In this episode, Associate Professor in the Doctoral Program of Physical Therapy at Rutgers, Dr. Ellen Anderson, talks to Dr. Stephanie Weyrauch about burnout in physical therapy.

Today, Ellen talks about her dissertation on burnout, the distinction between normal stress and burnout, and how these markers of burnout fit into the anecdotal accounts of burnout seen in blogs and magazines. Why is data so limited on burnout in physical therapy? Which settings within physical therapy experience the highest rate of burnout?

Hear about the many factors impacting the number of therapists affected by burnout, how Covid-19 has affected recent graduates and students, and the causes of burnout, all on today's episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• "When people work with people who are in crisis, there are a lot of demands placed on them - very different than in other kinds of work, for example."
• There are 3 categories in burnout:

1. Emotional exhaustion.
2. Depersonalisation.
3. Personal Accomplishment.

• "When we think about just being stressed out, it's hard to know what that means because everyone's stressors are different."
• "If a physical therapist has high perceived stress, that's correlated with emotional exhaustion, which is a part of burnout, but not the full definition of burnout."
• Researchers have suggested that there's 2 ways to look at burnout:

1. The Personal Approach. Make the person resilient, and they will be able to handle any kind of environment.
2. The Work Environment. Make a nurturing environment that's conducive to good work, and supporting people who are in crisis, then you're supporting the workers and you'll have less burnout.

• "Younger physicians have higher rates of burnout than do older practitioners."
• "When people in healthcare feel as though they don't have control of the situation, or they cannot contribute to good patient care, effectiveness, and efficiencies, that the burnout rates are higher."
• "There needs to be an understanding on how stressful and difficult it is to work with people who are at risk and people who are in crisis."
• "We need to be thinking about ways in which physical therapists can have some participation in systems that supports everyone in that work environment."
• "One of the things that's very detrimental when people share thoughts and ideas, is that the first response they get is 'we cant' or 'no' without any kind of real honest investigation into the suggestion or recommendation."
• "Breathing practices and meditation are two strategies which help people be able to manage their stress effectively. The idea is that you practice those things so that when you need it, you can use it."

More about Stephanie Weyrauch

Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company's workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government.

Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery.

Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.

More about Ellen Anderson

[caption id="attachment_9555" align="alignleft" width="150"] Rutgers School of Health Professions in Newark. 11/7/16 Photo by John O’Boyle[/caption]

Ellen Zambo Anderson, PT, PhD is an Associate Professor in the Doctoral Program of Physical Therapy at Rutgers, The State University of New Jersey where her primary teaching responsibilities are in Therapeutic Exercise, Development Across the Lifespan and Clinical Inquiry. Dr. Anderson, a Board Certified Geriatric Clinical Specialist, earned a BS in Physical Therapy from West Virginia University, an MA in Motor Learning and Control from Columbia University and a PhD in Health Sciences from Rutgers University. She is the Assistant Director of the Rutgers Community Participatory Physical Therapy Clinic, a student-run, pro-bono clinic in Newark, NJ, and serves as the Special Olympics Global Advisor for Young Athletes.

Dr. Anderson is the co-author of the textbook, Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach and has spoken internationally on physical activity, mental health, and complementary health practices. She is also co-owner of YogiAnatomy, a company that provides continuing education for rehabilitation professions on topics related to complementary approaches for managing well-being, health and function.

Suggested Keywords

Physiotherapy, Research, PT, Health, Therapy, Healthcare, Education, Training, Stress, Burnout, Wellbeing, Mental Health, Stressors, Support, Covid-19, Exhaustion, Depersonalisation, Accomplishment, Environment,

To learn more, follow Ellen and Stephanie at:

Website: https://stephaniesandvickweyrauch.academia.edu

https://ptsmc.com/stephanie-weyrauch

https://www.yogianatomy.com

Facebook: Stephanie Sandvick Weyrauch

Instagram: @thesteph21

Twitter: @thesteph21

LinkedIn: Stephanie Weyrauch

YogiAnatomy

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Read the Full Transcript:

Speaker 1 (00:07):

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

Speaker 2 (00:37):

Welcome back to the podcast. I am your host, Karen Litzy and today's episode. We have our good friend of the podcast back, Dr. Stephanie Y rock, and she is interviewing Dr. Ellen Anderson all about burnout in the physical therapy profession. I'm not going to go into Dr. Anderson's bio because Stephanie reads that in the beginning of the podcast. We don't need to double up on that, but what you're about to hear, I'll give you some highlights is they talk about the three categories of burnout and does the research definition of burnout jive with the anecdotal accounts of burnout that we see on blogs and podcasts and things like that. They also talk about the difference between stress and burnout or perceived stress and burnout. The main causes of burnout in physical therapy, how COVID is affecting burnout. And Dr. Anderson talks about some things that perhaps you can do as an individual to help with your perceived stress.

Speaker 2 (01:41):

And she hypothesizes on some things that perhaps some businesses, some physical therapy businesses can do to help their employees with stress and burnout. So thanks to doctors why rock and Anderson and everyone enjoy today's episode. Hello everyone, and welcome to the healthy, wealthy and smart podcast. I'm your guest host today, Dr. Stephanie, why rock and, or once again, going to partner with the American physical therapy association, private practice section to discuss a topic that has been in the forefront in healthcare and that's burnout. This is an especially relevant topic. I think as COVID-19 pandemic continues to rage on, and I've actually been asked to write an article for PPS impact magazine on this. And so when I went to do some research on this topic, I of course found a lot of blog posts and opinion articles by physical therapists throughout the profession on this topic, but was really surprised to find that there's really not a lot of research in physical therapy on burnout.

Speaker 2 (02:50):

And I was surprised by that because it's so frequently discussed in our profession. So eventually my literature review led me to our guest today, Dr. Ellen Anderson. So Dr. Ellen Zombot Anderson is an associate professor in the doctoral program of physical therapy at Rutgers university in New Jersey where her primary teaching responsibilities are in therapeutic exercise development across the lifespan and clinical inquiry. Dr. Anderson is a board certified geriatric clinical specialist and earned a BS in physical therapy from West Virginia university, an ma in motor learning and control from Columbia university and a PhD in health sciences from Rutgers university. She is the assistant director of the Rutgers community participatory physical therapy clinic, which is a student run pro bono clinic in Newark, New Jersey, and serves as the special Olympics global advisor for young athletes. She's the coauthor of the textbook complimentary therapies for physical therapy, a clinical decision-making approach, and has spoken internationally on physical activity, mental health and complimentary health practices. She's co-owner of yoga, Yogi anatomy, a company that provides continuing education for rehabilitation professions on topics related to complimentary approaches for managing wellbeing, health, and function. So thank you so much Dr. Anderson for joining us today on our podcast. And again, I read your dissertation and I've, I found it really interesting that you decided to tackle burnout for your PhD dissertation. So maybe summarize your dissertation a little bit, tell our listeners a little bit about yourself and how you became interested in this area of research.

Speaker 3 (04:38):

Okay, great. Yes. It's a pleasure to be with you, Stephanie. Thank you very much. Initially I became very interested in complimentary therapies and through the work that I do with my colleague, Judy Deutsche, where we published a textbook in that area, I was interested in the application, the safety and the efficacy of complimentary therapies for patient populations. And that got me to realize, or helped me realize that there is a fair amount of data that suggests these complementary therapies can be useful for our patients, particularly in the areas of mood reduction of stress, as well as reduction of pain. And so that got me thinking about using approaches such as Reiki or yoga, meditation, breathing practices for self care as well as patient care from that point. However it was determined that we really didn't know what stress was in physical therapists or what burnout is in physical therapist, because as you've identified, a lot of people are talking about it, but there hasn't been a lot of research in that area.

Speaker 3 (05:57):

And so I started to embark on trying to get a handle on what is the stress and burnout in physical therapists. My focus took me to burn out. And the reason for that is because burnout was defined by fruit and burger back in 1975. And it was based on his observations in working with healthcare providers. And what he observed is that when people work with people who are in crisis, there are a lot of demands placed on them, very different than in other kinds of work, for example. And he began to categorize some behaviors that he saw in people who were becoming more and more stressed. And then it was Nass latch who developed the mass latch burnout inventory. And so what mass latch did was kind of support the observations of fruit and Berg by saying there are three categories that we need to look at in this thing called burnout, that there's emotional exhaustion, there's depersonalization and there's personal accomplishment.

Speaker 3 (07:16):

And so when we think about just being stressed out, it's hard to know what that means because everyone's stressors are different. So what stresses you out is different than what stresses me out, you know, when you kind of come to your work with a certain constitution about what keeps you even keel and what are your triggers? The burnout goes a little bit further because it's not just emotional responses. And in this case, emotional exhaustion is that sort of physical, mental exhaustion that many people might be feeling. That's just one part of burnout. So the next part of burnout is this deep personalization. And what that means is that you kind of begin to separate yourself out from your patients. And there's this phenomenon of, of I'm sick of thinking that the patient is to blame for their problems. You know, so they brought it on themselves and some psychologists and researchers suggest that perhaps this deep personalization is really kind of a protective mechanism because you're dealing with people in crisis all the time. And then you have the personal accomplishment and that's where you feel like your, a rat in a, in a maze or in a wheel. And you just keep going round and around and you ask yourself, finally, what am I doing this for? Am I really making a difference? So the, the, the curiosity for me is, was understanding the D the difference between just job stress and burnout, and that physical therapist in fact, would fall into a category of people working with people who are in crisis most of the time.

Speaker 2 (09:28):

I think that that's really interesting that, you know, we have a defined a true research definition of burnout. I'm wondering what your opinion is on how this definition fits with these anecdotal accounts of burnout that we're seeing in some of these blog posts that people post or that TA magazine has been posting about regularly.

Speaker 3 (09:50):

It doesn't really jive a very well, to be honest with you. So when, when I see comments about burnout, I just say to myself, well, people are stressed out and, and we should honor and respect the fact that people are very stressed out. That burnout technically from a research standpoint has a different definition. And what I found through my research is I did study and survey physical therapists, both using the mass latch burnout inventory, which has the three part, but I also included the perceived stress scale. And so the perceived stress scale, I think, is a very valuable tool because as I mentioned, previously, stressors for you are different than stressors for me. And the perceived stress scale has been used in thousands of studies. And it's looked to be sort of a gold standard if you will, to get a finger on the pulse of people's stress, because it is about perception of your stress.

Speaker 3 (11:04):

And, and so what I found in my, in my dissertation was that all, although physical therapist had better perceived stress scores than the national sample that I compared it to, there was a relationship between a high perceived stress score and burnout especially in the category of the emotional exhaustion piece. And so what we, what we saw was that if therapist had high emotional exhaustion, they were seven, seven times more likely to actually have burnout. So let me tell you what burnout is. According to those three parts is if you do the burnout scale, and you're very high where you're high in emotional exhaustion and you're high in deep personalization, and then you have low professional accomplishment, you fall into the category of burnout. And so what I found was that 29% of PTs are high in emotional exhaustion, and that is consistent with what people are talking about in the blogs related to being stressed.

Speaker 3 (12:27):

Okay. The other thing that I want to know is that in a lot of studies that are being done with physicians and nurses with burnout, sometimes the headline is 50% of physicians have burnout. And what they did was that they used the burnout scale, but they focus their, their headline on the fact that it was emotional exhaustion. And so there was recently a systematic review that looked at just that is the reporting of burnout and how it's a little bit of a mixed bag now where it traditionally had been the high score in exhaustion depersonalization on a low score in professional accomplishment. But now people are reporting even just on the emotional exhaustion. So when we think about PTs and what I found was that 29% had emotional exhaustion and then 12% had actual burnout. And so that's, that's really a concern because we're talking that we have a vulnerable PT workforce out there when it comes to stress and when it comes to burnout.

Speaker 2 (13:56):

So if somebody has, if a physical therapist has high perceived stress, that's correlated with this emotional exhaustion, which is a part of burnout, but not the full definition of burnout.

Speaker 3 (14:09):

You got it, it's perfectly stated.

Speaker 2 (14:11):

So do you think that we, that our research needs to maybe reassess the definition of burnout? Or do you think that people, that we just need to get the word out there about what burnout actually is and educate people that, you know, you're not quite burned out yet? You're, you're emotionally exhausted. Here are the steps that you can take to decrease this high emotional exhaustion to prevent burnout, or what, what's your kind of opinion on that?

Speaker 3 (14:39):

Well, it would be a wonderful thing if it was so simple. But the reason why it's not simple is because people have looked at well, what comes first is an emotional exhaustion, and that leads to depersonalization followed by lower professional accomplishment. And the answer is not clear. So there are different models that have been proposed and tested to show that it can be multi-directional. And so it's not easy to say that if we manage stress, as we know stress, the perceived stress that we will have made a dramatic effect on burnout, because if depersonalization is what drives emotional exhaustion or low self-efficacy kind of low personal accomplishment, low self-esteem that type of thing in your workplace, if that drives burnout, then managing stress may not have as dramatic effect on those areas. So I, I think it's, I think it is behooves us to think about the complexities of stress and that mirrors the complexities of burnout.

Speaker 3 (16:04):

But I think that the first step is to be thinking about what are those stressors in the workplace because researchers have suggested that there's two ways to look at burnout, and that is the personal approach, so that you're more resilient to that stress, to that emotional exhaustion. And then the other area of focus should be on the work environment and the, the experiences that a person has at work. So we see that there's both sort of schools of thought that you, you make a person resilient and they will be able to handle any kind of environment. And then the, and then the counter is that if you make a nurturing, caring environment, that's conducive to good work and supporting people who are in crisis, then by that you were supporting the workers and you'll have less burnout.

Speaker 2 (17:14):

I think that those are some very interesting points. You know, this is obviously a very popular topic in our profession. Why do you think there's then we had, we've talked about that. There's not a lot of data for this. And just so our listeners know, like there's maybe a few studies, including Al including Dr. Anderson's recent dissertation, which was published in 2014, there's a couple of articles that have been published since then, but most of the research has been, was done in like the eighties and the nineties. So it's like over 20 years old. Right. So why do you think that data regarding burnout is so limited in our profession? And is there really any research going on in this area right now in our profession today?

Speaker 3 (18:00):

Yeah, I I've thought about that quite a bit, and I'm not sure why there hasn't been much, much research in the area. You can imagine that when I was working on my dissertation, I was shocked that there wasn't anything that was substantial. Everything was very old, as you had mentioned. And it was done in very discrete populations. So one was in rehab inpatient facilities in Massachusetts. Another wasn't a head injury unit in the Pacific Northwest. So very specific, nothing quite as broad as a national sample. Why, I don't know. I, in general, though, the efforts in looking at burnout has been focused on nursing and in physicians and MDs. And the only thing that I could come up with is there's a difference in the way we think and do things if you're medicine versus when you're rehabilitation. And I think that in comparing some of my findings in, especially in the areas of deep personalization and personal accomplishment, is that PTs typically were scoring much lower than nurses and physicians in those two categories.

Speaker 3 (19:24):

And I speculate that perhaps it's because of the kind of relationships that we have with our patients, that because we spend more time with our patients, we get to know our patients, families, and a lot of instances that it's very hard for us to depersonalize when you really spend a lot of time with someone. And that may also contribute to the fact that PTs score better than people in medicine, in the area of personal accomplishment, because although things may be crazy in your, in your practice setting, the fact that you can see a difference in the individual clients and patients that you see may in fact be reinforcing for that personal accomplishment.

Speaker 2 (20:16):

So is your belief then based off of what you found in your research, that kind of the difference between say physical therapists and nurses and physicians, which are more studied than what our profession is that we have better really, you know, longer lasting relationships with our patients and get because of that, we get a lot more accomplishment. Whereas physicians and nurses are more short term relationships with their patients. And so kind of those better scores and deep personalization and in personal accomplishment kind of help us save us from being burnt out. Like maybe our physician and nursing colleagues is that a,

Speaker 3 (20:57):

That is my hypothesis, but I haven't tested it. But that in looking at some of the publications in physicians of, of all different practice settings they are scoring typically higher, interestingly, except for those in mental health fields. So that may be a situation, two fold. Number one, is that a person working in mental health may actually have more skills to deal with their own stress and burdens. But they also may be spending more time with their patients because of the kind of therapeutic relationship that would occur in, in mental health.

Speaker 2 (21:44):

I think that your hypothesis is a very logical one, because if you think about, so if we, if we look at those studies from 20 years ago, obviously our profession has changed a lot. I mean, healthcare in general is just always changing. So, you know, right now student loan is at an all student loan debt is at an all time high wages for physical therapists are basically the same as what they were in the nineties. And the two thousands, we continue to experience decreases in payment. We have rising productivity expectations in order to maintain that bottom line. And so a lot of these factors are kind of cutting into our ability to form these relationships, so to maintain those good scores and depersonalization, and to have that personal accomplishment. But I'm interested in potentially knowing your opinion on how you think these factors have impacted the number of physical therapists affected by burnout.

Speaker 3 (22:43):

Yeah, I think that it has one of the, one of the findings that I observed in my research and that others have observed in medical populations is that younger therapists, younger physicians have higher rates of burnout than do older practitioners. And it's speculated that it's because the more seasoned therapist or physician has learned how to manage, right. They've learned how to manage sort of the, the game, if you will. They've also learned strategies for self preservation. So that gets us into that twofold area again, right. The personal, you know, wellbeing, and then the institution as something separate, I think it be worth it to take a look now, even compared to five years ago, with all the things that you've described, they were occurring five years ago when I did my dissertation, but then along comes higher expectations for productivity.

Speaker 3 (24:01):

And now, you know, let's throw in a worldwide pandemic onto that. Right. And so I think that what we've, what we'll, what we will see is that institutional changes that people may not have been able to keep up with because it's happened so rapidly over time, or it's sorry, that's weird. It's happened so rapidly within a short period of time that I think it would be worth looking into what changes have occurred in perceived stress or burnout. Within the past couple of years in physical therapy, because I would predict that those numbers would be greater than they were back in 2014.

Speaker 2 (24:51):

Well, I mean, that leads me beautifully to my next question is how do you think COVID-19 has contributed to burnout in physical therapy amongst physical therapists?

Speaker 3 (25:01):

Right. So when, so, although I didn't ask the question in my survey about what's causing you to be burned out or, you know, identify things that are stressors in your life. What I know, what I know from the literature is that when people in healthcare feel as though they don't have control of the situation, or they cannot contribute to good patient care effectiveness and efficiencies that the burnout rates are higher. So there is something to be said about this time in COVID where in our physical therapy world, we went from non essential to essential. We went from, you know, not doing rehab to doing nursing care. I colleagues of mine who were sent to the Mork colleagues of mine who worked security desks because in order for them to keep their job, they needed to say I would do assigned duties. So if we know that having little say about your work environment, little, say about how much time you spend with patients or what your responsibilities are, or what responsibilities you can delegate to other people, we know that that's contributing to burnout then hello, because that's exactly what happened to the physical therapy profession during COVID.

Speaker 2 (26:39):

So you teach at Rutgers what types of what types of instances of burnout or stress have you experienced amongst your students who are now like fresh into our profession and the students that are maybe still in PT school? How have they reacted to this COVID-19 pandemic in relationship to burnout or perceived stress?

Speaker 3 (27:04):

Right. So I think that we, we probably have cooked two cohort of students, the ones that graduated in 2020, who did a big sigh of relief because, because of in our program, the amount of weeks and hours they had got in for clinical experiences was complete by the time that they started to be pulled out of their clinical rotations. So all of our students were able to reach a level of competency and entry level so that everyone graduated in 2020. So they were like, just so relieved the group that is scheduled to graduate in 2021 have been dealing with the stresses, the traumas that come with changing responsibilities and different expectations because of COVID. But I think that by and large, they've had excellent clinical instructors, so kudos to the physical therapy profession and that they have been able to take the challenges in stride in part, because of the support from the institutions and their clinical instructors.

Speaker 3 (28:30):

I think that the students that are engaged in academic work, their stressors come from the fact that they know that they are in a program that's delivering information very different than the previous year and their hands-on experience has been truncated. And, and that, despite the efforts of the faculty to give them all the experiences that they normally would have in person that we are limited by the COVID restrictions of our university. So what we've, what we've attempted to do is to speak about the virtues of tele-health. We have some testing opportunities for students to engage in tele-health and improve their skills with communication and observation. Also giving directions watching movement from like you and I are right now from across the screen. And I do think that that is something that many therapists are learning. There's many courses and, and many workshops that you can do for best practices in doing telemedicine. So I think some of our students will be better equipped coming out because they have had some work in that area.

Speaker 2 (30:09):

So we've talked a lot about some of the different stressors that potentially could lead to burnout, but do you think are the main causes of burnout amongst physical therapists?

Speaker 3 (30:19):

Yeah, I think number one, I think autonomy is, and, you know, we got out from under the physician prescription. But if you think about autonomy from many practices in which the productivity demands is so high that you feel as though you've lost some sense of autonomy, and that comes from not being able to perhaps schedule your patients based on their needs. So, you know, if 30 minutes session versus 45 versus an hour so that contributes to a decrease in, in autonomy, which we know is that, which is a stressor when it comes to burnout. The other thing that is a big factor is redundancy. And it can be primarily in documentation where, you know, we've all experienced that you fill out one form, then you fill out another, then you have to do this chart and so on and so forth.

Speaker 3 (31:20):

You have this information in four or five different places, and that contributes to burnout because what happens is you feel as though you've imparted your professional opinion and you've made your professional observations, and that should be good enough. And you know what, Stephanie, it probably should be good enough. The fact that we have to, you know, regurgitate it in three different ways for different purposes is, you know, sucking the life out of people. All right. So the other thing that happens is that acknowledgement of credentials and continuing education and bettering yourself when that is not honored and respected by an employer or by a setting that contributes to burnout. And so in the physician world, they talk about having their board certifications. And we could also think about that in physical therapy as well. So even if you've got staff that have qualified or are now OCS is, or sports, clinical specialists is they need time to maintain that expertise.

Speaker 3 (32:35):

They need to do continuing education. They need to see the right patient caseload. They need time to do some outcome measures so that they can maintain that level, that high level of expertise, and that needs to be respected and time needs to be given to those professionals. Otherwise you can see an erosion of professional accomplishment. So it, it's not from my, my work, but from the readings that I've done in other professions, you know, predominantly medicine and nursing, these are the institutional things that contribute to burnout. And I can see that how that can they can have a big role in physical therapy as well.

Speaker 2 (33:23):

So I recently did a very unreliable and bias social media study pool on this topic asking you know, what, which physical therapy setting is burnout most prevalent. And I had 147, a sample size of 147 on, and I was kind of surprised by the results, but here were the results. 48% said private practice, 23% said, hospitals, 24% said skilled nursing facilities, and 5% said home health agencies. Do you think based on kind of what your research showed and based off of what you've read and potentially what your alumni have said, do you think that there is a higher rate of burnout amongst physical therapists in certain settings? And if so, what settings do you hypothesize put people most at risk for burnout and how can leaders within those settings decrease the rate of burnout amongst their employees?

Speaker 3 (34:25):

Okay. So I don't have to hypothesize because I actually have the data that was not part of my dissertation. So I will share that with you now. All right. So the winner in the burnout rate is skilled nursing facilities at 24%. Okay. followed by home a home care at 14% closely followed by the hospital outpatient department at 13% and private outpatient at 12%. So 12, 13, 14%, you know, sort of in the ballpark, but the standard, our skilled nursing facilities. And in, in a statistical analysis that I even still don't remember or can explain the one that stands out is truly statistically significant difference are those people who practice in skilled nursing facilities. And I mean, I would have to say that that number is probably in a higher, I mean, look what our colleagues in skilled nursing facilities had to deal with with COVID.

Speaker 3 (35:39):

You know, people were not being able to have visitation by family members, right. Trainings for going home sometimes were done via zoom sometimes in person for maybe five minutes. But think about that, think about all of the subacute rehab, people who didn't have family support when they're, you know, they're following surgery. They've never been in that kind of situation before, and they had to do that totally alone. And the demands that were placed on the rehabilitation staff and the nursing staff to keep moving forward with subacute care, nevermind all of those residents in long-term care that needed attention. So it, it back several years ago, it was still ranking pretty high as a stressful burnout written place to be long-term care. And I think it's still gonna sort of be at that level if not higher, what can they do?

Speaker 3 (36:50):

I still, I still have to go back to having compassionate supervisory support that there needs to be an understanding on how stressful and difficult it is to work with people who are at risk and people who are in crisis. And with that compassionate understanding supervisor comes a system that optimizes the physical therapist clinical decision-making professional opinion and allows therapists to continue to impact people's lives as positively as we do and not be burdened or, you know block or have a blockade set up through unreasonable demands and expectations. I think that the other the other idea that I didn't speak about earlier also is this sense of fairness and justice, and that comes from also the supervisor and, and the institution, and that it appears that when there's good transparency by knowing what everyone's case load is by knowing what the expectations are and that everyone is contributing to a a great unit or a great facility and that there's rewards and acknowledgements.

Speaker 3 (38:37):

And sometimes it doesn't have to be an actual bonus or reward. Those are nice, but sometimes it's just the acknowledgement. And at the same time that there shouldn't be any kind of punitive action on people who are not able to accomplish the same benchmarks. So I'll give you an example of something that happens in medicine quite a bit is that physicians who work in clinics are, have their appointments, you know, done by a scheduler, and they will have an income based on bonus based on how many people that they see. But what happens is when people cancel, they don't see anyone and there's no one there to fill in that spot. So physicians are, who are in that situation, feel like I'm not pulling my weight, but it's no fault of my own. And now I'm also being penalized because I don't have that slots filled. So I can't generate a ticket if you will, in order for a charge to go in, and yet it's by no fault of their own. And so we need to be thinking about ways in which physical therapists can have some participation in systems that supports everyone in that work environment.

Speaker 2 (40:17):

Do you have any advice on any of those systems or any thoughts behind developing those systems?

Speaker 3 (40:24):

I don't actually, I think that those are for, for different minds than mine right now. And I bet that there's plenty of people in the private practice section who have looked into different types of systems that include participatory type management strategies.

Speaker 2 (40:48):

I think you're probably correct on that statement, Dr. Anderson and, you know, most physical therapy facilities, including private practice, we're moving towards using data to make decisions. So how, what advice would you give to private practice owners? How can they use data to measure burnout amongst their employees?

Speaker 3 (41:09):

Yeah, I mean, I think, I think one of the the easiest tools to use is actually the perceived stress scale. It's by Cohen, it's free, you know, there's plenty of places where you can find it online and know how to score it. And one of the reasons why I, this is because I've done the perceived stress scale with groups of therapists who take continuing education courses with my partner and me and they are often surprised at what their score is. So some who thought they would score really high on this perceived stress scale, realize that no, they really didn't. And those who thought, you know, they were getting along pretty okay. When they went through those questions, they're like, Oh, I didn't think I would score that high. And so it, it leads to a conversation about that personal side, right? So what are you think that your stress, but your perceived stress scale kind of comes out a little bit low.

Speaker 3 (42:22):

So what are you doing in your life? How do you approach your day? What are the things that you do to manage your health and wellbeing? And I think that facilities that make that part of the culture will do really well with being able to use some of that information from the perceived stress scale, not where they're collecting the data, but they're increasing the awareness of their employees and the people that work together. And it opens up the opportunity to have a conversation about the stressors at work, the stressors at home, and how people can support each other and how people are coping with their stressors.

Speaker 2 (43:09):

What advice or solutions do you have for private practice owners or any, or organizational leadership on managing burnout amongst their employees once they kind of figure out some of the data points that you mentioned previously?

Speaker 3 (43:23):

Yeah, I, I think that one of the things that has come out in some of the literature is the fact that when you're working with highly intelligent people. And so remember that burnout came from people who were working in healthcare, right? They, they are licensed healthcare providers. They often have advanced degrees. They often have specialties. One of the keys is to give people a voice regularly. And then what is also been found is that when people are given a voice and suggestions are made for changing in the environment or something that could help greater efficiency, that the response from the administration is that I will look into that and then come back with information to either support that idea or to say at this time, and in this situation, that idea won't work. And here are the reasons why, but one of the things that's very detrimental is when people share thoughts and ideas, is that the first response they get is we can't, or no, without any kind of real honest investigation into the suggestion or recommendation. And so I think that that's a very sound place to start and trying to have a clinic or a facility that is going to be resilient against all of these forces that are going on in healthcare and have a happy and healthier staff.

Speaker 2 (45:23):

What about employees? What type of advice do you have for employees who are maybe close to, or are experiencing burnout?

Speaker 3 (45:32):

Yeah. institutional change takes a very long time, and sometimes it can be really frustrating, particularly if you don't have those empathic caring supervisors who are going to sort of beat the drum for you. And so you have the chance to turn to yourself. And what we know from some work site studies that have focused on healthcare providers is that breathing practices and meditation are two strategies, which help people be able to manage their stress effectively. And the idea is that you practice those things so that when you need it, you can use it. So, you know, you could always think, well, like when I get really anxious or whatever, I just stop and I take some deep breaths. Oh, okay. That's great. But when do you, do you always have an opportunity to like, just stop, pause and like take your deep breaths? No, you, you have to anticipate that this is happening and you have to be really good at pulling that up very quickly. And that comes from a regular practice. And I think that in general, we know those practices are really good for managing the balance of the sympathetic and parasympathetic nervous system. We know that those practices help increase heart rate variability, decreased blood pressure, decreased heart rate. And so it's not, those are strategies that are not just great for managing stress, but they're also great for managing your overall health.

Speaker 2 (47:27):

Well, Dr. Anderson, this been a great conversation. I know that I have learned a lot and I'm really looking forward to using some of this information to write my article. One last question that I want to ask you, that we ask everybody on this podcast is knowing where you are now in your life and in your career. What advice would you give to your younger self?

Speaker 3 (47:53):

Huh. I think, I think to my younger self, well, Hmm. Okay. There's two, there's two sides to this sword. One is that if I wanted to be more accomplished, I would say in my career I would have focused earlier on, on a line of inquiry or a line of research. However, not having done that. I can't say that I have a lot of regrets and I have dabbled in a lot of things so that you, you saw from my bio, that I have a lot of different interests and I don't do anything with a half effort. So, you know, a lot of research went into the book. A lot of research went into my being the advisor for young athletes for special Olympics. You know, there's, there's, I haven't really ever fallen into anything. I feel as though I've put a lot of effort into that and, and all of those parts of who I am. I enjoy immensely and I wouldn't want to give anything up. So my advice is if I had a clear career trajectory, I should have focused more on one area. But I don't know if that was really me to begin with.

Speaker 2 (49:34):

Yeah, don't we all want to have one area that we want to focus on and have a very clear trajectory. I think of 2020 has taught me anything. It is, that is not something that's going to happen most of the time. Well, I want to thank you so much, Dr. Anderson for joining us today on the podcast, and thank you so much for your time. Thank you to our, thank you to our listeners for listening to another episode of healthy, wealthy, and smart, and hopefully you will stay healthy, wealthy, and smart.

Speaker 1 (50:10):

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

In this episode, Co-Founders of Survivorship Solutions, Jillian Schmitt and Kristin Carroll, talk about Cancer Survivorship and the need for Caner Rehab Education.

Today, Jillian and Kristin talk about the prevalence of cancer, the importance of competency in cancer rehabilitation for all rehab clinicians, and compiling educational courses from leaders in the field.

When should cancer rehabilitation start? Jillian and Kristin tell us that learning is not enough, hear about the value of mentorship, and Jillian and Kristin's community of clinicians, all on today's episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• "Cancer is not just one type of cancer. Cancer is not just what you're seeing on the outside, there are physical changes on the inside as well."
• "One thing that physical therapists have to keep in mind is that 100% of physical therapists, at some point in their physical therapy career, will see someone with cancer."
• "If you want to stay on the bus, get competent and elevate your skillset to everything, not just cancer rehabilitation, but add that as another skill in your pocket."
• "If you are a clinician or a therapist, it really is your ethical responsibility to take care of every patient that comes through the door, regardless of what their past medical history is. If you are not confident and competent in taking care of oncology patients, get that way. There's a solution for you. Educate yourself, feel comfortable, feel confident, take care of your patient the way you should."
• "For administrators and leadership teams, you really want to know that your team can take care of this population. If you do not have something in place that is ensuring that your clinicians and rehabilitation teams are really competent at taking care of these patients, you need to get that way, and you need to get that way pretty quick because the regulations and requirements from the very top levels are requiring that you do that."
• "If your oncologist is not talking to you about function and what's happening to you during your cancer journey and how that is going to be mitigated, or how you're going to have a rehabilitation therapist of some sort as part of your team, ask for it. It needs to have this bottom-up push as well."
• "Think big, be brave, and just go for it."
• "Keep being a sponge. Keep learning. Don't be afraid to try new things. When you're starting to get burned out, try something else. Keep learning and keep growing, and eventually you're going to find something that just wows you and really makes you change not only your career, but your personal growth as well."

More about Kristin

Kristin has been in clinical care and leadership roles within the Boston and Hartford healthcare systems for over 30 years. For over a decade she has focused on elevating her oncology specific practice with Klose coursework in lymphedema, oncology and breast cancer rehabilitation specialty courses through Julia Osborne and the American Physical Therapy Association (APTA); Academy of Oncologic Physical Therapy, and earned completion certificates in Chemotherapy/ Biotherapy Agents and Radiation Therapy from the Oncology Nursing Society. She is planning to sit for the 2021 Oncologic Certified Specialist Examination.

Kristin has been a mentor, clinical coordinator, and educator at both the system and collegiate level. She continues to serve as an educator through her role as an instructor within Survivorship Solutions 'clinical education course: Core Competencies in Interdisciplinary Cancer Rehabilitation, contributing to guest podcasts on Breast Friends Cancer Support Radio, Mama Bear Cancer Support Radio Talk Show, and The OncoPT Podcast, contributing to Alene Nitzky' s book "Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care", and as invited speaker at the International Breast Cancer and Wellness Summit, and the American Congress of Rehabilitation Medicine National Conference 2020.

She actively supports and is involved in the oncology community as a member of the American Congress of Rehabilitation Medicine Integrative Cancer Rehabilitation Task Force, Connecticut Lymphedema Consortium, local and national chapters of the American Physical Therapy Association (APTA); APTA Academy of Oncologic Physical Therapy, Hospice and Palliative Care Special Interest Group, and serves on the board of the APTA Connecticut Oncology Special Interest Group as Program Coordinator.

Kristin received her Bachelor of Science in Physical Therapy from Northeastern University.

More About Jillian:

Jillian is a licensed physical therapist with over 20 years of experience in patient care, clinic development, management, and consulting within the fields of oncology, orthopedics, pediatrics, ergonomics, and corporate health. She studied biochemistry and business management at the University of Texas at Austin, and received a Bachelor of Science degree in Healthcare Sciences and a Master's degree in Physical Therapy from the University of Texas Medical Branch in 2001.

Much of Jillian's early career focused on orthopedic and pediatric physical therapy intervention, specializing in complex, limb-salvage rehabilitation programs, spinal dysfunction, and sports medicine. Later, she turned her attention to program development, clinic start-ups, and management within the corporate healthcare industry. For the past six years, she has consulted in the implementation and optimization of survivorship services and cancer rehabilitation programs within national healthcare organizations.

Jillian maintains professional licensure in physical therapy and participates in continuing education programs and certifications within oncology and other specialties. She serves as a contributing and presenting team member for the American Congress of Rehabilitative Medicine (ACRM)'s Integrative Cancer Rehab Taskforce and is a member of both the Education Section and Oncology Section of the American Physical Therapy Association (APTA). She also participates as a member of the Hospice and Palliative Care Special Interest Group (SIG).

Jillian regularly contributes to podcasts, journals, and other professional publications related to oncology, healthcare, and business, and she participates and contributes regularly within the entrepreneur and small-business community of the Chicago-land area, including SCORE mentorship and women-led business groups.

In 2016, Kristin and Jillian founded Survivorship Solutions, LLC., an education and consultancy firm dedicated to supporting clinicians and healthcare organizations in implementing high-quality cancer rehabilitation and survivorship services.

The company collaborates with national and global experts in oncology, survivorship, and rehabilitation to grow team safety and competencies in oncology knowledge and evidence-based care.

Suggested Keywords

Physiotherapy, Learning, Cancer, Research, PT, Health, Therapy, Oncology, Survivorship, Healthcare, Education, Training,

Recommended viewing

https://vimeo.com/485402119

https://survivorshipsolutions.com/p/core-competencies-in-interdisciplinary-cancer-rehabilitation-2-0

To learn more, follow Jillian and Kristin at:

Website: https://survivorshipsolutions.com

Vimeo: https://vimeo.com/survivorshipsolutions

Facebook: Survivorship Solutions

Instagram: @survivorshipsolutions

Twitter: @survivorshipsol

@KCarrollPT

@JSchmittPT

LinkedIn: Kristin Carroll

Jillian Schmitt

Survivorship Solutions LLC

NetHealth Webinar:

Rehab Therapy Outpatient Services 101: How to Expand into the Home or Assisted Living Facility.

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Read the Full Transcript:

Speaker 1 (00:00):

Hey, Kristin and Jillian, welcome to the podcast. I'm so happy to have you guys on

Speaker 2 (00:07):

Or happy to be here.

Speaker 3 (00:09):

Thank you so much for having us on today.

Speaker 1 (00:11):

So today we're going to talk about cancer, survivorship. This is something that I've spoken to, one of your colleagues, Dr. Nicole Stout with, but before we get talking about that, what I would love to know is how the two of you came together to create survivorship solutions, the how, and the why behind it.

Speaker 2 (00:31):

So, Kristen and I knew each other before we started the company together for a couple of years, we, we previously worked for another organization and had similar roles and that was to implement cancer rehabilitation, service lines within healthcare systems. And Kristen and I really connected during that time. And we really enjoyed working with each other. We valued a lot of the same things. And so once we left that situation or once that situation of our, our, you know, once that's working together no longer happened for that particular company, we decided that we were great together and that we would we needed to continue the work. And so we started survivorship solutions together

Speaker 3 (01:21):

And Julia and I are both physical therapists and I have a special, I've been working with oncology patients for over 12 years. And even though we're both PTs, we both kind of had different soap boxes and what we were so passionate about. And Jillian has a love and just a savvy for business and growth. And you know, I just love to educate and things like that. So together, you know, just our, our strengths and our passions just forged us forward to create this, this company to, to continue to help healthcare organizations, but also individual commissions that, that really just needed to get more information on how to take care of people with cancer.

Speaker 1 (01:59):

Yeah. And that was my next question is where, where was the gap that, what was the gap that you guys saw that you were like, Hey, if we can put our heads together and create this, we're really going to help fill that gap?

Speaker 2 (02:11):

Right. Well, you know, for me personally, it was I was not a cancer rehabilitation therapist for most of my, my clinical career. I was in orthopedics and I th the opportunity to begin working in cancer rehabilitation actually came about it was pretty unexpected. I received a phone call from a very good friend of mine and also therapists I would school with. And I've been in practice for 15 years and she said, you know, I think that this would be a really good opportunity for you, you know, you, you've married sort of this business. And I, because I had opened clinics and I had done a lot of the, the business part of it. And but I really loved clinical practice. And I also had a very personal situation occurring in my life, or one of my loved ones was experiencing the cancer journey and really having a lot of issues and a lot of problems that I was really familiar with. But I, you know, like weakness and numbness and things like the things that physical symptoms, but I was just kind of watching through this lens and like, all right, well, that's like what I do every day, but why isn't somebody helping him? So it was all these three things that kind of came together and took me out of my orthopedic world pretty quickly and thrust me into the cancer rehabilitation world, which I had thought, I mean, admittedly been very naive of until that happened.

Speaker 3 (03:43):

Yeah. And I was working in an outpatient center and had surgeons come to ask if I would become competent to learn how to take care of breast cancer patients. Cause they were breast cancer surgeons. So I went to Olympia DEMA course and I learned all about lymphedema. And then I came back and I saw a breast cancer patient and I was all excited to use my new education that I just learned and she didn't have lymphedema, but I was like, Oh my God, what do I do with her? I mean, I learned all about lymphedema isn't that cancer rehab isn't. And so Julie and I learned quickly that in order to really become competent, to take care of people with cancer, you have to travel around the country at your conferences and online and, and do all sorts of things to get there. But a lot of it was just disease specific, like just breast cancer. So how do you learn how to take care of everybody that has all different kinds of cancers and all the different problems? So we felt that it really was our ethical responsibility as we were working with healthcare organizations to make sure that if we were going to implement a program, we had to make sure the team really was confident and competent to do that. So how we created education to go along with that implementation.

Speaker 1 (04:54):

Yeah. Excellent. And, and I will say that people who, like, I know people who've been diagnosed with cancer and as of yet only like two of them have gone to physical therapy. One of which was because I said, you have to go to physical therapy, she had a double mastectomy. And I said, tell your doctor that you want to go to PT afterwards. And she was like, but the doctor gave me this list of exercises. And I said, no, no, no, no, no. Tell your doctor, you want to go to see a physical therapist after this and, and sh afterwards she was like, yeah, I I definitely needed a PT. And so I think the issue here, and we'll get into that, we'll get into this conversation in a little bit, but you know, the issue here is that cancer is not just one type of cancer. Cancer is not just a, what you're seeing on the outside, but there are physical changes on the inside as well. And that's where being a knowledgeable physical therapist on, on the rehab of people diagnosed with cancer is so important, but let's talk about cancer in particular. So cancer itself can affect anyone true or false. That's absolutely right. Yeah, definitely. And so let's talk a little bit about the, this sort of prevalence of cancer and what that means for us right now,

Speaker 3 (06:31):

Almost 17 million cancer survivors in the country. And so that is all different ages, you know, doesn't matter which sex, all different kinds of cancers, definitely cancer is not discriminant. And so you talk about the gap in care. And Andrew Chevelle is, is kind of huge in our cancer rehab world and does research. And you know, she talks about the 83% of general cancer survivors have problems that really require rehabilitation and take it to the other end where women sorry, excuse me, general cancer metastatic or stage four, they have up to 92% of problems. So obviously somebody that has a chronic cancer condition is going to have more and more problems because they are receiving more and more treatments. And so the percentage of people that actually get rehabilitation is only about 30% according to, to her study. So that's, you know, that's a huge gap in care wizards.

Speaker 3 (07:25):

It's 83% of general cancer survivors or the 92% of our metastatic breast cancer patients. That's a huge gap with 30%. So when we're looking at that, if you're young and you're diagnosed with cancer and you have treatment, you're going to grow up to have perhaps problems, you know, as you get older. And so, you know, these people are inside our clinics already. And sometimes it's a little tiny past medical history. That's checked, you know, on their, on their form and we see cancer, but yet we're a little bit afraid sometimes to ask a little bit about what that is. And, and even I do that when I'm in a private room with my cancer patients that I'm treating them, I have no problem talking about what they went through, but on an open clinic. And I see that little word cancer, sometimes I, I will say, Oh, well, you had cancer. What kind did you have? And you know, but we really have to have these conversations. What kind of cancer did you have? What kind of treatment did you have because it really can impact the treatment that you are providing your patient, whether they're a pediatric patient, you know, an inpatient and outpatient adult really doesn't matter what the setting is. It really could depend on what your care plan is going to be.

Speaker 1 (08:41):

And Karen, you, you had mentioned that you said you asked, can anybody get cancer and can this affect everybody? And absolutely. And I think what's, what's really interesting is that healthcare professionals, you, myself

Speaker 2 (08:56):

Included, we don't necessarily automatically think about like the, the functional consequences of having cancer, even though we see it. We're so we have this new normal instilled in us that we sort of expect cancer patients to not have normal function or not be doing well. And it just really to be part of what the expectation is once you get that diagnosis. And even me, even somebody that has worked in therapy for a long time and having a person very close to me, experiencing physical symptoms, I still, it was almost like a, it was just sort of like an out of, Oh, you know, like I didn't really make sense to me why he wasn't getting it, but it wasn't sort of this, well, this is a person that needs to have therapy. That connection wasn't, wasn't quite there yet. And I think that that's true for a lot of clinicians.

Speaker 2 (09:49):

They say, well, we, we don't see cancer patients, but but w w what Christina likes to say, well, yes, you actually, you have, and you do you see them probably every day on your schedule, there's such a high percentage of people that cancer at this point, that if you're seeing any population in ortho population or a neuro population or whatever in your clinic, you have seen patients that have either current or a previous diagnosis of cancer. And so you are, these patients are coming into our clinics already, and people are just not really making that connection.

Speaker 1 (10:23):

Yeah. I remember when I spoke to Nicole, she said, one thing that all physical therapists have to keep in mind is a hundred percent of physical therapists in, at some point in their physical therapy career will see someone with

Speaker 2 (10:36):

Absolutely, absolutely. Probably this week. Yeah. And like, you know, it's, it's not, it's not when, or, or it's, I mean, like it's very, very soon because patients also don't necessarily think about the fact that they have a cancer diagnosis and it's something that they really need to kind of put, put front and center when they are going to rehab. So maybe they've had a knee replacement or they've had some other traditional rehabilitation problem, like a BA like back pain or whatever they go to PT for. And they had that pesky, you know, cancer diagnosis 10 years ago that colorectal cancer, but they, they got it and they got the third, but so they don't really, but you know what, those things that happened 10 years ago with that diagnosis and the medications that that patient had and the treatments that that patient had are actually going to impact the way that they heal in, in physical therapy. And so I think the patient doesn't understand the significance of it. And then the clinician doesn't really understand the significance of it. And it makes a huge impact in how well that patient is gonna, you know, do and how, and in the course of their therapy, it really should kind of direct the course of their therapy and and predict how well they're going to be able to, you know, certain, certain things that should be in therapy and certain things that should really not be done in therapy should be based on that.

Speaker 1 (11:57):

And something that as you're saying, all of this, that kind of struck me is that in physical therapy, you know, we are expected to have the competency to treat people with a total knee replacement, low back pain post-stroke Ms. But you guys have traveled around the country. You've spoken to many physical therapists, is that clinical competency in cancer rehab there amongst the physical therapy profession. And this is a silly question, but is it essential?

Speaker 3 (12:35):

I do. I think it was definitely not there. I mean, there are therapists that are very skilled at providing lymphedema treatments, and there are therapists that are very skilled in targeting certain kinds of breast cancer. But I think one of the things that we think, what I think about is that the things that people going through cancer treatment, it's kind of like an anticipated decline, right? Like we kind of know that they're going to feel like crap when they're going through chemotherapy. And I think that maybe, and I had this assumption that once their chemotherapy is over, they're going to be fine. And I think a lot of the providers think that as well, we kind of know that they're not going to do well during treatment, but I don't think that a lot of people know is that they don't do well even after treatment and that six months and years later, they have these effects.

Speaker 3 (13:24):

And because there are one in eight women that get breast cancer, and there are so many men that get prostate and other lung cancers are, are breast cancer women, and are prostate men have to take medications sometimes for five and 10 years, that affects their musculoskeletal system that affects every ortho therapist. If they're treating these people that are in their clinics. So there may be a general awareness, but I think there is kind of pick and choose, like you make it a lung cancer patients that you're treating for weakness. You don't have to treat weakness, you don't to treat balance issues, but you may not really understand what the chemo regimen did to the patient, why they're having those. So I think explain the why around it helps to decrease the fear that some therapists have of treating, because I sure was afraid when I saw my frail bald patients walking in, I was really afraid I was going to hurt them. And I didn't feel safe to take care of them because I had one month of DEMA course, and I wasn't. So we kind of wing it, right. Because there's not really many resources out there. Right, right.

Speaker 2 (14:36):

Back into my schoolwork and looked and to see what oncology criteria like curriculum that we had gone through when I was a student. And yeah, I mean, it was so minimal. It was less than a week was one core, like within one class that wasn't oncology focused. It was, I mean, the amount of information that clinicians were getting in school and professional programs was very, very minimal. And of course that's more than 20 years ago when I was in school. But even now even now I would say that there was a huge percentage of of clinicians that take our course who are new grads. They just got out of school. So we know, and we've communicated with them. Talk to them. This is not in their curriculum. They are not learning this in school. Otherwise they would not be seeking out some of this information that they know is really important anyway. And that's physical therapists, occupational therapists, anybody that's in allied health or are seeing patients really needs that they need to have this foundational, basic knowledge that makes them safe and makes them competent to care for these patients. And so it is a little, I I'm sure the education, maybe at some point we'll catch up, but it hasn't yet.

Speaker 1 (15:56):

Yeah. And, and I'm sure it also depends on what's on the MPTE, but that's a whole other thing and let's, we won't get into that, but we know that certainly exists when it comes to educational curriculum in schools. Yes. At any rate I digress. Let's talk about, let's talk about when should rehab physical therapy, occupational therapy start. So someone is diagnosed with cancer. When do they start their rehab?

Speaker 3 (16:27):

The rehabilitation starts at diagnosis and that's when the American cancer society. And so many of our, our industry regulators recommend that it started and it start from diagnosis all the way from end of life or end of care. And, you know, we compare this to kind of our other service lines, but, you know, somebody is having a knee replacement they're coming in for prehab, right. They're coming in for education, they're coming in for strengthening before they do that. And it's, it's no different for a patient with cancer. They need to be armed with what they are going to go through. Not only the education to help decrease their fear, but also the problems that they are going to incur, understanding that we have the skillset and the tools to be able to support them throughout that journey. And I think the other thing that rehab teams don't realize is that general clinicians that don't have specialties really can treat the scope of most of the impairments that people have. Just like we all can you know, balance and numbness and tingling and strength issues and fatigue, and just, you know, the list goes on and on, but if you have a pelvic health issue or if you have lymphedema, then we triaged to our, to our specialists

Speaker 2 (17:35):

And, and best practice really dictates that when you're going to begin any type of a treatment or any type of incur, any type of or undergo any type of surgery or anything like that, it's really to establish a baseline. And in cancer, there's really, it's, it's very important to establish a baseline because we know pretty, pretty well that cancer treatments are going to cause problems. They're going to exacerbate existing problems. And so if we can add diagnosis, capture what that baseline is for that patient and monitor and survey that patient and make sure that that patient is not there, that their existing, their preconditions or existing deficits or impairments are not getting worse or that new ones are not popping up. That really is best practice because we know that if we can see something pop up, you know, and catch it immediately, it's going to be a lot easier to take care of and to recover from or to prevent even then, if it's something that we don't, you know, that we don't look for until after treatment is over, maybe, you know, the patient is having a lot of functional problems that are really obvious.

Speaker 2 (18:50):

If you just wait until then it's going to be a lot harder to intervene and it's going to, I mean, and this is it's gonna be a lot more expensive. I mean, something that may take just an education and maybe one visit and rehabilitation from the very onset and the very beginning even something, you know, just as you're going to have this, you're going to have a lumpectomy you're going to guard you. You know, let's make sure that when this happens, you're going to continue to do range of motion within a certain, you know, limitation, but that the patient knows that that can later prevent like three months of a frozen shoulder. Right? I mean, like we know that this, these things happen all the time and it's easy to just kind of get in there from the beginning. So best practice is, is at the very beginning at diagnosis, patients should definitely be at least screened for impairments and informed that rehabilitation is part of their medical care. They should expect it, their patient should walk in knowing that rehabilitation is part of their medical team. Yeah, absolutely.

Speaker 3 (19:52):

And this is, and this is something that Nicole Stout talks a lot about in her research has called the process perspective surveillance model. And that is, you know, screening patients before each intervention. So we know kind of what we call each medical touch point. So whether they're having surgery or chemotherapy or radiation really being screened before each of those interventions. So like Jillian said, we can kind of pick up on those impairments when they're acute in nature, that's really important.

Speaker 1 (20:19):

And so let's talk about cancer rehabilitation education. I think we've already established that physical therapists do not get an adequate amount of cancer rehabilitation education in school, and you may not get it on the job either, depending on where you work. So couple that with millions and millions of people getting diagnosed with cancer every year rehab should start at the point of diagnosis. So let's talk about the education around it, because if that is the case, and now it is recommended rehab start at the time of diagnosis. And there are tons of PTs in this country and not many know how to deal with this. How do we educate physical therapists in a robust manner so they can help with these patients?

Speaker 2 (21:15):

Well, I think that things are kind of catching up here. It's been established that cancer rehabilitation is important and it needs to be part of cancer patients cancer care. And we have national regulatory agencies and different sort of top level drivers that are encouraging and really requiring organizations to provide cancer rehabilitation. So we have a lot of these companies that are starting to recognize, all right, are people that are in house already need to be doing this. And then from the clinician's perspective. And, and I can say this as a, as a physical therapist, if, if my boss had come to me in my outpatient clinic and said, okay, we're going to have a bunch of oncology patients come in the doors now. Because there's these guidelines and we're going to see this influx of patients and you guys are gonna be treating these patients.

Speaker 2 (22:15):

I would have been like, okay, like I would have been really nervous about it. And so we, we still sort of were getting that response as organizations are starting to implement some of these policies that are requiring that their organizations provide these services. So we're also getting this sort of searching from these clinicians, like, all right, I'm going to see cancer patients. And when I go online, I see like a billion, different CU courses for different types of, I mean, I can be different specialists in this or a specialist in that, or I can take this or I can take that. What I really want to know is how can I be safe to see these patients coming through the door. I don't, but maybe cancer is not there. And you know, what, what they're interested in, they don't want to specialize in it.

Speaker 2 (23:03):

That's fine. And so they don't want to spend thousands of dollars on specialties and weekends, but they do want to be safe and they want to know. And so Chris and I kind of came at it from that perspective, like, all right, we're gonna, we're gonna say, we're going to get more referrals in your clinics because of these guidelines, because it's the right thing to do because research says that cancer patients need it. But what's really important to us is that your clinicians feel competent. They feel safe. How can we create the education that your, your clinicians are gonna feel like they can have anybody land on their schedule and that's going to be fine because that's going to make them feel comfortable. And what that's going to do is going to make their bosses feel comfortable there. The leadership is going to know that their entire Rhea team has a competency and anybody can kind of come through there and that their service is going to be very similar from facility and location location.

Speaker 2 (23:48):

So we, that's kind of where we started with. We weren't, we didn't, we didn't want to make a course that was going to make somebody a specialist. Those are out there and they're awesome. And we work with all those people that make those courses. So we know they're awesome. We wanted to create something that was respectful of somebody's time and their money, and, and really want to just pull the most excellent parts of all those specialties into one spot so that a therapist could go through it and be pretty confident in their leadership can be pretty confident that they were that they were gonna be able to take care of these patients as they come through the doors.

Speaker 3 (24:23):

Yeah, Kristen, and then I, I was live and then I was living in the cancer rehabilitation world. So I knew a lot of the experts and the leaders in the field from just attending their courses and conferences like Nicole, Nicole Stout, and Julia Osborne. And, you know, just all of these amazing people that really aligned with the same mission and vision that Jillian and I both had to spread this education. And, but what was missing was a comprehensive online platform. And, you know, I I'm sitting for the specialty exam in February, but I'm an expert in certain things, but I certainly not the expert on everything. And so Joanie and I said, you know, when we're learning, we want to learn from our role models, right? Our peers and our colleagues who respect in the field. So we went out and we asked them, you know, will you help us create this education?

Speaker 3 (25:18):

And they all said, absolutely it's really important. And why it's important is because we have to get it in the hands of people quickly. I, it took me 12 years to kind of get all this information. We don't have that kind of time because we have almost 17 million people that need this care right now. And these patients are in the clinics and, and they need it. You know, they're, they're just people that want to do marathons and, you know, raise their children and go to school and do all the things that everybody else does. So how do we get it into the hands of people? So we went out and they created this, this education, and then we went and got it approved recently for continuing education credits. So it really is an amazing compilation of education that spreads a blanket over all different kinds of cancer, disease types and all the impairments. But it isn't just for somebody that wants to be competent and confident. Cause I went through it myself and I learned a lot of information and I've been doing this for over 12 years. So it really is also for clinicians that are interested in cancer rehabilitation that work in cancer rehabilitation, but are also experts because they will learn about a lot of things that there are no courses for like pharmacology. There are no courses for pharmacology, right. They're out there right now for to learn from

Speaker 2 (26:39):

It's really for the whole team. Yeah. And so when, so let's

Speaker 1 (26:44):

As a physical therapist I go through, through this chorus, I'm confident, I'm competent. And is it like, okay, thanks. I guess I'm, I'm, I'm good now. I don't need anything else. So what happens after this sort of ed, you have this experience with you guys and you're, you know, relatively confident and competent is, is that where the learning ends?

Speaker 2 (27:12):

No, I, I, I really love that you asked that question actually, because this is what I, this is my soap box. You know, we all, all of our presenters for our course, they all have their soap boxes. They're all specialists about what they think is the most important. That's why our education is awesome. We, you know, we went to the specialist, we said, give us 30 minutes, you know, or, or whatever that you think is the most important part of your specialty that you think all general people should know, and then they bring it in and that's, what's in the core. So you kind of get the best of everything and what the specialist actually think the general therapists really need to know about certain things. But we did recognize absolutely that once you have, this is acumen or you, this information about, you know, cancer rehabilitation and you have got to be able to communicate with others that have the same information that, that are there in the same world.

Speaker 2 (28:02):

Because even though there are going to be a lot of patients that are starting to come in in the future right now, it's a little bit of a small world. It's kind of a, a small world in regards to who is in cancer rehabilitation. And we know this because we go to the conferences and we see the people that come to the different lectures and the presenters. And we know that this is kind of a small world because we see that a lot of the same people over and over again. And, and so the education is really important, obviously for Kristin and I, we have it updated constantly by the presenters. Each one of them is responsible for their segment so that we know if legislation changes, if there's evidence that comes out, something happens where their presentation or their part of our education needs to be updated.

Speaker 2 (28:42):

That's going to happen in pretty, pretty much in real time. But how do we answer our students' questions later? How do we grow their interest or their confidence beyond just an online course and the way that Chris and I have been doing that, as you know, we've worked with clients and we've sort of built this community within our own clients, that they reach out to each other all the time and communicate in that way. They know they've got other people that are doing the same thing, implementing the same types of interventions or screenings or things like education. And so they can connect with each other. And that's great for those clients. But we've really recognized that there is there is a need for a community where people could really discuss their patients, discuss their experiences, discuss their education and grow from there.

Speaker 2 (29:32):

And so that's actually something that we're working on right now really hard. And we, we already, you know, it's rolled out for our clients right now. So it's just a matter of being able to make it more of a public forum where people can, they they've got this, they've had the education. So they kind of were speaking the same language, at least at a bare minimum. And then they can discuss and communicate. And what's nice about it is that we've got all of our partners who have created our course, like Nicole Stout and Mary Lou Valentino. And some of these others who are very reputable, well-known that created part of our course for us. And they're all in there like, heck yeah, we're going to be part of this conversation. We want to be part of this community. And so our vision of course, is that we can have discussion groups and different opportunities where people can get their questions answered about either about the education or applying that application, that education to real life scenarios. How can they get that feedback and that comradery that they're going to need to feel even more confident in this industry. That's why we have, that's why we have great relationships is that they all want to do this. They all know this community is important and it's not a big ask. It's not like, Hey, can you talk to a bunch of therapists that really think this is important? They're I mean, they're, they're all in it. They're all in. So

Speaker 3 (30:51):

Being an Island is, is kind of scary. And like you said, you take that education and then you go back into your clinic or your place. And for people that are working in rural communities, they may be the only person that is taking this education. And we're all really busy people in our work lives and our home lives. And I think one of the hardest things for me as a clinician and a business owner is what do I need to know right now? You know, there's so much research that comes out. And so that's how we also wanted to support with, with workshops. And you know, what is the need to know research that you need to know that's coming out today? You know, you can't afford to fly all over the country and go to all these conferences. Well, guess what, we've tidbit from all the conferences that now that's out there, that's pertinent to you so that you understand what's going on out there in the world without having to do that.

Speaker 3 (31:43):

And so it's you know, it has meant so much to Gillian and I to work with all of the partners that we have. All of the organizations that we work with are so passionate. We've met clinicians that are passionate. I've never met anyone that has not been exposed to cancer in some way, whether it's personally a friend, family, somebody, so everyone is connected by it. Nobody doesn't want to take care of somebody that's going through this. So it's really, how do we all kind of work together to support each other? That if you have questions kind of there in a non-threatening way. Certainly, you know, when Julia and I first met Nicole Stout, we were, you know, at, at, in section meeting and she was standing over there and, and, you know, Julie was like, I'm going to go over there and meet her. I'm like, no, no, it's Nicole Stone. You know? And I was so intimidated by her and because she was a big wig. Well, yeah, but when you meet her, you go, you meet her and you learn that she has the same passion and mission and commitment to people that you do. And, and she's so accepting and welcoming that, that really went away. And I felt like we had to really offer that to everybody else so that they could acknowledge that these people are, are very willing and receptive to helping.

Speaker 1 (32:58):

Yeah. Yeah. She's fabulous. Plus, I mean the shoe collection, I mean, I mean, can we just be envious of her shoe collection? And so, but yeah, she's, she's fabulous and what she does for the, for the physical therapy world oncology in particular. But I think the PT world as a whole is, is huge. As a student, she might, people might be intimidated by, by that. I mean, we were, but I think that that's what we're trying to do is as we're breaking down those, those barriers for our students, and we're saying, Hey, look, you know what your course is awesome as taught by an awesome person. And here's an awesome person that you can ask that question too. Yeah. Yeah. What a wonderful opportunity to give to your students to, to have to have those collaborations and those relationships, which in, in my, in my eyes, relationships are everything they're key. And, and that's the thing for me that keeps pushing this profession forward. As we wrap things up, I'm going to ask each of you. So what would be your big takeaway that you want the listeners to come away with from the talk today?

Speaker 3 (34:09):

I think one of the biggest things that I learned was actually back at CSM. And somebody said that as physical therapists, we are medical coordinators of care and is our ethical responsibility to really be able to take care of everybody that comes into our care. And he said, you know, what, if you're not competent to treat everybody get off the bus because you're bringing our profession down. You know, we have autonomy. Now we can have people coming into our clinics without physician referrals. So we have to know this many, many PTs can order x-rays and things like that. So my take home message is if you want to stay on the bus, get competent and elevate your skillset to everything, not just cancer rehabilitation, but add that as yet another skill in your pocket so that when that patient comes in, you can either treat them or you can triage them. A stroke patient comes into my clinic. I can evaluate them and educate them, but I might triage them somewhere else so that they get more targeted care. So that's, you know, I just want everybody to get on the bus. Yeah.

Speaker 1 (35:20):

Awesome. Jillian. Well I think my takeaway that I would provide it really depends on the audience on who is listening. So if you are a clinician or a therapist like Kristen, it really is

Speaker 2 (35:38):

Your ethical responsibility to take care of every therapy. Every patient that comes through the door, regardless of what their past medical history is you should be able to provide the highest level of care for that patient and as therapists. And we all know you have the heart of a therapist, you want to do the best for your patients. So if you are not confident and competent in taking care of oncology patients, my takeaway to you is get that way. There's a solution for you, educate yourself, feel comfortable, feel confident. You take care of your patients, where you said there's a solution for you. I'm an action girl, but my takeaway for administrators and for leadership teams of your organizations is you really want to know that your team can take care of this population. And when you do something, when you do something and you want to be sure that your team is competent, you put forth these standards and people have to meet these standards.

Speaker 2 (36:31):

And so my, my takeaway for then is that if you do not have something in place that is ensuring that your, your clinicians, that your rehabilitation teams are really competent in taking care of these patients you need to get that way and you need to get that way pretty quick because the regulations and the the requirements that are coming down from the very top levels nationally are requiring that you do that. So it's not just an ethical thing on the clinician side. It really, and, and also this is a new patient population or not, not a new patient population, but this is a patient population that is going to expand. We're going to see a lot more on ecology patients. And so that is an opportunity to reach out to sort of almost a new I don't want to call it a market cause I don't like to call people a market, but it is, it's a new, it's a new market for, for those administrators and most leaders.

Speaker 2 (37:28):

And then the takeaway, of course, if we have patients listening or, or relative caregivers coast survivors is what we call people that are in the lives of, of a person with a diagnosis of cancer. Ask for it. My takeaway is that this is part of your medical care. You should be, if you're not, if you're, if you're on ecologists, your provider is not talking to you about function and what's happening to you during your cancer journey and how that is going to be mitigated or how you're going to have a rehabilitation therapist of support as part of your team. If somebody has not said that to you yet ask for it because it needs to have this bottom up push as well. And it seems so logical when you talk about it. But again, you know, you gotta look, you gotta understand your audience and who are you talking to? What language are you speaking? Yeah.

Speaker 1 (38:16):

Excellent. All right. So before we get to where everyone can find you, I have last question, it's the question I ask everyone. And that is knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad?

Speaker 2 (38:33):

I would tell my younger self or anybody that is kind of starting out in their career and they know they're doing what they love to think big, think big and be brave and just go, just go for it.

Speaker 1 (38:48):

Excellent. Kristen,

Speaker 3 (38:50):

I think that I would tell my younger self to just keep being a sponge, keep learning. Don't be afraid to try new things, you know, when you're starting to get burned out, try something else, which is what I did. I kind of kept jumping around and I found I was passionate about each of those things and just keep learning and keep growing. And eventually you're going to find something that really wows you and really makes you change not only your career, but your, you know, your personal growth as, as well.

Speaker 1 (39:23):

Excellent. Very good advice all around. So now where can people find you? Where can they find the course? What's the name of the course? Give me all the details.

Speaker 2 (39:31):

Great. but you can find [email protected]. That's our website and our courses on our homepage. So they can just click, click on the link, they'll see the education and they'll see some of the other, you know, consulting services and things like that that we also provide. But and certainly there's contact page. They can reach out to us. We're happy to, to have conversation with anybody.

Speaker 1 (39:59):

Perfect. And what about social media? Where can people find you follow you, et cetera?

Speaker 3 (40:03):

We are all over social media. We're on LinkedIn. We're on Twitter, on Instagram and I forgetting what's the other one, Facebook both personally and professionally where we're both on there. So maybe you can find us there.

Speaker 1 (40:17):

What are your handles?

Speaker 3 (40:19):

Our business handle is survivorship solutions for LinkedIn and for Twitter. It's survivorship Sol.

Speaker 1 (40:26):

Perfect. Excellent. And we will have the links to all of this at the show notes for this episode at podcast on healthy, wealthy, smart.com. So if you want to get more information on the course, follow them on social media become if you're a physical therapist out there listening, and you want to become competent and safe to treat patients, cancer patients, which we now know, we all will at some point then definitely check them out. So Kristin and Jillian, thank you so much for coming on. I appreciate your time.

Speaker 2 (41:03):

Thanks so much for having us. It's been our pleasure.

Speaker 3 (41:06):

Thanks, Cara. It's been fun. Thanks so much.

Speaker 1 (41:08):

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

In this episode, Founder of Science PT, Dr. Erik Meira, PT, DPT, talks about his campaign platform as the President-Elect of the American Academy of Sports Physical Therapy, and the many components of this platform.

Today, Erik talks about his roles within the academy over the past 15 years, his formal 5-year strategic plan, creating an executive board separate from the executive committee, and creating a research agenda. What is the overarching vision for the academy?

Who is on the executive committee, and how is the executive board chosen? Erik elaborates on organisational structures and boundaries, and embracing the tenets of Diversity, Equity, and Inclusion, all on today's episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• "If you look at any 1 or 2 year period, it'll look like things are getting done, but when you look over a longer period of time, you'll see a lot of what gets published kind of has a circular nature to it."
• "You have to build the boundaries of your sandbox, and then let the person play in the sandbox."
• "Not every great presenter is a great leader, and not every great leader is a great presenter."
• "Not everybody wants to keep progressing and keep pursuing, and somebody stepping back should not be slighted and that should not be seen as a negative."
• "Somebody turning something down today does not mean that you shouldn't offer it to them tomorrow."
• "Nobody can be you better than you. Remember that. And that goes two ways - remember that the person that you're talking to is also not you. They don't have a brain that works like you, thinks like you, and sees things like you, and they're trying to be the best person that they are as well."
• "We all have different perspectives, and that's okay."

More about Erik Meira

Erik Meira is a consultant physical therapist in Portland, Oregon. He is a Board Certified Sports Clinical Specialist and an NSCA Certified Strength and Conditioning Specialist with extensive experience in the management of sports injuries at many different levels. He also created and oversees the PT Podcast Network.

The son of an engineer and a school teacher, he developed a love of science at a young age often running home experiments comparing/contrasting the effectiveness of products such as detergents and preservatives. Before beginning physical therapy school he studied philosophy and psychology while geeking out on chemistry and physics courses. Although he follows medical science professionally, he is a fan of all fields of science, particularly particle physics and astrophysics.

He began his rehab training at the University of Florida where he had the opportunity to be a student athletic trainer with Gator Football. After finishing his physical therapy degree, he moved on to The George Washington University Hospital in Washington, DC where he overhauled the patient education program and became a physical therapy adviser to the GWU Medical School. After moving to Portland, OR he started his own private practice Elite Physical Therapy & Sports Medicine now called Black Diamond Physical Therapy. He also founded and directed the Northwest Society for Sports Medicine, a group of regional sports medicine providers who provided continuing education, professional support, and community outreach in the Pacific Northwest.

Erik is extremely active in the American Academy of Sports Physical Therapy (AASPT), currently serving as the Representative at Large on the Executive Committee. In 2008 he helped initiate, organize, and then chair the Hip Special Interest Group. From 2012-2019, he was the Sports Section Program Chair for Combined Sections Meeting (CSM) for AASPT. He has authored several articles and textbook chapters, and has lectured at conferences around the world sponsored through the National Strength and Conditioning Association, American Physical Therapy Association, and the National Athletic Trainers' Association, covering topics such as the hip, knee, shoulder, exercise prescription, returning athletes to sport, science application, and ethics in practice. He is a frequent consultant to professional and collegiate sports teams and individual professional athletes.

Suggested Keywords

AACPT, Campaign, Opportunities, Strategy, Learning, Sports, Physiotherapy, Research, PT, Health, Therapy, Architecture, DEI, Diversity, Equity, Inclusion, Problem-Solving,

To learn more, follow Erik at:

Website: https://thesciencept.com

Podcast: https://ptinquest.com

https://ptpodcast.com

Instagram: @erikmeirapt

Twitter: @erikmeira

Subscribe to Healthy, Wealthy & Smart:

Website: https://podcast.healthywealthysmart.com

Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264

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Read the Full Transcript Here:

Speaker 1 (00:01):

Hey, Eric, welcome to the podcast. I am happy to have you on.

Speaker 2 (00:06):

Thank you so much, Karen. It's a, an honor to be here.

Speaker 1 (00:10):

I know it's so nice to see you, even though we're not in person, hopefully one of these one of these years, maybe next year fingers crossed. We'll be able to see each other in person.

Speaker 2 (00:20):

Yep. Fingers crossed for sure. Yeah. I'm looking forward to it. It's I can only do so much zoom. I so much prefer being in person with people to do to do conversations and to do a teaching as well.

Speaker 1 (00:32):

Oh yeah. Teaching is, I mean, what a, it's just a whole different ball game when you're on zoom or whatever platform you're using. So Eric, today, you're on the podcast to talk about your campaign platform. So for people who don't know, Eric is a present elect candidate for the American Academy of sports physical therapy, which is part of the American physical therapy association. Did I get all that right?

Speaker 2 (01:05):

Yes, that's right. We're one of the academies, one of the components of the AP TA.

Speaker 1 (01:09):

Right? So you are here to talk about your campaign platform. So I'm going to hand the mic over to you and I want you to let the listeners know what are the components of your campaign platform?

Speaker 2 (01:24):

Sure. I, I, I really appreciate that. Yeah. So first to clarify, some people have the question, what's the difference between a president and a president elect and for the for the American Academy of sports, physical therapy, the AAS PT our president is elected to serve one term as the president elect. So kind of the president and waiting under the current president for one year, so that the transition is smoother when that happens and then they serve a three-year term after that. And so a little bit of my background is I've, I've been involved in I've been involved with the Academy for, for, you know, well, over a decade, I've been in leadership positions within the Academy continuously for the last 15 years. And so that's everything from just being a member of a, of a committee moving up to, I founded a special interest group.

Speaker 2 (02:17):

I then was the chair of a special interest group moved on to be the, the section programming chair. So I was involved with all of the the academies program at combined sections meeting did that for about six years. And then the last two years I'd been serving on the executive committee as a representative at large. So I have a, I have a huge history with this Academy and a lot of the things that a lot of the changes that have been made over those last 15 years, I've been very involved with and really trying to move things forward. And so one of the reasons I'm running for, for president elect at this point point is to try to kind of complete the mission, so to speak and, and really help set the Academy up for, for the future. We're, we're coming up on 50 years of, of existing as an Academy.

Speaker 2 (03:08):

Or as a component, we used to be a section like most of the other components. And now what I'm looking for is, you know, what's the next 50 years look like, are we set up for, for that future? So the first thing that I'd like to, I actually have five points that I'm highlighting for my campaign. The first one is I would like to create a formal five-year strategic plan that systematically, it gives us something to systematically work towards for our goals over time. And, and so, you know, the Academy has traditionally had strategic planning as a component of what it does, but it has never actually put forward a formal announcement to the members to say in five years, this is where we would like to be as, as a target. And that's something that I think can be really useful for, for a component to have to give a little bit of guidance to.

Speaker 1 (04:05):

And if, if you are elected, how will you go about implementing that?

Speaker 2 (04:10):

Yeah, so a five-year strategic plan. So currently the executive committee does a strategic planning meeting once a year to set basically the agenda for the next year. And so what this would be is actually sitting down and going over where would we want to be in the next five years? And that would be a process of, of actually first, you know, surveying the members, talking to members, trying to get that information of where are we going to go, want to go pitching ideas to the members, to get some feedback from that and then putting it together and setting it forward. And, and again, you'll notice it's a five-year plan. Our terms are only three years. And so that's kind of the point is something that outlives any one executive committee and is something that really is looking to kind of go past that one.

Speaker 2 (04:57):

One of the other points that I'm kind of looking at exploring is creating a separate executive board separate from the executive committee, which is an organizational strategy that a couple of other components have used as well, but it's also very common in associations in general. And so the idea there would be you know, I, I see this in the future as being something that the executive committee would work to create a five-year strategic plan. And then that would be reviewed by an executive board who would then have potentially have voting power to to approve such a plan and, and look at going through implementing the strategy.

Speaker 1 (05:36):

And so can you tell the listeners what, what is made up of the executive committee, who is on that executive committee within the organization, and then how would that executive board be chosen?

Speaker 2 (05:52):

So right now the Academy just has an executive committee and a lot of times within the Academy, they use the term executive board and executive committee interchangeably. And that's not always the case necessarily. So our current executive committee is made up of five elected positions. They are the main elected positions of the Academy. The other elected positions are our nominating committee. And so these are the elected officials. There's five of them and they, they make all, they do all the decision-making for the Academy. And that's, I mean, that's great. You want people who are voted in to be making the decisions you don't want, just, you know, all appointments across the board like that. And so the problem that that sometimes can create is, you know, they get into, they can get into the weeds of dealing with the nuance and the details and all of these things.

Speaker 2 (06:44):

And a lot of times decisions, especially in a large component like ours sometimes they're very nuanced, complex, challenging. They're not easy to kind of educate out on a sound so to speak. And so what an executive board would do first off that would be made up of all of the members of the executive committee would also serve on the board. But then you add additional members that are representative of the rest of the Academy to allow additional conversations that would happen like once a year, for example, of all right, we've been working on a bunch of stuff for the last year. Here's what we're going to bring forward. And again, this would be, this is how it's working towards our five-year plan. This is the, these are the issues. Here's a really tough decision that we're up against that we've had lots of conversations we brought in outside consultants.

Speaker 2 (07:35):

We've, we've had again, conversations after conversations, and now we need to convince the board that this decision is the right decision. And the example here would be well, if that board disagrees, this is where again, these are things that would have to be figured out in designing a board. Would they have the authority to block an executive committee or would it just be, Hey, we're just going to go on down on record that we don't think this is a good idea. And the board, you know, is, is doing this alone. And again, just, just being a little more transparent with that. So those other members, you would want it to, you know, you think of all the different components of a, of an Academy. And, you know, we have, like, we have practice, we have research, we have education within our Academy, we also have early career professionals.

Speaker 2 (08:26):

We also have diversity equity and inclusion as its own part of it. And then we have our SIGs as well. So I could see a representative from, from, you know, all those different committees. So, you know, practice research these could be, the chairs would sit on that and, and there could be a conversation about whether or not those would become elected right now, they're appointed positions and then and DEI and early career professional. So we get all of those voices having a strong voice and then maybe a, an at-large position, which could be a SIG chair, or a couple of SIG chairs could serve in that role there. And, and then, you know, they kind of get that opportunity to be heard, but again, it's still kind of behind closed doors, but it expands that ability to have those conversations out and, and get more advising for an executive committee.

Speaker 1 (09:18):

Got it. And, and because the you've got the, these people on an executive board that are part of these different sections within the Academy, I would then imagine that you can get some more input and feedback from the members. So it sounds like, and you can correct me if I'm wrong. You're trying to allow the members of the Academy have a bigger voice in the decisions made by the, by the executive board.

Speaker 2 (09:43):

Exactly. Cause one of the issues we have is, you know, we have an Academy that's, you know, seven between seven and 8,000 members in any given time during the year, there are definitely fluctuations and all being represented by five people and five people that, you know, yes, they were elected their position and they do know a lot of people within the Academy. They can go talk to those people, but then you have a tendency of just talking to the friends of the executive committee, for example. And so the more, the more kind of diverse voices you can get into the conversation the better. And, and again, if you have an executive board that has a very unified voice, well, that's a very strong position that you would be taking as opposed to a more divisive type position than these would be things that would probably have to have more of a conversation.

Speaker 1 (10:28):

Okay. All right. I like it. Let's move on to, you've got, you said you had a, a couple of things within your plan. So we talked about a five year strategic plan and executive board. What else?

Speaker 2 (10:40):

So the other thing I'd love to see is creating a research agenda and that would be to kind of lay a roadmap for the research needs of our members and explore our ability to drive this research potentially through some Academy funding as well. And so, you know, research and science, that's something that I hold very dear. I it's, it's you know, pretty much everything that I kind of geek out about, you know, in particular. And I hear a lot from, especially our early career researchers, but then other researchers as well, especially the ones that are running smaller labs of of how a lot of times, it's hard to know what is kind of useful information from clinicians or what the true path is to get to what we want to know. And then I hear from the clinicians on the other side, you know, I've been practicing over 20 years and there's a lot of things that I don't feel like we've made much progress much real progress over my career and, and it can get kind of frustrating.

Speaker 2 (11:35):

And, and what I mean by that is if you look at any one, like, like one or two year period, it'll look like things are getting done, but then when you look over a longer period of time, you'll see that a lot of what gets published kind of has a circular nature to it. So they, they're kind of revisiting some of the same questions, not really doing a very thorough job of answering that. And what I mean by that is a lot of times, you know, a group will have, it's like, look, we only have one study that we can do. We're going to try to answer as many questions with this one study as we can. And what ends up happening is it's so diluted that they don't really answer any question really thoroughly for the future. And again, this is looking for where are we going to be 20 years from now with this information?

Speaker 2 (12:20):

I understand that small steps are frustratingly slow, but that's where we actually make a difference long-term. And so creating a research agenda would basically take clinicians X are some of our researchers. And then ideally also methodologist that they're, they're what we call meta scientists. So people who study this study the science of studying information. And so making sure studies are designed appropriately making sure that replication is being set up, making sure that a study isn't biting off more than it can chew. And so in a research agenda can lay out here are the next five steps that we need to see to go towards what we're trying to get done. And then researchers can look at that. It can be published publicly, and they can look at that and say, Oh, I can actually step in right here. And the thinking here is if you have a large Academy kind of endorsing that these are studies we'd like to see done, that should increase the value again from the publishing side where journals would look at it and say, Oh, well, you know, this is a study that was very well executed.

Speaker 2 (13:24):

That answers the question specifically that was asked by an Academy. This is going to be cited in future studies. This is something we'd want to publish. So kind of putting those incentives kind of on both ends of it.

Speaker 1 (13:36):

Got it. So kind of using the Academy as maybe a jumping off point for ideas for future studies, given the input from the members and what they're seeing clinically and what they would like to see, continue on in the research.

Speaker 2 (13:49):

Yeah, exactly. And so part of that too, is, you know as a clinician, you might say, you know what, I would just love to have an answer to this right here. And it may seem really simple to the clinician of, I don't see why that's a hard thing to answer. And that's where the research community can go, come in and say, all right, well, if you want to answer that, you actually have to start with this very simple question way over here that you're not even thinking about. And so we're going to start there and lay the path so that clinicians can also see where are we on this path to see what do we know and how does this actually develop over time? And I think that that's a huge value both for, for the practitioner and for the researcher,

Speaker 1 (14:27):

Right? And, and on the research side. So obviously the clinician side. Great. Cause we're getting some of what we're seeing every day put into the research from the researchers side. It's Hey this is what we're seeing. You get an endorsement from the from the Academy and maybe it will maybe it will allow you to have a greater chance of being published. I don't know. That's not that I'm not phrasing that in the best way. You could probably phrase it better.

Speaker 2 (15:01):

Put it is, I would say that it makes their research more translational. So it's showing that. And, and so, and I think this is something that researchers sometimes struggle with where they're, they're trying to kind of dress up the clinical application side of things to make it more clinically applicable. So it gets that, that, that, that translation, but by doing that, it actually kind of dilutes their, the quality of the study, so to speak because there's certain looking at too many things. And so by getting that opportunity for the research community to say, Hey, it may not look clinically relevant yet, but it's going to be. And so then they're part of that clinical relevance as a package. So instead of one study trying to answer everything, you would have a suite of studies that actually lays your foundation for, for gives you a good foundation for knowledge.

Speaker 2 (15:57):

And, and I'd like to stress. I mean, there are plenty of, of research labs in our profession that are doing this themselves and doing a phenomenal job of that. And this wouldn't necessarily be for them. It's just, we have a lot of questions to answer. And there's a lot of, of again, some of these smaller labs and early career researchers that are looking to jump in and, and, and even some, you know, research clinicians who are like, Oh, I can, I can do a 10 person study that answers this one little, very finely asked question. If it's laid out for me, I can then take that and run with it, or simply just do a replication of it.

Speaker 1 (16:36):

And how does this look practically running through the Academy? How does this happen

Speaker 2 (16:44):

Here would be, you know, somebody would bring it forward an idea, for example, and there would be, you know, we do have a research committee they would start organizing around a couple of research questions and right off the bat. And, you know, I posted this on my blog this idea around a research agenda and I did get some people actually contacted me through my contact form saying, Hey, this sounds really awesome. Are you thinking about, you know, a return to play after ACL? It's like, well, sure. Are you thinking about Achilles repairs? Sure. Again, it's we lay out the agenda and the idea here would be that they would also be living, breathing documents, so to speak that would be revisited every year or every two years. And Hey, where are we? The idea, you know, you lay it all out and then as things get done, you know, you things get checked off the list, so to speak it just gives us a way to have kind of a repository for, for thoroughness that I think is often beyond the scope of a, of a large lab.

Speaker 2 (17:42):

And this is where, you know, even large labs can step in and say, wow, there's a ton of basic science work that got done by lots of little entities. Now we're going to swoop in and we're going to collect 500 subjects and we're going to now do an effectiveness study based off of all of the solid foundation that was laid out for us. So we didn't have to do year after year of sequential studies. We have a base of studies that we can now just move forward.

Speaker 1 (18:11):

Got it, got it. So you're looking at this from the Academy standpoint as being a repository of ideas that early career researchers, clinician researchers, smaller labs can go in and say, Hmm, I think I can, I think I can handle this. I'm going to pull this out and I'm going to see what I can do. I'm going to try and create a study.

Speaker 2 (18:30):

Exactly. And this is also one of, some of our really, you know, big, big names. So to speak. Researchers can look down and go, no, no, no, no, no. That's, that's not how you design that study for something I can use. I would need you to also do this here. And then our research committee and our methodologists might even kick back to them and say, Oh, I understand that what you're actually doing is adding another study in between not necessarily trying to do too much with one study. And so again, this is where it's creating a sounding board that all these people can have these conversations.

Speaker 1 (19:01):

Got it. Okay. All right. I think I understand it now. Thank you. Sorry for asking so many questions.

Speaker 2 (19:07):

No, no, of course. And then ultimately, you know, the name of the game is almost always funding. So if, if we can then set up some, some grants, for example, to say, you know, we want to, we have money set aside to pay for this next step. And then, you know, people can pitch the ideas to us. We can do like a register report process where we would review the study before it was even starting to collect data to say, Oh, this looks beautiful. We're going to, we're going to give you money to complete this.

Speaker 1 (19:35):

Got it. All right. Sounds like a plan. Okay. So what else is on your platform?

Speaker 2 (19:42):

So another thing I'd like to see is creating more structure to our organization. So something that, you know, as I mentioned, we just had the four, you know, executive committee members, and then we've had other we've had committees over the years, as I've said, I've served on a lot of those. But a lot of times what ends up happening is that everything ends up having to go through the executive committee for final approval for every single step. And, and I understand the need for that. I mean, these are the elected officials, these are the ones making the decisions, but when you get to a Academy, as large as ours, it kind of can start to smack a little bit of micromanagement and making it that if you've ever been in a, in an environment where you're feeling micromanaged, it really feels like your hands are tied, your creativity is stifled and you can't really give to the, to the institution if you're in that situation like that.

Speaker 2 (20:33):

And so the way that that gets solved is actually to have better defined roles that people are stepping into. So our, we have a new membership engagement director, Jamie little, who's just absolutely phenomenal. And he's been with us for the last year. And one of the things that he likes to point out is you have to create, you have to build the boundaries of your sandbox and then let the person play in the sandbox. But you, you give them a lane to be in so that they feel confident in what they're doing and feel supported in what they're doing, not just giving them like a very vague instruction and then say, then come back to me and show me what you got. And then I'm going to change everything anyway, but really empower them to say, Hey, here's, here's the goal.

Speaker 2 (21:23):

Here's generally what, you know, what your role is to say, like the chair of the practice committee or the chair of the education committee. And, you know, let's see what you can do. And you know, as long as it's not too far out in left field, we're going to support, support that all the way through. And so since I've been on the executive committee, we've expanded the leadership opportunities for our SIG members. So SIGs used to just have a chair in a, in a vice chair, and now they also have a practice lead and education league, a membership league, and a communication lead, all opportunities for people to step in and take leadership roles and allows us to to let people demonstrate what they can do in the Academy. And I mean, the beauty of it is I, these people, when they step into these roles, I don't know who half of them are. I've never heard of them. And I think that is awesome. That's not me trying to think of somebody to fill this role. That's somebody who stepped up and said, I want to do this role. And of course, some of them are not going to do very well, but a lot of them are really going to demonstrate who they are and what they can do. And it's an opportunity to to let our members really kind of, kind of contribute to the Academy.

Speaker 1 (22:35):

Yeah. And it also sounds like you're developing a bit of like a leadership development pipeline.

Speaker 2 (22:40):

That's exactly right. Yeah. And that's where, you know, and that, that gets to the final. One of my points is and embracing the tenants of diversity, equity and inclusion, and make sure that that applies to all of our members and our future members. And that's going to ultimately make our Academy a better overall. And again, this is the thing that, you know, people get, they get hung up on. And again, diversity equity inclusion typically noted as DEI is kind of the popular initialism that's used now. People get hung up on, Oh, well, that's referring to minorities. Oh, that's referring to gender. It's like that also refers to early young professionals, older professionals people who otherwise don't, you know, quote unquote fit into the to the, the, the club, the cliques, so to speak. And we just want to make sure that we're embracing of all the different voices that are within our Academy and make sure that they, they feel they feel represented and they feel seen.

Speaker 2 (23:45):

And so, you know, you mentioned leadership development. That's definitely one part of it. And a lot of components, a lot of times leadership and, and presentation. So like getting up at a conference and speaking a lot of times they're kind of shoved together as the same thing and not every great presenter is a great leader and not every great leader is a great presenter. So we don't want to fault people for being really strong on one, but not so great on the other. And so we want to create two opportunities for the, the face of our Academy, which is our leadership and our presenters to develop as, as again, as leaders. And then as people who are getting into more of the education side.

Speaker 1 (24:29):

Right. And like you said, they don't have to be the same person that's right. So you can speak on behalf of the Academy, let's say it's at CSM, or maybe even an international conference, something like that as, as a representative. But it doesn't mean that you're the president of the Academy, nor does it mean because you're on the executive board, you get to speak at these different places. It has to be something that is earned, not just given for the position that you're in.

Speaker 2 (24:59):

Yeah. And so that's, that's another definition of diversity is playing to your strengths. So not trying to make one person do everything, but try to find the best person for that job regardless of who they are. And it may be that they're really good at one thing, and they're not so great at other things, instead of trying to shoe horn them into things that, that they're not gonna Excel at, let them really shine where they, where they can shine. And, and again, you know, we're an Academy between seven and 8,000 members. We don't need to have one person doing everything. It's really an opportunity that lots of people can step up and fill different roles. And, and I think that's just, it's just great for all of us.

Speaker 1 (25:37):

Absolutely. And it also makes people feel like they're wanted. Yes. Yeah. And that's important because there's nothing worse than not feeling wanted.

Speaker 2 (25:47):

The other thing too is, you know, I'm a, I'm a big data guy, big analytics guy. And so one of the things that we used DEI in particular for, and this was a little over a year ago when we put together a task force to look at it. And that, that was the mission of the task force was to see what do our demographics, how do our demographics break down along gender and along race race identity. And the simple thing is you can just look at those numbers of the membership and then how do our leaders break down by gender and by racial identity. And then how do our presenters break down in the same way? And so in some respects, we had very, very good matches you know, specifically CSM presenters were pretty well representative specifically in gender, not quite so much when it came to race.

Speaker 2 (26:50):

So we're able to say gender is pretty well addressed from the CSM side. Now that doesn't mean there's, there's not future issues or not some issues still to be solved, but it looked much better for example. But then when we looked at leadership and we looked at some of our other, other events, we had some bigger issues around that specifically. And so, you know, a lot of people will say, Oh, so, you know, are you saying that you know, some of your leaders are racist or massage? Monistic, it's like, no, that's not how this works. What it means is that there's something at play here that is restricting equity and inclusion because of all things being equal, it should balance itself out in that way. And, and, and again, looking at the way CSM programming was selected it was intentionally set up to try to increase the number of submissions in and then trying to go strictly based off of the merit of the submissions and the quality of the speakers and not trying to read into it anymore.

Speaker 2 (27:52):

And it kind of organically started to sort itself out. And so this is where, you know, when we look from leadership, well, if you have an Academy of 7,000 plus people, and you only have five elected positions, a couple of nominating committee, a couple SIG chairs, there's just not a lot of opportunity for people to step up and have a path to leadership. And so that's why we expanded the leadership opportunities within our SIGs. Again, a little more low risks low stakes opportunities for people to step in demonstrate their, their abilities. And then if they want to pursue further, they have an opportunity. And that's the other thing to remember is not everybody wants to keep progressing and keep pursuing. And somebody stepping back and saying, I don't want to do that, is that should not be slighted. And that should not be seen as a negative either.

Speaker 1 (28:40):

You, I was just going to say that, darn it. I was just going to say, then that person can make the decision if they want to continue further, is this for them? Is it not? But it at least gives people the opportunity to make that decision for themselves.

Speaker 2 (28:57):

Yeah. And not only that, when, when talking from a leadership perspective, what leaders have to understand is that somebody turning something down today does not mean that you shouldn't offer it to them tomorrow. And so you may offer somebody an opportunity. They'll say, you know what? I just don't have time for that right now, I'm going to have to pass. And, you know, a lot of times people are advised, you know, never say no, because you never know what it's going to lead to. It's like, okay, well then it's, you're just encouraging people to take on way more than they should be doing. And then you end up with a handful of people doing everything. And so a good, a good developing leader is someone who recognizes, you know, I'm not in a good spot right now to take that on, to do it justice.

Speaker 2 (29:37):

So I'm going to pass for now. But then when another opportunity comes around, you know, bring it back to them and, and keep, keep asking. That's cause a lot of times, you know, especially when we talk you know, women in the workforce in particular, a lot of times they may be, you know, stepping back a little bit with you know, child-rearing and things like that. Which, which honestly, I don't understand why men wouldn't be doing the same thing, but this is where they may not want to be engaged in that way for a year or two, but then they need the opportunity to step back into it. It's not a matter of, Oh, well they just say no to stuff. So we don't ask them anymore. That's not really fair to people.

Speaker 1 (30:17):

No. And that's, I think it's so important is to remember that you have to ask because a lot of people feel like maybe they're not smart enough. They don't know enough people, but boy, they really want to try and get involved, but no one really asked them. Yep. So if you don't ask someone, you may be missing out on some great opportunities that that person can bring to the table. Great ideas. So I'm a huge fan of just asking and then if they say no, then you circle back and you ask again, and if they say, no, you keep circling back and circling back. That's what I did as part of the nominating committee for the private practice section. It was just a lot of circling back, a lot of conversations and sometimes long conversations, you know, because it's not like if someone says, Oh, no, I don't want to. I'm always like, okay, tell me why. Tell me, you know, tell me more, tell me what the barriers are now and what might that look like in a year or two, just so that we have, you know, a good also repository of people who we know want to serve this Academy or the section or component or whatever you want to call them.

Speaker 2 (31:34):

Yeah. And that's where and I like how you, how you put that at the asking the question of, okay, well, you know, can you explain why not now, again, assuming it's not a personal issue. And they may say, you know, I'm, I'm just not really good with this one part of that job. And it might be, Oh, we can get somebody else to do that. You know, that that's not a problem. As a matter of fact, there's another opportunity for another person to step up into a role. And so, you know, hearing them out from that perspective. I remember when I took over as programming chair for CSM, we greatly expanded, you know, we went from, I think it was eight or nine sessions that we offered at CSM. And then I took over and it was like 36. So it was like full, you know, big explosion.

Speaker 2 (32:19):

And it was more, a matter of APA had always offered us that, those number of slots and we just turned them down. We just wanted to do one every, every block and not program against ourselves. And I was like, Hey, if they're going to get us a spot, I'm going to throw people up there. And it was difficult the first year because we didn't have enough submissions to support that, but I wanted to set the precedent. No, no, no, we are going to do this. And so I then had to get on the phone and walk around at conferences and say, Hey, can you submit something on this, this or that? Or why aren't you submitting something on this, this and that. And the most common answer I got back was, Oh, I didn't, I didn't know that, that anybody wanted me to submit something like that. I didn't know that you guys were interested in that. It's like, no, yes, we are definitely interested in that and pleased and trying to lay things out. And then of course stressing that. There's a difference between me asking and me accepting, you know, a lot of times it's just, Hey, give me some missions so that we have something to work with here. And we don't have to accept, you know, necessarily the same speakers over and over, but because of that opportunity to do that.

Speaker 1 (33:24):

Yeah. Amazing. And now, Eric, what would you say when looking at this platform? So we have five-year strategic plan, creating research agendas, expanding organizational structure, creating an executive board and embracing the, and progressing the tenants of DEI. What is sort of the over arching vision in your mind for the Academy?

Speaker 2 (33:49):

So what I'm trying to do is really set things up for and the term that I've been using since I came on as, as representative at large, as well as my big thing is, is architecture. So I'm trying to set up kind of a scaffolding for our members to inhabit and to, and that is set up in such a way that the Academy can move forward into the future with the ability to be adaptable as things are changing, but also to be strong at the same time. And, and that's something that I think having things laid out, you know, I mentioned five-year strategic plan. That's where I would start. And then I would love to see, you know, a 10 what's the 10 year strategic plan. What's the 20 year strategic plan. I mean, that was something that, you know, we just passed a 2020 which, which turned out to be a different year than I think we were anticipating.

Speaker 2 (34:38):

But back in 2000, that was vision 2020. That was the APA made a strategic plan of where we want to be in 20 years. And I think people forget how important strategic planning is. You know, there's a lot of decisions that happen in the course of a year within any organization. And a lot of times there could be three or four perfectly acceptable, you know, courses that could be taken you know, decision courses that can be taken on one of those, you know, big decisions that need to be made, but one of them may support the strategic plan down the road better so that when you're making that next decision, it's going to build off of the previous one, as opposed to just solving the problem that's in front of you. And so making sure again, kind of like that research agenda, making sure that what you're doing today is something that can be built upon tomorrow.

Speaker 2 (35:33):

We're never finished. It's never the end. It's never, we've just solved it. It's how does this set us up for the next thing that we're going to be doing, you know, down the line and, and intentionally laying that out. And, and so some people will ask, well, w w so, so how locked in is this five-year plan? It's like, no, it's, it can be amended as we go. I mean, that's, that's kind of the whole point of it. It's just that we have some sort of a vision going forward with that. And so again, it's more trying to set things up, not for me, not even for the, our, our younger members, but for the members that haven't even joined yet that they have a path through their career, through our Academy, that our Academy supports them every step of that way. And they feel like they're involved as they go through.

Speaker 1 (36:22):

Yeah. And if 2020 taught us anything, it's that amendments are probably needed on any five-year plan. So if it's locked in, it's locked in and it can't be changed, then we're all in a lot of trouble.

Speaker 2 (36:33):

Exactly. Right. Yeah. Everything has to be flexible.

Speaker 1 (36:36):

Yeah. Everything needs some fluidity to it these days. That's for sure. Well, Eric what, what are the things that you want the listeners to take away from this and to think about the possibilities of you being president of the Academy?

Speaker 2 (36:53):

Well, what I would say is you know, I was elected as a representative at large a couple of years ago because I'm, I'm a regular old member. I don't have a PhD. I'm not a, you know, I have not taught in a S you know, as a school or anything like that. Not academic, not a researcher. I owned a private practice for almost 20 years. Just sold it. I work with patients day in and day out. I'm not, again, I'm not conducting research, I'm not doing these things. I do continuing education. I talk to a lot of physical therapists. I do a lot of mentoring across across the country and across the world with other sports physical therapists. I know this world inside and out, and what I'm trying to do is bring forward an entity that supports that.

Speaker 2 (37:50):

Ultimately, it's not that it supports the researchers. It does support the researchers, but that's not the mission. It's not supporting the clinicians either. It does support the clinicians, but that's not the mission it's to support our patients, to make sure that they get the best service possible by supporting our researchers and our clinicians and doing it in such a way that it's integrated in such a way that makes our members feel like they are getting a back and forth conversation with the Academy, which is made up of all the other members. So it's everybody talking across each other. Everybody communicate communicating everybody working together towards some common goals, trying to make their careers, what they want it to be setting it up so they can hand it off to the next generation to make it what they want to be as well.

Speaker 1 (38:40):

Excellent. Sounds wonderful. And now it does, it sounds great. Now, Eric, where can people find you if they have questions or comments or they just want to say hello?

Speaker 2 (38:52):

So probably the easiest way is well, the, the, the most comprehensive one is just going to the website that I run, which is called the science, pt.com, all one word, the science PT, make sure you put the at the beginning. And that's got links to my Twitter account. My, I have an Instagram account although I'm terrible at it. If you want to see an old man hitting something with a rock, that's pretty much what I do on Instagram. But definitely available for the most part on, on Twitter. But there is also a contact form on my website that if you have any questions, you can click on that, right on the homepage. There's a, a button that's, that's a link to my campaign page. And so you can go there and, and everything that we've talked about, I have a blog post and individual blog posts for each point that I highlighted going into more detail.

Speaker 2 (39:41):

And also as I, you know pointed out in this conversation, there are things I don't have answers for. I'm just talking about where I'm thinking of pointing things and then getting information and seeing is this something we can work towards, and maybe it's something we need to revise or change and do differently. But these are just my thinking from what I've seen from all my years of service, things that I think are very doable, very possible within our current means within our current support, within our current structure to really set us up, to grow into the future. And so just that website probably is, is the the most comprehensive spot.

Speaker 1 (40:18):

Perfect. And then before we go, last question, which I didn't tell you about, I probably should have done that. I think you'll be fine. I think you can handle it. So knowing where you are now in your life and your career, what advice would you give yourself as the new grad as that, you know, young, young, professional,

Speaker 2 (40:37):

You know being flexible, being adaptable is, is always the biggest thing be patient for probably the best lesson that I've learned is that nobody can be you better than you. And remember that. And that's, that goes two ways. Remember that the person you're talking to is also not you, they don't have a brain that works like you and thinks like you and sees things like you, and they're trying to be the best person that they are as well. And so the more that we can support each other to both be better at all times, I think is huge. And I think that's something that you can carry in with your patients when you're working with them of being compassionate, to understand that, you know, it might be easy for you to get up every morning and do a 30 minute run, but that might be like torture to the person you're talking to. And it's not their fault. They're not lazy, they're not wired wrong or whatever. It's just the way they, and we have to be supportive of, of that. But then that's also with our colleagues when we're trying to have conversations around things as well, to, to understand that you know, we all have different perspectives and, and that's okay.

Speaker 1 (41:47):

Absolutely. And what wonderful advice. So Eric, thank you so much for coming on and sharing your platform. I'm sure myself and the listeners really appreciate it. So thank you

Speaker 2 (41:58):

So much for having me. I really appreciate it. You're doing a great job with all of this.

Speaker 1 (42:02):

Aw, well, thank you. That's very kind and everyone, thank you so much for listening for tuning in, have a great couple of days and stay healthy, wealthy and smart.

In this episode, Co-Owner of Champion Physical Therapy and Performance, Dr. Mike Reinold, PT, DPT, talks about his platform in the running for President-Elect of the AASPT.

Today, Mike talks about the 'why' behind his campaign, what he's going to focus on as president, and how to make the academy more accessible and inclusive.

What is Mike's vision for the academy? Hear his thoughts on adding value to the academy members, his plans to provide networking and mentorship opportunities, and his advice for his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• "I'm going to judge my success of leading the academy, if in the end of my term, you clearly asked the members 'why are you a member of the AASPT?' And they have a very clear and distinct answer."
• "The most important thing we need to do right now is to re-brainstorm the mission and the vision of the academy to make sure that we're doing one thing: we're focused on the goals and objectives of the members."
• "I'm pretty certain at this point that everything I've accomplished in my career is because I specialised. You need to start general, but if there's something you're passionate about, every second of down time you have, learn how to be the best at that. Just be absolutely amazing at something."

More about Mike Reinold

Mike Reinold, PT, DPT, SCS, ATC, CSCS, C-PS is a world renowned and award-winning clinician, researcher, and educator. As a physical therapist, athletic training, and strength and conditioning coach, he specializes in all aspects of sports performance and rehabilitation. Mike is currently the Co-Founder of Champion PT and Performance, in Boston, MA, and Senior Medical Advisor for the Chicago White Sox after years of working at prestigious institutions like the American Sports Medicine Institute, Massachusetts General Hospital, and as Head Athletic Trainer and Physical Therapist for the Boston Red Sox. He has authored dozens of publications, lectured at national conferences, and has an educational website and podcast at MikeReinold.com.

Suggested Keywords

AASPT, Physiotherapy, Research, PT, Health, Therapy, Healthcare, Education, Mentoring, Training, Networking, Sport, Athletics, Election,

To learn more, follow Mike at:

Website: https://mikereinold.com

Facebook: Mike Reinold

Instagram: @mikereinold

Twitter: @mikereinold

YouTube: Mike Reinold

LinkedIn: Mike Reinold

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Read the Full Transcript:

Speaker 1 (00:01):

Hey, Mike, welcome to the podcast. Happy to have you on.

Speaker 2 (00:04):

Hey, Karen, how's it going? Thanks again for for having me on your amazing podcast. I F I F I, I remember being on in the past

Speaker 1 (00:13):

So long ago. Yes. It has been a long time, but here we are. We're back.

Speaker 2 (00:18):

That's what happens when we, when we're, we're both veterans we'll, we'll call it. We're both veterans. We, we, we did this in the past, but, but yeah, no, honestly, like big kudos to you for keeping this going and doing such an amazing job with it. Thanks for having

Speaker 1 (00:31):

Any time. And we'll talk about your podcast a little later, but now, you know what it's like to be cranking out episodes on a weekly basis, right.

Speaker 2 (00:39):

And staying up with it, right. It's like, it's a way of life now for us.

Speaker 1 (00:43):

It is, it is. That's why there's like a hashtag podcast life, I think on Instagram or something. It's, it's a thing. It's a thing. So today you're here because you are running for the president elect position for the American Academy of sports, physical therapy. So I wanted to have you on to talk about why you're running and what your platform is and what you hope to do if elected. So let's start with, what is the why behind your running.

Speaker 2 (01:13):

And I love that. That's how you started this off, because that's how I start everything off. Right. If we don't establish our why, right. Like what's the point of even coming out. But a lot of people, they, they, they don't focus on the end. Right. They focus on just doing the day to day. So I love that you started off with a Y so I'll, I'll be honest with you. This is something I've been thinking about probably for the last, I don't know, several years or so. I never felt that it was the right time for me. I've had a lot of my mentors pushing me to, to run in the past and the past elections. And yeah, I mean, trust me, it's really humbling to know that the majority of past presidents of the Academy are all pushing me to run and, and kind of, you know, it's really an honor to be nominated by them, right.

Speaker 2 (02:03):

Like, you know, Mike boy, Kevin Willett, George Davies, Tim Tyler. I mean, it's Melissa gigantic of past presidents that were kind of nudging me to do it, but I was resistant for awhile. And I think that was a good thing because at that point in my career, I don't think I was ready. And I don't think I would've, I would've done the Academy justice for what it needed. Right. So I was kind of resistant for awhile. You know, I, I started a private practice. I have like four jobs, right? Like we all do, right. Like to an extent, you know, I'm flying, you know, to, to work with the white Sox. I, you know, private practice doing all these things with the educational stuff. So for me, it was always like, it wasn't the right time, but things have changed a little bit.

Speaker 2 (02:44):

And I humbly say this now. And I, I really came to this conclusion the last couple of years of my career. I, I really believe I'm on the descent. Right. And don't you think at some point in time, it's, it's all it's about, okay. I am now on the decent portion of my career and I've completely changed my focus on trying to help others succeed. And I can't wait to see the people that I work with surpassing me. Right. Leapfrog me just like we did, like when we were 20 years ago in our career. Right. And that, that kind of point. So I got, so my why right now is that I am completely shifted towards more of a leader right. In a leadership type position with my career. So both educational, both with my, my companies and with the organizations I worked for that, I thought it was a great time to do this so awesome that I've been getting nudged by, you know, such, such amazing people, but I didn't feel it was right until, until now. And I think now I have the time I have the energy, I have a little bit of the head space to now be able to, to focus on this and it's time to give back and it's time to help the next generation. So that's my why.

Speaker 1 (03:56):

Yeah. And that's, I think it's really important for anyone listening. If you are thinking about being of service, whether that be to something, to a section or whatever you want to call them Academy of the AP TA that, you know, you have the head space and the time. Right. Because you just don't want to be saying, yeah, sure, sure. I'll do this. I'll do that. And then guess what, what happens if you get elected and you don't have this space, you don't have the time. Well, that's just not the way to, to enter into, be of service to others. And like you said, you're at that point in your career, at least it sounds like what I got from what you said, that you really want to be of service to others, that you've kind of, you're, you're content, you're happy within your career and probably the time of your life and everything else that you can now do this for others.

Speaker 2 (04:48):

Right. And, and I'm, I'm very eager. Right. I had a lot of good mentors in my career that helped open doors for me, but don't get me wrong. Like we need to be the one stepping through those doors. You have to have the energy and the effort to do that. Right. But for me, it's about opening doors for others. Right. And I saw how much the Academy helped me early in my career, and I really kind of want to do that. Right. And you know, it's funny, Mike Delaney and I were just talking about those. So Mike's running for vice-president right now as well. So I'm myself for president him for vice-president. And we are so similar with our, our beliefs and everything that we have, that we were like, let's team up to try to, to do this. So that way we can really give back and help.

Speaker 2 (05:29):

And we both said this. We said, if, if we don't get elected at this point in time, we actually think that our time, our window will pass. Right. At that point in time, we'll probably be in our fifties. Right. And I am not sure that we would be the right people to lead the Academy at that time, because we want to still be relevant. We still have students. We still work with like clinicians and educate all, all around the country, the world, right. Where we still are in touch with them. I'm not sure if I would be the right leader six years from now or seven years from now, it was probably one of the next election. We would be open if I would be the right leader for that. I, I, I'm not sure. Maybe I would be more out of touch. So Mike and I both said, I think this is our window. If we're going to do it, it's probably now or never.

Speaker 1 (06:14):

Okay. So let's talk about your platform. What do you hope to accomplish as, as president, what are things that you really want to focus on?

Speaker 2 (06:24):

So I, again, I love, I love how you start with the why, and then, and then you talk about, you know, what you want to accomplish. I love that because to me, it's not, it's not about coming up with like a list of things I want to do. What I want to do is I want to flash forward six years or whatever it may be. Right. I hopefully would get reelected if I get elected the first time. Right? So we'll say three years to be conservative maybe, but flash forward. And what I want, what I want to know is I'm going to judge my success of leading the Academy. If in the end of my term, you clearly asked the members, why are you a member of the American Academy of sports, physical therapy? And they have a very clear and distinct answer, right?

Speaker 2 (07:10):

That to me is going to define my success. Because right now, the number one thing I'm hearing from people, both veterans in this field, people in the middle of their career, early career professionals, students, they, they ask, why should I join the Academy? They don't know what they get out of it. Right? And it's, it's one thing to just be a part of a group. But the question always is, what's the value? What am I going to get out of that? So that's how I'm going to judge our success as an executive committee at the end of this, is, is it very clear that we achieve the objective that you know, why? And I think the most important thing we need to do right now is I think we need to rebrand storm the mission and the vision of the Academy to make sure that we're doing one thing we're focused on the goals and objectives of the members.

Speaker 2 (08:00):

It's not about me, right? It's not about my ideas, my initiatives, what I want to get. It's not about me or my legacy to me, it's about what the members get out of it. And I think it's actually pretty simple. I, I looked on the website, I'm just trying to like dig out like the mission statement. Right. And it's very like corporate, right? Very like, like very about like, you know, advocacy and like, you know, making, you know, sports, physical therapy like prominent, right? I actually want to see the mission statement changed the simply the American Academy of sports, physical therapies here to help you specialize in sports, physical therapy, right? You are going to become a specialist now because we're not learning stuff like this in school, we shouldn't be learning stuff like this at school. It was very hard to be, to graduate as a new grad and be a very well-rounded proficient physical therapist.

Speaker 2 (08:44):

Right. But if you want to specialize, if you want the best education to learn everything you need about to become a sports physical therapist, if you want to stay cutting edge, right. If you want opportunities and networking, to be able to become part of this group. And more importantly, if you want mentorship with some of the best people out there, that is why you joined the Academy. And I know right now, a lot of people say that all the time is I'm not sure what the benefit of my membership is, and that's why people drop off. And that's why people don't renew is they're not getting enough out of the Academy. So that's what, that's what I want to achieve. And that's how I am going to grade our executive committee. If, if we do get elected is at the end of this, if it's very clear, have we achieved our mission, that the members know that our whole goal is to help them specialize in sports and to get a job in sports. Right. I think that's what people want in sports. That's a big, big things is an advanced orthopedics. This is sports it's different, right? So that that's, that's kinda, that's kind of what, what we hope to accomplish.

Speaker 1 (09:47):

And how, how would you go about doing that? What changes do you think need to happen to number one, help more people join the section? Cause I know it, it is hard, you know, I'm part of, I'm part of the sports section I joined a couple of years ago. I let my orthopedic one last. So I left the orthopedic and I joined sports. And I'm also involved in the private practice section. And I know it's something that we're always trying to think about in the private practice section is how can we get more people to join? What are we missing here? You know, how can we be more inclusive? So how can the sports section be more inclusive to get those people in, to get them from what it sounds like you're saying, mentorship, education, jobs and just fulfillment within your career. It sounds like

Speaker 2 (10:40):

Here, and this is what I think it is. The past leadership has been amazing. Right? And the stuff that even the current board has done in this last few years is really evolved, right? So there's tarnished take the next step with technology and all these other things. They're doing a really good job with that sort of thing. To me though, I, I really think we need to refresh just the vision a little bit. And I want to reevaluate all of our decisions in all of the things we provide. And just answer that simple question. Does this help you become either become or become a better sports physical therapist. Right. And I think, I think we need to take a step back. Sometimes it's not about what we think is cool or what we think is a list of objectives. It's about how do the memberships actually get value out of the Academy.

Speaker 2 (11:26):

And I think that's, that's the biggest thing we're going to do. So that's a little bit of the vision, but we're going to reevaluate everything, right. There's, you know, one of the big ones is education, right? One of the big ones education and staying current with, with research, right. So recently just in the last year or so the Academy got rid of one of the free benefits of being a member was access to the international journal of sports, physical therapy. And I think that was one of the biggest reasons why a lot of people were members, right. They got, they get access to a free, very well like established journal. Right. So they took that away from the membership a little bit. And again, I just wonder why, I mean, if the reason you join is to, to learn and stay current about being a sport, physical therapist, I don't want to take away benefits.

Speaker 2 (12:11):

Right? Like there's, there's gotta be a way we do that. Right. so I, I, you know, there's, there's, there's a ton of different avenues, right? Like you said, it's hard to go over this and just like a quick like kind of podcast, but I think it's about like networking opportunities. Cause it's all about who, you know, in this world. Right. But for me, it's about education and mentorship, right? We have some amazing clinicians that are part of this Academy that we need to learn from and that we need to go work with. Right. So we have residencies, we have fellowships. Those are great well-established things. Those are large, those are daunting, right? Like, like that's a big commitment, both time and finance for you to go do one of those things. We need to have more accessible opportunities, either online or shorter term, those types of things.

Speaker 2 (12:56):

I think we need to leverage, remember sports, physical therapy. That's where my background comes in. That's all I've done. My whole career is work with pro athletes and stuff. Right. Is how do you get a job in pro sports? How do you get a job in the MLB or the NBA or the NFL? Right. We need to leverage our, our connections. Like I'm friends with people in all these leagues, the PTs and all these leagues. And I've reached out to all of them. And I said, we need to start collaborating more. What if we have joint education sessions? What if we have mentorship opportunities where you come to spring training with me for eight weeks. Right. And who do you think is going to get a job when a physical therapy job opens up now in major league baseball, somebody that's just off the street with a good resume or somebody that's actually done a mentorship program with somebody already established.

Speaker 2 (13:40):

So that's part of the things that I think that's what I bring to the table is these connections and sports. And these are the things I've done. Like I, to me, I feel like I am I'm representative of the membership. I'm a clinician, you know, we treat our butts off. Right, right. And we're still working with people, you know, all the time we published clinical research, right. Impactful clinical research that have great implications that everybody wants to learn from. Right. We teach this to everybody after we publish it. Right. So we're on the trenches. We're working with the pro athletes. We're working with the collegiate athletes. Like I want to give people the opportunities that I've been fortunate to have. And I think that's a big part through networking, mentorship, education. I think those are the three big areas that are really push.

Speaker 1 (14:24):

And I really loved the mentoring aspect or Avenue of that. Especially like you said, maybe some online options and things like that. Obviously during COVID these things have become more and more prevalent, but I think it also does well for members who may be don't have, don't have the finances. They don't have the resources to let's say, even travel to a continuing education moment or even go to CSM. So I think to make things more accessible to all members or to people who want to become a member, right. Cause you may have someone out there is like, I'd really like, want to be part of the sports section. But man, I don't know if I can, like you said, do a residency or fellowship, which can be very expensive and time consuming or maybe they're a later in life PT and they have a family that they have to care for and they can't go off for 12 weeks or something like that. So I think to have those virtual options would be really great. And, and for me, I think it would be something that would really generate some interest in the section.

Speaker 2 (15:38):

Yeah. And that's my wheelhouse. Right. And that's what, that's what we did. I mean, it's funny. Like I stumbled into online education. Like I don't even like 12 years ago now. Right. Remember where the we're the old ones again, Karen. Right. I stumbled into that and have all these online courses now. And I did it for one simple reason. I was unable to travel around and teach. Right. Because I, I was now in getting a new baby. Yeah. Well, no, I was, no, that was before that I was in professional baseball. Right. So meaning like I worked 24 hours a day, seven days a week. I can't take a weekend off and be like, Hey, I know you guys have a game tonight, but I'm going to go teach a course in Louisiana. Right. Like they couldn't do that. So I got in that, but then yes, then you get you, and now you add family on top of that, right?

Speaker 2 (16:23):

Like, yeah, that's a big deal. So, so I started teaching online to kind of scratch that itch for myself, to keep giving back right. And sharing and educating and men that it's amazing how many people around the world you can touch by, by doing it online. And again, we need to catch up with that and just shows again, like, like, you know, the current state of even like the AP team totally. That they don't, they don't even have a way to a good, solid way to be able to offer continuing education credit for people with online courses. It's a mess. It just shows you how, like it's a, we're, we're getting a little outdated. I think we just need to refresh the vision for modern day, you know, this next generation of VCPS and people that want to get further along in their career, we need to meet them where they are.

Speaker 2 (17:06):

And not just assume that like some of the old standards that they've done. Right. And I think that's why bringing some new vision to the board is helpful. Right. I mean, the board has been pretty consistent for a long time. Right. The board has been quite academic for a long time right now. Right. There's not a lot of clinical leaders that are in the trenches, like working with athletes every day. I think there should be both, right. Like, don't get me wrong. I think we need both. We need clinical and academic in there, but I think we need to collaborate on that because I do think there's different perspectives if you know, depending on what you do all day. So I'm pretty excited for those things. Cause I actually think that's going to make a big impact. And, and again, I just think like the benefit of being a member is going to skyrocket. You have all these opportunities.

Speaker 1 (17:51):

Absolutely. I agree. And now before we kind of wrap things up, is there what would you like the listeners to kind of take away from the discussion? What is your main point?

Speaker 2 (18:05):

Yeah. vote for me now. I'm just getting abs. No, in all honesty, I'm like, I, I'm pretty humble about it. Like if, if, if I'm not elected, like I, it's not a big deal to me. I CA I can't wait to continue to continue to contribute to the Academy and help people. Right. For me, it was like, this is the right time to kind of give back and to be able to do that. I think my experience, I think I've done what a lot of people join the Academy to try to also accomplish. I've been there. I've done that. I understand what they're going through. And I'm, I want to get the Academy back to helping exactly, exactly. Achieve your goals. And that's it, it's about the member. It's not about me. It's about the membership. So yeah, and I think that's it.

Speaker 2 (18:47):

And you know, again, just just you know, also throw up Mike Malaney again, as vice-president, because I humbly, I can't do this by myself. Right. We're all busy. Like you're busy, I'm busy, we're all busy, right. This is a team effort. And I think in some fresh vision of people that have this clinical background, like Mike and I, and I've been, I've been big sports PTs our whole career, like adding that to the current board that's already in place, I think is going to be quite a nice dynamic that is going to really help lead this Academy in the future.

Speaker 1 (19:19):

Excellent. And now let's talk a little bit more about you. Where can people find you, your, your podcast website, anything you want to share?

Speaker 2 (19:29):

Awesome. I'm easy to find, right? So I'm just Mike ronald.com. If you want to learn a little bit more about this election and the process with that, you can go to microsoft.com/vote, and there's some info on there that you can, you can get I have a podcast, I have a blog, you know, kind of blot for over 10 years. So there's like a thousand articles on there. So people always ask like, where should I, where should I get started? I'm like, well, you got a lot to catch up on. Right. There's a lot of articles out there, but yeah, no, I'm easy. I'm on social media. Like I just, I really am at the point in my career where I want to help others. So I, you know, we try to hit every, every channel we can to, to have the most impact. So, so yeah, just head to my website, there's a lot to learn on there. And and like I said, Mike reynolds.com/boat, and you get a little bit more info about this election.

Speaker 1 (20:14):

Excellent. And last question. What advice would you give to your younger self knowing where you are now in your life and in your career? What advice would you give yourself as that fresh face? New grad?

Speaker 2 (20:28):

You know, this is, this is actually funny because I, I just wrote this to my, to my newsletter last week. Right. It was kind of funny that I literally, I just wrote this last week and I just wrote like the next one for this weekend, that's going out this weekend. But I, there was one thing I accidentally did in my career that I stumbled into that I, I it's become clear now that that is what we should do. And I said, like, I am pretty certain at this point, everything I've accomplished in my career is because I specialized ready. And in this week's newsletter, I actually talk about like how to, how to arc your career path that way to do that. But like, I remember early in my career, like I got, I got some heat from some other physical therapists that I was too specialized.

Speaker 2 (21:13):

Right. And you were like, no, you need to be generally, like, you're not good with neurologic injuries or something. And I'm like, all right. But like, for me, like getting really good at one thing helped me achieve all the goals that I wanted to get to, to get a job in professional baseball, right. To win a world series, right. To, to open my own clinic, to open my own gym and sports performance center. Right. It was all because I specialize in something. So we need to be general, you need to start general, but if there's some your passionate about say, it's like soccer, football, whatever sport it may be. Right. You just, every second of downtime, you have learn how to be the best at that. Just be absolutely amazing at something. And I think that was the biggest key to my career is overhead athletes and shoulders, like in baseball.

Speaker 2 (21:58):

Like I just, I got super lucky that I engulfed myself in that environment and became a specialist in that. Right. And again, just, that's another thing that the Academy needs to do, and it needs to help people that want to get super specialized in one thing to be able to do that. So I think that would be my biggest thing right now. You know, it keeps evolving as we, as, you know, as we get older, but I think right now is for an early career professional is master the basics, but follow your passion and make sure you are just, you're putting your extra grind and hustle into like, become the best you can at that side. And then it'll grow, you know, grow over time. And then when you're lucky like us, Karen, and you're a little bit older, you, you go to work one day and you're like, gosh, I just have, I have six baseball players today. That's all that's on my schedule. It's like, it's pretty cool. You know, I played catch three times yesterday. Right. Like that's kind of cool. I got, I got paid to play catch. Right. That's kind of cool. So, yeah. So I think that would be my biggest advice really for the early career professionals. That would be good.

Speaker 1 (22:58):

Well, what, great advice. Thank you so much. I don't think I've heard that one yet. And I think that's a great, I think that's great. And hopefully that will help some of our students and younger clinicians as they try and figure out and navigate their career. So thank you so much and thanks for taking the time out and coming on today. I really appreciate it.

Speaker 2 (23:15):

Thanks for having me, Karen. You're the best. This is awesome. And I appreciate it. The LC in the future, I'm sure fingers crossed

Speaker 3 (23:22):

One day. We'll actually be able to see each other in person, right.

Speaker 1 (23:26):

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

In this episode, CEO of Julie Wiebe Physical Therapy, Inc., Dr. Julie Wiebe, PT, DPT, talks about running and pregnancy.

Today, Julie talks about running/exercise and pregnancy, creating baselines, the research around female running form, and she busts some pregnancy myths. When can you return to running after pregnancy?

What is Julie's definition of 'postpartum women'? She tells us about structuring exercises around their daily exercises and goals, pelvic health education, and she gives some advice to clinicians working with postpartum runners, all on today's episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• "Landing mechanics are affected by what's happening north."
• "Let's understand what they looked like beforehand so that we have a better idea of how to help them find their way back."
• "Just because you had a baby doesn't mean you should be in pain and weak for the rest of your life."
• "Listen to what's happening, but learn to interpret it."
• "If your 10 minutes is spent running and that's your goal, you'll do it. But if I say you've got to lay down on the ground and do rehab exercises that make no connection for you, you're not going to be motivated to do that."
• "Pelvic health does not mean that you have to be clinically prepared to do internal work. It just means that you're treating the musculoskeletal of someone who happens to have a pelvis, which, last I checked, is everyone. You don't have to be certified as a women's health specialist, but you can get information, read books, watch videos, take courses so that you are competent in treating a woman postpartum that wants to get back to running."
• "The pelvic floor is not the only gatekeeper that creates pelvic health. It is a component of multiple body systems, and we need to understand that those systems affect the way the pelvic floor acts and behaves. The pelvic floor itself needs to have attention directed at it, but when we talk about just the pelvic floor, it isolates it away from relevance to other areas of care."
• "Learn to ask questions, and ask questions that make you uncomfortable. You will get more comfortable with it, and understand that what you're trying to do is open a door of communication."
• "When you read the conclusion in research, is there any other explanation that could've come to that same conclusion based on what you're seeing?"
• "We need to start broadening our lense, and I think we're broadening it to look at females as not just little men."
• "Instead of thinking of learning as this linear thing, include and transcend. Instead of it being a linear line, let it be concentric circles."

More about Julie Wiebe

Julie Wiebe, PT, DPT has over twenty-four years of clinical experience in Sports Medicine and Pelvic Health, specializing in pelvic/abdominal, pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness and sport after injury and pregnancy, and equip pros to do the same. She has pioneered an integrative approach to promote women's health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations (ortho/sports medicine, pelvic health, neurology, and pediatrics). A published author, Julie is a sought after speaker to provide continuing education and lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes through telehealth and her clinical practice in Los Angeles, California.

Suggested Keywords

Physiotherapy, Pregnancy, Research, PT, Health, Therapy, Healthcare, Education, Training, Postpartum, Running, Exercise, Pelvic Health, Conversation,

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Foundations + Running Bundle A

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Read the full transcript:

Speaker 1 (00:07):

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

Speaker 2 (00:39):

The host, Karen Litzy and today's episode. I'm really excited to round out our month all about running injuries and running rehab with Dr. Julie Wiebe. She has over 24 years of clinical experience in sports medicine and pelvic health specializing in pelvic abdominal pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness in sport, after injury in pregnancy and equip pros to do the same. She has pioneered an integrative approach to promote women's health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations, or at those sports medicine, pelvic health neurology, pediatrics, a published author. Julie is a sought after speaker to provide continuing education lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes to through tele-health and her clinical practice in Los Angeles, California.

Speaker 2 (01:48):

So Julie's amazing. And in this episode, we talk about some myths about running while pregnant and in the postpartum. And of course, the question that everyone always asks Julie is how can we return to run after pregnancy? So Julie answers that question and cause a lot of really helpful hints for practitioners to look for when evaluating postpartum women and those postpartum women, those runners can be anywhere from six weeks to six years, 16 years, 20 years after having a child. And she also encourages clinicians to think critically, to look deeper, to have a framework for evaluation, to try and, and, and get a baseline to ask your patients to film themselves while they're running or exercising so that you can understand what they look like when they're doing what they do. There's a lot of variables to post to running post-pregnancy and Julie really runs through all of them.

Speaker 2 (03:01):

So I want to give a big, huge thanks to Julie for coming on the podcast today and sharing all of this knowledge. And she also has a discount on the course. So she has a course on running a postpartum running. So she has a course for the listeners. So all you have to do is enter the promo code Litzy that's L I T Z Y my last name for 20% off treating and training the female runner. And just to be clear, this is for professionals, not for individuals. So this is for clinicians. So a huge thanks to Julie for that. We'll have all of the information, including links to everything in the podcast at podcast dot healthy, wealthy, smart.com. And tomorrow you can catch Julie live along with Dr. Ellie summers, Dr. Chris Johnson and Tom goom for our live round table discussion. That's tomorrow, March 30th at 2:00 PM Eastern standard time.

Speaker 2 (04:10):

If you can't make it still sign up because you'll still have a chance to get your question answered by the panel, and you will still get to watch the replay any time you want. And listen, this is a deal. It is $25 for four of, in my opinion, some of the best minds when it comes to running injury and rehab. So sign up today. If you're listening to this today, sign up today because you have until probably, I don't know, it starts maybe until like quarter to two tomorrow, which is March 30th to sign up for our live round table discussion. Again, that's with all four guests from this month, Ellie summers, Chris Johnson, Tom goon, and Julie Wiebe. So sign up to day. Hey, Julie, welcome back to the podcast. I think this is like your third visit to help you well, yes, thank you for sharing your platform with me again.

Speaker 2 (05:11):

I appreciate it. Of course. And, and this month, the month of March, we're talking all about running, running injuries, running rehab, and I know something that you're passionate about is caring for the postpartum woman that returned to running after giving birth. And, and we'll also talk a little bit about running while pregnant. Right. So I think that there are, there's a lot to cover. And so we are just going to, we're going to zoom right through this unintended since we're on zoom. But let's start first with running while pregnant. I feel like there's a lot of myths around running while pregnant. I don't know that it's understood very well by many people, including clinicians as well as the pregnant women. So I'm just going to kind of throw it over to you and let you just kind of talk about the, the running pregnant woman.

Speaker 3 (06:14):

Yeah. You know, and I think I think that regarding running and pregnancy, I mean, that's our focus, but really exercise and pregnancy. We still have, we are limited in our understanding of all things. Related to that I think we are started, we have information about things like cardiovascular response or, you know, some of those pieces of the puzzle. But in terms of the musculoskeletal, the neuromuscular, the response of the female host inter like how is that impacting the mom's body systems. Right. and I think that where we are struggling to have a lot of research there in part, because it's hard to find women that are willing to be participate in research. And then there's also a lot of, I, you know, we have to be protective of them. We have to protect them. And so, so it's this, you know, we want to honor that stage of life, but we also need to research it.

Speaker 3 (07:13):

So so I think we are struggling to, to understand all that, but we're starting to get more and more attention on it, which is awesome. As far as pregnant runners go there's only a few studies that I'm aware of that actually look at the pregnant runner and and of those one is a case study and one is on five women. So we have very limited understanding of what exactly goes on, but there were some themes. So I'll just share some themes. One is that in, in both the studies, they were, they were followed, the women were followed throughout the pregnancy changes were seen in all of the women on how they continue to run through the pregnancy meaning. And particularly the one with the five women, they all did something different, which is the variability is what we're seeing now.

Speaker 3 (08:07):

Everybody's bodies individually adapted differently. But the through line for them was there was a loss of pelvic and trunk rotation. So when we think about that pregnant runner, this is the way I've started describing it. The belly covers a ton of joints. Like it goes from the thorax to the pelvis. It it's basically, it takes all of these reciprocating joints and it turns it into a unit joint. Like it's one big joint, it blocks motion. So it reduces pelvic and trunk rotation. And so it limits, and then it forces them to rotate elsewhere. All of these are adaptions to help them continue to move through space appropriate for pregnancy and running. But when they go into the postpartum, they carry it with them. And that was what happened in both of these studies. They found that at six months for the woman who was the case study, and then at six weeks postpartum for the women, the five women in the other study, they held onto these, these some of these variables into the postpartum period and where that's significant is that women are given that okay by their doctor at six to eight weeks.

Speaker 3 (09:19):

This just like, you can just start doing your thing again. But their understanding is I got to just lose weight and get a flat belly. What our understanding needs to be is we need to understand what's changed for them. Biomechanically neuromuscularly emotionally, you know, fatigue, stress, like all of we have to understand all of those pieces and help them restore their interrelationships. Neuromuscularly biomechanically to be more like their baseline in order to prepare them for return to run. Like it's not just, okay, let's get him stronger. It's how do we help them restore that efficiency in their patterns that they lost, but no one realizes they lost it. So six years later, they show up to an orthopedic office and they have some of these running injuries, but how much of it is related to the compensations that they carried into their postpartum. So that's sort of a, an entry point into our conversation.

Speaker 2 (10:17):

Yeah. And that's, that is so interesting. And it makes sense that they would carry that over because our brain has is plastic and it's going to adapt. And our our sense of where we are appropriate susceptive sense is going to adapt to that. And it just doesn't end because the baby's not inside you anymore.

Speaker 3 (10:40):

Correct. And you're pulling it off, like in your mind, like you're still pulling off running, like you're actually running. So it, the understanding of what has changed is not understood globally. And I think like, I mean this, the running study related to the five runners that I mentioned, and that was from 2019. So this is, you know, relatively hot off the presses in terms of clinical understanding. So our job clinically is to help restore reciprocation that's really, and we understand the reciprocation is so important for all sorts of pieces of the puzzle for running. And one of those things is actually reducing ground reaction forces, getting our center of mass over that lead leg. Reciprocation is a huge piece of that. And so understanding just that, if that is all you walk away with today, understanding that you're a female that has a postpartum is postpartum, meaning they have a pregnancy in their history when you're working with them related to it, running injury.

Speaker 3 (11:39):

If it has a ground reaction force components like a knee or anything, you should be looking North of the border, not just foot strength, not just cadence, not like you have to look North and understand, are they actually reciprocating? Where's that reciprocation coming from? Because when you have a unit joint of the lumbar spine in the lower, the only thing that's left is like TL junction and above. So that's where they're reciprocating is way up high at the chest. And if you watch Fumo runner, that's what they're doing. They're punching the sky, it's all up, up, up, up chest high. And it's, that's the pattern that they partially developed during the pregnancy to continue running and pregnancy. There's nothing wrong with that. It co it's an appropriate compensation, but it does. If you don't restore actual reciprocation between the trunk and the pelvis, that's what you're looking for. And if the woman is in gripping her abs, cause she wants to get flat abs again, that's a UDA joint, it's a uniform engagement of the abdomen is what most women hang on to, or try to do while they're running. And that continues to keep their reciprocation high. So it's like understand what's going on North of the border for these women, versus just looking at things like landing mechanics, landing mechanics are affected by what's happening North so

Speaker 2 (12:59):

Well that's so, yeah, that is so interesting. And now I'm going to be, you know, in central park watching all these women to see, okay, are they just running with their, from like the thoracolumbar junction up? And then just having legs move like a cartoon character or are they actually getting excursion and rotation through the trunk?

Speaker 3 (13:19):

Amen. Yeah. And then we're getting into summer, right? I mean, I'm here in California, so we're gonna be able to see people's abdomens. And the thing that I, my cue for my clinician friends is what's going on with the navel. Like if their navel is staying straight, dead, straight, the whole time they're holding their abdomen. So stiffly through their run, that they aren't reciprocated. Like they can't be like, that's an indication that's a quick and dirty clinical sign that you can see that that means the reciprocation is likely coming up higher. And then it'll sort of clue you in and you'll see it. And they're, they're the ones punching high in the sky. They've got ribs flared up, like it's sort of, and that's a lot of our female runners. And it's a lot of our women that have never had children because they're holding their abdomens.

Speaker 3 (14:03):

Cause that's what they think they're supposed to do. And we also have studies that have shown us that stiff abdomen when they had men jump off a height actually increase their ground reaction forces. So it makes sense it's part and parcel, right? Like, you know, we just got to sort of brought in and I think that's my hope when I talk about stuff like this with my ortho and sports medicine, friends and colleagues because that's really, I'm a sports medicine, PT, I'm not a traditional pelvic health PT, but is to broaden our lens and add these ideas into our differential diagnosis. Like we need to start thinking about how these things are affecting. Some of the things we look for in sports medicine. Like we understand to look at how ground reaction forces what's happening, but we don't often this into our thought process. Like how, why is that a typical running pattern for women? It's not just because we have brought her hips and Q angles and, you know, blah, blah, blah, look North, look North with me. There's more going on for these women. And and we have some strategy pieces that we could add into our thought process to help them

Speaker 2 (15:13):

Yeah, amazing coming in hot, right out of the gate pair with a great tip for everyone. So thank you for that. And one one question that I want to ask, just so the listeners really understand when you talk about postpartum women, can you define what that means?

Speaker 3 (15:32):

I'll give you my definition. Sure. It doesn't necessarily mean that it is the definition. But I consider anyone who's ever had a baby. And, and here's what I'll say about that. I think technically it's the first year that might be kind of more of a technical thought process. And that's mainly because I started learning this backwards when my, on my patients who were 35 and 45 and 55 and 65. And they still look like me. This is million years ago. Now when I was at postpartum early postpartum, like the way that I was using my body and it was creating issues for me, they were using their bodies that same way. And they were like, well, they had grandchildren at that point. And so once we start understanding, yes, it's a normal process that women go through, but our job is to understand what they went through and help them find their way back to efficiency and effective use of their structure and their systems and their like I D I was Chris. I love that Chris Johnson talked about their ecosystems, like, you know, like looking at all of those pieces for them and understanding our job is to help them get back to their baseline, their individual baseline. Cause my torso is this, like this with this link legs. Some people have long legs short, let you know, like to understand that. So my, one of my big pushes I hope to achieve at some point is to get baselines, like, let's start getting baselines. I was women. Yeah, go.

Speaker 2 (17:09):

I was just gonna ask that you, you beat me to the punch. I was just going to say, so if someone is coming to me as a woman who is a runner and she had a child would say a year ago or two years ago, even how do I know what her baseline is?

Speaker 3 (17:27):

Correct? Well, what I do is I have them try to bring me film from prior to the injury. So these are for women that haven't had babies or like what they look like running prior to having a baby. And again, so many women have said to me, well, I leaked even before I had a baby when I ran. So then you might find stuff in their running form that might help explain that like Mabel's that go straight ahead? You know, things like that. But it does give us sort of an understanding of, is the running form that we're seeing right now, is that speaking to why they're having the injury, the, whatever it is, or is this the running form they've always had and they used to run without any difficulty. Like, you know what I mean? Like, so for me, that's how I started to create their baseline.

Speaker 3 (18:15):

Even if I can't see what they look like. And a lot of women will, like, when we talk about diastasis, like, you know, something like along those lines, which I might have to define for the audience, but some women will send me pictures of them in a bikini from like their early twenties. They're like, Oh my gosh, you're right. I actually had a line down the middle, but I never gave it any thought because my belly was flat. But now that my belly is not flat, you know? So it's like, that's where we can start to kind of get some comparisons for baselines. But one of my goals is to reach into the medical community, meaning the obstetricians and the midwives and the nurse practitioners. If any of you are out there is to say, let's start creating baseline. You're the first contact for some women they'll come in for a prenatal visit or something like that. Like, let's get some baselines, encourage them to take video. How will they're lifting how they're running? You know, how are they doing these things that they want to get back to afterwards so that they have a library of their own baseline? Like let's understand what they look like beforehand so that we have a better idea of how to help them find their way back.

Speaker 2 (19:18):

Yeah. Yeah. Great answer. Thank you. And so we've talked a little bit about this return to run after pregnancy. And I know you said that is, that's what people want to know from you. How do I go back to running after I had a baby and you know, everybody wants a protocol. If you could do this, then do this and this then do this. Right? Right. So when someone says to you, when can I start running after I had a baby, what is your answer?

Speaker 3 (19:50):

My answer is, and everyone hates it. It depends, but I tell them what it depends on. And so, and that's what it does get a little tricky in a situation like this, because these are some of the variables that I want to know. So my, whenever I get a question like that, my favorite is when I get it from a practitioner, what should I tell my patient who wants to get back to running? And I'm like, okay, well, my, my response to you is I actually wrote a blog like this. Like, and I always get, Hey, quick question. And I'm like, it's not a quick question. It shouldn't be a quick question. You know, did they have a vaginal delivery? Was it traumatic? Did they have forceps? Did they have a Syrian? Was it, you know, did they have bed rest? Were they on bed rest?

Speaker 3 (20:29):

If you're on bed rest, no, you're not gonna start running right out of the gate. You're like, you know, like there's so many variables there was it a complicated pregnancy? Was there, you know, what's been happening to them during the recovery process, have they, you know, are they having postpartum depression? You know, what's the you know, what are all these variables that they're experiencing? Where are they having postpartum depression? Or are they depressed or having baby blues, partly because they've lost their exercise program. Like what, what are all of these variables that we're looking for and what was their athletic capacity before? What is it now? Or what are their goals? Cause I like to make goal specific recommendations. So those are some of like, those are just that's scratching the surface, but I don't want to make it sound like this is an inaccessible population to work with because you don't know what all those things are.

Speaker 3 (21:19):

But what I usually talk to my patients about is I understand their goals and then I break them down and we start preparing for them. So my program for you needs to prepare you for what you want to do. And I need to understand the demands that you're up against. If you want to run, I need to prepare you for impact. I need to prepare you for endurance. I need to prepare you for power and possibly change of direction, depending on what you want to do. Trail runs and jump over rocks and things like that. Like I need to prepare you for what it is you're going to be up against. And part of that preparation is looking at your form, giving you great form twos, helping you build in new form, creating an interval program, getting you impact ready. Like there's, it's not just, I need you to do some curls and tell me stuff and some cables, and now you can run.

Speaker 3 (22:10):

And I think that that's, but that's a typical postpartum recovery program, but it isn't a prep for return to run. I need to teach you to reciprocate. I need you to strengthen into those reciprocal movement patterns. I need you to do single leg work. I need you to do single leg loaded work. I need you to do single leg impact work. You know, I gotta get you practicing some of those pieces. Then I know you're prepared. And if you're leaking or having pain or having an I give you these things we're looking for while we're doing the prep work, we're just not quite ready. We need to modify those things. Keep giving you opportunities to build capacity and strategies for the kind of work you want to do. I'm going to build that back into your system so that you're ready. And if you're, again, if you're symptomatic during all the prep work, we're just not quite ready for the actual events, but let's figure out what still needs to be tweaked and what needs work. You know what I mean? And then like, let's start with elliptical, let's start with hiking. Let's start with things that don't have impact. If we're not, if we're having symptoms with impact, like sort of really parse, what's still creating the problems so that we can troubleshoot that. And then, and then get you back into interval prep, walk, run. You know what I mean? Like it's yeah. So it's yeah. So that's running, that's more running specific.

Speaker 2 (23:27):

Yeah. So if you're not, it's not like, okay, the doctor gave you the all clear at six to eight weeks depending. So I'm just going to give you a walk run program. And that's what you will do. There is a lot more building because like you said you to monitor, you want to give people their program, you want to monitor their, their reaction to it, their symptoms, and then make the necessary adaptations that you need to make and use your clinical judgment. Because we know that there's not a whole lot of research around even returned to run after pregnancy. There's not a lot of research to that, correct?

Speaker 3 (24:05):

Yeah. We're getting, we're starting, we'll give credit where you know, we're trying, but we, yeah, we have a lot of work to do. We need to figure out there's a lot. We need to understand just basics. But, but like some of the things that I, I I'm trying to create like little things, people can remember, like prepare, then participate, monitor, and modify. Like just keep get like put those pieces together for yourself. Cause some people don't have access. That's the other thing, like if anyone out there doesn't have access for whatever reason to the practitioner, like you are, you have a lot of power by knowing what to monitor for knowing it's not normal to have pelvic pressure or leaking or pain while you're running. It's not normal. Like we want you to feel good while you're running and you know, just cause you had a baby, does it mean that you should be in pain and leak for the rest of your life?

Speaker 3 (25:01):

Like that's an incorrect, like I think we did. We say we're going to bust myths. Like that's a myth D please don't buy into it. So yeah, and I think I lost your question in there somehow. Did I? No, no, no, no. Boston my own head. No, not at all, but it is. It's like these, like what else? You know, and then follow the other thing I try to tell people is follow your success. If it seems to be that you're having more symptoms on the flats, but you're okay if you are going uphill, which is not unusual because it sort of helps you have a better running form automatically. Then let's walk the flats, run up the Hill. You don't like listen to what's happening, but learn how to interpret it. I think that's what I'm hoping clinicians can be, is really great interpreters of what's happening with the patient standing in front of them so that they can they can be better guides.

Speaker 3 (25:54):

I mean, that's really ultimately what we're doing. We're guiding people through their process because everyone's process is going to be a little bit different. It should be. And I would love for, I would w I went a hundred percent with lots of over the protocol, charge everybody 10 books now, but it doesn't exist because everyone is different everyone's path through pregnancy is different. That one study we have was so fascinating. All those women did something different to get through the pregnancy running. So, so we, we were just learning, right. We're learning about, about everybody's path through, through all this stuff. So how can we guide them? And I think monitoring modifying, progressing not gradually in a scared way, but in a smart way, like, Oh, we tried that. That was too far. All right. So backing off a little bit. Let's try this. Let's modify, modify, keep adapting. So I don't know. Now I'm going down a whole nother rabbit.

Speaker 2 (26:48):

No, no, no, that's it. This is all, this is all amazing. And I, and I really think the listeners will, we'll definitely come away with, you know, the, the monitor and make it adaptations and watch and listen. And also, like you said you sort of referenced Chris Johnson, sort of talking about the whole ecosystem. So again, I think it's important to when you are sitting down with this patient for the first time, you know, you have all these questions, but then your other questions are, well, how old, how old is your child? Do you have more than one? What are your responsibilities at home? Do you have a nanny? Are you a single mom? Are you working? What are your time constraints? Like, because all of that feeds into what kind of program you can give this person, because they may say, Hey, listen, I have 10 minutes a day to do some exercises. And, and what happens a lot is people think I only have 10 minutes a day. It's never going to work. Right. So how do you get around those with your clients?

Speaker 3 (27:51):

I usually use their exercise program is their fitness program, whatever it is, like rather than ask them to stop. I, and so, I mean, we're talking early postpartum versus someone who's maybe coming back two years later. Right? So you know, I try to integrate, my goals have always been, or my path has always been about building brain strategies, neuromuscular. So then I'm teaching them how to re-establish. Some of the, the, the, so let's talk early postpartum things get kind of funky in terms of how components of the central stability Central's control system operates. I'm working on helping them reconnect and implement it into their function. They have to take care of their kids. If you're lifting your kid, we're going to do it in a way that sort of pulls in the brain's going to use all these components to help them start, to learn, to be reintegrated into your movements, just movement going up the steps.

Speaker 3 (28:50):

Guess what steps is just like running. We're going to actually, if your goal is running, I'm going to make going up and down the steps with your laundry hamper or your baby as your prep for return to run. But we're going to do it super low impact. We're going to think it through. We're going to have to, like, we're going to rebuild that reciprocation through walking up and down the steps. We're going to, you know, match it to your function right now. But if you're two years out and you're, it's a different ball game, I'm going to use your running as your program. I'm going to adapt your running and keep you below your symptom threshold or make it look a whole heck of a lot like running so that you're motivated to do your, if your 10 minutes is spent running and that's your goal, you'll do it.

Speaker 3 (29:32):

Do you know what I mean? But if I say you got to lay down on the ground and do these rehab exercises that make no connection for you, you human, emotional, or your brain to your goal. You're not going to be motivated to do that. So I have always broken down their exercise programs, if they are CrossFitters or going to gym or whatever it is, show me three exercises that you like to do. Yoga, Pilates, whatever it is, what are three things let's implement these ideas and strategies under something that you enjoy, because I know you'll be compliant. And then they know you're listening. That therapeutic Alliance is there, like out of the gate, you want to help them get to their goals,

Speaker 2 (30:11):

Right? So it's, it's like, you can take things they're already doing and modify, adapt it, allow them, give them the tools they need to implement. What will help them in that exercise. And ultimately perhaps help them get back to their running or whatever it might be. Okay.

Speaker 3 (30:31):

Break it down, break it down and then build it back up. That's got it. That's a pretty straightforward way to do it with any athlete. It doesn't have to be running. But you got to know what they're up against. So I, if I am not familiar with something, I just say, show me, I don't know, show me what that is. And I don't know the words, I'm the first one to admit it, but I can't remember what that, can you just show me that and they'll sh and then you can break it down. Like, I think that's, to a lot of people's barriers to working with athletes is they don't feel comfortable with the sport. And then of course we have, you know, members of our community that say things like, well, do you lift, do you even run? I know. And it's like, like, it's really I don't, I don't surf and I will never, my first surfer when I moved to California, you know what I did, I looked at YouTube and I looked at, I watched, I watched videos.

Speaker 3 (31:30):

I looked, I tried to understand what are the physical demands of surfing, but that didn't mean I couldn't help him. You know what I mean? Like, don't get me started. So anyways, so I think that it intimidates because also like, that would mean that men couldn't work with female athletes too. Like, cause you don't have a vagina. Like that's, it's a, it's an illogical argument and it makes me mad. So anyway, surfing is I that's one of the examples that I use because I don't surf and I never will because I'm afraid of sharks. So we w w your job, our specialty physical therapist should be movement analysis. That to me is a pretty basic part of our definition. And I know that you can at least pick out efficiency. Do you know what I mean? Like, you can pick out efficiency and I use video, like crazy.

Speaker 3 (32:19):

Have them bring you videos of them. Weightlifting have them bring you videos of running, and then you can slow it down. Look at it, really carefully. Look at it at home before you stand in front of them, start to break it down, look online. What is a clean and jerk, and then ask them to send you a video of a clean and jerk compared them and start to pick out where it's different. There you go. You know what I mean? Like, I think that we create this barrier for clinicians to be able to participate in this kind of care if we make it unattainable because they don't actually participate in it anyway. Yeah.

Speaker 2 (32:56):

Listen, I could not agree more. I think that's the dumbest dumbest argument against a qualified physical therapist, seeing the person in front of them, because what if you're the only physical therapist for 50 mile radius? What are you supposed to like, sorry, pal. I'm not an Olympic lifter can help you.

Speaker 3 (33:17):

Yeah, it's so stupid. It's so stupid. Well, and it's really the other thing too then is it's also important to sort of highlight and carefully and kindly and respectfully say that's also how pelvic health is understood by so many. Well, it's not, that's not my department, but it's physically inside the woman standing in front of you. It's part of her department. So like, you may be the only practitioner for miles and you are the only person that understands the human body, the way you do as a physical therapist. It behooves you to start understanding some of these processes. When we start to talk about our differential diagnoses for runners is to understand what is happening, what, how might this have affected what I'm seeing clinically? And then it's not, it's not pelvic health, like in this movie way, it's pelvic health as a, it's a, it's a friend to helping you understand what's going on with these patients.

Speaker 3 (34:16):

So, so again, like in the same way that, you know, folks get scooted away from participating with female athletes or athleticism, we don't want to scoot them away from pelvic health because it's scary or UV, or it's not their department. Like we need to open those doors broadly and say, let's, let's skill everybody up. Let's equip everybody, the pelvic health community to understand fitness better, and the fitness community to understand pelvic health better. Like let's everybody come to the middle and not create barriers inside the community to those things. Like, let's appreciate the perspective that we each bring so that we can optimize the care for our patients who don't have resources to go down, you know, and with telemedicine creates new opportunities until unless we can't do it nationally. Right. Can we have a talk about that?

Speaker 2 (35:08):

Yeah. I would love to have a talk about that. Like maybe every, every licensing board across the country, again, it's so stupid because we take a national exam, but we're only licensed in anyway. Yeah. We could have, we could have a round table on that one. But you know, what you said is really important about so for the physical therapist or even other health professionals listening pelvic health, it does not mean that you have to be clinically prepared to do internal work, right? No, not necessary. And it just means that you're treating the musculoskeletal health of someone who happens to have a pelvis, which last I checked is everyone. And so, and so you should, you should be able to do that. You may not ha you don't have to be certified as a women's health specialist, but you can take get information, read books, watch videos, take courses so that you are competent in, let's say for the sake of this month, I'm runners treating a woman postpartum that wants to get back to running.

Speaker 3 (36:25):

Right. And there, and that's, and I think that that's partially, I mean, to just be fair, I think we all learn pelvic health in a very isolated way in PT schools. You know what I mean? So I think that there's been a huge change in the conversation in the pelvic health community over the years. And it's just starting to get out there in, in other ways. So it also behooves those of us. And again, like I find myself always serve in the middle of these worlds. Those of us who communicate it in a way that's relevant to like, let's be communicating in a way that is enticing to learn more. Like, I want those to gain those skills and and understand it in a way that is relevant. And I, and so, yeah, so we have a lot of work to do to the physical therapy educational programming to start to build it into models a little bit differently, so that it's under some of the other side a little differently too. Right. So it's just, we're all we're evolving, but it is true that it has classically been defined that way. Right. Like, right. And so I think so anyway, yeah. So I, I agree with you, there's a lot we can do there. And it's also like, can you at least talk about like, and to have some ability to do that is important, you know, so,

Speaker 2 (37:45):

Yeah. And, and hopefully people like yourself and maybe podcasts like this and other podcasts that are out there will really help clinicians. And non-clinicians, you know, your, your, your gal that, that just had a baby. Who's like, I, I don't know what to do. How, what do I do? Yeah. You know, I just had someone contact me today who is eight months pregnant and she's starting to have a little low back pain. And she said, you know, should I just go to the doctor or should I just go to any PT or what should I do? And and I was like, Oh, I'm so happy that she's reaching out for a physical therapist, you know? But a lot of people just don't even know that that's an option. Right. So,

Speaker 3 (38:32):

Yeah. Cause the messages, while you're pregnant, low back pain, you're pregnant, you know? And, and so it's really, there's a lot of education that needs to happen, but I do think you know, so much of it is around I'm trying to think of a good way to say this, centering the woman as like that, those concerns just because they're common. I hate the common. Not more, it's not, I hate that. I get it, but it's also like, it just always has been, but that doesn't mean that's how it should be, or it has to be moving forward. Like I think we're starting to get more female researchers, myself trying to do that too, to help, you know, we're trying to have females asking questions for females and to the credit of this one particular, he will never know. I should write him a note, but like I had a conversation once with a running researcher.

Speaker 3 (39:28):

And I was like, did you think about the fact that that lady was probably in continent? Like he had just done something at CSM and he goes, that would never have crossed my mind. And I, and he wasn't like a poopoo that couldn't possibly be a variable. He was like, it looks like you need to start doing some research. And it was, it was literally like the last nail in the coffin of me, like meeting that, like I knew I wanted to go that direction, but it was one of those, you know, those really landmarking conversations that just sort of are like, w wait, wait, wait, wait, wait, I'm point. Knowing what I'm doing, like cooking you in the right direction. Yeah. It's to say, you know, this is you, you understand it. And I think that's, you know, again, you know, we talked a little bit about clinical utility and research, like trying to ask the questions that women need to ask, you know, so we need for your eight month pregnant lady, we got to get better information to her and to people that can care for her in her local community.

Speaker 2 (40:25):

Yeah. And, and again, you know, we talked a little bit about this before we went on, but, you know, asking the right questions, asking questions, asking simple questions. Because as, as we've spoken about the research for even simple, for simple questions is not there. So before we went on, Julie was saying, you know, we don't know what the pelvic does when we go to sit to stand, what is it doing when we're walking? We don't, we don't know what's happening in the pelvis and the pelvic floor and, and, and articulations above and below. So how are we supposed to know with certainty what's happened when you're running or when you have impact or jumping? So I think these, like you said, these smaller questions need to be looked at and researched, and then hopefully that body of work can build up to something much more clinically.

Speaker 3 (41:15):

Yeah. We need to sort of, we need to build in the basics and, and, and, and we're working like there are teams working on that, like we have, and we're using computer modeling as a way that this is starting to get there because we can't the issue. And also, I really want to make something super clear before we get moving. This direction is one of the things that I'm trying to be really careful about is not just talking about the pelvic floor, but to talk about pelvic health, because the pelvic floor is not the only gatekeeper that creates pelvic health. And it is a component of multiple body systems. And we need to understand that those systems affect the way the pelvic floor acts and behaves and the pelvic floor itself, you know, needs to be, have attention directed at it. But B because when we talk about just pelvic floor, I think it isolated away from relevance to other areas of care.

Speaker 3 (42:05):

So I just want to be clear on that. So but we don't know what its behavior is. Cause we can't see it. We can't put a, you know, it's just, we are, but we're starting to get new ways to be able to understand it better through a technology advances. So we're getting there, right? Like, so that's been a barrier to understand this better in in the dynamic, in dynamic activity. And we are seeing computer modeling as an option to help us start to understand this a little bit better, but that modeling is usually done on like an N of one. One of my favorite studies is a computer modeling study, but it's with something, I can't remember the title now off the top of my head, but it was something like, you know computer modeling of pelvic, the pelvic floor during an impact activity and an athletic female or something like that, or for female athletes.

Speaker 3 (42:52):

But then it literally says in the methods section that the woman they chose wasn't athletic and I'm like, well, crap. Okay. But I mean, it gives us, it gives us new insight. We'll take it. But I would really like to see it on someone who is an athlete, because, you know, we want to understand all of those variables anyways. So, you know, we're just trying to get there, but we haven't always, we can't visualize the pelvic floor in when we're watching a runner, but we can watch it's relationships. We know it's related to the glutes. We know it's related to the pelvis and the low back and the abdomen and diaphragm, we can watch all those other relationships. And we're really good at that in ortho, in sports medicine. So there's all of these interrelationships that we can watch and understand that a little bit better and differently, but you know, there's elements of what's going on there today. I am grateful to our pelvic health community for their capacity to treat directly.

Speaker 2 (43:49):

Yeah, yeah, absolutely. And now, before we start to wrap things up what I'd like to ask you is for, let's say the clinicians that are listening to us right now what, what is your best advice to those clinicians who are working with, let's say female runners who are postpartum at any point postpartum, whether it be six weeks, six months, six years, what have you,

Speaker 3 (44:22):

Oh let's see. That's kind of a loaded question, but I think it would be to learn to ask questions like that would be my best advice, like, and ask questions that make you a little uncomfortable. You will get more comfortable with it. And understand that what you're trying to do is open a door of communication. Like create a conversation around this with your athletes. Here's what we know, which is not much, but my understanding is after you've had a baby or two, it affects your running form and you can hang on to those changes six weeks, six months, six years, whatever, wherever they are, unless we actually look at them. So I'm wondering how that as part of your medical history is affecting what you're doing, but along with that often comes problems with how you're activating your abdomen. Or you might have a public health consideration like leaking when you're running or painful sex constipation.

Speaker 3 (45:24):

Like there's other problems that women have that are under the public health realm. You know, and so so I'm going to ask you, so have them in your intake form, have them, you know, are you comfortable having a conversation with me about that part of your life and your experience? Cause I'm wondering how it might be affecting what we're seeing here. We understand that there's an interrelationship with learning. The research is limited, but, and if you're not comfortable talking to me, understand that, you know, it is something that I think might be a variable. And so I'm going to actually at least try to incorporate your pelvic floor and your diaphragm and some of those interrelationships into our programming. But I also have someone down the street that you can talk to a few, be more comfortable. I just want to open that door, like open the door to a conversation.

Speaker 3 (46:07):

Like if that, if nothing else, if they aren't comfortable, you also should be skilling up to understand these components. How do you, what should, what do you see in a typical postpartum runner start looking for navels, start looking, going to central park, whatever it is, start to pay attention to these other variables and serve to give fit, give it new. Meaning like I, cause I read a lot of running research and athletics like sports medicine research and the meaning that it's attributed that is attributed to it is often based on what we've understood in men or like a strength based model. Like, well, they're just there post your chain. Isn't strong enough. Well, my question is why, why would every freaking females post your chain the off? Let's put that. Let's start thinking about that. That's the kind of questions I want to ask. Like the why we're seeing that as our common, it's not just structure, it can't just be structured because women aren't all structured the same P S all women do not run it into your tilt.

Speaker 3 (47:08):

Like they don't, what do you mean? Come on. Nobody does the same thing. All of us. Like it can't be. So it's like with what we've put this meaning on it and if you're postpartum or you're pregnant, you're you have an anterior tilt. Well, we have to have research has shown us. That's not true. So it's like, and then I don't know how you can overstride and inter tilt at the same time. Like, we need to really think about that because, but we've always, that's sort of the lens. And so everything gets filtered through it to the point that we exclude, like other, like, instead of thinking, Oh, well, this can't be the explanation. Let's ask other questions. It's this becomes the definition. Does that make, am I making sense? A hundred percent. Yeah. So it's like, how do we start say, okay, that's we didn't get to the bottom of it.

Speaker 3 (47:57):

What other questions can we be asking? And and, and to start to look at women, not just women, men too. So it's, it's like, how can we start to ask our questions a little bit differently? How can we start to and really it's to look for the, why's not, what is, why, why in the world are we finding this with all of our female athletes? Could it be the way that we've trained them to suck their stomachs in all the time, since they were 12 and 10, you know, like how could that possibly affect an entire generation of, of participants, right. Let's start looking at this, you know, so yeah. So I love her. Yeah. I mean, we brought up Eric Miura prior, so we'll throw him a little shout out here, but I wanna, I, I heard him speak at a conference.

Speaker 3 (48:45):

I don't even know time has no meaning now, but and one of the things he said was I, which I love was talking about with research. When you read the conclusion and research, is, is there any other explanation that could have come to that same conclusion based on what you're seeing in the light? And I thought that's so smart because sometimes I'm like, Oh, yay. My biases, my biases, whatever affirmed. And, but I, but so he was referring to that related to the research, but I think one of the things that I keep trying to think through for myself, and I think would be a really wise way for all of us as clinicians to think about it is what are other reasons why they responded to my treatment? What are other reasons that they could be experiencing this problem that has nothing to do with what I've always understood?

Speaker 3 (49:28):

You know what I mean? And I am sharing my bias. Like when I look at a female runner, I'm not like, Oh, that calf looks weak. I'm like, Oh, wow. Look at their central control system. Cause that's, you know, that's my lens. So I, you know, so I want to be open to understanding all of that other stuff, but I already, I already learned all that stuff. And this piece is something that isn't being considered by a lot of permissions. And so, yeah, so again, we need to start just broadening our lens and I think we're broadening it. I hope to look at females as not just little men and the problem we have wider pelvises, estrogen, and Q angles. Like there's other things happening for us that, that are not explained by those things. You know what I mean?

Speaker 2 (50:13):

Absolutely. Yeah. Thank you. This was awesome. Now, where can people find more information about you, more information about your, you have a running a female running course, where can, yes. Where can, where can we find all of that?

Speaker 3 (50:32):

I am at Julie PT and I have discovered that you can misspell my name and still find me. So it's J U L I E w I E B E P t.com. And I have, I do have an online course that was recorded from alive lives online opportunity. So it does have that flair that feel, but it also has the questions, which I love. And, but I also have lots of free resources in terms of blogs, videos. I do a lot of podcasts and have a newsletter to let you know about when opportunities are coming up. Like this one and what's coming up for us this next week to be a part of the round table. But but yeah, and I'm on all the socials

Speaker 2 (51:19):

You're everywhere. Thank you so much. You're all over the place in a good way. Not in a bad way, in a good way. So thanks so much before we sign off, I'll ask you the same question I ask everyone, and I probably asked you at twice or three times already, but we'll ask again, you can keep giving the same answer I want growing and learning. So that's true, but that's true. Yeah. So what advice would you give to your younger self? You know, what I'm going to share?

Speaker 3 (51:49):

It's funny. I was just thinking about this before we got on, but, and this is something that I've learned during the pandemic and and it's from Aaron Nyquist just, but he was referring to the spiritual, but I'm going to relate it to our walkthrough. Learning is instead of thinking of learning as this linear thing that I learned this, and now I know this, so that's stupid. I learned I'm making it on my hand. No one can see me. I forgot it was on a podcast, but instead of it being linear, which is so much of what ends up happening in our rural this dichotomy, Oh, well, biomechanics is stupid pain. Science is everything like, instead of it becoming linear in our thoughts is to think include and transcend. And instead of it being a linear line that it'd be concentric circles. And I was like, Oh my gosh, if I could be a learner like that, always if I had started my thought processes that way, like, wow, that would have been important for me as a person growing, but as a clinician growing to like that, instead of it becoming these battles that we get between these dichotomous, like VMO and like Karen, you remember BIMA, well, remember BMO, but instead of these like dichotomous thought processes, let's see, what can we continue to include?

Speaker 3 (53:05):

And then how do we transcend it doesn't mean that what we used to think was horrible and versus stupid. It's like, how do we keep building on that in concentric circles versus this linear thought process? So, yeah, so that was, that was just on my mind today.

Speaker 2 (53:19):

What wonderful advice it's like, it's like a reverse, it's like a reverse funnel. Yeah. Yeah. It just keeps getting brought. Our perspectives should broaden our questions should really never be answered. Like we should never get to the end of that. Do you know what I mean? And I just, I, anyway, it was a really just as so much has changed and, and it's been a really challenging year for all of us. I thought it was a, and we're headed back to a new transcendent, normal that I hope will bring a lot of changes for all of us. You know, I just, it was, I, I think it's a really important perspective as clinicians to, so I thank you so much for sharing that and thank you for spending the time today and tomorrow. I know, and tomorrow is our round table with you and Ellie and Chris and, and Tom.

Speaker 2 (54:08):

And I was saying like, gosh, to have the four of you on like one stage is like, Holy crap. I can't even believe it. So thank you for that. And so everyone you can find out how to join us all by going to podcast dot healthy, wealthy, smart.com. I mentioned it in the beginning, in the intro as well. So Julie, thank you so much. I appreciate you and appreciate your, your knowledge and your insight. Well, thanks so much for having me again, Karen. I appreciate it. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and stuff.

Speaker 1 (54:38):

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

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Chris Johnson to discuss empowering runners through rehab. He is a Seattle-based physical therapist, performance coach, speaker, and multiple-time Kona Qualifier.

In this episode, we discuss:

• Is resistance training needed for runners?
• Are training errors to blame for running injuries?
• How can clinicians guide the decision-making process around pain and return to running?
• Chris's best advice to be a running injury expert.
• How can the profession of Physical Therapy be thought of as your best friend in healthcare.
• The importance of being present and curious.

Resources:

• Chris's Instagram
• Chris's Facebook
• Chris's Website
• How to Improve Profits AND Profit Margins in Your Practice Webinar from New Health
• Running Round Table Talk

More About Dr. Johnson:

Chris Johnson completed his undergraduate studies at the University of Delaware, where he earned a bachelor of science with distinction while completing a senior thesis in the physical therapy department under Dr. Lynn Snyder-Mackler. Chris was a member of the varsity men's tennis team, scholar athlete, captain in 2000, and recipient of the Lee J Hyncik award for excellence in athletics and academics. He remained at the University of Delaware to earn a degree in physical therapy while completing an orthopedic/sports graduate fellowship under Dr. Michael J. Axe of First State Orthopedics. Following graduation, he relocated to New York City to work at the Nicholas Institute of Sports Medicine and Athletic Trauma of Lenox Hill Hospital as a physical therapist and researcher. He remained there for the ensuing eight years until 2010 when he opened his own physical therapy and performance facility, Chris Johnson PT, in the Flatiron District of Manhattan. In May 2013, Chris and his wife relocated from New York City to Seattle to pursue a more active, outdoor lifestyle. In addition to being a physical therapist, Chris is a certified triathlon coach (ITCA), three-time All American triathlete, two time Kona Qualifier, and is currently ranked 16th (AG) in the country for long course racing. Chris is also extensively published in the medical literature and has a monthly column on Ironman and an elaborate youtube channel.

Subscribe to Healthy, Wealthy & Smart:

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Read the full transcript here:

Speaker 1 (00:00):

Hey, Chris, welcome back to the podcast. I'm so happy to have you on in our month. All about running and running injury and running rehab. So thank you for carving out the time.

Speaker 2 (00:11):

It's fun to be back it's it's always a pleasure to connect with you. And it just snaps me back to New York city and I still don't know how we never crossed paths when when we were both there, but here we are, and I'm glad we connected and also happy women's history month. You're someone who's sort of spearheading a lot of great stuff in this space. And I think a lot of people, especially women look up to you and that you're a role model. So things that you've accomplished and continue to work on.

Speaker 1 (00:47):

That's very kind. Thank you. And now today we're going to do a basic Q and a with Chris Johnson. So Chris gets tons of flooded with questions and comments and things like that from emails to social media. And so I thought, well, let's see if we can make life a little bit easier, reach a wide audience and get some of these questions and concepts under control for you and out to the public. So let's start with a common question that you get is all is kind of around resistance, training and running. Do you need it? Do you not need it? I know that's a really broad question. So I'll throw it over to you around the the, the concept of resistance training and

Speaker 2 (01:40):

Yeah, and it's a, it's such a great question. I think that everyone's default answer is, you know, basically resistance training is a Holy grail for runners. And I do think it, it has its place, but I think that there are a lot of gaps in the research. And is it something that I prioritize myself as well as in working with the athletes I coach? Absolutely. But I think that anytime you're working with the runner, the primary goal is to get them into a rhythm with their training and to establish consistency of training. And then you can consider to start layering things in this is assuming someone's training and they're healthy. They have no remarkable past medical history. I, I think that, you know, the answer to that question differs especially if we start to get into master level runners who typically have a remarkable past medical history because most of these injuries and conditions go under rehab.

Speaker 2 (02:41):

You and I both know that as clinicians. So I think that a lot of the resistance training may just be cleaning up sloppy rehab that perhaps they didn't get around to addressing things at the tail end of the rehab. So there's a quote that I love, which is, you know, resistance training is really coordination, training under load. So, so yeah, I do think it has its place but it should be there to support our running, into build our capacity to run, but I've seen a lot of people get it wrong and they end up whether it's, if they're racing, they go into races where they're a little bit sluggish or they're carrying some residual fatigue. I've seen people get injured in the weight room if they're not perhaps if they're, you know, younger and more green. So yeah, I, I do think it has its place, but like everything you have to approach that, that runner athlete on an individualized basis and just understand where they're coming from.

Speaker 1 (03:40):

And in your experience, working with runners, what are the biggest barriers to resistance training for runners? Because not everyone has, you know, access to the same equipment and time and everything else. So what, what have you found to be the biggest barriers to resistance training?

Speaker 2 (04:00):

I think a lot of runners are intimidated by it unless they come from perhaps a multi-sport background where they've spent time in a weight room. I think right now with the pandemic, obviously resources and equipment or gyms are not as accessible or gyms opened in New York city right now are on a limited basis.

Speaker 1 (04:22):

They're open on a limited basis. I think you have to make an appointment a certain times and things like that.

Speaker 2 (04:29):

Yeah. And then I think that when people do get to the gym, they may not know what to do, and they may resort to something that they see on social media, some of the time, which might be fine. But I think that with running running has predictable performance demands. So it shouldn't be a mystery in terms of what we're trying to do. We're trying to challenge the calves, quads, lateral hip. And we're also we're not layering this in a ton. We're layering it in maybe twice a week on average. So but yeah, I think a lot of runners lack direction, and that's something that, you know, I try to put out a ton of content online. So people start to see how I'm approaching it. And I'm trying to essentially synthesize the literature and translate it to to just the everyday runner.

Speaker 2 (05:18):

And I think that there's also this element of rhythm and timing with running and that doesn't always get addressed through resistance training. I think perhaps a little bit more since some of Ebony Rio's research, but again, that's really in the rehab sector space talking about tendons, but I think that a lot of the TNT work or the tendon neuroplastic training work just has such salience to resistance training programs as well. So anytime, you know, people work with me, they're, they're going to get accustomed to using a metronome. It's just one more factor variable that I think that we can control for when we're prescribing. I

Speaker 1 (05:58):

Love the metronome. I love it. Love

Speaker 2 (06:01):

It easy. After a while though, I

Speaker 1 (06:03):

Give to everyone, even with my, even with my younger athletes, they get it, you know, and actually with those younger athletes, I'm talking teens, it's using the metronome, although they're like, Oh my God, I have to listen to this again. But it is actually good to give them a little bit of discipline around the, around the movement, around the exercise. But I love, I love the metronome. I have my patients like download the metronome, get used to it when you're exercising. I know it can be a little monotonous, but I think like you, like you said that with the research of Ebony Rio and others, I think it gives people, I don't know, like a, a little bit more discipline around their training.

Speaker 2 (06:49):

Yeah. I use it a lot when, if I'm giving someone calf raises something like a rear foot elevated split squat. If we're basically doing like a three zero three where it's like down on three seconds, up on three seconds without pausing yeah. It helps to maintain this rhythm. And a lot of the times I'll stop the exercise when they break that rhythm. Because it's telling me that, you know, maybe we're starting to reach the upper end of their abilities for that given exercise.

Speaker 1 (07:18):

Right. And we all know that three seconds to one person is very different to another.

Speaker 2 (07:22):

Yeah. Well, and this is what, you know, when Scott Morrison talks about anchoring and I just did that Instagram post on, you know, stop being awake or start to anchor. I'm starting to realize I'm becoming a dissenter. But you know, that's where the metronome comes in. And I've played with this so much. I mean, my, my neighbors probably think I'm crazy because I'm like out front with a metronome going, and I'm doing all these weird exercises. Well, weird to them.

Speaker 1 (07:49):

What sort of things do you implement to get over the barriers? Well, you just answered that. Anything else that you may implement to get over barriers to resistance training for runners? Like, like you said, in that runner who is very intimidated, maybe never used resistance training before.

Speaker 2 (08:06):

Yeah. I mean, I, a lot of the times when patients show up to my house, I mean, I'm working out of my garage. We have a space on our property, you know, when they arrive a lot of times I'm deliberately training. So they see what I'm doing and they see that this is a normal part of my routine. And then they get a lens into my racing background, yada yada. And so I want them to realize that this is something that is normal. And I think in a lot of running circles, and I think this is starting to change that it's not prioritized to the extent that it is. And maybe I'm just getting older because, you know, as a master athlete, it's amazing having dealt with some patellar tendon issues, like my body craves resistance training, where if I don't do it, I start to sort of get reminded. My knee feels so much better after I load it and load it relatively heavy. Now you have to be cognizant for reasons I mentioned before, in terms of like, you're not going to want to do a bunch of heavy squats. If you have a race coming up you can keep your body under load, but you need to be a little bit more calculated with your exercise selection as well as your dosage.

Speaker 1 (09:12):

Yeah. And, and that's where I think working with a coach or therapist or someone who understands understands one resistance training and two race training and how you can kind of blend those together is really important. And now sticking with training, let's talk about training errors. Can we just blame everything on training errors? Is that, is that an okay thing to do now? Or am I, is that not good? And I say, I say that with a wink for those people who are listening.

Speaker 2 (09:40):

Yeah. I mean, I think it's a convenient thing to do, but I think that I'm going to get myself in trouble here. I think it's a little bit lazy too. In, in, I think that having lived in New York city that you realize the life load factor, right. You know, there's different stressors in New York, between loud noises, you know, smelly things, you know, financial stressors in crowded spaces, you know, maybe your sleep has fallen by the wayside. So you may have a training program that's very sensible. And, and then all of a sudden you have something come up. I think to one of my, I'm an athlete who I'm working with right now, and this guy's just been just so tough and durable. And recently things have started to take a turn in a bad way. You know, he, he lost his mom.

Speaker 2 (10:38):

He's been having to contend with that. He's had some other job-related issues and and then he he's come down with the patellar tendinopathy and his training didn't change that much. And we actually dialed it back a little bit and it just shows it sometimes all of these other factors, you know, play such an important role in the overall being or totality of that athlete. So, you know, I, I, I think that we'd be much better off calling them ecosystem EHRs where perhaps there's a disconnect, but I think that we have to be careful, always blaming it on training. And I, I get the point, I think that, you know, from a, from a research standpoint, maybe the reviewers are requiring the authors to, to present it in that manner. But I just think there's a lot more moving parts. And I find myself having worked with a ton of athletes over the course of my career, being an athlete that you have to really be in touch with your ecosystem.

Speaker 2 (11:39):

And I don't know who first came up with that word. I know Greg uses it quite a bit, but I think it's something that, that is great to consider. And anytime I start working with an athlete, I have a conversation and it doesn't end during that initial consultation or phone call, but I'm saying, tell me about your life. What was it like growing up? You know, what, what was your relationship with food? You know, what kind of sports did you play? You know, were you in public school? Did you go to private school? What was college like if you went to college, you know, what's your current situation? Are you single? Are you married? Do you have kids? Are you a single parent? You know, I need to capture all this information and that's just scratching the tip of the iceberg in that conversation's never ending. So I feel like the more I know where people are in life, the easier it becomes to start putting down sensible workouts on paper and make sure when you put them down on paper, they go and pencil nodding.

Speaker 1 (12:34):

Yeah. I love that. Getting deeper into those questions and, you know, we had a conversation a couple of weeks ago with the surrounding a female athlete on clubhouse and Tracy Blake, who is just fabulous. I don't know if you're familiar with Tracy. She's a physical therapist in Canada. She's worked with a lot of professional athletes there, including their Olympic volleyball team. And she was talking about questions to ask. And I think oftentimes this is sort of floated over kind of skimmed over by a lot of PTs because we asked, tell me about, tell me what happened, what happened with your injury? Tell me what happened here, not the questions you just said. Tell me about your life. Are you married? Like Tracy said, you know, a question she always asks is, do you have children? Do you have pets? What, cause that gives you an idea. What are your responsibilities throughout the day? Yeah,

Speaker 2 (13:29):

I always say, you know, look, give me a lens into your situation and let the conversation unfold from there. And I think, you know, whether you're a physical therapist or coach, I think all physical therapists or coaches, whether they realize it or not, you know, you're, you're trying to basically capture that ecosystem. And to, to just have, you know, talk to people about, you know, I just have a candid chat with folks and from there, then we can start pulling levers.

Speaker 1 (13:59):

Right? Cause then you're getting a, really, a more holistic view of this person. And then you can say, okay, they have two small children they're working from home. Their kids are being at school, school, they're at home. They don't have the time to spend two hours a day between training and running and everything else. And how can you make things work for them? Is that about right? Yeah.

Speaker 2 (14:25):

And I think that any, any time a patient or athlete consults us, they're looking at us as an agent of change and the true agent of change is themselves. And it's trying to help them plot out their own course. And maybe you, you know, you're shining a light on the path here and there, or making sure that they don't step into a pothole along the way. But that's something that, you know, I find myself more and more. I have any expectations to, I don't do things to people. I sit there and troubleshoot with them. And, and I think that that's what we, as physical therapists are phenomenal with. And not only do we have the skillset, but a lot of times it most of us have positioned us to have the time to do that. And you can't rush that process. So but yeah, we're, we're not in a system that incentivizes that, you know, you don't get paid to talk to people, you get paid to do things to people. And that's the fundamental problem with, for the reimbursement structure, for people who are in network. I mean, you and I are a little bit spoiled in the sense that when we're providing care, it's just ourselves and the patient, but that's, I think that needs to be the standard or approximate the standard. Yeah.

Speaker 1 (15:41):

And isn't it like amazing when that aha moment comes as you're sort of talking through things like you said, troubleshooting, and the patient goes, Oh, wait a second. I can do blah, blah, blah, blah, blah. Or, Hey, maybe that I didn't even think about that. Maybe that is contributing to XYZ.

Speaker 2 (15:57):

Yeah. And I, that's a lot of motivational interviewing and sometimes, you know, I was talking with a couple of people yesterday. Sometimes people who've already arrived, you know, if we're, if we're discussing surgery, you know, I think our goal is to always try to help people avoid surgery, but sometimes people are just dead set and you say, look, you know, I get the sense that you've really just you've arrived at the fact that you're going to have this surgery. Am I correct in saying that, and you know, if that's what you've elected to move forward with, this is your decision. What questions do you have about the surgery? You know, and, and then you may start getting into a conversation and say, Hey, can I, can I share my experience? You know, this happened to me with my clavicle. I was in Hawaii, we'll be traveling to Argentina to speak.

Speaker 2 (16:44):

My wife was pregnant. We had a little one, I was going to have to do a lot of physical tasks. And I'm like, I just need the surgery. I didn't have it on my right shoulder when I, my clavicle fracture. And I was just dead set. I'm like, I'm in Hawaii, there's a competent doc. This is not a super involved procedure, like a soft tissue procedure of the shoulder hip. And I had this and I could have been kicked myself for doing it in hindsight, but no one would have talked me out of that at the time. So sometimes people have to learn through their mistakes and sometimes that can be a tough pill to swallow, but that, that patient ultimately controls that decision. So sort of bobbing and weaving, but,

Speaker 1 (17:25):

And, you know, you just led perfectly into the next topic I wanted to cover. And another question that you get asked often and that's, and that is surrounding pain and pain and decision-making, so we, you, I feel like you led perfectly right into that. So let's talk about how we as clinicians and practitioners, where our role is when it comes to pain and decision-making for that client or that athlete.

Speaker 2 (17:53):

Yeah. It's it's one of the first things, if not the first thing that I discussed with people I did a book chapter for this it's called clinical care of the runner. Dr. Harris. Who's a physician at university of Washington was the editor. And he asked if I would read a chapter on training principles. And I essentially said, the first thing that we needed to discuss is someone's relationship with pain and what their understanding of it is and how they approach decision-making in around pain. Because if you're running, you're going to be dealing with pain at some point, you know? And and I think people have an inaccurate understanding a lot of the times. So, and I think sometimes we, you know, I'll use an analogy that Mike Stewart or you used which I think is brilliant. You know, sometimes when we're out training and we're driving through a school zone, right?

Speaker 2 (18:48):

School's in session, the lights are blinking, slow down. All right. Sometimes you may be driving through that crosswalk. School's in session lights are blinking and you have a crossing guard. Who's standing in the middle of the stop sign. Maybe that's a case of someone's dealing with the bone stress injury. So you need to really hate that. Other times you may be driving through that school zone. It's a weekend, no blinking lights proceed as is usual. And I think that's a good way to think about training, but you know, you and I both know that if someone has a lower limb tendinopathy, you know, we want to monitor their pain and understand how it's responding as a function of a particular training session, whether that's a run, whether it's a plyometric training session or a heavy, slow resistance, but we don't want to shut that person down in it.

Speaker 2 (19:37):

As much as we in our profession may be, high-fiving each other thinking that we're doing a good job of this. Most of the people that consult me, even people perhaps worked with me in the past for short periods of time. They still, when they experience pain, they assume damage and inflammation. And what do they do? A lot of times they, they they'll resort to taking anti-inflammatories and here we go. I mean, this is a, this is where things go South. So I think it's just important to say, Hey, what sense do you make of this? You know, what do you, what are your reservations? Are you okay working through some pain? And I think from there then the stage is set to proceed. But with a lot of, I've worked with a lot of master athletes and they're, they've had a history of lower limb tendinopathy.

Speaker 2 (20:23):

I know that with my left knee, that, you know, I, I worked through almost a year of pain, but I never stopped training. And I was just sensible in how I was staggering, my workouts to afford appropriate recovery time. And and also just knowing how college and synthesis behaves. So yeah, I think that people have a, a skewed understanding and it's also something very personal, but yeah, if you're working with athletes, it's a critical conversation to have. And I do think that this is where I know Ellie was on talking about bone stress injuries, that if you are remotely concerned about a bone stress injury, and it involves a high risk site, like zero out of 10 pain is the goal. Most other instances, I'm a little bit more cavalier, but if I know, if I see some of the signs that I would associate with the bone stress injury, especially if we haven't had imaging, I'm going to be conservative as hell. Yeah.

Speaker 1 (21:19):

And I think it's important to, to note that understanding the runner and that's where understanding the ecosystem comes in and understanding, especially for bone stress injuries, where those high likelihood of those injuries occurring. So it also like you have to know your stuff as well is what I'm getting at when it comes to runners and, and having that conversation around pain can be uncomfortable for that runner or for that person. Cause you may have to dismantle a lot of long-held beliefs. So how do you go about that with your, your athletes?

Speaker 2 (21:57):

I just asked everyone who who connects with me. I say, can you give me w what, what's your understanding of your situation? You know, and I think runners, a lot of times may not come clean if they're dealing with pain, because if they go to see a healthcare professional, they're going to be concerned that they're going to get shut down work. Perhaps they interpret it as a sign of weakness. If they're out on a group run, they don't want, want to be the one complaining. So I just say, Hey, you know, what's your understanding of your situation? And no one's ever asked him that. And that's when the conversation unfolds. So, and I think the way people respond is going to be different pending the person, the situation. But I think it's remissive anyone who's working with a runner or an athlete if they don't ask that question. I feel like I started to answer your question, but I don't know if I do.

Speaker 1 (22:48):

No, you did. That's exactly what I wanted. That's exactly what I wanted to hear. Cause I want the listeners to get as much of this like great little tidbits of information from you as they can. And you know, all of the questions, the questions to ask the patient that you've given so far, I think are great jumping off points for any therapist, regardless of whether you're working for, with a runner or an athlete. But that question of give me the, let me know, what is your understanding of what's going on? And that opens up a whole lot of doors for you. And then, you know, as the therapist, you have to be well versed in the science behind pain and, and how to talk to people. And, and of course it's a whole other conversation, but you know, I think what you're highlighting here is that you can't wing it.

Speaker 2 (23:36):

No. And I think sometimes, you know, I had a question from a third year DPT student who watched a presentation. I gave at some and they're like, Hey, I feel like I'm starting to ask the right question, but then I don't know how to respond and follow up. And and I think that, you know, you can't rush this process if you're in, if you're a young clinician that you're going to get better at this through reps, through life experience and just through sort of being in the trenches with people. But you know, the other thing I tell folks is I say, look, you're a smart person, you know? And I, you know, when I first acknowledge the fact, I think it's good that you're being proactive and addressing the situation, but left to your own devices. What do you feel like you, you need to do to get on the other side of this and they start to formulate a plan and I do, I don't need to do anything.

Speaker 2 (24:27):

I just need to pose these questions and say like, I think that's pretty sensible, you know? Are you okay if we nudge a little bit and you start to basically prepare them for the fact that this plan has got to be progressive, if we're talking about getting them back to running, because they have to get back to a low-level plyometric activity. And I just love these conversations. And, you know, people ask me, they're like, where you learn motivational interviewing. And I'm like, I lived in New York city for decade. I'm like, I just talk to people and I have no agenda. I'm just curious, you know, it drives my wife crazy. Cause if we're ever out in public this happened yesterday. I went to, I had to get a new watch because my watch crapped out and this guy was checking out some watches and we just got to talk to me. And my wife was looking over at me, like, where are we go?

Speaker 1 (25:12):

Your wife is looking at her watch, like, come on, Chris, get it together

Speaker 2 (25:18):

And things off the shelves.

Speaker 1 (25:21):

But it's true. I think that, you know, asking good questions, motivational interviewing a lot. Yes. There's a lot of books. You can pick any book on motivational interviewing and read it and it will definitely give you some insight, but it's the more you do. It's the more people you talk to and not just your patients, anybody, the more you talk to anybody, it will help you be a better motivational interviewer. And the more that you listen and like really listen and start to formulate it's practice. I guess you start to formulate your follow-up questions in your head as you're listening. And again, it's just practice, practice, practice.

Speaker 2 (25:57):

Yeah. And it's, it's fine. I think that it takes on a slightly different flavor as a function of, you know, what generation the person's coming from too, you know? So but yeah, it's just fun to help troubleshoot with people and to really get them to trust in themselves. Because most of the, the folks that consult me, I mean, they're endurance athletes, namely runners and triathletes these days, and they're going to manage their situation conservatively. Sometimes I feel like they need to be talked off the ledge. If they're going to opt for a more invasive procedure, if that's not really appropriate or perhaps an injectable of some sort. So, but yeah, getting people to trust in their body and and not drag them in for therapy all the time, you know, and I, I have to prepare people for that to say, you know, how do you anticipate this is going to go?

Speaker 2 (26:49):

And they're like, well, maybe I'll see you two to three times a week for six to eight weeks. I'm like, who's footing that bill. No, no, one's good. Yeah. So I say, you know, but this, this requires a lot of work on us on the back end because when I write an email, I mean, email, I wrote to this person yesterday, it was basically like, you know, two pages and cause it, kids dealing with the bone stress injury, the parents don't really understand the implications of it. He's going to be running competitively in college. And, and I think that he was under the notion that he was going to be back to running in four weeks. And I'm like let's talk about more like four months. And I lay this out and I'm like, you know, I know this is probably a little bit, you know, overwhelming, or you weren't expecting to hear this. What are your thoughts on this? You know, to engage him, to just know where he is after I've presented this information and he got the memo. But that's, that's a tricky thing about bone stress injuries is people fall under the, you know, the idea that they're just gonna take a couple of weeks off and plugged back in.

Speaker 1 (27:49):

Yeah. Yeah. And again, that's where you, as a, as a therapist and a coach comes in and helps the decision-making you're ultimately, you're not that runner, you're not that athlete. So you're not the ultimate decision maker, but your job is to give as much information and, and your professional opinion as to their situation as you can.

Speaker 2 (28:14):

Yeah. And I, I think that it traces back to that question is like, what are your expectations or questions around this surgery? I mean, this is a very involved procedure. They're putting you under anesthesia and they're cutting your body open. Never we'll frame it like that, you know, when I'm working with people. But you know, I, I rehabbed all of these people after these very involved, soft tissue procedures of the shoulder when I was in New York, coming from Dr. Nicholas in his staff. And yeah, I'm like, this is going to be six months to a year before you feel like your, your shoulder is like firing on all cylinders.

Speaker 1 (28:47):

Yeah. Yeah. I had, I had a complex soft tissue shoulder repair and it was a year anyway, we can go on and on when it comes to a patient mindset, fear, trepidation, everything else. I think that's for another podcast. But I think you definitely got across the decision-making process on behalf of us as a therapist or coach and how we can influence that process for the patient.

Speaker 2 (29:12):

Yeah. And I think that if patients aren't on board, I mean, if they are around muddy water where there's a sinister situation and they start sort of dilly-dallying, I think that we need to really put our foot down his therapist too and say, look, you know, you've consulted me and here are my recommendations or here's my professional advice. And if you're not going to take it, let's just, let's just part here. And sometimes we don't need to do that a lot, but I think sometimes we drag our feet as clinicians and we need to, we need to put our foot down if we have to protect that person from themselves, because we can't get tangled up in that mess. I can't think of the last time that's happened, but it has happened over the course of my career.

Speaker 1 (29:57):

So those, I mean, those are sticky conversations to have, but for the safety, I mean, our job is to protect that, protect our, our athlete, our patients. So if that is our job, then you have to have those sticky conversations. Yeah. And that's it. All right. So I think that was thank you for that conversation on decision-making and hopefully it sparks plant some seeds in our listeners here. And now we'll go on to two more questions that you usually, that you get the easy ones. You will we'll breeze through these too. These are easy. How do you become a runner running injury expert To how many times do you get that question? How can I do what you do?

Speaker 2 (30:41):

Yeah, I it's, I, I love getting it it's flattering. You know, and, and it's something that it was sort of, I looked back and all, I, there, there were a couple of defining moments in my life. And one was when I was told that I'd never be able to run again. You will never run again. Right. I heard that a couple of times from very world-renowned orthopedists. And I think that's what ultimately put me on a trajectory to do this. And I never ran competitively when I was younger. I probably should have been channeled into a little bit more of a, a running program, but I was always playing sport, different sports, you know, from skateboarding to soccer, to tennis, to baseball, to basketball, to lacrosse, to, you know, rollerblading snowboard, like you name it. I played it. And except football, just because my high school didn't have a football team.

Speaker 2 (31:39):

So I always relied on running to help me in sport. But I feel very fortunate in hindsight that I never started really formal distance running until I moved to New York city around like maybe 24, 25. But I, I think that when I started getting into triathlon is when I started working with a lot more runners. And I think when I started distance running, that was around the same time and it's just a fun bunch to work with. And I think that initially I was overconfident and it got to be frustrating when I'm like, geez, this is a healthy person. Like I would send them out. I'm like, Hey, I think you're doing good. And they would come hobbling home. Or they would call him and be like, Oh, I blew up on that run. And I'm like, why are these people blowing up on these runs?

Speaker 2 (32:25):

Like I thought they were doing a good job. And then it just really forced me to stare at myself in the face and say like, what do I need to be doing to really help these people? And, you know, I started reading a lot of the research. I started spending time around runners. I started speaking a lot with this fellow Bruce Wilke, who was sort of like a savant with running who unfortunately has since passed. But I started to really get a handle on running and not only on running, but just the mindset of runners, how they approach training how they've sort of just been dismissed by the medical community. Because you're like, Oh, here's a runner here comes another crazy runner. And then you start to realize that runner, when someone tells you they're a runner, you don't have other athletes.

Speaker 2 (33:09):

When you meet someone, you know, you could meet someone, you could meet a world-class athlete and they may not come claim that the fact that they play a competitive sport professionally, or they play a professional sport until you talk to them, runners like I'm here, I'm a runner, you know? And so they really stuff, they go through an identity crisis. So you have to look at this from so many different lenses. You have to understand the performance demands of the sport. You have to understand, you know, just running communities. You need to understand that these people's identity revolves around their running. So they become fragile when they're not running. So I just loved the challenge of, you know, addressing all these different factors and and it helps that I, that I'm still training and racing competitively because I sort of go through, I think a lot of the same struggles and challenges that they face so I can speak to them.

Speaker 2 (34:01):

But I think that if people want to go, go in on running as a young clinician, coach running is having a moment go all in, right. We saw an uptick and running with the, you know, with the pandemic. And I think that if you're going to work with runners, you don't want to say like, Oh, I do general outpatient orthopedic, orthopedic rehab. It's like, no, my whole practice revolves around running. You know, people are like, they come to me because they know that, you know unfortunately I've had a pretty rich experience in terms of my, my didactic training. And, you know, when I was getting reps under my belt in New York city. So I feel like now I can look at things through a very global lens when a runner presents and we can troubleshoot most of the time, I'm seeing people for one, maybe two sessions. But I think that that running rehab is challenging in a lot of different ways, but if people have a, an interest go all in,

Speaker 1 (35:02):

I think that's great advice. And I also really liked that. You just mentioned, Hey, I'm not seeing runners three times a week for six to eight weeks. You know, I'm not, this is not how I'm, I'm, I'm building my practice. And I think that's important to let people know, because I think a lot of newer graduates or students might be thinking, Oh, this is going to be great. I'm going to be working with people several times a week for six weeks. And then they're all better. Not so much the case when it comes to running injuries.

Speaker 2 (35:31):

Yeah. And their runners just seem to perpetually get these niggles and aches and pains. But, you know, I, I, I think it's doing a disservice because if you bring someone in, if you say, Hey, look, I need to see a couple of times a week for the next six to eight weeks. You know, someone told me that I'm like, man, I must have something serious going on. So I just say, Hey, look I'm not concerned. Anything sinister is present. I want you to be sensible. You're around muddy water, but carry on. All right. In calling me if you need me. And I think that they're like, wow, I've had people reach out and are, you know, this person told me they were running five to six days a week and their quads were a little bit sore. I'm like, Oh, you're good, man.

Speaker 2 (36:10):

You don't need to see me. You know, I said, and I asked him some, some more involved questions, but I'm like, you don't need to see me. That's a really empowering message, you know, because the person's like, Hey, I'm here ready to pay you. And you're telling me that you don't want to see me. I, one of a guy who's become a good friend of mine. He was dealing with some hip pain. He was in a bicycle accident and he had some films in between x-rays MRR because of a woman who who's pulling out of a parking lot, had collide with him for whatever reason. And you know, and I got a lens, you know, I saw his power profile on his bike. I saw the lifts that he was doing because we were training at the same facility. And he's like, I, I need to come and see you for physical therapy.

Speaker 2 (36:52):

I'm like, no, you don't. I'm like, I'm watching you lift, man. You don't need to come and see for, you know, let's, let's just chat. If we cross paths here and he's become a very good friend, he, he always jokes. He's like, you're the only PT you've told me not to come and see you. He's like all these other people are like trying to get me in and get me on these programs and tell me, I need hip surgery and PRP and yada, yada. So, but you need to know that nothing sinister is going on the flip side of the coin.

Speaker 1 (37:19):

Right. And that's where experience comes in and confidence as a clinician comes in as well. And that takes time. So you're not going to be, so what I'm getting is if you want to be a running injury expert, go all in, read the research, do the things, take the classes and take time. It takes time and leave your ego at the door.

Speaker 2 (37:39):

Yeah. And I think the patterns will become, they'll become pretty straight away in terms of where runners are getting into trouble. You know, where are these injuries are manifesting? And, you know, I, I think that most of it is being disconnected or out of touch with your ecosystem and not laying down programs that sort of reflect your ecosystem and realize that target is always moving. Right?

Speaker 1 (38:03):

Yeah. Yeah. Excellent. Okay. Final question of our interview here. And again, it's, it's an easy one. So, so we talked about this ahead of time. This is an easy one. So, well, how do I even phrase this in looking at the profession of physical therapy, what can we do better to define what we do and kind of stake our claim on what we do as a profession?

Speaker 2 (38:37):

Yeah. I still am organizing my thoughts around this. I went into physical therapy because I thought it put me in the best possible position to help troubleshoot with people through a conservative approach. And I think that the challenge we have is physical therapy is a very tricky thing to define. And I think that where we're ultimately, and this is a quote from Jen Shelton, who was you know, in born to run, she was a young gifted ultra runner at the time. I don't know what she's up to these days, but she's she's a trip in all great ways, but she said physical therapists are your best friends in healthcare. And I think that we're well positioned to be the first line of defense because we're trained across such a broad through such a broad range. So, you know, you may see us working in cardiopulmonary capacity.

Speaker 2 (39:40):

You may see us working in wound care. You may see us working in a neurologic geriatric with geriatric population. You may see us basically with working with pro sports teams you know, pelvic floor. I mean, it's tricky when you have all these moving parts, but I, I don't think that we've defined who we are as a profession, to the extent that we need to. And and I think that's why a lot of other people end up defining us sometimes in good ways sometimes in bad ways. But I think that it's sort of like, you know, I'm in Seattle, I'm going to use a microbrew example. You know, you have run of the mill rehab. And I think some people lump physical therapy ended up, but physical therapy to me is sort of like a microbrew, right. We need to tell people what to think about it.

Speaker 2 (40:34):

We can't let them conjure up their own ideas. We need to really define who we are as a profession. And and I, I don't think we've done that yet. I think that we're, we're getting there, but I don't, I don't think we've done a really good job defining physical therapy. Cause if you ask people, you know, people are like, yeah, I've tried physical therapy and we know the same, the response, it's a heat ultrasound TheraBand. And it's always funny when people connect with me, they're like, this is so different from like what I expect to physical therapy to be. And I'm like, well, what did you expect it to be? And it was generally the response is what I just mentioned. And they're like, you just helped me troubleshoot and in sort of the seamless way. And, and that's what I think we do.

Speaker 2 (41:21):

We triage and troubleshoot. But we look at things through the people who I really respect in life. They're able to look at challenging situations through multiple lenses. And I think that that's how we're trained as physical therapists. And I think that that's why we're in such an incredible position to troubleshoot with people. So I don't know why you've got my gears grinding even more. And I, I, I think about this morning, noon and night is, you know, how do we better define our profession? So we don't let people conjure up their own ideas of what it is, because I think a lot of times if they've had a bad experience, that it becomes very skewed in physical just saying physical therapy doesn't capture it.

Speaker 1 (42:09):

Yeah. I agree with that. And so what can we do as a profession to change that? I agree it needs to be changed. And I agree we need to be the ones out in front talking about what we do and how we do it and why we do it. So when, when you think about that, what sort of ways can we be out in front and take control of the narrative?

Speaker 2 (42:33):

I mean, I think it needs to be orchestrated. And I think that that's, that's a major challenge right now. Because I think that is a profession we're a little bit more fragmented than, than one might think. So I think that we have to have a lot of people come together from different sectors of the field and have have a long, hard staring in the mirror and talk with each other to try and arrive in a definition for what we do. And I think it's a really challenging thing, but I think it's something that is very important, but I think also individuals like yourself where you start to represent the profession. You know, I try to do the same thing. I think that holds a lot of weight too. So I, I think it, you sort of have to take a multi-pronged approach.

Speaker 1 (43:23):

Yeah, yeah. So you have to take that 30,000 foot approach by having a lot of people from different areas come together and give that wide umbrella. But then from a micro position, individuals can also be out there and trying to, to change, to make a change.

Speaker 2 (43:40):

Yeah. And and I, I'm confident that we're going to do that. I don't know. I feel like I'm in my early forties now and I'm starting to become more reflective in life. Right. And and really think about, you know, a lot of things, one of which is a profession and, you know, I just feel like a pig in poop having landed in this profession because I'm such a diehard PT, but I also, like, I feel like the perception of physical therapy needs to change too.

Speaker 1 (44:09):

And, you know, I will say that I do see it changing slowly. I mean, this is a big ship to turn and I'm talking from a societal standpoint. And I say that because I see more and more in mainstream media, whether it be on television, print, blogs, podcasts, et cetera, that journalists are now reaching out to physical therapists. Whereas they would have reached out to a trainer, a chiropractor, a yoga instructor, or something like that when it comes to their articles on everything from training to, I just did an interview yesterday about pillows, you know? So it seems like, well, what, why would they reach out to a PT about pillows? You know, but it's nice that they are reaching out to PTs about things like that. And things about training and things about COVID rehab and, and long haul COVID patients, you know, physical therapists are now being part of that conversation. I'm seeing that more and more from main street, main stream journalists. So I feel like that's a good sign.

Speaker 2 (45:12):

Yeah, for sure.

Speaker 1 (45:14):

A good sign, for sure. And, and also showing that journalists are open to hearing from different groups. So I always say to physical therapists like contact your local newspaper, if you live. And, you know, I'm from a small town in Pennsylvania contact that local newspaper asked to write an article, ask to, you know, be a contributor, get onto your local news stations find, cause that's, that's the way the general public finds out, you know, on social media, there are some people like yourself and others that have great social media followings and are putting out great content designed for the consumer. But a lot of physical therapists on social media, probably myself included do social media posts for other therapists. So it's a little different, right.

Speaker 2 (46:01):

Yeah. And I think that's okay. And I think it's

Speaker 1 (46:03):

Okay. Yeah. But I think we, it could be broader.

Speaker 2 (46:07):

Yeah. I just, I think that when I work with folks and I, I'm not alone here, but when people start getting a lens into my thoughts on a particular situation, if they're like, Hey, I have some calf pain, they call me on the phone. They're like, they may be an athlete. And they're like, Hey, I have some calf pain, but a great example. This guy reached out to me the other day. And he was dealing with what he was told was an Achilles tendinopathy. And he was under the care of a physician and other rehab professional outside of the profession and I'll leave it at that. And when he came to see me, his primary complaint was he was starting to lose coordination in his left, lower extremity on the run. And he started to feel more disjointed on the bike. This isn't an Achilles tendinopathy.

Speaker 2 (46:54):

He may have symptoms that, you know, that are consistent, but that's not what's driving. So, you know, you start to think of, okay, well what could this be? You know, is there something going on maybe like from a differential diagnosis, you're starting to run through like, Hey, is he's telling you this, like okay, is this unilateral? Is that bilateral? You know, is there any loss of sensation, strength, power you know, is this, like if we just start asking a different set of questions, you know, could this be a runner's dystonia? Could it be something like multiple sclerosis, it could be ALS. So you have to, when someone says, Hey, I have this complaint, we're asking in terms of what's running through our mind and the questions we ask, they're very different. So I'm going to start challenging him from different coordination tasks.

Speaker 2 (47:44):

I'm going to take them through lower quarter screen. I'm going to get a lens into his running. You know, I'm going to understand how an Achilles tendinopathy would present if he's not having issues doing calf raises. And he's able to sit there and jump in place. I'm like, you're killing is, is pretty, pretty good, man. You know? So for whatever reason, there's this timing issue in his Achilles is probably seeing a different or an unaccustomed rate of loading that, that he's not withstanding from a timing perspective. So, you know, he's someone that probably ultimately needs to consult a neurologist, right? So why is no one told him that for a year? And they're telling him that he needs to do a more aggressive form of scraping and he's a candidate for a PRP, excuse my language, but that. Right. So this is where our role is just so critical because we sit, we spend an hour with people or at least, you know, a lot, and we, we can sit there and troubleshoot with people and really get them into the right hand. Why is no one ever he's like your assessment makes so much sense to me. And so many examples. Yeah,

Speaker 1 (48:51):

Many, many examples. Well, Chris, this was great. What a good conversation. I think there's a little bit of got a little bit of everything in here, and hopefully we answered a lot of w V a lot of the questions that you get on, on a daily, weekly, monthly basis. So thank you so much now, where can people find you?

Speaker 2 (49:11):

I can't tell you no,

Speaker 1 (49:13):

I'm going off social media now.

Speaker 2 (49:17):

Instagram is good. I'm just at Chris Johnson, the PT, and I'm in the process of revamping my website and that should hopefully be done at some point in the next couple of weeks. And and that's gonna really just, I think, make it easy to understand what some of my offerings are and how to sync up with me. And yeah, for folks, if, if you want to sign up for a crazy newsletter please join my newsletter. It's a little bit of reverence. So I'm preparing it now in, in good ways. So,

Speaker 1 (49:49):

And how can they sign up for your newsletter? That'll be on the website and Chris Johnson, pt.com or Zara and PT.

Speaker 2 (49:56):

Chris Johnson, pc.com. Yeah. Going back to my roots,

Speaker 1 (50:01):

Go keeping it simple. Right? Well, this was wonderful. Last question, knowing where you are now in your life and career, what advice would you give to your younger self now that you're, you're pondering, you're pondering life in your early forties.

Speaker 2 (50:18):

Oh, stop taking yourself so seriously be present with people, equally people, power, power, your phone off, and and be present with people. And for folks who are who are coming to see you understand that a lot of what brings about changes in what helps people are these non-specific effects, you know, during a clinical interactions. So don't feel like you need to have this gnarly didactic knowledge. That's going to come in time by continuing to read the research, spending time around other mentors or clinicians. You respect taking courses from them. But if you can just be present and engage with someone, take a genuine curiosity in their situation, that's going to do wonders and and yeah, take the pressure off yourself.

Speaker 1 (51:07):

Excellent advice. Excellent. And I thank you so much again, Chris, for taking the time out. And we will see you in a couple of days next in a week or so for a round table discussion, which I also think will be phenomenal. So thank you so much.

Speaker 2 (51:22):

Yeah. Thanks again for having me on Karen and keep up the great work. It's fun to, to just sort of follow your, your journey and calling me if I can do anything to support you.

Speaker 1 (51:31):

Thank you so much. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart.

In this episode, we have Tom Goom with us again to join us with our running injuries and running rehab talk this March. Today we will be talking about acknowledging types of persistent pain in our athletes or runners.

He talks about the bigger picture on persistent pain and its other connections, differentiate this persistent pain versus series of acute flare ups, where we should focus the treatment, and navigating injured athletes return to their sport and many more.

Key Takeaways

• we mustn't lose sight of the bigger picture. And actually, I think sometimes we do need to acknowledge that it is more of a persistent pain state, and not necessarily a series of flare ups of acute injury.
• Gritting your teeth and pushing on through isn't always the right answer… we do need to know when we need to back off a little bit.
• Focus on getting you well and ready to race rather than rushing you to get through a particular event when you've got a whole life of running ahead of you.
• Try and see if you can recognize when you are looking at a more persistent pain state and to try and really get to know that person and the bigger picture and what's driving that

Suggested Keywords:

Pain, athletes, running, persistent, bigger picture, acute injury, symptoms.

More about Tom Goom

Tom is physiotherapist and international speaker with a passion for running injury management. He has gained a worldwide audience with his website running-physio.com and has become known as The Running Physio as a result! Tom remains an active clinician committed to providing high quality, evidence-based care.

Social media handles:

Twitter: @tomgoom

Instagram: @running.physio

Website: Running-physio.com

Resources:

Running Injury and Rehab Webinar

NetHealth Webinar

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Read the Full Transcript Here:

Speaker 1 (00:01):

Hey, Tom, welcome back to the podcast. I'm excited to have you on today.

Speaker 2 (00:06):

Thanks for having me back. I really enjoyed it. Last time we took proximal hamstring. Didn't we last time it was a good chat

Speaker 1 (00:13):

We did. And now this time you are part of the month of March and this month we're talking all about running injuries and running rehab. So what we're going to talk about today is persistent pain in these athletes. And I know this is something that you're seeing more and more of. So let's dive in what let's talk about as physical therapists or physiotherapists. Do you feel that we're acknowledging these types of persistent pain in our athletes or in our runners? Or are we just thinking, Oh, well, you know, they have this tendinopathy or this strain and it's just keeps recurring. It's just like a, it gets better and then becomes an acute injury again or this back pain. Oh, same thing. It, it kind of goes away and comes back. So what, what is your opinion on that? Are we acknowledging persistent pain in these athletic populations?

Speaker 2 (01:20):

Yeah, that's a good question. I think maybe we D we do look at it a bit more, like you're saying, we just kind of see it as a sort of repeated acute injury may be large rather than seeing it as a persistent pain problem. And I think that's because in part, when we see people with persistent pain, part of our, of our advice and our management is for them to be active. So if you've got someone to come see seeing you, that is actually already sporty, they're already active that, you know, you kind of think, well, what else needs to be offered here? And I think sometimes we don't really think about the sort of psychosocial practice in sporty or active people, because they're not obviously fear avoidance, especially if they're keeping their sport going. So we, we tend to go down the route. That's perhaps a bit more biomedical isn't now we looked at biomechanics, we look at strength and conditioning and these all can be valuable, but we mustn't lose sight of the bigger picture. I don't actually think sometimes we do need to acknowledge that it is more of a persistent pain state and a, not necessarily a series of flare ups of acute injury.

Speaker 1 (02:24):

How do we differentiate this is persistent pain versus a series of acute flare ups.

Speaker 2 (02:30):

Yeah, I think there's going to be an overlap between those things. We know that people with persistent pain that isn't necessarily stable with change can change quite a lot. People go through periods of quite severe flare ups as well. I think it's about sort of looking at the bigger picture and looking at the connection between things like pain and load. So in, in an acute injury situation with something like tendinopathy, quite often, there is quite a clear load pain relationship. It hurts when I load it. It doesn't hurt when I don't, I'm in a more persistent pain state. We might actually see that that relationship becomes a lot more blurry that the pain may well flare up when load hasn't changed or the pain may remain present. When there isn't a great deal of loading going on. So we start to see a bit of a breakdown of that connection between load and pain. And perhaps you start to see other aspects influencing symptoms, you know, lack of sleep, stress, fear, et cetera. We see other sort of types of behavior creeping in there as well around maybe avoidance coming in. So now they are backing away from their sport. So I think that's something we need to have a lookout for particularly that lack of relationship between load and pain and then exaggerated pain response as well.

Speaker 1 (03:48):

And when we're looking at these more sporty athletic people are runners how do they differentiate from say maybe our non sporty or non-running population?

Speaker 2 (04:01):

I think that there will be some definitely some, you know, some crossover between different people in different groups. And I really would, you know, w I use the term athlete, but I, I have a really broad definition of that. Someone, someone who wants to be regularly sporty and active fits that category for me. So I'm not necessarily necessarily when I say athlete referring to an elite athlete, competing at a high level, this, this can be people that want to be running three or four times a week, that really comes in that category too. But I think they can have, you know, similar concerns to someone that's not sporty around pain and damage, for example. So they might have similar concerns there. They might both have quite high life load which is a term I quite like this, somebody mentioned in one of my courses recently.

Speaker 2 (04:49):

So, you know, this is where you've got lots of stress going on with, with work and family life this kind of Highlife load that plays upon your pain. And they may also both groups have poor recovery. So, you know, athletes may not be brilliant sleepers non-athletes may not be brilliant. Sleep is too, they might not get much downtime much emotional recovery. So there can be quite a lot of of overlap. I think perhaps where they differ is they may have quite different goals. So I think it's, I see Mike might have wanted to go back to running half marathons, marathons, ultra marathons, and beyond potentially. So that might be quite a different goal to non-athletes that want to be more functional with day to day activities or lower level activities, perhaps like walking distances and perhaps something that we do see in athletes.

Speaker 2 (05:38):

That can be different though. Again, we see this in non-athletes too, is they may be a bit more inclined to push through pain. Most of us that have done sports at any level will know that pain is quite often a normal part of sport. And to some degree we do have to work with it. If, if we stopped every time, something we we'd never really, really do sport for very long, but this isn't necessarily always the right approach, gritting your teeth and pushing on through. Isn't always the right answer. And it's not always obvious that that's the case, but sometimes actually we do need to know when we need to back off a little bit. I'm an athletes particularly really highly driven athletes may not be quite so good at recognizing when they need to back off.

Speaker 1 (06:21):

Yeah, that's for sure. Especially if, like you said, they've got this goal of, I want to run a half marathon and marathon or an ultra to be able to, to have to abandon that goal due to pain, persistent pain or injury is, can be very devastating. Right. So how do you, how do you navigate that with your athletes and with your runners, especially with a more persistent pain, how do you navigate that? Very, I would say very sensitive goal or topic with these, with these runners or athletes.

Speaker 2 (06:58):

Yeah. It's not, it's certainly not easy. I think it's it can be challenging. I think wherever possible, we want to try and invite them to review their expectations and goals. So that it's not necessarily us being prescriptive and saying, this isn't realistic, or you're not going to achieve this, but if we can help them have slightly more fluid expectations of themselves and slightly more realistic goals, the ideal world then is that they then come around to the idea that perhaps this marathon they've got on the horizon, if it's not realistic for them, that they can set a different goal with it. And th this is one of the things, again, sometimes with, with higher level athletes, certain personality types is that being, being able to persist is a good skill, a good good thing to have, you know, and you need it when you get to sort of modulating 19 in the marathon and your legs are heavy.

Speaker 2 (07:50):

And, you know, you've got to keep going to hit your target. Tom, you need that in the time. You've got to have that level of persistence. And, and for that to be at least a little bit rigid because you you've got to, if you're going to achieve that goal, you've got to keep going, but to keep going at a certain time. So at times that rigid persistence is useful, but if you apply that all the time when circumstances are changing and your expectations are rigid, it doesn't really work very well. So for example, with the situation's changed, you're now in quite a lot of pain, you're struggling with day-to-day activity. This marathon is, is a lot closer now than, than we would, would like it to be. Ideally we have to try and encourage them to be a bit more fluid there and say, okay, well perhaps what we need to do is change that goal a little bit.

Speaker 2 (08:37):

Let's push it a little bit further down the line, give ourselves a bit more time and helping them see the positives of that decision can help. So you all often say to them, well, you know, if we can, if we can move this, you know, a few months down the line or let's go for a half marathon or a 10 K, it's going to take the pressure off you. You're not going to feel like you're constantly chasing your tail because you're trying to catch up with the training. You're not able to do. You're going to be able to focus on the rehab side of things. You're not going to feel so much pressure, and we can really focus on getting you well and ready to race rather than rushing you to get through a particular event when you've got a whole life of running ahead of you.

Speaker 1 (09:15):

Fair, very fair. And, and I think that's great for clinicians to hear, because I think that wording is very sensitive to the, to your patient and also gives them the goal gives them that aspirational goal that they can eventually get to. So I think that wording was great. Thank you for that. Now here's a tough question. And, and I don't know all the answers to this one, but in your opinion, and in your experience, what do you feel may be driving persistent pain in these runners or athletes?

Speaker 2 (09:53):

Well, we had us, that's a good question. Isn't it? A million dollar question and I would acknowledge I don't, I certainly don't have all the answers with this, and I don't think the research does yet either because it's an area, you know persistent pain in athletes isn't brilliantly well researched. So I think there's a lot that we can, we can learn about this, but there's a few things that would, I think, would spring to mind here. So I think beliefs are important. So and this is, can be beliefs around what the pain means. And then they, you know, what the pain means is if it's, if it's a sign of damage if they think it means they need to stop their exercise altogether, how they feel their body's gonna respond to exercise when they have pain that continuing to run, for example, will that be more harmful for them?

Speaker 2 (10:38):

It can be around beliefs around training too. A lot of people will feel that unless they're pushing themselves a hundred percent in every session it's not worth doing. So that can be quite difficult then for them to pace themselves and modify their training because it kind of all or nothing really. I think one of the things that I'm realizing more and more over the years working with with people and athletes is if they are quite heavily reliant on the sport for their mental wellbeing, then that can have a bigger impact too, because they might be using that, that sport to help them with their mood or anxiety or depression. So if they can't do their sport, it increases the impact of the injury. And I think it increases the fear associated with that because they're losing this coping strategy, they're losing physical fitness, they start to worry about the future.

Speaker 2 (11:27):

And I think maybe that links in with pain science, because it increases the threat that this injury has, and that has the potential then to have a knock on effect in terms of the pain and increasing pain severity and things. And a lot of these things are interlinked. I think training behaviors go hand in hand with that, you know, tending to push yourself hard all the time, boom, or bust, things like that. I think there's also a lot of stuff that we might not necessarily, we see like negative messages from others. So other other athletes, sometimes coaches, health professionals, unfortunately I'm so pumped. Sometimes we can be responsible for that life. I've treated lots of runners. Who've been told that they should never run again, for example, by various different health professionals. So we need to be aware of that. I think Google might have a lot to answer for I don't, I'd love to know. I think you've been Dr. Google doc to goo exactly. I don't, I don't know many situations where someone's been worried about something and put it into Google and felt better.

Speaker 2 (12:31):

What you find is the worst case scenario from it, which does amplify, you know, it does amplify people's worries. And that's actually something as a clinician, I would check in with your patients about what what'd you do when you worried about this? Did you go and Google it? What'd you find when you Google it? How does it make you feel? Because quite often they'll find the worst case scenario and I feel a lot more worried. So we want to discourage them from doing that, come to us. If you've got questions about your care, that's what we're there for really. So there's a lot of things that also impact of the injury, perhaps not being fully addressed. So you know, looking beyond the kind of physical impact of the injury, but the loss of the social side of the sport, the loss of their identity around sport the effects, as we said, it might have on mental health.

Speaker 2 (13:18):

There's lots of other things that go alongside the injury that often don't get talked about. And if they're not addressed, I think they can amplify it as well. And then the final thought I would add to this is perhaps if not had really particularly appropriate rehab it may be, it's been very focused on pain and not really focused on function in maybe that it's not been progressive and it's not really looked to address their rehab needs, lots of stretching and foam rolling and, you know, ice and, but no real kind of planning and progression in that.

Speaker 1 (13:50):

Okay. So that leads me to the next question as clinicians, where should we be focusing our treatments? Good segue there.

Speaker 2 (13:57):

Yeah. I like the connection. You've done this before, I think. Yeah. Yeah. I think, I think he's got to start in the first session with trying to develop an understanding for that person, if we can help them to, to understand their injury. And it takes time to build on that, but really make that part of that first session and give them the opportunity to share their story in that first session and also to air their concerns. You know, I really think we want to make the focus of these treatment sessions on the patient and their needs, not necessarily a kind of a list of things we need to tick off to do in a session because there is actually research showing that quite often, people whose needs aren't really identified we can be quite dismissive as clinicians. So we want to get in there right in the early, early stages and say, you know, what would you really like to, to from, from your treatment?

Speaker 2 (14:52):

What are your concerns? What are you particularly worried about here? What would you really like us to help with? Because we can start with that. I think that helps us form a good, strong connection. We can really help them understand the injury and build on it from there. I think that alongside shared goal setting, I think big PA plan of I'm a big fan of collaborative working you know, so you're working towards their goals. How can we help them achieve those goals together? And again, get a good idea of those in the first sessions. And it is part of the reason I really love working with rhinos is because many of them have a goal. Even if it's just, they want to get back to running 5k, you know, great, brilliant. It's a measurable goal. We can start the planning towards that pretty much from, from session one.

Speaker 2 (15:37):

And then we do want to have some progressive rehab because they're all gonna be psychosocial factors. In many cases, we've talked about, you know, beliefs to address perhaps poor recovery load management to talk about that quite often, there are physical needs as well. So we need to address those if there's a lack of strength or control or range and address them in a progressive way, as opposed to just loads of stretching and rolling, and then we can start to do a graded return to sport when, when they feel like they're physically and psychologically ready to engage in that.

Speaker 1 (16:10):

And what are some, some examples that maybe you can give of the types of diagnoses or the types of patients that you're seeing coming to you with persistent pain, you don't have, we don't have to go into, you know, the specifics of how you treat XYZ, but what are some things that you might be seeing in your patients coming to you with persistent pain?

Speaker 2 (16:36):

So I, I do specialize to some degree in tendinopathy. So we will see a lot of patients with long-standing tendinopathy lots of patients with proximal hamstring tendinopathy, because that's particularly the area I've researched in. But it will say Achilles tendinopathy issues as well. See people with low back pain and hip pain as well, falling into this category people with persistent patellofemoral pain syndrome persistent bone stress injuries, like medial tibial stress syndrome. So it's do see quite a mix. And, and many of those will have been treated first and foremost in quite a kind of biomedical model. I think,

Speaker 1 (17:16):

Yeah, so I think I just wanted to ask, cause I think it's important that clinicians out there hear like, Oh wait, you can have a persistent tendinopathy problem. You know, you can have like, Oh, I, I wasn't aware. I thought, you know, after let's say proximal hamstring after a year of rehabbing, if that kind of comes back, Oh, it's probably just like a muscle strain. It's probably not that tendinopathy again or, or not again, but it continuation of that. Absolutely. Yeah. And

Speaker 2 (17:50):

To give you a clinical example then, because we talked a little bit about how the connection between load and pain can be blurry about how that may, we may see an exaggerated response. So to give you an example of that proximal, hamstring, tendinopathy patient that I've been working with who will not be able to sit for more than maybe 30 seconds because that will really cause a flare up in their symptoms. Now we can see then that's a, that's a really exaggerated pain response. And the average person sits for somewhere around six to seven hours a day. So not to be able to tolerate even 30 seconds of sitting because there's pressure around that that tendon is, is an exaggerated pain response. And that person's pain will fluctuate not necessarily in line with load. So there'll be days where her symptoms are much worse and she doesn't really know why it's not because she's run a long distance or done anything different.

Speaker 2 (18:53):

The fluctuations in activity levels might be small in the range of a few minutes here and there. And yet the pain response is really exaggerated. And again, I talked about sort of beliefs and things go going into, you know, going into this area. And when we talk to this particular person about her beliefs, you can see she's very concerned that sitting damages the tendon and therefore that adds to the threat value associated with the city. She's very fearful of sitting when you ask her to do it, you can see she's really reluctant, but also we need to acknowledge why it really hurts. It's really hard for a long time. So there should be no judgment and our pie, we should be reckless. Yeah. This is really difficult. This is having a huge impact on this person's life. Can't if you can't sit down and even to have a cup of tea or to watch a move at the end of a long day, what should we eat dinner? Like that's big. So I think we have to recognize that as a persistent pain picture and with aspects of tendinopathy in there that we can manage, but just seeing it, like you say, as, Oh, it's just another flare up of the proximal hamstring tendon. We were missing that bigger picture, I'd say.

Speaker 1 (20:01):

Yeah. And that was a great example. Thanks for that. And now, you know, when we talk about running, we talk about athletes. So one thing they all want to do is they want to return to their sport. So can you talk to us a little bit about how we navigate that, how we prepare these people to return to their sport and what that, what that sport may look like?

Speaker 2 (20:24):

Yeah. I think, I think maybe we start, if we can, by seeing if we can reduce irritability a bit where possible. So if we think back to that lady, I was talking about Verrier to boost symptoms at the moment. So if I go straight into a greater return to running, I think that's probably going to be a little bit too much to start with. So in many situations we may we say, okay, let's see what we can do to reduce the symptoms and irritability helping someone understand their pain and that it's not a sign of damage can help helping them work out a list of things that may help to reduce their pain. Maybe particular exercises that help simple things like, you know, using heat or ice if necessary, but trying to give them strategies and work with them. So they've got a little bit of a list of things that can turn that, that pain volume down a little bit, and we're placing them in a bit more control, reducing that threat value.

Speaker 2 (21:17):

And then we can start to work towards that graded return to sport. And again, if we want to plan together because we really want the person to be in the driving seat and us maybe just helping, you know, being a bit of a satnav along the way to keep them on track. So we've had this recently really lovely runner I've been working with who in the first session said to me you know, what she'd like to do is first of all, build some strength then increase her cardio fitness by bringing in a bit of cycling and swimming. Then she wanted to bring in some, some impact and some plyometric exercises before doing a graded return to running. And I thought immediately, brilliant, this is fantastic. This person has a great plan.

Speaker 1 (21:57):

And they find this woman,

Speaker 2 (22:00):

I met wonderful one, and this, this is someone with a lot of experience in sport. Who's also studied a sport of science, so knows the topic really well, but that's a fantastic plan. Let's go with that plan and just help the person with their plan there. So, and we might follow quite a similar plan to that for, for patients. You know, we try and calm things down where we can, we build some strength to try and address some of their physical needs. We bring in some cardiovascular exercise to build some fitness up. We start to introduce impact because it can build impact tolerance, but it also is often a a way of developing some power. So perhaps some plyometric exercise to restore power, which is often neglected in rehab. And then we start to do a graded return to running and that's then where we got to try and work with them around their goals and also work with them around pain. And that can be a bit of a barrier.

Speaker 1 (22:53):

Yeah. And so how much pain is acceptable? How much is too much? Yeah.

Speaker 2 (22:59):

Like our pain scales you know, sort of scoring pain out of 10. And I, I would say there's actually quite a few studies that have done that quite successfully. So I think there's some value in that. But what we've talked about with these pain groups is that the connection between load and pain, isn't very clear and the pain response is exaggerated. So if we're guided purely by pain, we are going to struggle a little bit, I would say with these patients. So I would tend to say that the patient needs to decide what they feel is acceptable, and we provide some, some guidance. And we need to try, and if we can look at longer term trends, then now patients quite understandably might get very focused on day-to-day pain fluctuations, but it's actually more the long-term in pain over the, over the weeks and months that we're a little bit more interested in.

Speaker 2 (23:49):

And we also perhaps need to recognize that there are almost two slightly separate goals here, improving function and improving pain. If you're seeing improvements in function and pain, hasn't changed, that's still a win because you're doing more. In fact, that's quite good when, because you're doing more and your pain doesn't get worse, but patients often won't see that as a win because understandably they may want that pain to go away, but we can often folks first will say, okay, well, let's start with what you feel is a manageable level of exercise. Let's work with it consistently. First of all, and then gradually build as long as you feel the pain is, is an acceptable level. And sometimes what we tend to see then is over time, they're able to do more and more, and then gradually that pain does subside because they're able to do more.

Speaker 2 (24:39):

They're more confident they're starting to get their life back. The threat value of the pain is starting to go down, but that takes quite a long time. So I think quite often, wherever possible, placed the focus a bit more in function and just save the patient a few phone that feel that it's manageable. It's acceptable. This is fine. If it's too much, if it's not manageable, we'll dial it down a little bit, but we want, if we can to stay consistent with exercise, because otherwise we're going to have a lot of beam, bus tear will build you up and stop they'll drop and stop. We want to just see, can we keep you ticking along, even if it's at quite a low level

Speaker 1 (25:13):

And do you have your patients keep a log or a journal or some way so that they can see, Oh, I was doing this. I started with Tom on March 1st and here it's April 1st. And this is what I was able to do Marsh. Now this is what I can do in April. My pain's around the same, but look at how much more I can do, or maybe my pains a little less. Or do you, how do you keep track of all that? Do you give that to the patient to help them with their own sort of locus of control? And are you using the pain scale? Are you saying well, what is your pain March 1st? Let's compare that to April 1st. Let's compare that to March 1st.

Speaker 2 (26:01):

Yeah. I would try and see if we can monitor that goal activity because it's important to be able to see that they're improving and they're progressing towards their goal. If you've got quite a specific goal, like running a 5k in order to get that, you've give it a C you know, how, how far you're able to run. And that's the simplest question. How far can you run now? But that can be it could be steps for day. If someone's wanting to build up their walking, it could be minutes rather than miles with any activity, really. So I think it's a good idea to try and monitor what people are doing. I do, I do use the pain scale a little bit. It depends on, on how comfortable the person is with it, whether they like using that. I tend to perhaps make it a little bit more simple and just say, is your pain mild, moderate, or severe sort of break it down into those into those three sort of different categories, really.

Speaker 2 (26:58):

But the thing is with pain is there's so many different aspects of it. Are we talking about average pain day to day? We talking about peak pain. What did the pain get up to is it's at its highest, we're talking about pain frequency. So how often you've had that pain during the day, are we talking about pain distress, which I think is almost a separate thing. How distressing are you finding that pain? So if you're especially worried about it, that pain often will be more distressing, even if the severity isn't necessarily higher. Do you see what I mean? So I think, I think where possible we focus on the golf function and we, we try and take that focus off pain a little bit because as well, you know, if patients are monitoring it every day, that drawing that focus on pain every day, and they're asking ourselves, how much does it hurt?

Speaker 2 (27:47):

Even some patients have no one used the term morning MRI. I used to get up in the morning and do it, do a sort of stretching test on his Achilles. That was what he called his morning MRI to test the Achilles out and see how he thought it would be that day. We don't really want to do that. To be honest, we want to focus on what your valued activities let's really try and bring them back in, build those up and keep a kind of a little casual, casual notice of pain, let pain tell us if it's too much, if it's breaking through, into your attention and in telling you it's too much, that's probably when we need to act, if you're looking for it, if you're, if you're kind of really questioning, is it worse today? I'm less concerned about it.

Speaker 1 (28:26):

Got it. Yeah. So you don't want them to, you don't want your patients to be waking up and be like, wait, do I feel, do I feel more pain today? Weight you're you're well aware that you have pain.

Speaker 2 (28:38):

Yes. Yeah, absolutely. I think that calling is focusing on the pain as well. It's quite, it's quite a normal thing to do. I think we've kind of pathologized it a little bit. But I think actually it's understandable for people to do that. There's another layer of context around the pain and what it might mean and what that might mean for your, for your future. So I'll give you an example from myself. So I have I have psoriasis and I have nail bed changes with psoriasis and that increases the likelihood of you developing cirrhotic arthritis. So a couple of weeks ago and surfing on Twitter and someone posts a link to a research paper that says new studies shows link between nail bed changes and severities, psoriatic arthritis. And I start thinking, yeah, my fingers are a bit sore today, you know, and that's one of the areas where you can get psoriasis, arthritis, changes in the joints and the fingers.

Speaker 2 (29:41):

And then I throw it comes back a little bit later that day and for a few more days afterwards, and now I'm sort of noticing like achy thumbs hands are a bit stiff in the morning. And if I allow myself to keep focusing on that and measuring that and worrying about that, it would be understandable that that could become really quite a worry for me, because then you think, well, is it cirrhotic arthritis? That's been, that's known to actually affect the joint and perhaps even damage the joint. And if I've got nail bed changes, that means it can be very severe. And what impact would that have on my life? And these are all just normal things that we have as, as people, as health professionals that know quite a bit about pain. So I think we can acknowledge for someone who's not a health professional.

Speaker 2 (30:25):

There's probably a lot of that going on, particularly the pain's been there a long time and pains is a real nuisance because it can, you can kind of like stop worrying about it. And then, then you have the pain and it kind of reminds you and goes on about you and that can start worrying prices over again. So it is hard. And I think sometimes it's health professionals, we think like, well, I talked to them about their pain and I reassured them that pain doesn't damage tech. But that if you think that that is enough to wipe out that concern, we are. Yeah, but we may need to be consistent with that message several times. And we might need to encounter that worry coming up several times and to try and help someone contextualize their symptoms and to see that not what they're fearing, but what really is going on.

Speaker 2 (31:18):

And to look at a bit the now of how symptoms are. So with my hands, you know, I don't have any of the classic signs of cirrhotic arthritis. I don't have swelling. I don't have a loss of joint range. I've actually been tested for psoriatic arthritis and it was negative. So it was trying to contextualize it and see the reality is I've just turned 40 and I've got slightly stiff fingers. That's the reality. So let's focus on the now and what is real for you now and not what you fear might be coming up in the future.

Speaker 1 (31:47):

Yeah. And that's something that I say to myself every time I wake up and my neck's a little stiffer sore, you know, my upper back feels a little sore instead of my, what I used to do is, Oh, okay. I better not go to work today. I better just relax. Let me get a heating pad. Let me just, I don't want to do anything. I should probably just lay down. And these are all the things I used to do. And so now when I wake up or if I do have a flare up of neck pain or something like that, now I'll just say, okay, I know nothing is seriously damaged. I have the MRIs to prove it multiple. And you know, these are just things that I have to continually say to myself. And I think I'm pretty well versed in, in the science behind pain and, and even working with people with persistent pain. I mean, I do it every, but even for myself, I have to continuously sort of recite these mantras to myself in order for me to get through the day when I have a little bit more discomfort or pain. So the struggle is there, you know, and I think imparting that and telling that to your patients, especially your runners with persistent pain. I think that can be very powerful.

Speaker 2 (33:07):

Yeah, absolutely. And, and recognizing, as I said, the bigger picture of knowing the person and, and the things that make them make up them as a person. And if they are, for example, running to their mental wellbeing, what, what, what is the, the thing that, that they're running to help? And how does that link to their pain? Are they running to help anxiety? In which case are they someone who is perhaps going to struggle with negative thoughts about chain, and they're going to be drawn into ruminating about those negative thoughts about pain, and they're going to be looking for reassurance that those thoughts, you know, jumping on Dr. Google, I'm finding actually it makes it worse because they see all the negative outcomes they're afraid of laid out on a web page. So if they are someone with, with that, then they, they may need more, more help with that. They may need to, you know, you may need to work with a mental health professional to help them work with those thoughts and to find ways perhaps to not get drawn into that ruminating pattern and to look for other coping strategies, we show it to them. The long-term can be useful because they're less reliant and upon the sport, because they actually learn perhaps a slightly different relationship with that, with their thoughts and from that, then can help that their mental wellbeing.

Speaker 1 (34:22):

Yes. I agree with that. And Nelson, before we kind of wrap things up is there anything that we missed or that maybe we flew by a little too quickly that you want to elaborate on? And if not, what would be your best advice to a clinician that is working with AF that is working with people with or athletes with persistent pain problems?

Speaker 2 (34:54):

I think in terms of things we might have missed, I just would say that there's a, there's a nice paper from Halon as torn in 2017 that's well worth a look, which is, is actually looking at things a little bit more in terms of pain in athletes. And there's, there's quite a nice quote in that that I'll just briefly read now if that's the case. So they say even low level inflammation, for example, linked to sleep deprivation, ongoing stress and load exceeding the tissues capacity can reduce the athlete's mechanical nociceptive threshold sufficiently to make normal mechanical demands of sport painful. So that sort of Lincoln into this bigger picture stuff saying here, actually, if we're not recovering enough, or the load is excessive on the tissues, it's actually going to have an effect potentially on sensitivity know nociceptive threshold.

Speaker 2 (35:49):

So this is where it's quite important for us to see the bigger picture. They also say in that paper that the, the link between tissue change and pain is thought to reduce over time. So if you've got someone with very persistent symptoms, years' worth of pain, you should already perhaps be suspecting that this is probably not just going to be driven by the tissues. I mean, when is there ever a situation where pain is, but, you know, it's probably going to be a bigger picture here that we need to identify. And I think that's probably one of the key messages to take from what we've talked about. Hey, really, you know, you, you start right with the first question is perhaps just to, to try and see if you can recognize when you are looking at a more persistent pain state and to try and really get to know that person and the bigger picture, and what's driving that because then I think you're going to get better results with them and then try and see if we can work gradually towards their goals and just keep them on track with it and give it time.

Speaker 2 (36:45):

It will take time, you know, this, the patients I'm seeing, we're looking at at least six months, probably a year of working together because there's so much to work through. I think we sometimes say, Oh, we reassured them about their pain. Give them some exercises away. They go, it's not really like that. You know, it's going to be lots of ups and downs. We're going to have to stick with them for a while and just keep chipping away, but you can get some really good results with people and you can get them back to the sport that they, that they love. And that can be a really, really big thing for them.

Speaker 1 (37:13):

Yeah. that's a great way to to end our conversation here. One, one question, what was the, who's the author of the paper from 2017?

Speaker 2 (37:26):

I think it's Hamline at all. I believe it was in the but I can find a link to it for you to put in the, in the show notes, if you would.

Speaker 1 (37:36):

Perfect. That would be great. And I will look it up as well. But thank you for that. Now before we finish our conversation, where can people find you? If they have questions?

Speaker 2 (37:48):

Yeah. Come and say hello on on Twitter, I'm at Tom goo or an Instagram ad running dot physic. Also I've got my website, which is running-physio.com. So yeah, come and say hello, ask questions and things. So it's good to chat.

Speaker 1 (38:03):

Perfect. And last question. What advice would you give to your younger self knowing where you are now? And I know we've, you said this before is, and I have to say something different. Now you get a chance to give yourself a second piece of advice.

Speaker 2 (38:16):

Oh, good question. Oh now that I'm thought 14 spending a bit on top, I'd, I'd say really enjoy your hair while it's there. Yeah. now I don't know, in all seriousness, I think I would probably sort of say you know, really make sure that you kind of value value, that things are important in life friends and the family, you know, always, always try and put those things first because ultimately they're, they're the things that are most important for us. And I think a lot of people already know that and I've learned it, especially during COVID, but I think there's a lot to be said about, you know, focusing on family and friends and things first you can still have a very fulfilling career and things, but I think that that's the important, the important stuff. That's what makes, makes life great. Really

Speaker 1 (39:08):

Excellent advice. Well, Tom, thank you so much for coming on to the podcast again and sharing all this great information with us. I really appreciate your time. Thanks for having me back here. And it's been really good pleasure, pleasure, and everyone. Thank you so much for listening. Have a great week and stay healthy, wealthy and smart.

In this episode, Founder and Host of Entrepreneurs on Fire, John Lee Dumas, talks about the 71000-word, 17-step, 273-page success roadmap that is his first traditionally published book.

Today, JLD talks about the launch of his book, The Common Path to Uncommon Success, and we get to hear a few of the 17 foundational steps to success, and we hear about identifying what we want to achieve, all on today's episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• "The online experts in this world... will lead you to believe that the path to uncommon success is "secrets", "hidden", maybe it's "complicated." It's none of those things. All of them [successful entrepreneurs] have taken what has turned out to be a very common path to uncommon success."
• "Freedom is one simple word, but it's so hard to attain."
• A few of the 17 steps to uncommon success:

1. Identify your big idea. "So many people are living and acting in a weak, pale imitation of somebody else's big idea."
2. Discover your niche. "Identify, within your big idea, an unserved opportunity."
3. Create your content production plan.

Suggested Keywords

Uncommon Success, Roadmap, Process, Entrepreneurship, Wealth, Prosperity, Freedom, JLD, Entrepreneurs on Fire,

More about John Lee Dumas

John Lee Dumas is the Founder and Host of Entrepreneurs on Fire, an internationally-acclaimed award-winning podcast with over 1 million monthly listens and 7-figures of annual revenue. To date, he has interviewed over 3000 of the world's leading entrepreneurs, including Gary Vaynerchuck, Barbara Corcoran, and Tony Robbins.

His first traditionally published book, The Common Path to Uncommon Success, is an amalgamation of the lessons learnt from the over 3000 interviews he's done.

Get the book: https://uncommonsuccessbook.com

To learn more, follow JLD at:

Facebook: John Lee Dumas

Instagram: @johnleedumas

Twitter: @johnleedumas

YouTube: John Lee Dumas

Subscribe to Healthy, Wealthy & Smart:

Website: https://podcast.healthywealthysmart.com

Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264

Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73

SoundCloud: https://soundcloud.com/healthywealthysmart

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iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927

Read the Full Transcript Here:

Speaker 1 (00:01):

Hey, JLD welcome to the podcast. I am so excited to have you on

Speaker 2 (00:06):

Fired up to be here. Thank you for having me and listen. You've got a beautiful cat. I've got a beautiful dog. They might make a Paris's in this interview who knows

Speaker 1 (00:15):

It is possible. And I have to say, this is like a full circle moment for me, because I have always as a podcast or looked up to you for your podcasting, for your show entrepreneur on fire 3000 interviews. I mean, that is, that is amazing. And, and for all the listeners out there that is not easy to do. And now you've got a new book coming out. Your first traditionally published book. How exciting is that?

Speaker 2 (00:47):

Listen, I'm fired up. This is a combination of the 3000 plus interviews I've done over the last decade. I've interviewed some of the world's most successful entrepreneurs over the years, and I've learned from every single one of them. I mean, every one has been my mentor and I've been able to distill their genius down into what has turned out to be 71,000 words of my blood, sweat, and tears. Cause it took me 480 writing hours to write the 71,000 words, the 273 pages that comprise this book. But I couldn't take a single word out. This is a definitive 17 step roadmap to financial freedom and fulfillment. So if that's interesting to you, this book is your guy,

Speaker 1 (01:34):

Which is amazing. So it's the common path to uncommon success, the road to financial freedom and fulfillment. And you know, you, as we know, have been very successful online entrepreneur, but let me ask you a question. Sticking in that online entrepreneur have people been lied to by the quote unquote experts in the online business world.

Speaker 2 (01:59):

Listen, the online experts in this world. There's a lot of fantastic ones that are doing amazing things out there. And there's some not so fantastic individuals out there who will lead you to believe that the path to uncommon success is secrets. It's hidden. Maybe it's complicated. Listen, it's none of those things I've seen over 3000 successful entrepreneurs and I've interviewed over 3006 successful entrepreneurs. And I've seen that all of them have taken what has turned out to be a very common path, a very common path to one comma success. Now, by the way, it's hard work. It is absolutely hard work, but it's a common path. It's not secret. It's not hidden. It's not complicated. It is a very, very clear, very common path. And it's not something that, again, these so-called gurus that will try to, you know, sell you some key for $1,997 and 97 cents. Like, listen, that's the answer. The answer is clear. The content is out there. I've done over 3000 interviews. You have individuals like Karen and others who have done interviews. There's great content out there to be had. And I could tell you right now, just go listen to all 3000 of my episodes, but that's tens of thousands of hours or is distilled down into one book, 17 steps, 273 pages. And it's there for you. That's the common path to uncommon success.

Speaker 1 (03:29):

And when you look at success and we look at financial freedom and fulfillment, what, what do we really want to achieve here? What does that mean?

Speaker 2 (03:38):

So this is what I've really identified. That individuals really desire in life. Freedom. Freedom's one simple word, but it's so hard to attain, but think about it when you're free every single day to wake up and to do these three things, do what you want, where you want with whom you want. What else is there in life? Like when you can literally say, I get to do what I want to do, where I want to do it with whom I want to do it. I have that freedom. That's happiness, that's success. That's what people want. And this is what so many people have been able to achieve. You know, unfortunately, a lot of people don't think that's possible and they will never be able to achieve as a result. But those type of people don't listen to podcasts like this. So I know I'm talking to the right individuals right now. It's there. It's possible. It's, it's, it's a, it's a common path to your version of uncommon success.

Speaker 1 (04:38):

Now, you know, you say in the book, it's a 17 step roadmap. Most people will give you five steps or maybe eight steps, right? So what, what is the 17 step roadmap? If you can give us a couple of little snippets or details.

Speaker 2 (04:54):

So here's the process it's like when I interviewed these 3000 plus now individuals, and I've been able to really boil down and distill down the core foundational elements that all successful, aren't new or share in common. There were 17 of them. Like I wish there were 18 or 16. I like even numbers, but listen, it was 17. I couldn't take one away. I couldn't add one. It was just simply 17 foundational steps. And I was able to put them in a chronological order. And before me, I had the 17 chapters of the book and a step-by-step format, 17 steps to financial freedom and fulfillment. And let's go over a couple right now. Number one, this is where most people get it wrong, by the way, identify your big idea. Keywords, your big idea. So many people, Karen, they are right now living and acting in a week pale imitation of somebody.

Speaker 2 (05:53):

Else's big idea. They're like, Oh, look what Karen did or John. And they're having success doing these things. Let me just do that. And then they wonder why they're not successful most because they're a week pale imitation of those people that are trying to copy. They're copying somebody. Else's big idea. That person, it's their big idea. It's their zone of fire. That's why they're successful because they're living in their zone, a fire. You need to sit down maybe for the first time in your life, by the way, and really give yourself the time, the space, the open bandwidth to really come up with and identify your big idea. And your big idea is out there. Your zone of fires out there and chapter one, listen, it's not just words on a page. There are exercises. I teach you how exactly you get to your big idea.

Speaker 2 (06:42):

And that is a super critical part. That by the way, most people will die. Never even knowing what their big idea is because they never took the time to sit down and identify it. And it doesn't even take much time, which is the sad and scary part. But here's the thing here. If it was just that simple to identify your big idea, it would be one chapter in my book. And there were just be one chapter in my book. There's 17 steps. So there's a lot more to it than I than identifying your big idea. Let's just jump to step two. And then we'll skip a little ways ahead to, to show you any part of the book as well. But once you have your big idea, people are like, Oh my God, I'm so excited. Like I have my big idea. Let me go all in on this.

Speaker 2 (07:22):

That's a huge mistake because guess what? Your big idea is a great idea. And other people have had it too. And there's competition. That's out there crushing your big idea, which is a good thing because that's proof of concepts. That means that your big idea really is proof of concepts, but you can't right now launch against entrenched competition that's out there. So instead you go to step two, which is discover your niche. That means you're going to identify within your big idea, an un-served opportunity, a void that needs to be filled, that you can be the best solution to that real problem within your big idea. That's how you win. Like Karen, when I launched a podcast, that was just this broad idea, but then I was like, well, I'll launch a business podcast. That's a little more niche. Okay. It's still kind of broad.

Speaker 2 (08:14):

There's a lot of people there. Well what about an interview business podcast? Okay. There's like seven or eight other interview business podcasts. What about a daily interview? Podcasts of the world's most successful entrepreneurs, zero other competition. The day I launched entrepreneurs on fire, it was the best daily podcast interviewing entrepreneurs. It was the worst daily podcast interviewing entrepreneurs. It was the only daily podcast interviewing entrepreneurs. Like can't you see, like, that's why I won at such a high level. How can you be the best? Sometimes it means being the only, or it means niching down till you look around your competition is terrible. So you can kill them immediately. You can beat them up. That's how you discover your niche. Then of course, there's step three, four, and I take you all the way through and beyond. Let's skip forward right now to step seven.

Speaker 2 (09:09):

So every chapter in this books, an average of a three to 5,000 words, this chapter I wrote and I wrote and I wrote, and I wrote 13,500 words. By the time I finished this chapter, step seven, chapter seven, creating your content production plan. That is why we've won financially at such a high level because our content production plan is amazing. And I say that because it took us 10 years to get here. It's stunk at first, but now it's amazing. And I poured it all into this chapter and it is phenomenal and it's listen, it's not easy to emulate, but it's all there for you. And you will see after reading this chapter, why we're winning at such a high level and frankly, you know why you might not be because likely your content production plan is nothing in the same realm of what we have just like ours.

Speaker 2 (10:06):

Wasn't in this realm, obviously when we launched back into, you know, almost 10 years ago now, so that's just a glimpse of three of the 17 steps. And we have actually a bonus chapter called the well of knowledge. And it's a really cool chapter is chapter 18, a bonus chapter. And that's just the best pieces of advice, mentorship, inspiration, motivation that I picked up over the years. I just dropped it into this chapter. And this meant for you to really just take your ladle, dip it into the well of knowledge every now and then when you need it, when you need a little bump, a little boost. And man, that chapter is really cool because it's not meant to just read all at once. Like go there, consume it. One passage to passage, get the kind of inspiration you need, then get back to work. That's the process

Speaker 1 (10:56):

Amazing. Well, I mean, I don't know about anyone else listening, but I am so excited to get my copy, which it releases on March 23rd. So tell us, tell all the listeners here a little bit more of the details of the book launch so they know where they can get their copy.

Speaker 2 (11:11):

So listen, all the magic is going to be happening over at uncommon success. Book.Com, uncommon success book.com. You can head over there. You'll see the personal endorsements from Seth Godin, Gary Vaynerchuk, Neil Patel, Erica Mandy, Dorie Clark. You'll see a video of me describing more details about the book. You'll see. The first chapter is there for free just to read, to consume it, to see kind of like, well, how my writing process is plus the five bonuses that come with the pre-orders. So do not wait until March 23rd. You want to pre-order this book because it is amazing what we've done for these five bonuses. Just one of them, by the way, I'm to your door. All three of my journals, the freedom mastery and podcast journal. I'm literally shipping to your door at my expense. Well, drop them all. If you live in the United States of America, outside of the U S I'm going to give you the digital pack of all three immediately they're beautiful fillable versions. They're awesome. And there's four other insane bonuses. You can learn more about those other [email protected].

Speaker 1 (12:21):

And I, I ha I will say congratulations are in order already. Cause an Amazon I checked today is already a number one bestseller on Amazon and it's not even out yet. And for the listeners, I am going to be giving away five copies of the book and you'll find all the details on my Instagram page. So check that out. Cause I will be giving away to five lucky winners, five copies of this book, because if you just go on to the website and read even the first chapter, you're like, man, I get it. You know, and I, and I also love the fact that you're vulnerable, that you're saying, Hey, this didn't happen overnight. And that's what a lot of people think. And that's what a lot of people sell. And it's so refreshing to see people out there experts like yourself saying it's hard work, it's work, but you can do it. So you're welcome. So I want to thank you so much for coming on the podcast. And one more time, where can people find all the info,

Speaker 2 (13:21):

Uncommon success, book.com, check it out a lot of great stuff there. And once again, much appreciated.

Speaker 1 (13:30):

Thank you so much. And everyone thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, sports physical therapist specialist, Dr. Alli Gokeler, talks about motor learning.

Today, Alli tells us about the process of motor learning, how patient autonomy is advantageous to rehabilitation, and how to motivate patients. How does Alli measure motor learning outcomes? Alli elaborates on his on-field rehabilitation model, and the importance of incorporating cognition in ACL injury rehabilitation.

Alli talks about RTS from a motor learning perspective, how to continue motor learning on the field, and he gives his younger self some advice, all on today's episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• Alli defines motor learning:

1. "In order to acquire motor learning, you need to practice. If you don't practice, you can't learn something."
2. "The learning process itself cannot be measured directly. It's only something you can measure indirectly."
3. "What motor learning should result in is: it should lead to relatively permanent improvement of motor skills."

• "Be careful how you interpret this process. Quite a few clinicians have a tendency to provide feedback because they intuitively try to correct a patient."
• "Be a little bit patient with your patient, because learning takes time. Don't interrupt the learning process too soon."
• "Motor learning, as well as learning a language or math, is a non-linear process."
• "One of the strong drivers of learning is intrinsic motivation."
• "We provide our patients with a significant amount of autonomy, which means the patient gets a certain level of control over the exercises."

"Providing autonomy during rehab enhances learning."

• "Around 70% of people prefer to receive feedback after a good performance of an exercise. What happens in most clinical situations, with all good intentions, we typically give corrective feedback, which typically means you didn't do something according to the standards of the therapist. This may affect their motivation."
• "If you look at the brain activity of someone that is instructed to do something, or the brain activity of a person who has some control over what they're going to do, you have completely different brain patterns. When you give them some control, they are much more engaged, and this is a prerequisite in order to learn something."
• "If you want to be certain that learning has taken place, you need to measure, otherwise you can't be sure that the patient has learnt something."
• "If you're good at something, it's not challenging anymore. If it's too difficult, then it's overreaching."
• "One-on-one training is not what's needed for a football player. They are team athletes."
• Alli's on-field rehabilitation model:

1. Neurocognition: Reaction time, decision-making, selective attention, inhibition and working memory.
2. Motor component: Strength, range of motion endurance, and speed.
3. Sensory: Visual, auditory, and environmental factors.

• "We need cognition during our motor control, and if we only work on pre-planned activities, we miss something from the on-field situation."
• "An ACL injury isn't just a peripheral injury, but it's also a neurophysiological lesion, and that needs to be considered in rehab."
• "With colleagues that work with paediatric patients, some of the motor learning principles that they use could be very beneficial for us working with orthopaedic, sports-related injuries."

Suggested Keywords

Motor Learning, RTS, PDCA, ACL, Rehabilitation, Neurocognition, Therapy, Physiotherapy, PT, Training, Injuries, Sport, Wellness, Health, Recovery, Injury-Prevention,

More about Dr. Gokeler

Dr. Alli Gokeler has 28 years of experience as a sports physical therapist specialist.

In 1990, Alli graduated with a degree in Physical Therapy from the Rijkshogeschool Groningen. Following his graduation, he worked in both the US and Germany as a physical therapist. In 2003, he earned his Sports Physical Therapy Degree from the Utrecht University of Applied Science. In 2005, he started a PhD project at the University Medical Center Groningen, Center for Rehabilitation.

He is a researcher-clinician and a clinician-researcher with a passion for multidisciplinary injury prevention. He has over 40 peer-reviewed publications, and he regularly gives lectures worldwide. In his free time, he loves to do mountain biking.

To learn more, follow Alli at:

Facebook: Motor Learning Institute

Instagram: @motorlearninginstitute

Twitter: @Motor_Learning

YouTube: Motor Learning Institute

Website: https://www.motorlearninginstitute.com

ResearchGate: https://www.researchgate.net/profile/Alli_Gokeler

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Read the Full Transcript Here:

Speaker 1 (00:07):

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

Speaker 2 (00:37):

Welcome back to the podcast. I am your host, Karen Litzy and today's episode is brought to you by net health. So net health is hosting a three-part mini webinars series on Tuesday, March 9th, entitled from purpose to profits. How to elevate your practice in an uncertain economy after 2020. I think you're going to want to sign up for this. So you're going to hear from a panel of guests that have over 50 years of combined experience working in the PT industry sign up will begin tomorrow, which is Tuesday the 23rd, February 23rd for this mini webinars series. So head over to net health.com/litzy to sign up once again, that's net health.com forward slash L I T Z Y. So check it out and sign up now. Oh, and it's free. Okay. So this whole month we've been talking about ACL injury and rehab. So today's episode is with Dr. [inaudible].

Speaker 2 (01:41):

He has 28 years of experience as a sports physical therapist specialist. In 1990, he graduated with a degree in physical therapy from I'm not even going to pretend to try and pronounce this. So you can just go onto the podcast website to find out where he went to school. Cause I'm not even going to attempt it following his graduation. He worked in both the us and Germany as a physical therapist in 2003 here in does sports physical therapy degree from you trick university of applied science in 2005, he started a PhD project at the university university medical center, grown again, center for rehabilitation. He is a researcher, clinician, and a clinician researcher with a passion for multidisciplinary injury prevention. He has over 40 peer reviewed publications and he regularly gives lectures worldwide in his free time. He loves to mountain bike and you can check out more from him and his [email protected].

Speaker 2 (02:46):

Okay. So today we talk about just that we talk about motor learning. So the process of motor learning, how patient autonomy is advantageous to rehab, how to motivate, how to measure low motor learning outcomes on field rehab models and the importance of cognition and ACL rehab. And we talk about Allie's brand new model for Mona motor learning, which will be out hopefully in a month or so. So a big thanks to Allie. And of course, thank you all for listening to this month on ACL injury and rehab. Hey, Alli, welcome back to the podcast. I am happy to have you on once again.

Speaker 3 (03:31):

Thank you for inviting me. Yeah. It's been awhile pleasure to be here today.

Speaker 2 (03:34):

Yes. And so, as people, if you've been listening to the podcast, you know, that this month has been all about ACL injury and rehab. And so what better person to have on the new to talk about kind of the rehab process after an ACL injury and your specialty, which sort of motor motor learning. So the first thing I want to ask you is can you define motor learning?

Speaker 3 (04:02):

Yeah, that's it, that's a very good question. And I I've taken three, I think important aspects of motor learning that I think are relevant for clinicians that listen to this podcast. The first one is in order to acquire motor learning, you need to practice. If you don't practice, you can't learn something and that may be pretty straight forward, but I still think it's important. The second one, and that's a little bit of a vague one, but the learning process itself cannot be measured directly. It's only been some been something that you can measure indirectly. And I I'll touch back on that a little bit later. What I mean by that? And the third point is what model learning should result in is that it should lead to relatively permanent improvement of motor skills. And last year I gave the example of writing how to ride a bicycle for this year.

Speaker 3 (05:03):

I thought, Hey, maybe skiing is a good example. And so if you've taking ski lessons as a teenager and you became quite proficient in skiing, it could be for many different reasons for job or any other reason that you haven't been going to the Rocky mountains, but at the age of, let's say 35, you have some time again, and you have some financial resources and you'd, Hey, let's spend the week again in Vermont or the Rockies and maybe a little bit of rusty at the beginning, but perhaps after a day or two, you get the hang of it again. So this is I think a great example of what motor learning means. It means that you acquire something and it sustains over time. Now that needs to be distinguished from performance. And this is, I think one of my key messages that I would like to point out to clinicians when you work with your patient in the clinic and you have your patient doing an exercise.

Speaker 3 (06:11):

And this relates to my second point is that motor learning is not directly observable. What you see in the here and now is performance. Now I get, I can give you two examples. So let's say you have a patient after an ACL injury six weeks post-op and you want to have your patient work on balance, not patient number one comes in and stands on one leg. And actually what you're seeing, you're very happy, very stable not any excessive movements is able to maintain balance for 30 seconds. Okay. You're you might be happy with that. Now, your second patient comes in from the same surgeon, also six weeks post-op and when you have this patient perform the same exercise, you see that a patient sometimes needs to take the hands of the hips or needs to hold onto something, or puts the other foot down to maintain balance.

Speaker 3 (07:16):

And from these two examples, you may draw the conclusion that the first patient has better motor skills and has better learning potential. And the second one has poor motor skills and is not such demonstrating good learning potential. We don't know. We only, we only know that performance in patient one is better for sure. Performance in patient B is not as good for sure, but that doesn't mean that the dis says anything about the learning potential. In fact, it may be that the learning potential in patient one is, or has already been reached because this is at the max of his abilities, various for the second patient with poor performance, there may be a large learning potential. So that that's that's I think very important. And what you need to consider as a clinician is be careful how you interpret this process, because what I know from my early days, and also when I teach courses, is that quite a few clinicians have a tendency to provide feedback because they would intuitive to literally try to correct patient too, because you see that it's not able to maintain balance.

Speaker 3 (08:40):

So we need to say something. So we will usually do that in with feedback. And we typically do this with corrective feedback. And my second take home message would be, be a little bit patient with your patient because learning takes time. So maybe unless you feel that there is an unsafe situation, but if that's not the case, let the patient practice and re evaluate in the week or in two weeks time. But don't interrupt the learning process too soon. Because when I go back to the skiing example, remember when you haven't been skiing for for like 15 years or when you started to ski, it, it, it was probably something like this first day, quite difficult. Second day, still difficult. You might even get frustrated third day, no improvement. However, on the fourth day snow not being able to ski ski lift is closed.

Speaker 3 (09:55):

And on the fifth day means there was no one day without any skiing lessons on the fifth. There you go out again, Hey, and all of a sudden you feel like, Hey, I I'm, I'm better than I was on day three, although you haven't practiced in the day in between. So this is what I mean, learning is not only happening as you practice, but there's also some processing afterwards going on in your brain that helps to acquire those motor skills now. And if you interrupt that process like vote by providing a lot of corrective feedback you may actually, although with all good intentions, I don't want to disqualify that, but maybe it's better to leave the process happening and evolve and then provide feedback later on.

Speaker 2 (10:50):

Yeah. It kind of reminds me of have you ever heard the term helicopter parent? So it's the parent that's always hovering over the child, making the decisions, not allowing them any autonomy for themselves. And so it reminds me of that helicopter therapist who's on top like, Oh, I see that if you use the example of balance, Oh, I see that you struggled a lot with your balance. Why don't you try and do this? Well, why don't you do this, try this, try this, try this. And, and in that as the therapist, are you taking away the autonomy for the patient and what kind of, how can that affect the outcomes for that patient?

Speaker 3 (11:31):

Yeah, that's an excellent point. Karen C motor learning, as well as learning a language or learning math is a nonlinear process, which means how you learn how to ride a bicycle was probably different from how I learned it. So, but what we typically do as clinicians, we have this, this, this clinical guidebook in our, in our mind map that we think based on our experience or based on our beliefs, how we need to guide our patients from simple skills to more advanced skills from single task skills to do a test skill, whatever. However, we don't know how this patient is actively engaged in this process, actually, by example, that you were provided the, the patient is directed by the, by the parent or, or the child is directed by the parent and is actually a passenger. Now, I think one of the strong drivers of learning is intrinsic motivation.

Speaker 3 (12:41):

So what role do you give your patient if you direct them, where to go, what to do, and also you give them corrective feedback are these all strong drivers for self-organized learning? I'm putting a question Mark behind it. So people need to think about them for themselves. I can tell you what we do in, in, in our clinical situation. And that's based also on our research we provide our patients or in ACL injury prevention, we provide a significant amount of autonomy, which means an athlete or a patient gets a certain level, not complete control, but a certain level of control over the exercises. So they can choose, for example, out of 10 exercises, they can pick three exercises that they would like to do on that particular day, in an order they would like to do. And we know from a substantial body of research that providing autonomy during during rehab enhances enhances learning.

Speaker 3 (13:59):

And I can tell you this from a research point, but it can also give you a brief insight from a recent survey that we've done among patients that completed their rehab. And we sent them an open questionnaire about their experience in in the entire process of rehabilitation. And one thing that two things that really stood out were a positive environment, a positive environment with relatedness of the therapist towards the patient, and not as a patient, but as a person that's quite important. So it's not a ne it's not an ACL patient. No, it's, it's, it's a person with an ACL injury. That's quite, quite, quite an important distinction. And the second thing that stood out was and you, you touched on that before is the autonomy some self-control over the rehabilitation process. And this was a qualitative study that we did my PhD student while surveilling ran the study.

Speaker 3 (15:10):

So it's not something that I'm just saying as a scientist, but this is also what we get back from our patients. And when we ask them so going back to the clinical situation this is what we apply also by providing our patient with the opportunity, instead of me always providing the feedback I'm asking them, or I'm giving them the opportunity please let me know when you want me to give you feedback. That is a great example of of autonomy, the thing, easy question. Yeah. And, and, you know, what's, what's, what's what's quite important to understand is if w if we think how humans preferably like to receive feedback if we, if we, if we ask a healthy population and the same applies to to an injured population, it turns out that around 70% of the power of the people prefer to receive feedback after a good performance of an exercise, what happens in most clinical situations with all good intentions? I really don't want to question that, but we typically give corrective feedback, which typically means you didn't do something according to the standards of the therapist. That means that maybe seven out of the 10 people that you provide feedback to may not really like this, and this may affect their motivation. This may affect their learning potential because they like to receive feedback when something went well, they, they conversely they already know when something didn't go well and they don't need us to rub it in or to remind them they already know.

Speaker 2 (17:15):

So you, you touched on a word that I was just going to ask you about, and that is motivation. So why is motivation key in motor learning?

Speaker 3 (17:28):

If you look for example, at the brain activity of a person that is instructed to do something, or you look at the brain activity of a person who has some control over what they're going to do, you have completely different brain patterns. And I can tell you that the second one, the second example, when you give them some, and when they can choose, they are much more engaged, and this is a prerequisite in order to learn something.

Speaker 2 (17:59):

Yeah. And, and I think we can probably all look back on our own personal experiences of learning, whether that be academic learning, or learning a physical task. I think we all like to have a little bit of control over that versus just have stuff thrown at us without our IM without our input or without our thoughts on it. So I think that makes perfect sense. And now, so we spoke about how motor learning is, non-linear why motivation and autonomy is so important. Now let's talk about, we've got this patient with who had an ACL repair and they want to get back to sport. They, they are, they are ready mentally. So we'll put that to one side. They're ready mentally. So let's talk about the return to sport from a motor learning perspective.

Speaker 3 (19:02):

In my opinion, return to sports is we first need to define what we mean. And I think the 2016 consensus meeting gave us some leeway in that direction. And I think one of the most important things that stood out is that it's a continuum. It is not one moment in time. And I think what I read in the literature often is is that it's such a that coma to choice yes or no at at six months or nine months, whatever you're, you're, you're, you're believing in. I think what we need to understand is certainly in light of the high number of secondary ACL injuries, particularly in the young population, in, in, in pivoting type sports, that's number one. But also the second one is that, you know, only, I think a disappointed percentage of people reach their pre-injury level.

Speaker 3 (20:00):

So their performance is not up to par. So do those two factors. When we, when we look at that, I think it all starts prior to the surgery. So the rehabilitation, I think is one of the key factors that we need to, that we need to consider anything that's left. Unaddressed will show up even in higher magnitude, after the ACL reconstruction, which was the second trauma to the knee. And, and then in, during the entire rehabilitation process, something very simple. And I can't stress that enough if, if walking is not normal and how do, how do many clinicians assess a normal gait pattern? They usually ballpark it, but, you know, even a slight deficit of five degrees is clinically meaningful. And now, now just follow some logical sense. If you're walking is not normal, what do you think will happen with the running?

Speaker 3 (21:01):

W what do you think, what would you expect? How, how the squat will be executed by the patient and how will the single leg up will be done or a drop foot, a good jump. So that's why I think that all these elements from a motor learning perspective, and also we'll touch back on that a little bit later, of course, sound strengthening program, you know, no question about it, very important, but I think it is, it is very important to also incorporate the model learning process so that we make sure that the patient is learning or relearning those motor skills, but Mo and I can also stress enough. It's also important that we as clinicians really, really measure and boarding and, and I, we just completed and published a study among Flemish physiotherapist. And one of the things that came out of this study is that many don't use the evidence-based principles, meaning also they don't use two criteria as they don't assess and in order, and that's also coming down to model learning. If you want to a certain that learning has taken place, you need to measure, otherwise you can't, you can't be sure that the patient has learned something.

Speaker 2 (22:22):

And how do you, what are some examples that you can maybe give the listeners of how you measure these motor learning outcomes? Because I think that's important to let people kind of wrap their heads around that. And on that note, we're going to take a quick break to hear from our sponsor and be right back

Speaker 4 (22:41):

On Tuesday, March 9th, net health is putting on a three-part mini webinars series entitled from purpose to profits, how to elevate your practice in an uncertain economy after 2020, you're going to want to sign up for this. You're going to hear from a panel of experts that have over 50 years of combined experience working in the PT industry, signup will begin tomorrow for this mini webinars series. So head over to net health.com/litzy to sign up once again, that's net health.com forward slash L I T Z Y.

Speaker 3 (23:16):

Yeah. So I use, then that's something from, from the business that you probably know that the PDCA cycle, the plan do check act and the P and the plan, which means you do a baseline test. So first you need to let's say balance. So there's the patient have a balance deficit yes or no. You can use the star balance says you can use th the balance error scoring system. That's your baseline test. Now, it's up for you as, as a physiotherapist with your clinical reasoning. Does the patient need an intervention to target a balance? Yes or no, or are we happy with, but let's assume now there is a balance deficit. Now we go to the do, which means what is my intervention? So my intervention could be, I'm planning to do balance training for four weeks, with two therapy sessions in the clinic, and four sessions at home consisting of those and those exercises.

Speaker 3 (24:21):

And then AF in between I'm doing an interim evaluation, is the patient going on track as I'm expecting or not? I can still find tune my my intervention program, a training program. And then I do a final assessment after, after two weeks and preferably even one little bit later on as well to make sure that the effects of the balanced training are really sustained over time. Remember what I said about riding a bike or skiing and that's a very simple procedure you can use. It doesn't take a lot of time but it's, it needs to be integrated in your daily practice because if you don't measure, you don't know.

Speaker 2 (25:09):

Yeah, absolutely. And I love that. I think people can get behind that PDCA cycle and cause, you know, PTs love things that are regimented and you know, things that sort of follow a plan. So I think this is a really easy, and I think people can get behind it. And I also think that it will keep your patient on track and keep you on track and organized versus just like throwing whatever up against the wall and seeing what sticks, if you measure it, you're, you know, you're, you kinda know where this patient is going and that makes all the difference.

Speaker 3 (25:51):

Yeah. Which, which th that's a good point that you I, I forgot to mention it actually in the, in the, in the planning cycle, I'm incorporating my patient. So I'm discussing the baseline tests and I'm asking in my patients, so you have a balanced deficit. What do you think is needed for you to improve your score? What do you think is could be if you score eight out of 10, so zero would be no balanced error. 10 would be the maximum errors that you can acquire. So you have an eight, what do you think is reasonable to achieve in two weeks time, for example, and then the patient could say, yeah, I think I'm I can reach a seven. Hey, that's the interesting information. Why, why are you so conservative? Why can't, why can't you challenge yourself from, from an eight to a four, for example?

Speaker 3 (26:42):

So I always creating this interaction with my patient. You know, I can in conjunction with, with, with me and my patient, I can set goals that, and that's quite important as well. That need to be challenging for the patient, because if you, if you already a good or something, you're not challenging and it's not challenging anymore, if it's too difficult, then you then it's overreaching. But it, it has to be something that the patient sees. Okay. I really got to put some effort into this is again, which is, again, something for important for learning.

Speaker 2 (27:22):

I was just going to say that I said from a motor learning standpoint, if you do nothing that gives a substantial challenge to your patient, are they really going to see the benefits of those exercise or of your plan? Exactly. Yeah, yeah. Yeah. That makes perfect sense. Okay.

Speaker 3 (27:45):

And also going back to to the first example where the two patients with the balance exercise, if, if I give my patient an exercise, it is usually an exercise that creates difficulty for them. So if I see a perfect demonstration, then I'm kind of thinking, yeah, what is the learning potential here? So I purposely make the exercise a little bit more difficult right away. And I explained that to them, I'm explaining to them, don't expect to, to master this exercise today or tomorrow. And I always give that example of, of riding a bike and, and a lot of patients like that because, Oh yeah, I remember that I fell down quite a few times and and that that's in ACL rehab. It's, it's more or less the same process.

Speaker 2 (28:37):

Yeah. And, and I also want to switch, well, this isn't really switching gears just moving forward. So yes, we know that return to sport is a continuum you've got returned to sport and returned to performance, different things. And one of the things that I spoke about with Nicole [inaudible] is the importance of on-field rehab. So I know that's something that you're also passionate about. So do you want to kind of tie that into what, what therapists can do on field to continue to foster this motor learning within their sport, whatever that sport may be?

Speaker 3 (29:20):

Yeah. I think that's, that's something that's underappreciated and, and maybe that's because we haven't really integrated the motor learning processes in our rehab. And one of the things that we have to consider is when you observe your patient in the clinic and you a certain motor behavior, that's all what it means. It stems down to the interaction between the environment. The task at hand could be a jumping exercise, could be a single lag, actually, whatever. And, and, and, and to behavior that you're seeing. So there is a task athlete, environmental interaction, which means the movement that you see from that interaction only is valid for that interaction. You cannot extrapolate a jump landing strategy from a box in a physiotherapy clinic. And imagine how this athlete would play lacrosse or American football or soccer. It's completely different game, completely different worlds.

Speaker 3 (30:37):

So I think that's where one of the main reasons why single leg hop test and accessed by, by, by Kate Webster and, and, and Tim, you, it were shown not to be valid predictors of secondary ACL injury, because a hop test is something completely different than how an athlete performs on the field. So, in, in, in that regards I think we need to take the patient to the field and to see how the patient is performing based on that interaction that I just refer to the tasks, the environment, and the athlete interaction. And then you get meaningful information where the, where that patient is is add, which for example also means that one-on-one training is not what's needed for a football player. They are team ball athletes. So you need to do something with the ball. You need to be on the turf and you need to do something with teammates

Speaker 2 (31:43):

That yes, when you're working with someone with a team sport, you have to have those other I don't want to say distractions, but you know, other people, a ball scanning a field versus just going one to one with you.

Speaker 3 (32:02):

Yeah. And we, we've just completed an analysis of 47 non-contact ACL injuries in Italian professional football. Just this work that I've done with Francisco Della Villa from the ISO kinetic group. And what we did is we, we looked at the injury mechanism through a different lens and what we the lens we use was a neurocognition lens. So we looked at the inciting events that happened before the ACL injury took place, because so far the literature is predominated by the dynamic valgus collapse. And I totally agree. I totally agree. However, it doesn't tell you what led to the injury. It just tells you what the end point is. That's dynamic velvets now. And what we've done now is what are now some typical events occurring during a match play in which a non-contact ACL injuries took place. And we took two neurocognitive factors. One is the selective attention. So are you able to maintain attention to the relevant information in this regard and filter out irrelevant information? And the other one is, did we see some impulsive behavior of defenders? And they were running into a situation in which basically the attacker waiting for them to approach. And then at the last moment, they made a deceiving action that the defender did not entail.

Speaker 2 (33:40):

And now in the very small timeframe,

Speaker 3 (33:43):

The defender had to change the movements in a timeframe that you don't have enough time to coordinate those movements well. So if you think about this as a framework, how injuries may happen, we also need to consider this framework, how we integrate that in our rehabilitation process. And this is what I do from day one. And certainly this is what I do re related back to your question for the on-field this framework we use for the on-field rehabilitation. And I've created a model for that.

Speaker 2 (34:19):

Yeah. So I was just going to say, I know that you've created a model and it's going to be published soon. So let's talk about what that model is. And if you can kind of walk us through that, that would be great.

Speaker 3 (34:31):

So the model is consists of three main pillars. The first one is neurocognition and neurocognition, you need to think about reaction time. Decision-Making selective attention, as I mentioned before, but also your ability to control impulsive behavior. That's called inhibition. Can you, can you change your intended movement? Yeah. That's something to control your impulses. Very important. Working memory is another aspect. So those are the neurocognitive components. Then we have the motor component, and I think that's where most physios will be quite familiar with. So we think about strength, range of motion endurance speed, things like that. Yeah. That that's, that's I think pretty straightforward. Then we have the sensory part. So in the sensory part, we can have the visual components so we can alter the visual input, maybe quite relevant for ACL rehab as Dustin grooms has already shown. And also my colleague and part of borne, Tim layman has demonstrated that with EEG, that the patient may have some visual reliance, but also things like, do you have your patient do training with shoes on is, are you playing on the hard surface, soft surface lighting conditions, auditory information.

Speaker 3 (36:06):

Now those three factors, neurocognitive motor, and the sensory part. What I did in my model, I created like a gauge, so I can create an exercise combination in which I have a relatively simple motor skill. So not so demanding, standing on one leg, for example, but what happens now, if I, and more cognitive load, for example, by having them do math subtractions, or working on the synaptic sensory station by doing motion tracking. Now I can see what the influences is of an added neurocognitive load on my motor art, because those three shape my functional movement coordination. Likewise, I can turn back. My neurocognition lit and stay with the same exercise and do now something on the sensory part. And this is what we all do as clinicians. So we do a single leg balance exercise, and we have the patient stand on on the, on the foam surface, or we have them close their eyes.

Speaker 3 (37:14):

So we already doing this, but I think the model can help you. How do I plan my exercises within one rehab session? And I'm changing that from week two week. And why would this be important? Well, first of all, we all always need to consider that we have, we need cognition during our motor control. And if we only work on pre-planned activities that, that are often in happened, we miss something exactly what you pointed out already from the on-field situation. They have to perceive a lot of information. They have to process that information and then execute the movement. And here's where cognition comes in. And we do this by being aware of that, we can use these gauges. What we do is we actually create a rehab environment that we call in part a board. And we call that an enriched environment in which we constantly provide different stimuli to the patient.

Speaker 3 (38:22):

That means the rehab from week one to week two is not the same, which means variation, something new, something I haven't done before. Again, this could already motivation so significantly, and I can tell you from experience, patients love this. The second benefit would be since you're providing different stimuli, you actually confronting the brain every time with a new situation and the brain has to find solutions. And this is I think very important also from the motor learning perspective that we need to consider to enhance the neuroplasticity of the brain, because an ACL injury is not just a peripheral ligamentous injury. It is also a neurophysiological lesion and that's, I think, needs to be considered and rehab.

Speaker 2 (39:19):

I mean, I, I have to say for me, I really liked this model because it, it gives you a great way. Like you said, to plan out your session so you can maybe enlarge the motor component one day or take it back another day, do more, neurocognition move that back, do more sensory, do sensory motor, maybe not so much neuro do a little bit of all three. So it's sort of like, I just sort of see the Venn diagram, just expanding and contracting with all three of those bubbles, which I think is really great. And like you said, it gives you, it's almost from a therapist standpoint, a clinician standpoint, I feel like it gives me permission to play around and come up with some fun things and be a little more original.

Speaker 3 (40:06):

Yeah. And I think what it also does it, it, it may help you as a therapist to get a better understanding where some underlying deficits may be because we only, we T we typically like to measure the outcome. So let's say I'm doing an agility course, and I'm just looking at at the time. And then I see, Oh, the patient is not so fast. So I need to do more training. Well, what you could maybe do is try to untangle a little bit and to see if the patient from the motor perspective has all the necessary requirements in order to be fast. Maybe there's a deficit there, but let's assume it's not the case. So all, all the strength, all the rate of force development, all these parameters are satisfactory. That must mean that there's something else in the system that can't cope with the demands. And that could quite well be that there is an underlying neurocognitive deficit, and this may help you as a therapist to work more on those neurocognitive elements with the intended goal that the patient becomes faster, but maybe not so much, but we're doing more plyometrics and, and doing more speed now working on the neurocognitive aspect.

Speaker 2 (41:30):

Yeah. So it's, it's a, a treatment as well as an evaluative tool to kind of see where some deficits are and how you, you and your patient together can plan to move forward. Sounds great. When when will this be widely available?

Speaker 3 (41:49):

I hope we have it out in a month, the time from that pending on, on the, on the publication process, but please stay tuned.

Speaker 2 (41:58):

Okay, perfect. And we will let, we will let people know. I will put it on social media when that is out. So that sounds great. Well, I mean, thank you so much for coming on and talking about this, I've been taking copious notes. I think this was great. Before we get into where people can find you, I have one last question and I ask everyone this, and that's knowing where you are now in your life and in your career. What advice would you give to your, to your younger self?

Speaker 3 (42:23):

Good question. I think what would have helped me if I would have spent more time in the neurological field, I think in, in what I still see, or with colleagues that work with pediatric patients, I think some of the motor learning principles that they use could be very beneficial for us working with more orthopedic sports related injuries. That's something I did not understand back then, because my interests were solely in the, in the sports domain, but in retrospect, I should have spent more time in, in the neurological and pediatric field.

Speaker 2 (43:04):

Great advice and great advice for anyone who is maybe at that starting point in the sports or orthopedic rehab world and trying to figure out, Hey, what is there something I'm missing here? So I think that's great advice now, where can people find you and find all this great stuff, all your great info.

Speaker 3 (43:24):

All right. So we have a website from our company and our company's serves as the hopefully as the intermediary between academics and the clinical field. I, I work in both fields. I'm, I'm a clinician, I'm a researcher. And with our platform, actually our community model learning Institute, we want to create a bridge between the academic field and the clinical field, because I think we can all improve, but we need to find each other and we need to speak the same language and have respect mutual respect for one another. And if we engage in in such a culture by exploring, by facilitating one another, I think we can create a lot of new things and approaches with the overall purpose to help our patient. This website will be updated in a month from from now. So we will we will be offering completely new courses, which are also have the opportunity to get coaching from us. So it's not frontal education, but we offer for every course participant to receive life or written feedback on their progress during the course, because our premise is that we want to create a course in such a way that you can apply it into your setting after you've completed the course.

Speaker 2 (44:58):

That sounds amazing. And we will have links to to the website. We'll have also put the link up to your research gate profile so that if people want to look at some of the papers that you mentioned today, they can just go there and see all the papers that you have authored and co-authored do. I think it would be really helpful. And if people want to find you on social media, where's the best place to reach out to you there

Speaker 3 (45:26):

Would be Twitter, Instagram, or Facebook.

Speaker 2 (45:30):

Perfect. And what are the handles if you know them off hand motor learning Institute. Perfect. Perfect. Okay. So thank you so much. And like I said, I will have everything available up on the website at pod podcast at healthy, wealthy, smart.com. So Allie, thank you so much for coming on again. I really appreciate it.

Speaker 3 (45:55):

Thank you, Karen. And I really want to say, thank you so much for setting this up. I think this is exactly what we also stand for, that we create a platform in which we can exchange our ideas. We can ask one another question that that's the best way I think, to move forward. So really thankful for you to organize this and yeah.

Speaker 2 (46:16):

And so everyone, thank you so much for listening. Have a great couple. I have a great week and stay healthy, wealthy and smart. Well, a big thank you to Allie for coming on and sharing all this great information about motor learning as it relates to ACL injury and rehab. And of course thank you to our sponsor net health. So remember on Tuesday, March 9th, net health is putting on a three-part mini webinars series entitled from purpose to profits, how to elevate your practice in an uncertain economy. You're going to hear from a panel of guests that have over 50 years of combined experience working in the PT industry, signups will begin tomorrow, which is February 23rd for this mini webinars series. So head over to net health.com/ let's say to sign up once again, that's net help.com forward slash L I

Speaker 1 (47:04):

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

In this episode, 3rd Year DPT Student at Rosalind Franklin University of Medicine and Science, Briana Zabierek, talks about her DPT Study Guide.

Today, Briana tells us about her experiences in PT school and the frustrations that led her to start the DPT Study Guide. How is the DPT Study Guide helping students? How does Bri find the time to do it all while still studying? She elaborates on the future of the DPT Study Guide, what students can expect to find in the guide and current developments.

Briana tells us about how the DPT Study Guide is compiled, finding her entrepreneurial interest, and she gives her younger self some valuable advice, all on today's episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

• How Bri manages her time:

Change of pace: Set a timer for 45 minutes. Put all notifications off, and just zone in on your work.

Master a topic, then move on: Be comfortable bouncing between topics. Master the main ideas before moving on to another topic. Don't try to do a whole topic in one go.

• "The long-term goal is not just to provide products and merchandise, but to really make it a place where you know you're stepping into a simplified version of PT school."
• "If you have the passion for it, and this is something that you believe in, then you can make anything happen."
• "You don't have to be an entrepreneur to make these opportunities possible for yourself."
• "Take more breaks and realize how valuable those can be for hitting reset with your mind and focus, and also make time to have some fun."

Suggested Keywords

PT, DPT, Study Guide, Health, Prioritizing, Studying, Entrepreneurship, Efficiency, Physiotherapy, Time Management,

To learn more about Briana:

[caption id="attachment_9507" align="alignleft" width="150"] www.melissa-manzione.com[/caption]

Bri was raised in Lockport, IL. In 2017, she graduated with a BSc from the University of Nebraska-Lincoln, Double Majoring in Nutrition, Exercise, and Health Science, and Nutrition Science with a Minor in Psychology. She is currently studying toward her PhD in Physical Therapy at the Rosalind Franklin University of Medicine and Science, with her graduation expected in May of 2021. Her mission statement: To serve, encourage, and equip patients and students in reaching their full potential.

Follow Briana at:

Facebook: @dptstudyguide

Instagram: @dptstudyguide

LinkedIn: Briana Zabierek SPT

Twitter: @dptstudyguide

Website: https://dptstudyguide.com

https://dptstudyguide.com/downloads

Subscribe to Healthy, Wealthy & Smart:

Website: https://podcast.healthywealthysmart.com

Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264

Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73

SoundCloud: https://soundcloud.com/healthywealthysmart

Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart

iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927

Read the Full Transcript Here:

Speaker 1 (00:01):

Hi, Bree, welcome to the podcast. I am happy to have you on.

Speaker 2 (00:05):

Thank you. Thanks for having me. Sure.

Speaker 1 (00:07):

And we'll give a shout out to Dr. Sarah Hague for putting us into contact with each other and telling me all about the great work that you're doing with DPT study guide. And we're going to talk about that today. So before we talk about the guide itself, why don't you share with the listeners, your sort of personal experiences with PT school, which you are still in your third year student at Roslyn Franklin. So share a little bit about your personal experience with PT school and maybe some of the frustrations that came up for you.

Speaker 2 (00:41):

Yeah, yeah, absolutely. So first and foremost, I think every student kind of encounters a little bit of a roadblock just starting out between my roommates and just our class itself, we had some pretty good comradery to begin with. And so I always felt that that was a good option to at least discuss, you know, areas that I maybe was struggling with or they were struggling with and just kind of have this like melting pot of different ideas and different ways that we could all just get the job done and kind of figure out what we need to know for exams. But as time went on, I think we all kind of fell into our own little like habits and patterns and maybe a little bit what we're comfortable with. And then what I realized was when I think it was about like the middle of middle or towards the end of first year we had our neuro unit and that is kind of where everyone hit a wall with our study habits and just retaining the information and just kind of collectively as a class, we were making our own separate study guides and they would be like these super, super long word documents.

Speaker 2 (01:56):

And I'm talking like 50 plus pages full of yeah. Like eight point text. And I was kind of like attached to them. Like we all would get on like our Google docs and like start typing up information and it just became really overwhelming. And so what I realized was like, I kind of have an opportunity for myself and for my colleagues is to just simplify things a little bit like I was getting sick of kind of going through the PowerPoint slides that were, you know, 120, 150 slides long and just little snippets of information on each. And so I kind of just took a step back and, and saw an opportunity to really simplify things, not just for myself, but something that I thought would be helpful just to transform any student's education going forward. And it was in again, late in our first year when I was inspired by different cash based physical therapists and kind of exposed to that world and realized that there was an opportunity for me to step into like a neat niche position. We kind of get started there kind of with like a side hustle. So that's kind of where everything stemmed from, and right now it seems to be going pretty well. Just looking forward to kind of like sharing the experience.

Speaker 1 (03:13):

Yeah. And so tell me a little bit more about the guide itself. Can you kind of give an example of a section of it and how it helps other students? Right.

Speaker 2 (03:26):

So one thing that I definitely picked up on when I started posting the information on Instagram, which is my, my primary platform that I use was trying to get the main points of any kind of lecture or chapter into about like eight to 10 pictures on Instagram. And so what I wanted to do was share that information to simplify things for followers and students in general. But the guides themselves are focused around that idea. So kind of finding information that is most relevant to clinical practice and then finding information that's most relevant for board exams, meaning safety, or, you know, most basic like phases of cardiac rehab, pulmonary rehab and stuff like that. And I, I always felt like I mentioned kind of going through so many chapters, so many pages, so many slides it was getting exhausting, trying to figure out what I needed to know. And so the whole point of the study guides is to just really get to the meat and potatoes of everything. And then if you need to find something to reference later on, that's when we obviously go back to our PowerPoints in our articles.

Speaker 1 (04:35):

And how are you simplifying or sort of taking out those pieces that you described for the meat and potato pieces. Do you have a system as to how you extract that information from these lectures or is it a group effort? How is that being done? A little,

Speaker 2 (04:54):

A bit of both. I, like I said, we collaborate a lot as friends and classmates throughout the years. And then I really actually took the advice from Dr. Sarah Haig. So another shout out to her, she mentioned just go back to the objectives, whether it's the lecture that you're sitting in, in PT school or it's the textbook chapter that really lays out a good I don't know, six to 12 main ideas, and then I go back there and try and figure out, okay, what information from this chapter, can I really pull and fit it into these like umbrella topics? So that's kind of where I started at. And then some of the samples that I have up on the website to reflect like, okay, let's just put the fancy details away. And what do I need to know if I'm seeing a patient or if I'm seeing these questions on a board exam

Speaker 1 (05:45):

And what has the response been from your fellow students?

Speaker 2 (05:50):

So my class, my classmates are really excited about it. I post a lot of daily questions in, for board exams and they're excited to see it, they've moved their head ideas themselves to start an Instagram just for studying purposes. And then having that collaboration aspect has been really helpful. So I'll even get messages from a few of them saying that, Oh, well, you know, this is something that I haven't gone over yet. So I appreciate you kind of like pushing me to review it and, and stuff like that. But even from complete strangers, like how much support I've, I've gotten has been overwhelming almost, especially with trying to handle studying for boards and preparing for my final clinical rotation overwhelmingly positive. And I kind of attribute that to the field itself. I think going into a profession where we're, we're taught to care for others and put others first and all those ethical principles people are just really grateful to have an opportunity where they can see the information and either like bookmark it and kind of synthesize it right away instead of having to go through all like the dirty work themselves.

Speaker 2 (06:58):

So it's been overwhelmingly positive and I just want to shout out to everybody who's following along. I appreciate the support,

Speaker 1 (07:05):

And now you hit upon something that I want to dive a little bit deeper into, and that is time. So where are you finding the time? Because I know that I hear from a lot of students that they feel overwhelmed. There's not enough time in the day to begin with. So do you have any tips or tricks that maybe other students or even practicing clinicians can learn as to how you parcel out your time to be able to do all of this?

Speaker 2 (07:33):

That is a great point. It has taken me probably the last three to four years, even before PT school to figure out what works best for me. And kind of even coming to the realization of, you know, you, you do need to manage your time before I would be a little bit of a procrastinator. As in like I would, I would start a project and then I wouldn't really finish it. And I was like, okay, well I've already started it. So I'll get to it later. It's almost like more of a, a productive procrastinator, I guess. And so what really has helped me is a change of pace. So I know I don't remember the exact name of the timer, but you either set 45 minutes or 30 minutes where you're just zoned in notifications are off. And you're just focusing on that topic for a little bit.

Speaker 2 (08:21):

And then also mixing in a variety. So in the beginning of PT school, I would try and get through all of my lectures that we had that day, the same evening. And that was just that wasn't going to happen. I tried my hardest, but it was just wasn't going to happen. So what ended up doing was bouncing between topics, even if it feels a little bit unnatural. What I've noticed with my classmates and with myself is we want to just master a topic first, before we move on. And I think the most helpful tip that I can give is to really just be comfortable with bouncing between things and just mastering the, the main ideas before moving on to another topic, because the more that you get caught up in the details, the more you're going to kind of lag and again, procrastinate going to other topics. So that is first and foremost, give it some variety, mix things up and then really set a timer. And then lastly, like I said, just taking a peek at the objectives of the lecture and the chapter is really going to tie together, you know, what you need to pull away for clinical practice or, or board examinations.

Speaker 1 (09:28):

Yeah, because I think so often we can sometimes get lost in the weeds and we don't pick our heads up to see those bigger pictures. So I think that's really great great advice for students and for physical therapists alike. So now we know why you started DPT guide and now have a better idea of what it is. So my next question is what, what is the goal for you of the DPT study guide

Speaker 2 (09:58):

First and foremost, I, I want to make it a community. I think the longterm goal is to be not just to provide products and merchandise, but to really make it a place where students and practitioners alike can come and just review without any, I dunno, egos or preconceived notions or anything like that. Just coming into a place where like, you know, you're, you're stepping into just a, a simplified version of PT school or PT practice. So that's the ultimate goal is just making a community for people to come together and not, not entirely making it about DPT study guide, but making it about the appreciation and respect for physical therapy itself. I do a lot right now on the page about daily, weekly posts covering a variety of topics, as well as sharing a lot of other students, other clinicians work that they are doing to promote the profession, promote their small businesses. And so that's, that's kinda, my, my longterm goal is to just make it this safe space, I guess, for PT students and clinicians alike.

Speaker 1 (11:12):

And now is this something that is meant to help people pass their board exams? Cause I just want to make sure that we're kind of differentiating so that people, especially students that are listening if they want to get this guide or get these guides from you, is this something that's like, you're gonna pass your boards if you do this. Cause I don't want there to be any information there.

Speaker 2 (11:36):

Right? Absolutely. My first line of products is geared towards the board exam, especially the MPTE. I think long-term, I would like to branch out and see, especially in Canada, my boyfriend is Canadian. So you kind of giving some respect, a little shout out there too. But first and foremost, yeah, it's going to be focusing on the MPTE and then down the line I would like to extend it into just clinical practice, you know, how things have evolved from our standardized examination to how things are in the clinic or in the hospital.

Speaker 1 (12:10):

Got it, got it. Okay. So what can people expect? What if I, if I am a student and I want to download this, what can I expect to find,

Speaker 2 (12:23):

Do a lot of aesthetics? So I try to pull in like I said, the information that is relevant to both clinical practice and board examinations by kind of seeing where the attention is going to be in terms of like the mind's eye. So transitioning from what we made in school during our first year with those 50 to 60 page documents with just white background, black text, it's really hard to find the information that you think is going to be important. And kind of just simplifying it into basic examination procedures, basic interventions phases of rehab medical screening, laboratory values. And like I said, kind of the meat and potatoes of everything that PT is just so that students don't get overwhelmed with the details. It's going to be like bright and bold big ideas and then kind of like,

Speaker 1 (13:21):

Got it, got it. And, okay, so now we have a better idea of where you would like this to go. So tell me, what else do you have in development? What are you thinking that you can add to this? And it looks like, so what I mean, when you're on the website, it looks like it, the addition to it is, can be infinity. So I think it's important for people to know that it's not like you go onto your website and it's one big gigantic guide. Right, right. So where do you see this going? What do you have coming down the pipeline?

Speaker 2 (14:08):

So first and foremost is getting out both PDF copies and paper copies of the study guides. And then once I feel like that has a pretty steady response rate, then I want to transition into maybe even tutoring one-on-one video instructions or even student courses where they can go through maybe a differential diagnosis and orthopedics or differential diagnosis medication review in neurology and even down the line. This is like probably five years from now. I have a very invested passion and pain science, and so kind of pulling those things together and offing offering courses for professionals and students alike. So I, I have high hopes. I think it's going to be a little bit of a learning curve and seeing what the demand is for students and professionals when the time comes. But I, I have full intentions to continue to grow with the demands that are out there for students and professionals.

Speaker 1 (15:16):

Awesome. And now, you know, this is obviously very entrepreneurial and which is very exciting. So where did that spark come from? Because not everyone has that kind of entrepreneurial spirit and nor do you need to have it to be an excellent physical therapist, but where did that come from for you

Speaker 2 (15:38):

First and foremost? I have to, again, shout out to a dear friend of mine. His name is Travis. Robertson. He is, he was a third year student when I was a first year student. And like I mentioned, during that neuro unit where things kinda got a little hazy with studying, he mentioned to me that like, you know, why don't you just take a chance and see what the market is out there? He was very invested in cash based physical therapy at the time. And so then I started looking into, I mean, all the major ones, Aaron LeBauer was first and foremost, Danny Mada, Jared Carter. I actually even kind of more on like the female entrepreneur side of things is when I found obviously Karen Lyndsey and Dr. Hague more, just more opportunities to see what those people were doing in their own journeys.

Speaker 2 (16:28):

And so he really inspired me to just take a peek at what's out there. The more that I learned about cash based businesses, owning your own PTP clinic, the more I realized that there's different opportunities with side hustles with other income streams. And that's when I, I kind of took my passion for simplifying PT studies into like the study guide form and realizing it's going to take a little bit of effort upfront. But you know, if you have the passion for it and if you feel it's like, it's something that you believe in and fit that this is truly something that I believe in, then you can make anything happen. Like you said, you hit the nail on the head. You don't have to be an entrepreneur to make these opportunities possible for yourself.

Speaker 1 (17:11):

Yeah, no, definitely not. Definitely not. As long as you can stay organized and motivated and at some point reach out for help. I know not necessarily in the beginning, but you know, as time goes on reaching out for help when you need it is always a great thing as well. Well, it sounds like you've got, it sounds like you've got everything under control. I think you might be more organized and, and, and you've got your, you know, what together, more than I do. So I may, I'm a little so now what, where can people find you? Where can they find the guide? Yes.

Speaker 2 (17:58):

So the website is plain and simple DPT study guy at.com. I also run primarily the Instagram account, which is the handle is DPT study guide. And then that same handle you can find on Twitter and Facebook. If you're interested in connecting to me personally I do have a LinkedIn as well, and that would be my first and last name Breeza Barrick. So we can connect there too, but yeah, everything is easily accessible from the website and from Instagram page.

Speaker 1 (18:30):

Awesome. And, you know, just so you know, it's also very easy to download and it is very pretty and it's very organized and looks very it looks great. So I highly suggest if you're listening to this, especially if you're a student and even if you're not, if you want to brush up on your open and closed pack positions for all your joints, definitely a check out to DPT study guide.com. Now the last question is something I ask everyone it's knowing where you are now in your physical therapy student journey. Normally I say, in your life and career, what advice would you give to yourself right out of PT school, but why don't we say, what advice would you give to yourself maybe before you started physical therapy school to where you from, where you are now?

Speaker 2 (19:16):

Oh, that's a great one. Looking back, I would make more time for breaks. I feel like students are way too hard on themselves in terms of, I need to be studying 24 seven. If I'm taking a break, it makes me weaker. It makes me less smarter or whatever the case may be. Take more breaks and realize how valuable those can be for just hitting, like reset with your, your mind, your focus. And also just making time to have some fun. I, I really feel that our class emphasize that a lot because we were also motivated to perform as best we could on test exams and really trying not to sweat the small stuff. Obviously, like I said, the whole goal of it was to let's focus on the big picture and maybe try and make it a little bit easier on ourselves throughout the way.

Speaker 1 (20:11):

Excellent advice. Excellent. Well, Bri, thank you so much. You are absolutely wonderful and makes me very excited for the future of our profession, knowing we have people like you getting ready to graduate and enter the workforce. So thank you so much for coming on the podcast.

Speaker 2 (20:29):

Yeah. Thank you so much for having me. I really appreciate it.

Speaker 1 (20:32):

My pleasure, and everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart.