employs dry needling for muscle and tendon problems. He is active as a researcher and regularly presents at national conferences in primary care sports medicine.
Outside of medicine, he enjoys traveling, cooking, and being active outdoors, having competed in several marathons and three Ironman Triathlons, including the Hawaii Ironman World Championships.
For more information on Michelle:
Michelle Cummings graduated magna cum laude from the University of South Carolina with an undergraduate degree in Exercise Kinesiology. During her studies, she spent three years as an undergraduate research assistant working on a study which focused on implementing health and nutrition programs into churches. Michelle then earned her Masters Degree in Physician Assistant Studies at the Massachusetts College of Pharmacy and Health Sciences. Prior to going to HSS, she worked as a PA for a private orthopedic and sports medicine practice focusing on upper extremity injuries. Michelle enjoys helping patients get back to their active lifestyles while also providing them with a thorough understanding of their orthopedic diagnosis. In her spare time, Michelle enjoys running, cycling, hiking, traveling, and crossword puzzles.
Read the full transcript below:
Karen Litzy: 00:01 Hi, Doctor Lingor and Michelle welcome to the podcast. I'm really happy to have you guys on today to talk about the HSS Ortho Injury Care. So thanks for coming on. Alright, so let’s sort of start from the beginning. All right, so what is the goal of this new clinic? What is the why behind it?
Dr. Lingor: 00:27 It just has always been a good place for orthopedic and sports medicine conditions. One of the problems that we've had at the hospital is getting appropriate access early on when patients need to be seen. So our providers tend to be pretty busy. So what we wanted to do is create a resource for patients to be able to go for their acute sports medicine and orthopedic needs.
Karen Litzy: 00:55 So that takes me to the next question is why sports medicine over other specialties? Obviously there was a hole to fill, right? So why this over others?
Dr. Lingor: 01:08 For myself, I really enjoyed helping keep people active and I think somebody’s activity correlates with their quality of life. And so if we can help, you know, people when they get injured or something to hold them back from, from being active on a daily basis, that's kind of where I wanted to help out.
Michelle Cummings: 01:33 For me, It's two fold. One because I'm so passionate about sports in general and secondly, the specialty itself, you can actually make people better a lot quicker than in other specialties. So that's what drew me to sports.
Karen Litzy: I agree. I think with those sports injuries, I know coming from the physical therapist’s perspective, you kind of see this progression, right? So regardless of the age of the patient you kind of see from injury and you can really follow them through to recovery, which is really exciting from my standpoint and now, what are the commonly treated injuries seen in the clinic?
Dr. Lingor: 02:14 So we see all sorts of musculoskeletal injuries, the common stuff if somebody has a shoulder injury or just shoulder pain, we see a lot of knee injuries after athletic event, hip pain, all sorts. So any of the extremity injuries we do specialize in. And for patients that have back pain, fortunately we are a suited at HSS to have a back pain clinic. So we direct those patients to the right, the right place.
Karen Litzy: 02:47 And so why should a patient come to this Ortho care clinic versus going to the ER? What is the difference?
Michelle Cummings: So the difference? Well, the ER you'll always have long wait times and they're not always apt to treat just orthopedic and sports injuries. So here we have an x ray onsite. Quick access to films as well as splinting and casting availability here. And what's Nice is you can actually schedule appointments online or call directly and we schedule same day and next day appointments. So if a patient sprains their ankle, you know, a night at basketball, they can go on and schedule an appointment early the next morning. So to try to shorten the wait time to the ER.
Karen Litzy: So you alluded a little bit to the splinting and casting, but you know, as non-operative clinicians, what types of conservative treatment are you providing for these patients as they come in?
Dr. Lingor: 03:49 So a lot of this stuff, you know, fortunately for us and most patients just don't want it to be checked out to see if they have something that they need to be more concerned about and kind of be directed in the right area. And fortunately we're kind of at a good position to give them access to all the resources that we have at the hospital for special surgery for those patients that need it. For stuff that we can take care of in the office here, we do have, as Michelle said, the x rays, we can do injections into different areas as necessary and we have the use of ultrasound to make sure that we are accurate with the injections and the care that we're providing.
Karen Litzy: 04:36 So this is how new? It's pretty new, right? When did you guys first open?
Michelle Cummings: Yeah, we first opened in November of 2018 so it's been a couple of months now.
Karen Litzy: And as with everything new, every new venture, right, it has its ups and downs. So what are some of the challenges that have come up since this clinic opened?
Dr. Lingor: 05:02 Well, the biggest challenge is just getting our name out there and letting people know that we exist. We've been very fortunate to have a lot of interest both in our hospital and in the community to get people in the door when they need to be seen and get them moving in the right direction. So there's been a lot of positive energy that we've been able to benefit from in our first few months and we're still working out some kinks and not everything is smooth as you mentioned when you first get going. But, we've been very blessed to have a great staff around here that, that are all interested in, in doing what's best for the patient and providing exceptional patient care.
Karen Litzy: 05:46 And so you have some challenges, I'm sure there's also been some pros, right. So what have you found since opening the clinic have been a real positive or maybe even things you didn't even expect?
Dr. Lingor: 06:03 I think one of the nicest things is that our patients generally are in a pretty good mood when they come here because they're oftentimes patients, they're looking to go to the ER and they anticipate, you know, waiting for a couple hours and may have been told to follow up with her orthopedist at that time. And so patients are, excited when they come to a very reputable hospital and then being able to get an appointment the same day or the next day. And so they're pretty excited about that, about that opportunity. And so that's just kind of fun to work in that kind of environment where everyone is in a good mood off the bat.
Karen Litzy: 06:44 Yeah, that sounds amazing. And I would also have to think that, you know, when you go, if you have an orthopedic injury or like you said, it's soft tissue ortho injury and you go to the ER, you're not guaranteed to get an orthopedic specialist to treat you in the ER. Would you say that's correct. So is that how this kind of differs?
Dr. Lingor: 07:04 That's exactly right. If you go to the emergency room, they have the resources for, you know, taking care of the life threatening or really serious things. And that's perfectly appropriate for the ER because we don't treat those sorts of things. And with patients that go to the ER and have a lot more of the, you know, 90% of the orthopedic injuries where it's appropriate for us. And so this is a way for us to cut down on patient’s wait times and their costs as you know, an emergency room bill. Get them moving in the right direction right from the beginning.
Karen Litzy: 07:50 Do you guys take insurance?
Michelle Cummings: It's actually listed on our website. So if a patient had questions about the insurances we take, it's all listed on the website, but we take all major insurances.
Dr. Lingor: 08:04 And that's pretty easy to find if you just Google HSS ortho injury care, you'll see it pops right up and you can see the insurances that we take and you can book yourself online and really booking an appointment is about a three minute process.
Karen Litzy: 08:19 Nice. And is this something that you patterned after? Like is there another clinic like this somewhere else in the country or is this one of a king clinics?
Dr. Lingor: 08:33 To our knowledge, this is one of the first ones in the region. I think a lot of other orthopedic places that have walk in clinics and stuff like that. I think this is the first stand alone clinic that operates, kind of how we do and you know, something we saw as a need and it's been a wildly successful in our first few months.
Karen Litzy: 09:01 Which is amazing. Dr. Lingor, I have a question for you. So aside from being an orthopedic physician, you also have a nutrition background, which I find really interesting. So are you able to infuse any of that within this clinic or do you see that as maybe something that you might want to infuse into in the future?
Dr. Lingor: 09:23 Well, with the sports medicine and medicine in general, being a field of nutrition in its other fields, it is something that I really enjoy learning about and trying to keep up with. In the clinic right now, it just helps me to better counsel patients and answer questions that they have, about nutrition and things that they can do to optimally heal and prevents some of the chronic conditions. And so I utilize it that way. And fortunately at HSS we do have a nutrition and dietetics team that we call upon as well as physicians who specialize in nutrition. We need more help. So it's not, I don't solely practice in the field of nutrition now, but kind of more as a complement to what we offer at the clinic.
Karen Litzy: 10:16 Yeah, I think that's great. Where do you see this going? Where do you see this, you know, that old question, where do you see this going in five years?
Dr. Lingor: 10:29 Yeah, so we're kind of looking at the hospital for special surgery as branching out to a couple of different other sites around the city, as well as a couple of places throughout the country in Las Vegas and in Florida. And so we're looking at kind of making this, you know, this being the flagship and then kind of model after the places just because it has seemed to do so well for our patients and for our physicians as well to get patients in. So by that I mean that when patients call other doctor's offices and they can't be seeing those to us, and then if necessary, then we get that patient back at an appointment that's a little bit more expedited then what the other physician would have been able to originally see them.
Karen Litzy: 11:26 Yeah. So you're sort of like, that patient could come in to you guys and if you feel like a referral is necessary, then you can kind of help streamline the process for the patient, which is amazing for patients because that's what they want. Because they come to you, they don't know what's going on.
Dr. Lingor: 11:41 Yeah, that's exactly right. And often times when they call one of our surgeons office, it may be a day at the surgeon just happens to be in the operating room and you know, regardless of how bad they want to see that patient, if they just don't have the ability to get them in. So, that's why I always say that we are here when the patient needs us and kind of get them moving in that right direction.
Karen Litzy: 12:01 And you know, and looking on the website, you have Michelle, a physician assistant and then a couple of other orthopedic physicians. How do you guys all kind of work together to make this clinic run?
Michelle Cummings: Now that’s a good question. So Dr. Lingor is here more than anyone else as the medical director. So He's here usually five to six days of the week. We are closed on Sundays and I come in later in the morning and cover the night shifts and then we have the other providers that will cover sometimes on the Thursdays and also on Saturdays they cover in the need to fill in the gaps.
Karen Litzy: Got It. And this will be kind of like you said, your flagship operation and then hopefully kind of move this model throughout the country. I guess my question is from where you are now then from where you started, I mean, you obviously see this as something that's sustainable, right? Because I think a lot of people, when new things kind of move into their communities, there are always a little hesitant. What do you do for the community? And New York City's a big community, right? Like you said, getting the word out is part of it. But do you have any plans on kind of being part of like really being part of maybe even smaller communities, New York is gigantic, but really kind of getting into the community to get people to trust?
Dr. Lingor: 13:39 Yeah, I think that's really great point. And that's one of the things that just in our area, we're located on 65th street and second avenue. And so we see a lot of patients just in our area with, you know, a few block radius of patients walking by who have seen the signs a little bit and then come in and check it out to see what it is and say, Oh yeah, I have this knee issue. I wonder if you guys can take a look at it. We do welcome Walk-in's we prefer patients to make an appointment just to decrease their own waiting time. But we do see a lot of that and just providing that access to patients when they need it. I think has really helps build our name in our own little community that we serve right now.
Karen Litzy: 14:22 Yeah. I have my own practice and that's always the hardest thing, like you said, is getting the word out, letting people know you're there. What other marketing things, have you guys done that you've found successful so that if people are listening, they're like, wow, I really wish we had something like that in our community. Maybe they want to start it. What would your best advice be?
Dr. Lingor: 14:49 Well, one of the things that fortunately New York City has a plethora of is sporting events around being open during those times. So, like for instance, when the New York City Marathon is going on, you know, on that Sunday will be open that day to provide, access and for again, people in the area just to kind of get our name out a little bit more that people are walking by and having, you know, welcoming people in if they need to be seen by one of our providers that day and not, you know, that for the runners. Cause they're a little busy that day. Right? Yeah, exactly. Hopefully not too many of them. But we are just one block off the race course over the edge of some of those special events and volunteering with those groups. It's something we look forward to.
Karen Litzy: 15:48 Yeah. So kind of making partnerships within the community so they know you're there and they can refer to you and all that fun stuff.
Dr. Lingor: 15:56 Yeah. So we have several of our positions that do volunteer in past years with those events. And so we see when patients come in for the marathon Monday that they host after the New York City Marathon. Those patients, you know, they're seen by a medical professional that then if they need to get further testing done now we can provide that access to people.
Karen Litzy: 16:24 Fantastic. I mean, it sounds like you've got a great, a great niche over there and that you've definitely found a way to kind of plug that hole, right. You've found a way, you saw this sort of lack of accessibility and have made something a lot more accessible. So is there anything that we missed or anything that, you know, you want to the listeners to kind of remember about the clinic?
Dr. Lingor: 16:53 Yes. Things come up and unfortunately musculoskeletal injuries come up unexpectedly at the worst possible times. And there's a lot that can be done if when patients have that time of need, whether they're going on vacation or have a major life events. That's our primary goal is to provide access for the patients when they need it and help them sort through some of the frustrations. And difficulties that come along with musculoskeletal and sports injuries and you know, get them back to their level of health and quality of life that they're used to enjoying.
Karen Litzy: 17:38 Awesome. And Michelle, how about you? Anything that we didn't touch upon or any closing thoughts that you want to share?
Michelle Cummings: No, I think just thank you for having us on the show and helping us get the word out. It's very helpful from different aspects to get out the word out in New York. So thank you for having us.
Karen Litzy: Yeah, you're welcome. And you know, I think it's also important, like now as a physical therapist, this is great for me to know because you know, we see patients directly now, so someone comes to me and I'm not sure, then for me it's great to say, Hey, there's a clinic that specializes in this. And then what it does for me is it kind of builds up my credibility with the patient because I'm sending them to a place where they're going to get the help that they need.
Dr. Lingor: 18:25 I’m very excited that physical therapists have the direct access, so through the physical therapy and find that, you know, the physical therapists that we commonly work with. It's been a great relationship with that. We look forward to expanding on that. And again, thank you very much.
Karen Litzy: 18:46 My pleasure. My pleasure. Thank you so much for coming on. So again, if you want to find out more information, you can go to hss.edu/ortho-injury-care. Is that right?
Dr. Lingor: 19:06 The easiest thing is just go to Google and type in Ortho injury care.
Karen Litzy: 19:14 Or you can go to podcast.healthywealthysmart.com and we'll have the link right there for you so you can just click on the link and go right to it. And hopefully we see more and more of these types of clinics popping up around the country because it certainly does fill a gap. So thank you guys for all that you do to help people with sports injuries, musculoskeletal injury. So thank you. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dolores Hirschmann. Dolores is a STRATEGIST & COACH. She helps clients clarify their “idea worth sharing”, design their communication strategies, and implement business growth systems.
In this episode, we discuss:
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THE IDEA OF YOU: A Framework for Clarity of Self
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Clarity of life purpose
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Clarity of who you are as a leader
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Clarity around how to set goals and set yourself up to achieve those goals
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Her work as a TEDx organizer and how you can get on that stage
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And so much more!
Resources:
Dolores’ LinkedIn
Dolores’ Facebook
Dolores’ Twitter
Dolores’ Instagram
Dolores’ YouTube:
Website: http://mastersinclarity.com/media/
Free Gift
"Stand Out the TED Way: Be Seen & Grow Your Business" eBook Download https://doloreshirschmann.simplero.com/bc
ApexNetwork Physical Therapy
For more information about Dolores:
Dolores is a STRATEGIST & COACH. She helps clients clarify their “idea worth sharing”, design their communication strategies, and implement business growth systems. Her clients become speakers and authors and take their message to larger audiences like TEDx and beyond. She works through group coaching, workshops, one on one coaching, as well as public speaking. Dolores is a writer, TEDx Organizer, and participant in TED conferences. She is a CTI certified and ICF accredited coach and has a business degree from the Universidad de San Andres, Argentina. Originally from Buenos Aires, Dolores speaks fluent Spanish, English, and French and lives in Dartmouth, MA with her husband and four children.
Read the full transcript below:
Karen: 00:00 Yeah. Hi Delores, welcome to the podcast. I'm happy to have you on.
Dolores: 00:05 I am so excited to be chatting with you today.
Karen: 00:08 And now in your bio, like I read, you're a tedx organizer. You help support speakers on the TEDX stage. So can you elaborate a little bit more about that? Cause I know a lot of my listeners would love to one day be on a ted or a tedx stage.
Dolores: 00:23 Yes, absolutely. I mean at the core of my work is my passion for ideas and because of that I, I I pursued as a volunteer. I pursued the TEDX platform. If you wand as a tedx organizer and in doing so I really connected with something that I love to do, which is help people clarify. And I know we're going to talk a little bit about this today, but you know, clarity comes in two ways. First is an internal clarity and then annex I communications clarity. When you bring yourself out into the world, which is what speakers do day in and day out, right? They bring out their messages. And so what I do with speakers today in my work, I held them in both guide, find the message Clive, find the overall communication strategy so that they can actually engage their audiences and kind of moved on.
Dolores: 01:16 You love their other movement or their, their impact. Right. And so that's on the, on the strategy side. But on the tactical side along the speakers just are not getting out there often enough simply because they just don't have time to pitch and to put themselves out there. And being in front of organizers and event planners. So with, in my company, in the agency side of my company, we actually have two services. One is where we actually research and pitch of peoples we have for them to speak in virtual and live events. And another one specifically signed four stages that are a little bit more harder to get in. It could be a telex, it could be, you know, some of the newer stages are coming up that are more inspirational or more kind of the idea based stages versus more the pitching stages. Um, and so what we'll do is we'll help the speaker life other core idea, clarify the positioning so that they can send out in the selection process and then help them with the research and the application process until they get selected. And that's something that I, you know, we do it for very specific clients whose message is ready for that kind of platform.
Karen: 02:32 Okay. So let's talk about getting this clarity around ourselves as a speaker because you had mentioned that a couple times, you know, getting clarity on who you are on your idea and, and even on where you want your idea to be, right? Because not every stage is right for every person. So let's talk about that clarity. Let's first talk about how to get clear on yourself.
Dolores: 02:58 Yes. So one of the things I am involved into, and I haven't, I realized that all my life, whether I was aware of it or not, I have been kind of this puzzle maker. Right? You know, what once as we started evolving and developing ourselves and becoming more self aware, I mean, especially when I did my coaching training, um, a lot of my internal introspection was about what is it that I bring to this world? Like we all have unique brilliances who all have that thing that we do well. Um, and for me that is that p being a puzzle maker. But to make a puzzle, you first have to have puzzle pieces. What I mean by that is we are always kind of lumping all of ourselves together in a tight box. And so when we're in that place is very difficult for us to really get to know ourselves because we are kind of mishmash with what has happened today.
Dolores: 04:02 The pain we had 50 years ago, um, and what we think we want to do, right? It's all kind of all mixed. And in order to make a puzzle, again, you need to pull out the puzzle pieces. So one of the things that I consistently do is create frameworks to break things apart so that we can build them back together. And so this framework, I, there's a friend where I designed called the idea of view and all it is really ease, deconstructing the different parts of who we are and the different kind of what I call layers of clarity that we can access so that when we actually pull them apart and look at it layer by layer, we can have a much more comprehensive picture of who we are. And in doing so, we can better assess where we're going. Does that make any sense?
Karen: 04:52 It does. It does. And would you mind giving us a, an example of maybe an exercise within this idea of you like a deconstruction exercise?
Dolores: 05:04 Yeah. And so let me just run you through the layers first. Okay. Uh, and then we'll hop into one or two exercises here that will help you better understand what I mean. So in the idea of you, and you know, I, I can send you some images later. It's, it's all about mmm. Getting Cody from the inside out so that at the core we begin with terrifying the you and, and, and he's, I say the idea of you because I believe that each one of us was born in purpose and for a purpose that we're kind of a seat of a, of a something, right? And so at the core of this exploration is what is your life purpose? Now this is a really big question and the question that has been around for many years, but I'll buy that today. It's kind of very heavy in, in making the decisions of our career paths and where we want to go, right?
Dolores: 06:00 And so I posted not as exactly the word we're going to do, but simply the who we are at our core, independent what we do. And so one way to do this is to think of yourself as a metaphor. Now you do this exercise. Please don't go and knock on your neighbor's door and let them know what metaphor you are because they're going to look at you like you're crazy. But when I did this exercise myself, I came up with my own personal life purpose statement, which is going to sound grandiose and he should sound round you dos because it's a lifelong purpose, right? And for me is I am the light that brings clarity. Clarity is at the core of who I am, independent of any activity or job that I'm holding. You see the difference. It's something that I can help a being.
Dolores: 06:56 I am attracted to like that lump of puzzle pieces because I like sorting them out and making a new picture. That's what I am in all aspects of my life. I've been like the cloudy maker for family situations, for job situations, for ideas, for for four speakers talks. I always bring that element right? So we begin with that and then we go and transition into identify what are our values and when I talk about values, I talk about what are the top things in your life that when you don't have them or you're not honoring them in your life, you just feel off. For example, I am, I have a big value on adventure. And when I was doing this work for myself at the time I was a young, youngish mother of four children. And you can say that having four children is an adventure in itself, but when you're in it, diaper in diaper a how day in, day out, it doesn't feel like an adventure.
Dolores: 08:01 It really starts looking like a very big routine after routine. Like it just doesn't feel exciting. And I, and I met some people might or might not agree with me, but that was my experience. And so when I recognize that adventure was a very big part of who I am and that not honoring my sense of adventure was kind of bringing me down, just that knowledge made me ask myself, okay, what can I do to fulfill that need of adventure? And you know, here's the thing Karen, is that tell us a shifts and changes can be very subtle. They don't need to be like moved to Africa. You know, it just do. Okay. Then I will just make time every week and maybe an hour a week to learn something new or to meet someone new or to explore a new place, even if it's just a new supermarket where I'll do food shopping.
Dolores: 08:54 Right? But, um, but it's just understanding what is it that is then that makes you tick and making sure that those values are being honored in your life. Then we go to understand your unique brilliance. What is it that you would excel, add in a natural way that you are, that you love doing. You never get tired of doing it and that, um, and then you always bring value. And what happens is again, when we are not connected with who we are, we sometimes unconsciously move away from that. That comes easy. Sometimes it's, I believe that work must be hard. So I might as well put that grit to it and we, and we discard maybe opportunities that might come our way that our land with our unique buildings because it feels too easy. So therefore I'm probably not regulated. Right? Right. And then, and then we explore another ring of clarity, another layer of clarity.
Dolores: 09:59 Quiches and this might be a great exercise for, for me to pause for a minute, but it's a ring of clarity of how do we define your life's work. Now, if you remember when I talked about life purpose, I talked about purpose of your sole purpose of who you are. Who doesn't mean that he defines the work that you do? A lot of people are trying to like calm, packed your job with your life purpose. And you know, there's a, there's a, there's another step in between and that is a step of your life's work. And why is it important? Because you have to translate your life purpose into as something that the world needs. Because, because even nobody needs your life purpose as it states in its true form. Um, then you might be both frustrated entrepreneur if you launch yourself into, like for example, when I first started, I just wanted to bring clarity to everybody and he was like, I wasn't getting anywhere, right?
Dolores: 11:05 Was, it was a very broad, esoteric value proposition that everybody liked it. I mean, I remember people saying, I really like you. I like when you say I put your ride. I just not sure how I can benefit from you. Um, and that's really great feedback to get right because it's like you're casting the net a bit too wide, way too wide. And I, and I see this a lot in the newly, you know, new business owners, entrepreneurs, we're following their passion. And again, it's not about that they're wrong, it's about they just need one more step. And this step is the lives we're defining your life's work. And here's a little exercise that we can share with your audience. And it's redundant. You have a venn diagram and you have four circles. What is your life purpose? Right? Just in that way of stating it broadly and grandiose, you know that people will look at you funny to share it in the subway.
Dolores: 12:03 And then the other circle there would be what people will pay for Nike nearly researching what will people, what do people pay for people pay for photographers, for weddings be both paid for accountants. People fave for a strategy for business growth. Like those are real things that other people are salad. Then another circle in this, in this damn, I'm would be, what are you trained to do? Like what are, what is your academic background and your past job experience, bathroom. Why? Because you don't want to just hop on a wagon and say, I'm going to do this because I love doing it, but no real credibility or kind of credentials.
Karen: 12:51 Exactly. It'd be like me saying, you know, I'm really good with numbers, so I'm going to be an accountant to be a physical therapist. Yeah. No one's gonna pay me for that. They'll think I'm crazy. Exactly. Exactly. Because you know, it's, there's something to be said about
Dolores: 13:07 some credentials. Um, um, and so, so really make a list of whether you were wrong and choosing your career path, our certifications you received. I would challenge that and look at what they can still bring you to life right now. Like, even if you're a doctor and you don't want to be a doctor anymore, that doctoral degree will go a long way to validating what you know and then putting into some, some other kind of surveys. Right. Absolutely. And then the last one is, so we have life purpose, what people will pay for what you have experience, job or, or academic. Um, and the last one is what does the world need? Or what does the world need more off? So when you do those four kind of circles and maybe do a little less in the middle, what you then looking at is what are the common denominators?
Dolores: 14:07 Where do all these four circles come together? So for me, you know, clarity is what my brain, right? And people pay for business strategy. People go for communication strategy. People pay for, uh, you know, maybe speaking people who pay for growing their business. My academic background, which at the time I was in school, I was kind of resenting it because I wasn't excited about it. Every day. I remember my mom would say, okay, you don't like what you're doing. Do you have any other ID? And I would say no. Then she would say, then finish what you started. Best Advice I ever got. Um, like stay on. I get that degree. Even if you have to like, you know, put a little bit of effort to it. Just get that done. So going to business school, I have to say 20 years later going to business school was the best decision I made at 18, even if I did 11, because he gave me the tools to narrow down my business and to be our business strategist. And so, so that's where my academic and what does the world need more off the world needs more ideas that can have a positive impact in the world. And the truth is, in my work and masters in clarity, we stand behind those ideas, typically in the hands of service entrepreneurs who have new methodologies, new perspective, new angles or new ways to helping their market or the world.
Dolores: 15:40 And that's that. Um, so as far as you know, that exercise is, is really helping you narrow down of how to you become off service in this world with your life purpose in a way that can be financially, not just financially sustainable, but can I might say financially abundant.
Karen: 16:03 Right. And there's nothing wrong with that.
Dolores: 16:05 How old is all right with that? Because the more abundant you are, the more you can do the work you're called to do, the more the world's will benefit.
Karen: 16:15 Absolutely. And I really love the, that sort of venn diagram of those categories. So I'm going to just repeat them and I want you to let me know if I got them right. So, um, what is your life's purpose then? That's a big grandiose statement that's supposed to be grandiose. Uh, what will someone pay you for? What does the world need more of and essentially what are your credentials? That right. I think that four parts. Exactly. Okay, great. Great. Great. Yeah. And, and I think if, if you can really sit with those questions, cause I don't think it's something that's not answered in five minutes, right. Syntheses questions. And how do you, and, and, and I dunno if there's a straightforward answer to this, but how do you know what your life purpose is? Because you know, sometimes when people hear that they're like, whatever.
Dolores: 17:14 Yeah. So here's a couple of ways to do it. MMM. You can sync off and moment in your life where you felt completely, um, completely valued and completely, um, like you were, you were at critical element of a situation where we're maybe without you playing whatever role you were playing, maybe outcome would have been very different or not positive in one way or another. That's one way to ask yourselves and start asking, you know, some days is, is asking you as a, what roles have I played most of my life? What do people know me for? What do people say about me? Um, and I, and I did that exercise and I asked my, the people in my life, my food, my mother and my friends. And, um, and you know, a lot of people would say things like, well, I would always call for you to you is I was needing to make a decision. I was the go to person for decision makers. Um, it's funny, I'm actually posting a blog on, on that, on this particular topic this week, um, because I'm helping my daughter made college decision right now. Um, so it's just really going inside and also go into your inner circle asking how do I bring value? What, what is it that the role that I play that I'm somehow always falling into that role in any kind of social or professional environment.
Karen: 18:59 Yeah, that's great. And I think that'll give the listeners a little bit something more to think about when they're trying to kind of discover what their life purpose is because I know I find that to be a bit difficult as well and I'm sure I'm not alone in that.
Dolores: 19:15 Yeah. Yeah. It's, it's, it's, it's one of the things that can always include us. Um, but my experience is that it did for many years until I came up with that, with that metaphor that I'm the lie the breeze clarity and sometimes I want to challenge people because we try to make this life purpose statement very complex or very sophisticated and symptoms is so simple that we rejected for its simplicity.
Karen: 19:52 That's true cause because we think it needs to be so over the top. Amazing. When in fact some simple as smart, right?
Dolores: 20:01 Yeah. Yeah. And any, maybe it's simple bod grandiose and so are our cultural belief system that who are we to believe that we can be that good comes into play and also mucks things up.
Karen: 20:17 Yeah. That self doubt and lack of self compassion for, uh, for ourselves can kind of derail us every time. Right?
Dolores: 20:27 Absolutely. And I think, you know, I mean this is just my perspective and I, if I might share it, I think that I really believed that each one of us in the world, not just me, all of us are here in person for a purpose. We were a gift and that that grandiose side is actually bigger than us. Um, we're just here. I, I believe to do a job that we're called to do within a universe that is much bigger than us. So to reject our brilliance is a, it's a, it's to reject that gift of who we are.
Karen: 21:08 Yeah. I love that. Thank you for saying that. And now let's say we kind of have this clarity of life purpose. We have more clarity around who we are as a leader. What do we do then? What's the next step? How do we then
Dolores: 21:26 goals? Yeah, so there's a couple more layers that, um, that will take your right there. So then the next layer would be clarifying how you interact with the world. And for that you have a lot of online assessments. There's one that is free that I love is basic, but it works. It's called 16 personalities. Got Home. It's based on Myers Briggs. You have finder and Colby and um, uh, an agreement like this, a lot of assessments out there, but those are really great and those are fun. And you learn more about how the world perceives you because that's important as well. And then, and then, and then we put all this to work. How would we do to work? Two more steps or internal one is we, and maybe I, I'm happy to do this for you and maybe the lessons will love this is um, identify and bring forth your internal leader and that is the highest voice.
Dolores: 22:26 We have voices in our head just for all of you are there. Yes, I do have voices in my head and there's nothing wrong with me. And we typically have most of the judgmental whiny voice that says that we're not enough. That's usually the loudest, but when we tap into our internal leader or captain that voice, then we can start kind of all of those not so happy or positive voices. So tapping no leader is an great um, resource because it will be that voice of reason that says to me, the Lord is slow down. Think about what you're going to say. Like you got this, uh, yes, it's hard, but you know, keep them going. That kind of positive reinforcement. And then the other part of this kind of clarity is understanding again in the same line, what is that conversation in your head and how many times a day you're going into victim mode, things are happening to you versus I got this, this is hard, but this is happening for me.
Dolores: 23:34 Right? And, and so that, that kind of wraps up the clary layers and the mindset layers. And then I think this is what you were alluding. It's like, okay, now what we do, right, right. Was parts one is the exercise of goal setting. How do we set goals that are honoring our values, our purpose, our internal leader? And from a positive mindset or victory mindset perspective. So how do we set goals from that? And our goal setting is not mixed science is they have to be smart, specific, measurable, attainable, um, timely. Um, and uh, and they have to be a stretch from where you are. But nod, I want to lose a hundred pounds in a month, right? Setting yourself up for failure. And so the goals are the big kind of gps as well. We're going lag. You can have a goal for each part of your life or only the parts of your life that need attention right now and is a great exercise with that.
Dolores: 24:44 It's called a wheel of life. A lot of, uh, you can probably find that online is it breaks your life into different kind of sections like a pie. And he helps you really assess from one to 10, one being this is not working really well, 10 being I'm rocking aid and from one to 10 and tried to understand which part of the life is not doing so well and so that he can focus on that. And then at the end of the day, Karen, all this is wonderful, but that transformation and our true selves as leaders only comes to shine in the details of every day. And that's why I talk about habits all success. So at the end of the day, how we wake up in the morning, how we brush our teeth, how we get dressed, how we make our bed. And yes, making your bed is part of [inaudible] leadership and what we eat, how we greet the post man, how we say hi to our coworkers. Those are the tiny details of our day that honestly make our big life. Okay.
Karen: 25:56 And you, you, you're about that. The making the bed thing all the time. And I started doing that a couple of years ago and I remember someone asked, why, why do you make your bed? I'm like, cause then I feel like I start out my day with a little wind.
Dolores: 26:10 Yes. I actually, one day I may have, I've always made my bed. I was raised that way and it was actually bothered me not to, I think at some point I was, you know, this, this balance. And at some point I was so, so kind of one, I was wound, wound very tied when the kids were little. And I remember having a coach who said, I challenge you not to make any bad this week. So I actually had to not make that because it was becoming a burden to me. But years later, my sister, teen 16
Karen: 26:44 year old, oldest son, um, started making his bed and I hadn't said a word and I noticed it and he said, yes ma'am, I read this book and he gave me the book. And it's a book that I recommend always. He had read this book called the power of habit from child. I don't know if you've read it and I, it's, for me, it's an amazing book and everywhere. And that book taught my 16 year old back then to make us better. Oh, how wonderful. Charles Duhigg would be so proud.
Dolores: 27:15 I was going to say, maybe I should send a note that he accomplish almost impossible.
Karen: 27:20 I ain't got it. He had a teenage boy to make it better. Exactly. Yeah. That's amazing. Yeah. And then how, so, you know, you work with your clients and they've gone through all of these steps and then how do you, how do they then say or decide kind of where did it go from there? Right. So let's say someone's already a leader and they want to do a Ted talk. Somebody wants to do a Tedx talk. Right. Which are probably a lot of people listening to this podcast. So they go through all this. They have a good clarity of self, an idea of self, what's the Prac, what do you do, how do you do that?
Dolores: 28:06 So is a good question. So actually if someone comes straight, like let's say I didn't have work with me and they come to me just to do a talk, I will go through the process even though it might feel not linear. That is good to do with my talk because especially in the life purpose because with a talk like a Tedx talk on the of the talk is an idea that can have a positive impact in the world and that is right in the line of what we were just talking about. Your life purpose and your life's work. And so what I do is I bring that conversation APP and say, okay, this is your life purpose. Great. Your idea is kind of the cousin of your life purpose because it is an actionable version of your life progress. For example, for me, if I were to do a talk, it would be about how cloudy frameworks can help entrepreneurs realize their impact.
Dolores: 29:10 So my life purpose is clarity, but for the idea is the concept of clarity for frameworks as a tool for the purpose of serve as entrepreneurs realizing their impact. I'm just kind of very specific. So what we do is we tap into who the speaker is, what is it that they've always known about themselves, what is it that they've always longed to do or accomplish in this world? And then we explore about on the work they do, because here's the thing, can everybody comes to me and says, I want to give a talk. And I say, okay, what's, what's your core idea? What do you want to share? And they go on and say, well, let me tell you about my work. And it's on and off for like 30 minutes. Right? And and when you're pitching to any stage, but specifically at Tedx stage, the organize who will ask you one question and he's like, can you tell me your idea in one short sentence? And most people can. So that's why the life purpose, um, and a framework that I teach for, for stating your core idea come together to create this one line idea statements that then the top will be based on.
Karen: 30:22 Got It. Thank you for that. Cause I think that's a big point of clarity, if you will, for people who might be thinking about pitching themselves to do a big talk somewhere that you should be really be able to state the purpose of your talk, like you said in one sentence, succinctly and but with the punch, right?
Dolores: 30:46 Yeah. Yeah. But here's the thing is not, you know, they get caught up in this sexiness of it. Yeah. And they lose the practicality of it. So it depends the market. If you are looking to stand out in your market so that people will hire you, I would say lose a sexy gained the clarity. If you're looking to send out in an application to be speaking, then the stress, the, the to stress, the takeaway with the audience will get and the uniqueness of your process.
Karen: 31:27 Great. So it really depends who you're talking to him. Sure, sure. Because in the end, especially if you're talking about a Tedx talk, it's all about what, like you said, it's all about the audience, not about you, not you.
Dolores: 31:40 No, no, and I actually have had, you know, I love the work of the Tedx or the speaking if you want. What I love about it is that
Dolores: 31:53 people come to get that Karen, right? Like that kind of thing that they want the tedx stage or whatever stage and what they gads when they do this work of clarity is they get a Vishen so much bigger than they had before. I had a client what a multi multimillion dollars coaching program, a company, very successful is 16 years in business. And she did the work to get on that stage. And because of that work, she completely rebranded her company after 16 years, change the name because she realized that what the core idea of her work and the essence of our work was so much bigger than the brandy she of created for her company. And she was, she was kind of, she was feeling that the company was a little stale because she had reached the boundary, the box she had made for herself.
Karen: 32:52 Yeah. Oh my gosh. That has me thinking so much. It really does. And I think, you know, often times people get caught up in themselves instead of in the idea. And I think that can derail you.
Dolores: 33:09 It is, it is kind of a process then without knowing you'll fall in love again with your work. Awesome.
Karen: 33:18 Well, that just sounds amazing and I think you gave such great tips and, and really kind of got into the work that you do with, with uh, entrepreneurs and, and possible speakers and a executives. So thank you for sharing all of that with us. Is there anything that we missed or things that you want the listeners to really take away?
Dolores: 33:43 Um, I think that whatever you are doing, whatever situation you are in your life right now, just checking and understand where you stand. Don't make decisions from what other people say unless you also include your higher voice in the conversation.
Karen: 34:08 Excellent. I love that advice. And then I have one last question and it is again, another piece of advice and it's the question I asked everyone and that is knowing where you are now and your life in your career, what advice would you give to that? You know, fresh face Gal right out of college?
Dolores: 34:26 Well I, I, I would say to her, stay in this state of wonder. Trust your gut and yourself and it's okay. Life is not linear.
Karen: 34:41 Awesome. And where can people find you if they want more info or if they have any questions,
Dolores: 34:49 they can come to masters in clarity.com and right on the main home page you'll have a big orange button that says free resources and you can find different resources that you can download for free and start getting the clarity unique.
Karen: 35:07 Awesome. And then just so the listeners know, we'll have all of these links will be up on our website at podcast out healthy, wealthy, smart.com and that Dolores also has a free gift. Stand up the Ted way, be seen and grow your business ebook downloads. So we will also have that on the podcast page under this episode as well. So thank you for that and thank you for coming on today. This was great.
Dolores: 35:34 Thank you so much for having me. I had a lot of fun
Karen: 35:37 and everyone who's out there listening, thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Laurie Seely on the show to discuss gut health. Laurie is a Certified Health and Wellness Coach specializing in helping people repair their gut from Candida, IBS, and Heavy Metals Toxicity.
In this episode, we discuss:
-The number one question you should be asking your doctor at your next check up
-How you can assess the health of your stool
-Simple solutions to improve your gut health
-Laurie’s long journey to overcome Candida
-And so much more!
Resources:
Laurie Seely Website
Laurie Seely Facebook
Young Living Parafree
Candida, IBS, and Heavy Metals Education Facebook Group
FREE GIFT: 7 STEPS TO KILL CANDIDA CHECKLIST
For more information on Laurie:
I’m a Functional Medicine Health Coach, a lover of Young Living Essential Oils, a mom to a beautiful little girl, and a professional opera singer, formerly in the chorus at the Lyric Opera of Chicago.
I suffered for years with IBS and all the horrible, embarrassing symptoms that came along with it, including a raging candida (yeast) overgrowth. Eeeeew!
With help from my health coach and the School of Applied Functional Medicine, I learned how to kill Candida and repair my gut. I am a health detective! Now I teach people how to kill Candida and repair their gut through workshops, group programs, essential oils, and 1-on-1 coaching.
Many of my clients find surprising side effects such as extra energy, clearer skin, fewer wrinkles, better digestion, less need for medications, lower blood sugar, and clearer thinking!
Laurie Seely
Read the full transcript below:
Karen Litzy: 00:01 Hey Lori, welcome to the podcast. I am happy to have you on.
Laurie Seely: 00:05 I'm so happy to be here. Thank you Karen.
Karen Litzy: 00:08 Of course. And as we were talking about before we got on the air, the way that we were introduced to each other is through Christine Gallagher, who's a really wonderful business coach and she was part of my women in PT Summit, in our inaugural summit a couple of years ago. And so I just want to give a quick shout out to Christine for the hookup here.
Karen Litzy: 00:31 She’s great. So now obviously in your bio I talked about the fact that you're a functional medicine health coach, but I have a feeling a lot of people aren't exactly sure what that is or what that means. So would you mind giving the listeners a little bit of background on to what that is exactly.
Laurie Seely: 00:48 I got a certification as a health coach and then I continued at the school for Applied Functional Medicine and they offer another certification. And basically that's where I learned all my stuff. You learn about just really how to be a health detective because there are so many symptoms of dis-ease that a lot of doctors will label as an illness. And I was very interested in this kind of, it's not really medicine, but I was very interested in this kind of health detective work because I went through this whole thing myself with IBS and Candida and I still had a couple of pieces left to really, really find health for myself. And it was at this school that I've finally put in the last couple of pieces to make that happen. And so, in the process I became a functional medicine health coach. Isn't that cool? Now I help other people that had the same sort of problems that I once had.
Karen Litzy: 02:08 Yeah. And I feel like oftentimes that's kind of the way life takes us, right? We kind of have these experiences and we figure them out for ourselves and then we try and delve a little bit deeper to widen the net and then help others. So I think it's great when you can kind of make that change. But a question, what were you doing before you were a health coach?
Laurie Seely: 02:32 Well, I was an opera singer actually. I was singing fulltime in the chorus at the lyric opera of Chicago, which was really, really fun. And actually I just recently quit there. I was doing both at the same time for a while, which was a really difficult juggle. And I feel like this is where my heart lies and my passion now. So yeah, I was an opera singer.
Karen Litzy: 03:12 What a career, what a career switch. Yeah. I love talking to people who have had different careers within their life because I always think like it gives people hope, you know? So if you're not doing exactly what you love right now, that there's hope, you may find that thing that kind of, like you said, gives you your passion. Right? Fantastic. All right, so now let's talk about the health coaching aspect of things. So let's say I'm one of your clients. I come to you and I've already been to my doctor or maybe I'm going to see my doctor. So what are some important questions that maybe doctors should be asking us that they're not? Maybe that, yeah, we're not delving into as much.
Laurie Seely: 03:49 So I think that the number one most important question a doctor can ask you is what does your poop look like? And specifically, what does it look like and how often do you poop? Because that is your body's way of telling you when there's something wrong. I learned that functional medicine school that most dis ease begins in the gut. We don't say all because we just want to, you know, 99.9% of disease begins in the gut, I would say, right? And that's your first indication. That's your body telling you, hey, there's something wrong. You know? And so we need to be educated on our part. What poops should look like. Right. And I feel like this should be like on the commercials on TV instead of like, you know what pharmaceutical drug can help you with your IBS.
Laurie Seely: 04:52 They should be telling us what our poop should look like so it doesn't have to go all the way to IBS. We can see right at the beginning, you know what, I'm pooping little marbles like that's, that was my problem for most of my life. Little marbles with occasional bouts of diarrhea and I went for close to 40 years not knowing that there was anything wrong. If one doctor had asked me what my poop looked like when I was say 12 years old and I was old enough to kind of tell him, well about nine times a day I'm pooping little balls. He'd be like, wow, there's something wrong with you. We need to figure out what it is. And I feel like there's so many people who are in the same boat, you know, it never would have gotten to candida for me. I had a yeast infection for a year, every single day. And if somebody had asked me at 12 years old, what does my poop look like? I just, I feel like it never would have gotten that bad. And I feel like there's so many other people in this world who are in the same boat, you know, and who are maybe at some sort of state of disease that really could have been kind of nipped in a bud years ago when it was much less.
Karen Litzy: 06:05 Hmm. Yeah. And so if we're going there, right? We're going to talk about poop right now. We're in it, we're doing it.
Laurie Seely: If you have a conversation with me long enough, it'll eventually go there.
Karen Litzy: Yes. This is it. Obviously a very good question that your doctor should be asking, but now if people listening to this next time they go to their doctor, they can bring this up, correct?
Laurie Seely: 06:33 Yeah, absolutely. And you want to be very clear because even doctors can mess up with this. You know, there was one chiropractor that I was at who asked, we sort of, we get treated in the same room, a bunch of us, and there was another client, they're getting treated at the same time. And she was making comments that kind of made the chiropractor and me kind of go to, sounds like you're constipated, but we didn't say that. And he asked her, how's your digestion?
Laurie Seely: 07:04 She’s like oh, it's fine. And then he left the room and I said, what does your poop look like? How many times do you poop a day? And she said, Oh, I'm pooping like once every 10 days. Oh my God. Yeah. So I was like, wow. Like I didn't want to alarm her, but I sort of explained, you know, that it shouldn't be that way. So, that's the thing, when you talk to your doctor, like get gross, get like in it, tell them what it looks like, what it feels like, the texture, the smell, how long it takes to pass, because they need to know all of those things. And sometimes the doctor's going to get grossed out by that. And you know what, find a different one because you need to be able to talk about this stuff.
Karen Litzy: 07:45 Okay. So let's talk about what it should look like. So there is a chart called the Bristol stool chart. So can you tell us what it is and what it should look like?
Laurie Seely: 07:59 So on the chart it goes from number one to number seven. So number one is constipation and that's the tiny little balls. Number seven is diarrhea, that's watery stools. And number four is Nirvana poop. Like exactly what it's supposed to be like. It's like soft serve, ice cream texture. And it's not going to smell very much. It's going to be light brown in texture, easy to pass. We're talking one or two minutes and it's all gone all out and it leaves almost nothing to wipe. So that's the, the good stuff. And then they have, you know, the different levels in between one, four and seven also. So you can, you can Google that. There's like great illustrations online.
Karen Litzy: 08:50 And so obviously if you're at a one or a seven, we pretty much know something's up, right? Yep. So four is perfect. What if you're at three or a five? I mean, are these things to be worried about?
Laurie Seely: 08:56 I honestly, I don't think so. If you're at a three or a five, it's probably not your norm. If that makes sense. Like you want to look at where, where is it usually? Right? What is your pattern? If you have a couple of days with a little bit of stress and suddenly you're pooping tiny little balls, but then you get back to a number four after that, you're good. It was the stress you got over it. Right. Do a little yoga, some deep breathing, you'll be fine. Same thing happens with diarrhea. You know, a lot of people get stressed diarrhea. So if that's a temporary thing and it's due to stress that's temporary, then you're fine.
Laurie Seely: 09:49 If it's happening all the time, then you need to know that, yeah, it's a problem and you need to do some detective work there and that's time to do a stool test or to do any number of blood tests for parasites and stuff like that. So that's time when you want to, you want to find out what's causing it. A lot of times like, okay, so I went to my gastroenterologist, I said, I have IBS, I'm constipated all the time. Sometimes I have diarrhea. I told her the whole story and she said, we don't know what causes IBS.
Laurie Seely: 10:24 So that's another indication that you need a new doctor. So that's what I did. I got a new doctor because there are so many things that cause IBS and that's time to just find yourself a health detective and figure it out. There's a great test from the Meridian Valley lab called a comprehensive stool analysis and Parasitology times three. So that will tell you all of the expected beneficial flora that you want in there. It'll measure imbalanced flora. Any flora that's dysbiotic or like out of crazy, out of balance. So you know exactly really what's supposed to be there. It's also going to measure how much yeast you have in there because everybody pretty much has yeast in their digestive tract. It's just when it gets overgrown and it's bad. And then it also measures like mucus and then it checks for parasites and it's a three day test.
Laurie Seely: 11:26 So if you find a doctor that gave you a stool test and it's just from one bowel movement, that's not a good enough test. If it finds something cool, then you got lucky. But it's good to test over the period of at least three days. There are some stool tests that go up to six days. So the reason for that is that the bacteria and the parasites and the candida, it all travels in groups like in clumps, they like to stick together like a school of fish, right? And from one bowel movement you could be full of parasites and in one bowel movement you pass a whole bunch that doesn't have any parasites in it because they were hanging out somewhere else in your colon. So that's why you want to test over three days. So then you have a pretty good chance that if there's any parasites in there, you've found them.
Karen Litzy: 12:27 Yeah, that makes sense to me. And now let's say you do this test and something is positive. Where do you go from there?
Laurie Seely: Well, there's a lot of things you can do about that. It depends on your doctor. He might give you a pharmaceutical antiparasitic drug to take, which can be effective and there's the possibility that it's not effective as well. You always want to retest. What I do with my clients is I use a product from young living essential oil as it's the best thing that I've found so far, the most effective and it's called para free and it's full of various essential oils and all. So, other ingredients that are known to support intestinal health and are, I can't say that they're known to kill things because it hasn't been approved by the FDA, but I've seen in my practice and in my own body and in my mother's body, that it clears up parasites.
Karen Litzy: 15:29 So now let's say you do this comprehensive stool analysis and you find something, it's treated either by your physician with the pharmaceutical or through the essential oils, but I guess it's probably important to note that with the essential oils that like you said, they're not FDA approved and they're not studied or tested. It's just more like anecdotal stuff.
Laurie Seely: 16:01 There are many case studies and actually it seems like from the case studies that the para free is actually more useful.
Karen Litzy: 16:14 Well it would probably behoove someone to do some research on that because it's hard to I think get buy in from a lot of people when something isn't well-researched. That's a word I was going to say, test it. But research is probably better. Probably a better way to put that. So, you know, at least someone will, we'll do that to help people make a better decision.
Laurie Seely: 16:50 Right. Well, here's a thing, the reason why they're not FDA approved is not because the FDA looked into it and disapproved them. It's because the FDA doesn't want to waste their time on something that can't be patented because they're natural ingredients in there. They're not synthetic versions of natural ingredients it’s the actual natural ingredient. And so those things can't be patented and they can't, you know, companies can't make money off of that. And so the FDA doesn't want to use their funding on that.
Karen Litzy: 17:23 Right. Yeah. Well hopefully someone can do like a nice comparative study between that and a pharmaceutical and see what works and what doesn't.
Laurie Seely: 17:34 I think one of the issues that pharmaceuticals are usually aimed at just one thing. And the para free has been useful in treating a wide range of parasites. So it's like throwing a huge blanket on it. You Kill Them all. But you're right. You're right. It'd be nice if it were more widely publicized.
Karen Litzy: 18:05 All right. Now let's say we talked about this a little bit. Let's say you're on the one of the Bristol stool chart, which means that you're constipated and everyone at some point in their life has been, and we know it's not comfortable, so how can we relieve this?
Laurie Seely: 18:29 So there's a couple of different ways. It depends on what's causing it. So before doing a stool test, I would try, what I'm going to tell you now, I would first look at how much water are you drinking every day. So the rule of thumb for how much water you should be drinking is you see how many pounds you weigh, divide that by two. And that's how many ounces of water you should be drinking every day. So if you weigh 140, you should be drinking at least 70 ounces of water per day. Right? Now there's a lot of people who are already doing that, but there are a lot of people for whom that would be quite a bit of water. That's really what we need to be doing because, the number one and the Bristol stool chart is an indication that your stool is dehydrated and you're still maybe dehydrated just because you're not drinking enough water, it's possible that the muscles along your colon aren’t functioning absolutely properly and that you're just moving along slowly because there's not enough water in your stool.
Laurie Seely: 19:36 So that's the simplest fix. Right? And then also if you do that and you find that it doesn't fix it or it improves it, now you're still drinking more water. Another thing to do is consider that maybe you don't have enough magnesium intake. So a lot of us don't have enough magnesium just because we're not getting it anymore from the fruits and vegetables because of modern day farming practices. It's not in the soil. So if it's not in the soil, can't be in the vegetables and that's where we're supposed to be getting our magnesium from. So we use supplements. So there's, the form of magnesium that helps to stimulate the bowels is called magnesium citrate. And so you just see, you try taking some magnesium citrate and there's a very easy way to figure out how much of that you need.
Laurie Seely: 20:32 You want to get the powdered version because it's easier to lower or raise your intake right then like taking a capsule. And so you start with half a teaspoon of magnesium citrate. And you do that for about three days because it takes a while for it to build up in our bodies. And if after about three days you're not moving along the way you want to be, then you raise it by another half teaspoon and you just keep doing that in three day intervals like that until you're where you want to be. And it's possible that you might go up a little too far and have diarrhea and then you know, for sure that half a teaspoon or less than that is what you need.
Karen Litzy: 21:17 Right, right. Yeah. So it's a little bit of trial and error there, but I get it.
Laurie Seely: 21:22 I mean that if you're trying to do things naturally, that's how it is.
Karen Litzy: 21:27 Yeah, for sure. Okay. So we've got lack of water, lack of magnesium. Anything else that can contribute?
Laurie Seely: 21:35 Well, we always say we should have more fiber. Right? And that could be part of it as well. So you want to make sure that you're eating enough vegetables because I never recommend a person to get their fiber from things like shredded wheat or bread or things like that. But that's what we see in the media, right? We see like, oh, have your high fiber bread and that's going to help you. Well, wheat actually can irritate the colon. Whether you have a sensitivity to it or not because of the way that it's being produced nowadays. It's a very common irritant. And so that could be, I mean, maybe you're eating bread and that's your problem, right? So if you feel like maybe it's a fiber issue, then the way to get fibers through vegetables and I'm talking about like spinach, Kale, leafy Greens.
Karen Litzy: 22:34 Yeah. So that makes sense. So you want to start having more water, kind of eating a little bit healthier and things may even out for you. Okay, great. So is there anything else with constipation that we didn't go over about kind of how to relieve it or what might be causing it?
Laurie Seely: 22:55 Well, those are the places that I would start. And if you don't make any headway there, then got to find yourself a health detective, I think.
Karen Litzy: 23:07 Yeah. Yeah. All right. Sounds good. Now you made mention of this earlier, but, and I know it's part of your history and kind of why you became a health coach, but talk a little bit about Candida and what it was like for you for 10 plus years.
Laurie Seely: 23:28 So, my whole life, this whole thing with my digestion just kept getting worse. I didn't even know that I had a problem. I was unaware of it. That's why I'm here. Like educating people about it, bringing it into the light. Eventually I started having like three to six or more yeast infections every single year, which I also didn't know, but that's considered frequent for yeast infections. And then eventually, this is a little while after I had my daughter. My immune system just tanked and so did my thyroid and I had a yeast infection for every day for an entire year. I remember spending a week at Disney with an itch that I couldn't scratch. It was just horrible. So that's when I finally, I took the plunge. I was googling the whole time, like, there's probably a good 10 years that I was like, why am I getting so many yeast infections?
Laurie Seely: 24:32 And I would Google that and it would come up as a candida, you know, a systemic candida infection. I was like, no, no, no. It couldn't be that, because then I of course googled the remedy for that. And it just seemed like so hard and such a problem to go through that I was like, no, it's gotta be something else. It can't be that. So when I finally admitted it, I mean, that was the first day of the rest of my life, you know? And, I started my journey to health
Karen Litzy: 25:11 So aside from having the recurrent and constant yeast infections, was there anything else that you noticed that maybe you ignored?
Laurie Seely: 25:20 Yes. Looking back, I started to have, when I wasn't constipated, I was having far more urgent diarrhea, which actually led to like public accidents. Very, very embarrassing. And I got some allergies that I had always had some allergies, but it was just so bad that I was seeing an allergist and I was using Flonase and other steroid nasal sprays. And of course that was just making my problem worse because steroids actually kill gut bacteria and that was the root of my problem. And then after that allergies then more yeast infections. That was I think the allergies and the more frequent diarrhea that I didn't put it together. I didn't understand.
Karen Litzy: 26:19 Yeah. And that always seems to be the way because especially when you're in it, it's kind of like hard to connect all those dots, right? Because you're just trying to take care of the symptoms.
Laurie Seely: 26:30 I was constantly putting band aids on symptoms, not realizing that they had a common cause. And sinus infections also. Yeast kinda likes to live in the warm, wet areas and sinuses are a really good place for them to take up shop. And I had that problem too.
Karen Litzy: 26:50 Gosh. What a way to go through life.
Laurie Seely: Yeah. Yeah. And you know, there's so many people who are really experiencing this all the time still and also haven't connected the dots, you know.
Karen Litzy: Well, you know, hopefully you can raise a little bit more awareness for people and have them be a little more aware of how they poop yes. And what it looks like and the consistency and this smell and all that stuff so that hopefully we can, cause you know, what you put in your body's got to come out, right? So, I think it's important that we pay attention to what our body is doing because like you said, our bodies are pretty good at telling us when things are wrong. When things are out of homeostasis and if checking your poop, that seems pretty easy to me so then you could say, oh, this doesn't seem right. Maybe I should call my doctor about this.
Laurie Seely: Exactly. Yes, exactly. Just have to pay attention.
Karen Litzy: Yes, we have to pay attention. Well, now is there anything that maybe we didn't cover that you feel like who I really want your listeners to know this.
Laurie Seely: 28:21 I think we got everything.
Karen Litzy: All right, well then I have one last question for you and it's a question that I ask everyone, and that's knowing where you are now in your life and your career. What advice would you give to yourself, let's say right out of school, or maybe in your case when you first started getting into the opera world?
Laurie Seely: 29:05 Oh, well this is, yes. Advice that I wish I'd had. Just keep trying get used to hearing no.
Laurie Seely: 29:20 Because in the opera world we deal with a lot of rejection. There's a lot of auditions and you might get out of, I don't know, 20 auditions, you might get one job. So I really would have liked to start to hear that, to know that it was normal. You have all these auditions and just get one job, you know? But I have a very stick-to-it-ness sort of nature to me and I rolled with it.
Karen Litzy: 29:52 Gosh, I'm sure so many people have been in your boat many times over and would have loved to have had that advice. And now you have, which I'm very grateful for, something for the listeners. So what is a Freebie for people?
Laurie Seely: 30:10 So I have a seven step program that I use with my clients to help them get over candida and repair their gut. And I have a blog post on my website that goes through those seven steps. And it also has a very handy downloadable checklist that you can use as you're going through the program.
Laurie Seely: 30:42 So, and it also has a very nice list of Anti-candida foods, foods that are allowed and not allowed on the anti-Candida, a diet that is very handy to print out and just hang in your kitchen so that you can check it every once in a while and see what kind of recipes you want to make for yourself. Because when you're doing the Anti Candida Diet, it can be very difficult and very depressing to try and figure out what there is that you can eat without feeding your candy jar. So for anybody who sort of was thinking, oh, that might be me, I don't know, you can go to my website and check out that post. And there's so many other posts on there about IBS and Candida and food sensitivities and all that stuff. You can go down quite a worm hole on my website.
Karen Litzy: 31:33 Perfect. And we'll have the link to the seven steps to kill Candida checklist. We will have the link to that in the show notes over at podcast.healthywealthysmart.com so you can one click and it'll take you there. And where can people find you?
Laurie Seely: 31:55 I am at laurieseely.com and I'm also on Facebook at Laurie Seely functional medicine health coach. And I also have a group on Facebook called Candida Ibs and heavy metals education group.
Karen Litzy: 32:14 Awesome. And again, we'll have all the links to that. So if you have questions you want to get in touch with Laurie, you can pop over to her website. If you weren't writing all this down, you can go to the podcast website, click onto it and it'll take you right there. So Laurie, thank you so much for coming on and talking to us about poop which is a first for me on the podcast.
Laurie Seely: So that's awesome. I'm so glad I get my bad for you.
Karen Litzy: It was at first. And hopefully people, no pun intended, got a lot out of this. So Lori, thanks so much for coming on and everyone else, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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LIVE on the Third World Congress of Sports Physical Therapy Facebook page, I welcome Professor Ewa Roos to discuss the GLA:D Program. Professor Roos is an internationally leading researcher and change agent in the field of musculoskeletal health. She has been able to both produce high-impact clinical research and translate that research into clinical tools that are easily and effectively implemented in hospitals, primary care clinics and even community settings in municipalities.
In this episode, we discuss:
-The three components that make up the GLA:D program
-Are GLA:D exercises superior to performing any other form of exercise?
-The benefits of participating in group therapy
-A sneak preview into Professor Roo’s talk at the World Congress of Sports Physical Therapy
-And so much more!
Resources:
3rd World Congress of Sports Physical Therapy
GLA:D Program
Ewa Roos
For more information on Professor Roos:
Professor Roos has a passion for advancing the frontiers of knowledge in muscle and joint health to improve the quality of life of those with musculoskeletal disease and to improve health care delivery for these conditions. Her focus is on patient involvement, non-surgical and surgical treatments and clinical care pathways.
A decade ago Professor Roos and colleagues started to investigate the evidence underpinning the outcomes from arthroscopic knee surgery. When they found very little evidence to support the ever-increasing frequency of these surgical procedures, they started investigation of the efficacy of arthroscopic surgery compared with sham surgery or structured exercises through a series of high quality randomised controlled trials performed in collaboration with Danish and Norwegian orthopaedic surgeons and physiotherapists. To the surprise of many and the concern of some, the results of these and other research projects have found that arthroscopic surgery for the degenerative knee is no better than sham surgery or non-surgical treatments for improving pain and loss of function.
Professor Roos is an internationally leading researcher and change agent in the field of musculoskeletal health. She has been able to both produce high-impact clinical research and translate that research into clinical tools that are easily and effectively implemented in hospitals, primary care clinics and even community settings in municipalities. She has also served as an expert on clinical guideline committees for osteoarthritis (Sweden and Norway 2003, Sweden 2012, 2017--, Osteoarthritis Research Society International 2014, China 2017), knee osteoarthritis (Denmark 2012) and meniscus pathology (Denmark 2015), thereby impacting the delivery of clinical care in the Nordic countries and worldwide.
One of the principal outcomes from her research has been the development of the Good Life with osteoArthritis in Denmark (GLA:D®) project for people with knee and hip pain. The GLA:D® project is an outstanding example of how to successfully implement evidence-based clinical guidelines in primary health care practice and municipalities. Its underlying principles focus on patient education, patient empowerment, exercises and self-management. Since 2013, more than 1000 clinicians nationwide have been trained in delivering GLA:D® care to about 30,000 patients, who report remarkable improvements in health in terms of less pain, less disability, consumption of less pain medication, increase in physical activity, reduced sick leave and return to work (www.glaid.dk). The GLA:D® project now serves as a template for establishing similar initiatives in other countries including Canada (2015), Australia (2016) and China (2017).
Professor Roos’ research unit at University of Southern Denmark now has 20 members, attracting international recognition for its involvement in evidence-based medicine, development of patient-reported outcome measures and pioneering research in the field of joint injury, osteoarthritis and the role of surgery and exercise in treatment.
Professor Roos plays an active role in breaking down the barriers between disciplines and forging interdisciplinary teams to collaborate on addressing key research questions of common interest. She is open-minded and inclusive, welcoming the opportunity to work with other disciplines and professional groups - a trait not always found in academia – to ensure the highest standards and the best possible outcomes for people suffering from musculoskeletal disease. To this end, she has been integral to the creation of the new Center for Health in Muscles and Joints at the University of Southern Denmark, which aims to become the leading institution in Denmark for information exchange, interdisciplinary research and innovation in the domain of musculoskeletal health.
Professor Roos has published many articles in lay language targeting patients with osteoarthritis, often in collaboration with the Swedish and Danish Rheumatism Associations and she has made hundreds of appearances in printed and electronic media and TV. She takes every opportunity to increase political awareness of the impact of muscle and joint disease for the individual and the society and the proven benefits of physical activity for those with these conditions in Denmark and internationally, to raise its visibility through public debate, and to advocate for its recognition as a public health priority to offer treatment of muscle and joint disease equal to that of other chronic diseases including heart disease and diabetes.
In 2014, her contribution to public health was recognised when she won the OARSI (Osteoarthritis Research Society International) Clinical Research Award for her “outstanding work in exercise as prevention and treatment of joint pain, joint injury and osteoarthritis”. This is the first time this highly competitive award was given to someone other than a medical doctor and to a Danish researcher. In addition, in 2014, she was awarded the Queen Ingrid of Denmark’s prize for outstanding arthritis research by Queen Margrethe II of Denmark, and the Danish Rheumatism Association (Gigtforeningen).
Professor Roos is the author of 205 peer-reviewed publications. She has published in high impact journals such as the New England Journal of Medicine, the British Medical Journal and The Lancet. Her work has been cited in total 10952 times with 1 paper cited more than 1100 times and 23 additional papers cited more than 100 times. Her h-index is 54 (January 2018). She has supervised 21 PhD theses to completion with her students having professional backgrounds in medicine, physiotherapy, nursing and sports. Four of her PhD students have received awards and/or prestigious post-doctoral funding from the Swedish or Danish Medical Research Councils.
Her success in attracting project funding is testament to the value that funders place on her research. In total, she has attained over 27 million SEK, 10 million DKK, 0.6 million AUD, 0.8 million CAD, 0.9 million USD and 4.2 million Euro as applicant or co-applicant since 2005.
Read the full transcript below:
Karen Litzy: 00:00 My name is Karen Litzy. I'm a physio therapist. I'm based in New York City and I am so happy to be on the Third World Congress of Sports Physical Therapy Facebook page interviewing Professor Ewa Roos. And we are going to talk a little bit about her background and the GLA:D program and a sneak peek at what she's going to be speaking about at the Third World Congress, which is October 3rd through the fifth in Vancouver, Canada. So Professor Roos, thank you so much for taking the time out and joining us today on this Facebook live.
Ewa Roos: 00:44 Thank you. It's very exciting to meet you Karen.
Karen Litzy: 00:47 Yes. And for all of you who are on watching, if you have questions, we can see them. So feel free to put questions in as we get a little bit more into the conversation. But before we get to the meat of what our interview is about, can you talk a little bit more about yourself?
Ewa Roos: Okay. So what do you want to know?
Karen Litzy: Well, let's talk about how long you've been a physio therapist and kind of what led you into the work that you're doing now.
Ewa Roos: 01:16 Okay. So I've been a physiotherapist since I graduated back in 1981. So that's a really long time ago. And the reason why I moved into this area was because I was very much involved in sports. I went to a sports high school and I competed on the national team in my sport, which is something called orienteering when you're running in the forest with the use of a map and a compass. And I got an obvious injury and suddenly I couldn't run as much as I wanted to run. And I visited a number of sports medicine doctors and they actually can’t tell me either and that built up some frustration and eventually actually have surgery for these overuse injuries. That was not very smart either. So that really sparked my interest and then my career. And then getting a degree in physical therapy was the fastest way of getting to work with what I wanted to work with Sports medicine.
Karen Litzy: 02:21 And what took you from that, from getting your degree to where you are now? Professor, researcher.
Ewa Roos: 02:28 When I think back I realized that I had aspirations of becoming a researcher already as a kid. I published my first paper back in the 80s. But it didn't really take off until I found a very good supervisor in the mid nineties and that's good advice, I think. Find yourself a good supervisor.
Karen Litzy: 02:57 And so you’ve been conducting research in that since the 80s. And can you tell everyone where you currently are working?
Ewa Roos: 03:05 So I'm working at University of Southern Denmark.
Karen Litzy: 03:09 And that takes me into the GLA:D program. So before we start talking more about it, can you let the listeners know what does GLA:D stand for?
Ewa Roos: 03:22 So GLA:D stands for good life with osteoarthritis in Denmark.
Karen Litzy: 03:26 And when did this program start?
Ewa Roos: 03:30 So I think I would like to start by saying that while I am a researcher, GLA:D is not really a research because GLA:D came out of the frustration I felt knowing about all the evidence that was out there and sitting on clinical guideline committees in Sweden, Norway, Denmark, China and globally. And we could see that all guideline committees, they're recommended patient education, exercise and weight loss if you were overweight as first line treatment for osteoarthritis. And there were lots of money spent on these clinical guidelines, but nothing changed in clinical practice because of these guidelines. So GLA:D actually came out of pure frustration and we realized that something needs to be done to help clinicians implement these clinical guidelines into their practice. That was the beginning of the GLA:D program and that was in 2013.
Karen Litzy: 04:41 Okay, so it's yourself, Soren Skou. Yes, I pronounced that correctly.
Ewa Roos: 04:48 Soren Skou was my PhD student at that time. And Soren is a very young, smart, energetic young man and the combination of the two of us was really good to make things happen.
Karen Litzy: 05:05 Okay. So before we get into, and we'll talk about some of the discussions on social media regarding the GLA:D program in a little bit, but before we get into that, can you talk a little bit more about what is involved in the program and how it works?
Ewa Roos: 05:23 Okay, so the whole aim is really to improve quality of care for patients with osteoarthritis and to do so we use three components. The first is that we educate clinicians in Denmark, it's mostly physiotherapist. It could basically also be other clinicians who have the sufficient background and knowledge about osteoarthritis and knowledge about exercise as treatment. So we have a two day course to educate about osteoarthritis and about delivery of exercises. That's the first component. The second component is then what these clinicians deliver in the clinical practice. So that is patient education and exercise therapy, which is group based and supervised by a clinician built on evidence. And the third very important component is that we evaluate the outcomes with an electronic registry. But I would again like to point out that this is not per se a research project because this is uncontrolled and this is real life. This is what happens across a nation.
Karen Litzy: 06:46 I think it's important to note that this is not like a randomized controlled trial, you’re collecting the data that you are finding from clinicians, from actual patients sort of in the trenches so to speak.
Ewa Roos: 06:59 Yes. So if you run most controlled trial, everything is very much controlled. That's not the case when you do it in real life clinical practice, but GLA:D it's a minimum, it's a core package of patient education and a 12 exercise sessions. But as a clinician you're always the one who determine what your specific patient need. So you have to deliver the patient education and you have to deliver the exercise, but you are absolutely free to add whatever you think your patient may need. They may need manual therapy to improve the range of motion of the joint or something else. That is absolutely fine. You can also send them to a dietician if you think that would be beneficial for them, et cetera.
Karen Litzy: 07:53 And so sorry for that. We may hear horns and sirens because I'm in New York City, so I apologize everyone. So as far as the program is concerned, so it's not like a clinical practice guideline but rather a full program. So I guess my question is if clinical practice GLA:D guidelines weren't being followed, how do we know that the program is going to be something that's sustainable and followed? Do you know what I mean? Like if therapists were like I'm not following these clinical practice guidelines.
Ewa Roos: 08:31 So, I’m not really sure I understand your question. But, so I think that's probably why to be able to answer that or respond to that question I would say that it's basically that we can see that clinicians want to take the courses and we can see that they actually register patients in the registry and we can evaluate the outcome. And that's a very good way of measuring the quality of what's being delivered. We can see how many sessions they have attended, for example, and things like that.
Karen Litzy: 09:06 Yeah, yeah, exactly. So if I'm a clinician, so if I'm looking at it from the clinician standpoint, for me, it gives me some accountability. Right? So it's like, of course we're always accountable to our patients and should be to ourselves. But it's always good to know that you're being held accountable and being held to a certain standard for your patient in order to kind of be part of the program, if you will. And I think that's important because otherwise, I mean, human beings, right? We get lazy and we're not following things as best as we should. So I think that's an important component of the program.
Ewa Roos: 09:55 I would say that the longer we go on, the greater is the part that has to do with quality assurance.
Karen Litzy: 10:03 Absolutely. Yeah. And so, you know, let's get into some of these discussions on social media now that we have a better idea of what the program is, so some of the discussions are regarding whether the GLA:D program is superior to performing other forms of exercise. But what are your thoughts on this?
Ewa Roos: 10:24 Yeah. Okay. So when you do a research study, the primary outcome can be pain relief. And if you look at randomized control trials and if you look at the effect that you find from different exercise program, there are no studies showing that one type of exercise is superior to another program when it comes to pain relief. So when the neuro muscular exercise program that we used in GLA:D is being compared to other exercise program, we can say it's similarly effective, but it's not more effective than other exercise programs. But what is interesting is that we can see that when we deliver it in clinical practice, one of the thing is that we're able to teach it to physiotherapists with very different backgrounds. You know, we have taught more than thousand physiotherapists in Denmark and some of them are real musculoskeletal experts, but some are not.
Ewa Roos: 11:28 And just being able to teach a program to clinicians with very varying background that is in itself, something that requires a good framework for the program. I think. So that is one aspect and then we can see that we're actually able to have about 25% pain relief directly after program. So we can kind of duplicate the findings that we have in randomized controlled trials. But what I think is even more important is that we can maintain that improvement at one year. And that is something that we don't always see in randomized controlled trials actually. So in some regards it looks like we're doing better than in the randomized controlled trials. And this is not a research project. So I can't tell you why I can just say that the clinical findings are really good and encouraging because it looks like there must be some kind of a better understanding of the disease from the patient's perspective. And there are some indications that there are some lifestyle changes. One third for example, report that they have increased their physical activity level. We can see that one out of three stop taking painkillers and we can see that there is a lot less sick leave, especially among the knee OA patients at one year.
Karen Litzy: 12:58 And do you feel that, at least in Denmark, I'm assuming if a thousand therapists have gotten through this, this is a pretty recognized program in the country. So do you feel like patients have more buy in so to speak because it is a recognized program?
Ewa Roos: 13:17 That's a very interesting question. And my feeling is that there was more buy in from patients, from clinicians and from those referring to the program that is general practitioners and orthopedic surgeons. What the general practitioners tell me is that they really like to refer to program where they know the content of what is being delivered. They don't really like to refer to a physical therapy as a black box treatment that they don't really know what is going to be delivered. And I guess to some extent they may be right because there has been delivered passive treatments for which there is really no evidence in these patients.
Karen Litzy: 14:07 And the other thing that I find interesting about the program is that it's in a group setting. So you have a lot of people together in one group and I also wonder does that also foster, first of all, it's a nice sense of community, you have a support group. Again, accountability on the patients. If it makes them more accountable, they’re doing their exercises, right? And they've got the support.
Ewa Roos: 14:36 Yeah. You can see that when you go and audit the clinics that you can kind of see the interplay between the patients. And there was some kind of positive peer pressure, you know. And for example, we do some exercises on the floor very deliberately and there may be older patients who come in and say, I cannot get down on the floor because I haven't been on the floor for the last 10 years. You know? And the physio can say, well that's fine, you don't have to, you know. But after a few sessions, that person will be on the floor, not with the help of the physio, but inspired by the other patients and as some kind of side effect, you know, they're also learn how to get up with the help of a chair and they get less fear of falling because they know they can get up again.
Karen Litzy: 15:22 Right. And I look at that as such a positive for the program, but also for the patient, the individual patient, because then they're more likely to do the exercises. I’m sure part of it is they're doing exercises on their own. I would assume it's not just twice a week or however many times a week you're coming into the program.
Ewa Roos: 15:44 So what we told them actually is that this is twice a week. And we do not require them to do anything at home if they want to, sure they can do it. But there is no requirement of home exercises. And I think that makes it maybe, but this is pure speculation, a better experience because you feel sure if you're more secure about what you do, you have someone to hold your hand because it's painful to start exercising when you have osteoarthritis and you ask your body to do things you haven't done for a long time. And many people get anxious if they should exercise at home and they also feel bad conscience if they don't do it. So actually I think it seems to be a better experience to tell people do this twice a week. We know it will be better if I did it three times a week. But we also know that for most people it's not possible to squeeze that into their daily life. So it's a very pragmatic decision to say twice a week because that is what most people can do. It's not the best, but it is pragmatic.
Karen Litzy: 16:55 And do you find that your class attendance is always very high? Meaning are there a lot of dropouts?
Ewa Roos: 17:04 Yeah. So if we look at the last annual report that I have access to was from 2017 we are about cleaning of the data for 2018 but that was nearly about 30,000 patients. And we can see that eight out of 10 patients have completed at least 10 supervised sessions. That is very good, I think.
Karen Litzy: 17:27 Very good. Yeah. Because you know, people always say exercises are great, but if you’re not going to do it it’s not going to make any bit of a change. Now is there anything else about the GLA:D program that you'd like to talk about and let everyone know about before we talked more about what you're going to be speaking about at the conference?
Ewa Roos: 17:53 So I think it's important to say that the GLA:D program would not be the success it is if it didn't have the buy in from the clinicians and that the clinicians wouldn't feel that it really supports their clinical practice. And because it's the clinicians who take ownership of the program and it's them who kind of market it in their local areas, it's them who inform the general practitioners. So GLA:D is really more of a grass root movement or bottom up initiative or whatever you would like to call it. We actually had no, or very, very little funding to get this whole thing started. We actually only had funding to set up an electronic registry. That was it. The rest was just pure frustration, hard work and wonderful support by all the clinicians who have embarked on this and they feel that it really eases their daily practice and it has also made it possible for them to attract new patients. So it's actually been a good business for them in that sense.
Karen Litzy: 19:06 Yeah, and I also liked that you mentioned earlier that if you've got a patient taking part in the GLA:D program, that it doesn't mean that you're not perhaps seeing them for one on one therapy as well.
Ewa Roos: 19:19 So GLA:D, it's a framework, you know, and there are some core things that you have to deliver, but if you would like to deliver extra things on that because you are the clinician, you're the only one that knows the patient. I think that's really, really important to stress. And I think this pragmatic approach and this flexible approach is part of the success. And that may come because we have all worked for very long in the clinic and know what it's like to be in the clinic and we know that it needs to work. So for example, if it was a research project, we also do functional tests. Like we look at walking speed and chair stands just for example. And if you did that in a research project, you would do three attempt, you know, but we don't do that. We only do one attempt because that is what you can do in clinical practice. So, we have tried to do everything in a way that we evaluate the outcome. We can check the quality, but we've done it with minimum resources on the therapist.
Karen Litzy: 20:38 And oftentimes that's what it's like when you're in a clinic.
Ewa Roos: 20:41 You need to make your ends meet during the daily work because else you won't do it.
Karen Litzy: 20:51 Exactly. Exactly. And I think it's also worth mentioning that the GLA:D program is not only in Denmark, it's also in let me see if I can remember Australia, China, Canada.
Ewa Roos: 21:07 Yes. This year in April, Switzerland will come on board. In November in New Zealand will come on board.
Karen Litzy: 21:16 Great. And the thing that I found really interesting is in China is that it's physicians who are running the program, their orthopedic surgeons, which is in your head, you think, well, that was interesting. It's competition, so to speak. But I think it's, I think that's great. And hopefully in other countries, hopefully you guys will expand in other countries in the near future as well. All right, so let's get to what you're going to be speaking about at the Third World Congress of sport physical therapy. So can you give us a little preview?
Ewa Roos: 21:55 Okay. So we haven't been talking much about research. We've been talking about implementing clinical guidelines in clinical practice. But I think I have been so fortunate that I actually grew up academic department of Orthopedics and that has put me in a position that I've had many close collaborations with orthopedic surgeons and we have across professions then been interested in surgery and exercise therapy as treatment for different kinds of problems, mostly knee problems. So, over the years I have been involved in randomized controlled trials where we have compared surgery to exercise for an acute ACL tear in the young active populations, for a meniscal tear in the middle aged population and for severe osteoarthritis in people that we have provided with nonsurgical treatment, comprehensive package and then randomized them to have a total knee replacement in addition or not. So I will talk about the outcomes of these trials and I will talk about how you as a clinician can use these results in a shared decision making with your patients.
Karen Litzy: 23:20 And I think that's so important, having that shared decision making, being honest with your patients and giving them all points of view so that they can then make the decision that’s best for them.
Ewa Roos: 23:31 Yes, because there are pros and cons with different treatment strategies and there is not one treatment strategy that fits all patients, but I think it's really good if patients can get informed so they're able to make a treatment decision that is right for them.
Karen Litzy: 23:52 Well I am definitely looking forward to that and you know, as we speak, I am seeing and a 12 year old girl who had an ACL tear with subsequent surgery, and I see a lot of ACL patients. So that is something that I always try and give, you know, all views so that they can make the best decision. And sometimes that involves being the quote unquote bad guy.
Ewa Roos: What do you mean by bad guy?
Karen Litzy: Well, not bad guy, but sometimes telling them things that they don't want to hear saying to the patient because you're trying to give them all points of view and sometimes patients don't want to see all points of view. I think oftentimes, and this has been my experience with patients is they want to hear the point of view that is going to confirm what they've already decided without hearing all the points of view
Ewa Roos: Confirmation bias.
Karen Litzy: Right. And so sometimes you have to if you want to be open and honest with your patient and give them all of the information that they can take with them to make that decision. Sometimes you have to tell them things that maybe they're not wanting to accept.
Ewa Roos: 25:15 It would be very beneficial if we could develop educational packages or educational tools for young patients as well. Just as we have for osteoarthritis patients. That will be really beneficial. But it's a hard nut to crack because when you're young, you think you're invincible and your perspective is not very long. You want things to happen here now or yesterday would have been even better.
Karen Litzy: 25:43 Well, I'm definitely looking forward to that because I'm always looking for better ways to communicate with my patients and really to be able to give them all of the information they need. So I am definitely looking forward to your talk. And we've got a couple of comments that I'll just read. All right. I am going to not say this person's name right, but Meredith Gosh, I hope I said that correctly. She said, your work is incredible. Your work is incredible. You truly make the world a better place. So proud to know you. Hope to see you soon.
Karen Litzy: 26:47 And then another one from Jay F Esqulare who is part of the world Congress, said you're a pioneer in the world of physio therapy, knee injuries, osteoarthritis and rehab programs such as GLA:D, so amazing to have you at SPC 2019. So, hopefully, everyone who is listening will now be a little bit more curious. Will want to come to Vancouver to listen to your great talk. So again, it's Vancouver October 3rd through the fifth of this year, 2019 in Vancouver. All the information is right here on the Facebook page. So you can go and click on the link on the Facebook page and we'll even put it underneath this video. And if it's okay with Professor Roos, we can also maybe put some links to the GLA:D program as well.
Ewa Roos: 27:50 You can link to GLA:D Canada and GLA:D Australia and you will find information in English. That might also be a good thing.
Karen Litzy: 27:57 Awesome. Yeah, that would probably be great, we're going to be in Canada even better. So in English.
Ewa Roos: 28:03 If you link to GLA:D Switzerland, you will also get information in French, German, and Italian.
Karen Litzy: 28:10 Awesome. So we've got a lot of languages covered there which is wonderful. So Professor Roos thank you so much for taking the time out of your day today and coming on, and I look forward to seeing you in Vancouver in a couple of months.
Ewa Roos: 28:24 Nice talking to you Karen.
Karen Litzy: 28:27 Thanks so much. Bye everybody. Thanks so much for coming on and we'll see you in a couple of weeks with another interview.
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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Robin Meyers on the show to discuss fear. Robin Joy Meyers is an international speaker, fear strategist, molecular geneticist and radio show host. She educates and empowers women who are thought leaders, executives and entrepreneurs. Robin specializes in implementing strategies to harness the positive power of fear to their advantage through executive coaching, workshops, and speaking engagements.
In this episode, we discuss:
-The science behind the fear response
-Why self-awareness is key to harnessing the power of fear
-Recognizing the positive and negative side of fear
-How Robin transitioned her career throughout different periods in her life
-And so much more!
Resources:
Robin Meyers Website
Robin Meyers Instagram
Robin Meyers Twitter
Robin Meyers Facebook
Robin Meyers LinkedIn
For more information on Robin:
Robin Joy Meyers is an international speaker, fear strategist and molecular geneticist.
She founded Navigate2Empower to educate and empower women who are thought leaders, executives and entrepreneurs, on how to harness the positive power of fear to their advantage. Robin specializes in implementing strategies for self-awareness, mindset and leadership through executive coaching, workshops, and speaking engagements.
As a molecular geneticist, Robin discovered the TUB36 gene, a gene that affects the wing formation of fruit flies. She is also the host of the popular radio show, Activate Bold Choices, and is best-selling author of “Alone but Not Lonely” and “The Art of Unlearning.”
Read the full transcript below:
Karen Litzy: 00:01 Hey Robin, welcome to the podcast. I am happy to have you on. All right, so we've got a lot to talk about here. Just given your bio, we've got a lot to dive into. So the first thing I am so curious about is what is a molecular geneticist and how did you get into that field?
Robin Meyers: Yeah, I have an eclectic background. I know I got into molecular genetics actually really because I didn't get into med school. I thought I was going to go to med school and I didn't get accepted in the states. And of course my parents were like, you're not going out of the country. I was like, okay. Although now looking back could have been fun. So I went to, I got accepted into Case Western reserve in Cleveland, Ohio and sounded like a great program. So I went and became a molecular geneticist down the road.
Karen Litzy: And what does a molecular geneticists do exactly?
Robin Meyers: You spend quite a lot of time in the lab. I actually was in a lab working with fruit flies. So in a lab with a lot of fruit flies, killed many of them a lot on research. So I was on research specifically looking for genes that had to do with flight.
Robin Meyers: 01:34 So lots of DNA work and I'm not talking about, I'm talking old school, so now I'm going to date myself. Old school, 1986 to 89 where you know, the DNA plates were big glass plates that had to be poured. That was the hardest part I think.
Karen Litzy: I mean it's pretty amazing because now you know, we hear a lot in the news about women in stem, science, technology, education, medicine. So we hear a lot about women in stem and how the push is to get more women involved in these professions. So you were involved in this profession in a time where I have to think there weren't a lot of women there.
Robin Meyers: Well interestingly enough, I never really put that together until recently in my life that maybe I was a pioneer. I don't know.
Robin Meyers: 02:34 I was too shy and quiet then to even think about that. But, it's true. There really weren't, and it was really on the forefront because when I graduated it was just the beginning of the human genome project and all of the human genetics. You know, my first job was with the French Anderson Group who was part of that genome project. And one of my companies that I started working for was the first DNA purification columns, like the disposable kind. And it really was on the forefront. So kinda cool.
Karen Litzy: No, I think it's amazing. I think that this is the coolest thing. And, and when I was reading through your bio, I feel like, so just for context, Robin and I have known each other for well over a year now, right? Maybe year and a half, two years, I'm not quite sure. But I remember reading her bio thinking, well, I didn't know any of this.
Karen Litzy: 03:28 I didn’t know you discovered a gene. I did not know any of this. And I just think it's like so cool that here you were and I will say a pioneer in the fields of stem. And I just wanted to highlight that for people so that, you know, they know that you’re coming from this sort of, I would think analytical data driven background.
Robin Meyers: I really am actually, you know, and it's funny how for me as I developed, I always thought of my science and my master's degree was kind of just a stepping stone into whatever that next step was of my life. But dots do connect, you know, and when you start to own it, you do see these patterns. I did, I discovered a gene. And it's funny, it wasn't until recently, even in the salon when it was like you did what?
Robin Meyers: 04:25 And the ironic part is the gene, it's still called TUB36 because it's on the chromosome region of 36 in fruit flies has to deal with the wing formation, for fight or flight for flying like dystrophy and working with fear and that whole concept, it's like, it's just kind of weird and ironic and exciting and just interesting.
Karen Litzy: Yeah, it's really interesting. And so let's get into now this other part of your life and your career, which is a fear strategist. So the same question as what is the molecular geneticist I have for what the heck is a fear of strategist.
Robin Meyers: So I've taken over owning fear strategy because, you know, I became a coach, you know, after I left my graduate degree and became a wife and a mother and went through that phase of my life, and other jobs, I really started to figure out who I was and finding my own voice and dealing with my own fears and things like that.
Robin Meyers: 05:38 And so I worked with women giving themselves permission to look outside the box and working in transitions really. And so I've been every kind of transitional kind of coach to life strategists. And when it comes down to it, as I've owned the molecular genetic side and the science of fear, I was like, I'm a fear strategist. Like really what it is, is being able to understand that fear is real. And I think that's really where my message is right now. Like, if I can get the world to understand the science of fear, that it's not just this thing that should stop us in our tracks. Yes, it's limiting beliefs, but we can work through that. And I think when people hear the science of it and realize that it does work to our advantage, it creates a whole different conversation in this world.
Robin Meyers: 06:35 So it makes people stop and say, what is that? Instead of like, you're just another coach. But there is the science. So it kind of for me kind of stirs up the science and to be able to say, let me tell you, let me explain my science background to you.
Karen Litzy: Yeah. So let's talk about the science of fear. So what is it about fear? What happens with them? I'm assuming that's what happens within our bodies, when we have that feeling of fear. So could you tell the listeners a little bit more, give us a background on what is the science.
Robin Meyers: Okay. So it's totally fascinating. So the science is, you know, our brains so anyone in science will understand this, that you know, our brain is the most complicated organ in our body. Our emotions basically are lit up from different regions of our brains working together in combination and lighting up and igniting. The fear response is in combination of five areas that light up.
Robin Meyers: 07:41 And that's the amygdala, the sensory cortex, the Thalamus, the hypothalamus and hippocampus, all those areas. When a fear response comes they have to work together to produce that next step for the fear. Now the interesting thing is as all of that coordinates together, the Amygdala, which is like the size of a cashew, not only decodes your emotions, but it stores the imprint of every fear of every response from pre verbal stages throughout your entire life. Like every single thing, if you think of it like a tattoo, like you keep getting a tattoo with every single thing every fall, every emotion, every emotion associated with fear is another tattoo. And I don't think people actually realize, it's almost like if you could kind of tell me all about your life and actions that have happened. And I could sit there with a stamp, an ink pad, and just stamp a piece of paper and like you could physically see how many imprints you have.
Robin Meyers: 08:53 It's fascinating because not only do imprints start storing prior to you even realizing it, and that's more so because our parents impose their imprints of fear on us, but every little thing for the good and the bed. So there's a whole pattern of evolution that happens.
Karen Litzy: First of all, I love the metaphor of the tattoo imprinting in the Amygdala. I love that. I'm going to start using that with patients who have chronic and persisting pain. I love it. Thank you. And it takes me back to, you know, as you know, Robin, I have a long history with chronic pain and a lot of that was centered. What kind of made the pain worse or prolonged would be fear avoidance behaviors. So I can't do that. It's going to hurt my neck. I don't want to do that it's going to hurt my neck.
Karen Litzy: 09:55 I can't sleep. It's going to hurt my neck. So now I look back and think of that day when that pain first happened, I woke up and couldn't get out of bed. So much pain. And the thing that I guess I didn't connect until right now was how fearful I was. How fearful I was laying in bed not being able to move. So can you imagine the size of that Tattoo in my amygdala?
Robin Meyers: Yeah, exactly. Exactly. So the idea is to take it one step further is to realize what those imprints are and remove the ones that aren't serving you. And you know, that's easier said than done. It's not easy. No, no, no. I'm not saying any of this is easy, but there's some that have been imposed that you really can't put your finger on it.
Robin Meyers: 10:52 Right? And then there's some that you've had an accident or something that you can put your finger on it, but it's not serving you. And then there's some deeper wounds that you really have to work through. But if you can start removing the ones that totally aren't serving you and actually work through it so it makes you the more you've worked through it. What I find with my clients, with myself, just people I deal with, it makes you live much more presently and actively and it takes courage. I always say it’s actively moving through the action with the conscious courageous presence because you have to be present and it is, it takes a lot of courage, no doubt.
Karen Litzy: And how do you start working through some of these things? Like can you give the listeners, I don't know, one or two tips or exercises that they might be able to start doing today if they realize they have a fear that might be holding them back.
Robin Meyers: 11:54 So the biggest thing really is self awareness. It's really taking the time for you to understand who are you and just you forget kind of the noise of what your responsibilities are. If you've got, you know, spouse, dog, kids, whatever stage of life you're in and everyone has a different stage. So, and just to tell your listeners I had three kids and now 22, 24, 27. So I've been through a lot. Trust me. So I get it all. But whatever stage you're at, I only say build in five minutes every morning just to be in your own thoughts. And ask yourself, what do you need? You know, it really does come down to self awareness and saying, these are my non negotiables for me only for me. And you're going to find that you become very aware of people that work in your life, things that work in your life, conversations and what's acceptable.
Robin Meyers: 12:57 Once you start doing that, you're able to kind of start peeling away and going after things that have held you back. You know, the other side of this conversation is that our brain, as brilliant as it is and everyone's brain is, is great at keeping us in the patterns that it's been given. So a lot of that is reprogramming and there's ways to actually get into your subconscious and reprogram. But it is reprogramming. So it's baby steps and sometimes it's two steps forward and three steps back. And it's being very gentle with yourself and not beating yourself up and saying, okay, tomorrow's another day, but it's just breaking into a new pattern.
Karen Litzy: And those patterns I agree in the brain can be so deeply set, deeply set from childhood into adolescence, into adulthood. Like you said, whenever a stage in life that you're in.
Karen Litzy: 14:01 And you know, again, I go back to this population of people with pain, which is a huge population across the world. It's a $1 billion industry and that's just back pain, forget about every other kind of pain. So I think being able to work with someone to maybe tap into some of these patterns that we have developed, I think can really help people perhaps make sense of some of their pain, help overcome some aspects of that pain. I can say anecdotally from myself, so an n of one that being able to do that for myself was really helpful, I felt was for me the next step that needed to happen.
Robin Meyers: I totally agree with you. It's sometimes like those patterns of talking yourself like, but if I get out of bed I might hurt. But if you don't get out of bed and you don't try, will you hurt? What is that risk?
Karen Litzy: 15:13 Looking at the risk reward there. Right, right.
Robin Meyers: I'll go back to a story if you don't mind. When I was 11, I think I was 11 I used to ride horses. I don't even know if I was good at it, but I used to ride horses. I had a really bad accident and I broke my back in three places. I ended up being fine. Actually it ended up being a blessing in disguise because I had a horrible scoliosis that they discovered. But I was in a back brace and possible surgeries and you know, initially it was like, is she going to walk? And things like that. It was a nine month recovery, but, and I was 11, so I think it, as much as it affected me, my parents really obviously dealt with it.
Robin Meyers: 16:01 Fast forward to my daughter being 10 years old and we lived in the countryside of outside of DC in Virginia where horses are Galore. She wanted to ride horses. I actually didn't think twice about it. It was a local farm. It was around the corner. I would take her, I would watch got her all the safety equipment. My father happened to call me, my mom had already died and my father had called me and didn't call me often. And instead of like, hi, how are you today? He just ripped into me. He just, you know, his, the first thing out of his mouth was, I'm so disappointed. Are you stupid? And I was like, oh well those are triggers to my childhood. Hello father. But when I sat, now when I process it, I understand in a way where he was coming from and I said, she's fine.
Robin Meyers: 16:53 I had an accident and I understand your thoughts. So for me, I honestly had to make a conscious decision to say, I could have easily said, you're not going to ride because I had this accident and I'm afraid for you versus processing. Listen, it was an accident. Logically it was an accident. I'm going to be there. We have all the possible safety stuff. Is there a possibility of an accident? Yes. Is there the probability? I don't know, but why am I going to not let you try something because of what happened to me. So that's an easy imprint to get rid of. Right. But it's just an example of making a real conscious choice to say, I'm going to cut that cord right there and not let that pass on. Because if I let it pass on, then she at some stage in her life would either say, I've always wanted to do this and I'm going to try it, or I'm never going to try it, but I wanted to do this.
Karen Litzy: 17:57 Yeah. And you are able to kind of change that imprint. You cut that fear, but your father couldn't.
Robin Meyers: No, he couldn't. He was furious. Oh, he was so mad. And that's coming probably for him of a place of fear.
Karen Litzy: Right. I'm sure when that accident happened to you, your parents must have been beyond scared.
Robin Meyers: I'm sure. I'm sure. And for them, you know, they obviously had to drive to every doctor's appointment and all of that and every ounce of pain I felt probably was as bad, if not worse for them. Right. As a parent. So. Sure. So I get it.
Karen Litzy: Yeah. Yeah, I get that as well. And I think that's a really great example for the listeners of how you can start to change these imprints or tattoos that have taken hold in your brain to allow you to move forward in the PT World.
Karen Litzy: 18:55 And this is probably in more worlds than PT, but we call that graded exposure to activity. So for instance, for me, I'll give an example. I felt I couldn't carry anything because it would hurt my neck. So I carried nothing around New York City, a place where you have to walk everywhere and groceries and things. I was like, I can't carry anything. So I always get everything delivered until, until the one day. I spoke with a physical therapist from Australia, David Butler, and he said, well, why don't you just go to the grocery store and put like, I don't know, a loaf of bread and a bag of snacks in it would be so light and just carry it home and see what happens. Right. And so that's what I did and I got home. I was like, okay, that felt pretty good.
Karen Litzy: 19:49 And then each time I went I would add one or two more things to the bag. So gradually exposing myself to the activity that I was fearful of doing. Until now I can carry, I'm like a pack mule, you know, running around New York City. But if he had not encouraged me and helped me to see that I was doing a disservice to myself through fear, I don't know where I would be today. And I'm assuming that's what the kind of work that you do with your clients is helping them to see the fears that are holding them back.
Robin Meyers: Right, absolutely. So I try and work with everyone to see, to acknowledge what it is. And you have to acknowledge it, right? I mean it's something, but once you peel back that layer of it, is it logical or illogical?
Robin Meyers: 20:46 Did something happen or did something not happen? And then what is the origin of it? And, with the groceries, how do you start working through it? Because when you become more present and you start learning about you and like using you as an example, right? You learned that you are stronger than you thought, it didn't hurt and now instead of holding yourself back. So you did move through it and you actively were aware of your surroundings and how you felt. There's actually a genetic disorder called Urbach-Wiethe disease, and it's a mutation where people cannot feel fear. It's very rare. It's like 400 people in the world or something and its parts. It's not just in the Amygdala, it's parts of certain regions of that combination of the brain. I don't know the other regions, but like that harden and kind of waste away.
Robin Meyers: 21:50 But now that wouldn't work to your advantage. Right. I mean you want to have that element of awareness and I think that's what fear needs to be looked at like a positive awareness of listening to yourself.
Karen Litzy: Yeah. And I think oftentimes when you're coming from a place of fear, you're in it so to speak, it's really hard to acknowledge that because do people feel like acknowledging that is acknowledging a weakness that they might have?
Robin Meyers: Exactly. And that's where the conversation needs to shift. Because I think when people realize that the science of fear exists, like the diagnosis is, it's not if you have it or not. Everybody has fear. Right. So if we want to talk like, you know, as practitioners, the diagnosis is you have it. The prescription is you have a choice on how you react to it.
Karen Litzy: Yeah, for sure. You definitely have it. We all have fear and how that fear manifests itself. Now in the beginning you said it could be good or bad. So how could fear be good? Cause I think we always associate with fear being bad.
Robin Meyers: Right? And that's what has to change. That's the conversation that needs to shift because I think there's an element of fear that's good. I really do. I think it needs to work to your advantage. You know, I honestly think that it makes you stop and think.
Robin Meyers: 23:29 Now again, there's different levels of people's fears, right? So I don't think in an half hour or an hour we're going to be able to like solve the world's problems. It's good because it makes you actively move through the action of fear. So if you can take that imprint in that tattoo and look at it and say, answer the question, what is it? Identify what is it? Why am I afraid of this? Why? Why is this going to hold me back logically? Why is this going to hold me back.
Karen Litzy: Logically? See but that's the hard part. When you have fear, it's hard to get that logic, right?
Robin Meyers: And that's the whole part though of almost, you have to reverse the brain, your brain function and trick your own brain because your brain is going to keep you set in that fear based negative side. But we need to do is switch that whole paradigm to the positive side.
Robin Meyers: 24:36 So I was at a course for a workshop that I did and I was one of the facilitators and the last part was this trapeze for some reason I don't like heights, I've never fallen, but just not my thing. Like I'm not going to jump out of an airplane anytime that like it's not enjoyable for me. I don't ever see doing that. But this trapeze, and this was like a pretty rustic course by the way, climb up this 40 foot tree that had the little pegs in it. Yeah, turn around on a very small perch and jump, you know, like four feet out to catch the trapeze bar. I sat there for a while looking at it as most of the people were going and I'm like, I think I'm good for the day. And then I'm like, you really got to go do it. Like why not now? You're totally harnessed in right. So logically I'm harnessed. There's no reason why I shouldn't, my body on the other hand is like, I'm shaking like a leaf. I know I can't get hurt.
Robin Meyers: 25:42 Just do it. Like you have to trust yourself to just go do it. I ended up climbing up this tree. Of course when you get up to the top of the perch, I was turned around and hugging the tree. Yeah, I could see that. Yeah. Yeah. And like the guy below is like, okay, turn around. And I was like, yeah, give me a second. I'll be there in a moment and you know, go to the edge. Then they're like, just jump. And I was like, Eh, okay. You know, and you'd have to pause. But again, it's that logic and your brain playing games with you. But again, I'm standing in a harness where I know I'm not going to do a face plant onto the ground. So I took a deep breath, right. And eventually walk to the edge and put my arms in front.
Robin Meyers: 26:31 I actually caught the trapeze. Thank God that would have been embarrassing. But I trusted myself, you know, again, will I ever jump out of a plane. No. Cause that's not enjoyable to me.
Karen Litzy: Like there are limits to where you can push yourself. And if it's not like Marie Kondo says, if it's not going to bring you joy, then you don’t have to do it right.
Robin Meyers: But, I did it and it was a point, it was more proving to my own self that I could take that leap of trust. So that's where I think it's really getting in tune and in touch with yourself that you can understand fear working for you and not against you and really using it to move you forward in life. You know, I remember when I first started coaching, one of my first instructors said, when you're excited about something and you're fearful of something, like that's a great combination. And I've always really, it's always proven true to me and I've always believed it. Because it's kind of like not proceed with caution. It's just be aware. It's just that self awareness, you know, listen to yourself, trust yourself. But go for it.
Karen Litzy: And I think that's great advice. Listen, trust and go for it. Yeah. I mean, why not? Because what's the worst that can happen? You fail.
Karen Litzy: 28:07 And that's okay too. Right? Okay. I failed plenty of times. Oh my goodness. If you never failed in life, what have you been doing with yourself? Right. So I totally get that. And now, so you went from, like I said, molecular geneticist to fear strategist, coach. How did you make that transition? I think this is a great question because there are a lot of people who work in healthcare, very science based who are like, hmm, maybe I'm ready to make that leap, but I just have no idea what to do.
Robin Meyers: It's a great question. So my transition took many years and let me cut it short for everybody else in the world. So obviously I was younger and did my molecular genetics training and jobs, and then I took a stint of time to raise a family and then I went back into the workforce smaller jobs.
Robin Meyers: 29:18 I always taught. I ended up finding, I taught biology and stuff like that. So I kept my science going. I'm not into research in my later years, but I kept it going and then realized that I never really gave myself permission to be me and to use my voice and my strengths. And so that's when I started to kind of look towards the coaching program. And especially working with professionals and women professionals. I think overall, but all professionals allowing themselves to think outside the box. And in saying that, you know, and this comes down to the whole fear thing, we're always told that you know, you're either left sided, your brains left side or right side, right, were dominant in one side or the other. So I really don't believe that. I feel like when you give yourself permission to really learn who you are, there's a great synergy that can happen and you can combine both sides of your brain and that's when you really start listening to yourself.
Robin Meyers: 30:29 So, even if you're in a science based world or something, you know, for me, my greatest strength right now is really connecting the dots back into the molecular genetics of fear and being able to bring a whole different angle and discussion and awareness, that I would not be able to. And I don't think many people can have the discussion that I'm having with it cause they just don't have that. So I think it's great to be able to combine your sciences and whatever creative side that you want to.
Karen Litzy: Yeah. So don't throw away the science part, use it, use it to your advantage, use everything you've learned to help others.
Robin Meyers: Absolutely. There are ways to connect the dots. And I mean, like you and I, you were saying, you know what, we've known each other a couple years and it wasn't until recently that I either admitted it or if you guys found out that I was a gene finder.
Karen Litzy: Now knowing that it makes so much more sense for what you do now.
Karen Litzy: 31:47 Now I'm like, oh, now I, yes, this makes perfect sense. It just comes back full circle as to that. I think the natural progression for you in your career and you know what was next for you. To me it all makes sense.
Robin Meyers: Yeah, it makes sense to me now too. It really is coming full circle. And I was actually just having a conversation. Someone's like, you know, you're kind of been in this business for several years now. And I'm like, actually I feel like I'm new. I almost feel like I've started over again just because I finally allowed myself to Mesh the worlds together. And that's what I would say is, you know, you don't have to stay science in the left brain and whatever the creative is the other side, you can mesh it and at whatever stage of life you're at, you know, if there's something that really excites you in that other world, find the time.
Robin Meyers: 32:44 And even if it's once a month or once a week, you know, find something in that other element that you want to explore it.
Karen Litzy: Yeah, absolutely. Great Advice. And, now that takes me to the last question that I ask everyone, but I feel like you might've just answered it, but I'm going to ask it anyway. Knowing where you are now in your life and in your career, what advice would you give yourself as a new Grad, as the molecular geneticist fresh out of college and Grad School?
Robin Meyers: Well I was very much an introvert, so maybe be a little more outspoken. But to allow things to happen and not think that it had to be one way only. I walked that line, like if it wasn't going to be something, just molecular genetics, then I had to leave the field.
Robin Meyers: 33:43 You know what I mean? And I think if I knew what I know now, although again, it all works full circle, I would have realized like you can think outside the box and I think that's what makes us all unique and you know, whatever your background is, you're bringing a very special element to the conversation. So think outside the box. And that's where I would have said to myself, you know, don't stop being creative just because you're taking one path.
Karen Litzy: And, I think that's great advice for anyone, but especially for women in the stem profession. I think that's really great advice. And now where can people find more about you? And if they have any questions where are you?
Robin Meyers: The best way to find me is just to go to my website, which is www.robinjoymeyers.com. And from there you can get on my calendar.
Robin Meyers: 34:43 I'm always happy to set up a discovery call with anybody if you want to have just a chat for 40 minutes and you have questions, things about what I'm doing and where I'm traveling and busy speaking with the fearless women's summit right now, all over the US. And I'm taking a group only of 10 women to Italy in October for a retreat of giving yourself permission to be you. So yeah, just go to my website because that's the easiest way to find me.
Karen Litzy: Awesome. Well, that sounds pretty amazing and thank you so much for coming on and sharing all of this information on fear with myself and with the listeners, and I can tell you, I said I'm totally using that tattoo thing. I think that's brilliant. So thanks for that. I'll give you credit for sure. I will credit you for that. Thank you so much for coming on. I appreciate it.
Robin Meyers: Thanks, Karen. It's been a blast. Thank you.
Karen Litzy: And everyone out there. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Mark Merolli, Ann Green and Professor Catherine Dean. In this episode we discuss our upcoming focused symposium at the World Confederation for Physical Therapy Congress in Geneva Switzerland on Sunday May 12th at 4:00 PM. The title of our symposium is Education: Technology and Informatics.
In this episode, we discuss:
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The why behind our focused symposium.
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Current global entry standards for physiotherapy in relation to digital health technology and informatics.
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How technology affects the world of physiotherapy and are we preparing new graduates to meet those demands
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A sneak peek into the specifics of our talk.
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What we hope the symposium and discussions in Geneva will lead to.
_ And much more!
Resources:
WCPT Congress 2019
Professor Catherine Dean Twitter
Ann Green Twitter
Dr. Mark Merolli Twitter
For more information on Mark Meroli:
Dr. Merolli is Physiotherapist (musculoskeletal) and Certified Health Informatician. For many years now, he has been a leading voice on all matters technology in physiotherapy. He has global reputation for his expertise in digital health and informatics, which has led to his involvement and consultation on this area across several WCPT and member organization events and initiatives. He has presented on digital health at several recent APA, and WCPT conferences, run workshops, written articles for member magazines, and been interviewed on podcasts to discuss these areas. His research interests include how technology is engaging patients to be more active participants in their own health management and how we can ensure the digital preparedness of future health professionals.
For more information on Ann Green:
Ann Green MSc, FCSP, FHEA is Head of Life Sciences at Coventry University. Ann is a Fellow of the Chartered Society of Physiotherapy, awarded for her contribution to education, research and policy. Throughout her career Ann has worked in higher education and has developed physiotherapy programmes in the UK and internationally. She has been active within professional accreditation, physiotherapy educational policy and worked for the UK health regulator, the HCPC, in programme approval and international registration. Ann’s research outputs span 20 years with her earliest publication about admission and progression trends in undergraduate programmes and her recent publications relating to postgraduate physiotherapy education and the development of the individual, the profession and careers. She has been invited to speak internationally on advancing physiotherapy practice. Her current research with an international team, is on social media and its role in global physiotherapy professional networks. Ann is one of the co-founders of the Big Physio Survey, an open access resource which enables physiotherapists from across the world, to share case studies online, which forms a global repository to showcase our rich and diverse profession.
For more information on Catherine Dean:
Professor Catherine Dean is a physiotherapist with a full-time academic appointment with teaching research and administrative responsibilities. In 2011 Professor Dean moved to Macquarie University in a key appointment for the University’s expansion in health and medicine. She was appointed the inaugural Head of the Department of Health Professions and has established NSW’s first professional entry Doctor of Physiotherapy (DPT) degree. The Macquarie DPT includes advanced physiotherapy skills, business management, leadership, policy and advocacy units as well as completion of a research project. In 2014, she received the Executive Dean’s Service Award for engaging students and the community in establishing the Discipline of Physiotherapy and in 2015 led the DPT teaching team which was awarded the Faculty of Medicine and Health Sciences excellence in teaching award. In 2017, she was appointed Deputy Dean of The Faculty of Medicine and Health Sciences. Prior to her Macquarie University appointment, Professor Dean worked as an academic with teaching, administrative and research responsibilities at the University of Sydney for 20 years. Her research interests are developing and testing of rehabilitation strategies to increase activity and participation after stroke, translating evidence into practice and clinical education. She has published in leading journals such as Stroke, Archives of Physical Medicine and Rehabilitation and Pain. She has been awarded over $5.8 million in grants for research and education. Professor Catherine Dean’s research has changed physiotherapy practice in stroke rehabilitation. Professor Dean’s research findings have been integrated into national and international clinical practice guidelines, such as the NHMRC-approved Clinical Guidelines on the Management of Stroke and featured on the Canadian Stroke Network StrokeEngine site.
Read the full transcript below:
Karen Litzy: 00:01 Hello everyone and welcome to the podcast. I want to welcome Mark back onto the podcast and Anne and Catherine, welcome for the first time. I'm so happy to have you all on this episode. And for all the listeners, what we're going to be talking about is our focused symposium that is going to be taking place at WCPT in Geneva May 10th through the 13th for the WCPT meeting. And our symposium is education, technology and informatics, and it is Sunday, May 12th at 4:00. So if you are going to be in Geneva, you're going to want to come to this focused symposium. Now, this all sort of started with Mark, so I'm going to throw it to you first as to so you could tell the listeners why you wanted to even put this focused symposium together.
Mark Merolli: 00:58 Thanks for doing this again. And I'm actually really excited that actually got you on some part of this wider team, uh, to, to be part of this focusing posing in Geneva. And it's great to be on your podcast again. Uh, but you're right, when we last spoke on the podcast, we talked I think more broadly about just the impact that technology, the wider discipline of informatics is having on the physio profession, future trends, disrupters, et cetera. And I think obviously for no uncertain terms that work has continued and that impact continues to grow. But one of the things that, you know, obviously, are very near physio educator for some time now. And I think working in that space of, um, health informatics, um, digital health, uh, so, you know, the intersection of technology and healthcare, I think one of the things that's been really readily apparent to me for some time now is need.
Mark Merolli: 02:02 Um, and to ask ourselves the question as to where this all fits into the way we educate our future physical therapists, physiotherapists. So I thought when calls for abstracts came along and sessions for WCPT, that it would be very topical, um, for WCPT and the wider profession to embrace the idea of, you know, let, let's have a look at, at current ways we educate university students, um, in this space? Have a look at perhaps where technology features in what we teach, where it should feature, where it can feature. Um, and I was just really glad to see the WCPT thought this was equally worthy. Um, I'll debate, um, and put it up as a focus symposium for us. Uh, and the speakers on, on the symposium, the panel yourself, uh, your entrepreneurial self. Um, and, and Ann Green will have known for a very long time as a physio educator in the UK.
Mark Merolli: 03:04 Um, and Catherine, uh, over here in Australia as well, who's a very innovative forward thinking educator who's one of the few people I know who's pushed to this stuff for many, many years before this was really a debate. Uh, I thought you were all pretty much perfect, um, example of people that could help push this topic and discuss it. So that was the motivation from my end. Um, I think it's one thing for you and I to talk about technology in the profession but a very different but complimentary themes to talk about how this all fits in education. Um, cause I think in no uncertain terms, we either don't do it, um, we don't know how to do it or we do it quite ad hoc for the most part. Um, so it would be really, really nice to discuss at WCPT, we're hoping to get along as many people as possible as to how we might actually go forward with this and see informatics, technology, digital healthcare starts to become a more sort of interwoven thread in the way we're trying to future proof this profession. So I'm really looking forward to doing this with all of you. So thanks for, thanks for spreading the word for us I guess.
Karen Litzy: 04:18 Yeah, and I mean I'm really looking, I've learned so much just from listening to the three of you, so I can guarantee if you're in Geneva you are going to learn a lot with this focused symposium. So, Ann let me throw it to you now and can you give us a little snippet as to what your part of this symposium is going to focus on?
Ann Green: Okay. Well Hello Karen. I'm really pleased to be part of this podcast and join this panel. So as Mark said, it had been an educator for a long time. I've involved with a professional body in setting curriculum guidelines. I've involved with statutory bodies. Um, and I suppose that's the obvious point when, when you saw when you forming curriculum. So it was really interesting to have a look what the UK is doing and then have conversations with, with Catherine, Mark about Australia and yourself about at the U.S. and what we all found was that there are, are a few guidelines.
Ann Green: 05:19 And so I'm really interesting to discuss with everybody in the audience. Is that a good thing? Is that a liberating or should there be more guidelines? Um, I've previously been involved with Mark and do this research around social media and it's interesting that a number of guidelines appeared from all corners once physios became very active on social media. So it would be interesting to know, um, what we can learn from that. Uh, and whether it's professions, accrediting bodies, individuals we should be guiding or letting people freely develop and uh, and see what happens.
Karen Litzy: And do you feel like looking at those guidelines for social media, which like you said, I think we can all agree that probably most, uh, physical therapy governing bodies of countries around the world have some sort of guidance on social media that came way after people were using. So yes.
Karen Litzy: 06:21 So it's one of those kind of, are we asking for permission or asking for forgiveness and, and I think that's where guidelines around informatics can be kind of interesting because you want to know, are we asking for permission or are we doing things like wild west? It, that's a definitely a US thing. Um, uh, is it going to be like the wild west out there as more informatics and more technology get involved in the profession where then people have to ask for forgiveness for certain breaches of let's say privacy or things like that?
Ann Green: Yeah, I suppose, I think what we did learn from social media and the guidelines, the teeth essentially came round to good professional behavior. Um, uh, maybe mmm. Maybe in terms of going forward with how people are using technology, um, in health cat, it will perhaps be framed around, you know, the sort of common standards that we have for professional behavior, respecting patients, privacy, um, and um, and using evidence.
Karen Litzy: Yeah, absolutely. And now, Cath, can you talk a little bit more about what you're going to be sharing a in Geneva with this symposium?
Catherine Dean: 07:37 Oh yeah. Thanks Karen. I'm, hi, I'm Catherine. I'm, I'm an educator. For a long time in 2011, I changed university and I had the opportunity to develop a physio therapy program from scratch from a green field, which is a, I've never worked so hard in my life, but it's very exciting. Um, when I came to the knee university, I really wanted to ensure that our graduates, it was future proofed and future focus. So I knew I had to embrace technology and, and um, health informatics. I wasn't quite sure how to do it. Um, I was very fortunate to meet Mark at a conference who helped me out. And I really want to share at the conference a little bit about what I did, what worked and what didn't. Uh, um, the lessons I've learned it you learn a lot from the errors as you make and hopefully I can stop some other people making some of my errors. Um, but I'm really interested in what other people have done because there's still lots to solve. And how do we actually adequately prepared, um, the future professionals for practicing a ever increasing digital world. So be there Sunday, May 12th at 4:00 PM Geneva.
Karen Litzy: 08:45 And what, what do you feel like from your perspective and with the students that you've worked with in the past and are currently working with, what do you feel the biggest, I guess, barrier to, having these students be, whether it be, cause they seem to be proficient in technology, right? What is it that is maybe the biggest barrier about using this within the practice of physical therapy?
Catherine Dean: 09:14 I think it probably intersects a little bit with what Anne said. I think, well, they often proficient in using their technology. They perhaps don't understand the ramifications around privacy issues. Uh, and then I think some of the other issues is it's around professional behavior. Again, uh, your, your, your digital profile is, it is, it reflects the profession as well. So you need to think about, um, adequate oh, standards and provisional by, but I also think while they can be really good at technology and make flashy things, sometimes the content still misses the critical analytical skills that are needed. So, um, I, in some ways it's just another format for communicating and it has its own challenges about that. What you do communicate has to be accurate and evidence based.
Karen Litzy: 10:08 Yeah, for sure. And Mark Your, you know, your goal in putting this panel together is to really spark conversation and to get people interested in informatics. But one thing we didn't talk about in this podcast yet is, and it's a question I get every time I say, oh, I'm doing this focus symposium on informatics. It's what's informatics?
Mark Merolli: 10:32 We haven't had to refer people back to the other podcast episode. I don't remember look in no uncertain terms. When we talk about informatics, we're, we're really talking about information science, um, and is an essentially where technology plays a role in how we improve use of inflammation in healthcare. So, you know, we were covering everything from the way we collect health information, store it, uh, analyze it and then essentially put it into practice. It's about making healthcare safer, more efficient, more evidence based, you know, improving essentially the quality of health information using technology. If I can put it in a nutshell. Ready for if Karen, if I could probably just echo Cath sentiments. Really it's um, I agree 110% with what she said, but part of the other reason for having this topic and the symposium, I think yes, we are all passionate advocates but this is also an exercise in supporting, uh, our colleagues, uh, and the wider physio profession as well.
Mark Merolli: 11:33 Um, and much like implementing technology into practice, whether that be a small practice or a hospital. Um, you know, technology requires a big change management exercise. And one of the, you know, we were just talking about the barriers here. One of the barriers is also the confidence and the skillset and the that are actual educators and workforce clinical supervisors have to support this too. Um, so one of the things I'm very passionate about and part of the reason for getting the word out there here is that, you know, we actually need to consider the existing work force, the audience of this symposium, our colleagues, the other educators who are expected to teach these students these themes but may not also be all at 100% confident themselves. So I think that's probably one of the other barriers and considerations that I'd like to throw into the debate as well. Um, how we can support the existing workforce.
Karen Litzy: 12:30 And I think that's important. And I think part of what I guess I should say what I'm going to talk about during this symposium as well. Um, but, uh, I think what I'm going to be speaking of, I'm coming at this from a practice owner, from a practicing clinician. So I'm served, people are wondering what I'm doing on this panel of academics because I am not an academic. I'm not in, I'm not teaching in a university. Um, but I am coming at it from the point of view of the practice owner, the practicing physical, the practicing physical therapist and the point of view as someone who may be hiring these students as they come out of school and, and supervising the students. And so I think from a practice standpoint, I mean I'm really looking for, uh, graduates who at least bare minimum have an idea of what informatics are.
Karen Litzy: 13:30 Um, kind of what we use. Mark you just said, but I'm also looking at how can we use technology to make my practice run a little bit more smoothly. And that can be an electronic medical proficiency and electronic medical records, understanding how electronic medical records work and why they're there. Um, and again, the safety and privacy around that. And also using technology with my patients, whether that be an APP or a wearable, how it's like, yeah, anybody can use an app or a wearable, but to marks, uh, I think other passion, you know, big data sets and things like that. Yeah, anybody can do that. But then what do you do with the data you're collecting? It's got to go somewhere. You have to understand how to use that in order to help improve your patients' journey with you and also your practice as a whole.
Karen Litzy: 14:24 So that's kind of where I'm coming from. A little bit more of the, how can this all be applied in the real world with real patients and real businesses, whether that business be a large hospital, which is going to be way different than what I do. Um, and in some respects, large hospital systems maybe have better data collection. I don't know. I'm just throwing that out there cause they have more resources at their fingertips. So I would, I'm looking forward to are the people who are sitting in the audience to kind of get, Hey, this is what I use for my practice. So kind of sharing best practices amongst people from all over the world I think can really go a long way in supporting each other. Like you said, mark, kind of bringing it back full circle. Yup.
Mark Merolli: 15:07 They symposia are very collaborative and that's the whole point of these. Um, you know, we're, we're hoping to not talk too much, uh, outside of audience discussion. Uh, I think we're at a very unique opportunities to point with this topic. Uh, and I think that, you know, as a collective and WCPT has always been a great forum for that to really shape this debate. Um, and actually create some state of, of, you know, guidance going forward. I, and again, like Cath has said in, in our discussions a lot, um, guidance is one thing, but you know, creativities in hello. Um, we actually hope that some of the ideas come from the room and come from the session.
Karen Litzy: 15:48 And so let me ask you all the same question before we wrap things up here. And that is your pie in the sky view of this symposium. What would be the best outcome you can hope to achieve at the end of this two hour symposium? Right? Two hours. Yeah. Okay. So what would be your, your best outcome for this two hours symposium? So any one of you can kind of take it first?
Ann Green: Um, I'll, I'll go first. Okay, go ahead. Well, I'd like people to think that the time went really fast and they wish their discussion and debates could've gone on longer and that they will continue those debates at the conference and the each person we'll go back
Ann Green: 16:39 and say, I am going to get involved. I am going to effect change in my own region,
Ann Green: 16:45 in my own area with the people that I'm interacting with.
Karen LitzyL Awesome. Mark Cath. Either one want to,
Catherine Dean: 16:53 for me, I would like to connect with people who had some bright ideas they have tried and had success with and I'm really happy to to just have a network of academics that are really trying to work on this so you can actually have a kind of a community of practice where you can share your ideas and share what's gone worked well and what hasn't. And and um, look, they'll always be local contextual factors, but there's probably lots to share and, and, and some good ideas if we can get together in a, in a virtual environment. Yep.
Mark Merolli: 17:30 Yeah, it looks similar to me. I think what I'd love to say is very much the way that the whole social media landscape ramped up, um, on the back of WCPT congress is, I, I've loved after this congress, you know, educators far and wide start to actually talk about this stuff, starts to try and think of ways, um, to bring this into professional development and university curricula and that um, technology, digital healthcare informatics stays, you know, high on the, you know, WCPT annual member organization agenda. Um, and we sort of see it as a regular feature at conferences and et Cetera. So from this day forth, the type of thing.
Karen Litzy: 18:10 Yeah. And I think that's all great news. I would say I would hope to kind of meet other clinicians and practice owners who may be, can again collaborate and be the driver for a lot of the technology that we're seeing in every day use that can then be brought back to maybe local universities and to say to them, hey, listen, this is what we're seeing in practice. This is what needs to be taught to your students. And then see if we can have that collaboration between the academics and the clinicians, which I think is, is sorely lacking in our profession as a whole. That's just my opinion. Um, but I definitely feel like having great collaborations between the academics and the fulltime clinicians can just drive the practice forward in, in a way that will make us more innovative and creative and, and quite frankly, a happier profession. Um, so that would be my sort of pie in the sky view is to really get a lot of cross pollination between all of us
Karen Litzy: 19:21 So. All right, one more time. I'm going to thank Mark and thank Ann thank Cath for coming onto the podcast today and for being great partners, uh, in what will definitely be a really fun and interactive symposium. Again, it's edge, it's called education, technology and informatics and it's Sunday, May 12th at 4:00 PM, and that is at the WCPT conference in Geneva, Switzerland. So if you're there, come by, um, and sit down, share your thoughts, make sure you're coming. We want you to come armed with your thoughts on informatics, what you're doing, what worked, what didn't, so that we can have a really robust conversation within the room. So guys, thank you so much for coming on and I look forward to seeing all of you in, in real life,
Karen Litzy : 20:16 Geneva.
Karen Litzy: 20:21 Yes, bye bye. Thanks everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Jason Falvey on the show to discuss healthcare fake news. Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT. Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness.
In this episode, we discuss:
-The definition of fake news as it relates to healthcare and medical disinformation
-What Jason recommends you do when you encounter articles with a high comment to retweet ratio
-How you can avoid falling trap to your biases by crowdsourcing to interpretate literature
-The importance of seeking information not affirmation
-And so much more!
Resources:
NY Times Fight Fake News
Why Healthcare Professionals Should Speak Out Against False Beliefs
Jason Falvey Twitter
Jason Falvey Yale
Email: jason.falvey@yale.edu
The Outcomes Summit, use the discount code: LITZY
For more information on Jason:
Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT. He holds a bachelors degree in English, and a doctor of physical therapy degree from Husson University in Bangor, Maine and a PhD in Rehabilitation Science from the University of Colorado, Anschutz Medical Campus. He is also a board-certified geriatric clinical specialist. Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness. To date, Jason has authored or co-authored 18 peer reviewed papers in widely read rehabilitation journals.
Read the full transcript below:
Karen Litzy: 00:01 Hey Jason, welcome back to the podcast. I'm happy to have you back on even though we're not talking about what we usually talk about when you're on these podcasts and we have our specials with Sandy Hilton and Sarah Haag but I think this is still a really great topic and I'm happy to have you on to dive into it.
Jason Falvey: 00:24 It’s great to be back and I have been excited to present this topic for a couple of months. While it’s no sex podcast part five I think we can definitely got come up with some interesting points for the audience.
Karen Litzy: 00:37 Yeah, I think so too. And so everyone today we are talking about fake news as it relates to health care. Because I know a lot of you that are listening are in the healthcare world and if you're not, this is also a great way for you to kind of understand that everything that you read on social media isn't true gasp, right. So, Jason, let's talk about first, what in your opinion, is the definition of fake news as it relates to healthcare and let's say medical disinformation?
Jason Falvey: 01:19 Yeah, I like the term medical disinformation because fakes news is not nearly as common in medicine, you know, as far as the falsified information. But medical disinformation is much more common than people may realize. The context is most of the hundred shared articles of last year, over 50% of them are of poor evidence quality when experts have actually rated that. So when I talk about fake news and medical disinformation, I'm really kind of breaking it down to a handful of categories. So there's fake news that's rare, but it does happen that's false or completely inflammatory, you know, that is completely falsified data, or completely false claims that are created to either scare somebody into making different health care decisions or drive them towards a curative product that may be your marketing. So that’s not common, but that definitely is out there. I think the more common pieces of fake news and medical disinformation are hyperbolic and intentional.
Jason Falvey: 02:34 So the splashy headline that says Bacon Causes Cancer, you know, where people are putting that headline so it’s clicked on and read when the real story behind a lot of that evidence is substantially more nuanced. And then there's also hyperbolic and unintentional where a well meaning university employee publishes a press release on investigators article and misstates or over-interprets the conclusions to be much broader, more sweeping than they are suggesting that a drug cures cancer or Alzheimer when really it was affective in early stage studies for one particular protein in a mouse model. So those are the three definitions I tend to stick with, but really it's medical information that's not fully accurate, that’s shared widely and may influence healthcare decision making.
Karen Litzy: 03:32 When we talk about these flashy headlines and this medical disinformation whether intentional or unintentional, as healthcare professionals, sometimes we're responsible for sharing that. It's not just the lay public. Right. So when you look at these headlines and you read through let's say a press release, is that where it ends? Do you say to yourself, yeah, this sounds good. I'm going to share it.
Jason Falvey: 04:05 I think that should be the focus of what we talk about today and that is how do we as health care providers recognize fake news? How do we kind of avoid unintentionally sharing it and how do we avoid intentionally sharing it? So I think my guiding principle for all of these things, for any healthcare professional, it's Hippocratic oath, it's do no harm. And then health care beyond what we do with patients and beyond the hands on care that we provide sharing misinformation, whether intentionally or unintentionally has the potential to cause harm. Patients for going standard of care treatment and in lieu of an alternative medicine or unproven other therapy that may actually cause their health to decline, you know, or causing them to participate in a treatment that is unlikely to benefit them and causes harm both financially or time and potentially health care harm. So I think Hippocratic oath above all else should really drive our decision making and the impetus for why we should care about this. And the other guideline I use is I really want patients and providers both to be looking at social media and healthcare information that they're sharing and really make sure that they're seeking information, not affirmation. So they're seeking to broaden or challenge their pre held assumptions and not just share things, read things and kind of propagates a worldview that just affirms that are already firmly held biases to harm a patient.
Karen Litzy: 05:58 Okay. Yeah, but so you mean we can't cherry pick things to confirm our own biases to make ourselves look better? Is that what you're trying to say here?
Jason Falvey: 06:16 Yeah, that sounds like a terrible polarizing thing to say, but I'm really going to stand by that I think and just say I really don't think we should be cherry picking evidence and just sharing evidence that is fully supporting our world view. We may have a brand to keep, you know, I don't think I would widely share studies that I think are well done that maybe say physical therapy isn't as helpful as other things, but I certainly would acknowledge that they exist. I don't think I would market them heavily, but I certainly wouldn't ignore them or basically say that they're not accurate either. But I think we have to be really careful, especially when we're talking about vulnerable patient populations, thinking about patients with dementia or patients with cancer who are really hanging on hope that there's something medically that can be done that's outside of what's already been offered to them and kind of have a cure. And I think it's really important that we choose our language and we choose what we share, how we share, and the quality of what we share very carefully.
Karen Litzy: 07:29 Well, and you know, that goes back to do no harm. And I think goes back to being an ethical person because when you look at these vulnerable populations, like you said, the elderly people with possibly terminal diseases, people with chronic pain, these are people who are looking for things that they feel they have not gotten that will fix them. Right? And so that's where snake oil salesmen come in. That's where people sort of touting that they have this great flashy thing that isn't supported with evidence, but it sounds really, really good. And so how do we as healthcare professionals combat that without looking combative and turning off those people that we actually want to help?
Jason Falvey: 08:22 Yeah. How do we combat that information without unintentionally propagating it either. I think when we evaluate information, I think one of the things I really encourage is time, take time to think about the information, take time to research the primary source of that information. Take time to recognize if there is potentially both sides of an issue. So outside of things like, you know, vaccinations causing autism, which is a clearly manufactured result. If you follow back the evidence or if you go ahead and follow back evidence about infant chiropractic work. But I guess generally falsified or highly, highly, highly biased to the point where there really isn't a pro side, but a lot of medical things have a potential pro and con side. So I think it's important to recognize the nuance and carefully layout reasons one why you disagree with something and two the rationale methodologically, not just your opinion of kind of how you came to that conclusion.
Jason Falvey: 09:42 But I think you have to do that without validating what you think is a very poor quality or highly biased or dangerous source to share. If, for example, you saw a tweet about the harms of vaccination and it may be, it was for your older adult population getting the chicken pox vaccine and it caused them Alzheimer's, you know, caused them to get dementia. Let's say you just saw a story like that. Which is not true. How do you, you know, how do you combat that? Some people would just retweet it with a really dismissive comment, like this is garbage. Don't listen to them. Well then doing that, and I'm guilty of this in the past as well, we've actually unintentionally propagated that information. Right now I have not very many followers, so 2000 followers all of a sudden see that and potentially one more retweets it and then another 2000 people. So I unintentionally exposed 4,000 people. Even if I'm dismissing that information, I've lent it credibility by sharing yet.
Jason Falvey: 10:51 I think what I have to do is write something about the study, not actually link or validate in some way and not unintentionally spread fake news. And there's not an easy way to do that. So I think you really have to toe the line between not sharing the primary sources, potentially providing that provider of fake news, financial revenue from clicks, which is a lot of times what they want. Or providing a really misguided researcher, a clinician validation that their technique is not loved by the general medical population because they're jealous of his success, you know, something that they can take it the other way to spin it as a positive for their business.
Karen Litzy: 11:39 Right. And because if you're re tweeting this and clicking on it and retweeting it, you're giving it life, which is what they want. That's what we don't want to do.
Jason Falvey: 11:52 Right. And I think that's one of the ways that propaganda is designed right from the early days of using propaganda as a war tool. It was shared not just for people that believed in it heavily. It was shared in outrage and passed along and whispered about which served the exact same purpose. So really it's hard to discipline ourselves in a really, like we see something, we feel like we immediately have to react on social media and immediately have to comment on it. And I've been guilty of sharing articles that are either satire and actually taking them seriously, which has happened once in a fatigue non-caffeinated state. And also information or studies, which I think in hindsight probably weren't high quality or perhaps overstated its conclusions. My own articles have had overstated conclusions written and press releases that weren't by me or interpretation of written press releases that are perhaps more definitive than I would have wanted, you know, not fake news, but certainly unintentionally declarative about the quality and strength of the evidence versus, you know, the hypothesis generating evidence that it was.
Karen Litzy: 13:16 Yeah, absolutely. You sort of alluded to one way as healthcare providers that we can combat the fake news or the medical disinformation and that's taking time to read the source if it's a press release, to read the article, to maybe look at the methodology and to see how would rate this study? So that's one way we can combat it, which takes time. And like you said, on social media, people often react quickly because it's emotional. So maybe we need to take a deep breath and then take a moment and think about what we want to do. Do we want to share this misinformation or do we want to read it and come up with maybe another way to share more positive information? What else can we do as healthcare providers to get around this fake news?
Jason Falvey: 14:14 When we encounter something that we think is fake news or unintentionally or intentionally hyperbolic to the point where we think it's harmful to patients. And I think that's the line I draw. If I think that potentially sharing or engaging with this information in any way which propagate information that's harmful to patients. I generally take a little extra caution. And one of the things I look at, you know, I see in politically or in health care news, if I see a that goes out that has a really high comments or retweet ratio. So there's this term ratioed and it's not scientific and it's not peer reviewed. But I find that the good starting point when you see a tweet from a government official or a healthcare provider, healthcare related source, and there's more than double the amount of comments, then there is retweets and the likes.
Jason Falvey: 15:18 It makes me go and do a little bit more investigation. You know, sometimes those comments are positive and way to go. And sometimes there's a lot of skepticism or criticism of the findings or people really, you know, offering some real insight into some of the problems in methodologically or otherwise. And often a well done methodological study can be completely blown out of the water on Twitter by a very poorly written headlines. Right. We should care about storylines, not just headlines. And one of the ways we do that, looking at comments, retweets, and the likes, looking at that ratio and look at the source, right? Who's retweeting? And so I pay attention to that because most fake news on the Internet is actually propagated by bots. So there's a very high percentage of fake news that was propagated by automated accounts that are automatically set up to capture certain hashtags or certain language and amplify it.
Jason Falvey: 16:23 You know, if you're a political audience would know that that's how the Russians basically designed the misinformation campaign to influence the 2016 election using bots to amplify certain messages. Well, that happens to a lesser extent in health care. There are certain pockets, you know, of health care professionals, and there may be some in our profession that provide certain treatments. There may be some in other alternative medicine professions, there may be some in mainstream medical professions that are physicians or nurses who use their medical expertise and propagate information about medical techniques like abortion or vaccines in a way that makes them seem more credible. So I look at who's retweeting what the population of people are retweeting is, who the person the primary sources coming from. Right. You said if it's a summary of an article from a press release or somebody's blog, like I want to go and find that primary source and then also look at the bias of the person who may be interpreting that information for me if they're a credible source.
Karen Litzy: 17:40 Yeah. And I think you also want to keep in mind those hot button issues may have more misinformation about them. Like you said, vaccines, abortions, these are hot button issues, right? So you have to I think take a more examining eye to some of these hot button issues then with others. That's not to say that other issues in health care do not have as much misinformation surrounding them. But when you're talking about things that are really emotional for people, I think that's when you have to also take a good editing eye to some of this information being put out there.
Jason Falvey: 18:26 Looking at the source of information is one thing you can see. Cleveland clinic has accidentally posted fake news before where they put in like a really positive result from an innovative experimental therapy for cancer. And they put it in a brain scan and said this person had a miraculous results forgetting to mention that they also were receiving the standard care and this additional therapy would, they didn't know if that was the cause or if it was just a normal reaction to the normal care. But then all of a sudden you created a demand for something that is at best maybe ineffective and at worse, we don't know if it's harmful. By having a high visibility site, your responsibility for news is even higher. So I think that's an important piece. Like know who's tweeting it, but then go back and make sure you have the whole story. If it sounds too good to be true.
Jason Falvey: 19:38 This is the humanities education that a lot of PT students have complained that they've had to take history and literature and policy courses throughout their undergraduate degrees and some have suggested streamlining education to really eliminate those things. My counter argument is those skills you learned from critical thinking and critical reading and analysis and understanding of historical context and how to read hyperbole, how to read marketing and different kinds of language really with a critical eye, you tend to develop a radar for when you're suspicious of information and when you want to go and look a little deeper, even if it's from what you view as a pretty credible source.
Karen Litzy: 20:27 Yeah, absolutely. So we've got taking your time really looking at not only the source of the article but who's re tweeting it and that retweet to comment ratio. Is there anything else that we should be doing as healthcare professionals to make sure that we're not propagating this misinformation?
Jason Falvey: 20:54 Another thing I think would be really helpful is crowd sourcing, right? So most of us are networked on social media with a lot of other really knowledgeable professionals. You know, I know that on my Twitter feed alone, half the people are probably smarter than me.
Karen Litzy: 21:10 Oh, I don’t know about that.
Jason Falvey: 21:14 But that's intentional, right? Like I want to be in a community of really intelligent people who think about issues critically, who may have different opinions than me. And I could say, I just read a study about Xyz and the conclusion seems flawed. Who would want to, you know, and maybe I don't name the article, maybe I don't put a link to it. I just put the tweet and throw out a few names and say, Hey, I would love if some of my community would like to take a look at this and tell me what they think. Right. If I'm on the borderline of whether or not I think this is legitimate or I asked somebody in the profession, you know, lean on them to really make sure that I'm taking that extra step to not share information that is influencing medical decisions in a negative way.
Jason Falvey: 22:03 And I teach my patients these same strategies, right when I'm talking to patients and caregivers who are googling information, WebMDing, looking at blogs, and I've had patients with significant neurological illnesses that are terminal. And one of the places I've practiced, and I won't name that place if it's a relatively rare disease, but this person searched the literature and she was very well educated person, searched the literature high and low for a cure for her neurodegenerative disease and found one that was highly controversial. Probably harmful. And she invested thousands of dollars and hundreds of hours of travel over three months for something that was not beneficial while she was askewing typical medical care. So you know, that kind of taught me how to teach patients, not just how to look for information, right? That's part of the problem. But how to evaluate information, how to triangulate information to make sure that the reference that they found is supported by expert opinion and maybe other articles and making sure that there's a critical mass of support for this particular treatment before they really make a major alteration to their course.
Jason Falvey: 23:21 A single article about a vitamin supplement that might help that has little harm. You know, that may be something that I don't intervene on, but somebody who's thinking about making massive changes to their medical routine, whether it has directly to do with Rehab or not. I encourage people to look at the literature critically and I use the word triangulation and I draw it out. I'm just like, you should be able to verify this information should be similar between these three things. Right? And if they tell me that they've done that and they found those three things, I'm more comfortable, even if I disagree, at least I've done my diligence to make sure they looked at the issue in a robust way and not fallen victim to something that was purely a single tweet or Facebook post of medical disinformation.
Karen Litzy: 24:15 That's a shame. And I think it's important that you brought up that as healthcare professionals, we should be talking to our patients about this and we should be teaching them stuff. Glad that you went through that. Yes, we should be teaching them what to look for. If we can have a more educated patient base and a more educated base of health care professionals that high in the sky view. Of course the amount of misinformation may be less.
Jason Falvey: 24:45 Yeah. And I think there are certain countries that have done a lot of work. Norway for example, has done a lot of work from a country perspective on educating citizenry on medical and you know, general disinformation, both political and medical and teaching, how to recognize it. Giving a lot of the same strategies we've talked about of really time and a little bit of additional resource and that solves so many of the problems. If you don't change some of these decision making process and they still are firm believers in the medical information at that point then you go to some of the other strategies, you know, more targeted intervention. But I think as a general population strategy, those are great places to start and really just, I tell patients all the time, I am going to be telling you seek information, not affirmation.
Jason Falvey: 25:45 If you have a friend who told you about this treatment, you need to remember that everybody responds individually, the medications and treatments and you know, cause I think we've all had patients that say my friend got this therapy and their knee got better, really inappropriate for that patient. But it's really hard to walk that back, you know, from just your professional opinion. So teaching them how to look for information and letting them look for it on their own instead of providing it to them I have found is sometimes a helpful strategy because it feels like I'm not forcing my view on them. At the end of the day you can rest knowing that you put tools in people's hands, you know, health care providers or patients teach them how to do these things. I mean, but it does take some effort on their part too.
Jason Falvey: 26:37 You definitely have to want to read these things carefully and you have to have the mindset that you don't want to just look for information that validates what you already believe. And I've seen this, you know, I don't like to pick on dry needling, but I definitely have seen people who are very strong believers in dry needling, just cherry pick evidence that supports their worldview, without recognizing that there's a lot more nuance to that discussion. And I'm not anti or pro dry needling. I'm pro information. Looking carefully and realizing that there are patients who do benefit from it, but it is certainly not a blanket treatment that everybody should be using and it's a tool in your bag, like everything. So, I think it's really important to just have that seek information, not affirmation. If I can say something a few times on this podcast that will be what it is.
Karen Litzy: 27:40 Well, and then my next question would be, after having this great conversation, is there anything we missed and is there anything that you really want people to stick in people's minds, which I think you just said it, but I'll ask the question anyway.
Jason Falvey: 27:55 Yeah. And I think the other thing is like, when you are a healthcare professional, I think investing money in like high quality sources or whatever source. For me, I tend to read a newspaper in New York Times or Washington Post. I have a subscription to it. I try to support that kind of, you know, to provide financial resources to a place that I trust to provide good information because that is positive reinforcement, right? I try not to provide positive financial rewards to places that are providing this information. And you do that by clicking on their articles, right? You read a headline and it's like vaccines cause autism study says, and I clicked on that headline, I’ve unintentionally propagated and supported financially that fake news provider who now is incentivized to create more fake news. So I think it takes a lot of discipline to not fall victim to our need to read everything.
Jason Falvey: 29:02 And you know, sometimes we have to think about the greater good is not clicking on that article. Shutting it down, blocking that news source or whatever, if you really feel like it's egregious enough and not engaging with it. Creating polarization. Polarization is what creates ratings on television. Polarization is what creates ratings on radio, polarization is what gets people to download podcasts and things that are highly controversial. Polarization, you know, sells books, right? The top selling books on New York Times bestseller lists are generally, there's political books that exist, sometimes multiple political books that are on that list from different points of view. So I think it's really important that we don't support agregious, you know, fake news providers or fake healthcare news providers and don't engage with them on Twitter because that's giving them a form of a positive attention. Even if you're criticizing their work, that they can go ahead and leverage to share more.
Karen Litzy: 30:13 Yeah, I thank you for all that great information. And hopefully the listeners can really take this in and understand that what we do on social media has ramifications one to our profession and two to the people we serve. So before we leave, I have a last question and normally I ask people, what advice would you give to yourself as a new Grad? But I'm going to ask you, what advice would you give to yourself as a new Grad physical therapist in light of fake news?
Jason Falvey: 30:50 Oh, that's a great question. Beyond the sentence I said of seek information not affirmation, which I think is helpful for research and beyond, I think one of the things I would tell myself as a new Grad physical therapist in this era is I would be incredibly thankful for my English education, my bachelor's degree in English, all of the humanities and critical thinking classes that I took and all of the writing that I did because trust me, I wrote enough papers as an undergraduate that probably could have qualified this fake news cause I didn't really read the books very carefully and really had some made up opinions about what I thought was happening. So I think I can recognize the difference in that writing now. And I would tell myself, be appreciative of the education in humanities and the historical context that you've gained and use those skills. Don't forget about them. They are valuable parts of your tool bag. They are not direct patient care skills, but there among the most critical soft skills you can obtain to really do a good service to your patients and teaching them how to use those skills and taking healthcare into their own hands.
Karen Litzy: 32:13 Awesome. Well, thank you so much. This was a great discussion. I'm glad we finally got to do this. Where can people find you if they want more info or to ask you questions?
Jason Falvey: 32:26 Yeah, so I am listed on the Yale site, I am not officially representing Yale now just to put that out there, but my email address is on the Yale division of geriatrics site. I'm also on Twitter at @JRayFalvey and I'm sure you'll put that in your show notes. Those are the two things. And hold me accountable. Do you see me sharing something that you think is not a great source of information? Tell me about it. Right. And I think holding each other accountable is part of this process and doing that in a professional way is all the better.
Karen Litzy: 33:07 Thanks again for coming on. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Peter Fabricant on the show to discuss pediatric ACL injuries. Dr. Peter Fabricant is an orthopedic surgeon specializing in pediatric and adolescent orthopedic surgery. His clinical expertise is in sports medicine and trauma surgery of the knee, hip, shoulder, elbow, and ankle.
In this episode, we discuss:
-How to determine if a patient should have non-surgical treatment or surgical treatment following ACL injury
-Rehabilitation considerations following Physeal-Sparing ACL Reconstruction Surgery
-Setting realistic expectations for return to sport with the pediatric population
-And so much more!
Resources:
HSS Peter Fabricant
For more information on Dr. Fabricant:
Dr. Peter Fabricant is an orthopedic surgeon specializing in pediatric and adolescent orthopedic surgery. His clinical expertise is in sports medicine and trauma surgery of the knee, hip, shoulder, elbow, and ankle.
Dr. Fabricant completed his undergraduate studies at the University of Rochester, graduating with honors. He then attended Yale University School of Medicine. During his orthopedic surgery residency training at Hospital for Special Surgery, Dr. Fabricant earned a Master of Public Health Degree from Columbia University, and won several awards for excellence in patient care and innovation in patient safety.
Following residency, Dr. Fabricant completed two fellowships: first in pediatric orthopedic surgery at The Children's Hospital of Philadelphia and the second in sports medicine at Boston Children's Hospital. This afforded him the unique opportunity to study with renowned mentors at both institutions, including Dr. Lyle Micheli, Dr. Mininder Kocher, and Dr. Theodore Ganley, in order to compile additional subspecialty training uniquely focused on the care of children and adolescents with sports-related injuries. He has cared for athletes and performers at all levels, including the Boston Ballet, Babson College, the International Skating Union World Figure Skating Championships, and the Boston Marathon.
Dr. Fabricant is an accomplished researcher, with over 100 peer-reviewed publications and 15 book chapters in circulation. He has received multiple institutional, national, and international awards for clinical research, including the Herodicus Award (AOSSM), the Excellence in Research Award (AOSSM), and the Promising Career Award (PRiSM Society), among others. Dr. Fabricant currently serves on several research and education committees in two international professional societies (POSNA and PRiSM). He is a member of several pediatric orthopedic and sports medicine research consortiums, through which he participates in cutting-edge multicenter clinical research studies with many of the most prolific researchers in pediatric and adolescent sports medicine.
He also serves on the editorial boards of Clinical Orthopaedics and Related Research (CORR) and the Journal of ISAKOS, on the Peer Review Committee for the Orthopaedic Research and education Foundation (OREF), and as a reviewer for several academic orthopaedic journals including the Journal of Bone and Joint Surgery (JBJS), the American Journal of Sports Medicine (AJSM), and the Bone & Joint Journal (BJJ).
Dr. Fabricant understands the physical and emotional complexities of injuries in youth and adolescent athletes. Sports and recreational activities provide social, emotional, and physical development, leadership skills, and encouragement for children to work as a part of a team with their peers. Dr. Fabricant has dedicated himself to addressing sports injuries in the context of all of these important issues and strives to return his patients back to their sports and activities as quickly and as safely possible, while minimizing the risk of future injury and prioritizing their long-term health and well-being.
Read the full transcript below:
Karen Litzy: 00:00 Hi Dr. Fabricant Welcome to the Healthy Wealthy and Smart Podcast. I am so excited to have you on today to talk about pediatric ACL injuries.
Karen Litzy: 00:13 So we're just going to kind of jump right into it because I know our time is limited here so the reason that I wanted to do this is because I have a patient now with an ACL tear who had surgery and there seemed to be a lot of questions in the rehab world around this population. So after a confirmed ACL tear in a pediatric patient can you take us through your decision making process as to whether or not that patient will have non-surgical treatment which would mean high quality rehab or ACL reconstruction plus rehab.
Dr. Fabricant: 00:53 Yeah that's a really great question. So historically kids who still had you know growth remaining who had open growth plates would kind of be held off until they were fully grown and then have an ACL reconstruction then. But we know that that's not the ideal thing to do just because they have an unstable knee they can develop cartilage and meniscus injuries that might not be repairable once they reach the maturity but there are a subset of patients who tend to do pretty well without surgery and with high quality rehab alone. And so typically when I'm evaluating a patient the ones that tend to do well with high quality rehab alone would be typically younger patients. So kids who are like under 14 years old and kids who have non full thickness ACL tear. So like a partial ACL tear like a 50 percent tear.
Dr. Fabricant: 01:49 And so kids who are young and who have you know a 50 percent partial tear their ACL who have rotational stability of their knee so their knee doesn't kind of rotate during things like a pivot shift examination. Those are kids who tend to do pretty well without surgery with a period of protected weight bearing bracing and high quality rehab. When I'm seeing kids who are either older and or have a full thickness ACL tear with a really unstable knee those tend to be the kids who we recommend surgery for especially if they're involved in cutting or pivoting sports jumping or landing sports things like that. So that's basically how I approach it in general.
Karen Litzy: 02:34 And so let's talk about the surgical procedures because there are several surgical procedures one can do on a pediatric ACL patient taking into account the growth plate damage. How do you decide which surgical procedure to do with this population?
Dr. Fabricant: 02:57 I think that's a great question too. So I kind of think about these kids in three groups.
Dr. Fabricant: 03:04 Let's go from kind of oldest to youngest so the oldest type of kid is the kid who either has growth plates that are closed or near closed or they have very little growth remaining let's say like less than six months of growth remaining. Those are kids that I kind of think about a little more like adults. But then within that within kind of specific to your question the kids who have open growth plates. The question I ask myself are kind of are these kind of the youngest kids like prepubescent kids. So those are kids with greater than 2 years of growth remaining. In girls, those who haven't had started having their periods yet. In boys and girls kids who really haven't had a growth spurt or who are kind of prepubescent.
Dr. Fabricant: 03:53 There's kind of that group and then there's the pubescent kids who are between let's say two years of growth remaining and six months of growth remaining you know in girls let's say they've had their periods for a year, in boys they may have already showed some signs of puberty or of their growth spurt. So those are kind of the pubescent kids even though they have growth remaining and so in thinking about a reconstruction technique I try to figure out are they in the prepubescent group or the pubescent group. And then there are a couple of different described surgical procedures in each but in broad generalities the prepubescent group you need to really avoid the growth plate completely and so that can be done either with techniques where you do drill tunnels in the bone but you confine it to the epiphysis of the bone or the area that's kind of away from the growth plate or you can do a procedure where you're not drilling any tunnels which would be like the IT Band ACL procedure and that those both can protect the growth plate and they're both been well described and then in the kids who are pubescent who have growth remaining but maybe not so much growth remaining those kids you typically can drill tunnels in the bone but you just need to use a graft that's made of soft tissue because if you take let's say a bone plug from a graft and fix it across the growth plate that can inhibit their growth and cause a limb length deformity limb length discrepancy or like an angular deformity of the limb.
Dr. Fabricant: 05:31 So that's kind of how I think about the two groups that still have growth remaining and taking surgical procedures.
Karen Litzy: And does the activity of the child come into play when deciding on which procedure to do or is it really just their kind of bony anatomy and age.
Dr. Fabricant: Yeah it's mostly their age and skeletal maturity and their developmental maturity. The sports sometimes come into play when you're deciding whether or not to do a reconstruction but once you kind of made the decision to do a reconstruction you know which technique you choose is typically chosen based on their skeletal maturity.
Karen Litzy: 06:11 Got it got it. And then you sort of alluded to this a little bit earlier talking about the meniscus but why is the health of the meniscus so important in the pediatric ACL patients.
Karen Litzy: 06:22 So from what I've read it seems like if there is a bucket handle tear or other repairable meniscus injury surgery is really warranted. Why is that?
Dr. Fabricant: 06:42 So if there's the meniscus is pretty precious tissue and it's really the shock absorber of the knee but it also provides secondary stability to the knee, nourishment of the joint. It provides congruence between the femur and the tibia and so it's really important to try to save as much meniscal tissue as possible and then these kids obviously have quite a long life ahead of them and many have a long athletic career ahead of them. So you definitely want to save as much meniscus as possible so if there is a large unstable meniscus tear and the knee remains unstable it's likely to continue to degenerate whereas if you go and stabilize the knee and fix the meniscus you have the best chance at preserving that tissue and getting it to heal.
Karen Litzy: 07:20 Yeah that makes sense. And now for a lot of my listeners who are physical therapists this is sort of the money question right.
Karen Litzy: 07:27 What are the most important considerations for rehab after these physeal-sparing ACL reconstruction surgeries?
Dr. Fabricant: 07:36 So it's interesting there's not like a really strong evidence base about like specific things with rehab but I would tell you that kind of the way that I approach it and kind in in broad generalities typically the first six weeks are where there's the biggest difference depending on how the procedure goes. So if if it's let's say a procedure where you're drilling tunnels and fixing it with implants you know those kids can tend to weightbear relatively soon the implants tend to confer a lot of stability to the graft and allow the body to heal the graft. If there's a meniscus repair at the time of surgery, I tend to protect the weight bearing for a total of six weeks just to let the meniscus heal and in the kids who end up getting the IT Band ACL because there are no tunnels drilled in the bone and therefore there's no like screws holding the graft in place and the graft tends to be fixed to the periosteum of the bone or the skin around the bone with heavy duty suture.
Dr. Fabricant: 08:39 Those kids I tend to protect for six weeks regardless of if they've had a meniscus tear repaired just because I want to make sure they've started to have some biologic healing of the graft before I let them really bear full weight. So for me the first six weeks are kind of the most critical portion where if I've done a IT Band ACL and I'm kind of relying on suture for fixation I tend to protect their weight bearing a little longer but once they hit about six weeks for me at least the rehab tends to progress the same whereas essentially all kids are kind of started to wean off crutches by six weeks starting to work on strengthening and then for me I tend to let kids start to jog around 12 weeks and from there on it's pretty similar rehab to the adult rehab.
Karen Litzy: 09:24 So why with the ACL reconstruction using the IT band, why is no lunging a precaution with this population.
Dr. Fabricant: 09:37 When I was in training I had some of my mentors would say that they found that kids who load the knee from a flexed position after any ACL reconstruction tend to kind of flare the knee up especially in the early phase and so I tend to tell kids to avoid you know deep lunges and squats early on. So that's just something that I do I don't know that there's a lot of great evidence for that but it seems to have worked for some of my mentors and so I've kind of adopted it into my practice as well.
Karen Litzy: 10:13 Got it. Got it yeah. Because I read that out of Boston right. And OK so that makes a lot of sense because I often wondered.
Karen Litzy: 10:24 Well they can jog and run but they can't squat or they can't lunge. And is that obviously to protect the knee and is that also to maybe protect secondary problems like patellar tendinopathy or something like that.
Dr. Fabricant: 10:38 You know right after surgery there is a bit of inflammation going on in the knee and so certainly doing like deep squats and lunges can increase the risk of further inflammation.
Dr. Fabricant: 10:50 But I really do like squats like leg presses that go down to about 90 degrees of knee flexion. I really find it helps strengthen the knee without inflaming it too much. But you know the physical therapist that we work with tend to do that and the patients do pretty well and they end up building it pretty quickly.
Karen Litzy: 11:12 That makes sense. And now let's talk to a lot of these kids want to return to sport. I mean you're working with kids all the time as you know their attention spans are a little short and they're all really excited to get back to sport A.S.A.P. but according to the IOC consensus on pediatric ACL they recommend waiting twelve months to return to sport. So what is your thought on that?
Dr. Fabricant: 11:43 Yeah I would say the short answer is I agree with that completely. I typically mentally prepare kids for a year to return to play.
Dr. Fabricant: 11:53 I think that you know there's really three things you need in order to successfully return back to sports safely. So one is the anatomy which is really the job of the surgeon and reconstructing the anatomy. The other is you know strength and balance and coordination which is a team effort between the physical therapist and the patient and the surgeon as well. And then the third thing is just time. So it just takes about a year for the graft to incorporate and mature and remodel and kind of be biologically ready. And I think that's the hardest part about this surgery is really kind of keeping the kids engaged for a full year. I think kids sometimes hear about some professional athletes who get back to sports sooner than a year and so they feel like they want to get back sooner than a year.
Dr. Fabricant: 12:39 But I typically tell families you know a couple of things. First off the average time to return to sport, even in professional athletes like in the NFL is about eleven months. So even in pro athletes who have no job other than to rehab their knee you know they don't have chores and schoolwork and things like that that it's still about a year and that's an average. So while they might hear you know on the news about people who get back after six or eight months there's also people who don't get back for 14 or 16 or 18 months. And so even professional athletes it takes about a year and then the other thing is that kids are really even higher risk than professional athletes because typically you know if there's something about the child's anatomy or their physiology or how they're moving
Dr. Fabricant: 13:24 That puts them at such high risk that they're gonna tear their ACL when they're 11, 12, 13, 15 years old. They're at higher risk patient than the guy or gal who goes through you know high school and college and professional sports before tearing their ACL. They've made it through let's say 30 years of life before tearing their ACL. So I tend to try to kind of work with kids and families and say you know look you're a higher risk than a professional athlete for one and two you know all they do all day is rehab and it still takes them a year to get back to sports. So I tend to agree with the one year recommendation. I tend to let kids just because they're itching to get back. I tend to let them do some light practice with their team at the beginning of the following season. So for instance if a kid injures themselves midway through a soccer football season in the fall you know usually it's around nine or 10 months till the next beginning of the next season I say that they can do some kind of non contact practice with their team just so they can stay involved. But I do agree with the one year before they're really kind of on the field or the court competing with other kids.
Karen Litzy: 14:33 Yeah and I'm so glad that you brought up what they see on TV and what they hear or see on social media because that's something that's so pervasive amongst a lot of these kids and they think someone else did it. They should be able to do it too. So I thank you for that. And I think that advice to tell the parents and to keep reiterating that to the patient to the pediatric patient is so important because boy they just want to every day. Well when can I do this. Well when can I do that and being able to keep them like you said motivated but realistic expectations and being honest is a challenge.
Dr. Fabricant: 15:14 Yeah you're totally right. I think that even setting expectations before surgery you know they kind of forget you know when their knee starts feeling pretty good around three or six months but you know I think the other important thing is that you know what they hear on TV and in social media tends to be the exceptions to the rule rather than the average.
Dr. Fabricant: 15:31 So they hear about the person who gets back to sports at six or seven months but they don't necessarily hear about the people who take a year and a half to get back to sports in the pros or who don't make it back to sports in the pros. So I think you know also telling them they're probably getting a bit of a biased view when a lot of these kind of news outlets kind of sensationalize people who are getting that quickly they think it's the norm when actually it's the exception.
Karen Litzy: 15:54 Absolutely. I just had this conversation the other day about what a bell curve is and how some people are on one side some people are on the other but most people are in the middle.
Karen Litzy: 16:04 And to really keep that in mind when you see these big extremes so now is there anything else that you would like to add as far as let's say speaking to physical therapists or people who are going to be working with your patients. Anything else you would like to add as far as the pediatric ACL patient is concerned.
Dr. Fabricant: 16:27 Not not really. I think we really kind of touched upon all the important topics. I think it's just important to understand a lot of people are really beginning to realize that you know kids aren't just small adults and they have their own unique considerations both with the surgery and in the rehab and in the kind of mental preparedness for sports. And so I always really enjoy working with therapists who enjoy working with kids and engaging kids because it's not just that the surgery and even the exercises are different it's the whole kind of mindset and the approach. And so when the whole team is on the same page it's always really rewarding.
Karen Litzy: 17:09 Awesome well thank you so much for taking the time out. And where can people find more about you if they would like to know more about you and what you do and have any questions.
Dr. Fabricant: 17:18 Yes so I practice at the Hospital for Special Surgery so they can go to the hospital for special surgeries Web site which is a Hss.edu they can look me up on that Web site or they can Google search my name at HSS and we're here and happy to take care of our youth athletes who get injured.
Karen Litzy: 17:39 Awesome. Well thank you so much and everyone else. Thank you so much for listening. Have a great couple of days and stay healthy wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Nikki Kimball on her experiences as a female distance runner. Nikki Kimball is an American distance runner specializing in the Ultramarathon. She is also a physical therapist in Bozeman, Montana.
In this episode, we discuss:
-Nikki’s journey to becoming a long-distance running athlete
-The societal health and wellness ramifications of running
-How Nikki’s experience as a physical therapist has shaped her running journey
-Gender differences, both physical and financial, in competitive running
-And so much more!
Resources:
Shannon Sepulveda Website
Shannon Sepulveda Facebook
Oiselle
Trail Sisters
Nikki Kimball Instagram
Email: nikkikimball@yahoo.com
For more information on Nikki:
Nikki Kimball (born May 23, 1971) is an American distance runner specializing in the Ultramarathon. She ran her first 100-mile race at the Western States 100 Mile Endurance Run in 2004, and was the female winner. She was the winning female at Western States again in 2006 and 2007, becoming only the third woman to win Western States three times. In 2014, she won the Marathon Des Sables multi-stage endurance race on her first attempt. Prior to running, her main sport was cross-country skiing. She was crewed at the 2007 Western States by U.S. Senator Max Baucus of Montana, where Kimball lives. She lives in Bozeman, Montana.
For more information on Shannon:
Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.
Read the full transcript below:
Shannon Sepulveda: 00:00:00 Hello and welcome to the Healthy, Wealthy and Smart Podcast. I am your guest host, Shannon Sepulveda, and I am here with Nikki Kimball. Hi Nikki. So Nikki, can you tell us a bit about you and what you do?
Nikki Kimball: What I do? My favorite subject, I am a physical therapist here in Bozeman and I also coach running, ultra marathon running. And I got into that because I've been an ultra marathon race or professional racer for almost two decades. And that's kind of what I do.
Shannon Sepulveda: So in the ultra marathon running world, when you say Nikki Kimball, people are like, oh, Nikki Kimball. And I feel like, so Nikki is a very accomplished ultra marathoner for those of you who don't know who Nikki is. So we are very, very fortunate to have her here on the podcast. So how did you get into ultra running? Because back then it seemed like it's not as popular as it is now.
Nikki Kimball: 00:01:01 No, I don't think it is, but there were still, you know, a boatload of us. I mean there are thousands of us who absolutely loved this sport and we, you know, there wasn't much money at it or anything like that. It wasn't very popular. But I think a lot of cross country skiers come into it sort of organically because of the training we do for cross country skiing is essentially ultra marathon training, which is kind of funny because the women don't get to race very far. The longest they can do is 30K at the Olympics. It's pretty pathetic. But regardless, we always trained with the guys anyway. So we would do these four or five hour run hike things in the woods. And so it was kind of doing it anyway.
Nikki Kimball: 00:01:50 And in graduate school I raced a lot of 5K's, 10K's, half marathons, marathons, just kind of wherever. Cause I had a store team that sponsored me and they'd pay all my race entry fees. And so I just go do fun things. And it just like sort of saved me through Grad school because it had gave me this other thing besides studying all the time. And it made me sort of mentally clearer. I just loved it and I'm just like running makes me happy. It just makes sense to go out and run and run and run. And so yeah, at the time it wasn't super, it wasn't mainstream popular, but those of us who did it loved it. Did it all the time.
Shannon Sepulveda: So you grew up Nordic skiing?
Nikki Kimball: 00:02:41 Yes, in high school. I grew up in a town called Chittenden in Vermont, so south central Vermont town and I grew up skiing. My brother was four years older, so he was skier and the Bill Koch Youth Ski League is this big, big thing then. I don't know if it still is, but there would be these races for kids and because I mean the kids who would be racing, you know, from eight years old on, they kind of knew what they were doing, but they had to do something for like the little brothers and sisters. So they'd have these races, they called Lollipop races because you get a lollipop at the end and you might go 100 meters maybe holding your parent's hand. But I believe I was three when I first did this. I basically learned how to ski and walk at the same time, I'm sure.
Nikki Kimball: 00:03:31 And so yeah, I mean I just don't remember life without competition, without endurance sports.
Shannon Sepulveda: And then did you race in college?
Nikki Kimball: And I raced at Williams College, so all four years, so division one racing. Then, partway through college I decided to switch to biathlon. So my senior year I had to keep my rifle at a professor's house cause they weren't too keen on having rifles on campus. And so I raced a couple of years in biathlon hoping for the ‘98 Olympics and I raced through ‘94.
Shannon Sepulveda: Oh Wow. So how is biathlon different from cross country skiing, like endurance wise. What do you think?
Nikki Kimball: Similar, really similar. I mean, it's just adding this sort of cognitive piece to it. I mean to go from skiing as hard as you can to shooting clean for five rounds is, it just requires a whole different skillset.
Nikki Kimball: 00:04:37 Of patience and humility and cognition. I mean, looking at where the wind is and deciding you know, how to change your sites on your rifle, by this, you know, it's just an extra layer. And I loved that.
Shannon Sepulveda: Do you feel like that has influenced your ultra racing at all? Like part of it?
Nikki Kimball: Probably not a ton. I mean, I think the calmness needed to do well in biathlon in the humility is super helpful. So those two things are good because if you're racing a hundred miles, something is going to go wrong and running. You don't have perfect races when you're beyond 20 hours, you just don't. And so having, you know, biathlon does teach a bit of that, sort of humility but also ability to change with the changing situation. You might come into the range and the wind's coming from a completely different direction than it was when you, when you cited your rifle in and you have to deal with that.
Nikki Kimball: 00:05:48 And similarly, an ultra marathon is very common that you come into an aid station and the bag of stuff that you wanted there isn't, or your crew isn't there or something that you expect isn't there. And so that ability to think during the race and make changes to your plan during the race is definitely something is common between the ultra running and biathlon.
Shannon Sepulveda: Cool. So then when you say graduate school, do you mean physical therapy? And so how did you get into running, cause it sounds like that's where the transition went into ultra running, is that right? Or where the transition to competitive running?
Nikki Kimball: Yeah, absolutely. Because I threw 94, I was ski racer, which is sort of a different body type also, more muscular and a lot more upper body mass. So, you know, through 94, ski racing was the only thing I really wanted to do. And I also was kind of I hadn't raced anything long in running, so I wasn't very, and I wasn't good.
Nikki Kimball: 00:06:57 I was fantastic for the middle of the back. I hadn't really realized that I had any ability in running because my abilities not in running, it's in enduring. I always qualified for nationals in D1 skiing. And there was definitely something I wasn't good at. Actually in 94, after a really successful year of biathlon doing well at Olympic trials, I wasn't expecting to make the team because I can shoot very well. Did very well at nationals. And then I ended up getting very sick with depression, losing about 20 pounds and I couldn't even run three miles. Like I couldn't, I couldn't do anything.
Nikki Kimball: 00:07:55 I was just sleeping. All I did. And when I went to Grad School, I came in with a completely different body. I mean I lost all my muscle, and really I was in Philadelphia, so I'm like, well, what can I do? So running was the thing I could do and this was way before most psychiatrists and counselors were thinking that exercise was important for running. But I sort of knew it, you know, I just knew that I could think better, I could function better, all of those things, everything better when I'm exercising. And so it was sort of natural for me to just my daily dose of endorphins that is just critical to me. Even having normal brain function. It would be like I'd have to run an hour a day just to stay sane.
Nikki Kimball: 00:08:49 So then I went to graduate school and I'm in Philadelphia and I go and do this 5K race and I win it, and I'm like, what the heck? I am not a runner. This is crazy. And then the store team picks me up and then we just started running longer and longer and more and more trails and you know, so it wasn't something I never set out to be a good ultra marathon runner. It just sort of, it just was what I did anyway. And then I realized it was a support.
Shannon Sepulveda: Yeah. That's really cool story. Awesome. So what was ultra running like when you started and how is it different now? Cause I mean, how long ago was that when you started?
Nikki Kimball: 00:09:38 I started in ‘99, 20 years ago. It was still very, very competitive at the top. But the fields were not as deep. And there wasn't, you know, it was never talked about in runner's world, I don't think runner's world even knew what ultra running really was. And it didn't really need to create a magazine, but it was like runner's world is for sort of mainstream runners and getting people into running and it's fantastic for that. But ultra running was never something that would even be considered in, you know, for their audience. And I think that's really telling now. They know now they talk about ultra running and that kind of stuff. And ultra running is now becoming appealing to your general public. It’s just not something that's freaky anymore because it's in the running media.
Nikki Kimball: 00:10:32 Part of me wants to go back to the old ways where you raced and you had only water at the aid station. The aid stations might be two hours apart and you want a belt buckle after you set a world record you know, it was great. Not that I ever set any world records, but, that's the trail runner part of me. But that was kind of Nice. It wasn't very commercial. And now it is more so, but I'm also part of that. I mean I was in films about running several films about running. I was promoting, you know, Nike northface Hoko, which ever sponsor I had at the time. And you know, kind of using my running to promote basic health and fitness things. And you know, I mean it just, I mean I definitely was heavily involved in media surrounding running, so the increase of popularity of running, I'm not innocent in that.
Shannon Sepulveda: I think it's awesome. I think it's really great because not everybody's going to be fast at a 5K and some people are really good. It's completely different. Being fast at a 5K is completely different than running a hundred miles. Yeah, it's totally different. And some people are really good at it and some people are not. And some people, the accomplishment of running just running 50 miles or 18 miles or whatever, will get them through, get them on a high for a whole year. I mean, the fact that they can do that. So I think that's amazing.
Nikki Kimball: 00:11:54 And it'll get them training for a whole year. Will get them healthier in an age in which sedentary lifestyles our biggest killer, or contributes to it anyway. We really need to make sports mainstream and running is so easy and it's something we don't need special equipment for, you can do it on any budget. And then you can still compete in it.
Shannon Sepulveda: But I mean, it's like if you were a baseball player, you can't just go play baseball games a lot of the time. But if you're a runner, you can always say, I'm going to sign up for x race and train for x race.
Nikki Kimball: 00:12:49 Yes. And so it’s the perfect lifestyle, lifetime sport and you can do it if you're running, you know, if you're running team, if you, let's say you want to do stuff with people, you're running team doesn't show up for a workout. You can do that work out on your own. You know, it can be as social or isolated as you want to be. And I think runners know that, you know, sometimes, you know, you and I are both physical therapists. Sometimes we have a whole day of patients. We want to go out and run the five, 10 whatever miles by ourselves because we're just, we need that break and not talk. And then other times, you know, you want to go out with a group of 10 people and just, you know, just chat the whole way.
Nikki Kimball: 00:13:40 And I swear that if political leaders could do all of their work while running, things would actually work. I mean, cause I swear every, you know, every long run you go on, somebody comes up with an idea that just seems brilliant.
Shannon Sepulveda: Yeah. And you get to talk to people who believe different things and have actual conversations with people because there's nothing else to do, right. You're out in the woods for four hours and that's who you're with and you can talk about stuff and you're not checking your phone. And now I think it's great.
Nikki Kimball: Yeah. And it's something that's so foreign to us in modern times. You know, we're always sort of plugged in and we're always hanging out with only others like us and running sort of takes all that away. Yeah, I really liked that.
Shannon Sepulveda: And I think, you know, even, you know when I get postpartum women in here and they want to run a 5K after they've had a baby and they're like, well I'm not really a competitive runner.
Nikki Kimball: 00:14:37 I just, I really want to run this 5K. And I'm like, that is awesome. I really want to run it in under 30 minutes. Well that's such a great goal. Like let's do that and it's attainable and it's great. It gives people a goal of something to do. It doesn't have to be 100 miles, you know, like it doesn't, that’s the beautiful thing about running.
Nikki Kimball: And I love about ultra and running in general is that different variations on running are becoming popular. Whether it's spartan racing or color runs or you know, like none of those events is going to attract every person, but it's going to attract somebody. And if somebody gets hooked because they like having paint balls thrown at them, like great, if that keeps that person from getting type two diabetes, I mean it's the cheapest medicine we can buy.
Shannon Sepulveda: Oh yeah. And I think that that's why it's so awesome being a physical therapist because we know how important exercise is and getting people back to that. So like they don't die and they don't get type two diabetes and they don't get heart disease.
Nikki Kimball: 00:16:01 And we're not rehabbing their total knee replacements because of obesity. You know? I mean they have a total knee replacements because they earned it.
Shannon Sepulveda: Yeah. I think it's so great just to be able to have, you know, running become more mainstream so it's more accepted and people are really excited about it. I mean, when you go to marathons and you see people of all shapes and sizes completing marathons, I think it's so cool and it's so different from what it was 20 years ago.
Nikki Kimball: Absolutely. Absolutely. I mean, marathons didn't kind of include, they certainly didn't encourage and often didn't allow people to finish a marathon in six hours or more. And now we've got that in there just has to be a place in athletics for all adults because if this is the way we are going to stay healthy in a world that is more and more sedentary, then we need to make it fun because otherwise it's not going to be sustainable for most people. And you know, and we also need to have resources out there for people to do these sports.
Nikki Kimball: 00:16:56 And I just keep seeing more and more emphasis on building trails and on making shoulders on roads so that people can safely bike or run or whatever. I think the more these sports grow, the more people demand from their local government that we have trails, that we have safe places to work out. And play and do all those things that are just going to save us money in the end because we're all healthier.
Shannon Sepulveda: Yeah. No, I think it's great. So let's talk about how has being a physical therapist impacted your career?
Nikki Kimball: Probably for the better and for worse. We over analyze everything exactly. I mean, and I'm sure you remember when your first a physical therapist and you're working in general orthopedics and you see people coming in and they're in their sixties and that's old to you because you're in your 20s and you're like, oh my gosh.
Nikki Kimball: 00:17:50 I have all these things that are going to happen to me. Yeah. So you start getting these ideas of things that happen with aging. So that's a little, that's actually probably good, a little cautionary tale there, but, for the first 18 years of my ultra running career, I never missed significant time from races, from any running injury. I mean, the races that I missed were mostly from direct trauma cause I fell off something or trail running is a little aggressive. And I also mountain bike and dirt bike and ski race and do all that. So you know, I definitely have had injuries, but they're usually direct trauma, not repetitive trauma. And I think PT has been the biggest factor in that. I mean also I just have good genetics. Having treated every running injury there is, I could see when one was coming up and I think that helped a lot.
Nikki Kimball: 00:18:44 Oh, I've got this little thing, Ooh, that's not just muscle soreness. That sounds more like, you know, it band and Oh, maybe I should have somebody look and see if my hip is strong or if I’m overstriding or whatever. And so I think, you know, running is a huge deal and running and prevention of an injury is so much more important than fixing it. And PT has given me the patience for that, you know, like, okay, I know I need to take a week and be water running now because I've worked with so many people who didn't do that and now they're out for four or five months.
Shannon Sepulveda: Do you see differences in injuries between ultra runners and like your recreational 5K’er?
Nikki Kimball: 00:19:35 Yes and no. Your recreational 5K’er often it's their first year running and they're much more likely to get injured and injuries that are completely preventable. Just because they just sort of get into it without any guidance. Ultra runners first of all, probably have the genetics that allow them to run that long. So they're probably mechanically more, more ready to run ultras. And then some of the ultra running injuries we see are just like, they can be really serious because we can I think once we're out there racing, to be successful, you have to be able to put pain in a little box or just sort of deflect it. And you really don't, like when I was racing, I really didn't feel pain so much cause I could just sort of play in my head with it. And so you can get people who in ultra running who will go into a race with a stress fracture and it becomes a frank fracture.
Nikki Kimball: 00:20:35 And I've seen that with several ultra runners and you know, that's not your recreational 5K runner might get a stress fracture, but they'll probably actually going to go seek help while it's still a stress fracture and not going to let the bone actually break in half. So sometimes runners, ultra runners can be a little, aren't good at using pain as a guide. I think your recreational 5K runners going to come into when their knee starts hurting or their ankle starts hurting and they're gonna be like, Hey, something's funky here. And so I think those recreational 5K runners are much more likely to get injured, but their injury is also going to be much easier to manage. And ultra runners were all, I mean, most of us I think are addict to the sport and to running and to exercise. And you know, I just know how tempted I am to run if injured, you know, cause I have to work out or I'm just staring at the wall being brain dead. I mean, I really like without you know, at least a few times a week infusion of endorphins I don't function and I think a lot of our ultra runners are that way and we can so we basically go until something's really bad.
Shannon Sepulveda: 00:21:51 So I'm always interested in like the mental aspect of pain.So when you were like racing in your, you know, cross country racing biathlon you're like super anaerobic, like you gotta get over that governor in your head that says slow down. So that sort of mental capacity for pain versus I'm on Mile 90, I have pain everywhere. It seems like a different type of pain. Do you classify those as a different type of pain in your head or are they kind of the same?
Nikki Kimball: 00:22:20 I think in my head they're the same or similar. In ski racing I could always say, or in biathlon, well I'm going to lie down at the end of this kilometer to take a bunch of shots. So you know, you know that that pain is, is there, but I think I dealt with it mentally by, it's going to be over very quickly and it always was. So in that it's somewhat different but so in ultra running you have less intense pains but for a lot longer period of time. And so I don't get to say, oh well it's going to be over soon because this, now you have another four hours left. And I think that got me to the point where I would think of pain as this is just this neural sensation.
Nikki Kimball: 00:23:09 It's nothing more than that. There is no reason to put any emotion into this sensation that's coming in. I mean, I think part of what gives pain its power is fear of pain. And in an ultrathon you have long enough to think that you have to deal with pain in a different way. And if I can just take the power away by saying, okay, I have a nerve signal telling me that my hip hurts or my knee hurts. But that's all it is. It's just a neural signal. And because I think the anesthetic effect of our chemical changes when we run, we can do it. I mean I don't think I'm really tough about pain. Like if it's just, if we're just sitting here and you know, somebody hits me, it's going to hurt just as much, but while I'm running I can take so much more.
Nikki Kimball: 00:24:04 And as long as you don't fear it, it's just way, way easier to tolerate.
Shannon Sepulveda: It's so interesting cause it's like when I hear you talk, there's such similarities to chronic pain and like what we know about chronic pain and how as like PTs we treat chronic pain where it's like, you know, these are just neural sensations coming in. The brain controls where you are, what you're doing. Do I need to get out of here? You know, and how we gradually increase people's exposure to certain things to get them out of chronic pain. So when I hear you talk, that's like exactly what I think of. Like you think about it as a neural sensation, not, you know, this emotional response that you have to like give into.
Nikki Kimball: Right, right. And you know, I think that ultra running can be a very good metaphor for life in many ways.
Nikki Kimball: 00:24:57 And that's one of the ways, and I think that medicine, both physical medicine, physical therapy plus medicine, human medicine are starting to research ultra running, which is incredible. And I think, I think we need to look at things like ultra running for managing chronic pain. We need to look at ultra running to see. But I think we need to do more and more research to find like what is it that benefiting here? I think it would be extraordinarily hard to thrive through chronic pain. I mean, we've both worked with so many people with chronic pain and it's really, really horrible. But if you can, you know, do you just give up? I mean there's no, we don't have like a pill form now, we don't have anything that will just kind of get rid of it right away.
Nikki Kimball: 00:25:56 Nothing. And so we have to be able to manage it. And I think ultra running is about managing stuff and so maybe somebody in medicine finds out what, you know, what factors allow us to thrive despite that pain, to win the race despite the pain that we're in. And certainly there's a lot of research out there on mental health. What is it, you know, we know there is, you know, six or eight different things that were changing when we're running that might affect our cognition and mental state. Like, you know, what is it we don't really know. But we know something about running is lessening the effects of depression and other mental illnesses and we know that is lessening the effects of some pains.
Nikki Kimball: 00:26:44 So it's just this brilliant area of untapped research or a research opportunity. I mean, there's so much out there and it's very much in its infancy. But you are seeing people being serious about running medicine now.
Shannon Sepulveda: Yeah. It's really interesting when I hear you say manage the pain because that's like when I have conversations with my patients that have had chronic pain for years. I have a conversation of like, this is chronic, we are going to manage it. You're going to have flare ups and you're going to manage it and it's gonna get better. But at some point you're going to have a flare up and it's going to be okay. And so when you think about managing versus curing, it's, I guess very similar to ultra running like it is, I'm in mile 80, I'm going to manage this, right, because I've got to finish it and it's going to flare up and I'm going to manage it and it's going to get better.
Nikki Kimball: 00:27:37 Yes, exactly. And I think this is where all types of medicine need to come together. I mean it's neuro, psych, it's mechanics, it's all of those things. Because how else are we going to let people live quality lives with chronic pain or mental illness, any of those kinds of things. And ultra running is sort of microcosm and like, it's like, yeah, like your whole, you know, it's like a lifetime. And, you know, 100 mile race. And so I think there are really important pieces of information in there that can be applied to our world in general.
Shannon Sepulveda: Yeah. That's so interesting. Okay. So the next thing I want to talk about is gender equity in ultra running are running in general. Both prize money, sponsorship, but also physiologically. So which one do you want to start with first? So to just talk about it, because I know you're a very good advocate for women and gender equity and this is a problem in many sports. So let's talk about the problem in ultra running.
Nikki Kimball: 00:28:52 It is, it is a problem and in many sports. I must say on the good side, just to start this out on a good note the changes through my lifetime and how women are treated in sport has been amazing. I mean, when I started racing in the 70s, you know, there were oftentimes, you know, races just for men or you know, the men would get prize money and the women wouldn't get any. And that was really, really common. We just sort of expected that.
Nikki Kimball: 00:29:42 And you know, all through high school and college, and this still happens unfortunately, you know, being a high level ski racer, the women, we would race 5K when the men would race 10K and you know, that stuff is still happening but getting better hopefully sometimes that's changing. And sometime in the 2000 odd you just really stopped seeing prize money be different. Because prize money is so transparent and you know, there were still a few holdout races that would prize the men and wouldn't prize the women. And in Europe that was very common, which is kind of shocking to me. But many, many races, money for the men and you know, something cute for the women and the fights for gender equity already had enough traction behind them to finally, to really call out race directors who didn't prize equally.
Nikki Kimball: 00:30:52 And with the Internet and with everything being freely, with being able to get that information really easily from your computer, race directors would look really, really horrible at this point if they weren't prizing equally. And so the last 15 years has been pretty good that way. Then we have sponsorship. And most of our contracts tell us we aren't supposed to talk about how much we're getting paid. And that's a brilliant strategy by the marketing people for, on these big companies that sponsor runners because why pay a woman what she's worth when you can pay 12 times less? And that's not an unreasonable that actually I have seen that in order of magnitude difference between males and females, why pay or that isn't, you know, if your customers, when they go to buy that jacket, don't know that, you know, Sarah gets paid 5,000 a year and Joe gets paid 10,000 or a hundred thousand a year, why would we, you know, why would they pay that?
Nikki Kimball: 00:32:00 And I think that's the next area to go or to get down, get down to and really dig into hopefully the last one. There's still other subtle forms of sexism that happened, but this is still a major, major form of sexism that's happening. And I've thought through my professional career and then once I started trying to add up how much I would have made if I'd done the same thing as I did but be a male. And once I realized that I would probably have an extra house in the most expensive part of town, I decided to stop torturing myself. And so some sort of transparency there has to happen. But the other, the subtle stuff, some athlete contracts give you bonuses for getting their logo in print media or on television or all those things will still look through the sports pages in any local paper.
Nikki Kimball: 00:32:58 And they're still often, you know, eight pictures of men compared to one picture of a woman. Or, you know, even if it's two men to each woman in the sports pages, that's money we're not getting because you know, you're not in the picture. I won the race. But the guy's winner gets in there and you still look at Wikipedia. If you look up Wikipedia or any of those race sites or running sites. They'll often have, you know, they'll talk about a race and they'll say, you know, the course record is held by, and it's always the guy. I also have the course record, right. But so then again, the men gets so much more promotion from media and all of that.
Nikki Kimball: 00:33:46 And then that gets the sponsor's thinking that they have a better return on investment from the men because the men are like, look, here's what you know, here are all the newspaper articles I was in, magazine articles I was in. So those more subtle types of sexism are harder to fight. And I think some of us are doing it. Gina Lucrezi is an ultra runner and very solid alternative, but also really great supporter of women's ultra running and has started a company called trail sisters that is huge and just getting bigger and bigger and it is to address some of these issues and also address other physiological issues that women have to fight, have to face. These things are happening. It's just not as fast as I'd like.
Shannon Sepulveda: 00:34:41 I know it's so hard. I mean, I feel like the same thing happens even with like small companies and like they've just had to like fight tooth and now just to even like get, you know, compared to Nike or something like that, just even get themselves and they're a running company for women, but, no matter what it seems like we're fighting an uphill battle.
Nikki Kimball: Yes, we are. And you know, I remember it just a few years ago, I had a couple of women runners I was treating and I was like, Oh, you know, we get into the talk about sponsorship money. And I'm like, well, they've got to be doing better than I did. And you know, both of them were like, yeah, we're about 25% of what the men were.
Nikki Kimball: 00:35:29 I'm like, well, that's better than I did at my worst. At least they're not getting one 10th, but yet again, it's still, it's not okay.
Shannon Sepulveda: It's not. Okay. And so what do you think we can do?
Nikki Kimball: I think we talk, we keep open dialogue. We support people like Gina who have trail sisters. We support brands like Oiselle who are trying to make a difference. And I think that each of us you know, each female athlete is one cog in the machine of getting female athletics taken seriously. I mean there was a time when women weren't allowed to run a marathon because our uterus would fall out, which makes a lot of sense as a women's health specialist. It's gross when it happens. But each of us just does her part to make it a little bit more fair.
Nikki Kimball: 00:36:30 The unfortunate thing is each of us doing our part makes us less sponsorable. Cause if I'm out there whining about the sponsors treating me poorly versus my male counterparts, they're not going to want to sponsor me. But at this point, it doesn't matter I'm past my professional career anyway. But I do know I probably could have been more quiet and you know, tried to look cute and race that way and because you need and probably that would have been better for sponsorship. Cause you definitely notice that the women getting on covers of magazines, it's not necessarily the fastest ones, but they're always cute. And that's not so much the case in the mens. I mean, I'm sure men face it in some ways, but I don't think that sponsorship has as much to do with how they look. And if they're willing to put pictures of themselves in a sports bra as their profile picture on Facebook or whatever. It's just a huge, huge topic.
Shannon Sepulveda: 00:37:19 It is. I know it brings me back to, I played tennis when I was younger and so it brings me back to a New York Times article awhile ago on Serena Williams and Sharapova and it was just like, how much more money she got. She's pretty.
Nikki Kimball: That sort of Sharapova thing happens everywhere.
Shannon Sepulveda: So let's talk about physiology. When are the women going to beat the men?
Nikki Kimball: Women beat the men when the race is long and difficult and has really bad conditions.
Nikki Kimball: 00:38:24 Men do have a physiological advantage. Yeah. They absolutely do. That's why we need a men's race and a women's race because they absolutely have a huge physiological advantage. However, when stuff gets bad, women thrive. It was so cool to see. I know that if I'm in the last 10 miles of a hundred mile race and I come upon a guy, I'm going to beat him. If I come upon a woman, it’s on and that's not just because we're competing against each other because I see this in my practice as well. Due to biological differences we do tolerate pain better. Is that biologically something that happens so that we can survive childbirth, you know, I don't know, I think it is a real thing.
Nikki Kimball: 00:39:17 Like I think that pain probably hurts more for a guy then for a woman on average. And that's totally on average, but women just push themselves, so they're just able to push through so much. All the times I've been in a national or world class event that I've been on the men's podium, which has been three times it's been bad conditions. One of the hottest years at Western states, I was third out of the men and you know, there were a lot of men there who could have beaten me, but they, you know, it's super hot and they're just dropping like flies and the women are just kind of like were fine. So there's gotta be, you know, something going on there and how much of it is so is social construction and how much of it is biology and how much of it is psychology and you know, all of these things playing a role.
Nikki Kimball: 00:40:13 I do know that we do relatively better to the men when things get tough.
Shannon Sepulveda: It's like grit. I wonder if, I'm just thinking about, since I'm a women's health PT, like sleep deprivation, I wonder if women deal with that better than men do just because of we have to, we have newborns. Same thing with pain, like you have to deal with it in childbirth.
Nikki Kimball: And whether we have kids or not, right? We still have those genetics to say, how would humans continue to continue? Evolve, how would any of that happen if we went, couldn't go nights without sleep and a very, very painful pregnancies and deliveries. And then come back from the aftermath of delivering a baby, which is just like, it's just something that doesn't happen in any other part of our lives.
Nikki Kimball: 00:41:11 We just don’t go rip tissue, men don't experience that. I haven't experienced that and I'm not sad to miss that. We have to be able to do that and it would make sense evolutionarily that we have some, you know, women have some capability to withstand and thrive through pain that men may not have as much access to and we also have to forget about it and do it again.
Shannon Sepulveda: Right. That's the other thing. And I often wonder that I'm like, Gosh, we just forget about that so quickly. Like with childbirth. It's like in a couple days or a week, you know, you forget about the pain. And I often wonder that with like, you know racing. you just forget about it. You're like, oh, I forgot how much that hurt.
Nikki Kimball: And you remember that at mile something in the race and you're like, while you're racing, you're like, why did I sign up for this again?
Nikki Kimball: 00:42:12 And that's regardless of sex because we all feel it. And we all come back and do it again. There's something greater about running and racing than there is about pain.
Shannon Sepulveda: Do you feel like physiologically in the last 20 years, like women have made incremental gains as far as like ultra running? Are you feel like it's always been like the popular.
Nikki Kimball: No, I don't think physiologically we really have changed. But I think that, and this, it goes across from men and women, is that there's just more people doing the sport. So we are with greater numbers. We're going to have more fast people and those more fast people are going to teach other, the ones who come behind them.
Nikki Kimball: 00:43:16 And like records always fall, right? Like why did nobody run a four minute mile until Roger Bannister did? And then everyone starts running, well, not everyone, but many, many elite men were running for a minute sub four minute miles. It wasn't that he was physiologically different. He was just the one to be able to say, no, that's not a barrier. You know, and I think that every time one of us breaks a record, it gives the person behind us that confidence that if the course record used to be 20 hours in and now it's 19, well now we know we can break 20 hours. And then so everybody comes to I think there's such a huge mental component to this because we certainly don't evolve that quickly. And granted, there's so much more media attention and money.
Nikki Kimball: 00:44:06 I mean, like people are now guys are making a livable wage. So few of them, you know, from running, maybe a couple, maybe some women are, I don't, I don't know. I don't think so. But we're starting to see, you know, we're starting to get a lot of gain. And also, you know, my generation of ultra runners, the women were all, we all had to work full time who aren't getting paid or we weren't getting paid well. And so, you know, I think of course records going down and people getting faster, and that's just a natural evolution that happens in every sport. I mean, the science behind it gets better, the training gets better, the food gets better, I remember one year, this guy writing, oh, my time at western states would have won in 1970 whatever.
Nikki Kimball: 00:44:55 And I'm like, let's talk apples to apples in 1970 you would have been in a canvas shoe and you might've had a potato chip and a couple bottles of water. I find that very frustrating. I do think that each generation, it's still going to be the same qualities that bring those top people up. We do bill, like I wouldn't have run the times I did had people not done similar things before me. I wouldn't have even known that that was something to go for. And so each of us who publicizes the sport and who does good things in the sport makes it easier for the person coming up behind him or her.
Shannon Sepulveda: How long does it take for an ultra runner to peak? Like how many years?
Nikki Kimball: 00:45:45 That's a really good question. Honestly the science isn't there. We are evidence based practice for us physical therapists is so, so important. How do like do evidence based practice on somebody who's an ultra runner? I tried to extrapolate from studies done on a marathon or maybe, but they're not even that many studies on those folks. So you know, I really don't know that we know that, but I do know a couple things. One is that people tend to have a race career of somewhere between like three and 10 years where they're really, really good, but they don't seem to have much longer than that. Like, there's a steep drop off in speed at some point. And is that mental, is that physical?
Nikki Kimball: 00:46:38 I’m not sure how linked it is to actual chronological age. You know, you might fly in your twenties and then by 31 you're kind of done, or your best 10 years might be 40 to 50. Like it just, it seems that there's some equation out there between age, miles on your body and you know, hard races run and length of duration of your running career that would sort of point to, you know, when you might be best. But I've seen, you know, I peaked at 36, I've seen people peak in their forties, people peak young, you know, so it's all these n of one groups. I mean, it's really, I love to know more it, but it's just so multifactorial. How would we ever study it?
Shannon Sepulveda: And everybody has different backgrounds and high school in college.
Shannon Sepulveda: 00:47:39 Right. So this would be a great transition to talk to you about hardrock this year. For those of you who don't know, Nikki came in second. And we were all cheering her on like on irunfar.com, so just tell us about that, your age and how that impacted you.
Nikki Kimball: Yeah, hard rock was amazing. It was easy to get into it in the nineties and now is so popular that thousands of people apply for 140 something spots. So anyway, I've tried to get into it for years and I finally got in and I knew that at my peak, I would run that course really, really well. It was really made for me. It's super, it was really high altitude. You know, you're going over many peaks over 13,000 feet.
Nikki Kimball: 00:48:39 You're not getting below 10,000 feet very often. I mean, it's just, it's just fantastic and it's exposed and it's rocky and it's gnarly. And it's just a steep and fun and 31,000, 33,000 feet of gain and a hundred miles. It's awesome. So part of me really wanted to run it when I was younger and really, really strong because I'm hours slower in a hundred mile race than I used to be. I mean hours. So for this race, you know, finally get in, I know I'm not at my best. I'd also been battling an injury from a snowshoe race that really, that finally took me out later in the year. I had actually been training for about four months because of this injury had sort of taken me out for a while and I had four months of really fantastic training going into that. So not a lot, but I still had 30 years of competition to go back on, or 40 years actually of competition to go back, fall back on.
Nikki Kimball: 00:49:41 So, you know, so I get there and I know I'm not at my best, but I also know that two of the other top women in the race are also in their forties. And you know, none of us were all way past our prime. And one person who was, who was young, who, you know, who won it, you know, she's 20 years younger than me, she better be able to beat me. So it was just this magical race where we just start, you know, you just running along and talking to people cause that's a big part of ultra marathon culture is amazing and shifting with the influx of money and influx of people self promoting on social media. That stuff's really, really frustrating. But, hardrock the spirit of hard rock is very much in that old school, ultra running.
Nikki Kimball: 00:50:34 We all want to get into the finish. I mean, yes, we're going to compete against each other, but we're also really supportive of each other. And we are having a few people in the sport who aren't supportive of their competitors and that's really, really sad. But at hardrock I ended up, you know, in this group of people, one who was a PT, a pre PT student of mine. He and I along with Darla, ask you the Darla ask you and somebody had a couple of other people ended up in this group and the six person group and Jeff was my student. He and I were having a competition to see who could tell the most bad jokes. And so that was really fun. And this is the first like 20 miles. We're just kind of like chill and having fun and you do things like talk and tell horrible jokes because it makes the time go cause you can't race for all 30 hours, you're going to race for the last couple.
Nikki Kimball: 00:51:28 Sort of having that community around me just made me happy. I was running well, you know, running up towards the front and I had a bit of an explosion. Like, I just, you know, you have really bad patches and I had this massive just meltdown after one aid station and I just kind of walking up through the woods and frustrated and I know, and all I'm thinking is even five years ago, I would be, I'd be four miles ahead of where I am right now. And it was really hard and I've been dealing with the slow down for at least eight years at this point. And I just laid down in the middle, you know, like mile 29 I just laid down in the woods where nobody could see me and just sort of thought about age and really had this sort of amazing epiphany of like, I was just, I mean, I laid there for like 15 minutes.
Nikki Kimball: 00:52:34 But just thinking about, you know, why, why am I expecting myself to still be on the podium for the men and all these races when these men are now 20 years younger than me? And, you know, this is like, like I am asking my body to be what it was when I was 30, and when I was in my mid thirties and I’m 47. Like it was amazing to finally, after fighting and fighting and just being like, why am I slowing down? This is so frustrating. I'm training just as hard and I'm getting slower and now that the sports popular and people are winning with times that were easy for me at one point in my life. And, you know, just that sort of Sour Grapes of, uh, and it finally sort of occurred to me that, you know, in this little part of the race, and this is what ultra running does, is it pushes you so far that you have to think beyond the way you would think in normal situations.
Nikki Kimball: 00:53:30 And it finally sort of dawned on me, and this should have come more easily than this, but that I should be celebrating what my body can do instead of what it can't. I mean, I'm 47 and still running, you know, a hundred mile race with 30,000 feet of gain and being on the podium. Like that's huge. And I'm doing it with people I've run with my whole life and with people who, with a former student of mine who is now just graduated PT school and he actually ended up second for the men. So we ended up sharing the podium spot and you know, he's 20 years younger than me. And it just made me think about what's important in ultra running. And really what drew me to it is that I love running in the woods and that I love the mental clarity that comes with running.
Nikki Kimball: 00:54:28 And I love the community of people who do this sport. And you know, like you sort of getting back to that despite a massive slow down in my racing was critical. And it's something that I've just been fighting. I've been fighting a cancer, my body changing rather than sort of managing it. Like we talk about managing chronic pain, managing depression, managing these things. We had to manage our aging and instead of just, you know, I was totally know my body doesn't obey the laws of physiology. I'm not aging, Duh, Duh, Duh and, but you know what I am. And I had to give myself a little permission to do that. So hard rock really, really gave me that back. I mean, yes, I was probably five hour slower than I would have run it when I was 35 but I should be 47 and I have 90,000 miles on my body.
Nikki Kimball: 00:55:28 Like I shouldn't be fast anymore.
Shannon Sepulveda: And you still came in second which suggests you got faster, like literally like this epiphany and then you're like, I can just do this.
Nikki Kimball: Yeah, kind of cause I had, you know, been caught by a bunch of people and then I just sort of gave up the results. This is hard rock. Like this is the race. People sell their soul to get into like, I'm here in the most beautiful mountains of San Juan mountains are stunning. I am having this catered hundred mile trek through this beautiful country with amazing people. That's what it is, you know? Yeah. Winning races is cool and that's fun and it's great, you know, like it's a huge ego boost and all that but it’s pretty shallow.
Nikki Kimball: 00:56:22 It is fleeting. Like you might win now, it doesn't mean you're going to win the next time. I mean, you know, there has to be something much, much bigger than results to get you to do the sport. And I think giving up any care of where I finished and just being like, you will finish this, you know, it's a gift to be able to get into this race unless you're injured, you better finish. It was just a good sort of cap to my running career.
Shannon Sepulveda: Yeah. It almost seems like that's almost a gift of aging because maybe you couldn't think like that when you were 35 and you did have another race. You know, like, I could never, I always did have the next thing and now you're like, I can just do this for fun.
Nikki Kimball: 00:57:13 Right. And I can coach other people and coach them in a way where I attempt to use my physiology but my physical therapy knowledge and help them to run without injury or to get any injury that comes up. We treat it immediately, we immediately manage it. We don’t run somebody into the ground and there's so many people coaching. There's no oversight in coaching, you know, who maybe took a three day course and have a certification. That does not make them a knowledgeable coach. And we're seeing that all the time. And so I like sort of, I love that I get to coach and I usually I keep about eight clients at a time because I don't want more than that because then I can't take care of them.
Nikki Kimball: 00:58:11 I can't help them. And I want people to love running and I want it to be, I want it to be healthy. In a lot of the people I work with used running as part of their mental health treatment plan. And if you're treating depression with running and you have an injury, it's disastrous. You could die. Keeping people running healthy is my new thing, you know, like that's my, you know, it's like, okay. Yeah, it was great to, you know, be the best ultra runner in the trails runner in the world for a while. That was awesome. That was really fun. It was great. Now it's more about like, what running's really about and what am always has been about. But I probably lost sight of when, you know, traveling the world and you know winning stuff.
Shannon Sepulveda: So let's talk about your coaching because it would be pretty cool to be coached by a world champion, technically one of the best in the world. So tell us about your coaching and what you do.
Nikki Kimball: 00:59:23 And so if my clients, I coach people locally, I mean, you know, I sort of just starting, I've taken people under my wing my entire running career and sort of coached without coaching, you know, and now if I coach people locally, it's amazing because I actually get my hands on them, you know, I can do a screen of where are they tight, where are they strong, where are they weak, where they loose, where, you know, is there something funky going on with their running? Has somebody tried to change their running gait? Because that usually messes stuff up because you have all these people who, you know, went to a CI running course and think they know my biomechanics and usually massive changes to people's gait gets them injured.
Nikki Kimball: 01:00:11 I just like being the person who runners can come to for physical therapy and for coaching who could hopefully do a better job of predicting and avoiding injury. I've treated runners for 20 years as a physical therapist. I mean because our evidence isn't great, we have to combine mechanical knowledge with physical therapy evidence on sports that might be similar and on our experience, I mean I can't, I just look back to the 1990s. I'm like, how the heck did anyone I treat get better. You know, like it was luck. Cause you know, I think of all the mistakes I made in my first, and I'm still making mistakes, but the horrible mistake I would make, things I would miss and my first 10 years of treating runners, I mean just, I mean I think that's what I can offer.
Nikki Kimball: 01:01:10 And coaching is something that's just well beyond what, you know, your person who never studied physiology or mechanics or something and there are some people who are self taught coaches who are very, very good, but they have a lot to catch up on.
Shannon Sepulveda: And do you coach remotely to your work with like physical therapy remotely? Like you do the screen, tell me what you found. I'll do the coaching.
Nikki Kimball: Absolutely. Absolutely. And I think that's critical. The hard thing is knowing who the physical therapist is in that area. I have a Bozeman client right now whose wife is on sabbatical from the MSU. So He's traveling around. So when he's in another place, like who do I send them to for PT? And I don't insist, I mean I need hands on the people who I coach if I can, like I want to know how they're doing, but I'd certainly don't insist that they use me as a physical therapist that's referral for profit and I don't, I'm not okay with that. And there are fantastic running PTs in town.
Nikki Kimball: 01:02:19 I've got great people to send my people to and sometimes they come to me often they do and that's great too. But if I'm missing something, I want to call in another therapist because why not, why not use that knowledge that's there? So really what I found is the best thing I can, the best thing I've come up with, with getting, working with a PT, if I don't know the area, is having the athlete go to the running store, they're running specialty store and say who's good here. Not to say that it's always going to give you the best result, but, you want to go to a therapist who has seen runners, who's worked with runners, because it's just a different skill. I mean, you're not going to come to me for neck pain because like, no, I give you really a problem.
Nikki Kimball: 01:03:06 So I think that can help. And then physical therapists who specialized with treating runners were super geeky about it and we love when our patient comes and says, Hey, can you talk to my coach? She's also a PT or ex phys. I mean oftentimes or physiologists. I mean, you know, like what I, you know my strength and in biomechanics I also have a weakness of physiology cause we don't study it as much. So it's great to be able to talk, you know, if one of my patients says, Hey, I want you to talk to my coach. And they sign their release. It's fun to talk to their coach and be like, Hey, and you just, you know, the coach is going to see if it's something different than the PT is and you know, and you really work together. I love that part of it.
Shannon Sepulveda: 01:03:51 Oh yeah. I mean even with me and when I have, you know, women who come to me that leak when they run and I'm like, I'm really good at making you not leak when you run, maybe making you not have prolapse symptoms when you run. I'm not your performance coach. Like you go see experts and experts and an expert and they're going to like Dork out on the stride and you know the form and everything. Right. But I can help your pelvic floor when you're running. Exactly. And that's why we specialize. I was like, you know, you can geek out with running.
Nikki Kimball: 01:04:33 Like I could go to so many courses and I don't have time to do that. It's not my forte, but these people are really good at it. And the thing is you're really good at women's health, pelvic floor stuff because it's what you do. And you applied the geekiness of pelvic floor health that I applied to running. So of course, yeah, of course. I want my person with incontinence to see you and my person who was a runner to see me and I think if we all shared it would be great.
Shannon Sepulveda: It would be so great because as you realize how much more you don't know, even when I have an injury, I go see a PT, like I'm not treating myself. I don't do stuff right. I never do it. So I think your PT tells me, he tells me to do it, I do it. And they do hands on things that are just so different. And so I go see a PTs all the time for my stuff because I'm really good at what I do and they're really good at their niche and what they do. And PT is such a huge field that you can't be good at everything. Well, so where can people find you if they want coaching?
Nikki Kimball: 01:05:20 I've always done it word of mouth, but it's Nikkikimball@yahoo.com is sort of my public address that people can reach me at. Facebook doesn't really work because I get frustrated, but don't answer stuff. I just love coaching people of all levels, you know, but again, you know, I'm going to coach somebody for mostly ultra running or I love coaching, people in their fifties, sixties, seventies for shorter distance stuff because I think masters in veteran athletes, you know, athletes over 50 have, you know, they have so much to gain from sport and the book knowledge I have, there is no way I could have coached people people past, you know, 45 and before I realized a massive slow down myself.
Nikki Kimball: 01:06:46 It doesn't matter that you get it intellectually. You don't get it until you feel it. And when I'm three minutes a mile slower than I was at my best, you know, you know, you know, age is something.
Shannon Sepulveda: It is, it totally is. I mean, it's the same thing when, you know, I have pregnant women that I've never had a baby before and then want to run a, you know, I thought I could run a 5K like eight weeks after I had a baby before. Because when you don't know, I know it happens to you and then you're like, oh yeah, like I do get sore with age. Childbirth does something to your body, right. You don't know until you experience it and you can't expect someone to know that you can't.
Nikki Kimball: 01:07:39 The other thing, I mean, it's not like all parents throughout history haven't told their kids. You just wait. Sony. I mean, but it doesn't matter. We can say those things. It doesn't, it doesn't, you don't get it until you go through it. I mean, and I think book knowledge is super, super important and evidence and all that, but experience can't be discounted.
Shannon Sepulveda: Well, and it's also really nice to have someone that has gone through it and knows because you want someone that has been through it and knows what to do and has experienced that. So they can have empathy for you as a person, as an athlete, and assist you.
Nikki Kimball: 01:08:16 And also, you know, if it took me nine years to come to terms with my aging as an athlete, well, why would I expect my 57 year old runner to be okay with running a 30 minute 5K when she used to run a 20 minute 5K? Like how? Yeah. You know, like, it's important, you know, to have gone through that too, you know, I don't know, you know, seeing as it took me forever to teach myself that lesson and I still don't think I'm completely there. I don't know how well I do helping people through that. But I wish I had had some buddy who had gone through that slow down with me when I did.
Shannon Sepulveda: 01:09:12 Thank you so much for coming on the podcast. We'd really, really appreciate that.
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LIVE from the Align Conference in Denver, Colorado, I welcome Kory Zimney and Jessie Podolak on the show to discuss why language matters to patient care. Dr. Zimney is an Assistant Professor within the Department of Physical Therapy at the University of South Dakota, Senior Faculty with International Spine and Pain Institute (ISPI), and researcher with Therapeutic Neuroscience Research Group and USD Center for Brain and Behavior Research. Jessie currently owns and operates her community's first direct-pay physical therapy practice, seeing a variety of patients with acute and chronic pain conditions. She has been teaching pain science and manual therapy techniques at continuing education courses since 2013.
In this episode, we discuss:
-How language affects your actions
-Looking at language through the patient perspective
-What is negative effective priming
-Ways that you can enhance your communication style
-And so much more!
Resources:
Align Conference
Kory Zimney Twitter
How to make stress your friend Ted talk
For more information on Kory:
Kory Zimney, PT, DPT has been practicing physical therapy since 1994 following his graduation from the University of North Dakota with his Masters in Physical Therapy. He completed his transitional DPT graduate from the Post Professional Doctorate of Physical Therapy Program at Des Moines University, Class of 2010. At this time, he is in the candidacy phase in the PhD PT program at Nova Southeastern University.
Currently Dr. Zimney is an Assistant Professor within the Department of Physical Therapy at the University of South Dakota, Senior Faculty with International Spine and Pain Institute (ISPI), and researcher with Therapeutic Neuroscience Research Group and USD Center for Brain and Behavior Research. His primary teaching, research, and treatment focus is with pain neuroscience, therapeutic alliance, and evidence-based practice for orthopedic injuries of spine and extremities. He has published multiple peer reviewed research articles in these areas. Past work experiences have been with various community-based hospitals working in multiple patient care areas of inpatient, skilled rehab, home health, acute rehab, work conditioning/hardening and outpatient.
He has completed the Advanced Credentialed Clinical Instructor program through the American Physical Therapy Association and is a Certified Spinal Manual Therapist (CSMT) and assisted in the development of the Therapeutic Pain Specialist (TPS) through the ISPI certification program; and has a Certification in Applied Functional Science (CAFS) through the Gray Institute.
For more information on Jessie:
Jessie received her Master's Degree in Physical Therapy from the College of St. Catherine, Minneapolis, in 1998. She completed her transitional DPT from Regis University, Denver, in 2011. She has been teaching pain science and manual therapy techniques at continuing education courses since 2013. Jessie currently owns and operates her community's first direct-pay physical therapy practice, seeing a variety of patients with acute and chronic pain conditions. She has special interests in manual therapy, Pilates, spine and running injuries. She is a certified clinical instructor through the APTA and has completed her Therapeutic Pain Specialist certification through ISPI.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody, welcome back to the podcast. I'm your host, Karen Litzy coming to you live from the align conference in Denver, Colorado. And I am fortunate enough to be sitting here with Kory Zimney and Jessie Podolak and we're going to talk about the workshop that they did yesterday and will probably do again tomorrow on moving our language and why language matters around people with persistent pain. So my first question is why does it matter?
Jessie Podolak: Well, words are powerful. We started off by just doing some cool quotes that words change worlds, right? And words can pierce like a sword. The tongue of the wise brings healing. And that's just ancient wisdom, right? We've known that words just have so much power. They shape our perceptions, they shape our action. We know even from the research, just how we look at something. So for example, one of the studies we cited was if crime is presented as a beast, okay, crime is a beast versus crime as a virus.
Jessie Podolak: 01:12 When crime is presented that way with just those two words. And we survey people and we say, what should we do about crime? Those who hear crime is a beast, 71% say we should increase law enforcement. 51% of those who hear crime has a virus say we should increase law enforcement. So the word evokes more of an action response when we hear the beast versus virus. And other one was the economy, is the economy stalled or is it ailing? If the economy is stalled, we jump start it, right, stimulus package. If it's ailing, maybe we take measures that are really going to do long term change. We look at education levels or socioeconomic things and what can we do with this economy? So words shape so many things in general and in healthcare, the word surrounding pain, can evoke a lot of fear.
Jessie Podolak: 02:08 They can evoke a lot of a knee jerk reactions of what needs to get done. It can kind of force us to look at these more short term solutions. And I think that's been a theme emerging throughout this conference is that there's so many things that we do that are helpful in the short term but can actually be harmful in the long term. So the words that we have surrounding pain, probably lend themselves many times to short term solutions. And if we want to look at really a sea change in how we approach pain, we've got to think and consider our language.
Kory Zimney: 02:45 When we look at what we're just talking about, you know, a lot of people, I think they look at it and they go, well that's just a little change. You know, it was only 20% different. What's the big deal? And to me, you know, and it's all about nudges, that a lot of times it's just these little changes that can make huge difference for some people. And I get for a lot of people it probably wouldn't make a big difference, but if it did make a difference for a person, why wouldn't I want to try to maximize every little opportunity that I could get? And I know some people look at it like, well, I don't think language is that be all, a lot of people I can tell arthritis and they don't have a problem because I used that word and I get that. But what about that one person that it did make a difference for? How do you know it didn't make a difference for somebody? And if we have good evidence that shows that these little changes can make a difference, why wouldn't we try to maximize every little bit of that?
Karen Litzy: 03:33 Yeah. And I think that harks back to Kory to what you said this morning about everyone in the room has probably treated one person in pain and that's great. You treated one person, but you can't extrapolate what works for one person to a population. And so I agree that I think in as much as saying, do no harm, changing words around that might connect with someone I don't think is going to be incredibly harmful. By reframing words that maybe we know might be a little harmful. Like arthritis or what are some other ones from yesterday?
Jessie Podolak: One for me was wear and tear. How often do we say wear and tear. And what's the first thing that pops into your mind when you hear wear and tear? What's an object? Yeah, the tire. And what's that gonna do? It's gonna blow.
Jessie Podolak: 04:24 Right? So if I say you have wear and tear, what is kind of even a subconscious thing? They're just waiting for it to blow. And how does that influence your movement? How does that influence the adventure you have in life? How does that influence your whole being? Just knowing I have wear and tear for some people they might say, well I don't care. I'm going to wear it out. I'm going to grind that thing to the ground. But for others they might say, oh my gosh, these tires have to last me another 20 years. I better take really, really good care and back way off. So wear and tear is a hot button one for me.
Kory Zimney: 05:03 But yeah, so it's just those little phrases that are so easy for us to throw around. But we have to recognize that the lens that the patient looks through is probably different than the lens that me as the therapist with all my education and training on how I look through it. And I think that's just, again, taking that patient perspective is something that we all can hopefully try to do a little better sometimes.
Karen Litzy: 05:28 Yeah. And one thing from yesterday's class that I had never heard of before was negative effective priming. So can you explain what that is and then how we use it maybe not even knowing we're using it as therapists.
Kory Zimney: 05:43 Yeah. It’s really kind of what you talk about is kind of what you start thinking about. And so if I'm telling you how you're going to lose, if you don't do your exercises, you won't be able to do these things. And just create more of a negative type of attitude to everything, in everything the patient sees then will be directed more towards the negative. Where if you can flip it to more of a positive type outlook as far as when you do this, you'll be able to do these things and you can do that. And again, always flipping it to more of a positive direction. So again your just priming them, nudging them, turning them towards things that they can do as compared to, you lost this, you won't be able to do that. So, it's those little shifts and changes to focus on those positives. As a clinician, you know, you struggle like our patient’s so negative. And then we come up with these negative phrases sometimes and it's like, well, how are we helping prime them the right direction?
Karen Litzy: 06:34 Right, and what are some examples of maybe common negative priming that we may do as therapists?
Kory Zimney: 06:41 If you don't do your exercises, you know, that shoulder's gonna only get worse. You know, if you're overweight, you know, this puts lots of extra pressure on your knees, they're more likely to wear out. It’s just those little negative type of things. It's so easy. We can look at, we were talking about what they lose, you know, the kind of the gain aspect or the loss aspect. And oftentimes we tend to talk about the losses and patients will get focused on that, on the negatives. That's just human nature that we focus on negatives. As a clinician, if we're adding to that, it's only going to multiply more. Back in younger days as a clinician, I'd always get so proud of, you know, if I could get their problem list to 10, I thought, how cool am I am double digits.
Kory Zimney: 07:24 You know what I mean? Just get that problem list as long as possible, you know, but really looking at the optimism list, what things can they do? You know, what things can they do better? And you know, isn't that, how cool is that? That you can do that? In focusing on those things and what they can do better, what things they can do instead of on what things they've lost, what things they couldn't. So that's that kind of priming a kind of nudging more into a positive direction compared to our traditional, you got dysfunction, you can't do this, you're broken.
Jessie Podolak: 07:50 Yeah. And even the way we asked that question, Lindsay had just a really nice thing this morning that she talked about with goals instead of, you always think of, you know, what are your goals? And that's kind of an obscure thing, but I think she asked it in a way that was something like, tell me something that you'd like to do more of, be better at, or return to doing that you currently can't. It flipped it because it started, you know, there's this great quote from a Ted talk that I love by Kelly McGonigal called making stress your friend. It's awesome. She has this quote in there near the end where she said, you know, it's so easier to run towards something than away from something. And if you look at your patients, what are they right in their goals?
Jessie Podolak: 08:29 I want to get rid of this pain. I want this away from me. I want to avoid it. It's so overtaking their life that they're running from it. But if we can just direct people towards what is to come and even get them to maybe cast a little vision, which I know is scary. Right? And you don't want to have false hope. We talked a lot about that, about how to balance reality and honesty. And sometimes to say, I'm not sure how this is going to turn out, but I'm with you in it. Right? But I think, you know, this is the worst I've ever seen, or man, this is the biggest trigger point I've ever felt, no wonder you hurt. Those things come from a place of pity or sympathy which it's well intended, but it's not as far on the empathy and compassion scale that we want.
Jessie Podolak: 09:26 We want that empathy and compassion of, I see where you're at and where you've been, but I'm with you as we go forward, I guess how I look at it.
Karen Litzy: Absolutely. And I think that sentiment of yes, I'm with you, but being honest, so doesn't mean everything's pie in the sky. And I think that's where people, when they hear about this, explain pain, quote unquote or PNE, they think, oh, you're just talking away the pain and you're not being honest. You're not being realistic. But that's not what we're saying when you're talking about language and talking about communicating with someone who has persistent pain. So one of the examples we used yesterday was like hippo A and we said, you know, yes, you're, you may have pain and we're going to work on strengthening. There is a chance you might need surgery, but if you do, you'll be stronger going in. So you have to be honest, you can't say to someone with severe hip OA, you'll be fine. Just do a couple exercises. It's just not realistic. And then when the person isn't fine, that's a steep fall.
Jessie Podolak: 10:18 Yes. And it goes back to this, not swinging too far on the pendulum away from the bio, it's still bio-psychosocial. And how do you explain something that there are biomechanical issues in a way that's not scary that still honors the bio, but that kind of de-catastrophizes or softens, it's really just about softening and responding. Like watching the patient's nonverbals. You can tell when you're starting to freak somebody out. And so then you make the adjustment and you just be very, very present.
Jessie Podolak: 11:12 So it's certainly our language, but like, as you know, Kory talked about is communication. And I really like what Jonie said about pain neuroscience communication versus just education, I the smart therapist I'm going to teach you, silly patient about how this works. No, this is about communication and dialogue and how do we do that?
Karen Litzy: Yeah. And Kory, I think you said this yesterday, but correct me if I'm wrong, I think you said that the body is not fixed rather a robust ecosystem that has the ability to change and grow.
Kory Zimney: 11:54 Yeah. And that was actually a TPS grad that we have that talked about that. The beauty of the amazing plasticity and I mean I go back to when I used to, you know, work somewhere in our rehab unit and when a patient came in with a stroke, you knew there was brain damage and you could see the MRI report. But the beauty is you had no idea what they might be able to function and do afterwards, right? Because you'd look at those areas that were destroyed, where the infarct was and stuff like that. And some of them amazingly regained function and the ability to walk and their ability to transfer and get out of bed. So you just always had this ultimate optimism, you know, as the traditional neuro type of Rehab Therapist, when somebody would come in with their stroke or spinal cord and in their ability to be able to do things. But for some reason in the orthopedic world, we just have this like, oh, well, yeah, sorry.
Karen Litzy: 12:38 Yeah, sucks to be you.
Kory Zimney: 12:44 We just create this, like the body can't be adaptable to these things. And now that they've done the imaging studies on normal people, we're all walking around this stuff. We've all had this beautiful adaptability, whether it was from a neurological orthopedic, any kind of change that's gone on on our body, but we don't ever appreciate, and look at that from that optimistic again in realistic sense, you know. But again, we know that if you have a little tear in your meniscus that might be an issue. Yes, it's a huge bucket handle and you can't straighten your knee out and it clicks every step. Yup. That's probably a major deal. But otherwise a lot of people can get by with that. No, I don't know with absolute certainty, but the beauty is we should be able to find out in four to six weeks because we can train the body, help it become more adaptable. We can explore different motions and movements and see how you do with it. And if it still doesn't, the awesome thing is we do have surgical options, to make that better. And so that's just that beauty of appreciating the adaptability of the human body. And I don't know that we, for some reason, we seem to have lost that appreciation to some degree.
Karen Litzy: 13:46 Yeah, and I think that's something that I know I'll be using with my patients just to say, listen, you are this robust ecosystem, and I think if we share that with all of our patients, I think they may have a mind shift change there.
Jessie Podolak: Yeah. If you think of ecosystems, so many things go into it. Yeah. Right. It's not just the musculoskeletal. I think just that if people could really view the body as juicy and more robust and just multifactorial, and I think that's where maybe we got off track is we just started seeing the body as a machine.
Karen Litzy: Which I have to say is my pet peeve. I hate when people say, your body's just like a car. I'm like, no, it's not because the car doesn't breathe. We're not mechanics. We're not this. Like that is not how it works. Where I'd like to think as people we’re a little more complex and in a very good way, right? So now what would be the thing that you want people to take away from why language is important when it comes to working with people with persistent pain.
Kory Zimney: 14:56 For me it's just being mindful of that, you know, taking that moment and again not to as a therapist, don't overthink it either. Don't think, oh, what words can I say? And if I said arthritis all crap, their patients going to catastrophize and never be able to walk again. No. But just be mindful of it and be present with your patient. Because when you're truly present with your patient, you can see that look in their eye and you can get that sense that they may be getting a little bit worried or catastrophizing or a little anxious and stuff like that. So it's that ability to just be present and mindful that words do matter. But again, not so overly mindful that you freeze and you don't act either. We still have to just be human, just being a part of that. And again, that's just that communication piece that really is what we're talking about.
Jessie Podolak: 15:38 I would just echo what Kory said. It's just be with your patients. Care, invest in them. Some of the patients who it takes every ounce of energy they have just to make it to your appointment. Realize that they're giving you the trust and kind of the gift of their time and their precious energy. And so, even when you have that busy day, even when you know you're kind of sucked dry, just to give them that time that you have with them and to slow down a little bit, listen, be mindful and you know, I just think it's just about being a little softer, just softening out the rough edges and being that safe place. You know, Louis Gifford, one of our heroes said reassurance is an analgesic and sometimes we can't reassure that that hip is going to not need surgery, but we can reassure that I'll be with you. We’re in this, I'm in this with you. So that's what I would say.
Karen Litzy: Awesome. Well, thank you so much, Korey, Jessie, I appreciate both of you and I really enjoyed your talk yesterday, so thanks so much for coming on.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Duane Scotti on social media marketing. Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.
In this episode, we discuss:
-How to decide which social media platform is right for your marketing strategy
-What social media content will best build loyal customers
-The benefits of scheduling out social media content in advance
-And so much more!
Resources:
Duane Scotti Twitter
Duane Scotti Instagram
Spark Physical Therapy Facebook
Spark Physical Therapy Website
The Clinical Outcomes Summit
For more information on Duane:
Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.
Duane is currently the founder of Spark Physical Therapy, providing prehab, rehab, and performance optimization services either onsite or in the comfort of your home within the Cheshire/Wallingford CT region. He also is a clinical assistant professor in the Department of Physical Therapy at Quinnipiac University responsible for coordinating and teaching musculoskeletal examination, intervention, and advanced manual therapy within the orthopedic curriculum.
Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation, dance medicine, gymnastics medicine, and rehabilitation for runners.
Duane has been in clinical practice working with orthopedic, sports, and performing arts populations since 2003. He has strong clinical and research agendas in screening, injury prevention, and rehabilitation for runners, dancers, and gymnasts. Duane uses an integrative model of manual therapy including manipulation, mobilization, and soft tissue treatment including dry needling and the Graston technique for the management of musculoskeletal dysfunction. Duane is a physical therapy advocate and is actively engaged with the American Physical Therapy Association and serves as Vice President of the Connecticut Physical Therapy Association.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Janet Kantor with Duane Scotti, a physical therapist from Connecticut who is joining me today on healthy, wealthy and smart. And today we're talking about doing a specific niche on social media and really just nailing it. You are nailing it, Duane. So first of all, thank you so much for coming on.
Duane Scotti: 00:19 Thank you for having me. This is awesome. I'm very happy to be able to talk to you about this topic today.
Jenna Kantor: 00:26 Yes. So I would love to know first, how did you choose what social media platform you were going to put most energy on or also I've seen you on Instagram, but you may also be on other platforms and I would just love for you to expand on that.
Duane Scotti: 00:41 Great question. When I was looking into kind of getting into social media and using it as a platform, I thought about what is my audience, right? So most of the patients that I treat are adolescents, so I basically treat gymnast runners and dancers and a lot of them are on Instagram. So I started the Instagram account and started learning everything I could learn about Instagram, but their parents are on Facebook. So a lot of, you know, their parents are on Facebook and there's different groups on Facebook. So that's been beneficial from that standpoint. So those are really the two platforms that I utilize. I do have a Twitter but I haven't used it. Primarily because that's more for professional and other PT’s and that's not really my target audience.
Jenna Kantor: 01:27 Right, right. Absolutely. I like how you hit the nail on the head regarding Twitter specifically, I'm not as active myself. I have something set up where it automatically posts, but my heart isn't there because that's like you said, not where my target audience is. And I like how you bring that up. So how does your content differ from Facebook where the parents are, to Instagram, where the kids are?
Duane Scotti: 01:52 There's not too much differences in terms of I do post the same content basically to both platforms. The messaging is a little different if I'm sharing it to a group. So specifically at our local dance studio, we have a closed group so my messaging is going to be a little bit different, kind of targeting the parents and looking out for their dancer, as well as the stories on Instagram. So the stories are on Instagram are a little different, but the content posts that I do on a daily basis, they are going to be the same post that just instantly goes over to Facebook and I'll shoot it over there from Instagram.
Jenna Kantor: 02:27 And you just mentioned a little bit about you have kids who are going to these dance schools. There's a relationship you already have with these parents that's helping you build these groups. Would you mind elaborating a little bit more on how that came about?
Duane Scotti: 02:44 Yeah, so, well I guess first off, I do have two daughters. One is a dancer and one is a gymnast
Jenna Kantor: 02:49 Shout out to your kids.
Duane Scotti: 02:51 So they are at the local gym, the local dance studio that I've been affiliated with awhile. I also taught at the local studio, I was a dance instructor there. And you know, obviously those relationships, the families, they kind of have known me and trusted me for years and I've helped out their dancers before. So those are kind of how those relationships have been built. It's really more of me just being present and being there for, you know, picture day and you know, I'm there doing, you know, kind of complimentary screenings and things of that sort. So you kind of develop that rapport and relationship with the families where you kind of earn their trust, that you're going to be kind of looking out for their dancer.
Jenna Kantor: 03:34 You know, you hit upon something that I think is so valuable. I actually interviewed Karen Litzy the other day for her own podcast, this podcast in which we are interviewing for right now. And she was talking about these relationships and how she just lives her life and through the things that she's already passionate about. She's made these relationships and help those relationships grow. And it sounds like that's what you have hit upon, which you agree.
Duane Scotti: 04:01 Absolutely. Absolutely. Relationships are everything and from a practitioner standpoint, your relationship with your patient and their families are important. But then expanding beyond that and you know, things are a lot different than the healthcare world. And when I first graduated, you know, it was prior to direct access time and everything was about trying to foster that relationship with your referring physician. Now it's a completely different animal. You know, my relationships I'm fostering with are the communities in which I serve. So looking at the gymnastics community or it's the relationship with the coaches, right? And having, you know, I'm just thinking about the first facility that I started in, it was talks with coaches, not just one saying, Oh yeah, I'm a physical therapist, let me treat your gymnast. But it was many talks, many conversations you developed that rapport, that relationship, and then that turns into, hey, can you help this gymnast out?
Duane Scotti: 04:56 Oh we have another one. Can you help this one out? And then you kind of foster that relationship over time and then you wind up seeing, you know, your practice or your business kind of growing from that standpoint. And it's really kind of getting into our communities and for me at least that has been successful is having those relationships with, you know, the dance studio owners, the gym owners, now we're treating out of an aerial silk studio. So really you develop that relationship and then they recommend your services to people that are in their circle, right. And their business because they trust you. So I think those relationships are definitely, definitely important for kind of long term success.
Jenna Kantor: 05:38 Yeah. And it just makes it more enjoyable because you honestly enjoy each other and so I think that's great. So let's go back to the social media stuff. Your content itself, I mean, I've seen the video of you dancing with your daughter, which was great. What was it? The diggy?
Duane Scotti: 05:53 That was the Kiki challenge.
Jenna Kantor: 05:56 I think that video pretty much went viral. Am I correct?
Duane Scotti: 06:00 Yeah. That one was definitely my best performing video. So yeah, it was fun. That was something that, you know, a lot of people were doing that. And I think you saw on the news like a dentist had done it. I was like, you know what, we should do this as a physical therapist and just showcase what physical therapists do. So, you know, my daughter's a dancer and she was interested. I said, Gabby, let's do it and let's do a little dance. So we just kind of put it together real quick and that was fun. And that's the thing I do like about social media. It's really nice. You can have fun with it. We are professionals and we always have professional interactions with our patients, but we also have fun with them.
Duane Scotti: 06:37 Right. And we're human, we’re people. So just kind of showing some of that human side I think has been definitely beneficial. And you know, if you look at your insights on, you know, Facebook or Instagram, the posts that do the best are the ones where I am not trying to be super serious and I'm not showing the best technique and the best tool in my toolbox that I know it's more of me just being genuine and it's more of you know, doing a silly dance or you know a picture with the family or you know, something that's kind of outside the box.
Jenna Kantor: 07:14 It lets people feel more connected to you. So let's go into more on Instagram because Instagram unlike Facebook, Facebook you can schedule posts for free, Instagram you can’t right? So are you using one of those paid for platforms to post or do you just post daily and what is your schedule that you abide by to be consistent?
Duane Scotti: 07:40 Well, you hit a really important point is that consistency is key with Instagram and Facebook. It is one of those things and it's just like anything we do in life habit, right? Exercise goals, running goals, wherever it is. Getting to the gym, you gotta be consistent and I don't know, people for different things what like two or three weeks to form a habit and then it becomes a habit. And for me that's been helpful where now it's just part of my daily routine and scheduling it in advance and doing batching and kind of putting videos together, putting, you know, writing, you know, batching all your posts together. It's definitely helpful. It makes it easier. But unfortunately Instagram does not have, like you said, where you can schedule out your posts, so you do need to post it. Then I have heard of other platforms that you can utilize to put your posts in, but it still will send you a reminder to your phone saying this post is ready to go. And then you'd have to open Instagram and actually post it. So that is the limitation in terms of time management. So it is “work” where you need to think about it. Hey, I have to post on this day. I've thought about and you know, and maybe in the future trying to delegate a bit of that out, just to ease a little of the burden of having to do that. And I actually trialed that shout out to Nikki when I was on vacation.
Jenna Kantor: 09:04 Hi Nikki. I don't know who you are, but thank you.
Duane Scotti: 09:07 She did an awesome job and I wrote all the posts in advance and she did the posting for me when I was out of the country and I couldn't post. So I think it's a doable model, but you still needed to write the post. And because I think, again, going back to being human and genuine, right? So a lot of these bigger businesses, you know, they have marketing people who are doing their posts, but you can tell it's more from a marketing angle and standpoint. It's not that person being genuine and who they are.
Jenna Kantor: 09:34 That was so eloquently said. I don't know if we'd go out for coffee, but good, good job.
Duane Scotti: 09:41 Right, right. So that is, you know, on Facebook they do have the scheduling, but if you're going to wind up forcing an Instagram, again, like I said, you can just shoot it over to Facebook then. So yeah, I unfortunately don't have a scheduling system that will just like send them all out. Which would be nice.
Jenna Kantor: 09:58 And then for the content preparation, do you pretty much do like on Sunday you prepare for the week or do you kind of do daily? Do you have a system for that yet or how do you do that?
Duane Scotti: 10:10 Sure. I don't do that specifically on Sundays, but on Sundays I do iron all my outfits for the week.
Jenna Kantor: 10:15 You buy clothes that you need to iron? That's lesson number one. You're supposed to buy shirts that are iron free, like you don't need an iron. So let's start there. Now move onto the creating of content.
Duane Scotti: 10:33 Yeah. So it's really whenever I have free time, so there's no specific day where I'm like, okay, Sunday is the day that I'm going to do all that. It's whenever I have a chunk of time, then I have a calendar. I have a plan for what's going to be coming out when and then it's a matter of all right, I'm going to do these videos, whether I'm going to write some captions in the videos from adding music, whatever the case may be. And then I have all those ready to go. So that's like my videos ready to post folder on my phone there. And then I will have the write ups. So then whenever I have free time it's like, okay, let's write up this post that post that post. And so then it's kind of done in advance. Ideal world is I would have like a full week's worth of content and I found that is so much better because it's not stressful thinking about because your day is busy, right?
Duane Scotti: 11:17 So I teach during the day, you know, doing the practice in the evenings and on the weekends. And you know, if I get to the point where it's, oh, I don't have a post today, it’s stressful and then you have the pressure of coming up with something right on the spot. And so having it in advance, it's a lot easier where it's ready to go, the writing is done, the post is actually done, the videos are done and then it's a matter of just literally opening up the platform and hitting the plus button and there's your video and copy paste, boom, boom, boom and then you're off and running.
Jenna Kantor: 11:48 Yeah. And you're hitting upon why I'm actually considering investing in an Instagram, a paid for platform to post for Instagram because this is where the value of being able to schedule it out really comes in because you could schedule it out for a year. I mean, imagine that you just hammer it out, you know, you're like, I love you children. You go play, you get to watch movies this whole weekend while I create content. And then you pull them in, you say, hey, you know what, I would like you to create choreography to five songs. So then you could do the family thing a couple times. But yeah, I think that is a key thing to maybe even tap on. I'm actually brainstorming for myself, not even giving you advice because for me, Instagram personally is a platform that I'm just about to start going for. I took the time with Facebook first, I'm very on top of that and now Instagram is my next target to like create those habits. So it's really good for me as a practitioner to hear what you're doing, what your experience is and how possible it is, so thank you.
Duane Scotti: 12:58 Yeah, I know. And on Instagram, you know, it is a little different from Facebook in that I feel like you need to write a little less. And attention spans are a little different on Instagram. So, you know, those things are different and obviously the hashtags are important on Instagram, whereas Facebook, they're not. So you know, knowing which, you know, tags to use can help bring your reach to a wider audience and kind of your target audience. So you do have to give some thought to the actual tags that you are going to use on Instagram, which I think helps, you know, get your stuff seen.
Jenna Kantor: 13:35 Yeah. How did you find the Hashtags for you? Because you could sit there and say Hashtag dance and see that a lot of people post dance, but if you're going to really target the people in your area, how did you get those hashtags?
Duane Scotti: 13:48 So I do some local hashtags. I'm still looking at towns, right. So Wallingford, Connecticut, Cheshire, Connecticut, North Haven, Connecticut and we'll look at those local tags. And I don't know if anyone really truly knows the answer to the algorithm. But it is, you know, do you go with the hashtags that have the most numbers or because there's so many things posted on them anyway your stuff's never going to be seen. Or do you go with some that aren't in the millions or the hundreds of thousands so you can get into your niche, right? So I try to make them relevant to whatever the post is and then relevant to my target audience and you know, looking at if it is something on the ankle and ankle pain or maybe you're someone searching for that or ankle sprain I use those tags.
Jenna Kantor: 14:38 Yeah. That's great. Well, thank you so much and my last question would be do you consider yourself an expert on social media?
Duane Scotti: Definitely not.
Jenna Kantor: That is where I think it's perfect to end for all you practitioners. We have worked so hard to get our licenses to work on these patients in physical therapy or honestly in any health career that you are pursuing. You don't need to be an expert. You just need to start. And the more you do, the more curious you get and the more you will learn. And Duane Scotti here is definitely a perfect example of that. So thank you so much for coming on this podcast and sharing your knowledge.
Duane Scotti: Yes, thank you so much for having me.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE from Graham Sessions in Austin, Texas, I welcome Justin Moore on the show to discuss the American Physical Therapy Association. Dr. Justin Moore, PT, DPT, a physical therapist and veteran of both the profession and the association with more than 20 years' experience, leads the American Physical Therapy Association in the role of CEO. He has been with APTA for 18 years and has held numerous positions, including executive vice president of public affairs, leading the public policy agenda and payment and communications departments, leading its federal and state affairs advocacy departments and serving as the association's lead lobbyist on Capitol Hill.
In this episode, we discuss:
-How the APTA strives to provide an inclusive experience as a macro organization
-What Justin would change about the APTA
-APTA’s role in the World Confederation for Physical Therapy
-Justin’s biggest takeaway from the Graham Sessions
-And so much more!
Resources:
Email: justinmoore@apta.org
Justin Moore Twitter
Justin Moore LinkedIn
World Confederation for Physical Therapy Congress 2019
The Healing of America by T.R. Reid Book
For more information on Justin:
Justin Moore, PT, DPT, a physical therapist and veteran of both the profession and the association with more than 20 years' experience, leads the American Physical Therapy Association in the role of CEO. He has been with APTA for 18 years and has held numerous positions, including executive vice president of public affairs, leading the public policy agenda and payment and communications departments, leading its federal and state affairs advocacy departments and serving as the association's lead lobbyist on Capitol Hill. Moore also previously oversaw APTA's practice and research departments. He has been honored for his contributions to physical therapy and public policy by receiving the R. Charles Harker Policymaker Award from APTA's Health Policy and Administration Section and the Distinguished Service Award from APTA's Academy of Pediatric Physical Therapy. In addition, Moore has written, presented, and lectured on health policy, payment, and government affairs issues to a variety of health care and business groups across the country.
Moore received his doctor of physical therapy degree from Simmons College in Boston, Massachusetts, in 2005, his master of physical therapy degree from University of Iowa in 1996, and his bachelor of science degree in dietetics from Iowa State University in 1993. He was honored by Iowa State University's College of Human Sciences with the Helen LaBaron Hilton Award in 2014 and the university's Department of Food Science and Human Nutrition's Alumni Impact Award in 2011, and he was the Family and Consumer Sciences' Young Alumnus of the Year in 2003. He also recently completed a 3-year term on Iowa State University's College of Human Sciences Board of Advisors. Moore was part of the inaugural Leadership Alexandria class in 2004 and served on the Northern Virginia Health Policy Forum Board of Directors.
Read the full transcript below:
Karen Litzy: 00:01 Hey Justin, welcome back to the podcast. I'm so happy to have you back. So we have a couple of questions to get through today and we also want to talk about the first half of Graham Sessions. So we are recording live at Graham sessions in Austin, Texas. And I've got a couple of questions for you and then we'll talk about your big takeaways from the morning session here at Graham sessions. So first thing is, and this will probably be addressed at Graham sessions tomorrow, but what is the APTA doing the American Physical Therapy Association doing to address the current needs of physical therapists, physical therapist assistants and students to ensure their membership is quote unquote worth it?
Justin Moore: 00:44 Yeah, it's a great question. It's a question I get often and unfortunately don't have always a great answer because it is such a personal and passionate issue of how do you find value inside this community of APTA. And as you know, value has two meanings, an economic meaning, do you get a return in your investment? And so we look at the physical therapist and the physical therapist assistant of investing in APTA and do they get a return, so there's an economic part of this question, but there's also a principal part. Do you value APTA? And we'd like to focus on that. And then how can we really engage the physical therapist and the physical therapist assistant and really showing value to APTA and getting value from APTA. And I sort of look at it in Adam Grant's philosophy of give and take, you know, the transactional or economic value is what do you get from APTA?
Justin Moore: 01:38 And then the give is what do you give to APTA? We're really blessed by our members giving to us and increasing the value for all. And I think the value at the end of the day, the take home value that PTs get from APTA is we're an unabashedly, aggressive about increasing the opportunities for physical therapists. So if you believe in that mission and that value, how do we continue to connect you to your colleagues? How do we continue to build a community that's going to make this career you've chosen make a difference in people's lives, but also return a fulfilling career to you. And so get that return on investment and that value. So, another thing I'll just tie is our board of directors has been really aggressively looking at how do we continue to be relevant to the next generation of clinicians. And we know healthcare is changing. We know business is changing and we have to be getting better at being relevant at the point of care. We have to get better at promoting the value of our profession and we have to get better at connecting our experts. And right now, I think that's what our strategic planning process is about, is how do we become more relevant to those individual clinicians and professionals.
Karen Litzy: 02:50 And I think that's different from a couple of standpoints. One and we’ll probably talk a little bit about this tomorrow, is that APTA is obviously a macro organization. There's 101,000 members. So how do you incentivize members from one not dropping off, So a retention issue, right? And two, how do you attract them in to have that feel of more of a micro organization? Right? Cause it's all about the details and it's all about incentives. So how can the APTA, which is a very large organization and it needs to be that way. It can't be small. So how do you give a macro organization a micro feel?
Justin Moore: 03:35 Yeah, absolutely. It's our greatest challenge. And I think, you know, one of the things that is very good about APTA is we interact with probably 95% of potential members in a five year period. So we have 80% market share of students, 30% market share of practicing professionals. It's a little less than 10% of physical therapist assistants. So we do engage with almost our entire community over a five year period. But we have to return value in the short term to keep them a member. And the greatest challenges that is, how do you let this very diverse clinical community, how do you build a spirit and harness the power of inclusion? So people can find their people so they can find their community inside this large network of professionals. And sometimes APTA has been too complex, too fragmented, and too divisive to achieve that objective.
Justin Moore: 04:29 And so we have to look at those themes on a pretty regular basis is how do we become more inclusive? And so how do we help people find their people, their network of individuals, because they're going to get great value in that if they're going to be a better private practitioner, if there going to be a better pro Bono clinic operator? If they can connect to their people that's going to return value, how do we reduce the fragmentation? We all are committed to promoting the value of PT Well, if we're talking about the value of a certain part of PT, we're constantly competing inside the PT world. It really dilutes our impact. And we know that from data is we're a pretty fragmented community. And so we've got to reduce that fragmentation and build unity. And have to be better working together.
Justin Moore: 05:17 We're not unified. The bigger you get, the harder it is to feel the intimacy. We had a consultant work with APTA’s board one time and he put up a matrix. He said, you can be three of the four things in the quadrant, but you can't be the two things that are across from each other. And the two things that cross each other in that matrix were intimacy and strategic. And so to be a strategic organization, can you still be intimate in an association of one where you address every need, every one, and we have to figure out, we're going to be a complex organization, but we have to figure out how to give an intimate experience, but be strategic in that intimate experience.
Karen Litzy: And it's a challenge. It's a challenge for a large organization, but it's good to hear that that's on the minds of the people at APTA.
Justin Moore: 06:06 Yeah. I think we've realized that we have fallen short at times of really being able to connect people, really giving people a sense of inclusion. Even though we've tried to be inclusive. If it is not conveying that to the end user or member and they don't feel included then we're missing the mark.
Karen Litzy: One thing it's not about is the money.
Justin Moore: We can give you in economics, I always tell the story is, you know, it is a federated model, has a complex new structure, but APTA dues are 295 in the realm of that, it's a pretty low price point inside of professional associations. If you compare us to other medical associations, other nursing professions, it's a pretty low price points. We probably return economic value for transactional value to the member, and show that value pretty well. But if they don't value their experience, it doesn't matter what the price point is. And so that's what we really have to work to achieve.
Karen Litzy: 06:59 Yeah. Not Easy. I look forward to seeing what comes out in the next couple of years there. Okay. Moving on. If you can end with, maybe we already said this a little bit, but if you can change one thing about the APTA organization, what would it be and why?
Justin Moore: 07:13 I think it would be to harness the power of inclusion. We've really been focused on that and how do we create a community that at times has been competitive or fragmented and how do we bring them together for commonality and unification around promoting the value of PT, promoting the brand of PT and we're going through a process right now at APTA of rebranding and we're going to be launching that in the next 12 months. And what we found is we went through the research on doing that is we're conveyed way too many opportunities to put your own perspective of what the value of PT is. And we need to really get unified and more inclusive in that march toward promoting our value.
Karen Litzy: 07:57 Simplify the message a little bit more. It is hard because within physical therapy you have so many options of workplaces and how you work and who you work with and states and personalities. And I mean the list can go on and on. I would imagine having that sense of inclusivity among 101,000 members, but 300,000 PTs across the country is not easy when everyone is so diverse, diverse in race, religion, gender and diverse in practice settings. So it's like you have to not be, I'm trying to do everything but a master of none.
Justin Moore: 08:43 If you're trying to do everything, you're actually doing nothing. That's sort of been a challenge for APTA. They're trying to be all things to all people and was at times maybe a little bit mediocre at everything. So we really have to do that. And I think the common theme is we've done some analysis both on the data side and then actually a social listing. And two themes come out about the PT community is we're pretty divisive. So when you guys see this is people like to tear other people down or can say that they're better at a certain thing than others. So if we could get away from that divisiveness and correct that, that would be great. If an outsider was looking at our dialogues, it would not be a positive experience.
Karen Litzy: 09:36 I’ve had a patient tell me like what you guys really don't get along. I’ve seen some conversations on social media. And I was first of all shocked that a patient would actually bring that up so people are looking and they are reading.
Justin Moore: 09:44 We've had outside consultants that have look at this and they said they can't believe two things. How some of our acting members tear us down. And so these are people who have already made a decision to join us but yet like to tear down the organization. And then what we found is when we were out looking at the research on our next strategic plan and looking at net promoter scores our highest distractor group, was some of our longest serving members, and essentially we figured out we're not engaging their expertise well enough. And so that was sort of a wake up call for us instead of saying, oh, why are former leaders tearing us down? We said, wait a minute, they're feeling lost. They're feeling not included. They have given a lot of time to this association and now they feel like they've been dropped off a cliff. And so how do we give them a parachute, how do we give them a glider? What can we do to keep them in the spirit of inclusion?
Karen Litzy: 10:36 I think that's great because you know, in some conversations I had yesterday, someone brought up to me that it was really great and it was that the APTA has 101,000 quote unquote experts. So the organization is not the expert. They're the facilitators of all these experts that they have at their fingertips. And just think how much the organization can do by being a stellar facilitator of all those experts.
Justin Moore: 11:05 APTA is a vehicle. We don't practice, we don't do research, right? We don't do, we do a little bit of education. We do a little bit for professional development, but we can be a vehicle where our educators can educate, our researchers can publish, our researchers can have access to funding and our practitioners can get that. So we have to really leverage our role as convener. Our role as networker. As a funder. The very basic principle of association is people come together for collective success. So they give us dues you use to put into a collective operation for PR, for advocacy, for all those things. And we've got to get better at that. Include that spirit of inclusion.
Karen Litzy: 11:46 Perfect. Alright, next question. So the World Confederation of PT Conference is coming up in a few months in Geneva in May. So how is the APTA improving its outreach and involvement in the international world of physical therapy? Are you going to be in Geneva?
Justin Moore: 11:54 Yeah, it's a big priority for APTA to be an international partner and contributor to global PT. And so WCPT is one part of that. It's not our inclusive effort. But APTA has a long history of involvement with WCPT including being one of the founding countries and including having at least a couple of presidents I believe. So, most recently, Marilyn Moffat was president of the WCPT. So we have a longstanding commitment and contribution to WCPT and the conference in Geneva will be a great community of international leaders where we can go and be in a posture of learning. So a lot of times we're not going to, we go and have a delegation at WCPT, but we're really going to interact with our colleagues in Australia and the UK and the Netherlands and really learn from their successes and how we can apply those back here.
Justin Moore: 13:01 I think this morning at the Graham sessions when we heard T.R. Reid and it's a great book. I highly recommend it, but he went around and experienced healthcare in different countries. That's sort of what we do at WCPT. We go and we talk to the Netherlands of how did they stand up their registry? How did the UK be frontline in primary care, how did Australia get this great expertise in sports and orthopedics and manual therapy? And so what can we do to really leverage that global community to improve care back in the US as well. WCPT is just like APTA, it’s an organization. And so we have a responsibility as a member. It's interesting, WCPT doesn't have members that are individual physical therapists. Their membership is the organizations that comprise the countries.
Justin Moore: 13:49 And so we are one of about over a little over a hundred member organizations at WCPT and we, you know, we take that responsibility very seriously and always are looking for opportunities to contribute to their objectives and especially when they're aligned with our objectives.
Karen Litzy: I’m looking forward to going to Geneva. I can't wait. I think it's going to be awesome and I'm actually going to be staying with some international PTs. So one from Canada and one from Ireland. I go to a lot of international conferences. It has really changed the way that I practice, it has changed my outlook on the profession as a whole. And what you find when you talk to therapists from different countries, we're not all that different. The way we practice, the challenges that we all have in these different countries are very similar. And I found that to be very eye opening.
Justin Moore: As a physical therapist who's gone into association management, I've gotten huge value from some of my colleagues of other physio therapy associations.
Justin Moore: 14:46 So Cris Massis at the Australian physiotherapy association, he's just been a great role model. Someone to learn from. And it's nice because it's safe. You know, we're not competitors. He's got his lane. I got my lane and he's been a great resource. Mike Brennan, who was at the Canadian Association a few years ago has been a great reference and resource and I've just been able to observe a lot of these international CEOs and how they conduct their business. And it's been a great learning opportunity for me as well, a little different clinic than the practitioners.
Karen Litzy: 15:20 The parallels are there and the APTA, we’re as clinicians trying to learn from each other and as heads of organizations you're trying to learn from each other.
Justin Moore: It's one of the strongest things is the opportunity to interact with those other CEOs.
Karen Litzy: So before we finish up, what were your biggest takeaways from the morning here at Graham sessions?
Justin Moore: Well, I thought my biggest takeaway, or I don't know if it’s a takeaway or my biggest observation is a lot of thought provoking conversations are already starting. And this concept, and we're going to face this all the time, this concept of what is next in healthcare reform that was started by a T.R. Reid’s presentation, but also what does that mean for physical therapy and where do we need to change our lens? Where do we need to change our focus and how do we need to adapt to be part of the solution, not part of the problem was a key theme. There's a lot of brains in that room, and so I'm looking forward to how they process over the next several hours and come up with solutions. It's easy to point at the problems, but the solutions are always more complex.
Karen Litzy: 16:29 So thank you so much for coming on.
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On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Jim Dunleavy on the New York House of Delegates. Jim Dunleavy is Chief Delegate of the New York Physical Therapy Association Chapter. James Dunleavy graduated Cum Laude with a Bachelor of Science in Health Education from Manhattan College in 1976. He received a P.T. Certification in 1977, followed by his MS. P.T. in 1983 from Columbia University. James was a Co-founder and acted as its first President of the Acute Care Section from 1992-1997. He served as an APTA Director from 1998-2004 and received the APTA‘s Lucy Blair Service Award in 2005. Currently, James is the President of the New York Physical Therapy Association, an office he took in 2006.
In this episode, we discuss:
-What is a motion?
-An overview of how the delegate assembly functions
-Jim’s advice for new graduates who are looking to get involved in professional organizations
-And so much more!
Resources:
Jim Dunleavy Twitter
New York Physical Therapy Association
For more information on Jim:
APTA spokesman James M. Dunleavy is administrative director of Rehabilitation Services at Trinitas Regional Medical Center in Elizabeth, New Jersey. He also serves as adjunct faculty in the Transitional Doctor of Physical Therapy Program at Rutgers University. As an active member of APTA, he founded the association’s Academy of Acute Care Physical Therapy and served as its president for 5 years. He has held various volunteer positions within the association, including serving as a director on the APTA Board of Directors. Dunleavy also has held many volunteer leadership positions on APTA’s New York Chapter Board of Directors, including treasurer, district chair, district director, and president. In 2005 he received APTA’s Lucy Blair Service Award. He was the first recipient of APTA’s Acute Care Section Leadership Award, now named after him. He received a bachelor’s degree in education from Manhattan College, a master’s degree in physical therapy from Columbia University, and a doctor of physical therapy degree from Massachusetts General Hospital Institute of Health Professions.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor with Jim Dunleavy who is the NYPTA chief delegate. And I am very excited to be interviewing this morning. So first of all, thank you so much for agreeing to be interviewed on the wonderful, healthy, wealthy and smart. So delegate, chief delegate. Would you mind explaining what that is for anyone who does not know and what that is related to within the New York Physical Therapy Association?
Jim Dunleavy: 00:30 Well, the chief delegate actually leads the delegation from New York to the national house of delegates each year. I'm basically the organizer. I do the assignments of motions. I hold webinars and phone calls with the delegates during the course of the year to get them up to speed with the issues that are facing us that are brought before the house of delegates each June.
Jenna Kantor: 00:58 Yeah, it's excellent. And I'm on that email list and so I'm always just going reading, having different physical therapists help transcribe it for me. So thank you, you just are so good at keeping us up to date with that. So for you, I'm just wondering on a weekly basis, how much time do you need to put into your job?
Jim Dunleavy: 01:17 I would say it varies. It gets more as we get closer to the house of delegates each June. The APTA has gone through kind of a metamorphosis and has created almost a year round type of governance process. So, the motions are starting to be brought out in concept form, usually early in the fall. In the past it's just been we get it in March, we read it, we go to the house, that's it. But now we have to really look at it almost as a year round job to keep people on top of it. Make sure we see what issues are coming possibly before the house. And giving our input from New York as to how we feel about these motion concepts and then the full blown motion will affect us in New York.
Jenna Kantor: 02:15 So when you're saying motion, what do you mean by motion? Is that a new law? What is that?
Jim Dunleavy: 02:20 We run a house of delegates. It's similar to a mini Congress or a mini house of Representatives. And so the issues that come before that house have to be in the form of a motion, which is a clearly defined statement, whether it be a policy, whether it be charging the APTA to do something, whether it be a philosophical or sociological position. And the group will review it, they will discuss it, they will argue about it and then they will vote on that motion.
Jenna Kantor: 02:54 Oh, so it's like when it goes to the Senate or Congress. So if I was to think of the school house rock video where they're singing, I'm just a bill. Do you like that reference? Yes, but honestly, that's where my brain needs to go cause I'm massive beginner with this. So I right now I'm an alternate, which I'm very just honored to even be an alternate for the possibility of going. So I was wondering what is it like, let's say day one at the delegate assembly? Is it just people just kind of, you know, is it, how are things brought in order? Is there an introduction? Are there, is there a ceremony with candles and, and you know, it was some sort of like traditional dance. What happens on day one at the delegate assembly?
Jim Dunleavy: 03:49 The candles and the dancing, that's a good idea. Maybe we'll get them going a little bit more. First two things. One, you mentioned the term delegate assembly. The delegate assembly is actually New York's own little congress, little house of Representatives. What I'm chief delegate of is the delegation of New York that goes to the national house of delegates. So in New York, we're a little different than other states. We have 10 districts. We have representatives from each of those districts come to our delegate assembly, usually in April or May, where we review all the things that are going to come before the house of delegates plus vote on any bylaw changes or other issues that are going on in New York state alone. In terms of how it's structured, you have delegates are voted upon to go to the house of delegates by our delegate assembly.
Jim Dunleavy: 04:51 So that's one set. Then in addition, each district has the ability to designate one person. So there's 10 and then whatever is left in the order of the voting in the delegate assembly, those people are on our alternate list. So, believe me, it happens every year. We have people who drop out for various reasons. In fact, I have one right now that I have to replace, so I don't know where you were on the list, but you might be getting a call from me later. I have to keep track of that and I have to constantly update the APTA delegate list and the chapter deligate list. So they get all the information that they need either as now an active delegate and not an alternate.
Jenna Kantor: 05:44 If somebody was an alternate, like my situation and then I'm down at the end of the list. But I'm also, honestly, I really am grateful to be on the list especially as a new Grad. So I'll take it, so if I was able and fortunate enough to, you know, be able to fill in for someone, does that make me for the next year as a regular delegate or am I still considered an alternate?
Jim Dunleavy: 06:10 The delegation is a one year service time. So we will vote this coming April I think is the delegate assembly. We will vote for the delegates going to the 2020 house of delegates. This group of delegates that are going to Chicago in June of 2019, they were voted upon last delegate assembly. So it's a one year cycle. We've actually talked about changing that to maybe get a little bit more experience in four people. So we're talking about maybe changing the bylaws to two years of service. I'm not sure yet, but it is a one year service time.
Jenna Kantor: 06:58 Okay. Very good to know. Alright, so let's go back to day one. So we're at the house of delegates day one. So apparently there was no dancing ritual. So what is the order usually on day one at the House of delegates?
Jim Dunleavy: 07:24 For the New York chapter, what we usually do is our delegation comes in usually the day before the house opens. And I usually try and hold a, what we call a caucus meeting to just orient everybody, go over any changes that I'm aware of and in any of the motions, prepare the delegates for the next morning, which are the interviews for people running for national office because the house of delegates is the voting body that votes for president, vice president and so on. We have interviews of those candidates all morning and we have I think four rooms or five rooms that we have delegates in who asks these candidates questions, we will then come back as a delegation together. We will talk about the candidates, make our selection and then start to work on the motions. Then after that, usually in the late afternoon, early evening, the house of delegates starts and it's a pretty impressive place if you've never been there because you have over 400 plus of your colleagues from around the country sitting in front of a large dais with the speaker and other officers there. And we run a parliamentary rule meeting with the idea of making the best decisions for the profession in the United States.
Jenna Kantor: 08:53 This is honestly very exciting to me as much as I'm calm as I'm saying this, like it's just, it's getting my heart beating and I'm like, I want to be there one day. This is just a random, silly question, but Lord knows anyone who knows me, I love random silly questions. So if I was to be interviewing for any of these amazing higher positions, that can make a great difference. If I did the splits or broke into a song and dance, would that help my position or possibly pull things back or maybe would you cast me in a Broadway show instead?
Jim Dunleavy: 09:24 I'd probably go with the Broadway show. Probably doing the song and dancing in an interview here, I don't think the culture would really take to that very well. I think though that the culture in the interviews is changing with the age of the delegates. We talk a lot about millennials. We talked a lot about all of them, gen x’ers and everything else. And how we have to change our communication style in order to reach out to our newest members and future leaders. I've seen a change in culture and that it's a little bit lighter, but I don't think we're doing the song and dance just yet in the interview process.
Jenna Kantor: 10:18 So no Hamilton rap? No, no, no. Okay. Okay, good. Just good to clarify it. In the hallway, right to take care of those nerves. So when going in the rooms, this honestly reminds me cause I have the musical theater background of auditions. It really does. So for you guys on your end, as you are interviewing these people, I mean aside from the buckets of coffee that you're probably having to just stay really focused. You really need to see that people are right for these positions. Do you try to make it a friendly environment or like what kind of environment are you trying to create to help that person who is being interviewed?
Jim Dunleavy: 10:59 Well, I think we're trying to make it a level playing field because what we have done is we have agreed to do a set questions in every room so that the delegates that are in each room gets to hear each candidate's answer to the same question. Then each room does have an opportunity to ask some of their own questions. So when I ran for APTA board and I had to do these interviews myself, that was not the case. I had no idea what was going to be thrown at me in terms of questions. You could be asked anything. I think now it's at least fairer, it's a level playing field for the candidates. They know they're not going to get any serious kind of Gotcha questions cause we went through a period of time where people thought that was fun. So I think it's a much easier experience for the candidate then perhaps maybe it was when I ran. I think people still get insights into these people.
Jenna Kantor: 12:16 Absolutely. And for working with your team when you are discussing, cause you're saying people are in different rooms, you know, you have the different rooms and are you guys all, is it say Melanie goes in, she gets interviewed in one room. Does she get sent to the next room and the next room? So all three groups interview?
Jim Dunleavy: 12:37 Yes. The candidate will get a schedule for the morning, what rooms they have to be in. So usually very close to each other
Jenna Kantor: 12:48 And muscle relaxers. Anything for the nerves, right?
Jim Dunleavy: 12:51 Absolutely. Yeah, there is. And there is a candidate's lounge where they set up food and coffee and everything else. So you have a place to go and cry when you mess up in the interview. It really is a very well oiled machine how they do it. So what I'm going to have to do as chief delegate, I'm going to have to basically divide up our delegates equally for each room. And then I'm in one room with what we call the Northeast Caucus, which is all the states, pretty much in the northeast. But they'll be New York delegates probably somewhere in the neighborhood of six or seven, maybe eight in each room. So they can hear the differences in the different questions and then I will bring them all back together after the interview session and go through that and make sure that everybody hears what was said in every room by each one of the candidates.
Jenna Kantor: 13:48 Oh, that's so smart. Yeah. I really like how you guys have a system because that's not easy to even develop that system that works for everyone. So I think that's really, really cool how you guys have that organized. So you're done with all these interviews, you have to decide that night for that or was that during the whole weekend that that's part of the house of delegates?
Jim Dunleavy: 14:09 It used to be much more laborious until we went to electronic voting. So after the day of our interviews that evening, the house will open and one of the first orders of business is that we will all vote on the candidates. And then at the close of that session, which is usually around eight o'clock that night, the results are posted both outside the house of delegates room. And on these huge screens that we have in the house of delegates proper.
Jenna Kantor: 14:40 Wow. Wow. Well organized. So you've done the interviews and now we're at lunch.
Jim Dunleavy: 14:49 Up to the interviews, I bring my delegates back to a caucus room that I've got assigned and we start to talk about the candidates and start talking about the interviews.
Jenna Kantor: 15:02 Okay. And then after that discussion, what's after that?
Jim Dunleavy: 15:07 Then later in the afternoon, we're going to have what we call motion discussion round tables where chief delegates and some delegates if they want to come, can come. But we come and discuss strategy issues and or changes in motions, get more information on particular motions that are going to come before the house. And usually we have two or three of those in the course of the days that we're together. So that once we get to the floor as many of us as possible, have the same information about a particular motion.
Jenna Kantor: 15:44 Oh that's so great. So you can get on the same page. That's brilliant. I really liked that. That's so smart. And that's the new thing you were saying.
Jim Dunleavy: 15:50 Well we used to do it a different way. We used to have these called motion discussion groups where motions were assigned to a room and then you would run around and trying to listen to the information that way. We're going to try these round tables where I'm assuming it's going to be set up, like each table is going to be a motion and you could go to whatever one you want, and just do that for a period of time. I think that's a good change.
Jenna Kantor: 16:18 I love that. I like how you guys are always trying to fix a problem, solve and improve. That's really incredible. And then we get to the meeting after everybody's on the same page. Everyone understands what's going on. Everyone then comes together. There's that vote at the beginning, right, like you said. And then is it all run by Robert's rules?
Jim Dunleavy: 16:39 Yes. Everything we do is via Robert's rules. We have a speaker of the House who's basically our facilitator, making sure everything moves forward as quickly and efficiently as possible, but also within the realm of Robert's rules of orders. So everybody is dealt with in a fair way. We don't want people, we have very small states. For example, we have states that may only have two delegates there. New York is a larger state. We have 25 delegates. So if you're looking to influence votes in order to get something passed, you're generally going to try and go to the California's, the New York's, the Illinois’, the Florida’s, the Texas’, to try and garner as many votes as you possibly can for whatever issue you're trying to support. So the smaller states need to have protections. And so I think the caucus process of them being assigned to the caucuses from throughout the United States, they get much better information before they meet because then they're just not talking amongst themselves and they also have the ability to create relationships with some of the larger states. So we all know what everybody is doing.
Jenna Kantor: 17:57 What do you mean by caucus? Would you mind defining?
Jim Dunleavy: 18:00 There are caucuses set up throughout the United States. The one New York is in is called the northeast caucus. It's actually the oldest. We have states from Maine down to DC, I think it is on the east coast.
Jenna Kantor: 18:17 Oh. So it's like a region essentially?
Jim Dunleavy: 18:19 It’s a regional Caucus. Now that caucus does not have any authority in terms of voting. We don't block vote. We don't try and get everybody together and vote one way at a particular issue. That's not the purpose of the caucus. The purpose of the caucus is to share information, to perhaps bring a motion concept like I did with the New York motion this year to the caucus to get viewpoints and ideas. And perhaps as a caucus, ask for information, ask for changes in the way we do things, and send that to the house officers. So it's an information gathering, sharing and actually very stimulating meeting. We have one in the fall and we have one in the spring, and we have one here. We had one here the other night, so we're looking I think in March or April to have one. It's up in Vermont, I think. And then the one in the fall, I don't remember where that one is, but basically it is part of a year round governance process where we'll be talking about motion concepts at all of these.
Jenna Kantor: 19:38 And for those who don't know, we are actually at the combined sections meeting, which I did not say. So when he's referring to here, he's talking about here in DC 2019. Yes, yes. This is excellent. So during Robert's rules, how was it handled for someone who's new and they're not familiar with what even Robert's rules is? Is there somebody who teaches them when to raise their hand or say a motion or a vote of where somebody to just make sure, for lack of a better word, that they're in line?
Jim Dunleavy: 20:16 It can be intimidating the first time for a new delegates especially when they first walk into the house and they see the physical enormity over get it. You don't get a sense of that until you're there. It's also very, I find it very exhilarating to have all our colleagues together in one place. What APTA does, it's a PowerPoint slide presentation to orient new delegates to the process. We have an orientation handbook in New York where I do a conference call and we're probably going to move to a webinar format next time, with all the new delegates each year. So I basically go over what their role is, what to expect, some of the mechanics of what they need to do. And even with that, I know some of them are still not totally clear, we did that in November. And so I'm still getting questions. So, the good part is I'm getting the questions. In the past, I remember when I was a new delegate, we had no such orientation. It was, here you go and you're done and you just deal with it.
Jenna Kantor: 21:42 Oh, just praying that you just rose your hand the correct way.
Jim Dunleavy: 21:47 Exactly. Right. They do have a lot of resources now. In New York, we usually buddy up, the new delegate with an experienced delegate. So if they feel for whatever reason, they don't feel like you can find me or talk to me, they have this other person that they can reach out to.
Jenna Kantor: 22:09 Yeah, that's wonderful. I definitely could see myself wanting to lean over and be like, what are they talking about? And you know, would you mind defining this? So I think that is a great thing that's already in play to get that mentoring. I could definitely imagine myself, and this has been advice from others that the first year, not that I wouldn't vote on things, but to spend more time just being quiet and listening because there's so much to take in. Would you agree?
Jim Dunleavy: 22:37 Absolutely. It takes time to get used to the process. And so you have to, early on as a new delegate, you have to spend your time dealing with the mechanics of what's before you. But there are also situations where new delegates may feel very passionate about a particular issue that's coming before the house. And so how we've done it in our chapter, is we've tried to keep it as open as possible. I do not restrict our delegates from getting up and having their say at the mic. And what I have noticed is I think the newer delegates are much more better equipped, I guess the best way to handle that situation. I know in the past and I was one of them, the first time up to the mic in front of 400 of your closest friends can be a little intimidating. I've seen with our newer delegates, a much higher sense of confidence in and a knowledge base and again, the passion that they bring. I think we're going to have a number of delegates here in New York for many, many years to come that will be great representatives of the chapter.
Jenna Kantor: 24:06 I love hearing that. It's very exciting. I'm so grateful to have somebody like you in New York who's really leading us with such clarity. And I just want to thank you. Thank you. Thank you. Thank you for coming on to this podcast because this is going to be a resource that I'm going to be sharing out with people who are interested, a lot of students for sure. Cause I'm definitely, even though I'm still a new Grad so I still have that, you know, flowery perspective. So for you to take the time and sit with me on the last day of CSM when we're very exhausted. I am truly grateful. So thank you Jim Dunleavy for coming on. Do you have any final words of advice you would like to give to anyone regarding the house of delegates?
Jim Dunleavy: 24:50 Well, I would just say for everyone to get involved. In New York you have multiple places to get involved. You can get involved at your local district level. That's where I started. Somebody invited me to a meeting and here I am years later doing these types of things and also having served in national office and creating a section. It's been a wonderful, wonderful part of my career. You always get paid back 10 fold, what you give. And so I would say get involved. Call the chapter, call your local district representative, find out when the meeting is locally, and start that process there because the thing that drove me was going to a meeting that a friend brought me to actually when I was in PT school. And I left that meeting thinking I do not want these people making all these decisions without me talking about this. And that was kind of my driver. You know, people have different drivers, but I think get involved because that's the only way the profession is going to move forward.
Jenna Kantor: 25:58 Thank you. Thank you so much. Those are excellent words of wisdom. Thank you for coming on.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Karen Litzy on her journey to become a leader of the physical therapy profession. Karen Litzy, PT, DPT is a licensed physical therapist, speaker, owner of Karen Litzy Physical Therapy, host of the podcast Healthy Wealthy & Smart and creator of the Women in Physical Therapy Summit.
In this episode, we discuss:
-How Karen started her career in New York City
-The importance of relationship building to grow your practice
-Why you should say yes to things that align with your values
-A sneak peek at the Strictly Business Mastermind
-And so much more!
Resources:
Karen Litzy Twitter
Karen Litzy Instagram
Karen Litzy Facebook
FOTO Outcomes Summit, use the discount code LITZY
For more information on Karen:
Dr. Karen Litzy, PT, DPT is a licensed physical therapist, speaker, owner of Karen Litzy Physical Therapy, host of the podcast Healthy Wealthy & Smart and creator of the Women in Physical Therapy Summit.
Through her work as a physical therapist she has helped thousands of people overcome painful conditions, recover from surgery and return to their lives with family and friends.
She has been a featured speaker at national and international events including the International Olympic Committee Injury Prevention Conference in Monaco, the Sri Lanka Sports and Exercise Medicine Conference, and various American Physical Therapy Association conferences.
Karen has been featured in magazines and websites like Redbook, Women’s Running, Martha Stewart Living, Family Circle, Health.com and CafeMom. She has been a guest on several podcasts including Entrepreneur On Fire, Hack the Entrepreneur, and The Healing Pain Podcast. She lives in New York City.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor interviewing for Healthy, Wealthy and Smart. And I am here with the founder, the original Mama Jamma, Healthy, Wealthy and Smart Karen. And I am going to be a major fan girl. No apologies for this at all because I've been wanting to interview Karen for a long time because she is just one of the most inspirational people in physical therapy. And I would say honestly amongst women and physical therapy, the leadership that you take is absolutely incredible and I appreciate you agreeing to coming on. So thank you.
Karen Litzy: Well thank you. And I think this is the first time I've been interviewed on my own podcast. I think so unless you count the time Bronnie Thompson was asking me questions and made me cry. But for the most part, this is definitely the first time.
Jenna Kantor: 00:51 Not a meltdown in this one. Well what I'm really excited about as so anybody who is a fan of Karen lets you see all that she does. This is to really learn about her backstory and also how possible it is to get to where she is at now. So one thing we were talking about the other day, Karen, as you were saying, how you moved to New York and you knew no one, I would love for you to expand upon that and how you took those steps to knowing everyone.
Karen Litzy: Well, so when I first moved to New York, I knew my roommate because we had gone to high school together and maybe two other people that we went to high school with. And what I decided to do when I first moved to New York is I couldn't find a physical therapy job that I felt like it was a good fit.
Karen Litzy: 01:43 And so I ended up working at what was then called Reebok Sports Club. It's now an Equinox, but it was this sort of a country club in the city. So it was a very high end, very expensive gym. So I started working there as a personal trainer. And because of that environment, there were so many personal trainers, Pilates instructors, nutritionists, not to mention all of the people who go in and out of the gym and all the clients I was lucky enough to work with. And because of that I was able to meet hundreds and hundreds of people. And to this day, those trainers, the people who work, like a computer program there for children, there are nutritionists, pilates instructors. To this day they still refer patients to me. And that was wow, 18 years ago. So, you know, we talk about building relationships and how important that is.
Karen Litzy: 02:41 And I think having that as my first job in the city and being exposed to so many different people, I felt like it really helped me build relationships and friendships at this point that have continued to blossom and grow. And I mean, I just had a patient that was looking for a strength and conditioning coach. And so I said, well, I work with one, a person who is amazing. And he was one of the first people I met at my new job 18 years ago. So it was a bit of like an unconventional path for a physical therapist and it's just cause I couldn't find my fit. I couldn't find that niche that I really wanted and maybe the clinic that I really wanted to work at and now that being said, I knew ahead of before I moved to New York that this gym existed and that it was a high end gym and that I would be exposed to a different kind of clientele.
Karen Litzy: 03:36 I don't know why I looked that up to begin with, but it was because of that, that gave me the idea to go out on my own and to start seeing patients in their homes and home gyms and homes and offices because all of the personal trainers at this gym, we're seeing people outside of the gym. If they're doing that, then why can't I do that? Why can't a physical therapist do that? Why do they only have to come to a clinic in a more traditional sense of the word? So it was because of that first job that I met so many people and those relationships continue to grow other relationships and that I got the idea to do my business.
Jenna Kantor: 04:28 That's incredible. So for you, now that your network has expanded over time, clearly it's like full bloom. Hello, I look at you almost like the Oprah of physical therapy here. So how do you keep in touch or maintain these relationships with all these people? Like what is your skill for that?
Karen Litzy: So as far as maintaining them within New York City, it's pretty easy because we'll get together or you send a quick text. Cause most of these people are my friends and I credit working at that gym and also playing softball in central park that I was able to meet so many people.
Jenna Kantor: You play softball. Hold on, pause, elaborate.
Karen Litzy: So one day I was running in central park and I was like, Ooh, softball. So I went down and I was like, Hey, do you guys allow girls to play? And they were like, no. And I was like, oh, um, okay. And they said, well, what do you do?
Karen Litzy: 05:16 And I said, well, I'm a pitcher. And then they asked if I was good. And I peeked my head around and looked at their pitcher. I'm like, I'm better than the one you have. And so the next week I went for my tryout and then I became their pitcher. And then the following, summer I was recruited to play in a fast pitch like windmill fastpitch league. So I played there for several years and all the guys that I played with on that softball team, are lawyers, and they have referred patients to me. And you know, you just keep in touch. And so I met my two best friends that way in the city and they refer people to me from a business standpoint, but they're also my friends, you know, and they're part of my lifeblood of being in the city. And so my best advice if you're moving to someplace where you don't know anyone is to get involved in things you like to do.
Karen Litzy: 06:07 So I love playing softball. So that's what I did, you know, and I loved working out. So I decided to work in a gym as my first job. So instead of kind of pigeon holing yourself into what just physical therapy or just this, just that, like really kind of open yourself up because you never know who you're gonna meet. So in this city it's easy to keep in touch, well, I shouldn't say it's easy. It's not easy, but if it's a priority for you and your life, you make it and you make it a priority and you put in the effort. And so for me, and as you know, Jenna, you keep in touch with a lot of people. You spend your time on networking and on making those relationships. And the best way to do it is to make it a priority.
Karen Litzy: 06:47 And so I may have, you know, my week is sort of chunked out so I have patient care, but then there's times where I'm like, okay, all I'm going to do is write emails and send messages to people and it's in my calendar, it's write emails and send messages to people just so that you're still in there hemisphere.
Jenna Kantor: You know, it's keeping those relationships. Otherwise it becomes that long lost relationship. Even if when you hang out with them again you could just act like no time has passed. It's still something that needs to be rekindled. So it avoids that.
Karen Litzy: And it's putting in the effort. Like a good friend of mine, his name is Dr. Jordan Metzl who's a physician in New York and he does free workout classes every month. And so I try and make it a point, okay, I'm going to go to one of his classes even though I can't walk for two or three days because my legs are so sore afterwards. But I make it a point because he's my friend and I want to support him and I think what he's doing is important.
Jenna Kantor: 07:37 I love that. I'm sure I've probably seen pictures of you after the workout going, just finished the workout with Metzl right now. I love that. And you actually are tapping upon something that I know we are 100% agree upon is really supporting what other people are doing. Showing up for what they do is a real big part of the networking and how your life and your career has truly grown.
Karen Litzy: Yeah. It's just being supportive of people that you believe in. So going to something like the CSM where there's 16-17,000 people here, like there are people that I want to make it a point that I at least say hello and that I have a conversation with, even if it's just five minutes, you know, because it's important to me and I hope it's important to them, but I know that it's important to me because I want to show up for them and I want to support them.
Karen Litzy: 08:31 And so that's just what you do if you want to keep your relationships going. And as far as keeping relations with international colleagues, it could just be a quick, a quick note on Twitter or a quick email or hey, I thought about you the other day because I really want to introduce you to this person because I think you guys should at least know each other cause you're doing the same research or you know, I met a colleague in the Netherlands and he has since referred patients to me in New York and he's a physio in London, but you just keep in touch with people and you do good work. And I think that's the best way to keep your relationships going. And it doesn't have to be every day, right? It could be consistent.
Karen Litzy: 09:24 It takes five minutes. A lot of times I do this when I'm on the bus cause I'm going from patient to patient. So what else am I supposed to do on the bus? You know, so that's sometime when I'd be like, okay, I'm going to make sure that I reach out to so and so in Australia or to this person in Pennsylvania or to this and that's a good time. So I'm lucky in that sense that I have like random downtime. Chunks during my week and you just, if you think about someone, just let them know.
Jenna Kantor: Yeah, it takes seconds. It takes seconds. Okay. So you have your hands on many things which I love about you. So you have this podcast, which is amazing and soaring and now you also have a team working for you with this podcast.
Jenna Kantor: 10:07 You have your own practice, you have the speaking course. What am I missing? You have a course coming up that's going to be helping practitioners, which is amazing. You’re the nominating committee for the private practice section? Am I missing anything? I want to make sure we tap and tap everything. Okay. So you're doing all these things now, did they all come about all at once for you to achieve it? Or did some of them overlap as you were developing them? Oh, and you're working to become a paid speaker. I mean these are a lot of fantastic things, all a hundred percent possible to achieve in a life, but for you achieving each and every one, have some of them overlapped in the process of growing? I would love to hear that journey.
Karen Litzy: 10:56 Yes. And I also think that one allows for the next and allows for the next. So one event allows for the next event and for the next and for the next or one experience allows for the next. So for instance, starting the podcast many years ago, I took a couple of years off to go back to get my DPT, but starting the podcast had led to credibility and has led to visibility and in maybe some vulnerability on my part. So when people can see that you're being credible and you're being authentic and you're putting yourself out there, they're drawn to that. And so from that, I was invited to be on a proposal to CSM and then that got me public speaking a little bit. And then maybe from that someone sees you, it's like, hey, you know something, I really like this. We should try this.
Karen Litzy: 11:50 And so I kept saying yes, yes, yes, yes. And to say as a piece of advice, say yes to everything until you can say no, terrible advice. I don't know. It was terrible advice. Awful. So what I started to do, cause I was saying yes, everything and it is overwhelming and you get burnt out and you start to cry and then you don't feel like you have a personal life. And I want a personal life as well. So now what I've started to do is say yes to things that align with your values. Say Yes to things that in your gut it's a hell yes. Because when you start saying yes to things that are like, I guess I should do it, it's a no, like if you're saying I guess I should do it, you don't want to be shoulding things.
Karen Litzy: 12:30 It's like, yes, I want to do this. Not, yeah, I guess I should do it. And so I think having that in my mind has been able to narrow my focus a little bit more. So it sounds like I'm doing a lot, but it's all inter related.
Jenna Kantor: It's connected. And I even left out that you have the annual women in PT Summit.
Karen Litzy: But again, that's all connected, right? So I think it started with the podcast and then doing a little bit of speaking and then I really started to enjoy speaking more and more. And because of that I have made that a priority. And for me each year I pick a word that I like to kind of follow my year and to base decisions on and things like that. And so this year it's courage. And so one of the things that I really wanted to have the courage to do was to do more public speaking and to put out a course to help physical therapists create their own private practice and occupational therapists create their private practice.
Karen Litzy: 13:27 And these for me, takes a lot of courage and planning and things like that. But if you, like I said, I sort of planned my week in little chunks. So if you can do that, you can get everything done. You just have to put your mind to it. And I also as just a FYI on how I manage my time is that I kind of use pomodoros. So a Pomodoro is a concept that's a 25 minute work block. So I'll set a timer for 25 minutes. I turn everything else off. Sometimes I'll put theta wave music on in the background or binaural beat music because that music is supposed to help increase theta wave, excitability in your brain, which is supposed to have, this is all very, you know, but it's supposed to help you be able to block out distractions and help you focus and things like that.
Karen Litzy: 14:17 It's the kind of music you hear when you're at the spa. And so I will do that and block everything else out. And it's amazing how much you can get done in 25 minutes. Like so if you are full of distractions, yeah, it's going to take you forever. But if you can really focus for 25 minutes, then you can write that blog post in 25 minutes instead of screwing around for three hours. You know what I mean? And if emails come in, like I'm not the president of the United States, like it's not that important. It's just not. I think we're in a world now where everything has to happenmnow. Now, now, now, now. Whereas I mean, I can say, I mean I started my podcast in 2012 and then took a couple of years off.
Karen Litzy: 15:03 It's 2019 so it's not like it's an overnight success. You know, I started speaking, the first CSM I spoke, it was in Indianapolis, which was, I don't even know how many years ago. So again, this is just been years of work and years of working on your reputation and years of working on myself in order to get to these points. Nothing is an overnight success because you're always laying foundations and groundworks that can take months or years. So I think it's really important for people to understand that.
Jenna Kantor: And habits, habits are a big thing too, because I'm sure it took you a bit to even make this, this 25 minute habit.
Karen Litzy: Oh my God. Yeah, because I love to be distracted. Squirrel. I'd be like, what? I love to be distracted. But it's true. So to be able to do that and calm my mind down to focus on one thing took practice, but just like we tell our patients with like practice your exercises, if you practice these methods, you become better at the methods. It's the same thing.
Jenna Kantor: 16:02 Yeah. I definitely can relate with that. So now for you, what is your next, oh my gosh. I can't wait for you to listen back to this podcast in like a couple of years and be like, what is your next, cause you have, you have things coming up and maybe those will be your next you would want to discuss, but I would love for you to share that.
Karen Litzy: My probably biggest next is the soonest are the quickest next, let's put it that way. The quickest next would be this course that I'm developing for physical therapists and occupational therapists called Strictly Business Mastermind. And it's to help them create their own cash PT or hybrid or if you already have a practice and you're trying to transition out into a cash based practice.
Karen Litzy: 16:52 So it's really for those two groups of people. And I'm really excited about that and hopefully we'll have that solidified in the next couple of weeks and put that out there.
Jenna Kantor: That's going to be incredible. And honestly to speak to the fact that we don't have a woman and physical therapist yet leading something like this and we need to, it's for anyone. You need to see somebody who you can even visually identify with. So on top of the content that you're going to be providing, which is going to be off the charts, I'm grateful that you are filling a void that needs to be filled in.
Karen Litzy: And I think it's important to know that I'm not teaching this on my own because I don't have the answers to everything. I can't do everything. It's just physically impossible and mentally impossible.
Karen Litzy: 17:36 Like I can't do it. So I'm lucky to have a lawyer involved. I'm lucky to have an investment advisor involved. And someone who's an expert at SEO and Michelle Collie who's an amazing colleague with like 5,000, no, not really, but like a whole bunch of clinics in the Rhode Island area because these are people who quite frankly are doing things better than I am. And so to be able to share their knowledge with people, I think it's going to be a little bit unique in that space. Because I know I can't do it on my own. And so I asked for help.
Jenna Kantor: And it's okay to ask for help. And honestly, I definitely wouldn't use the Hashtag better together right now for this because it really is, as much as you are taking the lead on it, it is so good to get to work with other people and everybody benefits from it.
Karen Litzy: 18:26 Of course. Of course. I just feel like that's important for people to understand that you can't do any of this alone. And that if, if you do, you'll burn out, but if you have the wherewithal to find out, well, what are your weaknesses? Like, what are you good at? What are you not so good at? What do you love? What will someone pay you for? And if you can fill that out and kind of connect the dots, then you'll know what you're good at and then what you're not good at. Just find someone else who is. Because you're doing a disservice to yourself and you're just doing a disservice to people who are spending their money and their time to learn from you. So it's all about respecting the audience. And so what I really want to do is respect the audience and give them the best user experience that they can get and meet those expectations. And I'm my harshest critic.
Jenna Kantor: So I think everyone is, I think everyone is their harshest critic. Well, thank you so much for coming onto your own podcast to just share this. I love how you're just so authentic and insightful and just so true to your own story. And I think a lot of people just appreciate that about you and I definitely do. So thank you.
Karen Litzy: 19:52 Thanks for having me on.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Sue Griffin on how to be the speaker for the APTA’s House of Delegates. Dr. Sue Griffin is the Speaker of the House of Delegates for the American Physical Therapy Association.
In this episode, we discuss:
-What are Robert’s rules of order
-The responsibilities of the Speaker of the House of Delegates
-What roles you should seek in order to prepare for Speaker responsibilities
-Why Sue loves the APTA
-And so much more!
Resources:
National Association for Parliamentarians
Use the discount Code: LITZY
For more information on Sue:
Dr. Griffin has been a physical therapist for more than 30 years. She has practiced in a wide variety of clinical settings throughout that time, and continues to practice in acute- and long-term care. Dr. Griffin has taught ethical coursework for entry-level and post-professional PTs and PTAs at the state and national level.
Examples of Dr. Griffin's accomplishments include:
Elected Speaker of the House of Delegates for the American Physical Therapy Association in 2014.
Full-time professor for the Physical Therapist Assistant Program at Blackhawk Technical College in Janesville, WI for more than 20 years.
Served on the Ethics Committee for the Wisconsin Physical Therapy Association from 2007-2013.
Chaired the Wisconsin Physical Therapy Association Task Force in 2004, when the Wisconsin PT practice act was updated.
Lead instructor in a PTA program, delivering content in a wide variety of clinical areas. Long-term and
indepth involvement in clinical education. Licensed doctor of physical therapy with a broad background in many areas, including longterm care, acute and rehab spinal cord, acute head injury, inpatient and
outpatient orthopedics and neurology, and amputation. Board certified in geriatrics. Very active member of WPTA and APTA.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. And I'm here with Sue Griffin, which is absolutely incredible. I am just a fan of anyone who is involved with the APTA and really making a change. So would you mind sharing, your the speaker of the House of delegates, would you mind explaining what is that position? I would love to learn.
Sue Griffin: 00:20 Sure. So speaker of the house runs the house of delegates. So the house of delegates is pretty analogous to like a representative body like you'd have in your state legislature, like the assembly. So, every state chapter gets to elect physical therapists as representatives. And it's the number is based on the number of members they have in their chapter. So we have about 400 every year that together and they kind of look like, you know, if you've seen those old convention things like the long tables and the state signs, I mean, that's kind of what it looks like. It's in these huge ballroom. There is a day is, and so up on the day is, that's where I preside from. And so the speaker stands on the day is and runs the meeting and it's incredibly formal because you can't have 400 people like talking over one another.
Sue Griffin: 01:09 It sound like, you know, English parliament or something, which we don't want. So that's the state chapter part. And then we also have all of the sections have a representative, the student assembly sends two representatives, the board of directors are there and the PT Caucus. So they all have representatives. They don't have a vote, but they are able to speak and debate and offer motions and things like that. So that's how our association creates positions and policies.
Jenna Kantor: 01:44 So with all these people together, you are leading the meeting? Robert's rules and all.
Sue Griffin: 01:51 Yes, very, very formal. And so we stick to Robert's rules really strictly because otherwise again, like it would be chaos.
Jenna Kantor: 02:00 Oh yeah, absolutely. And would you mind explaining what are Robert's rules for those who do not know?
Sue Griffin: 02:06 Everyone knows what. No, I'm kidding. I'm kidding. No.
Sue Griffin: 02:09 So Robert's rules of order is a specific kind of school of parliamentary process. So there are a couple of different schools, but this is probably the most famous. And so there's literally a book that kind of like a thick little mini Bible and it helps you run a meeting. So it has rules about procedure, like who can speak when and if someone brings a motion, in other words, if they want to take action, they present in a very carefully worded format and then there are processes for how people can change or amend that motion so that you can, it's a way for a group to make decisions.
Jenna Kantor: 02:47 And it makes it easier for everyone else to follow.
Sue Griffin: 02:50 Right. And the basis is really to protect the voice of the minority and yet still let the majority accomplish their will.
Jenna Kantor: 03:00 I love that kind of the whole purpose of it. And what is the time commitment for your position?
Sue Griffin: 03:05 It varies a little bit, but there's kind of a low level steady level of commitment that's probably five to 10 hours a week because I also serve on the board of directors, so I have to participate on all the board activities as well as manage the house activities. And then like times like this, like pretty much from January through June. So the house of delegates right now is always in June, so pretty much from January to June, or at least CSM to June is when people are really working hard on their motions and we're trying to help them craft them. And so I would say the time commitment is, you know, probably 15 to 20 hours a week.
Jenna Kantor: 03:45 That's great. That's great. Well, you're making a big difference, so that makes sense. And then of course as it gets closer, I'm sure it increases.
Sue Griffin: 03:52 It does. I don't know that I'm making a big difference. I think I'm helping everybody make a big difference. Now, I'm going to think I'm trying to just, you know, I'm the facilitator. I'm not the, I'm not the maker.
Jenna Kantor: Yeah, yeah, absolutely. So as the facilitator, why do you like this job?
Sue Griffin: Oh, it's just great. I mean, first of all, it's just so many passionate and really smart people, you know, coming together and they all have such great intent. I suppose every process like this is political to some extent, but you know, we don't have, everybody is really trying to move and accomplish what they really believe is best for the profession. And I feel like we really have a group that shares common values at a really deep level. And it's just so exciting to see those people come together and be able to accomplish things because physical therapy is the best profession. Right? And so for us to be able to do things that can help us elevate our level of practice, get people to access us better. I mean that's the kinds of things that you know our association is trying to drive to do. And this is, this is a big part of that. This is the driving body in many ways.
Jenna Kantor: 04:59 Oh absolutely. That's honestly why I love the APTA personally. So for you, what past experiences greatly contributed for you being able to handle and take on this position? I would love to hear your journey.
Sue Griffin: 05:12 I think a really formative part was when I served as the secretary of our state chapter in Wisconsin and I did that role for four years and you know, secretaries have to take minutes. And so, you know, you're in a meeting with maybe 12 or 15 people and that meeting is not run very strictly on Robert's rules of order. So, you know, there's a lot of discussion, which is really perfectly appropriate. But at some point, you know, I would find myself kind of listening and then I'd say is so is this what you're trying to say? No, I'd take notes and I help people craft motions and they're like, yeah, yeah, that's, that's what I want to say. That's good. So it really helped me learn how to listen to a lot of conversations and try to distill the essence of what people were trying to accomplish.
Sue Griffin: 05:55 And that has served me very well because part of the speaker's role is to serve on a committee called the reference committee, which is a group that helps people guide and craft their emotions in a way that's specific. And so it's really helpful for that, but it's helpful when you're trying to facilitate a group of 400. You have to be able to listen and kind of hear and try to sense where people are going. Cause they kind of know where they want to go. They don't always know how to get there. So I think that really helped. But then, you know, early on I became a member of the National Association of Parliamentarians, which has a lot of great educational resources. So that's how I learned a lot about, more about the intricacies of Robert's rules. And I was really lucky that I got to serve for seven years.
Sue Griffin: 06:39 So I'm from Wisconsin, and Illinois runs a state assembly like New York does. So I served as their parliamentarian for several years. And so, you know, again, I wasn't running the meeting, but I had to understand it. I had to prepare it, it had to help me learn how to anticipate when amendments might be coming, how would you handle them. And so it really taught me a lot about how to prepare for the meeting in a way because you never want to be surprised if you can avoid it. So I would say those are really the main things that helped me prepare for the speaker role in particular.
Jenna Kantor: 07:15 I love that because there's not one way. What are other jobs, as obviously from what you got to be part of was helpful, What are other jobs that you would recommend people try to be appropriate for your position?
Sue Griffin: 07:34 I think anytime you can be in a position where you are responsible for facilitating, so certainly, you know, being a chapter president, but even, you know, running a committee meeting. So, I think those are good roles. There's a position on the board of directors called the Vice Speaker of the house. So that person becomes obviously intimately involved.
Jenna Kantor: 08:00 So going back to that question, so what jobs, aside from the ones that you just mentioned, would you recommend people could take on in order to be appropriate for your position if they were looking and going, oh, one day I'll be Sue Griffin.
Sue Griffin: 08:19 Well probably one thing I should've mentioned that I didn’t and it's you really need to be a delegate to the house of delegates, right? I mean, I did that for 15 years at least. So they need to be a delegate and that really helps them, I think link into other, I mean, at least to help me link into other opportunities, either at the chapter or section level so that they can kind of figure out their path. But again, being a secretary I think is a really good role. Anything where they have to run a meeting so they could be like even a SIG chair or a, you know, a committee chair. It doesn't have to be president, but certainly being chapter president could help because you obviously have to run meetings. Being on the reference committee is phenomenal. I mean it gives you a great role. And then we also have another position on the board called the Vice Speaker of the house of delegates. And sometimes people who've been in the vice speaker wanted to go to speaker and sometimes they haven't. So I mean it's not obligatory of course. And it's not required to be vice speaker, but those are some other ideas or options I would say.
Jenna Kantor: 09:20 Awesome. I love that. And what motivated you to work specifically towards this position? Cause there's a lot of positions that make a great difference in the APTA. So what made you go this is the fit for me.
Sue Griffin: 09:33 Yeah, that's actually the only one I've ever really wanted. And you know, my very first probably hour as delegate, you know, back in 1995, I just was captivated by the formality of the proceedings. I was captivated by how he managed everything and how he really helped people accomplish their work. And that was very appealing to me to be able to help people move forward and accomplish what they wanted to do.
Jenna Kantor: 10:01 What is something you have accomplished in this position that makes you so proud? There may be many. I can see your brain going tick, tick, tick. Oh Gosh, there's a lot. But I would love to hear one or maybe a few that pop in your head.
Sue Griffin: 10:14 Well, it's funny cause you know, I'm a Midwesterner so I can't be proud of myself for anything. You know, I can be proud of other people.
Jenna Kantor: 10:21 That counts, that counts. We're all in this together, so I would love to hear that.
Sue Griffin: 10:25 I mean I'm really proud of how the delegates work really hard. Well first of all I guess I’ve been really honored because they really have put a lot of trust in me and so they have allowed me to help them enact procedures and activities that make the house more efficient. And so I'm really proud of how people who've been really entrenched in something that's really formal and very traditional laden had been really willing to change and to take on change and to try different things and procedures to see if we can improve. I feel like the association on the whole is like on the cusp of really bold things and so I'm really proud of being able to help the house as a major decision making body try to also change in ways that are kind of in lock step with that boldness. I'm really proud of all the work the house created for the first time in my knowledge, a special committee to do a complete revision of every single policy position, standard document guideline in our whole association, like 350 documents and they've done this over the course of two years. So I'm really proud of their work and again, how they've really elevated the level of work and function of the house. So that's pretty cool.
Jenna Kantor: 11:40 That is. That is, and you've been around for all of it to happen. I love that. What goals are you working towards now or goal that you are working on in your position to just up the ante. Make it even better.
Sue Griffin: 11:52 I think it's just kind of that same thing right? Like trying to continue to move on with that progression, stay in with the boldness, we're all moving into our next century, right. As a profession and as an association. So I think again, you know, people don't come together and meet in the same way that they did 50 years ago and the house is 75 years old this year. That's very exciting. It's got a solid feel. So you know, we don't do these things, obviously nobody works the way they worked even 10 years ago. And people I think think differently and want to interact differently than maybe they did 10 or 20 years ago.
Sue Griffin: 12:38 So in order for the house to be meaningful and be a way for people to make decisions, it has to allow processes that are comfortable to people in that they facilitate the way they're used to working together.
Jenna Kantor: Oh yeah, absolutely. Final question. Why do you love the APTA?
Sue Griffin: Oh Man. Cause I said, you know, this is the best profession ever. And to be able to come together with a group of like minded, passionate, brilliant people, to be able to, you know, move our profession forward and to get people to access physical therapy who really need it. There's nothing better.
Jenna Kantor: Yeah. I couldn't agree more. Thank you so much for coming on and just sharing your passion and also helping people understand not only what you do, but if they want to be the next Sue Griffin, how they could do it. So thank you. Thank you. Thank you.
Sue Griffin: Well, thank you for having me on and everybody should go be a delegate.
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On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Phil Tygiel on bylaws within the APTA Private Practice Section. Phil Tygiel, PT, MTC, is the PPS Bylaws Committee Chair. The Bylaws Committee reviews, maintains, and updates the Section bylaws to meet the needs of the membership and the requirements specified in the guidelines set forth by APTA.
In this episode, we discuss:
-What information is contained within the bylaws
-The process for changing a bylaw
-The multiple avenues you can enact change within your professional associations
-And so much more!
Resources:
PPS Member Bylaws
Email: tygielpt@aol.com
FOTO/NetHealth Outcomes Conference (use the code LITZY)
For more information on Phil:
Phil Tygiel, PT, MTC, is the PPS Bylaws Committee Chair. The Bylaws Committee reviews, maintains, and updates the Section bylaws to meet the needs of the membership and the requirements specified in the guidelines set forth by APTA.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor. I am here with Phil Tygiel who is the head of the bylaws committee for the APTA private practice section. So first of all, thank you so much for coming on to healthy, wealthy and smart to be interviewed. So I just wanted to do this podcast for people to get a better understanding of bylaws and their value and why it can be a long process for some, for change. You were actually, before we even started, you started to talk about how there is this rule where it's like this five year rule and I would love for you to go into that. Why there's a five year rule for change.
Phil Tygiel: We're actually, that's for APTA, not for the private practice section.
Jenna Kantor: Oh, okay. Okay. Oh, thank you. So there we go. It's something you already clarified. Thank you. So for the private practice section, is there some sort of rule like that?
Phil Tygiel: 00:51 No, you can bring up bylaw changes anytime you want to. I always discourage it. I always say my job as chair of the bylaws committee is to put the bylaws in an envelope, seal the envelope and keep it sealed for the duration of the president's term. Bylaws are great. They outline rights, privileges and responsibilities, and they are not to be taken lightly or changed lightly. And very often people will come to me and say, we need this change in the bylaw. And when I look at what they want to do, they don't have to change the bylaws to do that. Bylaws, as you mentioned, are somewhat rigid and they're supposed to be, they're not easy to change. It requires prior notice to all of the members that you intend to change the bylaws. And the reason for that is you're changing their rights and privileges.
Phil Tygiel: 01:41 They have a right to know that you're changing the rights and privileges. You have to have prior notice of at least 30 days prior to the meeting. And then there's debate and it takes a two thirds majority to change any bylaw. As I said many times, the board will come to me and say, I want to change this bylaw. And I usually try to discourage it and figure if there's ways to do what they want to do without changing them is all too often people run to the bylaws and we have to change this when actually the bylaws are pretty good. They don't need change. For instance, there was one year the board, I think it was the membership committee wanted to have lowered starter dues for new members and they wanted to change the bylaws. Biggest dues are outlined. The dues structure is outlined in the bylaws. But I looked at the bylaws though the board had the right to lower the fee but not raise it. So they didn't need a bylaw change to get that starter dues change in that case and discouraged it. And we didn't go in there and change the bylaws.
Jenna Kantor: 02:47 So you were saying that you guy’s meet and they have to submit it 30 days prior. So I'm wondering for the 30 days prior, like how often do you guys meet in general, so how many times would there be that opportunity for it to be heard and voted upon if it would get that far?
Phil Tygiel: 03:07 Technically we have two meetings a year, one at the private practice section annual conference and I think they have one at CSM this year. I'm not even sure about that. So those are the only two times that you can change the bylaws. You do need a quorum at a meeting, which was a certain number of people have to be there. And usually the CSM of business meeting you don't have one. So pretty much the only time we tried to change the bylaws if needed is at the annual conference. As I said, the 30 days notice goes out and all of the discussion occurs at the business meeting when we vote yes.
Jenna Kantor: 03:46 How long have you been in this position, first of all. And then from your experience and all the years that you've been in this position, how many bylaws have you actually changed?
Phil Tygiel: 04:00 Yeah, I think I've been doing it about 20 years now. Nobody else wants it. So I keep on getting recycled and in those years I think we've probably changed, made minor changes to the bylaws about five times. Don't ask me what those changes were. I put the envelope away.
Jenna Kantor: 04:23 So for you it doesn't sound like it makes much of a difference when these bylaws are changed that much because it really is set up pretty well already.
Phil Tygiel: 04:33 I think they're pretty good. I mean they let members know what they're entitled to do, what the dues are going to be. If they have concerns how to raise those concerns. It tells them how often we have meetings. What prior notice we have for those meetings. It lays out the fiscal responsibilities of the board and all the board positions. So most of that doesn't have to be changed. It can stay where it is. Sometimes I've been in situations where one of the positions on the board has certain responsibilities that are assigned, like they're in charge of three committees and sometimes people want to put that in the bylaws that the vice president will be in charge of these committees. And that's usually a mistake because you'll change committee liaisonships based on the new personnel you have, you know, you're going to let new people every three years and you might have one person who's vice president who was very good on programming. So they will be liaison to the program committee. The next vice president might be much better off from communication. So they'd be the liaison to publications committee though, that type of thing. So you don't want certain things you don't want etched in stone and the bylaws, remember, if you make a mistake with the bylaws, it also takes a two thirds majority to correct that mistake. So sometimes bylaws mistakes stay in place for years and years. So again, you want to tread very lightly on changing them.
Jenna Kantor: 06:11 Well, I mean you were already saying that you're only meeting two times a year, so that already is a limitation on getting that two thirds majority vote. So I can definitely see how that could be impeding on change. No, I definitely have to be honest. From my perspective, this seems like a definite area where there might be room for change and my mindset, because I'm a new Grad, so I'm thinking, oh my gosh, this sounds so stagnant. Like there is not a set way to really make big, big changes. I would love for you to speak on where my brain is going and educate me.
Phil Tygiel: 06:47 Oh, actually there's a way, there's lots of ways to make big, big changes that don't require bylaws changes. For instance, let's say there was direction that you wanted the private practice section to take, you wanted them to lobby congress to do something and you wanted to make that a priority. That's not a bylaws issue. You would show up at a business meeting and say, I move that the private practice section endorse this position. Okay. Now, first of all, it does not require prior notice. It only requires a majority vote, not a two thirds vote. And those are the more important things that most of us are concerned about. Which way we're going, what do we want to accomplish? Those things are not in the bylaws. What is in the bylaws is how you can do those things. The fact that you have to have these meetings, that you have the right to speak, that you have the right to vote, that you have the right to make motions. So that's a very, very fluid process. Also remember sometimes if you have a really good idea that nobody else thought about, you can go to the board and say to the board, hey, why doesn't the section do this? Same with your state association and all that. So you can just say, let's make this happen. And that can be done with the snap of a finger. So not being able to change the bylaws does not restrict what you want to accomplish. Does that make sense to you?
Jenna Kantor: 08:10 And then what you do as somebody is saying it's not in the bylaws, it doesn't allow it in the bylaws and then you can't find that it's in the bylaws. What is the professional way to handle that kind of communication with that individual that you're trying to work with?
Phil Tygiel: 08:28 The first thing I usually do is ask what is it you are trying to accomplish? And I want to see if there's a way they can accomplish that without having to change the bylaws. If we find that they do need to change the bylaw to accomplish what they want to accomplish. Let's say they want to add two new people to the board of directors, that would require a bylaws change. We would then draft a motion and to change the bylaws by changing this section on the board of directors by adding two positions. The executive board would look at it and see if they approved it, which they don't have to do. Membership has priority over leadership. We should always keep in mind that the pyramid is inverted. Membership is on top president is way at the bottom.
Phil Tygiel: 09:22 So the membership has the right to do what they want to. So anyway, then we would draft the bylaw in the case of APTA sections, chapters, any bylaws change that the section has, has to be in keeping with the bylaws of APTA. So we'd run it by APTA to make sure it's not in violation of anything that APTA wants to do or says you have to do. For instance, let's say we wanted a bylaw change that would prevent life members from being members of the section. I don't know why anybody would want to do that, but the APTA would look at that and say, you can't do that. That's a violation of the APTA bylaws. So we do have that higher authority anyway. If the bylaws are keeping with what the APTA will allow we would publish it to the membership and probably in Impact or maybe online saying we will be voting on this bylaw at the next meeting.
Phil Tygiel: 10:31 Next meeting comes and the bylaw is moved. And someone has to say it and then there's debate and then they call for a vote. Since you need a two thirds majority with a standing vote, it's carried if it's not clear with standing vote, but it could be close, you do a roll call vote where everybody stands up and counts off. And if you don't get your two thirds, you don't get the bylaws. And it's important to remember what I said originally. The bylaw protects your rights and privileges as do Robert's rules of order. So even if there’s a fairly hefty majority that feels that their rights and privileges of being violated, they have a right to say we're not going to let you pass this.
Jenna Kantor: 11:21 I like how you connected it back to the APTA because they are the Higher umbrella organization if you will, of the private practice section. And this actually can segway into what I was mixing up at the beginning of this interview. So if you wanted to make a change but it didn't go in accordance with the APTA bylaws, now this is where they have the time limit on how often?
Phil Tygiel: 11:47 Yes. It got to be a nuisance of people would come in with requiring bylaws changes every year and many of them were really not necessary, but they are very time consuming to debate. So many years ago, and don't ask me how long ago it was moved and seconded and passed that it's in the bylaws that you can only have bylaws amendments every five years I think it is with the APTA and that goes through the house of delegates which is a completely different process membership doesn't vote, your delegates do. That can be bypassed. It requires a two thirds vote just to hear the bylaws if you want to do it in an off bylaw year. So it got rid of some of that cumbersome activity that really wasn't necessary.
Jenna Kantor: 12:38 No, it's good. It's really good to hear your perspective and just gain a better understanding of how well put together everything already is and why it may not be the fastest for the change, but there's a big reason for that. So thank you so much Phil, for coming on to just share your knowledge. So people who are looking for change, they may not necessarily, well now they know they may not necessarily need to go to you to find out about how to change the bylaws. They are actually still a lot of opportunities to get it done elsewhere. So thank you so much.
Phil Tygiel: 13:10 My pleasure. I think the main messages that the association, whether it's private practice section, or any other section, belongs to the membership and they have rights and privileges. They can make change and sometimes the change comes from a single person with a new idea and sometimes that new ideas violently objected to by people in leadership, people who have been there forever. But there is a mechanism to be heard. There is a mechanism to make change and advance and we do very well with it. Sometimes, a good idea, it takes three or four years to pass. But that's not because of the system. It's just cause it took you that long to get people to understand what you were trying to do. That's not necessarily bad.
Jenna Kantor: 13:50 That's good. And I love that. I like how it really does revolve around membership because we are all in this together. And for us to just come forward with an idea, thinking, oh, I'm right, I'm right, I'm right. That's not how it works in a community at all. So thank you. Thank you so much.
Phil Tygiel: 14:04 Thank you.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
LIVE from the Combined Sections Meeting in Washington DC, I welcome Dr. Mike Pascoe on the show to discuss the use of social media to disseminate physical therapy educational resources. Mike Pascoe, PhD, is a neurophysiologist and assistant professor in the physical therapy program at University of Colorado. His scholarly efforts center around the investigation of constructivist approaches in technology-enabled learning environments (e.g., wiki usage, interactive modules, cadaver skin examination, etc..) to improve learning outcomes and student satisfaction in anatomy courses.
In this episode, we discuss:
-Research highlights in the field of cadaver anatomy
-How Mike utilizes social media and live blogging during his anatomy courses
-How the Anatomical Board serves anatomy educational goals in Colorado
-Cognitive principles of learning for success in PT school
-And so much more!
Resources:
#APTACSM Twitter
Mike Pascoe Twitter
Mike Pascoe Website
Mike Pascoe Snapchat
TedxBoulder - Mike Pascoe - The Ultimate Gift - Donating your Body to Science
Learning Scientists Website
- My wife Stephanie’s website - https://spascoedpt.com/training/
- University webprofile - https://som.ucdenver.edu/Profiles/Faculty/Profile/15328
- Research Gate profile - https://www.researchgate.net/profile/Michael_Pascoe2
- Academic website - http://mikepascoe.strikingly.com
- Light field photography - article
- Student created wiki - article
- Live blogging - article
- State Anatomical Board, body donation - TEDx Talk
- Writings on medium.com - https://medium.com/@mpascoe
- AnatomySnap information - https://www.snapdex.com/anatomysnap
- YouTube channel - https://www.youtube.com/user/redbnr22/videos
- Vimeo channel - https://vimeo.com/pascoe
- Add me on SnapChat - https://www.snapchat.com/add/anatomysnap
- Publons peer review profile - https://publons.com/researcher/1374925/michael-a-pascoe/
For more information on Mike:
Mike received his PhD in neurophysiology from the University of Colorado (Boulder) in Dec 2010. He then joined the faculty of the Physical Therapy Program in the School of Medicine at the University of Colorado, Anschutz Medical Campus. He teaches clinical anatomy and in his spare time loves hanging out with his wife Stephanie and their dog Maia.
Read the full transcript below:
Karen Litzy: 00:01 Hey everybody, this is your host, Karen Litzy and we are coming to you live from the combined sections meeting in Washington DC. And I have the pleasure of once again seeing assistant professor Mike Pascoe. I saw him late last year in Denver. So Mike, Welcome to the podcast. Thank you for coming on.
Mike Pascoe: 00:18 It's my pleasure. Thanks for having me.
Karen Litzy: 00:20 All right, so we read your bio, but what I would love to hear from you is a little bit more about yourself so the listeners kind of know where you're coming from and what we have in store for our talk today.
Mike Pascoe: 00:32 Yeah, let me give you some things about myself that I really just drive who I am and what I do. So I am a Colorado native, so there's just a lot of fun things to do in Colorado and I've managed to stay in a really awesome place. And so there's a lot of fun to have there and a lot of that fun I have with my family. So I'm married to Stephanie Pascoe, she's a PT, so she's the clinical half of the marriage. And so we liked doing a lot of things together and we like keeping our two daughters busy as well. So very family driven and we've got a lot of fun with a five year old and a three year old girls. So I like to bill myself as a minority in a sorority. That's what things look like around my house. Lots of pink and yeah, so I basically am here at CSM with Stephanie and we both get to go do our own things and check out the various different talks, different posters, different presentations. And I've been able to come to CSM since I started at CU in 2011 so yeah, it's been a great conference. Great to catch up with old friends and make some new ones.
Karen Litzy: 01:36 And so today we're only on day one of the conference, but have you gone to any lectures or any poster presentations that really stand out in your mind?
Mike Pascoe: 01:45 Yeah, I really wanted to see what Chad Cook and others had to say about predatory publishing. So that was very informative. I'm aware of the concept and fortunately have not fallen prey myself, but it was good to just see the numbers and how big of a problem in this, you could, you could call it an epidemic. So
Karen Litzy: 02:03 Yeah, package that really well. Predatory journals, predatory conferences, things like that. I mean it's a thing and people fall for it.
Mike Pascoe: 02:11 Yeah, they said that the analogy is everyone's got a rich relative in Africa that just died and wants to offer you $1 billion. So it's a new spin on that old email tactic.
Karen Litzy: 02:23 Exactly, exactly. And it's unfortunate. It's unfortunate, but hopefully they're chorus kind of gave you a little bit of insight on what to watch out.
Mike Pascoe: 02:33 Yeah. If you go onto Twitter, which if you're not on Twitter, then I don't know what's going on. It's the best way to find out what's going on, at the conference. Great #APTACSM. And that's where a lot of us are sharing the real pearls from the session. So there's a lot to catch up on there. But then following that was a real exciting meeting of special interest group with the Academy of physical therapy education. Then that's the anatomy educators special interest group. So that grew last year was the first year there were maybe 50 of us and now there's 133 so we're really growing a nice base and we're really starting to cut our teeth on what we wanted to find and how we want to really enhance PT education specifically in the anatomy domain.
Karen Litzy: 03:16 Great. So now let's talk about that. So let's talk about your teaching background and what you’re doing over there at the University of Colorado medical campus.
Mike Pascoe: 03:27 Yeah, so about 80% of my time on campus in my role is as a teacher. So I'm really striving for excellence there. And basically I started in 2011 they hired me with very little teaching experience at the professional level, but I really had a passion for teaching undergraduate students when I was a graduate ta. So that's where I first fell in love with teaching anatomy. And then I got on board with CUPT and I teach PT anatomy. That's my main role. About 50% of my job is designing and delivering the content for the PT students. But I've also been able to extend into the physician assistant and a medical student anatomy courses. So that keeps me pretty busy. It's a lot of gross anatomy. It's a lecture in the morning and then going into the lab in the afternoon and looking at the cadaver donors.
Karen Litzy: 04:17 I remember those days.
Mike Pascoe: 04:20 I'm telling Ya, it's the most memorable and favorite course of all PT students
Karen Litzy: 04:26 It actually was my favorite course and I firmly believe every human being should take gross anatomy because you should know what's going on in your body.
Mike Pascoe: 04:35 You should know how the equipment operates. And there's some real good research out there and you know, a lot of people can identify where the heart is, but you ask them where the liver is and that's where we need a little bit of improvement.
Karen Litzy: 04:46 Absolutely. So now outside of teaching, what other things are you working on? Any kind of research?
Mike Pascoe: 04:53 Absolutely. And you know what I've learned from all the excellent mentoring I've had in my role is that you should really cover your basis. It should really be optimized in what you're doing with your research as an educator. So what you do is you do education scholarships. So I walked away from bench research and neurophysiology and now my laboratory is the classroom. So I do educational research. It's every bit as rigorous as looking through a microscope and you know, modifying genes in a lab. But basically the students are my subjects and I will take an idea that I think is going to be a way to improve my anatomy, teaching, design a protocol, get my IRB approval, collect the data, get some graduate students under my mentorship to help run through the project. Sometimes we find a positive result and sometimes we don't, but we send those results out anyway and I've been able to get some projects out the door.
Mike Pascoe: 05:46 Just a couple of highlights. There's a type of photography called light field photography, so that's been really interesting to see how you could change the focal point of a cadaver photo after the photo's been taken. Lot of anatomy clustered together, so it's often hard to get everything in focus so that gets around that. But also publishing on students using a Wiki to organize their study materials and why blogging. Actually I got to do a lot of live blogging, have a PT conference and we surveyed the people using a viewing the coverage and they really had positive rankings and satisfaction with the coverage. So I'm really promoting that and hoping that more PT conference organizers jump on top of that. It's a compliment to Twitter.
Karen Litzy: 06:31 So how were you live blogging and how is that different? I was going to ask is that, what kind of platform is that?
Mike Pascoe: 06:37 Yeah, we use a platform called cover it live. They're still out there. No conflict of interest, no disclosure, no relation, but basically what you do with live blogging as you can really issue more of a transcript of what's going on there. No character limits. Like Twitter, Twitter is usually more about the bite size pieces, but a live blogging is much more of a script and you can really capture a lot. You can integrate photos. And what's been really fun is to capture the question and answer session part of the session. People really rated that as a really good feature of live blogging.
Karen Litzy: 07:11 So you pretty much have to know how to type well to do that.
Mike Pascoe: 07:14 Right.
Karen Litzy: 07:16 Because for someone like me who has to look at the keys at the same time, cause I never learned how to type. Yeah, that would be my problem.
Mike Pascoe: 07:23 Hunting and pecking is hard, but the bigger skill is contextualization and knowing your audience. And it was real good for me to learn about how to interpret what a physical therapist was saying about a whiplash and the anatomy of neck muscles and how that can be put together so that way a PT audience would benefit the most. So yeah, that's a big skill as well.
Karen Litzy: 07:47 That's awesome. I've never heard of that. I mean I don't think I can do it because like I said, I can't really type, but I love the fact that it's long form. And so if I wanted to, if, if I wanted to watch you do this, how do you, how do you do that Mike as not for you as a person blogging but as the consumer.
Mike Pascoe: 08:09 So we have to get a marketing campaign out there. And what we ended up doing was just promoting the link to the webpage through social media. So fortunately people are very aware of that conference has come with their own hashtags and people are having conversations around the conference leading up to the conference. So we took advantage of that. Now we would just publish in advance, these are the sessions Mike is going to be covering. So come back this day at this time for the live coverage. The real beauty of this platform too, as you can play them back, well you don't play them back, you, you scroll through a timeline and you get to look at the content that way. So it was really rewarding to know that you're helping people real time, but for the busy clinician that can't step of treating patients at 2:00 PM that could come in and look at it later. That's really good.
Karen Litzy: 08:59 Sounds great. So aside from being a little more innovative in your teaching and in academia, in education, which obviously, is a must these days. What else are you doing as your role at CU or your role as an educator?
Mike Pascoe: 09:19 So another real cool role that I took over about a year ago was, it's an administrative role, but it's for the state, Anatomical Board of Colorado. I serve as the secretary treasurer. And so I oversee the day to day operations at the anatomical board. And basically this is still educational because what we do with the anatomical board, our big mission is to serve the educational goals of anatomy education in the state of Colorado. So think of every health care profession program, PT, OT, MD, dental graduate programs. Whenever a program would like to use a donor for an educational resource, they approach us, they make a request, we take a look at how many donors we have available. And we're very fortunate in Colorado that we have a very large donor pool, a large donor base, and I help assign the donors. And so indirectly I'm able to impact thousands of students a year with anatomy education simply by facilitating the use of cadaver dissection.
Karen Litzy: 10:21 That's awesome. Very cool. I often wondered how that worked now, well at least now I know how it works in Colorado. So you had mentioned earlier the use of social media. So if people are listening to this and they're not familiar with you, I obviously suggest following you on social media, but how has your use of social media impacted the way that you teach and the way that you sort of view education in physical therapy?
Mike Pascoe: 10:51 Yeah, so I incorporate social media into my teaching directly and indirectly. So directly I have recognized that there's a real power behind this, this cognitive psychological principle called retrieval practice. So any way you can get your students to practice retrieving information without the learning materials in front of them, they're going to benefit. Studies have shown that for decades. So how am I going to, aside from doing like the polling audience response system, how can I really get their attention? And I found what's really successful is to use social media and people are doing Twitter, people are doing Instagram, but students really pay the most attention to content on snapchat. And if you're not familiar with snapchat, the thing that makes it different, what sets it apart is that the content disappears after 24 hours. So when you're doing retrieval practice, you don't need it necessarily for the student to preserve the questions and answers.
Mike Pascoe: 11:49 They just need practice interacting with the content that goes away. And they know this. So there's something about the way the brain is wired and the brain pays more attention to ephemeral content so they know it's going to go away. And so I, I push out questions during the semester and they get the question, they get the answer later. So it's great for the students, but it's great for me, the educator I found with Twitter and Instagram, it really took so much time, to perfectly create the right content. But everybody on snapchat understands that it's raw, it's unedited and it's uncurated. So as long as I put the correct information out there, it's quality enough. So it's very quick. It's very rapid. And every time the students find out that I run in anatomy related snapchat account, they can't believe it. At first they’re in disbelief like what's going on.
Mike Pascoe: 12:38 But once I convinced them that this is educationally based on sound pedagogy, they're onboard. And then I'll have a break from it and they'll bug me. We need more snaps. Pascoe put some more content out there. So if you want to check out what I'm talking about, the handle, the username on snapchat is anatomy snap. I'm all one continuous word and I'm telling you, it's been really exciting. I collected data this summer. I'm looking at the data now and hoping to see, number one, if students found it satisfactory, but number two, how did their exam scores look? They could have been the same. They could have been worse, it could have been better. The exciting thing is I've learned how to put a protocol together that will allow me to level up beyond satisfaction. And did your learning change has your knowledge base change? So stay tuned for that publication.
Karen Litzy: 13:28 Awesome. And now can you give an example of some of your snaps? So yeah, give me a couple of examples so that people kind of get an idea of what you mean. Like what do you mean you're putting stuff out for anatomy? Like just taking a picture of like a muscle or dissected bodies. So give me an example, but before you do well give me an example for us then I have another question.
Mike Pascoe: 13:53 Yeah, no, it's good to leverage it. Leverage the principles, you can get retrieval practice and you can also get leverage examples and just to like real life examples. So you're at a table, you're just going through the upper extremity anatomy and you're between lectures or whatever you're doing as an educator. Put your hand on the table and elevate your thumb and get the extensor pollicis longus tendon to pop up. Take a picture, add text. What tendon end do you see here? Drawn Arrow. Then you can take it further. Just keep building, keep elaborating. What's the line of inquiry that the student would go through? How would you go through this at the cadaver? What anatomical region does this tendon define? Anatomical snuffbox? The next snap question is now what structures as a physical therapist are you most interested in finding in the stock box? So then you could go through that. You can step through a very sequential Socratic series of snaps, and then you can say, okay, everybody send me a snap of your snuffbox if you so choose. They'll usually do this without solicitation. But that's an example.
Karen Litzy: 14:59 So I think that's great and it actually leads perfectly into my next question is, are you creating a curriculum for your snaps or is it just off the cuff?
Mike Pascoe: 15:10 You know, I'm very mindful and aware that doing things intentionally is the best way to go. So what I did for the summer is I did focus my snaps on a specific aspect of anatomy in the course and that was blood flow diagrams. So I do look at my learning objectives and those informed my teaching methods. So these snaps, although they seem frivolous and accessory, what they really do is there a direct extension of being able to describe the path that blood takes from the left ventricle to a distant site in the body. So it is very informed. It's very intentional, it's in the curriculum, but you have to be mindful that not all students are going to go there. It has to remain optional. I do not think it's appropriate to push your students into social media. There's a lot of valid reasons students don't want to go there, but for the ones that are there, I've found it's 90 to 95% of the students. And you know what? It's a great way to role model and show them how to be professor professional and how to use social media in an appropriate way. That's beyond tearing down somebody's beliefs and ideals.
Karen Litzy: 16:16 Well said. So there is a method to your madness is what you're saying. There is not, it's not random like, oh, I stub my toe today, I know I'm going to do something on the foot.
Mike Pascoe: 16:28 Yeah, exactly. It's intentional and yeah, it's been out for so long that it's just time that everybody had a good understanding of how to use it appropriately and then how we can really think about incorporating it into education.
Karen Litzy: 16:40 I think that's a great way to incorporate into education and hopefully people listening to this will now follow anatomySnap. No S. I follow you on snapchat and I can say that it's really interesting. It's really interesting even as a, a more quote unquote seasoned PT because I feel like you can never have too much anatomy. That's so great. Now, anything else that you're doing that's kind of outside of the box with your students or even without your students as far as furthering your education?
Mike Pascoe: 17:16 I think that another thing to bring up here is how there's a real need for physical therapists that are anatomy instructors to understand what is needed to know and what is nice to know. So that's my second area of work. The first area is the technology integration, but I've really developed some nice ways to look at what do anatomist that teach physical therapy students need to teach their students. So I'm just looking at the data now, but I recently put out a survey to about 200 people in the, that our stakeholders for the physical therapy programs, talking faculty, clinical instructors, recent graduates, the two most recent classes. Do you and your opinion think that in your practice you need to name all 10 bronco pulmonary segments of the lung? That was an example of an objective for which most people rated. No.
Mike Pascoe: 18:11 Like that is not essential. So I take that feedback and I improve my curriculum. On the other hand, should a PT student be able to know name every spinal segment that is serving a muscle, the myotomal innovation and most people, the majority came back saying, yes, that's neat to know. So it's been really nice not being a PT to survey a wide base of people. The next step is going to be to survey the community at large to kind of level up the methodology, get a consensus document together and then present that to the educators in the PT Community.
Karen Litzy: 18:49 Great. Well it sounds to me like you're up to some really fun stuff and I look forward to touching base again when you have a lot of this data together and you're ready to present. So is there anything that we didn't touch on?
Mike Pascoe: 19:03 Well, Gosh, let's see here. Anything else? I guess if you're really interested in body donation, it's often, it's often confused with my driver's license has a heart.
Mike Pascoe: 19:17 But that's organ donation and that's totally separate. You do need to opt into whole body donation. And I go through this concept in a six minute ted talk and basically if you, if you just search youtube for Pascoe Ted x, you'll find a nice little talk I was able to put together for Tedx Boulder in Colorado and just kind of let people know what body donation is all about. And the title of the talk is the ultimate gift because we have extreme gratitude to the individuals that make this choice to, to give us the ultimate gift, the body that has served them all of their life. And now we'll go on to serve health care professionals as they work toward being able to take care of, to treat those patients.
Karen Litzy: 20:04 I love it. So everyone, don't worry, we will have links to everything on the show notes under this episode. So before we wrap things up, I have one more question. Given where you are now in your life and in your career, what advice would you give to yourself as a new Grad or to your students? Like when you were a student, what advice would you give to yourself?
Mike Pascoe: 20:40 So there's two I want to give you. One is more like the life side of things and learning to say no, I had definitely gotten myself in trouble. Okay. So I'm super passionate about teaching and every time I was approached with a teaching opportunity I rationalized how I could make it work and I trick myself and I got way overloaded with teaching. So I would go back to, you know, 27 year old Mike. Like you're going to have a lot of opportunities, but there's a, there's a tactful way to say no. And even though that time may not be the right time, things do cycle back around, you'll get another pass at it if it was meant to be. And then the other more practical. For those of you that are PT students, those of you that are looking at getting into PT school, you have to look at your study techniques.
Mike Pascoe: 21:27 So I've totally revolutionized the way I do office hours. When students come in and they've had a bad performance on an anatomy exam and they say, I don't understand, I studied so much, I blow a whistle and I throw a yellow flag on the ground and I say, hold up. The penalty on the field is quantity does not equal good learning. So you have to look at these psychological, cognitive principles of learning and what got you through in Undergrad will not get you through in PT school. The volume is too much. So in the show notes, I'll give you a link to a really excellent website that summarizes these key principles of learning and you've got to look at your study habits. Then you've got to be prepared to change them. Otherwise you're in for a really painful and arduous path through your physical therapy curriculum, in other programs that you might be pursuing.
Karen Litzy: 22:20 Amazing advice. Thank you so much. What's the name of the website?
Mike Pascoe: 22:24 So the name of the website is a learning scientist. And I believe if you just Google learning scientists, you're gonna find a website that has principles of effective learning.
Karen Litzy: 22:36 Thank you so much for sharing that. And I'm sure the students and myself will greatly benefit from that. So thank you. And now where can people find you on Twitter? We know where they can find you on snapchat. How about Twitter?
Mike Pascoe: 22:49 Yeah, go ahead and look for me @mpascoe. You know what, if you're looking at the Hashtag for the conference, I'm tweeting up a storm here, so that will be a good place to catch some of my contributions and go from there.
Karen Litzy: 23:05 Awesome. Well Mike, thank you so much for taking the time out at CSM where we, everybody's busy. I get it. We're all busy. So I really appreciate you for taking the time out coming on the podcast and sharing all this great info. So thank you so much.
Mike Pascoe: 23:19 Yeah, my privilege and thanks to you, Karen, for getting everyone together and being a vessel for getting this information out.
Karen Litzy: 23:25 Thank you very much. And to all the listeners, have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Shayla Swanson on her company, Sauce. Sauce was founded by a former Canadian national team cross country skier as a way to support her ski racing. Sauce founder, Shayla Swanson, was frustrated with traditional winter headwear that she found to be too hot, too itchy & too ugly. An avid sewer, Shayla set out to create functional, stylish and comfortable products that met the needs of elite athletes and outdoor enthusiasts alike.
In this episode, we discuss:
-The story behind the beginnings of Sauce
-How Sauce tailors and personalizes their products from Bozeman
-What is in the future for Sauce
-Shayla’s advice for female entrepreneurs
-And so much more!
Resources:
Shannon Sepulveda Website
Shannon Sepulveda Facebook
20% off with code “hws19” on: Sauce Website
Sauce Facebook
Sauce Instagram
For more information on Sauce:
Sauce was founded by Shayla Swanson, a former Canadian national team cross country skier as a way to support her ski racing. Sauce founder, Shayla Swanson, was frustrated with traditional winter headwear that she found to be too hot, too itchy & too ugly. An avid sewer, Shayla set out to create functional, stylish and comfortable products that met the needs of elite athletes and outdoor enthusiasts alike.
Sauce started as a hobby for Shayla while she was ski racing and working through her degree in Exercise Science from Montana State University. She began selling Swift Toques to teams and clubs who wanted a custom item for their group. The product line evolved from there, and soon saw the additions of the Swift Headband, Ventilator Headband, and the fleece-lined Chill Toque. After several exciting seasons of ski racing full-time and a near Olympic team miss in 2010, Shayla decided to jump into Sauce full time, putting 100% of her enthusiasm and effort into the entrepreneurial venture.
Commitment to pursuing one’s goals, a strong belief in one’s own potential, and using constructive evaluation for growth, are all important ingredients for a successful athletic career. While skiing and sewing hats are not the same, it turns out that those behaviors are also the key to making it as an entrepreneur. The lessons learned in Shayla’s ski career have helped her navigate the business world and grow Sauce into a company with distribution across North America and beyond.
For more information on Shannon:
Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.
Read the full transcript below:
Shannon Sepulveda: 00:00 Hello and welcome to the healthy wealthy and smart podcast. I am your guest host, Shannon Sepulveda and I am here with Shayla Swanson. Can you tell us a bit about who you are and what you do?
Shayla Swanson: My name is Shayla Swanson. As you said, I am the owner of a company called Sauce and we specialize in headwear and select apparel pieces for endurance athletes. My background is in Nordic ski racing. So I spent my teens and twenties training really hard to try to make the Olympics in cross country skiing. I didn't quite, but I got close and I got to do some really amazing things. The other thing is that I was always a sewing nerd and I love to sew and make clothing. So I began making headwear for my ski team and other ski teams. In the early two thousands, we found that most of the headwear we were given was really hot, too itchy, really ugly.
Shayla Swanson: 01:02 And so we set out to kind of fix that situation and things moved from being kind of a hobby or an accidental business and to being a real business. So that was pretty exciting.
Shannon Sepulveda: Take us from your competitive Nordic ski days to just like why you started the company, where it was, what you did, like the start of the company.
Shayla Swanson: The start of the company was really just me talking to a couple of teammates saying, hey, I have this idea, let's make some hats and try to sell them to stores and then we can make a little money to help support some of our ski racing. And I had at that point made maybe a couple of orders for local ski clubs and then realized I didn't like sewing that well. So I got some people to help me. My tolerance was about two CD's worth of sewing.
Shayla Swanson: 01:59 Like I would listen to two albums and then I was, I was done but that didn't get me very many in the grand scheme. So these teammates of mine said, yeah, we'll help. And we basically devoted a weekend to cutting and sewing and making hats to try to sell to some of the local stores and our connections in the ski world helped us. So they said, yeah, we'll put these in our store and put a little tag on them that says the proceeds benefit you guys. And so that was kind of your one. And then from there things changed and you know, some of my teammates weren't interested anymore and they didn't like sewing all that well either. And so we basically, from there it was kind of me and one of the teammates, my friend Rhonda, that continued on with the business.
Shayla Swanson: 02:49 So Rhonda and I started turning things into a little bit more of an actual operation where we would create a catalog and send out to stores and actually try to sell at wholesale. We also had a custom program that we offered to teams and clubs and events. And amazingly enough, it kind of, it worked. So that was in 2000 probably, that was from like about 2003 until 2008 and all that time we were operating under the name SOS headwear and the name SOS came from a blog that I had and my blog was where I updated results and stuff that I was doing skiing and it stood for Shayla on Skis. So we were at SOS headwear, and then in I think it was 2009 that we decided to kind of rebrand and there was a nice little phonetic connection between SOS, which you know, is phonetically pronounce sauce and then the brand name sauce, which is the topping that you use to spice something up.
Shayla Swanson: 03:54 And so we thought that are colorful, boldly patterned headwear that kind of worked. It still confuses people and I get email solicitations from India, but that's kind of where the name came from. 2009, we started operating under the brand name Sauce. Rhonda and I were both still ski racing, trying to make the 2010 Olympics in Vancouver. Unfortunately neither of us were successful in that, although we both got really close and she knew at that point she wanted to go and work in a different field. So at that point she kind of left the business and I carried on and I started attending trade shows and actually trying to sell some product. So I would say the start of the official like 100% effort toward the business started in 2010. And it's been quite a rollercoaster ride of fun since then.
Shannon Sepulveda: 04:50 That's awesome. So I should say to our listeners, for those of you who are not familiar with Sauce headwear, if you can picture a kind of like a workout hat and really, really fun prints, that's how I would probably describe Sauce Headwear I know this podcast is based in New York and we were in Bozeman, Montana. But whenever I wear my Sauce hats in Manhattan, I always get comments like, people love them. They're like, where did you get that? And I was like, I'm going to try to get Shayla to get these in the stores in Manhattan. But I was running in central park with all my Sauce stuff and I always got compliments because they're just kind of fun. They're not muted in any way. I did not grow up Nordic skiing because I grew up in New York, but, I did not know that.
Shannon Sepulveda: 05:43 I feel like the Nordic see culture is kind of fun in that sense. Like they tend to wear really bright, fun colors. And so that's kind of what Sauce headwear looks like. And you now, not just, you don't just make hats. Now you make other things. So why don't you tell us about branching out from hats?
Shayla Swanson: We are not trying to be a huge apparel line. What I think our sweet spot is and has been, is bringing a product to the market that we think we can do a better job at, I guess do something a little different that isn't out there and really focused on kind of our elements of like making stuff that's just right, warm, really comfortable and easy to wear and you know, brightly patterned and really pretty. So we make a couple of leg where styles, one of them that I think is our most unique and really applicable to our female athlete audience is our flurry tight.
Shayla Swanson: 06:45 We've put some fleece lining on the quad and also sections of the butt where you get cold in the winter. Those are the two areas where, you know, you come in from a winter run or a winter ski and you think, Oh, I'm freezing on my butt and on my quad. So what we did was we left the rest of the tight unlined cause those areas stay pretty warm and I'm just focused on those spots. So, that's an example I guess of one of our apparel pieces. And we also do like a winter skirt and we have a summer product line that includes some tights and a tank top. And then also another product that I think I liked this one because of the name, we call it the cheeky retreat. So what it is just a nice skirt to cover up your tush if you really don't want it on display. Anyway, that's some of our other stuff.
Shannon Sepulveda: 07:29 I bet you that skirt would be really good for like changing out of your bathing suit, like on the side of a river wherever you are.
Shayla Swanson: Yeah, it's an excellent, it's a great little coverup.
Shannon Sepulveda: Yeah, it keeps things hidden while you want to change underneath. It works out really well for that. And I have tried the flurry tights. I loved them because yes, when you're a female and you run your butt gets cold and your thighs get cold and everything else does not. So it's really nice to have, you know, your calves can breath. What Shayla does is also takes her hat patterns and creates leggings out of them.
Shannon Sepulveda: 08:22 So they're just the really fun colors. And why don't you tell us a bit about like your custom program, because I know at least for most of the races in Bozeman and probably Missoula and probably Canada to lots of light, lots of places, in our race bags we get Sauce hats or headbands that have a logo of whatever the races generally which are awesome. So why don't you tell us a bit about that custom program?
Shayla Swanson: One of the really great business avenues that we sort of happened upon by accident was custom headwear for teams, clubs and events. We do two different options for custom. One is we take our stock product, so all of the hats and head bands that we have in stock and we add a logo to them. So we call that are basic custom program.
Shayla Swanson: 09:16 And it's really great cause that allows we can do orders as few as 12 and it's really relatively inexpensive and it’s kind of a nice option for people. And then we also do what we call our full custom program. And that involves working with a customer to put a design together that is totally unique to their event or their store. We’ve outfitted orders that are like just an event order, but we've also gone as big as working with the whole, Canadian Jack Rabbit program, which is a youth scaly program in Canada that has over 10,000 kids in it. And they submitted drawing ideas to us and we held a contest to see who liked, you know, which design idea they liked best. And then we turned that little kids designed into a hat pattern and outfitted the whole country's youth programs. So that was pretty exciting for us. We currently don't do that order anymore because they have a sponsor that outbid us, but we loved it. It was awesome. Sometimes we have worked with, currently all of our product is sewn in our facility in Bozeman. In the past we have worked with manufacturers based in Los Angeles to help us out with orders that we couldn't quite handle on her own.
Shayla Swanson: 10:36 So the nice thing about it though is that with the options that we have, we can accommodate, you know, we can really be, you know, cottage industry and do something really small and unique for a small customer. And then we can also access those other avenues to produce larger orders for big groups. So it's kind of fun.
Shannon Sepulveda: 10:54 So along those lines, why don't you tell us about like your manufacturing, cause I think you do everything in Bozeman, right? Which is really awesome. So tell us a bit about that.
Shayla Swanson: Sure. Initially when we started doing this, I did not really contemplate the idea of doing all of the sewing in house. I was kind of content working with the manufacturer. But then we started just running into situations where you get a batch of hats back that weren't quite right. Or you know, you wouldn't be able to tweak a sizing concern until you already, you know, had placed your order with this group. And anyway, we just were running into all these situations where I thought, man, it'd be awesome if we could just make this stuff here. And so I bought some industrial sewing machines.
Shayla Swanson: 11:41 Industrial sewing machines are interesting because they only do one thing. So unlike a home sewing machine that can do a bunch of different stitches in a programmed, you know, design, basically industrial machines only do one thing. So in order to make our products, we have four different machines that are able to do all the stitch patterns that we use in our stuff. And yeah, I was lucky enough to find some amazing sewers so, Bozeman is a funny little space in the world of manufacturing because we have several different companies that are much larger than we are, but they make all of their product here. So there's this weird little, like sims makes their waders here and mystery ranch backpacks. So we have access to are sewers in town who are, who are really skilled at what they do.
Shayla Swanson: 12:28 And I was lucky enough to actually hire on three former sims employees, sorry. Sims. And they've been awesome. So they love it. They are given super flexible work hours. They do what works for them and they just sit around the machines and laugh and talk and have a great time and they make all of our stuff and they're really fast and good at it. So it's really fun. We have rolls and rolls of fabric and the corner of our space, we have a big cutting table. We use a big upright solid to cut all the patterns out. We're able to, you know, make small adjustments to sizing on the spot, you know, which is really great. And then they just sewed them up, finish them up, keep them in our inventory space where our office is basically a large garage. So it's not pretty, but it works really well for our purposes. And it's just really fun to think that of all of the love that goes into each thing that we ship out the door.
Shannon Sepulveda: 13:32 So I want to know how you create your patterns. And how you get that fabric made because you have fun new patterns every year. And I didn't know if that was like your brainchild or if it's a couple people's brainchild or if it's the company's brainchild or how you pick what pattern you'd like.
Shayla Swanson: Yeah. So it's not all me, that's for sure. There are trending reports that come out for the outdoor industry and I don't think they're as important in the outdoor industry as they are in, you know, the fashion industry. But, but what will happen is, a couple of companies come out with these trending reports that, that show you kind of what colors they think are going to be on trend for the upcoming season. And then what we do is we are an accessory piece.
Shayla Swanson: 14:24 And so really we don't need to follow, we don't need to create our own trends, but we need to kind of follow what the other brands are doing. So if we see a company if the trending reports are coming out that, you know, really muted colors are, are going to be more prevalent than we want to try to offer some of those colors in our prints and patterns so that we can match your jacket from say Patagonia or something like that. So what we do is we just tried to I work a couple of different graphic designers who specialize in textile design and they'd come up with some concepts based on textile trends as well as color trends. And then we put that all together to try to make our line a really nice, complete offering to people cause you also want to make sure, you know, we want to make sure that if somebody loves pink, they can find a little pink in one of our hats.
Shayla Swanson: 15:11 So we try to make sure kind of every main color is offered as well. So it's something between the science and art, I guess it's not all just creative energy going into that. We have to also look at some of the other factors and figure out where we fit in the mix. It's pretty fun and exciting. I wish I, I can't, I'm not as adept to the graphic design part of things. So I don't do a lot of the actual design, but I get to pick what I like best and, and where to go next. So it's really cool.
Shannon Sepulveda: Especially because I love you Patagonia, but this year their colors were terrible. They were all these like muted colors. They had maybe like one bright color. And so I was like, I guess I'm just going to have to get a muted color and like wear a fun sauce hat.
Shayla Swanson: 15:58 Well, I hope you were at least able to coordinate one color out of our hat with your jacket.
Shannon Sepulveda: I was, yes, I was. I appreciate that you have fun colors. Oh, I'm hoping next year Patagonia, we'll have more bright colors. Bright colors will be back in season.
Shayla Swanson: Right. What I've actually had to do is, because I'm always going to be wearing one of our hats and I don't want to buy a new jacket every year is I've had to resort to black and gray in my outdoor apparel, because then I know I can always look okay with whatever hat I'm wearing and not have to buy a new jacket every year.
Shannon Sepulveda: Yeah. I also think another great thing about Sauce hats, so, so Shayla and I both have kids is that and we both have a boy and girl is that, you can throw a toddler girl in all boy clothes and put a really fun toddler pink sauce hat, and then they look really, and then they look really cute. Yeah. So it's pretty awesome. Oh, why don't you tell us about your Kiddo?
Shayla Swanson: Oh my. I have two little ones and they are really fun and really hard at the same time. But it's been kind of fun because we made a baby hat for a while. And I was sort of like, yeah, it's really super cute, but I couldn't really get behind it as far as like whether or not it was a great product for kids. But yeah, we have this little chill hat that we make and I should also mention, we call our hats tukes that stems from my Canadian background.
Shayla Swanson: 17:32 Winter hats in Canada are called tukes and it's spelled in a way that makes everyone want to say Toke or Torque even. So, it's a little confusing for people. But anyway, we make a little chill tuke for kids and it's been like the best hat for my young ones. I can't believe it. It's like I just have this constant stream there. I start them in the small move them up through the other, the other sizes. And what's great is that they're tight enough that they stay on their heads and I think they forget that they're on, which I think helps they so they don't pull them off. And the other thing is that they're warm but they're not like so hot that the poor little kid is like drenched with sweat underneath their hats.
Shayla Swanson: 18:12 So they don't try to rip it off because they're uncomfortable either. So our chill tuke for kids has been amazing. My daughter who is almost a year, wears our large and my son who is three, where's our toddler size and yeah, it's been great. I can get behind them now.
Shannon Sepulveda: Yeah, they're pretty awesome. Cause they have just like a fleece band. Right. And the top doesn't have fleece. So like when kids are playing hard, they don't totally sweat.
Shayla Swanson: And that's kind of our whole little goal with our headwear line is just to make sure that we're keeping, you just right warm. We want to make sure that you don't notice your head when you're out there exercising. Because I know for myself, I've worn Wool hats and been drenched with sweat and miserable and then you want to pull them off and then your hair freezes and then you're more miserable.
Shayla Swanson: 18:57 So that's kind of our whole mantra is just let's keep you warm but not too warm.
Shannon Sepulveda: Yeah. So, along those lines, since not everybody Nordic skis or lives in a place for Nordic skiing so runners really wear these hats a lot. I see out even when I was visiting Seattle, I saw a lot of runners in Seattle wearing the hat. So why don't you talk to us about just like other sports that they're useful for?
Shayla Swanson: Our line has now expanded to be a 12 month, you know, four season line we have some of are products that are ideal for summer activities. And then we also have our winter product line. So our winter product line, I would say we're kind of geared really, you know, well basically any activity really, I mean anything where you want to be comfortable and colorful and you might work up a sweat.
Shayla Swanson: 19:54 So that might be running or hiking or skiing. And also we're a great little, like if you're an alpine skier and you wear a helmet so you don't really need a hat while you're skiing. We do make a helmet liner that fits under helmets. And then we also make a lot of our products are great little like lodge hats. So if you want to cover a pure helmet head and feel like you have put a little bit of effort into your appearance our products are great for that. And the other thing that we have when we expanded into this spring summer product line, we've introduced a couple of visor styles that have really flexible brims. They can be worn under helmets if you're a cyclist. They are great for running and hiking. And then we also have a product that's like a kind of two ways visor that can be worn.
Shayla Swanson: 20:37 It's really if you're hiking and you're not sure what the weather's going to do, so you can cover, you can kind of cover up or wear less people say they love those on a boat too, because it keeps you from burning. That's our viser. I think what the feedback that I'm thinking about what's coming from this woman who said she loved, she always wore her hair in a ponytail and she always had like a part in her ponytail, in her hair, you know? So the way she would brush her hair back, she would always end up with like a sunburn in that area. But she said that with that product, she loved it because she still had plenty of room to like get her hair out the back, but she could kind of pull that piece back and so she didn't burn her head.
Shayla Swanson: 21:21 So anyway, just little random stuff. Some of the stuff that, some of the benefits we claim are things that we thought of. A lot of them aren't benefits that we didn't think of, but there were people have decided works well for them. So that's pretty nice to hear that stuff too.
Shannon Sepulveda: Why don't you talk about your tassels because I feel like you're the only, I don't know. I haven't seen any other hats that have flower tassels.
Shayla Swanson: The Flower Tassel. Yes. So, so our idea was kind of to bring a little bit of fun and spring summer brightness to the coldest dreariest winter day. So along those lines, we started using these little tassels on the top of some of our hats. Some people love the tassels, some people hate the tassels, but there are enough that love them that we definitely keep doing it.
Shayla Swanson: 22:11 And so we offer three different styles of Tassel on the hat. And one is like a traditional kind of looks like a graduation tassel. And they're kind of popular in the Nordic world and maybe not anywhere else, but a runner sometimes or sometimes they bounce a little in your head. So, yeah. But they're cute. They're cute. And the colors are really pretty. The other type of tassels that we make is a flower tassel. And those come with mixed reviews. But again, it's one of those things that people who love them love them. We have a few stores that order exclusively flower tasseled hats because they know they will sell them because people think they're cute. In our offices I will say that we don't love the flower Tassel because while we've been able to outsource manufacturing of most of the tassels just cause they're kind of a pain, we have, we still make the flower tassels.
Shayla Swanson: 22:58 We’ve tried to find someone who can help us make them but no luck so far. So, so we have some weird weird little non transferable skills that we joke about in our space where like we're really good at tying knots really quickly because you need to tie four knots on a flower tassel. And then we have a pom pom we can put it on the top of our hats too. A little pom is really cute. We get lots of different colors and anyway, that's another piece when we try to pick our prints and patterns, we have to try to figure out if we have tassels that work with the prints and patterns.
Shannon Sepulveda: And so if someone wants to do a custom order, they can pick their hat print, tassel, logo.
Shayla Swanson: 23:44 And that's kind of what's nice about say working with us versus other larger businesses that do custom work is that we can really say like, you'll get, you know, get an email saying like, these are all of your tassel choices, these are your fabric choices for your hats. It's kind of very customized. Very cool.
Shannon Sepulveda: So why don't you talk a bit about your price point? Because for the life of me cannot understand how you make everything in Bozeman and the hats are still $30. Wow. Because that's pretty awesome, I think for a company to be able to do that.
Shayla Swanson: 24:20 Yeah. The honest truth of it is this is the healthy, wealthy, smart podcast. Let's just say I probably won't be getting overly wealthy, but I love what I do. And so it doesn't matter too much. But it is true. There's something, the reality of it is that if you want to be really profitable in the apparel industry, I think you definitely have to send your stuff to places where they don't have to pay people much to make it the reality was sewing a hat or a piece of clothing is that it's touched. Every single seam is basically driven by a person. There are a few exceptions, but in general, a person is responsible for every seam on your clothing.
Shayla Swanson: 25:11 Unlike an injection mold plastic piece or something like that where it's, you know, where it's really mechanized and automated. And so, yeah, as far as our price points go, we have to maintain some level of competition or competitive, you know, placement in the industry. So, yes, it is true that our profit margins are not as great as they could be, I suppose. But then we couldn't offer, we really, I think that we wouldn't have a business if we outsourced to somewhere like Asia or places because they have high minimums. They can't offer the flexibility that we can. So I feel as though, it's an interesting situation because I don't think we could do what we do using a different type of manufacturing model. Yeah. So what's really been great for us is that we have, this year in particular, we have really streamlined a lot of our production processes.
Shayla Swanson: 26:07 I think we're getting faster and faster at everything we make, we're cutting down on complication and skews and things. Anyway, everything we can do to basically improve our efficiencies and make sure that we can be competitive with our price point and also be a healthy business. Yeah. So, yeah. So it's interesting.
Shannon Sepulveda: Can you talk a bit about the contest? It seems like you have every year where someone designs a hat.
Shayla Swanson: Yeah, that's a fun one. So one thing that we have started to do, well I guess it's been probably five years of the contest now. We have a contest that runs every year in August or September, we call it our special sauce design contest. And what it is, is we basically send out a little pdf template and people can download it and basically send in a design idea.
Shayla Swanson: 27:04 And what's really great is that we used to get comments, people would email us and be like, hey, why don't you have any hats that are blue? Or why don't you do this, this, this, or the other thing. And so it's been really great to be able to put the ball in our customer's court and have them tell us what they want to see. Every year we receive entries and we put them up on Facebook and we also allow people to vote on our website. You know, Facebook may or may not be a great avenue for that but yeah, people vote for their favorite designs and then we make them. So this year we had two really beautiful, we had a really beautiful floral that came through. We had basically two that were really neck and neck for first and second, so we decided to produce them both.
Shayla Swanson: 27:49 And this graphic designer in town here in Bozeman that submitted this ridge line mountain design. And then what's really cool is that at the end of the year we kind of tally up how much we sold and then a percentage of the sales go back to the winners chosen charity. So yeah. So this year one of the hats we'll be donating to a foundation called the neo kids foundation. It's up in Sudbury, Ontario, which is where the winners of the contest live and that's where they wanted their proceeds to go. And then one of the designs here is going to go back to basically a fund for the Bozeman education. That foundation that supports kids that are homeless basically, who come and need some assistance that way.
Shayla Swanson: 28:41 So we're really excited about that part of the contest too, cause it just gives us a chance to give back.
Shannon Sepulveda: So we can find you in Bozeman. We can find you online. So why don't you tell us a bit about like where you're located in the country, what types of stores and like if people want to check out your products, where would they go?
Shayla Swanson: We are carried by about 200 retail locations across North America. So if you go to our website does have a store locator, which I will admit is about 90% complete. It's really hard to stay on top of all this stuff. We are distributed in the types of stores that carry us or generally like running shops. More like outdoor stores.
Shayla Swanson: 29:32 Also anything that's kind of got a Nordic edge to it. Those shops typically carry us. So yeah, so we're available online. They're available about 200 retail locations and if somebody out there can think of a store that we should be in in that we're not, we always take suggestions for wholesale accounts that we should be reaching out to. So that's where you can find us.
Shannon Sepulveda: Yeah, I was thinking about that when I was in Manhattan in November. I was like checking out stores. I was like where it just be as so many people complimented me on my hat. Cause I feel like New York is a lot of people tend to wear more muted things. Or in big cities in general, I think it's more muted. It's more muted.
Shayla Swanson: 30:22 And that is one thing I will say is that we do, well, a lot of our patterns are kind of bright and colorful. We always make sure we have a black and white option. We always make sure we have a gray, you know, it's like we try to make sure we can also appeal to the more subtle Palette. Our winter product line has men stuff. And we always carry a black plain old basic black as well too. Our neck gator product is called our frosty. Kind of like the buff is sort of the Kleenex or the bandaid. The brand that became the thing. So, my parents used to call it a chill choker.
Shannon Sepulveda: 31:10 That was a new brand, like back in the 80’s. But we as children, I was growing up, we used to always call the chill choker. And I feel like it was wool and we wanted to just like rip your neck off and awful. And then they were like turtle fur, do you remember that?
Shayla Swanson: Well and that brand is still that brands still around there. You see them in places that carry us as well. Occasionally. But turtle fur is still around. We have a product coming out next fall. We currently make a like a neck breeder, but it's a lightweight net gate or color frosty for the neck. Next season, next fall we have a product that'll be coming out called throat coat. It's our aligned neck warmer.
Shannon Sepulveda: 31:57 Oh, that's such a good idea. My son had, I think I got it at your clearance sale at the Cammo. But it's really good idea to get, um, like a fleece lined one for the really cold days for, especially for downhill skiing.
Shayla Swanson: And the product we're, we're using the liner, we use them polar tech products to line our stuff. So for installation their fabrics and we're using a kind of a mid weight style, so it's like warm, but it's not going to be like saturated with breadth and moisture, like a fleece might be. And then it like freezes and it's stinky. My team might still be stinky, hard to say, but yeah, there anyway, all this stuff you try it, you try to think about, but it's something that's just a reality.
Shannon Sepulveda: 32:49 There’s a place in Bozeman where you can Nordic ski and it's like all sourdough, right? So it's all up for nine miles, go all the way up for 10 all the way up for 10 miles. And so you get super sweaty all the way up and then you come down and you pretty much don't really have to ski on the way down and you're buff just becomes like an icicle because just like knock knock, by the time you get to the trail head because you've sweated all the way up and then you just freeze, freeze all the way down, all the way down. That's a tough, tough trail to dress for. You have to have like a backpack of layers to it. Right. To get down, to get down comfortably. I typically choose to just be really, really cold at the bottom. Yeah. And then turn on and then get in your car and turn on your seat heater. By the time you get to the house, then the cars finally warmed up and then you feel pretty good. What's new in the future? What can we look forward to?
Shayla Swanson: 33:50 We have a few new products next season. We have really cool new patterns that are kind of basically images of our natural world that are going to be placed in the hats and the headbands anyway, so we're venturing out a little bit from what we typically do, but I'm really excited about. It's been well received by the stores that have seen the line already. So we have some new prints and patterns. It's usual. And then we have a couple of new headwear products that are sort of like hybrids of stuff we've already been doing just to I guess diversify the line a little bit and make sure everyone can find products that are aligned and warm enough for them.
Shayla Swanson: 34:37 Anyway, that's kind of confusing. But I guess just in general, I'm our main product designer and I've been having children for the last few years and I haven't been feeling overly creative. My mom brain has, has really, I would say, shut that down for me. So I'm feeling like I've turned a corner here. I have a nearly one year old and I can, I'm feeling like I can start to think again. And so I'm looking forward to seeing what that, what that brings because it's always when I'm outside skiing or outside running or hiking that ideas come to me where I'm like, Ooh, this is, this would be a great product. So I'm looking forward to that. And so as far as what's coming next, I have a few things on the immediate horizon and then after that we'll see.
Shannon Sepulveda: Cool. Yeah, I feel like you need like for at least for headwear winter headwear I feel like you need like the fleece line warm hat for like walking around town. And then you need like the thin hat for exercising and then you need the thin headband. Cause sometimes it's just your ears it get cold. And then you need the fleece lined headband. And then you probably need more stuff, but those are like my four go tos for like winter. But you definitely need the like non, it's nice to have the nonactive totally fleece lined hat for like warmth.
Shayla Swanson: 35:30 The two products that we make that I think are good for casual or activity on a cold day. If you will athleisure headwear, we make a slouchy beanie. It's kind of like a slightly more, styled hat I guess. And it's, and it's really warm and cozy. So I, that's my like where around Go to and then we make our chill.
Shayla Swanson: 36:19 Tuke is another one that you can wear casually in and look pretty cute, but it also works really well if you're skiing on earth, doing something on a cold day. And that's the one that has our little swirl closure at the top where you can kind of create some space and vent a little bit if you get too hot or you can throw a topknot out there if you, if you're so inclined. I never have hair long enough to do that. And that wasn't an intended benefit. The ponytail through the hole. People have figured out how to do that. Ooh, it's really cute picture of that on our website. And right now actually of someone doing that who had long, beautiful hair and just put the hat down over top of it and it's like, anyway.
Shayla Swanson: 36:55 We have products that have more of like a standard ponytail hole right at the back of your head. But this one is kind of more at the top, which makes it a little weird, but it's still pretty cute if you have the right length of hair. I have recently kind of refallen in love with is our Bandura and it's basically like a kind of a pocket band. But what's nice about it versus some of the other brands that make more of like an active pocket band is this one. It doesn't, it looks more like an intentional addition to your outfit. So it's something you can work casual or active and basically it just looks like a little tank top sticking out from underneath whatever your layer over top is.
Shayla Swanson: 37:39 So it's kind of hard to explain I guess on audio but it's like a fabric piece that goes around your waist. Elastic. Yeah, it's like a, it's kind of like a tapered fabric piece that goes around with the band around your waist. And it separated into six pockets and all the pockets are kind of semi secure, so they have a little flap over top and then they have an elastic drawstring waistband, so it's got some nice integrity. If you do pack it with stuff, it's not going to fall off. And like uses that. I, you know, I've been using it recently to cross country ski and I've thrown my water bottle in the back. And then I put my keys and my snack and my kick wax and my cork and I'm all, I've got everything I need.
Shayla Swanson: 38:23 And what I also like is it's not tied around my waist. So that's really comfortable for me too. And then but other things I've heard people say like I've been at events where someone will come by and say, Oh, I wore this and while I was backpacking in Europe, I need another one. It was amazing. Like, so she said that she wore it everyday in Europe as kind of a money belt, but what was great is it just looked like a little black layer sticking out from under her shirt. So she's just, it was funny, she came, I didn't expect such a rave review from somebody, but she came back and was thrilled. And then it can also turn like any, it's great for cycling because if you want, if you want extra pockets but you don't want to wear a jersey that has pockets. You can throw that around your waist and then you can turn any shirt into a jersey.
Shannon Sepulveda: 39:11 How about the sports bars or you're going to start making sports bras?
Shayla Swanson: I don't know. People ask me to, the two questions I get a lot. Are you going to make sports bras and then also are you going to make like cycling shorts with shammies? Oh, the thing I feel about both of those products is there's a lot of r and d that goes into making the perfect shammies and making the perfect sports bra and, and I'm just not sure we're, we're up for that. I don't want to throw something out to market and then being like, oh that actually is really not as good as the other ones you can find out there. So you know, maybe maybe it would be like, uh, yeah, probably not is realistically the answer.
Shayla Swanson: 39:49 But I think what would be interesting is maybe we can find a way to supply people with like cute little shammy containing underwear that, you know, I can buy from someone else and then they can make sure that they can wear it under our shorts and then it would be kind of work for that as well.
Shayla Swanson: So to answer, I guess I should probably clarify like that's the kind of sports bra that maybe we could make, but if, but when it comes to making something that's really supportive and actually does a great job for women who have larger breasts, I don't think that would be hard.
Shayla Swanson: 40:33 Yeah, there are some really great brands. Like there's actually a Montana based company called Anelle and it was founded by a woman in a small town in Eureka, Montana who I think she, well their company's based in Eureka. I think that's where she's from, but they make this amazing Bra for women with large breasts and like sports bra. They do a really great job and they're there. I see them at some of the trade shows I attend and am friends with some of the people that work for that brand, but so yeah, I think we'll leave it, leave it to the experts.
Shannon Sepulveda: 41:06 Awesome. Anything else you want to add or talk about as far as Sauce and your company, Bozeman? Did you start it in Canada and then came to Boseman?
Shayla Swanson: Yeah. I moved here in 2003 to go to school. So I think we had made hats for one year before I moved here and then I moved here and I kind of became the US distribution center. Rhonda was still in Canada. But no, I guess, I mean it's become this really great and exciting thing. I didn't ever really anticipate for my hobby to grow into a business that would actually pay me a wage and it does. So it's pretty awesome. And I really like what I do, although I do wish every now and then, there wasn't a day when I learned, like, I kind of would like to like not learn an important lesson every day, be nice to have one or two days where I didn't think to myself, oh, that's something I need to remember.
Shayla Swanson: 42:01 You know, I'm sure that's the case for most of us that you, I mean, you never want to stop learning, but sometimes you just wish it was a little bit easy for most entrepreneurs. I have been pretty good. I think one thing that has really helped me is that I truly have this, I learned how to lose early on, I guess with my ski racing. Like it's, you know, it sounds like a weird thing to say, but it's true. You know, you win some, you lose some. And I think it's important to learn how to lose and understand that it's not the end of the world and understand that really every time you try something, as long as you learn something from it, it's a success, you know?
Shayla Swanson: 42:43 Yeah. So that's kind of how I try to move forward. I've only made one or two, like really expensive mistakes, so these ones are harder to deal with. But you know, we're all doing our best, so you gotta just have to do what you can and, and move forward.
Shannon Sepulveda: Do you have any advice for any other female entrepreneurs?
Shayla Swanson: Oh, I think one thing I'm not doing a great job at, so this is I guess me telling someone to do different. I love every part of my business and the problem I'm having right now is that I'm trying to do too much of it. And I've heard that that's a kind of a common thing, probably also a barrier to really making it big in some of these things as I have a little trouble letting go of certain aspects of my business.
Shayla Swanson: 43:30 But truly it's not necessarily because I am like super type A and can't let someone else do it. It's more just cause I really liked doing it. So anyway, I have to, I have to figure that out for myself. So I guess my advice to someone would be if you can, you know, delegate and do a good job of getting someone else to take care of some of this stuff off your plate is probably a good idea.
Shannon Sepulveda: What I find is, I mean, after I started my own practice, it was great and I love it, love it, love it. But you can't turn off. No, there's no, especially with kids too, it's like I would love to be able to turn off, be present, and I'm trying really hard to do that. But it's hard. There's always something to be done.
Shayla Swanson: And that's one thing, you know, having kids, like before I had kids, it was, I worked long days, I liked what I did and then I went home and that we didn't even have internet at our house at that time.
Shayla Swanson: 44:21 We did that on purpose. My husband and I just decided like, we want to work when we're working and we want to not work when we're at home. And so we had this great little like work home separation was really helpful. And now I can't have that because there and we don't really, we, my husband and I swapped to take care of our kids. So basically I'm either working or I'm taking care of the kids and there's never enough time to do either one. And then you have to sleep because if you don't sleep, you get cranky. So yeah, I don't have a great solution for that. I think you just have to do what you can to try to turn off when you're with your kids and keep a list. I think a list is really critical because then you can turn off your brain as long as the stake has been planted somewhere where you know you won't forget what to take care of.
Shayla Swanson: 45:05 I read that in a great book. It was called, I think it was called getting things done and that was his main, main, main advice was you only have, like if it's, you have one place where you keep track of that kind of stuff and only one, like you don't have a phone and then a calendar and a little mole skin notebook. And then you have one place where you keep track of things and you always write down what you're doing and what you need to do. And then that way when it's time to not think about it, you don't have to think about it cause you know where it is. And you know that you won't forget because it's in that one place.
Shannon Sepulveda: 45:40 That's such a good idea. It's really helpful because like last Friday it was late. I was trying to get all my paperwork done and I knew I had all day. Monday is my admin day, but I still felt like I needed to get it done on Friday. But if I had just re wrote it down, these are the things we're going to do on Monday, then I come back on Monday and I finished that. Right. All there.
Shayla Swanson: Thank you. Getting things done. Book. I don't remember who, that was helpful. It was a good book.
Shannon Sepulveda: Why don't you tell us where we can find you? Social Media, etc. And how we can get in contact with you.
Shayla Swanson: 46:32 Sure. So I'm online, we are at www.sauceactive.com. I'm on social media. You can find us at Sauce active on Facebook. That's Facebook and Instagram primarily when we actually post. And if you want to get in touch with us by email info@sauceactive.com is probably the best email address.
Shannon Sepulveda: So if someone who is listening has a great store that says, Hey, they should carry sauce, we should email you.
Shayla Swanson: That would be great. That would be great. If you have anything to anything to say, we'd love to hear from you.
Shannon Sepulveda: Do you have a newsletter?
Shayla Swanson: Oh Great. Yes, we do have an email newsletter that we send out. It's not super regularly regular, so don't, don't be afraid that of a bombarded inbox. But there is a newsletter sign up at the bottom in the center of our website, so we do send that out.
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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Sarah Haag on the show to discuss pelvic health for the non-pelvic health PT. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
In this episode, we discuss:
-Intake questionnaires to screen the pelvic floor for patients with low back pain
-Pelvic health red flags
-How to address pelvic floor health with a conservative population
-Assessing the pelvic floor muscles without doing an internal exam
-And so much more!
Resources:
Oswestry Low Back Pain Disability Questionnaire: http://www.rehab.msu.edu/_files/_docs/oswestry_low_back_disability.pdf
Sarah Haag Twitter
Entropy Physio Website
Home Health Section Urinary Incontinence Toolkit
For more information on Sarah:
Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Teacher.
Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
Read the full transcript below:
Karen Litzy: 00:01 Sarah, I was going to say doctor Sarah, hey, it just feels weird because we've known each other forever. But Sarah, thank you so much for coming on the podcast to talk about pelvic health for the non-pelvic health PT. So there are a lot of physical therapists who I think are interested in pelvic health, but maybe they don't want to like dive in literally and figuratively. So what we're going to do today is talk about how we as physical therapists can treat people with pelvic conditions, with pelvic issues without necessarily doing internal work. What are the functions of the pelvis, really important for bowel and bladder health, right?
Sarah Haag: 00:49 I mean, it is very important for survival, sex, very important for quality of life and propagation of the species. So these are all things that matter. But also when people come in with low back pain, when people come in with hip pain, I always find it very interesting that people say, but I don't do the pelvis. You know, the pelvic floor is only a musculoskeletal structure. We're not trained in most programs to palpate or to touch. It's just skeletal muscle. That's all we're assessing for really as pelvic floor PT’s. So I just think it's interesting. It's like a blurry void when you're looking at a body diagram. Oh, there's your knee. So it's really important I think to understand what's there and you don't have to go there, but you have to know what's there and know that some people need help there and help them find the help.
Karen Litzy: 01:34 So if someone, let's take this person that has low back pain because that's a diagnosis that we can all agree that we see on a regular basis. So what are a couple of questions you can ask during your initial evaluation?
Sarah Haag: So the subjective part of the initial evaluation that perhaps a lot of people are missing or that can take in that pelvic area. There's a couple of ways that you can kind of like cheat your way in where you don't even have to think about what to ask to begin with. If you have a red flag questionnaire, there is a bowel and bladder question on there. So, it’s really interesting because people will sometimes circle yes on those and then never discuss it. Like, wait a second, we asked the question, they said yes, it's a thing.
Sarah Haag: 02:22 So there's your in, it was like, I noticed you, you marked yes on the bowel and bladder changes. Can you tell me a little bit more about that? Most of the time it is not truly a red flag. Most of the time it is not a sign they need to be referred to a physician. Most of the time it's like no one's ever asked me that. Yeah. Stuff is different. There's your in. And then also if you use the classic Oswestry. So it was modified I think in 2001 or 2002 to take off a sex questionnaire. The second question of the questionnaire and it was revalidated and all of those things, but if you use the original, it's pretty awesome because now they're like, Huh, nobody's asked me about sex. And then you'd be like, ah, I see that this is an issue.
Sarah Haag: 03:06 One of my favorite Twitter stories is I get a direct message from someone asking me about a patient who was having pain with intercourse and I was like, thanks for reaching out. Absolutely. Can you tell me more about when they're having trouble and where it hurts? Would you like to know where it hurt their knees in one particular position? And I said, fantastic. You can help with that. So, so it's not always, it might be a sex problem, but it's not necessarily that problem. So we have to not be shy about asking those. Low back pain is the most expensive health care problem we have in terms of multibillion dollar, probably millions and millions worldwide. And so of course addressing back pain, we're still working on the best way to do that.
Sarah Haag: 03:52 But there’s a high prevalence of urinary incontinence and people who have low back pain. So if you're seeing people who have low back pain and after, if anyone else went to the pregnancy talk this morning, after vaginal deliveries, the prevalence of incontinence goes ways up, goes way up. So if you're seeing someone with back pain, if someone has had babies, all you can eat what you can do. So we were like, well I see this in your history cause that's pertinent history for back pain. Correct. And then it's like, Hey, I noticed this, any issues with this? And here's the reason I'm asking because you can't just go, do you pee your pants? Because people like, do I smell like what happened? Like, so if you're just like, you know, there is a really high prevalence and the nerves in your back go to your pelvis and all of these things.
Sarah Haag: 04:32 So I'd be really curious to know are you having any issues in this area? Cause there's help if you are. And then kind of go from there.
Karen Litzy: And I want to backtrack for just a second. When you were talking about red flags and said some are truly red flags and some aren't. So just so that we're all on the same page, what would be those truly red flags?
Sarah Haag: Truly in the pelvic world or in the entire rest of your body world is any unintentional weight loss or weight gain, 10 or 15 pounds over a short period of time. Also like fever, like temperature issues, loss of appetite when you have those other constitutional symptoms that go along with it. So just having some quirkiness with your bowel and bladder, it's really no reason to panic. But if you have also a fever and also a recent traumatic event, no, no, we want to just make sure everything's okay.
Sarah Haag: 05:26 And the cool thing is that if you go to the doctor, it's like you don't have a UTI. Everything else is looking fine. Awesome. Then I can help with that. But the red flags, there's been a couple of great papers that have come out where it's like, it's not like if you have pain at night, freak out. No, no. If you have pain at night but also a sudden bowel and bladder change and also, okay, now we need to check in for it. But don't panic if it’s the only one.
Karen Litzy: And now let's say you're using these questionnaires and someone puts on bowel, bladder or someone circles sex as something that they're having difficulty with. And I love this question because this was something that was brought up last year at CSM. So there was a physical therapist there who said, well, I live in the south and these are not easy questions to ask because people are more conservative or they don't want to talk openly about their bowel and bladder issues or about sex with their partners.
Karen Litzy: 06:28 And so what do you say to those people? Those therapists that, are dealing with a population that's maybe much more conservative and they're not sure how to approach those subject matters.
Sarah Haag: I always say just always with kindness and with a good intention and with a good explanation. So you can't not do it because it's awkward for you. You should be asking for a medical reason, right? So quality of life is in our wheelhouse, right? Like we're doing all sorts of quality of life questionnaires. Pee in your pants is a huge detriment for your quality of life in many cases, not being able to have sex can impact your relationship with your partner, your feelings of ability to even have a partner, having babies. All of these things that end up being huge stresses, which is gonna make a lot of other things not as good either.
Sarah Haag: 07:28 Just start simple if you're asking questions. So if someone comes in with like straight forward knee pain, I'm like, how sex, no, that's not how, that's not where we go with that. But if someone's coming in with low back or pelvic issues, the way I usually approach it is to bring it up anatomically. So this is the anatomy. This is what we're doing. These are where the muscles go. Most people don't think about them. And when they're, if they're having issues like incontinence or have had babies, those pelvic floor muscles are muscles. Like everything else. We're going to work in PT. So I'm going to ask you some questions and I try to do it in a spot where you have some privacy. I know some PT places you're like in the middle of a gym.
Sarah Haag: 08:06 If you can find a quiet corner, do everything you can to put them at ease. But just to be like this is why I'm asking. And if you can see that resistance be like all right, like it's not necessarily the number one priority for this treatment anyway, but if those things happen to be issues there is help, it can get better and you just let me know if you have any questions. Cause not everybody wants to talk about it and it's not my job to convince you to deal with it. It's my job to help you if you want help.
Karen Litzy: And if you're a physical therapist that isn't specializing in pelvic health, it's a little bit different. Cause if you're specializing in pelvic health and people are going to you because you specialize in pelvic health it’s way easier, you know, these questions are going to come up. But for those of us who don't specialize in pelvic health, then those questions can be a little bit more sensitive. So I just want you to make that distinction there for people.
Sarah Haag: 08:48 Yeah. And also if you're going to ask if you're going to take that step and be like, all right, I'm going to ask about the incontinence. I mean cause sometimes you're in situations where it is an obvious issue. Other times it's like, well, based on their history they're actually at risk for it. Then you can talk prevention, which has always been kind of fun. But just if they give you some information, especially if you got up the guts to ask them, then please, please do something with it. Don't just be like, oh yeah, so great incontinence noted in the chart. I'll put it on the diagnosis list, like how the plan and there are some things you can do without doing a pelvic floor exam that can make amazing changes.
Karen Litzy: 09:49 How can you evaluate pelvic floor muscles without having to go internally? I think that's a question everybody wants to know.
Sarah Haag: Great question. I'll be honest, some people don't want you to touch him there like full stop. And so I will actually give people, I would say it's kind of like a choose your own adventure. So we can actually, we can all check our own pelvic floor muscles right here. And I would basically talk you through it. You would tell me what you felt. I keep an eye on everything else to see what else you were doing. But it would be very honest that my assessment is going to be, I believe you, it seems you're doing it correctly. Right? But I have to believe you, but you can actually palpate externally. As a clinician you can actually do it and you can do it in sidelying.
Sarah Haag: 10:33 You can do it in hooklying and some people will do it in prone. I'm not a super big fan cause I can't see their faces. And also it can be kind of a vulnerable position. Basically if you just palpate, if you find the ischial tuberosity, you know about where the anal sphincters are. Okay. There's normal human variation. So I always say move slow and make sure you're asking for feedback. But you know, mid line is where the sphincters are going to be. We're not going midline. So you just kind of find that ischial tuberosity and palpate your way around to the medial part of it. And that's where the pelvic floor attaches. So then you can kind of talk them through, like I'd like you to squeeze and there's a bunch of different cues.
Sarah Haag: 11:22 One of the most common cues, especially for the back end, is to like squeeze. Like you don't want to pass gas and that's awesome. But if you're a main problem with urinary incontinence, that's the back side, back side, not the front side. So how do we get it up there? So another cue that has been found to be very helpful, it's only been studied in men, but it is, shorten your penis. But what's interesting is ladies, I know we don't have them, right? Imagine that feeling, right? So like just imagine like pulling in, right? It totally changed where hopefully if this is a class, it would have asked where did you feel it? But like it, it changes it from the back and biases it towards the front of it. So find a cue that gets them to go, oh my God, I felt something.
Sarah Haag: 12:07 You're like, awesome. So if you're doing a Kegel and like this happens, you're probably not doing it right. If that's happening, you're probably not doing right. But if like I'm Kegeling now and then I let go, you shouldn't have seen me get taller or tensor or breathe funny. It should be very sneaky. So as you're palpating on the medial side of the ischial tuberosities your feeling for those muscles to contract. So it's kind of like a gentle bulge and you can totally feel this on yourself here if you're comfy or somewhere else. But when you feel it, it's almost like when you're feeling like if you have your biceps slightly bent and you kind of like contract and you feel at tensioning and like a little bit of a bulge, that's what you're feeling for.
Sarah Haag: 12:51 Okay but it can always be tricky cause I use the word bulge. Some people will have people push down. So we should also be able to like relax your pelvic floor and push down, like having a bowel movement. That shouldn't happen when you're trying to contract. So like when I say bulge, you should feel like a gathering of the muscle. That's what you're feeling. If you feel your fingers get pushed down in a way they're doing the opposite of a contraction. So there they're relaxing. It would kind of depend on what they were doing and the cues you were giving. So it could just be like, I'm pushing down like doing a Valsalva. But it is basically a lengthening into the pelvic floor. I don't know if it's always a relaxation, so to speak.
Karen Litzy: 13:33 It's kind of lengthening. And what is the difference between that Valsalva or lengthening and that small bulge? Like why is that significant?
Sarah Haag: When you feel it, you'll know it's significant because if they're pushing down in a way that's not a contraction. So if you're going for strengthening or more closure to hold things in, yeah, you want that kind of like tensioning and bulge. But if you're actually the problems, constipation, I can't get things out, you want them to be able to relax and link them.
Karen Litzy: Got It. Okay. All right. So now we know how we can kind of feel our pelvic floor muscles without having to do an internal exam. So once you figure out, and kind of what you said sort of leads right into the next question is if you have someone that's coming in with incontinence and you are looking for that sort of tightening or gathering up of the muscle, which I think that's a nice cue for people to understand because bulge can sometimes be a little confusing for people, but I liked the cue you're feeling the gathering of that musculature.
Karen Litzy: 14:45 Is that something that you are then going to add into a home exercise program or like once you find that the pelvic floor muscles working or it's not working, what next? What do you do?
Sarah Haag: Well, so I'll be honest. It's always I like him and people are brave enough and the patients were brave enough to be like, sure you can have a feel like let's figure this muscle thing out. I usually try it in a normal active kid in a normal setting. So not a public one. No pelvic settings are normal too. But in like just a normal like say outpatient therapy, be it or orthopedics or neuro, I would actually have them ask more questions about incontinence before even checking the pelvic floor muscles. Because the different types of incontinence are going to kind of tell you a little bit more about what you should do.
Sarah Haag: 15:35 So some people have incontinence when they tried to go from sit to stand or when they cough or when they go running. So I want to know a little bit more about when is it happening because if it's only ever when you're putting your key in the front door or when you're running into the bathroom, that's more urgent continence. Would pelvic floor muscle exercises help? Maybe, but also probably looking at their overall bladder health, which is where a voiding log would come in very handy. And actually a shout out to the home health section and they have an incontinence urinary incontinence toolkit. It's free for members for sure, but I think it might be free for everyone.
Sarah Haag: 16:15 So it's a pdf that actually talks you through the different types of incontinence because the most common form of incontinence urge incontinence, which is you're an urge incontinence is proceeded by a strong urge to go. So this is one of those things where, so there's a bathroom at the end of the hall. So if you're like, I'm totally fine, but then your eyes wander, you're like, oh, I could go and I didn't have to go. And then I would get up to go and I got to the bathroom and all of a sudden it's like, oh, where did that come from? Like all of a sudden it felt like your kidneys did a big dump, but they don't, that's not how kidneys work.
Sarah Haag: 16:59 It's just how it feels to you. So what that really is, is your detrusor muscle kind of going, I'm so excited. I imagine a puppy, like have you ever like gone to let a puppy out the door? Like, so they're like, hey, I want to go out and you get up and you make a move for that door. And they're like so excited. Your bladder is like that sometimes. So that's more of a behavioral thing because what would you do with the puppy who's now like, wait, every time I do this, she lets me out. Pretty soon you're letting that puppy out every 10 minutes because yeah, because that's what the puppy trains you to do. So that's kind of more of a behavioral thing. And so that's proceeded by a strong urge. So it's not just when you're going to the bathroom, but if you get a strong, unexpected urge and leak, and that's usually a lot of people also experience some urgency and frequency.
Karen Litzy: So if you feel like you're not getting to the bathroom in time, what would be a really logical plan to that?
Sarah Haag: 17:52 You'd go more often, you're like, Ooh, maybe I need to not wait so long. But the thing is that then you're training yourself to go more often, your bladder is perfectly capable of holding more that kind of sensitivity and those signals you're interpreting or like, ah, no, I should go now. And then pretty soon you're that person who can't make it through a movie. You're that person who can't make it past a bathroom without needing to go. And you're the person that no one wants to go on a road trip with because you're stopping every like hour on the hour and every rest stop. But now is that because your brain is interpreting this as such? I know that there's a physical manifestation obviously, but is that like have you trained your brain and to feel that way to interpret that as such? I would say yes because most of the time, even if it wasn't intentional, like it's kind of like a slippery slope. It's like I almost didn't make it that one time. I'm going to plan ahead. And then what starts to happen, especially if you're like, all right,
Sarah Haag: 18:54 your bladder is filling up. You kind of feel like you need to go and you go to the bathroom and it came out and it's like, all right, so that was nice and normal. But then imagine that time where you're like, hold on, I almost didn't make it, but you were stretched this much. You're going to start going when the bladder stretches this much. And then pretty soon if you let it so you're like, Ooh, now I'm going down here. Now I need to go sooner. And this is one way you can tell this is happening. And it can happen sometimes without ending up with a diagnosis of urgency, frequency or incontinence. But where you get to the bathroom and you feel like you've got a goal, but then nothing happened. Goals, like it's the smallest tinkle and you're like, I thought it wasn't gonna make it, but that's ah, that's all that's in there. And so that was like big urge little output. That's kind of a mismatch. And that'll happen sometimes.
Sarah Haag: 19:48 But like if you're paying less than that, that's not much more than your poster board then a nice healthy post void residual. So you don't have to empty at that point if you're bladder’s saying, empty me now. And that's all that's in there. Yeah. So it's kind of like you're the sensitivity of your bladder has turned way up. Just like how we would compare that to the pain. So the sensitivity is turned way up so that it takes less of a stimulus in the bladder itself to trigger that feeling of you have to go, even though the bladder is barely full.
Sarah Haag: And there's actually some interesting conversations with urgency and frequency in that feeling of extreme urge, can that be considered a pain? And so it's kind of interesting conversation because there is normal, there is a normal sensitivity of normal urge, but when that urge becomes pathological, yeah.
Sarah Haag: 20:47 Too bothersome. Does that crossover into it? Distressing emotional experience? I would think so. Like can you imagine if you're like on a train or something like that and you have to really, really, you have, you're having that urge. I mean, that's very distressing dressing. That's very distressing. That's like you're suffering. So if you have someone like that what do we have them do? So they keep a diary, which you can get on the home health section and we'll have a link to that in the show notes. You basically ask them to keep track of things for a couple of days. I tend to keep it simple with what are you drinking and when and when, when are you going to the bathroom? If people are willing to measure, that's the best, but not many people are willing to measure.
Sarah Haag: 21:37 So what I try to have them do is to kind of come up with their own plan. And I tell them this is not an exact science because you're not measuring, but that's okay because if you have a strong urge, which is kind of a lot, but you have like a little tinkle, that's kind of a mismatch. If that only happens after your third Mimosa, okay, that might actually be like a normal bladder thing. Do you know what I mean? So we kind of look at things that they're bringing in that may or may not be irritating to them. We look at are they getting enough fluid and bladder loves, loves water. But the first thing most people cut out if they're having urgency, frequency or incontinence is water is they cut out their water. It'll almost always backfires.
Sarah Haag: 22:19 So don't do that anyone watching. It also makes you constipated, which you can increase your urgency and frequency. So, so yeah, so surprise. Everything needs to work well to work well. Okay. But yeah, so you kind of look at that and I just look for patterns and then I have people try to change one thing at a time. If all you're drinking his coffee all day, but actually you have good data, good parts of your day and bad parts of the day. Is it the coffee? Because if you're drinking coffee all day, you're probably not going to be very nice to me if I say, how about you stopped drinking coffee? Um, emotional response up. So you just kind of look at it. It's like, Oh, when does this happen? What do we need to change? And it can really help you narrow down. Is it really urge incontinence? Is it actually just frequency and they're not leaking like they thought they were or you know, is this primarily a stress incontinence issue?
Karen Litzy: Well, so it sounds to me like there's not a lot of hands on work there.
Sarah Haag: No, no, it's more behavioral.
Susan: 23:27 Do you ever use pelvic tilting to get the posterior versus anterior pelvic floor?
Sarah Haag: So that's a neat work with from Paul Hodges Group. So however you're sitting, most of us are Slouchy, just do a pelvic floor contraction, however your brain tells you to do that, do it and just feel where you feel it. But then if you get yourself in a situation where you like get more of that Lumbar Lordosis, and so like you stick your tail out, you get more lumber lordosis and then you do the exact same thing. So you're not changing your cue. For most people it's cuts to the front. And it's kind of neat because one of the things, one of my pet peeves is when we were talking about earlier is my pelvic floor therapist get tunnel vision and are just doing pelvic floor exercises, but not reintegrating it into how they're, they're using their body.
Sarah Haag: 24:18 So if you have a runner who's a chronic but Tucker and she's leaking out of the front, obviously, how would it feel if you like got those glutes back a little bit? Because you can't run and Kegel at the same time. You can't, you can try. It's not going to go well. And certainly not for like a 5K and let alone not a marathon. So changing how that is biased because most of us don't think about the pelvic floor until you have a problem, right? But they've been working, right? They've been doing their thing. You're using them when you walk up those stairs you're using them when you're getting up off the floor. So they do something, the key goal is like your bicep curl. You want a stronger bicep, you're going to do some curls, you want a stronger pelvic floor, you're going to have to do some pelvic floor exercises.
Sarah Haag: 25:07 But that's not your management plan. You kind of want to, someone said it yesterday, kind of like the core muscles are there like automatic, like when you get ready to do something you don't think, okay transversus were good. Like it just all happens and you want to kind of get the pelvic floor back into that system and make sure it's strong enough and coordinated enough to do its part. So you don't think about it.
Dave: 25:37 So along those lines then, would you say that if somebody is more lordotic, they're more likely to engage the anterior floor and then flat back more of the posterior floor?
Sarah Haag: 25:47 That tends to be what they're finding on like EMG studies and what I will see clinically with people if they do a ginormous buttock. It’s really interesting if you're like, how's your breathing when you do that and, and how good is your squat, let's say when you do that. And it's like, Eh, it is what it is. I'm like, okay, so what if we do kind of take it into where some people, especially if they've been told by other practitioners to like watch your Lordosis, it's kind of huge. Which isn't really a thing. But you know, they kind of, they're kind of like going in there, they're like, I'm so scared but it kind of feels good and then you have them do that movement or try that exercise. Usually they're like, that was way easier than I thought it was going to be.
Sarah Haag: 26:30 But again, if it's not working, then we try something else cause everyone's anatomy is different. Sometimes if they have a lumbar issue, getting into the ideal position for their pelvic floor, may or may not be easy for them, at least at first. But I think you need to play around with how it feels and how it's functioning as opposed to, I mean, I've been guilty of it in my career of like, ah, you need more or less of what you're doing with your spine and were just different. So it's where it works best is where it should be.
Jamie: 27:03 So for a lot of the outpatient conditions and orthopedic setting, there's still an emphasis on giving some kind of qualitative documentation to the muscle contraction, whether it's a manual muscle test or something like that for payment purposes. So what are some strategies or tips for clinicians to be able to take that palpation externally and then relate that into their strengthening documentation?
Sarah Haag: 27:29 So if you're just checking externally, like just palpating outside, it's like a plus minus like, Yup, I felt it. Uh, they couldn't find it. So kind of plus minus, cause you can't give it more than that. We also have to remember, so when I write about pelvic floor strength in my documentation, I have a number I can put and you can grade it. You have to do that internally, which is why if you're like, ah, we need to know more, refer him to a friend or go to the training. But I usually give a lot more information. So like, all right, so they, you know, they had like a three out of four, three out of five squeeze. The relaxation was not very coordinated and kind of slow, but then their subsequent contractions were five out of five.
Sarah Haag: 28:09 All right. Do you know what I mean? We have to, because of payment and insurance and all of those things, we have to write something down. So what I do is I write down what I find and I'm happy to talk about it. So if you want to deny it, I can talk vagina all day with you. And I have, and their questions usually get shorter and shorter. Um, because really they're asking for information that isn't necessarily the most helpful. So if you're checking an externally plus minus, but also I've had people who five out of five but still incontinent,
Sarah Haag: 28:41 So then they're like, well they're not weak but you put down, you're going to do strengthening. I'm like, well yeah, because it's more of a strengthening, not just a strengthening with a functional goal attached to that, if that makes sense. So sometimes it's more words, but don't be shy about one. Well, first of all, please be honest, be as accurate as you can be, but also don't be shy about doing the best care and be willing to stand up for it. If it gets denied. It's not cause you gave crappy care likely. I mean, do you know what I mean? I'm like, I dunno how long you practice, hopefully. Good. But if you get denied, it's not necessarily key because you gave bad care or even did a bad note. It's because they decided they weren't going to pay based on something. Hopefully logical that you can talk about. You can always appeal. So don't let payments scare you away from giving the best care.
Sarah Haag: 29:36 Sorry. Another soapbox of mine. So that was urge incontinence. Stress Incontinence.
Karen Litzy: So let's talk about that because I think that gets the more airtime, so to speak. So that's when you see the crossfitters are the weightlifters or there's a great gymnast pitcher yesterday going backwards where you there backwards over the pommel horse, not the pommel horse. It's the worse just a horse. A spurt. Like it was, yeah. And you're just like, that could be photo shopped, but also it probably isn't. Yeah. Or like we've all seen like the crossfit videos where women are peeing and then everyone high fives them because they worked so hard that they peed, which, you know, not normal. We know that that's been addressed by a lot of a pelvic health physical therapists.
Karen Litzy: 30:32 So I would like to know first I think we just gave the definition of stress incontinence, but I'll have you give the definition quickly. But then I'd like to go back to something that the question that Dave had asked about the positioning and how that works within weightlifting or within, you know, waited or loaded movements. But go ahead and give the definition of stress incontinence first.
Sarah Haag: So stress incontinence is basically when there's an increase in intrabdominal pressure that is greater than the closure of pressure of the urethra. And you have some sphincters as well as the pelvic floor helping keep all of that closed. But if you increase the pressure enough on the insides, and that's why you hear, and again, it's primarily women, but also a lot of men after prostate surgery, they cough and you get a spurt or you know, you jump and you feel it come out.
Sarah Haag: 31:21 Those are usually because the closer pressure has gone down or the intra abdominal pressure has gone up.
Karen Litzy: Okay, great. So now what does that look like? For the average physical therapist who's not a pelvic health therapist. And let's say they are seeing someone for hip pain and you ask them, are you ever incontinent? Or if they are, you know, heavy lifters are, they are adding load and they say, oh yeah, but that's normal. Or they have low back pain and they say, yeah, but that's normal. Everybody does it at my crossfit box or whatever at my gym. So how do you then, if you're not you, you are someone who's not a pelvic health therapist, how do you address that?
Sarah Haag: Well, first of all, what all of us should know while incontinence is super common, it is not normal.
Sarah Haag: 32:16 Not ever being dry is normal. So we need to get away from this idea that like, well, everyone's doing it. It's like does that make you want to do it? Like I feel like, no, I feel like no is the answer. So first of all, just, and sometimes they don't know that. Like, I know that in some like young girl gymnastic teams, like the color of their leotards are chosen to like, not show the pee because they're incontinent that young. Yeah. And I see a lot of women as adults sometimes before they've had babies sometimes after, right? So like what's the, what came first? But they've had lifelong issues with what's essentially public flourish. She's with incontinence, sometimes pain with intercourse, all of those things. Competitive gymnasts, competitive cheerleaders. Dancers tend to be probably the biggest, runners or another group.
Sarah Haag: 33:12 There's been some studies, there's one study and I cannot recall it. I mean, it's probably like 15 years old now. We're 100% of this division one female track team reported urinary symptoms. 100%. Like every girl. So common. Heck yeah. Normal. So many girls. Yeah. So the biggest thing if you're not a pelvic floor therapist is to check out their function. So if they can identify when they're having issues, it's when I get to this particular weight or it's when I get to mile 17. Okay. And I usually throw in, like if I ran 17 miles, I'm not really sure what my body would do. Like I dunno, but it still shouldn't leak. But if you can find out where that breakdown in the coordination in the endurance and the strength and whatever it is happens and look at what's happening there.
Sarah Haag: 34:04 Because if you can run 17 miles or you can lift 200 pounds without leaking, but then you do, you're not, you're not weak. Right? Like if you can do all of that, something's happening there to make this happen. Cause if you can lift 200 pounds in that league, something's working, it's just not still working when you try to live 210. Okay. So let, let's look at what's changing or number of repetitions. Right? That’s what you're looking at.
Sarah Haag: 34:52 So if you collapse your chest and which I would probably do after running 17 miles and I'm like this. And now what happens when I collapse what happens to my bottom half when I collapsed my shoulders? Well my butt just tucked. Cause I'm just trying to get through now. The funny thing is the breathing is also harder. So while I'm doing this as kind of a mechanism to keep going, it's harder to breathe because nothing's working diaphragm to have a full excursion, right? Yeah. So, so I like to look at if you're running fine for 17 miles, I want to see you at mile 16. I want to see what's changing over that mile. I want to see what you looked through my team. And can you, when you start to get to that point, can you make an effort to change something?
Sarah Haag: 35:32 Do you notice a change in your breathing when you're lifting 210 instead of 200 and kind of look at it from that way cause you're not going to kegel why you do that. What do you mean? Oh well say to like precontract and prime and all these things and, and that's fine, but it's like if we go back to the running, you're not kegeling and all that time your pelvic floor after like 30 seconds is like, dude, you don't want me to get that tired. Like it's going to be like, we're going to stop that now. So yeah. So the way I would approach that, if you're not me, yes and not going to do a vaginal exam, is you look at their performance. So if they said, I have knee pain when I do this, when I go from 200 to 210, they're my squat.
Sarah Haag: 36:13 How they do, they're looking at the mechanics. You would look at what's happening, what is different? Cause you know, the joint can do it, you know, the muscles can do it. What's changing. And you would address that. So it’s really no different if they can tell when they're leaking, you're just looking what can, what are the things that can change it? Usually the tail lift and looking at their breathing or two really easy ways to go about it.
Karen Litzy: Okay. All right. That's great. And, and, and that goes with that. Does that also work with, let's say instead of you're not a runner weightlifter, but you’re like a new mom or something like that and you're okay, but then by the end of the day after you've been maybe lifting the baby or you know, doing whatever you're doing it, it doesn't necessarily have to be sport related is what I'm saying.
Sarah Haag: 37:06 I think about like function, but definitely, I mean, you asked about, but no, just everyday if getting out of a chair makes you leak, that's, but then it's basically a squat. So you are, you're looking at the activity that they're having difficulty with and making small changes got in most cases.
Karen Litzy: So I think the biggest takeaway here for me is that not everything is solved by doing a kegel.
Sarah Haag: I think a lot of non pelvic health PT’s may have that, that misconception that if someone has incontinence, well Kegel time. Right? And that's all you gotta do. That's what most people do. If they go to the doctor and they mentioned it's like, ah, you know, that's pretty normal. It's not, it's common. And then they'll be like, do some kegels and, and a lot of women and men don't know how to do them.
Sarah Haag: 37:53 So then they're just, I'm squeezing stuff and it didn't work. And it's like, Oh, before we get too far, can we check and see how you're doing them? And I think that's kind of a beautiful segway. So let's say you have your new mom or you have your athlete or whatever and you are, you've tried some stuff, right? Cause none of this is life or death, right? I mean it's fine to try some things. So already not doing anything about it. So trying to change up a couple of things is perfectly within your purview, especially again, you're seeing them for hip or low back. It all, it's all together. You're good. But if it's not changing, if it's not getting better, if when you ask them, you know, can you contract your pelvic floor, what do you feel? They're like, I got no idea.
Sarah Haag: 38:33 And they're like, but please also don't touch me there. Or are you touching there and you're like, yeah, I don't feel anything either. And I've used all my cards but I don't know what to do. That's when you refer. Because just like any other things, somebody coming to see you as a physical therapist, you're going to do some things. And if those things are not working or they're getting worse, you're going to try something different. Or call the doctor or refer to a friend. Right? So if you change some things and you're like, I'm amazing, they're all better. Awesome. Do they need to go to pelvic floor therapy? I'd say no if their incontinence resolves or their pain resolves. But sometimes with especially we see it a lot more in I would say the more active athletic population is a pelvic floor that's more like this.
Sarah Haag: 39:19 So it's like tight and there's a hundred people call it hypertonic or high tone or short pelvic floor and all these things and basically in my brain, the way I categorize it is like you should be able to contract your pelvic floor and you should be able to let it go. And we can all get better at that. But if you're like, I'm here, how good is my contraction going to be? Because I'm not showing you my pelvic floor. Like it's not going to, it's going to taste like it's going to not move very much. But if you get them to relax more or they're like, oh, I didn't know that was there, that's better. Then you all of a sudden you have a good contraction.
Karen Litzy: How do they relax? Do you just say relax?
Sarah Haag: 40:01 Before somebody tells him to relax, the worst thing to do is be like, can you just relax? So I try to have them feel the difference between contracting and not contracting. Because what will happen and people use what the traps all the time is like. So like, ah, so much tension. All right. Again, telling you to relax your shoulders. Things I didn't think of that. But if you squeeze and let go like as a little bit of like, Oh, I feel that, oh, oh there's some more space there. So I start with that. Okay. The pelvic floor. But again, if they're like, I just don't know, that's something that is so easy to feel with a vaginal or rectal exam. So that's where it's like, ah, you're having some trouble. I would recommend, would you see my friend for one visit have this exam, they're checking out your muscles and just see if he can feel that relaxation and then come up with like cueing or a plan that works for them.
Sarah Haag: 40:54 Cause it's not just about like slacking everything out. It's really feeling that that relaxation, that lengthening of the muscles there and being intentional about it. You don't want to lie there would hope like maybe it'll let go at some point.
Audience member: So you talked about kegeling and what about dosage or prescription and quality versus quantity and how you prescribe that to your patient.
Sarah Haag: There is no hard and fast rule as to like how many, how much. So that's where, again, I would have them do some and see how the coordination goes. Cause if they're otherwise neurologically intact and they're kind of getting it, how many do they need to do?
Sarah Haag: 41:57 I would say it's not unreasonable to go kind of basic strength and conditioning principles of, you know, like I know eight to 12 reps three times a day. That's an okay starting point. And actually, I don't know if you know this, so I'm writing a book on incontinence and the PT people have it, but it's the editor just asked me, she's like, well, since we don't have like a hard and fast number, do we, should we put that in there? And I said, I think we do. So that's a good starting point. Not everyone would be able to do that right off the bat, but also some people be able to do that and they're not getting better. So it's kind of like let's start here and see what happens. And then you can kind of titrate it up and down. If I do an exam on somebody and they can't contract for 10 seconds, they can only contract for five, I'm not going to have them contract for 10 seconds at home. I would probably honestly in that case, have them go, I need you to make sure you can feel the good contraction. So you actually also asked about quantity and quality. I want quality, because all of us can do 100 crappy ones. I'm not sure how much it would help. So really looking to be like, okay, so I feel that contraction and I'm breathing
Sarah Haag: 43:10 and I usually actually have stopped counting seconds. I've had people go by breath, so if you, let's do it. We're going to squeeze our pelvic floors and you're just going to keep squeezing as you breathe in and breathe out normally. Nothing, nothing fancy. And then keep squeezing while you breathe in and breathe out and let go. And what I hope you felt was a squeeze to start with maintaining the squeeze. Some people will feel kind of like a little, a little wave as they breathe, which is not unusual. But then when you stop the breathing and you let go, you should feel that let go. So if you didn't feel that, let go. I usually say that's one of two things without feeling right. I can't tell without feeling is that you got tired and you lost it or you forgot to let go.
Sarah Haag: 43:51 So that's okay. Have a wiggle reset and try again. Because if you're not feeling the contraction, what are you doing? Like you might as well take a walk because then you'll actually be using your pelvic floor. I like going with the breath because a lot of people like to hold their breath when they're like, they'll do like they'll just suck at it and it, you'll feel a lift, but it's just a vacuum. It's not really your muscles doing their thing. So by doing the breathing, if you breathe in and out twice nice and slow, it's 10 seconds. You don't have to count. So if I have you do four of those, you just have to like count on fingers, two breaths come and arrest for two breaths. So much easier to keep track of. And then people actually do them. Cause if I could tell them to do ten second holds, one, two, three, four, five, six, nine, done. And that's not really helpful either. So like the too slow breaths. Now you're breathing and don't have to count and you're going to stay honest.
Audience member: 44:57 So trying to bring this into the neuro world for someone who's post stroke and has stress incontinence or they've had neural damage of some sort and have stress incontinence, Are there any PNF techniques where you can incorporate the pelvic floor to help with that?
Sarah Haag: I haven't had PNF stuff since college. And I'm old. So what I would say is, is if I'm recalling that they go through movement patterns and as you're doing those things, there are things will be happening on the pelvic floor. It seems to make sense. What specifically, I don't know, but if you're kind of working more with that tone in general, I've only had a couple of patients come see me like post CVA and feeling their pelvic floors is amazing because while it makes perfect sense that one side might be like hypertonic are nonfunctioning until you feel it.
Sarah Haag: 45:49 It's like, wow, that's so cool. Like once I totally normal springy, they can contract and relax the other side just like they're, they're hemiparetic arm. It's cool. With stuff like CVA or neurological involvement, you really want to make sure you're on board with the physicians and you know that bladder function is still intact because depending on where the stroke is and what exactly happened or where the spinal cord injury is, you don't want to mess around with screwing up the bladder or the kidneys. So if they're not going to the bathroom or they're only leaking during transfers, that could be stress incontinence or it could be overflow incontinence because their bladder is so distended with the effort. So that's something you would really want to make sure you talk with their nurse or their attending physician and make sure, so how are things working?
Sarah Haag: 46:38 Because the other thing we need to remember is a lot of things we're still working on people who have had neurological insults, right? So once you're like, okay, bladder is relaxing as it fills, contracting, as it empties, it's emptied fine. We're not worried about this being overflow incontinence. I would actually start to incorporate stuff like blow before you go. Where you're managing it the same way you would for someone not having a stroke, but half of that, the beam continent and actually going to the bathroom it seems, I can make it sound very simple, but I have a slide and of course that I teach where it has all the like the tracks up to the brain and all the tracks who, the spinal cord to the bladder. But we got the sphincters, we got the detrusor, all of this stuff just happens.
Sarah Haag: 47:25 And when I click the slide from this beautiful simple picture, it's just font about this big, explaining all of the complex things that are happening so far as we know. So again, as long as they're, bladder is functioning on that basic level where it knows when to empty and it can empty, I would treat him like a anyone else and not assume that it's just because of a high tone pelvic floor on that one side. That's the issue. But if you get that person and you do your PNF, please tell me what happens. And if it changes their incontinence, I would really like to know.
Karen Litzy: And when you're looking at the bladder function, that is something the physician is doing through an ultrasound, is that how that works? How did they do that?
Sarah Haag: They can do it through an ultrasound so that that they are, they can look mostly at like post void residual.
Sarah Haag: 48:12 But then also there's a test called neuro dynamics. And this is a test that involves, a catheter and there you're a threat. And then a probe and another orifice down there to help measure for intra abdominal pressure. And it's kind of a neat test. If someone wanted to do it on me for free, I would probably do it. But they're also looking at an EMG the whole time. So they start to fill up your bladder was sailing so you know how much is in there and you're awake for this test because they go tell us when you, when you feel the first urge to go and they mark where that is. And so you can see how much fluid is in there. And I'm like, tell us when you get like the, I should go to the bathroom now urge. And they mark that and then they're like, okay, tell us when you can't take it anymore.
Sarah Haag: 49:00 And they mark that. So then they know how much your bladder can truly hold. But also looking at what's your detrusor doing, which is the smooth muscle around your bladder, what's happening to your pelvic floor, where is the weakness? And usually when they're full, sometimes they'll have people cough to see if anything leaks or if any sphincters happen or sphincters what they're up to. But it's, it's involved. But there's a lot of good information. And interesting side note is that if you do so, that's really I think really helpful for like a neurologic population just to make sure. I did have one patient I was lucky enough to work with a PT who became a physiatrist who specialized in neurogenic bowel and bladder and she let me come down to watch urodynamics of one of my patients who was really against cathing.
Sarah Haag: 49:46 He didn't want to cath. So she came down, she brought him down to the urodynamics and as it and cause he's like, I am voiding 400 to 600 milliliters every time I have a bowel movement. And like that's pretty good. I mean like most are four to 600 CCS and turns out it was only under very high pressure. He was already getting reflects into his kidneys and after he voided four to 600 CC's, he still had four to 600 left, which is too much. So even though he was having some output, that was the test that really made it clear to him like, oh, it's coming out, but it's not healthy. Like I need to cath.
Jamie: 50:41 What are some of the considerations that you might go through in your thought process when you're dealing with a male versus a female pelvic pain or incontinence issue?
Sarah Haag: 50:53 That's a lot. I could talk for days on that. Well I'm not sure. When you're talking about considerations. We need to take into consideration our patient preference and what they're comfortable with. We can tell when our patients are uncomfortable or we should be able to but then kind of try to work out, they might not want to talk to me about this, but who can I get that they would, cause a lot of people would assume that men aren't really comfortable talking to females. But a lot of the men who come to see me, just want help, and we've had several male students come through and you know, they run into like women not wanting a male therapist to do it.
Sarah Haag: 51:36 It's just finding that, right? Just like any other body part, finding the right person to help. But then if we go to, you know, bringing up those subjects, I don't know that in my brain it's so, so different. Male to female, you're going to take into consideration their history for sure. I feel happy saying that because now with we have kind of like a gender spectrum, right? We have people who, who have transitioned in varying degrees and we have people who haven't transitioned but totally identify with the gender. They weren't assigned at birth and all of these things. So basically I take it functional. So can you just walk me through the issues you're having, your questions, concerns when it's a problem, if anything makes it better, does anything in particular make it worse? And then we problem solve from there?
Sarah Haag: 52:26 So I guess I didn't really have a good, a good answer, man. Male to female. Their situations are usually different, but it's kind of different across one gender or the other. Anyway. Is that kind of answer it? Yeah. Great question.
Karen Litzy: Well, thank you so much. Thank you. I think we covered a lot and I thank you guys for being here and I hope that you guys got a lot out of this and can kind of take this back to your patients now. So last question that I ask everyone and it's so knowing where you are now in your life and your career, what advice would you give to yourself as a new Grad?
Sarah Haag: Ask more questions. To be honest on, I came out of school pretty much like, like the teachers know best and what I learned is right.
Sarah Haag: 53:16 And then when you get into the real world, I ended up thinking I was not very good at my job for awhile because like you would do what you were taught to do but it wouldn't work. And then, you know, some things happen and I got older and more comfortable and when you start asking questions you realize there isn't one answer. So if you start asking those questions, you're part of, you're part of the solution. By kind of pushing those boundaries and not like, I wish I would've just asked more questions sooner. I'd be so much smarter than I am now.
Karen Litzy: Where can people find you on social media if they want to get in touch with you?
Sarah Haag: Sarah Haig, PT on Twitter, you can find me on my website, www.entropy.physio and um, I mean Facebook, Sarah Hague.
Sarah Haag: 54:07 I don't know what my picture looks like right now, but I'm friends with Karen, so if it says I'm friends with Karen, that's probably me.
Karen Litzy: Awesome. And just so that everyone knows a lot of this stuff that Sarah spoke about, we will have links to it. We'll have links to the home health section. We'll have links to the testing, the urogenic testing. Is that neurodynamic testing? You could just send me a link or something about it. So we'll have it all in the show notes. Thanks everyone for watching the live. We appreciate it and everybody, thanks for listening. Have a great couple of days. Stay healthy, wealthy, and smart.
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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jazz Biancci on the show to discuss the power of tuning in to your body. Jazz Biancci, CAPP, founder and creator of The Consciousness Project 2020, is an Author, Speaker and Channel, helping people access their invisible influences to discover what they don’t know they don’t know, to have a greater impact in the world.
In this episode, we discuss:
-The importance of tuning in to your body’s awareness and emotions
-How to live with more integrity during your daily interactions
-Why you should shift your inner dialogue towards kindness
-And so much more!
Resources:
Speakers Who Dare
Jazz Biancci Twitter
Jazz Biancci Website
Jazz Biancci Facebook
For more information on Jazz:
Jazz Biancci, CAPP, founder and creator of The Consciousness Project 2020, is an Author, Speaker and Channel, helping people access their invisible influences to discover what they don’t know they don’t know, to have a greater impact in the world. Jazz has been a speaker at the Fit, Feminine & Fierce Conference in NYC, the Speaker Salon NYC, and a panelist at Soul Clarity & Abundance Live. She is currently the online host and co-producer of MamboNYC.com, co-host and producer of Spiraling Inspiration on blogtalkradio.com, producer of Healing & Becoming The Divine Masculine, and producer and moderator of The Summer Series LIVE: Anchoring During Troubled Times, and Conscious Masculinity Part ll: Diving Deeper.
Read the full transcript below:
Karen Litzy: 00:00 Hey Jazz, welcome to the podcast. I am happy to have you on. And for those of you who have not listened to the podcast before and have not heard me talk about the speaker salon that I was involved in over the summer last year and the mastermind that I continue to be involved in through Trisha Brouk, then you need to go back and listen to some of the episodes I did with Trisha Brouk because that is where Jazz and I met. So we met last summer. We were a part of a small group of this speaker salon. And for me it was a real big shift in mindset in life. And I always credit all of the people in the group, not just Trisha for being the leader of the group, but everyone else in the group, and Jazz was one of them. And so that's how she and I met.
Jazz Biancci: 00:53 Oh, thank you. That was probably a crossroads in my life. It was definitely a game changer.
Karen Litzy: Yeah, I agree. I, um, it changed my life and all aspects of my life, not just speaking, not just business, but personal confidence, everything. It was just this big, big, yeah, crossroads for me as well. I just absolutely loved it. And Jazz was just this amazing public speaker getting up on stage. Like I was saying, I remember the first time I went, everybody got up on stage. And I was wondering, I'm like, is everyone here a professional speaker?
Karen Litzy: 01:37 What is this? And I was very, very intimidating, but at the end I think we all definitely got so much out of it. And the support and the love, the community was great. But today jazz is here to talk about the power of being in our body. So Jazz, my first question to you is, what the heck does that mean?
Jazz Biancci: It means fully inhabiting your body to allow to provide some feedback that it's meant to provide. So I believe the body is a biological computer and it plugs us directly in to this energetic grid that lays across all things. And so when we're in our body, our sensory system is at work. And we receive messages. So the language of the body is very different from the language of the mind because there are no words. And so to understand and interpret those messages, it requires us to inhabit our body versus, you know, a lot of people live life from the neck up and it's all logic, linear thinking.
Jazz Biancci: 02:47 And there's a level of detachment. So when their body has a response to something, a person, a situation, they're slower on the uptake if they even feel it at all. Because we can feel residents, we can feel when something is a no.
Karen Litzy: So is this like an excuse my kind of layman's terminology here. Is this what people would refer to as their gut feeling? Or is this something more?
Jazz Biancci: It's a combination. So there's a, there's a heart intelligence and there's the gut feeling and they all worked together.
Karen Litzy: And how do we tap into this? So I feel like I am certainly hand raised one of those people that's probably more head up or neck up then the rest of your body. I fully admit that I am. So how can we tap into those other parts to the heart, to the gut feelings and how can we do that?
Jazz Biancci: 03:54 I used to be a linear, logical head person too. And I found my way back into my body as an athlete and a dancer. And I started noticing when I was at the gym and in dance class, how the reach of my arm connected me to my heart. And so a great way to start is just to get physical if you can, and if not to take a moment and just put your hands over your heart in the morning. Take 10 seconds to remind yourself that your heart is not only beating to keep you alive, but it's also feeding you information. And then as you move throughout your day and you're having interactions, notice how you feel when you're ordering your coffee and they call your name. How does it feel? And without judgment, but start to pay attention to your responses to people, to the things you're saying and how it resonates in your body.
Jazz Biancci: 04:58 Because often people will ask us questions like, uh, do you mind helping me with this? And sometimes the answer is no, but we say maybe because we're being polite and feel how that resonates because that lie resonates much differently than the truth.
Karen Litzy: Interesting. And, and I, I think we've all been in these situations, like you said, someone asks you to do something and you say maybe are you say yes. And I was in a situation a number of years ago where I said yes to something, but it was literally giving me stomach pains and you know, it was making me so anxious because I knew deep down this is not right, but I am a bit of a people pleaser. And so I said yes. So for those people like me, which I, I think there's a lot of us out there and a lot of the people that listen to this podcast are, you know, we work in healthcare.
Karen Litzy: 05:57 We want to stay healthy. You want to stay fit. And oftentimes were big givers, right? Because we're, we want to heal people. You know, we want to help people, but then it kind of backfires on ourselves. So what do we do in those situations where someone asks you to do something, you feel it in your gut. It's not, it's literally making you sick, but you say yes anyway.
Jazz Biancci: Well it's, it's baby steps, right? It's a process. So the noticing is a start. Like I used to tell myself, yeah, workout in the morning. I am not a morning person. I have never been a morning person. And so starting to notice how that felt in my body, whether I was able to change it or stop saying, oh I'm going to work out in the morning. It was a different story. So we start by noticing how it feels and then we start asking ourselves, well, why did I say yes?
Jazz Biancci: 07:05 So why did I say maybe when I met and start delving into that because it takes a while before we are in grace enough to say, I would really love to help you with that, but my plate is full right now. Can I help you find someone else?
Karen Litzy: That's great. That's a very, very nice way to say no. And the offer of saying, can I help you find someone else or I have someone else in mind I think is a great way to, from the people pleaser standpoint, again, I'm going to be selfish and go from the people pleaser stand point that you still feel like you're helping even though you're not the one who can do it.
Jazz Biancci: Exactly. And you're in your heart. Because sometimes when we don't understand how to do something and we're, we're getting our legs about us, we can be short or curt or rude just to try to get that boundary laid down, you know? And we don't have to do that. We can take our time with this process and notice what we're doing when we're doing it, understand why we're doing what we're doing, when we're doing at being graced with that and sit in our hearts and give us an answer that's a win win for everyone.
Karen Litzy: 08:32 Yeah. So when we're talking about, you know, being in your body, we're, I'm just going to recap the steps because I'm a step person. I'm a checklist person, kind of. So noticing first what's happening in your body. And like you said, it doesn't mean you have to sit and meditate for 20 minutes or 30 minutes. It's just take a moment to remind yourself where you are and how you feel in that moment. And then delve into the, why did I say yes or maybe when it should have been a no, and delving into the why is something that we've been talking about a lot lately on the podcast and that why goes pretty deep. So it's not just why did you do this? Oh, because I didn't want to. And that's the end of the conversation. And then finally being graced with your decision. And then the most important is to come up with a win-win response for everyone. Got It. Well that seems easy.
Jazz Biancci: 09:38 It does seem easy. The hardest things usually do.
Karen Litzy: That sounds like I've got it down pat now I just have to practice it. And I would assume just like, you know, you were an athlete and a dancer. How many times did you practice certain movements in order to perfect them? Or to feel comfortable with them. Right. So I would assume that this process is just a lot of practice, right?
Jazz Biancci: Ongoing. And it's not about judging ourselves or being mean or shaming ourselves. It's not about that. It's just like, it's a scientific experiment. That's all it is. How can I improve? How can I shift?
Karen Litzy: And so if you're, let's say you're working with a client and you're working with them on this sort of shift, what pieces of advice seems to resonate most with your clients? And again, knowing everyone is different and has a different path, but are there exercises or things that you do with clients that you're like, you know, this is pretty powerful. This is something that seems to work.
Jazz Biancci: 10:55 I have them keep a journal. First I just do like the tick system. So noticing how many times a day that you lie. Like when you're like counting and you're like putting like marks and then you get to the five and you cross it over. So it's just that easy to start noticing how many times a day you lie. So you have a notebook and you just make a tick or use your notes on your phone and you just put a one Monday, one, two like you just keep adding ticks and you count it up at the end of the day. Because it's fascinating because we lie a lot, this self-deception is astounding and it does no service to anyone when we're out of integrity because that's what that is. We're being inauthentic in a moment because we are taught to be polite before we consider ourselves and we can do both without being disingenuous.
Karen Litzy: So yeah, it'd be like little white lies or maybe, yeah.
Jazz Biancci: Yeah, because it's all about the observation and understanding what kind of situations prompt us to lie. Noticing when we have fear, because fear is huge. If you're afraid of retaliation or punishment, you're prone to lie to get approval.
Jazz Biancci: 12:40 So it's like noticing those moments that that turn up the volume and then noticing how that makes you feel. Because there is a different way. We just haven't been taught what that way is.
Karen Litzy: So you start, you have people get a journal or like you said on their phone and write down how I'm going to do this because I wonder how many times do I even say a little white lie. I'm going to do this. I would encourage the listeners to do this as well and we'll see what we come up with. It's really fascinating. Yeah, it sounds really, really interesting. So, all right, let's say I do this system for a week and I like five times in a week. What do I do about it? What does that mean? What does that lead to?
Jazz Biancci: Well, it leads to noticing what kind of lies you're telling it to whom, right?
Jazz Biancci: 13:30 Because they may, they may be the lie that like, hi, how are you today? I'm fine and you're not, you know, and then reconstructing that answer so that it feels right in your body and appropriate for the social situation. So someone may say, hey, how are you? And you could say, well, I'm hanging in there, you know, that's acknowledging what you're feeling without giving too much information.
Karen Litzy: Yeah, because I would think that you can acknowledge it, but giving too much information, people will be like, why is she inappropriate? So you have to kind of know where that line is between, you know, allow like divulging information but then being like, what is wrong with like why is this person saying this in this context at this time?
Jazz Biancci: So you're honoring and acknowledging and being aware of your environment at the same time because the residents of truth and creating the habit of truth for yourself.
Jazz Biancci: 14:43 As you begin to notice how that frequency vibrates, the way a drop of water into a glass of water does, you see the ripples, you can feel it. And over time it's, it's a purification. It's a gentle way to start the purification process because the body is an incredible instrument. What I found in doing these practices, I know when someone's lying to me because it feels different than truth. And so it's a confidence of knowing that I can rely on myself and my instrument and my body to provide information that I can rely upon because being able to rely on the body because there are no words attached to it, the body doesn't lie. And so those moments I've had moments. I'm sure you have too, that an alarm has gone off within you that you don't necessarily understand. And do you follow? Do you not follow it?
Jazz Biancci: 15:52 Is your imagination, are you having an anxiety attack? For me it happened in queue boarding an airplane and I've been flying all my life and I was going to Haiti for work. It was my fifth trip to Haiti. I was excited, our whole team was going and we were waiting in queue and all of a sudden something happened in my core and I was terrified and I went to my friend and my coworker and told you, I'm like, I am not getting on this plane. I'm not going. And of course she was like, what are you talking about? We have a job to do. And I'm like, no, something doesn't feel right. And so we went to the director and she's like, you can sit by him and you've heard me speak about this. And I let myself be peer pressured and I wasn't competent in that feeling yet that alarm is one of the first times I felt that.
Jazz Biancci: 16:48 And so I got on the plane, I was sitting next to the director and I buckled in and I'm like, what am I doing? But I still didn't have the courage to say, I’ve got to get off of this airplane. I sat there. So we take off, there's this huge commotion and the commotion is moving forward. The stewardesses cannot get the situation under control and the plane has to turn around the air marshals come on the plane and escort the situation off the plane. So the grid that we have within us in our hearts, that electromagnetic energy pulse connects to what's going on in our environment. And I was connected to that woman because she was in my environment and it was an alarm going off for me to get off the plane. It was also a great moment to take notice. Okay. So when my body does this, I now have evidence to listen and thank God it was just the air marshals and an escort off the plane.
Karen Litzy: Sure, sure. That's Crazy. And you know, we've all had these, oh, why am I doing this? Why am I doing this? And then oftentimes that feeling ends up being validated somehow. Now through this work, through this, you know, learning how to be in your body, what has that done for you? So what has that done for your life or for your career that you can share?
Jazz Biancci: 18:34 It allows me to stand in my power and I'm still in awe of it because it's like there's this super power with that we never learned about. No one tells us about that we can fall into by accident. And it's always there. I've always had this ability to be keyed in. And then, you know, you hit puberty and you're a teenager and you're rebellious and you fall away from yourself because you're trying to fit in and then you fall back into yourself somewhere along the line if you're lucky. And so for me, it's really being able to stand in my body, in my strength and know what is right for me. Because when situations happen, the tendency is to go outside of ourselves and have, a caucus about, well, this happened. What should I do? What should I do?
Karen Litzy: 19:36 You always reach out to our friends or family and say, okay, what do I do now? What do I do? I want to do this, but I don't know if I should do this. So what do you think? What do you think? What do you think? And you know, it's like too many cooks in the kitchen.
Jazz Biancci: It's too many cooks in the kitchen and it pollutes the truth for us. And so being able to be in our power is about being in authenticity and integrity and in truth so that you don't go to outside counsel because the reality is no matter how many angles I give you of a story, they're not going to give you the full picture. You aren't there and you don't know what I feel inside my body. You don't know the energy of the situation and I'm not going to have that much time to go into depth with you.
Jazz Biancci: 20:22 So it's being able to hold your own counsel and, and stand in that council because everyone's going to have an opinion about that. So whether it's the choice you make in your career or it's a love relationship, there are going to be outside influences that want to put seeds in your ear. But the reality is only you know the truth. Only you have to deal with the consequences of your actions and only you can know what's right for you. And so being in my body and being in my heart and learning to trust this incredible mechanism has allowed me to do that. And it's changed my life cause I'm not wavering or trying to please anyone because even though we don't think we're trying to please anyone. Well we ask for advice. You know there's like, I remember this was really big for me back in 2005 when like sex in the city and and this whole dating thing and no, there was like the whole Mr. Big and it's a cultural thing, right?
Jazz Biancci: 21:37 So we can think that we're supposed to behave a certain way and believe that that behavior is right and us, it's who we are. I'm a New Yorker. This is what I do when the reality is if you take a moment and you drop into your body, well maybe that isn't how you feel and that doesn't feed what you ultimately want and you're doing a disservice. Are you strong enough to make another decision and then strong enough to stand in it?
Karen Litzy: Yeah. Doing a disservice to yourself. And that's hard. It is. That's hard to, to make a decision and stand in it and be confident in that decision and confident with your own self and your ideals that this is what is correct. This is what is good for me when, yeah, you have the peanut gallery and either ear telling you otherwise or maybe agreeing or not agreeing or what have you.
Karen Litzy: 22:36 But that's hard and I feel like I just want to acknowledge how difficult that is.
Jazz Biancci: It is hard, but you know, it gets easier because you share less things with less people, you know? Because I don't really need to ask someone what I should do in my relationship. I know what I need to do in my relationship. I may need to vent, I may need a hug, I may need to pass an idea over with one of my friends. But it allows me to preface to preface the conversation and say, Hey, I would've had something by you and I want to know what you think about this specific point right here. Or I need to vent. So I really don't need any feedback right now. Are you okay with that? It lets us frame how we need people to show up for us because I don't necessarily want everyone's opinion.
Karen Litzy: 23:41 Yeah, but you want and an ear to listen sometimes
Jazz Biancci: If I know that I have the deli across the street and I want coffee and all I have to do is go across the street and get the coffee and come back, that's much easier. Okay. Then asking the doorman, the person in the elevator, the fire guide, the fire department guy standing outside, I'm the person holding the door for me when I go into the Deli and the Deli person, what kind of coffee I should get. You know this the same way when we have problems, we bounce like a pinball in a pinball machine back and forth. We know what we want to do. We're just trying to get comfortable with it. But if we are in our bodies and in our hearts and we, we feel the resonance because when something doesn't vibrate properly, like when alive vibrates in your body and you have been doing this practice for a while, it feels violent.
Karen Litzy: 24:51 That's interesting. I'm kind of thinking on your, I love that example of why do I need to ask every person I come in contact with from my apartment to the Deli across the street, what kind of coffee I need to get. And when you say that, anybody would be like, well that's ridiculous. And yet that's what we do with big decisions in our lives, our relationships in our lives is we ask everyone.
Jazz Biancci: We give our authority away when really we know the answers. It's just working that confidence and that trust in ourselves and the best way to work that confidence and that trust is to sit with what's going on and see what resonates, what choices feel right.
Karen Litzy: 25:43 So it's really taking time out of your day. Not a lot, but working through those steps that we mentioned earlier. And the more you practice it, like we said, the better and perhaps more efficient you will get at tuning into your body and knowing what that feeling is like, because I would assume if you're new to this, that you're not even maybe sure what you should be feeling. Like how do you know what you should be feeling?
Jazz Biancci: You don't because everybody is different. But if you had a friend who lied to you all the time, you couldn't count on them for anything. That's how it feels from the outside. And you would probably not be friends with that person. Once we start to notice how often we lie to ourselves, we realize that we’re that friend, except we can't get away from ourselves.
Karen Litzy: 26:51 And so you need to be making some changes.
Jazz Biancci: Because you need to trust yourself above all others. The relationship that you have with yourself is the map you take out into the world. And so part of this practice is seeing how it feels. And at first you may feel nothing. At first it's kind of amusing. Uh, it may make you like a little sad like, wow, why did I just do that? I didn't even have to lie in that scenario and I just did it completely unconscious, you know? So it, it helps you in that consciousness as well. So you can start making informed decisions and start listening because sometimes our mouth is on automatic and it's saying things that are completely detached from our truth. It's the talking of Shit.
Karen Litzy: And only until you can kind of be in your body, can you really get a sense that's what you're doing?
Jazz Biancci: 27:54 Yeah. That sometimes we talk ourselves out of the things we want. We pretend that we want something that we don't want.
Karen Litzy: Yes, absolutely. Absolutely. That happened to me last year. I kept thinking I should do this. Someone told me to do this, I should like it, I should like it. And in the end I was like, this is not for me. And I just changed the entire thing for me like a year to figure that out here to kind of realize, wait a second. Oh, okay. No, I have a little more confidence and I know how I want this to go now I get it.
Jazz Biancci: Yeah. Because you know it's okay to take your time. There's no rush. We think there's a rush, there's no rush ticket where we're going. We have to figure out how we want to do things.
Karen Litzy: Absolutely. And I think that is a great, great piece of advice. And you know, I have one more question to ask is what I ask everyone. But before I do that, is there anything that we missed or anything that you really want the listeners to take away from everything we spoke about?
Jazz Biancci: 29:10 I would say engaging with curiosity and practicing tenderness with yourself is epic because we're not tinder, especially if you're in New York. It's very, very rare that you get a tenderness, but it starts to allow you to discover more things about yourself because you start integrating and making space for the child within you. And it's really quite magical. I mean, your life can really change with a little bit of tenderness and it starts with you telling yourself the truth and how you do it.
Karen Litzy: Yeah. That's such great advice and something that over this past year I have definitely started to do more of. We were speaking before we went on the air about how we are always like so harsh to ourselves and it got me thinking like I feel like we are the biggest assholes to ourselves. You know what I mean?
Karen Litzy: 30:30 Like sometimes like you would never be friends with yourself the way you speak to yourself. We put up with it, but now I can see through the tips that you've given today, how we can change that. That's a big shift for people and I hope that they use some of these techniques and steps to kind of stop being such an asshole to yourself and instead be the friend that you always needed. We should be able to be all of that to ourselves, like you said. So you can kind of stand in your power and know what you need and know what you want in your life. And I realized that doesn't happen in like a week, but it takes as long as it takes. Right?
Jazz Biancci: Well, I mean it's a commitment, right? It's just like any commitment the gym, your career, they're all commitments and they're all a process.
Karen Litzy: 100%. And now before we go, I have one more question for you and that is knowing where you are in your life and in your career, what advice would you give to your younger self?
Jazz Biancci: 31:51 I used to be, so I still am very sensitive, but I would break my own heart. So I would say I would tell my younger self to be less cruel and more kind.
Karen Litzy: And that's great advice. And I think anyone listening to this can take that advice as well. Now Jazz, what do you have coming up in 2019 and where can people find you?
Jazz Biancci: Oh, I'm so excited for 2019. So if you want to hear me speak live, there is speakers who dare, which is March 26 at the triad theater in New York City. It's going to be amazing. Um, they can find me www.jazzbiancci.com and I'm working with an editor now, so I expect that my book will be out mid-summer, hopefully sooner. Yeah, I'm so excited. I'm so excited. It's been like a lifetime of making this happen. You can always check my website.
Jazz Biancci: 33:11 I do a conscious masculinity panel the first Wednesday of every month and the panel is amazing. I am so blessed to have such brilliant men participating. So that's on a facebook live and you can find me on facebook at Jazz Biancci, conscious consciousness architect.
Karen Litzy: Jazz. Thank you so much for coming on and sharing all of this good stuff with us. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Mohammad Rimawi on the show to discuss foot and ankle health. Mohammad Z. Rimawi, DPM, AACFAS, brings a wealth of knowledge and expertise to Grand Central Foot Care in Midtown East, Murray Hill, and the surrounding New York City area. As a board-qualified foot, rearfoot, and reconstructive ankle surgeon with specializations in traumatic foot and ankle injuries and complex deformities, he is able to offer his patients top-tier care no matter what problem they bring him.
In this episode, we discuss:
-The anatomy of the foot and ankle
-The most common foot and ankle injuries
-The differences between a high ankle sprain and low ankle sprain
-The importance of the diabetic foot check
-When surgery may be an appropriate intervention
-And so much more!
“If your body says something is wrong, chances are it is.”
“Proprioception is very key for me in the rehab process.”
“Preventive medicine is the best medicine.”
“Establishing ties with other professions is important.”
“The feet can be a window into your overall health.”
For more information on Dr. Rimawi:
Mohammad Z. Rimawi, DPM, AACFAS, brings a wealth of knowledge and expertise to Grand Central Foot Care in Midtown East, Murray Hill, and the surrounding New York City area. As a board-qualified foot, rearfoot, and reconstructive ankle surgeon with specializations in traumatic foot and ankle injuries and complex deformities, he is able to offer his patients top-tier care no matter what problem they bring him.
Dr. Rimawi earned his doctorate from the New York College of Podiatric Medicine, where he made his mark. Not only did he graduate above the 90th percentile of his class and serve as class president for four years, but he was also recognized with the Student Service Award. That award goes to the student voted by the graduating class as making the biggest impact on the field of podiatry. Beyond his peers’ recognition, Dr. Rimawi was inducted into the Pi Delta Honor Society for his achievements in his research and his studies.
With those accolades to his name, Dr. Rimawi continued on to a three-year reconstructive foot and ankle surgery residency at DeKalb Medical Center and Jefferson Health. His colleagues and the hospital staff at the latter named him the Podiatric Resident of the Year.
It’s no surprise, then, that Dr. Rimawi is still impressing in his field. He’s a published author and accomplished lecturer, as well as an associate of the American College of Foot and Ankle Surgeons. In the spare time Dr. Rimawi manages to carve out, he loves to read, hike, and root for his favorite sports teams.
Resources discussed on this show:
Grand Central Foot Care Website
Mohammad Rimawi Instagram
Address: Grand Central Footcare
122 E 42nd Street, Rm #2901
Midtown East and Murray Hill
New York, NY 10168
Phone: 212-697-3293
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
Ashley Micciche is the CEO of True North Retirement Advisors, an independent financial advisory firm managing $230 million in client assets, and located just outside of Portland, Oregon. Ashley specializes in helping small business owners exit their business & retire with financial security by crafting and implementing a custom-designed exit plan.
Whether you’re looking to retire in the next few years or you’re on draft one of your business plan, you should plan for the end in mind. Ashley is going to walk us through the 3 universal, must-do steps to help you get what your business is worth so you can retire with confidence and financial security!
Press play and get ready to take some notes!
More about Ashley:
Ashley Micciche is the CEO of True North Retirement Advisors, an independent financial advisory firm managing $230 million in client assets, and located just outside of Portland, Oregon. It’s a family business, that she owns with her father.
Ashley specializes in helping small business owners exit their business & retire with financial security by crafting and implementing a custom-designed exit plan.
She started her career as a financial advisor in 2007 after graduating magna cum laude with a Bachelor of Science degree in Business Finance from Portland State University.
Early in her career, Ashley developed expertise in 401k consulting for small businesses, and she quickly realized that business owners nearing retirement were not taking the steps necessary to exit their business. She watched several of her business owner clients walk away from their business at retirement without the financial security they needed.
Today, she is on a mission to transition 300 small business owners successfully into retirement in the next 10 years.
Ashley started her first business at the age of 8 years old, taking care of her neighbor’s pets & plants, and picking up their mail when they went on vacation – for $3 a day. She ran that business (a complete monopoly with 100% profit margin!) for 3 years.
FULL TRANSCRIPT
Karen Litzy: 00:00 Hey Ashley, welcome to the podcast. I'm happy to have you on.
Ashley Micciche: 00:04 Thank you so much for having me, Karen.
Karen Litzy: 00:06 Sure. Now before we get to the meat of our interview, I would love for you to fill in the blanks a little bit from your bio that we read to introduce you so that the listeners get a little bit better sense of where you're coming from.
Ashley Micciche: 00:21 I know one of the things that was mentioned in there was I started my first business when I was eight years old. I didn't know it at the time, but you know, I was very entrepreneurial growing up and I started this business where I would pick up your paper and your mail and water your plants and feed your dogs and cats if you went on vacation. I found out really early on that if I worked really hard and I posted flyers and put flyers on mailboxes, put stuff in the newsletter and our neighborhood advertisement that I would get business from that. If I didn't work hard, if I didn't post flyers or do any of that, I got nothing. So I learned these really awesome lessons about hustle and working hard and making $3 a day doing all this work early on. And so that was a really neat experience because it taught me a lot that I have carried with me over the years and now starting my own real business.
Karen Litzy: 01:32 And those are lessons that you know you can take with you for your whole life. And now you are at True North Retirement Advisors as the CEO and retirement plan specialist. So today you're going to share with us three universal must do steps to help you get what your business is worth so you can retire eventually which is something we all want to do. Well, maybe not everyone, but most people want to retire and we want to be able to retire with confidence that we can live a lifestyle that we want to live. So let's go through these three universal must do steps.
Ashley Micciche: 02:13 So what we do is exit planning for business owners. And I think what's really unique about that is that we don't have any skin in the game. Like it doesn't matter to us who you sell your business to or you could sell it to a family member, another employee, you could sell it to an outside third party. We don't have any skin in the game in that regard. So what we do is we really just work with our clients to identify those goals and what's important to them and what the value of their business is so that they can achieve what they're looking to do when they exit their business.
Karen Litzy: 02:50 Oh, I was going to say, because I'm assuming everyone's got a different goal to exit their business. Right? And so it has to be personalized and individualized.
Ashley Micciche: 03:00 Yes. And so we have a step by step process for this. But what I found is that the process really diverges after the first three steps based on who you end up selling your business to, what that timeline looks like. But there are three universal steps to exiting your business. And so the first universal step is valuing your business, understanding what your business is actually worth. And it's kind of like if you know, you want to retire, Exit Your Business, sell your business in five or six years or whatever that is, that's sort of like the destination on your GPS. And if you don't put a starting point in, if you don't put in where you are today, what the value of your business is today, it's almost, your GPS can not tell you how to get where you want to go. So you really have to take inventory of what your business is worth today.
Ashley Micciche: 04:00 And I find that a lot of people don't do this vital first step because they have a lot of misconceptions about what's involved in value in a business. So they think that it's going to cost them thousands of dollars. It's going to take weeks or months. Someone's going to come in to disrupt their business because they need to ask questions and you know, dig into the books and records and all of a sudden, so they're like, no, I don't want to do that. Like I'll just use a rule of thumb or hey, I know this other practice across town that's close in size to mine and they sold their business for this much. So I'm just gonna, you know, I'll go with that. But you know, if you don't start with an accurate valuation, it's nearly impossible to take the other steps necessary to exit your business.
Karen Litzy: 04:52 Okay. So I will admit, I have no idea how to do that. Yeah. So what would you say to someone like me and I am a business owner? How do I even start valuing the business?
Ashley Micciche: 06:07 Yeah, so that's a really good question. And you're not alone, Karen. There was actually a study done about three years ago by the business exit institute. They do a lot of research in this area and they found that 98% of business owners have absolutely no clue what their business is worth and how to go about doing that. So, the neat thing about valuing your business is that more technology tools exist today. So there's a software tool that we use to value a business and anyone can access this. It's free, but really with a pie with eight pieces of information, like your revenue, what you pay yourself, what your compensation is, your debt and certain other things like if you rent or own the space where your business is occupied, but there are a critical pieces of information to value your business.
And if you get those, if you can get those eight pieces of critical information and enter it into the valuation tool, then it will spit out an evaluation for you. It'll tell you, you know, Karen's practice is worth $689,000 or whatever it is based on those parameters that you put in. And it doesn't take long. It takes like five minutes to do it. Once you've gathered the data, the toughest part is gathering the data. When you use this software tool, there's 50 pieces of information you can put in. But what we did is we went back to the software developer and we said, okay, tell me the bare minimum pieces of information that I could put into the software tool for it to spit out the valuation for my business. And so we use that, what their advice was to us.
Ashley Micciche: 07:03 Plus some of the other things that we know from what we know moves the needle on valuation. And we came up with this checklist like, Hey, if you can get these eight pieces of information, what your revenue is, your pretax income, if you owe other people money, if you have bank loans, if you rent or own the space that you're in, those are the things that have the largest impact on what your business is worth. And then once you enter that into the software tool, it'll spit out your evaluation. It's fantastic. And I'm so excited about it because what I found, this is not our core business, like this is it. So we actually make this tool available to anyone who wants to use it for free. Because what we want them to do is get unstuck, get out of the head mind space of using a rule of thumb or a really inaccurate estimate.
Ashley Micciche: 08:01 Because once you know what your business is worth, it unleashes the rest of this process. And when you see that number tangible, you know, Karen's business is worth this amount, then you can start to make some important decisions about, okay, so is this going to be enough that, you know, if I want to exit and a year or two years, you know, what do I need to do if this isn't what I hoped it would be? So it really influences a lot of the other decisions we make in the process. Valuing your business and knowing how to value your business is step one. So what is step two? Step two would be establishing what your timeline is and your goals. So you know, a lot of people have this idea in their head, I want to retire and exit my business in 10 years or five years.
Ashley Micciche: 09:00 Or maybe it's like January 25th you know, 2021 like they've got it dialed in down to the day. And so that would be the first thing. And not just when you want to leave, but figuring out, okay, how were you involved in your business today? And then how do you see that involvement evolving over time? Because the reality is for most people who are not business owners or entrepreneurs, they have a very specific set retirement date and they go from working full time to retirement date and then fully retired. But for a lot of business owners there, they sort of have this phased out exit. And so it's important to kind of think about how to do that, which is great for a business owner because if you have somebody else who's taking over ownership at or who's doing a lot of the day to day management or seeing patients or whatever that may be, you can pull back over time a little bit and have this phased out retirement so that you can test the waters and make sure that whoever that person or those people are are fully equipped to be able to run things in your absence.
Karen Litzy: 10:16 Yeah, that makes perfect sense to me. And also I would think it's really hard for some business owners. Have you found that with the clients that you work with that that's not easy?
Ashley Micciche: 10:28 Yeah. I mean, cause your business, it's like your baby, you know, blood, sweat, tears. You've made so many sacrifices, a lot of it too. It is very much a part of your identity and who you are. And that's okay. You know, I totally get that. I think that the important thing about this establishing your timeline and goals is what feels right to you and what do you want. It's not up to me to tell you what you should do. It's up to you to figure that out.
Karen Litzy: 11:00 Not Easy, not easy. But this is good. As you're saying all of this, I'm kind of thinking in my head like, okay, I should probably be thinking about this stuff cause it's not even something that's on my radar right now. But I guess it's never too soon.
Ashley Micciche: 11:14 No. And actually the best exit plan starts when you start your business, but most people are so heads down focusing in growth mode that rarely if ever happens because it really does require this mindset shift. But you have to start it before you're burnt out. So I've seen a lot of business owners who, because they didn't plan, they didn't start this process, you know, five, 10 years out, which is really an ideal timeframe to be doing this. They wait until they're sick and tired of working and they're ready to retire. And so they don't have the time to be able to craft that ideal accent or maybe they sell their business to somebody who in a fire sale where they just want out and they don't care what they get for their business, but if they would have planned more, they could have got, you know, what they wanted in a lot of cases.
Ashley Micciche: 12:18 I didn't work with this person on their exit, but I know somebody who just retired this past summer and he was a third generation owner of his family business that his grandfather started. It was a good business, a good cashflow, it was a solid business. But he didn't do any planning and didn't identify a successor and he just got way too burnt out and literally just walked away and shut the doors and left with nothing. And that, to me it was really sad just because it was, you know, third generation. And he was fortunate because he didn't need to sell his business in order to retire. You know, it wasn't a must do, but for most people, you know, your business is your largest asset. And so it's so important we plan for all these other things, like when we're going to take social security and investing in all these things, but a lot of times the business and the value of the business gets neglected.
Karen Litzy: 13:29 Yeah. There's no question. I am in a lot of different entrepreneurial groups and this is a topic that never comes up.
Ashley Micciche: 13:39 Oh really? That's surprising.
Karen Litzy: 13:40 Yeah. It's a topic that never comes up and it really should because now that as you're speaking more and more on this, it's got me thinking about my sort of long-term plan and where do I see myself and what should my goals be. So this will be something for 2019 for me to really sit down and give it the time and space that it needs. So I think it's great. Okay. So, number one, valuing your business. Number two, establishing a timeline and goals that I'm assuming are realistic. We don't want to say, well it's January, so I want to retire in three months and now this is it.
Ashley Micciche: 14:25 And actually before we move on, can I give you a couple of other questions that I think your listeners may not say. So obviously it's important to consider the WHO. So who is best suited to take over the ownership of your business after exit. Now a lot of times, especially in family businesses, there are family considerations and we'll just kind of a trick question cause there was always family issues, like maybe somebody is involved in your business, like one child out of your three children is involved. And you know, most parents want to do what's fair for their kids and so it can create a lot of strife in the family, when there's family involved. So we want to be really careful about that. And I think a lot of business owners make some not so good decisions because of that family element.
Ashley Micciche: 15:20 Like I'm sure we've all seen it where you have a second generation who doesn't have the same mindset, doesn't have that same fire and isn't very well equipped to, maybe they were a good employee, but they're not very well equipped to run the business. So that's really important as well. And then the other thing that I think really drives who you want to look at to be your successor is whether or not how important it is for the business to stay in the community. So a lot of business owners are really heavily involved in their community and no matter what an outside buyer tells you, that dynamic is going to change. So it's really important, especially if you're looking to sell to maybe like a competitor or someone like that outside of your immediate community. It's definitely going to change, you know, that experience from your client or your patient's point of view.
Karen Litzy: 16:21 Oh yeah, definitely. Especially in health care because if you're in any sort of healthcare business, you are deeply entrenched into that community and they depend on you. Yeah, that's a great consideration to think about during this timeline and goal step. Anything else that we really need to think about in this second step?
Ashley Micciche: 16:48 You know, a couple of other things have to do with the financial element. There was this other study that was done that looked at most business owners want to retire in the next 10 years. And that same study that I mentioned before from the business owner acts or business exit institute said that they found that 75% of business owners would exit today if their financial security was assured. So most entrepreneurs, business owners who aren't looking to exit, aren't doing so because they feel like financial aid, they're not ready yet. So that really plays into the next step that's universal in that process, which is to determine if you have a gap financially. So you know what your business is worth, you know, what your other financial resources are. And when you look at all of those things, is that going to be enough to, do you have enough to retire?
Ashley Micciche: 17:51 Is that going to be enough to provide the income needs that you have and your family has in retirement or not? That's really the third step. And so what we do in this step is we look at what are your assets? We know what the business is worth, but we also have to consider the after tax business value. Cause that's a big surprise, right? Then you have what you get to keep after Uncle Sam does. So you know, we have to plan for that. And then you might have other assets like your investment portfolio or rental properties and all of these things are, or social security, you know, all these things are providing income for you in retirement. And so you have to replace whatever income you were getting when you were working in the business.
Ashley Micciche: 18:45 That’s usually the challenge is because most people, they do have a gap. The business or their personal financial resources are enough to provide the income that they want and desire in retirement. So, we have to start making some decisions about what levers we can pull. So sometimes you can pull levers to increase the value of the business. Depending on what the business looks like, sometimes there's not as much flexibility there. So it might be, you know, rethinking what your plan was for retirement. Like are you willing, you said you all work five more years, are you willing to work six, seven or eight more years if that's going to help fill the gap. So understanding if a gap exists or not, and discovering your gap, that's the third step because it really leads to how much are you either going to need to grow your business value or on the personal side, your personal assets and income in order to make sure that that gap is filled.
Ashley Micciche: 19:55 I would think that that third step is where you really have to start making some hard decisions depending on how you want to live your life when you retire. And actually one of the things that comes up a lot is if sometimes people get revenue from very limited sources, you might have, you know, five or 10 clients that provide 50, 60% of revenue or maybe you have a practice that especially on the medical side, maybe are more dependent on insurance reimbursement. And so one of the things that can increase value is if you can convert or incentivize more of those people to pay with cash. Know that can be something that's more attractive now to an outsider versus relying on insurance reimbursements found that true for dental practices. I would imagine it's true pretty much across the board for most medical or physical therapy type companies.
Karen Litzy: 21:00 I would agree with that. And I think there is a big trend moving towards a cash based therapy practice. That's what I have. So I don't take insurance. I'm out of network. I'll help you get reimbursed. But my clients pay me cash for my physical therapy services. And I think there's definitely a big trend to that, especially now with rising costs of healthcare and large deductibles. Everybody's cash based at this point because some people have deductibles of $10,000, which needs to be paid before you can get reimbursed anyway. So everybody's paying out of pocket.
Ashley Micciche: 21:45 Yeah. Well good. Karen, you've already increased the value of your business by doing that.
Karen Litzy: 21:50 All right. Yeah, go through this tool and look at my goals and all that other stuff and get at least a rough idea of the value of what my business is. I even think about retiring and I always said, you know, Oh, I've got like 30 more years before I retire, but I feel like I said that like 10 years ago and I'm 10 years older. You know what I mean? So this is a good reality check for me and hopefully for the listeners as well to really start thinking about your business and how you want to, like you said, how you want to exit and how you then want to move on into retirement years at whatever time frame that is for you. Do you have examples of clients, you don't have to obviously say their names, but clients that you worked with that did a really good job at all of this and how that ended up improving their retirement?
Ashley Micciche: 22:50 So one of the clients that comes to mind is somebody who's actually still in the process of exiting, but I think the key for this client was that they really started early on. So this is actually another medical practice and they have two other partners and both of whom are younger, but one of them is in their early forties, and then the other one's in their 50s and then the one who's retiring is in his sixties. So the trick is, the younger people have to be able to afford to buy out this older owner, but they have a great relationship. They've talked and communicated with each other along the way to minimize any misunderstandings or potential lawsuits or breakup of their partnership, so they've done a really good job of planning that and having those discussions.
Ashley Micciche: 23:46 He’s a planner by nature, so he's done a really good job in making sure that, this is what the practice is worth, this is what I need when I exit. And he's most likely going to get that just because he's done all this planning and all the partners are on the same page and they're structuring his buyout in a way that they can afford and they're not going to rely on bringing in somebody new or doing that before he exits. So just the planning element and the communication is really helping them out. We’ve had other clients in that same boat who did successfully exit. And it all started with just understanding what was required to exit the business. What do I need to do? What are the levers I can pull to increase either the value of my business or the value of my personal assets. So I'm not relying so much on the business now. Some people, their business is so huge as far as their net worth, the percentage of their net worth that they have no other choice than to really focus and hone in on that to maintain the same lifestyle that they had or provide a legacy or you know, satisfy some of those other exit goals.
Karen Litzy: 25:15 Yeah. And it sounds like aside from these three universal steps to exit, that communication with other stake holders within your business and your family and business partners is paramount to having a smooth exit. So there's no surprises.
Ashley Micciche: 25:33 Yes. And actually that is something that we tried to do. So if we're working with a client x in the business before we ever draft the exit plan, it's kind of like the strategic plan, but it's for your exit. So before that's ever drafted, we bring everyone together the team. So family is involved, especially the spouse and if your children is in the business, we want to involve them early on in the discussion so we make sure everyone's on the same page. And then also all the others like CPA, attorney. There's a lot of people who have a role in making this process as successful as possible. And so part of our job is to facilitate all that and to help move the process along by getting the attorney or the CPA involved at the right stage of the game.
Karen Litzy: 26:31 Yeah, absolutely. If you're not an entrepreneur or you're not a business owner, you don't realize how many people are on your team, how many people are working behind the scenes to make your business successful. And so it's obviously important to involve all of them in your exit plan cause everybody's going to be affected in one way or another. Now is there anything that we missed going through these three universal steps?
Ashley Micciche: 27:00 No, I don't think so. It's about sally in your business. First and foremost, figuring out where you're at and then get most important goals and what that timeline looks like and then figuring out if there's a gap or not and then what to do about it if there is.
Karen Litzy: 27:15 Well, this was great and I have to tell you, I am really going to start looking at this more seriously now after having this conversation. Hopefully the listeners will as well who are entrepreneurs or even for people thinking about being an entrepreneur. So maybe you haven't started your business yet. Like you said, the ideal time to do this is when you start. So they'll have like a leg up on all of us entrepreneurs who have not done this yet. I'm a little jealous of those new bees. Now before we end, I always ask everyone the same question. And that's knowing where you are now in your life and in your career, what advice would you give to yourself as a new Grad out of college?
Ashley Micciche: 28:00 Gosh, that is such a good question. It's funny cause when I graduated college I pretty much, I didn't have a lot of fun in my twenties. Honestly I didn't, I didn't travel. I started in what I'm doing today straight out of college and that was 11 years ago now. So, I think if you would've asked me that question a few years ago, cause I always regretted not having a bit more fun in my twenties and now that I'm in my thirties, I actually am glad that I did. I did what I did and I didn't travel more and I just really focused on my career because I think I'll have a few more options down the road. But honestly, to answer your question, the thing career wise that I wish I would've done when I first started as a fund generalist financial advisor, one of the things that I was told by a lot of mentors who had been advisors for 20, 30 years was that the best way to grow your business when you're new is to cold call.
Ashley Micciche: 29:08 And so I did that and I cold called for two years, I made over 25,000 calls and I wouldn't say it was a total waste, but when these people who are giving me this advice very well meaning advice, they were genuinely trying to help me. They built their business cold calling in the eighties and nineties before the do not call lists before, people hated you if you were calling them cold. And so it's a different world today. So I think I learned career wise is that I wish I would have been a little bit more creative and trying other things in order to grow my business early on because I feel like now if I would have done that, I would've obviously done some other things and not relied so much on a strategy that for me it just didn't work very well.
Karen Litzy: 30:07 Yeah, I think that's why the advice to give to yourself and we've all been there definitely doing things that looking back on it, you're like, what was I thinking?
Ashley Micciche: 30:17 Yeah.
Karen Litzy: 30:19 Where can people find you? Where can they find true north? Let us know where we can connect with you online.
Ashley Micciche: 30:28 Sure. So the website is http://www.truenorthretirementadvisors.com/and for the free unlimited lifetime access to the valuation tool where you can enter that information, go to https://truenorthretirementadvisors.com/valuemybusiness/ If you go there, you'll get access to the checklists. So it's a pdf checklist that explains to you here are the eight pieces of information to gather, where to find it quickly and easily. And then from there you'll get access to the valuation tool. And the beauty of this is you could go in and do the valuation for free and then you can update it in six months or a year or you know, if your business changes and see how some of those adjustments have changed or valuation. So it's cool. It's not a one and done and it's totally free because we really want people to just, we found that if they can figure out what their business is worth and that's the key to unlocking the rest of the steps that are so necessary to exiting.
Karen Litzy: 31:41 I'm going straight to that url and I'm going to get this valuation tool because I think it's awesome. So thank you so much for sharing that. That's such a generous share. And how about social media? Where can we find you?
Ashley Micciche: 32:10 Yeah, so our YouTube channel where we go a little bit more in depth on some of these exit planning, retirement planning topics. We have our biggest presence on LinkedIn.
Karen Litzy: 32:29 Yes. And just before we went on the air, I said, is this how you pronounce your name? And I got it right, but only because I watched your YouTube videos. I knew how you pronounced it, but don't worry, everyone will have a direct link to the youtube and to linkedin and to of course the free gift that Ashley has so generously shared with all of us. So Ashley, thank you so much. This was eye opening.
Ashley Micciche: Thank you so much, Karen. This was a lot of fun. And I'm so happy to share this with your listeners. Awesome.
Karen Litzy: And to all of you listeners, get that free gift and we will be back with you in a couple of days. Have a great few days and stay healthy, wealthy, and smart.
Thank you for listening to this episode with Ashley Micciche!
- Share your thoughts with the Healthy, Wealthy and Smart family in the comment section below!
- Connect with me on twitter, instagram and facebook to stay updated on all of the latest!
- Show your support for the show by leaving an honest rating and review on iTunes!
Have a fantastic day and stay Healthy, Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Evangelos Pappas joins the show to discuss the editorial in the Sports Medicine Journal, Time for a Different Approach to Anterior Cruciate Ligament Injuries: Educate and Create Realistic Expectations. Dr. Evangelos Pappas’ research interests are in the areas of sports medicine, biomechanics and musculoskeletal physiotherapy. Specifically, his interests are in the areas of etiology of lower extremity sports injuries, effectiveness of injury prevention programs, motor control re-training for the prevention and treatment of knee pathologies, epidemiology of ACL injuries, rehabilitation of lower extremity injuries, and dance medicine
In this episode, we discuss:
-How patients interpret the practitioner’s language and use of medical terminology surrounding ACL injury
-Strategies to communicate the medical management of ACL injury to set realistic patient expectations
-The limitations of the research in determining who will benefit from surgical versus conservative treatment for ACL injury
-Physical therapy utilization and patient outcomes
-And so much more!
“We have identified a big discrepancy between the expectations of the patient and the research and the outcomes that we know are produced after conservative or surgical treatment.”
“It is very frequently a life defining moment.”
“We do fail to communicate accurate information to our patients.”
“It is really risky to advocate to all patients conservative treatment including those who want to return to high level pivoting sports.”
“We don’t have good data to know who’s going to do well with conservative management at this point.”
For more information on Dr. Pappas:
Professor Evangelos Pappas trained as a physiotherapist in Thessaloniki, Greece before pursuing a Masters in Orthopaedic Physical Therapy at Quinnipiac University and a PhD in Orthopaedic Biomechanics at New York University in the USA. Prior to coming to the University of Sydney, He taught for 11 years at Long Island University-Brooklyn Campus in kinesiology, clinical decision making and musculoskeletal pathology and physiotherapy. His excellence in teaching was recognized by his nomination for the Newton award for excellence in teaching. A/Professor Pappas joined the University of Sydney as a Senior Lecturer in 2013 where he continues to lecture in the areas of musculoskeletal physiotherapy, and particularly as it relates to the upper and lower extremities.
Professor Pappas is also active in musculoskeletal research. His research has been funded by the National Institutes of Health and intramural grants. He has presented his work in more than 50 national and international conferences and he has been interviewed on the radio as an expert on knee injuries. His publications appear in top journals in the fields of physiotherapy, sports medicine and biomechanics. One of his publications received the T. David Sisk award for best review paper from Sports Health; a leading multidisciplinary journal in sports medicine. In addition, Professor Pappas has served on the research subcommittee of the awards committee of the American Physical Therapy Association.
Resources discussed on this show:
Zadro, J.R. & Pappas, E. (2018). Time for a Different Approach to Anterior Cruciate Ligament Injuries: Educate and Create Realistic Expectations. Sports Med. doi: 10.1007/s40279-018-0995-0. https://www.ncbi.nlm.nih.gov/pubmed/30284693
Episode 227: Dr. Evangelos Pappas: ACL Rehab & Research 101
Episode 048: Physical Therapist Dr. Evangelos Pappas
Evangelos Pappas Twitter
Evangelos Pappas Facebook
Email: evangelos.pappas@sydney.edu.au
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
F. Scott Feil chats with Mike Connors, Mark Milligan, & Dana Tew regarding the upcoming opportunity for the state of Texas to have Direct Access passed along with how PTs in Texas can get involved and contribute to making this a reality.
Texas Physical Therapy Association Website: https://www.tpta.org/
TPTA Capital Area District Facebook Page: https://www.facebook.com/CapitalAreaDistrictTPTA/
APTA Direct Access Page on Website: http://www.apta.org/StateIssues/DirectAccess/
APTA Action App on APTA Website: http://www.apta.org/ActionApp/
Texas House Bill 29: https://legiscan.com/TX/bill/HB29/2019
Evidence:
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Texas Department of State Health Services. (2018) Texas Projections of Supply and Demand for Primary Care Physicians and Psychiatrists, 2017 – 2030. Austin, TX: Texas Health and Human Services https://dshs.texas.gov/chs/hprc/default.shtm
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Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort ME Horn, JM Fritz BMC health services research 18 (1), 887 https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-018-3699-0 3. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Frogner et al Health Serv. Res. 2018 https://www.researchgate.net/publication/325319327_Physical_Therapy_as_the_First_Point_of_Care_to_Treat_Low_Back_Pain_An_Instrumental_Variables_Approach_to_Estimate_Impact_on_Opioid_Prescription_Health_Care_Utilization_and_Costs 4. Denninger TR, et al. The influence of patient choice of first provider on costs and outcomes: analysis from a physical therapy patient registry. J Orthop Sports Phys Ther. 2018;48(2):63–71. http://pt-cpr.com/images/jospt.2018.7423.pdf 5. Rhon, D. I., Snodgrass, S. J., Cleland, J. A., Sissel, C. D., & Cook, C. E. (2018). Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule. Perioperative medicine (London, England), 7, 25. doi:10.1186/s13741-018-0105-8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249901/ Biographies: Michael Connors, PT, DPT, OCS, PhD received his Master of Physical Therapy degree from University of Medicine and Dentistry of NJ-Rutgers University in May 2003 with honors. Dr. Connors obtained his post professional Doctor of Physical Therapy degree from Temple University in December 2008. He became a board certified specialist in Orthopaedic Physical Therapy by the American Board of Physical Therapy Specialties in June 2011. He completed a PhD degree in Physical Therapy from Texas Woman's University in August 2017. Dr Connors is the current President of the Texas Physical Therapy Association. He also is an assistant professor within the UNT Health Science DPT Program. Email: mjconnorspt@gmail.com Mark Milligan PT, DPT, Cert TPS, OCS, FAAOMPT Mark Milligan is an orthopedic manual therapist that specializes in the evaluation and treatment of musculoskeletal and spinal conditions, both acute and chronic. He is Certified in Therapeutic Pain Science, Applied Prevention and Health Promotion and dry needling, Board Certified in Orthopedics and a Fellow of the American Academy of Orthopedic Manual Therapy. He earned his Doctorate of Physical Therapy at the University of the Colorado School of Medicine in Denver, Colorado. He went on to complete an Orthopedic Physical Therapy Residency and Orthopedic Manual Physical Therapy Fellowship with Evidence in Motion (EIM). He is a full-time clinician and Founder of Revolution Human Health, a non-profit physical therapy network and he also founded a continuing education company specializing in micro-education. He is currently a physical therapist with Encompass Home Health in Austin, Texas. Dr. Milligan serves as adjunct faculty for the Doctor of Physical Therapy Programs at South College and The University of St. Augustine. Dr. Milligan is also primary faculty for Musculoskeletal Courses for EIM. Mark has presented and spoken at numerous state and national conferences and has been published in peer reviewed journals. He is an active member of the TPTA, APTA, and AAOMPT and is current the Capital Area District Chair for the Texas Physical Therapy Association and has great interest in public health and governmental affairs.
Revolution Human Health is a non-profit physical therapy network in Austin, TX that transforms the healing experience by offering access to treatment, education, and movement based therapy for all.
Continuing education division specializes in customized, micro-education for physical therapists across the country. Customizable options of courses include manual therapy, spinal and extremity manipulation, dry needling, clinical reasoning, and preventative care and population health. Please contact us about customizing a course for you and your team!
Email: markmilligandpt@gmail.com
Dana Tew PT, DPT, OCS, FAAOMPT
CEO/ Program Director of OPTIM Physical Therapy and OPTIM Fellowship Program. Dana specializes in orthopaedic physical therapy. His experience includes clinical management of patients with both acute and chronic orthopedic injuries in the outpatient environment. His practice is focused on integration of manual therapy and exercise into a holistic, evidence-based and biopsychosocial approach to physical therapy treatment. He is the residency manager of Harris Health System’s Orthopedic Physical Therapy Residency Program. He was honored by the Texas Physical Therapy Association Southeastern District, as clinical instructor of the year in 2013. He is also a guest lecturer at Texas Woman’s University and has presented at multiple conferences. Dana earned his APTA Board Certification in Orthopedic Physical Therapy and is also a Fellow, in the American Academy of Orthopedic and Manual Physical Therapists. He has served locally for the Southeastern District, as a delegate for the TPTA, and nationally on the American Board of Physical Therapy Residency and Fellowship Education credentialing council for the APTA. Email: danatew@gmail.com
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jamey Schrier back on the show to discuss business fundamentals. Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.
In this episode, we discuss:
-How to establish a clear vision and find the why behind your goals
-Why comparisons to others will keep you small
-The importance of sharing the narrative behind your practice with your team
-Planning and budgeting for the bottom line that aligns with your goals
-And so much more!
“Measuring your progress, measuring your success compared to where you are now and where you’re going—when you do that—you stay in line with who you are.”
“When you put a pen to paper, it’s powerful.”
“Alignment is everything in our business.”
“Not knowing the answer isn’t the problem, it’s asking the right question. The answer is out there.”
For more information on Jamey:
In 2004, Jamey Schrier was facing the soul-crushing struggles of private practice ownership. He couldn’t figure out how to grow his business without sacrificing family, income or time.
Armed with an insatiable curiosity, Jamey invested the next 9 years and over $300,000, to learn how to free himself from his practice. At the end of his journey, Jamey finally discovered the formula to creating a self-managed, profitable and stable practice that allowed more time with his family and more time to work “on” his business.
Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.
Resources discussed on this show:
Jamey's FREE training on howto generate referrals
The Practice Freedom Method Website
Jamey Schrier Twitter
The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change
Start with Why
The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing
Free online community for NetHealth
Email: jamey@jameyschrier.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jeanette Bronée on the show to discuss mindfulness. Jeanette helps leaders and companies rethink performance by asking the “Right Why®.” She teaches them how to create a culture of care by unlocking what truly drives performance, engagement and motivation from the inside out. For 15 years, she has coached clients and delivered speeches about how physical health and emotional-mental wellbeing affect performance and prevent stress and burnout. She shows how focusing on how our mindset affects our self-care habits at work and at home and believes, that when we leave our humanity at the door when we go to work, we leave behind our most valuable resource for success. She incorporates her background in integrative nutrition, mindfulness and hypnotherapy to help people work better by working healthy.
In this episode, we discuss:
-How to ask the right why to find a way forward
-Practical exercises to ground yourself in stressful situations
-The use of metaphors to describe experiences
-How mindfulness can facilitate change
-And so much more!
“If we can refocus our question, then our unconscious mind will help us find the answer.”
“We find solutions by acknowledging what’s not working and then moving into curiosity.”
“If we don’t pause for a moment, we can’t even listen.”
“We’re not running out of time, we’re running out of focus.”
“We don’t solve problems in a new way under stress, we just repeat what we’ve always done.”
“Our self-talk really creates our experience.”
For more information on Jeanette:
When Jeanette Bronée’s parents both died of cancer just one year apart, she was told it wasn’t a matter of if, but when she would get cancer, too. So she took charge of her health and wellbeing, sharing what she learned about the power of mindfulness by founding Path for Life in 2004. Since then, she has taught more than half a million people how to ask the “Right Why” to unlock the answers that prevent burnout, fuel peak performance and create a culture of care.
Now, she helps leaders and companies rethink performance and culture to create sustainable success by supporting our most important resource -- our human resource. She has delivered TEDx talks, as well as keynote speeches and workshops at corporate events and workshops around the world.
Her book, EAT TO FEEL FULL, a guide for eating to thrive, gained nationwide recognition in the news media as a new approach to health and eating that helps us break with our dieting mentality and focus on eating to fuel our performance.
She holds a business, marketing and communications degree and is a certified Integrative Functional Nutrition and Meta-Medicine Health Coach. As a Hypno-Therapist, she uses the power of the mind to create change (but don’t worry she doesn’t do tricks). She is also a Certified Felt Sense Focusing Professional, which she has found to be the key to learning what drives our choices and how we can take charge of our wellbeing.
Resources discussed on this show:
Path for Life Website
Jeanette Bronée Website
Jeanette Bronée LinkedIn
Jeanette Bronée Twitter
Free Gift: Use code “Healthy” for 30% off the yearly online program Get Healthy Online
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
Happy New Year from the Healthy Wealthy and Smart Podcast family! On this episode, I welcome Shanté Cofield on the show to discuss how to set achievable goals for 2019. Dr. C. Shanté Cofield, aka The Movement Maestro, is a former Division I athlete with a passion for movement surpassed only by her passion for learning. Shanté graduated from Georgetown University and then continued her educational pursuits at New York University, graduating with a Doctorate in Physical Therapy (DPT) and becoming a Certified Strength and Conditioning Specialist (CSCS). Shanté is a board certified Orthopedic Clinical Specialist (OCS) who practices in Los Angeles, California with specialties ranging from CrossFit injuries to pelvic floor dysfunction. Shanté is the creator of The Movement Maestro, a website and social-media based platform devoted to all things human movement and mobility related.
In this episode, we discuss:
-The importance of understanding the why behind a goal before setting the goal
-Why boundaries are important to set before pursuing your goals
-How to bring human connection into social media
-Building a supportive community that will serve you
-And so much more!
“People don’t know how to set goals.”
“We tell our patients all the time you have to be patient, and yet we don’t apply that to ourselves.”
“What social media has become is another language –it’s another way to connect with people.”
“We don’t attract what we want, we attract what we are.”
“You have to be ok with the fact that not everyone is going to love you.”
“If you’re selling something—you’re marketing—you have to push it more than you want to.”
For more information on Shanté:
So, this is the place where it’s standard practice to give you a sterile glimpse into my professional life and hopefully convince you that I’m qualified enough for you to let me treat you. But, you should know, I’m anything but traditional. Before you keep on reading, I’d love it if you could take a few moments to watch the video from the home page (if you haven’t already) and learn a little bit about me. I know that four minutes is a lot to ask of someone in 2018, but, that video IS me.
I’m a firm believer that everything in life is about connection. As it relates to our bodies, we are a united whole, with all the parts working together and affecting each other, and as such, that is how I treat. As it relates to the universe, we are all connected in some way, be it blood, physical proximity, belief systems, or energy. And as it relates to choosing a provider, choosing to listen to a podcast, or choosing to attend a course, I believe that it is paramount that you are able to connect with that person. As such, I teamed up with a close friend to film something that I felt would give you a better understanding of who I am, what I’m about, and hopefully make you realize that I am an actual person, not just a picture on a screen, a voice in your headphones, or words on a piece of paper.
BUT FOR THOSE OF YOU WHO STILL WANT THE INSIDE SCOOP, HERE’S THE RUNDOWN:
Hometown: Summit, NJ
High School Sports Played: Soccer, basketball, lacrosse, ice-hockey (for real), javelin
College: Georgetown University (’07)
Sports Played: 4 years of Division I soccer, rugby (1 season)
Graduate School: New York University
Date Graduated: 2010
Degree Earned: Doctor of Physical Therapy
Additional Certifications:
OCS – Orthopedic Clinical Specialist
CSCS – Certified Strength and Conditioning Specialist
CF-L1 – CrossFit Level I Trainer
SFMA – Selective Functional Movement Assessment Provider
FMS – Functional Movement Screen Provider
FRCms – Functional Range Conditioning Mobility Specialist
NKT – NeuroKinetic Therapy (Level I) Provider
FMT B/P/B/A – RockTape Basic/Performance/Blades/Blades Advanced Certified (I am a RockTape Lead instructor, I had better be certified in all these things!)
Other Hobbies and Activities: CrossFit, ex-marathoner, indoor rock-climbing, professional meme viewer, guitar, sneakerhead, SoCal lover
So, if you’ve made it this far, I commend you. I’ve got my fingers crossed that if you didn’t know anything about me before, you’ve now got enough to formulate some kind of picture and make a decision about our future together. Be nice. If you want to rendezvous, contact me. If you want to hear me talk, subscribe to the podcast. And if you want to be like Aerosmith and never miss a thing, subscribe to my newsletter. Thanks for your time.
Resources discussed on this show:
The Movement Maestro Website
The Movement Maestro Instagram
Email: shante@themovementmaestro.com
Maestro Courses
Rocktape Courses
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Andrew Vigotsky and Dr. Nick Rolnick back on to the show to discuss Andrew’s paper, Interpreting single amplitude in sports and rehab sciences.
In this episode, we discuss:
-What information can you conclude from a surface EMG study
-The limitations of surface EMG research
-What to look for in a surface EMG methods section
-And so much more!
“I would urge practitioners not to make clinical decisions primarily based off of surface EMG or any acute type of measure especially when they want a longitudinal outcome for a given patient.”
“There are no studies that validate surface EMG as a predictive outcome for strength or hypertrophy.”
“Look for studies that are relevant to your patient population and your outcomes.”
“I would look at all surface EMG studies with a critical eye especially as they pertain to your patient population and desired patient outcomes.”
“Don’t apply measures that aren’t validated to the outcomes you want.”
For more information on Andrew:
Andrew is currently a PhD student in Biomedical Engineering at Northwestern University, where he studies neuromuscular biomechanics. He has published papers in areas ranging from rehabilitation to surface electromyography methodology and biomechanical modeling. His dissertation works aims to understand the neuromechanical implications of muscular heterogeneities.
For more information on Nick:
Dr. Nicholas Rolnick, DPT is a licensed physical therapist, the founder of the Human Performance Mechanic and the co-founder of Blood Flow Restriction Pros. He received his Doctor of Physical Therapy Degree with academic honors from Columbia University in New York City.
Through his work as a physical therapist his goal is to keep his patients in perfect balance, have the skills to recognize asymmetries and help patients enjoy the benefits of pain-free movement.
He teaches across the United States as a clinical instructor for SmartTools Plus and is an adjunct faculty member at Concordia University – Chicago where he teaches Kinesiology I and II in their MS Applied Exercise Science Program. He also speaks nationally and internationally on the use of blood flow restriction therapy for various diagnoses and populations.
He has been featured on The Mind Muscle Project Podcast, Highly Functional Podcast, The Muscle Medicine Podcast, The Missing Variable Podcast, the PTA Tapes Podcast and the Alinea Podcast. He currently lives and works in New York City.
Resources discussed on this show:
Vigotsky, Andrew & Halperin, Israel & Lehman, Gregory & Trajano, Gabriel & Vieira, Taian. (2018). Interpreting Signal Amplitudes in Surface Electromyography Studies in Sport and Rehabilitation Sciences. Frontiers in Physiology. 8. 10.3389/fphys.2017.00985.
Andrew Vigotsky Twitter
Andrew Vigotsky Research Gate
Andrew Vigotsky Facebook
The Human Performance Mechanic Website
The Human Performance Mechanic Instagram
The Human Performance Mechanic Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Dr. Kristen Schulz, DPT on how to make exercise fun. Kristen is a Physical Therapist and running coach who helps runners achieve their next PR without nagging injuries. She is the creator of the Run Your Life Method, an online course providing a comprehensive and individualized approach for runners. Run Your Life’s mission is to provide runners the resources (prehab, rehab, strength training, recovery, nutrition, training, and mindset) they need to stay healthy, so they can enjoy the sport they love for their entire life.
In this episode, we discuss:
-How Kristen’s exercise routine has evolved into adulthood
-Kristen’s favorite go-to exercises
-How variety in activities can help you avoid burnout
-And so much more!
“If you’re burnt out and you’re not enjoying what you’re doing, try something new.”
“There’s a lot of different ways to incorporate fitness into your life and it doesn’t have to look like someone else’s.”
For more information on Kristen:
Kristen is a Physical Therapist and running coach who helps runners achieve their next PR without nagging injuries. She is the creator of the Run Your Life Method, an online course providing a comprehensive and individualized approach for runners. Run Your Life’s mission is to provide runners the resources (prehab, rehab, strength training, recovery, nutrition, training, and mindset) they need to stay healthy, so they can enjoy the sport they love for their entire life.
Kristen’s passion for her work stems from suffering a number of injuries herself. She ran competitively in high school and college with plans of continuing to improve her running times after college. However, injury after injury kept her from reaching her goals. It wasn’t until she started incorporating a comprehensive approach to running that she found herself able to run without constantly being injured. She finds great joy in being able to teach others how to do the same.
Kristen has had the opportunity to live in many different parts of the country and currently resides in North Dakota. She graduated from Northern Michigan University with a degree in Exercise Science and Spanish, completed her Doctorate of Physical Therapy at Rocky Mountain University of Health Professions, and is a Certified Strength and Conditioning Specialist (CSCS).
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Kristen Schulz Instagram
Kristen Schulz Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Matthew Villegas on how to deal with anxiety in physical therapy school. Matthew Villegas’ goal, as someone born with a brachial plexus injury (trauma to the bundle of nerves near the shoulder blade and collar bone), is to help others with brachial plexus injuries live life to their fullest and dare to run and compete in crossfit through his skills as a Physical Therapist.
In this episode, we discuss:
-How anxiety manifested itself in Matthew’s DPT experience
-Matthew’s tips on how to tackle the challenges of a DPT program
-What pre-PT students should do before going to PT school
-And so much more!
Memorable Quotes from this episode:
“Give everything it’s due time and not necessarily focus too much on one thing.”
“Live through the moment and let whatever happens, happen.”
“The staff, the faculty are there for you and do want to see you succeed.”
For more information on Matthew:
My name is Matthew Villegas. My goal as someone born with a brachial plexus injury (trauma to the bundle of nerves near the shoulder blade and collar bone) is to help others with brachial plexus injuries live life to their fullest and dare to run and compete in crossfit through my skills as a Physical Therapist. I host the Capable Body Podcast (available on iTunes, Google Play, and Stitcher), which aims to bridge the gap between healthcare providers and real people with real stories. Also, the podcast features an active Facebook community that is a safe space where I share more means to connect with my guests as well as some behind-the-scenes extras.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Matthew Villegas Website
Matthew Villegas Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Tameka Duncan on physical therapy for high school athletes. Dr. Tameka Duncan, DPT, Cert. MDT is a licensed physical therapist. It is one of her greatest passions to impact people's lives daily through preventative and rehabilitative services by helping restore quality of life and improve overall function through physical therapy services.
In this episode, we discuss:
-Why Tameka is passionate about working with high school athletes
-The experience needed to treat high school athletes
-How Tameka has established expertise and rapport with athletes in her community
-And so much more!
Memorable Quotes from this episode:
“A knowledge of the sport and some continuing ed classes are needed.”
“They have a vision, they have a reason and they are motivated to get back to whatever that sport is.”
“I’ll just let my results and my reputation speak for themselves.”
For more information on Tameka:
Dr. Tameka Duncan PT, DPT, Cert. MDT is a licensed physical therapist in Clarksville, TN. One of Dr. Duncan’s greatest passions is physical therapy. She loves fostering change through preventative and rehabilitative services. She takes great pride in helping restore patient’s quality of life and improving their overall function to return to the things they love doing most.
Dr. Duncan attended Howard University in Washington, DC where she obtained her Bachelor of Science degree (2005) in Health Science with a concentration in pre-physical therapy. She later went on to attend the University of Maryland- Baltimore in Baltimore, MD where she obtained her Doctor of Physical Therapy degree (2010). Dr. Duncan has worked in a variety of settings throughout her practicing career. She spent 8 years in the outpatient orthopedic setting and recently transitioned to the home health setting, while starting her own mobile physical therapy practice, Vitality Sport & Rehab, LLC. Dr. Duncan’s area of specialty is treatment of the spine, to include both the neck and the back. Dr. Duncan obtained extensive training in the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) obtaining her MDT Certification in January 2017. Dr. Duncan is also very experienced and enjoys treating various injuries sustained by the young athlete to the aging geriatric.
In her spare time, Dr. Duncan enjoys spending time with her husband, her family/friends, working out, attending church, salsa dancing, mentoring youth, and spending quality time with herself. She loves fitness and has participated in several physique competitions. She is also a Beautycounter consultant, a skincare/makeup line that aims to get safer products into hands of everyone. Dr. Duncan best describes herself as a down to earth, outgoing, fun loving person that enjoys meeting and experiencing various people and cultures.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
SFMA Website
Vitality Sport and Rehab Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Private Practice Section Annual Conference in Colorado Springs, Colorado, I am joined by Dan Mills to chat about humanitarian work. Dan Mills, PT, currently serves on the Board of Directors of the American Physical Therapy Association. He is the sole owner of Performance Rehab Clinics, a multisite, PT-owned, outpatient PT business in Salt Lake City.
In this episode, we discuss:
-How Dan became involved in humanitarian work
-Characteristics to look for in humanitarian work
-How to make a lasting impact in the communities that you serve
-A few considerations before engaging in philanthropy
-And so much more!
“Every wheelchair user deserves the right to be examined and fitted by a physical therapist.”
“I waited for the right opportunity.”
“You have to find a fixable problem.”
“We have to find a way to reframe it so it’s not medical tourism.”
“Finding out what they need rather than us impose our western view of what they need is a really, really difficult thing.”
“There are so many solvable problems out there.”
For more information on Dan:
Dan Mills, PT, currently serves on the Board of Directors of the American Physical Therapy Association. He is the sole owner of Performance Rehab Clinics, a multisite, PT-owned, outpatient PT business in Salt Lake City. His practice focus is general orthopedics and occupational medicine. He is passionate about Ironman triathlons, backcountry skiing, fly-fishing, and family. He just completed his tenth humanitarian trip to Africa and his third full Ironman. He has served on APTA committees including Finance and CSM Review (on behalf of PPS). He has also served as PPS Treasurer and Vice President.
Resources discussed on this show:
Dan Mills Twitter
Performance Rehab Clinics Website
Motivation UK Website
US Aid Website
APTA Pro Bono Opportunities
NetHealth Free Online Community
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Carrie Callahan and Matthew Bremekamp on the non-profit Empower SCI: a residential rehabilitation program for individuals with spinal cord injuries. Carrie Callahan is a physical therapist and one of the founders of Empower SCI and Matthew Bremekamp was a participant in the program who has now become a mentor with Empower SCI.
In this episode, we discuss:
-Empower SCI’s mission to integrate patients back into their community
-The benefits of volunteering with a non-profit
-A multitude of ways to get involved and support Empower SCI
-Carrie and Matthew’s favorite memories while working with Empower SCI
-And so much more!
“A lot of the topics that are covered in inpatient rehab are vital to survival but not necessarily knowing how to enjoy life once again.”
“Those seeds were planted and the information that was given to him years ago as a participant has literally rolled into this full, meaningful, substantive existence for him that he could come back and share.”
“The power of the human spirit is the biggest thing that I’ve learned about during the time we’ve had Empower.”
“Look at life more of as a why not instead of a why.”
For more information on Carrie:
Carrie Callahan has practiced physical therapy for over 12 years, graduating from Ithaca College in 2003. She currently specializes in seating, positioning and wheeled mobility, earning her Assistive Technology Professional Certification in 2015, and now holds a position as Territory Sales Manager for Permobil, TiLite and ROHO products in the Boston area. She has a passion for teaching manual wheelchair skills, and has led Empower SCI in teaching these skills at Abilities Expos and through day courses for students, therapists and wheelchair-users in the Long Island and Boston communities. She also enjoys taking part in the adaptive sports community through Spaulding Adaptive Sports Centers, and in January of 2016, she was part of a team of one doctor and three clinicians who pioneered the monthly Adaptive Sports Medicine Clinic at Spaulding Rehabilitation Hospital. At Empower, she is co-founder and president of the program, leader of wheelchair skills activities, leader of the Knobby Tire Ride and Roll Fall fundraiser, coordinates participant applications and communications, and loves to co-lead the Back on Board surfing event each July with the Testaverde Foundation.
For more information on Empower SCI:
Empower SCI is a non-profit corporation established to enable individuals with spinal cord injuries to lead happier, more meaningful and more independent lives. Empower SCI seeks to fill the gap in the rehabilitation industry that has been created by a decrease in length of stays at rehabilitation hospitals and outpatient services during the recovery from a spinal cord injury.
Through community outreach and a two week residential rehabilitation program at Stony Brook University in Long Island, NY, Empower SCI will provide the knowledge, tools, strength, and support that individuals with spinal cord injuries need to thrive.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Empower SCI Website
Empower SCI Facebook
Empower SCI Twitter
Matthew Bremekamp LinkedIn
Matthew Bremekamp Twitter
Matthew Bremekamp Facebook
Carrie Callahan Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Secili DeStefano, PT, DPT on the show to discuss the International Pelvic Pain Society and the importance of mentorship. Secili received her Master’s (2001) and Doctorate (2007) degrees in physical therapy from Marymount University. Secili administers premium care to a large, diverse population of outpatient orthopedic patients. She has a special interest in rehabilitating the biomechanics including the ribs, spine, hips and pelvis.
In this episode, we discuss:
-Secili’s highlights from the International Pelvic Pain Society
-Why you should seek mentorship opportunities at conferences
-The most important traits a mentor should possess
-What qualities should a mentee look for in their mentor
-And so much more!
“Mentorship is bilateral.”
“Mentoring is just one piece of a bigger puzzle of mastery.”
“Sometimes you just need that person to give you permission to change your self-talk.”
“Struggle builds strength. We are all going to have struggles but in that, what opportunities are there for you to be successful in the future.”
For more information on Secili:
Secili received her Master’s (2001) and Doctorate (2007) degrees in physical therapy from Marymount University. Secili administers premium care to a large, diverse population of outpatient orthopedic patients. She has a special interest in rehabilitating the biomechanics including the ribs, spine, hips and pelvis. Over the past several years in practice, she has focused on preventing injuries, promoting health and wellness, and creating solutions for complex and persistent pain. Secili is a manual therapist, and performs Triggerpoint Dry Needling (TDN) and utilizes Graded Motor Imagery. She is also certified and performs a variety of different prevention and optimization programs for athletes. She uses RealTime UltraSound Imaging to assist the patients in optimizing movement and performance. Her heart for patients locally, nationally and internationally leads her to foster research, speak, and consult on a wide variety of healthcare topics.
Secili also provides care for men’s and women’s pelvic health (bowel, bladder, sexual dysfunction and incontinence), conditions specific to athletes, breast health, pre-partum, pregnancy, post-partum, bone health, osteoporosis and osteopenia, persistent pain (fibromyalgia, chronic fatigue and other widespread chronic pain syndromes), postsurgical health and restoration (e.g. post-hysterectomy, C-section, post-prostatectomy, etc.), hypermobility syndromes (e.g., Ehler’s Danlos), pelvic, back, hip and sacroiliac joint pain and dysfunction (e.g., Femoral Acetabular Impingement). She assesses and fabricates custom orthotics; evaluates and consults area businesses on worksite ergonomics; and provides health, wellness, consulting and screening services to area athletic programs, travel teams, and specialty programs including Olympic hopefuls, high level football players, dancers, swimmers and soccer players. Secili is committed to optimizing patients’ movement and performance.
Secili has received numerous professional awards and certifications resulting from her work experience, continuing education pursuits and her involvement in her professional associations. She serves on many national task forces and work groups for improving health care. Currently, she is serving on the American Physical Therapy Association (APTA) NEXT Conference Work Group and APTA She has served as the Virginia Physical Therapy Association Vice President and Delegate to the APTA House of Delegates. She has served as the Director of Research for the APTA Section on Women’s Health. Secili is a Certified Direct Access Practitioner, which means that she is able to practice without a referral from another practitioner. She has received the distinction of Certified Orthopedic Specialist and Emerging Leader from the APTA. Secili has served as a Center Coordinator of Clinical Education and is a Certified Clinical Instructor. She has also been honored as a Distinguished Commencement Speaker. She is currently teaching at George Mason University in their Department of Health Administration and Policy. Her first year as a Mason professor, she was nominated by the students for the Career Connection Faculty Award.
Prior to her career as a physical therapist, Secili worked as a student athletic trainer in the University of Texas athletic department. Secili has her own decorated past in sports including Go Ruck, Spartan Races, marathons, weight lifting, dancing, swimming and gymnastics. She enjoys spending time with her husband, two children, friends and extended family, as well as, traveling and reading.
Resources discussed on this show:
International Pelvic Pain Society
Secili DeStefano Twitter
Bodies in Motion PT Website
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the New York Student Special Interest Group Conference, I welcome Dr. Chanelle Yoder, DPT on this episode to chat about story telling. Chanelle is a Doctor of Physical Therapy, specializing in manual therapy and functional medicine, and an esteemed storyteller + author in progress. She is a cash-based concierge practice PT business owner, proudly servicing individuals in Southern Indiana.
In this episode, we discuss:
-How a clinician can build trust through vulnerability
-How to incorporate story telling into your practice
-When you should introduce industry knowledge into your patient’s care
-Chanelle’s self-care tips to ensure you show up at every patient visit
-And so much more!
“The more humanistic you can appear to someone else, the more humanistic you can make them feel about you.”
“When you’re really trying to transform someone’s life from a health perspective, it becomes very important to reach them at a very deep level that’s very impossible to find strictly from a clinical perspective.”
“It’s all about finding the feeling you have in common.”
“So many people just want to be heard and they want to know that you truly respect where they are coming from versus just pushing your agenda.
“We are not going to jive with everybody.”
For more information on Chanelle:
Dr. Yoder graduated from the University of Indianapolis with a Bachelors of Science in Human Biology and minor in Psychology in 2007. She applied to DPT school 15 times before temporarily accepting defeat, consequently accepting enrollment for PTA school at the University of Indianapolis, thus graduating with her Associate of Science in Physical Therapy Assistance in 2009. Chanelle reapplied to DPT school yet again, only this time to the flex DPT program at the University of St.Augustine, FL. Dr. Yoder was finally offered admission, and successfully endured 4 years of bi-weekly cross-country commutes to earn her DPT in August 2014.
Dr. Yoder has utilized her extensive experience within each setting of physical therapy, including acute and post-operative orthopaedics, acute-TBI-CVA, sub-acute rehab, home health care, outpatient manual orthopaedics, acute cardiopulmonary care, and skilled nursing care, to fuel her approach to relationship-centered concierge-based integrative physical therapy.
The many ups and downs of her journey, in addition to the accompanying wisdom earned, have been remarkably documented through her personal storytelling within the online media marketplace, successfully fueling her organic business marketing, patient-centered outcomes, and adjacent career fulfillment. Her proven theory to success in the art of relationship building via organic storytelling is the primary inspiration to her digital course, The Enchantment Method©️, an academy transforming clinicians into story-rich, content dominating, relationship-obsessed masterminds.
Resources discussed on this show:
Embody Boss Website
Embody Boss Facebook
Chanelle Yoder Facebook
Chanelle Yoder LinkedIn
Embody Boss Instagram
Brene Brown Website
Fearless Speaker 1/2 MasterClass
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Jenna Kantor, DPT guest hosts and interviews Dr. Andrew Tran, DPT on building a business from memes. Andrew Tran is a Physical Therapist who has worked in a variety of settings as a new grad. From travel PT, to Skilled Nursing Facility, outpatient ortho, and starting his own practice in his first two years. He is the founder of Physio Memes, LLC with the goals of connecting Physios globally via humor and merchandise to proudly represent our profession. Also, owner of Transcend Health, LLC which is an outpatient private practice with the vision to create a healthy, empowered, and educated community to build a life of resilience.
In this episode, we discuss:
-How Andrew got started in building physical therapy memes
-From hobby to business: Andrew runs through some of the business 101 basics
-Why entrepreneurs must master time management
-Andrew’s advice to ignite the fire for budding entrepreneurs
-And so much more!
“I had no clue how to turn this into a business.”
“If I’m going to do this, I have to be consistent.”
“The big thing was time.”
“Take that first initial step.”
For more information on Andrew:
Andrew Tran is a Physical Therapist who has worked in a variety of settings as a new grad. From travel PT, to Skilled Nursing Facility, outpatient ortho, and starting his own practice in his first two years. He is the founder of Physio Memes, LLC with the goals of connecting Physios globally via humor and merchandise to proudly represent our profession. Also, owner of Transcend Health, LLC which is an outpatient private practice with the vision to create a healthy, empowered, and educated community to build a life of resilience.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Physio Memes Website
Physio Memes Instagram
Andrew Tran Instagram
Andrew Tran Facebook
Transcend Health Facebook
Shopify
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Jasmine Williams on the act of giving. Jasmine Williams is a Doctorate of Physical Therapy student who has a desire for inspiring people and Pre-DPT students. Jasmine enjoys sharing information to those who want to pursue a career in physical therapy along with inspiring individuals through her experiences as a Doctor of Physical Therapy Student.
In this episode, we discuss:
-The benefits of giving to others
-Easy ways you can begin giving to others daily
-Jasmine’s most rewarding experience helping an individual
-And so much more!
“You get to see the product of what you put into that person.”
“If you don’t regularly give, you could have other people missing out on what ever goodness you could be giving to that person.”
“It can amplify with one simple act of giving.”
For more information on Jasmine:
Jasmine Williams is a Doctorate of Physical Therapy student who has a desire for inspiring people and Pre-DPT students. She enjoys playing volleyball, roller skating, biking, listening to music and spending time with the people she loves.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Jasmine Williams Facebook
Jasmine Williams Twitter
Jasmine Williams Instagram
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jenn Edden on the show to discuss how to manage cravings. Jenn Edden is a sugar addiction expert, author and empowerment coach for over 14 years. She is a graduate of the Institute for Integrative Nutrition in NYC and is certified by the American Association of Drugless Practitioners.
In this episode, we discuss:
-How entrenched habits impact cravings
-What ingredients to look for on food labels
-Jenn’s food recommendations to energize your morning
-Food rotation strategies to prevent habit formation
-And so much more!
“When your gut is out of whack, you crave sugar.”
“Diets don’t work.”
“Cleaning up what you eat when you’re not out is imperative.”
“Packaging is deceiving.”
“It doesn’t have to be as expensive as people think.”
“Real whole food over processed will always win out in the body.”
“Being healthy is simple.”
For more information on Jenn:
Jenn Edden is a sugar addiction expert, author and empowerment coach for over 14 years. She is a graduate of the Institute for Integrative Nutrition in NYC and is certified by the American Association of Drugless Practitioners. Jenn holds a Bachelor of Science in Biochemistry from Stony brook University and attended medical school briefly before deciding that wasn’t the right path for her. Growing up with depression and anxiety, Jenn has seen the effects first hand of what sugar can do to your physical and mental well being. After healing herself of gastritis in her mid 20’s Jenn had since dedicated her time and energy to spreading the message about how to kick and manage sugar addiction in a non depriving way.
How many times do you get to the end of your day wishing you could have done it differently? And for sure with more energy and without that extra cup of coffee and 3pm snack that has left you not only hungry for something more but has just sabotaged your never ending weight loss goals! Jenn aims to give us back the power that you somehow lost in your busy life without dieting, deprivation or denial. She simplifies the complex while delivering real results in life, food and business.
To grab a complimentary copy of Jenn’s book and learn how to kick cravings in under 7 days download it here …https://jecoaching.com/freecopywomanunleashedbook/
Resources discussed on this show:
Amazon Fresh
Jenn Edden Coaching Website
Jenn Edden Twitter
Jenn Edden Facebook
Woman Unleashed Book
EWG Guide to the Dirty Dozen
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Dr. Meghan Wieser on dance physical therapy. Meghan is a Doctor of Physical Therapy and Certified Strength and Conditioning Specialist and received her PT degree from Widener University. She enjoys working with motivated individuals who take an active role in their health. She loves working with dancers, athletes, and active adults.
In this episode, we discuss:
-Why Meghan became a dance physical therapist
-Do you have to be a dancer to treat dancers?
-Is dance a sport?
-Meghan’s recommendations and resources on dance physical therapy
-And so much more!
“Half of PT is building a relationship with somebody.”
“If you can’t connect to what they do every single day—what they live and breathe—you’re only going to get them so far.”
“Shadow somebody who treats dancers.”
“Immerse yourself in the art first.”
For more information on Meghan:
I’m a Doctor of Physical Therapy and Certified Strength and Conditioning Specialist and received my PT degree from Widener University. I enjoy working with motivated individuals who take an active role in their health. I love working with dancers, athletes, and active adults. I’m an avid traveler and love trying new foods and learning about the cultures of the places I travel to. I’m a very active person, I dabble in a little bit of everything: weightlifting, yoga, running, hiking, etc. I have a strong passion for physical therapy and hope to someday change the face of healthcare.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Meghan Wieser Instagram
Meghan Wieser Facebook
Meghan Wieser Personal Facebook
Neuro Tour Website
Performing Arts Special Interest Group
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Jon Mulholland on the show to discuss how to get involved on the medical team for Olympic athletes. Dr. Mulholland has acted as the Chiropractic Consultant for the United States Olympic Training Center in Lake Placid, NY, and has traveled extensively as one of the team chiropractors for the US Bobsled & Skeleton Teams. He has worked multiple World Championship events in a variety of sports, and has treated athletes from dozens of different countries. He was also the Sports Medicine & Performance Enhancement consultant for the New Zealand Cycling Teams at the 2012 Summer Olympic Games in London, where he helped the team win two Olympic medals.
In this episode, we discuss:
-How health professionals can get involved with Olympic Athletes
-Jon’s experiences working in the Olympic village
-Common misconceptions about the Chiropractic and Physical Therapy professions
-Key habits that high-level athletes have developed to enhance their performance
-And so much more!
“If the athlete thinks it works—it works. Period.”
“Have a good skillset and be a good person.”
“If you’ve ever worked with sport, it sounds glamorous, but it rarely is.”
“Show up every day.”
“It’s a long-term commitment in the world of Olympics.”
For more information on Jonathan:
Dr. Mulholland has earned both his Bachelor’s Degree in Exercise Science and his Doctor of Chiropractic degree. He also holds two post-graduate qualifications in sports chiropractic, in addition to being a Certified Strength & Conditioning Specialist.
Dr. Mulholland has acted as the Chiropractic Consultant for the United States Olympic Training Center in Lake Placid, NY, and has traveled extensively as one of the team chiropractors for the US Bobsled & Skeleton Teams.
He has worked multiple World Championship events in a variety of sports, and has treated athletes from dozens of different countries. He was also the Sports Medicine & Performance Enhancement consultant for the New Zealand Cycling Teams at the 2012 Summer Olympic Games in London, where he helped the team win two Olympic medals.
He lectures regularly around the world and treats patients at his private clinic when he isn’t traveling. He currently lives in Plattsburgh, NY with his wife and two children where he spends most of the year trying to stay warm.
Resources discussed on this show:
Ideal Athlete Chiropractic Website
Jon Mulholland Twitter
Ideal Athlete Chiropractic Facebook
United States Olympic Committee Website
Rehab Therapy Operational Best Practices Forum
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Megan Leigh McLain on physical therapy advocacy. Megan McLain is a new graduate physical therapist from Atlanta, Georgia with a passion for advocacy. She is working in outpatient orthopedics and enjoys treating patients in persistent pain and those with chronic illnesses.
In this episode, we discuss:
-How Megan became interested in advocacy
-Is it difficult for physical therapists to get involved in advocacy?
-How telehealth can improve access to underserved populations
-Future advocacy efforts in pain science
-And so much more!
“All of us are advocates for PT.”
“We do not have pain science education in our curriculum.”
“The National Advocacy Dinners for students are a great idea.”
For more information on Megan:
Megan McLain is a new graduate physical therapist from Atlanta, Georgia with a passion for advocacy. She is working in outpatient orthopedics and enjoys treating patients in persistent pain and those with chronic illnesses.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
American Physical Therapy Association Website
Megan Leigh McLain Facebook
Megan Leigh McLain Instagram
Megan Leigh McLain Twitter
CONNECT for Health Act of 2017
Fearless Speaker 1/2 Day Workshop
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Tim Gabbett on the show to debunk myths about training load, injury and performance. Tim holds a PhD in Human Physiology (2000) and has completed a second PhD in the Applied Science of Professional Football (2011) , with special reference to physical demands, injury prevention, and skill acquisition. Tim has published over 200 peer-reviewed articles and has presented at over 200 national and international conferences. He is committed to performing world-leading research that can be applied in the ‘real world’ to benefit high performance coaches and athletes.
In this episode, we discuss:
-The acute:chronic workload ratio and how it relates to risk of injury
-Is the 10% rule foolproof?
-Ways to quantify training loads
-Practical ways for practitioners to translate research into the clinic
-And so much more!
“Social media is great for sharing information but sometimes those myths get perpetuated on social media and they grow.”
“Risk doesn’t equal rate.”
“We don’t coach the number—we coach the athlete, we coach the patient.”
“Load is just part of the puzzle.”
“When you’re in the basement or when you’re in the ceiling, keep the percentage changes in load from week to week quite small but if you have moderate to high chronic loads then you can probably progress a little quicker.”
For more information on Tim:
Dr. Tim Gabbett has 20 years experience working as an applied sport scientist with athletes and coaches from a wide range of sports.
He holds a PhD in Human Physiology (2000) and has completed a second PhD in the Applied Science of Professional Football (2011) , with special reference to physical demands, injury prevention, and skill acquisition.
Tim has worked with elite international athletes over several Commonwealth Games (2002 and 2006) and Olympic Games (2000, 2004, and 2008) cycles. He continues to work as a sport science and coaching consultant for several high performance teams around the world.
Tim has published over 200 peer-reviewed articles and has presented at over 200 national and international conferences. He is committed to performing world-leading research that can be applied in the ‘real world’ to benefit high performance coaches and athletes.
Resources discussed on this show:
Gabbett TJ Debunking the myths about training load, injury and performance: empirical evidence, hot topics and recommendations for practitioners Br J Sports Med Published Online First: 26 October 2018. doi: 10.1136/bjsports-2018-099784
Gabbett Performance Website
Tim Gabbett Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Linda Ugelow on the show to discuss how to develop public speaking confidence. Linda Ugelow is a presentation and confidence coach who helps new and seasoned professionals overcome the fear of public speaking while communicating effortlessly and effectively across different media.
In this episode, we discuss:
-Identifying the underlying stress factors of being seen and heard
-How to master the art of inner communication
-How visibility can fast track your career, credibility and thought-leadership
-Reframing why you are delivering your message to your audience
-And so much more!
“Fear is something that you have and you have to push through it because otherwise you won’t get things done.”
“If you don’t feel safe inside yourself, you’re not going to feel safe in front of other people.”
“Give some compassion to that inner critic. Recognize that the reason the critic is there is to protect us.”
“Get comfortable with saying nice things to yourself.”
“Fill yourself with your own internal validation and everything that comes out from the external is bonus.”
For more information on Linda:
Linda Ugelow is a presentation and confidence coach who helps new and seasoned professionals overcome the fear of public speaking while communicating effortlessly and effectively across different media.
As a performer of 35 years and with a master’s degree in expressive therapies and movement studies, she’s been helping people get comfortable in their own skin for decades.
Linda is also the producer and host of the TV show Women Inspired which can be found on her website www.lindaugelow.com/shows
Resources discussed on this show:
Linda Ugelow Facebook
Linda Ugelow LinkedIn
Linda Ugelow Youtube
Linda Ugelow Twitter
Linda Ugelow Instagram
Linda Ugelow Website
Free guided visualization for speaking confidence
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Ruth Backlund on emotional and physical trauma. Ruth Backlund is the founder and owner of Energy Works Myofascial Release, specializing in John Barnes Myofascial Release and Active Myofascial Therapy- Irene Diamond. She helps active men and women enhance their health and well-being, improve mobility, and avoid unnecessary surgery.
In this episode, we discuss:
-The difference between emotional and physical trauma
-Should physical therapists differentiate trauma with their patients?
-How Ruth reacts to emotional patients to facilitate the healing process
-The importance of being present with patients who may be dealing with emotional trauma
-And so much more!
“Emotional trauma is usually less visible.”
“Everybody has emotional trauma. Everybody has physical trauma.”
“Sometimes with emotional trauma, they blank out.”
“Rushing in abrupts that processing of that emotion.”
“Don’t judge them in advance.”
“A person comes in as a whole package.”
For more information on Ruth:
Ruth Backlund, RN, BSN, CGEI
RN – 30 yrs
Expert Level MFR Therapist – 9 yrs
Founder and Owner of Energy Works Myofascial Release, specializing in John Barnes Myofascial Release and Active Myofascial Therapy- Irene Diamond.
I help active men and women enhance their health and well-being, improve mobility, and avoid unnecessary surgery.
I use a clinically comprehensive whole-body approach to healing through gentle myofascial stretching to decrease pain and increase range of motion.
My goal is to help my clients achieve physical and emotional health and well-being by facilitating the healing journey, teaching self-care techniques, and enable sustained long-lasting relief.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Energy Works Myofascial Release Website
Ruth Backlund Instagram
Energy Works Myofascial Release Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Steph Lagana on the show to discuss morning routines. Steph Lagana is a Business Strategist and Spiritual Teacher. She leverages her background in national security to ground conversations on intuition and the energetics of business. Steph works with women to build their business and align with their strengths so they can market themselves naturally and powerfully in service of their calling.
In this episode, we discuss:
-Myths surrounding morning routines
-Practical strategies to implement your unique morning routine
-How long should I commit to develop a new habit?
-The benefits a morning routine can have on both your life and business
-And so much more!
“A morning routine can be anything that really you want to turn it into.”
“When you design your morning routine, you get to win your day.”
“You don’t have to do the same thing every day.”
“Be kind to yourself and honor that sometimes things happen.”
“If you allow yourself to set those boundaries, you can absolutely win your day.”
“The framework that works is the one that works for you.”
“You can revolutionize your life with tiny habits.”
“Your morning routine does not have to look like anyone else’s.”
For more information on Steph:
Steph Lagana is a Business Strategist and Spiritual Teacher. She leverages her background in national security to ground conversations on intuition and the energetics of business. Steph works with women to build their business and align with their strengths so they can market themselves naturally and powerfully in service of their calling.
Resources discussed on this show:
Steph Lagana Facebook
Steph Lagana Instagram
Mythical Enterprises Website
Miracle Morning Book
Tiny Habits Website
Your Sacred Craft Facebook Group
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Dr. Kitiboni Adderley on continuing education for international physical therapists. Kitiboni (Kiti) Adderley is the Owner & Senior Physical Therapist of Handling Your Health Wellness & Rehab. Kiti graduated from the University of the West Indies School of Physical Therapy, Jamaica, in 2000 and obtained her Doctorate of Physical Therapy from Utica College, Utica, New York, in 2017. Over the last 10 years, Kiti has been involved in an intensive study and mentorship of Oncology Rehabilitation and more specifically, Breast Cancer Rehab where her focus has been on limiting the side effects of cancer treatment including lymphedema, and improving the quality of life of cancer survivors.
In this episode, we discuss:
-The importance of continuing education
-Common barriers to pursuing continuing education
-Highlights from Kitiboni’s experiences in post-professional education
-Kitiboni’s top recommendations for professional development
-And so much more!
“The medical spectrum is changing so quickly.”
“You have to stay learning. Don’t get comfortable where you’re at.”
“Learn a new skill so you can serve your population better.”
“Find an authority in something that you love.”
“There’s almost no excuse to not be better educated.”
For more information on Kitiboni:
Kitiboni (Kiti) Adderley is the Owner & Senior Physical Therapist of Handling Your Health Wellness & Rehab. Kiti graduated from the University of the West Indies School of Physical Therapy, Jamaica, in 2000 and obtained her Doctorate of Physical Therapy from Utica College, Utica, New York, in 2017. Over the last 10 years, Kiti has been involved in an intensive study and mentorship of Oncology Rehabilitation and more specifically, Breast Cancer Rehab where her focus has been on limiting the side effects of cancer treatment including lymphedema, and improving the quality of life of cancer survivors. She has been a Certified Lymphedema Therapist since 2004. She is also a Certified Mastectomy Breast Prosthesis and Bra Fitter and Custom Compression Garment Fitter.
Kiti is avid believer in continuing education to advance her skills and improve her treatment offerings to her patients and clients. She has a passion for orthopedic and women's health and strives to provide high quality, personalized care. She is a very manual therapist and is trained in Myofascial Release and McKenzie's Techniques she is certified in Pregnancy Massage and is a Certified Kinesio Taping Practitioner and Instructor.
As she continues grow and to expand her skills, she provides a higher standard of care for the community she serves. Kiti believes prevention is better than cure and that there must be a holistic approach to the patient and the community. She has dedicated her time and knowledge educating the public about wellness and how to manage chronic non communicable diseases such as diabetes and hypertension. She is about to launch her podcast “H.E.A.R. (Health Education Awareness & Rehabilitation) Caribbean” which will highlight the Medical and Wellness Professionals and education those in the region and beyond.
Kiti is a Professional Advisor of The Bahamas Breast Cancer Initiative Foundation, the One Eleuthera Foundation and a Susan G Komen Breast Cancer Educator. She has served as President of the Bahamas Association of Physiotherapists for four years and currently represents the Bahamas at the World Confederation for Physical Therapy. She has worked with numerous National Sports Teams and has volunteered with the National Kingdor Parkinsons Association.
Kiti enjoys spending time with her husband, and her three daughters. She also enjoys immersing herself in Nature, traveling and experiencing other cultures, reading, cooking and crafting.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Handling Your Health Wellness and Rehab Website
Kitiboni Adderley Twitter
Handling Your Health Instagram
Handling Your Health Facebook
HEAR Caribbean Podcast Facebook
Kitiboni Adderley Facebook
Kitiboni Adderley LinkedIn
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Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Kevin Schmidt on the show to discuss cycling in physical therapy. Kevin Schmidt is a Physical Therapist and Clinical Bike Fitter in Portland, Oregon who founded his own niche bike-centric PT practice ‘Pedal PT’ in 2012. His office is a unique hybrid insurance/ cash-pay model which is 95%+ direct access, that sees the full gamut of Orthopedic musculoskeletal rehab clients, with a specialty in bike fit and solving complex cycling injuries. Pedal PT also is the first private practice in the country to be certified in both Sustainability practices and Bike Friendliness, and is active in the local cycling community, including their popular monthly ‘Free Coffee for Bicyclists’ events.
In this episode, we discuss:
-Kevin’s journey to becoming a bike-centric physical therapist
-Why physical therapists are uniquely qualified for bike fitting
-The benefits of franchising a cyclist physical therapy business model
-Strategies to build mutual engagement and support from local businesses
-And so much more!
“This job is part PT, part wrench monkey.”
“The physical therapist is the best person to perform bike fits.”
“I estimate that roughly 70% of equipment that’s sold during bike fit these days is unnecessary for people to achieve pain free cycling.”
“When we are talking about a franchise, we are selling a business model.”
“The more that you give away, the more it comes back to you so much more.”
“Don’t be afraid to put yourself into situations that make you nervous.”
For more information on Kevin:
Kevin Schmidt is a Physical Therapist and Clinical Bike Fitter in Portland, Oregon who founded his own niche bike-centric PT practice ‘Pedal PT’ in 2012. His office is a unique hybrid insurance/ cash-pay model which is 95%+ direct access, that sees the full gamut of Orthopedic musculoskeletal rehab clients, with a specialty in bike fit and solving complex cycling injuries. Pedal PT also is the first private practice in the country to be certified in both Sustainability practices and Bike Friendliness, and is active in the local cycling community, including their popular monthly ‘Free Coffee for Bicyclists’ events.
At it's core, Pedal PT is value-driven company, and all employees are required to cycle to work year-round. Pedal PT's model of Bike Fitting is designed to be a collaborative approach with local bike shops vs competing with them. The office design was fully built-out with bike amenities, indoor bike parking, bike tools/equipment, bike fit station (with proprietary designed and built bike trainer), and changing rooms.
As of June 1st, Kevin completed the final FDD paperwork to be able to Franchise this innovative model, and is now on a mission to build a community of Pedal PT “cycling healthcare revolutionaries” throughout the US to elevate the PT profession within the realm of treating cyclists, and create a united voice to address bike fit without being driven by bike industry.
Resources discussed on this show:
Pedal PT Website
Pedal PT Facebook
Pedal PT Twitter
Pedal PT Instagram
Kevin Schmidt Instagram
Bike PT Website
Bike Fit Website
Specialized Website
Franchise Pedal PT
Email: kevin@pedalpt.com
2018 PPS Annual Conference: Bike Fitting roundtable with Erik Moen, PT
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the New York Student Special Interest Group Conference, I welcome Dr. Kyle Rice on the show to discuss NPTE preparation. Dr. Kyle Rice is a licensed Physical Therapist and the CEO of the PT Hustle, LLC, a company that specializes in one-on-one coaching and strategy development for the National Physical Therapy Examination (NPTE).
In this episode, we discuss:
-How to develop your own personal study guide
-Why you should avoid study bait during your test preparation
-Time management tips to make the most of the limited time before the October NPTE
-And so much more!
“You have to build your own personal study list.”
“Make sure you stick to the list you built.”
“Common sense is not common practice.”
“Find someone who is already at your point B or beyond because they will give you the quickest routes to get there.”
For more information on Kyle:
Dr. Kyle Rice is a licensed Physical Therapist and the CEO of the PT Hustle, LLC, a company that specializes in one-on-one coaching and strategy development for the National Physical Therapy Examination (NPTE). Kyle graduated from Florida International University (FIU) in 2013 with his doctoral degree in Physical Therapy. He also received his Orthopedic Certified Specialization after graduating from the Brooks/UNF Orthopedic Residency Program in 2016. Over the past five years, Dr. Rice has served successfully as the NPTE Prep Coach for over 150 physical therapists and has assisted over 3000 student physical therapists pass the NPTE with his courses, lectures, podcasts, and intimate discussions about NPTE preparedness.
Resources discussed on this show:
The PT Hustle Website
Free Quick Read Ebook, "9 Strategies Students Are Using To Get Over a 700 on the NPTE"
The PT Hustle Facebook
Kyle Rice Instagram
Kyle Rice Twitter
Kyle Rice Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Stacy Menz back on the show to discuss the Private Practice Section’s Impact Magazine and 2018 Annual Conference. Stacy Menz, PT, DPT, PCS is the editor of Impact Magazine, a pediatric clinical specialist and the owner of Starfish Therapies. Stacy received her Master’s degree at Boston University in 2000 and her Doctorate of Physical Therapy at Boston University in 2005. She is the founder and owner of Starfish Therapies a pediatric physical therapy company in the San Francisco Bay Area.
In this episode, we discuss:
-The importance of collaboration as a leader
-Commonalities within leadership positions in different physical therapy settings
-A behind-the-scenes look at Impact Magazine
-How Stacy prepares to make the most of her PPS annual conference experience
-And so much more!
“There’s a place there for everybody.”
“I am a huge fan of collaboration and I don’t want to reinvent the wheel.”
“You’re always going to get stuff from the sessions but it’s about who you meet at the bar or at lunch that can really make your conference--It’s the conversations you weren’t expecting to have or that person you weren’t expecting to meet.”
“Don’t wait till you have that question and don’t be afraid to reach out.”
“Be involved.”
“Share or use the resources.”
For more information on Stacy:
Stacy Menz, PT, DPT, PCS is a pediatric clinical specialist and the owner of Starfish Therapies. Stacy received her Master’s degree at Boston University in 2000 and her Doctorate of Physical Therapy at Boston University in 2005. She is the founder and owner of Starfish Therapies a pediatric physical therapy company in the San Francisco Bay Area. Their mission is to make a difference in the lives of each child and family that they interact with. In addition, Stacy has experience as a teaching/lab assistant for Boston University, South College, and Chapman University's Doctor of Physical Therapy programs, has presented at state and national conferences, and teaches continuing education courses for pediatric physical therapy. She is the editor of Impact, the Private Practice Section's magazine and is a board member for KEEN San Francisco. She is also involved in both her state and national pediatric physical therapy sections. She has been interviewed on Sirius XM's Doctor Radio regarding pediatric orthopedic conditions, as well as Profiles in Leadership and Start a Therapy Practice.
Resources discussed on this show:
Private Practice Section
Impact Magazine
PPS 2018 Annual Conference
Starfish Therapies Website
Stacy Menz Twitter
Starfish Therapies Twitter
Starfish Therapies Instagram
Email: stacy@starfishtherapies.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Juan Michelle Martin on why pelvic health is gaining popularity. Juan Michelle Martin earned a Doctorate of Physical Therapy (DPT) in 2007 from New York Institute of Technology and over the last 10 years she has amassed significant experience in orthopedics, women’s health including high risk pregnancy, pediatrics and neurological disorders both within the acute and outpatient settings.
In this episode, we discuss:
-Juan’s transition from outpatient orthopedics to pelvic health specialty
-Stigma surrounding pelvic health conditions
-How to find a qualified pelvic health physical therapist
-And so much more!
“I always wanted to dive into that niche but having kids solidified it for me.”
“There’s more popularity due in part to social media.”
“Just because it’s common does not mean its normal.”
“If you have an issue, you shouldn’t have to suffer.”
For more information on Juan:
Originally from the beautiful island nation of Barbados, I moved to the US for college via a volleyball scholarship. At the time I also had the honor of representing the Barbados Senior National Volleyball team having competed at the junior level. I earned a Bachelors degree in Biology in 2004 from the University of Montevallo with minors in Psychology and Kinesiology as I knew I wanted to pursue a career in therapy and wellness, due in part to my own personal experience as an athlete. As a student and athlete I also had the privilege of working in the training room under the head athletic trainer and expanding my knowledge base regarding return to sport from injury as well as prevention. I earned a Doctorate of Physical Therapy (DPT) in 2007 from New York Institute of Technology, working as a graduate assistant in the athletic training department with several of their sports teams while there.
Over the last 10 years I have amassed significant experience in orthopedics, women’s health including high risk pregnancy, pediatrics and neurological disorders both within the acute and outpatient settings. However my desire to focus on women’s health came not only out of a love from my work experiences but developed even more as a result of my own experience with 2 pregnancies. I developed stress urinary incontinence during the pregnancy which seemed to worsen after and more with my second child. After engaging in rehabilitative exercises and strengthening, I was able to return more intense physical exercise, without any issues.
I have continued to strengthen my skills and knowledge through mentorship with other amazing therapists within the field as well as several continuing education courses to continue to focus on evidenced based treatments and solutions. My goal with JMM Health Solutions is to bring awareness to the area of pelvic health and all it’s associated issues, not only for the female, but also the male and pediatric populations. Just because it’s common doesn’t mean it’s normal!
When not treating patients I love to spend time with my family, my awesome dog Miko, Crossfit and other sports.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Email: jmmartin@jmmhealthsolutions.com
JMM Health Solutions Website
APTA Women's Health Directory
Herman and Wallace Directory
Pelvic Guru Directory
JMM Health Solutions Facebook
JMM Health Solutions Instagram
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Alison Sim on the show to discuss persistent pain. Alison Sim has a keen interest in educating health professionals about the latest science surrounding pain, especially pain that hangs around – chronic or persisting pain. Alison qualified as an osteopath in 2001. She has a Masters of Pain Management from Sydney University Medical School and Royal North Shore Pain Management Research Institute. She has lectured at Australian Catholic University, Victoria University, RMIT and George Fox University in a variety of science and clinical subjects. She has also worked as part of the teaching team at Deakin University Medical School and is currently based in Melbourne, Australia.
In this episode, we discuss:
-Societal and financial implications of chronic pain
-How Alison develops a therapeutic alliance with patients with persistent pain
-Lessons from Pain Heroes: Stories of Hope and Recovery
-The importance of empowering patients and enhancing their control over their symptoms
-And so much more!
“People are starting to catch on but these things take ages to translate through to shifts in healthcare systems.”
“A multimodal, biopsychosocial approach is what’s required to get the best outcomes.”
“I really place a lot of value on listening and understanding. From that platform, you have a lot more opportunity to make change.”
“Don’t take the responsibility of the patient’s outcomes to heart.”
For more information on Alison:
Alison Sim has a keen interest in educating health professionals about the latest science surrounding pain, especially pain that hangs around – chronic or persisting pain.
Pain science can be quite disheartening as a topic – there are no magic bullets or quick fixes. The science can sometimes paint a bleak picture of poor outcomes for any single modality approach. This makes engaging with this material difficult and the result is that practitioners might choose to avoid exploring the material at all. Alison’s seminars and workshops aim to investigate the approaches that have a strong evidence base of proven results and demonstrate how they can be applied in clinical practice. This means better outcomes for your clients and patients.
Alison qualified as an osteopath in 2001. She has a Masters of Pain Management from Sydney University Medical School and Royal North Shore Pain Management Research Institute. She has lectured at Australian Catholic University, Victoria University, RMIT and George Fox University in a variety of science and clinical subjects. She has also worked as part of the teaching team at Deakin University Medical School and is currently based in Melbourne, Australia.
Alison works part time at Brighton Spinal and Sports Clinic and welcomes referrals for patients with chronic pain. http://www.brightonspinal.com.au
Resources discussed on this show:
Brighton Spine and Sports Clinic Website
Beyond Mechanical Pain Website
Pain Heroes: Stories of Hope and Recovery
Beyond Mechanical Pain Twitter
Beyond Mechanical Pain Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda, DPT guest hosts and interviews Antony Lo on biopsychosocial considerations for the female athlete. Antony has earned his degree in Physiotherapy, a Masters in Physiotherapy and took part in the Musculoskeletal Physiotherapy Specialisation training program – the highest form of training a physiotherapist can take in Australia. Having successfully grown 2 private practices (Sans Souci Physiotherapy Centre and Penshurst Physiotherapy Centre), Antony sold these to concentrate on his Specialisation Training Program and developing educational courses for health professionals and the general public. He still consults at 2 locations in Sydney seeing everyone from children to the elderly, as well as his sports-specific patients. He also travels around Australia to deliver seminar information and provide consultations for those interested in his approach.
In this episode, we discuss:
-How do we hurt females with exercise?
-Practitioner language and iatrogenic harm
-Advice for the female athlete navigating the healthcare system
-Antony’s experience treating diastasis recti
-And so much more!
“Holistic women’s health is more to me than what is just happening in the pelvic area.”
“How you do the exercise is much more important than the exercise you choose.”
“We don’t actually know mechanistically why things happen.”
“If we make something a problem and then we make a product to solve the problem, you can make money from that.”
“Being a nice person goes a long way in helping people much more than technical knowledge.”
For more information on Antony:
Physiotherapy since 1993. During this time, he has earned his degree in Physiotherapy, a Masters in Physiotherapy and took part in the Musculoskeletal Physiotherapy Specialisation training program – the highest form of training a physiotherapist can take in Australia.
Having successfully grown 2 private practices (Sans Souci Physiotherapy Centre and Penshurst Physiotherapy Centre), Antony sold these to concentrate on his Specialisation Training Program and developing educational courses for health professionals and the general public. He still consults at 2 locations in Sydney seeing everyone from children to the elderly, as well as his sports-specific patients. He also travels around Australia to deliver seminar information and provide consultations for those interested in his approach.
Antony can help you in a number of ways – his unique skill set and approach allows him to help those in pain – from those with acute injuries to those with long-term chronic pain – and those who are interested in enhancing their performance for sport, work or recreation. He mainly uses exercise, manual therapy, dry needling and various other techniques to help his clients. A big emphasis is placed on teaching you about your condition, what to do about it and how to help yourself.
For more information on Shannon:
Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women’s Health Physical Therapist and is currently the only Board-Certified Women’s Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.
Resources discussed on this show:
Physio Detective Website
Physio Detective Twitter
Physio Detective Facebook
Antony Lo LinkedIn
Physio Detective Youtube
Bulletproof Your Core and Pelvic Floor
Email: Antony@physiodetective.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Stacy Menz on the show to discuss a pediatric case study. Stacy Menz, PT, DPT, PCS is a pediatric clinical specialist and the owner of Starfish Therapies. Stacy received her Master’s degree at Boston University in 2000 and her Doctorate of Physical Therapy at Boston University in 2005. She is the founder and owner of Starfish Therapies a pediatric physical therapy company in the San Francisco Bay Area.
In this episode, we discuss:
-Impairments and developmental milestones throughout childhood
-Incorporating a home program into a family’s daily routine to enhance carry-over
-Motivational interviewing with both child and family
-Motor control and motor learning principles in pediatric treatment interventions
-And so much more!
“One of the fun things about being in pediatrics is that you’re constantly playing.”
“Nothing is stable. You can get them strong but then they grow and then all of a sudden they’re weak again.”
“There can be things the parents aren’t ready to handle at that point in time, you have to go where the parent’s at.”
“You might have the perfect plan, but you need a plan B and C and D as well.”
“The motor learning happens way faster than the strength builds up.”
For more information on Stacy:
Stacy Menz, PT, DPT, PCS is a pediatric clinical specialist and the owner of Starfish Therapies. Stacy received her Master’s degree at Boston University in 2000 and her Doctorate of Physical Therapy at Boston University in 2005. She is the founder and owner of Starfish Therapies a pediatric physical therapy company in the San Francisco Bay Area. Their mission is to make a difference in the lives of each child and family that they interact with. In addition, Stacy has experience as a teaching/lab assistant for Boston University, South College, and Chapman University's Doctor of Physical Therapy programs, has presented at state and national conferences, and teaches continuing education courses for pediatric physical therapy. She is the editor of Impact, the Private Practice Section's magazine and is a board member for KEEN San Francisco. She is also involved in both her state and national pediatric physical therapy sections. She has been interviewed on Sirius XM's Doctor Radio regarding pediatric orthopedic conditions, as well as Profiles in Leadership and Start a Therapy Practice.
Resources discussed on this show:
Starfish Therapies Website
Stacy Menz Twitter
Starfish Therapies Twitter
Starfish Therapies Instagram
Email: stacy@starfishtherapies.com
Pediatric Balance Scale
Peabody Developmental Motor Scale
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Dr. Liz Koch, DPT on work life balance. Liz was raised in western Kentucky, Paducah. She then played soccer at TN Tech while pursuing an engineering degree. She finished her engineering degree at the University of Kentucky. After taking a year off of school, she completed her doctor of PT at the University of Kentucky. Many reasons lead to the switch from engineering to PT.
In this episode, we discuss:
-Why Liz opened her own practice to achieve her ideal work life balance
-What work place qualities you should look for when applying to jobs
-How participating in hobbies increases your ability to reach out to your target population
-How to achieve a full body workout and achieve mental clarity in the outdoors
-And so much more!
“Being outside and doing activities is part of life.”
“It allows me the freedom to do what I love to do.”
“Whenever I travel to go ride on a different trail, I am marketing too.”
“It’s not just the workout, it’s also the mental clarity that you get from just being away.”
For more information on Liz:
Liz was raised in western Kentucky, Paducah. She then played soccer at TN Tech while pursuing an engineering degree. She finished her engineering degree at the University of Kentucky. After taking a year off of school, she completed her doctor of PT at the University of Kentucky. Many reasons lead to the switch from engineering to PT.
From being an athlete from a very young age including kayaking, mountain biking, and horseback riding, she has had to deal with injuries and different pains. Her mother was a PT and always helped get he back to the sport as quickly as possible while still factoring in her long and healthy life.
One of the biggest injuries landed her two different weeks in the hospital. She understands the need and drive to get back. After 8 months of PT she was back competing in freestyle kayaking. She has had to do PT for many injuries including several mountain bike crashes.
The great thing about Liz is that she understand the movement patterns of each individual sport and the mechanics of it. With her engineering background and her life long love of these sports, she can help you ride the trail, the water, the horse sooner.
She has a wonderful support system of her family including her husband and dog and loves living in the blue ridge mountains.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Blue Ridge BioMechanics Website
Blue Ridge BioMechanics Instagram
Blue Ridge BioMechanics Facebook
Blue Ridge BioMechanics Youtube
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Beth Darnall back on the show to discuss the role of psychology in pain treatment. Beth Darnall, PhD is Clinical Professor at Stanford University in the Department of Anesthesiology, Perioperative and Pain Medicine, and by courtesy, Psychiatry and Behavioral Sciences. She is principal investigator for $13M in national pain and opioid reduction research projects. She investigates targeted pain psychology treatments she has developed to reduce chronic pain, as well as pain and opioid use after surgery.
In this episode, we discuss:
-How both sensation and emotions influence someone’s pain experience
-Do clinicians receive training in pain?
-The importance of behavioral medicine and pain modulation strategies to reduce pain suffering
-The success of opioid tapering in the outpatient setting
-Why physical therapists should collaborate with pain psychologists
-And so much more!
“Pain is much more than just a noxious or negative sensory experience.”
“Psychology is actually integral to our experience of pain but curiously we don’t tend to treat it that way in our society and in our culture.”
“If we treat half of the definition of anything how can we be surprised when our outcomes are suboptimal.”
“Once we have ongoing pain, keeping our attention focused on pain is actually counter-productive.”
“Patients do not want to be on opioids.”
“We need to flip the script and integrate psychology in the very beginning.”
For more information on Dr. Darnall:
Beth Darnall, PhD is Clinical Professor at Stanford University in the Department of Anesthesiology, Perioperative and Pain Medicine, and by courtesy, Psychiatry and Behavioral Sciences. She is principal investigator for $13M in national pain and opioid reduction research projects. She investigates targeted pain psychology treatments she has developed to reduce chronic pain, as well as pain and opioid use after surgery. In 2018, her compassionate, community-based, patient-centered opioid tapering research was published in JAMA Internal Medicine and received a national award. She is now leading a $9M national study on compassionate opioid tapering. She delivers pain psychology and opioid reduction lectures and workshops nationally and internationally. She is author of The Opioid-Free Pain Relief Kit ©2016; Less Pain, Fewer Pills: Avoid the dangers of prescription opioids and gain control over chronic pain ©2014; and Psychological Treatment for Chronic Pain ©2018. She spoke on the psychology of pain relief at the 2018 World Economic Forum (Davos, Switzerland). She has been featured in major media outlets, including O Magazine, Forbes, Scientific American, The Washington Post, BBC Radio, Nature and TIME Magazine.
Resources discussed on this show:
Beth Darnall Website
Beth Darnall Twitter
Beth Darnall Products
Psychological Treatments for Patients With Chronic Pain
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Mick Hughes and Randall Cooper on the show to discuss the Melbourne ACL Rehabilitation Guide 2.0. Mick is an experienced Physiotherapist & Exercise Physiologist who consults at The Melbourne Sports Medicine Centre. Mick has expertise in ACL injury management and ACL injury prevention and has previously worked for elite sporting teams such as the Collingwood Magpies Netball team, Newcastle Jets U20s Soccer team and NQ Cowboys U20s Rugby League team. Randall is an experienced Sports Physiotherapist, Founder and CEO of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, and Fellow of the Australian College of Physiotherapists.
In this episode, we discuss:
-The six phases of the ACL Rehabilitation Guide
-Why pre-habilitation objective measures are better comparisons to reconstruction outcomes
-How to assess return to sport after ACL surgery
-The importance of mental readiness for return to play
-Strength and conditioning for injury prevention throughout the athlete’s career
-And so much more!
“Every ACL rehabilitation protocol needs to be individualized and clinicians need to take a clinical reasoning approach. It’s athlete specific. It’s sports specific.”
“If you can combine a good story that resonates with the athlete or patient with the statistics and research that’s out there, you can usually paint a powerful message.”
“We shouldn’t be doing protocols.”
“Every ACL reconstruction patient shouldn’t be painted with the same brush.”
“An injury prevention program is really important.”
“Time is a poor indicator for future success.”
“The whole rehab process needs to be criteria driven.”
For more information on Randall:
Randall is an experienced Sports Physiotherapist, Founder and CEO of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, and Fellow of the Australian College of Physiotherapists.
As a Sports Physiotherapist Randall has worked with some of Australia's most notable sporting organisations including the Hawthorn Football Club, the Australian Winter Olympic Team, and the Victorian Institute of Sport. He consults from the internationally renowned Olympic Park Sports Medicine Centre in Melbourne. Randall has also attained the title of Specialist Sports Physiotherapist as awarded by the Australian College of Physiotherapists in 2008.
Randall is the Founder and CEO of Premax. Premax in an Australian company that manufactures a range of sports skincare and massage creams. Premax is available in Australia, Asia, UK and Europe, and will be launched in North America in 2019.
As an Adjunct Lecturer for the La Trobe Sport and Exercise Medicine Research Centre, Randall advocates sport and exercise medicine, physical activity, health and well-being for all. He provides support to the Centre, activity assisting in translating research findings to key stake holders including the international research community, health practitioners, and the general public.
For more information on Mick:
Mick is an experienced Physiotherapist & Exercise Physiologist who consults at The Melbourne Sports Medicine Centre. He is currently completing a Masters of Sports Physiotherapy.
Mick has expertise in ACL injury management and ACL injury prevention and has previously worked for elite sporting teams such as the Collingwood Magpies Netball team, Newcastle Jets U20s Soccer team and NQ Cowboys U20s Rugby League team.
Resources discussed on this show:
Premax Website
Randall Cooper Twitter
Randall Cooper LinkedIn
Mick Hughes Website
Mick Hughes Twitter
Mick Hughes Facebook
Mick Hughes Instagram
Melbourne ACL Rehabilitation Guide
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jarod Carter on the show to discuss strategies for patient acquisition. Jarod Carter PT, DPT, MTC opened Carter Physiotherapy in Spring 2010, a 100% cash-based clinic where he provides an hour of one-on-one care in every treatment session. Via creative marketing and his reputation for producing fast results, his patient schedule was full within 6 months of opening his cash-based practice. In the fall of 2011, he released his first book My Cash-Based Practice and has been blogging, podcasting, and speaking on all aspects of the out-of-network practice model ever since.
In this episode, we discuss:
-Jarod’s top strategies for acquiring new patients and clients
-How to gain different referral sources in your area
-Why investing in video content has helped boost Jarod’s practice
-Investing time on the initial phone consultation for lead conversion
-And so much more!
“I don’t really promote the idea of physician marketing.”
“Video can be really, really powerful.”
“Giving them more than one option to connect with you and request information or start a conversation is huge.”
“Start developing your personal brand early on.”
“Start retirement investing right away.”
For more information on Jarod:
Jarod Carter PT, DPT, MTC opened Carter Physiotherapy in Spring 2010, a 100% cash-based clinic where he provides an hour of one-on-one care in every treatment session. Via creative marketing and his reputation for producing fast results, his patient schedule was full within 6 months of opening his cash-based practice. In the fall of 2011, he released his first book My Cash-Based Practice and has been blogging, podcasting, and speaking on all aspects of the out-of-network practice model ever since. After over 5 years of researching the subject and consulting with many legal and compliance experts along the way, he released his newest book: Medicare and Cash-Pay Physical Therapy
Jarod enjoys surfing, swimming, travel, and time with family. He married the girl of his dreams in April of 2015 and they welcomed twins into their life in January of 2018. They currently reside in Austin, TX with their golden retriever, Stella.
Resources discussed on this show:
The Cash-Based Practice Podcast
Cash-Based Practice Podcast iTunes
Jarod Carter Website
Carter Physiotherapy Website
Jarod Carter Twitter
Jarod Carter LinkedIn
Jarod Carter Facebook
Jarod Carter Youtube
Patient Sites
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Tricia Brouk back on to the show to share tools to be a fearless speaker. Tricia Brouk’s passion for storytelling has shaped her work in film, television, and theater for over twenty-five years. Tricia is committed to producing and directing stories that entertain, uplift, and foster an exchange of ideas. As the Executive Producer of TEDxLincolnSquare, she curates the top speakers in the country, and her production company, The Big Talk Productions, shoots documentary shorts on the thought leaders making an impact on our world.
In this episode, we discuss:
-The importance of getting clear on your driving reason to take the stage
-The tools that can help you become a fearless speaker
-Differentiating between the speaker’s objectives and their action
-How to communicate your expertise as a conversation with your audience
-And so much more!
“We as an audience want to trust our speakers.”
“If you’re worried about being scared, you’re not focused on the audience and delivering the content.”
“It’s very important to rehearse under mild stress and then continuously increase that stress.”
“We all have a bag of tricks.”
“Never apologize from the stage.”
“The first step is to put yourself out there.”
“We forget that ‘no’ is an opportunity for a new door to open.”
“You have to put yourself out there in order to give your idea and your story the possibility to be heard by anyone.”
“We need to flex the muscle over and over again in order to release the feeling of self-consciousness.”
For more information on Tricia:
Tricia Brouk is an award winning director. She is also writes and choreographs for theater, film and television. In addition to her work in the entertainment industry, she applies her expertise to the art of public speaking. She’s the executive producer of TEDxLincolnSquare and has choreographed Black Box on ABC, The Affair on Showtime, Rescue Me on Fox, and John Turturro’s Romance and Cigarettes, where she was awarded a Golden Thumb Award from Roger Ebert. And the series she directed, Sublets, won Best Comedy at the Vancouver Web-Festival. She’s written two musicals, a play, a sitcom pilot, and a feature film. The documentary short she directed and produced This Dinner is Full was official selection at The New York Women in Film and Television Short Festival, as well as the New York City Independent Film Festival. She also hosts the Speaker Salon in NYC and The Big Talk a podcast on iTunes.
Resources discussed on this show:
The Big Talk with Tricia Brouk
Tricia Brouk Website
Speaker Hub
The Big Talk Season 5
Email: tricia@triciabrouk.com
Text ‘Tricia’ to 44222 to receive the “7 Step Formula to Fearless Speaking”
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome the Healthcare Education Transformation Podcast co-hosts F Scott Feil, Brandon Poen and Stephanie Weyrauch to discuss healthcare education. The Healthcare Education Transformation Podcast is brought to you by 3 physical therapists looking to pursue educational roles and are interviewing prominent guests within the realms of healthcare and education aimed at PTs and other healthcare providers who want to transition to education.
In this episode, we discuss:
-The mission behind the Healthcare Education Transformation Podcast
-The current state of physical therapy education
-Proposed solutions to a few of the limitations in healthcare education
-The strength of the foundations in physical therapy education
-And so much more!
F Scott Feil:
“There’s so many different ways to leverage any of your degrees.”
“There’s been a wish for more interprofessional communication and collaboration.”
“Get rid of lectures and let’s just get out into the clinic and do more rounding and clinical learning with the other professions in the real setting.”
“There just needs to be more interprofessionalism amongst healthcare.”
“We just need to get back to patient centric care.”
“We are finally coming into our own and we’re owning our field as movement experts and movement and musculoskeletal specialists.”
“If you’ve got an idea and you’re afraid of criticism—just go out and do it, try it. Worst case scenario you’ll learn from it.”
Stephanie Weyrauch:
“There’s this weird limbo that a new graduate has.”
“Trying to improve problem solving and critical reasoning within the student population is really important.”
“There are just as many good clinical instructors as there are bad clinical instructors.”
“You should be more worried about how the student perceives you as a teacher than how you perceive the student.”
“We need more academics.”
“Don’t be afraid to ask for feedback.”
Brandon Poen:
“We cannot deny that finances are involved and run a lot of it too.”
“It’s not the DPT program that necessarily sets the cost, it’s the people and the finances above them.”
“There has to be this broad exposure because at the end of the day people are going to choose different routes.”
“Your network equals your net worth.”
“We are not going to grow if we are not uncomfortable.”
For more information on Brandon:
Brandon Poen, PT, DPT is the co-creator of The Healthcare Education Transformation Podcast and a physical therapist currently working at The Virginia Center for Spine & Sports Therapy in Midlothian, Virginia. He is originally from Bourbonnais (pronunciation: Bourbon –nay ), IL and he graduated from Northern Illinois University in 2015 with his Doctorate in Physical Therapy and Minor in Spanish. After graduation he moved to the Detroit suburbs to follow his fiancé and worked at St. Joseph Mercy Oakland Outpatient rehabilitation for 2 years until his fiancé got matched to Virginia Commonwealth University’s General Surgery Residency Program prompting his move to Richmond, Virginia. Brandon’s professional interests include orthopedics, pain science, psychology, teaching, podcasting, and education reform. Personal interests include running, hiking, and flying
For more information on F Scott:
F Scott Feil has been a physical therapist for over 12 years in almost every setting imaginable. He received his BA in English from Wake Forest University, his Masters in Physical Therapy from East Carolina University, his DPT from University of St Augustine and is currently working on his dissertation for his Educational Doctorate through University of St Augustine as well. He is the creator of PTEducator.com which is essentially the NetFlix of Healthcare courses. It is an info-tainment site aimed at increasing healthcare literacy through online practical courses and blogs for both the public and clinicians. He is also the co-host of The Healthcare Education Transformation Podcast, The Fantasy Doctors NBA Podcast, and is a freelance injury writer for The Fantasy Doctors. He is also an adjunct professor for Baylor University’s new DPT program.
For more information on Stephanie:
Dr. Stephanie Weyrauch is employed as a Doctor of Physical Therapy at RehabAuthority in Thief River Falls, Minnesota. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis and her Bachelor of Science in Biology from University of Mary in Bismarck, ND. She has served on multiple national task forces for the American Physical Therapy Association and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Dr. Weyrauch is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership and currently manages the social media accounts for the American Physical Therapy Association Education Section and PT Day of Service. Dr. Weyrauch has performed extensive scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in a top journal in rehabilitation.
Resources discussed on this show:
Healthcare Education Transformation Podcast
Brandon Poen Website
PT Educator Website
Stephanie Weyrauch Website
Healthcare Education Transformation Podcast Twitter
Stephanie Weyrauch Twitter
Brandon Poen Twitter
F Scott Feil Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Susan Clinton on the show to discuss a pelvic health case study.
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Susan Clinton on the show to discuss a pelvic health case study. Susan C. Clinton PT, DScPT, OCS, WCS, FAAOMPT, WHNC is an award winning physical therapist and the co-owner and founder of Embody Physiotherapy and Wellness. She is also an international instructor, mentor, and presenter of post-professional education in women’s health and orthopedic manual therapy. She has helped thousands of people with pelvic and orthopedic problems discover continence and health, reduce pain, and return to their activity goals.
In this episode, we discuss:
-The most important part of the evaluation: the subjective
-Assessing load and posture and the effect on the patient’s symptoms
-Designing a home exercise program to enhance and deemphasize different movement patterns
-How to progress your treatment and allow the patient to help strategize
-And so much more!
“If you ask the questions in the right way, you can get some deeper answers back.”
“It’s easy to take your eyes and go straight to the pelvis.”
“It’s so hard to evaluate and not treat.”
“There’s no such thing as a bad posture, it’s just a dominant one.”
“They just get into patterns.”
“Let’s stop trying to endure and start trying to make changes in the moment.”
“People hear about 10% of what we say.”
“There is no right or wrong.”
“If I lock her into one movement pattern, I’ve sunk her boat.”
“Having a family is a contact sport.”
For more information on Susan:
Susan C. Clinton PT, DScPT, OCS, WCS, FAAOMPT, WHNC is an award winning physical therapist and the co-owner and founder of Embody Physiotherapy and Wellness. She is also an international instructor, mentor, and presenter of post-professional education in women’s health and orthopedic manual therapy. She has helped thousands of people with pelvic and orthopedic problems discover continence and health, reduce pain, and return to their activity goals.
Susan is active in teaching and research as an adjunct instructor for the University of Pittsburgh, Chatham and Slippery Rock University. She is a published author in peer reviewed journals on topics such as chronic pelvic pain and clinical practice guidelines for pregnancy and pain. She is the co-host for “Tough to Treat – A Physical Therapist’s Guide to Treating Complex Patients”.
She is active with the American Physical Therapy Association, American Urogynecologic Society and the International Continence Foundation. She is the Co-founder and Board of Director for the Global Women’s Health Initiative.
Susan resides in western Pennsylvania with her husband and enjoys walking / hiking, ballroom and country line dance. She is an avid supporter of music, the performing arts and international objectives for women’s health.
Resources discussed on this show:
Embody PT Website
Susan Clinton Twitter
Susan Clinton Instagram
Susan Clinton Facebook
Email: susan@embody-pt.com
Clock Yourself App
Tough to Treat Podcast
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Lindsay Padilla joins me to discuss her experience leaving academia to become an entrepreneur. Dr. Lindsay Padilla is the founder of Course Power, a company that helps trailblazing entrepreneurs create student-centered courses, content and communities that get their clients A+ results! Using her tenure-track years spent teaching adults online at a community college and the ridiculous amount of learning she has done in all things education, her team specializes in supporting digital entrepreneurs with the early stages of course or program creation, with a focus on optimizing content and elevating the experience using student feedback. With this unique background, she is also the rambunctious host of the Academics Mean Business Podcast, which shares the journeys of other academics who have started businesses.
In this episode, we discuss:
-Why Lindsay left academia to pursue entrepreneurship
-How to create and optimize a business with an academic background
-Does expertise and value need to be understood by the public to sell courses?
-Do you need an academic degree to sell knowledge online?
-And so much more!
“Look at your time that you give to the institution.”
“It’s not unspoken but it’s expected that we give a lot of our time back and in many cases we are not compensated back for that time particularly fairly.”
“The institution kind of exploits our passion for teaching and learning and loving on our students.”
“Probably the biggest thing we struggle with is marketing.”
“Higher ed has a PR problem.”
“The institution doesn’t just hold the knowledge anymore.”
“You’re impact is bigger than you can probably imagine at this moment.”
“What you can create is infinite.”
For more information on Lindsay:
Dr. Lindsay Padilla is the founder of Course Power, a company that helps trailblazing entrepreneurs create student-centered courses, content and communities that get their clients A+ results! Using her tenure-track years spent teaching adults online at a community college and the ridiculous amount of learning she has done in all things education, her team specializes in supporting digital entrepreneurs with the early stages of course or program creation, with a focus on optimizing content and elevating the experience using student feedback. With this unique background, she is also the rambunctious host of the Academics Mean Business Podcast, which shares the journeys of other academics who have started businesses.
Resources discussed on this show:
Academics Mean Business Podcast
Lindsay Padilla Facebook
Lindsay Padilla Twitter
Lindsay Padilla LinkedIn
Lindsay Padilla Instagram
Lindsay Padilla Website
Email: hello@lindsaympadilla.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Joel Erway onto the show to discuss how to position yourself as an expert. Joel helps coaches, experts, and consultants increase revenue through simple online sales webinars by showing them how to charge what they're actually worth. #WorthIt
In this episode, we discuss:
-The mindset of an expert
-Why you should lead with an offer to solve your audiences’ pain or pleasure point
-How to generate noise for a new launch
-The importance of authority positioning
-And so much more!
To be an expert you have to change your mindset to reflect that you have something of value to offer. Joel reassures, “We are all experts in something.”
Being an expert does not mean you have to know more than everyone on a topic. Joel has found that, “Expertise is relative,” and, “You really just have to be one step ahead of whoever your ideal customer is.”
Content producers build a consistent audience over time where ultimately, “There’s so much pent up demand if you have any sort of good will with your audience.”
There is untapped potential for revenue generation within your audience and Joel stresses, “Make the damn offer.”
For more information on Joel:
Joel Erway is founder of The Webinar Agency, which helps businesses build live and automated webinars. He is also the host of two podcasts, Sold With Webinars and Experts Unleashed.
Current small business owner consultant responsible for 7-figure growth in multiple client's businesses. His personal mission is to implement 6-figure growth in every 1-on-1 client he works with through digital marketing and online sales webinars.
Former sales engineer for 5 years - grew a brand-new territory to more than $2MM+/year in sales; Responsible for 7-figure growth of multiple online business clients; Exclusive webinar coach for Russell Brunson's private mastermind clients; Converted as many as 30% of attendees into sales from cold traffic
Resources discussed on this show:
Sold With Webinars Podcast
Experts Unleashed Podcast
Joel Erway LinkedIn
Joel Erway Facebook
Joel Erway Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews David Bayliff on relationship building. David Bayliff is the owner of Bayliff Integrated Wellness which provides mobile concierge physical therapy and wellness services to residents of Paradise Valley and North Scottsdale.
In this episode, we discuss:
-Why David began building new relationships through social media
-What David does daily on social media to recognize the efforts of others
-How David manages his in person relationships with his online relationships
-How consistency demonstrates your authenticity
-And so much more!
David’s mission is to bring more joy into the world and he stresses, “I’m just a believer in being positive.” And, “I just want to spread good cheer.”
By putting in the effort to recognize others, David has found that, “In supporting others, I have been able to attract the people I want to support me.”
To develop true relationships, David recommends, “Be authentic with what you have to say.”
For more information on David:
Hi. I am David Bayliff, owner of Bayliff Integrated Wellness; providing mobile concierge physical therapy and wellness services to residents of Paradise Valley and North Scottsdale. It is very common that individuals do not seek help because they are in pain. But, rather, they seek help because pain prevents them from doing what they Love. I focus on providing solutions to helping people find that missing Love. Many of my clients seek my help because they are proactive, and they choose to invest in their health before it becomes an expense.
My slogan: Move. Live. Life. I am dedicated to encouraging Movement, to promote healthy Living, so that one can lead the Life they desire.
I bring the playground back into people’s lives!
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Bayliff Integrated Wellness
The Mobile PT Podcast
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I invite Eric Robertson on the show to talk about residencies and fellowships. Dr. Eric Robertson, PT, DPT, OCS, FAAOMPT, is the director of Graduate PT Education for Kaiser Permanente in Northern California, where he directs the orthopaedic residency and orthopaedic manual physical therapy fellowship programs. He is also an adjunct associate professor of clinical physical therapy at the University of Southern California. Dr. Robertson serves on the executive board of the American Academy of Orthopaedic Manual Physical Therapists as secretary and is a Fellow of that organization. He is board certified in orthopaedic physical therapy and has extensive experience in post-graduate clinical education and hybrid educational models. He’s current an associated editor for the Journal of Physical Therapy Education and a member of the American Physical Therapy Association’s media corps.
In this episode, we discuss:
-The evolution of residency programs
-The future standards for residency and fellowship training
-Sustainable business and educational models in the face of growing student debt
-Is it ok to be a generalist in physical therapy?
-And so much more!
Residency education covers a wide variety of clinical settings and patient populations in comparison to fellowship programs. Eric stresses, “You see a lot more specialties represented.”
There has been growing interest among new graduates to hone their clinical skills as Eric has found that, “People who are graduating PT school are a lot more aware of the role of residency as part of their clinical and professional development.”
Orthopedic residencies are facing new challenges as Eric believes, “The supply seems to be exceeding the demand.”
There is not yet a clear delineation between residency and fellowship programs and their unique challenges as Eric states, “Let’s talk about residency programs as its own bucket and let’s talk about fellowship programs as its own bucket.”
For more information on Eric:
Eric Robertson, PT, DPT
APTA spokesman Eric Robertson is director of Kaiser Permanente
Northern California Graduate Physical Therapy Education, and associate professor of clinical physical therapy at the University of Southern California. Previously, he served as assistant professor of physical therapy at Regis University in Denver. He received a bachelor’s degree in physical therapy from Quinnipiac University and a doctor of physical therapy degree from Boston University. He is a board-certified clinical specialist in orthopaedic physical therapy and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists, where he currently serves as secretary on its executive board. Robertson has taught musculoskeletal physical therapy, pharmacology differential diagnosis, and radiology courses in several physical therapy education programs from entry-level through the postgraduate level. He is the immediate past chair of the public relations committee for APTA’s Orthopaedic Section. Robertson serves on the editorial board of the Journal of Physical Therapy Education. He has authored several web-based continuing education courses for entry-level and postprofessional physical therapy residency and fellowship programs. He leads a quality and health outcomes assessment team for rehab services at Kaiser Permanente in Northern California. Robertson’s research interests lie in health service utilization, evidence-based practice, clinical reasoning, and exploring the impact of technology on health care. He is a frequent national presenter and specializes in information management and the use of social media in health care. He is founder of PTThinkTank.com, a popular website devoted to critical observations of health, science, and the physical therapy profession, and cofounder of Talus Media. A prolific writer, his work has been published in several peer-reviewed journals, on popular health websites, and in large television and print media outlets such as the Wall Street Journal, Good Morning America, and Time magazine.
Resources discussed on this show:
Residency Education in Every Town: Is It Just So Simple?
The Impact of Physical Therapy Residency or Fellowship Education on Clinical Outcomes for Patients With Musculoskeletal Conditions
Postprofessional Cartography in Physical Therapy: Charting a Pathway for Residency and Fellowship Training
Eric Robertson Twitter
Eric Robertson Facebook
Eric Robertson Instagram
Kaiser Residency and Fellowship Programs
USC Hybrid DPT Program
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Alex Engar and Will Boyd on creating a partnership online. Healthy Funnel is a healthcare digital marketing company created by Dr. Will Boyd and Dr. Alex Engar - Two physical therapists who are insanely passionate about helping other PTs grow their dream business without tech overwhelm!
In this episode, we discuss:
-How Alex and Will began their partnership through online media
-Digital marketing in healthcare
-Why your partnership should have a shared vision
-Alex and Will’s first in person meet up
-And so much more!
While communicating across social media, Alex and Will stumbled into an amazing partnership with one another. Alex and Will believe, “If we teach each other and kind of team up, maybe something good could come out of it.”
Take advantage of social media and the connections that are possible as Alex and Will remind that, “Communication happens so easily online now, if you let it.”
Starting a partnership is almost like being in a work marriage as Alex and Will recommend, “Find someone who shares your ultimate end goals.”
For more information on Alex:
As a Doctor of Physical Therapy, I’m an enthusiastic human movement expert with a passionate focus on fighting sedentarism. You didn’t know sedentarism was a thing? That’s a shame, because it’s probably killing you...
I’m a fiercely energetic believer in our own power to create the life we want. I’m always learning and never afraid to back down from a good challenge. I know that you can’t reach your potential without pushing your limits.
With an unyielding disposition to work hard until the job’s done, I'm comfortable setting and accomplishing goals that drive progress towards both personal and organizational change. I believe in thorough planning with a dash of early morning inspiration to get things done in the best way.
I’ve been a leader in pushing forward multiple endeavors, crossing a wide variety of disciplines. From leading the charge towards interprofessional diabetes management to exploding hydrogen balloons in front of hundreds of happily screaming kids, my skill-set easily adapts to present needs.
In short, I’m an optimistic, personable, trustworthy guy emboldening those around me to positively challenge their perception of what they can accomplish. I make amazing things happen, while having a blast the entire time.
For more information on Will:
My path into the health world has been a rather unorthodox one. Once an English teacher working abroad, I took the LSAT expecting to go to Law School before having a revelation: I couldn’t sit all day. My next move was to head back to school and try to get into Physical Therapy School. I’ve been a lifelong competitive soccer player and advocate for maintaining a healthy lifestyle. Some of my current interests include treating patients with chronic pain, self-development research, and learning the cash-based practice principles that are out there.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Healthy Funnel Website
Will Boyd Website
Email: will@willboydpt.com
Email: Alexjengar@gmail.com
Healthcare Digital Marketing Group
Will Boyd Twitter
Alex Engar Twitter
Will Boyd Facebook
Ads For PTs Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Martin Asker on the show to discuss a handball injury case study. Martin is a sports medicine therapist specialised in shoulders and biomechanics. He has worked with different elite European handball teams since 2000 and for the last 12 years with a special focus on youth and adolescent elite players. He works part time as clinical lead at a multidisciplinary sports medicine clinic in Stockholm, Sweden mainly seeing shoulder related problems and part time as a PhD-candidate at the Musculoskeletal & Sports injury Epidemiology Center (MUSIC) at Karolinska Institutet in Stockholm.
In this episode, we discuss:
-Teasing out subjective findings and when to refer for imaging
-How the acute:chronic workload ratio impacts young handball athletes risk for injury
-Essential and nonessential objective measurements that are relevant for return to sport
-The importance of strength and conditioning in end ranges of motion and return to throwing programming
-And so much more!
Understanding the motivation behind why a youth athlete seeks care can help guide your patient education because, “They don’t see you when they are in pain, they see you when they can’t perform anymore.”
The acute:chronic workload ratio is an important consideration for injury management as Martin stresses, “Being an on and off, on and off player, it won’t do anymore.”
Your clinical tests and measures need to be robust enough to translate to the sport setting because, “What we measure on the bench does not correlate to what happens when they are throwing.”
Framing your language surrounding a shoulder health maintenance program as being a performance enhancer will help improve compliance as Martin has found that, “They care, but they care more about the performance than injury prevention.”
For more information on Martin:
Martin Asker, MSc, PhD-candidate
Martin is a sports medicine therapist specialised in shoulders and biomechanics. He has worked with different elite European handball teams since 2000 and for the last 12 years with a special focus on youth and adolescent elite players. He works part time as clinical lead at a multidisciplinary sports medicine clinic in Stockholm, Sweden mainly seeing shoulder related problems and part time as a PhD-candidate at the Musculoskeletal & Sports injury Epidemiology Center (MUSIC) at Karolinska Institutet in Stockholm. The overall aim of his PhD project is to deepen the knowledge in shoulder function in elite adolescent handball players and the specific aim is to investigate risk factors for, and prevention of shoulder injuries in such population. He also has a special interest throwing biomechanics and its relationship to throwing performance and injuries. Martin is also a board member of the Medical Committee of the Swedish Handball Federation and part of the medical team of the Swedish youth-16 national handball team.
Resources discussed on this show:
Email: martin@specialistgruppen.se
Martin Asker Instagram
Martin Asker Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Jeremy Sutton on empowerment. Jeremy Sutton is the host of The Servant PT Podcast which is about servant leadership in the medical field. There are interviews with professionals from the medical, fitness or sports fields that have been leading with a servant's heart. There are also episodes with tips or steps to being a better servant leader.
In this episode, we discuss:
-Why you should empower others
-How much time does it take to invest in others?
-What Jeremy does to empower others one-on-one
-Jeremy’s favorite moments of empowerment
-And so much more!
As a servant leader, Jeremy has found that, “When we empower other people, we help them live out their purpose.”
From posting short Facebook LIVE videos to typing a short text message, Jeremy believes that, “You can really invest in people really easily these days.”
Not only does empowering others enhance their life, from Jeremy’s experience , “I usually get more out of doing something for someone else.”
For more information on Jeremy:
Jeremy Sutton PT, DPT has been a Physical Therapist for over 8 years, mostly in outpatient orthopedics. Jeremy Sutton owns a clinic (Vivian Physical Therapy, Inc.) in rural North Louisiana where he treats people through a servant leader’s mindset with the goals of returning them back to living life the way they enjoy by restoring mobility, restoring hope, and ultimately restoring their life!
He is also the creator and host of The Servant PT Podcast. The Servant PT Podcast is about servant leadership in the medical field. There will be interviews with professionals from the medical, fitness or sports fields that have been leading with a servant's heart. There will also be episodes with tips or steps to being a better servant leader.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Servant PT Podcast Website
Servant PT Podcast iTunes
Servant PT Podcast Facebook
Jeremy Sutton Facebook
Jeremy Sutton LinkedIn
Email: vivianpt@aol.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda, DPT guest hosts and interviews Brianna Battles on training postpartum athletes. Brianna Battles is the CEO of Everyday Battles LLC. She specializes in coaching pregnant and postpartum athletes, as well as educating coaches on how to help athletes navigate the physical and mental considerations of athleticism during these chapters in a woman’s life. Brianna has online courses and resources for both fitness professionals and athletes and is the founder of the movement and online education, Pregnancy & Postpartum Athleticism. She has built an international team of coaches who are equipped to work with pregnant and postpartum athletes.
In this episode, we discuss:
-Common diagnoses following pregnancy that impact an athlete’s performance
-How trainers and physical therapists can collaborate for the postpartum athlete
-The good and bad of social media during the postpartum period
-Cultural expectations surrounding what postpartum should look like
-And so much more!
Adjusting a training regime during pregnancy and postpartum can be a huge psychological hurdle for athlete’s to overcome. Brianna has found that, “We have to make the most informed decisions possible without ego getting in the way.”
Shifting cultural expectations surrounding what you should look like or be able to do during postpartum is one of Brianna’s biggest goals. She stresses, “Birth is a big deal. Pregnancy changes your body. And postpartum is not just a six week timeline it’s an ongoing change.”
While social media can be full of inspiration, it may also only show us the highlight reel of how someone has been progressing through postpartum. Brianna reminds, “Never compare yourself to who you see on social media and what their story is.”
For more information on Brianna:
Brianna Battles is the CEO of Everyday Battles LLC. She specializes in coaching pregnant and postpartum athletes, as well as educating coaches on how to help athletes navigate the physical and mental considerations of athleticism during these chapters in a woman’s life. Brianna has online courses and resources for both fitness professionals and athletes and is the founder of the movement and online education, Pregnancy & Postpartum Athleticism. She has built an international team of coaches who are equipped to work with pregnant and postpartum athletes.
Brianna is an advocate for women who want train during pregnancy and make a sustainable return to performance, lifestyle, function, career and activity in the postpartum chapter. She has been able to accomplish this not just with her own coaching efforts, but by also educating coaches to do the same in their communities and online.
Brianna has a local strength and conditioning program, but has shifted her focus to working online and traveling for seminars in an effort to reach a broader audience.
She has experience in coaching in Division 1 collegiate athletics, corporate wellness management, personal training, strength and conditioning, presenting, remote coaching, mentoring and habits.
Brianna has her Master’s Degree in Coaching and Athletic Administration and her Bachelor’s degree in Kinesiology. She is an active member of the NSCA where she is a Certified Strength and Conditioning Specialist (CSCS), and a USAW Sports Performance Coach. She has completed multiple continuing education courses and mentorships in the women’s health and strength and conditioning realm.
She lives in Southern California with her husband, 2 sons (Cade and Chance) and 2 boxers.
For more information on Shannon:
Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women’s Health Physical Therapist and is currently the only Board-Certified Women’s Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.
Resources discussed on this show:
Email: briannabattles@everyday-battles.com
Brianna Battles Website
Pregnancy and Postpartum Athleticism Website
Brianna Battles Instagram
Brianna Battles Facebook
Women’s Health APTA
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Angelica Napolitano on her physical therapy golf niche. Dr. Angelica Napolitano is a Jupiter, Florida native who earned her Bachelor’s of Science in Exercise Physiology from Florida State University, and then went on to further her education by receiving her Doctorate of Physical Therapy from Florida International University. Through her passion of the sport and extensive knowledge base regarding physical therapy treatment, Angelica is sure to provide you the pain free transformation you’re striving to achieve that will allow you to execute next level performance in your golf game or any sport you desire to enhance.
In this episode, we discuss:
-How Angelica developed a niche in golf
-Unique challenges that face a female treating in a male dominated sport
-Angelica’s advice for budding female entrepreneurs
-And so much more!
Having first-hand experience in your niche is important to build patient rapport as Angelica has found that, “You build that trust and it just starts from there.”
As a female treating in a male dominated sport, it is integral to maintain a professional environment as Angelica stresses, “There needs to be boundaries.“
For those interesting in breaking the mold and starting a practice despite their fear, Angelica reminds, “The what-ifs are going to hold you back from success in life ultimately.” Angelica advises to, “Be a trailblazer.”
For more information on Angelica:
Dr. Angelica Napolitano is a Jupiter, Florida native who earned her Bachelor’s of Science in Exercise Physiology from Florida State University, and then went on to further her education by receiving her Doctorate of Physical Therapy from Florida International University.
Angelica has had experience in various practice settings from pediatrics to geriatrics and everything in between. She has spent the last couple years as the Regional Manager and Lead Physical Therapist for a company that provides physical therapy and wellness services to those who are battling substance abuse and addiction disorders. Angelica quickly developed a strong passion for helping this patient population as she got to experience their transformations not only physically, but mentally and emotionally by witnessing each patient’s journey to recovery on a first-hand basis.
Her ability to positively impact others through her advanced skillset to promote a pain and drug free lifestyle has been the most rewarding experience in her career thus far. It not only magnified her competency but allowed her to develop her own identity and autonomy as a practitioner while simultaneously gaining managerial experience in her supervisory role. Although, Angelica devotes most of her time to serving others, she also enjoys spending time playing golf with friends, family and clients. She has successfully treated patients who suffer from pain and functionally related movement disorders directly associated to golfing.
Through her passion of the sport and extensive knowledge base regarding physical therapy treatment, Angelica is sure to provide you the pain free transformation you’re striving to achieve that will allow you to execute next level performance in your golf game or any sport you desire to enhance.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Optimal PT and Wellness Website
Angelica Napolitano Instagram
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Ryan Lee on Facebook LIVE to discuss entrepreneurship. Ryan is the founder of REWIND. And while he's got the 22+ year health and fitness background (Master's Degree in Exercise Physiology, Created world's fastest workout video, yada yada), he's obsessed with living a good life. Which includes helping his thousands of customers achieve their goals and spending as much time as humanly possible with his wife and four kids!
In this episode, we discuss:
-Ups and downs that shaped Ryan’s entrepreneurial journey
-What you need to prioritize every morning that drives your business
-How to incorporate story-telling into your marketing
-Why you should invest in connection and personalization to win over your audience
-And so much more!
Failure is not something to be feared but embraced as Ryan reminds, “You have to prepare for the ups and downs.”
Consistently producing material does not have to be a chore as Ryan has found that, “We start to over-content stuff.”
Going above and beyond to make your audience feel special will set you apart from your competitors as Ryan recommends, “It’s little touches that matter.” Ultimately, Ryan stresses, “When you connect with people, you get lifetime fans.”
For more information on Ryan:
Ryan Lee is the founder of REWIND - home of the world’s first nutrition “Superbar”. He’s also the author of The Millionaire Workout, Passion to Profits, was featured on the front page of The Wall Street Journal, and called “the world’s #1 lifestyle entrepreneur” by Entrepreneur.
Resources discussed on this show:
Ryan Lee Website
Rewind Website
Rewind Facebook
Rewind Instagram
Original Facebook Live Interview
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Felicia Wenah on networking as a physical therapy student. Felicia enjoys managing, branding and marketing for those in private practice within the health and wellness profession (especially Boss Women in Physiotherapy).
In this episode, we discuss:
-Advantages to networking as a student
-How to maintain professional relationships with a busy school schedule
-Felicia’s top conference recommendations
-And so much more!
Felicia seeks guidance from physical therapy professionals and has found that, “As you seek knowledge and you are able to apply it, whether it’s instantly or later on in the future, you feel more confident and comfortable with taking the steps you need to take in life.”
Managing school on top of new professional connections can be a juggling act but it allows you to “better decipher where [your] priorities need to be for that moment.”
Maintaining relationships doesn’t have to be forced. From Felicia’s experience, “I let them come to my mind and then I reach out to them.”
For more information on Felicia:
She enjoys managing branding and marketing for those in private practice within the health and wellness profession (especially Boss Women in Physiotherapy).
She is most likely with a client, training and development staff/mentee, traveling to a conference/seminar OR most importantly spending quality time with mi familia.
Contact her to see how I can guide you with connecting your YOU-nique skill sets to obtaining and maintaining the interest of your target audience in the health and wellness profession.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Felicia Wenah LinkedIn
Felicia Wenah Facebook
Felicia Wenah Youtube
Felicia Wenah Twitter
Felicia Wenah Instagram
Smart Success PT Live
Ascend Conference
Women in PT Summit
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Brendan Sullivan joins me to discuss worker’s compensation advocacy. Brendan Sullivan, PT, DPT, OCS, MSCS, CSCS began practicing physical therapy in 1997 after graduating from Utica College of Syracuse University. Dr. Sullivan is an ABPTS Board Certified Orthopedic Clinical Specialist (OCS) and Certified Strength & Conditioning Specialist (CSCS) through the National Strength & Conditioning Association (NSCA). He is a member of the American Physical Therapy Association (APTA) & is active in both the Workers Compensation Research Institute (WCRI) NY Advisory Committee & New York Physical Therapy Association (NYPTA) Public Policy Committee.
In this episode, we discuss:
-How Brendan became involved in advocacy
-Principles of advocacy: determine the issue, desired outcome, stakeholders, authority and public policy
committee
-What is worker’s compensation?
-Changes in the worker’s compensation medical fee schedule
-And so much more!
Communicating with policymakers is an art and Brendan recommends, “You want everything to be comfortable and form a nice rapport but you have to get down to business.”
With advocacy efforts, there has been an incremental change in the fee schedule, “On average, all regions, there’s going to be a 25% increase to the fees that are paid for PT and OT.”
While improvements in the fee schedule have been made, Brenden warns, “We don’t want to see the potential benefit negated that would come from a fee schedule increase.”
Physical therapy is a feasible alternative to other treatments for pain management and the data shows, “Opioids still represent the highest drug spent within the worker’s comp system.”
For more information on Brendan:
Brendan Sullivan, PT, DPT, OCS, MSCS, CSCS began practicing physical therapy in 1997 after graduating from Utica College of Syracuse University. Dr. Sullivan is an ABPTS Board Certified Orthopedic Clinical Specialist (OCS) and Certified Strength & Conditioning Specialist (CSCS) through the National Strength & Conditioning Association (NSCA). He is a member of the American Physical Therapy Association (APTA) & is active in both the Workers Compensation Research Institute (WCRI) NY Advisory Committee & New York Physical Therapy Association (NYPTA) Public Policy Committee.
Dr. Sullivan opened a small personal training & wellness center in February 2001. After 2 short years, the business expanded into a more expansive gym where clients and local residents could utilize the facility during the week. His desire was to offer the public a comfortable facility where anyone could work with physical therapists in a setting where they could receive therapeutic services or the consultation of highly skilled fitness professionals.
This blend of physical therapy & fitness services continues to be the driving force in the businesses success. As the public becomes more educated on the benefits of exercise & health maintenance becomes more self-directed the skills offered by physical therapists are self-evident. The centers' mission is to help individuals achieve and maintain their optimal fitness & functional level in the community and with recreational sports or activities. In 2016, he was named the Arthritis Foundation's Medical Honoree for their upstate NY Walk to Cure Arthritis. More recently, Dr. Sullivan became a Multiple Sclerosis Certified Specialist (MSCS) and graduated from Evidence in Motion Institute of Health Professions with his clinical doctorate.
Resources discussed on this show:
Brendan Sullivan LinkedIn
Brendan Sullivan Website
Brendan Sullivan Twitter
New York Physical Therapy Association
Worker's Compensation Institute
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Dr. Kaylee Garrett Simmerman, PT, DPT on how to deal with negativity. Kaylee is a 27 year old, passionate, driven Doctor of Physical Therapy who is striving to surpass all of her goals and dreams in order to change the world one step at a time. She was a ballet dancer for approximately 20 years and had to quit due to injuries, bringing her to her current career choice. She is ultimately interested in being able to treat the dancer population, incorporating her expertise in pelvic health as well as pain science education.
In this episode, we discuss:
-What is a negative Nancy?
-Kaylee’s experience with both a friend and a colleague naysayer
-How to handle negative feedback and not let emotions overcome you
-What qualities to look for in your support team
-And so much more!
Receiving feedback from your team or mentor is important for growth and from Kaylee’s experience, “I love feedback but if you’re not going to be constructive about it, that’s not helpful on either side.”
In the face of negativity, Kaylee recommends taking a moment to compose yourself instead of leaping into defense mode and, “assess the situation and decide whether or not it’s worth being upset about.”
One of the most important qualities your support team should posses is strong listening skills. Kaylee stresses, “Finding the person that’s going to give you positive feedback instead of negative feedback is very important.”
For more information on Kaylee:
I am a 27 year old, passionate, driven Doctor of Physical Therapy who is striving to surpass all of my goals and dreams in order to change the world one step at a time. I’ve been married to the love of my life for close to a year and cannot wait for many more! I was a ballet dancer for approximately 20 years and had to quit due to injuries, bringing me to my current career choice. I am ultimately interested in being able to treat the dancer population, incorporating my expertise in pelvic health as well as pain science education.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Kaylee Garrett Simmerman Facebook
Kaylee Garrett Simmerman Website
Smart Success PT Live
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Lindsey McAlonan on advocacy. Lindsey McAlonan is the SPT Delegate in the Student Assembly and she wants to inspire students to find their passion within this profession. Most importantly, she has found the value of being an advocate for patients and the PT profession. She wants to challenge all students to take a step outside their comfort zone to educate people on physical therapy, continue to stay active in the APTA, and bring a positive change to the profession in order to enhance their experience.
In this episode, we discuss:
-Why Lindsey loves her position in the Student Assembly
-The difference between advocacy and policy
-Grassroots advocacy outlets to get involved in
-How to utilize the APTA Action App
-And so much more!
Advocating for physical therapists and patients is as easy as telling people about the benefits of physical therapy. Simply, “Being able to tell people about what we do is advocacy.”
As the SPT Delegate, Lindsey welcomes student concerns as she states, “I want to be that voice for the students at the House of Delegates.”
For the most impactful advocacy, Lindsey recommends, “Bring a personal story.”
For more information on Lindsey:
Draw a circle that relates to your comfort zone, and then think about the outside of that circle, this is where the magic happens. I heard this quote from a physical therapist a couple years ago, and these words of wisdom have resonated with me ever since. I used that quote as a key to unlock my future on which PT school I should attend. I was faced with a decision to attend a school close to home in Kansas or find the courage and strength to move to Connecticut where I didn’t know or have anyone to support me. I knew these opportunities would lead me down different paths.
This decision has impacted me and helped me to become the best version of myself as a PT student. I currently serve as Secretary at Sacred Heart University, the VP of the CT Student Special Interest Group, and am a member of the Membership Project Committee. I was consistently pushed outside my comfort zone to pursue leadership opportunities and attend conferences, National Advocacy Dinners, and the Federal Advocacy Forum.
I am running for SPT Delegate to inspire students to find their passion within this profession. Most importantly, I have found the value of being an advocate for patients and the PT profession. I want to challenge all students to take a step outside their comfort zone to educate people on physical therapy, continue to stay active in the APTA, and bring a positive change to the profession in order to enhance their experience.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Lindsey McAlonan Twitter
APTA Action App
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jesse Johnson joins me to discuss wealth and spirituality. Jesse is a success and mindset coach with a very unique approach to money and spirituality. She works with spiritual leaders, healers, and coaches to experience sales and their business as a spiritual process to earn significantly more money for their calling in life. Her clients create financial and creative abundance by dismantling the false beliefs they hold around wealth and taking action to bring money into their lives with integrity so they can serve at the highest level - no compromise, no self-sacrifice, no mediocrity, no poverty.
In this episode, we discuss:
-Four problems that block you from manifesting the wealth you want
-How to shift your mindset from a place of scarcity to a place of abundance
-Why it is difficult to assign personal responsibility and how it impacts your business
-How to create win-win situations to cultivate your own entrepreneurial growth
-And so much more!
Shifting your mindset allows you to find more creative solutions and then, “The whole universe of possibility is actually available to us.”
Aligning your values and goals is a powerful way for entrepreneurs to create wealth, otherwise, “People don’t actually allow themselves to want what they want and to know what they want.”
There is always a reason why you are not living with financial freedom. Jesse has found that, surprisingly, “Most people are either not charging enough or not selling enough.”
Designing win-win services breeds an environment of creativity and abundance and Jesse believes, “Entrepreneurship is one of the most powerful spiritual practices there is.”
For more information on Jesse:
Jesse is a success and mindset coach with a very unique approach to money and spirituality. She works with spiritual leaders, healers, and coaches to experience sales and their business as a spiritual process to earn significantly more money for their calling in life. Her clients create financial and creative abundance by dismantling the false beliefs they hold around wealth and taking action to bring money into their lives with integrity so they can serve at the highest level - no compromise, no self-sacrifice, no mediocrity, no poverty.
Resources discussed on this show:
Jesse Johnson Coaching Website
Jesse Johnson Instagram
Jesse Johnson Facebook
Jesse Johnson LinkedIn
Free Gift
San Diego 2 day intensive
Email: jjcsteam@gmail.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, DPT guest hosts and interviews Greg Todd, PT on mentorship. Greg Todd is the co-owner of Renewal Rehabilitation in Wesley Chapel and Hyde Park. He graduated from Florida International University with a Bachelors of Science Degree in Physical Therapy, and received his strength and conditioning certification through the National Strength and Conditioning Association in 2000. Greg now serves as a consultant for 12 (and counting) medical and technology companies and has lectured at numerous universities and nationally recognized seminars on his innovative business and technology strategies that he has used throughout his successful 15 year career.
In this episode, we discuss:
-What is mentorship?
-Work and life time management trade-offs
-Some of Greg’s most challenging and rewarding experiences as a mentor
-Top qualities a mentor should possess
-And so much more!
With every decision you make, there will be other opportunities affected as Greg reminds, “Whatever you say yes to, you’re saying no to something else.”
Having been a mentor for hundreds of people, Greg has found that, “It’s amazing what happens when people jump.”
One of the most important qualities of a mentor is being a great listener because, “A mentor doesn’t tell people what to do.” Greg stresses, “If you can’t listen, then you will be really ineffective in your mentorship.”
For more information on Greg:
Greg Todd is the co-owner of Renewal Rehabilitation in Wesley Chapel and Hyde Park. He graduated from Florida International University with a Bachelors of Science Degree in Physical Therapy, and received his strength and conditioning certification through the National Strength and Conditioning Association in 2000. He has over 15 years of experience in outpatient physical therapy. Greg is a board certified orthopedic certified specialist through the American Physical Therapy Association, and has served as the official physical therapist for Saddlebrook Tennis and Golf Resorts for the past 10 years. He also works as a consultant for professional tennis players on the ATP and WTA tour. Greg is also an avid runner, and has completed four marathons, seven half-marathons, and numerous 5k races.
Over the past 10 years, Greg has grown his 2 private practices from 3 to 17 employees, and has had a 10% increase in net revenue for the past 8 consecutive years. He credits this to the amazing team culture of his company, using innovative marketing strategies, having a thorough understanding of the business of physical therapy and embracing the use of technology as a way to connect with more frequently with patients and build the brand of what makes physical therapists so vital and powerful to the healthcare industry.
Greg now serves as a consultant for 12 (and counting) medical and technology companies and has lectured at numerous universities and nationally recognized seminars on his innovative business and technology strategies that he has used throughout his successful 15 year career.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Greg Todd Website
Greg Todd Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Federal Advocacy Forum, Jenna Kantor, DPT guest hosts and interviews Jeremy Curtis on freedom of speech in the APTA. Jeremy Curtis is a Doctor of Physical Therapy student at Tennessee State University and President of the APTA Student Assembly.
In this episode, we discuss:
-Why did Jeremy run for president of the student assembly?
-What Jeremy loves about the APTA
-Things the APTA can look to improve with new leadership
-Words of wisdom Jeremy shares regarding student advocacy
-And so much more!
Taking on a leadership role as a student is a large time commitment however Jeremy found he was passionate and, “The biggest thing for me was just wanting to create change and wanting to be a voice for minority students as well.”
Jeremy believes that the APTA can improve their representation as, “The population is becoming more diverse and we need to reflect that as well.”
Growing organizations should always strive for excellence and, “As a professional organization, we should be open to critiques and constructive criticism of ourselves.”
For more information on Jeremy:
The foundation of any profession is having an effective team to establish a vision, and to have the wherewithal to carry out the vision in an efficient manner. There also must be a productive leader in place that has a clear plan that he believes will have a positive effect on those that he is slated to serve. Virtually, an effective leader must know the way, go the way and lead the way. As class president, I have been able to hone and practice my leadership skills. I focus on open communication, proactivity, and practicing ethical standards. I am also a leader that is involved beyond the status quo. In 2016, I served as the Student Government Affairs Liaison for Tennessee. The opportunity to attend the Federal Advocacy Forum increased my yearning for professional knowledge. These opportunities have molded my communication skills when speaking about the profession. It is imperative to relay the positives about the profession in an understandable manner to outside professionals. Additionally, I hope to aid in the fight against student debt. Soaring costs of education, without linear advancements in income, has the potential to be a deleterious issue. Now is the time to combat this issue, and I plan to continue the fight that the SABoD has initiated. Additionally, I would like to aid in creating initiatives for financial growth for the PT-PAC. We are the future and it is our duty to invest now to ensure the steady growth of the profession. Thank you for your consideration.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Email: aptasa.president@gmail.com
APTA Student Assembly Facebook
Jeremy Curtis Twitter
Jeremy Curtis LinkedIn
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Tom Goom joins me to discuss a gluteal tendinopathy case study. Tom has gained the nickname ‘Running Physio’ after years of combining his passion for physio and love for running together to specialise in management of running injury. He’s written widely on the topic with over 200 evidence-based articles for his own site, running-physio.com as well as contributing to the BJSM Blog, Runner’s World and the Telegraph. In 2016 he published a masterclass on proximal hamstring tendinopathy in the Journal of Orthopaedic and Sports Physical Therapy. He presents his Running Repairs Course in the UK, internationally and online, covering a range of topics from training load management to bone stress injuries, strength and conditioning and more.
In this episode, we discuss:
-Crafting the subjective portion of your evaluation
-Objective measures at the impairment, activity and participation levels
-Multimodal treatment approaches to manage gluteal tendinopathy
-Intrinsic factors that affect tendon health
-And so much more!
Identifying what running really means to your patient will help guide your goals for therapy as Tom stresses, “I want to know about the impact the injury is having on them.”
Modifying activity levels is an important aspect for your exercise prescription and you have to convey to your patients that, “It’s this kind of balancing act of risk versus reward.”
It is important for clinicians to avoid iatrogenic language in their patient education and only, “Highlight the good things.“
Establish at the onset to, “Expect flair ups.” as managing patient expectations during their rehabilitation is key to long term success.
Treating gluteal tendinopathy is both challenging and rewarding and Tom believes, “There’s an art to it as well as a science.”
For more information on Tom:
Tom is a physiotherapist with over 10 years of experience and a very keen runner! He graduated with a BSc (Hons) degree in 2002 and since then has worked in clinics in the UK and overseas. His career started in Winchester where he worked in the NHS and developed a specific interest in lower limb rehab and joined the physio team at a semi-professional football club. Following the Tsunami in 2004 Tom travelled to Sri Lanka and did voluntary physiotherapy work in a hospital, teaching local staff, treating patients and fundraising for new equipment. Tom returned to the UK in 2006 and started working in Brighton as a senior physiotherapist. His interest in rehab continued to grow and he ran lower limb and spinal rehab groups as well a chronic pain programme.
Tom started RunningPhysio in March 2012 to help those training for marathons that spring, since then it’s developed into a resource used by runners all over the world. Tom has written for Running Fitness, Men’s Running UK, and the British Journal of Sports Medicine blog. His work has featured on Kinetic Revolution, Bartold Biomechanics and a host of online sports sites.
A few words from Tom…
I’m learning about running all the time, one thing I’ve found is that there are a lot of opinions out there! No 2 people will give you the same advice and I respect that. My plan with this site is to share my view on injury prevention and management when running. I welcome different views and ideas so please feel free to comment. I don’t claim to have all the answers but I hope people will find this site helpful. I’ve got a few miles under my belt and a few good PB’s – 39:30 for 10km and a 1:28 half marathon. In April 2013 I did my first marathon and loved it! I finished in 3:12:28 – full story here.
I work at The Physio Rooms clinic in Brighton. For more information or to arrange an appointment see our Clinic Page.
If you have any questions feel free to leave a comment or chat to me on Twitter via @tomgoom. Please note that due to very high numbers of comments and questions we aren’t able to reply to everyone
Resources discussed on this show:
Running Physio Website
Running Physio Twitter
Running Physio Facebook
Tendon Health Questionnaire
Pain Catastrophizing Scale
Hudl Technique
Plinsinga et al 2018: Psychological factors not strength deficits are associated with severity of gluteal tendinopathy: A cross‐sectional study
Ganderton et al 2018: Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial.
Mellor et al 2018: Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Federal Advocacy Forum, Jenna Kantor, DPT guest hosts and interviews Doreen Frank on advocacy in physical therapy. Doreen chaired the New York Physical Therapy Association’s Legislative Committee from 1992 to 2003 and is a past recipient of the American Physical Therapy Association’s State Legislative Leadership Award and the New York Chapter’s Outstanding Service to Chapter award. She was also the recipient of the Doreen Frank Legislative Leadership Award, an award given to those who serve the NY Chapter of the APTA. She remains a consultant to the Legislative Committee.
In this episode, we discuss:
-The driving factors for advocating for the profession
-Doreen’s extensive involvement in advocacy throughout her career
-Doreen’s experience overcoming discouragement and learning from her mistakes
-Doreen’s advice to inspire physical therapists to join the advocacy effort
-And so much more!
Doreen remains inspired by the connections she has built with both the therapists and patients in her state and has found that, “That feeling of being consistent and getting to know all of your people, that made a difference.”
Bringing physical therapy concerns to legislators is well received as Doreen encourages, “We really have so much respect both on the state legislative level and on the federal level.” Doreen reminds that, “People want to hear from physical therapists, they truly consider our opinion.”
Doreen believes that change only happens when more and more people join the advocacy effort and she stresses, “Democracy is not a spectator sport. You have to participate, you have to be the ones to advocate change.”
For more information on Doreen:
Doreen Frank is a 1981 graduate of SUNY Upstate Medical Center where she earned a Bachelors of Science degree in Physical Therapy. Prior to establishing Columbia Physical Therapy, P.C. in 1987 with her husband Bob, she worked in Brooklyn, San Francisco and Seattle. She is a member of the American Physical Therapy Association with membership in the Sections on Private Practice, Orthopedics, Women’s Health Care and Sports PT.
Doreen chaired the New York Physical Therapy Association’s Legislative Committee from 1992 to 2003 and is a past recipient of the American Physical Therapy Association’s State Legislative Leadership Award and the New York Chapter’s Outstanding Service to Chapter award. She was also the recipient of the Doreen Frank Legislative Leadership Award, an award given to those who serve the NY Chapter of the APTA. She remains a consultant to the Legislative Committee. In 1986, she became certified by the Neurodevelopmental Treatment Association for treatment of Adult Hemiplegia. In 1991, she earned certification in Isenhagen Work System Functional Capacity Evaluations, Work Conditioning, Functional Job Analysis and Pre-Work Screening.
In 2009, Doreen was certified by Atlas Ergonomics, LLC and was qualified to join the Atlas network as a full-service provider. After rigorous training and testing in the specific needs of employees in call centers, commercial transportation and public transit, as well as in general office settings, she now joins the nation’s largest provider of ergonomics services to employers. Known for its results-based ergonomics programs, Atlas works with its nationwide network of physical therapists, occupational therapists, and ergonomists to reduce work-related injuries among employees, with an emphasis on measurable, bottom-line results.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Email: doreen@columbiapt.com
Doreen Frank LinkedIn
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Jenna Kantor, PT, DPT hosts and interviews Roger Herr on advocacy in physical therapy. Roger Herr is the Secretary of the Board of Directors of the American Physical Therapy Association (APTA). Roger is a graduate of Temple University and has practiced physical therapy on both the east and west coasts. His involvement in the APTA has been longstanding at local, state and national levels. He is passionate about making a difference and communicating that to his audience.
In this episode, we discuss:
-Why is advocating for physical therapy important?
-How each generation of leaders enhance New York’s advocacy efforts
-Loose guidelines to follow to land a leadership position
-Why different perspectives enrich professional advocacy
-And so much more!
A major advocacy goal is to educate the public on the benefits of physical therapy as Roger expresses, “I love advocating because we get to explain what we do to others.”
As the physical therapy profession continues to grow in scope, both young and old physical therapy advocates are needed for different advocacy aims as Roger believes, “Different generations have different attributes.” Younger generations will lead online media outreach programs as Roger has found that, “Our society has less of that legacy role and more like what do we need to do now.”
Getting involved in advocacy can follow multiple courses as Roger stresses, “Written rules or guidelines kind of give a path but there are so many untraditional paths in our profession.”
For more information on Roger:
Roger Herr is the Secretary of the Board of Directors of the American Physical Therapy Association (APTA). Roger is a graduate of Temple University and has practiced physical therapy on both the east and west coasts. His involvement in the APTA has been longstanding at local, state and national levels. He is passionate about making a difference and communicating that to his audience.
History: Physical Therapist at New York University Medical Center; taught in NYU’s Physical Therapist and Physical Therapist Assistant programs and has worked in both home health and a nursing home; spent a decade on the West Coast: 8 years in Seattle and 2 years in San Francisco; returned to NYC in 2014 to join ICS and be closer to family.
Where have I seen you before? As a physical therapist (BS Temple 1987), health care manager (MPA NYU 1992) who has worked in post-acute care with a focus on community health; as a site visitor/surveyor, CMS (Medicare), serving on NQF Technical Expert Panels, and with a national health care analytics organization specializing in post-acute care measures and reporting; at Sutter Care At Home in San Francisco; on the Board of the American Physical Therapy Association and as an appointee to the National Quality Forum Measurement Application Partnership Post-Acute Care (NQF MAP PAC).
Extracurricular: Walking, running, swimming, biking and yoga; certified yoga teacher; plays upright bass and enjoys good food and mood enhancing beverages…such as coffee.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Roger Herr Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Søren Skou joins me to discuss Good Life With osteoArthritis in Denmark (GLA:D). Søren Thorgaard Skou (STS) (PT, PhD) is an associate professor at the University of Southern Denmark and Næstved, Slagelse, Ringsted Hospitals in Denmark. Soren is one of the main architects behind the implementation of the highly successful treatment program Good Life With osteoArthritis in Denmark (GLA:D) for patients with knee and hip pain.
In this episode, we discuss:
-Education of physical therapists in delivering care in accordance with clinical guidelines
-Patient education and neuromuscular exercise for patients with OA-like symptoms primarily from the hip or knee
-The national GLA:D®-registry for data collection and evaluation of results
-The growing global support of the GLA:D program
-And so much more!
Translating the research evidence for osteoarthritis pain management to clinical practice can be difficult as Søren stresses, “Even though we had the evidence, the implementation was missing.” The goal of the GLA:D program was to bridge that gap by, “Giving the clinicians a toolbox to bring home instead of them having to read the evidence and then trying to translate that into something clinically useful.”
The elements of the program are designed to facilitate pain reduction in the short term and build new habits for the long term. Søren has found that, “The group based sessions are very supportive also for motivating the patients to continue participating.” In addition, Søren believes, “Education is key to the long term effects.”
For more information on Søren:
Søren Thorgaard Skou (STS) (PT, PhD) is an associate professor at the University of Southern Denmark and Næstved, Slagelse, Ringsted Hospitals* in Denmark. He has vast experience within the field of early treatment of knee pain and has been the principal investigator of three high-quality randomized controlled trials, one of which was published in The New England Journal of Medicine, the highest ranked of all general medical journals. STS is one of the main architects behind the implementation of the highly successful treatment program Good Life With osteoArthritis in Denmark (GLA:D) for patients with knee and hip pain. Furthermore, he is a recipient of the prestigious Sapere Aude Research Talent Award from the Danish Council for Independent Research and several other research awards.
Resources discussed on this show:
Email: stskou@health.sdu.dk
GLA:D Website
Søren Skou Twitter
GLA:D Canada
GLA:D Australia
BJSM: GLA:D to have a high-value option for patients with knee and hip arthritis across four continents: Good Life with osteoArthritis from Denmark
Ewa Roose email: eroos@health.sdu.dk
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Craig Cody joins me to discuss taxes. Craig Cody is a Certified Tax Coach, Certified Public Accountant, Business Owner and Former New York City Police Officer with 17 years experience on the Force. In addition to being a Certified Public Accountant for the past 15 years, he is also a Certified Tax Coach. As a Certified Tax Coach, Craig belongs to a select group of tax practitioners throughout the country who undergo extensive training and continued education on various tax planning techniques and strategies to become, as well as remain, certified. With this organization, Craig has co-authored an Amazon best seller book, Secrets of a Tax-Free Life.
In this episode, we discuss:
-The biggest mistakes small business owners make regarding taxes
-Strategies medical providers can use to lower their tax bill
-Retirement planning vehicles that are right for you
-How can proactive tax planning help private practices?
-And so much more!
Craig recommends seeking advice from a CPA for all your accounting needs because Craig believes, “We should do what we are good at and let other professionals do what they are good at.”
To make the most of proactive tax planning, begin today as Craig reminds, “For most planning, January and February is going to be too late.”
Reach out to a CPA to find what business entity and retirement vehicles are best for your practice as Craig stresses, “By communicating, you will save more money if you’re working with the right people.”
An accountant can help find different opportunities to lower your tax bill and, “Pay what you’re legally obligated to pay.”
For more information on Craig:
Craig Cody is a Certified Tax Coach, Certified Public Accountant, Business Owner and Former New York City Police Officer with 17 years experience on the Force. In addition to being a Certified Public Accountant for the past 15 years, he is also a Certified Tax Coach. As a Certified Tax Coach, Craig belongs to a select group of tax practitioners throughout the country who undergo extensive training and continued education on various tax planning techniques and strategies to become, as well as remain, certified. With this organization, Craig has co-authored an Amazon best seller book, Secrets of a Tax-Free Life.
Resources discussed on this show:
Email: craig@ccodycpa.com
Phone: 516-869-4051
Craig Cody and Company Website
Craig Cody Twitter
Craig Cody and Company Facebook
Profit First: Transform Your Business from a Cash-Eating Monster to a Money-Making Machine
Free Gift: 10 Biggest Tax Mistakes That Cost Business Owners Thousands
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Sharon Holand Gelfand joins me to discuss stress and nutrition. Sharon’s path to nutrition began when her son was diagnosed with Crohn’s, Ulcerative Colitis and Ileitis (Irritable Bowel Disease, which is an autoimmune condition). Her decision to tackle his condition led her to change careers and sent her to graduate school where she completed a Masters of Science in Applied Clinical Nutrition (MSACN).
In this episode, we discuss:
-How stress impacts our physiology and the first warning signs of being overstressed
-The vitamins and minerals that most people are deficient in
-Food and supplements to incorporate into your diet to combat stress
-How to heal your gut with fermented foods
-And so much more!
Fatigue can be one of the first indications that stress is beginning to impact your health and Sharon has found that, “We are given so many signs but we don’t pay attention to them.” Your body will tell you when something is awry and the key is to be able to recognize the signs as, “Everything’s awareness.”
Healthcare practitioners must prioritize self care before being able to fully help others as Sharon reminds, “If we don’t put that oxygen mask on ourselves first, we are going to be dead.”
When incorporating your new health promotion plan in your life, Sharon recommends, “Don’t try to do it all at once…It’s a habit, it’s practice.” While it can be difficult to be consistent with a healthy lifestyle, Sharon challenges, “Do you want to be proactive about it or wait until something happens and then have to react?”
For more information on Sharon:
Sharon’s path to nutrition began when her son was diagnosed with Crohn’s, Ulcerative Colitis and Ileitis (Irritable Bowel Disease, which is an autoimmune condition). Her decision to tackle his condition led her to change careers and sent her to graduate school where she completed a Masters of Science in Applied Clinical Nutrition (MSACN).
During this process Sharon realized that she had been ignoring her own symptoms, including IBS, migraines, eczema and hypoglycemia to name a few. She learned how to heal herself, her son and her whole family through proper functional testing, food, supplements and changes to their lifestyle.
Sharon is a certified functional nutritionist and a member of the American College of Nutrition. She believes you need to stop guessing, start testing and works with men and women who are sick and tired of feeling sick and tired, and want to get to the root of their health issues once and for all so that they have more energy, less brain fog, lose weight and feel great!
Sharon believes that if you don’t get the right nutrients, that if you keep borrowing from your own health account and depleting it, your body becomes inflamed and your brain gets foggy. You have to take care of yourself and your health first (think airplane: place oxygen on yourself first), to think clearly within your own life, before you can have the energy to bring to others, whether it is family, friends or coworkers.
Resources discussed on this show:
Email: sharon@sharonholand.com
Sharon's Website
Sharon's Facebook
Sharon's twitter
Sharon's Instagram
Sharon's LinkedIn
Sharon's Youtube
Nutraceutical
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Josh Payne joins me to discuss how he began his concierge physical therapy practice. Dr. Josh Payne is the owner of Freedom Physical Therapy, providing concierge services to his clients in Denver, CO. Josh started his practice after getting tired of the traditional physical therapy model in multiple outpatient clinics that he worked in. He is an advocate for the growth of the physical therapy profession, and for the trend towards more personalized care.
In this episode, we discuss:
-Why Josh decided he wanted to open his own private practice and how he laid the foundations for his business
-Josh’s top referral sources he used to build his patient case load
-Some mistakes made along the way while growing his practice
-What the future has in store for Freedom Physical Therapy
-And so much more!
Josh believes confidence in yourself as a therapist will go a long way in helping you grow your practice. Josh stresses, “The whole reason why I want to start a practice is to give my patients what they truly deserve.”
Entrepreneurs can invest an abundance of time in their business and setting boundaries at the beginning can be an important consideration. Josh found that, “I took away everything that wasn’t helping me go in the direction I wanted to go forward with.”
Job burnout is becoming more and more common in physical therapy. Find the right blend for your practice as Josh advises, “Don’t be afraid to be different in the world of PT.”
For more information on Josh:
Dr. Josh Payne is the owner of Freedom Physical Therapy, providing concierge services to his clients in Denver, CO. Josh started his practice after getting tired of the traditional physical therapy model in multiple outpatient clinics that he worked in. He is an advocate for the growth of the physical therapy profession, and for the trend towards more personalized care. Dr. Payne believes that a holistic approach is what is needed for truly effective care. In his free time, he enjoys mountain biking, camping, and hiking with his wife Shelby. Josh graduated with his Doctorate in physical therapy from Texas Tech University in 2013.
Resources discussed on this show:
Josh Payne Instagram
Josh Payne Facebook
Freedom PT Concierge Website
Email: drjosh@freedomptconcierge.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Madeleine Silva joins me to discuss the empowered patient journey. Madeleine supports a wide range of holistic doctors, healers and practitioners looking to reach their dream patients. A sought-after healthcare speaker, an innovative healthcare futurist and an acclaimed healthcare business coach, Madeleine will generously share her best, actionable advice from 25+ years of healthcare business experience.
In this episode, we discuss:
-The digital disruption of healthcare and how it’s impacting providers
-What is the “Empowered Patient Journey”?
-How to build a community for your practice with Facebook live and Facebook groups
-Patient myths that will stifle your success
-And so much more!
With access to healthcare information readily available, Madeleine stresses, “It’s harder to convert patients now more than ever.”
The most important qualities patient’s look for in their providers is that they spend time listening, care and readily share information. In addition, Madeleine has found, “What people are mostly looking for from their healthcare provider today is actually to be empowered.”
Patients are highly motivated to participate in their healing process and Madeleine believes, “We have an opportunity to put health back in healthcare.”
For more information on Madeleine:
With an international mindset, diverse healthcare background and what many call an artistic approach to business, Madeleine Silva promises to make you rethink how to grow a healthcare practice, influence and income in today’s rapidly changing, patient-driven digital economy.
Madeleine supports a wide range of holistic doctors, healers and practitioners looking to reach their dream patients. With over 80% of adults searching online before ever stepping foot in a healthcare practice, Madeleine says there is no faster way to establish yourself as the go-to expert in today’s digital revolution than by creating a community of raving fans online.
A sought-after healthcare speaker, an innovative healthcare futurist and an acclaimed healthcare business coach, Madeleine will generously share her best, actionable advice from 25+ years of healthcare business experience. Be ready to become a Healthcare Hero of the Empowered Health Revolution. It’s not business as usual.
More about Madeleine:
Madeleine was born in Vevey, Switzerland, grew up in Helsingborg, Sweden and moved to San Francisco, USA by herself when she was just nineteen. She grew her first business to 6-figures in just nine months and continued to double her business revenue the second and third year. Like many of her clients, as her business grew, Madeleine got stuck working in the center of her business, overwhelmed, maxed out and without any time to continue to develop her business vision. After years of struggling, on the brink of losing her home, Madeleine finally cracked the code to the Freedom Switch Formula and successfully created an 8-hour workweek while growing her profit margin to an impressive 65%. She had started 5 businesses from scratch on shoestring budgets and successfully sold two businesses for top dollars.
Resources discussed on this show:
The Patient Will See You Now: The Future of Medicine Is in Your Hands
Freedom Switch Website
Freedom Switch Facebook
Madeleine Silva LinkedIn
Freedom Switch Welcome to Healthy Wealthy and Smart listeners!
Healthcare Hero Facebook Group
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from Washington DC at the Federal Advocacy Forum through the American Physical Therapy Association, I am joined by Dr. Sharon Dunn to discuss advocacy in physical therapy. Dr. Sharon Dunn is the President of the American Physical Therapy Association. Since beginning service through the professional organization as a student, Sharon has also served as the State Government Affairs Chair; Louisiana chapter President, Vice President, and Delegate.
In this episode, we discuss:
-Physical therapy advocacy for both the patients and the profession
-Policy agenda wins for the APTA
-New public policy priorities for 2018
-How to bring advocacy to your community, state and country
-And so much more!
Dr. Dunn believes the focus of advocacy efforts should be about the patients as, “Stories are where the meaningful conversations occur.” Dr. Dunn has found, “To bring the patient’s story to the congressional leadership is what really makes a difference.”
Physical therapy advocates have made significant progress on Capitol Hill as Dr. Dunn reassures, “Hill staffers and congress people see the value of hearing from physical therapists and physical therapist assistants.”
Approach legislators with a win-win scenario as Dr. Dunn strategizes, “Never leave that meeting without offering to be a solution.” She reminds, “Share with the legislators what you do for your patients and not always go about the money or the payment but how can physical therapy be a solution to the healthcare crisis in this country.”
For more information on Dr. Dunn:
Sharon Dunn, PT, PhD, OCS received her BS in PT in 1987 from LSU Health Sciences Center in her hometown of Shreveport, LA. She has since completed a Master’s of Health in ’96 and a PhD in Cellular Biology and Anatomy in ’06. She has been a faculty member at LSU since 1990, currently as an Associate Professor and Chair of the Rehabilitation Sciences Department. Since beginning service through the professional organization as a student, Sharon has served as the State Government Affairs Chair; Louisiana chapter President, Vice President, and Delegate; and of course is the elected APTA President.
Resources discussed on this show:
Sharon Dunn Twitter
#ChoosePT
Prosper Act
PT PAC
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Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor, SPT guest hosts and interviews Allison Gibbons, SPT on The Backstage of Medicine. Allison is a first year physical therapy student at New York University and is Head of Operations and Outreach of the Backstage of Medicine. The backstage of Medicine (TBSOM) has been created to allow any and every one to explore the many medical fields out there in the world.
In this episode, we discuss:
-The Backstage of Medicine: a non-profit organization providing healthcare occupation mentorship
-Allison’s experience navigating the pre-health undergraduate journey
-How to connect the perfect mentor and mentee
-And so much more!
Young students are exposed to a set few occupations from their parents and are not exposed to other opportunities. Allison believes, “You are not set in stone for one thing. No one should tell you what’s best for you; you should be able to explore it.” Allison encourages, “You’re the only person who knows what’s right for you.”
The Backstage of Medicine brings a variety of healthcare bloggers together to accumulate information for those interested in exploring different careers in healthcare as, “No one person has the key to success; we have to learn from each other.”
For more information on Allison:
Allison is a twenty-one year old first-year Doctorate student at New York University pursuing a Doctorate in Physical Therapy and Neurological Rehabilitation aiming to blend physical therapy and soccer in impoverished areas throughout the globe.
She grew up in the woods on a lake in tiny Rhode Island and now currently roaming the East Village of Manhattan. When I'm not studying chances are I'm cutting up my knees playing soccer or spending hours creating Spotify playlists. I spent my undergrad working as a tutor/TA and soccer coach. I was able to combine the best of both worlds by joining the Soccer Without Borders team in 2012. Continuous education is what becoming a health professional is all about
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
The Backstage of Medicine Website
Allison's Twitter
Allison's Instragram
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Caralyn Baxter joins me to discuss her experience as a physical therapist in the 2018 Olympic Games. Dr. Caralyn Baxter is a physical therapist for United States Ski and Snowboard and spends roughly a third of the year traveling with the US Freeski Halfpipe team to domestic and international competitions. Most recently, Cara wrapped up a trip to PyeongChang, South Korea for the 2018 Olympic Games where her team brought home gold, silver, and bronze medals. When not traveling with the team, Cara works out of the Center of Excellence in Park City, UT with all US Ski and Snowboard disciplines, developing long term rehabilitation plans and collaborating with the high performance strength and conditioning team to optimize athletes’ health and success.
In this episode, we discuss:
-How Cara’s volunteer work brought her to the 2018 Olympic Winter Games
-What to expect with sports medicine on the road in comparison to in the clinic
-Prioritizing self care in the face of long working hours during competition season
-Cara’s top moments as a clinician in the Olympic Games
-And so much more!
Breaking into sports medicine takes perseverance and grit as Cara has found that, “Sports medicine is very much a world of needing to prove yourself and make those connections first before an opportunity of having a paid position is going to be placed in front of you.” Cara stresses, “You have to be persistent.”
While treating Olympic athletes on the road can be demanding, ultimately, you are responsible for providing the best care for the athletes as Cara reminds, “It wouldn’t be an Olympic experience without the athletes.”
To enhance your success in sports medicine, Cara advises, “Take advantage of any opportunity out there because you never know what door that’s going to open for you.”
For more information on Caralyn:
Dr. Caralyn Baxter is a physical therapist for United States Ski and Snowboard and spends roughly a third of the year traveling with the US Freeski Halfpipe team to domestic and international competitions. Most recently, Cara wrapped up a trip to PyeongChang, South Korea for the 2018 Olympic Games where her team brought home gold, silver, and bronze medals.
When not traveling with the team, Cara works out of the Center of Excellence in Park City, UT with all US Ski and Snowboard disciplines, developing long term rehabilitation plans and collaborating with the high performance strength and conditioning team to optimize athletes’ health and success. She has a particular interest in athlete brain health and concussion rehabilitation, and in the summer of 2017, Cara partnered with Dr. Jeffrey Kutcher and implemented the first sports neurology pre participation exams for the US Freeski Halfpipe Team. Additionally, Cara has served as a guest lecturer on concussion rehabilitation at the University of Utah and presented at the 2017 Medical Emergencies in Skiing and Snowboarding conference.
Resources discussed on this show:
Cara Baxter Instagram
Cara Baxter Twitter
Email: cbaxter@ussa.org
Boston Globe: There’s more than one way to make an Olympic dream come true
Concussion Corner Podcast with Dr. Caralyn Baxter
Headspace
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Brent Brookbush joins me to discuss the state of physical therapy education. Dr. Brookbush has been an impassioned human movement professional since 1998, a passion that can only be matched by his love for education. Developing a presentation style focused on the clear and engaging delivery of evidence-based, practical education, he has been a resource for industry giants such as, New York Sports Clubs (TSI), Equinox, NASM, SHAPE Magazine, Power Plate, BeachBody. Etc. As the founder and CEO of the Brookbush Institute of Human Movement Science, Dr. Brookbush continues to revolutionize education in the industry with cutting edge online resources, live workshops, academic support for universities, as well as providing consulting and print publications. He continues to pursue his passion as CEO, educator, author and speaker, as well as practicing as an independent clinician in New York City.
In this episode, we discuss:
-The evolution of physical therapy education and emerging education models
-Ways multimedia can enrich the learning experience for different learning styles
-Simple solutions to raising costs of physical therapy tuition and student debt
-Brookbush Institute: a multimedia continuing education resource
-And so much more!
Multimedia education models allow for optionality when engaging different learning styles at various price points. Ultimately, Brent believes, “We have a chance here to bring down tuition costs significantly.” With physical therapy schools opting for traditional in-person exclusive educational models, Brent believes, “PT schools, for the most part, are lagging severely behind.”
With the current state of physical therapy school education up for debate, Brent stresses, “The APTA has to stop chasing the medical model.”
Physical therapy practice continues to evolve and it can be challenging to remain current with new information. Brent promotes, “Have an educational game plan.”
For more information on Dr. Brookbush:
Dr. Brookbush has been an impassioned human movement professional since 1998, a passion that can only be matched by his love for education. Developing a presentation style focused on the clear and engaging delivery of evidence-based, practical education, he has been a resource for industry giants such as, New York Sports Clubs (TSI), Equinox, NASM, SHAPE Magazine, Power Plate, BeachBody. Etc. As the founder and CEO of the Brookbush Institute of Human Movement Science, Dr. Brookbush continues to revolutionize education in the industry with cutting edge online resources, live workshops, academic support for universities, as well as providing consulting and print publications. He continues to pursue his passion as CEO, educator, author and speaker, as well as practicing as an independent clinician in New York City.
Resources discussed on this show:
Brookbush Institute Website
Brent Brookbush Facebook
Brent Brookbush Youtube
Brent Brookbush LinkedIn
Brent Brookbush Twitter
Brent Brookbush Instagram
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, James Roberts joins me to discuss disability and fitness. James Roberts was born with a congenital disability called femoral dysplasia and a floating hip of the left leg as well as scoliosis of the spine. James grew on a NATO base in S.H.A.P.E (Casteau), Belgium but now reside back in Prestatyn, North Wales. James is an online training and nutrition coach by trade, but was an elite Paralympic athlete for just over a decade. James has been lucky enough over those years to have represented Great Britain at countless World Championships and 2 Paralympics Games (Beijing 2008 and London 2012) to just name a few.
In this episode, we discuss:
-James’ exciting career as a multisport Paralympics athlete
-Bridging the gap between disability and fitness
-Are people with disabilities underestimated?
-How to reach your ideal clients through social media
-And so much more!
Growing up, James always challenged himself to never let his disability limit his development, asking himself, “Well how can I adapt this simple and mundane task now so that I can integrate with my peers.” As a result of his perseverance, “I’ve learnt different skill sets and it’s made me the person I am today speaking to you.”
James tailor’s programs to each of his client’s goals and not to their disability as he is, “Looking at what’s this person’s ability and what are they actually capable of and pushing them to those extremes.” When working with client’s with disabilities, he stresses, “Treat them no differently than you would treat an able bodied client.”
For more information on James:
I was born with a congenital disability called femoral dysplasia and a floating hip of the left leg as well as scoliosis of the spine. I grew on a NATO base in S.H.A.P.E (Casteau), Belgium but now reside back in Prestatyn, North Wales. I'm an online training and nutrition coach by trade, but I was an elite Paralympic athlete for just over a decade. I've been lucky enough over those years to have represented Great Britain at countless World Championships and 2 Paralympics Games (Beijing 2008 and London 2012) to just name a few.
I started out my sporting career in swimming and was part of British Swimming's Potential Squad from 2003-05. During that time, I held the SB8 200m breaststroke and 50m breaststroke national records.
After being dropped from the GB swimming programme, I moved on to rowing in 2006. The transition happened fairly quickly as I made my first senior international competition that summer at the 2006 World Championships in Dorney Lake, Great Britain and made the final finishing 6th. 2007 World Championships Semi-Finalist, 2008 Paralympic Finalist (5th) and 2009 World Championships Finalist (5th).
I made another transition of sport, this time to sitting volleyball. From 2010 until 2012, I amassed 56 caps for Great Britain. My first international was a surprise selection to compete at the 2010 World Championships in Edmund, Oklahoma, USA. I was lucky enough that my time with the squad, to have competed for Great Britain at my only European Championships in my repertoire as well as a Continental and Intercontinental Cup. My career calumniated at the London 2012 Paralympics were the GB sitting volleyball squad lost in the quarter-final to eventual silver medallist Iran.
So why the website?
Having a disability myself I completely understand the adversity one can face on a day-to-day basis. Also, I wanted to bridge that gap between mainstream fitness and disability, as there is not a lot of fitness topics about for people with disability to widen their knowledge and/or to just improve their quality of living.
Resources discussed on this show:
Fit Amputee Website
Mind Set Game Podcast
James Roberts Facebook
James Roberts Instagram
James Roberts Twitter
James Roberts YouTube
Fit Amputee Resources
Fit Amputee Media
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Michael Bade joins me on Facebook Live to discuss the difference between a residency and fellowship program. Michael is an assistant professor in the University of Colorado Physical Therapy Program. He is board-certified in orthopaedics and is a fellow in the American Academy of Orthopaedic Manual Physical Therapists. He is currently an affiliate faculty member of the Regis OMPT fellowship program and in addition to his experience as a fellowship director, he has assisted with the design of several residency programs.
In this episode, we discuss:
-What is the difference between a residency and fellowship program?
-Michael’s advice for developing a competitive application and exploring different financial options
-Do residency and fellowship programs enhance your clinical practice?
-Should residency be mandated to elevate the practice of physical therapy?
-And so much more!
To develop a competitive application for a residency program, Michael recommends, “Networking is probably one of the more impactful things you can do.”
The practice of physical therapy continues to evolve as the knowledge base grows and seasoned practitioners can remain up-to-date by pursuing a fellowship or residency. Michael believes, “No matter what time in your career you can always benefit from going back and learning more.”
Having been an integral part of many fellowship and residency programs, Michael has found, “Residency and fellowship education are investments in your overall career and ultimately I think that it leads to a lot of increased job satisfaction as your clinical skills grow and it’s a very powerful and transformative experience.”
For more information on Michael Bade, PT, DPT, PhD, OCS, FAAOMPT:
Michael is an assistant professor in the University of Colorado Physical Therapy Program. He is board-certified in orthopaedics and is a fellow in the American Academy of Orthopaedic Manual Physical Therapists. He helped create the Duke University Medical System Orthopaedic Manual Physical Therapy Fellowship and was the first graduate of that program in 2008. In 2012, he received his PhD in Clinical Science from the University of Colorado with an emphasis on comparative effectiveness trials in orthopaedics. After graduating with his PhD, he was the director of the Regis University Orthopaedic Manual Physical Therapy Fellowship as well as an instructor within that program. He is currently an affiliate faculty member of the Regis OMPT fellowship program and in addition to his experience as a fellowship director; he has assisted with the design of several residency programs.
Resources discussed on this show:
Email: michael.bade@ucdenver.edu
Michael Bade Research Gate
Michael Bade LinkedIn
University of Colorado: Michael Bade
Webinar: post-professional career options
MedBridge
Rodeghero 2015
Smith 1999
Jones 2008
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jennifer Stevens-Lapsley joins me on Facebook Live to discuss the pathway to a PhD. Dr. Stevens-Lapsley received her Physical Therapy degree at the University of Delaware, where she went on to complete a PhD in Biomechanics and Movement Science with a focus in Applied Physiology. She then completed post-doctoral training at the University of Florida. Her research uses a multifaceted approach to evaluate intervention strategies designed to enhance the effectiveness of rehabilitation in older adult patient populations. As such, her research ranges from understanding the mechanisms of skeletal muscle dysfunction to studies of implementation of best rehabilitation practices in post-acute care settings.
In this episode, we discuss:
-Deciding whether a residency, fellowship or PhD program is right for you
-How to identify the qualities in a PhD program that best match your career goals
-Why the perfect mentorship match is essential for growth and success
-The key elements Dr. Stevens-Lapsley looks for in a stand out PhD application
-And so much more!
With many lifestyle options for students, they can pursue higher education at their own pace and explore different approaches to learning as Dr. Stevens-Lapsley stresses, “There are such a myriad of ways that PhD training can unfold.” With multiple PhD programs in the country, “The options continue to grow… It is nice to have a variety of options to figure out what is going to fit your individual needs.”
While the learning style, academic environment and available resources are important deciding factors, Dr. Stevens-Lapsley suggests you appraise, “The track record of the mentors in the program as one of the most important considerations.” Dr. Stevens-Lapsley has found that, “Finding the right mentor for a PhD is like a mini marriage.”
Asking about a PhD program’s success rate with securing loan repayment plans for their students is an important consideration as Dr. Stevens-Lapsley stresses, “While people see the finances as the ultimate barrier, our math suggests that it shouldn’t be.”
For more information on Dr. Stevens-Lapsley:
I received my Physical Therapy degree at the University of Delaware, where I went on to complete a PhD in Biomechanics and Movement Science with a focus in Applied Physiology. I then completed post-doctoral training at the University of Florida.
Research Interests
My research uses a multifaceted approach to evaluate intervention strategies designed to enhance the effectiveness of rehabilitation in older adult patient populations. As such, my research ranges from understanding the mechanisms of skeletal muscle dysfunction to studies of implementation of best rehabilitation practices in post-acute care settings. More specifically, my research includes the evaluation of mechanisms of quadriceps dysfunction, interventions to maximize savings with bundled care with joint arthroplasty, pragmatic trials in medically complex patient populations, and health services research to understanding how rehabilitation services impact hospitalization rates and functional performance. One additional area of research emphasis is the development and refinement of more intensive and progressive strategies for the rehabilitation of older adult populations.
Responsibilities:
Director: Rehabilitation Sciences PhD Program, MOVE Lab
Co-Director: RESTORE group
Investigator, ACCORDS
Investigator, VA Geriatric Research, Education, and Clinical Center
Resources discussed on this show:
University of Colorado: Jennifer Stevens-Lapsley
Email: Jennifer.Stevens-Lapsley@ucdenver.edutw
APTA: PhD Programs
Research Gate Profile: Jennifer Stevens-Lapsley
NIH Loan Repayment Plan
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Lousiana, Matthew Villegas organized a Q & A with Dr. Karen Litzy and Dr. Sandy Hilton about pain science. Dr. Litzy is currently the owner of Karen Litzy Physical Therapy, PLLC, a concierge physical therapy practice in New York City, where she sees clients in their home, gym or office and she is the host of the Healthy Wealthy and Smart Podcast. Dr. Sandy Hilton is a physical therapist and her clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women. Sandy is the co-host of Pain Science and Sensibility, a podcast on the application of research into the clinic.
In this episode, we discuss:
-How does psychology and culture impact someone’s pain experience
-Managing expectations and celebrating small wins with patients with CRPS
-Self care tips to prevent empathy burnout in physical therapy
-Interprofessional collaboration to best manage persistent pain patients
-And so much more!
Explaining pain needs to be part of a graded education program just like any exercise program as Sandy reminds, “Everyone learns differently and pain is a uniquely individual experience.”
Every small success should be celebrated and Sandy encourages patients to, “Claim those victories because when you can start doing that¸ you can start building on them.”
Patients with persistent pain would benefit from assurance and motivation as Karen stresses, “If you can be the person for that patient to listen to them, to offer good solid advice, help them take control over their life versus the pain controlling their life, and being able to really get them to understand that they are not fragile and they’re not broken and they’re not damaged goods, that’ll go a long way of getting them better without putting your hands on them or loading a tissue.”
Sandy believes the role of the physical therapist is, “Un-scaring someone and giving them a path to follow and sign marks along the way to be able to recognize that they are getting better and being there to walk it through with them.”
For more information on Karen:
Dr. Litzy is currently the owner of Karen Litzy Physical Therapy, PLLC, a concierge physical therapy practice in New York City, where she sees clients in their home, gym or office. Aside from physical therapy clients she also sees clients for wellness training, surgical packages and golf fitness evaluations. She is on the board of directors for the non-profit Physical Therapy Business Alliance and part of the PT Day of Service team. Dr. Litzy consults with physical therapy colleagues on how to start and maintain a successful out of network physical therapy practice. http://karenlitzy.com/
For more information on Sandy:
Sandy graduated from Pacific University (Oregon) in 1988 with a Master of Science in Physical Therapy and a Doctor of Physical Therapy degree from Des Moines University in December 2013. She has worked in multiple settings across the US with neurologic and orthopaedic emphasis combining these with a focus in pelvic rehabilitation for pain and dysfunction since 1995. Sandy teaches Health Professionals and Community Education classes on returning to function following back and pelvic pain, has assisted with Myofascial Release education, and co-teaches Advanced Level Male Pelvic Floor Evaluation and Treatment. Sandy’s clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women. Sandy is the co-host of Pain Science and Sensibility, a podcast on the application of research into the clinic.
For more information on Matthew:
My name is Matthew Villegas. I host Capable Body Podcast (available on iTunes, Google Play, and Stitcher), which aims to bridge the gap between healthcare providers and real people with real stories. Also, the podcast features an active Facebook community that is a safe space where I share more means to connect with my guests as well as some behind-the-scenes extras.
Resources discussed on this show:
Matthew Villegas Website
Matthew Villegas Twitter
Sandy Hilton Twitter
Karen Litzy Twitter
World Congress on Pain
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Carrie Pagliano joins me to discuss women as leaders and entrepreneurs in physical therapy. Carrie Pagliano currently serves as President for the Section on Women's Health of the American Physical Therapy Association and is the owner of a private women's health/pediatric pelvic health clinic in Arlington, VA.
In this episode, we discuss:
-How Carrie manages being a mom, leader and entrepreneur in physical therapy
-How to elicit the needed support from your tribe to catapult you to success
-A framework for creating value and solving people’s pain points when building your own practice
-Embracing your vulnerabilities and practicing gratitude over even the small successes
-And so much more!
The variety of settings and time management structures in physical therapy afford women the opportunity to manage work and life, as Carrie reminds, “We have so many roles in our profession in which women and specifically moms can choose to be a part of, depending on where they are in their family development.” Women bring value to the workplace and Carrie believes, “Regardless of where we are in our career and family life cycle, we have a lot to offer.”
Jumping at opportunities when they arise, regardless of the timing, has helped Carrie grow into leadership positions. Carrie stresses, “It’s an uncanny ability that I think women have is making things happen.”
Success in any endeavor is a product of the support received from those around you and Carrie has found that, “It’s not about me; it’s everybody around me who helped make this happened.”
For more information on Carrie:
Carrie J. Pagliano received her Masters in Physical Therapy from the University of the Sciences in Philadelphia in 1999 and Doctor of Physical Therapy from University of St. Augustine for Health Sciences (USAHS) in 2007. Dr. Pagliano is double-Board Certified in Orthopaedics and Women’s Health and holds Manual Therapy Certification from USAHS. In 2007, Dr. Pagliano founded the MedStar Georgetown University Hospital PM&R Pelvic Floor Program and in 2014, founded the MGUH Women’s Health PT Residency. Dr. Pagliano is a co-instructor for women’s health focused Real Time Ultrasound education, teaching assistant for pelvic floor education and clinical instructor for student education. She lectures nationally in the areas of chronic pelvic pain, integrative practice models and pelvic floor dysfunction.
Dr. Pagliano currently serves as a Committee Member with The American Board of Physical Therapy Residency and Fellowship Education and as an adjunct professor at Marymount University in Arlington, VA. Dr. Pagliano sits on the Board of Directors for the Section on Women’s Health (SoWH) of the American Physical Therapy Association as President and is the chairperson for the SoWH Name Change Task Force.
Dr. Pagliano resides in Arlington VA with her husband and two children.
Resources discussed on this show:
Carrie Pagliano Twitter
Carrie Pagliano Website
Carrie Pagliano LinkedIn
Carrie Pagliano Facebook
Carrie Pagliano Instagram
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Jenna Kantor, SPT guest hosts and interviews Ali Schoos on opening a physical therapy private practice. Ali owns Peak Sports and Spine Physical Therapy and enjoys leading and learning from her dynamic and passionate team, and believes in excellent customer service. She specializes in biomechanics of the shoulder, spine, and lower extremity, including gait analysis and orthotic fabrication.
In this episode, we discuss:
-How Ali’s experience in different physical therapy settings contributed to her success as a private practice owner
-Ali’s top 3 business strategies for a successful private practice
-Ali’s management mistakes with employee satisfaction and patient acquisition
-How to attract your dream patients through community involvement
-And so much more!
Ali advices people who are on the cusp of starting their own business to be brave. From her experience, “I trusted that I knew I was going to be able to do this. I trusted I was going to have that ability.”
To manage a team that is dedicated to the values, mission and vision of the company, Ali has found that, “As a boss, you can be respectful and you can be collaborative but you can’t be nice to everybody. We don’t lead by being nice.”
Ali has honed her skills as a manager through trial and error. She advices, “It’s learning how to have honest conversations with people… It’s not about the person, it’s about the behaviors. ”
For more information on Ali:
Ali enjoys partnering with her patients of all ages. She has treated professional baseball, tennis, and soccer players, as well as high school, collegiate, and weekend athletes, and everyone in between. She’s dedicated to finding a solution to complex problems, and helps people overcome their body’s obstacles, no matter the challenge. As a Certified Orthopedic Specialist since 1993, Ali works with a variety of difficult cases and utilizes her “Sherlock Holmes-type” skills to find an answer. She leads each patient toward a more active lifestyle. She specializes in biomechanics of the shoulder, spine, and lower extremity, including gait analysis and orthotic fabrication.
Ali owns Peak Sports and Spine Physical Therapy and enjoys leading and learning from her dynamic and passionate team, and believes in excellent customer service. She hopes you’ll be an active participant in choosing your health care provider and recognize Peak Sports and Spine as your primary care physical therapy clinic. “I believe in a partnership between you and your physical therapist.”
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Ali Schoos Twitter
Peak Sports and Spine Physical Therapy Website
Jenna Kantor Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Shannon Sepulveda guest hosts and interviews Julie Wiebe on pelvic health and the female athlete. Julie Wiebe, PT has over 20 years of experience in both Sports Medicine and Pelvic Health. Her passion is to return women to fitness and sport after injury and pregnancy and equip pros to do the same. She advocates for the awareness of pelvic health issues in fitness and promotes innovative solutions for women through her blog, videos and social media. She shares her evidence-based, integrative approach internationally with both professionals and women through live and online educational programs. Find out more and connect with Julie at www.juliewiebept.com
In this episode, we discuss:
-How to support pelvic floor health for return to sport in the female athlete
-Linking orthopedic and women’s health physical therapy
-When to refer your athletes to a pelvic health physical therapist
-Educating coaches on incontinence in the adolescent female athlete
-And so much more!
Pelvic health is a component of an athlete’s sport performance as Julie encourages, “Start to think about the pelvic floor as more than just something we can strengthen, it’s something we can control and have it perform.”
The pelvic floor has an important role in the body’s proximal control and stability system. Julie stresses, “There is really no separation in the body, the pelvis and the pelvic floor are part of everything.”
Orthopedic physical therapists can include pelvic floor rehabilitation in their return to sport protocols as Julie reminds, “If we understand the pelvic floor and the pelvic floor complex as a muscle group, just treat it like any other muscle group and talk about it that way.”
For more information on Julie:
Julie Wiebe, PT has over twenty years of clinical experience in both Sports Medicine and Women’s Health. Following her passion to revolutionize the way women recover from pregnancy and return to high levels of fitness, she has pioneered an integrative approach to promote women’s health in and through fitness.
Her Diaphragm/Pelvic Floor Piston Science concepts have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations. Julie is a sought after speaker to provide continuing education courses and lectures internationally at clinics, academic institutions, professional organizations, state and national professional conferences.
Julie maintains a cash-based clinical practice in Los Angeles and shares her approach to bridge the gap between rehab and fitness with pros and women worldwide through online courses and mentoring.
A published author, she advocates for awareness of pelvic health in fitness on her blog and through social media (Twitter/FB/IG-JulieWiebePT) www.juliewiebept.com
When not trying to change the world one pelvic floor at a time, Julie is happy to focus on her first passions: being mom to the Z’s (Zoe and Zack), and wife to David.
For more information on Shannon:
Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.
Resources discussed on this show:
Julie Wiebe Website
Julie Wiebe Facebook
Julie Wiebe Instagram
Julie Wiebe Twitter
Shannon Sepulveda Website
Shannon Sepulveda Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Carrie Fuller guest hosts and interviews Dr. Peggy Lynam on the importance of APTA membership. Dr. Peggy Lynam has been practicing as a physical therapist for 36 years and currently is an Associate professor in the DPT program at Long Island University- Brooklyn, N.Y. Dr Lynam is a Board certified clinical specialist in neurologic physical therapy, and in addition to her faculty role, she maintains a part-time home health practice, providing service mainly to geriatric adults with neurologic conditions.
In this episode, we discuss:
-Peggy’s involvement in the APTA and NYPTA
-What is the APTA’s House of Delegates?
-The many ways to be an active member of the APTA
-How students can seek mentorship opportunities within state and national associations
-And so much more!
Becoming involved in any association position can be rewarding and enriching. From Peggy’s experience, “Each role seemed the best role for me at that point in my professional life and my personal life.”
Specifically, if you are interested in broader policy solutions, being involved in the Association’s House of Delegates keeps you at the forefront of the issues within the profession. Peggy found that, “The best thing about serving in the house is you are a part of contributing to what the association is going to be doing, how we are moving forward and how we are influencing the profession to move forward.”
The American Physical Therapy Association is foundational to the success of the profession. Peggy stresses, “We promote the profession. Without the Association, I don’t think our profession of physical therapy would exist anymore.”
For more information on Peggy:
Dr. Peggy Lynam has been practicing as a physical therapist for 36 years. She received her B.S. degree in physical therapy from Ithaca College, a post professional Masters degree from Long Island University and a T-DPT degree from A.T. Still University
She currently is an Associate professor in the DPT program at Long Island University- Brooklyn, N.Y.
Dr Lynam is a Board certified clinical specialist in neurologic physical therapy, and in addition to her faculty role, she maintains a part-time home health practice, providing service mainly to geriatric adults with neurologic conditions.
For more information on Carrie:
Carrie Fuller, PTA, RPSFC, PYTc is a RPSF Certified PTA in Neuro-Developmental Treatment (NDT), is a Professional Yoga Therapist candidate in the practice of medical therapeutic yoga and received PTA Recognition of Advanced Proficiency in Neuromuscular Physical Therapy from the American Physical Therapy Association in 2012. Carrie earned a Bachelor of Arts-Summa Cum Laude, Disability Studies in 2016 at the City University of NY. Carrie is currently the New York Physical Therapy Association Greater NY District’s Secretary and has been a Greater NY District Delegate to the Delegate Assembly for the past 8 years. At the National level, Carrie is the elected PTA Caucus Representative of the NY Chapter and will have participated in the APTA House of Delegates for 7 years this June. She has been an ambassador for PT Day of Service for the past three years. Carrie presently works as the Senior Physical Therapist Assistant at Mt. Sinai West.
Resources discussed on this show:
Carrie Fuller Twitter
Carrie Gatlin Fuller Facebook
New York Physical Therapy Association
APTA Student Assembly
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
Following the CSM After Dark series, the Healthy Wealthy and Smart Podcast followed up with the panelists to hear their after thoughts from the experience. Make sure to catch up on Part 1 and Part 2 before listening to this show!
Dr. Rupal Patel, PT, DPT twitter
- “Everyone had a unique perspective.”
- “Everyone also needed to feel safe to share their story.”
- “Look beneath the surface, the façade, or the face to learn about what makes them diverse or what makes them unique.”
- “We need more of these kind of venues where we have different people from different diverse backgrounds sharing their unique perspectives and stories.”
- “Find someone that they can relate to that is a physical therapist in their community… and reach out to them.”
- “We need to move beyond just talking about diversity and really putting some traction or action behind it.”
Dr. Monique Caruth, PT, DPT twitter
- “After hearing the other four women speak, it actually encouraged me to be more forthcoming about my experiences and my story because I know I am not alone.”
- “Even though we were all women, there was difference in ethnicity and also difference in sexuality and gender as well. Diversity shouldn’t be based on just gender or color.”
- “I hope we become a more inclusive profession and we all become better.”
- “We are already at a disadvantage.”
- “It’s important for people to see someone looking like them and being a role model for them as something to achieve.”
Dr. Uchenna Ossai, PT, DPT twitter, facebook, instagram
- “I’m not alone.”
- “There’s nothing more inspiring and energizing knowing that you have a community within a community.”
- “It’s hard to develop that sense of self worth.”
- “There’s different repercussions.”
- “All can be elevated by understanding our bias and bias is not bad but it’s bad if we deny that it exists.”
Sherry Teague, CFO, PTA twitter, Email: Teague@valuebeyondthevisit.com, Kornetti and Krafft Healthcare Solutions
- “Getting that message spread out will be really important.”
- “The world inclusion is probably the word we should be using.”
- “We didn’t get here in one motion… it would be nice to see incremental steps across the board.”
- “You only have one chance to make a first impression and oftentimes those kinds of things, the paper forms and the restrooms and the environment you walk into is the first impression you can make with the client.”
Dr. Lisa VanHoose, PT, PhD twitter
- “Everyone had a unique story but there was a commonality in the fact that their identities had almost marginalized them during their PT education.”
- “It’s important for us to ask questions and for us to be ok with being in those uncomfortable experiences.”
- “There’s this desire for us to be better.”
- “That means you just need a little more validation in that you are worthy not just to be at the table but also to be asked to dance.”
- “There’s more variation in a group then there is between groups.”
- “We all kind of struggle from imposter syndrome but racism for professionals really makes that worse.”
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Dr. Stephanie Weyrauch guest hosts and interviews Dr. Lisa Dorsey on her experiences in academia and with entrepreneurship. Dr. Lisa Dorsey is the co-founder and President of Eloquentia Consulting, a holistic firm that supports professional development within organizations, specifically focused on higher education. She currently holds the position of Assistant Professor in the Department of Physical Therapy and Athletic Training in the Doisy College of Health Sciences at Saint Louis University. Previously, she served as the Associate Provost for Undergraduate Education, Dean for the Doisy College of Health Sciences, Associate Dean for Academic and Student Affairs and Associate Dean for Graduate Education for the Doisy College of Health Sciences, and the Director of the Program in Health Sciences at Saint Louis University.
In this episode, we discuss:
-How to manage work life balance as a woman in the physical therapy profession
-Eloquentia Consulting, LLC: mentorship for women in the workplace
-How to develop leadership careers in higher education
-Barriers to advancing to leadership positions
-And so much more!
Lisa has a history of standing up against limiting beliefs about women’s ability to balance work and family. In one memorable exchange in a public setting she recalls feeling, “like so many doors were shut by that statement for all the women in the room.”
It is possible for you to enjoy both a great career and have meaningful relationships. From Lisa’s experience, “You can do both pieces. It’s about choices and it’s about how you integrate that life balance into your work.”
A good leader will want to collaborate with you and find solutions for your career growth. Lisa encourages, “Don’t be afraid to have that conversation.”
For more information on Lisa:
Dr. Lisa Dorsey is the co-founder and President of Eloquentia Consulting, a holistic firm that supports professional development within organizations, specifically focused on higher education. She currently holds the position of Assistant Professor in the Department of Physical Therapy and Athletic Training in the Doisy College of Health Sciences at Saint Louis University. Previously, she served as the Associate Provost for Undergraduate Education, Dean for the Doisy College of Health Sciences, Associate Dean for Academic and Student Affairs and Associate Dean for Graduate Education for the Doisy College of Health Sciences, and the Director of the Program in Health Sciences at Saint Louis University.
She has completed a number of research and scholarship projects exploring physical therapy intervention for neurological impairment, higher education organizational structure, student success models in physical therapy and women in leadership and the workplace. Her current and most recent research projects include Pathways of Leader Self-efficacy for Women in Higher Education and Women Leading Women: Strategies and Support for Lifelong Career Development in Higher Education. She is engaged in the profession of physical therapy at the national level as the Chair for the Task Force on Graduate Outcomes, in higher education as an accreditation reviewer for the Higher Learning Commission, and serves her local community as the Secretary for the Board of Education in the Mehlville School District.
She was the recipient of the Saint Louis University Woman of the Year Award in 2016, the Student Development Collaborative Partner Award, the Faculty Commitment to Experiential Learning Leadership & Service Award, and has been a Saint Louis University- YWCA Leader in the Workplace. Dr. Dorsey holds a Bachelor of Science degree in Physical Therapy and a Master’s in Business Administration from Saint Louis University, a PhD in Educational Policy and Administration in Higher Education from the University of Minnesota and a Women and Power: Leadership in the New World certificate from the Harvard Kennedy School.
For more information on Stephanie:
Dr. Stephanie Weyrauch is employed as a Doctor of Physical Therapy at RehabAuthority in Thief River Falls, Minnesota. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis and her Bachelor of Science in Biology from University of Mary in Bismarck, ND. She has served on multiple national task forces for the American Physical Therapy Association and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Dr. Weyrauch is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership and currently manages the social media accounts for the American Physical Therapy Association Education Section and PT Day of Service. Dr. Weyrauch has performed extensive scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in a top journal in rehabilitation.
Resources discussed on this show:
Eloquentia Consulting Website
Stephanie Weyrauch Website
Stephanie Weyrauch Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, the Healthy Wealthy and Smart Podcast brings another installment of CSM After Dark Part 2 featuring the following diversity panelists:
Dr. Rupal Patel, PT, DPT twitter
- “It’s so hard to explain equity to people.”
- “People are not as woke in most of our faculties.”
- “Everyone doesn’t have the same privilege and barriers.”
- “Diversity is being asked to the party. Inclusion is being asked to dance.”
- “Separation exists and that’s what creates those divides.”
- “It’s going to take a long time but I think it takes all of us being advocates.”
Dr. Monique Caruth, PT, DPT twitter
- “The women are often afterthoughts.”
- “You are basically assuming affirmative action is what got my degree or what got me here.”
- “No matter what setting you’re in, you have to work twice as hard.”
- “If you are showing that example that you’re willing to make that change, other people are going to follow to.”
Dr. Uchenna Ossai, PT, DPT twitter
- “Discrimination, bias, all of it has evolved.”
- “It’s in our blood.”
- “I’m doing all this and still I have to be at 150 to be considered in this mediocre conversation that I’m having.”
Sherry Teague, CFO, PTA twitter
- “It’s up to y’all. Guys like y’all are the only ones that can change minds. You gotta be loud, you gotta be insistent because as a woman I am less than.”
- “Raise those young men to be different.”
- “Our country has to have a fundamental shift from patriarchy to inclusiveness.”
- “You will never win. What do you say to that?”
- “It’s insidious, it’s this beautiful dance.”
Dr. Lisa VanHoose, PT, PhD twitter
- “You are fully aware of differences. You are fully aware of disparities but we play blind.”
- “As a society and a profession, we lack compassion.”
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Carrie Fuller guest hosts and interviews Ginger Garner on her run for public office. Dr. Ginger Garner is a University of North Carolina at Chapel Hill trained doctor of physical therapy (DPT), as well as a licensed athletic trainer (LAT, ATC) and professional yoga therapist (PYT). She has spent her career advocating for maternal health and recently spoke at World Congress on Physical Therapy on the global maternal health crisis and what mindful, integrated physical therapy can do to affect postpartum outcomes. Dr. Garner is now running for the North Carolina Senate, District 2.
In this episode, we discuss:
-The back story and inspiration behind Ginger’s run for North Carolina Senate, District 2
-The support system involved in running for public office
-Ginger’s positions on North Carolina’s healthcare, environment and education
-How Ginger’s background as a physical therapist enhances her run for office
-And so much more!
The volunteer work Ginger has pursued throughout her life she defines as the turning points which helped fuel her passion for advocacy. She found that, “The best jobs I have ever had never paid me a dime.”
Before pursuing public office, Ginger found value in the feedback from those around her and that “The only reason I can do it is because I have the support of other people.”
Assuming many different roles in society as a woman can be challenging. From Ginger’s experience, she stresses, “It really doesn’t matter what we do, we are going to come under heavier scrutiny for that.”
For more information on Ginger:
Dr. Ginger Garner is a University of North Carolina at Chapel Hill trained doctor of physical therapy (DPT), as well as a licensed athletic trainer (LAT, ATC) and professional yoga therapist (PYT). She has spent over 25 years studying and creating “best fit” evidence-based yoga practices in and outside of healthcare. A clinician and researcher specializing in functional, integrative medicine and wellness, Dr. Garner is the founder of Professional Yoga Therapy Institute® and author of Medical Therapeutic Yoga © 2016, now translated in four languages. She has spent her career advocating for maternal health and recently spoke at World Congress on Physical Therapy on the global maternal health crisis and what mindful, integrated physical therapy can do to affect postpartum outcomes. Dr. Garner is now running for the North Carolina Senate, District 2.
For more information on Carrie:
Carrie Fuller, PTA, RPSFC, PYTc is a RPSF Certified PTA in Neuro-Developmental Treatment (NDT), is a Professional Yoga Therapist candidate in the practice of medical therapeutic yoga and received PTA Recognition of Advanced Proficiency in Neuromuscular Physical Therapy from the American Physical Therapy Association in 2012. Carrie earned a Bachelor of Arts-Summa Cum Laude, Disability Studies in 2016 at the City University of NY. Carrie is currently the New York Physical Therapy Association Greater NY District’s Secretary and has been a Greater NY District Delegate to the Delegate Assembly for the past 8 years. At the National level, Carrie is the elected PTA Caucus Representative of the NY Chapter and will have participated in the APTA House of Delegates for 7 years this June. She has been an ambassador for PT Day of Service for the past three years. Carrie presently works as the Senior Physical Therapist Assistant at Mt. Sinai West.
Resources discussed on this show:
Ginger Garner NC Website
Ginger Garner Website
Professional Yoga Therapy Institute Website
Medical Therapeutic Yoga Website
Ginger Garner for NC Senate Facebook
Dr. Ginger Garner Facebook
Ginger Garner Twitter
Medical Therapeutic Yoga: Biopsychosocial Rehabilitation and Wellness Care Book
Carrie Fuller Twitter
Carrie Gatlin Fuller Facebook
Caring Economy Website
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Jenna Kantor, SPT guest hosts and interviews Sandra Norby on women in leadership roles and their presence on social media. Dr. Sandra Norby PT, DPT is the president of the American Physical Therapy Association Private Practice Section.
In this episode, we discuss:
-Social media for private practice owners
-Sandy’s reflections on her social media experience
-Do men tend to be more recognizable on social media?
-Ways women can showcase their accomplishments
-And so much more!
Social media is an important tool for business owners to market their existence because now, more than ever, “People find you through social media.”
One of the benefits of social media is being able to engage with people all over the world. Sandra believes, “It’s a way for us to share our story to a wider audience in a split second.”
Sandy recommends building connections with people who will help share your successes on your behalf. She has found that, “We need to support each other.”
For more information on Sandy:
Sandra Norby, PT, DPT is CEO and Co-Founder of HomeTown Physical Therapy, LLC. This Iowa based corporation provides a practice model for ownership and champions the leadership of women in physical therapy. Sandra has served on many leadership positions in APTA and PPS, including being a member of PPAC and two terms as a Director on the PPS Board. She was awarded the 2017 APTA Federal Advocacy Leadership Award for her instrumental work on making Locum Tenens a reality for physical therapists.
Sandra received her Physical Therapy Masters degree from the University of Iowa and her DPT from the University of Montana – Missoula. She has an expertise in compliance and billing and has been a speaker at many state and national events on topics that include technology, leadership, and championing the success of women in physical therapy.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
APTA Private Practice Section
WendySueSwanson MD Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, the Healthy Wealthy and Smart Podcast brings another installment of CSM After Dark Part 1 featuring the following diversity panelists:
Dr. Rupal Patel, PT, DPT twitter
- “When you’re an immigrant kid it’s about not just the education but what is the value of that education in terms of jobs and economy.”
- “You have to own face diversity.”
- “The biggest guidance which is very silent is my parents.”
Dr. Monique Caruth, PT, DPT twitter
- “I was greeted by a sign that says, ‘All aliens follow this line. All residents follow that line.’ Alien? Am I an alien? That was my first encounter with being different or being labeled as something different.”
- “I get asked all the time by my patients, ‘Wow you speak English so well, what’s your first language?’ and I am like, English.”
- “I had to learn to modify my accent. I still have one but it’s not as pronounced because in school a lot of people couldn’t understand when I spoke.”
- “The first time I met with the Director of Rehab at that program she stopped and said while we were talking, ‘Wow, you’re more articulate then what I expected.’”
- “I battled with who to sit and eat lunch with every lunch time.”
- “We try to be as passive aggressive as possible.”
- “In order for our profession to grow, people have to be aware that their not dealing with colleagues who are like them, who believe the same things that they believe. They are also not going to be treating patients who believe the same thing that they believe or live the same life that they live.”
- “As a profession we don’t do any justice in supporting people who are not like us.”
- “A lot of things do not apply to African American patients that we try to encourage people to do.”
Dr. Uchenna Ossai, PT, DPT twitter
- “I was in a sea of white faces.”
- “I am used to being in white spaces. I am used to accommodating.”
- “The process of going through PT school where you’re the only one and then you have professors who do the oppression through denial, ‘Oh, I treat everyone the same. I don’t see color. Vagina, penis, no different.’ Trust me it’s not the same.”
- “If someone just got kicked out of their house because they’re transgender and live in a state that won’t protect them that pain isn’t going to go away. Evidence based medicine isn’t going to help that.”
- “It was so hard to finish that process when I felt that I had no one.”
- “There is a disease that we have called complicit.”
- “Me disagreeing with you is not anger.”
Sherry Teague, CFO, PTA twitter
- “Going to the restroom can be quite the special treat.”
- “I’ve been fired for who I am.”
- “You knew you were being looked over because you’re different.”
- “The patients that you meet that are LGBTQ they are at risk by simple being who they are.”
- “Those of you that are straight, just always assume that you don’t know. Ask the questions in a very non-binary way.”
- “You could make a difference as a healthcare provider.”
Dr. Lisa VanHoose, PT, PhD twitter
- “As a minority, sometimes you have to massage your message a little bit because people can be sensitive.”
- “Those adjectives that you just gave me about slavery that’s how I feel about PT at times.”
- “I think holistic admission is going to be our saving grace.”
- “We are using the term inclusion as a way to put a Band-Aid on it.”
- “Sometimes we forget the stories.”
- “Ask questions.”
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Jenna Kantor, SPT guest hosts and interviews Brianne Showman Brown on hydration. Dr. Brianne Showman Brown has been a licensed physical therapist since 2006. Since that time, she has been helping active adults and athletes get back to the activities they love. As ideas and theories in rehabilitation, functional movement, and nutrition are constantly changing, she is constantly searching for the new information in order to get you back to the activities you love as quickly (but safely) as possible.
In this episode, we discuss:
-The physical and mental effects of not consuming enough water throughout the day
-Physical therapy setting and productivity requirements and their implications on water consumption
-How to fit water breaks into your day and busy patient schedule
-Increased water consumption results in more bathroom visits?
-And so much more!
Relying on your thirst signal for your body’s need for water is surprisingly not accurate as Brianne states, “By the time your body even tells you to drink water, you’re already passed that point of being dehydrated.”
For our body to function at the most optimal, Brianne stresses, “All of our organs need water to function.”
Being chronically dehydrated leads to poor performance because, “If you’re so dehydrated, your body is going to shut down what it has to in order to keep you alive.”
For more information on Brianne:
Dr. Brianne Showman Brown has been a licensed physical therapist since 2006. Since that time, she has been helping active adults and athletes get back to the activities they love.
As ideas and theories in rehabilitation, functional movement, and nutrition are constantly changing, she is constantly searching for the new information in order to get you back to the activities you love as quickly (but safely) as possible.
Being a CrossFitter and runner herself, she also understands the desire to want to push through the pain, not wanting to take time off, and wanting to get back to activity as soon as possible when required to take time off. She does her best to keep you active in the things you are able to do, modifying as necessary, but not taking you completely out of the gym, off the track/field, or off the road.
For more information on Jenna:
Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Get Your Fix Physical Therapy Website
Get Your Fix Physical Therapy Facebook
Get Your Fix Nutrition Facebook
Brianne Showman Brown Facebook
Get Your Fix Physical Therapy Instagram
Get Your Fix Nutrition Instagram
Brianne Showman Brown Instagram
Get Your Fix Physical Therapy Twitter
Brianne Showman Brown LinkedIn
Servant PT podcast episode with Brianne Brown
Duck Legs Podcast episode with Brianne Brown
The Capable Body podcast episode with Brianne Brown
PT tech talk episode with Brianne Brown
AZ Culture Weekly Blog
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Bobby Cappuccio joins me to discuss living your truth. Robert Cappuccio is a respected motivational speaker and educator. He is a highly sought-after corporate coach, and considered to be a leader and pioneer in the areas of personal and professional development, as well as behavioral change.
In this episode, we discuss:
-The challenging childhood that shaped Bobby’s life
-How every Hero’s journey is helped and directed by a guide
-The limitations and potential destructiveness of inward focus
-How to hone in on your originating intention and achieve happiness
-And so much more!
More than most, Bobby knows that life will always have challenges; his approach has been to develop strong relationships and reach out to others. Bobby stresses, “Everybody who has gone through something, what gets them out of it is not necessarily pulling themselves up by their own bootstraps but interacting and formulating and cultivating continually effective relationships.” As a result of this belief, Bobby believes, “There is no such thing as a self made man or women.”
Bobby suggests finding your passion by focusing on where your interests already align as, “We might not know what our passion is but we all have curiosities.” As a result of this, “When behaviors and values align, that’s when passion, discipline, willpower, perseverance—all the attributes we associate with success—occur automatically.”
When you start to live your life in a way that is authentic and true to yourself Bobby believes that, “You don’t chase happiness, you attract it.”
For more information on Bobby:
Robert Joseph Cappuccio, aka Bobby, has spent the last two decades pushing for both an industry and individual shift in perspective, from a solely outward focused goal oriented approach to health and fitness to a more holistic approach that is centered on behavioral change. A phenomenon that has helped position PTA Global (a company Bobby co-founded) as a leader in professional fitness development.
Bobby has championed both his personal and professional experiences into practical programs designed to help corporate, industry personnel, as well as individuals, get what they truly want. An ideal he firmly believes attainable because result comes from process – be it the process of working on who you are in the moment, the creative process, or strategic processes in business and in one’s personal life.
Bobby began coaching shortly after a paradigm shift occurred in his life. He was in his early twenties, and a certified personal trainer. Born with a severe facial deformity and diagnosed with Tourette syndrome at age nine, he suffered abominable abuse in and out of his home until he stumbled upon a marvel: exercise. It saved his life. He discovered that by redirecting his focus, he could affect positive change in not only his life, but in the lives of the people he in turn trained. In helping others, he was in fact helping himself. In sharing his discoveries (both learned and experienced) over the years, he became a world-renowned speaker, author and coach.
As co-founder of PTA Global, former head of training and development at David Barton gym, former director of professional development at the National Academy of Sports Medicine (N.A.S.M.), Director of Coaching at the Institute of Motion (IOM) and content curator for PTontheNet, Bobby’s reach runs wide. A sales, leadership, and cultural development consultant for various companies including Hilton Hotels, Virgin Active, Fitness First, 24hr Fitness, David Lloyd Leisure and multiple small businesses nationally and abroad, Bobby travels the world impacting lives, inspiring positive change and growth in individuals and companies alike. A presenter at business and fitness conferences across the globe including IDEA, Filex, CanFitPro, FitPro, IHRSA, Pure Fitness Asia, Perform Better, Equinox, Gold’s Gym International, Lifetime Family Fitness, and countless other corporate events, conventions, and workshops aimed at training and developing top notch fitness professionals, Bobby continues to share the impact of honing in on behavioral change in helping clients reach their professional, fitness, and wellness goals.
Bobby can be seen weekly on his YouTube and Facebook Video sessions, and heard on various podcasts, tackling subject matters ranging from how sleep affects productivity to tried and true sales closing techniques and customer retention strategies.
Resources discussed on this show:
Bobby Cappuccio Website
Bobby Cappuccio twitter
Bobby Cappuccio Facebook
Bobby Cappuccio LinkedIn
Bobby Cappuccio Instagram
Bobby Cappuccio Youtube
Joseph Campbell: The Hero's Journey
Chris Winfield Website
Theory U: Leading from the Future as It Emerges
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Ali Schoos, PT guest hosts and interviews Dr. Sandra Norby on leadership. Dr. Sandra Norby PT, DPT is the president of the American Physical Therapy Association Private Practice Section.
In this episode, we discuss:
-The steps Sandra took to attain leadership positions
-Building a business community
-The vision for the Private Practice Section
-How you can get involved in leadership positions
-And so much more!
Leadership styles vary and different people have different strengths. Assembling these different styles and strengths is important when developing at team as Sandra recommends, “It’s not good to pick someone necessarily just like you, we need everybody’s varieties and then appreciating their strengths.”
Many new ideas are being implemented under Sandra’s leadership of the Private Practice Section. Sandra believes, “Our membership is really relying on us to make a difference in their lives as well as the lives of all of our patients.”
As the Private Practice Section continues to grow, Sandra wants to ensure everyone still has a voice. She stresses, “We need to do the things that our members are expecting us to do.”
For more information on Sandra:
Sandra Norby, PT, DPT is CEO and Co-Founder of HomeTown Physical Therapy, LLC. This Iowa based corporation provides a practice model for ownership and champions the leadership of women in physical therapy. Sandra has served on many leadership positions in APTA and PPS, including being a member of PPAC and two terms as a Director on the PPS Board. She was awarded the 2017 APTA Federal Advocacy Leadership Award for her instrumental work on making Locum Tenens a reality for physical therapists.
Sandra received her Physical Therapy Masters degree from the University of Iowa and her DPT from the University of Montana – Missoula. She has an expertise in compliance and billing and has been a speaker at many state and national events on topics that include technology, leadership, and championing the success of women in physical therapy.
For more information on Ali:
Ali enjoys partnering with her patients of all ages. She has treated professional baseball, tennis, and soccer players, as well as high school, collegiate, and weekend athletes, and everyone in between. She's dedicated to finding a solution to complex problems, and helps people overcome their body's obstacles, no matter the challenge. As a Certified Orthopedic Specialist since 1993, Ali works with a variety of difficult cases and utilizes her "Sherlock Holmes-type" skills to find an answer. She leads each patient toward a more active lifestyle. She specializes in biomechanics of the shoulder, spine, and lower extremity, including gait analysis and orthotic fabrication.
Ali owns the clinic and enjoys leading and learning from her dynamic and passionate team, and believes in excellent customer service. She hopes you'll be an active participant in choosing your health care provider and recognize Peak Sports and Spine as your primary care physical therapy clinic. "I believe in a partnership between you and your physical therapist."
Resources discussed on this show:
APTA Private Practice Section
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, Jenna Kantor, SPT guest hosts and interviews Bronté Miller, SPT on how to create a student special interest group in your state. Bronté Miller is a Student Physical Therapist at Stony Brook University, Class of 2019. Last year, she led a team of students to co-found the NYPTA Student Special Interest Group (SSIG). The SSIG is an organization designed to promote PT and PTA student professional engagement, networking, and inter-school collaboration. The SSIG is currently in its first term as an organization, with Bronté as President. Bronté believes that transforming our profession starts with empowering students to grow as leaders and problem solvers through earlier engagement in the physical therapy community.
In this episode, we discuss:
-The role of student special interest groups in the physical therapy industry
-Considerations for working with a SSIG including how to balance the time commitment with school
-How to recruit the right leadership team for success
-The future of the NYPTA Student Special Interest Group
-And so much more!
Jump starting a Student Special Interest Group in your state is both rewarding and feasible. Bronté recommends, “Have a plan from the get-go on how you’re going to do this.”
Working with a diverse and dedicated group of people is key to achieving better results as Bronté found that, ”Having such a fantastic team was absolutely essential for our SSIG to succeed.”
While developing a SSIG in your state can be challenging, Bronté advises, “Don’t be afraid to reach out to other students because I think you’ll be surprised how many want to really dive in and get involved.”
For more information on Bronté:
Bronté Miller is a Student Physical Therapist at Stony Brook University, Class of 2019. Last year, she led a team of students to co-found the NYPTA Student Special Interest Group (SSIG). The SSIG is an organization designed to promote PT and PTA student professional engagement, networking, and inter-school collaboration. The SSIG is currently in its first term as an organization, with Bronté as President. Bronté believes that transforming our profession starts with empowering students to grow as leaders and problem solvers through earlier engagement in the physical therapy community.
For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
Resources discussed on this show:
Bronte Miller LinkedIn
Bronte Miller Twitter
Bronte Miller Facebook
Student SIG Leaders Facebook Group
Email: elizabeth.b.miller@stonybrook.edu
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Marissa Fayer joins me to discuss female entrepreneurship and HERHealthEQ. Marissa Fayer is an 18-year medtech executive, entrepreneur, and philanthropist whose mission is to advance growth and prosperity for organizations and the communities in which they operate. Marissa is the President of Fayer Consulting LLC, the CEO of the non-profit HERHealthEQ, a partner at LLEX Partners, the COO of Olympian Capital, and a business owner with Arbonne International. Her expertise and vision connect organizational optimization and development with responsibility to bring about a more giving global community with health and opportunity.
In this episode, we discuss:
-How Marissa stepped into the world of consultancy and philanthropy
-Broadening the definition of wealth to encompass more than just material goods
-HERHealthEQ: Bringing medical equipment to females in need all over the world
-The not-so-glamorous but important side of running a non-profit
-And so much more!
Before branching into new entrepreneurial pursuits, Marissa recommends, “Don’t take the leap without a net.”
Often our own industry offers the best opportunities for new ventures, we just need to look at what needs are not being adequately met. From Marissa’s experience in the medical equipment industry, “I saw that there was waste in the industry and I was trying to figure out what to do with that.”
Although non-profits may think of themselves as solely pursuing altruistic aim, all non-profits require fundraising. Marissa stresses, “Non-profits are businesses and the best ones actually operate as businesses... Non-profits do need money.”
For more information on Marissa:
Marissa is an accomplished Entrepreneur, Senior Executive, Consultant, and Board Member with more than 15 years of success across the medical devices, pharmaceuticals, medical technology (MedTech), healthcare, biotech, and consumer goods industries. Leveraging extensive turnaround experience, Marissa is an invaluable asset for a company that has encountered a period of stagnant or declining revenue and is seeking guidance in order to reinvigorate and improve operational processes and redevelop business strategies to realign with corporate objectives. Her areas of expertise include M&A, fundraising, offshoring, outsourcing, Kaizen and Lean manufacturing, growth, FDA, quality management, supply chain management, budgeting, Six Sigma, R&D, and CRM.
Throughout her executive career, Marissa has held leadership positions with Fayer Consulting LLC; Arbonne International LLC; Accumed; Providien Medical; and Hologic. She has been responsible for consulting with clients to transform their organizations with a focus on due diligence, pre- and post-M&A integration, operations management, production and product transfers (intra-company and internationally), strategy development, project management, program management systems, cross-cultural development, as well as business development, cost reductions, and implementing Lean practices. She has also been responsible for increasing revenue through the management of project teams for new products, as well as restructuring operational processes to reduce organizational costs.
Marissa obtained her MBA (Summa Cum Laude) with a Major in General Management and a Minor in Marketing from the University of Connecticut, and she received her BS in Manufacturing Engineering from Boston University. She completed the Comprehensive Financial Modeling and Valuation Analysis Training from the Investment Banking Institute (IBI); she attained her Green Belt/Bronze Lean Manufacturing Certification, and she is a Certified Professional Coach. In addition to her executive career, Marissa is the Founder of the global not-for-profit, HERHealthEQ, where she provides medical devices and equipment to small regions in developing nations. She also serves as a Board Member with Game Changers, Young Executive Board Chairperson with Elisa Monte Dance Company, and she serves as a mentor with Wedu Mentor. Marissa is fluent in Spanish.
Resources discussed on this show:
Marissa Fayer Website: access the free gift: Top 10 influential Philanthropists handout
Marissa Fayer Instagram
Marissa Fayer Twitter
Marissa Fayer Facebook
Marissa Fayer LinkedIn
HERHealthEQ Website
Fayer Consulting
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Combined Sections Meeting in New Orleans, Louisiana, it is my pleasure to welcome Dr. Sarah Haag, Dr. Sandy Hilton and Dr. Jason Falvey back for Part 4 all about sex. Check out Part 1, Part 2 and Part 3 and enjoy another installment!
In this episode, we discuss:
-Biomechanical considerations for different sex positions
-How to support your partner following child birth
-Why sexual dysfunction may be an important predictor of future cardiovascular problems
-Sexual health for the LGBTQI+ population
-And so much more!
Pelvic health interventions follow the same treatment principles as any other orthopedic conditions. Sandy stresses, “Strength and conditioning principles really do apply to pelvic health it’s just the movement is a centimeter, it’s very small but the scale is proportionally the same so if you’re having problems with loading and frequency and dosage of your program, just adapt it. You don’t have to stop.” Sarah reaffirms this and recommends that patients, “Do what you do and should you run into issues, again graded exposure and practice I think is the best answer.”
When treating sexual dysfunction, it’s important to consider what could be affecting patients beyond purely biomechanical ailments. For example Sarah explains that, “When someone does become ill, if you’re not typically the caregiver and now there’s that role shift, that’s a psychosocial issue.” Jason stresses the importance this can play with older adults as, “It’s a very hard transition for people to transition from caregiver to lover.”
All physical therapists should be able to break past the stigma surrounding pelvic health issues, even if it is not their specialty. It’s important to inform patients that help exists as Sarah has found that, “When it comes to sexual dysfunction and bowel and bladder dysfunction, a lot of people don’t know what’s normal and even when people aren’t happy with the function which is really the key that they need to get help, they don’t know that there is help.”
For more information on the guests:
SARAH HAAG PT, DPT, MS, WCS CERT. MDT, RYT: Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Most recently, Sarah completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Instructor. Sarah plans to integrate yoga into her rehabilitation programs, as well as teach small, personalized classes.
Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
SANDY HILTON PT, DPT, MS: Sandy graduated from Pacific University (Oregon) in 1988 with a Master of Science in Physical Therapy and a Doctor of Physical Therapy degree from Des Moines University in December 2013. She has worked in multiple settings across the US with neurologic and orthopaedic emphasis combining these with a focus in pelvic rehabilitation for pain and dysfunction since 1995. Sandy teaches Health Professionals and Community Education classes on returning to function following back and pelvic pain, has assisted with Myofascial Release education, and co-teaches Advanced Level Male Pelvic Floor Evaluation and Treatment. Sandy’s clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women. Sandy is the co-host of Pain Science and Sensibility, a podcast on the application of research into the clinic.
JASON FALVEY PT, DPT, GCS, CEEAA: Jason is a board certified geriatric physical therapist with a strong interest in improving outcomes for both frail older adults and older adults with hospital-associated deconditioning. He has current funding from the Foundation for Physical Therapy (PODS 1 Award, 2015) and the Academy of Geriatric Physical Therapy to support his participation in ongoing research the use of a novel Progressive High Intensity Therapy (PHIT) training program on medically complex older adults after acute hospitalization. He also has funding from both the American Physical Therapy Association Health Policy and Administration Section and the Home Health Section to evaluate how physical therapists can reduce avoidable hospital readmissions. Lastly, Jason is collaborating with local long-term care providers to determine how physical functioning can be assessed and best managed to reduce rates of falls, ER visits, and hospitalization.
Resources discussed on this show:
Jason Falvey Twitter
Sarah Haag Twitter
Sandy Hilton Twitter
Uchenna Ossai Twitter
Meryl Alappattu Twitter
Rena McDaniel Twitter
A THERAPY TOOLKIT FOR TREATMENT OF URINARY INCONTINENCE
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Rachael Norman joins me to discuss the Better patient experience. Better was designed for private pay patients to get their money back from insurance for out-of-network care. Our team and software ensure each claim is processed according to the terms of your patient's health insurance policy, and that they are paid back in a timely manner.
In this episode, we discuss:
-The basics for understanding out-of-network benefits
-Best practices for Superbill creation
-How to reduce the likelihood of claim denials
-Keeping up with Modifiers, Diagnosis Codes and Conflicting Codes
-And so much more!
It is the clinician’s responsibility to provide the information needed for their patients to receive reimbursements from their insurance companies. Rachael stresses, “Superbills are important and having all the details on them really matters. It can save everyone a lot of headaches later.”
Navigating the insurance world can be challenging because, “We see different requirements come up very quickly with very little notice.”
It is important for clinicians to keep up-to-date on insurance requirements for reimbursements; otherwise, “That could mean that someone who is owed money isn’t getting it.”
For more information on Rachael:
Rachael is creating simple products for healthcare, using her tech experience and health background. She studied Biochemistry and Biophysics at Stanford University. She has conducted medical research at the National Institute of Health; as a medical volunteer in Niger, West Africa; and is an author on multiple academic publications. Rachael has spent her career in operations at startups developing technology products that improve lives.
Resources discussed on this show:
Better Website
Better Claims Twitter
Better Claims Facebook
Better Claims LinkedIn
Can Apps Slay The Medical Bill Dragon?
Empowered patient missing in medical claims process: Part 2
Oakland Start-Up Company Forgives Medical Debts
TPOT Podcast: Making Private Pay and Out-of-Network "Better"
Better for providers
Email: hello@getbetter.co
Superbill blog
HMO/PPO blog
Debt campaign
5 Tips for your Private practice
A Guide to NPIs blog
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor and Katie Schmitt join me to discuss Fairytale PT. Jenna Kantor, SPT and Katie Schmitt, SPT, both physical therapy students from Columbia University, developed Fairytale PT, a movement-based musical program where children get to actively participate in shows based on popular fairytales.
In this episode, we discuss:
-The ambitious beginnings of Fairytale PT and the dedication of Jenna and Katie to their mission
-How Fairytale PT incorporates therapeutic exercise into the choreography
-Interprofessional collaboration with occupational therapy students
-Jenna and Katie’s vision for Fairytale PT and how you can get involved
-And so much more!
Physical therapy schools without performance backgrounds can still participate in Fairytale PT. Jenna stresses, “It’s not about talent, it’s about enthusiasm.”
Navigating the medical world as a pediatric patient can be scary and intimidating. Katie clarifies the challenge as, “How do we give these kids a break and how do we give these parents a little bit of a break and take them out of the beeping and the sounds and the doctors coming in and out and rushing around.”
In a fun environment, Fairytale PT is able to achieve therapeutic goals as Jenna states, “The movements the kids are doing are extremely healthy for them.”
For more information on Jenna:
JENNA KANTOR (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life - a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University's Physical Therapy Program. She is also a co-founder of the podcast, "Physiotherapy Performance Perspectives," has an evidence-based monthly youtube series titled "Injury Prevention for Dancers," is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt
For more information on Katie:
I fell in love with Physical Therapy when I realized that with it, I could breathe on my own. My background is as an actor. I have done Shakespeare in New York, film and television in Los Angeles and ran a travel web series with my husband where, for five years, we went to every state and reviewed bed and breakfasts.
It was when I challenged myself to run a mile, that I realized the more I work out and listen to my body the less I need medicine. I learned what it is like to breathe without inhalers, steroids or machines. Today I am an avid cyclist and third year student at Columbia University Medical Center working on my Doctorate in Physical Therapy.
There is so much about PT that I love. My clinicals have been in outpatient orthopedics at Miccass Physical Therapy in New York and Imagine Physical Therapy in South Carolina and sub-acute rehab at The New Jewish Home. I have spent time with dancers and Broadway performers, on the inpatient TBI floor at Bellevue, observing at Memorial Sloan Kettering Cancer Center and with the outpatient cardiopulmonary PT team at Columbia University Medical Center. From all my experience to my husband's story of recovery from a car accident and coma when he was a teen, I have realized that PT affects many aspects of life. My goal is to help little kids learn how to breathe, help patients fight cancer and help dancers perform to their peak.
Resources discussed on this show:
Jenna Kantor Website
Fairytale Physical Therapy Website
Jenna Kantor Facebook
Jenna Kantor Twitter
Jenna Kantor Instagram
Jenna Kantor LinkedIn
Physiotherapy Performance Perspectives
Katie Schmitt LinkedIn
APTA Blog on Fairytale PT
The 90 Day Year
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Nick Wolny joins me to discuss Facebook ads. Nick Wolny helps small business owners and online entrepreneurs leverage Facebook advertising, Facebook live, and content marketing to attract more clients and make more revenue. His passion for the health industry comes from a personal transformation, having lost 105 pounds and keeping it off for 14 years. Nick has been featured with SUCCESS Magazine, Yahoo!, LeadPages, the Houston Chronicle, Ramit Sethi’s I Will Teach You To Be Rich, and VICE. He studied classical music at Rice University.
In this episode, we discuss:
-Facebook ads and what they can do for your business
-How to maximize the effectiveness of a boosted post through ad manager and your subscriber list
-Different ways to target and reach warm traffic, cold traffic and the look-a-like audience
-How to know when it’s time to outsource your advertising responsibilities
-And so much more!
The ubiquitous and consistent use of Facebook worldwide provides you an incredible platform to promote your content to an ideal audience. Nick reassures, “The people that need your help, that need your product, program or service, it’s a very, very high probability that they are on Facebook.”
Nick recommends targeting ads to your current subscribers first and foremost, because he has found that, “Cold traffic is the hardest sandbox to play in.”
Images have historically dominated social media, but Facebook has publically stated their intention to move towards video content and even prioritize Facebook live. Nick recommends, “Whenever possible you should use video.”
Crafting advertising content that strikes a balance between connecting with people and promoting your product can be difficult. In Nick’s experience, “The ads that do best are the ads that feel like regular posts.”
For more information on Nick:
Nick Wolny helps small business owners and online entrepreneurs leverage Facebook advertising, Facebook live, and content marketing to attract more clients and make more revenue. His passion for the health industry comes from a personal transformation, having lost 105 pounds and keeping it off for 14 years. Nick has been featured with SUCCESS Magazine, Yahoo!, LeadPages, the Houston Chronicle, Ramit Sethi’s I Will Teach You To Be Rich, and VICE. He studied classical music at Rice University.
Resources discussed on this show:
Nick Wolny Website
Nick Wolny Facebook
Nick Wolny Instagram
Free Gift: The Quick Start Facebook Ad Setup Guide For Small Business Owners and Service Providers
#161: (Case Study) Facebook Ads Success for Local Fitness/Yoga Studios with Nick Wolny
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On the first Healthy Wealthy and Smart LIVE on Facebook, I am joined by Julie Wiebe to discuss the pelvic floor and sports performance. Julie Wiebe, PT has over 20 years of experience in both Sports Medicine and Pelvic Health. Her passion is to return women to fitness and sport after injury and pregnancy and equip pros to do the same. She advocates for the awareness of pelvic health issues in fitness and promotes innovative solutions for women through her blog, videos and social media. She shares her evidence-based, integrative approach internationally with both professionals and women through live and online educational programs. Find out more and connect with Julie at www.juliewiebept.com or via social media twitter/FB/IG JulieWiebePT.
In this episode, we discuss:
-The anatomy of the pelvic floor and its vital role in biological functions
-How to broach the topic of pelvic floor health with your patients
-Julie’s go-to biomechanical screening tests for performance and pelvic health
-Enhancing breathing patterns for pain management and sports performance
-And so much more!
Incontinence following pregnancy has unfortunately been normalized in our society and it’s up to clinicians to educate women about pelvic health and advocate for greater access. Julie stresses, “We have better solutions now for athletes than we’ve had in the past.”
One of the most important functional tasks that Julie addresses with all of her patients and clients is the act of breathing as Julie believes, “Breathing is your gateway into all these systems.”
Julie utilizes recruitment of core muscles and breathing techniques in her treatment interventions to promote movement fluidity. She stresses, “It has to be a team, it’s all working together and it needs to move in a responsive way.”
For more information on Julie:
Julie Wiebe, PT has over twenty years of clinical experience in both Sports Medicine and Women’s Health. Following her passion to revolutionize the way women recover from pregnancy and return to high levels of fitness, she has pioneered an integrative approach to promote women’s health in and through fitness.
Her Diaphragm/Pelvic Floor Piston Science concepts have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations. Julie is a sought after speaker to provide continuing education courses and lectures internationally at clinics, academic institutions, professional organizations, state and national professional conferences.
Julie maintains a cash-based clinical practice in Los Angeles and shares her approach to bridge the gap between rehab and fitness with pros and women worldwide through online courses and mentoring.
A published author, she advocates for awareness of pelvic health in fitness on her blog and through social media (Twitter/FB/IG-JulieWiebePT) www.juliewiebept.com
When not trying to change the world one pelvic floor at a time, Julie is happy to focus on her first passions: being mom to the Z’s (Zoe and Zack), and wife to David.
Resources discussed on this show:
Julie Wiebe Website
Julie Wiebe Facebook
Julie Wiebe Instagram
Julie Wiebe Twitter
Online Courses: Grab 20% off Adult Pro Course bundles with code Healthy20 (Piston Science Bundle A and B), Sports Med Bundles A and B, and Piston Science Module One. For individuals-Pelvic Floor Piston: Foundation for Fitness.
Blog
Live Courses
Video Blog/Previous Podcasts
Media Samples
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Nick Tumminello joins me to discuss exercise prescription. Nick Tumminello is the 2016 NSCA Personal Trainer of the Year, and the Editor-in-chief of the NSCA Personal Training Quarterly journal. He's the author of three books: Building Muscle and Performance, StrengthTraining for Fat Loss, and Your Workout PERFECTED. He's been a trainer for over 20 years, is the former strength coach for team Ground Control MMA and has trained professional athletes in field, court, combat and physique sports.
In this episode, we discuss:
-How to apply the 4 principles of strength and conditioning to program design
-Progressive and regressive load management
-Why the Socratic Method should be used when discussing training philosophies
-Nick’s approach to new fitness fads
-And so much more!
Nick has found that trainers train their clients with trendy methods and neglect to tailor a program to meet the clients’ unique goals. When designing a program, Nick stresses, “The approach is determined by the goal… It’s not determined by my bias as a trainer or my favorite pet exercise.” A client must always be the driver of their own success, but Nick sees an important role for strength and conditioning coaches to enable their client’s full potential. He believes, “A facilitator gives people what they need to achieve what they want.”
A solid training and rehab regime is built on adhering to these four principles: goal specificity, individuality, progressive overload and variability. Nick has found that, “If you focus your training or your rehabilitation approaches on principles and you go from principles up not methods down, your training or your rehab approach will never go out of date.”
Nick’s experience with members of the health and fitness community has led him to believe that an open approach to communication rather than a divisive or pedagogical one will lead to more success in promoting your message. Nick advises, “Ask more questions and genuinely listen.”
For more information on Nick:
“A bit of an outsider…”
That’s how Nick Tumminello describes himself in the fitness industry. He’s an independent thinker who avoids falling in line with the crowd. His goal is to provide practical solutions that deliver specific results.
Nick’s hybrid approach to training allows him to leverage the tools, knowledge and skills of many disciplines and methods to help his clients and to educate other trainers how to deliver results.
As early as his teenage years Nick knew that he wanted to be a trainer. His early influence came from his mother, growing up in a gym watching her prepare for bodybuilding competitions. She’ll tell you that “Nick grew up on iron and sweat.”
As a way to connect Nick and his mother attended fitness events and conferences from the time he was 16 years old.
Personal training is the only ‘real job’ nick’s ever known. But, his story isn’t common. Not being one to fall in line with the crowd Nick never attended college or got a degree. He graduated high school as an average student. He worked hard to accumulate a lot of on the job experience and despite his distaste for structured education Nick was very interested in learning.
After being fired from his first two personal training jobs due to his independent thinking and lack of needing to ‘fit in’ he went off on his own to start a business.
Training and fitness aren’t a hobby to Nick. This is a profession that he’s very passionate about.
It would be easy to confuse Nick as a ‘science guy’ due to his ability to challenge thoughts and ideas, the way he respects the scientific process and critical thinking. However, he’s most excited by the application and end results that the information he learns and the ideas he creates can produce. “Studies and research are great, but if there is no practical application there is no need”
Nick’s approach to many things can be described in three words…
Hustle and Muscle.
This is applied in training, business and intellectually for Nick.
Resources discussed on this show:
San Diego Pain Summit
Nick Tumminello Website
Amazon: Your Workout PERFECTED
Amazon: Building Muscle and Performance: A Program for Size, Strength & Speed
Amazon: Strength Training for Fat Loss
Nick Tumminello Instagram
Nick Tumminello Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Cheryl Keller Capone joins me to discuss how she navigated her experience with chronic pain. Dr. Cheryl Keller Capone is an Associate Research Professor in Center for Comparative Genomics and Bioinformatics and Department of Biochemistry and Molecular Biology at Penn State University. She is currently using genomics and DNA sequencing technologies to study blood cell development with an overall research goal of understanding gene regulation in mammals. In total, she has over 23 years of scientific research experience in several different fields, including muscle development, neuroscience, and mitochondrial DNA forensics. She is also a certified personal trainer through the National Academy of Sports Medicine, and a recreational triathlete.
In this episode, we discuss:
-Cheryl’s long journey with chronic pain
-The catalyst for Cheryl’s road to recovery
-Implementing the biopsychosocial model and functional movement to combat persistent pain
-Empowering advice for those experiencing persistent pain
-And so much more!
Cheryl advises practitioners to remain humble about their ability to diagnosis and treat patients who suffer from persistent pain. From her experience, she states, “I wasn’t expecting any sort of specific diagnoses. In fact, I was very frustrated by the fact that individual providers were focusing on one thing or another and trying to pin it down to one particular structural cause.” After many disappointments, Dr. Keller Capone was exposed to a practitioner who effectively communicated his humility and willingness to try different treatments and she found that, “This was a very refreshing response to me.”
To those who are suffering from chronic pain, Cheryl recommends participating in activities you find joyful and meaningful. She found that making small improvements in these activities helped prove to herself that, “This is not permanent, changes can be made. It helped me with hope.”
The most empowering belief system that helped guide Cheryl was one of self-ownership, she stressed to herself, “I was going to have to own this. I was going to have to own my pain and own my recovery and be responsible.”
With persistent pain, it is important to remember that while the journey may have ups and downs, there are no barriers to your recovery. Cheryl advises, “There is most likely a path forward for everyone… Take ownership of your own path.”
For more information on Cheryl:
Dr. Cheryl Keller Capone received her Ph.D. in Biochemistry and Molecular Biology from Penn State University in 1999. Her graduate research focused on muscle development and differentiation, and during this time was awarded the Paul Berg Prize in Molecular Biology, the Roberts Graduate Fellowship, and the Frederick J. Wedler Outstanding Doctoral Dissertation Award.
After graduate school, she transitioned to the field of neuroscience where she studied the molecular biology of GABAA receptors in mammals, followed by a year in industry where she worked in the field of mitochondrial DNA forensics.
In 2009, Cheryl returned to Penn State University, and is currently studying blood cell development with an overall research goal of understanding molecular mechanisms of gene regulation in mammals. She also has extensive experience in genomic technologies and methodologies, including DNA sequencing and data analysis.
Outside of the lab, Cheryl is also a former collegiate runner, who became interested in strength training and movement following a long injury history and many years of chronic pain. This experience led to her interest in pain science as well as a certification as a personal trainer through the National Academy of Sports Medicine. When not in the lab or working with clients, Cheryl enjoys strength training, running, hiking, swimming, cycling and spending time with her husband and son in State College, PA.
Resources discussed on this show:
Dr. Cheryl Keller Capone Twitter
Dr. Cheryl Keller Capone Instagram
Dr. Cheryl Keller Capone LinkedIn
Dr. Cheryl Keller Capone Facebook
Dr. Cheryl Keller Capone Blog
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Fritz Boettner joins me to discuss hip replacements. Dr. Fritz Boettner is a specialist in joint-preserving arthroscopic surgery and minimally invasive total joint replacements of the knee and hip. His practice concentrates on the nonsurgical and surgical treatment of early arthritis. As part of a patient-centered individual approach, he performs arthroscopic cartilage surgery and joint preserving osteotomies, as well as minimally invasive total joint replacements and resurfacings.
In this episode, we discuss:
-The evolution of hip replacement surgeries
-Pre-surgical considerations for anterior and posterior surgical approaches
-Post-surgical restrictions on movement
-Rehabilitation and pain management considerations following hip replacement
-And so much more!
Having the optionality of either surgical approach allows each patient to be evaluated to ensure the best outcomes. Dr. Boettner states, “Having different types of approaches at our availability allows you to select which would be best for the patient.”
Pain and functional management following hip replacement surgery is the same for either approach with the goal being that, “Everything is geared towards early discharge.”
Dr. Boettner stresses that physical therapy providers be mindful of their interventions and avoid adverse outcomes with unnecessary exertion. He reminds, “If you don’t do anything with the hip, patients will be fine after hip replacement.”
For more information on Dr. Boettner:
Dr. Fritz Boettner is a specialist in joint-preserving arthroscopic surgery and minimally invasive total joint replacements of the knee and hip.
His practice concentrates on the nonsurgical and surgical treatment of early arthritis. As part of a patient-centered individual approach, he performs arthroscopic cartilage surgery and joint preserving osteotomies, as well as minimally invasive total joint replacements and resurfacings.
“Minimal invasive surgery reduces surgical trauma, resulting in advantages for early rehabilitation,” he says. ”In addition, patients love their cosmetically appealing incision.”
Born in Germany, Dr. Boettner studied at the top international centers for his specialty, completing fellowships in four sub-areas, as well as additional training in pelvic osteotomies and open hip dislocation with surgeons in Germany, Switzerland and the United States. He has authored an orthopedic textbook, as well as numerous scientific publications.
Resources discussed on this show:
Dr. Boettner Website
HSS Website
Dr. Boettner twitter
Dr. Boettner Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Molly Hayward joins me to discuss passion as the driver for entrepreneurial success. Molly Hayward is the visionary female founder of Cora, a San Francisco startup and disruptive consumer brand pioneering products that fit women’s lifestyles, prioritize their wellness, and empower women globally. Molly was the first entrepreneur in the now-trendy menstrual management space to establish a modern, healthy, socially conscious brand, presenting the issues of healthier products and women’s global social justice to the mainstream female consumer.
In this episode, we discuss:
-The story behind Cora: from idea to successful subscription business
-How passion and perseverance disrupted the feminine product industry
-The importance of removing unessential daily tasks as your business grows
-How to position a product to enhance quality of life and foster a worldwide community
-And so much more!
Molly sought to create a mission driven company with Cora and has successfully helped women in developing countries continue their education during their monthly menstruation. Molly stresses, “Girls education and female empowerment is completely essential to economic development and poverty alleviation.”
Most entrepreneurial opportunities begin when you yourself find a need not being served in the marketplace as Molly reminds, “It does start from a problem that you yourself experience.” From Molly’s experience, she shares that, “It’s critical to get started because it’s such a learn-as-you-go process.”
Entrepreneurs tend to want to do it all and are eager as momentum starts to grow. In light of this, Molly advises, “Try to narrow your focus early on and do fewer things better rather than try to have your hands on every potential opportunity.”
Passion for your vision will help you as an entrepreneur navigate the many twists and turns on the road to success. Molly recommends, “Do what you love and trust that things are going to continue to move in the right direction.”
For more information on Molly:
Molly Hayward is the visionary female founder of Cora, a San Francisco startup and disruptive consumer brand pioneering products that fit women’s lifestyles, prioritize their wellness, and empower women globally. With body-conscious organic tampons, an elegant user experience, and sustainable menstrual products given to girls in developing countries for every monthly supply shipped, Cora represents the smart, chic, and conscious woman of today and is transforming the experience of womanhood on a global scale. Molly was the first entrepreneur in the now-trendy menstrual management space to establish a modern, healthy, socially conscious brand, presenting the issues of healthier products and women’s global social justice to the mainstream female consumer. Forbes writes, “Serial entrepreneur Molly Hayward has a fresh take on feminine hygiene, reimagining everything from the absorbent materials to the packaging, with a deep commitment to social justice." At 28 years old, she has been featured in major television and media outlets, and garnered awards for her innovative and holistic approach to elevating women globally through for-profit business. Molly has a deep knowledge of menstruation in both its commercial and cultural contexts, and has been described as a visionary badass with soul. Learn more about Molly and Cora at www.cora.life.
Resources discussed on this show:
Molly Hayward Twitter
Molly Hayward LinkedIn
Cora Twitter
Cora instagram
Cora Website
Thanks to our sponsor for today's podcast Net Health!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Isa Herrera joins me to discuss holistic healthcare. Isa Herrera is a licensed physical therapist and an expert in integrative pelvic floor therapies in the field of women’s health. At her healing center in NYC, Isa pioneered the use of integrative modalities like Maya Abdominal Massage, Low Level Laser Therapy, Reiki, Sound Healing, and Andean Energy Techniques, and spent years as an adjunct professor at Hunter College in New York teaching pelvic floor techniques to 3rd year doctoral physical therapy students.
In this episode, we discuss:
-Society’s demanding expectations on women
-Developing trust and compassion with your patients to discuss pelvic pain, sexual health and incontinence
-The importance of collaboration with your patient’s broader healthcare team when delivering holistic healthcare
-Female Pelvic Alchemy Program: Trade Secrets for Energizing Your Sex Life, Enhancing Your Orgasms, and Loving Your Lady Parts
-And so much more!
With the many selfless roles women take on in the modern world, from child rearing to running businesses, it can be difficult for women to spend time on their own needs. Isa empowers women with, “The time is right for women to seize the moment and to become the heroines of their own story.”
It is the role of the therapist to give their patients the tools needed to build towards optimal health as in the end, “[The patients] have to be responsible for their own work.”
A therapeutic alliance is developed the moment you make contact with a patient. Trust is even more elevated in intimate settings such as pelvic health, where Isa reminds us, “You have under 15 seconds to make that impression to make sure that they trust you enough to open up to you.”
One of the most important qualities of a great therapist is humility as Isa recommends, “If we don’t know something and we are not comfortable with it, we should own it.”
Physical therapists often adopt beliefs that hinder them from growing their businesses. To overcome those limiting beliefs, one of the first steps Isa states is, “We have to get out of this scarcity mindset.”
For more information on Isa:
Isa Herrera is a licensed physical therapist and an expert in integrative pelvic floor therapies in the field of women’s health. At her healing center in NYC, Isa pioneered the use of integrative modalities like Maya Abdominal Massage, Low Level Laser Therapy, Reiki, Sound Healing, and Andean Energy Techniques, and spent years as an adjunct professor at Hunter College in New York teaching pelvic floor techniques to 3rd year doctoral physical therapy students.
She developed her expertise in diagnosing and treating pelvic pain and pelvic floor dysfunction by helping over fourteen thousand women since 2005 at her NYC-based healing center Renew Physical Therapy.
Most recently, Isa has used her vast clinical experience and expertise and incorporated it into her new online school www.PelvicPainRelief.com, a online educational portal whose mission is to create a global language for patients and professionals seeking accurate, integrative information relating to all things about pelvic health.
Isa's online school PelvicPainRelief.com is founded on evidence-based education and over 10 years of tried and true protocols that incorporate exercises, techniques, and integrative tools to maximize patient healing. She is also now bringing her business and clinical wisdom together as well for professionals to coach and mentor women who want to create or up-level cash-based practices in the field of women's health.
She is also the author of five books on the topic of pelvic floor dysfunction and pelvic pain and her newly released book, Female Pelvic Alchemy is an international best seller in 4 women's health categories. After suffering from pelvic floor dysfunction herself after the birth of her daughter, Isa has made it her life’s mission to help women overcome pelvic floor dysfunction, and also to educate professionals on the right mix of evidence-based and integrative techniques to help patients achieve lifelong health and wellness.
Resources discussed on this show:
Pelvic Pain Relief Website
Renew PT Website
Female Pelvic Alchemy Program
Free Gift: Pelvic Starter Kit
Female Pelvic Alchemy S.T.A.R.R. Program
Professional Training
Female Pelvic Alchemy Book
Isa Herrera Facebook
Isa Herrera Instagram
Isa Herrera LinkedIn
Isa Herrera Twitter
MTV True Life "I Can't Have Sex"
The Guardian - The Vagina Dispatches
Readers Digest - The One Core Exercise Every Woman Should Be Doing
USNews and World Report - Shocking Numbers of Fit Young Women Have This Embarrassing Problem
Regis and Kelly Live
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
Happy New Year to the Healthy Wealthy and Smart family! To start off the year, I am joined by Dr. Jen Esquer to discuss social media management and product launches. Jen is a private sports physical therapist who creates programs, hosts workshops, and treats one on one for a more direct and precise experience. Her mission is to heal the world and the best way she can do that is through empowering you to learn how to heal yourself!
In this episode, we discuss:
-Why building a large social media platform may be simpler than you think
-Empowering fresh graduates to spread their knowledge to the public
-Audience engagement techniques which can help launch a product
-The must-have tools Jen uses to enhance her social media presence
-And so much more!
Fresh out of school you have a unique knowledge base to share with your audience as Jen states, “You know something that people don’t know.” Some of the most beneficial content can be the simple foundations in your field as Jen reminds, “People don’t even know basic information.”
Most influencers have adopted the mindset that there is always more to learn and, “They continue to do the work, it’s never done.” To continue reaching new successes, Jen encourages that, “We always should want to continue growth.”
To gain trust with an online community, you have to produce valuable content as, “Consistency is everything.” Jen’s recommendation is to, “Give out information because it only builds up your credibility even more.” Although giving away so much free content may seem to come at a cost, the reward accrues from building trust and helping future clients make sense of it all. Jen has found that, “The more that you can put out there, the more that you’ll get back.”
For more information on Jen:
The best way I like to explain myself, is that I am a MOVER! I have been active since I was a young child, falling in love at an early age with gymnastics and competing for 9 years. After quitting at age 16, I competed in track and field (pole vault and triple jump) and danced. Though I sustained minor injuries, including a thumb fracture, sprained ankles, and pulled muscles, I never once went to a physical therapist. Yet, I loved anything having to do with anatomy, physiology, and without knowing for sure whether physical therapy would be my path, I decided to study Kinesiology at California State University, Fullerton.
While I coached gymnastics for 3 years, I found myself constantly asking, “Why am I taping an ankle? What is truly the issue and how can I help further?” I was seeking more! I was fortunate enough to meet someone teaching a Pilates Bootcamp and quickly fell in love with the specificity of body movement. I started instructing pilates classes, both on the reformer and mat for 6 years throughout undergrad and graduate school. Not only did I appreciate how much pilates reminded me of gymnastics conditioning, but I loved the focus on intricate muscle activation, isometric holds, strict form, and body awareness through core activation.
After graduating with my M.S. in Kinesiology, I was accepted into Loma Linda University where I received my Doctor of Physical Therapy degree. I quickly accepted a job at VERT Sports Therapy and Rehabilitation in beautiful Santa Monica, CA. Since working, I have met amazing individuals who have aided in the expansion of my knowledge of the body. I have studied Myodetox directly under co-founder, Vinh Pham (@vinnierehab), taken a RockTape course with @themovementmastro herself, and learned from many others professionals in the rehab game.
I am now stepping into the next chapter of my career as a private sports therapist, creating programs, hosting workshops, and treating one on one for a more direct and precise experience. My mission is to heal the world and the best way I can do that, is through empowering you to learn how to heal yourself! Becoming educated on what is going on with your body is the most powerful piece of knowledge for establishing health and longevity for a pain-free and active lifestyle!
Resources discussed on this show:
Jen Esquer Instagram
Jen Esquer Facebook
Jen Esquer Website
Phonto app
Splice app
Vont app
Pic Stitch app
Leadership Academy
Jeff Walker
Lori Harder 14 Day Challenge
Canva
Leadpages
Thinkific
Aweber
Convert Kit
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
In this episode I am joined by DPT student and Healthy Wealthy & Smart production assistant Julie Sias for our annual end of the year wrap up. Julie is in her final year of physical therapy school at Chapman University.
In this episode we discuss:
-
Julie's great advice for DPT students getting ready to head out on their first clinical rotation
-
How to handle an unpleasant or sticky situation on a clinical rotation as a student
-
The first steps to preparing for the NPTE
-
The top 10 episodes of 2017
-
The amazing line up of guests for 2018!
On behalf of myself, Julie and my wonderful virtual assistant Kortne Parkman I want to thank all of YOU for listening and supporting the podcast throughout the year. It means so much to all of us and I want to say that I appreciate each and every one of you!
Thank you and best wishes for Healthy Wealthy and Smart 2018!
xoxo
Karen
On this episode of the Healthy Wealthy and Smart Podcast, Primoz Bozic joins me to discuss Ultimate Guides. Primoz Bozic is an online business coach for top performers. He started his journey earning just $7/h as a programmer in Slovenia, and now runs a 6-figure online business while traveling the world. He works with world-class experts like celebrity makeup artists, songwriters and high performance coaches to help them turn their expertise into an online business that changes the lives of millions of people. His superpower is helping you create super detailed and comprehensive blog posts and Ultimate Guides that become the #1 resource in the industry and attract thousands of high quality visitors to your online business.
In this episode, we discuss:
-What is an Ultimate Guide?
-How to attract high quality customers by offering free online content
-Primoz’s step-by-step guide to create the best content in your industry
-How to produce simple and digestible content for your ideal customer
-And so much more!
In order to create the best content, you will need to spend a lot of time on it but Primoz believes it will be well worth the effort because, “You can create this asset once and then use it everywhere to attract new, high quality customers.”
An Ultimate Guide can be proliferated across different media channels such as audio and text. These different formats increase your chances of reaching the most diverse audience and Primoz believes that, “Now you have this ability to really stand out from all the other people.”
One of the most important aspects of your Ultimate Guide is that it is relevant and understandable by your audience. To accomplish this, Primoz advises, “Talk to your customers.”
For more information on Primoz:
Primoz went from being a 20-year old socially awkward computer science student earning $7/hour with no connections, no experience and no business knowledge to earning multiple 6 figures with his online business, all while living in Slovenia. He now coaches world-class experts, CEOs and rising stars on growing their online businesses by creating world-class content, Ultimate Guides and premium online courses.
He has served as the lead coach and product manager for Ramit Sethi’s “Zero to Launch Accelerator”, a 7-figure online business coaching program. He has created multiple successful online courses that range from $50 – $1,500, had multiple 5-figure product launches and coached private clients for $400/hour. His clients include celebrity makeup artists, world-class songwriters and world’s best high performance coaches.
Primoz has been featured in Yahoo Finance, Business Insider, Entrepreneur, Growthlab, Ramit Sethi’s Zero to Launch, Derek Halpern’s Yes Engines, Selena Soo’s INFLUENCE, as well as all major Slovenian newspapers. He has spoken to audiences of several hundred people, at events such as Ramit Sethi’s Forefront and Selena Soo’s Get Known, Get Clients LIVE.
Resources discussed on this show:
Primoz Bozic Website
Ultimate Guide Checklist
Primoz Bozic LinkedIn
Primoz Bozic Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the podcast, I welcome Dr. Sharad P. Paul to discuss medicine and health. Dr. Sharad P. Paul, MD is a skin cancer surgeon, family physician, academic, skincare expert, evolutionary biologist, storyteller, and social entrepreneur, as well as an adjunct professor at Auckland University of Technology. Born in England, with a childhood in India, he is a global citizen who lives Down Under. In 2008, was featured in international editions of Time and in 2015 was awarded the prestigious Ko Awatea International Excellence Award for Leading (Health) Improvement on a Global Scale.
In this episode, we discuss:
-The most important questions to ask your physician at a yearly check-up
-The Genetics of Health: making medicine personal
-How historical human migration and diet patterns influence your Vitamin D levels and Omega 6:3 ratio
-Should the medical system be proactive or reactive with illness?
-And so much more!
The healthcare system today is primarily focused on reactively treating illness with very little resources going towards proactive treatment and advice. Dr. Paul stresses, “Medicine isn’t health. Medicine is an industry... It doesn’t automatically mean good health.”
Dr. Paul believes that achieving good health is done by both recognizing genetic risk factors and adjusting your environment appropriately. For those seeking to provide more personal healthcare, Dr. Paul advises, “It’s important to get to know the person and not just the illness.”
Dr. Paul advocates people become knowledgeable about what it takes to live a healthy lifestyle and take action to achieve their health goals. Dr. Paul recommends to, “Increase your sense of personal responsibility.”
For more information on Dr. Paul:
Dr. Sharad P. Paul, MD is a skin cancer surgeon, family physician, academic, skincare expert, evolutionary biologist, storyteller, and social entrepreneur, as well as an adjunct professor at Auckland University of Technology. Born in England, with a childhood in India, he is a global citizen who lives Down Under. In 2008, was featured in international editions of Time and in 2015 was awarded the prestigious Ko Awatea International Excellence Award for Leading (Health) Improvement on a Global Scale. Dr. Paul is an award-winning author (fiction, nonfiction, poetry and medical textbooks), a prolific contributor to major national and international magazines and journals including MindBodyGreen, and a frequent radio and television guest.
Resources discussed on this show:
Sharad Paul Facebook
The Genetics of Health on Amazon
Sharad Paul Website
Sharad Paul Twitter
MindBodyGreen: This Is Exactly How Much Coffee You Should Be Drinking
The Myth of Race | Sharad Paul | TEDxAuckland
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the podcast, I welcome Daniel Thomas Hind onto the show to discuss Evolution Eat and the components of a healthy lifestyle. Daniel Thomas Hind is the founder of EvolutionEat, a transformational weight loss and lifestyle company designed to help overwhelmed folks solve their eating, food and weight problems. Over the past few years Daniel has specialized in helping busy executives and high performers who tend to have a tough time prioritizing their health over their jobs, businesses, careers, and families. And here’s the kicker…he’s figured out how to make the process fun so that it lasts forever. Every week, tens of thousands of people read Daniel’s material to learn how to use psychology, mindset and healthy habits to live a more meaningful life. Welcome Daniel to the show!
In this episode, we discuss:
-Evolution Eat: how to proactively take control over your lifestyle
-Daniel’s food and exercise journey
-Developing the right mindset for change
-How to set-up a morning routine that powers the rest of your day
-And so much more!
Daniel encourages you to jump at new opportunities and overcome natural feelings of hesitation and fear. From Daniel’s experience, he stresses, “It’s often when you lean into that edge that the most extraordinary things occur simply because you don’t know how to predict for them.”
To reach your full potential you cannot neglect your basic needs as Daniel believes, “Your health is baseline.”
A sustainable healthy lifestyle over the long-term is achieved with healthy habits. Daniel has found that, “It’s a skill you develop and practice over time versus a goal that you accomplish.” Ultimately, it is not the end goal that counts but the process you develop to get there as, “Goals are a place to come from not a place to get to.”
For more information on Daniel:
Daniel Thomas Hind is the founder of EvolutionEat, a transformational weight loss and lifestyle company designed to help overwhelmed folks solve their eating, food and weight problems.
Over the past few years Daniel has specialized in helping busy executives and high performers who tend to have a tough time prioritizing their health over their jobs, businesses, careers, and families. (Sound familiar?) And here’s the kicker…he’s figured out how to make the process fun so that it lasts forever.
“Most people know what’s healthy for them, you don’t need another diet guy on the internet to tell you what to eat,” Daniel says. “When it comes to emotional eating, stress eating and all kinds of habitual overeating, you can’t just give someone a diet and say, ‘Here, good luck!’ There’s a lot more going on under the hood that influences our decision-making, and there’s a key distinction between someone trying a new diet for a few months and fully adopting a lifestyle as a way of being. That’s what I’m here to uncover and teach. Because your health is baseline.”
Every week, tens of thousands of people read Daniel’s material to learn how to use psychology, mindset and healthy habits to live a more meaningful life.
Resources discussed on this show:
Free Gift: EvolutionEat Starter Pack
Evolution Eat Website
Evolution Eat Instagram
Evolution Eat Twitter
Daniel Thomas Hind LinkedIn
Email: Daniel@evolutioneat.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
Happy December to the Healthy Wealthy and Smart family! On this episode, I welcome Tricia Brouk on the show to discuss the elements of a memorable talk. In addition to working in the entertainment industry, Tricia Brouk applies her expertise as a director and writer for film, television and theater to the art of public speaking. She’s the executive producer of TEDxLincolnSquare and has choreographed Black Box on ABC, The Affair on Showtime, Rescue Me on Fox, and John Turturro’s Romance and Cigarettes. The series she directed, Sublets, won Best Comedy at the Vancouver Web-Festival. She’s written two musicals, a play, a sitcom pilot, and a feature film. She’s been featured in Inc. Magazine, Huffington Post, Broadway World and has been a featured guest on Leaders In The Trenches, Ultimate Leadership, EO Fire, and Weekly Alignment. She also hosts the podcast, The Big Talk on iTunes, where she interviews people who talk for a living.
In this episode, we discuss:
-Tricia’s simple formula to make a powerful talk
-How to craft a raw and meaningful story
-Introversion and ways to overcome stage fright
-The importance of communicating expectations for success
-And so much more!
Over her career, Tricia has been able to work on a variety of projects by maintaining confidence in her talents. Tricia recommends jumping at any new opportunities that present themselves and that, “It was all about saying yes, being challenged and not being afraid of failing.”
To create a powerful and meaningful talk, Tricia advises, “Inspire what you have to offer without selling what you have to offer.”
The most powerful talks use stories and a point of view that are unique and authentic to the speaker. As a result, “You disarmed the audience by sharing something about yourself, by showing up and being vulnerable.”
For those wanting to improve their public speaking, Tricia suggests that, “You have to flex the speaking muscle just like you flex the bicep.” To gain more comfort on stage, there is no substitute to practice. Tricia recommends gradually pushing boundaries, starting with family and moving on to co-workers, as she has found that, “Repetition is everything.”
For more information on Tricia:
Tricia Brouk draws on experience as a TEDx organizer, a writer, director and choreographer in film, television, and theater to help you bring your life-changing talk into focus. Her unique point of view will get you onto the big stage and guarantee you an unforgettable big talk every time.
I view public speakers through the same lens I do an actor. You have something important to say and it’s my job to help you find the way to say it with truth, confidence, vulnerability, awe, compassion and courage. With the help of my direction and guidance, I’ll bring your life-changing speech into focus, while giving you the unique insight into what makes an unforgettable big talk. I’ll break down your script just like I do with a film or play. I’ll identify the arcs the beats, and if what you are saying is actually what you mean to say. I’ll identify what you need to do for your big talk or your Keynote, as they are very different. Once I do that, we’ll work together on clarifying, specifying and performing your big talk through blocking, repetition, and simple techniques I use with actors.
My goal in the room is to create a safe space so you can drop in. When you are working on the material, I’ll help you find new and interesting ways to communicate your very important talk. Once we find those, together, I will help you maintain the integrity and consistency of the performance so you can be free to talk to the audience, like you’re talking to a friend. I will help illuminate the importance of what you, as a speaker, want to say and how you communicate that information so that your audience leans in.
Resources discussed on this show:
Tricia Brouk Website
Tricia Brouk Twitter
Krumping is language. | Brian HallowDreamz Henry | TEDxLincolnSquare
The Big Talk Website
Gift: 4 Ways To Inspire Your Audience, Create Adoring Fans and Organically Drive New Business
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I had the pleasure of speaking with Melissa Morrison about her journey following a concussion. Melissa Morrison is the International Bestselling author of the book, Unstick Your Stuck. She is a Certified Co-Active Professional Coach, a Certified Neurosculpting Facilitator and a speaker. As a TBI Thriver Life Coach she works with TBI survivors to find their new normal so they can heal and gain their life back personally and professionally.
In this episode, we discuss:
-How Melissa’s concussion symptoms impacted her daily life
-Melissa’s experience with medical providers following her concussion
-Why Melissa became a life coach and began her work with TBI survivors
-The various components of neurosculpting
-And so much more!
Symptoms of a concussion can often go unnoticed at the time of injury. From Melissa’s experience, she states, “I didn’t think it was that bad. It was something that I thought would just go away.” Melissa was unable to receive appropriate medical management of her concussion leading to greater harm to her psychology. She states, “That was hard for me to look in the mirror and not see anything… There was a disconnect.”
One of the turning points of Melissa’s journey was when she was able to express herself freely and feel as though she was in a safe environment. With the help of her physical therapist, Melissa found that, “There was actually a chance after this that maybe I could heal… She understood what I was going through… She really listened to what was going on.” For concussion management, Melissa advises all medical providers to, “Really slow down and listen because a lot of times the processing of the person with a concussion is slower than it was prior to… Really taking the time and believe them. Believe what they’re saying.”
Melissa’s life path was altered following her injury in a direction that has led her to pursue her passions. Despite the hardships, she remarks, “Having this concussion was a wakeup call from the universe.”
For more information on Melissa:
I am Melissa S. Morrison, CPCC, CNSF, CFE.
I am a recovering accountant and a brain injury thriver who found my passion as a life coach and an author. I specialize in working with people who want to stretch the edges of their comfort zone by transforming and taking the lead in their lives. As a traumatic brain injury survivor, I understand what it means to personally transform. I am living proof that you can step into your truth no matter what circumstance you face in life.
I obtained my coaching certification from the Coaches Training Institute as a Co-Active Professional Coach. I am a Certified Neurosculpting® Facilitator from the Neurosculpting® Institute, aimed at improving lives using neuroscience through education of overall brain health and re-wiring old stories through meditation.
My career background in leadership and business in auditing, consulting, and fraud creates a unique viewpoint as a life coach. As a Certified Fraud Examiner, I am equipped with the tools to recognize and eliminate the personal fraud we all hide behind.
I excel at being creatively curious with clients, bringing my strong intuition and awareness into the space and bringing the energy and fun we need back in our lives.
Here is me. I am loving, caring and powerful. On the other hand: I’m blunt; I’m bold; I’m a risk-taker. I am also driven, curious, inspirational, and intelligent. Honesty is number one and I plan to give that to you in all the work we do together. I want this to be interactive; to start conversations.
Resources discussed on this show:
Free copy of Unstick Your Stuck
Melissa Morrison Facebook
Melissa Morrison Website
Coach Training Institute
Neurosculpting Institute
Email: Melissa@melissasmorrison.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Christian Barton on the show to talk about exercise for patellofemoral pain. Dr Christian Barton is a physiotherapist who graduated with first class Honours from Charles Sturt University in 2005, and completed his PhD focusing on Patellofemoral Pain, Biomechanics and Foot Orthoses in 2010. Dr Barton’s broad research disciplines are biomechanics, running-related injury, knee pathology, tendinopathy, and rehabilitation, with a particular focus on research translation. Dr Barton has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals, and he is an Associate Editor for the British Journal of Sports Medicine.
In this episode, we discuss:
-Why exercise is so important in treating patellofemoral pain
-Exercise prescription principles for optimizing therapeutic programs
-Muscle power and its role in absorbing load during activity
-Utilizing graded exposure to address fear around movement
-And so much more!
The current literature shows, “Exercise is the key intervention, along with education” for patellofemoral pain. Although uncertainty exists around specific exercise prescription parameters, Dr. Barton has found that, “The exercise that probably should be provided is primarily hip and knee based on current evidence.”
Dr. Barton is a proponent for conservative management over injections and surgical interventions for patellofemoral pain and encourages all clinicians to, “[make] sure that patients take this on board and you stop them from looking for quick fixes.”
While strength and power deficits will exist for individuals with patellofemoral pain, other factors such as recovery expectations and fear of movement can further impact clinical presentation and intervention. Dr. Barton stresses, “Ultimately, you need to treat the patient in front of you.”
For more information on Dr. Barton:
Dr Christian Barton, APAM, is both a researcher and clinician treating sports and musculoskeletal patients in Melbourne. He is a postdoctoral research fellow and the Communications Manager at the La Trobe Sport and Exercise Medicine Research Centre. Christian’s research is focussed on the knee, running injuries and knowledge translation including the use of digital technologies. He has written and contributed to a multitude of peer-reviewed publications and is a regular invited speaker both in Australia and internationally. He also runs courses on patellofermoral pain and running injury management in Australia, the United Kingdom and Scandinavia. He is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, and a guest lecturer at La Trobe University and the University of Melbourne.
Christian is currently studying a Master of Communication, focussing on journalism innovation. He is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine, as well as Associate Editor at Physical Therapy in Sport.
Resources discussed on this show:
Christian Barton Twitter
La Trobe University Sport and Exercise Medicine Research Blog
The International Patellofemoral Research Network
Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis
How can we implement exercise therapy for patellofemoral pain if we don’t know what was prescribed? A systematic review
IPFRN Exercise Guide
2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions)
Hip rate of force development and strength are impaired in females with patellofemoral pain without signs of altered gluteus medius and maximus morphology
La Trobe University Blog: Hip muscle rate of force development is impaired in females with knee cap pain
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I had the pleasure of speaking to many attendees at the Private Practice Section Annual Meeting in Chicago as few weeks ago. I asked people to answer 2 questions:
1) What was your biggest take away from the day?
2) How do you think it will change the way you practice?
This short and sweet episode is a great recap of the PPS meeting and I hope it will inspire you to attend next year!
Resources mentioned in this episode:
Mel Robbins
Sally Hogshead
Jamey Schrier
Private Practice Section
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Net Health Event at the Private Practice Section Meeting in Chicago, Sturdy McKee joins me on this episode to discuss finding your core vales and your vision as components of business management. Sturdy is a business coach, entrepreneur and business owner who also happens to be a physical therapist and private practice owner. As a business coach and instructor, Sturdy brings the practical knowledge of owning, operating and growing businesses, combined with extensive training and learning, to clients who want to improve their business operations and achieve their personal and business goals.
In this episode, we discuss:
-Current challenges facing the physical therapy profession
-What is a vision of meaning?
-The top three qualities Sturdy looks for in job candidates
-How to motivate employees with Key Performance Indicators
-And so much more!
Sturdy stresses that a vision for your business should be put into practice daily in order to get your team members fully aligned behind it. He stresses, “You don’t want core values to be aspirational. You don’t want them to be things you hope for and want to do some day—They need to be actual rules you live by now.”
New physical therapy graduates are skilled in treatment and clinical judgment, however, they have had limited opportunities to develop softer skills such as communication and developing patient rapport. Sturdy advises new graduates, “You don’t go work on the strongest muscle group, you work on the stuff that isn’t.”
Coaches of athletic teams share many similarities with business leaders and many coaching tactics can be applied to business management. Most importantly, Sturdy has noted that, “[Coaches] don’t focus on the outcome, the metric, what they focus on is the process.”
For more information on Sturdy:
Sturdy is a business coach, entrepreneur and business owner who also happens to be a physical therapist and private practice owner. His “Why” is to help people succeed. He has a special place in his heart for physical therapist entrepreneurs and private practice owners. As a business coach and instructor, Sturdy brings the practical knowledge of owning, operating and growing businesses, combined with extensive training and learning, to clients who want to improve their business operations and achieve their personal and business goals.
Sturdy created and taught “Clinicient University”, a 2 day business crash course for Clinicient client owners and operations executives. Attendees of this 2-day course realized an average increase in revenue of 8.9% in the first 3 months following attending with the top of the range at 22%.
Sturdy has served as an EO Accelerator Mentor, helping business owners define their vision, mission and values, as well as achieve their business goals. He spent the last year building a team of business coaches at Clinicient, an EMR & Revenue Cycle Management company for physical, occupational and speech therapists.
Sturdy finds immense satisfaction in coaching and working with business owners and executives to help them achieve their business and personal goals.
Resources discussed on this show:
Jim Collins: Big Hairy Audacious Goal
New Zealand All Blacks
Kelly Duggan LinkedIn
PPS Conference
Sturdy McKee LinkedIn
Sturdy McKee Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I had the pleasure of welcoming Dr. Ebonie Rio onto the show to discuss tendinopathy. Ebonie is a physiotherapist and researcher with extensive experience in tendon pain. She is a post doctoral researcher at La Trobe University, and completed her PhD in tendon pain, researching “Corticospinal responses associated with patellar tendinopathy and the effect of externally paced strength training.” Her research has changed rehabilitation practise around the world.
In this episode, we discuss:
-Tendon Neuroplastic Training
-Motor cortex changes with tendon pain and the powerful role a metronome can play for your brain excitability
-How to utilize time under tension and load to reduce tendon pain
-The importance of patient input for goal setting
-And so much more!
Ebonie suggests, “We are not winning the battle with musculoskeletal pain. It is so common.” Physiotherapists need to be aware of and utilize the best evidence available to treat the growing problem of musculoskeletal pain. Ebonie believes a skillful examination and evaluation can guide differential diagnosis and she stresses, “It’s critical that our rehab, as we go forward, becomes much more tailored to what we are seeing in front of us.”
Ebonie is a proponent of utilizing isometric exercise in addition to other adjunctive therapies to reduce pain and develop adherence into a loading program. She suggests, “When you see someone with pain, we need a way in. And as physios, we’ve got some really great tools.” Ultimately, to treat tendon pain, the research evidence supports that, “Load is our primary modality.”
Manual skills have a role in the examination but from Ebonie’s perspective the information specifically from palpation is more limited. She outlines, “The problem with palpation is that it is nonspecific. Lots of things are going to hurt to poke.” Due to the nonspecific nature, Ebonie has found that, “Our hands are incredibly important; poking is just not that useful when it comes to diagnosis.”
For more information on Dr. Ebonie Rio:
Ebonie is a physiotherapist and researcher with extensive experience in tendon pain. She is a post doctoral researcher at La Trobe University, and completed her PhD in tendon pain, researching “Corticospinal responses associated with patellar tendinopathy and the effect of externally paced strength training.” Her research has changed rehabilitation practise around the world. She currently is involved in a variety of projects investigating tendon pain, especially in the lower limb, however also other areas such as investigating innovative new rehabilitation techniques. Ebonie also still consults clinically, having been previously involved at the Australian Institute of Sport, Australian Ballet, and Winter Olympics.
Resources discussed on this show:
Leung et al 2015: Motor cortex excitability is not differentially modulated following skill and strength training.
Professor Jill Cook
Email: e.rio@latrobe.edu.au
La Trobe Sport and Exercise Medicine Centre
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Alan Stein joins me to discuss the qualities of great leadership. Alan Stein, Jr. is a veteran basketball performance coach, corporate speaker, podcast host and social media influencer. Alan delivers high-energy keynote performances to develop genuine leadership, authentic team cohesion and true mental toughness. He inspires his audiences to take immediate action and improve their mindset, habits and productivity.
In this episode, we discuss:
-Alan’s transition from basketball performance coach to corporate speaker
-The 3 steps needed to create change: awareness, understanding, reconditioning
-The role of a “change agent” in overcoming barriers to change
-Important qualities in a great leader: self-awareness, vulnerability, competency, vision
-And so much more!
From Alan’s experience, transitioning into a new career does not have to be done overnight and can be developed over the long term. Alan encourages, “Anything good takes time to build.”
Alan promotes utilizing your current network to its utmost potential to support new ventures. He believes, “Relationships are one of our most important currencies.”
Change can often result in setbacks which is why many people fear it; however, Alan finds that change is necessary for improvement and growth. He believes that sustainable change is, “daily recalibration… It’s definitely not this linear ramp that is always going up to improvement.”
Being a leader means positively impacting the lives of those around you. Most of the qualities of leadership can be learned, cultivated, practiced and improved. Alan stresses, “Leadership is a choice.”
For more information on Alan:
Alan Stein, Jr. is a veteran basketball performance coach, corporate speaker, podcast host and social media influencer. He has spent the past 15 years working with the highest performing athletes on the planet (including NBA superstars Kevin Durant). Alan delivers high-energy keynote performances to develop genuine leadership, authentic team cohesion and true mental toughness. He inspires his audiences to take immediate action and improve their mindset, habits and productivity. In other words, Alan teaches organizations how to utilize the same strategies in business that elite athletes and coaches use to perform at a world-class level. He is an amicably divorced father of 7-year-old twin sons (Luke and Jack) and a 5-year-old daughter (Lyla) and lives just outside of Washington, D.C.
Resources discussed on this show:
Alan Stein Jr Website
Alan Stein Jr Twitter
Alan Stein Jr Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Ascend Conference in Washington DC, I am joined by CEO and Co-Founder of Strive Labs Scott Hebert to discuss business metrics for physical therapy practices. At Strive Labs, we're changing the way individuals and health systems manage the most common health condition in the United States: musculoskeletal disease. Our care management platform enables healthcare providers to inform, engage, and empower their patients to reach their recovery goals and avoid chronic injury.
In this episode, we discuss:
-How Strive Labs manages customer relationships from acquisition to retention
-The most important business metrics for physical therapy owners
-How to calculate your Net Promoter Score
-Crafting relevant email campaigns for current and prospective patients
-And so much more!
Promoters are people who are going to recommend your services to friends and family. In order to create a net promoter, you may need to go beyond only satisfying customers. From Scott’s experience, he stresses, “Satisfaction is important. Satisfaction is the foundation of any good business, but what people have started to realize is that satisfaction in many ways is kind of worthless. Loyalty is what’s priceless.”
There are dozens of ways potential clients can stumble upon your services; most of them are via online platforms. Because of this, Scott encourages all practices to maintain an online presence. He has found that, “If they are looking for physical therapy, you need to be able to be present in that local region.”
As your business grows, you may find yourself having difficulties finding ways to scale or automate certain aspects of your responsibilities. If you are wondering if automated email marketing is right for you, Scott suggests, “That moment you start to feel like you’re losing control of things… that could be a moment to start considering it.”
For more information on Strive Labs:
At Strive Labs, we're changing the way individuals and health systems manage the most common health condition in the United States: musculoskeletal disease. Our care management platform enables healthcare providers to inform, engage, and empower their patients to reach their recovery goals and avoid chronic injury.
Our team of creative thinkers, healthcare professionals, industry experts, and technologists are all working together to develop new solutions for improving the patient experience. In 2017, Strive Labs became part of the WebPT family, and together, we’re going to help rehab therapists obtain new patients, retain existing ones, and get all of them better faster.
Resources discussed on this show:
Strive Labs Website
Net Promoter Score
Survey Monkey
Google My Business
Mail Chimp
Infusion soft
Rehab Therapists Give Back
Scott Hebert Twitter
Strive Labs Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Ascend Conference in Washington DC, Rick Gawenda joins me on this episode to discuss the CPT codes. Rick Gawenda, PT, is a licensed physical therapist with 25 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services.
In this episode, we discuss:
-The 4 components to determine levels of CPT Codes: history, examination, clinical presentation, decision making
-Differentiating the complexity levels of CPT Codes with patient case studies
-Challenges with billing higher complexity levels differently than lower complexity levels
-Common myths surrounding the treatment of Medicare patients
-And so much more!
Therapists are not documenting relevant patient co-morbidities and clinical presentation. Rick finds, “We are underestimating the complexity level.”
Although CPT codes are complex, it’s important for any healthcare practitioner to understand their billing process and avoid the potential for abuse or fraud. Rick finds that our current understanding is limited and can be seen as abuse since, “We don’t know we are doing it wrong.”
Rick outlines multiple ways you can bill to maximize your payments for your treatment sessions but notes that it is important to be ethical. He stresses, “Nobody wants to be on the radar of an insurance company.” And more importantly, “Reputation is everything. It takes a long, long time to develop a positive reputation and it can be gone in a heartbeat.”
For more information on Rick:
Rick Gawenda, PT, is a licensed physical therapist with 25 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He graduated with a Bachelor of Science degree in Physical Therapy from Wayne State University in Detroit, Michigan, in 1991. Mr. Gawenda is also Director of Finance for Kinetix Advanced Physical Therapy, a private practice with offices located in Southern California. In addition, he previously worked as the Director of Physical Medicine and Rehabilitation at Detroit Receiving Hospital where he was responsible for physical therapy, occupational therapy, and speech-language pathology services, both in the inpatient and outpatient setting.
He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services. Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.
Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is the Past President of the Section on Health Policy & Administration of the APTA as well as Past President of the Michigan Association of Medical Rehabilitation Program Administrators.
Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.
Resources discussed on this show:
Gawenda Seminars
Episode 175: Making Sense of ICD 10 w/ Rick Gawenda, PT
Darci Lynne: 12-Year-Old Singing Ventriloquist Gets Golden Buzzer - America's Got Talent 2017
Centers for Medicare and Medicaid Services
Rehab Therapists Give Back
Ascend Conference
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Travis Zigler joins me to discuss eye health. Dr. Travis Zigler is on a mission to end preventable blindness. In 2010 he graduated from The Ohio State University College of Optometry with Magna Cum Laude honors. He went on to own two optometry practices in South Carolina specializing in "difficult to fit" contact lens patients and dry eye, but soon found his passion for entrepreneurship.
In this episode, we discuss:
-Missions abroad with The Eye Love Cares Foundation and the impact of preventable blindness in third world countries
-How often should you have your eyes checked?
-Selecting the right optometrist/ophthalmologist for you
-Surprising factors that affect Macular Degeneration and Dry Eye Disease
-And so much more!
Having regular eye exams can also function as a general health screen. Dr. Zigler notes, “An eye exam is the only time that we can actually see live blood vessels and we can actually see a live nerve in the back of your eye. And that can tell us a tremendous amount about your health.”
From Dr. Zigler’s experience, most conditions are a result of many lifestyle factors such as diet, exercise and hydration. He believes, “If we learn how to solve this chronic inflammation problem that plagues the western society, all of us in the US, then it is going to make a huge difference.”
Dr. Zigler believes in a holistic plan of care for all of his patients with most preventable eye problems being a symptom of a systemic problem. He stresses, “Disease is your body’s way of telling you you’re doing something wrong.”
For more information on Dr. Zigler:
Dr. Travis Zigler is on a mission to end preventable blindness. In 2010 he graduated from The Ohio State University College of Optometry with Magna Cum Laude honors. He went on to own two optometry practices in South Carolina specializing in "difficult to fit" contact lens patients and dry eye, but soon found his passion for entrepreneurship.
In 2015, he started Eye Love, an eye wellness company with a mission to end preventable blindness. Along with his wife, Jenna, they continue to work part time in optometry and build Eye Love with the goal of eventually opening free clinics in the US and abroad. Because 703 million people are blind due to lack of glasses, they give a portion of all profits back to those who can neither afford nor obtain eye care in Jamaica and South Carolina.
When he's not working on Eye Love or in clinic, he enjoys traveling to Jamaica, running, and playing the ukulele while he drinks his morning coffee.
Resources discussed on this show:
Eye Love
Dry Eye Syndrome Support Community
Dr. Travis Zigler Facebook
Dry Eye Community Video Series
Eye Love Cares Foundation
American Academy of Optometry
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I had the pleasure of welcoming Ben Cormack onto the show to discuss exercise and pain science. Ben Cormack owns and runs cor-Kinetic. Cor-kinetic provides educational courses based on modern movement and pain sciences within a strong evidence based framework. They have delivered courses in Europe, Asia, USA and South America and present regularly at national and specialist subject conferences around the world.
In this episode, we discuss:
-How exercise influences pain
-Keeping healthcare more patient-centered with exercise optionality
-How to communicate pain science both verbally and experientially
-The Five A’s of Exercise Adherence
-And so much more!
People seek out healthcare providers because, “People are always looking for a rational or an answer to their problem.” The research evidence doesn’t support biomechanical explanations of pain, however with pain science, Ben finds, “We can give people a rationale, we can give them an answer but it doesn’t have to be a definitive answer that says it’s this or it’s that.”
Chronic pain can lead to a feeling of helplessness, but by better explaining what pain is and promoting activity therapists can convey to patients that, “The body is always changing according to what we do which is in a way empowering for people because they are gaining control of that change.” Ben reveals that for successful pain management, “It’s the process, not the destination.”
Exercise prescription is a powerful tool for pain management. The current evidence suggests, “The specifics really don’t matter that much but actually doing it does.” As a provider, Ben has found his role has evolved in that, “It’s much more about facilitating people to do things themselves.” In summary, Ben stresses, “Pain science is understanding people. Movement and exercise are basic tenants of being a human being.”
For more information on Ben:
Ben Cormack owns and runs cor-Kinetic. Cor-kinetic provides educational courses based on modern movement and pain sciences within a strong evidence based framework. They have delivered courses in Europe, Asia, USA and South America and present regularly at national and specialist subject conferences around the world.
Ben is a musculoskeletal therapist with a clinical, rehabilitation & exercise background stretching back 15 years. He specializes in a movement & exercise based approach with a strong education component and patient centered focus.
Resources discussed on this show:
Cor-Kinetic Website
Mishel 1981: The measurement of uncertainty in illness
Darlow et al 2013: The enduring impact of what clinicians say to people with low back pain
Peter O'Sullivan
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
LIVE from the Ascend Conference in Washington DC, I am joined by Co-Founders of PT Day of Service Efosa Guobadia and Josh D’Angelo to discuss PT Day of Service. PT Day of Service has brought together nearly 8,000 volunteers from 42 countries in just two years. Treating at a pro bono clinic. Working in a soup kitchen. Cleaning up a park. No matter where or how, we have the ability to positively impact change. Whether we call ourselves 'Physical Therapists' or 'Physiotherapists,' service embodies who we are, what we do, and how we act. Join us this year on October 14, 2017!
In this episode, we discuss:
-What is PT Day of Service?
-The future of PT Day of Service and Efosa’s and Josh’s goal of transcending the status quo
-Building a team with shared values to achieve goals
-Ways you can give back to those affected by recent natural disasters
-And so much more!
PT Day of Service encourages physical therapists to give back to their communities and all across the globe. Josh states, “It’s about writing service into the DNA of our profession….PT Day of service has always been about what we can do when we unite, when we join together as a profession”
The goal of the PT day of Service team is to, “create a platform from which people can stand and serve to move the world in a positive direction.” Dedicating a day of service gives the opportunity for each person to make a lasting impact on their communities and Efosa remarks, “The power that we have, from one interaction, from one touch point can change the world.”
For more information on the PT Day of Service Story:
EFOSA GUOBADIA:
What if. I imagine a few things have started that way in the past, and a few things will start that way in the future. This particular ‘what if’ came to my mind in February 2015. I was doing health volunteer work off the Amazon River in Peru. As I looked upon the river, an idea that had been bubbling in the back of my mind suddenly shot to the front in full force. What if, on the same day, clinicians, students and associated staff of the Physical Therapy profession volunteered in different communities around the world? What if, we then shared those moments and acts in a way that was galvanizing, inspiring, and promoted connections all over the world? What if!?
Being on the Amazon and watching the river flow, I couldn’t help but think of our profession of Physical Therapy as a flowing river. A river made up of passion, love, life, kindness, and heart. A river that enhances and is enhanced by the shores it passes and the encounters it makes. Our River. Our Profession. Our Communities. The idea was taking form that a Day of Service would be another wave to have a positive impact on all involved. I was smiling as the thought was developing and I knew I had to share it with someone. I emailed Josh right away...
JOSH D'ANGELO:
Let's shoot for the stars. Back in February, I received an email at about 11:30pm. As I curled into bed and saw the email was from Efosa, I could not help but read it. Our exchanges often serve as a place to reflect on our lives, careers, and what physical therapy can and should be. This particular email happened to be a new idea, something to the effect of starting a 'PT Day of Service.' Three sentences into the email, I had a visceral response, one that told me this is something we not only should do, but something we need to do; a chance for the profession to show what we can do when we all work together. At 11:35pm, I popped back up, turned the light on, and flipped open my laptop. Over the next 15 minutes, I did my best to articulate that this was NOT just another idea, this is a movement we HAVE to start.
Later on that night as I drifted off to sleep, I remember the last thought that crossed my mind: 'Let's really do this. Let's shoot for the stars.'
EFOSA & JOSH:
What was once an idea has evolved into a real, palpable movement driven by eight volunteers, a growing list of international ambassadors, and many supporters across the world. We have had the chance to talk about servant leadership, community engagement, and all that is possible when we ask ourselves how we can do our part to make life better for those around us, when we ask ourselves how can we put compassion into action. We know the impact will be real on not only those we serve, but on our profession and ourselves.
To our knowledge, this is the first global Day of Service coordinated by a whole profession. It gives us the chance to lead and serve at the same time. Our hope for this day is that it sparks new connections, strengthens established ones, and further stimulates conversations on how we can keep this river flowing strongly for our profession and the communities we touch. Because...What if.
Resources discussed on this show:
PT Day of Service Website
Ascend Conference
Day of Affirmation Address
Stephen Colbert 2011 Commencement Speech at Northwestern University
Rehab Therapists Give Back
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I had the pleasure of continuing the conversation following the Women in Physical Therapy Summit with both Dr. Michelle Collie and Dr. Sandy Norby. Dr. Michelle Collie is the CEO of Performance Physical Therapy, a multi-clinic private practice with over 130 employees in Rhode Island and Massachusetts. Michelle dedicates time to teaching, mentoring and coaching women through their careers. Dr. Sandra Norby is CEO and Co-Founder of HomeTown Physical Therapy which provides a practice model for ownership and champions the leadership of women in physical therapy.
In this episode, we discuss:
-Reflections on the Women in Physical Therapy Summit
-What it takes to open a private practice and be a female entrepreneur
-Why prioritizing self-care may improve your ability to lead others
-The future of the Private Practice Section and public advocacy of physical therapy
-And so much more!
One of the most important qualities of successful entrepreneurs and leaders is the strength to remain true to themselves. Dr. Collie stresses, “We need to have the courage to be authentic and not change who we are for other people.”
The Women in Physical Therapy Summit has provided an opportunity to build a strong nationwide community. Sandy’s biggest take away from the conference is that, “All of us women now have a confidant or a connection… At a drop of a hat, we’d all be very willing to help them out.”
As evidence supporting the efficacy of physical therapy continues to build, it becomes easier to share this information with the public and juxtapose non-invasive physical therapy treatment with less conservative and more costly interventions. Dr. Collie finds that, “It’s an exciting time for PTs. We are all learning how to advocate better for our profession because we are all respecting and understanding the value of it.”
For more information on Dr. Collie:
Dr. Michelle Collie PT, DPT, MS, OCS is the CEO of Performance Physical Therapy, a multi-clinic private practice with over 130 employees in Rhode Island and Massachusetts. A graduate of the Otago University Physiotherapy program in New Zealand, Michelle came to America in 1994 to gain additional clinical experience. She completed post-graduate studies at MGH-IHP in Boston Massachusetts followed by becoming a board certified clinical specialist. Michelle chairs the National Private Practice Marketing and PR Committee and devotes much of her time to advocating for the profession of physical therapy. The Performance Physical Therapy team have received multiple awards including the 2012 RI Outstanding Philanthropic Business Award and the 2014 prestigious National Private Practice of the Year award. With over 25 years of experience, Michelle has provided clinical instruction, published articles and presented at a local and national level on physical therapy, marketing, entrepreneurship and leadership. Finally, Michelle dedicates time to teaching, mentoring and coaching women through their careers.
For more information on Dr. Norby:
Sandra Norby, PT, DPT is CEO and Co-Founder of HomeTown Physical Therapy, LLC. This Iowa based corporation provides a practice model for ownership and champions the leadership of women in physical therapy. Sandra has served on many leadership positions in APTA and PPS, including being a member of PPAC and two terms as a Director on the PPS Board. She was awarded the 2017 APTA Federal Advocacy Leadership Award for her instrumental work on making Locum Tenens a reality for physical therapists.
Sandra received her Physical Therapy Masters degree from the University of Iowa and her DPT from the University of Montana – Missoula. She has an expertise in compliance and billing and has been a speaker at many state and national events on topics that include technology, leadership, and championing the success of women in physical therapy.
Resources discussed on this show:
Women in Physical Therapy Summit
The Leadership Gap by Lolly Daskal
Peer2Peer NetWork PPS
Sole Shero Half Marathon
APTA Private Practice Section
PPS Annual Conference
@MyPhysTherapist Twitter
PPS Monthly Marketing Toolkit
PPS Fit Factor
HomeTown Physical Therapy
Performance Physical Therapy
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
In this chapter of the #PTSideHustle I share my biggest take aways from the Women in PT Summit on leadership. The Women in PT Summit took place on Saturday September 23rd in NYC. It brought together some of the finest leaders in the physical therapy world including our keynote speakers Dr. Sharon Dunn, president of the APTA and best selling author and executive leadership coach Lolly Daskal. This episode is all about changing your mindset and getting in touch with your self and you needs.
In this episode I discuss:
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The importance of authenticity in your life and in your business.
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Why knowing your values is paramount to your business
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How amplification can improve your side hustle
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My leadership archetypes and how they can help and hinder me in my life
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And much more!
Resources I spoke about in this episode:
Women in PT Summit
The Leadership Gap by Lolly Daskal
Dr. Sharon Dunn
Thank you to our sponsor for today’s episode. Get your free month today by clicking on the link below:
Freshbooks
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Mark Merolli joins me to chat about eHeath and physical therapy. Dr. Mark Merolli is a physiotherapist, health informatician and digital health consultant. He works in the digital health research and academia space and practices physio in a sports and musculoskeletal practice.
In this episode, we discuss:
-The many forms of digital health
-The latest trends in eHealth for business marketing and knowledge management
-Opportunities for physical therapists to leverage health data for improved treatment outcomes and insurance reimbursements
-Mark’s case for why healthcare professionals should collaborate with tech companies to create digital healthcare products
-And so much more!
Physical therapists can benefit from leveraging social media for both patient management and education. Mark stresses, “Social media is one trend that we can’t ignore.”
With innovations such as wearable technology wide scale, fairly accurate accumulation of health data is now possible which can be used to better understand treatment outcomes and change the way insurance companies think about reimbursement. In this age Mark understands that, “Information is power.”
Many applications are being developed for health and wellness needs and Mark has found that, “There’s a lot happening in the digital health space.” However, many apps underperform due to lack of insights from healthcare practitioners who more readily understand the patient experience. Unfortunately, Mark has found that, “Healthcare is inherently slow to adopt a lot of these trends.” Mark believes healthcare providers should partner with digital innovators and have a role in developing these technologies because, “It’s the practicing health professional’s role to have an intimate knowledge of healthcare.”
For more information on Mark:
I’m Mark Merolli, a passionate digital health and informatics professional. I work in academia, research, clinical practice, as a consultant, and on various entrepreneurial projects.
My clinical background as a Physiotherapist has been rewarding and grounding. After years focussing on clinical practice exclusively, I was drawn in by the paradigm shift I was witnessing both with my own patients and in the wider community – a push enabled by technology. I was an early adopter. During a stint living and practicing abroad in the United Kingdom, I was fortunate enough to gain some experience working at a digital media agency alongside my clinical work, specialising in online, print media and advertising. This parallel experience to health practice was invaluable and provided a foothold to explore “digital” in “health”. Working as part of the online team helped me gain extensive knowledge in the web, social media, website management, search engine optimization (SEO), digital analytics and, digital strategy. By doing this, I was better able to conceptualise the digital landscape and relate it back to my passion – healthcare.
All of my experiences have led me to focus my career very much in the digital health space. I have a PhD in this area, specialising in social media for health but my interests and expertise covers a range of technologies and areas (especially consumer-centric technologies that influence participation in health – mHealth, apps, sensors, telehealth, virtual reality, games, etc).
Now, I research, lecture, educate, strategise, speak and provide thought leadership on all things digital health to various health organisations, entities and individuals. I love all of my roles!
I also have formal qualifications in health informatics, such as Membership in the Australasian College of Health Informatics (MACHI), am a Certified Health Informatician Australasia (CHIA), endorsed by Australian College of Health Informatics (ACHI) and Health Informatics Society of Australia (HISA), and am the Chairman of the International Medical Informatics Association – Participatory Health and Social Media Working Group (IMIA – PHSM).
My real passion is to connect with likeminded health professionals and other stakeholders who are interested in this big wide world we now call “digital health”. As technologies continue to intertwine with healthcare, it’s important we’re equipped with the knowledge and understanding to operate confidently in this environment. My overall vision is to connect with, educate and up-skill health professionals across a variety of digital health areas and to help solve practical solutions in future models of healthcare.
My Mission: “To connect professionals with digital health”
My Credo: “For health professionals..by health professionals”
Resources discussed on this show:
Mark Merolli Website
Mark Merolli Twitter
Mark Merolli LinkedIn
patientslikeme.com
TEDMED: Cole Galloway Go Baby Go
TED Talk: Meet e-Patient Dave
epatients.org
Society for Participatory Medicine
Digital Resources about Technology and Physio
Social Media for Physios: Mark’s Training and Business Course
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Osman Ahmed joins me to discuss concussion management and eHealth. Dr. Ahmed is a Lecturer in Physiotherapy at Bournemouth University, England and also works for the Football Association in England as a physiotherapist within their elite disability football programme. Since completing his PhD he has published and presented widely in the fields of concussion and eHealth/social media healthcare.
In this episode, we discuss:
-Is social media propagating myths about concussions?
-Why healthcare providers should be engaging in eHealth initiatives
-Challenges with concussion management for disabled populations
-The important role journalists play in disseminating knowledge about concussions in the mainstream media
-And so much more!
More providers are beginning to engage the public with healthcare information through the use of social media. Dr. Ahmed warns, “Social media is not going to stay the same. Social media is going to evolve.” The challenge for clinicians is to keep current with the different platforms and continue to engage with users. He encourages, “We have to engage patients where they are.”
Most of the markers in our current assessment tools for concussion recognition and concussion assessment will not have the same validity in disabled populations. Dr. Ahmed stresses, “There is a big opportunity to enhance the care for athletes with a disability when it comes to concussion in sport.”
Dr. Ahmed believes transforming the public’s view of concussions through the conduit of influencers in the media may be one of the best options for getting better healthcare outcomes following injury. As a result of a more informed public, “Better educated clinicians are going to be able to treat concussions better. Better educated parents are going to be able to manage their kids’ symptoms better. Better educated players are not going to push each other to go back until their symptom free.”
For more information on Dr. Ahmed:
Dr. Osman Ahmed is a Lecturer in Physiotherapy at Bournemouth University, England and also works for the Football Association in England as a physiotherapist within their elite disability football programme. He graduated from the University of Nottingham in 2002, and worked clinically until commencing his PhD in 2008 at the University of Otago, New Zealand on the topic of concussion in sport (with a focus on social media and concussion). Since completing his PhD he has published and presented widely in the fields of concussion and eHealth/social media healthcare.
Resources discussed on this show:
Consensus statement on concussion in sport
Dr. Ahmed will be travelling as the squad physiotherapist with the England Cerebral Palsy football team IFCPF CP Football World Championships (San Luis Argentina, September 4-24)
Osman Ahmed Bournemouth University
Email: ahmedo@bournemouth.ac.uk
Osman Ahmed Twitter
Dr. Mesko: eHealth information
Richard Weiler: Do Neurocognitive SCAT3 Baseline Test Scores Differ Between Footballers (Soccer) Living With and Without Disability? A Cross-Sectional Study
Sport Concussion Assessment Tool: 5th Edition
CDC: Concussion Checklist
Mayo Clinic Website
Cleveland Clinic
CDC: Traumatic Brain Injury and Concussion
Football Association
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Scott Ford joins me to discuss building wealth for a lifetime. Scott Ford is Founder and CEO of Cornerstone Wealth Management Group, an independent Registered Investment Advisory firm serving entrepreneurs, business owners, executives, and their families. The firm specializes in comprehensive wealth management, business liquidity strategies, and SBA financing. It is Scott’s mission to help his clients pursue financial freedom and live a balanced and fulfilled life.
In this episode, we discuss:
-How to shift to a long-term mindset with the Lifetime Extender Exercise
-The Sustainable Edge: balancing personal life to achieve professional growth
-Scott’s top habit changes to increase productivity
-Retirement, investment and saving strategies to make money last a lifetime
-And so much more!
Focusing on short-term career and personal goals can often lead to an underappreciation of the long-run. Scott envisions what can be accomplished over his longest potential lifespan, which he believes, “Gives me the opportunity and space to think about how I am going to accomplish that because it’s a long game.”
Scott encourages everyone to compound their accomplishments over the long-term by completing at least one important task every day. Scott stresses, “If I just accomplish one thing per day but I’m doing that over a span of 30 years and that one thing I know is the most important task, what impact is that going to have on me and other people’s lives over a 30 year span? It’s huge.” One of Scott’s tips for short term planning is to remember that, “What is on your calendar is what your priorities are regardless of what you tell yourself.”
While putting away money for retirement is always an important consideration, Scott believes aspiring entrepreneurs should leave enough to allocate to their current pursuits. “One of your best investments if this person has their own business is in themselves and in their business.”
For more information on Scott:
Scott Ford is Founder and CEO of Cornerstone Wealth Management Group, an independent Registered Investment Advisory firm serving entrepreneurs, business owners, executives, and their families. The firm specializes in comprehensive wealth management, business liquidity strategies, and SBA financing. It is Scott’s mission to help his clients pursue financial freedom and live a balanced and fulfilled life.
Scott is the author of three books: Financial Jiu-Jitsu: A Fighter’s Guide to Conquering Your Finances, The Widow’s Wealth Map: Six Steps to Beginning Again, and the New York Time Bestseller, The Sustainable Edge: Fifteen Minutes a Week to a Richer Entrepreneurial Life. He and his wife, Angie, reside in Hedgesville, WV and have two wonderful children as well as a dog and a cat. In addition to spending time with his family, Scott is a voracious reader and enjoys woodworking, Brazilian Jiu-Jitsu, golf, hunting, permaculture and beekeeping; basically anything outdoors.
Resources discussed on this show:
Dan Sullivan
IQ Grower pdf
The Sustainable Edge Website
Planner Pads
Google Docs
The Automatic Millionaire: A Powerful One-Step Plan to Live and Finish Rich
Cornerstone Wealth Group Website
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Alli Gokeler joins me to discuss motor learning following ACL injury. Alli has a special interest in motor control. He’s currently working on the development of prevention programs designed to reduce primary and secondary ACL injury rate and optimization of return to sports and performance.
In this episode, we discuss:
-The 4 principles of motor learning
-How to facilitate neuroplasticity with principles of motor learning
-Self-controlled feedback and how it enhances learning and motivation
-Dr. Gokeler’s take on the timetable for returning to sport following ACL injury
-And so much more!
The way clinicians guide and cue their patients can impact their patients’ success in learning motor skills. Dr. Gokeler outlines important considerations for clinicians and suggests, “A very simple change in wording can have a significant effect on learning.”
Incorporating motor learning principles into your treatment is not a one-sized fit all approach and can be dependent on the learning style of the patient, the task and the environment. Dr. Gokeler reiterates, “There is no motor learning principle that is the gold standard.”
Despite widely accepted ACL injury rehabilitation practices, patients continue to display high incidence of re-injury and altered movement patterns. Dr. Gokeler believes, “We need to step up and come up with better rehab approaches.” To improve long term outcomes, Dr. Gokeler advises all clinicians to, “Make rehab challenging, fun but attainable.”
For more information on Dr. Gokeler:
Alli Gokeler was born on 18 September 1967 in Groningen, the Netherlands. He obtained his degree in Physical Therapy in 1990 from the Rijkshogeschool Groningen. From 1991-2001 he worked as a physical therapist in the United States and Germany. Upon return to the Netherlands, he obtained a degree in Sports Physical Therapy from the Utrecht University of Applied Science in 2003. In 2005 he started on his PhD project at the University Medical Center Groningen, Center for Rehabilitation. Alli has a special interest in motor control. He’s currently working on the development of prevention programs designed to reduce primary and secondary ACL injury rate and optimization of return to sports and performance.
Resources discussed on this show:
Motor Control and Motor Learning---5th-Edition
Human Performance by Fitts and Posner
Richard Masters: The theory of reinvestment
Tim Gabbett Twitter
Alli Gokeler Twitter
Alli Gokeler Facebook
aclrehabilitation.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
In today's #PTSideHustle podcast series I talk about one of the most important things you need as an entrepreneur: the ability to network! Networking both inside and outside of the physical therapy world is vitally important to growing your side hustle into a full time gig (if that is your long term goal).
In the episode I talk about:
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How to find out if you are an introvert, extrovert or ambivert
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How to go to a meeting or conference where you know no one and walk away with new connections
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One of the most important aspects of networking that cannot be missed
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How to get to said meeting and conferences when you are on a budget
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Finally the added detail you need to do to be remembered.
Links I spoke about during this episode:
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Introvert, Extrovert, Ambivert Quiz
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Podcast Episode w/ Dr. Liam West
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Jason Eure, DPT joins me to discuss intraprofessional communication. Jason is an outpatient physiotherapist based in Virginia with an interest in exploring how our innate biases are influencing our reasoning abilities and preventing constructive communication.
In this episode, we discuss:
-Human susceptibility to confirmation bias
-How online communication differs from in person communication
-Common assumptions within arguments: what is being said and what is not being said
-How argumentation will progress the physical therapy profession
-And so much more!
Humans are susceptible to confirmation bias and “We tend to gravitate towards people who think like we do.” Jason also stresses that individuals do not weigh evidence from every perspective and come to rational decisions but, “We have these intuitive beliefs of something we just want to believe and then after the fact we will come up with justifications for why that is true. We are really biased in the way that we come to our decisions.”
Before trying to reason with someone, Jason recommends first establishing rapport with the person and then framing the argument around their values. Jason begins each conversation by asking, “What information would have to be provided to have them change their mind.” Jason also cautions, “If someone is not willing to have their mind changed, there’s literally nothing you can say to have them change their mind.”
While it’s important to consider the biases of others before engaging in an argument, it’s even more critical to assess your own biases and be willing to accept counter evidence which challenges your beliefs. Jason stresses, “Group reasoning always is going to outperform the individuals. It is absolutely essential for us to move the profession forward collectively.”
For more information on Jason: A Physical Therapist working in the outpatient setting. Aside from caring about dogs, movies, and music- I have a strong passion for my professional field. I have been compelled to write about various topics within PT to help nudge the profession forward in any small way I can. Recently, I have invested time exploring how our innate biases are influencing our reasoning abilities and preventing constructive communication.
Resources discussed on this show:
Hugo Mercier: Why Do Humans Reason? Arguments for an Argumentative Theory
Jason Eure Twitter
Jason Eure Facebook
Jason Eure LinkedIn
Jason Eure: Lost in Translation: Communication in Physiotherapy
Physiological Website
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Naomi Mdudu joins me on the show to discuss strategies for entrepreneurial success. Naomi Mdudu founded The Lifestyle Edit in February 2015, following a string of successful positions within the fashion industry in the UK. Her love of digital media and the lack of real-life content for women inspired her to create the UK’s first digital lifestyle glossy, which has amassed a loyal following in the UK and US in the short time since its launch. In 2016 she expanded The Lifestyle Edit business to encompass a consulting company that supports the small to medium sized female founded businesses she champions on the site.
In this episode, we discuss:
-How Naomi made the leap from managing a content platform to consulting small businesses
-How to differentiate yourself from others in your space
-Strategies for on-boarding new clients and how to manage their expectations
-Why you should focus on cooperation over competition
-And so much more!
Pursuing entrepreneurial ventures is more about conquering fear than taking excessive risks. Naomi has found, “The fear is more about the unknown. When you really break it down, many of us don’t have anything to lose.” She has found that challenging your mindset will help squelch most doubts saying, “I’m in a really strong and empowered position.”
Seeing your work directly contribute to your personal success and benefit others is one of the many rewards of being an entrepreneur. Naomi offers, “Every day I wake up knowing that my success boils down to me and how much I am willing to put in it. I can’t think of something more liberating than that.”
Expanding a business requires delegation of certain tasks to allow more time to focus on what actually matters. From Naomi’s experience, she states, “In order for my business to grow, I need to constantly be working in my mode of genius and delegate the rest.”
For more information on Naomi:
Naomi Mdudu founded The Lifestyle Edit in February 2015, following a string of successful positions within the fashion industry in the UK. Prior to launching The Lifestyle Edit, Mdudu was the fashion editor of Metro as well as City A.M.’s Style Editor and the PR to luxury Italian label Alessandra Ferreira. Her love of digital media and the lack of real-life content for women inspired her to create the UK’s first digital lifestyle glossy, which has amassed a loyal following in the UK and US in the short time since it’s launch. Hailing from South London, Mdudu graduated with a law degree, before turning to fashion and has worked with the likes of Harper’s Bazaar, Glamour and Tatler, all before reaching her mid-twenties. In 2016 she expanded The Lifestyle Edit business to encompass a consulting company that supports the small to medium sized female founded businesses she champions on the site. She’s currently living between London and New York, as she expands The Lifestyle Edit internationally.
Resources discussed on this show:
The Lifestyle Edit
The Lifestyle Edit Twitter
The Lifestyle Edit Instagram
Naomi Mdudu Twitter
Naomi Mdudu Instagram
1000 True Fans by Kevin Kelly
The E Myth Revisited
The 7 Habits of Highly Effective People
Rising Tide Society
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On today’s episode of the Healthy Wealthy and Smart Podcast, I welcome Jonathan David Lewis onto the show to discuss brand survival. Jonathan David Lewis is the author of Brand vs Wild, a Forbes contributor and a brand survival expert at McKee Wallwork + Co. Jonathan’s opinions are highly sought by numerous business and marketing publications, including Forbes, Digiday, and Advertising Age, where he explores the factors of stalled growth and the principles proven to help companies traverse the dangers of the brand wilderness.
In this episode, we discuss:
-What survival psychology can teach us about growing a business
-Why maintaining success requires continual curiosity
-Brand differentiation strategies and how to find your niche audience
-Brand vs Wild: how to navigate the increasingly harsh business world
-And so much more!
Business challenges can create fear, but fear is a primary driver of personal and business growth. Jonathan believes, “Fear is one of those emotions that is fundamental to business and career and life.”
Survival psychology describes three different reactions to adversity: being prepared, becoming paralyzed or panicking. Interestingly, Jonathan describes, “There is very little difference psychologically between a group of survivors who have crashed landed on a mountain or became lost in the desert and a group of business people who are just trying to navigate some sort of unexpected business challenge. We go through the same psychological reaction.”
Being an industry leader breeds complacency and arrogance. Jonathan warns, “One of the biggest enemies of continual learning is success.”
The age of mass marketing is coming to an end. New businesses should seek to be hyper-relevant to a very small tribe. Jonathan reminds us, “It’s okay to be small. It’s okay to be niche.”
For more information on Jonathan:
Jonathan David Lewis is the author of Brand vs Wild, a Forbes contributor and a brand survival expert at McKee Wallwork + Co.
As partner and strategy director at MW+C, Jonathan led his firm to be recognized by purveyor Advertising Age as a national leader in branding and marketing, winning the Southwest Small Agency of the Year, national B2B Campaign of the Year, and national Best Places to Work awards.
Jonathan sharpened his skills during the harsh years of the Great Recession, helping brands navigate today’s unforgiving new business paradigms. Jonathan’s opinions are highly sought by numerous business and marketing publications, including Forbes, Digiday, and Advertising Age, where he explores the factors of stalled growth and the principles proven to help companies traverse the dangers of the brand wilderness.
Resources discussed on this show:
Brand vs Wild
Jonathan David Lewis Twitter
McKee Wallwork & Company
Jonathan David Lewis Website
Survival Psychology by John Leach
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
In this episode of the PT Side Hustle podcast I discuss:
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What is an NPI number and do I need it?
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What is a covered entity
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What do I do when self doubt start to creep in?
Resources discusses in this episode:
APTA information on the NPI Number
NPPES Website
Are you a Covered Entity
Physio Matters Podcast
Thanks to our sponsor for this episode Freshbooks! Click here for a free 30 day trial.
Thank you for listening and supporting the PT Side Hustle Series. I appreciate it more than you know.
xo
Karen
On today’s episode of the Healthy Wealthy and Smart Podcast, I had the honor of welcoming Professor Lorimer Moseley onto the show to answer audience questions regarding persistent pain. Lorimer Moseley’s interests lie in the role of the brain and mind in chronic pain. He is Professor of Clinical Neurosciences at the University of South Australia and a Senior Principal Research Fellow at Neuroscience Research Australia.
In this episode, we discuss:
-The Pain Revolution: creating a public discourse about persistent pain
-Misconceptions surrounding the biopsychosocial model and pain
-Confronting medical providers who promote negative pain beliefs
-Is there merit in using placebo treatments for chronic pain?
-How does Lorimer stay critical of his own scientific work?
-And so much more!
Persistent pain needs to be understood not only by clinicians but the general public and policymakers. Lorimer believes, “It’s our most burdensome non-fatal condition facing our species.”
Clinicians need to understand what motivates their patients. Lorimer reminds us that, “When push comes to shove, in the raw moment, you ask a patient with persistent pain or anyone in pain, what do you want most right now? I think most of them would say pain relief.”
Medical providers hold a great deal of sway with patients. This influence can be used to validate what patients are feeling and aid the healing process. Lorimer states, “Nearly all health professionals have a natural tendency and a very slick skill set of legitimizing someone’s suffering.”
Although the biopsychosocial model differs in many ways from the biomedical model, there are many opportunities to share insights and practitioners of both frameworks should be self-critical. Lorimer advices, “It’s tempting for us to cast character judgments on those who are not like us. Actually, I think that people are trying to help their patients a lot of the time. They’re good people. I really think we need to collaborate and just keep open the possibility that we’re wrong. We have to be committed to try and prove ourselves wrong.”
For more information on Lorimer:
Professor Lorimer Moseley is a clinical scientist investigating pain in humans. After posts at The University of Oxford, UK, and the University of Sydney, Lorimer was appointed Foundation Professor of Neuroscience and Chair in Physiotherapy, The Sansom Institute for Health Research at the University of South Australia. He is also Senior Principal Research Fellow at NeuRA and an NHMRC Principal Research Fellow.
He has published over 200 papers, four books and numerous book chapters. He has given over 140 keynote or invited presentations at interdisciplinary meetings in 30 countries and has provided professional education in pain sciences to over 10,000 medical and health practitioners and public lectures to as many again. His YouTube and TEDx talks have been viewed over 200,000 times.
He consults to governmental and industry bodies in Europe and North America on pain-related issues. He was awarded the inaugural Ulf Lindblom Award for the outstanding mid-career clinical scientist working in a pain-related field by the International Association for the Study of Pain, was shortlisted for the 2011 and 2012 Australian Science Minister’s Prize for Life Sciences, and won the 2013 Marshall & Warren Award from the NHMRC, for the Best Innovative and Potentially Transformative Project. He was made Fellow of the Australian College of Physiotherapists in 2011, by original contribution, and an Honoured Member of the Australian Physiotherapy Association, their highest honour, in 2014.
Resources discussed on this show:
Pain Revolution
Pain Revolution Facebook
Explain Pain Supercharged
Body In Mind Twitter
Body In Mind
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Jo Gibson is featured to discuss physical therapy treatment of the unstable shoulder. Jo is a Clinical Physiotherapy Specialist working at the Liverpool Upper Limb Unit at the Royal Liverpool Hospital and a Consultant in private practice. She has worked as a Shoulder Specialist since 1995 and lectures nationally and internationally about assessment and rehabilitation of the shoulder complex. Jo has co-developed Masters modules with Liverpool University for the diagnosis and treatment of upper limb pathology and has co-authored national guidelines for the management of different shoulder pathologies. She has presented original research at many National and International conferences, published in peer-reviewed journals and written several book chapters. In addition she is an Associate Editor of the British Shoulder & Elbow Journal.
In this episode, we discuss:
-Using patient history to classify shoulder pathology
-Factors to consider when deciding whether to treat with surgery or rehabilitation
-The nervous system’s role in shoulder instability
-How to use language and metaphors to develop buy-in
-Jo’s takeaways from the British Elbow and Shoulder Society Conference
-And so much more!
Jo prioritizes learning about a patient’s history during the initial evaluation because it can serve as a roadmap for treatment. Jo has found that, “The biggest investment of my time is hearing how everything started and what the story has been from there.” Jo believes patient history to be more valuable than other evaluation method as she states, “The history tells me far more than any clinical test.”
Symptom modification can be an important psychological tool to encourage more confidence in a patients shoulder capabilities. Jo stresses, “It is very empowering for the patient because it shows them that if we make their muscles work differently they are stable.”
Jo’s treatment protocol includes a variety of functional exercises which utilize external cues to promote motor learning and neuroplasticity. Jo believes there is room for physical therapists to get creative with these treatments and that sometimes, “We kind of undermine the artistry of what we do.”
Jo has found that improving her communication skills has led directly to improved physical therapy treatment outcomes. Jo reminds us that, “This is about being human. Communication underpins everything we do… Patients are just the biggest source of information and actually they give us all of the clues and give us the language to use.”
For more information on Jo:
Jo Gibson Grad.Dip.Phys MSc.(Adv.Pract) MCSP. Jo Gibson studied physiotherapy at the Salford College of Technlogy and qualified in 1987. Her physiotherapy career started in Nottingham in 1987 at Queen’s Medical Centre where an encounter with Professor Angus Wallace fuelled her interest in the shoulder.
Jo moved to Liverpool in 1989 and after completing several years of rotational experience she joined forces with Professor Simon Frostick and in 1996 she became one of the first specialist Upper Limb Physiotherapists in the UK.
In order to increase her subspeciality knowledge and expertise, Jo completed travel fellowships in the UK, Europe and the USA sponsored by the British Elbow and Shoulder Society and Royal Liverpool University Hospital Trust Charities Board.
Since that time the Liverpool Upper Limb Unit has gained an International reputation as a centre of Excellence in Shoulder and Elbow surgery and it was here that Jo started working with Peter Brownson.
Jo has a passion for education and since 1996 she has lectured nationally and internationally on rehabilitation of the shoulder and she runs her own courses all over the World.
Internationally, in 2004 she was a co-founder of the International Congress of Shoulder and Elbow Therapists, a meeting which now runs tri-annually. In addition, Jo has served as Vice president and Chair of the education committee on the EUSSER board (European Society of Shoulder & Elbow Rehabilitation).
Nationally, Jo has been the AHP representative on the British Elbow and Shoulder Society (BESS) Council and in addition she has served as a member of the BESS Research and Education Committees. She is an associate lecturer at the University of Liverpool and has co-developed tailor made masters modules to support physiotherapists working in or towards specialist Upper Limb appointments.
Jo completed her Masters in Advanced Practice at Liverpool University in 2012 and completed her dissertation on the Biopsychosocial model cementing her belief in tailoring treatment to the individual and the importance of communication skills.
She continues to be involved in upper limb research, has presented original research at many National and International conferences winning three Best Paper prizes. She has published in peer-reviewed journals and written several book chapters. Jo has also co-authored BESS Care Pathways for the British Elbow and Shoulder Society.
Jo’s recognized expertise in the assessment and management of shoulder pathology has resulted in consultancy work with many elite sports teams in a variety of sports including football, rugby, cricket, gymnastics, swimming, boxing and tennis. In addition she is regularly sought out by other clinicians to help problem solve more challenging presentations.
Her close working relationship with Peter Brownson has been pivotal in the opportunity to develop postoperative rehabilitation regimes facilitating early return to sport or function and has resulted in a publication of results in an elite football population.
Resources discussed on this show:
Stanmore Classification
Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial
Derby Shoulder
Jane Moser Research
Noi Group Apps
Noi Group Website
Twitter #bess2017
British Elbow and Shoulder Society
Jo Gibson Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy & Smart podcast we continue with the PT Side Hustle series. This series is all about adding a side hustle to your physical therapy career.
In this episode I discuss:
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Types of side hustle (hint they don't have to be patient care related)
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An easy technique to get clear on what your side hustle could be (get a pen and paper ready)
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Setting SMART goals and why they is important
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Making sure everyone in your life is ready for your side hustle (sometimes it is not all about you)
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How to pick up at least 10 extra hours in your week.
Resources from this episode:
Freshbooks
Chris Winfield
Entrepreneur.com Side Hustle Series with Chris Winfield
Pomodoro Method
Example of Theta Wave Music
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Thank you for embracing this new series the PT Side Hustle!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Andrew Murray joins me to discuss the building blocks of population health. Dr. Murray is a Sports and Exercise Medicine doctor, GP and runner who has worked in the Olympic, Paralympic and Commonwealth Games, the Ryder Cup and with various national and international squads. He currently works for the European and Challenge Tour Golf, the SportScotland Institute of Sport, and the Scottish Rugby Union. He is passionate about increasing physical activity for health and has worked for the Scottish Government as their first “physical activity champion”, and enjoys research with the University of Edinburgh in this area.
In this episode, we discuss:
-The role of preventative care as the foundation for population health
-How much exercise is enough?
-How sleep and diet contribute to optimal health
-Practical tips to implement healthier lifestyle changes and ways to advocate in the community
-And so much more!
Modern medicine is capable at combating many ailments however, Dr. Murray believes, “What isn’t working at the moment is preventative medicine.”
From international government relations to community outreach programs, collaboration, education and other forms of social support are needed for more individuals to achieve optimal health outcomes. Dr. Murray stresses, “Everyone’s got a role as being part of the solution.”
Physical activity has been shown to be a key prevention tool. Dr. Murray encourages everyone to at the very least start small and get moving as, “Something is better than nothing…You’re never too late, you still got time…Start today.”
Although preventative medicine is not an immediate fix for patients, Dr. Murray encourages practitioners and the broader industry to adopt a long-term perspective for better outcomes over time. Dr. Murray is a proponent of, “If we do the basics right then good health will follow.”
For more information on Dr. Murray:
My background is as a Sports and Exercise Medicine doctor, GP and runner, whilst I have written a couple books, enjoy a load of speaking engagements and do a little journalism.
As a runner, I have completed challenges including a 4,300km run from far north Scotland to the Sahara desert, 7 ultra-marathons on the 7 different continents in under a week, and with Donnie Campbell the first run across the mighty Namib desert and a run across East Africa. Race wise, I’ve placed first in the North Pole Marathon, the Antarctic Ice Marathon, the Gobi Challenge, the Indo Jungle Ultra, and races closer to home, whilst also competing for Scotland in various events.
Work wise I have worked at the Olympic, Paralympic and Commonwealth Games, the Ryder Cup and with various national and international squads. I currently work for the European and Challenge Tour Golf, the SportScotland Institute of Sport, and the Scottish Rugby Union from the elite sport side of thing, but am passionate about increasing physical activity for health. To this end, I worked for the Scottish Government as their first “physical activity champion”, and enjoy my research with the University of Edinburgh in this area. Getting active, and staying active really is the best thing you can do for your health. Each step is a step to health.
I needed a good kick up the backside from a mate to get active again after university, and urge everyone to GET ACTIVE today, and spread the word.
Updates from various capers, health promotion stuff and injury advices will appear in my blog and the site content will be updated. My next big adventure is a husky riding, running extravaganza to Outer Mongolia in temperatures around -40 celsius in January 2016. Preparation and the adventure will be shared fully in my blogs.
Please take the time to check out my charities. Thanks to you all, over £150k has been raised through various runs for 3 amazing causes.
My books “Running Beyond Limits” and “Running Your Best – Some Science Medicine” are available via Amazon and the usual book stores.
For talks or inquiries, please get in touch !
Resources discussed on this show:
23 and 1/2 hours: What is the single best thing we can do for our health? Video
Yann Le Meur Website
Dr. Andrew Murray Twitter
Dr. Andrew Murray Website
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Jim Klopman joins me to talk about the integral role of balance for health and longevity. Jim is a lifelong innovator who has always been one of those people who thinks differently. He believes balance training has sharpened his ability to make new neural connections and see the possibilities and pathways that others miss.
In this episode, we discuss:
-The statistics of the death and injury caused by poor balance
-Four ways modern life impairs our balance
-The link between balance and athletic performance
-Balance training for concussion patients
-And so much more!
Jim believes that balance is a fundamental component of longevity; however its decline can easily be overlooked by most people. Jim has found that, “Balance is this kind of hidden system that we don’t know has gotten worse. When it gets worse, we don’t recognize it but we do see fall off in the performance of our sports.”
Jim notes, “We have more fitness, we have better physical therapy, we have better medical care. Our spaces that people walk around in since the ADA has been instituted are perfectly flat, there’s ramps everywhere, there’s no place you should be able to trip in any public space. Yet this number of accidental deaths and accidental injuries for the people over 65 have nearly doubled.” In a world where our balance system is no longer challenged on a daily basis, Jim believes individuals must work to actively include it in their exercise programming.
We gravitate to and enjoy sports and recreation which challenge our balance and yet day to day workplace activities we do are predictable. Jim believes, “The problem is that we are losing this sense of balance because of the modern world we live in.” He challenges, “We are not really meant to live in this world where there are perfectly flat floors and perfectly vertical walls.”
For more information on Jim:
Jim is a lifelong innovator who has always been one of those people who thinks differently. He believes balance training has sharpened his ability to make new neural connections and see the possibilities and pathways that others miss.
Originally Jim was looking for a way to maintain his own athletic performance well into his 90s. But the Slackbow Balance Training System he developed turned out to be a key to whole body and mind fitness that was even more revolutionary than he could have imagined.
He is eager to spread his knowledge, techniques and tools far and wide to help seekers like him tune their brains to perform better in work and sports, sleep better, look younger and live longer.
Resources discussed on this show:
SlackBow Website
SlackBow Products
SlackBow Facebook
Balance is Power
Email: jim@slackbow.com
Phone: (435) 200-3287
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy & Smart podcast I am so happy to debut a new series called the Physical Therapy Side Hustle! I get so many questions from physical therapists across the country every week that I thought I would answer many of those questions right here on the podcast.
Enter the PT Side Hustle Series! This series will have 2 episodes a month dedicated to the true side hustle. I will share my ups and downs as an entrepreneur, answers lots of your questions and hear from business experts. Topics will range from shifting your mindset, systems set ups, goal setting, handling the day-to-day grind of essentially working 2 jobs, marketing, branding and much more!
I am really excited to share this series with you and I hope you enjoy it as I much as I do!
In this episode I discuss:
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Why I decided to start a PT Side Hustle Business
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The big mistake I made when I first started
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Do you need a corporate entity for a side hustle?
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What kind of malpractice insurance do you need?
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How can you start to create your client list?
Resources discussed in this episode:
Is Professional Liability Insurance Worth it? This is a nice article from WebPT
Corporate Entities
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this episode of the Healthy Wealthy and Smart Podcast, I had the pleasure of welcoming Dr. Kenneth Miller onto the show to discuss patient care transitions between physical therapy settings. Dr. Kenneth L. Miller is a physical therapist and educator with more than 20 years of experience working in home care and inpatient rehab settings, as well as more than 7 years in adjunct faculty roles for the University of St Augustine, New York Institute of Technology, University of Michigan–Flint, and Touro College. He is a clinical educator at Catholic Home Care, in Farmingdale, N.Y., has developed a course on clinical pharmacology for GREAT Seminars and has several online courses for MedBridge. Dr. Miller chairs the APTA’s Home Health Section Practice Committee and is a member of the editorial boards of Topics in Geriatric Rehabilitation, GeriNotes, and is a manuscript reviewer for the Journal of Geriatric Physical Therapy.
In this episode, we discuss:
-The current state of information transmission between physical therapy settings
-Biomarkers used to evaluate the health status of patients
-The real risk of patient fragility and the importance of adequately overloading during treatment
-How to enhance home compliance and educate patients through technology
-And so much more!
Information sharing between healthcare settings is often not reliable. Instead practitioners should focus on ensuring they have the most salient information. From Dr. Miller’s experience, he states, “It is often difficult to get the information I need. It becomes futile sometimes to try and get that information. Some clinicians have stopped reaching out to hospitals and just try to do the best they can with what they have.”
Effective and literature supported biomarkers such as gait speed and distance are useful tools to assess risk of re-hospitalization and guide plan of care. Dr. Miller stresses to, “Get those biomarkers out there, so that way even if we can’t get all of the information, be very specific with the type of information, and we can reduce readmissions.”
With a growing demographic of home care patients, assessing patient risk level and the need for physical therapy is becoming more important. Dr. Miller notes, “Our patient case loads are going through the roof. I think we need to be able to triage our patients more appropriately for who does need care and who doesn’t and try not to make visits that are not necessary.”
One of the biggest challenges facing physical therapy exercise prescription is effectively loading patients. Dr. Miller shares that, “The only known way to combat frailty at this point is exercise and it has to be appropriately dosed.”
For more information on Dr. Miller:
Dr. Kenneth L. Miller is a physical therapist and educator with more than 20 years of experience working in home care and inpatient rehab settings, as well as more than five years in adjunct faculty roles. He is currently a clinical educator and physical therapist at Catholic Home Care, in Farmingdale, N.Y., and a consultant, for The Corridor Group. He has taught for New York Institute of Technology, University of Michigan–Flint, and Touro College.
He is the co-author of the book Providing Physical Therapy in the Home, published by the American Physical Therapy Association (APTA), as well as the author of peer-reviewed publications in Neurorehabilitation and the Journal of Geriatric Physical Therapy. He has presented at the APTA Combined Sections Meeting and NEXT Conference.
Dr. Miller chairs the APTA’s Home Health Section Practice Committee and is a member of the editorial boards of Topics in Geriatric Rehabilitation, GeriNotes, and the Journal of Novel Physiotherapy and Physical Rehabilitation.
He is the recipient of numerous honors, including three APTA Home Health Section awards: 2016 Section Contribution Award, 2015 Outstanding Effort Award, and 2010 Excellence in Home Care Award. In 2012, he received the Shining Star Award from the Long Island Health Network.
He is a Board Certified Geriatric Specialist, a TeamSTEPPS Master Trainer, an APTA Credentialed Clinical Instructor, and an APTA Certified Exercise Expert for Aging Adults.
Resources discussed on this show:
Fried et al. 2001: Frailty in older adults: evidence for a phenotype.
Dr. Kenneth Miller Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On behalf of the British Journal of Sports Medicine, I had the pleasure of speaking with Dr. Marie-Elaine Grant on taping and bracing in the athletic population LIVE from the IOC World Conference in Monaco.
Dr. Marie-Elaine Grant, is a chartered physiotherapist currently on the IOC medical commission and has monitored physiotherapy services on behalf of the IOC for the past 2 Summer Olympic games in addition to owning a clinical practice in Dublin, Ireland. Dr. Grant’s globally recognized Chartered Physiotherapist qualification has led to a career of preparing, rehabilitating and working with Olympic athletes and clinical patients.
In this episode, we discuss:
-The top 3 reasons for when to use and not use tape or a brace on your athlete
-Does the ongoing use of taping or bracing develop dependency?
-The most important considerations to uphold the integrity of taping during sport
-Is bracing or neuromuscular training more effective post-injury? And what are the validity of the outcome measures?
-And so much more!
There are many nuances to treating the high level athlete that can sometimes be more important than clinical reasoning. Dr. Grant believes, “Every elite athlete will have a very strict drill the day before and certainly in the hour leading into competition. And that drill and that discipline that they have developed that they get themselves to the starting blocks of the track that has to absolutely be something that is fully respected.”
The ultimate goal of a physiotherapist is to help the athlete return to sport without the use of taping or bracing. Dr. Grant finds, “The less dependency that athletes have on extraneous supports, the better and the more likely they are to have consistent and really good performances.”
Regardless of whether the mechanisms of taping and bracing have gained support from the research literature, “Athletes will continue to use it and they will continue to request it. Therefore, there is something in this… we have to try and understand why athletes find this beneficial even if the science is not there.” From Dr. Grant’s experience with the Olympics, she has found that the real importance is, “we need to have a much better understanding of what it is doing, how it does it and to ensure that athletes don’t develop a false dependency on it.”
For more information on Dr. Grant:
Dr. Marie-Elaine Grant (PhD, PT), Physiotherapist to the International Olympic Committee’s (IOC) Medical Commission, Games Group. Ireland’s Olympic Team Lead Physiotherapist from 1990 – 2010. A specialist member of the Irish Society of Chartered Physiotherapists.
Marie-Elaine is a physiotherapy graduate of UCD (University College Dublin). During the early phase of her career she worked in University Hospitals in Dublin before traveling to Europe and the USA to further her learning and skills. During this time she developed a keen interest in sports physiotherapy and advanced her knowledge and expertise by successfully completing post graduate courses in core sports physiotherapy skills and at the same time advancing clinical experience working with sports teams and aspiring young athletes before advancing to supporting the high performance athlete.
She was appointed to the Medical Committee of the Olympic Council of Ireland in 1990 and subsequently appointed as their lead physiotherapist. Marie-Elaine has served with the Irish Olympic Team for 5 consecutive Summer Olympic Games commencing with Barcelona 1992 through to Beijing 2008. She also served with the Irish Olympic Team for the Turin 2006 and Vancouver 2010 Winter Olympics and was appointed to 10 Irish European Youth Olympic Squads. In this role she planned, implemented strategies for provision of high quality physiotherapy services and injury prevention screening programmes for high performance and developmental athletes together with developing physiotherapy support networks with the National Governing Bodies of Olympic Sports.
Marie-Elaine was inspired by the commitment, focus and dedication of so many athletes which in turn inspired her to push the boundaries of her clinical understanding by undertaking further learning by scientific research. She was awarded a PhD in 1997, the title of her research thesis was: ‘Evaluation of the Effects of Spinal Strengthening using a Sports Medicine Exercise Approach’. She continues to participate in clinical research, has had peer reviewed publications and presents regularly at international conferences.
In 2011 Marie-Elaine was appointed to the International Olympic Committee’s (IOC) Medical Commission Games Group, as a clinical expert in sports physiotherapy, in this role she has been responsible for monitoring physiotherapy activities and facilities for participating nations at the London 2012 and Rio 2016 Summer Olympic Games and the 2014 Sochi Winter Olympic Games, and is currently preparing for the 2018 Winter Olympic Games to be held in PyeongChang. The key aims of this role are to protect the health of the world’s Olympic athletes and advance the role of physiotherapy within the global Olympic movement. Marie-Elaine continues to further advance sports physiotherapy ensuring recognition of the very important role that physiotherapy plays in protecting the health of the athlete through prevention, delivery of treatment of the highest standard and also intervention to support performance.
She continues to work extensively in clinical practice focusing on all aspects of sports physiotherapy. She also lectures on third level BSc Physiotherapy programmes and post-graduate MSc programmes in Sports and Exercise Physiotherapy for Universities in Ireland and has also been an external examiner. She supervises clinical placements for physiotherapy students and mentors post graduates.
She was awarded Specialist Membership of the Irish Society of Chartered Physiotherapists in Sports Medicine in 2006 which has been renewed in 2013 for a second term. In September 2013 she was awarded an Honorary Doctorate from University College Dublin in recognition of expertise and contribution to Sports Physiotherapy in Ireland and beyond.
Resources discussed on this show:
Marie-Elaine Grant Publications
Grant Physiotherapy Website
Marie-Elaine Grant LinkedIn
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, I had the pleasure of welcoming Cynthia Toussaint onto the show to discuss her experiences as a patient managing Complex Regional Pain Syndrome. Cynthia Toussaint is the founder and spokesperson of For Grace, an organization that promotes better care and wellness for women in pain. Toussaint championed and gave key testimony at two California Senate hearings – one was dedicated to CRPS awareness, the second explored the chronic under-treatment of and gender bias toward women in pain. She will lead a 2017 conference that will convene healthcare and policy leaders to bring pain care into the 21st century. The solutions proposed at the event will mandate structural changes that respond to patient needs and gender inequalities in California. Toussaint is the author of Battle for Grace: A Memoir of Pain, Redemption and Impossible Love.
In this episode, we discuss:
-The story behind Cynthia’s long battle with Complex Regional Pain Syndrome
-How Cynthia developed independent survival solutions when medical providers would no longer help
-Why gratitude, acceptance and grieving are necessary components for the management of chronic pain
-For Grace: better care and wellness for women in pain
-And so much more!
Cynthia’s long history of battling unimaginable physical and psychological pain has taught her how to be resilient. She believes, “We don’t know what we can live with until we are there.”
Cynthia has used her past experiences as inspiration for her advocacy and has created meaningful change for CRPS patients. Based on her experience, she stresses, “Don’t ever let anybody say you can’t get something done.”
Cynthia has found that adversity can breed strength and that, “People who go through the impossible odds survive and they go on to make the world a better place.”
After exhausting her family support system and the recommendations of her medical providers were unable to help with her chronic pain, Cynthia found her greatest relief through her own strength and will. She states, “With high impact chronic pain, we have to refuse to be a victim. We have to be our own advocates. We have to be deeply involved with self management.”
For more information on Cynthia:
Cynthia Toussaint serves as Spokesperson at For Grace and has had Complex Regional Pain Syndrome for 34 years. She later developed Fibromylagia and other over-lapping, auto-immune conditions. Cynthia founded For Grace in 2002 to raise awareness about CRPS and five years later expanded the organization’s mission to include all women in pain. Before becoming ill, she was an accomplished ballerina and worked professionally as a dancer, actor and singer.
Since 1997, she has been a leading advocate for women in pain, raising awareness through local, national and worldwide media as well as public speaking. Toussaint championed and gave key testimony at two California Senate informational hearings. The first, in May 2001, was dedicated to CRPS awareness. The second took place in February 2004 and explored the chronic under treatment of and gender bias toward women in pain. Both of these efforts were the first of their kind in the nation.
In 2006, Toussaint ran for the California State Assembly to bring attention to her CRPS Education Bill that Governor Schwarzenegger vetoed after she got it to his desk in its first year. Her next bill, a seven year effort, was signed into law by Governor Jerry Brown in 2015. This Step Therapy legislation reformed an unethical prescription practice used by the health insurance industry to save money in a way that increased the suffering of California pain patients.
Toussaint was the first CRPS sufferer to be featured in the New York Times, Los Angeles Times and on the Public Broadcasting System and National Public Radio. She is a consultant for The Discovery Channel, ABC News, FOX News, the National Pain Report and PainPathways, the official magazine of the World Institute of Pain. Also, she is a guide and guest contributor for Maria Shriver’s Architects of Change website.
Her many speaking engagements include the National Institutes of Health and Capitol Hill.
She is the author of Battle for Grace: A Memoir of Pain, Redemption and Impossible Love. Also, Toussaint is experiencing her first-ever partial CRPS remission largely due to the narrative therapy of writing this book.
Toussaint continues to be a leading advocate for health care reform in California. She was instrumental in changing public opinion which sparked sweeping HMO reform legislation that was signed by Governor Gray Davis in 1999. Her focus has now shifted to creating a single-payer, universal health care plan in California that would provide a model for the rest of the country.
Resources discussed on this show:
Battle for Grace: A Memoir of Pain, Redemption and Impossible Love
For Grace: Women in Pain Facebook
Cynthia Toussaint Twitter
For Grace Website
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On today’s episode of the Healthy Wealthy and Smart Podcast, Sharon Salzberg joins me to discuss her new book Real Love which will be released on June 6th, 2017! In her tenth book, Sharon Salzberg provides a pathway towards more sustainable and authentic connection by offering a creative toolkit of mindfulness exercises and meditation techniques that guide us to strip away our layers of habit to access a truer understanding of love, “real love.” This journey enables us to become more present and to begin to experience real love—love based on direct interactions, rather than preconceptions. When we are truly engaged in these present experiences we are not only able to feel more connected to our own core selves, but also to those around us, and ultimately to life itself. Divided into three sections, Real Love explores love in three arenas of life: for oneself, love for an other, and love for all of life.
In this episode, we discuss:
-An introduction to Loving Kindness Meditation
-Practical strategies to incorporate meditation into a busy schedule
-Is self compassion through meditation considered laziness?
-What Sharon hopes readers will learn from Real Love and viewing love as an ability not a feeling
-And so much more!
Sharon believes that our human brain, “can tend to fixate on what’s wrong and not appreciate what’s right and what’s good.” Loving Kindness Meditation understands our bias to focus on the negative and balances it with positive reflection for a holistic view of ourselves.
Incorporating meditation into a busy schedule can be as simple as being more present in everyday activities. Sharon stresses that, “Just short moments that break the crazy momentum that we get lost in, they make a difference too.”
According to Sharon, meditation is not a process of resetting our inner thoughts but rather enhancing them. “Our goal is not to wipe out thoughts, our goal is to develop a different relationship to our thoughts… The kind of awareness we are cultivating is balanced, it’s clear, it’s present, it’s loving.”
Sharon shares that the ultimate effect of meditation is revealed through a constant practice. By mastering the skill, “We learn to let go and begin again. When we do that over and over and over again, what happens is that our attention starts to get stabilized.”
For more information on Sharon:
Born in New York City in 1952, Sharon Salzberg experienced a childhood involving considerable loss and turmoil. An early realization of the power of meditation to overcome personal suffering determined her life direction. Her teaching and writing now communicates that power to a worldwide audience of practitioners. She offers non-sectarian retreat and study opportunities for participants from widely diverse backgrounds. Sharon first encountered Buddhism in 1969, in an Asian philosophy course at the State University of New York, Buffalo. The course sparked an interest that, in 1970, took her to India, for an independent study program. Sharon traveled motivated by “an intuition that the methods of meditation would bring me some clarity and peace.” In 1971, in Bodh Gaya, India, Sharon attended her first intensive meditation course. She spent the next years engaged in intensive study with highly respected meditation teachers. She returned to America in 1974 and began teaching vipassana (insight) meditation. In 1976, she established, together with Joseph Goldstein and Jack Kornfield, the Insight Meditation Society (IMS) in Barre, Massachusetts, which now ranks as one of the most prominent and active meditation centers in the Western world. Sharon and Joseph Goldstein expanded their vision in 1989 by co-founding the Barre Center for Buddhist Studies (BCBS). In 1998, they initiated the Forest Refuge, a long-term retreat center secluded in a wooded area on IMS property. Today she teaches a variety of offerings around the globe. Sharon resides in Barre, Massachusetts, and New York City. She served as a panelist with the Dalai Lama and leading scientists at the 2005 Mind and Life Investigating the Mind Conference in Washington, DC. She also coordinated the meditation faculty for the 2005 Mind and Life Summer Institute, an intensive five-day meeting to advance research on the intersection of meditation and the cognitive and behavioral sciences. At the 2005 Sacred Circles Conference at the Washington National Cathedral, Sharon served as a keynote speaker. She has addressed audiences at the State of the World Forum, the Peacemakers Conference (sharing a plenary panel with Nobel Laureates His Holiness the Dalai Lama and Jose Ramos Horta) and has delivered keynotes at Tricycle’s Buddhism in America Conference, as well as Yoga Journal, Kripalu and Omega conferences. She was selected to attend the Gethsemani encounter, a dialogue on spiritual life between Buddhist and Christian leaders that included His Holiness the Dalai Lama. The written word is central to Sharon Salzberg’s teaching and studies. She is the author of nine books including Lovingkindness, the NY Times best seller Real Happiness, and Real Happiness at Work. In her early Buddhist studies at the University of Buffalo, she discovered Chogyam Trungpa Rinpoche’s book, Meditation in Action. She later heard him speak at a nearby school: he was the first practicing Buddhist she encountered. While studying in India, Shunryu Suzuki’s book Zen Mind, Beginner’s Mind profoundly influenced the direction of her meditation practice. She is a weekly columnist for On Being, a regular contributor the the Huffington Post, and was a contributing editor of Oprah’s O Magazine for several years. She has appeared in Time Magazine, Yoga Journal, msnbc.com, Tricycle, Real Simple, Body & Soul, Mirabella, Good Housekeeping, Self, Buddhadharma, More andShambhala Sun, as well as on a variety of radio programs. Various anthologies on spirituality have featured Sharon Salzberg and her work, including Meetings with Remarkable Women, Gifts of the Spirit, A Complete Guide to Buddhist America, Handbook of the Heart, The Best Guide to Meditation, From the Ashes—A Spiritual Response to the Attack on America, and How to Stop the Next War Now: Effective Responses to Violence and Terrorism.
Resources discussed on this show:
Sharon Salzberg Website
Real Love Book
Sharon Salzberg Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Liam West joins me to discuss how young medical professions can break into the competitive sports and exercise medicine world. Dr. Liam West trained at Cardiff Medical School in Wales, United Kingdom and has transitioned into working in Australian Rules Football both at the elite and Academy levels whilst still working in Soccer for Melbourne Victory. He is also working in research at La Trobe University whilst also helping lead their SEM departments Social Media and content creation
In this episode, we discuss:
-Tools young clinicians use to break into sports and exercise medicine
-Tips for introverts preparing for networking events
-The key element to master for buy-in with athletes
-Why you should seek out communication training to supplement your clinical skill set
-And so much more!
Sports and exercise medicine has a lot of traction globally and getting involved in international conferences can lead to many opportunities. Dr. West believes, “You don’t just need a local network, you need an international network.” One of the easiest tools at your disposal to connect with people outside your geographic region is through the use of social media. However, Dr. West warns, “Be very careful on social media,” and always project professionalism.
Gaining access to a niche field like sports medicine requires hard work and self-initiative, Dr. West reminds us that, “People don’t owe you the experience.”
Sports medicine practitioners face the unique dilemma of supporting a team’s success while looking out for the player’s best interest and health. Maintaining professional boundaries is critical to sustaining objectivity and ensuring positive outcomes and Dr. West stresses, “You’re there to work, do not become a fan.”
While experience is valuable, young clinicians will find that athletes care more about your commitment to their success than how long you have been treating patients as Dr. West points out, “Athletes don’t really care how much you know until they know that you care.” Dr. West believes, “Honesty is really powerful with an athlete.”
For more information on Dr. West:
Dr. Liam West trained at Cardiff Medical School in Wales, United Kingdom. During his first few years there he also completed a Sports Science Bachelors degree to dip his toes into the alluring water of Sports Medicine. During his undergraduate studies he set up a student society to promote, educate and offers opportunities within SEM to his peers both in medicine but all areas of SEM such as physiotherapy, sports science etc. Through the national acclaimed success of this society he then crated similar societies across the UK before founding an overarching UK student society and later a European wide one.
These societies kick started what is now an extremely strong and vibrant junior SEM scene in the UK. In his fourth year of his studies he single handedly ran his own student SEM conference attracting 250 delegates - this introduced him to Karim Kahn and Peter Brukner. A role within BJSM followed and over the years this has developed into being a Senior Associate Editor and a role within education.
After his studies finished he completed a Diploma in SEM whilst working full time as a junior doctor. He picked up his clinical work by working in horse riding, the Women's Soccer Premier League and as the England Under 16 Doctor.
In 2015 he made the switch to live in Melbourne where he still currently resides. He has transitioned into working in Australian Rules Football both at the elite and Academy levels whilst still working in Soccer for Melbourne Victory. He has left hospital medicine and is working in research at La Trobe University whilst also helping lead their SEM departments Social Media and content creation. He wrote a chapter in the newly released Clinical Sports Medicine (Brukner and Kahn).
Away from Academia, after playing soccer all of his life he has now converted this season to playing Australian Rules Football and is slowly learning what a true contact sport feels like.
Resources discussed on this show:
Switch: How to Change Things When Change Is Hard
Liam West Twitter
Journal Articles:
BJSM: Inside Track
West, L. R. (2013). Sport and exercise medicine in the undergraduate curriculum. Are we inspiring the next generation of sport and exercise medicine doctors and helping them overcome the barriers they face getting into the specialty? British Journal of Sports Medicine, 47(11), 664-5
West, L. R., & Griffin, S. (2016). Sport and exercise medicine in the UK: what juniors should know to get ahead. British Journal of Sports Medicine, bjsports-2016-096631Published Online First: 8 October 2016
To train or not to train for SEM – the medical student dilemma - British Journal of Sports Medicine
What my 13 flight, 4 country sports medicine elective taught me – 5 lessons for success in sports & exercise medicine – British Journal of Sports Medicine
To MSc or not to MSc; a Doctor’s perspective – British Journal of Sports Medicine
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Jackie Whittaker and I discuss youth injuries in sport. Dr. Whittaker is an Assistant Professor in the Department of Physical Therapy, University of Alberta in Edmonton, Canada, Research Director of the Glen Sather Sports Medicine Clinic and recognized as a clinical specialist in musculoskeletal physiotherapy by the Canadian Physiotherapy Association. Jackie’s research is focused on prevention of youth sport injuries and the consequences of these injuries as it relates to later negative health outcomes such as inactivity, obesity and osteoarthritis.
In this episode, we discuss:
-The most common injuries in youth sports and their lasting impact
-Physical therapy’s role in youth medical care
-What is most important in your first patient encounter?
-How to intervene for primary, secondary, and tertiary prevention
-Dr. Whittaker’s current research on long-term effects of youth injury
-And so much more!
Physical therapy’s role in youth healthcare is very important and Dr. Whittaker notes that, “The leading cause of injury requiring medical attention is related to sport and recreation participation.” Injury amongst youth athletes is driven by multiple factors including early sport specialization and year-round seasons.
Within a few years following youth injury, Dr. Whittaker shares, “They are starting to head down this trajectory of having negative health outcomes,” which includes becoming less active and obese.
When treating adolescents, it is important to consider the long-term impact beyond the initial injury. Preventing negative outcomes in the future requires setting realistic expectations and instilling confidence in their body’s capabilities. Dr. Whittaker stresses, “We also have to have their long term musculoskeletal health in the back of our head when we are treating their acute injury and trying to get them back to sport.”
Physical therapists should advocate active alternatives to competitive sport to allow youth to maintain involvement in a peer group and mitigate risk of future negative health outcomes. Dr. Whittaker believes physical therapists need to have the difficult conversation about how, “There knee is never going to be the same again.”
For more information on Dr. Whittaker:
Dr. Whittaker is an Assistant Professor in the Department of Physical Therapy, Faculty of Rehabilitation Medicine, and Research Director of the Glen Sather Sports Medicine Clinic at the University of Alberta in Edmonton, Canada. She is recognized as a clinical specialist in musculoskeletal (MSK) physiotherapy by the Canadian Physiotherapy Association and is a Fellow of the Canadian Academy of Manipulative Physical Therapists. Jackie’s research interests lie in scientific inquiry that will substantially influence a shift in the approach taken to manage chronic MSK disorders from treatment of chronic disease (tertiary prevention) towards prevention and delaying/halting disease onset (primary and secondary prevention) including optimizing the musculoskeletal health of youth and adolescent populations. Jackie’s background combines knowledge gained through 21 years of clinical practice and intensive research training (PhD and post-doctoral fellowship). In addition to her appointment at the University of Alberta, Dr. Whittaker is an Adjunct Professor at the International Olympic Committee funded Sport Injury Prevention Research Centre at the University of Calgary, Canada and Associate Member of the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis.
Resources discussed on this show:
Jackie Whittaker Twitter
Jackie Whittaker University of Alberta Website
Email: jwhittak@ualberta.ca
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Kyle Ridgeway and Dr. Kenny Venere join me for Part 2 where we discuss the necessity for evidence in physical therapy! Kyle Ridgeway is a senior physical therapist at University of Colorado Hospital and coordinator of physical therapy quality improvement project in the medical intensive care unit. Dr. Kenny Venere is a home health physical therapist at Intermountain Healthcare in Salt Lake City, Utah. Make sure to check out Part 1 if you missed it!
In this episode, we discuss:
-Is physical therapy science based?
-Why we should breed a culture of skepticism in physical therapy
-Fad treatments and why practitioners are attracted to them
-Kyle and Kenny’s passion for the science behind physical therapy
-And so much more!
The current marketing of continuing education in physical therapy acts as a barrier to evidence based innovations. Kyle believes, “Because of perverse incentives and the way the continuing education model is structured, it lends itself to guruism… This is foundationally an educational problem,” as many physical therapists are not well trained to analyze claims and assess validity.
For the physical therapy profession to continue to advance in quality of care, Kenny stresses, “We need a culture in physical therapy that is skeptical. A culture that is comfortable with engaging in argument and debate.” He stresses that there must be plausibility to our treatments and that, “We have to be less certain in our convictions and I think that is a hallmark of a scientific profession.”
Scientific debate requires an open mind and the ability to incorporate new information however Kyle has found that humans struggle with this. He believes that, “If you were truly open minded and you’re coming in with no previous data, no previous preconceptions, and you are not taking a bayesian approach to this problem, you are equally open to both outcomes.”
Kyle restricts his treatments to those backed by sound evidence and carefully reviews newly vaunted treatments before exposing patients to them because, “These aren’t actually delineating things, these are actually diluting factors that make the profession we are at large less elevated.”
Kyle has found that physical therapy adds a great deal of value to the healthcare world and states, “My experience is other people in healthcare are just yearning for physical therapist’s input and once they get it they want more of it.”
Navigating the complexities of patient care can be difficult for new physical therapy graduates. Kyle advises, “We are seeing people at their absolute most distressing moments, in a convoluted system, with perverse incentives, and ridiculous rules. And it’s really complicated. I think the first thing was just letting in that uncertainty and being okay with the fact that you’re never there, you’re always improving, there is always something different to consider, and welcoming that journey.”
For more information on Dr. Kyle Ridgeway:
Kyle Ridgeway received a BA in neuroscience from Pomona College and a doctor of physical therapy degree from University of Colorado Denver: Anschutz Medical Campus. Currently, he is a senior physical therapist and team lead for medical ICU physical therapy at University of Colorado Hospital. He also serves as a clinical instructor for the University of Colorado Denver Physical Therapy Program. A quality improvement project in the medical ICU, that he designed and implemented, eventually became standard practice. He speaks nationally regarding acute care physical therapy specifically in critical care, acute care quality improvement, hospital readmissions, and outcomes following critical illness. He blogs at PT Think Tank https://ptthinktank.com/author/kridgeway/ where he aims to provide thoughtful analysis and critical thinking on various clinical, scientific, and humanistic topics relating to physical therapy. But, of course, that is just his opinion.
For more information on Dr. Kenny Venere:
Kenny Venere currently works as a home health physical therapist for Intermountain Homecare and Hospice in Salt Lake City. He graduated from Northeastern University in Boston, MA with his DPT in 2014. His primary interests within physical therapy are scientific literacy, meta-research and the philosophy of evidence based practice. He writes (infrequently) on these topics over at his website, www.physiologicalpt.com.
Resources discussed on this show:
Kyle Ridgeway Twitter
Kenny Venere Twitter
Talking Points: An Oxford-Style Debate on Dry Needling
Physiological PT
PT Think Tank
Why do humans reason? Arguments for an argumentative theory.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Kyle Ridgeway and Dr. Kenny Venere join me for Part 1 where we answer viewer questions on a variety of topics ranging from dry needling to physical therapy as a solution to the opioid crisis! Kyle Ridgeway is a senior physical therapist at University of Colorado Hospital and coordinator of physical therapy quality improvement project in the medical intensive care unit. Kenny Venere is a home health physical therapist at Intermountain Healthcare in Salt Lake City, Utah.
In this episode, we discuss:
- Should dry needling be implemented as a physical therapy intervention?
-What is physical therapy’s role in the opioid crisis?
-How can acute care PT’s better collaborate with home health PT’s following discharge from the hospital?
-And so much more!
Kenny and Kyle did not set out to change any minds at their dry needling debate at Combined Sections Meeting. Instead they sought to encourage skepticism to those who are still appraising the evidence and Kenny hopes, “they left more informed and just the greater goal of having people think more critically about how they choose to implement interventions in a physical therapy practice. How they think about the literature on interventions in physical therapy practice was really what we hoped to accomplish.”
Kenny advocates physical therapists should be very selective and vet new methodologies before they are adopted into their toolkit by supporting a high bar for evidence of effectiveness. He stresses, “Research is everything. Without it, we have nothing.”
Although physical therapists are well equipped to play a key role in treating chronic pain, opioid use is a multifaceted problem with many players both in the medical field and pharmaceutical industry. Kenny believes, “Physical therapists I think have a role but it’s important that we be humble in the claims we make about our role. We are by no means a panacea or a cure for the opioid crisis but I think we can play an essential role in what is a bigger puzzle.” Kyle warns about the realities of treating chronic pain and states, “I get justifiably nervous when we start talking about physical therapy as the answer to the opioid crisis…it’s nuanced and it’s layered.”
Kyle suggests hospitals should rethink how they evaluate patient satisfaction and disentangle pain from quality of service and care. Kyle points out that, “We made pain a vital sign. Patient satisfaction in the hospital is one of the most talked about things in administration and if you mix this context together there’s real incentive to say we have to do something to take this pain away.”
More collaboration across physical therapy settings may lead to a more holistic approach to tackling unique patient healthcare needs. Kyle finds that one of the problems is, “These communications really don’t happen between settings and especially between acute care and home health.”
For more information on Kyle Ridgeway:
Kyle Ridgeway received a BA in neuroscience from Pomona College and a doctor of physical therapy degree from University of Colorado Denver: Anschutz Medical Campus. Currently, he is a senior physical therapist and team lead for medical ICU physical therapy at University of Colorado Hospital. He also serves as a clinical instructor for the University of Colorado Denver Physical Therapy Program. A quality improvement project in the medical ICU, that he designed and implemented, eventually became standard practice. He speaks nationally regarding acute care physical therapy specifically in critical care, acute care quality improvement, hospital readmissions, and outcomes following critical illness. He blogs at PT Think Tank https://ptthinktank.com/author/kridgeway/ where he aims to provide thoughtful analysis and critical thinking on various clinical, scientific, and humanistic topics relating to physical therapy. But, of course, that is just his opinion.
For more information on Kenny Venere:
Kenny Venere currently works as a home health physical therapist for Intermountain Homecare and Hospice in Salt Lake City. He graduated from Northeastern University in Boston, MA with his DPT in 2014. His primary interests within physical therapy are scientific literacy, meta-research and the philosophy of evidence based practice. He writes (infrequently) on these topics over at his website, www.physiologicalpt.com.
Resources discussed on this show:
Kyle Ridgeway Twitter
Kenny Venere Twitter
Talking Points: An Oxford-Style Debate on Dry Needling
Physiological PT
PT Think Tank
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Brett Kestenbaum joins me for Part 2 of our discussion on outlining goals and defining success. Brett Kestenbaum is the co-founder of NewGradPhysicalTherapy.com, a website that provides tools and resources to help the transition from student to practitioner, and CovalentCareers.com, a technology whose mission is to make on-demand employment for healthcare professionals possible. Brett is dedicated to helping physical therapists find success and fulfillment in their careers.
In this episode, we discuss:
-High burnout among new PT graduates and alternative career avenues with this expertise
-Goal setting to establish a foundation for success
-Meditation as a secret weapon to enhance your focus
-Brett’s best advice to a new physical therapy graduate to achieve success
-And so much more!
Brett measures success as taking direct action towards terms that you choose for yourself. Brett reminds us that, “Success is a personal feeling that nobody can give you and nobody can define for you except you yourself.”
For busy professionals or entrepreneurs, the mind can be easily cluttered by a never ending stream of tasks. Brett finds that meditation leads to clarity of mind and a greater understanding of your goals and allows you to, “start taking actions in that direction.”
Organizing time without distractions allows for better management of responsibilities and the potential to streamline productivity. Brett believes, “Habits are muscles too. They are something you have to train and you’ll get better and better at creating habits over time and accomplishing tasks within a refined period of time as well.”
For more information on Brett:
Brett Kestenbaum is the co-founder of NewGradPhysicalTherapy.com, a website that provides tools and resources to help the transition from student to practitioner, and CovalentCareers.com, a technology whose mission is to make on-demand employment for healthcare professionals possible. Brett is dedicated to helping physical therapists find success and fulfillment in their careers.
Brett escaped the winters of his native New York, in order to attend grad school at NOVA Southeastern University in Ft. Lauderdale, Florida. He took a job at Scripps Mercy Hospital in San Diego following graduation. Brett has chosen to pursue a versatile background in physical therapy, by providing care to a highly dynamic patient population in both inpatient and outpatient settings. Outside of physical therapy, Brett is an avid golfer and has developed a new technology to help physical therapists find jobs, while studying lifestyle design. Shoot him an email if you want to play a round of golf!
Resources discussed on this show:
Brett Kestenbaum Twitter
New Grad Physical Therapy Facebook
Brett Kestenbaum LinkedIn
Brett Kestenbaum Facebook
New Grad Physical Therapy Website
Covalent Careers Website
Schedule a 15 minute chat with Brett here!
Westworld
Richard Feynman
Alan Watts
Sharon Salzberg
Pomodoro Technique
Chris Winfield
Email: Brett@covalentcareers.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Brett Kestenbaum joins me for Part 1 of our discussion on branding with social media and how to overcome fear that comes with broadening your career horizons. Brett Kestenbaum is the co-founder of NewGradPhysicalTherapy.com, a website that provides tools and resources to help the transition from student to practitioner, and CovalentCareers.com, a technology whose mission is to make on-demand employment for healthcare professionals possible. Brett is dedicated to helping physical therapists find success and fulfillment in their careers.
In this episode, we discuss:
-How to utilize online technology to build a community and leverage a greater audience
-Social media’s role in building a brand in your community
-Steps you can take to invest and build your website, develop copy and create a personal brand
-Overcoming mental roadblocks new graduates face in starting their businesses
-And so much more!
For new graduates, their own inner resistance to take risks and pursue opportunities can be their greatest hurdle. Brett believes, “Typically, that fear will stop people from taking any action in general.” Brett stresses to continue to push through the fear and take action because oftentimes, “That’s a barrier for everybody, and that’s your biggest opportunity that there is a barrier there.”
Regardless of the number of failures, successful entrepreneurs and practitioners attain the best opportunities through persistence. From Brett’s experience, his advice is, “I want to put myself out there as much as possible. And I want to stink as many times as possible. I want to sound like a goofy clown or whatever it may be as many times as possible. Because I know that one time—maybe—I will do something that will resonate with people and it will be a huge impact on my life and on my career.”
Young entrepreneurs often have insecurities about their ability to differentiate themselves and add value in the marketplace. Brett states, “The resistance is the part of the creative process that stops your from creating. It’s that question that comes up in your head. Am I good enough to create a blog post or is this blog post perfect? It’s the resistance that stops you from clicking the publish button.”
For more information on Brett:
Dr. Brett Kestenbaum is the co-founder of NewGradPhysicalTherapy.com, a website that provides tools and resources to help the transition from student to practitioner, and CovalentCareers.com, a technology whose mission is to make on-demand employment for healthcare professionals possible. Brett is dedicated to helping physical therapists find success and fulfillment in their careers.
Brett escaped the winters of his native New York, in order to attend grad school at NOVA Southeastern University in Ft. Lauderdale, Florida. He took a job at Scripps Mercy Hospital in San Diego following graduation. Brett is an avid golfer and has developed a new technology to help physical therapists find jobs, while studying lifestyle design. Shoot him an email if you want to play a round of golf!
Resources discussed on this show:
Brett Kestenbaum Twitter
New Grad Physical Therapy Facebook
Brett Kestenbaum LinkedIn
Brett Kestenbaum Facebook
New Grad Physical Therapy Website
Covalent Careers Website
Schedule a 15 minute chat with Brett here!
Greg Todd Twitter
Ben Fung Twitter
Rich Severin Twitter
Crossing the Chasm
Gary Vaynerchuk
Mark Cuban
Email: Brett@covalentcareers.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, I am honored to have Lolly Daskal join me to discuss her book The Leadership Gap. Lolly Daskal is one of the most sought-after executive leadership coaches in the world. As founder and CEO of Lead From Within, her proprietary leadership program is engineered to be a catalyst for leaders who want to enhance performance and make a meaningful difference in their companies, their lives, and the world.
In this episode, we discuss:
-The Leadership Gap and shifting concepts of leadership
-Lolly’s RETHINK system which celebrates all archetypes and shadow traits of leaders
-Taking advantage of leadership gaps created by the imposter syndrome
-Making the leap from good to great leadership
-And so much more!
Everyone has a chance to be a leader in their current roles as Lolly states, “If you are impacting someone, if you are influencing someone, if you are advising someone and if people come to you for help, you’re a leader.” The one commonality to becoming a great leader is, “we have to learn to lead from within.”
From Fortune 500 executives to stay-at-home mothers, all leaders can identify with virtues and shadow traits outlined in her book. Lolly reminds us, “These are human beings... It is so universal.”
Leaders can create self-doubt by comparing themselves to others. Lolly believes that to be a strong leader, “We have to stop looking outward… look inward—that is where all the treasure is.”
The potential to be a better leader occurs every day and leaders should always strive to be better tomorrow. Lolly advices, “When we choose greatness, then we take the higher standard of who we are.”
For more information on Lolly:
Lolly Daskal is one of the most sought-after executive leadership coaches in the world. Her extensive cross-cultural expertise spans 14 countries, six languages and hundreds of companies.
As founder and CEO of Lead From Within, her proprietary leadership program is engineered to be a catalyst for leaders who want to enhance performance and make a meaningful difference in their companies, their lives, and the world. Based on a mix of modern philosophy, science, and nearly thirty years coaching top executives, Lolly’s perspective on leadership continues to break new ground and produce exceptional results.
Of her many awards and accolades, Lolly was designated a Top-50 Leadership and ManagementExpert by Inc. magazine. Huffington Post honored Lolly with the title of The Most InspiringWoman in the World.
Her writing has appeared in HBR, Inc.com, Fast Company (Ask The Expert), Huffington Post, and Psychology Today, and others.
Lolly’s proprietary insights are the subject of her new book, The Leadership Gap: What Gets Between You and Your Greatness, and is available forpre-order here.
Her previous bestseller, Thoughts Spoken From the Heart, is available here.
Resources discussed on this show:
Lolly Daskal Twitter
Lolly Daskal Website
Lolly Daskal LinkedIn
The Leadership Gap Book
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Bart Dingenen joins me to discuss rehabilitation following an ACL injury. Dr. Dingenen is currently both a sport physiotherapist at Motion To Balance in Genk, Belgium and a post-doctoral researcher and lecturer at Hasselt University.
In this episode, we discuss:
-Physiological and psychological considerations for return to sport following ACL reconstruction
-How to structure treatments to promote motor learning
-The fine line of early return to sport and the risk for re-injury
-Integration of sport prevention training at follow-up
-And so much more!
More traditional approaches to rehabilitation following ACL reconstruction are limited to the physiology of the athlete. Bart believes, “Knee focused outcomes can be valuable but probably don’t tell us enough about the big picture of that patient in front of you.” One outcome measure isn’t adequate enough to determine how an athlete is progressing through therapy and Bart stresses, “We don’t treat a structure, we really treat a person.”
Bart stresses that the most effective intervention addresses the sensory motor system considering the neuroplastic changes that occurred following injury. He states, “If we just continue to consider the ACL as a pure mechanical problem, I think you miss so much.”
The clinician’s role is to provide a rich environment that is sport specific, fun and challenging to ensure compliance and reduce risk of re-injury. Bart recommends, “People have no time to be consciously aware of their knee. They have to have fun and they have to move. These aspects have to be there in your training.”
Treatment sessions should seek to mimic an open and dynamic environment which challenges the athlete physically and cognitively. Bart warns, “If you do [ACL injury prevention training] the traditional way you see indeed the compliance rates are really low.”
For more information on Bart:
Dr. Bart Dingenen is a sport physical therapist from Belgium. He is currently working as a postdoctoral researcher and lecturer at the University of Hasselt, Belgium, in combination with his work as sport physical therapist in the private physical therapy practice Motion to Balance, Genk, Belgium.
He finished his PhD in 2015 at KU Leuven (Belgium) on postural control in relation to knee and ankle injuries. Bart published numerous papers in international peer-reviewed journals over the last 5 years on ACL injury, chronic ankle instability, athletic screening, injury prevention, postural control and jumping and running mechanics, and is a well-respected speaker at both national and international conferences, workshops and symposia.
Resources discussed on this show:
Bart Dingenen Twitter
Bart Dingenen Publications
Return to sport Video
International Knee Documentation Committee Questionnaire
Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction: A Critical Step Back to Move Forward
Tim Gabbett Publications
Email: bart.dingenen@uhasselt.be
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On today's episode of the Healthy Wealthy and Smart Podcast, I had the pleasure of collaborating with Dr. Gene Shirokobrod from the Therapy Insiders Podcast to discuss female leadership in physical therapy. Gene is a doctor of physical therapy and entrepreneur and is currently the CEO of Recharge LLC and CEO and co-founder of UpDoc Media. He is also the co-inventor of arc and has had experience with crowdfunding, having raised $30k in 40 days on Kickstarter.
In this episode, we discuss:
-Why are women not thought of as leaders in the physical therapy profession?
-Creative solutions for hiring the best fit for your company's culture
-Enhancing the female voice through amplification
-How to grow an audience with solid content and consistency
-Strategies to overcome imposter syndrome and how to foster an environment for vulnerability
-And so much more!
Although women occupy many of the highest leadership roles in physical therapy, the influence of female therapists at professional conferences and on social media is not comparable. At a higher level, Gene notes, “We hark on evidence based and we hark on following data and data has shown that women are as good and in most cases better leaders than men but we are still entrenched in more traditional mindset of leadership.”
Both Gene and I stress that more conversation around gender in leadership roles in physical therapy needs to continue with the overall goal to ensure equality of opportunity. Gene believes, "It's about having the opportunity to be a leader and be seen based on merit and not on sex.”
Many different qualities can encompass successful leadership however the one value a leader must possess is the ability to, “make sure that other people around you are succeeding and I don't think that that's sex dependent.”
For more information on Gene:
Dr. Gene Shirokobrod is a physical therapist guided by entrepreneurial passion. He is the CEO of Verve LLC, who along with his business partner Corey Fleischer, developed and created arc. In 2014, arc was successfully funded on crowdfunding platform Kickstarter, raising over $30k in 40 days. After the launch of arc, Dr. Gene and Corey had the great experience of auditioning for Shark Tank. They made it through round 1 and being called to move on to round 2. While working as a full time clinician, Dr. Gene started a podcast called Therapy Insiders. What started out as a fun hobby, quickly grew into a serious endeavor. Therapy Insiders steadily gained listeners and followers, eventually reaching #1 Medical Podcast on iTunes. Due to the success of Therapy Insiders, Dr. Gene co-founded UpDoc Media, a company focused on producing high quality custom content and digital marketing for healthcare companies. UpDoc media launched with 4 podcasts, focusing on business, fitness, running and of course medicine. UpDoc media is focused on providing "content you NEED to know, that is delivered with clinical precision." In March 2017, he became CEO of his new venture Recharge. The company is a unique combination of physical therapy, CrossFit and Mindfulness training. Incorporating three important elements of health under one roof with a focus on the customer experience and fun. Recharge is home to HoCo CrossFit which is also owned by Recharge. Dr. Gene is also an adjunct faculty member at University of Maryland School of Medicine, Department of Physical Therapy, which is also where he received his doctorate degree. When not focusing on growing his companies, he is chasing his son Aaron (5) and daughter Zoe (1) with the help of his wife Jaimie.
Resources discussed on this show:
Women in Physical Therapy Summit
Therapy Insiders Podcast
Gene Shirokobrod twitter
UpDoc Media
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a
On behalf of the British Journal of Sports Medicine, I had the pleasure of speaking with Dr. Margo Mountjoy on psychological injury and abuse in sport LIVE from the IOC World Conference in Monaco. Dr. Mountjoy is a member of the IOC medical commission, FINA executive board member, and associate clinical professor at McMaster University. She explores the various types of harassment, how it can occur, and what safeguards can be put in place to help athletes report abuse.
In this episode, we discuss:
-What form does psychological abuse and injury take in the world of sports?
-How psychological abuse persists with the use of social media for the millennial generation
-How competitive sport culture can enable abuse
-The role healthcare professionals can play in preventing abuse
-Signs and symptoms of psychological and sexual abuse
-And so much more!
One of the key risks for psychological injury and abuse to occur is when “there is a differential in power relationships.” The differential of power could be due to differences in a variety of factors including age, religion, gender, sexual orientation, or athletic ability which leads to the harassment and abuse.
The advent of social media has led to more persistent forms of abuse which are carried off the field and into everyday life. With social media, there is no physical escape from the abuse and Dr. Mountjoy believes, “There is always someone that is ready to criticize.”
Psychological injury and abuse in sport is not unique to any one sport or region and global resources are available through Dr. Mountjoy’s research and the IOC to help combat this problem. In our roles as coach, support team or therapist, Dr. Mountjoy stresses, “Each and every one of us in sport has the ability to stop this. But not only the ability, we have the responsibility.”
One of the challenges of helping athletes is that, “Most athletes do not talk about their abuse while they are in sport because the process of abuse often silences the athlete. We see time and time again that we learn about harassment and abuse after they have retired.” However, healthcare providers have unique opportunities to engage athletes as impartial healers and provide support both physically and mentally.
For more information on Dr. Mountjoy:
Margo received her medical education and her family medicine training at McMaster University, Canada and her sports medicine specialty degree in Ottawa, Canada. Margo has worked as a community sports medicine physician in the Health & Performance Centre at the University of Guelph since 1988 where she has focused her practice on promoting elite athlete care and physical activity promotion in the general population. In addition, Margo has acted as the national team physician for Synchro Canada for 20 years as well as for the National Endurance Training Centre Athletes (middle and long distance track athletes) and the National Triathlon & Wrestling team training centres.
Margo is an Associate Clinical Professor in the Faculty of Family Medicine in the Michael G. DeGroote School of Medicine, McMaster University, Canada where she teaches sports medicine and is the Director of Student & Resident Affairs.
Margo is a member of the FINA Executive Board and holds the portfolio of Sports Medicine. She is also the Chair of the ASOIF Medical Consultative Group and a member of the IOC Medical Commission Games Group. Margo sits on the TUE committees of the IOC, WADA and CCES as well as the USADA and World Rugby Anti-doping Review Boards. Margo’s areas of research focus on elite athlete health and safety.
Resources discussed on this show:
BJSM Website
BJSM Podcast
IOC consensus statement on non-accidental violence in sport
Margo Mountjoy Twitter
Margo Mountjoy Publications
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, physiotherapist Alister Cran joins me to share his insights on treating the extreme sport competitor. Alister is a private practice physiotherapy owner in Surfers Paradise, Queensland, Australia. He assists with the Nitro Circus Live Tour of New Zealand and pursues his passion for sports physiotherapy treating a variety of high level athletes.
In this episode, we discuss:
-How to leverage opportunities early in your career to gain access to high level athletes
-Tailoring your social media presence to your ideal patient population
-Do you need to be a high level athlete to treat one?
-Managing expectations for return to sport following injury for high level performers
-And so much more!
To break into treating high level athletes and performers, oftentimes you have to sacrifice financial benefits for once in a lifetime opportunities. To break into niche industries, Alister recommends taking advantage of any exposure to your patient population and, “doing it for the experience,” after which good things will likely follow.
To reach the high level athlete, pursuing doctor referrals is wasted time as Alister finds younger athletes are likely to spend more of their time on social media. To make the most of your online presence and build brand awareness, Alister believes, “You’ve got to post consistently.”
Outlining the costs and benefits of an early return to sport and managing expectations can be challenging for extreme sport competitors. Alister advices, “Unless they are in the hospital, they are probably going to go back up that ramp.” Convincing show coordinators who view athletes as commodities can be even more challenging because, “There’s politics in physio and action sports.”
For more information on Alister:
Graduated Griffith University on the Gold Coast in 2012. Got a job with a Sydney based Physiotherapy practice ‘Bodyworks Physiotherapy’. Through bodyworks physiotherapy I began to treat extreme sports clients. I provided the physiotherapy for the Nitro Circus Live tours of both Australia and New Zealand. In addition to this, while still based in Sydney, provided the physiotherapy for the red bull ‘cape fear’ event. After a few years, came back to the Gold Coast and started working in a nursing home during the day and opened a room inside Funk Fitness gym at the beginning of 2016 outside of the 9-5 working hours of the nursing home. After about 4 months, I had saved up enough money and built up enough of a client base to not have to rely on the income of the nursing home anymore and have now worked full time out of a few rooms in the Isle of Capri shopping centre, Capri on Via Roma.
After coming back to the gold coast and opening Physio on Capri practice, I have maintained a relationship with bodywork physiotherapy and have been fortunate enough to be offered the Nitro Circus Live Brisbane show and the exhibition Ice Hockey match (Canada vs. USA). In addition to this, I was also offered the American and European leg of the Nitro Circus Live tour.
Resources discussed on this show:
Alister Cran Instagram
Physio On Capri Facebook
Alister Cran LinkedIn
Email: alister@physiooncapri.com
Get in contact with Alister to take advantage of his offer for a free initial consultation over Skype!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Win Kelly Charles joins us to share the patient perspective of living well with Cerebral Palsy. Win was born with Cerebral Palsy and has dedicated her life to inspiring others as a bestselling author, artist and podcast host of Butterflies of Wisdom. If you would like to learn more about Cerebral Palsy, Move Forward PT provides a great introductory resource: Physical Therapist's Guide to Cerebral Palsy. Be sure to check out the first episode with Win here!
In this episode, we discuss:
-The evolution of physical therapy care for patients with Cerebral Palsy
-Win’s experience being the first woman with Cerebral Palsy to wear an exoskeleton
-Win’s rehabilitation and fitness schedule
-First-hand advice from a Cerebral Palsy patient on how to effectively treat the condition
-The challenges of gaining adequate insurance coverage for lifelong conditions
-And so much more!
Cerebral Palsy has a variety of presentations and requires a customized treatment plan for each individual. Win encourages all physical therapists, “Don’t go by the textbook!”
Medical coverage is a never ending battle for patients with chronic conditions. Win has found results using innovative physical therapy technology but has had to go outside of her coverage. From Win’s experiences, “The medical system gives all of us the heebie-jeebies.”
Win has benefited from and encourages physical therapists to explore new technologies. Her positive experience being the first women with Cerebral Palsy to wear an exoskeleton has convinced her of the benefits of alternatives in physical therapy. She states, “I never thought I would see a day of my life where I would be the bionic women. I never thought that I would be walking in an exoskeleton.”
For more information on Win:
Born with Cerebral Palsy, Win Charles has defied the odds by becoming an author. Her memoir I, Win is an amazing story of how she remembers her life through the years of having a condition called "CP". As a competitor in the Kona Iron Man Triathlon, CEO of her own jewelry design company, and motivational speaker, Win Charles truly is an inspiration to many. Today Win Charles tours the country, speaking to schools and institutions to raise awareness about cerebral palsy and living a full life no matter what holds you back. She is also an advocate of veterans across the world.
Resources discussed on this show:
Win Charles Website
Win Charles Twitter
Butterflies of Wisdom Podcast
Bridging Bionics
Amanda Boxtel
Galileo Tilt Table
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, Dr. Sandy Hilton and I went into the crowd at the San Diego Pain Summit on the last day to get the attendee's views on the Pain Summit this year.
In this episode, we learn:
-
The common theme running through the San Diego Pain Summit
-
Which talks resonated with a lot of the attendees of the summit
-
The reasons why you should attend the summit
-
What is in store for the San Diego Pain Summit 2018
-
Lots of great behind the scenes conversations happy after hours
-
And much more!
"You know you are in the right room when you are definitely not the smartest person in the room" - Ben Cormack
"There is nothing I don't like about the San Diego Pain Summit" - Eric Purves
"It is a gathering of all of the clinicians I admire most in the world. Great to be able to to talk with them and pick their brains" - Laura Dunkley
"Wonderful conversation about clinical and scientific problems to learn and share together" - Jonathan Fass
"We are all a work in progress and you have to be a student first." - Nick Tumminello
"The emphasis on making things real for patients. We do things that matter for people" - Bronnie Thompson
Resources:
The San Diego Pain Summit
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
LIVE from Combined Sections Meeting, the Healthy Wealthy and Smart Podcast covers the professional dialogue that happens outside the conference halls driving the physical therapy profession forward. This episode features the thoughts from the following influential figures in physical therapy: Lisa Maczura, Rachel Jermann, Todd Davenport, Mike Eisenhart, Dee Kornetti, Karen Litzy, Jerry Durham, and Sean Hagey!
In this episode, we discuss:
-The importance of engaging patients at national conferences
-Why students should seek out more networking opportunities
-Humanizing patients to move the profession forward
-The importance of building self-efficacy in patients
-The need for stronger advocacy in physical therapy
-Validating the patient’s pain experience
-Engaging in professional dialogue and debate
-And so much more!
Lisa believes that patient engagement needs to be integrated into national conferences. She states, “We need to create a safe zone, not just for the PTs, but for the patients to tell their stories, to feel validated.”
Professional development needs to take place outside of the classroom by engaging in professional dialogue. From Rachel’s experience, she shares, “The failing that we see right now in education is you teach your students to treat patients, you may not teach them to interact in their profession.”
Physical therapists should be taking more ownership of the impact we make on society with public health advocacy. Todd states, “If we see the people who seek our care as people, our profession moves forward.”
Physical therapy needs to be at the forefront of transforming society by building self-efficacy in patients and encouraging movement. Mike stresses, “We have the ability to change the trajectory of someone’s life.”
Home health physical therapy catches a glimpse into the impact we make on the quality of life of our patients. Dee fears the profession can often,”get stuck with an inability to define our own value.”
Developing interpersonal skills and using reflective questioning can make a bigger impact than any manual technique for chronic pain patients. For chronic pain management, Karen believes our role is “To be able to reassure, to be able to validate that you’re pain is real. I understand, now what can we do about it?”
Engaging in professional debate on controversial topics is for the ultimate benefit of our patients. Jerry proposes, “Think about what you can gain from a conversation with someone you disagree with.”
Sean challenges physical therapists to promote the profession on larger platforms. He feels you should, “Be a part of something bigger than yourself. It’s the most rewarding thing I’ve ever done, I’d encourage you to do the same.”
For more information on the guests featured on this show:
Lisa Maczura Twitter
Rachel Jermann Twitter
Todd Davenport Twitter
Mike Eisenhart Twitter
Dee Kornetti Twitter
Karen Litzy Twitter
Jerry Durham Twitter
Sean Hagey Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode, Healthy Wealthy and Smart Combined Sections Meeting Scholarship recipient Becky Bouressa, SPT joins me to discuss CSM from a student’s perspective. Becky is a second year Doctor of Physical Therapy student at A.T. Still University in Mesa, AZ and is most interested in pediatric physical therapy and developing her niche through further clinical rotation experience. Stay tuned to the podcast for next year’s scholarship opportunity to attend Combined Sections Meeting 2018 in New Orleans, Louisiana!
In this episode, we discuss:
-How to prepare for and make the most of a conference experience
-Becky’s conference and networking highlights from CSM
-How technology can improve your next CSM experience and social media resources for students
-Recommendations for students networking with seasoned clinicians
-And so much more!
Combined Sections Meeting has ample opportunities for student engagement both clinically and professionally. Becky recommends preparing activities in advance to make the most of your conference experience as, “There is always an opportunity to learn at CSM.”
Becky encourages students to reach out to many of the lecturers from Combined Sections Meeting with follow up questions. She has found that, “People are happy to respond so don’t be afraid to [email]. They are open to answer any questions. They are there to teach.”
For more information on Becky:
Hello! I am a second year DPT student at A.T. Still University in Mesa, AZ. I am originally from Wisconsin where I received my undergraduate degree from Marquette University in Milwaukee. As of now, I am most interested in pediatric physical therapy, but am open to all types and hope to develop my niche through further clinical rotation experience.
Resources discussed on this show:
Combined Sections Meeting App
Doctor of Physical Therapy Student Group on Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Sarah Haag, Dr. Sandy Hilton and Dr. Jason Falvey for another installment all about sex. The was recorded live at CSM and we covered a wide range of topics including 50 Shades of Grey. Two of the four of us read the books…guess which two! Make sure to catch up on Part 1 and Part 2 and enjoy the show!
In this episode, we discuss:
-What’s normal female anatomy?
-Graded exposure for women’s sexual health
-Can interventions for sex be researched?
-Sex education for people with low back pain
-What you should and shouldn’t be inserting into the vagina
-And so much more!
For a lot of people in today’s society, there is almost no body part which escapes insecurity. Sandy believes the variety of human forms should be celebrated and genitalia is no different. Sandy reminds us that, “The normal human variability is as variable as noses.”
Patients may question whether they should continue sexual activity that is accompanied by chronic pain. Both Sandy and Sarah emphatically agree, “sex should never be painful,” adding, “if it doesn’t feel good, don’t do it.”
Many chronic pelvic pain patients may have adverse experiences with sex. Sarah finds that a graded exposure treatment plan which is sensitive to psychological associations and fears will lead to better outcomes. Sarah finds, “It’s really important to have something that the person doesn’t feel the need to protect against.”
For more information on the panel:
SARAH HAAG PT, DPT, MS, WCS CERT. MDT, RYT: Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the past 8 years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Most recently, Sarah completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Instructor. Sarah plans to integrate yoga into her rehabilitation programs, as well as teach small, personalized classes.
Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
SANDY HILTON PT, DPT, MS: Sandy graduated from Pacific University (Oregon) in 1988 with a Master of Science in Physical Therapy and a Doctor of Physical Therapy degree from Des Moines University in December 2013. She has worked in multiple settings across the US with neurologic and orthopaedic emphasis combining these with a focus in pelvic rehabilitation for pain and dysfunction since 1995. Sandy has teaches Health Professionals and Community Education classes on returning to function following back and pelvic pain, assisted with Myofascial Release education, and co-teaches Advanced Level Male Pelvic Floor Evaluation and Treatment. Sandy’s clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women. Sandy is also pursuing opportunities for collaboration in research into the clinical treatment of pelvic pain conditions.
Sandy brings science and common sense together beautifully to help people learn to help themselves.
JASON FALVEY PT, DPT, GCS, CEEAA: Jason is a board certified geriatric physical therapist with a strong interest in improving outcomes for both frail older adults and older adults with hospital-associated deconditioning. He has current funding from the Foundation for Physical Therapy (PODS 1 Award, 2015) and the Academy of Geriatric Physical Therapy to support his participation in ongoing research the use of a novel Progressive High Intensity Therapy (PHIT) training program on medically complex older adults after acute hospitalization. He also has funding from both the American Physical Therapy Association Health Policy and Administration Section and the Home Health Section to evaluate how physical therapists can reduce avoidable hospital readmissions. Lastly, Jason is collaborating with local long-term care providers to determine how physical functioning can be assessed and best managed to reduce rates of falls, ER visits, and hospitalization.
Resources discussed on this show:
Jason Falvey Twitter
Sarah Haag Twitter
Sandy Hilton Twitter
Pain Catastrophizing Scale
Orebro Scale
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
LIVE from Combined Sections Meeting, this episode of the Healthy Wealthy and Smart Podcast features Professor Peter O’Sullivan discussing elements of the biopsychosocial model for chronic pain management. Peter O’Sullivan is Professor of Musculoskeletal Physiotherapy at Curtin University, Perth, Australia. In addition to his teaching and research at Curtin University, he works in clinical practice as a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2005) in Perth, Australia. He is recognized internationally as a leading clinician, researcher and educator in the management of complex musculoskeletal pain disorders.
In this episode, we discuss:
-Why you should validate your patient’s pain experience, understand their beliefs and fears, and disconfirm them through behavioral learning
-The link between a practitioner’s language and self-efficacy
-The informal and non-threatening art of Peter’s initial examination
-Maintaining professional boundaries with chronic pain patients and avoiding burn out
-And so much more!
One of the strongest influences to better treatment outcomes for chronic pain patients is trust in the therapeutic alliance. “You’ve got to build a strong therapeutic relationship,” Peter suggests if you want to see patient’s engage in their program and take more control over their pain.
Treating chronic pain patients can be challenging. With the right evaluation framework and understanding of neuroscience, Peter believes you can make instant impact for the patient. Peter stresses, “The nervous system is so damn plastic. If you can get to the heart of what someone is thinking and feeling. Validate it and take them on a journey—it can break that schema up.”
Peter is critical of therapeutic techniques in physical therapy when in fact a majority of patients would benefit from relaxation strategies and progressive loading. He suggests, “I think we undermine how smart the body is…someone who gets in trouble is someone who is too hyper vigilant and probably obsessed with their technique.”
For more information on Peter:
Peter is the Professor of Musculoskeletal Physiotherapy at Curtin University, West Australia and is a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2005). His private clinic is Body Logic Physiotherapy in Perth www.bodylogicphysiotherapy.com.au. Peter has an international reputation for clinical research investigating the development, multi-dimensional assessment and targeted management of chronic spinal pain disorders. He has also developed a management approach for chronic low back pain – called ‘cognitive functional therapy’. He has published over 190 papers with his team in international peer review journals, has presented the findings of his research at more than 90 National and International conferences and has run clinical workshops in over 24 countries. Peter’s expertise is linking of clinical research to the clinical setting. (see www.pain-ed.com)
Resources discussed on this show:
Blink by Malcolm Gladwell
NOI Group
Body in Mind
Pain-Ed
Adriaan Louw
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On today’s episode of the Healthy Wealthy and Smart Podcast, I welcome Miye Fonseca to talk about the top strategies you can implement to pass the National Physical Therapy Exam! Miye Fonseca is the Founder and CEO of Therapy Exam Prep, provider of online NPTE and NPTAE exam prep courses focusing on the clinical thinking aspects, test-taking strategies and addressing factors on confidence, fear and test anxiety. She has spoken at student conclaves about exam preparation from a clinical thinking and practical approach.
In this episode, we discuss:
-Miye’s top 3 most important components for success
-Is taking practice exam after practice exam the best strategy for preparation?
-Why you need to think clinically and treat exam questions as mini evaluations
-How mindset can be the deciding factor to pass the NPTE
-And so much more!
The shift from academics to the NPTE’s clinically oriented framework can be challenging for students. From Miye’s experience, she found that she was, “viewing the exam too academically and not like a practicing clinician. Patients aren’t textbooks and they’re not study guides either.”
The NPTE mirrors clinical practice forcing students to deal with ambiguity and use the little bit of information available to start an effective treatment plan. Miye reminds us that, “In the clinic, you’re not going to know everything and you have to grasp onto one particular thing to help that patient.”
With stress levels high, mindset can be a deciding factor in getting a passing grade on the NPTE exam. Miye challenges future test takers, “Are you going to beat the NPTE or are you going to allow that exam to beat you?”
For more information on Miye:
Miye Fonseca, PT, DPT is the Founder and CEO of Therapy Exam Prep, provider of online NPTE and NPTAE exam prep courses focusing on clinical thinking, test-taking strategies and addressing factors on confidence, fear and test anxiety. She has spoken at student conclaves about exam preparation from a clinical thinking and practical approach.
Miye graduated from the University of Southern California with her class being ranked #1 for PT programs in US News for the first time. When preparing for her own board exam, she felt there had to be a better way to prepare than just reading a study guide book as there were no online prep courses at that time. The idea of Therapy Exam Prep came about after treating in private orthopedic practice for years and recognizing how the exam had transitioned into being more integrated and clinical.
Miye started the first online exam prep course for PTs and PTAs preparing for their own exam.
She brings the clinical examples into studying and treating the exam holistically by easing fear, stress and feelings of being overwhelmed. With many practical and powerful test-taking strategies as well as receiving training by the FSBPT on writing NPTE format style questions, Miye has been able to help thousands of candidates be successful.
She has worked with recruiting agencies, PT and PTA programs as a curriculum consultant, and also written exam prep articles in publications and blogs.
Resources discussed on this show:
Practice Exam Simulation
Exam Mistakes Video Series
YouTube
Snapchat: momohime11
Therapy Exam Prep
Email: miye@therapyexamprep.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On today’s episode of the Healthy Wealthy and Smart Podcast, Michael Matlack joins me to discuss the Physical Therapy Political Action Committee (PT-PAC). Michael Matlack is the Director of Congressional Affairs with the American Physical Therapy Association which advances the association's legislative priorities on Capitol Hill through federal lobbying, grassroots, and political action.
In this episode, we discuss:
-Physical Therapy Political Action Committee: What it is and what it isn’t
-How the PT PAC attracts the attention of legislators
-Important PT PAC initiatives in 2017
-Ways you can get involved with the PT PAC
-What is up with all those ducks??
-And so much more!
The most effective way to get past the wall of congressional staff and lobbyists is through direct lines of communication from practitioners and patients. To elicit action from our members of congress, Michael believes, “They need to hear from our members, our patients and how healthcare policy affects them.”
One of the initiatives the PT PAC is targeting for 2017 is physical therapy as an alternative to opioid use for pain management. Michael notes that we need to educate legislators that, “We can manage pain. You don’t need to do drugs to do that. Physical therapy is the answer in many ways.”
Members of congress are there to represent their constituents and physical therapists can get involved in local advocacy and contact their own representatives to make the biggest impact. Michael advises, “What’s most important is to share what you do and how this healthcare policy affects your patients. That’s what resonates with members of congress.”
For more information on Michael:
Michael Matlack is currently the Director of Congressional Affairs in the Government Affairs department of the American Physical Therapy Association (APTA). He oversees APTA’s lobbying team, PAC, and grassroots departments. Michael was employed by APTA on April, 1999.
Prior to joining APTA, Michael was employed by the National Society of Professional Engineers as their Manager of Congressional Relations for two and half years. Michael was in charge of their political action committee, grassroots programs, and lobbying on education and research issues.
Michael also worked at Pearson & Pipkin, Inc, a small consulting firm, the Republican National Committee and interned for former Congressman Richard Pombo (R-CA).
Michael is responsible for all political action at the federal level. Michael is in charge of APTA’s political action committee, PT-PAC. In the 2015-2016 election cycle PT-PAC raised more than $1.6 million through the direction of Mr. Matlack.
Michael received his Bachelor of Science degree in Political Science from North Carolina State University in 1993. Michael has been married to his wife Cynthia for twent-one years and has two children named, Summer and Kayla.
Resources discussed on this show:
Email: michaelmatlack@apta.org
Phone: (703) 706-3163
Legislative Action Center
Federal Advocacy Forum
PT PAC
House of Delegates
Private Practice Section Annual Conference 2017
Action App
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
LIVE from Combined Sections Meeting in San Antonio, Texas, Dr. Justin Moore joins me to discuss the American Physical Therapy Association’s initiatives for 2017! Dr. Justin Moore, PT, DPT, a physical therapist and veteran of both the profession and the association with more than 20 years' experience, leads the American Physical Therapy Association in the role of CEO. He has been with APTA for 18 years and has held numerous positions, including executive vice president of public affairs, leading the public policy agenda and payment and communications departments, leading its federal and state affairs advocacy departments and serving as the association's lead lobbyist on Capitol Hill.
In this episode, we discuss:
-The American Physical Therapy Association’s focus for 2017
-APTA’s renewed focus on building partnerships with others in the healthcare ecosystem
-The role of advocacy within the physical therapy profession
-Updates on APTA’s progress in new legislative initiatives and the regulatory environment
-How can diverse sections within physical therapy work together to promote the profession as a whole
-And so much more!
There are many opportunities for physical therapists to participate in advocacy and both individually and collectively impact the profession. Justin notes, “One of the things that physical therapy has is strength in numbers.”
The physical therapy profession nurtures ideal qualities for strong advocacy. Justin notes, “We are naturals at advocacy. We advocate for patients on a daily basis so advocating on that macro level and state capitols and on Capitol Hill is a great function for physical therapists.”
Dr. Moore’s advice to budding physical therapists is to utilize their energy and drive to, “Take more risks early.”
For more information on Justin:
Justin Moore, PT, DPT, a physical therapist and veteran of both the profession and the association with more than 20 years' experience, leads the American Physical Therapy Association in the role of CEO. He has been with APTA for 18 years and has held numerous positions, including executive vice president of public affairs, leading the public policy agenda and payment and communications departments, leading its federal and state affairs advocacy departments and serving as the association's lead lobbyist on Capitol Hill. Moore also previously oversaw APTA's practice and research departments. He has been honored for his contributions to physical therapy and public policy by receiving the R. Charles Harker Policymaker Award from APTA's Health Policy and Administration Section and the Distinguished Service Award from APTA's Academy of Pediatric Physical Therapy. In addition, Moore has written, presented, and lectured on health policy, payment, and government affairs issues to a variety of health care and business groups across the country.
Moore received his doctor of physical therapy degree from Simmons College in Boston, Massachusetts, in 2005, his master of physical therapy degree from University of Iowa in 1996, and his bachelor of science degree in dietetics from Iowa State University in 1993. He was honored by Iowa State University's College of Human Sciences with the Helen LaBaron Hilton Award in 2014 and the university's Department of Food Science and Human Nutrition's Alumni Impact Award in 2011, and he was the Family and Consumer Sciences' Young Alumnus of the Year in 2003. He also recently completed a 3-year term on Iowa State University's College of Human Sciences Board of Advisors. Moore was part of the inaugural Leadership Alexandria class in 2004 and served on the Northern Virginia Health Policy Forum Board of Directors.
Resources discussed on this show:
Email: justinmoore@apta.org
Justin Moore Twitter
Justin Moore LinkedIn
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
Thank you for listening to the Healthy Wealthy and Smart Podcast! In this episode I welcome Dr. Suzanne Shugg. Her mission is to change health care for the better by using insurance solutions, telemedicine and preventive care. Sounds familiar right? These are themes that come up regularly on social media and in discussions with fellow PTs and healthcare practitioners.
In this episode we discuss:
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How Endeavor Plus is shaking up the insurance market
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Why and how insurance companies function
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The steps telemedicine is taking to change the healthcare market
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What it is like to be the only woman in the C-Suite
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and much more!
More about Dr. Shugg:
Dr. Suzanne Shugg’s mission is to change health care for the better by using insurance solutions, telemedicine and preventive care. She currently runs a preventive Cardiology clinical treating metabolic and lipid disorders at NJ Cardiology Associates while teaching full time as a professor in the School of nursing at Rutgers, University. She also is the Co founder of Teleplus HealthCare, a telemedicine company that works to improve care and medical outcomes in cardiovascular and chronic care. Finally, she is the director of wellness at a new insurance and technology solution, Endeavor Plus. This solution has been designed to improve the health care choices and management for both the patients and providers while helping small businesses and hospitals save money.
Dr. Suzanne Shugg received her Doctor of Nursing Practice at what is now Rutgers in 2010. She has specialized in Preventive Cardiology and clinical lipidology. Prior to that she has practiced in general cardiology and in primary care as a nurse practitioner.
She has been published in the Journal of Clinical Lipidology “Low-density lipoprotein particle number predicts coronary artery calcification in asymptomatic adults at intermediate risk of cardiovascular disease”. She has published in the Federal Nurse Practitioner for, “Health Information Technology Presents New Opportunities for Advanced Practice Nurses”. Finally she has recently published in the NP Women’s Health Care Journal for, “Pregnancy’s effects on cardiovascular health: A woman’s first “cardiac stress test”. She has also written medical guidelines for Prevention of Cardiovascular disease and Cardiac Rehab. She has also written a guideline for professional’s treatment of LPa.
In 2010 she became a Clinical Lipid Specialist accredited by the National Lipid Association and shortly thereafter was nominated as a fellow. She has given various lectures on Women’s Cardiac Health, Prevention of Cardiovascular Diseases, Nutrition and Supplements, as well as advanced lipid testing. In addition, she was a consultant to set up a Preventive Cardiovascular Clinic at Oklahoma Heart
She sits on various editorial and preventive medicine boards and in her spare time she has done medical missions. When Suzanne is not working she enjoys being outside; running, kayaking, biking, scuba diving and hiking with her two dogs, Dudley and Maggie.
Thank you for listening to the Healthy Wealthy and Smart Podcast! LIVE from St. Petersburg, Florida post the Graham Sessions, Dr. Eric Robertson joins me to discuss population health! Dr. Eric Robertson, the founder of PTThinkTank.com and PTCoop.org, is the Director of the Kaiser Permanente Physical Therapy Fellowship in Advanced Manual Therapy in Northern California, and Clinical Assistant Professor at the University of Texas at El Paso. He specializes in orthopaedic manual physical therapy, radiology, evidence-based practice, and the impact of technology on healthcare.
In this episode, we discuss:
-Population health: The management of total health across different groups and the life spectrum
-Why prevention should be a primary focus in healthcare
-How population health addresses important objectives such as health literacy, resource management and access to care
-And so much more!
Innovators in healthcare reduce costs and improve quality care by intervening before complex conditions arise. Eric notes, “When you look at groups and systems that focus on population health by and large they are almost always focused on prevention.”
Physical therapists should start to think beyond their traditional role in the healthcare system and treat patients as a whole and expand their realm of care. Eric believes physical therapists should, “Conceptualize yourself as a primary care provider.”
Management decisions in population health are aligned to “[help] the patient enable their own pathway to health.” Eric believes prioritizing patient self-efficacy leads to better treatment outcomes and cost reduction.
For more information on Eric:
PT Think Tank’s founder, Eric is the Director of the Kaiser Permanente Hayward Fellowship in Advanced Manual Therapy in Northern California and Clinical Assistant Professor at the University of Texas at El Paso, where he teaching musculoskeletal physical therapy management. He received his physical therapy education from Quinnipiac University and Boston University. He is board certified in orthopaedic physical therapy and is a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Dr. Robertson is a frequent national speaker on leveraging internet technology in health care and evidence-based practice. Eric is also faculty for Evidence in Motion, LLC and an editor for the EIM Musculoskeletal Learning Academy.
Eric has authored several web-based continuing education courses for professional associations and several post-professional educational programs. At Regis University, Dr. Robertson researches the link between low back and hip pain as well as the use of instructional technology with physical therapist education. Dr. Robertson has a passion for the use of technology in healthcare and is a frequent national presenter as well as the founder of PTCoop.org, a curated, open-access collection of physical therapy learning resources. He specializes in information management and the use of social media in healthcare.
On the personal side, Dr. Robertson enjoys bonsai trees, hanging with his two weimeraners, fast mountain bike decents, the outdoors, and has a penchant for being interested in way too many things at once!
Resources discussed on this show:
Eric Robertson Facebook
Eric Robertson Twitter
Kaiser Permanente Northern California Orthopaedic Manual Physical Therapy Fellowship and Orthopaedic Residency
Kaiser Permanente Northern California Orthopaedic Manual Physical Therapy Fellowship and Orthopaedic Residency Twitter
Kaiser Permanente Northern California Orthopaedic Manual Physical Therapy Fellowship and Orthopaedic Residency Facebook
PT Think Tank
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On today’s episode of the Healthy Wealthy and Smart Podcast, Andrew Vigotsky joins me to answer audience questions and translate biomechanics literature to clinical practice. Andrew is currently a Master's student in Biomedical Engineering at Northwestern University in Evanston, IL, concentrating on musculoskeletal biomechanics. His thesis work aims to elucidate the relationship between the shear-wave velocity of muscle, as measured using Supersonic Shear Imaging, and muscle stiffness in vivo.
In this episode, Andrew answers:
-What is your biggest surprise on engaging clinical practitioners with research evidence?
-How much do you feel biomechanics matter when looking at injury and pain development across various exercises?
-If you were building your own program to maximize muscle hypertrophy what parameters would you use?
-What can we draw from EMG studies and what conclusions are fair to make?
-And so many more!
The goal of biomechanics research is to ultimately translate results to the clinic and enhance how clinicians treat their patients. Andrew states, “It’s only after you find those answers that you really understand what your results mean and how your question can affect society.”
Despite the large amount of research done each year in university labs, very little reaches practioners. Andrew notes, “There is a time lag from research to practice in the medical field of about 17 years.” Andrew believes clinicians can improve this transmission rate through a greater focus on science literacy and improved dissemination of new findings.
Best evidence based practice encompasses all elements of a biopsychosocial framework. Andrew believes, “Biomechanics still matters… It’s just in what context does it matter. From the people that are purely biomechanical, the neurophysiological and the pain science stuff matters a lot and we can’t ignore that.”
For more information on Andrew:
Andrew is currently a Master's student in Biomedical Engineering at Northwestern University in Evanston, IL, where he is concentrating on musculoskeletal biomechanics. His thesis work aims to elucidate the relationship between the shear-wave velocity of muscle, as measured using Supersonic Shear Imaging, and muscle stiffness in vivo. He is completing this work in two different labs: the Neuromuscular Biomechanics Laboratory and the Neurobionics Lab, under Drs. Sabrina Lee and Elliott Rouse, respectively.
Before attending Northwestern, Andrew graduated with a BS in Kinesiology from Arizona State University (ASU). It was during those undergraduate studies that he started getting involved in research; Erin Feser supervised him in ASU's Motion Analysis Laboratory, where he carried out two data collections that resulted in three publications. The studies investigated the effects of load on good morning kinematics and EMG amplitude, the acute effects of anterior thigh foam rolling, and the validity of the modified Thomas test. In addition to Erin's mentorship, I also grew close to Dr. Rick Hinrichs, who taught me a lot about biomechanics both inside and outside of the classroom.
While at ASU, Andrew was also able to secure an internship under Dr. Bret Contreras while he was completing research for his Ph.D. Bret has had a profound impact on how he thinks about movement and sports science. Together, they have published over a dozen papers related to strength, muscle hypertrophy, and physical performance, and have much more in the pipeline. Moreover, he has introduced Andrew to other great minds and researchers, such as Chris Beardsley and Dr. Brad Schoenfeld.
After graduating from ASU, Andrew completed pre-requisites for graduate school (i.e., math, physics, and engineering courses) at a local community college while splitting time between two laboratories: the Leon Root, MD Motion Analysis Laboratory, at the Hospital for Special Surgery (HSS), and the Human Performance Laboratory, at CUNY Lehman. At HSS, he worked under Dr. Andrew Kraszewski to develop a 3D-mesh model of the gluteus maximus. At CUNY Lehman, he worked under Dr. Brad Schoenfeld to train participants and collect data for a training study, and also designed and carried out a cross-sectional study that investigated the determinants of squat strength, which is currently in peer-review.
If you are interested in learning more about what Andrew has done or reading works that he has published, you can check out it out at ResearchGate, Google Scholar, PubMed, or my CV.
Resources discussed on this show:
Andrew Vigotsky Twitter
Movement Science Blog
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On today’s episode of the Healthy Wealthy and Smart Podcast, Dr. Sharon Dunn, PT, PhD, OCS, the President of the American Physical Therapy Association, joins me to discuss the Combined Sections Meeting in San Antonio, Texas and the APTA’s vision for 2017. Dr. Dunn is currently an Associate Professor and Chair of the Rehabilitation Sciences Department at Louisiana State University and was most recently elected APTA President.
In this episode, we discuss:
-The #ChoosePT campaign and its progress in promoting physical therapy as a pain management alternative
-The already record shattering CSM 2017 and what’s in store for attendees
-Themes APTA is pursuing in 2017 including the “quadruple aim” and encouraging a “therapeutic alliance”
-Looking forward to the 7 for 2017: New CPT Codes, MIPS Benchmarking, Continued #ChoosePT, Student Loan Support, Enhanced PTJ Online, Diversity Milestone, and Registry Revolution
-And so much more!
Dr. Dunn takes a practical and straightforward approach to working with the White House. She says the best advice she received was to, “Show up and offer the solutions” to halt the growing opioid crisis with physical therapy.
Dr. Dunn is supervising the launch of the Physical Therapy Outcomes Registry which capitalizes on more clinical data to encourage policy makers to support physical therapy. Dr. Dunn stresses, “We need more data to justify a change in payment.”
To meet the 7 for 2017 goals set by the APTA, Dr. Dunn believes, “The challenge is always alignment of stakeholder roots towards the collective vision of the profession.”
For more information on Sharon:
Sharon Dunn, PT, PhD, OCS received her BS in PT in 1987 from LSU Health Sciences Center in her hometown of Shreveport, LA. She has since completed a Master’s of Health in ’96 and a PhD in Cellular Biology and Anatomy in ’06. She has been a faculty member at LSU since 1990, currently as an Associate Professor and Chair of the Rehabilitation Sciences Department. Since beginning service through the professional organization as a student, Sharon has served as the State Government Affairs Chair; Louisiana chapter President, Vice President, and Delegate; and was most recently elected APTA President.
Resources discussed on this show:
Sharon Dunn Twitter
Combined Sections Meeting 2017
CSM Presentation: The Role of Physical Therapy in Exercise is Medicine: A Collaborative Symposium with the ACSM
Sharon Dunn LinkedIn
APTA Coding and Billing
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this week’s episode of the Healthy Wealthy and Smart Podcast, JJ Virgin, a celebrity health expert and four-time New York Times bestselling author, reveals how one life-altering event taught her to tap into an indomitable mindset, trust her instincts, and defy the odds, ultimately saving her son’s life…and her own. She’ll share the lessons she learned that can help you create your own resilient mindset.
In this episode, we discuss:
-The heart-wrenching story behind her new book Miracle Mindset
-JJ’s self care tips to manage any of life’s challenges
-How to access the healing power of the body
-How to create a mindset which builds resilience and fosters hope to become fearless
-And so much more!
Everyone faces challenges in their lives in different ways. From JJ’s experience, “As long as you have hope, you can do it.”
Mindset is one of the most powerful tools you possess to overcome difficulties. JJ stresses, “The real answer, again is above all of that, has to be that decision that I can do this. I can step up. I've got this. It’s scary but I’m stepping into it and not leaning away from it. I'm not going to run away, I’m going to expand my comfort zone. I’ve got it.”
What may seem like unfortunate and difficult challenges in life may often be opportunities in disguise. JJ has found that, “The worst years are often the best years. They are also the years that you’re going to grow the most because we don't grow when things are easy.”
For more information on JJ:
Celebrity health expert and four-time New York Times bestselling author, JJ Virgin reveals how one life-altering event taught her to tap into an indomitable mindset, trust her instincts, and defy the odds, ultimately saving her son’s life…and her own. She’ll share the lessons she learned that can help you create your own resilient mindset.
In 2012, JJ Virgin was in a hospital room next to her sixteen-year-old son who was struck by a hit-and-run driver and left for dead. She was told by doctors that he wouldn’t last through the night and to let him go. With every reason to give up, JJ chose instead to invest her energy into the hope that her son would not just survive, but thrive. In Miracle Mindset, she shares the lessons that gave her the courage to overcome the worst moment of her life.
During this difficult time, she learned valuable personal lessons that helped her rebuild her life and find success and purpose in herself, her work, and teach her sons and community how to face their own obstacles and trials. Lessons like “Don’t Wish It Were Easier, Make Yourself Stronger” and “Your Limitations will Become Your Life” will lead you to your own personal power and purpose, even when the deck seems stacked against you.
With true stories from her life, her clients, and other well-known thought leaders, she can help you transform your mindset and your daily habits to endure the difficult battles that life sends your way. Insightful, personal, and completely relatable, Miracle Mindset proves that miracles are possible when you show up, remain positive, and do the work.
Resources discussed on this show:
Miracle Mindset
JJ Virgin Website
The Brain That Changes Itself Book
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out the Final Blog Post of 2016: Advice You Need to Know!
On this episode of the Healthy Wealthy and Smart Podcast, Randall Cooper joins me to discuss the elements of bringing a product successfully to the marketplace. Randall is an experienced Sports Physiotherapist, Founder and Managing Director of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, Fellow of the Australian College of Physiotherapists, and designer of the Cooper Knee Alignment Sleeve by Thermoskin.
In this episode, we discuss:
-How to asses if your product idea fulfills a niche area in the market
-Why you should protect your intellectual property
-How to find a distributor that’s right for your product
-Unique obstacles healthcare practitioners face when launching a new product
-And so much more!
Once an idea is reasonably developed, Randall encourages entrepreneurs to solicit feedback on their product. He stresses, “Most of the time, that feedback you get from other people is extremely refreshing and helps solidify whether your idea is good or not.”
One of the biggest challenges physical therapists face is that they can rely on their stable career paths and potentially not take advantage of more risky but fruitful opportunities. Randall believes that, “The entrepreneurs who have nothing to fall back on, they grit down and they get through those tough times and they get to that next level because they have to.”
Before pursuing a venture, it is important to understand your underlying inspiration. From Randall’s experience, “The primary motivation has to be that you're changing things for the better and not that you want to be a millionaire and retire to the Bahamas.”
For more information on Randall:
Randall is an experienced Sports Physiotherapist, Founder and Managing Director of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, Fellow of the Australian College of Physiotherapists, and designer of the Cooper Knee Alignment Sleeve by Thermoskin.
As a Sports Physiotherapist Randall has worked with some of Australia's most notable sporting organisations including the Hawthorn Football Club, the Australian Winter Olympic Team, and the Victorian Institute of Sport. He consulted from the internationally renowned Olympic Park Sports Medicine Centre in Melbourne, Australia from 1999 - 2016. Randall has also attained the title of Specialist Sports Physiotherapist as awarded by the Australian College of Physiotherapists in 2008.
Randall is the Founder and Managing Director of Premax. Premax in an Australian company that manufactures a range of sports skincare and massage creams. Premax is available in Australia, Asia, UK and Europe, and will be launched in North America in 2017/18.
As an Adjunct Lecturer for the La Trobe Sport and Exercise Medicine Research Centre, Randall advocates sport and exercise medicine, physical activity, health and well-being for all. He provides support to the Centre, activity assisting in translating research findings to key stake holders including the international research community, health practitioners, and the general public.
Randall is also the designer of the Cooper Knee Alignment Sleeve by Thermoskin. This innovative proprioceptive sleeve features an anti-valgus strap, silicone dots within the sleeve to boost activation of the medial quadriceps and hamstrings, a patella sling, and a circular knit to optimise proprioceptive compression.
Resources discussed on this show:
Randall Cooper Twitter
Premax website
Premax Youtube
Cooper Knee Alignment Sleeve
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on the Final Blog Post of 2016: Advice You Need to Know!
On today’s episode of the Healthy Wealthy and Smart Podcast, Dr. Joe Tatta joins me to discuss the evolution of his physical therapy career. Dr. Joe Tatta is a doctor of physical therapy, board certified nutrition specialist and functional medicine practitioner who specializes in treating persistent pain and lifestyle-related musculoskeletal, metabolic and autoimmune health issues. His mission is to create a new paradigm around treating persistent pain and reverse our global pain epidemic.
In this episode, we discuss:
-Why fresh PT’s should focus on honing their skills
-Why an onboarding process is crucial to educating, selecting and motivating a successful team
-The limits of scaling a cash pay practice and when it might be beneficial to sell
-New integrated health centers for chronic pain and how it impacts the global pain epidemic
-And so much more!
For new graduates, the physical therapy profession offers many different ways to grow and develop. Joe believes, “One of the great things about being a physical therapist is you have so many different aspects and avenues to really go. There are so many options.”
Joe recommends creating a consistent treatment methodology for chronic pain patients. Joe states, “It created continuity of care. It created almost one mind. When you came into the clinic, patients knew that there was a method going on here and they felt safe there.”
Joe has found performance tracking to be a useful tool for his employees to help asses their strengths and areas for improvement. Joe states, “[Metrics] can actually be a way to motivate people but they can be an indicator as to how interested someone is in their job.”
To reverse the global pain epidemic, more creative options are necessary and physical therapists are perfectly aligned to take on an integral role. Joe stresses, “We have to find solutions to help [chronic pain patients].”
For more information on Joe:
Dr. Joe Tatta is a doctor of physical therapy, board certified nutrition specialist and functional medicine practitioner who specializes in treating persistent pain and lifestyle-related musculoskeletal, metabolic and autoimmune health issues. His mission is to create a new paradigm around treating persistent pain and reverse our global pain epidemic. He is the creator of the Healing Pain Online Summit and The Healing Pain Podcast designed to broaden the conversation around natural strategies toward solving persistent pain. Dr. Tatta is the author of Heal Your Pain Now; A Revolutionary Program to Reset Your Brain and Body for a Pain-Free Life by Da Capo Press.
Resources discussed on this show:
Dr. Joe Tatta Twitter
Dr. Joe Tatta Website
Heal Your Pain Now Book
The Pain Quiz
Heal Your Pain Now Website
Healing Pain Podcast
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out the Final Blog Post of 2016: Advice You Need to Know!
On today’s episode of the Healthy Wealthy and Smart Podcast, Dr. Dustin Jones joins me to chat about our educational session at this year’s Combined Sections Meeting in San Antonio, Texas! The discussion, OLD not WEAK: Strengthening the Older Adults, will be held on February 17, 2017 11:00 AM – 1:00 PM at the Grand Hyatt San Antonio, Salon E. We are looking forward to the conversation and hope you will walk away with more creative solutions for the geriatric population! If you can’t make it to the talk, follow along on social media with #OldNOTWeakCSM!
Description of the session:
In their contribution to the Choosing Wisely initiative, the American Physical Therapy Association (APTA) noted, don't prescribe under-dosed strength training programs for older adults. Under-dosed strength training in older adults has been the norm for far too long. Luckily, things are changing. The same principles physical therapists use to strengthen our athletic populations can also be used with older adults. How can we apply these principles to older adults? Drawing from current strength and conditioning principles and practices, attendees will learn to apply effective methods to strengthen their older patients. Starting with appropriate screening and ending with execution, attendees will learn the tactics to build strength and improve outcomes in their older patients.
Learning Objectives:
- Define the historical shifts in fitness and rehab that have led to current concepts in training methodology.
- Identify strength training precautions and contraindications for older adults.
- Describe how to appropriately dose, program, and monitor strengthening programs for older adults.
- Demonstrate fundamental strength training exercises for older adults.
CEU: 0.2
Dustin warns that, “We kind of form this preconceived notion of what an 80 something year old can do… Those stereotypes are being absolutely broken.”
Dustin has set out to convince physical therapists to re-think their view of this patient population. One of our goals of the talk is to get people to understand that, “Geriatrics can be sexy. Working with older adults can be fun and it can be exciting and it can be challenging.”
For more information on Dustin:
My name's Dustin Jones. I'm a Home Health Physical Therapist working to keep people resilient and independent at home. My background is in sports and orthopedics. I never intended to work with older adults. Yet, I've now found myself mainly working with older adults and loving it!
I blend a lot of what I learned working with athletic populations with helping my older patients improve their function. I am by no means an expert, but I hope to share mistakes made & lessons learned along the way to benefit other clinicians.
Resources discussed on this show:
CSM session: OLD not WEAK: Strengthening the Older Adults
OldNotWeak.com
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Olivia Charlet joins me to talk about empowering women to pursue their passion and live life on their own terms. Olivia is a coach and speaker and her mission is to uncover and unravel your deepest power and Zone Of Genius, realize how much potential you truly have, get totally aligned with your truth and calling, and take MASSIVE inspired action to create ALL of the results you want in your business and in your life.
In this episode, we discuss:
-The path to uncovering what you’re truly passionate about
-How to discover your financial blueprint and shift to a positive money mindset
-Motivational interviewing and strategies to develop rapport
-Building a fan base through authenticity and boldness
-And so much more!
Oftentimes people already have a sense of what they are passionate about and need to shift their mindset and pursue opportunities that do exist. She stresses, “There is a role for everything.”
Prior belief systems may be limiting your potential for change. Olivia advises, “I would always go with an open mind around anything you ever learn because ultimately if you do what you have always done, you will get what you always got.”
Aligning your reality with your dreams requires actively pursuing your passion. From her experience, she has found, “Listen to every single one of your cravings and always take action on them even if they scare the hell out of you.”
For more information on Olivia:
Half-French, half-Belgian, I was born in Tokyo. She grew up living in Dusseldorf, Johannesburg, Vienna, and Hamburg. After finishing her Bachelors in Finance in Boston, she moved to London to work in Finance for 3 years. After a life-changing coaching experience, she quit her job in Finance and completed a Master’s in Psychology and Psychiatry at King’s College and a Coaching Qualification with The Coaching Academy.
Olivia believes in being yourself. 100% yourself whilst running your business. Creating massive results should be done YOUR way and on YOUR terms. If it doesn’t feel aligned, what’s the point? If it’s not you being you, what’s the point? If you’re spending all day doing ‘shoulds’ in your business, what’s the point?
She believes you can have absolutely everything you want in your business and in your life. Anything is possible. She also believes that it can be incredibly exhilarating, fun, exciting, and in flow. If you’re forcing things or pushing in a way that’s not true to you, the results are just not going to happen for you. Or at least not as quickly as you’d like them to come.
Olivia’s mission in life is to uncover and unravel your deepest power and Zone Of Genius. Her mission is for you to realise how much potential you truly have, get totally aligned with your truth and calling, and take MASSIVE inspired action to create ALL of the results you want in your business and in your life. This comes naturally to me. Understanding you at an incredibly deep level, sensing what to ask you next and when to seriously push you out of your comfort zone so you can be SO insanely inspired that you feel the need to take MASSIVE inspired action that comes so intuitively and naturally that people around you have no idea what’s happened. They just KNOW something MASSIVE has shifted.
Resources discussed on this show:
Olivia Charlet Website
Olivia Charlet Facebook
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on the Top 10 Podcast Episodes of 2016!
On this week’s episode of the Healthy Wealthy and Smart Podcast, I join forces with the PT Pintcast and host Jimmy McKay PT, DPT to get a behind the scenes look at the Graham Sessions. This is the 10th anniversary of the Graham Sessions, which was founded by Steve Anderson, PT, DPT, Drew Bossen, PT, MBA and Patrick Graham PT, MBA. The Graham Sessions is a one and a half day meeting that allows physical therapists from across the country to come together and talk about the big issues facing our profession.
In this episode we talk about:
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Why the Graham Sessions were created
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Their most memorable discussions from past sessions
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How Steve's recent retirement affected his outlook on the profession and the session
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How Patrick's recent health crisis changed his outlook on life and career
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How to create and maintain a successful collaboration
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And much more!
After asking Patrick how his illness changed his outlook on life and career part of his answer included: "I don't think I worry about things as bad as I used to."
On how to create and maintain a successful collaboration Steve said: "You need people you can be 100% transparent with."
Patrick talks about the leadership of the profession and how important it is for the success of the Graham Sessions: "Continued support of our leadership to embrace something that is not of the norm says a lot about the 2 boards and the leadership and their vision for the profession."
A huge thank you to the Patrick, Drew and Steve for allowing Jimmy and I to be part of the 10 year celebration of the Graham Sessions. It was an honor!
Enjoy!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Dave Chase joins me to discuss challenges and opportunities of the current state of healthcare in the United States. Chase was named one of the most influential people in Digital Health due to his entrepreneurial success, public speaking & writing that recognizes healthcare's under-performance but contrasts that with a growing cadre of high-performing organizations that have solved healthcare's toughest challenges. Chase, widely published, co-authored the healthcare Book of the Year in 2014.
In this episode, we discuss:
-What is Health 3.0 and why human relationships take the forefront of this framework
-How to target the quadruple aim of a better patient experience, better outcomes, lower costs and happier clinicians
-Health Rosetta: The blueprint for wise healthcare purchasing
-Physical therapy’s important role in the emergent changes of Health 3.0
-And so much more!
One of the many challenges facing our healthcare system is the inability of the current system to embody patient centered care. Dave stresses, “We have seeded authority to government, administrators, and algorithms and treating a computer screen rather than the patient… We are all sort of treated as commodities and raw materials for this machine.”
Public outreach is necessary to educate patients on all potential healthcare options. Dave believes physical therapists are aligned ideally with Health Rosetta because, “People will almost always choose the least invasive option first.”
Improving the healthcare system begins with restoring the incentives for patient centered care. Dave states, “Almost everything in our system is designed around the convenience of the healthcare system not the convenience of the patient.”
For more information on Dave:
Chase is co-founder of the Health Rosetta that consists of 2 main pillars:
- Impact: The Health Rosetta Institute that is an education and certification entity that is like LEED/Fair Trade for healthcare; Media that includes the film and books. The Big Heist is the first fiercely non-partisan satirical film to tackle healthcare. In addition, they are publishing the CEO's Guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost;
- Investment: Backing the transformation of healthcare including the Quad Aim Fund, a seed stage venture fund.
Chase was named one of the most influential people in Digital Health due to his entrepreneurial success, public speaking & writing that recognizes healthcare's under-performance but contrasts that with a growing cadre of high-performing organizations that have solved healthcare's toughest challenges. Chase, widely published, co-authored the healthcare Book of the Year in 2014.
Chase was the CEO & Co-founder of Avado, which was acquired by and integrated into WebMD and the most widely used healthcare professional site - Medscape. Before Avado, Chase spent several years outside of healthcare in startups as founder or consulting roles with LiveRez.com, MarketLeader, & WhatCounts. He also played founding & leadership roles in launching two new $1B+ businesses within Microsoft including their $2 billion healthcare platform business.
Chase is a father of two great kids/athletes, husband & oxygen-fueled mountain athlete. His 2014 team placed 3rd in their division & 24th overall (out of 500 teams) in America's oldest adventure race where Dave took on the Nordic ski leg. Dave was a former PAC-10 800 Meter competitor.
Resources discussed on this show:
Dave Chase Twitter
Dave Chase LinkedIn
Health Rosetta
Rosetium
TED talk
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Advice You Need to Know!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Kim Marshall joins me to talk about oncology rehabilitation. Kim is a Doctor of Physical Therapy who recently directed her continuing education towards rehabilitation of the side effects of cancer and cancer treatment. In addition to becoming certified in the treatment of lymphedema, Kim completed the STAR training to address and treat other side effects of cancer including unspecified pain, neuropathy and fatigue.
In this episode, we discuss:
-The history of oncology rehabilitation and the role of physical therapists as a healthcare professional ally
-What is lymphedema and how can physical therapists learn to treat this condition
-Common side effects of cancer treatment and the influence on a rehabilitation program
-Important components of patient education and an exercise program for oncology patients
-And so much more!
Direct access oncology patients may not always be aware of the need for specialized care. Kim believes, “We need to be a little bit more available to patients to make sure if we can't treat them then we're getting them in the right direction.”
Patient education is critical during the initial phases of cancer treatment. Potential side effects are best screened early on so they can be more easily managed throughout the treatment. Kim states it is important for patients to understand, “Unfortunately if you've undergone the treatment for cancer, you're going to have a new normal.”
Physical therapists are well prepared to be a primary healthcare provider throughout the cancer treatment process, from preparing patients for treatments to supporting patients during treatment and recovery. Kim stresses, “I would be an advocate for finding somebody who you can go over your laundry list, we should be the healthcare providers that patients can come and complain to along with their concerns and fears.”
Kim encourages those interested in oncology rehabilitation to think about the added challenges of this field but also the potential for personal growth from treating this patient population. She shares, “It is really rewarding. There is something about the diagnosis of cancer and facing your own mortality. I always tell my patients I'm on the good end of this in terms of putting people back together. It's challenging… Every patient is a little different in terms of symptoms and a little bit different in terms of where they are in their recovery.”
For more information on Kim:
Kim received her doctorate of physical therapy from Western University and her physical therapy degree from California State University, Long Beach in 1985. She obtained her Masters degree in Biokinesiology from the University of Southern California in 1996.
She has specialized in the treatment of orthopedic injuries for the past 20 years. Recently, Kim has directed her continuing education towards rehabilitation of the side effects of cancer and cancer treatment. Kim developed this interest after her grandmother was diagnosed with breast cancer and, as a result of the surgery and subsequent treatment, her grandmother lost her shoulder mobility and developed lymphedema. In addition to becoming certified in the treatment of lymphedema, Kim completed the STAR training to address and treat other side effects of cancer including unspecified pain, neuropathy and fatigue. Kim co-founded Progressive Physical Therapy and Rehabilitation with Michael McKindley in October of 2004.
Resources discussed on this show:
Combined Sections Meeting: Oncology
Oncology Specialization
Star Program Oncology Rehabilitation
Physical Therapy Section on Oncology
Rehab Measures: Brief Fatigue Inventory
Lymphedema Quality of Life Questionnaire
Borg Scale
Fitbit
Bruce Protocol
Polar
You can reach Kim for any questions at her clinic Progressive Physical Therapy and Rehab by phone (714) 547-1140 or email kmarshallpt@att.net!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on the Top 10 Podcast Episodes of 2016!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Christine Gallagher joins me to talk about practical strategies for entrepreneurs to implement today! Speaker, trainer, bestselling author and award-winning business coach Christine Gallagher is founder of ShesGotClients.com, a company dedicated to teaching women around the globe how to find more meaning, fulfillment and purpose in their life through the power of entrepreneurship.
In this episode, we discuss:
-5 red flags that can tell you if you need to delegate
-What Christine calls “Genius Work” and methods of discovering your strengths
-How to develop and manage a team that compliments your business needs
-Christine’s favorite project management tools
-And so much more!
Entrepreneurial people often try to “do it all,” but a better strategy is to do what you are best at and delegate the rest. Christine advices, “Entrepreneurs who end up wearing all the hats start to feel like, ‘Well, even if I don’t know how to do this, it still needs to get done so I should do it.’ But if that keeps coming up, that's something you need to pay attention to… That's when you know that that needs to be delegated.”
Sometimes it can be easy for entrepreneurs to lose track of how much time they are putting into their work. Christine talks about exercises for entrepreneurs to rethink what they spend energy on and how they are compensated. She shares, “Think about what [you] are worth per hour doing [your] genius work. Genius work is what you love, what you’re extremely good at, what gives you energy instead of takes your energy away.”
As you develop your team, assessing strengths and assigning the right roles is key to getting the most value from each member. She stresses, “It really helps team members understand that they play an important role in the company and often because it's because of the strengths that they have.”
For more information on Christine:
Speaker, trainer, bestselling author and award-winning business coach Christine Gallagher is founder of ShesGotClients.com, a company dedicated to teaching women around the globe how to find more meaning, fulfillment and purpose in their life through the power of entrepreneurship.
Christine believes that when entrepreneurs find the courage to share their gifts and their message in a much bigger way, they will not only attract raving fans, enroll more clients, and enjoy more income, they also become a force for positive change in the world.
After applying Christine’s proven marketing methods, which she teaches via her Impact Academy and live workshops, her students and attendees typically experience a significant increase in subscribers, clients, sales and lucrative joint venture opportunities. Most importantly, they find a renewed sense of purpose and passion, allowing them to step into their bigger vision, connect to their “why” in order to serve at the highest level, and make a lasting, true impact in the world through a business they love.
The Huffington Post declared Christine to be one of “16 Brilliant Business Minds on Twitter,” she’s won the Bronze Stevie Award for “Business Mentor/Coach of the Year” for 2014, and she’s an Amazon bestselling author.
Christine is also an in-demand speaker, and has been featured in numerous publications such as We Magazine For Women, NewsDay, BlogHer, The Huffington Post, Social Media Examiner, and many more.
Resources discussed on this show:
Facebook group: Just Add Wifi Join to access the free 5 day challenge on how to build your tribe!
She's Got Clients Download the FREE guide: 5 Surefire Strategies to Escape the Dollars for Hours Trap
Asana
Google Drive
StrengthsFinder
Kolbe Assessment
Basecamp
Hire My Mom
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on the Top 10 Podcast Episodes of 2016
Happy New Year to the Healthy Wealthy and Smart family! To start off 2017, I had the pleasure of welcoming Dr. David Butler to the show to chat about his work, Explain Pain Supercharged, co-written by Dr. Lorimer Moseley. David is a clinician, an international freelance educator, an Adjunct Associate Professor with the University of South Australia and an Honoured Lifetime Member of the Australian Physiotherapy Association. His professional interests focus around the integration of neurobiology into clinical decision making and public and professional education in pain, stress and performance management.
In this episode, we discuss:
-David’s patient centered updates in Explain Pain Supercharged
-How the immune system and nervous system interact and impact pain symptoms
-David explains SIMS and DIMS and how to treat the patient more holistically
-Evidence for opioid alternatives that everyone possesses in their brain
-And much, much more!
Reconceptulizing pain as a protective signal instead of a marker of injury or disease is an important target concept to improve pain outcomes for persistent pain patients. David states, “The primary root metaphor out there has been pain is enemy. Therefore you see pain killers, war against pain, shotgun approach. It’s a big battle but we’re trying to change the primary metaphor to pain is protector so therefore pain softener, you can be sore but safe, hurt not harm and to get metaphors coming off this deeper, deeper conceptual metaphor.”
One of David’s goals of Explain Pain Supercharged is to create a digestible curriculum for patient education. David believes, “Knowledge is the greatest pain liberator of all.”
Physical therapists are at the forefront of empowering chronic pain patients with effective alternatives to pharmaceuticals. David stresses, “Your own drug cabinet in the brain can be more powerful than anything else.”
For more information on David:
David Butler is a physiotherapy graduate of the University of Queensland (1978). He has a graduate diploma in advanced manipulative therapy (1985), a masters degree by research from the University of South Australia (1996) and a doctorate in education from Flinders University (2010).
David is a clinician, an international freelance educator, an Adjunct Associate Professor with the University of South Australia and an Honoured Lifetime Member of the Australian Physiotherapy Association. His professional interests focus around the integration of neurobiology into clinical decision making and public and professional education in pain, stress and performance management. Food, wine and fishing are also research interests.
Author of numerous book chapters and articles and the texts Mobilisation of the Nervous System (1991), The Sensitive Nervous System (2000), David has also co-authored of Explain Pain (2003, 2nd Edn 2013), The Graded Motor Imagery Handbook (2012) and The Explain Pain Handbook: Protectometer(2015).
Resources discussed on this show:
noi group website
noi jam blog
Protectometer
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Take advantage of the Warby Parker offer here!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on the The Best Advice you Need to Know from Top Physical Therapists!
On this week's episode I am joined by Julie Sias, SPT. Julie is doctor of physical therapy student at Chapman University in Orange County, CA and has been one of the behind the scenes stars at Healthy Wealthy & Smart! Julie has been the perfect addition to the podcast and has been instrumental in the growth and quality of the podcast!
In this episode we discuss:
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Our favorite episodes and why we loved them
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Why collaboration is key in business and life
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The exact tools we use to produce the podcast each week
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How to find people to work for you virtually
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What we have in store for you in 2017!
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and much more!
The resources we talk about in this episode:
- Asana
- DropBox
- Rode Podcaster Microphone
- The Levelator
- BossJock
- Shure MV88 Microphone
- San Diego Pain Summit
- Kortne Parkman, marketing & strategic implementation
A huge thank you to all of the listeners of the Healthy Wealthy & Smart podcast! Your love has made this our best year yet and we want you to know that we appreciate more than words can say!
Thank you, thank you , thank you! We wish you all a very happy and healthy 2017!
xo
Karen, Julie and Kortne
On this week’s episode, Paul Potter joins me to chat about the elements of starting a cash practice from scratch. For more than 35 years, Paul Potter has successfully managed his own private practice and has authored On Fire: Ignite Your Passion with a Cash Therapy Practice and the Cash Practice From Scratch Course. He helps therapists fulfill their calling and create their own dream practice at his PaulPotterPT.com and CashPracticeFromScratch.com websites.
In this episode, we discuss:
-How to build an entrepreneur mindset and achieve professional freedom
-How to align your strengths with your ideal client base
-Why crafting a memorable patient experience will boost your practice and ultimately the profession
-The six essential steps therapists should take to launch a successful practice
-And so much more!
Paul encourages every therapist to build their own brand and style of care as a way to stay motivated. Paul states, “Every therapist should own their own practice whether in business for themselves or not.”
Competing in the marketplace comes down to one key factor. Paul stresses, “The therapist that will become a little bit more consumer focused and step out of the older models, save the best from the previous models and the heritage we have as a profession, and bring that into the new 21st century, those are the ones that will survive, do the best job and have the best patient experience.”
To have a sustainable business in the long term, crafting a memorable patient experience can be an important differentiator. Paul believes, “There is a consumer movement happening where they are taking control of their healthcare dollar.”
From Paul’s extensive experience, he has discovered that, “Private practice is born out of community and the more you can share that with accountants, my business friends, my wife, my good friends, those were so key in helping me launch a sustainable career that I still love 35 years later.”
For more information on Paul:
Paul is a physical therapist and mentor who lives in Nebraska with his wife, who is also a therapist. They have four daughters. For more than 35 years he successfully managed his own private practice. He now guides therapists on how to start up their own practice at his website PaulPotterpt.com and podcast.
Paul created the Cash Therapy Success Academy because he believes in the power and impact of therapy entrepreneurs creating small business. Therapy provided in large organizations is essential and make no mistake we need it. But the real magic begins with entrepreneurs –born with the unique gift to build successful businesses.
Paul knows what it's like to begin a start-up for less than $100 when he lacked the necessary finances and self-confidence. He experienced what it's like to start all over when devastated by a life threatening diagnosis. After managing his own private practice for over 35 years Paul knows how valuable it is to have the support and guidance from family, friends and experienced mentors.
The Cash Therapy Success Academy exists to help entrepreneurs like you create a fulfilling and profitable practice for yourself and those you care about. We provide quality resources and training through courses, books, and coaching found on the PaulPotterPT.com blog and Cash Therapy Success Academy.
Social Media Links:
Linked In
Resources discussed on this show:
StoryBrand by Donald Miller
Stay tuned for Cash Practice From Scratch launching January 3rd, 2017! Be sure to check out his blog for more great resources at PaulPotterPT.com. Paul welcomes any questions to his email heypaul@paulpotterpt.com.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on the Top 10 Podcast Episodes of 2016!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Christoph Trappe joins me to share how you can be an authentic storyteller in healthcare. Christoph Trappe (aka The Authentic Storyteller™) is a career storyteller who has worked as a journalist, a nonprofit executive, and a content marketing strategist and consultant. He is a globally-recognized content marketing expert who frequently speaks at marketing conferences about social media, blogging and results-oriented storytelling strategies.
In this episode, we discuss:
-Why healthcare practitioners should develop the skill of authentic storytelling
-How to promote your story to the world to make the largest impact
-Can ego sabotage your authentic story?
-How to craft a compelling and meaningful story
-And much, much more!
Christoph believes that differentiating your brand and attracting customer interest to your unique mission is the key to a successful practice. He stresses, “What it comes down to is whoever tells the best stories wins.”
Finding the best channels to disseminate your message is critical for growth. Christoph states, “Some people say it's not the best content that wins but it's the best promoted content that wins.”
While presenting to large audiences, Christoph discourages reliance on visuals and recommends stimulating a two-way dialogue. It is important to remember, “Story telling is a conversation even when people are not talking back.”
For more about Christoph:
Christoph Trappe (aka The Authentic Storyteller™) is a career storyteller who has worked as a journalist, a nonprofit executive, and a content marketing strategist and consultant. He is a global keynote speaker, frequent blogger and author. His digital initiatives have been recognized globally. He is currently helping hospitals across the United States share their authentic stories.
He is a globally-recognized content marketing expert who frequently speaks at marketing conferences about social media, blogging and results-oriented storytelling strategies. Some of his awards include:
- 2 on the global #hit100 of healthcare social media influencers (2016)
- 3 Content Marketing Account to Follow on Twitter for 2016
- Top 25 most interesting social media blogs in 2016
- Most Influential on the 2015 HIT99 Healthcare Social Media List
- IMA Marketer of the Year – 2015 and Best Blog – Community Engagement
- Top 10 content marketers on social media by Klout – 2016
- 100th Most Influential Marketer (Content Marketing World)
- 89th Most Influential Content Marketer on Twitter (Axonn Media, London)
- 5 content marketing expert to follow on Twitter by VEInteractive
- 14 (of 45) content marketer globally to follow (Mount Now)
- 2012 Corridor Business Journal Forty Under 40
- 2011 Freedom Festival Hero award (Cedar Rapids, Iowa) for community involvement
- 2007 one of three Young Iowa Journalists of the Year
- 2001 to 2005, numerous Iowa Associated Press Managing Editor reporting awards
Christoph sits on two global boards to advance the art and science of authentic storytelling content marketing:
- Content Marketing Summit Asia
- Internet Marketing Association International Executive Council
Content marketing in healthcare In his role as senior director of content marketing + content creation at MedTouch, Christoph and his team handle content writing across all sizes of website projects and advise healthcare brands across the United States on blogging, social media and eNewsletter strategies and how to align those strategies with patient/member/donor acquisition efforts. The team also partners closely with clients as needed to implement strategies. A key part of the team’s success is its internal engagement with physicians and leaders who actively request their guidance. The Content Marketing Institute has listed the team as a top global content marketing agency.
Resources discussed on this show:
Authentic Storytelling
Christoph's twitter
The Official Ted Guide to Public Speaking
Marketoonist
ZDoggMD Youtube
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Erin Jackson joins me to answer audience questions on healthcare law for physical therapists. Erin is a healthcare attorney, consultant, and health equity advocate. She also is a Managing Partner of Jackson LLP, a healthcare law firm in Chicago, and a Principal of Jackson & Co., a healthcare consultancy serving the compliance and business needs of providers and practices nationwide.
In this episode, we discuss:
-Why every independent PT practice owner needs a Privacy Policies and Procedures manual
-How to know if your practice falls under HIPAA rules and regulations
-Can referrals and profit sharing be kickbacks?
-Creative solutions for pro-bono work
-What a good legal representative should know and how to find the right one for your practice
-Everything you need to know about treating Medicare patients if you’re an out of network provider
-And so much more!
Before committing to your first job, Erin encourages reading the fine print to ensure it is the right fit for you. She recommends to not, “take one that really isn’t going to allow you to treat in the way that you have spent all this time educating yourself to treat. You really deserve to be in an environment that advances your profession and professional existence in a way that matches your vision and all of your hard work for the past several years.“
There is a conflict of interest when incentivizing current patients to refer others to your clinic. Erin states the consequences are, “It potentially thwarts the accuracy of information about the quality of the services when people are getting financial benefit.”
Hiring a healthcare lawyer is essential when incorporating your practice to avoid unnecessary challenges. Erin states, “The number one mistake I see people making is they have had their accountants set up their businesses. Now most of the time this is okay if you're opening a widget store however different rules apply to opening healthcare practices.”
For out of network providers, the argument for treating Medicare patients has high risk. Erin stresses, “If you're not in trial and you haven't been caught or gotten in trouble for this stuff, I would say most people's risk tolerance is way too low to tolerate this sort of risk… If you want to see Medicare beneficiaries, then take Medicare.”
For more information about Erin:
Erin Jackson is a healthcare attorney, consultant, and health equity advocate.
She is the Managing Partner of Jackson LLP, a healthcare law firm in Chicago, and a Principal of Jackson & Co., a healthcare consultancy serving the compliance and business needs of providers and practices nationwide.
In addition to her healthcare practice, Erin serves as the President of the nonprofit organization Inspire Santé. Using her healthcare knowledge and patient experience, she speaks to healthcare providers about the importance of maintaining a patient-centered practice. In the past year, she spoke at the APTA's Combined Sections Meeting, keynoted the Michigan Physical Therapy Association's conference, and appeared on podcasts like the APTA's MoveForward Radio. In 2017, she will be speaking at physical therapy conferences around the country and expanding her reach as an educator, consultant, and advocate.
Websites:
Jackson & Co. Healthcare Consultancy
Jackson LLP Law Firm
You can get more great insight from Erin on twitter and from her persistent pain blog here and health law blog here!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
Thanks for tuning in to this week’s episode of the Healthy Wealthy and Smart Podcast! Monique Costello joins me to chat about the healing nature of food. Monique Costello is a Certified Culinary Nutrition Expert, Integrative Holistic Health Coach and a Gourmet Cook who conquered her years of persistent pain with the very same element that fueled her passion, food.
In this episode, we discuss:
-Monique’s health journey with persistent pain
-The role of a health coach on a healthcare team
-How to utilize food to reduce inflammation and heal
-Monique’s timely tips for eating healthy during the holidays
-And much, much more!
Monique’s experiences with overcoming chronic pain have taught her the importance of positive thinking and challenging personal fears and limitations. She states, “If you're constantly thinking negative thoughts, there isn't a chance for positivity to win. It’s taking little ways of how we think and how we view the world and tweaking them. “
Monique is a strong believer that optimal nutrition and health looks different for everyone and requires self-reflection and experimentation. She recommends that you “Start to become a little more intuitive with your body and start to really notice what your body is telling you.”
Monique recommends pursuing mediation and personal growth to be the most optimal provider for your patients and clients. She stresses, “We don't stop and take time for ourselves… If you don't secure you first, you're not going to be able to help anyone else.”
For more about Monique:
Monique Costello is a Certified Culinary Nutrition Expert, Integrative Holistic Health Coach and a Gourmet Cook. After years of a debilitating break down of the body, chronic back pain and unexplained symptoms ranging from low energy, restless sleep and weight gain to dry skin, Monique found relief in the very same element that fueled her passion, food.
A champion recipe developer once featured on The Food Network, Monique now works as a health strategist through corporate wellness programs and a one-on-one coaching. She teaches Soma Institute's Health and Wellness certification program and healthy cooking classes at Kendall College along with hosting Clean Food Cleanse programs to help people recognize that food is medicine and it can heal you from the inside. Read more about Monique’s story at happyeatshealthy.com
Resources discussed on this show:
Entropy Physiotherapy Courses
Protectometer
If you’re interested in learning more from Monique, you can find more great resources on facebook, instagram, and twitter!
Sign up for the Happy Eats Healthy Newsletter and receive Monique’s 5 Sensational Summer Salads recipe at Happy Eats Healthy. You'll be the first to know about the launch of her online cooking classes as well!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Dr. Jamey Schrier joins me to discuss the tools necessary for an automated private practice. Jamey is a private practice physical therapy owner whose mission is to teach clinic owners exactly how to free themselves from their grueling daily work schedule, how to make more money and have more free time. With his book The Automated Practice: Success Secrets for Working Less and Earning More which has been an Amazon #1 best seller and his online education course, The Automated Private Practice, he has helped hundreds of owners with concrete strategies to automate and grow their business.
In this episode, we discuss:
-How Jamey transitioned from a clinician to a successful private practice owner
-The top three things that challenge private practice owners and what to do about them
-Why successful automation is mostly about building the right team for you practice
-The tools and technology Jamey uses to boost efficiency and grow his practice
-And much, much more!
Clarity is a key when transitioning from a clinician mindset to an owner mindset. Jamey stresses, “What do you want and how fast do you want it? Because we are in control, nothing else is controlling our future but us.”
Jamey believes that practical leadership is not accomplished through self-sacrifice but rather building a great team and effectively delegating duties. He states, “We can't do it all. So swallow your egos, swallow your pride, and be the real leader in your practice and bring great people on your team. Get people to take stuff off your plate that you don't like the most. Do it tomorrow—I promise you, it will come back to you 100 fold. “
If your goal is to ultimately automate your practice, one of Jamey’s biggest pieces of wisdom is, “You are not here to serve your business, your business is here to serve you. Build your business around you—build it around your superpowers, your natural ability, your passion. Build it around you and it will be the most successful business possible because you don’t serve the business well by doing things you don’t like, and frankly you’re not good at.”
For more information about Jamey:
In 2004, Jamey Schrier was facing the soul-crushing struggles of private practice ownership. He couldn’t figure out how to grow his business without sacrificing his family, income or time.
Armed with an insatiable curiosity, Jamey invested the next 9 years and over $300,000 to learn how to automate his practice. At the end of his journey, Jamey finally discovered the formula to creating a self-managed, profitable and stable practice that allowed more time with his family and more time to work “on” his business.
Today, Jamey is sharing his methodology and what he learned to practice owners all across the country. His book, The Automated Practice: Success Secrets for Working Less and Earning More, has been an Amazon #1 best seller and his online education course, The Automated Private Practice, has helped hundreds of owners with concrete strategies to automate and grow their business.
Today, Jamey spends most of his time teaching practice owners how to apply his methodologies through his revolutionary program called Lighthouse Leader.
As Jamey tells the story, a Lighthouse Leader is a professional practice owner committed to achieving personal freedom from the day the day stresses of business ownership without sacrificing income or quality of service. His unique approach combines sound business principles with best practices that he learned over 20 years in business. Jamey’s true gift is in his ability to share his wisdom in a fun, easy to understand and implement, way.
Jamey lives in the Washington D.C. area with his wife, Colleen, and two kids, Jack and Gracie. When not having fun with his family, you can find him on the basketball court, the golf course or reading in his favorite spot on the porch.
Resources discussed on this show:
Amazon: The Automated Practice: Success Secrets for Working Less and Earning More Get a FREE copy of his book from his website: The Automated Professional Practice!
Connect with Jamey on twitter and send any questions via email to jamey@jameyschrier.com!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S.!! Catch my interview on the Entrepreneur on Fire podcast with host John Lee Dumas! Subscribe here
And get the show notes here!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Dr. Jason Silvernail joins me for Part 2 of Ask Jason Anything! Dr. Silvernail is a Doctor of Physical Therapy who was selected for the prestigious Army-Baylor Doctoral Fellowship in Orthopedic Manual Physical Therapy at Fort Sam Houston for subspecialty training and graduated in 2010, earning him both a Doctor of Science degree from Baylor University and Fellow status in the American Academy of Orthopedic Manual Physical Therapists. A clinician and researcher, he has published clinical commentaries and original research in the medical literature including the Journal of Orthopedic and Sports Physical Therapy, Manual Therapy, and the Journal of Manual and Manipulative Therapy.
In this show, we discuss:
-The roadmap to a military physical therapy career
-Jason’s hiring process for seasoned professionals and new graduates
-How to translate the present body of knowledge into clinical practice
-Jason’s overall outlook for the physical therapy profession and advice for fresh PTs
-And so much more!
For more about Jason:
Jason Silvernail DPT, DSc, FAAOMPT qualified with a Master of Physical Therapy degree from the University Of Scranton Pennsylvania in 1997, and he has been in practice as a physical therapist since then. He completed his Doc tor of Physical Therapy Degree in 2006. He was selected for the prestigious Army-Baylor Doctoral Fellowship in Orthopedic Manual Physical Therapy at Fort Sam Houston for subspecialty training and graduated in 2010, earning him both a Doctor of Science degree from Baylor University and Fellow status in the American Academy of Orthopedic Manual Physical Therapists.
Dr. Silvernail is a board-certified Orthopedic Clinical Specialist (OCS) from the American Board of Physical Therapy Specialties and a Certified Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association.
He is a career military officer, practicing in the US Army since 1998, and has been stationed across the United States, Europe, the Middle East and in Afghanistan. Dr Silvernail has worked with a wide variety of patient populations and settings including orthopedic/sports, chronic pain, amputee and neurological rehabilitation, and strength and conditioning.
A clinician and researcher, he has published clinical commentaries and original research in the medical literature (including the Journal of Orthopedic and Sports Physical Therapy, Manual Therapy, and the Journal of Manual and Manipulative Therapy) and he has a prominent professional presence online where you can connect with him on Facebook or Twitter.
Dr. Silvernail is married to Carolyn T. Silvernail, who is a graduate student at American University with degrees in Exercise Science, Digital Film and in Music Performance. They live in the northern Virginia area and enjoy hiking, fitness, and ballroom dancing. Opinions expressed by Dr Silvernail are his own and do not represent the official policy or position of the United States Army, the Department of Defense, or the United States Government.
Resources discussed on this show:
Keith Smart Publications
Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy
The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model
Soma Simple
US Army-Baylor DPT Program
USA Jobs
San Diego Pain Summit 2017
Make sure to follow Jason on twitter and facebook for more great resources and conversations!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do’s and Don’ts of Social Media!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Dr. Jason Silvernail joins me for Part 1 of Ask Jason Anything! Dr. Silvernail is a Doctor of Physical Therapy who was selected for the prestigious Army-Baylor Doctoral Fellowship in Orthopedic Manual Physical Therapy at Fort Sam Houston for subspecialty training and graduated in 2010, earning him both a Doctor of Science degree from Baylor University and Fellow status in the American Academy of Orthopedic Manual Physical Therapists. A clinician and researcher, he has published clinical commentaries and original research in the medical literature including the Journal of Orthopedic and Sports Physical Therapy, Manual Therapy, and the Journal of Manual and Manipulative Therapy.
In this show, we discuss:
-How manual therapy is integrated into the biopsychosocial framework
-Rethinking the goals of your initial evaluation
-Strengths and limitations of a pain science perspective on patient care
-The roadmap to a military physical therapy career
-Jason’s hiring process for seasoned professionals and new graduates
-And so much more!
While Jason is a proponent for making advances in research, he also believes that there is more to gain from the existing literature to improve patient care. He challenges clinicians and researchers to “actually start using the evidence we already have. What can we do to build processes in our health systems to help us better integrate existing research evidence and clinical practice to make it relevant to clinicians, to make it relevant to payers, and to make it popular and effective for patients so patients start asking for it… What can we do to integrate and better use what we already know?”
Jason believes that there is a positive outlook for physical therapy and that the profession can fill a desired role in the current marketplace. He states, “Patients are looking for a low cost, low risk, non-invasive approach that they can have quick access to that is an appropriate match to their goals, that is matched to exactly what they want, and you can get what you want when you want it. There are not too many people in medicine that are offering something close to that, but PT is one of them.“
Utilizing the biopsychosocial framework for patient care has proven to be effective for Jason in his career. He advices, “One of the things I say the most to PT students is this job is half psychology and I used to think that my job was the evaluation, diagnosis and treatment of non-surgical musculoskeletal conditions. That’s actually not my job. I am in the business of behavior change. And if you’re a PT, you’re in the business of behavior change too. And the sooner you understand that and the sooner you start to work on your ability to help engage others for behavior change, the more success you will have in your profession. “
For more about Jason:
Jason Silvernail DPT, DSc, FAAOMPT qualified with a Master of Physical Therapy degree from the University Of Scranton Pennsylvania in 1997, and he has been in practice as a physical therapist since then. He completed his Doc tor of Physical Therapy Degree in 2006. He was selected for the prestigious Army-Baylor Doctoral Fellowship in Orthopedic Manual Physical Therapy at Fort Sam Houston for subspecialty training and graduated in 2010, earning him both a Doctor of Science degree from Baylor University and Fellow status in the American Academy of Orthopedic Manual Physical Therapists.
Dr. Silvernail is a board-certified Orthopedic Clinical Specialist (OCS) from the American Board of Physical Therapy Specialties and a Certified Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association.
He is a career military officer, practicing in the US Army since 1998, and has been stationed across the United States, Europe, the Middle East and in Afghanistan. Dr Silvernail has worked with a wide variety of patient populations and settings including orthopedic/sports, chronic pain, amputee and neurological rehabilitation, and strength and conditioning.
A clinician and researcher, he has published clinical commentaries and original research in the medical literature (including the Journal of Orthopedic and Sports Physical Therapy, Manual Therapy, and the Journal of Manual and Manipulative Therapy) and he has a prominent professional presence online where you can connect with him on Facebook or Twitter.
Dr. Silvernail is married to Carolyn T. Silvernail, who is a graduate student at American University with degrees in Exercise Science, Digital Film and in Music Performance. They live in the northern Virginia area and enjoy hiking, fitness, and ballroom dancing. Opinions expressed by Dr Silvernail are his own and do not represent the official policy or position of the United States Army, the Department of Defense, or the United States Government.
Resources discussed on this show:
Keith Smart Publications
Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy
The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model
Soma Simple
US Army-Baylor DPT Program
USA Jobs
San Diego Pain Summit 2017
Make sure to follow Jason on twitter and facebook for more great resources and conversations!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Nick Lucius and I chat about physical therapy wellness services. Nick is a Doctor of Physical Therapy and a Certified Strength and Conditioning Specialist working with Barwis Methods as an Applied Coach in Port St. Lucie, Florida.
In this episode, we discuss:
-How to transition from episodic care to wellness services
-The role of strength and conditioning in physical therapy services
-Nick’s thoughts on the Certified Strength and Conditioning Specialist
-How to develop a therapeutic alliance in a biopsychosocial model framework
-Advice for #FreshPTs
-And so much more!
When communicating desired outcomes to patients, it is important to stress the long-term wellness and quality of life aspects. He states, “have them understand that the goal is not to run you through the ground and to make you hurt, it’s really to empower you to live the rest of your life in the most positive and healthy way possible.”
In contrast to the biomedical approach to patient care, the biopsychosocial model can allow you to empower the patient and ultimately develop buy in for future wellness needs. He believes, “it really would benefit us to not look at us as a lifelong PT or lifelong clinician insinuating the mechanic, ‘Oh yeah, just come back to me and I'll fix you up.’ It's not like a car, you have feelings and emotions and thought processes, it muddies the water really fast, and that’s what really benefits having that wide range of education from strength conditioning to pain science to traditional physical therapy and that ties it all back in together.”
As a new graduate, Nick offers some advice for fresh PTs to, “Keep the hunger for knowledge and the hunger to really make substantial and life changing change for these individuals. When you get a couple of cases that might be discouraging or make you feel uncomfortable, everyone feels uncomfortable and at some point they got comfortable being uncomfortable, they got very used to having that hunger to try to keep driving to be better and better.”
For more about Nick:
Nick graduated from the University of Michigan with a Doctor in Physical Therapy in 2015. Previously Nick earned a Bachelors of Science from Grand Valley State University in Clinical Exercise Science in 2012. He is a Certified Strength and Conditioning Coach (CSCS) through the National Strength and Conditioning Association and CPR/AED certified through the American Red Cross. Nick began at Barwis Methods as an Intern prior to starting his DPT studies and is a Barwis Methods Applied Coach.
Make sure to follow Nick on twitter and facebook and find more educational materials at Barwis Methods where Nick is offering 10% off with the code: barwismethodHWS!
Resources discussed on this show:
Nick Winkelman Twitter
Mike Reinold Twitter
Kelly Starrett Twitter
Doc and Jock Podcast
Therapy Insiders Podcast
Essentials of Strength Training and Conditioning
Neuromechanics of Human Movement
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
P.S.S. Check out the inaugural Women in PT Summit here! Sign up now as space is limited!
Thanks for tuning into the Healthy Wealthy and Smart Podcast! I had the pleasure of chatting with Mike Connors about advocacy in physical therapy. Mike is a private practice physical therapy owner, an outside consultant for a professional ballet company in Fort Worth and an adjunct professor in orthopaedic physical therapy for the DPT program at the University of North Texas Health Science Center. In addition, Mike is the current President of the Texas Physical Therapy Association advocating regularly for the PT profession in Austin and DC on regulatory and payment policy issues impacting PT.
In this episode, we discuss:
-Levels of advocacy and ways to demonstrate the efficacy of physical therapy
-Mike’s pitch for APTA membership
-Mike’s initial wellness consultation and his focus on preventative care
-Advice to new professionals on empathy and preventing burnout
-And so much more!
Mike stresses the need for PT advocacy which can take many forms including calling an insurance company, talking to medical colleagues, and increasing awareness in the community in addition to legislative change. He states, “What did you do today that was in the patient’s best interest that the patient couldn’t do for themselves or didn't have the knowledge or the resources to do for themselves? We treat patients. We manage their complex presentations, but we do a lot more than I think we give ourselves credit for. That's a big part of why it is we don't have the widespread knowledge base about what we do because we don’t talk enough about what we do. PT has become the new fight club and the #1 rule of PT is not to talk about PT.”
Mike believes there are untapped candidates for physical therapy services due to public unawareness of the healthcare benefits. “Ironically, in private practice, we are sitting here all competing against one another for 20% of the pie and what we’re not seeing is another 75+% that’s out there that’s doing everything but physical therapy.”
Mike encourages entrepreneurship within physical therapy and recommends to continually strive for excellence. Mike advices, “Entrepreneurs are going to continually learn and evolve over time. Count your successes as much as you count your failures as long as you learn from them and you evolve then it was a worthwhile endeavor.”
For more about Mike:
Mike has a BS in Biology from Stockton College with a minor in Psychology (2001). His entry level degree in physical therapy is a Master of Physical Therapy from University of Medicine & Dentistry of NJ-Rutgers University (2003). Mike has a post professional Doctor of Physical Therapy degree from Temple University (2008). He became a board certified specialist in Orthopaedic Physical Therapy from the American Board of PT Specialties in 2011. Mike is currently finishing (ABD) the remaining requirements for completion of a PhD degree in Physical Therapy with an emphasis in applied biomechanics from Texas Woman's University (Anticipated completion 2016).
Mike began working with GTC in October 2004. He most recently rejoined the GTC family in June 2015 as the Director of the Fort Worth Clinic.
Mike's focus and specialization in orthopaedic physical therapy makes him an efficient clinician in managing patients with orthopedic dysfunction. He utilizes a multimodal approach to meet the needs of his patients and clients that include spinal manipulation, dry needling, KT taping, and various other interventions. Mike is certified in functional dry needling from Kinetacore. He has experience working with patients of all ages, from kids to adults and from the weekend warrior to the elite athlete. He is an outside consultant for a professional ballet company in Fort Worth and is an adjunct professor in orthopaedic physical therapy for the DPT program at the University of North Texas Health Science Center. In addition, Mike is the current President of the Texas Physical Therapy Association advocating regularly for the PT profession in Austin and DC on regulatory and payment policy issues impacting PT.
Mike is happily married to his wife Shannon. He enjoys spending time with his family, that includes two beautiful daughters. Mike enjoys staying active, running, traveling, exercising, biking, golfing and staying active in his faith community.
Personal statement: It's ALWAYS all about the patient. We exist as PTs to help patients move better with less pain. It's my pleasure to help patients achieve this goal on a day to day basis.
Social Media:
Greater Therapy Centers
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
P.S.S. Check out the inaugural Women in PT Summit here! Sign up now as space is limited!
On this week’s episode, I share the first part of my talk with Dr. Bronnie Thompson from one year ago on chronic pain management which will change the way you practice. Dr. Thompson has worked in the field of chronic pain management, helping people develop ‘self management’ skills for 20 years and has a passion to help people experiencing chronic health problems achieve their potential.
In this episode, we discuss:
-How to learn to live well despite chronic pain and her research on the 3 phases to reoccupy your self-concept
-How to incorporate values based pain management into your practice
-The value of motivational interviewing, the specifics of implementation, and why it’s not always about pain
-Why patience is key to a person-centered practice
-And so much more!
Healthcare providers should address the nature of chronic pain and the goal of treatment should be to educate patients on how to understand and manage their pain. Dr. Thompson found that for patients with chronic pain, “Hearing that this pain is likely to remain was a really important turning point for all the participants. So they stopped that search for the cure.”
Dr. Thompson promotes a psychosocial approach to learning to live well with chronic pain and making new sense of your self-concept. Dr. Thompson states, “When pain comes on, life becomes incoherent—it doesn’t make sense anymore. Your self-concept, the person that you think you are, suddenly goes. You can't rely on yourself to do the things that you used to be able to do and the expectations you have of yourself disappear. For a long time, people are sustained on this search to go back to the person they used to be. But 5, 10, 15 years later, they are never going to be that person. It’s about saying, ‘Who can I be now?’ The process of learning to live well is about recognizing, ‘I do need to let go of that desire to go back to my old self and look to build this new person.’”
One of the key aspects of learning to live with chronic pain is to find a sense of community and begin building new meaning in your life. Dr. Thompson states, “Carrying that invisible sort of separation, ‘I’m not who I used to be, I feel like I’m not who I used to be and yet nobody can see that’ is so isolating. It’s unbelievably isolating. To be able to say, ‘I can connect,’—what you do connects you with other people, the way you dress, the way you happen to tidy your house or not, the way that you drive—you’re going to look at other people and you’re going to say I'm like them or I'm different from them and that’s how we find our way.”
For more about Dr. Thompson:
I trained as an occupational therapist, and graduated in 1984. Since then I’ve continued study at postgraduate level and my papers have included business skills, ergonomics, mental health therapies, and psychology. I completed by Masters in Psychology in 1999, and started my PhD in 2007. I’ve now finished my thesis (yay!) and can call myself Dr, or as my kids call me, Dr Mum.
I have a passion to help people experiencing chronic health problems achieve their potential. I have worked in the field of chronic pain management, helping people develop ‘self management’ skills for 20 years. Many of the skills are directly applicable to people with other health conditions.
My way of working: collaboratively – all people have limitations and vulnerabilities – as well as strengths and potential. I use a cognitive and behavioural approach – therapy isn’t helpful unless there are visible changes! I don’t use this approach exclusively, because it is necessary to ‘borrow’ at times from other approaches, but I encourage ongoing evaluation of everything that is put forward as ‘therapy’. I’m especially drawn to what’s known as third wave CBT, things like mindfulness, ACT (Acceptance and Commitment Therapy) and occupation.
I’m also an educator. I take this role very seriously – it is as important to health care as research and clinical skill. I offer an active knowledge of the latest research, integrated with current clinical practice, and communicated to clinicians working directly with people experiencing chronic ill health. I’m a Senior Lecturer in the Department of Orthopaedic surgery & Musculoskeletal Medicine at the University of Otago Christchurch Health Sciences.
I also offer courses, training and supervision for therapists working with people experiencing chronic ill health.
Check out her blog HealthSkills for more great resources and follow Dr. Thompson on twitter, facebook, and LinkedIn.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
P.S.S. Check out the inaugural Women in PT Summit here! Sign up now as space is limited!
On today’s episode of the Healthy, Wealthy and Smart Podcast, Dr. Rachna Patel joins me to discuss common misconceptions of medical marijuana. Dr. Patel has been practicing in the area of Medical Marijuana since 2012 and step-by-step walks patients through how to use medical marijuana for their specific medical condition.
In this episode, we discuss:
-How medical marijuana functions in the body
-Conditions that can be treated with medical marijuana and surprising outcomes
-What the side effects of medical marijuana are and how to avoid them
- Alternatives to smoking medical marijuana
-Why lab-tested medical grade marijuana is very different from what’s found on the streets
-And so much more!
The therapeutic range for medical marijuana varies from patient to patient. A practitioner can help find the optimal ratio of the THC and CBD components of the plant which work best for the patient. Dr. Patel states, “You can adjust the effect that the medication will have on you based on the proportions of these different chemicals.”
One of the practical benefits of medical marijuana is the fact that, “These chemicals are fat soluble… Patients don’t have to take this medication every day. Once you take it, you have stores of it in your body.”
Medical marijuana has proven to be less addictive and have fewer side effects. From Dr. Patel’s clinical experience, there is growing evidence that medical marijuana could serve as a potential alternative to opioids. “When I was reading the research studies, a couple studies I came across said that when medical marijuana is used in conjunction with opioids, the marijuana helps to reduce the dose of the opioids that you have to use. What I found surprisingly, patients were able to come off of a lot of these pain medications and just use medical marijuana in its place.“
There are potentially many patient populations that could benefit from the use of medical marijuana. For some conditions like fibromyalgia, medical marijuana has revolutionized patient treatment plans. “I expected [medical marijuana] to be a part of the arsenal, I didn't expect it to be the only tool in the arsenal that these patients were using.”
For more information on Dr. Patel:
Dr. Rachna Patel has been practicing in the area of Medical Marijuana since 2012. She step-by-step walks patients through how to use medical marijuana for their specific medical condition. She completed her medical studies at Touro University College of Osteopathic Medicine and her undergraduate studies at Northwestern University. You can learn more about the work she does at www.DrRachnaPatel.com
Resources discussed on this show:
YouTube channel
How to Choose a Medical Marijuana Doctor.
Facebook Page: Listeners are welcome to ask questions on the page for Ask Me Anything on Wednesdays every week.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
P.S.S. Check out the inaugural Women in PT Summit here! Sign up now as space is limited!
On this week’s episode, I had the pleasure of discussing financial strategies for Doctor of Physical Therapy student loans with Joseph Reinke. Joseph Reinke is the CEO and founder of FitBUX, Inc which is introducing innovative finance products and technology to the student lending industry with a specific focus on physical therapists.
In this episode, we discuss:
-Why FitBUX is in the business of aiding human capital development
-Helpful and actionable strategies to manage student loan debt
-Options for new graduates in debt that want to start their own business
-Why student debt should not get in the way of a worry-free retirement
-And so much more!
Joe recommends starting as early as possible on the road to entrepreneurship if that is your long-term goal. “Even if you're a student and you know you're going to be an entrepreneur, start networking at all these events with people who have podcasts or have private practices. Get into that setting so all that human capital that you are developing is geared toward being that business owner because the more you do of that the higher probability you will be successful.”
Joe has found that finance is more about discipline and delaying gratification. Developing strategies to tackle financial obstacles can help provide the extra discipline needed. Joe states, “The other thing you’re doing that is even more important is you’re developing discipline. That’s one of the hardest things to do in finance. We want instant gratification on everything. It doesn’t matter what you’re doing in finance, it can be paying off your loan, saving for retirement, buying a house and paying that off—there is no instant gratification...”
Joe cautions his clients to consider the downside. The more prepared people are for unexpected shocks, the less they will struggle with financial obstacles. He recommends, “Keep it simple and strategize… The stress a lot of people get financially will be gone or it will be a lot less because you'll be prepared. That’s when I see a lot of people get into financial stresses. They just get hit with a tsunami at some time and they are not ready for it and that’s when you start seeing people stress out about money.”
For more about Joe:
Joseph Reinke is the CEO and founder of Fitbux, Inc. FitBUX is introducing innovative finance products and technology to the student lending industry with a specific focus on physical therapists. Thus far in FitBUX’s beta test, they have helped PTs develop financial strategies on over $11mn in student loans. Joe has been in the finance industry for over a decade and is one of the few CFA Charterholders in the world who has experience in both wealth management and business valuation (globally, there are only 120,000 CFA Charterholders). He has hosted numerous live chats about student loans with SPTs across the country, presented at the California Student Conclave, appeared on podcasts, and written numerous financial blogs.
Resources:
FitBUX: Sign-up for the beta test that is testing FitBUX technology to help answer SPTs and DPTs questions about student loans such as “do I invest or prepay my loans?”, “do I pay down my loans or go onto a Federal Income Driven repayment plan?”, “what are my refinancing options and should I refinance?”…And the beta test is FREE!
FitBUX Blog for Physical Therapists
FitBUX Blog on Finance
FitBUX videos on student loans
PT Pintcast Episode
NewGradPT: How Physical Therapy Careers are Changing
Social Media:
FitBUX Twitter
FitPT Twitter
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
P.S.S. Check out the inaugural Women in PT Summit here! Sign up now as space is limited!
On today’s episode of the podcast, Sarah Ecker PT, DPT, PRPC joins me to discuss the STAND (Sustainable Therapy And New Development) Haiti Project which is a nonprofit organization working to provide continual, orthopedic care to Haitian communities most in need. Sarah is a physical therapist specializing in pelvic health and has been traveling the country as a "Travel Therapist," working in some of the United States’ most impoverished communities. Sarah is STAND's Director of Pelvic Health and is continuing to help further the mission of STAND and ensure that women in Haiti have improved access to pelvic health and education.
In this episode, we discuss:
- What is the STAND Haiti Project and how you can get involved
-How Sarah’s pelvic health specialty led to surprising insights while volunteering in Haiti
-How language and cultural barriers impact your treatment
-Advice for physical therapy volunteers traveling abroad
-And so much more!
While volunteering in Haiti, Sarah began to realize that her pelvic health training was in need for this female population. She states, “Are the infections prevalent and common there? Sure, but also with chronic infection comes chronic tissue changes. We were definitely seeing a lot of prolapse, general pelvic floor dysfunction, different tissue changes, and incontinence. Things that are very common ailments I've seen in patients in the States. Just no one has ever really examined these women before. There is really very little, if any, gynecologist care or care surrounding pregnancy.”
After breaking through the language and cultural barriers, Sarah discovered that many Haitian women were not being treated for common pelvic health issues. She then set out to lead a team to focus specifically on pelvic health treatment. Sarah believes, “This is a population we can do something about. Once we started having that conversation and digging a little deeper with the women we were seeing that were in child bearing ages, it was really coming to the surface that they think this is normal, and this is okay, and this is something they have to live with.”
Empowering the Haitian women by educating them on pelvic health dysfunction was important to reaffirm their experiences. Sarah discovered, “I think this was a game changer when I said, ‘We see patients like this all the time in the United States. I treat these patients all the time. These are normal symptoms that happen with different life changes and experiences as a woman going through pregnancy and childbirth.’ Just to see the look on their faces when their like, ‘Oh, this is not just me. This is not my fault that I have these problems.’”
Once cultural barriers are broken and patient-therapist trust is built, educating patients can lead to breakthroughs. She stresses, “The most powerful, impactful thing you can do is to just start the conversation. It has to start with you because you’re the clinician and you have the information regardless of whether you have trepidation around even breaching the topic in cultures that stigmatize sex or pelvic health or embarrassing issues more than we do in our native countries… it's really just educating, disseminating the information, letting people know these are common problems and it’s not their fault and most importantly you can do something about it. That's the message that translates through any culture and any population.”
For more information about Sarah:
Sarah Ecker, PT, DPT, PRPC received her Doctor of Physical Therapy degree from New York University in 2011 after working for several years in the science, medicine, and technology department of a publishing company in the New York City area. She fell in love with pelvic health early on in her physical therapy career and worked in the NYC area at a specialized practice during which time she received her Pelvic Rehabilitation Practitioner Certificate from the Herman and Wallace Institute. For the last few years, Sarah has been traveling the country as a "Travel Therapist," working in some of our nation's most impoverished communities in just about every setting imaginable. Last year, Sarah discovered STAND: The Haiti Project, volunteered for 2 weeks in May, and instantly fell in love with the project, the people of Haiti, and the amazing co-founders of the organization, Morgan Denny and Justin Dunaway. Sarah is committed to continuing to help further the mission of STAND, and as STAND's Director of Pelvic Health will help to ensure that women in Haiti have improved access to pelvic health and education. When Sarah is not working and traveling, she enjoys- well... traveling, cycling, anything that gets her outdoors, playing guitar, spending time with family, and home-brewing delicious craft beer.
For more information on STAND:
STAND (Sustainable Therapy And New Development) believes that freedom from pain and disability is a basic human right, not a privilege. In rural Haiti, only the highest socioeconomic class can afford medical care, but most people do not have access at all. This lack of access to the most basic care leads to widespread suffering from disabling pain and injury. These unaddressed ailments engender an environment where people lack the ability to work, farm, and care for themselves and their families. The social effects of this lack of care and community support are too often poverty, famine, and even death. By providing access to rehabilitative care, STAND aims to decrease disability and reverse its social effects on the populace. As a result, Haitians will be able to work, provide for their families, contribute to their communities, and ultimately enjoy a higher quality of life.
STAND: The Haiti Project is a 501(c)3 nonprofit organization working to provide continual, orthopedic care to Haitian communities most in need. To accomplish this, STAND will equip local health workers with a rigorous orthopedic curriculum. A competent team of Haitian practitioners will be able to provide relief from disabling pain and injury at STAND facilities year-round, allowing people to return to productive, happy, and fulfilling lives. You can give a man a fish, or you can teach a man to fish. We do both.
During our trips to Haiti, we work to restore people's functional mobility by providing comprehensive evaluation and treatment for a variety of conditions and injuries. Many have experienced traumatic and injurious events with no assistance or counsel from trained medical providers. Others are children born with orthopedic or neurological conditions. Each and every one of these people deserves a safe environment in which they can access quality and professional care. STAND provides manual physical therapy, wound care, patient education, orthotics, and the fabrication of prosthetics to meet the diverse needs of its patient population. Volunteer teams consisting of physical therapists, orthotists, prosthetists, general medical staff, educators, and students work to deliver these services to the highest standard. STAND also provides outreach programs to local hospitals, schools, orphanages, and assisted living facilities.
Ultimately, our clinics will be staffed year-round by STAND trained Haitian clinicians.
Sarah welcomes your questions via email (sarahecker123@gmail.com) to find more information on the winter trip with the STAND Haiti Project! Make sure to connect with Sarah on LinkedIn!
Check out the episode with Dr. Justin Dunaway and Dr. Morgan Denny about the STAND Haiti Project here!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
On this week’s episode, Dina Behrman joins me to share strategies for healthcare professionals on how to utilize publicity and public relations. Dina is a journalist-turned-publicity coach who is passionate about empowering business owners to get the best kind of publicity for their business to raise their profile, position themselves as an expert, build their brand, find new opportunities, reach new audiences, put their prices up and help more people.
In this episode, we discuss:
-Why you should start calling yourself an expert
-How introverts can break personal barriers and promote their brand
-How to pitch to the media and gain your brand access and coverage
-Dina’s top tips for attracting more publicity
-And much, much more!
The media often selects authority figures who are “experts” on a topic or field. As a healthcare professional, you have expertise and must learn to communicate and represent yourself as an expert. Dina suggests, “The main thing is to start seeing yourself as an expert, because especially if you're a health entrepreneur and you’ve got that expertise in a particular area then you want to be pitching yourself to the press as an expert and as someone who can talk knowledgably about a subject. A lot of people have an issue calling themselves an expert and it’s almost like they need someone to come along and say, ‘Yes, you're an expert’ as opposed to feeling very confident about saying you know what I really know my stuff.”
Sometimes introverts can be preoccupied with their own discomfort to pitch to a journalist. Dina suggests instead focusing on the huge benefits your expertise can provide to so many people. Dina recommends, “Having a bit of a mindset shift and thinking about it from the point of view of coming from a place of service and thinking whatever it is that you're sharing, if it’s your knowledge and your expertise that's going to be helping other people... The people that read that, it’s going to have a huge impact on them it’s going to really help them and the reason for getting that PR and publicity is that you can reach so many more people than you would be able to reach normally. So there is the potential for you to be helping so many more people and you’re doing something really good in the world by getting publicity and sharing your knowledge and your expertise and your experiences.”
Starting your publicity journey doesn’t have to be complicated. Often the very basics of your education are immensely valuable to the public and can start the conversation. “You only need to be a couple of steps ahead of the people you are talking to to be of help to them… Journalists can't possibly know all of the ins and outs of your industry the way that you do and so you're going to know more than they do and you're going to be useful to them… They don't have those years of training and everything that you have. There is so much value you can give even if it seems like it’s the basic level.”
For more information about Dina:
Journalist-turned publicity coach Dina Behrman is a PR and publicity expert who works with female entrepreneurs who are struggling to take their business to the next level. She helps them get their business seen and heard in the media so they can share their story and help more people, whilst gaining more followers, raising their prices and making more sales. She has featured as a PR expert in The Guardian, BBC Radio, Huffington Post, Raspberry Magazine, BussinesZone, YFS, Prowess, Women Unlimited, Business Rocks Magazine, amongst others. Click here to download her media kit.
To get in touch, email her on dina@dinabehrman.com or click here to fill out a contact form.
Find Dina on social media: Facebook Twitter Pinterest LinkedIn
Make sure to grab her free publicity prep cheat sheet and check out her group program Business Fame School!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
P.S.S. Check out the inaugural Women in PT Summit here! Sign up now as space is limited!
Thanks for tuning into the Healthy Wealthy and Smart Podcast! On this week’s episode, Dr. Christian Barton joins me to discuss the running retraining program. Dr. Barton is a physiotherapist in Melbourne, Australia who has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals and he is also an Associate Editor for the British Journal of Sports Medicine.
In this episode, we discuss:
-Current evidence on the optimal foot strike pattern
-Do traditional PT interventions have a place in a running retraining program?
-How to configure a physical therapy plan of care for limited office visits
-Managing expectations on recovery timeframes for runners
-The growth in wearable devices and how to use them in your practice
-And much more!
An important aspect of running retraining is educating patients on how they can self-modulate their technique while they run. Dr. Barton states, “When you're doing running retraining, it’s not trying to dictate the way someone runs for an entire run, but it’s giving them options that they can use throughout that run and try things. Often, if they do try these things, they can find a happy ground where they can run pain free again.”
Offering the most value to patients with limited office visits can be challenging. Patient education is integral so you can prioritize exercise rehabilitation and running retraining during your treatment sessions. Dr. Barton believes, “Most runners are incredibly motivated… If you’re giving them value in terms of their running and you’re giving them great guidance with their rehab and great guidance with their running technique and they can see that after a few months, they will probably pay for another couple of sessions to follow up and keep progressing things.”
Managing expectations and setting realistic goals is important for optimal patient satisfaction and outcomes. Dr. Barton stresses, “You have to talk to your patient. It’s about a shared decision process. I don’t think we get to dictate to every patient exactly what they need to do. We need to ask them that question at the beginning—what is the most important thing for you moving forward? Is there a short term goal you really, really want to get to... At the end of the day, it's about patient choice and working with them to their goals.”
The growth in technology allows physical therapists to make better clinical decisions and help with patient buy-in. Dr. Barton states, “[Technology] is just a great facilitator and a great way of measuring things. It’s educating the patient as well. It’s not only your analysis but it’s also your ability to educate the patient on what’s going on.”
For more on Dr. Barton:
Dr. Christian Barton is a physiotherapist who graduated with first class Honours from Charles Sturt University in 2005, and completed his PhD focusing on Patellofemoral Pain, Biomechanics and Foot Orthoses in 2010. Dr Barton’s broad research disciplines are biomechanics, running-related injury, knee pathology, tendinopathy, and rehabilitation, with a particular focus on research translation.
Dr. Barton has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals, and he is an Associate Editor for the British Journal of Sports Medicine.
Resources discussed on this show:
British Journal of Sports Medicine
British Journal of Sports Medicine Facebook
British Journal of Sports Medicine Podcast
British Journal of Sports Medicine App
Conversation with Dr. Claire Hiller
Hudl App
Kinovea Program
Coach's Eye App
Garmin Foot Pod
La Trobe University Sport and Exercise Medicine Research Centre Twitter
La Trobe University Sport and Exercise Medicine Research Centre Blog
La Trobe Sport and Exercise Medicine Research Facebook Group
Running Physio Twitter
Make sure to follow Dr. Barton on twitter to get exposed to more on the latest research!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
Happy Labor Day to the Healthy Wealthy and Smart Podcast family! On today’s episode, Amanda Goldman-Petri joins me to discuss how systems can lead to independence and where your business may land on the wealth pyramid. Amanda is the founder of MarketLikeANerd.com and an internationally renowned “Work Smarter, Not Harder” Online Marketing Coach for entrepreneurs who want to maximize their profits while minimizing the amount of time and effort they put into their business.
In this episode, we discuss:
-Amanda’s life experiences and how she broke from the fee-for-service ceiling
-How to create organized systems that delegate tasks properly
-What is the wealth pyramid and how to achieve the end stage of wealth
-Goals and actionable steps for each stage of the wealth pyramid
-And much, much more!
Fee-for-service businesses like physical therapy have a scalability challenge. Creative solutions are key to working smarter not harder and moving up the wealth pyramid. Amanda recommends to, “Shift from the one-on-one to the leveraged offer because that’s better for long term sustainability and start automating your marketing because sales, while they are great in the short term for fast cash, are manual and time intensive. The more you can automate your marketing going into leveraged offers, the more scalable and sustainable your business is going to be.”
A capable team is integral to gaining more control over your time commitment to your business. From Amanda’s experience, “I really like delegating as much as possible in my business not just because I believe it is the most scalable way to do it but because it frees me up to do those things that I really, really love.”
Understanding each stage of the wealth pyramid allows entrepreneurs to get a sense of how they should be prioritizing their goals. Amanda states, “There are a lot of business owners who get into business because they want to make an impact on the world but they are so consumed with the need for them to pay themselves, the need for them to make money, that they never have that opportunity to feel released enough to focus on how their business can serve a greater purpose. I think ultimately that’s where most business owners would love to be.”
It’s common for business owners to think that hard work is the only way to success and independence however that mindset should only be temporary. Amanda believes, “We become accustomed to this idea that things have to be hard, that you have to sacrifice, that you have to hustle, and business has to be difficult… As long as you work smarter, you can make more money with less effort and it can make your business feel seamless.“
For more on Amanda:
Amanda is the founder of MarketLikeANerd.com. She is an internationally renowned “Work Smarter, Not Harder” Online Marketing Coach for entrepreneurs who want to maximize their profits while minimizing the amount of time and effort they put into their business. After overcoming poverty, child abuse, rape, teen pregnancy, and near death, Amanda was able to persevere and create her first $10K month within 4 months at the age of 22. She generated over $150K in her next business within 4 months at the age of 23, and in her first Market Like A Nerd launch she generated over $120K in 90 days while also expanding her business to 19 different countries.
She has helped clients turn $700 into $100K using Facebook ads, $300 into $16K using webinars, and sell out coaching programs completely within 90 days using free Facebook Group marketing strategies. Amanda has featured on major media outlets such as Small Business Trendsetters, ABC, CBS, NBC, FOX, The Huffington Post, Worth Magazine, International Business Times (and more) for her unique and nerdy approach to marketing. If you want to discover how to make more money while working less so you can screw hustle, screw sacrifice, and create a financially-free life full of impact and freedom, Amanda is the expert you need to talk to.
Resources discussed on this show:
Balanced Entrepreneur Facebook Group Community
Webinar: Welcome 50 ideal clients in 90 days
Follow Amanda on Facebook, twitter, and LinkedIn and check out all of the amazing programs on her website Market Like a Nerd!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog po
On this week’s episode of the podcast, I welcome Dr. Evangelos Pappas back onto the show to discuss current research on ACL rehabilitation. Dr. Pappas is a Senior Lecturer within the Discipline of Physiotherapy with expertise in sports medicine and musculoskeletal physiotherapy at the University of Sydney. He has published extensively in journals in sports medicine, musculoskeletal physiotherapy and biomechanics and he has presented his work in more than 50 national and international conferences. Dr. Pappas research passion is to develop programs that effectively prevent lower extremity injuries and identify rehabilitation techniques that provide optimal outcomes for injured athletes.
In this episode, we discuss:
-Biomechanical deficits that predispose athletes to ACL injury
-Treatment interventions and screening assessments for return to sport that reduce the likelihood of re-injury
-Training programs on ACL injury prevention
-Wearable technology’s impact on future ACL injury statistics
-And so much more!
Dr. Pappas is critical of physical therapy interventions that do not address deficits that could predispose the athlete to re-injury. He stresses, “Even though it is relatively easy to rehabilitate somebody after an ACL reconstruction in terms of regaining strength, range of motion, and even some proprioception, and even getting them ready for sports, I would strongly argue we are providing a disservice to this patient if we don't take it a step further and try to identify the biomechanical deficits that would potentially predispose them to an ACL tear and try and rectify those…”
ACL injuries not only affect the athlete at the time of injury and throughout rehabilitation but also may lead to lasting adverse health effects. Dr. Pappas states, “You have an athlete with an ACL tear at age 16 who develops osteoarthritis because that commonly happens within the next 10-15 years… They’re supposed to be in their most productive years and there are not many good choices because they are too young for a total knee replacement and their knee related quality of life is similar to someone who is 70 or 80 years old. We are very passionate about preventing those injuries because once they happen there are things we can do to prevent it from getting worse or getting another injury but just the fact that it happens it can really be a life defining event.“
The FIFA 11 + is a successful injury prevention program because it is incorporates an easy-to-follow dynamic warm-up into the daily practices of athletes. “The athlete does a 10 minute warm-up, they will have to do it either way. They have a choice of doing something that is ineffective like static stretching or they have the choice of doing something that is probably a little bit more fun and also effective… The same exercises that prevent the injuries are also good at making athletes run faster or jump higher and have a competitive advantage over their opponents.”
New research has found that athletes who have deficits in the single hop test still present a year post ACL reconstruction have a higher likelihood of re-injury. Dr. Pappas cautions, “Almost nobody should be returning to sport before 9 months after an ACL reconstruction. The knee will feel okay, especially if they had some allograft with no other side morbidity, but it's the job of the PT to discourage and convince the athlete to not return to sport earlier than 9 months after the ACL reconstruction.”
For more on Dr. Pappas:
Professor Evangelos Pappas trained as a physiotherapist in Thessaloniki, Greece before pursuing a Masters in Orthopaedic Physical Therapy at Quinnipiac University and a PhD in Orthopaedic Biomechanics at New York University in the USA. Prior to coming to the University of Sydney, He taught for 11 years at Long Island University-Brooklyn Campus in kinesiology, clinical decision making and musculoskeletal pathology and physiotherapy. His excellence in teaching was recognized by his nomination for the Newton award for excellence in teaching. A/Professor Pappas joined the University of Sydney as a Senior Lecturer in 2013 where he continues to lecture in the areas of musculoskeletal physiotherapy, and particularly as it relates to the upper and lower extremities.
Professor Pappas is also active in musculoskeletal research. His research has been funded by the National Institutes of Health and intramural grants. He has presented his work in more than 50 national and international conferences and he has been interviewed on the radio as an expert on knee injuries. His publications appear in top journals in the fields of physiotherapy, sports medicine and biomechanics. One of his publications received the T. David Sisk award for best review paper from Sports Health; a leading multidisciplinary journal in sports medicine. In addition, A/Professor Pappas has served on the research subcommittee of the awards committee of the American Physical Therapy Association.
Resources discussed in this show:
Dance Research Collaborative
University of Sydney: Evangelos Pappas
FIFA 11 +
Kyritsis, Polyvios, et al. "Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture." British journal of sports medicine (2016): bjsports-2015. Link: http://bjsm.bmj.com/content/early/2016/05/23/bjsports-2015-095908.abstract
Myer, G. D., Martin, L., Ford, K. R., Paterno, M. V., Schmitt, L. C., Heidt, R. S., ... & Hewett, T. E. (2012). No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction evidence for objective return-to-sport criteria. The American journal of sports medicine, 40(10), 2256-2263. Pubmed link: http://www.ncbi.nlm.nih.gov/pubmed/22879403
Make sure to follow Dr. Pappas on twitter and facebook! You can reach out to him with your questions via email evangelos.pappas@sydney.edu.au! Listen to Dr. Pappas first discussion on the show here!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
On today’s episode, I had the pleasure of welcoming Dr. Richard Severin PT, DPT, CCS back onto the show to address audience questions on pursuing a terminal degree and entering the world of academia. Dr. Severin is a physical therapist currently pursuing his PhD in Rehab Science at the University of Illinois at Chicago with a focus in cardiovascular physiology.
In this episode, we discuss:
- What it takes to get accepted into the right PhD program for you including how to find a mentor and develop a competitive advantage
-Differences between each terminal degree and their job prospects
-Is it possible to manage DPT debt and clinical work while you pursue a PhD?
-The changing academic world and growth in the job landscape
-And so much more!
The ideal PhD program for you comes down to finding the right mentor. Dr. Severin’s advice is to, “Find someone who does research that you are interested in. The PhD really is mentor driven. Usually if you’re considering going down that road, you have a list of researchers or authors you follow—you kind of know who they are already. So that’s the first step, finding the person. If you have discourse with them, reach out to them. And if not, you're not going to get a negative response from cold emailing and just say, ‘Hey, these are my interests, I would consider applying here, what are your opportunities?’”
Dr. Severin believes that the academic world is allowing for more entrepreneurial pursuits to support your income. He states, “You’ve got to eat what you kill. You’ve got to find ways to find revenue. Historically, patents weren’t something that contributed to rank and tenure and now they are starting to count. Social media is going to be a bigger thing now... Academia is starting to wisen up—which I think is good.”
Before applying to a PhD program, develop research experience to show that you can bring value. Dr. Severin recommends to, “Get a little bit of a taste of what it means to work in a lab before you commit yourself to 3 to 5 years of it. And that will look good on your application. There are usually 1 or 2 spots in most places, and if it’s a good lab with good researchers those are going to be very competitive spots. Sometimes even if it’s a smaller lab, funding is a scarce resource. It gives you a little bit of a taste, gives you an expectation of what you're going to be doing, and it also shows you can do certain things. A lot of times it is what you can contribute to our lab, goes back to those scarce resources, they want to bring in people who are going to contribute.”
Dr. Severin is optimistic about the prospects of researchers and clinicians bridging together to validate clinical practice with evidence. “There is so much [data] out there that if we can find a way to harvest that data, process it, that’s going to be huge for us. When we talk about proving our worth, imagine if we could get all the outcomes from all of the PTs and find out what is going on here, we can really have some strong numbers that can combat different organizations or insurance companies who are trying to take away our reimbursements.”
For more about Dr. Severin:
Dr. Severin is a physical therapist and ABPTS certified cardiovascular and pulmonary specialist. He completed his cardiopulmonary residency at the William S Middleton VA Medical Center/University of Wisconsin-Madison which he then followed up with an orthopedic residency at the University of Illinois at Chicago (UIC). Currently he is working on a PhD in Rehab Science at UIC with a focus in cardiovascular physiology. In addition to research, teaching and clinical practice regarding patients with cardiopulmonary diseases, Dr. Severin has a strong interest in developing clinical practice tools for risk assessments for physical therapists in a variety of practice settings. He is an active member within the APTA and serves on the social media committee and Heart Failure Clinical Practice guideline development team for the cardiopulmonary section.
His research interests include: Assessment of cardiovascular risk in orthopedic physical therapy patients, hemodynamic responses to orthopedic rehab, Heart Failure, End Stage Lung Disease, Transplant Rehab, Exercise Physiology, Sport Performance, Peripheral muscle changes with cardiopulmonary and metabolic diseases, Tendinopathy
Resources discussed on this show:
List of PhD programs
UIC Integrative Physiology Laboratory Twitter
Clinical Rehabilitation and Technology Research Certificate
Rehab Review Youtube Channel
You can find more from Dr. Severin on twitter, facebook, and his website PT Reviewer!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!
On this week’s episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Claire Hiller to the show to introduce us to dance medicine and how physiotherapists can break into the industry. Dr. Hiller is a physiotherapist specializing in dance injuries and her current research interests at the University of Sydney include further development of the Cumberland Ankle Instability Tool, prevalence and impact of chronic ankle problems, predictors of chronic ankle instability, dancers' lower limb injuries, and dance footwear.
In this episode, we discuss:
-Common injuries of the spine, knee, and ankle seen in dancers
-In-depth analysis of the lateral ankle sprain vs the high ankle sprain and differential diagnosis
-Pre-pointe assessments and when to give your dancer the green light
-How a medical professional can effectively collaborate with dancer, dance teacher, and parent
-And so much more!
Dr. Hiller encourages physical therapists to pursue their interest in dance medicine by taking continuing education courses regardless of their current background. She states, “Physical therapists and other allied healthcare professionals are trained to watch people move… Dancers are very forgiving, if you even show a glimmer of the fact that you have an understanding of just the basics that go into dance, and you know what to look for and how to look for it, and you understand the body and how it moves and how it all connects, then you can be just as good if that’s the field you want to go into.”
In dancers, lateral ankle sprains usually don’t occur in isolation and a full ankle assessment is necessary for a realistic prognosis back to sport. From her experience, Dr. Hiller has found, “Dancers will often do something at the base of the outer part of their foot. Dancers can also have a high ankle sprain component again because they are coming down from a [demi-pointe position] and that’s often missed. People will go back far too soon if they have that. It’s a really important injury to stay longer off than even your lateral ankle sprain.”
Dr. Hiller believes that parents should be tuned into their child’s complaints of pain and advocate early on for preventative care. “Some ways of training is you power on through everything. The life of a dancer is to live with pain, to be able to cope with pain. When you have pain, it is nothing unless you’re laid out on the floor and can hardly move. If your child is complaining of pain, and their consistently complaining of pain, don't wait till they are nagging you that they’re having pain. Listen to them when they start to say they have pain in my back, pain on the side of my knee, pain in my ankle, pain in my foot.”
Physical therapists have the training to facilitate a safe progression to pointe. Dr. Hiller illustrates this role, “A pre-pointe assessment is about whether your child is actually ready for that step of putting your pointe shoes on. It’s not just about being able to put the pointe shoes on and balance, you’ve got to be able to have the strength and the control at a certain level before you can safely get up on your pointe shoes. And not just safely, once you get up there and actually be able to do something and enjoy it.”
For more about Dr. Hiller:
Dr. Hiller has been awarded a Postdoctoral Fellowship at the University of Sydney to study ankle sprain and instability. Her current works aims to build on her doctoral studies which included: the development of the Cumberland Ankle Instability Tool (CAIT), an objective measure of functional ankle instability; finding bilateral changes following unilateral ankle sprain; and proposing a modified model of chronic ankle instability. Dr. Hiller is also a practicing physiotherapist with a special interest in dance injuries. She has been involved in convening specialist interest days at the International Association of Dance Medicine and Science Annual Meetings and recently co-convened the 4th International Ankle Symposium.
Current research interests include: further development of the CAIT, prevalence and impact of chronic ankle problems, predictors of chronic ankle instability, dancers' lower limb injuries, and dance footwear.
Resources discussed in this show:
International Association for Dance Medicine and Science
Harkness Center for Dance Injuries
Dance Movement Therapy Association of Australasia
National Institute of Dance Medicine and Science (NIDMS)
Ausdance
Healthy Dancer Canada - The Dance Health Alliance of Canada
Performing Arts Medicine Association (PAMA)
Articles mentioned in today's podcast:
1) Liederbach MJ et al (2008) Incidence of anterior cruciate ligament injuries among elite ballet and modern dancers. American Journal of Sports Medicine 36: 1779-1788
2)Sman AD et al (2015) Diagnostic accuracy of clinical tests for ankle syndesmosis injury British Journal of Sports Medicine 49:323-329
3) The Hazards of Ankle Sprains NYT July 25th 2016
Dr. Hiller invites you to reach out via email (claire.hiller@sydney.edu.au) and connect with researchers, clinicians and students interested in dance related research at Dance Research Collaborative!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!
Thanks for tuning in to the Healthy Wealthy and Smart Podcast! Coming to you from Chicago, Drs. Sarah Haag, Sandy Hilton, and Jason Falvey join me for Part 2 on our discussion all about sex! You can check out Part 1 from CSM in Anaheim, California here in case you missed out!
In this episode, we discuss:
-Broaching the subject of sex with your patients
-Recalibrating sex after surgery and childbirth
-Rising rates of sexually transmitted diseases in the older adult population
-How a bladder diary can help those with persistent UTI
-And much, much more!
Sex has multiple health benefits outside what is commonly perceived and can be utilized as exercise. “There is so much that sex is good for cardiovascularly, musculoskeletally. It’s just awesome for so many reasons mentally. When we talk about population health and things that keep people moving and happy—that’s a good one.”
Sex is an important activity of daily living and can be a tool for clinicians to implement into their home exercise program. “Pleasurable movement is one of the things that help you get back to normal movement. So if you can make this make sense and feel good, it’s probably going to be one of the first and well motivated things you’re going to do in an exercise program.”
After patients have undergone surgery, surgical restrictions are not you’re only guiding tool for sex. “Always let pain be your guide, if it hurts, don’t do it. Sex is never supposed to hurt—it’s supposed to be amazing.”
We tend to forget about the vital functions our pelvic organs perform every day. “Peeing and pooping and sex, they are all very basic bodily functions and we can start to forget about it. If I ask any of you how often you peed today, you would have to think really hard and I betcha 10 bucks you’d be wrong with whatever you guessed. You can go pee mindlessly.”
Today's guests:
Sandy Hilton PT, DPT, MS: Sandy graduated from Pacific University (Oregon) in 1988 with a Master of Science in Physical Therapy and a Doctor of Physical Therapy degree from Des Moines University in December 2013. She has worked in multiple settings across the US with neurologic and orthopaedic emphasis combining these with a focus in pelvic rehabilitation for pain and dysfunction since 1995. Sandy has teaches Health Professionals and Community Education classes on returning to function following back and pelvic pain, assisted with Myofascial Release education, and co-teaches Advanced Level Male Pelvic Floor Evaluation and Treatment. Sandy’s clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women. Sandy is also pursuing opportunities for collaboration in research into the clinical treatment of pelvic pain conditions. Sandy brings science and common sense together beautifully to help people learn to help themselves.
Sarah Haag PT, DPT, MS, WCS Cert. MDT, RYT: Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the past 8 years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Most recently, Sarah completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Instructor. Sarah plans to integrate yoga into her rehabilitation programs, as well as teach small, personalized classes. Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.
Jason Falvey PT, DPT, GCS: PhD Student Jason Falvey was awarded a Kendall Scholarship from the Foundation for Physical Therapy in 2014 and a Fellowship for Geriatric Research through the Academy of Geriatric Physical Therapy in 2015 to support his research examining the role of home physical therapy in enhancing function and reducing re-hospitalizations for medically complex older adults. He is also the primary investigator on a research grant from the American Physical Therapy Association, Section of Health Policy and Administration looking at the role of physical therapists in models of transitional care for older adults after acute hospitalization.
Resources discussed in this show:
Oswestry Disability Index
Finding a pelvic health PT
Holly Herman
Make sure to give Jason Falvey , Sarah Haag , and Sandy Hilton a follow on twitter!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and as always stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!
Today’s show is with Dr. Kelly Starrett where he answers audience questions concerning how he optimizes human performance. Kelly is a coach, physical therapist, author, speaker, and creator of the blog Mobility WOD. Kelly’s work across these mediums has reached large audiences and revolutionized how athletes think about human movement and athletic performance.
In this episode, we discuss:
-Allied relationships between physical therapists and strength and conditioning coaches
-Do anatomical variations impact ideal posture and movement?
-Why we should be taking a 30,000 foot view in our culture
-How Kelly reconciles pain science and biomechanics in his physical therapy practice
-How to build a large platform with the use of social media
-And so much more!
Kelly advocates that every human should be incorporating a mobility regime into their day to day lives. He states, “What does it mean foundationally to be a human being, what are the things we should be able to do? We remain agnostic about the way you want to train, but you better have a movement practice or at least express full range of motion if you plan on moving fast, lifting heavy, going up and down stairs, or picking up your kid.”
Kelly stresses that enhancing movement is a continual process and every day is a movement screen. “We don't expect movement competence to happen overnight. This is a process but eventually we should all be moving better and better and better because that is what it means to acquire skills as a human. It takes 10,000 repetitions as a baby to integrate a movement pattern. That means we have some tolerance in the system to buffer some less than ideal biomechanics. Overtime we should be refining that.”
Kelly challenges the physical therapy profession to focus more attention on educating the public on preventative care. He stresses, “When you have a fever, you take some Tylenol. If you have a cold, you don’t go see your doctor. If you have a cut, we teach people basic first aid. [Physical therapists] are not doing a good job teaching basic first aid around the body to everyone.”
We also discuss Kelly’s widely successful online fitness platform and the best ways to target and gain influence in your own local community. He states, “People are looking for advocates, they are looking for help… if you set out to influence a bunch of people, you influence no one. It’s not authentic, it’s not real. Solve a set of problems and be of use to your community and people will find you.”
For more about Kelly:
Kelly Starrett is a coach, physical therapist, author, speaker, and creator of [mobilitywod.com], which has revolutionized how athletes think about human movement and athletic performance.
His 2013 release, Becoming a Supple Leopard has become a New York Times and Wall Street Journal bestseller. [His] blog was voted #4 in Outside Magazine’s Top 10 Fitness Blogs of 2011, Breaking Muscle’s Top 10 Fitness Blogs of 2011, and Health Line’s Top 100 Health Blogs of 2011. Kelly and his work have been featured in Tim Ferris’ Four Hour Body, Competitor Magazine, Inside Triathlon, Outside Magazine, Details Magazine, Power Magazine, and the Crossfit Journal.
He teaches the wildly popular Crossfit Movement & Mobility Trainer course and has been a guest lecturer at the American Physical Therapy Association annual convention, Google, the Perform Better Summit, the Special Operations Medical Association annual conference, police departments, and elite military groups nationwide.
Coach Kelly Starrett received his Doctor of Physical Therapy in 2007 from Samuel Merritt College in Oakland, California.
Before starting his own physical therapy practice at San Francisco CrossFit, one of the first 30 CrossFit affiliates, he practiced performance-based physical therapy at the world-renowned Stone Clinic. In his current practice, Kelly continues to focus on performance-based Orthopedic Sports Medicine with an emphasis on returning athletes to elite level sport and performance.
Kelly’s clients have included Olympic gold-medalists, Tour de France cyclists, world and national record holding Olympic Lifting and Power athletes, Crossfit Games medalists, ballet dancers, military personnel, and competitive age-division athletes.
Kelly’s background as an athlete and coach includes paddling whitewater slalom canoe on the US Canoe and Kayak Teams, and leading the Men’s Whitewater Rafting Team to two national titles and competition in two World Championships. In his free time Kelly enjoys spending time with his wife Juliet and two daughters, Georgia and Caroline, surfing, paddling, Olympic lifting, hot-tubbing, and so-you-think-you-can-dancing.
Resources discussed on this show:
Stand Up Kids
Chris Powers
Dan Pfaff
Functional Movement Screen
Lorimer Moseley
David Butler
Greg Lehman
International Spine and Pain Institute
PTPintcast
Kelly welcomes you to stop by his clinic in San Francisco, California and see what he’s all about. You can find more from him at Mobility WOD and follow him on twitter!
Join me and other professionals for PT Day of Service this October 15th and give back to your local community!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and as always stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!
On today’s episode, Amy Mewborn discusses how she jumpstarted her career and now designs strategies for others to do the same. Amy is a serial entrepreneur, CEO, author, and operations and strategy expert. She teaches women business owners how to use technology and systems to leverage their business growth and maximize profits through automation.
In this episode, we discuss,
-Amy’s health journey and how she escaped the 9-5
-Building an information highway through automation technology
-What to do if your launch falls flat in the online space
-Mindset challenges women need to address to kick start their business
-And so much more!
Amy discusses the importance of taking action when branching out into new business opportunities. In Amy’s experience, she states, “You have to have the courage to take a risk, because if you don't, one day you will wake up and your entire life will go by and you've been going through the motions but never really got to where you want to be. Listen to your intuition, no one knows what is better for you than you do yourself and do as much research and be as well prepared as you possibly can.”
Amy describes the reciprocal relationship between passive income streams and personal independence as a result of automation. She states, “The more time that you can free up from the things that you are doing, the more revenue streams you can potentially create, the more income you can have, the more clients you can see, and the more time you can have off and have fun…That’s when our creative energy starts to flow.“
Amy embraces taking risks because failure can offer an equally beneficial learning experience. From her experience, she states, “Had I given up after falling flat on my face the first time, I would have just thought I would never be able to make it… it's just about going back and looking at what worked and what didn't work and how you're going to adjust going forward.”
For women who are hesitant to pursue a new venture, Amy reassures us that, “As women, we always wonder if we are good enough—is what I have to offer really any different or more valuable or anything better than what is already out in the market place? We don't think about how we do business with people we know, we like, and we trust… We constantly have to break through that mindset that we are not enough because there is probably someone out there who is just like us and is waiting for us to share our gifts and secrets with the world.“
For more information about Amy:
Amy Mewborn is a serial entrepreneur, CEO, author, and operations and strategy expert. She teaches women business owners how to use technology and systems to leverage their business growth and maximize profits through automation.
She has spoken with Carlsbad Chamber of Commerce, Healthy Living Expo, Health and Wellness Expo, and Blastoff Business Breakthrough. She has been a featured teacher and continuing education provider with the American Council on Exercise. Amy has been featured on CBS, KUSI, Fox, Ivillage, San Diego Magazine, Ranch and Coast, and is a contributing editor to a number of publications.
She is a sought after speaker on business topics surrounding increasing profitability through technology, systems, and automation.
Her passion is helping women business owners achieve financial independence, and every speech or educational program that she produces is designed to teach women how to increase their business through systems and automation.
Check out all the goodies Amy has for you on her website and send her your questions, comments, and concerns via email Amy@amymewborn.com.
You can also get her book The Great Escape: The Successful Women's Guide to Escaping the 9-5 FREE this week only!(July 25, 2016 to July 30, 2016)
You can find Amy on twitter, facebook, and instagram!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and as always stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on
the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!
On this week’s episode of the Healthy Wealthy and Smart podcast, Dr. Beth Darnall joins us to talk about the opioid epidemic and alternative treatments for patients experiencing chronic pain. Dr. Darnall is a Clinical Associate Professor in the Division of Pain Medicine at Stanford University and treats individuals and groups at the Stanford Pain Management Center. She is an NIH-funded principal investigator for pain psychology research that is examining the mechanisms of pain catastrophizing treatment, including a novel single-session pain catastrophizing class she developed (funded by the NIH National Center for Complementary and Integrative Health). She is dedicated to empowering life beyond pain.
In this episode, we discuss:
-The opioid epidemic and cost effective treatment solutions that you can incorporate into your care
-Tapering off opioid use, associated effects, and protocol
-How opioid use and chronic pain effect brain chemistry
-Pain catastrophizing defined and what patients can do if they have chronic pain
-And so much more!
Treatment for chronic pain with opioids alone is not sustainable and alternative treatment approaches are needed to retrain the brain. The research has shown that, “When we take opioids, it really changes brain chemistry. It actually changes the structure of the brain but so does chronic pain itself…[With alternative treatment,] you're rewiring and recovering and exercise and enjoyment and going out and getting back to doing the things you love, these are going to help facilitate your brain as it is rewiring, as you’re managing pain differently, as you’re becoming more and more active and functional.”
Evidence based healthcare providers must monitor patients who begin opioid treatment for chronic pain and how their condition evolves. “We want to ask ourselves a critical question—are people getting better? And this is where we've really fallen short, opioids will be prescribed and nobody is tracking long term to see if they are getting better or if there are new risk factors or addictive behaviors. It’s a constant process of monitoring… We need to do better at stopping what isn't working. If people aren't getting better, if their pain is only worsening, let's not add more of what isn't working. Let’s stop it and emphasize the alternatives.”
Dr. Darnall supports the biopsychosocial model for treating chronic pain because it effectively and comprehensively targets the nervous system. She states, “The nervous system leads us into this area where we’re really talking about the modulation of pain, the facilitation of pain and the exacerbation of pain… No matter where you feel pain in your body, no matter how it got started or why, the processing of it will occur in the brain and spinal cord. That's what we can target with some of these treatments and therapies, we’re able to dampen the experience of pain… The nervous system is a critically important part in helping decrease not only pain and intensity but more importantly how much a person suffers from pain. “
Dr. Darnall advocates a pain management approach that allows the patient to take more control in achieving a desirable outcome. She stresses, “The most important person on the healthcare team isn't the doctor or the psychologist or the physical therapist—it’s the patient. If you have chronic pain, you are the most important person on your healthcare team. My hope and my wish is that every person on your healthcare team will have a similar philosophy that is focused on empowering you to acquire the right information and the right skills so you can best self manage your pain and your symptoms so that you’re able to become more functional, to enjoy more of the life you have even with the health conditions you have so you’re able to live your best life possible.”
For more about Dr. Darnall:
Beth is a Clinical Associate Professor in the Division of Pain Medicine at Stanford University and treats individuals and groups at the Stanford Pain Management Center. She is an NIH-funded principal investigator for pain psychology research that is examining the mechanisms of pain catastrophizing treatment, including a novel single-session pain catastrophizing class she developed (funded by the NIH National Center for Complementary and Integrative Health).
She is Co-Chair of the Pain Psychology Task Force at the American Academy of Pain Medicine (AAPM), and in 2015 received a Presidential Commendation from AAPM.
Beth is author of Less Pain, Fewer Pills ©2014 and The Opioid-Free Pain Relief Kit ©2016. Her upcoming book, The Surprising Psychology of Pain: Evidence-Based Relief from Catastrophizing and Pain is due out in 2017. As a pain psychologist, she has 15 years experience treating adults with chronic pain, and she lived through her own chronic pain experience. She enjoys helping individuals with chronic pain gain control over mind and body and live their best life possible.
Beth is a licensed clinical psychologist (CA License #25495).
Beth received her doctoral training at the University of Colorado at Boulder and her clinical residency at the Southern Arizona Veterans Affairs Health Care System (Tucson VA Hospital). She received post-doctoral training at The Johns Hopkins University School of Medicine Department of Rehabilitation Medicine and the Bloomberg School of Public Health (T32 Fellowship). Clinically, she provided psychological services to patients with catastrophic burn, spinal cord injury or amputation. She was an Associate Professor at Oregon Health and Science University (2005-2012) prior to joining the faculty at Stanford University in late 2012. Her desire to specialize in the management of chronic pain was inspired by her clinical experiences and by her own personal experience with chronic pain.
Make sure to grab copies of Dr. Darnall’s books The Opioid-Free Pain Relief Kit: 10 Simple Steps to Ease Your Pain and Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control over Chronic Pain and follow her on twitter!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and as always stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult
On today’s episode, I had the pleasure of welcoming Dr. Jason Falvey PT, DPT, GCS onto the podcast to discuss how physical therapists can better treat the geriatric population. Dr. Falvey is currently pursuing his PhD at the University of Colorado Denver in the Muscle Performance Lab and is interested in optimizing rehabilitation for medically deconditioned older adults in post-acute and home care settings.
In this episode, we discuss:
-The push for more medically necessary research funding for the growing baby boomer population
-Are fresh PT graduates prepared to manage older adults?
-Jason’s top strategies to break cemented patient routines
-How to properly dose exercise for the geriatric population
-And so much more!
Jason explains the value of understanding optimal aging and long term health management when dealing with clients of any age and in any setting. He states, “In every practice area, knowledge of successful aging will make you a better therapist. If you’re a geriatric specialist or have good knowledge in that area, I think you would be an incredible asset to any healthcare organization.”
Some of Jason’s best treatment results come from empowering patient’s on their rehabilitation journey. “These patients we see are often homebound, their often not respected or valued or heard by medical professionals… So really getting in and promoting autonomy and putting power in their hands immediately to take charge of their care. It’s surprising how refreshing that is for patients and how much they open up after the first session.”
In order to maximize patient outcomes, clinicians need to understand the foundations of movement and address their patient’s functional deficits. To better illustrate this point, Jason proposes this example, “If I gave you a book in Spanish and I tell you to read it, you read through it and you don't understand because you don’t understand the foundation of the Spanish language and then I have you do 100 repetitions of reading that book, that 100th time you’re not going to be any better at it because I didn’t fix the foundational issue that you don’t know some of the basic vocabulary you needed to understand.”
Geriatric research is now beginning to incorporate physical function into the equation and physical therapists are at the forefront for advocating its importance. Jason stresses, “Physical function is its own independent risk factor for so many adverse outcomes like hospital readmissions, all cause emergency room visits, falls, cognition and physical function often run in tandem… I think there is increased recognition that how people move and interact with their community is not just a secondary outcome but it is a primary outcome… They haven’t included physical therapists in physician trials, so there is still work to do, but we have successfully promoted the message that mobility is important, mobility is a quality of life issue, and exercise is medicine and we need to integrate those things across the spectrum. “
For more about Dr. Falvey:
PhD Student Jason Falvey was awarded a Kendall Scholarship from the Foundation for Physical Therapy in 2014 and a Fellowship for Geriatric Research through the Academy of Geriatric Physical Therapy in 2015 to support his research examining the role of home physical therapy in enhancing function and reducing re-hospitalizations for medically complex older adults. He is also the primary investigator on a research grant from the American Physical Therapy Association, Section of Health Policy and Administration looking at the role of physical therapists in models of transitional care for older adults after acute hospitalization.
You can find more resources on Jason’s research here and follow him on twitter!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!
Happy Independence Day to the American Healthy Wealthy and Smart family! On this week’s episode, Greg Lehman and I review the evidence and rethink effective treatment strategies. Greg is both a physiotherapist and chiropractor who treats musculoskeletal disorders within a biopsychosocial model and simplifies pain science for clinicians around the world.
In this episode, we discuss:
-Why explaining pain leads to better treatment outcomes
-The case for and against repeated spinal flexion
-Does glute activation or inhibition affect pain?
-Functional training and the carry-over effect
-And so much more!
Greg stresses that most physical therapists should rethink what is valuable to their patients. He states, “The technical mastery is less important…It probably has more to do with how your patient feels comfortable and how you respond to them rather than you being a good robot who knows lines of drive and the biomechanics. That isn’t what is valuable and isn’t supported in all the research that we have.”
Greg also questions the effectiveness of being so specific with our interventions and takes a broader approach in his treatment philosophy. “I don't think there is any treatment that ever has to occur… It’s actually a neat, big question for therapy I would like to see addressed more. Is there ever a treatment that is absolutely necessary for a specific condition or are there a number of things that can be helpful? I tend to believe there are a number of things—I have my biases—but I think most things aren't that specific.”
Greg builds patient self-awareness with education and believes it is his most effective treatment tool. “I go right into education for low back pain. I am not too worried about getting them super active right away. I want to encourage them to getting back to doing the things that are important. If they tell me they are afraid to do a number of things that they like doing and they are meaningful activities, my go to intervention is to convince them they can start doing those things again.”
Greg suggests shifting our focus as clinicians from a purely biomedical approach to treatment and instead developing our psychosocial expertise. “I really believe it is okay to be simple. We don't really need the complexity that we try to do, especially the biomechanics. The big point of that is if you simplify your biomechanics, your physical interventions, it can allow you to develop your skills in the other areas, the psychosocial stuff and start taking more classes outside our typical training—psychologists, social workers, that type of stuff. That’s where we can build our skill set. There's not a better manipulation, there’s not that special exercise technique that you need to learn. It’s fun but it’s not necessary for patients with pain.”
For more about Greg:
- GREG LEHMAN BKIN, MSC, DC, MSCPT
He is a physiotherapist and chiropractor treating musculoskeletal disorders within a biopsychosocial model.
Prior to his clinical career he was fortunate enough to receive a Natural Sciences and Engineering Research Council MSc graduate scholarship that permitted me to be one of only two yearly students to train with Professor Stuart McGill in his Occupational Biomechanics Laboratory subsequently publishing more than 20 peer reviewed papers in the manual therapy and exercise biomechanics field. Greg was an assistant professor at the Canadian Memorial Chiropractic College teaching a graduate level course in Spine Biomechanics and Instrumentation as well conducting more than 20 research experiments while supervising more than 50 students. He has lectured on a number of topics on reconciling treatment biomechanics with pain science, running injuries, golf biomechanics, occupational low back injuries and therapeutic neuroscience. His clinical musings can be seen on Medbridge Health CE and various web based podcasts. Greg is currently an instructor with therunningclinic.ca and with Reconciling Biomechanics with Pain Science. Both are continuing education platforms that provide clinically relevant research that helps shape and refine clinical practice.
While he has a strong biomechanics background he was introduced to the field of neuroscience and the importance of psychosocial risk factors in pain and injury management almost two decades ago. Greg believes successful injury management and prevention can use simple techniques that still address the multifactorial and complex nature of musculoskeletal disorders. He is active on social media and consider the discussion and dissemination of knowledge an important component of responsible practice. Further in depth bio and history of my education, works and publications.
For more information on where Greg will be lecturing next, make sure to visit his website and keep up with Greg on twitter!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!
On this week’s episode of the Healthy Wealthy and Smart Podcast, Chad Prince joins me to discuss his book Physical Therapy Career & Salary Guide: Avoid the Income Ceiling and Put Your Career in the FASTLANE and strategies to add side income to your physical therapy practice. After working as a physical therapist for ten years, Chad transitioned into full-time administration seven years ago. Today, he manages an orthopaedic surgery practice. In his writing, he combines his years of professional business experience, his understanding of the healthcare world at large, and his personal journey developing a physical therapy product, the UELadder.
In this episode, we chat about:
-Chad's experiences with overcoming self-doubt and self-imposed limitations
-Unique PT opportunities to generate income without trading your time for money
-How to expand your audience globally and 10x the impact you can make
-How to get in the fastlane of healthcare innovation
-And much, much more!
As budding entrepreneurs, sometimes it is our mindset that is limiting us from achieving greatness. Chad suggests exploring these questions, “What do you want to give? What kind of impact do you want to have on the world? Who do you have to become to give that to the world? And you have to go ahead and believe that you are capable of that before you can become it.”
Chad addresses the limitations of the service model and the upside of taking an alternative view, “As long as we trade time for money we are limited by our amount of time…You might be able to work more but there is no way to 10x your work hours—it’s just not possible. But with online tools and with other types of businesses still inside physical therapy, it is possible to 10x your impact.”
As technology evolves in our profession, Chad stresses, “We’ve got to look ahead at changes that are coming and embrace those in a way that’s positive and healthy for the profession and our patients. That's ultimately going to be the sweet spot for us all.”
We wrap up the interview with some lessons from the memory of a legendary figure, Muhammad Ali, “He said I'm the greatest and said it over and over and over until he became the greatest… If we can have a full and complete understanding of our what, why, and how, we can say I’m the greatest at whatever it is we want to accomplish and we can go do it.”
You can find more from Chad on twitter and can follow his blog here! Get a copy of the book and check out Chad’s UELadder!
Be sure to check out the FREE 5 page report on PT Income Tips on the homepage, thanks to Chad!
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!
This week’s episode of the Healthy Wealthy and Smart podcast is a must listen if you are interested in learning more about CrossFit. Tune in, with Dr. Rick Daigle and me, to find out what CrossFit is all about and tips for choosing a box that’s right for you. Dr. Daigle is a physical therapist who is passionate about treating athletes and the Founder and President of Medical Minds In Motion which develops high quality continuing education courses for the allied health field.
In this episode, we discuss:
-Do you have to be in great shape to start CrossFit and is CrossFit a great way to get injured?
-Does CrossFit translate into daily movement?
-Must ask questions when shopping around for the perfect box for you
-What you can do to decrease your chance of injury
-And so much more!
If you’re interested in checking out CrossFit, it is important to find a box that challenges you but also modifies the workout of the day when your body is giving you red flags. Dr. Daigle suggests, “Doing things at the level that you are capable of doing it at and understanding regression and progression. And it goes that having a coach that understands regression and progression and understands that everybody is going to move a little bit differently.”
When first starting CrossFit, your box needs to understand your ability level to prevent injury. Dr. Daigle stresses, “You’ve got to earn the right to add load to a movement. You’ve got to kill the movement first, you’ve got to know it, you’ve got to own it without any load. So it’s the good box that will take that philosophy. And the not so good where they just put load on people, that's where injury happens.”
It can be challenging for the CrossFit athlete but always have the humility to accept the feedback from your body. “Listen to your body. If you're body doesn't want you to do something, oh well, then modify it and figure out how you can do a quality movement in a little bit of a different manner. The biggest things for injury prevention is having a good consistent mobility program and listening to your body. Your body will tell you when it's not ready to do something.”
CrossFit can be a great exercise program that incorporates variability and camaraderie. Dr. Daigle is a proponent for CrossFit and states, “It's about getting people moving. We live in a society that doesn't move enough. We live in a society that stays very, very stationary. I think CrossFit is a great avenue to get people moving and get people off their duff doing something different, doing something exciting, and improving quality of life.”
About Rick:
Rick Daigle, PT, DPT, FMT-C, is the Founder and President of Medical Minds In Motion, LLC™. Dr. Daigle is a graduate of Simmons College in Boston and had the opportunity to do an extended externship at Cincinnati Sports Medicine. Dr. Daigle is an active member of the APTA and is a Credentialed APTA Clinical Instructor. His clinical expertise/philosophy is focused around a manual and movement based model. He utilizes assessment tools and techniques such as the SFMA, Trigger Point Dry Needling, Kinesiology Taping and many more.
Dr. Daigle has worked with a variety of types of patients and has consulted with numerous collegiate and professional athletes. He has a special interest in Baseball Players and has studied the mechanics of pitching and how dysfunctional movement causes breakdown, leading to severe injuries.
Dr. Daigle is the creator of “Kinesiology Taping: Movement Assessments & Corrective Exercise Strategies”, seminar series which is meant to expose clinicians to various taping techniques, movement assessments and corrective exercise strategies used to determine what taping techniques are appropriate. He created MMIM with the sole purpose of developing high quality continuing education courses for the allied health field.
If you would like to hear more from Rick, you can follow him on twitter and facebook and be a part of the facebook group Physical Therapy: Practice, Education and Networking for everything rehab related.
Check out Medical Minds In Motion’s continuing education courses and follow the blog and twitter.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Also, check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!
On this week’s episode of the Healthy Wealthy and Smart podcast, I had the pleasure of welcoming Dr. Emma Stokes onto the show to discuss leadership and advocacy in physical therapy! Emma Stokes BSc (Physio), MSc (research), MSc Mgmt, Phd is an associate professor and a Fellow of Trinity College Dublin. She is the deputy head of the physiotherapy programme and teaches on the entry to practice programmes in Dublin and Singapore. The focus of her research and teaching is professional practice issues that builds on her work with professional, regulatory and charitable organisations. She is the Minister for Health's nominee for physiotherapy to the Health & Social Care Professions Council & Physiotherapists Registration Board in Ireland. She is currently the President of WCPT.
In this episode, we discuss:
-Practical steps that create leadership opportunities
-Why self-awareness and the Power of No are integral to leadership
-Thoughts on what may impact women on their path to higher goals
-Dr. Stoke’s experiences with failure and building resilience
-A framework for advocacy in physical therapy
-How to get the most from a conference experience
-And so much more!
Dr. Stokes shares great advice for those who want to get involved in higher roles that before you can lead others, you first need to be able to lead yourself. To develop that self awareness you must, “Be clear about what your values are. So learn about your values—where they’ve come from, how they serve you, how you use them in the service of others, what they bring to you as a person. And if you understand them very explicitly then you will understand when they are challenged and whether you're prepared to have them challenged or whether you need to put your hand up and walk away from a situation.”
We also discuss the importance of looking to a mentor to help cultivate leadership characteristics within ourselves. Dr. Stokes suggests that you, “Identify something that someone does that you admire and have this conversation with them. Find out how they got to where they are. Sometimes it is just looking at a behavior and saying that is a behavior that is a positive behavior that I would like to adopt. It is mimicking.”
Dr. Stokes reminds us that to have an effective therapeutic relationship with the best outcome for our patients, we need to guide them on their journey and that, “The solution is owned by the client. You unpack that solution with them and it is something they own rather than us giving them a fix.”
Being an advocate for physical therapy comes down to, “Understanding what it is you want to achieve and really drill down into that. Once you understand what the outcome is, then you need to look at context. What is the environment in which you want this change to happen, who are the key people that may be the decision makers, understand who the people will be in terms of allies, who are the
people who won't be so positive about this change... Understanding the context then allows you to think about what you want to do, the strategy… find the [evidence] you need in order to [support] this.”
More about Dr. Stokes:
Education and work experience: Emma Stokes qualified as a physiotherapist in 1990 [BSc Physiotherapy, Trinity College Dublin]. While working as a clinical physiotherapist at St. James’s Hospital, Dublin (1990-1996), she completed a post-graduate Diploma in Statistics in 1993 and MSc (Research) in 1995 both at Trinity College Dublin. She took up an academic position at Trinity College in 1996, completed a PhD in 2005 and a Master’s degree (MSc Mgmt, Business Administration) in the School of Business in 2008. She is an associate professor at the Department of Physiotherapy, Trinity College Dublin [1996 to date]. She was elected as a Fellow of the College in 2012. She commenced a Diploma in Leadership & Professional Coaching in September 2014. Since May 2015 she has been the President of WCPT.
Leadership: Emma Stokes has played a number of leadership roles over the course of her career. Since the early 1990’s, she has been an active member of the Irish Society of Chartered Physiotherapists (ISCP). As well as acting as a professional adviser, she has chaired the Society’s Standing Committees for International Affairs and for Finance. In 2012, she was appointed as the Director of Professional Development and has led the establishment of the ISCP’s first professional development unit, in preparation for the required organisational transformation of the ISCP when the physiotherapy regulatory board opens. Drawing on key stakeholder and member engagement as well as her international experience, she led the project that has culminated in the establishment of a unit of 3 staff and more than 40 volunteers whose chief function is to position the ISCP as a key provider of continuing professional development in the coming years. In 2010 she completed a 5-year term as a College Dean at Trinity College Dublin [15,000 students] with responsibility for student discipline. She was the first woman to be appointed to this senior academic management position.
Board membership: Her experience of eight board directorships covers the health, education, regulation and charity sectors. She recently completed a term as the chair of the board of a charity for people with Parkinson’s Disease – www.moveforparkinsons.com.
Regulation: She is currently the Minister for Health’s nominee to represent the physiotherapy profession on Ireland’s regulatory authority – the Health & Social Care Professions Council. She has been an invited speaker at the Federation of State Boards of Physical Therapy Regulators (USA) leadership workshop and annual conference and the International Network of Physical Therapy Regulators. She is a member of the recently established (2014) Physiotherapists Registration Board that will regulate physiotherapy in Ireland.
Research, scholarship and teaching: Dr. Stokes has had two main research interests. The first has been in the area of rehabilitation with a focus on novel ways to mediate exercise intervention and participation post stroke and in people with neurological disabilities. Her current research focus is on national and international professional issues in physiotherapy. She has published widely in these areas in international peer-reviewed journals. She co-leads the teaching modules on professional issues for the entry-level physiotherapy students at Trinity College Dublin and at the TCD Singapore programme. She spent time on sabbatical at the University of Toronto (2010). She was privileged to deliver the 2013 Chartered Society of Physiotherapy Founders’ Lecture in October 2013 - http://www.csp.org.uk/news/2013/10/11/physio13-founders-lecture-calls-physios-think-creatively In 2014, she was in receipt of a government scholarship from Taiwan as a visiting scholar and was invited to the University of Rhode Island as a Distinguished International Visiting Scholar - http://web.uri.edu/physical-therapy/2014/02/14/international-scholar-dr-emma-stokes-to-visit-uri/ She was appointed as an adjunct associate professor at the University of South Australia in August 2014.
International professional adviser: She has acted as an adviser to physiotherapy organisations advising on organisational development and capacity as well as professional issues. She was recently a member in a task force of the American Physical Therapy Association on scope of practice. She was the chair of a WCPT Working Group tasked with an organisational review of WCPT.
If you would like to hear more from Dr. Stokes, you can follow her on twitter! For more information on the IFOMPT Conference in Glasgow on July 4-8th, 2016, click here and if you’re interested in sharing your research in Cape Town in July 2017, head over to the World Confederation for Physical Therapy Congress 2017!
Make sure to connect with me on twitter to stay updated on all of the latest! If you would like to support the show, be sure to leave a rating and/or a review on iTunes!
Have a great week and as always stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page!
This week, Dr. Tim Gabbett joins me on the Healthy Wealthy and Smart podcast to talk about how he prepares athletes to perform at high levels of competition and mitigate injury risk during critical periods of play. Tim is an applied sports scientist who consults with elite international athletes and has authored numerous research papers that benefit the sports performance community.
In this episode, we discuss:
-Sport specific external and internal training loads
-How chronic training load history impacts training guidelines and injury prevention
-The mathematical relationship between fitness and fatigue and its effect on physical performance
-Why building trust with athletes supports the mental component of competition
-And so much more!
Tim stresses that it is more common for players to be undertrained than over trained when it comes to injury risk. He suggests, “High chronic load is protective against injury and gives you the physical qualities that allow you to compete.”
Tim also develops strong relationships with his athletes to help facilitate the training regimen. He emphasizes, “They need to know that I have their best interest at heart. I'm looking to keep them injury free and make sure they can compete as hard as possible. They know at the end of it I'm not asking them to do anything that will put them at risk, but it will prepare them better and keep them injury free.”
Our role as coaches and physical therapists is to guide our athletes during times of difficulty within training sessions for ultimate success in competition. “Winning games comes back to how often they have learned to win the session. The more often we can put players into sessions where they either dig in or give in, they learn to find a way to fight themselves out of the dark hole and the more likely it will be a familiar place in competition.”
For more information on Dr. Gabbett:
Dr Tim Gabbett has 20 years experience working as an applied sport scientist with athletes and coaches from a wide range of sports.
He holds a PhD in Human Physiology (2000) and has completed a second PhD in the Applied Science of Professional Football (2011), with special reference to physical demands, injury prevention, and skill acquisition.
Tim has worked with elite international athletes over several Commonwealth Games (2002 and 2006) and Olympic Games (2000, 2004, and 2008) cycles. He continues to work as a sport science and coaching consultant for several high performance teams around the world.
Tim has published over 200 peer-reviewed articles and has presented at over 200 national and international conferences. He is committed to performing world-leading research that can be applied in the ‘real world’ to benefit high performance coaches and athletes.
You can get in contact with Tim at his website Gabbett Performance and follow his updates on twitter!
Thank you for listening to the show and being a part of the Healthy Wealthy and Smart community!
If you would like to hear more from me, make sure to follow me on twitter and be sure to leave a rating and/or a review on iTunes to support the show!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page!
On this week's episode of the Healthy Wealthy and Smart podcast, I welcomed Jason Glass to edutain, or educate through entertainment, on his rotational power training philosophy. Jason is one of the world’s top Golf Strength and Conditioning Specialists and owns and operates Tour Performance Lab and Kinetica Golf Performance in Vancouver, British Columbia. He specializes in training rotary athletes, biomechanics, physical assessments and functional strength training.
In this episode, we discuss:
-Does rotational power only equate to explosive movement?
-Why Jason finds that his job is 80% psychological for better client-coach relationships
-Is functional training dependent on individual performance demands?
-Why Jason dropped his book and picked up a microphone
-And much more!
Coach Glass shared so many great pieces of advice especially on how developing relationships with his athletes was the difference maker in his career. Jason begins his assessment by asking the questions, “What would you like me to do for you? Why is that important to you? What are your strategies for this? Do you have the capacity or capabilities to do what you want to do? Do you have the skill set? You have the ambition; let's start with what you have.”
Jason also stresses the importance of aligning your training goals with your clients by, “Find[ing] their vulnerability, their fear. Can we take care of what we need to do and address their fears at the same time?”
Jason is a proponent for managing the psychological aspect of his training and not just focusing on his kinesiology expertise, "This is a human being that I'm training. If I can't communicate with the human being element and tell them this is why this is important… If they don't buy in, there will be no change."
Jason left us with these parting words that really resonated with me, “Dream big, over deliver, be undeniable." He reminds us to always stay true to yourself, do what makes you excited, do it well and you will be able to reach your goals!
Here’s more information on Coach Jason Glass:
Jason Glass is one of the world’s top Golf Strength & Conditioning Specialist. Jason owns and operates Tour Performance Lab and Kinetica Golf Performance in Vancouver BC; specializing in training rotary athletes, biomechanics, physical assessments and functional strength training.
Jason is a consultant for many top professional athletes from the PGA Tour, European Tour, Nationwide Tour, LPGA to professional snowboarding. He is also the head strength and conditioning coach for the Canadian National Team. Jason is also the head of the Titleist Performance Institutes Fitness Advisory Board.
Jason has been featured on the Golf Channel, Golf Canada Magazine and CBC Sports. Jason has his own TPI TV show “The Jason Glass Performance Lab”. Jason has published 3 DVD’s specializing in creating explosive rotational power in athletes.
Jason graduated from University of British Columbia with a bachelor of Human Kinetics and is a Certified Strength & Conditioning Specialist with the NSCA.
Jason is a professional speaker and lead presenter for the Titleist Performance Institute. Jason has presented internationally on golf conditioning, functional training, corrective exercise progressions, and creating rotary power for all athletes. His enthusiasm, sense of humour and passion for training makes Jason a crowd favourite on the speaker’s circuit.
Digest and enjoy all of the content Coach Glass provides on his website here and check out his podcast! You can find more from Jason on facebook and twitter!
Make sure to connect with me on twitter to stay updated on all of the latest! If you would like to support the show, be sure to leave a rating and/or a review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page!
On today's episode, we pick the brain of IT band expert, Mark Alexander. Mark is the founder of BakPhysio, a Sports Physiotherapist with a background treating the Australian Olympic and Commonwealth Games Triathlon Teams, and a former lecturer/manager on the La Trobe University post-graduate Master of Sports Physiotherapy program.
In this episode, we tackle:
-Common misconceptions surrounding the IT band
-Possible causal theories of IT Band Friction Syndrome and does the cause effect treatment
-Intrinsic anatomical considerations and extrinsic effects on lateral knee pain
-Mark's treatment approaches to lateral knee pain and "treat what you find" philosophy
-And much more!
We cover so much in this podcast and Mark helps dispels quite a few myths. The IT band is continuous with the entire circumferential fascia and it is not something you can target and lengthen. As Mark says, "you can have an impact on the myofascial attachments, but you're not releasing the IT band. If a scalpel can't do it, you can't do it."
We also learn some new effective ways to evaluate and treat patients with lateral knee pain. Mark recommends finding the extrinsic cause through the patient history. Mark’s key question and realization: “Ask them what their activity level has been over the preceding 3-6 months. What? How long? Intensity? Think about a graph with force or load on the y axis and x axis is just time and plot over time what the load has been like. In 80-90% of patients there is a spike! 3 weeks earlier they started to really ramp it up…Their IT band cannot handle that spike and load.”
Remember, every patient in front of you is unique! Understand the load and volume being put on their IT band and as ardently put by Mark, "treat what you find, challenge your assumptions, and compare to the other side." And for some guiding treatment principles, Mark suggests to, “Start with pyramidal foundation of stability and work up to strength.”
Thank you for listening to the podcast! You can find more from Mark on twitter and can reach him by email at mark.alexander@bakballs.com. If you want to learn more about bakballs, check out his company BakPhysio for more information!
Make sure to connect with me on twitter to stay updated on all of the latest! If you would like to support the show, be sure to leave a rating and/or a review on iTunes!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
P.S. Do you want to be a stand out podcast guest? Make sure to grab all the tools for free on the home page!
On this week's episode of the Healthy Wealthy and Smart podcast, Michol Dalcourt joins me to discuss how to integrate health and wellness principles to achieve individual performance outcomes. Michol is an industry leading expert in human movement, the inventor of the fitness tool "ViPR" and founder of the Institute of Motion.
In this episode, we discuss:
-The Institute of Motion's principles and intervention strategies
-Why sympathetic workouts must be offset with parasympathetic workouts for longevity
-How to effectively communicate dosage, timing, and exposure for exercise programs for clients
-Has the health and wellness industry exhausted the word "functional"?
-The 4 Q training model
-And so much more!
Michol addresses the multifaceted aspects of longevity including the physical, mental, and social considerations from the cellular level to the systems level. If you are interested in the health and performance strategies discussed, visit the Institute of Motion.
If you want to discover the beauty and intricacies of the human body and apply your knowledge of anatomy to learn how to prepare tissues for performance, you can immerse yourself in the Anatomy Live Expanded course. You can sign up here for the course on June 10-12, 2016 in Boulder, Colorado!
Thank you for listening to the podcast! If you would like to support the show, be sure to leave a rating and/or a review on iTunes!
Connect with me on twitter to stay updated on all of the latest!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On today's episode, I am joined by a very ambitious duo, Dr. Dave Kittle who is the CEO of Vinitial and Dr. Annie Abbate who is a physical therapist practicing in Brooklyn, New York. We talk about the evolution of the Vinitial app, which allows healthcare providers to text their patients without exchanging personal phone numbers, and how becoming an entrepreneur impacts your life.
In this episode, we discuss:
-What led up to Dave and Annie's decision to start a tech company
-Dave's lessons from failure and key ingredients for a viable business
-Advice for entrepreneurs on managing work life balance
-The Vinitial app and how you can use it to improve your healthcare practice
-And so much more!
Dave and Annie remind us that if you have an idea and entrepreneurial spirit, you need to take action! Failure can be expected and it is necessary for growth and success. Embrace the journey and persevere!
If you would like to utilize Vinitial in your practice, you can find more information here! You can connect with Dave and Annie on twitter!
Thank you for listening to the podcast! If you would like to support the show, be sure to leave a rating and/or a review on iTunes!
Make sure to follow me on twitter to stay updated on all of the latest!
Have a great week and stay Healthy Wealthy and Smart!
Xo Karen
On this week's episode of the Healthy Wealthy and Smart podcast, I had the pleasure of speaking with Stephanie Nickolich who is known as the Millionista Mentor. Stephanie left an unfulfilling corporate job to start her own online coaching business which gave her the ability to control her time and achieve financial freedom. We discuss her most important marketing strategies that you can implement to gain rapport with prospective clients and ultimately generate sales.
In this episode, we talk about:
-How Stephanie overcame adversity in her career and finances to go on to start a thriving business
-What sales funnels can do to improve your business
-Do's and don’ts of launching a sales funnel
-The steps needed to build an efficient team to increase your productivity
-And so much more!
Stephanie shares nuggets of wisdom from her journey and shows how accountability and self-knowledge fueled her passion and propelled her to reach her goals. You can find more from Stephanie on her website here! If you're interested in becoming a legendary entrepreneur make sure to check out her program which gives you the fundamental building blocks for starting an online business!
Thank you for listening to the podcast! If you would like to support the show, be sure to leave a rating and/or a review on iTunes!
Connect with me on twitter to stay updated on all of the latest!
Stay Healthy Wealthy and Smart!
Xo Karen
In today’s episode, I had a very candid conversation with Erin Jackson, who was a member on the patient panel at CSM. She bravely and openly discusses her personal challenges with persistent pain as well as her experiences navigating the healthcare system and being her own best advocate.
In this episode, we touch on:
-What led up to Erin's years of persistent pain
-The challenges of living with persistent pain and how to deal with other people’s perceptions of your journey
-
Her advice for people who have persistent pain and her experiences with the path to recovery
-
What clinicians can do to better treat patients with persistent pain
-
How to deal with the ups and downs of recovery from the patient standpoint
-
Much more!
I greatly appreciate Erin taking the time to come on the podcast and share her journey so that we can have a better understanding of those who are experiencing persistent pain. Hearing direct perspectives from patients allows clinicians to understand what they value, what their goals are, and how we can better treat and support them on their journey.
My hope is that this podcast can help people who have persistent pain know that there is hope for recovery. Although the journey is not likely to be quick or easy, the transition to being whole and functional again is rewarding.
You can find Erin on twitter and linkedin and if you want to learn more about her practice you can check out her website here!
Thank you for being a part of the Healthy Wealthy and Smart family. Make sure to leave a rating and/or a review on iTunes.
Connect with me on twitter to stay updated on all of the latest!
Stay Healthy Wealthy and Smart!
Xo Karen
In this week’s episode of the Healthy Wealthy and Smart podcast, I speak with Ali Schoos, a private practice outpatient orthopedic and sports medicine physical therapist out of Bellevue, Washington. Ali joins me to discuss why her goal is to change the current PT mindset from episode based care to full lifespan primary care and why this change could be fundamental to your practice.
In this episode, we talk about:
-What is a primary care physical therapist
-Why we should treat every patient like a direct access patient
-How to incorporate patient education in your treatment plan
-How physical therapists can impact the growing Alzheimer's population
-The benefits of exercise on body and brain longevity
-And so much more!
Currently, about 5.4 million Americans are living with Alzheimer's and will ultimately die from the disease because there is no cure. By 2050, it is projected that 13.8 million people age 65 and older will be diagnosed with Alzheimer's and the associated costs are expected to grow to over 1 trillion dollars.
Physical therapists are uniquely qualified to help provide the care needed for this patient population through preventative education and exercise-based treatments. Ultimately, we can help reduce future healthcare costs, improve quality of life for our patients, and slow the progression of the disease.
For more information, be sure to check out the Alzheimer's Association for great informative resources.
You can find more from Ali on twitter and check out her website here!
If you would like to learn more about the Graham Sessions, check out this podcast with Steve Anderson!
Thank you for listening and subscribing to the show! If you like what you're hearing, I would greatly appreciate you leaving a rating and/or a review on iTunes.
Stay Healthy Wealthy and Smart!
Xo Karen
Live from CSM, I was fortunate to sit down with Dr. John Childs to discuss the new frontier of DPT education. He is a founder and CEO of Evidence in Motion and a partner in Confluent Health which includes EIM, 75 physical therapy clinics across the States, and Fit for Work which helps employers reduce workers' compensation costs through consultative services.
In this episode, we talk about:
-How Evidence in Motion bridges the gap between research and clinical practice
-Technology's role in facilitating a new blended educational model for entry level DPT programs
-Revolutionizing the curriculum for the clinical educational experience
-Common criticisms of the blended educational model
-And much more!
The future of DPT education is evolving toward collaborative learning which helps students grow and come together as a profession. This new model also is able to lower the cost of education and give nontraditional students more opportunities to pursue a career in physical therapy.
John welcomes your suggestions by phone ((210) 364-7410) and email (john@eimpt.com). You can find more information about Evidence in Motion here!
Thank you for listening and have a great week!
If you want to stay updated, make sure to connect with me on twitter!
Stay Healthy Wealthy and Smart!
Xo Karen
On this week's episode of the Healthy Wealthy and Smart podcast, Dr. Sarah Haag and Dr. Sandy Hilton join me outside the Disneyland Hotel post CSM to take the taboo out of discussing sex. They are both physical therapists who work with anyone needing to get back to doing what they love and who they love and are making the discussion around sex a little more comfortable and approachable.
In this show, we discuss:
-What every PT should be asking their patients
-Why you shouldn't make assumptions about your patients' sex lives
-How to differentiate UTI from DOMS of the pelvic floor
-How you can approach your partner who has pain with sex
-Guiding principles for pelvic health rehabilitation
-How to navigate sex in the nursing home system
-And a lot more!
Sex is part of normal human function and no other species makes it this complicated. If you are experiencing pain with sex and you want to live a happier and more fulfilled life, there is something you can do about it by seeking help from a pelvic health physical therapist.
You can find more on twitter from Sandy (@SandyHiltonPT), Sarah (@SarahHaagPT), and myself (@karenlitzyNYC)!
Thank you for following along and listening to the podcast!
Xo Karen
In this week’s episode, Paul Lagerman, the Naked Physio, and I co-host part Two of live from the San Diego Pain Summit in San Diego, California. The summit is all about applying pain science to clinical practice and we were fortunate to have a few of the summit speakers, who all come from different healthcare backgrounds, join us to discuss how we should be addressing patients with chronic pain.
Let me refresh your memory as to this fantastic panel of pain experts:
- Ravensara Travillian is a massage therapist based in Seattle, Washington specializing in populations of refugees and veterans
- Sandy Hilton is a physical therapist that specializes in pelvic pain in Chicago, Illinois
- Greg Lehman is a physical therapist, chiropractor, and a research biomechanist from Toronto, Canada
- Bronnie Thompson is an occupational therapist and a senior lecturer on pain and pain management at the University of Otago in Christchurch, New Zealand
- Michael Shacklock is a physical therapist and research academic with interests in neurodynamics from Dunedin, New Zealand
In this episode, you will learn:
- How to manage chronic pain patients' expectations throughout your treatment plan
- Techniques to get your patients excited about their home exercise program
- We hear from San Diego Pain Summit organizer Rajam Roose
- And a whole lot more!
Chronic pain is complex and this discussion really benefited from having a multidisciplinary panel provide their diverse insights and experiences. As healthcare clinicians, we can help make sense of chronic pain in our patients' lives but we need to deliver that information to them in meaningful and relevant ways.
If you want to hear more from all of us, check us out on twitter! You can find some highlights from the summit with #sdps2016 and #sdpain.
Karen Litzy: @KarenLitzyNYC
Paul Lagerman: @nakedphysio
Greg Lehman: @GregLehman
Ravensara Travillian: @RavenTravillian
Sandy Hilton: @SandyHiltonPT
Bronnie Thompson: @adiemusfree
Michael Shacklock: @Neurodynamics
Thank you for listening and being a part of the Healthy Wealthy and Smart family!
Xo Karen
In this week’s episode, Paul Lagerman, the Naked Physio, and I co-host a panel discussion live from the San Diego Pain Summit in San Diego, California. The summit is all about applying pain science to clinical practice and we were fortunate to have a few of the summit speakers, who all come from different healthcare backgrounds, join us to discuss how we should be addressing patients with chronic pain.
Let me introduce you to this fantastic panel of pain experts:
- Ravensara Travillian is a massage therapist based in Seattle, Washington specializing in populations of refugees and veterans
- Sandy Hilton is a physical therapist that specializes in pelvic pain in Chicago, Illinois
- Greg Lehman is a physical therapist, chiropractor, and a research biomechanist from Toronto, Canada
- Bronnie Thompson is an occupational therapist and a senior lecturer on pain and pain management at the University of Otago in Christchurch, New Zealand
- Michael Shacklock is a physical therapist and research academic with interests in neurodynamics from Dunedin, New Zealand
In this episode, you will learn:
- How to explain pain to clients without leading them to believe that the pain is all in their head
- How to guide patients away from biomedical explanations of pain
- How to manage chronic pain patients' expectations throughout your treatment plan
- Techniques to get your patients excited about their home exercise program
- And a whole lot more!
Chronic pain is complex and this discussion really benefited from having a multidisciplinary panel provide their diverse insights and experiences. As healthcare clinicians, we can help make sense of chronic pain in our patients' lives but we need to deliver that information to them in meaningful and relevant ways.
If you want to hear more from all of us, check us out on twitter! You can find some highlights from the summit with #sdps2016 and #sdpain.
Karen Litzy: @KarenLitzyNYC
Paul Lagerman: @nakedphysio
Greg Lehman: @GregLehman
Ravensara Travillian: @RavenTravillian
Sandy Hilton: @SandyHiltonPT
Bronnie Thompson: @adiemusfree
Michael Shacklock: @Neurodynamics
Thank you for listening and being a part of the Healthy Wealthy and Smart family!
Xo Karen
On this week's episode of the Healthy Wealthy and Smart podcast, we have Dr. Sharon Dunn who is the president of the American Physical Therapy Association joining us to talk about the success of this year's Combined Sections Meeting in Anaheim, California and what to look forward to for next year.
In this episode, we discuss:
-Her highlights from this year's CSM and how you can get more out of next year's conference
-Important insights from our patients and how it added to the CSM experience
-What the Free the Yolk movement is all about and ways you can help break a Guinness Book World Record
-The human movement system as it relates to physical therapy identity
-The important themes that emerged from CSM
-The importance of the individual sections within the APTA to the success of CSM
-And so much more!
It was a pleasure to have Sharon on the podcast again! If you weren't able to attend all of the amazing lectures at this year's CSM, you can find all of the presentations at the APTA website here. Let's continue the high energy level and high attendance rate at next year's CSM in San Antonio, Texas! I’m really looking forward to what is in store for us next year!
Make sure to follow me on twitter (@KarenLitzyNYC) and thank you so much for listening!
Stay Healthy Wealthy and Smart!
Xo Karen
Live from the Combined Sections Meeting in Anaheim, California, we have another great interview with Dr. Karim Khan where we discuss the role physical therapists play in the healthcare team and the importance of daily physical activity on overall health. We are so fortunate to have Dr. Khan on the show. He is a Canadian sports physician, a professor at the University of British Columbia, and the editor of the British Journal of Sports Medicine.
In this episode, we talk about:
-Can physical therapists detect red flags and does direct access work
-Who is leading musculoskeletal research and pushing the evidence forward
-Physical therapists as leaders in exercise as medicine
-The importance of being physically active role models for our patients
-What macro nutrient is driving the obesity epidemic
-How you can utilize social media to garner interest in niche fields
-A live Q&A with Dr. Khan and Dr. Jill Cook
-And so much more!
It was great having Dr. Khan on the show! He offers great advice and support for the physical therapy profession and promotes an active lifestyle that can keep you Healthy Wealthy and Smart!
You can find Dr. Khan on twitter (@BJSM_BMJ) and make sure to tune into the British Journal of Sports Medicine Podcast!
Thank you so much for listening and subscribing! You can find me on twitter (@KarenLitzyNYC)
Xo Karen
I had the honor of sitting down with Dr. Jill Cook and busting some common tendinopathy myths. This episode with Dr. Jill Cook was recorded live in front of an audience at the Combined Section Meeting in Anaheim, CA about 2 weeks ago. It was a great experience and one of the highlights of my CSM experience.
A little more about Dr. Cook: She is a professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill’s research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas.
In this episode we talk about:
-
Are eccentric exercises are the best and only way to treat a tendinopathy?
-
Can use the same tendon therapy protocol for every tendon and every person.
-
A tendinopathy always involves inflammation.
-
Once you are pain free and back to sport you don't have to worry about the exercises you did in PT.
-
Why we shouldn't be selling messages we can't deliver.
-
and much more!
Dr. Cook shares so much information about tendinopathy in this episode that I think I learned more in 25 min that I have in the past 10 years!
Thank you again to the Private Practice Section of the APTA for all of their help to make this happen and thank you to Jimmy McKay, host of the PT Pintcast for the great intro!
Enjoy and stay Healthy Wealthy & Smart!
xo
Karen
This week's episode features Laura Roeder who is the founder of LKR Social Media and Edgar, a social media automation tool that prevents your updates from going to waste. Laura was named one of the top 100 entrepreneurs under 35 in 2011, 2013, and 2014 and presented the value of entrepreneurship at the White House. Laura makes technology simple to understand and implement for small business owners.
In this episode, Laura and I discuss:
- How software saves you time so you can do what you love to do.
- How to utilize social media to bring in new prospects.
- Why you should specialize your product because less is more to your customers.
- How she builds and manages a successful remote team from all over the country.
- The do's and don'ts of social media.
- Her advice for a budding entrepreneur.
- And a whole lot more!
Laura was a very special guest! She provided great insights on how to utilize tools for running your business and we get into the details about optimizing your social media presence to allow you to spend more time building relationships.
To find out more about Edgar, click here and make sure to follow Laura on twitter (@lkr) and facebook.
Thank you for listening and subscribing! You can find me on twitter (@karenlitzyNYC).
Stay Healthy Wealthy and Smart!
Xo Karen
Dr. Tim DiFrancesco, DPT, the lead strength and conditioning coach for the Los Angeles Lakers, joins us again on this week’s Thursday Quickie and we are talking all about the millennial generation.
In this episode we discuss:
- How to engage with millennials to accomplish performance goals
- The importance of linking your training principles and their primary motivation
- What candy exercises are and how to use them to your advantage while training millennials
- How to temper their expectations for immediate results
- Why this generation needs collaboration during the goal setting process
- And much more!
I had a great time chatting with Tim and I wanted to thank him for sharing great advice on how to engage effectively with millennials as well as helpful tips to apply to our patients, clients, and even fellow PT's. Make sure to check out his blog (tdathletesedge.com) and follow him on twitter (@tdathletesedge) and instagram (@tdathletesedge).
Thanks for listening to this week's Thursday Quickie and subscribing to the podcast! You can find me on twitter @karenlitzyNYC.
Have a lovely weekend and stay Healthy Wealthy & Smart!
xo Karen
Do you want to train some of the highest performing athletes in the world and keep them at the top of their game? On today's show, I talk with Dr. Tim DiFrancesco who is the lead strength and conditioning coach for the Los Angeles Lakers.
In this episode we discuss:
- How he made the leap into professional sports.
- How is top strength tips can work on every patient/client regardless of age or experience.
- Why your workout should focus on time under tension and perfect form.
- How to stimulate muscle growth by increasing volume of work.
- Why breaking perfect form effects long term performance.
- How a PT background sets you up for success in the strength and conditioning world.
- And so much more!
This was a great interview with Tim on how his background as a physical therapist influences his strength and conditioning principles. I learned a great deal from Tim on this episode and I hope you come away with some great insights to use immediately in your clinical or fitness setting!
Tim's Top Resources:
Kelly Starrett (http://www.mobilitywod.com/)
Dan John (http://danjohn.net/)
Pavel Tsatsouline (http://www.strongfirst.com/)
How to reach Tim:
Website: www.tdathletesedge.com/
Twitter: @tdathletesedge
Instagram: @tdathletesedge
Thank you for listening and subscribing to the podcast! And remember you can find me on Twitter: @KarenLitzyNYC
Don't forget to tune in for the Thursday Quickie 2/11/16 with Dr. DiFrancesco on working with millennials!
Stay Healthy Wealthy & Smart!
Karen
If you are a physical therapist and you have not heard of the Graham Sessions...don't worry you are not alone! The first time I heard about this meeting was last year and even then I had no idea what it was all about. So this year I was able to register for the event which took place at the beautiful Biltmore Resort in Phoenix, AZ in January. Because most PTs have no idea what the Graham Sessions are or they heard about the Graham Sessions on social media and are feeling left out, this podcast with one of the founders of the Graham Sessions, Steve Anderson, PT will hopefully answer all of the questions you might have about this meeting.
In this episode we talk about:
-
What are the Graham Sessions?
-
How did the Graham Sessions come about? (It involves a late night at a bar)
-
What were the topics covered in this year's Graham Sessions.
-
What were Steve's thoughts about the meeting this year.
-
What are Steve's thoughts on the future of the Graham Sessions.
I want to thank Steve Anderson, PT for being on the podcast and for being so generous with his thoughts on this conference and the future of the Graham Sessions.
As always thank you for tuning in and subscribing to the podcast! Have a great week and stay Healthy Wealthy & Smart!
xo
Karen
This week's Thursday quickie is part two if my conversation with the Latin American Strength and Conditioning Coordinator for the Houston Astros, Rachel Balkovec.
In this episode we discuss:
-
Her strength and conditioning philosophy and how she transfers that to her athletes.
-
How she individualizes the workouts for each player and position.
-
The way Rachel establishes respect in the weight room.
-
Who her mentors are (this is very sweet).
-
What is next for her in 2016!
This was another great talk with Rachel! She shares more stories and great advice for anyone, but especially women who aspire to be in Major League Baseball.
A huge thanks to Rachel and to you for listening and subscribing to the podcast!
Have a great weekend and stay Healthy Wealthy & Smart!
xo
Karen
Are you a strength and conditioning coach or physical therapist interested in working in Major League Baseball? Then this is the episode for you! I talk with the Latin American strength and conditioning coach for the Houston Astros, Rachel Balkovec.
In this episode we talk about:
-
How she found her self worth through strength training.
-
How hard work, sacrifice and the right attitude got her to where she is today.
-
What she needed to learn to work in MLB.
-
The ways in which she goes above and beyond for her players.
-
What it takes to be a strength and conditioning coach in MLB.
-
Her biggest challenge so far in her career.
-
Her advice to women wanting to get into MLB.
-
and much much more!
Rachel is a true inspiration, a hard worker and a great role model for young women coming up in the strength and conditioning world.
Thank you for listening and subscribing to the podcast!
Stay Healthy Wealthy & Smart,
Karen
In this week's Thursday Quickie Dr. Richard Severin and I discuss:
- The importance of being on social medial for all physical therapists.
- Why Rich likes to nurture open discussions on social media.
- Why the "why" matters when it comes to explaining treatments to your patients.
- Why trust and truth is paramount in patient care.
- Rich shares his go to resources on social media!
This was a fun Thursday Quickie with Dr. Severin and I hope it gets at least one more physical therapist to join the fun on social media! I would even go a step further to say I hope it not only gets physical therapists to join social media, but to engage fully with other therapists from around the world, expand your knowledge base and have fun!
Thanks for listening and stay Healthy Wealthy & Smart!
Karen
As physical therapists we are now front line healthcare professionals. Because of direct access (this means you can go to a physical therapist without a doctor referral) clients may be coming to us as an entry point into the healthcare system. As a result of this we need to treat every client with a holistic view. We need to at the very least screen the cardiopulmonary system within the overall human movement system. This is where Dr. Richard Severin comes in! He is a passionate proponent of taking vital signs and screen the cardiopulmonary system for every client in every setting.
In this episode we talk about:
- His background and interest in cardiopulmonary branch of physical therapy
- The importance of getting baseline measurements for every client in every setting
- Why it is important to take vital signs in all physical therapy settings.
- His response to “I have to see so many patients in my outpatient clinic I don’t have time to take vital signs”
- Risks of not taking vital signs.
- His talk at CSM
- And much more!
This is such an important topic for all healthcare professionals and taking vitals is something we should all be doing…..regardless of our work setting!
Thanks for listening and stay Healthy Wealthy & Smart!
Karen
This episode was literally recorded while Lenny Macrina and I were having lunch a the Titleist Performance Institute's Level 1 certification course in Rhode Island. This was Lenny's first podcast, although you would think he has done this his whole life. We had a great conversation and it was super fun!
In this episode we talk about:
-
The TPI Level 1 Certification
-
Lenny's approach to evaluating and treating and shoulder injury.
-
What might be missing the CrossFit athlete’s shoulder complex that may lead to injury.
-
What is the Red Zone and Green Zone and how does it relate to your patient's injury.
-
How to get a patient (specifically a CrossFit athlete) to buy in to your treatment plan.
-
How to sell as a physical therapist.
-
How Lenny harnesses the positive to continue to empower and motivate his clients.
-
and much more!
A huge thanks to Lenny for this great conversation and to you for subscribing and listening tot he podcast!
Have a great weekend and stay Healthy Wealthy & Smart!
Karen
Welcome to 2016!
The Healthy Wealthy & Smart podcast is back with new album art, new intro music (thanks to Candlebox) and a fantastic line up of amazing guests!
I could not think of a better way to kick off the New Year than with a revealing interview with Ms. Gloria Steinem. Ms. Steinem is a writer, lecturer, political activist, and feminist organizer. She travels in this and other countries as an organizer and lecturer and is a frequent media spokeswoman on issues of equality. She is particularly interested in the shared origins of sex and race caste systems, gender roles and child abuse as roots of violence, non-violent conflict resolution, the cultures of indigenous peoples, and organizing across boundaries for peace and justice. She lives in New York City, and just published her first book in over twenty years. During this interview we talk about that new book, My Life on the Road. It is a wonderful book full of history and nuggets of wisdom from Gloria.
In this interview we talk about:
- How the nomadic nature of her childhood shaped her life as an adult.
- The concept of talking circles and how that concept guided her throughout her life.
- What were her more memorable moments from her life on the road.
- One of her biggest fears and how she continues to overcome it.
- The biggest challenge for women today.
- What her thoughts are on being the “face of a movement”.
- Her advice on how to identify an issue and start a movement (it is easier than you think).
- And so much more!
I can’t thank Gloria enough for her generosity of time, words and thoughts. She is truly a remarkable woman who continues to live an extraordinary life.
For more information on Gloria Steinem and see her speak in person click here.
Enjoy the conversation and stay Healthy Wealthy & Smart!
Karen
This is the last podcast of 2015 and I am so happy to end the year on such a high note with my interview with Dr. Chris Powers, PT, PhD, FAPTA.
He is Professor in the Division of Biokinesiology and Physical Therapy and Co-Director of the Musculoskeletal Biomechanics Laboratory at the University of Southern California. Dr. Powers' research and teaching interests relate to the biomechanical aspects of human movement. More specifically, his research focuses on how altered kinematics, kinetics, and muscular actions contribute to lower extremity injury. He is particularly interested in the pathomechanics underlying knee and patellofemoral joint dysfunction. Dr. Powers is an active researcher, and has published over 150 peer-reviewed articles. He frequently lectures both nationally and internationally on topics related to lower limb biomechanics and the pathomechanics of orthopaedic disorders. Dr. Powers is the current President of the California Chapter of the APTA
In this episode we talk about:
-
The definition of the human movement system.
-
Why physical therapists are uniquely qualified to lead the human movement system paradigm.
-
The identity crisis of the PT profession and how the human movement system should be the thread that binds our profession together.
-
What are the biggest barriers to adopting and implementing the human movement system?
-
What should the PT professions unifying message be?
-
In the words of Dr. Anthony Delitto "What is the hold up?"
-
And much more!
What Dr. Powers and I would like for you to think about is: how would you describe what you do (as physical therapist) in only 5 words?
Have a great holidays season and Happy New Year! See you in 2016 and as always stay Healthy Wealthy & Smart!
Karen
In this week's Thursday Quickie Jennifer and I continue our conversation from Monday about leadership. But this week we focus our attention on the female leadership in physical therapy.
In this episode we talk about:
-
The lack of female leadership in the PT profession.
-
How our mindset needs to shift.
-
How we need to support each other to better our profession.
-
Peer to peer "bullying".
-
How to authentically lead and adapt to the current culture.
-
How to be your best self advocate!
Jennifer and I also issued a challenge to all of the listeners: We would like you to tweet to either of us who your pick would be for a great female keynote speaker for the PPS conference in Las Vegas in 2016! I can't wait to reach your choices!
@KarenLitzyNYC
@JGDubs
Have a great weekend and stay Healthy Wealthy & Smart!
Karen
What qualities make a good leader? Can those qualities be taught? Should leadership be taught in entry-level healthcare education programs?
In this episode my guest, Jennifer Green-Wilson and I tackle these big questions. We talk about:
-
The 4 qualities that are essential for a good leader.
-
How does Jennifer go about cultivating these qualities in her clients and students?
-
What needs to happen in entry-level education to make leadership skills part of the curriculum.
-
Her dissertation on leadership and practice management in entry-level education.
-
Who is the first person you must lead in order to be an effective leader.
-
and much more!
Jennifer is high energy and her passion for leadership is contagious!
Don't forget to tune in to the Thursday Quickie where Jennifer and I talk about female leadership in the physical therapy world...or lack there of!
Thanks for listening and stay Healthy Wealthy & Smart!
Karen
In keeping with the Thursday Quickie theme I am going to keep this short and sweet. In this episode Win and I talk about:
- Her writing process from thought to finished book.
- How she self published her books (she gives specific websites!).
- The timeline from idea to finished product
- And much more!
Again, to find out more about Win and her podcast Win’s Women of Wisdom go to:
Her website
iTunes
Win’s co-CEO of Win’s Women of Wisdom
Danielle Coulter
Thanks for tuning in to this week's Thursday Quickie with Win Charles!
Have a great weekend and stay Healthy Wealthy & Smart!
Karen
In this episode I was honored to speak with best selling author, artist and podcast host of Win's Women of Wisdom, Win Kelly Charles. Win is all too familiar with physical therapy as she was diagnosed with cerebral palsy at a very young age. From MoveForwardPT.com, "Cerebral Palsy (CP) is a general term used to describe a group of disorders that affect the normal development of movement and posture. CP is caused by an injury to the brain—such as infection, stroke, trauma, or the loss of oxygen to the brain—that occur before, during, or after birth or within the first 2 years of life. The injury to the brain is "nonprogressive," meaning that it does not get worse after the initial injury. However, the day-to-day activities that can be affected by the injury during an individual's childhood can worsen throughout the individual's life."
Believe me, Win does let CP stop her. She is one of the busiest people I know (she makes me look like a total slacker)! She has written several books, is an accomplished artist, teaches part time, is in school working towards a degree in education, snowboards regularly, and is the host of the podcast Win's Women of Wisdom. Like that is not enough she plans on launching a new podcast next year!
In this episode we talk about:
-
Win's experience with physical therapy.
-
How her physical therapy care has changed as she has gotten older.
-
Her best advice for physical therapists working with children with disabilities (it is always great to get the patient's point of view).
-
The most challenging aspect of her current physical therapy plan of care.
-
How important the rapport is between the patients and therapist.
-
How Win keeps in shape outside of PT.
-
The importance of a strong support team.
-
Her book I Win.
-
And much more!
This was a great conversation and I think it gives us all a better idea of what it is like to not only live with cerebral palsy but to live well with cerebral palsy!
A big thanks to Win for being so open and honest during our conversation.
Thanks for listening and stay Healthy Wealthy & Smart!
Karen
This week's Thursday Quickie is a continuation of the podcast from Monday about the PPS (Private Practice Section) Annual Conference in Orlando, FL. On Monday we heard from many attendee of the conference and today you will get my take!
In this episode I talk about:
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What being a media company first and PT company second means.
-
Gary's thoughts on the biggest social media marketing platform.
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Creating curiosity in the profession through social media.
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Why Instagram is important to you and your brand and how to use it.
-
What are Daniel Pink's ABCs of selling.
-
What the heck is an ambivert?
-
Neil Ihde's 10 Mistakes Leaders Make
-
Where are my ladies at??
-
Much more!
Thanks for listening and stay Healthy Wealthy & Smart!
Karen
A few weeks ago I attended the PPS (Private Practice Section) annual conference in Orlando, FL. I was lucky enough to team up with Dr. Sandy Hilton during the conference to ask attendees what they thought of the keynote speeches from Gary Vaynerchuk and Daniel Pink, the break out sessions and the overall vibe of the conference.
In this episode you will hear from many attendees and get real opinions and thoughts from the conference. What you will hear:
-
The big takeaways from Gary Vaynerchuk's keynote speech from the first night of the conference.
-
The big takeaways from Daniel Pink's keynote speech from day two of the conference
-
How people will take what they learned at the conference and apply it immediately to their practices.
-
Thoughts on some of the break out sessions throughout the conference.
This was my first time attending the PPS annual conference and I think it was well worth the price of admission. Not only were the session and speeches very good, the "behind the scenes" conversation with other attendees was stellar. It is great to connect with your fellow PTs doing such great and inspiring work!
Thank you for listening to this podcast and if you were at the PPS conference and want to add more about your experience find me on Twitter @KarenLitzyNYC
have a great week and stay Healthy Wealthy & Smart!
Karen
Happy Thanksgiving to all of the listeners in the United States! I was lucky enough to spend my holiday with family and friends. As a result I have a special guest co-host for the intro to this podcast!
In this week's Thursday Quickie (I know it is Friday but I have to take Thanksgiving off) I am happy to continue my conversation with Rom JB about writing effective copy that sells. In this episode we talk about:
-
As physical therapists who are our biggest competitors?
-
Rom gives a specific example of writing great copy.
-
What should be on the home page of your website.
-
Why your "About me/us" page is so important and what should be on it!
-
And much more!
As always thank you for listening and have a great weekend! Stay Healthy Wealthy & Smart!
Karen
Let's face it, writing good copy is not easy. This is something I struggle with and I am sure many of you struggle with as well. As a result I set out to find a guest to help clear up this whole copy writing thing. I was thrilled to interview Rom JB. Rom JB is a special educator, entrepreneur, copywriter and small business mentor based in New York City. In 2010, Rom founded RJB Educational Services, Inc., an in-home tutoring business. He has been able to grow his business by focusing on creating systems that decrease cost while increasing revenues and profits. Rom is also a copywriter that works with entrepreneurs and small businesses to better market and sell to their ideal clients.
In this episode we talk about:
-
The formula of how to write effective copy that sells.
-
Copy that presents you as an authority in your field.
-
Why should physical therapists and other health care professions know and understand the power of effective copy.
-
How can physical therapists and other healthcare professionals tap into the language of their ideal client.
-
And so much more!
Like I say in the intro get out your pen and paper be prepared to take notes....lots of notes! Rom's insights into the copy that PTs need and should be using is amazing!
To find out ore about Rom and get in touch him go to:
As always thank you for listening and stay Healthy Wealthy & Smart!
In this Thursday's quickie episode Justin, Morgan and I talk about:
-
More of the REAL PT experience in Haiti
-
The bug situation in Haiti (this is kind of a sticking point for me)
-
The accommodations and food you will have if you decide to volunteer w/ Stand: Haiti
-
A very quick Twitter advertising tutorial
The first part of this quickie, where we are talking more about Haiti we all knew it was being recorded. The second part of the quickie, where we are talking about advertising on Twitter, we had no idea it was being recorded. My big cat Benson jumped up on my computer when we were talking and he hit the record button. I decided to add it to the interview because it is all good stuff!
Enjoy this week's Thursday Quickie and stay Healthy Wealthy & Smart!
Karen
In this episode I speak to physical therapists Dr. Justin Dunaway and Dr. Morgan Denny co-founders of STAND: Haiti. STAND was founded in late 2014 in order to create a growing system of rehabilitative medicine in northwest Haiti. With a focus on education and creating local clinicians, STAND brings medical practitioners, including PTs, prosthetists, orthotists, and general medical practitioners, to Port-de-Paix, Haiti to provide treatment for the people in this region. STAND is currently in the process of creating a curriculum specific to the needs of NW Haiti that will become part of the local nursing schools’ educational programming. These lectures on orthopedic rehab medicine will be based on STAND director’ five years of experience treating patients in the country and created in conjunction with Youngstown State University’s PT faculty.
In this episode we talk about:
*Their latest trip to Haiti.
*Their successful Kickstarter campaign to create a short film about the STAND experience in Haiti.
*The history of STAND.
*What the volunteer experience is like.
*Some really extreme patient stories and what the patients sometimes have to do to get to the STAND clinic.
*What they need in the form of donations and volunteers.
As you will see in this episode their passion for physical therapy and their work in Haiti is infectious! If you are in the medical field I hope this interview will inspire you to volunteer with STAND. If you can't volunteer please consider making a donation.
Thank you for listening and stay Healthy Wealthy & Smart!
Karen
Almost every time I interview a guest for the podcast we end up chatting after the formal interview is over...sometimes for an extra hour! A lot of that content is really good stuff, so I decided to record it and send it out to the world! I suppose you can think of these "quickie" episodes as an after hours conversation.
In this week's quickie Jimmy and I talk about:
-
Why he decided to become a physical therapist
-
Who was his favorite musician to interview back in his radio days
-
What was his (and my) favorite concert
-
and finally what to call these after interview episodes. I did not take Jimmy's suggestion but I am pretty sure he will be using it on his podcast very soon!
Thanks for listening and I hope you enjoy this Thursday quickie!
Karen
In this episode I chat with DPT student and the host of the PT Pintcast Jimmy McKay. This was a super fun interview as I love hearing from students and getting their perspective on the world of physical therapy. It was also nice to get Jimmy on the other side of the interview...although I pretty sure at one point he started interviewing me!
In this episode we talk about:
-
A recap of the national Student Conclave
-
How he is preparing himself for the transition from DPT student to working PT
-
The PT Pintcast
-
His biggest challenges (or as Dr. Sharon Dunn calls it opportunities) as a DPT student
-
How hosting his podcast has changed him as a student and a person.
-
and much much more!
I also make up for the fact that I think I was the only person who has been on the PT Pintcast that did not share a beer with Jimmy....this time I made sure I did. I also have a "quickie" interview with Jimmy that will come out later on this week. That interview is a little more personal and little less PT talk. So be sure to be on the look out for that!
As always thank you for listening and subscribing to the podcast! Have a great week and stay Healthy Wealthy & Smart!
Karen
The month of November is National CRPS (Chronic Regional Pain Syndrome) Awareness month. National Institute of Neurological Disorders and Stroke defines CRPS as “a chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet), usually after an injury or trauma to that limb. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and mild or dramatic changes in skin color, temperature, and/or swelling in the affected area."
In honor of this awareness month I was thrilled to interview Joey Aquilino. He is living with CRPS and has become an outspoken advocate for those living with CRPS. It was so refreshing to hear an honest and very real account of what it is like to navigate the healthcare system when you have "something" wrong and you are in pain.
In this episode we talk about:
-
Joey's journey from initial injury to diagnosis of CRPS (it took a long time!).
-
How CRPS affected him emotionally as well as physically.
-
The steps and techniques he used to reduce depression and get moving.
-
Why he became an advocate for those living with CRPS
-
How his ordeal resulted in him finding himself and his passion.
-
The #JGF family and his Blogtalkradio shows
-
Plus much, much more!
I loved this episode because I think it is so important to get the patient perspective, especially with complex diagnoses like CRPS. A diagnosis like this goes so far beyond the time we spend with the patient during our sessions. Joey gives such an open and honest account of what he has gone through over the past several years and it is a great reminder for all healthcare providers who work with people in pain that you need to take the time to listen to the whole story!
A big thank you to Joey for sharing and to you for listening!
Have a great week and stay healthy, wealthy and smart!
Karen
When was the last time you stepped out of your comfort zone and took a chance on something new? If it has been a while I highly suggest you do something, even if it is small, at least once a week that challenges you and makes you just a bit uncomfortable. That is exactly what my guest on the podcast has done for years and as a result she is a Doctor of Physical Therapy, an assistant professor in the physical therapy department at Hampton University and the most recent Miss Virginia USA. Dr. Desiree Williams has accomplished so much in her life already because she takes those chances, works hard, is super organized, and is proactive about her life and her goals. This was such an inspiring conversation and my huge takeaway is to have more confidence in myself and believe in my values and my decisions.
In this episode we talk about:
-
Why she decided to become a PT.
-
How she got started in the pageant world and how she has been so successful.
-
Her top tips for managing your time efficiently (I thought I was organized but this girl puts me to shame).
-
Her platform as Miss Virginia USA and how she incorporates her education and passion for health and wellness into that platform.
-
How she is able to keep the negativity that can be associated with the pageant world out of her head.
-
Her best advice for students thinking of going into the world of academia
-
And much, much more!
Dr. Williams' confidence and positive attitude is clear and she gives so many nuggets of advice in this interview on how to stay positive, grounded and most importantly yourself.
Enjoy this wonderful talk and stay Healthy Wealthy & Smart!
Karen
This is the continuation of the interview with Dr. Bronnie Thompson from last week about living well with chronic pain. In this episode we answer listener questions!
In this episode we go through the following questions:
-
What she would say to give confidence to someone who is afraid that no matter what they do, they will always hurt?
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Is there value in a pain diary?
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Any tips on instituting an exercise program in widespread pain syndromes such as fibromyalgia?
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Any helpful strategies to get a reluctant patient on board with exercise?
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How does Dr. Thompson's research in pain apply to the manual therapy profession?
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And much much more!
I want to send lots of love and thank yous to Dr. Bronnie Thompson for an amazing interview experience and sticking around for this very important part two of our conversation.
Thank you for all of the positive comments and kind words from last week's interview and I know you will find the same value in this episode!
Have a great week and stay Healthy Wealthy & Smart!
Karen
I know what you are thinking...living well with chronic pain?!? Some thoughts that went through my head were:
"Are you kidding me...that sounds impossible"
"Sounds like an oxymoron to me."
"Does that mean take lots of pain meds to feel better?"
And I am sure you can think of lots of other things to say! But after you listen to this incredible interview with Dr. Bronnie Thompson, your thoughts will be challenged! You will start to see that yes...you can live well with chronic pain. You can find value and fun in your life doing the things you love despite pain.
In this episode we talk about:
- Values based pain management
- Dr. Thompson gives some amazing examples of motivational interviewing (I am talking really great so be ready to take notes!).
- The process your patients can follow to reoccupy their self-concept in the face of chronic pain.
- How to be a real human with all of your patient interactions.
- Making the patient the center of your practice.
- And so much more!
This is the first part of a two-part interview with Dr. Thompson. The second part will air next week!
Thanks for listening and if you like what you are hearing please share it and leave a rating here! Have a great week and stay Healthy Wealthy & Smart!
Karen
***PS....You will also listen to what made me totally break down and cry for the first time on air! Get the tissues ready!
In this podcast I am joined by Rick Gawenda, PT and he answers your burning questions about ICD 10.
Some of the topics we covered in this podcast are:
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The 7th character...what is it and when do you have to use it?
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How many ICD 10 codes need to be on a claim form? Can you ever have too many?
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What are the documentation requirements in the patient's medical records?
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Are the diagnosis codes the same as the treatment codes?
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What are external cause codes for injuries?
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Rick takes us through a few tutorials on how to code based on some diagnoses.
This was a super informative episode! Rick literally knows most of this stuff off the top of his head (which I was very impressed with) and he shares with us a very comprehensive look at the major aspects of the ICD 10 coding system.
Thank you all for listening and please feel free to share with friends and family! And if you like what you are hearing I would be ever so grateful for a review on iTunes!
Have a great week and stay healthy wealthy and smart!
Karen
As any medical professional will tell you, navigating the Medicare system is challenging. Add to that a cash physical therapy business and things can get really confusing! To help get us through this sea of confusion that is Medicare, Dr. Jarod Carter has written a fabulous book entitled Medicare and Cash Pay Physical Therapy. It is a comprehensive guide based on all he has learned from over five years of owning a cash-based clinic and many hours of working with different attorneys and authorities on this subject. Dr. Carter has also been teaching about the private pay business model for a number of years and often consults for in-network practices participating with Medicare. So this book is not only focused solely on the rules as they apply to cash-based practices. It is written for any practice owner wondering how she/he can accept private payment for the variety of services a PT business may provide to beneficiaries.
In this episode we talk about:
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Why Jarod decided to become a physical therapist
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Why and how he started his cash-based PT practice
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What is the difference between participating, non-participating, and no relationship w/ Medicare
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Can a PT opt out of Medicare
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What is an ABN and when is it necessary to use it vs. a private contract with your patients.
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Is there a "loophole" to see Medicare patients in a cash PT model
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And much more!
One thing to remember...if you have any questions about your practice and how it fits in to the Medicare system always contact a healthcare lawyer to help with your specific situation.
Enjoy the podcast and thanks for listening!
Karen
Are you a DPT student or new graduate thinking about opening your own cash based PT clinic one day? if the answer to that questions is yes, then this is the episode for you! In this episode I sit down with Dr. Kevin Prue, the president and director of Prue Physical Therapy and Sports Performance in Cary, NC. While I am not a huge fan of new graduates opening their own clinic straight out of college Dr. Prue may have caused my thinking to take some baby steps in that direction.
In this episode Dr. Prue and I discuss:
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His process of creating his business and when he started that process (hint it was not after he graduated!).
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The biggest successes he has had since opening the doors to his clinic.
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The biggest challenges in his business and the steps he has taken to overcome them.
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We go through a quick exercise to find his ideal client to help sharpen his marketing plan. This is something EVERYONE should do before they open a business.
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How he differentiates his clinic from the others in his area.
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His best advice for DPT students thinking about opening a PT business.
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And much, much more!
Dr. Prue's business is about to hit the one year mark and this interview is an honest look at what it takes to be a business owner with all of the highs and lows. Don't forget, it is hard work to own your own business, so if this is something you are thinking about doing at some point in your life be prepared to WORK!
I would love to hear your thoughts on the pros and cons of starting a #CashPT business right out of school. Please leave a comment or tell me about on twitter here.
"We are still the same people we just have more equipment." - Kiel Eigen
In honor of September being National Spinal Cord Injury Awareness month I was thrilled to interview Kiel Eigen. Kiel became paralyzed during a football game when he was in eighth grade, but like he says it does not stop him from living his life. I interviewed Kiel, along with his physical therapist Dr. Gina Tomassoni a few years ago after he completed a major milestone in his recovery.
In this episode Kiel and I talk about:
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His relationship with his physical and occupational therapists and how important that was for his recovery
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The major milestone he accomplished while still in high school
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How his life has changed since using a new wheelchair from Quantum Rehab
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How the new wheelchair differs from others on the market
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What Kiel does to keep in shape (you might be surprised)
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What his plans are for the future
As a physical therapist it is so important to know your client's point of view and life outside of their PT sessions. If you are not taking that into account I think you are definitely missing the boat and not doing your clients justice. The major takeaways from this podcast are to ask more questions, go beyond the traditional "goals" for your clients and understand their values. Once you know the values that mean the most to your client's only then can you make a comprehensive plan of care and make a major impact in their life.
The American Physical Therapy Association's vision statement is: Transforming society by optimizing movement to improve the human experience. This is an ambitious vision statement and I for one am OK with ambitious. Now comes the question: How do we do it? In today's episode I speak with Dr. Matthew Taylor about fostering creativity in rehabilitation and how incorporating creativity and compassion into our practice will help to transform our profession. It is important to transform the profession of physical therapy to move towards the vision statement of transforming society.
In this episode we talk about:
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How yoga has transformed Matthew's PT career.
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What is yoga therapy and how does it differ from regular yoga.
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The concept of creativity and how it fits into the practice of PT and wellness.
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How can we transform society.
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The 6 exercises for priming compassion.
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And much more!
This is a great conversation and I feel Matthew gives some concrete steps to help to transform you, the profession and finally society as a whole. So, please enjoy this episode and have a great week!
Karen
In this episode I am thrilled to interview celebrity chef, author and filmmaker Charles Mattocks. Also known as "The Poor Chef" he has been featured on The Today Show, Good Morning America, The Talk, CNN, Dr. Oz and Martha Stewart. He has also been recently featured at the TEDx conference in San Francisco. In this episode we talk about his newest project Trail By Fire, a movie about CRPS (chronic regional pain syndrome). CRPS is a very difficult diagnosis for the patient, family and caregivers and hopefully this film will bring more national/international attention to this diagnosis.
In this interview we talk about:
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His motivation behind making the movie.
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What he learned from interviewing people living with CRPS.
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His hope for Trial by Fire
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Why he is so passionate about helping people living with CRPS (and diabetes).
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What it is like to be a caregiver to someone living with CRPS.
Charles is so passionate about getting the word out about CRPS and Trial by Fire is a powerful film from the patient's point of view. Often times as healthcare professionals we see the patient for short snippets of time in their lives. As a result we sometimes don’t get the "whole picture" of our patient and that is what I think Charles is doing with this film. I look forward to seeing the finished product!
In this episode I had the distinct pleasure to interview physical therapist, author and mentor Paul Potter. He is genuine, real, and truly wants the best for everyone in the profession of physical therapy. His new book On Fire: Ignite your Passion with a Cash Therapy Practice will be available on Tuesday September 8, 2015. If you are looking for honest, actionable advice on creating the right mindset for a cash based practice and then implementing a roadmap to your ideal business then this is the book for you!
In this podcast Paul and I discuss:
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Why there is a growing interest in the cash PT model.
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Why Paul feels that being a physical therapist is a noble calling (of course I agree!).
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What is the important link between your mindset and starting a practice.
*The main reasons therapists are opting to start a cash PT model.
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How running a successful cash PT business is like competing in a triathlon.
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The 4 essential stages for business success...this is the roadmap!
After listening to this episode I hope that you find your "why" for starting a cash PT business, begin to change your mindset, be firm in your calling as a physical therapist and finally start to plan out your roadmap for success!
Do you want to get your hands on Paul's book On Fire? Check out the links below:
Paul's website http://paulpotterpt.com
Book landing page: http://paulpotterpt.com/onfirebook
Amazon: On Fire:Ignite Your Passion with a Cash Therapy Practice
Amazon: Cash Therapy Practice: Professional Freedom in the New Healthcare Economy
Have a great week and thanks for listening. And remember if you like what you are hearing I would love for you to share this episode with friends/family and please leave a comment below to keep the conversation going! Also, please do leave a rating and/or review on iTunes!
Thanks!
Karen
"The best way to find yourself is to lose yourself in the service of others." - Ghandi
This great quote from Ghandi is perfect for this week's episode. Often times we find ourselves so entrenched in our own lives that we forget there is a whole world out there that can benefit from the unique skills we have to give. That is why I am so thankful for my quests in this week’s episode! Dr. Josh D’Angelo and Dr. Efosa Guobadia are physical therapists and the co-founders of the Global PT Day of Service. They are a breathe of fresh air and after listening to this podcast you are going to want them as your new BFFs!
In this episode you will learn:
· What inspired them to create the Global PT Day of Service (and it is a good one).
· How their mutual friendship and respect for each other is a great example of how to live your life.
· Their take on why PTs should be giving back to their communities and how it can help move your business forward.
· Some examples of what they will be doing for the Global PT Day of Service.
· Their vision for the future of the Global PT Day of Service.
· How easy it is for you to get involved in the Global PT Day of Service.
This was such an inspiring interview and I hope that after listening you head over to the Global PT Day of Service, sign up and get ready to be of service to the people in your community. I hear so often that people in our communities don’t know what physical therapy is and what we do for our clients/patients. Getting out there in the community and using our unique set of skills, meeting people in the community and being of service to others sounds like a great way to spread the word about physical therapy!
“Service to others is the rent you pay for your room here on earth.” – Mohammed Ali
How can we bring life, liberty and the pursuit of independence to society? The American Physical Therapy Association's vision statement is: Transforming society by optimizing movement to improve the human experience. Dr. Cole Galloway and his team at the University of Delaware are taking this vision statement and making it into reality for children and adults with movement restrictions. His love for learning and helping is infectious!
Developmental Psychologist and Pediatric researcher James “Cole” Galloway thinks differently about the role of self-motivated mobility in shaping who we are in early life. As Co-Director of the Pediatric Mobility Lab and Design Studio and Professor at the University of Delaware, he invents assistive devices for children with motor impairments. His approach of combining high tech and low tech—or “go tech”—to restore physical independence and its neurodevelopmental consequences for disabled children has garnered the interest and funding of the National Institutes of Health, the National Science Foundation, the Dept of Education, the assistive technology industry and the toy industry.
I first saw Dr. Galloway speak at the TEDMED conference in 2014 where I was introduced to Go Baby Go. To watch his TEDMED talk click here:
In this episode you will learn:
· Dr. Galloway’s journey from PT to Phd to his remarkable work at the University of Delaware.
· The importance of clear communication for researchers and clinicians when it comes to complex concepts.
· How do you communicate in writing these complex concepts: get a step-by-step guide based on the work of Esther Thelen.
· Why you need to step out of your comfort zone and your profession to succeed in innovation.
· What is Go Baby Go, how was the program created, and where is it going?
· How can body weight harnesses be used for work and home for patients with movement disorders?
· Why it so important for physical therapists to lead the charge to help society move!
This was a fun and inspiring interview that if nothing else will have you up and moving….and maybe get you to think outside of the box on ways help others to move as well.
Thank you for listening and have a great week!
Karen
As many of you know one of the biggest downsides of secondary education is the staggering amount of student loan debt. This rate of student loan debt has increased substantially over the years so many millennials are especially mired in debt before they even start their first job. I know first hand this can feel very overwhelming and quite frankly a little depressing. I asked you (the audience) what questions you had for Bridget and I am so excited to bring you all the answers in this episode.
Bridget Casey is the author and creator of the financial blog Money After Graduation. She has an undergraduate degree in Chemistry and an MBA in finance. She is a passionate millennial on a mission to help others pay down their student debt and start investing the right way!
Bridget is also offering a FREE eCourse called the Debt Crusher eCourse that you can enroll in here.
In this episode Bridget and I discuss:
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When should you consolidate your student loan debt
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What is her best advice for someone graduating with close to $100,000 in debt and starting with a job that pays around $60,000-$70,000 per year.
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The difference between having a personal finance advisor vs. online companies (like Learn Vest) for meeting your financial goals.
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Should your income go to paying off your student loan debt or investing (such a common question)
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Should you start paying off your student debt while still in school
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Strategies for paying off student loan debt fast.
Thank you all for the great questions! This episode is sure to answer those questions and get you on the right path for investing and a plan for paying off those student loans!
Thanks for listening and have a great week!
Karen
Pain is an epidemic in so many countries around the world and physical therapists are uniquely qualified to be front line practitioners to help to quell this epidemic. This episode will give you more information about how you as a healthcare worker can begin to tackle pain and create a safe place for your patients to excel.
In this episode I sit down with physical therapy and Phd candidate Dr. Eric Kruger. Eric and I have known each for a few years and it was great to sit down and talk with him about his decision to go back to school for his Phd and all things pain and psychology.
In this episode you will hear:
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How his studies in applied experimental psychology changed his personal perception of pain.
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How has his coursework changed the way he would treat his patients in future.
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The importance of motivational interviewing.
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The importance of our expressions and behaviors as clinicians and how they may influence our patient's pain (positive or negative).
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How can we change the narrative around pain for our patients.
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How can we as practitioners help our patients plot a course through the uncertainty of pain.
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What is valued living for the patient. What is the difference between a value and a goal.
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How can we properly build a solid foundation to treat our patients in pain.
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The importance of collaboration with mental health practitioners in the PT world.
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Why being like Ray Donovan or Olivia Pope might not be the best way to practice PT.
Eric is so relaxed and thoughtful with his responses it makes it very easy to learn from him and stay engaged with his thought process. This was a fun interview so I hope you enjoy it as much as I did!
Have a great week,
Karen
I get a lot of questions from physical therapists and PT students from around the country about creating and ultimately running a successful cash PT business. I thought I would use a couple of podcast episodes to answer some of those questions. In this first part of the cash PT series I discuss how to set yourself up for success in the cash PT model. In this episode you will learn:
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How to create a solid foundation for a successful business.
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What are the three P's and how can they direct your business.
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The importance of your business website.
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What questions should you or your client ask to the insurance company.
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What information needs to be on your superbill.
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How to determine your fees.
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Tips for working in a home health model.
Like I said above this is the first part in a series of podcasts about the cash PT model. Be sure to stay tuned for more practical information on running a successful cash PT business.
If you like what you are hearing then be sure to leave a good rating and a review on iTunes and share with your friends and family!
Have a great week!
Karen
Jo-Ná A. Williams, Esq. founded J.A. Williams Law P.C. – The Artist Empowerment Firm in 2011 to provide artists and entrepreneurs with ways to successfully navigate their careers and provide assistance with business, entertainment and intellectual property matters. She founded Artist Empowerment Group in 2013 to advise artists on business, branding and marketing. Some of her clients have written best-selling books, reached the Billboard Top 100, and been nominated for Grammys. She’s been featured in Marie TV, The Vocalist Magazine, Women In Music, ReverbNation, CDBaby and The New York State Bar Association’s Entertainment, Arts and Sports Law Journal.
*Disclaimer*
"This interview is for informational purposes only and should not be construed as legal advice of any kind. Jo-Ná Williams and J.A.Williams Law, P.C. assumes no liability for use or interpretation of any information contain in this interview. This interview should not be an alternative to obtaining legal advice from a licensed attorney in your state based on the specific facts of your legal matter. Jo-Na Williams is licensed to practice law in the State of New York only."
In this episode Jo-Na and I discuss the following:
- How entrepreneurs may be losing money in their business by not being protected.
- How to chose the right corporate form for your business and how choosing the wrong one will cost you.
- Hiring employees: what you need to know to protect your business.
- Independent contractors vs. employees: who should you hire.
- Best place to create a contract and what provisions need to be in a contract when hiring. What to look for as an employer or potential employee.
- Do non-compete agreements hold water.
- The common mistakes entrepreneurs make with an online business. I was totally blown away by this one! There are so many legal considerations one must do when doing business online.
The moment this interview ended I made an appointment to talk with Jo-Na about my business! I have been working with her for years and am so grateful for her help! No too many of use would walk down the street naked....don't leave your business naked and vulnerable either!
I hope you learned a lot in this podcast and if you like what you are hearing don't forget to subscribe to the podcast and tell your friends and family about it! Also please feel free to tweet me! @karenlitzyNYC and follow Jo-Na Williams, Esg for more great legal tips!
Have a great week and stay healthy wealthy & smart!
Karen
In this episode I was thrilled to interview Dr. Sharon Dunn the current president of the American Physical Therapy Association. Dr. Dunn is a breath of fresh air and she has the right attitude and leadership skills to usher in a new era for the APTA. Her great Louisiana accent just adds to her charm!
In this episode we talk about:
· Her days growing up in Louisiana and how that helped to shape her leadership skills and her decision to be a physical therapist.
· How she first got involved in the APTA and her journey to becoming president.
· Her BEST advice for those physical therapists who might be on the fence about getting involved in the APTA….hint it is super easy!
· What were her personal challenges in taking over the reigns as president of the APTA.
· What are the biggest challenges facing the profession of physical therapy
· What steps can the APTA (remember if you are a PT you are the APTA…it is not just those with leadership positions) do to help with the challenges facing our profession.
· How does Dr. Dunn change the negative connotation of a challenge to a positive (I have started using this brilliant mindset daily).
· How physical therapists are uniquely qualified to accomplish the triple aim of healthcare.
· What does Dr. Dunn have in common with Albert Einstein (aside from being crazy smart!).
On the healthy Wealthy & Smart Community Board this week is the PT Day of Service. Treating at a pro bono clinic. Working in a soup kitchen. Cleaning up a park... No matter where or how, we have the ability to positively impact change. Whether we call ourselves 'Physical Therapists' or 'Physiotherapists,' service embodies who we are, what we do, and how we act. Become a part of PT Day of Service™ as we join together to better the world! The day of service will be October 17, 2015. For more information click here.
In this episode I was thrilled to interview Mike Eisenhart, PT, managing partner of Pro-Activity Asociates in New Jersey. Mike is leading the charge in the world of physical therapy to define our value beyond rehabilitation and move towards health and wellness in the community. This is where physical therapists are uniquely qualified to lead the charge!
In this podcast we discuss:
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How physical therapy can move from a strictly "rehab brand" to a "lifestyle brand"
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How to involve your community to stay healthy and active
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What advice does Mike give to other physical therapists who want to grow a sustainable business that goes beyond rehab and truly includes the client and community
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Learn the importance of "speaking the language" of the people you are trying to reach
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Why should PTs focus on secondary prevention
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What do we as a profession need to do to shift the public's view about physical therapy
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The importance of collaboration no matter the size of your business
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Find out where Mike sees his business going in the future
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Learn more about BaseCamp 31
In this episode with physical therapist Dr. Saliie Sarrel we talk about endometriosis. Dr. Sarrel received her Doctorate of Physical Therapy from the University of Medicine and Dentistry of New Jersey (UMDNJ). Additionally, she has a Master’s of Arts and Teaching from the University of Vermont with a dual focus in Sports and Nutrition Education. […]
In this episode Dr. Ravensara Travilian, a massage therapist, educator and all around amazing person talks about the need for trauma aware massage in some of our most vulnerable populations. She talks about her days of working at a refugee clinic in Seattle and how she was able to use massage as a way of […]
I was thrilled to have the opportunity to interview the CEO of the APTA Michael Bowers. He has a thoughtful and listening leadership approach that has served him well in past organizations and I think will be just the thing the APTA needs to move forward. In this episode we talk about: * How he […]
In this episode Dr. Sandy Hilton talks about her start in the field of pelvic health and how her treatments have changed over the years as she has grown as a practitioner. Sandy also gives us a preview of her upcoming lecture at the International Spine and Pain Institute’s Clinical Conference: Every Joint has a […]
Alison qualified as an osteopath in 2001. She is currently undertaking a Masters of Pain Management through the Sydney University Medical School and Royal North Shore Pain Management Research Institute. She has lectured at Australian Catholic University, Victoria University and RMIT in a variety of science and clinical subjects. She has also worked as part […]
In this episode I am joined by Dr. Louie Puentedura, PT, DPT, PHD to discuss his upcoming lecture at the International Spine and Pain Institute’s Clinical Conference: Every Joint has a Brain. The conference will take place June 19-21 in Minneapolis, MN. Here are some things you can expect to learn in this interview: * […]
In this podcast I am thrilled to talk to Dr. Adriaan Louw about the upcoming International Spine and Pain Institute Clinical Conference 2015: Every Joint Has a Brain. In this podcast he gives us a preview of his pre-conference course Too Hot to Handle: Desensitizing the Hypersensitive Patient about CRPS (Chronic Regional Pain Syndrome). He […]
Wim Dankaerts is a certified CFT educator. He is both, a highly skilled clinician, leading clinical researcher and dynamic educator. Wim Dankaerts is an Associate Professor in Musculoskeletal Physiotherapy at the University of Leuven, Belgium. He also works part-time in private practice in Tienen (Belgium) as a Musculoskeletal Physical Therapist. In this episode Wim gives […]
In this episode I am joined by Ann Wendel, PT, ATC, CMTPT; Mike Hopper, MS, ATC; and Mike Ryan, PT, ATC. We discuss the educational background and qualifications needed to become a certified athletic trainer. It is much more than most people think! We discuss the relationship between the physical therapist and the athletic trainer […]
In this podcast I am joined by Dr. Sarah Haag, PT, DPT; Dr. Sandy Hilton PT, DPT, and Ann Wendel, PT, ATC for a great discussion on waist trainers, made popular lately by the Kardashians and other celebrities.. We speak about the pros and cons of using a waist trainer to decrease the size of […]
Neil is a physical therapist, yoga therapist, Clinical Assistant Professor at UBC, and instructor for five yoga therapy training programs. He is the first physical therapist to win the Excellence in Inter-Professional Pain Education Award from the Canadian Pain Society. He is founding Chair of the Canadian Physiotherapy Pain Science Division, a past Board member […]
In this episode I lead a great group of guests in a lively discussion about the APTA. What are the aspects of the APTA we like and what are the aspects we don’t like. Why is the membership of the APTA so low and what are some constructive ideas to help with showing the value […]
In this very special episode Dr. Sandy Hilton interviews me! I am on the other side of the mic this week talking about my concierge’s style physical therapy practice in New York City. We also talk about how podcasts have emerged in the physical therapy and have been an integral part of the education of […]
In this episode I had the pleasure of interviewing Harris Doran about the art of improvisation. Harris is an actor, director, film maker, producer and coach. Harris and I discuss what improv is and how it differs from stand up comedy and sketch comedy/drama. We also talk about how improv can improve your ability to […]
Brooke Mcintosh is a third year DPT student at the University of St. Augustine, in St. Augustine Florida. She is the Student Assembly Board of Directors Director of Communication. In this episode we talk about what the student assembly does, how to get involved in the APTA at the student level, and more importantly why […]
In this episode I have a great conversation with NxtGen Institute of Physical Therapy program director Dr. Robert Duvall and Nxt Gen faculty member Dr. Francois Prizinski about post-graduate physical therapy education. We talk about: How the changes in the healthcare environment require changes in post-graduate education. How education needs to focus on creating well […]
Denise Duffield-Thomas is the money mindset mentor for the new wave of online female entrepreneurs. Her best-selling books “Lucky Bitch” and “Get Rich, Lucky Bitch” give a fresh and funny road-map to create an outrageously successful life and business. Denise helps women release their fear of money, set premium prices for their services and take […]
In this episode I am joined by Dr. Kyle Ridgeway, PT, DPT and Ann Wendel, PT, ATC, CMTPT. We are discussing our upcoming talk at the American Physical Therapy Association’s Combined Section Meeting in Indianapolis on Thursday February 5, 2015 at 11:00. Our talk is titled Direct Access Through the Continuum of Care. Our vision […]
In this episode Dr. Joe Brence gives up a preview of his upcoming lecture at the San Diego Pain Summit in February. Dr. Brence’s talk is titled The M.I.P. Algorithm: A Clinical Construct for the Application of Motor Control. A fundamental algorithm for the understanding of motor control that is scientifically plausible and easily applicable […]
In this interview I am joined by Dr. Matt Sremba, Dr. Kyle Ridgeway, Paul Mitalski, MS. They discuss their upcoming panel style lecture at the American Physical Therapy Association’s Combined Sections meeting, taking place in Indianapolis from February 4-7. This session is designed for the physical therapist (PT) interested in innovative best practice models for […]
In this episode physical therapist Dr.Jason Silvernail gives us a preview of the lecture he will be giving at the San Diego Pain Summit. Dr. Silvernail’s lecture is entitled: Crossing The Chasm- Integrating pain science into your process in the clinic or gym. How to change your explanation and reasoning while keeping your tools and […]
In this episode Larry Benz, Jerry Durham and I talk about the role of the physical therapist as a communicator with patients, insurance companies, and physicians and how we need to improve our communication skills to relate our value to these groups. We also talk about the role of physical therapy in the overall health […]
John F. Cryan is Professor & Chair, Dept. of Anatomy & Neuroscience, University College Cork. He received a B.Sc. (Hons) and PhD from the National University of Ireland, Galway, Ireland. He was a visiting fellow at the Dept Psychiatry, University of Melbourne, Australia (1997-1998), which was followed by postdoctoral fellowships at the University of Pennsylvania, […]
Dr. Pauline Lucas is a doctor of physical therapy through Northern Arizona University and a board certified women’s health clinical specialist, who received her initial physical therapy training in the Netherlands. She is a certified yoga and meditation teacher, and recently completed the Mayo Clinic Wellness Coaching program. She has over 30 years of experience […]
Welcome to the first episode of the new year! I am delighted to have on the show Dr. JR Rosploch. He is a physical therapist based in Green Bay, WI and the inventor of The Pronator. In this episode Dr. Rosploch not only talks about The Pronator but the process of going from an idea […]
Dr. Tracy Kemble is a leading expert of domestic abuse and is backed by over 20 years of recovery programs. She has PHD in Psychology and is a Laws of Attraction specialist. She is the In this author of 4 books, a speaker, columnist and television and radio personality. In this episode Dr. Kemble discusses […]
Dr.Ting Ting Kuo is a physical therapist and the Outpatient Therapy Manager at the Sillerman Center for Rehabilitation at Memorial Sloan Kettering Cancer Center. In this interview we talk about the role the physical therapist plays in the care of patients diagnosed with breast cancer from the time the patient is diagnosed to post surgery […]
In this episode of Healthy Wealthy & Smart @cynicalPT and I discuss what employers may want to look for when interviewing potential candidates. We cover everything from education background, to personality, hobbies, empathy, and the ability to relate to your patients. We also talked about if as an employer should you be Googling potential new […]
Nancy Beckley is an expert on compliance. She consults around the country and regularly speaks at conference and webinar about compliance issues. In this episode we talk about the components of a compliance program, why every clinic should have a program (whether you take insurance or not), how to start a program, and if a […]
Over the next few months I will be interviewing some of the presenters for the upcoming San Diego Pain Summit (www.sandiegopainsummit.com) which takes place February 20-22, 2015. Barrett is one of the speakers and he will be talking about Simple Contact. In today’s podcast he gives us an overview of what he will be expanding […]
Chris is a physical therapist and endurance athlete living and working in Seattle, Washington. We talked about how he manages his competitive endurance athletes after injury or painful episodes. We also talked quite a bit about how he integrates his knowledge of pain science when treating his patient population. And finally he talks about one […]
Rick is a licensed physical therapist and owner of Gawenda Seminars and Consulting. He is an expert on Medicare billing, ICD9 and 10 coding, documentation compliance and practice management. He regularly speaks around the country on these topics and in this interview we focused on the medicare as it relates to physical therapy outpatient practice. […]
Dr. Fass and I discuss residency and fellowship as it relates to physical therapy. Find out what they are, the difference between them, and does it add value to the individual therapist and the profession as a whole.
Dr. Thomas Tavantzis has over 35 years of experience as one of the industry’s top leadership psychologists and career development experts. He is also the Acclaimed Author of “Hard-Wired: Taking the Road to Delphi and Uncovering Your Talents” In this interview we talk about the following points: *What are natural abilities and how are they […]
Paige and I discuss an exciting new method she developed to help those recovering from trauma and stress. Her work is called Energetic Body Dialogue Services. EBD works to align patients with their bodies through physical, mental, emotional, spiritual, and energetic properties while restructuring negative thoughts and beliefs associate with trauma.
Dr. Leohne is a certified wound specialist and an active member of the APTA. In the interview we discuss how physical therapists can play a vital role in wound care. She talks about the types of wounds that can be treated, how to treat them and the role of the APTA in advocated for PTs […]
Dr. Lazar is an Associate Researcher in the Psychiatry Dept at Massachusetts General Hospital and Assistant professor in Psychology at Harvard Medical School. The focus of her research is the beneficial effect of yoga and meditation. In the interview we discussed the effect of meditation on the brain and how meditation might be beneficial to […]
Dr. Sofer and I discuss the importance of being an advocate for physical therapy and the importance of the APTA. Why should you join the APTA? What does the association do for the average PT at the state and national level? You will find out what legislative issues the APTA and specifically the New York […]
Dr. Griffiths and I discuss the role of psychology in the treatment of patients with chronic pain. What is her approach to therapy with chronic pain patients? hoe does she reach those patients who might be resistant to talk therapy? What tools does she incorporate into her practice? What are signs and symptoms a physical […]
Dr. Ridgeway and I talk about all things acute care physical therapy. Some of the imortant points covered in the interview are: 1) What is acute care PT and what is the value? 2) Is acute care just “walking” with a patient? 3) How do you make a connection with an acute care patient in […]
Alex is a sensory integration occupational therapy assistant. We discussed what sensory processing disorder (SPD) is and how it differs from autism. Alex shared how he treats children with SPD using play as therapy. We discussed the importance of parent or guardian participation in patient care and how to set up a sensory gym in […]
Nathan and I talk about how to start good habits when you are in PT school that can carry over to when you are a working physical therapist. Nathan gives some great advice on how to find that ever important school/life balance. We also talk about when it might be right to start your own […]
TJ and I talk about how DPT students can become advocates for the physical therapy profession. We also discuss the importance of mentorship and how to go about finding a mentor. We discussed the Service learning Clinic at Rutgers University and how it is helping DPT students gain valuable clinical experience and provide a much […]
Elan and I talk about the program he helped to develop at H & D Physical Therapy called Retrain Pain. The program is a biopsychosocial based program that includes neuroscience pain education in a very practical way for chronic pain patients. We also discuss motivational interviewing and how that is important when dealing with a […]
Drs. Joseph Brence and Francois Prizinsky talk about their new algorithm M.I.P. discus the following: ● Introduction to Motor Control ● Explanation of our historical understanding of motor control ● Where did we go wrong… ● What do we know to be truth ● Introduction of Motivation, Input, Plan (MIP) ● Clinical Examples of ease […]
In this episode I talk a little bit more about what I do everyday! I talk about how I came to own and operate a private home health business. In this episode I share I used some of the lessons I learned from Marie Forleo’s B-school to grow my business over the past year. I […]
John Barbis is a private physical therapist and serves as a board member for the Greater Philadelphia Pain Society. John and I discussed the wonderful work that the Greater Philadelphia Pain Society is doing for both the genreal public and the medical community. John then give us some very practical tips on how to use […]
Alan Siegel is one of the best-known figures in the branding industry and a longtime advocate of clarity and simplicity in communications. In 2011, Alan created Siegelvision, a new strategic branding and communications consultancy that champions clarity above all. Alan is also the founder and chairman emeritus of global branding agency Siegel+Gale. Alan and I […]
Sharon Salzberg is a meditation teacher and author. She is the cofounder of the Insight Meditation Society (IMS) in Barre, Massachusetts, and has played a crucial role in bringing Asian meditation practices to the West. The ancient Buddhist practices of vipassana (mindfulness) and metta (lovingkindness) are the foundations of her work. Sharon and I talked […]
Adriaan and I discussed the ins and outs of central sensitization. Adriaan shares his knowledge on what central sensitization is, how it can be diagnosed and what the role of the physical therapist is in the treatment. Adriaan is a wealth of knowledge and has the ability to take these very complex ideas and break […]
Eric and I discussed big picture issues and policies affecting physical therapists now. We talked about therapy caps via insurance companies, lack of true direct access in most states, and lack of the use of technology in the profession…amongst other issues. This was a fun discussion and Eric is a real pro! We also had […]
Stephanie, Holly and I discuss the important issues to DPT students now. The ladies gave tips on how to pick the right DPT program for you, how to choose the right clinical rotation, what they felt was missing from their PT curriculum and finally how to stand out when interviewing for your first job. The […]
In this episode I review the Simple Contact course given by Barrett Dorko in NYC 2 weeks ago. I discussed the course with Barrett Dorko, PT; Erica Meloe, PT and personal trainers Ben Sabo and Matthew Danziger. It was a great course based on neuroscience principles that I was immediately able to take to my […]
This is part 2 of my interviews on the cash based physical therapy model. Dr. Carter ad I discussed how to get new referrals to your business and how to network the right way. We also discussed the practical day to day running of a cash based business (i.e. how many patients per day, rates, […]
This show is part one of a 2 part show on cash based (non-insurance based) physical therapy practices. Ann, Allan and I discussed the pros and cons of a cashed based practice, why they decided to go with the cash based model, the importance of a mentor, and the big “mistake” they made when growing […]
Francesca and I discussed how and why she made the move from teaching group yoga classes to private one-on-one sessions with clients. She then shared with us the principles of her yoga teacher training course on how to teach yoga in the home or office. Highlights include how to create the yoga space and communications […]
We discussed what is an evidenced based practice, how to keep your profits up witht he changes in insurance, what does it mean to have a “niche ” in physical therapy, and the omportance f having a mentor for your nusiness (even if that mentor is not in the phyiscal therapy business). This show is […]
Dustienne and I discuss how yoga can help with the treatment of pelvic pain. We also talk about the importance of the breathe not only in yoga but in everyday life as a way to reset our nervous system. Dustienne even take us through a short breathing exercise that you can do anytime.
Dr. Hagins and I discuss his current research into yoga and its effects on blood pressure. We also talk about how breathing effects the abdominal cavity and back and pelvic pain. We also talk about the different types of yoga and what might be the best type for you.
Jovanka shares with us how to eat healthy and organic on a budget and she compared the popular “cleanses” on the market today. We also discussed her new program called the Clean Foods Diet Method. For more info on this program go to http://cleanfoodsdietmethod.com/
Bobby and I discuss some common reasons why people aim for but often do not achieve the health and wellness goals they set for themselves. And, we give advice on possible solutions for the health care professional to motivate their client and for the clients themselves.
Celebration of the 100th episode with special call in guests and a fun recap of the show and what I have learned as a result of being a radio show host!
Today we spoke about the amazing work these ladies are doing to empower women in the developing world and beyond. We spoke about how physical therapists can have an impact on the materanl health of all womend but espcially those with obstetric fistula and other complications that can arise after giving birth, We also spoke […]
Dr. Paul Rockar is the president of the American Physical Therapy Association. We talked about the future of the physical therapy profession and how it fits in to the ever changing health care world. We discussed the triple aim of health care and the Affordable health Care act and how PTs can take the lead […]
Marianne, Lila and I discuss their specialities within the women’s health specialy in physical therapy. We talked in depth about how physical therapy can help postpartum women and those suffering from pelvic pain, bowel dysfunction, and pelvic florr dysfunction. They also gave some great tips that every pregnant women needs to hear!
In this episode I discuss the recent Dr. Oz episode that featured “cutting edge” treatments for low back pain. I explained how those treatment were really not “cutting edge” or valid and then gave some suggestions as to what should have been on that list. I quoted the work of Eric Robertson, PT, DPT, OCS, […]
LJ and I continued the conversation from last week’s episode with Diane Lee about the Integrated Systmes Model. Then we had a great talk about LJ’s research into the Thoracic Ring Model. We spoke about how the Thoracic Ring Model relates to ISM and LJ gives some great tips on evaluation, treatment and pateint education.
Diane and I discussed the Intergrated Systems Model she developed with fellow physical therapist Linda Joy Lee. We discussed why the model came about and how to usethe model in the evaluation and treatment of patients. We also discussed the concept of “slings” and how it fits into the model of care.
Dr. Moseley and I discussed his current research into pain. He shares with us his definition of pain, how you could have clear tissue damage and not have pain, and how do other sensory cues afect the pain experience. We also discussed the role of spinal manipulations in pain, pain in children, and remapping of […]
Lori and I discussed how to best bring your experiences from 2012 into the new year in the most positive way possible. Lori shares with us some great advice on how to shift your perception of the events of the past year to enter the new year full of hope, passion, and love.
Adriaan and I discussed neuroscience pain education: what is it, who needs it, and why are physical therapists uniquely qualified to deliver this education. We also talked about his research into neuroscience pain education for pre-op lumbar surgery patients. Tune in to find out his results and what he is working on now. Have a […]
This show is based on the Explain Pain course by David Butler. I discussed the importance of the features of the therapist, patient, message, and context/environment when explaining pain to the patient. The importance of letting the patient speak and really hearing their story and using that when explaining pain. I also gave some helpful […]
Barrett and I discussed the use of story in PT, magic and its relation to neuroscience, and his writings on illusion, hallucination, and delusion. This was a great discussion as we related all of these topics to the practice of physical therapy.
Kathy Kreiter is the executive director of the International Association for the Study of Pain. We discussed why and when IASP was formed, the programs and conferences the run, the grass roots projects they have in developing countries and the scholarship and grant programs they support. If you want to more about this amazing organization […]
This show is part 1 of my review of the Women’s Health Section Fall Conference weekend with Dr. Lorimer Moseley and Dr. Paul Hodges. In this episode I am highlighting some of the more important points made by Dr. Lorimer Moseley over the weekend. This episode focuses on the input/output feedback loop, the sensitization of […]
Kevin, Karl and I discussed common golf injuries and how physical therapy and a proper golf swing can help treat or even prevent those injuries. We discussed how no matter what type of golfer you are (beginner to expert) it is important to work with a golf pro and a physical therapist to stay healthy […]
Jovanka and I discussed juicing and blending for optimum health and how to stay healthy eating whole foods. She also gave great advice on what kind of juicer to buy depending on where you are on your juicing journey. She even gave us one of her favorite juice recipes!
George and I discussed Olympics and technology. George gave us all the info on how to become a physical therapist for the Olympics athletes during the games. he also gave us insight on his experience at the London Olympics and why all physical therapists should experience the Olympics at least once. We also talked about […]
Dr. Elbaz is a pain management doctor and Dr. Lipnitsky is a chiropractor that specializes in chronic pain states. We discussed how they work together at Pain Physicians New York to achieve the best outcomes for their patients. We also discussed the varied treatments for chronic pain patients and how a team approach works best […]
Hillary Rubin is a spiritual and life coach. We discussed how to make lasting changes in life. Hillary also let us in on how she stays so positive in her life.
Dr. Ciuferri-Wnasacz is a naturopathic doctor. We discussed what a naturopathic doctor is, the credentials you should look for when seeking a naturopath, and the criticisms that they are not an evidenced based profession. She also shares with us her treatment protocol for patients with chronic pain.
Gabriela and I discuss the organization We Connect Now that she founded while she was a freshman in college. We Connect Now is a global organization that advocates for college and high school students with disabilities. Gabriela gives us her best advice for what to look for in a college and the surrounding community when […]
Estelle and I discuss everything you need to know about Multiple Sclerosis from the physical therapy perspective. We talk about symtoms, diagnosis, and physical therapy care. Estelle shares how physical therapists are uniquely qualified to have the privilege to treat those diagnosed with MS.
Dr. Puentedura discussed his research into spinal manipulation, particularly in the cervical spine. He talked about his preliminary studies into a clinical prediction rule for manipulation of the cervical spine. We also talked about the importance of pain science education utilizing the biopsychosocial approach in accordance with manual therapy and exercise. Dr. Puentedura stressed the […]
Jacob Lief is the co-founder and president of Ubuntu Education Fund. Jacob and I discussed everything from the inception of Ubuntu to the programs they offer to the future of this great non profit organization. Ubuntu’s model is: We are a community institution, and we support the most vulnerable children along the pathway out of […]
Colette and I discuss ways to reduce stress at home and in the work place. We also discuss her certification through Yale University, Coping with Work and Family Stress and her company InStep Consulting.
David Perry is the president and CEO of Mesacor, a company committed to developing next-generation ergonomic equipment that enhances safety and delivers measurable benefits via user-centered research and design. David and I discuss the need for ergonomic equipment in the gym/fitness setting to increase safety and reduce the chance of pain in the gym. As […]
Dan shared with us his incredible weight loss journey. From weighing over 600 pounds and finally having his “mirror moment” over a year ago to now losing close to 300 pounds with the help and guidance of his trainer Thomas. Dan was candid with his story telling and a true inspiration!
Debra and I discuss the importance of getting involved with the APTA. We also talk about the NYPTA’s recent lobbying efforts on various topics that impact our everyday lives as PT’s and PTA’s.
Tracy shares her vast knowledge of Autism and Fragile X Syndrome. We discuss causes, treatments, and the diagnosis of autism and Fragile X Syndrome. Tracy talks about the importance of a team approach to treatment and treating each child as an individual.
Joe and I discussed the petition he started for improved teaching of pain science in PT programs across the country utilizing the biopsychosocial model vs the biomedical model. We also spoke about new research into the effects of manual therapy.
Kevin and I discuss his golf expert certification through the Titleist Performance Institute and his new company Par 4 Success. We also talk about the most common golf injuries and how physical therapy can help treat them.
I interviewed all these wonderful women and great moms on what it is like going from one child to multiple children. They all gave amazing advice on raising healthy and happy children without losing yourself in the process. A must listen for ALL mommies!
Ting Ting and I discuss common diagnoses in pre and post natal women and how physical therapy can treat and help prevent these problems.
Estelle and I discuss Parkinson’s disease. What is Parkinson’s disease, how is it diagnosed, what are the signs and symptoms, and why it is important to just move! Estelle also talks about how she evaluates and treats those living with Parkinson’s.
Lauren and I discuss the amazing work that the non-profit, Davis Phinney Foundation does for those afflicted with Parkinson’s Disease. Their mission is to help people living with Parkinson’s disease live well TODAY!
Cory and I discussed the advantages of being an onsite PT, his goals as a physical therapist, and losing the operator mentality!
Sandra and I discuss her commentary article about treating pelvic pain with the biopsychosocial approach.
Vicky and Karen discuss the origin and evolution of the Institute of Physical Art from its inception in the last 1970’s to today.
Kory and I discuss how to treat acute pain with the biopsychosocial approach to prevent a chronic pain situation.
We discuss why certain fitness trends stick and others do not. We discuss spinning, cross fit and the basic needs of people to be part of a group/something bigger than themselves.
Rayne and Karen discuss the difference between physical therapy and occupational therapy and the work she does with children with Autism and Sensory Integration disorders.
Marjory shares her extensive knowledge on how to pick the perfect diamond, watches, and how to know you are getting the most for your money when selling gold.
Suzanne and Karen discuss her program to increase balance and strength, especially in an older population.
Amber and I discuss her BodyHeart movement and how she is changing the way we view and accept our bodies.