Navigating the Psychological Impact of Injury Images on Rehabilitation Paths

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, ICE Chief Executive Officer Jeff Moore discusses three fundamentals to working with individuals new to a fitness routine who encounter their first injury: avoid medical imaging, stay in the gym & modify around the injury, and be goal-driven to maintain motivation to continue to create a fitness habit.

Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

INTRODUCTION Hey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the P-10 ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. JEFF MOOREAlright crew, what's up? Welcome back to the P.T. on Ice Daily Show. I am Dr. Jeff Moore, currently serving as the CEO of Ice and always thrilled to be here on a Leadership Thursday, which is always a Gut Check Thursday. So first things first, let's hit the workout. Gut Check Thursday this week is going to be a bit of a partner WOD. So we've got four times, relatively simple. It's going to be 100 deadlifts, 100 power cleans, 100 power snatches. The weight is going to be 225-155 on the deadlifts, 135-105 on the power cleans, and then 95-65 on those power snatches. Essentially, you're going to decrease load with each movement, but obviously increasing complexity, and maybe more importantly, increasing grip fatigue. I'm looking at that workout thinking, boy, that's a lot of pulling on that barbell, but it's in teams of two, so break it up however you want, maybe five, maybe 10 reps on some of those things, and then pass it over to your partner, bang all of that out for time, and then post it so we can see how you did. Tag Ice Physio, hashtag Ice Train. I'm gonna do this at three o'clock with Say over at CrossFit Endure, our marketing director. We're gonna challenge this workout. I will make sure to post my time. so you have something to try and smash later on today or tomorrow whenever you have a chance to get to the workout. So that is Gut Check Thursday. Let's move on to the episode. THE ROAD TO FITNESS RUNS THROUGH MUSCULOSKELETAL PAIN We are talking about the fact that their life is in your hands. It sounds a little dramatic. I don't think it is, okay? We're gonna start off with the fact that whether we like it or not, we have to acknowledge it's true and that is the fact that the road to fitness runs through musculoskeletal pain. The road to fitness runs through musculoskeletal pain. We don't have to like that to acknowledge the reality of that. Meaning, if you're gonna take somebody who's relatively sedentary, is not on the path yet, and you're gonna bring them all the way to fitness, right? So through wellness, all the way to fitness, that journey, requires a lot of loading, and a lot of challenging, and a lot of recovering, and a lot of programming, and a lot of strain, and stress, and rebuilding, and remodeling. It is a journey, right, that involves a lot of stress to the organism, right, to be able to get it to adapt, to get to a point where you achieve fitness. You don't get there, first of all, quickly, and second of all, without ever experiencing any kind of symptoms, right? That's a lot of stress to the system. You're going to have some bumps and bruises and strains. I'm not talking about major injuries, but you're going to be working through some stuff, right? How we manage that stuff, especially acutely. And when I say we, I mean the entire team, right? Coaches, trainers, physios, chiros, fitness forward physicians, right? Everybody who these individuals are beginning to trust to guide them along this journey, how we all swoop in and manage the acute response to someone developing symptoms is going to dictate whether or not they stay on the path. And from our perspective, if they stay on the path, is a huge variable in the quality of their life. MANAGING THE INITIAL RESPONSE TO ACUTE INJURY DICTATES LONG-TERM OUTCOMES So when I say life is in your hands, what I mean is managing the initial response to someone's acute injury onset dictates probably the longevity, probably the level of thriving, probably the health span. That's why I'm saying life is in your hands because the way you respond to this will dictate those things. And those things really are the quality of this person's life. So let me tell you the three things specifically. that when someone develops symptoms in the gym, that our response kind of hangs in the balance whether or not this person continues along this path that we believe drives so many of the important metrics of the quality of someone's existence. Okay, so if an athlete develops symptoms, right, you're not going to get into a case study of how or why. It happens all the time. Somebody tweaks something, they develop symptoms. Here's the three things. AVOID MEDICAL IMAGING Number one, they avoid medical imaging, advanced medical imaging. If we want this person to stay on the path to fitness and they've recently developed symptoms, the number one most important thing is that they avoid advanced medical imaging, okay? We now know the problem, right? That most asymptomatic people have abnormal findings on imaging that can be really scary and knock someone off the path. I am not gonna get in to the myriad of studies here. Nobody reasonably well-read is gonna push back on this podcast and say that isn't true, right? We have now known for well over a decade, you think back to 2012 when the American Journal of Sports Medicine, right, took that cohort of folks, average age of 38. How many had abnormalities in their hips, asymptomatic people? 73%. How many had labral tears? 69%. No hip pain whatsoever, asymptomatic people. You think about that classic Brzezinski article, right? Not article, but systematic review paper. Took a bunch of different publications, bundled them all together, looked at the data, what did we see? Your average asymptomatic person, meaning no low back pain whatsoever, in their 50s. 80% disc degeneration, 60% disc bulges. We now know the average asymptomatic person has all of these findings on their imaging that can be concerning. This is why we focus on tissue health, not tissue shape. What we now all acknowledge is that your connective tissue changes over time in your face, inside your body, your spine, your labrum, right? It changes over time. It doesn't tend to correlate well to symptoms. The problem is if someone just got hurt, If they just started experiencing pain and they're nervous, right? And they're vulnerable and they get that image and they see something that looks kind of scary, it sticks with them. It bumps them off the path. They have a hard time letting it go. They say, well, yeah, I might be able to get healthier, but I saw that cartilage. It was torn. We're not going to fix that unless we go in there and fix that, right? And they get extremely fixated on this. They begin to lose confidence. in the rehab or strength and conditioning process. It really, really sticks. What we know is when that person develops symptoms, we could have sent the other 10 people in that class to get an image and we would have seen the same stuff, but it doesn't matter. We can say that until we're blue in the face. We have said that until we're blue in the face. When the person's injured, when they feel vulnerable, when they're in pain, when they're in that decision-making process and they get that image and they see something that looks scary and maybe somebody in the medical industrialized complex made it sound scary, Those things make it very, very difficult to keep that person on the path. So getting them to avoid that unnecessary image is a massive part of the acute triage process if we want to keep this person moving towards fitness. Now, it always is worth saying, But certainly there are some times when they should get an image. Of course there are. And that is why physios, chiros, physicians, I'm challenging you all to make sure you're available to these gym owners and these coaches that when something does happen, you've got that direct access training and license where you can come in and make that tough call. And it's a tough call on either side. Because if you do send them, we're risking this thought virus we're talking about here. If you don't send them and they needed it, you're possibly putting that person at significant risk. So don't make gym owners make that call. Don't make coaches make that call. This is what you're trained for. Get in there and make that call. And make sure that the gym owners know you're available that day for a quick consult to get that person's mind off of that possibility when that's appropriate, which usually it is, or doing the appropriate triage if it's necessary. Get that part accomplished, okay? Alright, number one, if you want to keep them on the path, avoid advanced medical imaging unless it's absolutely necessary. Have somebody qualified to make that tough call so that you can get over that hurdle quickly and efficiently. DON'T LEAVE THE GYM; USE THE GYM Number two, if you don't want them to fall off the path, You've got to convince them they don't need to leave the gym, they need to use the gym. People when injured, when in pain, are going to make a very broad assumption that they shouldn't be in the gym. It's the first thing they're going to say, right? They're going to go to put that membership on hold. Your job on the same day of injury is to help them realize that everything they need is actually in that gym. All the tools to rehab the injury that occurred are right there in that gym. The ability to regress the skill that maybe they were inefficient with is why they wound up straining something. are right in that jam. You can regress everything and build a better foundation so next time you get up to that PR or that new movement, you're more ready for it, you're doing it more efficiently, and you've done the accessory work so that you're not stressing different structures at an unnecessary rate, and now you're having a lot more success with these movements. All of those abilities, whether it's to rehab the area, to work on the skill that you struggled with, to build a better foundation, Those tools only exist in the gym. The number one place you should be after injury is in the gym. So don't let them leave, right? So help them understand that you might not do exactly what you just did, you will in a few months, but everything around here is what we're gonna use to make sure you can if you want to. Helping them realize, whoa, whoa, whoa, whoa, you don't need to be leaving the gym, you're gonna use this place, right? That's a critical part of the acute triage process. GET OBSESSED WITH GOALS And finally, number three, Get them obsessed with new goals or at least new angles at the same ones. What I mean by this? is that motivation is fleeting, especially in people that don't have well-formed habits yet, right? Something, some confluence of factors happened in their life where all of a sudden they became someone who goes to the gym, okay? That is a pretty fragile ecosystem early on. We know how tough habit formation is, you're learning new skills. Motivation can be fleeting and fragile. You gotta shift it, don't lose it. shift it, don't lose it. Get inside that person's brain quickly and figure out why they were coming to the gym and show them that they can achieve that while working around the injured area. If that person says, well, I'm here because I've been listening to so many podcasts and it sounds like Cardiorespiratory fitness is a massive predictor of longevity and healthspan and decreasing all-cause mortality. All the things, right? Like, I'm in, but I hurt my knee. So now I can't do the bike and run, etc. So I'm going to call it quits for a bit. You sure are not going to do that. You are going to be on the ski erg, right? Because those things don't involve high or low to those areas, but we can still challenge your cardiorespiratory fitness. We are going to get them obsessed with a different goal, right? If they had a gymnastics goal and right now their shoulders tweaked, we're going to help them realize there's nine other similar goals that don't involve that area that we have a very specific program to move towards. And we're going to get them obsessed with getting that goal. And then we're going to swoop right back around and get on the same path and grab the other one. We're just going to show them. There are so many amazing things that we can do in here. to keep chasing your original goal, add on new goals, work around the injuries, and still achieve everything you set out to do, we understand that motivation is fleeting and fragile. We are going to help them take that motivation they've got right now, and we're going to shift it a little bit. We are not going to let them lose it. And you've got to be convincing in that acute phase, because they're going to make some heavy-handed decisions with all that emotional energy, with pain on board, and you've got to be there to guide that process. SUMMARY Team… Whether people choose to chase fitness during their lives is going to be a huge predictor of the quality of their lives. As they chase fitness, they are going to have soreness. They are going to tweak things. We are not going to load the system for years and years and never bump into any of this stuff. How we as a support system come alongside that person in that acute emotional time when they're having pain is going to dictate if they stay on the path. If we can get them to avoid advanced medical imaging when unnecessary, if we can get them to stay in the gym and use it versus leaving it, and if we can take that motivation they have and shift it as opposed to getting rid of it, we can get this person staying on the path. and we can change the entire rest of their lives, their family's lives, everybody they interact with, their life is in your hands. Be a great resource. Think about those three things in that acute management phase. I hope it helps, team. Thanks for being here on Leadership Thursday. As far as courses coming up, We've got a bunch of them. Ice Sampler is coming up at the end of this month in just a couple weeks in Carson City. We're actually going to put a limited amount of tickets on sale for 2025 because we know this event is hard to get into. It sold out in one day last year so we're trying to make tickets available at different times to give folks an opportunity to be a part of the event in 2025. But before then, we've got a bunch of courses. We had 12 last weekend. I think we have another dozen coming up over the next weekend or two before Sampler. So get on PTNICE.com, check those out. A lot of online courses start on April 29th, which is only a few weeks away, and some of them only have a handful of seats. So get over to the website, check it out, have an awesome Thursday, do gut check. We'll see you next week, team.

OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.