#PTonICE Daily Show

Alan Fredendall, the Chief Operating Officer of ICE, shares insights on myofascial decompression (MFD) and its distinction from cupping. He discusses the effectiveness of MFD and its unique techniques that apply pressure and movement to alleviate tension. The conversation highlights the significance of pressure control in enhancing treatment outcomes and emphasizes aligning techniques with patient objectives. Listeners can also explore opportunities for further education and community engagement in physical therapy.

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer discusses important tools for acute care PTs: a good attitude, a backpack, a white board, resistance bands, sticky notes, and gait belts. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JULIE BRAUER Good morning crew. Welcome to the PT on Ice daily show. My name is Julie. I am a member of the older adult division. and I am coming to you live from my garage. So this morning what we are going to dive into are fitness forward tools that you can use in acute care and I'm going to do my best to demonstrate some of these tools that you can use to start loading these really sick folks up early. All right so We are going to dive in first by talking about the most important tools that you need to have with you as you go through the hospital and you go visit your patients in their rooms. TOOL #1 - THE RIGHT ATTITUDE So number one, the most important tool that you need is the right attitude. You have to have the right attitude about this. So let me unpack that. Bringing fitness forward care to sick older adults in the hospital. It is not about getting them to do a sexy deadlift with a dumbbell. It's not the sexy thing. It is not, holy crap, I just got this patient, they're in a hospital gown, they're super sick, and they're doing a deadlift with a dumbbell in the hospital. It's not about that. It's not about being able to get the video of that or the picture of that and being able to share that. That is sexy and that is cool and it is badass. However, the meaning is deeper. What the attitude you need to have is, is that you have this beautiful, amazing opportunity to plant a fitness forward seed in this patient who is sick, who has a ton of medical complexity, and you only get to see them potentially one time. You've got one shot to plant that seed and potentially be the catalyst that sets this person up on a better trajectory of health. That's an amazing opportunity. And I would encourage you all to be obsessed with that opportunity. Okay. Every single time I would go into a room, I thought, wow, I have this opportunity. I've got one shot. I could be the catalyst that changes their lives. And the thing about you all who work in acute care, man, you are doing some dirty work, right? You are seeing folks, whether they're young or old, they have multiple types of diagnoses and medical complexities. You are seeing them at their worst and you are seeing them in a very, very vulnerable situation. The fact that you are able to plant that seed yet you don't get to see the sexy outcome and yet you give them your whole heart and whole soul is so important. And it's hard to be in acute care and know that you're not going to get to see a sexy discharge where a patient is lifting a super heavy barbell or they are going all out on an assault bike. You're not going to see that. And that's tough, but you have to reframe it to be, I'm going to be obsessed with having the attitude that I could go into every single one of these rooms, plant the seed, and the patient is able to walk into an outpatient clinic. They want to do fitness-forward care because I planted that seed. And I think that's an incredibly, incredibly important story to tell yourselves so that you can continue to have the motivation to go in and see these folks who are sick day after day. And many times you may not actually get to get them to do the cool fitness board stuff. Okay. So that's the most important thing is having that right attitude. Okay. TOOL #2 - A BACKPACK So the second tool that you're gonna need to bring along with you to every single room is a backpack, all right? You absolutely need a backpack. So this is not the backpack I used in acute care. I used the backpack that they gave us as like a Christmas gift one year. This is a Nomadic. This is my travel backpack. This is a very sturdy, but very expensive and nice backpack. I do not recommend getting something like this to go into hospital rooms, okay? But I do recommend that you get something that's sturdy because you're going to be carrying around a lot of stuff in it. So get yourself the backpack. So what are we putting in the backpack? You're going to put weights in the backpack. No, most acute care therapy offices do not have weights. But you can bring your own. So I would bring a 15 pound dumbbell. and an eight-pound dumbbell, and I would put that in my backpack. Now, some of you are not able to bring a backpack potentially into the patient's room. Cool, then you bring it around and you leave it at the nurse's desk, okay? But the idea here is that you're bringing everything with you so that there is no excuse that you don't have the equipment because you're in the hospital. So you have your weights. Now, I've had people say, well, Julie, isn't that tough to carry around? And I say, yes, it is tough, it's heavy, but who else would want to be able to go rucking through the hospital with weights more than fitness-forward clinicians who are here listening this morning? I thought it was awesome. I felt like I was getting a lot of fitness in by carrying this stuff around throughout the hospital all day. TOOL #3 - THE WHITEBOARD Okay, so after weights, you're gonna have a whiteboard, okay? I'm using a whiteboard right now for my talking notes for this podcast. you all are going to want to use a whiteboard to create workouts with your patient. So have your dry erase markers and as you are digging into their meaningful goals and you're coming up with functional movements that match those meaningful goals, you are writing this stuff down, you are coming up with reps and sets, you are doing this with your patient. Now, I will say, you're not going to buy these and leave these in patient's rooms, right? This stays with you, okay? You can take a picture of this and give it to your patient, or the really cool thing about acute care is that they typically have whiteboards in the patient's rooms, and they're usually filled with some random information many times they are covered up with Call don't fall signs Those become great whiteboards. Okay, so I usually they're not helpful We all can can agree that call don't fall signs are not something that prevents somebody from falling. So I they're great whiteboards so I would take those down turn them around and with my dry erase markers cut right down the whiteboard on those signs then I would leave that in the patient's room maybe I would go find a couple extras and I would put some motivational phrases on there like uh i remember one very specifically i'm trying to kick covid's ass so i can get home in shopwood something like that or something that lets the providers know a little bit more about this patient their name is something that i always put on these signs their name and something about them a goal an interesting fact i want to try and have every provider who walks into the room treat this person a little bit more like a human than a number or a diagnosis and that's a way to do that so whiteboard, slash use the hospital whiteboards, use those signs that are all around the room, turn them over, use those as your whiteboard. TOOL #4 - RESISTANCE BANDS Okay, next, resistance band and TheraBands. Okay, so both. So resistance band is something like this, okay? These offer a lot more resistance than a TheraBand. However, I usually would bring a bag of theravans because i want to be able to leave some with patience right you can do endless things with the TheraBands. I would tie them to the bed rails many times. So even folks who are typically they're just lying supine majority of the day because they're so deconditioned, you can tie those around on the bed rails. They can pull from above, they can pull from the side, there's a lot of stuff you can do with them just tying them to the bed rails. with the resistance bands, this is where I would many times get people up into standing and I would do something like a paloff press. So if they're standing here and this is attached to the bed rail, I can have them do a paloff press to work some core. I can have them do some rotations, you can do rows, you can do a whole bunch of stuff with those resistance bands, but those come with me. I'm not leaving those in the room. TOOL #5 - STICKY NOTES Okay, next are sticky notes. Okay, sticky notes are amazing because they're versatile. So I have sticky notes and then even better than sticky notes, I have a really bright, uh, note card. And then I've also used paint swatches that you can get for free at Lowe's or Home Depot. Okay. So what I do with sticky notes or these things, they become targets, right? So if I'm gonna have folks be reaching for things or stepping to things and maybe I'm calling out colors or I will write on a sticky note a number and then they're not only doing a motor task, they're also doing a cognitive dual task perhaps, These are great tools. They're light, they're easy, they're cheap. The other thing I like with the sticky notes is I'd like to put little notes on them for people. So if I'm using targets with a sticky note, perhaps to show them exactly where I want them to do their deadlift, pick the weight up from and put it down on, I will put a note here that just says like, you're a badass or never give up or something like that. And then that's something that the patient can keep. So they're wonderful for targets. They are wonderful to do some dual tasking. So you can have people reach for yellow or reach for a number that is written on one of the colors. So you can yell out the color or the number. Very versatile tools, very easy to carry around with you. TOOL #6 - GAIT BELTS All right, and then also obviously a gait belt. You need to have a gait belt. obvious reasons for safety but also i have used a gait belt before and i have put it around the bed rail and okay i have never ripped a bed rail off of anything by putting the gait belt around it and tugging on it okay so i'll just say that are they the most sturdy things in the world no i've never ripped one off so that's my preface there. But I have looped this around the bed rail and then perhaps someone is sitting in a wheelchair and they have a really hard time just sitting up tall in their wheelchair, their core is very weak, I will do almost a modified rope climb where the gait belt is around the bed rail and they are pulling themselves up to sit tall, and then going back to the back of their seat, the back of their wheelchair, and then pulling themselves up to sit tall. I've done this in home health, where I looped this to the end of the bed, the bed frame, what am I calling it, footboard. But typically, in acute care, there really isn't a big enough space in those footboards, maybe some of them, but definitely a really cool tool to use to do unmodified rope climb really get that core activated for someone who is so weak that they barely can even sit tall in their wheelchair. TOOL #7 - SNACKS Okay and then lastly You need snacks, okay? Don't forget your snacks. I became so much more efficient and so much more productive when I started bringing food up on the floor with me and putting that in my backpack. So, get you some nuts, get you a bar, a little bit of healthy sugars, maybe some, I always had like clementines or mandarins, those were one of my favorite snacks. Make sure that you have some fuel so you are not having to really put a big stop in the middle of your day. You're not going down to the cafeteria, getting crappy cafeteria food, and it just kind of keeps you focused. When you take that break and go down to get a snack or a coffee, I think it just puts you in that mindset of like, I'm going to just chill and not work as hard. When you just keep hammering throughout your day and you're able to do that because you have fuel, it's really important. Okay, so that is what I put in my backpack. All right, so let's talk about some specific acute care hacks to load up your patients when you don't use the weights. Okay, so let's throw the weights out. My favorite hack, one of them, is to use towels. All right, now this is a towel that I have soaked in water. All right, because a soaked up towel is really heavy compared to a towel that's not soaked in water. So I will roll a towel up and I will put it in the toiletry buckets that are in every single patient's room. So usually these buckets come with soaps and little doodads, things like that. I just get rid of that and I soak up towels and I put them in the basin. Now, you can do a whole bunch of stuff with this. So for someone even in sitting, even having to hold on to this basin, can be very challenging. We can increase the difficulty by going overhead. We can increase the difficulty by doing some marching in sitting. We can do a deadlift from sitting. We can then get up into standing and we can do a deadlift as well. So the great thing about this is it's a great way to introduce the hinge to a patient who is post-op lumbar fusion. Yes, I am loading up someone who is post-op lumbar fusion day one. Why? Because they're going to be discharged. They were probably never taught how to do a hinge in the first place, which contributed to them ending up having surgery. and I want to be the person to break that cycle, right? They're gonna go home, they gotta empty the dishwasher, lift up Fluffy's kitty litter box, whatever it is, why not teach them here and now? So I will put the towel in the basin, and then I will teach them how to properly hinge with an elevated surface in the basin. So I'm teaching them a hinge pattern, loading it up a little bit so that they know how to properly hinge when they go home, okay? And less amounts of things you can do with that basin. The next piece of equipment that I love are your bedside commode buckets. Yes, the things that poop usually goes in. But this is not what we're using them for. We are using clean bedside commode buckets, okay? So the cool thing, buckets, they usually have a handle, okay? So it makes it a lot easier to hold on to than potentially the basin. So what I will do is I will put a bunch of crap in the bucket. So I will put my weights in there or I will go and get a bunch of ankle weights because typically therapy departments and acute care have ankle weights, put them in the bucket and now we got some load. So you can do the same thing. You can deadlift with the bucket, okay? you could do my favorite, which are carries. Okay, so loaded carries. So as you're walking with your patient, they could carry on to the bucket. And the cool thing is that it adds a little bit of a perturbation. Okay, so they're getting an internal perturbation just by holding on to an object. There's a truck coming by, I'm sorry. I am out in my garage. and there is destruction going on in my neighborhood. And it's disruptive. So I'm gonna wait until they go by. Okay, they're hanging out. I'm just gonna talk louder. Okay, so with the bucket, Come on, my friends, keep it moving, keep it moving. Don't say no on a live podcast. Okay, with the bucket, what you can do is if someone is non-ambulatory, they can hold on to the bed rail and they can go like this, back and forth with that bedside commode bucket full of equipment and full of weights, okay? They could hold on to it, hold on to the bed rail and march, just like this. They can swing that bucket forward and backwards. There's a lot of things you can do with the bedside commode buckets to add in a little bit of a perturbation. Okay, lastly, we'll talk a little bit about how to put all this stuff together. So when you are with your whiteboard, right? And you're talking and you're sitting with your patient and you're figuring what movements that you're going to do. This is where you can start introducing what an EMOM is every minute on the minute. You could start introducing what a rounds for time is. So very, very early on, typically patients don't hear about this stuff or feel what intensity is like or load until they're way into their journey and they go into outpatient potentially, right? So the amazing thing is that you get to start introducing them to what a workout is like this early on. Imagine that seed that you've planted, then your patient will understand what it's like to lift heavy and to work hard. They go to home health or they go to inpatient rehab and then they go to outpatient and they're able to advocate for themselves and understand, okay, This is too easy. I don't need that yellow TheraBand or I'm not working hard enough. This isn't challenging enough for me. You are able to give them that opportunity, which is absolutely amazing. And remember, you can be the one that has an impact on them. Farther down the road, you are not going to see that sexy discharge, but you were able to be the catalyst to spark some change. Okay. All right, my friends, that is all. The next time I come on here, I will actually show you an example of like an EMOM or a rounds for time, some examples of what I would actually do with patients in acute care. I will also, on the ice stories, I will post some of my reels I made back when I was in acute care, going back into the archives. I will post on our story my reels that show some of this stuff in action. Lastly, talking about our courses that are coming up. MMOA Live will be in Alabama, we will be in Minnesota, Wyoming, and Oregon for the rest, not the rest of September, we're not in September yet, but in September, so many opportunities to catch us live on the road. Alright everyone, have a wonderful rest of your Wednesday. 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 CUs 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.

Dr. Justin Dunaway, lead faculty in the Spine Division and expert in patient change tracking, discusses the significance of short-term changes in treating full-thickness rotator cuff tears. He shares insights from a decade-long study highlighting how demonstrating early improvements bolsters patient confidence in physical therapy. With over 75% of patients achieving success without surgery, Dunaway emphasizes the profound influence of belief in treatment outcomes, reshaping the future of rotator cuff management.

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member April Dominick discusses 4 topics to cover early in rehab for an individual who had a prostatectomy surgery in order to promote optimal physical and mental recovery! Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION APRIL DOMINICKPost-op prostatectomy, unique considerations for the PT. Let's talk about them. Today on the podcast, we'll talk about four topics that are unique to post-op appointments when it comes to treating someone with a, or after a prostatectomy. Overall, we address the person who comes in for prostatectomy care with similar basic foundations that we would any other post-op person, like rotator cuff repair, post-op knee replacement. We do this in regards to respecting general tissue healing guidelines and timelines, restoring mobility and function, as well as using those progressive overload principles in order to achieve those goals. Don't let the prostate piece scare you. It's basically the same, except for a few considerations that we'll talk about today. You are the musculoskeletal expert, and you can use what you already know for these general post-op sessions. The post-op PT eval will be, like I said, similar to the pre-prostatectomy eval that I talked about in my previous episode, number 1765. In that episode, I outlined some basic education on prostatectomy, options for surgery. I go into detail about what a rehab session would look like from the subjective to the objective to the treatment and, uh, week over the most common complaints, which are urinary leakage and erectile dysfunction. So the biggest takeaway from that episodes besides how to outline your eval and session is that pelvic floor muscle training prior to a prostatectomy is key for having incredible impacts on improving health-related quality of life post-op. So again, the outline of a prehab evaluation for someone prior to their prostatectomy will be very similar to the post-op. So I just wanted to take out some key pieces or topics to focus on today that are unique to someone who had a prostatectomy. So we'll talk about how to educate, intervene, and I'll give you some tools for four different branches of our post-prostatectomy tree. The first branch we'll talk about is surgery specifics and general pelvic floor knowledge. The second thing we'll talk about is bladder function. Then we'll go into sexual function. And our fourth branch is the psychosocial piece. So let's dive in. SURGICAL CONSIDERATONS Branch number one, surgical considerations to ask the patient. So the patient comes in, they've had their prostatectomy. What do we need to know about their surgery? Well, first off, we need to know which type of surgery did they have. And we're today talking about a full prostatectomy, so removal of the prostate and some seminal vesicles. So which type of surgery was used? Was it open, meaning they had much larger incisions in the abdomen in order to get to the prostate? which is gonna have a huge effect on rehab. Number two, is it a laparoscopy? And that's gonna be a lot smaller incisions on the abdomen, or was it robotic assisted? Generally speaking, those are smaller incisions. They have less trauma and much shorter hospital stays. Another important question to ask is how long was their catheter in? And on average, it's about one to two weeks. If it's longer, there is a big potential to impact short-term bladder function, like urgency, frequency, leakage, and there is a greater risk for UTIs. And then if they know about this, a lot of times they don't really know about this, but if they know about it, any information about how much nerve sparing was achieved during the surgery. We know now the greater the nerve sparing, the likely that there is better function from a bladder side of things, as well as sexual function. So that's just some general surgery considerations. Now we'll dive into pelvic specific education that we can give. In terms of the pelvic floor, most people don't know what the pelvic floor is and don't know how it's related to the surgery they just did. So ensuring that the individual has some visual models or pictures of the pelvic floor itself and how these muscles relate to bladder, bowel, sexual function, supports, and things like that. Then making sure that they know, hey, this is the surgery that you had. Here's what happened, if they're okay with you talking about it. That way they understand why they're experiencing certain side effects. And then asking them, very much understanding what is it that they need in terms of lifting? Do they have a toddler at home? Do they have a grandchild that they're lifting or a caregiver? What are their job duties? Does their work require that they lift? And making sure that we have those in mind so that we can prioritize those with their rehab goals. Still under our pelvic branch, we can also get some objective measurements from them, outcome measures that are really helpful for this population. From a bladder side of things, the International Prostate Symptom Score is helpful. They also ask about nocturia or nighttime leakage. And then the NIH chronic prostatitis symptom index, it talks about impacts of symptoms and their quality of life. From a sexual function standpoint, the erectile hardness scale and then the international index of erectile function, those basically have them rate their erections and the quality of those. And then psychosocially, there is a prostate cancer specific index cancer patients and it measures health-related quality of life, physical function, as well as emotional well-being. So those are some outcome measures that you can track changes of with your patients. And then still on the objective side of things for the pelvic floor, we want to get a general orthopedic assessment and pelvic floor specific assessment. And during that pelvic floor assessment, we are looking at hyper or hypotenicity. We are understanding what their awareness is of their pelvic floor, their connection, coordination, strength, so many different things that we can look at. And you can do an external visual palpation of the pelvic floor. And you can do an internal a digital rectal exam. However, that's only going to be once they are cleared by the physician around six to eight weeks. So that was all the surgery considerations that we want to ask, then the pelvic floor, just kind of like things that we want to go over, objective measures. BLADDER FUNCTION Now we're going to move into the bladder function and talk about education, exercise, and some general tools and resources for that branch. So education wise, we want to be educating these individuals that urinary incontinence is extremely common in this population. It can be significant and very much improve. We usually see most improvements within the year. Clinically, I've seen a lot of improvements in that first three to six months, especially if they're able to come in for PT. And then we want to be telling them about, hey, here's some education on pads, how you can use the weight of the pad to be a specific measurement for whether or not they're improving in their urinary leakage. So weighing the pads is a lot more objective of a measurement than asking, How many paths do you go through? And then teaching them, hey, there's different levels of absorbency of the pads. That could be another measure. If you need one that has a much lighter absorbency, then that can be another sign that you're improving. And then from a daughter's side of things, educating them on taking note of your daytime leakage and nighttime leakage. Reminding them that, hey, if you After the surgery, once you become more and more active, you may notice at first some more urinary leakage and we expect that. for some people. And as they do therapy, we also expect that to get better. So also being mindful for these tracking changes and suggestions. Some individuals may have a lot of anxiety with tracking these changes. So being careful with who it is that you actually recommend being very diligent about tracking. And then from an exercise standpoint to help with bladder leakage, we're always going to start with pelvic floor muscle training. And that can be isolated at the very, very beginning. And then, and we can start that as soon as the catheter is removed. There aren't any solid research-based protocols on how many reps exactly and how often and whatnot, but we generally want to be starting with isolated pelvic floor muscle contractions and then pairing that with functional movements pretty much right off the get-go. I'm gonna say sit-to-stands are one of the biggest and most common ADLs that someone post-op will have leakage with and because think about how many times we stand up to during our day as well. So really harping on mechanics and breathing and bracing strategies to help limit the urinary leakage with that. And then of course lifting, walking, returning to specific sports or job duties is going to be how we also want to pair our functional activities. our pelvic floor muscle training. Then we want to be teaching about breath mechanics and bracing strategies. So really leaning into, hey, there is a spectrum of breath mechanics like using an open glottis versus using a closed glottis. That's going to be a lot more intraabdominal pressure. And really teaching them how to gauge that pressure at the beginning to reduce the strain that they have with activities like standing up. Also ensuring that, hey, when they are lifting, they are not straining. They are not, as we like to say in the pelvic division, going down to the basement. And because that is going to increase unnecessary pressure on the area that is healing. And then progressively building up to increasing intra-abdominal pressures as well as external loads as they return to lifting or impact or return to their sport. From a bladder side of things, the tools that we can use, a penile clamp would be a tool that lightly puts pressure around the mid-shaft and then in doing so it kinks the urethra and that's going to over time increase bladder capacity and help them if they are struggling quite a bit with urinary leakage. All right, so that was the bladder branch. SEXUAL FUNCTION Now we're onto the sexual function branch. The sexual function piece, often the most distressing post-op change. Education-wise, we want to make sure that they understand, hey, there is no longer going to be wet ejaculate post-op due to the removal of the seminal vesicles. You may have a loss of penis length, Expect that. And then also reminding them that, hey, there may be some changes in your erection and orgasm, such as delayed onset or reduced intensity, maybe some increased pain or reduced sensation, but that is why you're working with me. We'll work together on some of those pieces. and then from an exercise or modality perspective for sexual function. Obviously, pelvic floor muscle training is going to be really helpful, making sure that they have an understanding and awareness of which muscles or where they need to be working if there are restrictions to the pelvic floor. So we can teach them some self-mobilization techniques, not only at the pelvic floor, but also globally at the hips and abdominals as well. And this is going to help promote local blood flow, which is what we need for sexual function and for interaction. And then modalities like dry needling plus stim are helpful for local and global blood flow. And then of course, regular aerobic exercise, 150 minutes a week, that is going to 100% improve their blood flow and just overall physical health in general. Other non-musculoskeletal tools that they can use to help with sexual function, penile pumps that can help with erectile function by increasing the local blood flow and maintaining penile length. There are various protocols for using these. And then a lot of folks are also recommended to use medication like phosphodiesterase to help with post-prostatectomy and sexual function. PSYCHOSOCIAL CONSIDERATIONS And then our third branch, the psychosocial branch. While this surgery removes something physically, we cannot forget the ricochet effects it has on the person's mental and emotional well-being. exercise levels pre and post-op, let's use this as an opportunity to create lifestyle change, to increase their aerobic and resistance exercise frequency so that they're not leading that sedentary lifestyle post-op that maybe they did pre-op. This is going to obviously improve mental health and the physical effects post-prostatectomy. While the surgery does affect the client, it also affects their social life. Say leaking or wearing a diaper, going out to happy hour, not a great look. And then also it includes the romantic partners or maybe even caregivers. So ensuring that we are addressing not only the individual who was affected from the surgery, but others in their life. And then tools wise, the Prostate Cancer Foundation, it's a great resource for finding providers, treatment centers, support groups, and there's a space for caregivers. So I really liked that website. Then there's the Mojo app, and that focuses on the psychological side of sexual function for erectile dysfunction. So it's created by a psychotherapist and pelvic floor physical therapist. There's lots of different exercises, little modules that they can go through. A support group is also included. It is not prostatectomy specific, but I think it's a great resource from the psychosocial side of things. And then of course, mental health providers are huge, especially those that are versed in pelvic conditions or even someone who's a sex therapist. SUMMARY Okay, in summary, we know that prehab is vital for these prostatectomy patients in order to improve their outcomes post-op. Post-op prostatectomy, the general guidelines of tissue healing are very similar in how we would use progressive overload principles, very similar as any other kind of operation or post-op. There's just those unique considerations that we talked about. We talked about that tree with some different branches, so making sure that surgically we asked them about specific questions like what was the type of surgery, how long did they have their catheter in from a bladder function branch. We talked about education of the pelvic floor itself and anatomy so that they understand why leakage is happening. We talked about breathing and bracing strategies and using those to up or down ramp the pressure to affect urinary leakage. And then we talked about pairing the isolated pelvic floor muscle contractions and coordination work with whole body strengthening and functional activities. Definitely focusing on sit to stands as they have the greatest urinary leakage. And then we talked about sexual function, ensuring that they know there are changes in their penis, like the erection, orgasm. They can do self-limbalizations to help with restricted areas. They can use the Mojo app, the penile pump, to assist in erectile function. And then from the psychosocial piece or branch, we talked about resources like the Prostate Cancer Foundation, mental health providers for both the client and the caregiver. So our next online cohorts, if you all are interested in pelvic classes through ICE, Our next online level one cohort starts September 9th. Level two starts October 21st, and that's where we really deep dive into post-op considerations. And we also talk more in depth about prostatectomies. Our next live courses are in Hendersonville, September 7th and 8th, Milwaukee, September 14th and 15th, and Galesbury, Connecticut, September 21st and 22nd. Thank y'all so much for listening, and I will catch you next time. 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.

Dr. Joe Hanisko, a fitness expert, delves into the common trap of over-optimization and perfectionism in health. He discusses how the relentless pursuit of perfection can lead to confusion and stress, diverting attention from foundational health practices. Hanisko emphasizes the importance of balancing mental health, exercise, diet, and sleep, promoting a more enjoyable and sustainable approach to wellness. He advocates for consistency over perfection, aiming for overall well-being instead of getting lost in complex trends.

Alan Fredendall, COO of ICE, shares insights on transforming documentation into a less burdensome task. He discusses legal obligations under HIPAA and highlights how new technologies, like the reMarkable tablet, can streamline documentation practices. With the promise of reducing daily paperwork to just five minutes, Fredendall emphasizes the tablet's ability to sync with electronic medical records for enhanced workflow efficiency. It's a game-changer for healthcare professionals looking to ease documentation stress!

Dr. Dustin Jones, a specialist in geriatric care, shares valuable insights on managing fragility fractures. He emphasizes three key strategies that focus on preserving mobility even after injuries. The discussion highlights effective rehabilitation practices that protect injuries while building strength and balance. Dr. Jones provides practical tips to prepare patients for future falls, ensuring a comprehensive approach to recovery. His expertise sheds light on enhancing the quality of life for older adults facing these challenges.

Cody Gingerich, a leading faculty member in extremity therapy, explores the nuances of movement corrections in physical therapy. He discusses the debate over how precise practitioners should be in correcting movement faults. Cody emphasizes the importance of finding a balance, advocating for a more individualized approach that prioritizes functional movement. Tune in to hear how to tailor physical therapy to meet the diverse needs of patients, and when it's best to allow more freedom in movement.

Dr. Jess Gingerich // #ICEPelvic // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Jess Gingerich defines hypertonicity as it relates to the pelvic floor and the role of the pelvic floor in the body as contractile tissue. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION JESSICA GINGERICHGood morning PT on ICE podcast. My name is Dr. Jessica Gingerich, and I am on faculty with the Pelvic Division here at ICE, and I am coming to you today to talk about the hypertonic pelvic floor. We got a great question in our online course about hypertonicity in the pelvic floor around pregnancy. And so before I dive into this, when we talk about hypertonicity in the pelvic floor, we really don't care necessarily if it's prenatal, pregnant, postnatal, really anywhere in the lifespan. We're gonna treat it relatively the same. there may be some factors that we think about at each stage of life but relatively we're treating it the same. DEFINING A HYPERTONIC PELVIC FLOOR So first and foremost the definition of a hypertonic pelvic floor and the reason I put that in air quotes is because we will hear so many different things overactive pelvic floor tight pelvic floor is when the pelvic floor muscles are in a contracted state um or a spasm And so, the symptoms of this can be leakage, heaviness, pressure, a dragging sensation in the vagina, painful insertion, whether that is during intercourse, a tampon insertion, vaginal exam, or anything else. urinary urgency, frequency, constipation, incomplete emptying that could be of the bladder or of the bowels, coccyx pain, pelvic pain, low back pain, and hip pain. So when you have your client that comes in and they say, oh my pelvic floor is so weak because I pee all the time I just can't control it. recognize that that could be their pelvic floor sitting in a contracted state with the inability or I want to say inability or awareness to relax. And so when we think of that contracted state with the inability to drop, recognizing that with that could come weakness as well. So there's a lot of different bubbles that we want to make sure that we are not missing when it comes to a tight pelvic floor. THE ROLE OF THE PELVIC FLOOR The role of the pelvic floor is to contract. So if you can kind of conceptualize my shoulders as the pelvic floor, we want to close the holes and lift and we want to also be able to open the holes and drop. We want to be able to do this during a lot of different tasks and that can be toileting, intercourse, achieving an orgasm, lifting weights during daily tasks, so that's your laundry basket, the kiddos, or even your body weight, lifting your body weight up off the floor or out of a chair. And then as well as just the gym, being able to do things in the gym and having the ability to essentially tension your pelvic floor to the tasks in front of you. When we think of a tight pelvic floor, we kind of have, as a pelvic floor profession as a whole, have kind of gotten into this, the Kegel, you know, not doing the Kegel, it's kind of like lost its meaning in our space, right? If you have a tight pelvic floor, stop doing Kegel, stop, stop, stop, stop, stop. Really, that's not what we want to do. We often hear to not do the Kegel because you're in that contracted state. So if I'm already here and I do a Kegel, I'm not getting much range of motion. I'm not going anywhere. However, we need to know how to do a Kegel for a couple of reasons. A, when you cough or sneeze, the reflexive nature of your pelvic floor should be to squeeze. We want that reflex, we want that ability to be able to do that. We want to train that. But the other thing that we can do is we can utilize the Kegel to improve our proprioceptive awareness, right? So if I am in this contracted state and then I go and do a maximal Kegel, I might be able to then now, okay, here, that's where I'm in that down or relaxed position. It can help improve your proprioceptive awareness. So key goals should absolutely be a part of the plan of care. Teaching the person what a pelvic floor contraction feels like, so what does it feel like when they are closed and up, as well as what does it feel like when they're open and down. So we call that the attic and the basement. We've said this before, it's really nice to use those terms. So if you're out in the gym or out in public, you can ask your client, are you in the attic? Are you in the basement? Rather than asking them whatever cue you gave them during their pelvic floor exam, you're not out there asking if they're squeezing their buttholes. That's really kind. Teaching them how to do this can be done with internal cues or external cues, recognizing that someone may respond better to one or the other. And so you're gonna need to be able to do both. If you are a therapist who does not do internal exams, that's fine. You can refer or you can take our live course and learn how to do the internal exam. and teach this person how to do a Kegel with right there feedback, there's your tactile cue, squeeze my finger. That can be so so helpful and remembering that this is going to create awareness and just teaching them where they are in space. Now, we talked about the kegel. Other passive interventions are gonna be that diaphragmatic breathing. We talk about this all the time. Using that big belly breath as the diaphragm descends, it's gonna take the pelvic floor with it. It is a passive range of motion of the pelvic floor. They can do this in different positions. They can do this in child's pose. They can do this in a happy baby. They can do this in a supported squat. And then also lastly is the functional dry needling. We can use dry needling to help calm down the pelvic floor. Now, the last bits around what we wanna do in the plan of care for a hypertonic pelvic floor is not discharge once this person says, oh my gosh, I know I'm in the basement, I can feel it, I just know I'm there. Or I'm in the attic, my holes are closed, I know that. We want to load them. We want to make sure that when this person comes in symptomatic, that we are teaching them where they are in space, we are changing their symptoms, but now we are loading them. We are getting them back to where they were, ideally beyond where they were. We want them to not have symptoms, but we want them to not need us, really. So getting them stronger, so getting them into a gym, whether you are teaching them about, or I guess really learning what their love language is around exercise, and then leaning into that. And showing them the type of programming that they may want, encouraging them to certain gyms. I know here in Greenville, we have a ton of gyms. I've got a lot of options with a lot of wonderful coaches that I can essentially push these people towards. once they are symptom free and feeling a little more confident in the gym. So that is what I've got for you today. Join us online or on the road. So head over to PTOnIce.com to look at where we are next and we look forward to having you. 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.

Alan Fredendall, a fitness expert known for his work with #FitnessAthleteFriday, dives deep into creatine and its many facets. He demystifies the sources and benefits of creatine, clarifying common myths, particularly about its safety for young athletes. The discussion also highlights how creatine supplementation can enhance cognitive performance, especially for younger vegetarians and older adults. It's an enlightening look at how this supplement affects various populations and the science behind its impact.